Nerve fibres in peritoneal endometriosis.
BACKGROUND
Endometriosis is a gynaecological disease that can be associated with severe pelvic pain; however, the mechanisms by which pain is generated remain unknown.


METHODS
Peritoneal endometriotic lesions and normal peritoneum were prepared from women with and without endometriosis (n = 40 and 36, respectively). Specimens were also prepared from endosalpingiosis lesions (n = 9). These sections were stained immunohistochemically with antibodies against protein gene product 9.5, neurofilament (NF), nerve growth factor (NGF), NGF receptor p75 (NGFRp75), substance P (SP), calcitonin gene-related peptide (CGRP), acetylcholine (ACh) and tyrosine hydroxylase (TH) to demonstrate myelinated, unmyelinated, sensory, cholinergic and adrenergic nerve fibres.


RESULTS
There were significantly more nerve fibres identified in peritoneal endometriotic lesions than in normal peritoneum (P < 0.001) or endosalpingiosis lesions (P < 0.001). These nerve fibres were SP, CGRP, ACh or TH immunoreactive. Many of these markers were co-localized. There was an intense NGF immunoreactivity near endometriotic glands, and NGFRp75 immunoreactive nerve fibres were present near endometriotic glands and blood vessels in the peritoneal endometriotic lesions.


CONCLUSIONS
Peritoneal endometriotic lesions were innervated by sensory Adelta, sensory C, cholinergic and adrenergic nerve fibres. These nerve fibres may play an important role in the mechanisms of pain generation in this condition.
Tokushige
Natsuko
N
Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW, Australia. ntokushige@med.usyd.edu.au
Markham
Robert
R
Russell
Peter
P
Fraser
Ian S
IS
D000293:Adolescent; D000328:Adult; D015740:Calcitonin Gene-Related Peptide / Q000032:analysis; D004715:Endometriosis / Q000473:pathology*; D004717:Endometrium / Q000166:cytology / Q000294:innervation* / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology* / Q000648:ultrastructure; D012016:Reference Values; D013373:Substance P / Q000032:analysis
D013373:Substance P; D015740:Calcitonin Gene-Related Peptide