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• W2137938382 abstract "Endometriosis is a relatively wide-spread benign but debilitating gynaecological disorder affecting women of reproductive age. Endometriosis develops following the implantation of endometrial tissue at ectopic locations, mainly peritoneal and on the surface of pelvic organs (Giudice, 2010Giudice L.C. Endometriosis.N. Engl. J. Med. 2010; 362: 2389-2398https://doi.org/10.1056/NEJMcp1000274Crossref PubMed Scopus (1296) Google Scholar). The prevalence of this disease varies from 4–50% in different populations (Cramer, Missmer, 2002Cramer D.W. Missmer S.A. The epidemiology of endometriosis.Ann. N. Y. Acad. Sci. 2002; 955 (discussion 34-6, 396-406): 11-22Crossref PubMed Scopus (374) Google Scholar, Eskenazi, Warner, 1997Eskenazi B. Warner M.L. Epidemiology of endometriosis.Obstet. Gynecol. Clin. North Am. 1997; 24: 235-258Abstract Full Text Full Text PDF PubMed Scopus (1162) Google Scholar), and occurs in up to 50% of women with pelvic pain and/or infertility (Giudice, 2010Giudice L.C. Endometriosis.N. Engl. J. Med. 2010; 362: 2389-2398https://doi.org/10.1056/NEJMcp1000274Crossref PubMed Scopus (1296) Google Scholar, Meuleman et al, 2009Meuleman C. Vandenabeele B. Fieuws S. Spiessens C. Timmerman D. D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners.Fertil. Steril. 2009; 92: 68-74https://doi.org/10.1016/j.fertnstert.2008.04.056Abstract Full Text Full Text PDF PubMed Scopus (351) Google Scholar). One of the suspected reasons for endometriosis-associated infertility is believed to be diminished endometrial receptivity and defective implantation (Arici et al, 1996Arici A. Oral E. Bukulmez O. Duleba A. Olive D.L. Jones E.E. The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program.Fertil. Steril. 1996; 65: 603-607PubMed Scopus (214) Google Scholar, Barnhart et al, 2002Barnhart K. Dunsmoor-Su R. Coutifaris C. Effect of endometriosis on in vitro fertilization.Fertil. Steril. 2002; 77: 1148-1155Abstract Full Text Full Text PDF PubMed Scopus (622) Google Scholar, Brosens et al, 2012Brosens I. Brosens J.J. Benagiano G. The eutopic endometrium in endometriosis: are the changes of clinical significance?.Reprod. Biomed. Online. 2012; 24: 496-502https://doi.org/10.1016/j.rbmo.2012.01.022Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar, Hahn et al, 1986Hahn D.W. Carraher R.P. Foldesy R.G. McGuire J.L. Experimental evidence for failure to implant as a mechanism of infertility associated with endometriosis.Am. J. Obstet. Gynecol. 1986; 155: 1109-1113Abstract Full Text PDF PubMed Scopus (42) Google Scholar, Illera et al, 2000Illera M.J. Juan L. Stewart C.L. Cullinan E. Ruman J. Lessey B.A. Effect of peritoneal fluid from women with endometriosis on implantation in the mouse model.Fertil. Steril. 2000; 74: 41-48Abstract Full Text Full Text PDF PubMed Scopus (76) Google Scholar, Lee et al, 2009Lee B. Du H. Taylor H.S. Experimental murine endometriosis induces DNA methylation and altered gene expression in eutopic endometrium.Biol. Reprod. 2009; 80: 79-85https://doi.org/10.1095/biolreprod.108.070391Crossref PubMed Scopus (165) Google Scholar). However, the functional mechanisms underlying the reduced fecundity are still not fully understood. It is evident that the eutopic endometrium of women with endometriosis functions normally and has almost comparable responsiveness to steroid hormones as is observed in non-endometriotic women. However, both animal studies of endometriosis and studies of human endometrium using single marker analysis comparisons have demonstrated differential molecular regulation, that suggest progesterone resistance in eutopic endometrium and impaired endometrial receptivity (Burney et al, 2007Burney R.O. Talbi S. Hamilton A.E. Vo K.C. Nyegaard M. Nezhat C.R. Lessey B.A. Giudice L.C. Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis.Endocrinology. 2007; 148 (en.2006-1692 [pii]): 3814-3826https://doi.org/10.1210/en.2006-1692Crossref PubMed Scopus (568) Google Scholar, Dimitriadis et al, 2006Dimitriadis E. Stoikos C. Stafford-Bell M. Clark I. Paiva P. Kovacs G. Salamonsen L.A. Interleukin-11, IL-11 receptoralpha and leukemia inhibitory factor are dysregulated in endometrium of infertile women with endometriosis during the implantation window.J. Reprod. Immunol. 2006; 69: 53-64https://doi.org/10.1016/j.jri.2005.07.004Abstract Full Text Full Text PDF PubMed Scopus (148) Google Scholar, Fazleabas et al, 2003Fazleabas A.T. Brudney A. Chai D. Langoi D. Bulun S.E. Steroid receptor and aromatase expression in baboon endometriotic lesions.Fertil. Steril. 