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PURPOSE: Polycystic ovary syndrome (PCOS) is a common endocrine disorder often linked to metabolic syndrome (MS), raising the risk of cardiovascular disease and type II diabetes. Certain indicators, such as the lipid accumulation product (LAP) and homeostatic model assessment for insulin resistance (HOMA-IR), can predict MS in PCOS patients. This study aimed to assess the predictive power of the visceral adiposity index (VAI) in comparison to LAP and HOMA-IR as predictors of MS in PCOS patients. METHODS: In this cross-sectional observational study, data from 317 diagnosed PCOS women were analyzed. VAI, LAP, and HOMA-IR were computed as indexes. Participants were categorized into two groups for index accuracy comparison: PCOS patients with and without MS. The data were assessed using a ROC curve. RESULTS: Among PCOS women with MS, 92.3% had abnormal VAI results, 94.5% had abnormal LAP results, and only 50.5% had abnormal HOMA-IR results. Conversely, the majority of PCOS women without MS had normal HOMA-IR (64.6%). When comparing these indexes using the ROC curve, VAI displayed the highest accuracy, followed by LAP and HOMA-IR. CONCLUSION: The VAI index proved to be a superior predictor of metabolic MS in PCOS women when compared to other indexes.
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Diabetes Mellitus Tipo 2 , Resistencia a la Insulina , Síndrome Metabólico , Síndrome del Ovario Poliquístico , Humanos , Femenino , Síndrome Metabólico/complicaciones , Síndrome Metabólico/diagnóstico , Síndrome del Ovario Poliquístico/complicaciones , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/metabolismo , Adiposidad , Estudios Transversales , Índice de Masa CorporalRESUMEN
OBJECTIVE: Polycystic ovary syndrome (PCOS) is a recognized risk factor for nonalcoholic fatty liver disease (NAFLD). The aims of this study were to investigate the prevalence and factors associated with NAFLD in women with PCOS and evaluate noninvasive indices of hepatic fibrosis in patients with PCOS and NAFLD. SUBJECTS AND METHODS: Patients with PCOS (n = 87) and women without PCOS (n = 40; controls) were included. NAFLD was diagnosed by abdominal ultrasonography after exclusion of alcohol consumption and viral or autoimmune liver disease. Anthropometric, clinical and metabolic variables, homeostasis model assessment of insulin resistance (HOMA-IR) index, lipid accumulation product (LAP), FIB-4 index, NAFLD score, and transient elastography (TE; FibroScan) were obtained in subsets of patients with PCOS and NAFLD. RESULTS: A total of 87 patients with PCOS were included (mean age: 34.4 ± 5.7 years, mean body mass index [BMI]: 34.7 ± 4.7 kg/m 2 ). NAFLD was present in 67 (77.0%) patients with PCOS versus 21 of 40 (52.5%) controls (p = 0.005). Women with PCOS and liver steatosis, compared with their NAFLD-free counterparts, had higher values of BMI, waist circumference, triglycerides, total cholesterol, alanine and aspartate aminotransferases, and γ-glutamyltransferase, along with higher frequencies of obesity, metabolic syndrome, and insulin resistance. NAFLD was independently associated with waist circumference, serum triglycerides, and alanine aminotransferase levels. The FIB-4 index was not compatible with advanced fibrosis in any of the evaluated patients, while NAFLD score and TE were compatible with advanced liver fibrosis in 1 of 26 (3.8%) and 3 of 25 (12%) patients, respectively. CONCLUSION: Women with PCOS had a high risk of NAFLD, and a combination of both was associated with central obesity, dyslipidemia, insulin resistance, and metabolic syndrome. Noninvasive methods suggested low rates of severe hepatic fibrosis in Brazilian women with PCOS. Arch Endocrinol Metab. 2020;64(3):235-42.
