Estrogen receptor-α immunoreactivity predicts symptom severity and pain recurrence in deep endometriosis.

Abstract

OBJECTIVE:

To determine the relationship between steroid receptor expression and pain symptoms in endometriosis.

DESIGN:

Cross-sectional SETTING: University Hospital PATIENT(S): Women with endometriosis (N = 92).

INTERVENTION(S):

Tissue samples were obtained from patients with surgically diagnosed endometriosis.

MAIN OUTCOME MEASURE(S):

A tissue microarray (TMA) was generated from patients with endometriosis. Data were collected on the presence and severity of dysmenorrhea, deep dyspareunia, dyschezia, and nonmenstrual pain by use of a numerical rating scale (NRS) at the time of surgery and after 1 year. The intensity of receptor expression was evaluated through immunohistochemistry and measured according to an immunoreactive score (IRS). Clinical variables were correlated to IRS by multivariate logistic regression analysis.

RESULTS:

Estrogen receptor-α (ER-α), progesterone receptor (PR), androgen receptor (AR), and aromatase expression differed among study participants. ER-α expression was reduced by progestin therapy, whereas of expressions of PR, AR, and aromatase were unchanged. Higher ER-α expression increased the likelihood of moderate to severe dysmenorrhea and deep dyspareunia in women not receiving hormonal treatment. In women receiving progestin therapy, persistently higher ER-α expression was correlated with greater likelihood of deep dyspareunia, severe dyschezia, and endometriosis-associated pain persistence at 1 year.

CONCLUSION(S):

ER-α, PR, AR, and aromatase were all expressed in deep endometriosis. ER-α levels best correlated with severity of symptoms, which suggests that ER is a key driver of deep endometriosis. Progestin treatment was associated with a reduction of ER-α expression; however, failure of ER suppression by progestins was also a predictor of pain severity and recurrence at 1 year.

• Authors: Nicola Pluchino, Ramanaiah Mamillapalli, Jean-Marie Wenger, Lauriane Ramyead, Panagiotis Drakopoulos, Jean-Christophe Tille, Hugh S Taylor
• Journal: Fertility and sterility (Fertil Steril) Vol. 113 Issue 6 Pg. 1224-1231.e1 (06 2020) ISSN: 1556-5653 [Electronic] United States
• PMID: 32416979 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2020 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• ESR1 protein, human
• Estrogen Receptor alpha
• Progestins

Topics

• Adult
• Biomarkers (metabolism)
• Constipation (diagnosis, etiology, prevention & control)
• Cross-Sectional Studies
• Dysmenorrhea (diagnosis, etiology, prevention & control)
• Dyspareunia (diagnosis, etiology, prevention & control)
• Endometriosis (complications, diagnosis, metabolism)
• Estrogen Receptor alpha (metabolism)
• Female
• Humans
• Immunohistochemistry
• Middle Aged
• Pain Measurement
• Predictive Value of Tests
• Progestins (therapeutic use)
• Recurrence
• Risk Assessment
• Risk Factors
• Severity of Illness Index
• Tissue Array Analysis
• Treatment Outcome
• Young Adult