%0 Journal Article
%T Interplay between Misplaced M¨¹llerian-Derived Stem Cells and Peritoneal Immune Dysregulation in the Pathogenesis of Endometriosis
%A Antonio Simone Lagan¨¤
%A Emanuele Sturlese
%A Giovanni Retto
%A Vincenza Sofo
%A Onofrio Triolo
%J Obstetrics and Gynecology International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/527041
%X In the genetic regulation of M¨¹llerian structures development, a key role is played by Hoxa and Wnt clusters, because they lead the transcription of different genes according to the different phases of the organogenesis, addressing correctly cell-to-cell interactions, allowing, finally, the physiologic morphogenesis. Accumulating evidence is suggesting that dysregulation of Wnt and/or Hox genes may affect cell migration during organogenesis and differentiation of M¨¹llerian structures of the female reproductive tract, with possible dislocation and dissemination of primordial endometrial stem cells in ectopic regions, which have high plasticity to differentiation. We hypothesize that during postpubertal age, under the influence of different stimuli, these misplaced and quiescent ectopic endometrial cells could acquire new phenotype, biological functions, and immunogenicity. So, these kinds of cells may differentiate, specializing in epithelium, glands, and stroma to form a functional ectopic endometrial tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease. 1. Introduction Endometriosis is an estrogen-dependent disease [1] characterized by the ectopic presence and growth of functional endometrial tissue, glands, and stroma, outside the uterine cavity [2, 3]. It affects deeply and negatively woman¡¯s quality of life, contributing not only to suffering but also to marital and family problems, to problems related to the achievements of work tasks, and overall to disability in woman¡¯s role in modern society [4¨C7]. Its treatment, medical or surgical depending on each case, on the contrary, could improve and partially restore women¡¯s health-related quality of life (HRQoL), like is reported by Jia et al. [8] and Gao et al. [9]. Risk factors for this disease are nulliparity, high education level, and social class (probably because these patients undergo accurate medical controls more easily) [10], although it is widespread across countries and ethnicities, and women continue to experience diagnostic delays in primary care [6]. As is suggested by many authors [11, 12] the risk of endometriosis appears to increase for reproductive health factors that may relate to increased exposure to menstruation (i.e., shorter cycle length, longer duration of flow, or reduced parity). The risk appears to decrease for
%U http://www.hindawi.com/journals/ogi/2013/527041/