2003; 80: 820-827Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar, Lee et al, 2009Lee B. Du H. Taylor H.S. Experimental murine endometriosis induces DNA methylation and altered gene expression in eutopic endometrium.Biol. Reprod. 2009; 80: 79-85https://doi.org/10.1095/biolreprod.108.070391Crossref PubMed Scopus (165) Google Scholar, Lessey et al, 1992Lessey B.A. Damjanovich L. Coutifaris C. Castelbaum A. Albelda S.M. Buck C.A. Integrin adhesion molecules in the human endometrium. Correlation with the normal and abnormal menstrual cycle.J. Clin. Invest. 1992; 90: 188-195https://doi.org/10.1172/JCI115835Crossref PubMed Scopus (592) Google Scholar, Lessey et al, 1994Lessey B.A. Castelbaum A.J. Sawin S.W. Buck C.A. Schinnar R. Bilker W. Strom B.L. Aberrant integrin expression in the endometrium of women with endometriosis.J. Clin. Endocrinol. Metab. 1994; 79: 643-649https://doi.org/10.1210/jcem.79.2.7519194Crossref PubMed Scopus (4) Google Scholar, Taylor et al, 1999Taylor H.S. Bagot C. Kardana A. Olive D. Arici A. HOX gene expression is altered in the endometrium of women with endometriosis.Hum. Reprod. 1999; 14: 1328-1331Crossref PubMed Scopus (347) Google Scholar). Also the novel “high-throughput omics” analyses – epigenomic, transcriptomic and proteomic studies – demonstrate that when endometrial tissue from patients with endometriosis is compared with that from healthy women, different regulation occurs at the molecular level (reviewed in Altmäe et al, 2014Altmäe S. Esteban F.J. Stavreus-Evers A. Simón C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Simon C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Guidelines for the design, analysis and interpretation of “omics” data: focus on human endometrium.Hum. Reprod. Update. 2014; 20: 12-28https://doi.org/10.1093/humupd/dmt048Crossref PubMed Scopus (103) Google Scholar). Microarray-based gene expression technology that allows simultaneous monitoring of thousands of gene transcripts is so far the most used omics platform for molecular analyses of the endometrium in women with endometriosis. It is observed that the profound transcriptomic changes during the window of implantation in eutopic endometrium appear to create an inhospitable environment for an implanting embryo, due to dysregulation of genes involved in embryonic attachment, stromal decidualization, immune function, and apoptotic responses, that contribute together with angiogenic factors and dysregulated progesterone and aromatase activity, to the pathophysiology of endometriosis-associated infertility (Aghajanova, Giudice, 2011Aghajanova L. Giudice L.C. Molecular evidence for differences in endometrium in severe versus mild endometriosis.Reprod. Sci. 2011; 18: 229-251https://doi.org/10.1177/1933719110386241Crossref PubMed Scopus (108) Google Scholar, Burney, 2013Burney R.O. The genetics and biochemistry of endometriosis.Curr. Opin. Obstet. Gynecol. 2013; 25: 280-286https://doi.org/10.1097/GCO.0b013e3283630d56Crossref PubMed Scopus (23) Google Scholar, Burney et al, 2007Burney R.O. Talbi S. Hamilton A.E. Vo K.C. Nyegaard M. Nezhat C.R. Lessey B.A. Giudice L.C. Gene expression analysis of endometrium reveals progesterone resistance and candidate susceptibility genes in women with endometriosis.Endocrinology. 2007; 148 (en.2006-1692 [pii]): 3814-3826https://doi.org/10.1210/en.2006-1692Crossref PubMed Scopus (568) Google Scholar, Kao et al, 2003Kao L.C. Germeyer A. Tulac S. Lobo S. Yang J.P. Taylor R.N. Osteen K. Lessey B.A. Giudice L.C. Expression profiling of endometrium from women with endometriosis reveals candidate genes for disease-based implantation failure and infertility.Endocrinology. 2003; 144: 2870-2881Crossref PubMed Scopus (594) Google Scholar). However, existing clinical data on one hand suggest impaired implantation in women with endometriosis, while on the other hand the results from egg donation sharing programmes, for example, show that oocyte recipients with and without severe endometriosis had comparable cycle outcomes, suggesting that the implantation defect may lie within the embryo (Díaz et al, 2000Díaz I. Navarro J. Blasco L. Simón C. Pellicer A. Remohí J. Impact of stage III-IV endometriosis on recipients of sibling oocytes: matched case-control study.Fertil. Steril. 