NEW PERSPECTIVES IN THE PATHOGENESIS OF ENDOMETRIOSIS – POTENTIAL TREATMENT STRATEGIES TARGETING THE SMART ADULT STEM CELLS

摘要

POPULATIONS OF CLONOGENIC EPITHELIAL AND STROMAL CELLS WERE FIRST REPORTED IN 2004 AND SINCE THEN, DIFFERENT POPULATIONS OF STEM/PROGENITOR CELLS HAVE BEEN IDENTIFIED. THIS REVIEW IS AIMED AT BRINGING NEW PERSPECITVES FOR ENDOMETRIOSIS DEVELOPMENT, TO PROVIDE A BETTER UNDERSTANDING OF PATHOGENIC THEORIES, ALONG WITH POTENTIAL TREATMENT TARGETS. STUDIES SHOW THAT ENDOMETRIUM IS RICH IN STEM CELL POPULATIONS, SUCH AS ENDOMETRIAL MESENCHYMAL STEM CELLS (EMSC), ENDOMETRIAL EPITHELIAL PROGENITOR CELLS (EEP) AND SIDE POPULATIONS (SP). THEIR ROLE IS IMPORTANT IN PHYSIOLOGY, REGENERATION AND REPAIR, BUT ALSO IN THE GENERATION OF ENDOMETRIOSIS. ENDOMETRIOSIS MAY ARISE FROM DISLOCATED OR ABERRANT STEM CELLS, FROM THE ENDOMETRIUM OR EXOGENOUS SOURCES, SUCH AS BONE-MARROW. MORE FINDINGS SUPPORT THE BIDIRECTIONAL MOVEMENT OF CELLS BETWEEN EUTOPIC AND ECTOPIC ENDOMETRIAL TISSUE THROUGH SIGNALING PATHWAYS. EMSC RESIDE IN A PERIVASCULAR NICHE AND ARE LIKELY TO MEDIATE ANGIOGENESIS AND STROMAL REGENERATION. TREATMENT OPTIONS FOCUSE ON THE INHIBITION OF THE ECTOPIC EMSC MIGRATION, PROLIFERATION AND ANGIOGENESIS. THE MAIN PURPOSE FOR THE FUTURE CLINICAL PRACTICE IS TO ESTABLISH ACCURATELY THE DIAGNOSIS OF ENDOMETRIOSIS AND POTENTIAL THERAPEUTIC TARGETS. THE ADVANCEMENTS IN OUR KNOWLEDGE ABOUT DIFFERENT TYPES OF ENDOMETRIAL STEM/PROGENITOR CELLS PROVIDE THE BASIS FOR A BETTER UNDERSTANDING OF ENDOMETRIOSIS PATHOGENESIS.