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Enfermedad del Hígado Graso no Alcohólico/etiología , Síndrome del Ovario Poliquístico/complicaciones , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Humanos , Resistencia a la Insulina , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/fisiopatología , Síndrome del Ovario Poliquístico/fisiopatología , Factores de Riesgo , Circunferencia de la CinturaRESUMEN
Polycystic ovary syndrome (PCOS) is a chronic dysfunction associated with obesity and metabolic disorders that can be ameliorated by treatment with metformin. Brown adipose tissue (BAT) has been recently identified in adult humans, and irisin is a myokine that induces BAT formation. The aim of this randomized controlled trial was to evaluate whether a short term treatment with metformin alters BAT activity and plasma irisin levels in women with PCOS. The participants were randomly assigned to receive metformin (1500 mg/day, n=21) or placebo (n=24) during 60 days. BAT activity was assessed by 18F-FDG positron emission tomography-computed tomography (PET-CT) and plasma irisin levels were measured by enzyme immunoassay. The groups were similar in age, body measures, metabolic profile and PCOS phenotypes. BAT activity did not change significantly in the women treated with metformin (median Δ SUVmax=-0.06 g/ml, interquartile interval -2.81 to 0.24 g/ml, p=0.484, Wilcoxon's test) or placebo (median Δ SUVmax=0.98 g/ml, interquartile interval -2.94 to 4.60 g/ml, p=0.386). In addition, plasma irisin levels remained unchanged in the groups treated with metformin (median Δ=-98 ng/ml, interquartile interval -366 to 60 ng/ml, p=0.310) and placebo (median Δ=28 ng/ml, interquartile interval -1260 to 215 ng/ml, p=0.650). These results suggest that in PCOS women BAT activity and plasma irisin levels may not change after a brief treatment with metformin.
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Tejido Adiposo Pardo/efectos de los fármacos , Biomarcadores/sangre , Fibronectinas/sangre , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/patología , Tejido Adiposo Pardo/metabolismo , Tejido Adiposo Pardo/patología , Adolescente , Adulto , Método Doble Ciego , Femenino , Humanos , Persona de Mediana Edad , Síndrome del Ovario Poliquístico/tratamiento farmacológico , Adulto JovenRESUMEN
Objective: To evaluate whether brown adipose tissue (BAT) activity is altered in women with polycystic ovary syndrome (PCOS), and whether BAT activity correlates with plasma levels of irisin, a myokine that can induce BAT formation. Design: We performed a cross-sectional study including women with PCOS (n = 45) and a healthy control group (n = 25) matched by age and body mass index (BMI). Methods: BAT activity was measured using 18F-FDG positron emission tomography-computed tomography (PET-CT) and plasma irisin levels were measured by a validated enzyme immunoassay. Results: Total BAT activity was significantly reduced in women with PCOS (maximal standardized uptake value (SUVmax): median 7.4 g/mL, interquartile range 0.9-15.4) compared to controls (median 13.0 g/mL, interquartile range 4.7-18.4, P = 0.047). However, this difference was no longer significant after adjustment for waist circumference, a surrogate marker of central adiposity. In the PCOS group, BAT activity correlated negatively with BMI (Spearman's r = -0.630, P = 0.000) and waist circumference (r = -0.592, P = 0.000) but not with plasma irisin levels. Conclusions: BAT activity was reduced in women with PCOS possibly due to increased central adiposity. In PCOS women, BAT activity did not correlate with plasma irisin levels.
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Tejido Adiposo Pardo/fisiopatología , Síndrome del Ovario Poliquístico/fisiopatología , Tejido Adiposo Pardo/diagnóstico por imagen , Adiposidad , Adolescente , Adulto , Índice de Masa Corporal , Estudios Transversales , Femenino , Fibronectinas/sangre , Fluorodesoxiglucosa F18 , Humanos , Estilo de Vida , Persona de Mediana Edad , Síndrome del Ovario Poliquístico/diagnóstico por imagen , Tomografía de Emisión de Positrones , Resultado del Tratamiento , Circunferencia de la Cintura , Adulto JovenRESUMEN
Endometriosis is a benign gynecological disorder which presents significant challenges in terms of diagnosis and management. Despite decades of research, there are no sufficiently sensitive and specific signs and symptoms nor blood tests for the clinical confirmation of endometriosis, which hampers prompt diagnosis and treatment. The huge majority of potential biomarkers has been discarded in research stage and very few have been translated to clinical practice. Serum CA-125 is the most studied and used one, but studies have shown its poor diagnostic performance. Several factors involved in the chronic inflammatory process of endometriosis, such as hormones, cytokines, chemokines, angiogenic factors, oxidative stress markers and others, have been implicated in the disease's pathogenesis and have been extensively studied, but not a single one has successfully been able to accurately identify the disease. MicroRNAs have emerged more recently but their utility to detect endometriosis remains uncertain. The search for a biomarker or a set of biomarkers is still open and may benefit from novel molecular biology and bioinformatics approaches to mine and uncover molecular signatures specifically associated with the disease.