2000; 74: 31-34Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar). In this issue of Reproductive Biomedicine Online, Garcia-Velasco et al, 2015Garcia-Velasco J.A. Fassbender A. Ruiz-Alonso M. Blesa D. D'Hooghe T. Simon C. Is endometrial receptivity transcriptomics affected in women with endometriosis? A pilot study.Reprod. Biomed. Online. 2015; 31https://doi.org/10.1016/j.rbmo.2015.07.014Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar investigated the gene signatures for endometrial receptivity in patients with different stages of endometriosis using the endometrial receptivity array (ERA) test. The ERA test is a novel diagnostic tool for endometrial receptivity, composed of 238 transcript-biomarkers, and has proved to be accurate and consistent in detecting the window of implantation among different patient groups (Blesa et al, 2014Blesa D. Ruiz-Alonso M. Simón C. Clinical management of endometrial receptivity.Semin. Reprod. Med. 2014; 32: 410-413https://doi.org/10.1055/s-0034-1376360Crossref PubMed Scopus (35) Google Scholar, Diaz-Gimeno et al, 2013Diaz-Gimeno P. Ruiz-Alonso M. Blesa D. Bosch N. Martinez-Conejero J.A. Alama P. Garrido N. Pellicer A. Simon C. The accuracy and reproducibility of the endometrial receptivity array is superior to histology as a diagnostic method for endometrial receptivity.Fertil. Steril. 2013; 99: 508-517https://doi.org/10.1016/j.fertnstert.2012.09.046Abstract Full Text Full Text PDF PubMed Scopus (192) Google Scholar, Garrido-Gomez et al, 2013Garrido-Gomez T. Ruiz-Alonso M. Blesa D. Diaz-Gimeno P. Vilella F. Simon C. Profiling the gene signature of endometrial receptivity: clinical results.Fertil. Steril. 2013; 99: 1078-1085https://doi.org/10.1016/j.fertnstert.2012.12.005Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar, Ruiz-Alonso et al, 2013Ruiz-Alonso M. Blesa D. Díaz-Gimeno P. Gómez E. Fernández-Sánchez M. Carranza F. Carrera J. Vilella F. Pellicer A. Simón C. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure.Fertil. Steril. 2013; 100: 818-824https://doi.org/10.1016/j.fertnstert.2013.05.004Abstract Full Text Full Text PDF PubMed Scopus (301) Google Scholar). It is so far the only available comprehensive molecular measure of endometrial receptivity and hence is rapidly gaining popularity among fertility specialists. The current study by Garcia-Velasco et al. presents the first whole tissue endometrial transcriptome study in women with endometriosis that focuses solely on endometrial receptivity markers, and not on the whole genome as has been the case previously (reviewed in Altmäe et al, 2014Altmäe S. Esteban F.J. Stavreus-Evers A. Simón C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Simon C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Guidelines for the design, analysis and interpretation of “omics” data: focus on human endometrium.Hum. Reprod. Update. 2014; 20: 12-28https://doi.org/10.1093/humupd/dmt048Crossref PubMed Scopus (103) Google Scholar). Interestingly, their study detects no significant differences in gene expression levels of the 238 receptivity markers in any of the different stages of endometriosis when compared with healthy women. And as functional in silico analyses demonstrate only minimal differences between the study groups, the authors conclude that the possible impact of endometriosis on endometrial receptivity, or at least on the molecular signature of it, from a clinical point of view may be small to non-existent. Not completely in line with the findings in that study, but still worth mentioning, are the data from previous transcriptome studies that also did not detect any significant differences in endometrial gene expression patterns during early luteal nor menstrual phases between women with and without endometriosis (Fassbender et al, 2012Fassbender A. Verbeeck N. Bornigen D. Kyama C.M. Bokor A. Vodolazkaia A. Peeraer K. Tomassetti C. Meuleman C. Gevaert O. Van de Plas R. Ojeda F. De Moor B. Moreau Y. Waelkens E. D'Hooghe T.M. Combined mRNA microarray and proteomic analysis of eutopic endometrium of women with and without endometriosis.Hum. Reprod. 2012; 27: 2020-2029https://doi.org/10.1093/humrep/des127Crossref PubMed Scopus (61) Google Scholar), and only minimal difference of endometrial transcriptome analysis in late secretory phase between controls and women with endometriosis (Sherwin et al, 2008Sherwin J.R.A. Sharkey A.M. Mihalyi A. Simsa P. Catalano R.D. D'Hooghe T.M. Global gene analysis of late secretory phase, eutopic endometrium does not provide the basis for a minimally invasive test of endometriosis.Hum. Reprod. 