Хронический эндометрит у женщин с эндометриоз-ассоциированным бесплодием
Хронический эндометрит у женщин с эндометриоз-ассоциированным бесплодием
Оразов М.Р., Радзинский В.Е., Волкова С.В. и др. Хронический эндометрит у женщин с эндометриоз-ассоциированным бесплодием. Гинекология. 2020; 22 (3): 15–20. DOI: 10.26442/20795696.2020.3.200174
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Orazov M.R., Radzinsky V.E., Volkova S.V. et al. Chronic endometritis in women with endometriosis-associated infertility. Gynecology. 2020; 22 (3): 15–20.
DOI: 10.26442/20795696.2020.3.200174
Хронический эндометрит у женщин с эндометриоз-ассоциированным бесплодием
Оразов М.Р., Радзинский В.Е., Волкова С.В. и др. Хронический эндометрит у женщин с эндометриоз-ассоциированным бесплодием. Гинекология. 2020; 22 (3): 15–20. DOI: 10.26442/20795696.2020.3.200174
________________________________________________
Orazov M.R., Radzinsky V.E., Volkova S.V. et al. Chronic endometritis in women with endometriosis-associated infertility. Gynecology. 2020; 22 (3): 15–20.
DOI: 10.26442/20795696.2020.3.200174
В статье освещены современные представления о роли эндометрия в генезе репродуктивных неудач. Отмечено принципиально важное место хронического эндометрита в структуре эндометриального фактора бесплодия при эндометриозе. Учитывая частую ассоциацию хронического эндометрита и эндометриоза, выявлены общие черты этих заболеваний. Дана характеристика микробиоты эндометрия при бесплодии, хроническом эндометрите и эндометриозе. Крайне важным направлением научного поиска является именно взаимодействие между микробиотой эндометрия и его иммунитетом, а не просто подтверждение присутствия микроорганизмов в эндометрии. Описаны современные аспекты этиологии и патогенеза хронического эндометрита и эндометриоза. Основными патогенетическими детерминантами хронического эндометрита являются срыв механизмов адаптации к постоянному воздействию микробов и, как следствие этого, снижение и неполноценность иммунного ответа и развитие аутоиммунных реакций. Современная парадигма развития и прогрессирования эндометриоза предусматривает наличие бактериальной контаминации эндометрия и брюшной полости, что, в свою очередь, становится триггером генетически-эпигенетических модификаций клеток, запуская разные каскады, лежащие в основе нарушений репродуктивной функции. Освещена патогенетически значимая взаимосвязь хронического эндометрита и эндометриоза. Выявлено, что хронический эндометрит может быть как причиной, так и следствием эндометриоза. Описаны нарушения рецептивности эндометрия при хроническом эндометрите, ассоциированном с эндометриозом, их значение в реализации эндометриального бесплодия. Отмечена важная роль микробиома в формировании репродуктивных нарушений. Ключевые слова: хронический эндометрит, эндометриоз, микробиота эндометрия, рецептивность эндометрия
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The article highlights modern ideas about the role of the endometrium in the genesis of reproductive failures. A crucial place of chronic endometritis in the structure of the endometrial infertility factor in endometriosis is noted. Given the frequent association of chronic endometritis and endometriosis, common features of these diseases have been identified. The characteristic of endometrial microbiota in infertility, chronic endometritis and endometriosis is given. An extremely important area of scientific research is precisely the interaction between the microbiota of the endometrium and its immunity, and not just the confirmation of the presence of microorganisms in the endometrium. The modern aspects of the etiology and pathogenesis of chronic endometritis and endometriosis are described. The main pathogenetic determinants of chronic endometritis are the failure of adaptation mechanisms to the constant effects of microbes and, as a consequence, the decrease and inferiority of the immune response and the development of autoimmune reactions. The modern paradigm for the development and progression of endometriosis involves the presence of bacterial contamination of the endometrium and the abdominal cavity, which in turn becomes a trigger for genetically-epigenetic modifications of cells, launching different cascades that underlie reproductive function disorders. The pathogenetically significant relationship between chronic endometritis and endometriosis is highlighted. It was revealed that chronic endometritis can be both a cause and a consequence of endometriosis. Disorders of the endometrial receptivity in chronic endometritis associated with endometriosis, their importance in the implementation of endometrial infertility are described. The important role of the microbiome in the formation of reproductive disorders is noted.
