title: Nerve fibres in peritoneal endometriosis.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, NSW, Australia. ntokushige@med.usyd.edu.au
authors.forename: Natsuko
authors.initials: N
authors.lastname: Tokushige
authors.forename: Robert
authors.initials: R
authors.lastname: Markham
authors.forename: Peter
authors.initials: P
authors.lastname: Russell
authors.forename: Ian S
authors.initials: IS
authors.lastname: Fraser
mesh_terms: 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
chemical_list: D013373:Substance P; D015740:Calcitonin Gene-Related Peptide