title: Changes in tissue inflammation, angiogenesis and apoptosis in endometriosis, adenomyosis and uterine myoma after GnRH agonist therapy.
abstract: BACKGROUND
  Information is limited regarding the multifunctional role of GnRH agonist (GnRHa) therapy in reproductive diseases. We investigated the pattern of changes in inflammatory reaction, micro-vessel density and apoptosis in the tissues collected from women with endometriosis, adenomyosis and uterine myoma who were treated with or without GnRHa therapy.
  
  
  METHODS
  Biopsy specimens were collected from lesions, myometria and corresponding endometria of 45 women with ovarian endometrioma, 35 women with adenomyosis and 56 women with uterine myoma. A fraction of these women were treated with GnRHa therapy for a variable period of 3-6 months before surgery. We performed immunohistochemical analysis of CD68, a macrophage (Mvarphi) marker and von Willebrand factor (VWF), a vessel marker, using respective antibodies. Changes in apoptosis were examined using TdT-mediated dUTP-biotin nick end-labeling assay and by the immunoexpression of activated caspase-3 in tissues after GnRHa therapy.
  
  
  RESULTS
  The infiltration of CD68-positive Mvarphi and VWF-positive micro-vessel density were significantly decreased in the endometria of women with endometriosis, adenomyosis and uterine myoma in the GnRHa-treated group when compared with that in the non-treated group. Marked decreases in inflammatory and angiogenic responses were observed in lesions and myometria of these diseases. When compared with the non-treated group, a significant increase in apoptotic index (apoptotic cells per 10 mm(2) area) and quantitative-histogram scores of activated caspase-3 after GnRHa therapy were observed in the eutopic endometria, lesions and myometria of these diseases.
  
  
  CONCLUSIONS
  GnRHa was able to markedly reduce the inflammatory reaction and angiogenesis and to significantly induce apoptosis in tissues derived from women with endometriosis, adenomyosis and uterine myoma. These multiple biological effects at the tissue level may be involved in the regression of these reproductive diseases.
authors.affiliation: Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. nemokhan@nagasaki-u.ac.jp
authors.forename: Khaleque Newaz
authors.initials: KN
authors.lastname: Khan
authors.forename: Michio
authors.initials: M
authors.lastname: Kitajima
authors.forename: Koichi
authors.initials: K
authors.lastname: Hiraki
authors.forename: Akira
authors.initials: A
authors.lastname: Fujishita
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sekine
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Ishimaru
authors.forename: Hideaki
authors.initials: H
authors.lastname: Masuzaki
mesh_terms: D000328:Adult; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D017209:Apoptosis / Q000187:drug effects; D053148:Caspase 3 / Q000378:metabolism; D018932:Chemokine CCL2 / Q000378:metabolism; D004715:Endometriosis / Q000188:drug therapy* / Q000473:pathology; D004789:Enzyme Activation; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D007889:Leiomyoma / Q000188:drug therapy* / Q000473:pathology; D016729:Leuprolide / Q000627:therapeutic use*; D008264:Macrophages / Q000187:drug effects / Q000473:pathology; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014841:von Willebrand Factor / Q000378:metabolism; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D053148:Caspase 3; D018932:Chemokine CCL2; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide; D014841:von Willebrand Factor; C111835:CCL2 protein, human; C067980:CD68 antigen, human; D000097382:CD68 Molecule