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1. Kitaya K, Matsubayashi H, Yamaguchi K et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol 2016; 75: 13–22.
2. Kimura F, Takebayashi A, Ishida M et al. Review: Chronic endometritis and its effect on reproduction. J Obstet Gynaecol Res 2019; 45 (5): 951–60.
3. Orazov M.R., Hamoshina M.B., Mihaleva L.M. et al. Molekulyarno-geneticheskie osobennosti sostoyaniya endometriya pri endometrioz-associirovannom besplodii. Trudnyj pacient. 2020; 1 (18): 23–32 (in Russian).
4. Lessey BA, Kim JJ. Endometrial Receptivity in Eutopic Endometrium of Women with Endometriosis It is affected, let me show you why. Fertil Steril 2017; 108 (1): 19–27.
5. Evans-Hoeker E, Lessey BA, Jeong JW et al. Endometrial BCL6 Overexpression in Eutopic Endometrium of Women With Endometriosis. Reprod Sci 2016; 23: 1234–41.
6. Lessey BA, Young SL. What exactly is endometrial receptivity? Fertil Steril 2019; 111 (4): 611–17.
7. Tai FW, Chang CY, Chiang JH et al. Association of Pelvic Inflammatory Disease with Risk of Endometriosis: A Nationwide Cohort Study Involving 141, 460 Individuals. J Clin Med 2018; 7 (11).
8. Takebayashi A, Kimura F, Kishi Y et al. The association between endometriosis and chronic endometritis. PLoS One 2014; 9 (2): e88354.
9. Cicinelli E, Trojano G, Mastromauro M et al. Higher prevalence of chronic endometritis in women with endometriosis: a possible etiopathogenetic link. Fertil Steril 2017; 108 (2): 289-295.e1.
10. Tolibova G.Kh., Tral' T.G., Iarmolinskaia M.I., Tsypurdeeva A.A. Endometrial'naia disfunktsiia u patsientok s besplodiem, assotsiirovannym s naruzhnym genital'nym endometriozom. Zhurn. akusherstva i zhenskikh boleznei. 2017; 66: 84–5 (in Russian).
11. Pinto V, Matteo M, Tinelli R et al. Altered uterine contractility in women with chronic endometritis. Fertil Steril 2015; 103 (4): 1049–52.
12. Verstraelen H, Vilchez-Vargas R, Desimpel F et al. Characterisation of the human uterine microbiome in non-pregnant women through deep sequencing of the V1-2 region of the 16S rRNA gene. Peer J 2016; 4: e1602.
13. Mitchell CM, Haick A, Nkwopara E et al. Colonization of the upper genital tract by vaginal bacterial species in nonpregnant women. Am J Obstet Gynecol 2015; 212: 611.e1–9.
14. Mlodzik N, Lukaszuk K, Sieg W et al. Endometrial microbiota – do they mean more than we have expected? Ginekol Pol 2020; 91 (1): 45–8.
15. Moreno I, Codoñer FM, Vilella F et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol 2016; 215 (6): 684–703.
16. Kyono K, Hashimoto T, Nagai Y, Sakuraba Y. Analysis of endometrial microbiota by 16S ribosomal RNA gene sequencing among infertile patients: a single-center pilot study. Reprod Med Biol 2018; 17 (3): 297–306.
17. Cicinelli E, De Ziegler D, Nicoletti R et al. Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. Gynecol Obstet Invest 2009; 68: 108–15.
18. Cicinelli E, Matteo M, Tinelli R et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci 2014; 21: 640–7.
19. Liu Y, Ko EY, Wong KK et al. Endometrial microbiota in infertile women with and without chronic endometritis as diagnosed using a quantitative and reference range-based method. Fertil Steril 2019; 112 (4): 707-717.e1.
20. Wang RL, Chen LX, Shu WS et al. Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps. Am J Transl Res 2016; 8: 1581–92.
21. Petrov Iu.A. Rol' mikrobnogo faktora v geneze khronicheskogo endometrita. Kubanskii nauchnyi meditsinskii vestnik. 2016; 3 (158): 113–8 (in Russian).
22. Baker JM, Chase DM, Herbst-Kralovetz MM. Uterine microbiota: Residents, tourists, or invaders? Front Immunol 2018; 9: 208.
