Endometriosis causes pain and/or infertility in 2 - 8% of women in the U.S., with an annual cost of more than $20 billion. Despite the clinical and financial impact of endometriosis, its pathogenesis and pathophysiology remain poorly understood and treatment options remain limited. We and others have demonstrated abnormal expression of genes regulated by progesterone (P) in eutopic endometrium of women with endometriosis, suggesting resistance to P. Given that P inhibits endometrial proliferation, sets the stage for apoptotic cell death at menstruation, and induces receptivity to embryo implantation, P resistance could contribute to the pathogenesis and pathophysiology of endometriosis by facilitating proliferation and survival of endometrial implants and by inhibiting embryo implantation. Current knowledge gaps include the amount and duration of P action required for normal endometrial function, the extent to which P requirements may be altered in women with endometriosis, and the functional consequences of P resistance. We have begun to define P action and requirements in unaffected women using a novel in vivo model of the human menstrual cycle, in which circulating P concentrations are defined experimentally. Preliminary data in fertile subjects validates our approach, defines the approximate minimum threshold serum P concentrations required for normal structural (~2-3 ng/mL) and functional (~5-10 ng/mL) endometrial differentiation, and identifies mRNA species that can serve as dose-sensitive markers of P action. Base on preliminary data and existing literature, we hypothesize: (1) that women with endometriosis exhibit abnormal endometrial structural and/or functional development at P concentrations that achieve normal differentiation in fertile controls, (2) that progesterone resistance can be overcome by supra-physiological P concentrations;and (3) that abnormal patterns of endometrial epithelial gene expression in affected women result from abnormal paracrine signaling in P-resistant stroma. To test the first two hypotheses, we will use our established in vivo model to directly compare P requirements for normal endometrial differentiation in fertile women to those in infertile women with and without endometriosis. The effects of P on endometrial structure will be assessed histologically and the functional effects of P will be assessed by qRT-PCR and microarray analysis of isolated epithelial and stromal cell fractions and immunostaining of tissue sections. To test the third hypothesis, we will combine normal epithelial cells with stromal cells from women with or without endometriosis as a xenograft in a murine host. Treatments with estrogen and varying doses of P will permit assessment of the stromal contribution to abnormal endometrial miRNA, mRNA, and protein expression. These studies will assess directly endometrial P resistance, the effect of stroma on abnormal endometrial function, provide dose-specific markers of P action, and establish P requirements in fertile and infertile women with and without endometriosis. These human data will provide a solid foundation for the development of novel diagnostic and therapeutic strategies for endometriosis.

Public Health Relevance

Endometriosis, a cause of pelvic pain, infertility, and pelvic and abdominal organ damage, affects about 4% of reproductive age women in the United States, with an estimated cost of $22 billion. The proposed research will produce a better understanding of the role of progesterone in endometriosis, identification of critically needed biomarkers, as well as provide a better understanding of cellular and molecular mechanisms of disease. The information gained will allow development of better diagnostic tests and therapy.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD067721-04
Application #
8708526
Study Section
Integrative and Clinical Endocrinology and Reproduction Study Section (ICER)
Program Officer
Eisenberg, Esther
Project Start
2011-09-15
Project End
2016-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
4
Fiscal Year
2014
Total Cost
$633,908
Indirect Cost
$130,325
Name
University of North Carolina Chapel Hill
Department
Obstetrics & Gynecology
Type
Schools of Medicine
DUNS #
608195277
City
Chapel Hill
State
NC
Country
United States
Zip Code
27599
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Strug, Michael R; Su, Ren-Wei; Kim, Tae Hoon et al. (2018) RBPJ mediates uterine repair in the mouse and is reduced in women with recurrent pregnancy loss. FASEB J 32:2452-2466
Matson, Brooke C; Quinn, Kelsey E; Lessey, Bruce A et al. (2018) Elevated levels of adrenomedullin in eutopic endometrium and plasma from women with endometriosis. Fertil Steril 109:1072-1078
Chang, Hye Jin; Yoo, Jung-Yoon; Kim, Tae Hoon et al. (2018) Overexpression of Four Joint Box-1 Protein (FJX1) in Eutopic Endometrium From Women With Endometriosis. Reprod Sci 25:207-213
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Khalaj, Kasra; Ahn, Soo Hyun; Bidarimath, Mallikarjun et al. (2017) A balancing act: RNA binding protein HuR/TTP axis in endometriosis patients. Sci Rep 7:5883
Matson, Brooke C; Pierce, Stephanie L; Espenschied, Scott T et al. (2017) Adrenomedullin improves fertility and promotes pinopodes and cell junctions in the peri-implantation endometrium. Biol Reprod 97:466-477
Yoo, Jung-Yoon; Kim, Tae Hoon; Fazleabas, Asgerally T et al. (2017) KRAS Activation and over-expression of SIRT1/BCL6 Contributes to the Pathogenesis of Endometriosis and Progesterone Resistance. Sci Rep 7:6765
Young, Steven L; Savaris, Ricardo F; Lessey, Bruce A et al. (2017) Effect of randomized serum progesterone concentration on secretory endometrial histologic development and gene expression. Hum Reprod 32:1903-1914
Miller, Jessica E; Monsanto, Stephany P; Ahn, Soo Hyun et al. (2017) Interleukin-33 modulates inflammation in endometriosis. Sci Rep 7:17903

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