Auf der Spur eines Rätsels: Angiogenese und Endometriose

Zusammenfassung

Endometriose ist ein komplexes Krankheitsbild, dessen Pathogenese rätselhaft ist. Praktisch mit jedem Zyklus gelangen Endometriosezellen durch retrograde Menstruation in die Abdominalhöhle. Ein Ansiedeln dieser Zellen in ektopem Gewebe kommt wahrscheinlich nur bei Frauen vor, bei welchen eine Dysregulation der umgebenden intraperitonealen Abwehrmechanismen vorliegt. Die erhöhten Konzentrationen an aktivierten Makrophagen, Lymphozyten, Zytokinen und Wachstumsfaktoren, welche in der peritonealen Flüssigkeit von Endometriose-Patientinnen nachgewiesen werden, sprechen zugunsten dieser Hypothese. In der vorliegenden Übersicht schlagen wir ein Modell vor, welches das komplexe Zusammenspiel der lokal produzierten Zytokine, Wachstumsfaktoren, Sexualhormone und Eikosanoide im Wachstumsprozess und in der damit verbundenen Gefäßneubildung dieser ektopischen Endometrium-Herde zusammenfasst. Die erhöhte lokale Sekretion von angiostimulatorischen Proteinen durch Endometrioseherde und deren begleitenden Immunzellen fördern die Rekrutierung von Kapillaren zum Ort des Wachstums der anwachsenden Läsionen. Zukünftige Therapien, welche diese angiostimulatorischen Faktoren bekämpfen und somit das Potenzial haben, die vaskuläre Pathogenese der Endometriose zu blockieren, werden ebenfalls erwähnt.

Summary

Endometriosis is a complex condition with an enigmatic pathogenesis. While retrograde passage of endometrial cells into the abdominal cavity during menstruation occurs in most women, implantation of these cells at ectopic sites appears to occur only in those with altered intraperitoneal defense mechanisms. The peritoneal fluid of women with endometriosis contains increased levels of activated macrophages, lymphocytes, cytokines and growth factors. We describe a model which integrates the complex interactions among locally produced cytokines, growth factors, sex steroid hormones, and eicosanoids in the growth and angiogenesis of endometriotic foci. Increased local secretion of angiostimulatory proteins by endometriotic deposits and accompanying immunologic cells promote the local growth of capillaries. Future therapeutic strategies may aim to counter these angiostimulatory factors.

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