23. Resta L, Palumbo M, Piscitelli D et al. Histology of micro polyps in chronic endometritis. Histopathology 2012; 60 (4): 670–4.
24. Kitaya K, Takeuchi T, Mizuta S et al. Endometritis: new time, new concepts. Fertil Steril 2018: 110 (3); 344–50.
25. Kitaya K, Yasuo T. Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. Mod Pathol 2010; 23 (8): 1136–46.
26. Kitaya K, Matsubayashi H, Yamaguchi K et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol 2016; 75 (1): 13–22.
27. Kitaya K, Tada Y, Hayashi T et al. Comprehensive endometrial immunoglobulin subclass analysis in infertile women suffering from repeated implantation failure with or without chronic endometritis. Am J Reprod Immunol 2014; 72 (4): 386–91.
28. Di Pietro C, Cicinelli E, Guglielmino MR et al. Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2013; 6 9(5): 509–17.
29. Wu D, Kimura F, Zheng L et al. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod Biol Endocrinol 2017; 15 (1): 16.
30. Kitaya K, Yasuo T, Tada Y et al. Unusual inflammation in gynecologic pathology associated with defective endometrial receptivity. Histol Histopathol 2014; 29 (9): 1113–27.
31. Vatansever HS, Lacin S, Ozbilgin MK. Changed Bcl: Bax ratio in endometrium of patients with unexplained infertility. Acta Histochem 2005; 107 (5): 345–55.
32. Radzinskii V.E., Petrov Iu.A., Kalinina E.A. et al. Patogeneticheskie osobennosti makrotipov khronicheskogo endometrita. Kazanskii med. zhurn. 2017; 98 (1): 27–34 (in Russian)
33. Bessudnova I.Iu., Kozhevnikova E.S. Varianty lecheniia khronicheskogo endometrita u patsientok s besplodiem i nevynashivaniem beremennosti. Zhurn. akusherstva i zhenskikh boleznei. 2016; 65: 60–2 (in Russian)
34. Amrieva D.Kh., Petrov Iu.A. Khronicheskii endometrit: patogeneticheskie aspekty. Vestn. DGMA. 2019; 4 (33): 59–63 (in Russian).
35. Khan KN, Kitajima M, Hiraki K et al. Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis. Fertil Steril 2010; 94: 2860–3.
36. Orazov M.R., Toktar L.R. Bakterial'naia kontaminatsiia: novoe slovo v patogeneze endometrioza. Akusherstvo i ginekologiia: novosti, mneniia, obuchenie. 2018; 6 (3): 29–37 (in Russian).
37. Khan KN, Fujishita A, Kitajima M et al. Intrauterine microbial colonization and occurrence of endometritis in women with endometriosis. Hum Reprod 2014; 29: 2446–56.
38. Moreno I, Franasiak JM. Endometrial microbiota-new player in town. Fertil Steril 2017; 108 (1): 32–9.
39. Khan KN, Fujishita A, Hiraki K et al. Bacterial contamination hypothesis: a new concept in endometriosis. Reprod Med Biol 2018; 17 (2): 125–133.
40. Khan KN, Kitajima M, Imamura T et al. Toll-like receptor 4 (TLR4)- mediated growth of endometriosis by human heat shock protein 70(Hsp70). Hum Reprod 2008; 23: 2210–9.
41. Koninckx PR, Ussia A, Adamyan L et al. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril 2019; 111 (2): 327–40.
42. Koninckx PR, Ussia A, Tahlak M et al. Infection as a potential cofactor in the genetic-epigenetic pathophysiology of endometriosis: a systematic review. Facts Views Vis Obgyn 2019; 11 (3): 209–16.
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1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ФГБНУ «Научно-исследовательский институт морфологии человека», Москва, Россия;
3 ООО «МедИнСервис» – Центр репродукции и генетики «Nova Clinic» («МедИнСервис»), Москва, Россия
*omekan@mail.ru
________________________________________________
Mekan R. Orazov*1, Victor E. Radzinsky1, Snezhana V. Volkova1, Marina B. Khamoshina1, Lyudmila M. Mikhaleva2, Marianna Z. Abitova1, Victoria B. Shustova3
1 Peoples' Friendship University of Russia, Moscow, Russia;
2 Research Institute of Human Morphology, Moscow, Russia;
3 MedInService – Center for Reproduction and Genetics “Nova Clinic” (“MedInService”), Moscow, Russia
*omekan@mail.ru