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Endometriosis/diagnóstico , Proteínas Angiogénicas/análisis , Animales , Biomarcadores/análisis , Citocinas/análisis , Endometriosis/patología , Femenino , Glicoproteínas/análisis , Hormonas/análisis , Humanos , MicroARNs/análisis , Útero/metabolismo , Útero/patologíaRESUMEN
INTRODUCTION: Obese women have special safety requirements for contraceptive choice, but the evidence supporting such decision is dispersed and sometimes conflicting. Despite being effective, well tolerated and safe for most women, hormonal contraceptives are underused by obese women due to fear of contraceptive failure, weight gain and venous thrombosis. Areas covered: We performed a comprehensive literature search to identify studies about hormonal contraception in overweight and obese women, including safety concerns. We considered the safety of hormonal contraceptives for otherwise healthy obese women and for those with comorbidities such as hypertension, diabetes, vascular disease, or a history of deep venous thrombosis. Expert opinion: Over time there is no convincing evidence that obesity increases the risk of contraceptive failure. Hormonal contraceptive users may have a modest weight gain that is comparable to that of non-users. Current evidence supports the safe use of combined hormonal contraceptives by obese women after detailed clinical screening to exclude comorbidities that may contraindicate the use of estrogens. Progestin-only methods are generally safe, and long-acting reversible contraceptives hold the best combination of efficacy, safety and convenience for this group, although individualization is advisable.
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Anticonceptivos Femeninos/administración & dosificación , Anticonceptivos Hormonales Orales/administración & dosificación , Obesidad/complicaciones , Sobrepeso/complicaciones , Anticonceptivos Femeninos/efectos adversos , Efectividad Anticonceptiva , Anticonceptivos Hormonales Orales/efectos adversos , Femenino , Humanos , Aumento de Peso/efectos de los fármacosRESUMEN
BACKGROUND: Nodal is a growth factor of the transforming growth factor ß superfamily that is expressed in high turnover tissues, such as the human endometrium, and in several malignancies. The effects of Nodal are modulated by the coreceptor Cripto and mediated by SMAD proteins. This study evaluated the gene and protein expression of Nodal, Cripto, total and phosphorylated (p) SMAD3, and SMAD4 in the proliferative endometrium of women with and without endometriosis. METHOD: Total RNA was isolated and complementary DNA synthesized from eutopic endometrium of women with (n = 15) and without (n = 12) endometriosis, followed by quantitative real-time polymerase chain reaction (PCR) to evaluate the gene expression of Nodal, Cripto, SMAD3, and SMAD4. Western blot was used to evaluate the protein levels of Nodal and Cripto, and immunohistochemistry was performed to localize SMAD3, pSMAD3, and SMAD4. RESULTS: Although Nodal expression was unchanged in women with endometriosis, real-time PCR indicated lower gene expression of Cripto (fold change 0.27, P < .05) in the endometriosis group. This difference, however, was not maintained at protein expression level as assessed by Western blot. The immunostaining of total SMAD3 was reduced in the endometriosis group (P < .01), but the localization of pSMAD3 and the nuclear staining of SMAD4 were unchanged. CONCLUSION: These findings suggest that the Nodal signaling pathway has subtle changes in the endometrium of women with endometriosis, but this imbalance may not cause functional damage as it seems not to affect the nuclear expression of SMAD4.
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Proliferación Celular , Endometriosis/metabolismo , Endometrio/química , Proteínas Ligadas a GPI/análisis , Péptidos y Proteínas de Señalización Intercelular/análisis , Proteínas de Neoplasias/análisis , Proteína Nodal/análisis , Proteína smad3/análisis , Proteína Smad4/análisis , Adulto , Western Blotting , Estudios de Casos y Controles , Endometriosis/diagnóstico , Endometriosis/genética , Endometrio/patología , Femenino , Proteínas Ligadas a GPI/genética , Regulación de la Expresión Génica , Humanos , Inmunohistoquímica , Péptidos y Proteínas de Señalización Intercelular/genética , Proteínas de Neoplasias/genética , Proteína Nodal/genética , Fosforilación , ARN Mensajero/análisis , Reacción en Cadena en Tiempo Real de la Polimerasa , Transducción de Señal , Proteína smad3/genética , Proteína Smad4/genética , Adulto JovenRESUMEN
The aim of this study was to evaluate ovarian reserve markers in women with systemic lupus erythematosus (SLE) and regular menstrual cycles, and explore the relationship of such markers with clinical and treatment features. This was a case-control study including 27 women with SLE and 27 controls. All participants were aged 18-40 years, were eumenorrheic and had not used hormone therapy or hormone contraceptives in the past six months. Clinical manifestations of SLE, past and current use of immunosuppressive therapy and organ damage index were assessed at a regular follow-up visit, while antral follicle count (AFC), serum anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) were assessed at early follicular phase of menstrual cycle. AFC was significantly reduced in SLE women [median (interquartile interval) 7 (5-11) versus 11 (7-12), p = 0.029]. AMH levels were more heterogeneous in SLE patients compared to the control group [1.23 (0.24-4.63) ng/ml versus 1.52 (1.33-1.88) ng/ml]. The SLE and control groups had similar serum FSH levels [6.44 (4.19-7.69) versus 7.5 (6.03-8.09) IU/L, p = 0.135]. AFC was inversely correlated with organ damage index (p = 0.046) and cumulative dose of cyclophosphamide (p = 0.028), while AMH levels were negatively correlated with the maximal dose of corticosteroid ever used (p = 0.003). These findings suggest that ovarian reserve may be decreased in women with SLE despite regular menstrual cycles.