2008; 23: 1063-1068https://doi.org/10.1093/humrep/den078Crossref PubMed Scopus (54) Google Scholar). Interestingly, findings similar to those of Garcia-Velasco et al. were observed in our in silico analysis of the transcriptomes of the well-characterized mid-secretory eutopic endometrium from women with and without severe endometriosis (n = 8 in each group), to be presented at the ASRM 2015 meeting (Aghajanova et al., ASRM Aghajanova et al, 2015Aghajanova L. Irwin J. Giudice L. Mid-secretory eutoipic endometrium in intramural fibroids and severe endometriosis: relevance to fertility.2015Google Scholar Abstract book). When comparing the genomic array data to the published 238 ERA genes (Diaz-Gimeno et al, 2011Diaz-Gimeno P. Horcajadas J.A. Martinez-Conejero J.A. Esteban F.J. Alama P. Pellicer A. Simon C. A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature.Fertil. Steril. 2011; 95 (60 e1-15; S0015-0282(10)00701-6 [pii]): 50-60https://doi.org/10.1016/j.fertnstert.2010.04.063Abstract Full Text Full Text PDF PubMed Scopus (370) Google Scholar), we identified only one gene (MMP26) that was dysregulated beyond the 3-fold threshold used with ERA when endometrial samples from women with severe endometriosis were compared with control samples (Aghajanova et al., ASRM Aghajanova et al, 2015Aghajanova L. Irwin J. Giudice L. Mid-secretory eutoipic endometrium in intramural fibroids and severe endometriosis: relevance to fertility.2015Google Scholar Abstract book). Nevertheless, these findings, together with those from Garcia-Velasco et al. and those on the normal implantation of donated embryos, do not rule out the possibility that endometriosis might impair endometrial receptivity. We feel there is not enough data to proclaim the “normality” of mid-secretory eutopic endometrium from women with endometriosis, as we cannot ignore the previous reports on molecular differences between mid-secretory endometrium from women with endometriosis compared with other phases of the cycle. Perhaps the molecular differences are there, but we just may not be able to pin down their exact spatial and temporal localization. Or, alternatively, the main abnormality resulting in implantation failure may not be the receptivity itself, but the established dysregulation of the process of stromal cell decidualization, which is not being picked up by the ERA test. Moreover, it has now been shown that there is a poor correlation between transcript levels and the abundance of the corresponding proteins (Fassbender et al, 2010Fassbender A. Simsa P. Kyama C.M. Waelkens E. Mihalyi A. Meuleman C. Gevaert O. Van de Plas R. de Moor B. D'Hooghe T.M. TRIzol treatment of secretory phase endometrium allows combined proteomic and mRNA microarray analysis of the same sample in women with and without endometriosis.Reprod. Biol. Endocrinol. 2010; 8: 123https://doi.org/10.1186/1477-7827-8-123Crossref PubMed Scopus (20) Google Scholar, Ning et al, 2012Ning K. Fermin D. Nesvizhskii A.I. Comparative analysis of different label-free mass spectrometry based protein abundance estimates and their correlation with RNA-Seq gene expression data.J. Proteome Res. 2012; 11: 2261-2271https://doi.org/10.1021/pr201052xCrossref PubMed Scopus (109) Google Scholar, Stephens et al, 2010Stephens A.N. Hannan N.J. Rainczuk A. Meehan K.L. Chen J. Nicholls P.K. Rombauts L.J. Stanton P.G. Robertson D.M. Salamonsen L.A. Post-translational modifications and protein-specific isoforms in endometriosis revealed by 2D DIGE.J. Proteome Res. 2010; 9: 2438-2449https://doi.org/10.1021/pr901131pCrossref PubMed Scopus (62) Google Scholar). Protein synthesis is the final result of the gene expression (although not all mRNA expression leads to protein production) and is more directly linked to the phenotype. Indeed, the Fassbender et al. study did not show any differences between women with and without endometriosis at a transcriptome level, but proteomic analysis of the luteal phase endometrium in the same samples allowed the diagnosis of endometriosis with high sensitivity and specificity (Fassbender et al, 2012Fassbender A. Verbeeck N. Bornigen D. Kyama C.M. Bokor A. Vodolazkaia A. Peeraer K. Tomassetti C. Meuleman C. Gevaert O. Van de Plas R. Ojeda F. De Moor B. Moreau Y. Waelkens E. D'Hooghe T.M. Combined mRNA microarray and proteomic analysis of eutopic endometrium of women with and without endometriosis.Hum. Reprod. 