ORIGINAL ARTICLE   

Minerva Endocrinology 2021 March;46(1):90-8

DOI: 10.23736/S2724-6507.20.03298-8

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Hormonal therapy potentiates the effect of surgery on gene expression profile of peripheral blood mononuclear cells in patients affected by endometriosis

Michele VIGNALI ¹, Serena PISONI ², Davide GENTILINI ^{2, 3}, Elena SPADA ³, Eugenio SOLIMA ⁴, Paola VIGANÒ ⁵, Massimo CANDIANI ⁶, Mauro BUSACCA ¹, Anna M. DI BLASIO ² ✉

¹ Department of Biomedical Health Sciences, M. Melloni Hospital, University of Milan, Milan, Italy; ² Laboratory of Molecular Biology, IRCCS Istituto Auxologico Italiano, Milan, Italy; ³ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; ⁴ M. Melloni Hospital, Milan, Italy; ⁵ Division of Genetics and Cell Biology, Laboratory of Reproductive Sciences, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy; ⁶ Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

BACKGROUND: Combined oral contraceptives (COCs) represent a common pharmacological approach for endometriosis. They have been demonstrated to mitigate painful symptoms in patients and are considered the first line therapy for symptomatic disease. The goal of this study was to evaluate whether the presence of pelvic endometriotic lesions can exert a systemic effect on PBMC gene expression and to investigate whether hormonal treatment may restore a normal gene expression profile.
METHODS: Forty women, with endometriosis at stage III-IV, were enrolled in the study. After surgery, 20, randomly chosen, were treated with COC for six months and 20 did not receive hormonal therapy. Blood samples were obtained few days before surgery and six months after surgery. Gene expression profile of PBMC was studied by microarray. Gene expression levels before surgery and post-surgery, in presence and absence of COC, were compared.
RESULTS: Nine genes previously reported to be overexpressed by endometriosis, were confirmed to be significantly downregulated after surgery. COC treatment lead to a greater down-regulation of these genes and to a significant down-regulation of 3 additional genes. 145 genes resulted downregulated and 28 upregulated by comparing gene expression before surgery with that 6 months after surgery in the presence of COC therapy.
CONCLUSIONS: Results support the concept that a systemic chronic inflammatory status is among the mechanisms underlying endometriosis. Moreover, they shed light into the mechanisms of action of COCs and strength the rationale for their use to improve quality of life of women affected by the disease.

KEY WORDS: Endometriosis; Contraceptives, oral, combined; Immune system; Inflammation; Gene expression