Expression Of E-cadherin, β-catenin, UpA And Their Relationship With The Recurrence Of Ovarian Endometrioma

Background and Objective:Endometriosis is a common gynecologic disease.associated with dysmenorrhea, pelvic pain and infertility.The current therapy consists of three main goals,including reduce pelvic pain;increase the pregnancy rate for women who desire to have children; and delay recurrence.Surgery is the main treatment choice for endometriosis,which can release pain and increase the pregnancy rate.But recurrence poses a formidable challenge.40-45%of EMs patients have relapse of the disease 5 years after the primary surgery and would require further surgeries.Repeated surgery associated with increased morbidity and health care costs.In patients with ovarian endometriosis,damages to ovarian reserve,usually coupled with uncertainty and pain.How to identify patientes with a high recurrence risk at the time of surgery may decrease or even prevent recurrence altogether.To date,few risk factors for recurrence have been declareed,but the findings are conflicting.The attempts to identify biomarkers for recurrence has become an challenge to clinical need.Endometrial cells migrate to implant and thrive in an ectopic location must undergo attaching,invading a new environment,proliferating to establish a blood supply.A number of studies have provided circumstanial evidence and suggested a role of adhesion molecules and urokinase plasminogen activator(upA) in the pathophysiology of endometriosis.E-cadherin is a key constituent of cellular adherence junctions in morphology and cellular polar.β-catenin plays a role in both cell-cell adhesion and intracellular signaling,which links to intracellular E-cadherin,and connects E-cadherin to the cytoskeleton.Abnormal expression of cadherins and catenins enable cell lose their adhesion and able to migrate,which plays a critical role in the initiation and progression of carcinogenesis.The whole adhesion complex of E-cadherin andβ-catenin is reduced in the endometriotic lesions.upA is a proteolytic enzyme that activate plasminogen to the highly protent plasmin.It is involed in extracellular matrix(ECM) proteolysis,growth factor activation,cellular proliferation and adhesion,MMp activation.The higher concentration of uPA in endometrium of women with endometriosis might result in tissue fragments with a higher potential to degrade the extracellular matrix and thus,in facilitated implantation processes.E-cadherin,β-catenin,UpA have an important role in the regulating of this physiological progress,but the role of E-cadherin,β-catenin,UpA playing in the recurrence of endometriosis is not clear.The objective of the present study is to investigate expression of E-cadherin,β-catenin,upA in the recurrence of endometriosis and to explore their relationship with the recurrence of ovarian endometrioma.Materials and Methods:Forty-nine tissue blocks were retrieved from Women's Hospital,School of Medicine,Zhejiang University,from Jan.2000 to July.2009 The study group with 34 cases who underwent two times surgery with final diagnosis EMs.The study group was divided into EMs primary group and EMs recurrent group.Control group contains 15 patients were diagnosed EMs during the first time operation.When they received second time operation,no EMs focal was found.Objects and Methods:Formalin-fixed tissues were embedded in and cut into 5-μm sections.with the first resultant slide being stained for H&E to confirm pathological diagnosis.Expression of E-cadherin,β-catenin,upA were detected by immunohistochemistry method (EnVision system).And for each patient clinical information was also collected.The SPSS statistical software system(Version 12) was used for statistical analysis. Only results with p＜0.05 were considered to be statistically significant.Results:1,Immunoreactivity for E-cadherin was restricted to glandular epithelial cells.None of the samples presented stromal E-cadherin immunostaining.in the study group Endometriotic tissues showed statistically significantly lower staining for E-cadherin in the study group when compared with the control group(P＜0.05).But there was no significant difference between the EMs primary group and EMs recurrence group(P＞0.05),2,β-catenin was detected in glandular epithelial and stromal cell.There was no significant difference between the study group and the control group(P＞0.05).There was no significant difference between the EMs primary group and EMs recurrence group(P＞0.05).3,upA localized in cytoplasm were detected in glandular epithelial and stromal cell.They were also detected positively in part in vascular endothelial cells. Endometriotic tissues in the study group showed statistically significantly higher staining for upA when compared with the control group(P＜0.05). There was no significant difference between the EMs primary group and EMs recurrence group(P＞0.05).Conclusion:1,E-cadherin,β-catenin,upA were detected in Endometriotic tissues,which showed the relationship between E-cadherin,β-catenin,upA and EMs.2,Decreased E-cadherin and increased upA may play a role in the pathogenesis of recurrence endometriosis.3,There are no significant different expression of E-cadherin,β-catenin and upA between the EMs primary group and EMs recurrence group(P＞0.05), suggest the mechanism causes of recurrence may be according with the pathogenesis of endometriosis.