Endometriosis is characterized by
inflammation and fibrotic changes. Our previous study using a mouse model showed that proinflammatory factors present in peritoneal
hemorrhage exacerbated
inflammation in
endometriosis-like grafts, at least in part through the activation of
prostaglandin (PG) E2 receptor and
protease-activated receptor (PAR). In addition, menstruation-related factors,
PGE2 and
thrombin (P/T), a PAR1 agonist induced epithelial-mesenchymal transition (EMT) of endometrial cells under
hypoxia. However, the molecular mechanisms by which P/T induce development of
endometriosis have not been fully characterized. To investigate the effects of P/T,
RNA extracted from endometrial stromal cells (ESCs) treated with P/T were subjected to RNA sequence analysis, and identified
activin A, FOS, and GATA2 as upregulated genes.
Activin A increased the expression of
connective tissue growth factor (CTGF) and mesenchymal marker genes in ESCs. CTGF induced the expression of
fibrosis marker
type I collagen,
fibronectin, and α-smooth muscle actin (αSMA), indicating fibroblast to myofibroblast transdifferentiation (FMT) of ESCs. In addition,
activin A, FOS, GATA2, CTGF, and αSMA were localized in
endometriosis lesions. Taken together, our data show that P/T induces changes resembling EMT and FMT in ectopic ESCs derived from
retrograde menstruation, and that these are associated with fibrotic changes in the lesions. Pharmacological means that block P/T-induced
activin A and CTGF signaling may be strategies to inhibit
fibrosis in endometriotic lesions.