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Lupus Eritematoso Sistémico/fisiopatología , Ciclo Menstrual/fisiología , Folículo Ovárico/diagnóstico por imagen , Reserva Ovárica/fisiología , Adulto , Biomarcadores , Estudios de Casos y Controles , Femenino , Humanos , Lupus Eritematoso Sistémico/sangre , Ciclo Menstrual/sangre , UltrasonografíaRESUMEN
A comprehensive review was performed to survey the role of angiogenesis in the pathogenesis of endometriosis. This is a multifactorial disease in which the development and maintenance of endometriotic implants depend on their invasive capacity and angiogenic potential. The peritoneal fluid of patients with endometriosis is a complex suspension carrying inflammatory cytokines, growth factors, steroid hormones, proangiogenic factors, macrophages, and endometrial and red blood cells. These cells and their signaling products concur to promote the spreading of new blood vessels at the endometriotic lesions and surroundings, which contributes to the endometriotic implant survival. Experimental studies of several antiangiogenic agents demonstrated the regression of endometriotic lesions by reducing their blood supply. Further studies are necessary before these novel agents can be introduced into clinical practice, in particular the establishment of the safety of anti-angiogenic medications in women who are seeking to become pregnant.
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INTRODUCTION: Endometriosis is a benign sex hormone-dependent gynecological disease, characterized by the presence and growth of endometrial tissue outside the uterus; it affects 10% of women of reproductive age and is associated with infertility and pain. Treatment of endometriosis involves conservative or radical surgery, or medical therapies. The goals for endometriosis treatment may be the relief of pain and/or a successful pregnancy achievement in infertile patients. Treatment must be individualized with a multidisciplinary approach. The classical treatments carry adverse side effects and in some cases a negative impact on quality of life. New agents promise a distinct perspective in endometriosis treatment. AREAS COVERED: The aim of this paper is to systematically review the literature evidence of new medical treatments for endometriosis, defined as pharmacological treatments not yet commonly available and currently under investigation. EXPERT OPINION: These new medical therapies would be used associated with surgical treatment and, in the future, will render possible the association of hormone therapy with non-hormonal treatment for endometriosis.
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Drogas en Investigación/uso terapéutico , Endometriosis/tratamiento farmacológico , Terapias en Investigación , Terapia por Acupuntura , Quimioterapia Combinada , Drogas en Investigación/administración & dosificación , Drogas en Investigación/farmacología , Endometriosis/etiología , Endometriosis/cirugía , Femenino , Humanos , Dolor Pélvico/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Terapias en Investigación/métodos , Terapias en Investigación/tendencias , Resultado del TratamientoRESUMEN
BACKGROUND: Activin A is an endometrial secretory product involved in inflammation and angiogenesis. The present study aimed to evaluate the effect of activin A and its antagonist follistatin on interleukin (IL)-6, IL-8, and vascular endothelial growth factor (VEGF) expression and release from cultured human endometrial stromal cells (HESCs) from women with and without endometriosis. METHODS: The HESCs were collected from women with endometriosis (n = 6) and controls (n = 6). Primary cultures were treated with activin A at different doses or activin A plus follistatin. The IL-6, IL-8, and VEGF messenger RNA expression was evaluated by real-time polymerase chain reaction and protein release was evaluated by enzyme-linked immunosorbent assay. RESULTS: Unstimulated HESC from women with endometriosis secreted more IL-6 and IL-8 than controls. The addition of activin A increased IL-8 and VEGF secretion in HESC from controls and decreased IL-6 and IL-8 secretion in HESC from women with endometriosis. These effects were counteracted by follistatin. CONCLUSION: Activin A regulates the expression and secretion of IL-8 and VEGF in cultured HESC, and this mechanism appears to be disrupted in eutopic endometrial cells from women affected by endometriosis.