2012; 27: 2020-2029https://doi.org/10.1093/humrep/des127Crossref PubMed Scopus (61) Google Scholar). Also, an earlier study of proteomic analysis in the eutopic endometrium of endometriosis patients identified 20 endometriosis-associated proteins that differed from those in women without the disease (Stephens et al, 2010Stephens A.N. Hannan N.J. Rainczuk A. Meehan K.L. Chen J. Nicholls P.K. Rombauts L.J. Stanton P.G. Robertson D.M. Salamonsen L.A. Post-translational modifications and protein-specific isoforms in endometriosis revealed by 2D DIGE.J. Proteome Res. 2010; 9: 2438-2449https://doi.org/10.1021/pr901131pCrossref PubMed Scopus (62) Google Scholar). This study also observed that protein abundance changes did not correlate well with published transcriptome data, emphasizing the extensive post-transcriptional modification of transcripts and/or the post-translational modification of proteins that occurs in the tissue. Any analysis of the full proteome is a challenging task as the proteome is large and of unknown complexity, being a result of alternative splicing of primary transcripts, the presence of sequence variation and epigenetic and post-translational modifications (Altmäe et al, 2014Altmäe S. Esteban F.J. Stavreus-Evers A. Simón C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Simon C. Giudice L. Lessey B.A. Horcajadas J.A. Macklon N.S. D'Hooghe T. Campoy C. Fauser B.C. Salamonsen L.A. Salumets A. Guidelines for the design, analysis and interpretation of “omics” data: focus on human endometrium.Hum. Reprod. Update. 2014; 20: 12-28https://doi.org/10.1093/humupd/dmt048Crossref PubMed Scopus (103) Google Scholar). A recently published work concludes that epigenetic mechanisms are involved in gene expression regulation in human endometrium in different hormonal milieu, and that the interplay between steroid hormone and methylome dynamics regulates normal endometrial functions (Houshdaran et al, 2014Houshdaran S. Zelenko Z. Irwin J.C. Giudice L.C. Human endometrial DNA methylome is cycle-dependent and is associated with gene expression regulation.Mol. Endocrinol. 2014; 28: 1118-1135https://doi.org/10.1210/me.2013-1340Crossref PubMed Scopus (56) Google Scholar). Another interesting outcome of the study from Garcia-Velasco et al. is the finding that endometriosis and non-endometriosis samples cluster by cycle day. The fact that these separately clustered samples were collected very close together on consecutive days (i.e. cycle days 18, 19 and 20) suggests that the endometrium undergoes very rapid changes from nonreceptive to receptive stages. The authors did not present the data on individual menstrual cycle length, which could potentially affect the above result. The unfortunate truth is that despite the extensive molecular research on the endometrium in health and disease we still don't fully understand the complex regulation and physiology of endometrial receptivity and the subsequent embryo implantation. Any research on the human endometrium is both complex and challenging, as the endometrium is regulated by cyclic hormones and autocrine/paracrine/juxtacrine factors, which, when combined with the varied genetic and environmental back-grounds of each individual, result in different biological responses. So answers to the questions: “to what extent, if any, is the endometrial receptivity affected in women with endometriosis and what is the clinical significance of these changes” must await the outcome of future studies. However, the accepted dogma of endometrial receptivity dysregulation in endometriosis is being significantly challenged. Is endometrial receptivity transcriptomics affected in women with endometriosis? A pilot studyReproductive BioMedicine OnlineVol. 31Issue 5PreviewEndometrial receptivity is still questioned today in women with endometriosis. The aim of this study was to assess the endometrial receptivity gene signature in patients with different stages of endometriosis by investigating transcriptomic modifications of their endometrium using the endometrial receptivity array (ERA) test. A prospective, interventional multicentre pilot trial was designed and implemented in two university-affiliated infertility units from Belgium and Spain. Gene expression microarray was used to diagnose the receptivity status by quantifying the expression of 238 specific genes directly related to human endometrial receptivity. Full-Text PDF" @default.
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