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Hum. Reprod. Advance Access published online on November 5, 2009
Human Reproduction, doi:10.1093/humrep/dep382
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Role of TGF-βs in normal human endometrium and endometriosis

Charles O.A. Omwandho1,{dagger}, Lutz Konrad2,4,{dagger}, Gülden Halis3, Frank Oehmke2 and Hans-Rudolf Tinneberg2

1 Department of Biochemistry, University of Nairobi, Nairobi, Kenya 2 Department of Gynecology and Obstetrics, Klinikstr. 32, 35392 Giessen, Germany 3 Fertility and Endometriosis Center, Rankestr. 34, 10789 Berlin, Germany

4 Correspondence address. Tel: +49-(641)-99-45282; Fax: +49-(641)-99-45209; E-mail: Lutz.Konrad{at}gyn.med.uni-giessen.de

Endometriosis is characterized by presence of endometrial tissue outside the uterus. Prevalence is estimated at 6–10% in the general female population and many patients experience pain and/or infertility. Diagnosis is achieved by laparoscopic intervention followed by histological confirmation of viable endometriotic tissue. Mild cases are managed medically with contraceptive steroids and non-steroidal anti-inflammatory agents. Surgery provides relief to women in pain but symptoms recur in 75% of cases within 2 years. Starting with menstruation, we have categorized endometriosis into six stages, namely (1) shedding of cells, (2) cell survival, (3) escape from immune surveillance, (4) adhesion to peritoneum, (5) angiogenesis and (6) bleeding. In most of these biological processes, which resemble metastasis, transforming growth factor-beta (TGF-βs) and their high-affinity receptors are involved directly or indirectly. TGF-βs are abundantly and differentially expressed in the endometrium under hormonal control. Although they are preferentially synthesized in the stroma, glands and macrophages also secrete TGF-βs into the uterine fluid, where interaction with preimplantation embryos is suspected. Because mRNA and protein expression of all three TGF-βs is increased around menstruation, we suggest that TGF-βs might be involved in initiation of menstruation. Furthermore, because of high postmenstrual TGF-β3 levels, we suppose that it might participate in scarless postmenstrual regeneration of endometrium. Our suggestions pave the way to novel routes of investigation into the roles of TGF-βs during menstruation and endometriosis.

Key words: endometriosis/TGF-beta/menstruation/diagnosis

{dagger} These authors contributed equally to the paper.

Submitted on April 22, 2009; resubmitted on September 1, 2009; accepted on September 3, 2009.


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