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Activinas/farmacología , Endometriosis/metabolismo , Endometrio/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Interleucina-8/genética , Factor A de Crecimiento Endotelial Vascular/genética , Activinas/antagonistas & inhibidores , Adulto , Células Cultivadas , Endometriosis/etiología , Endometrio/química , Endometrio/efectos de los fármacos , Femenino , Folistatina/farmacología , Humanos , Interleucina-6/genética , Interleucina-6/metabolismo , Interleucina-8/metabolismo , ARN Mensajero/análisis , Células del Estroma/efectos de los fármacos , Células del Estroma/metabolismo , Factor A de Crecimiento Endotelial Vascular/metabolismoRESUMEN
BACKGROUND: Activin A is a growth factor, produced by the endometrium, whose actions are modulated by the binding protein follistatin. Both proteins are detectable in the peripheral serum and their concentrations may be increased in women with endometriosis. The present study was designed to evaluate whether serum levels of activin A and follistatin are altered, and therefore have a potential diagnostic value, in women with peritoneal, ovarian and deep infiltrating endometriosis. METHODS: We performed a multicenter controlled study evaluating simultaneously serum activin A and follistatin concentrations in women with and without endometriosis. Women with endometriosis (n = 139) were subdivided into three groups: peritoneal endometriosis (n = 28); ovarian endometrioma (n = 61) and deep infiltrating endometriosis (n = 50). The control group (n = 75) consisted of healthy women with regular menstrual cycles. Blood samples were collected from a peripheral vein and assayed for activin A and follistatin using commercially available enzyme immunoassay kits. RESULTS: The ovarian endometrioma group had serum activin A levels significantly higher than healthy controls (0.22 ± 0.01 ng/ml versus 0.17 ± 0.01 ng/ml, P < 0.01). None of the endometriosis groups had serum follistatin levels which were significantly altered compared with healthy controls; however, levels found in the endometrioma group (2.34 ± 0.32 ng/ml) were higher than that in the deep endometriosis group (1.50 ± 0.17 ng/ml, P < 0.05). The area under the receiver operating characteristic curve of activin A was 0.700 (95% confidence interval: 0.605-0.794), while that of follistatin was 0.620 (95% confidence interval: 0.510-0.730) for the diagnosis of ovarian endometrioma. The combination of both markers into a duo marker index did not improve significantly their diagnostic accuracy. CONCLUSIONS: The present study demonstrated that serum activin A and follistatin are not significantly altered in peritoneal or deep infiltrating endometriosis and have limited diagnostic accuracy in the diagnosis of ovarian endometrioma.
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Activinas/sangre , Endometriosis/sangre , Folistatina/sangre , Enfermedades del Ovario/sangre , Enfermedades Peritoneales/sangre , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Endometriosis/patología , Femenino , Humanos , Enfermedades del Ovario/patología , Enfermedades Peritoneales/patologíaRESUMEN
OBJECTIVE: To evaluate the expression pattern of activin A, activin receptors, and activin modulators messenger RNA (mRNA) in the eutopic endometrium of patients with endometriosis at different phases of the menstrual cycle and to evaluate the mRNA expression of the same proteins in endometriomas during the menstrual cycle. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Women with and without endometriosis. INTERVENTION(S): Samples of endometrial and endometriotic tissue from women with endometrioma (n=48), and endometrial samples from women without endometriosis (controls) (n=48). MAIN OUTCOME MEASURE(S): Quantification of activin A, activin B, activin receptor II, nodal, cripto, inhibin α, and follistatin expression by real-time reverse-transcriptase polymerase chain reaction (RT-PCR). RESULT(S): The eutopic endometrium of patients with endometriosis showed [1] higher activin A mRNA expression in the proliferative phase and a lack of late secretory phase peak, [2] a lack of endometrial cycle-related variations of cripto and inhibin α mRNA expression, and [3] an inverse expression pattern of follistatin mRNA. Endometriomas showed similar variations in the expression of activin-related protein mRNA during the menstrual cycle as eutopic endometrium. CONCLUSION(S): The disturbed expression of endometrial activin A, cripto (activin receptor antagonist), and follistatin (activin-binding protein) suggests a dysfunction of the activin pathway in endometriosis. Endometriomas showed similar changes of activin-related proteins during the menstrual cycle, which supports a common biology for eutopic and ectopic endometrium in endometriosis.
