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Human Reproduction, Vol. 16, No. 4, 605-607, April 2001
© 2001 European Society of Human Reproduction and Embryology

The Mesothelium, Teflon or Velcro?

Mesothelium in endometriosis pathogenesis

Gerard A.J. Dunselman1,2,4, Patrick G. Groothuis1,3, Anton F.P.M. de Goeij1,3 and Johannes L.H. Evers1,2

1 Research Institute Growth and Development (GROW), Maastricht University, 2 Department of Obstetrics and Gynaecology and 3 Department of Pathology, Academisch Ziekenhuis Maastricht and Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands

Sampson's transplantation theory for the pathogenesis of peritoneal endometriosis is widely accepted. The events that take place, however, on the cellular and subcellular level during the transition of endometrial tissue in the abdominal cavity into peritoneal endometriosis remain controversial. The mesothelium plays a central role in the debate on this subject.The interaction between endometrium and peritoneum has been studied in an in-vitro model using amnion, peritoneum and mesothelial cells in culture on the one hand and cyclic and menstrual endometrium on the other hand. The results of these studies indicate that (i) an intact mesothelial lining prevents adhesion of shed endometrial tissue, (ii) shed endometrial tissue adheres to the peritoneal extracellular matrix and (iii) menstrual effluent creates its own adhesion sites by damaging the mesothelial lining thus exposing the extracellular matrix. Therefore we conclude that the mesothelium has the properties of Teflon, while the extracellular matrix resembles Velcro.

Key words: adhesion/endometriosis/menstrual endometrium/meso-thelium/pathogenesis

4 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht and Maastricht University, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. E-mail: g.dunselman{at}og.unimaas.nl


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