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High Expression of High-Mobility Group Box 1 in Menstrual Blood: Implications for Endometriosis

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Abstract

Endometriosis is a benign gynecologic disease characterized by the presence of ectopic endometrium and associated with inflammation and immune abnormalities. However, the molecular basis for endometriosis is not well understood. To address this issue, the present study examined the expression of high-mobility group box (HMGB) 1 in menstrual blood to investigate its role in the ectopic growth of human endometriotic stromal cells (ESCs). A total of 139 patients were enrolled in this study; 84 had endometriosis and 55 were nonendometriotic gynecological patients (control). The HMGB1 levels in various fluids were measured by enzyme-linked immunosorbent assay. Expression of receptor for advanced glycation end products (RAGE) in eutopic and ectopic endometrium was assessed by immunohistochemistry, and RAGE and vascular endothelial growth factor (VEGF) messenger RNA expression in HMGB1- and lipopolysaccharide (LPS)-treated ESCs was evaluated by real-time polymerase chain reaction. The HMGB1 concentration was higher in menstrual blood than in serum or peritoneal fluid (P <.001 for both). RAGE was expressed in both normal and ectopic endometrium. Administration of 1000 ng/mL HMGB1 or coadministration of 100 ng/mL HMGB1 and 100 ng/mL LPS induced VEGF production in ESCs relative to the control (P <.05). These results suggest that menstrual fluid has naturally high levels of HMGB1 and may promote endometriosis following retrograde menstruation when complexed with other factors such as LPS by inducing inflammation and angiogenesis.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Okayama University Medical School, 2-5-1 Shikata, Kita-ku, Okayama, 700-8558, Japan

    Keiko Shimizu MD, Yasuhiko Kamada MD, PhD, Ai Sakamoto MD, Miwa Matsuda MD, Mikiya Nakatsuka MD, PhD & Yuji Hiramatsu MD, PhD

  2. Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan

    Keiko Shimizu MD, Ai Sakamoto MD, Miwa Matsuda MD & Yuji Hiramatsu MD, PhD

  3. Graduate School of Health Sciences, Okayama University, Okayama, Japan

    Mikiya Nakatsuka MD, PhD

Authors
  1. Keiko Shimizu MD
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  2. Yasuhiko Kamada MD, PhD
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  3. Ai Sakamoto MD
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  4. Miwa Matsuda MD
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  5. Mikiya Nakatsuka MD, PhD
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  6. Yuji Hiramatsu MD, PhD
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Correspondence to Keiko Shimizu MD.

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Shimizu, K., Kamada, Y., Sakamoto, A. et al. High Expression of High-Mobility Group Box 1 in Menstrual Blood: Implications for Endometriosis. Reprod. Sci. 24, 1532–1537 (2017). https://doi.org/10.1177/1933719117692042

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