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Activinas/genética , Endometriosis/genética , Folistatina/genética , Proteínas Ligadas a GPI/genética , Péptidos y Proteínas de Señalización Intercelular/genética , Proteínas de Neoplasias/genética , Enfermedades Uterinas/genética , Receptores de Activinas Tipo II/genética , Adulto , Análisis de Varianza , Brasil , Estudios de Casos y Controles , Endometriosis/patología , Endometriosis/fisiopatología , Femenino , Regulación Neoplásica de la Expresión Génica , Hospitales Universitarios , Humanos , Inhibinas/genética , Ciclo Menstrual , Estudios Prospectivos , ARN Mensajero/análisis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Enfermedades Uterinas/patología , Enfermedades Uterinas/fisiopatología , Adulto JovenRESUMEN
Urocortin 2 (Ucn 2) and urocortin 3 (Ucn 3) are neuropeptides expressed by human endometrium. This study evaluated (i) the expression of Ucn 2 and Ucn 3 mRNA in endometriotic lesions and in endometrium of women with endometriosis; (ii) the effect of Ucn 2 and Ucn 3 on cytokines secretion from cultured endometrial stromal cells. Endometriotic tissue was collected from endometrioma (n=39); endometrial specimens were obtained from women with (n=39) and without (n=41) endometriosis throughout menstrual cycle. Tissue specimens were analysed for Ucn 2 and Ucn 3 mRNA expression and peptide localization; the effects of Ucn 2 or Ucn 3 on tumour necrosis factor (TNF-α) and interleukin (IL-4) secretion from cultured endometrial stromal cells was studied. Ucn 2 and Ucn 3 mRNA expression and localization were assessed by RT-PCR and by immuohistochemistry, respectively; cytokines secretion were measured by ELISA. Results showed that endometriotic tissue expressed both Ucn 2 and Ucn 3, with Ucn 3 expression higher in ectopic than in eutopic endometrium. Endometrial Ucn 2 mRNA expression in controls showed peak values at early proliferative phase, while in endometriotic patients low expression and no significant changes throughout menstrual cycle were observed. Endometrial Ucn 3 mRNA expression was highest in late secretory phase in controls, while in endometriotic patients low levels and no menstrual-cycle-related changes were found. When added to cultured endometrial cell cultures, Ucn 2 significantly increased TNF-α (P<0.01) and IL-4 (P<0.001), while Ucn 3 induced an increase of IL-4 secretion (P<0.01). In conclusion, endometriotic tissue expressed and localized Ucn 2 and Ucn 3; patients with endometriosis showed Ucn 2 and Ucn 3 mRNA expression in eutopic endometrium lower than in control group, with no endometrial cycle-related changes. Ucn 2 and Ucn 3-modulated TNF-α and IL-4 secretion from culture endometrial cells. These data suggest a possible involvement of Ucn 2 and Ucn 3 in the mechanisms of endometriosis.
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Hormona Liberadora de Corticotropina/metabolismo , Endometriosis/metabolismo , Endometriosis/patología , Inflamación/metabolismo , Urocortinas/metabolismo , Adulto , Células Cultivadas , Hormona Liberadora de Corticotropina/genética , Hormona Liberadora de Corticotropina/farmacología , Endometrio/citología , Endometrio/metabolismo , Endometrio/patología , Femenino , Humanos , Inflamación/patología , Interleucina-4/metabolismo , Ciclo Menstrual/fisiología , Células del Estroma/citología , Células del Estroma/efectos de los fármacos , Células del Estroma/metabolismo , Distribución Tisular , Factor de Necrosis Tumoral alfa/metabolismo , Urocortinas/genética , Urocortinas/farmacología , Adulto JovenRESUMEN
Left ventricular dysfunction in Chagas' disease is common but can be difficult to detect. We investigated whether measurement of plasma brain natriuretic peptide (BNP) could identify patients with left ventricular dysfunction who need further investigation or treatment. Among patients with an abnormal electrocardiogram or chest radiograph, a BNP concentration of 60.7 pmol/L or higher has a sensitivity and positive predictive value of 80%, and specificity and negative predictive value of 97%. Measurement of plasma BNP concentration could be a useful method to screen patients with Chagas' disease.