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      Priorities for Endometriosis Research : Recommendations From an International Consensus Workshop

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          Abstract

          Endometriosis is an estrogen-dependent disorder where endometrial tissue forms lesions outside the uterus. Endometriosis affects an estimated 10% of women in the reproductive-age group, rising to 30% to 50% in patients with infertility and/or pain, with significant impact on their physical, mental, and social well-being. There is no known cure, and most current medical treatments are not suitable long term due to their side-effect profiles. Endometriosis has an estimated annual cost in the United States of $18.8 to $22 billion (2002 figures). Although endometriosis was first described more than 100 years ago, current knowledge of its pathogenesis, spontaneous evolution, and the pathophysiology of the related infertility and pelvic pain, remain unclear. A consensus workshop was convened following the 10th World Congress on Endometriosis to establish recommendations for priorities in endometriosis research. One major issue identified as impacting on the capacity to undertake endometriosis research is the need for multidisciplinary expertise. A total of 25 recommendations for research have been developed, grouped under 5 subheadings: (1) diagnosis, (2) classification and prognosis, (3) treatment and outcome, (4) epidemiology, and (5) pathophysiology. Endometriosis research is underfunded relative to other diseases with high health care burdens. This may be due to the practical difficulties of developing competitive research proposals on a complex and poorly understood disease, which affects only women. By producing this consensus international research priorities statement it is the hope of the workshop participants that researchers will be encouraged to develop new interdisciplinary research proposals that will attract increased funding support for work on endometriosis.

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          Most cited references44

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          Clonogenicity of human endometrial epithelial and stromal cells.

          The human endometrium regenerates from the lower basalis layer, a germinal compartment that persists after menstruation to give rise to the new upper functionalis layer. Because adult stem cells are present in tissues that undergo regeneration, we hypothesized that human endometrium contains small populations of epithelial and stromal stem cells responsible for cyclical regeneration of endometrial glands and stroma and that these cells would exhibit clonogenicity, a stem-cell property. The aims of this study were to determine 1) the clonogenic activity of human endometrial epithelial and stromal cells, 2) which growth factors support this clonogenic activity, and 3) determine the cellular phenotypes of the clones. Endometrial tissue was obtained from women undergoing hysterectomy. Purified single- cell suspensions of epithelial and stromal cells were cultured at cloning density (300-500/cm(2)) in serum medium or in serum- free medium supplemented with one of eight growth factors. Small numbers of epithelial (0.22%) and stromal cells (1.25%) initiated colonies in serum-containing medium. The majority of colonies were small, containing large, loosely arranged cells, and 37% of epithelial and 1 in 60 of stromal colonies were classified as large, comprising small, densely packed cells. In serum-free medium, transforming growth factor-alpha (TGF alpha), epidermal growth factor (EGF), platelet-derived growth factor-BB (PDGF-BB) strongly supported clonogenicity of epithelial cells, while leukemia-inhibitory factor (LIF), hepatocyte growth factor (HGF), stem-cell factor (SCF), insulin-like growth factor-I (IGF- I) were weakly supportive, and basic fibroblast growth factor (bFGF) was without effect. TGF alpha, EGF, PDGF-BB, and bFGF supported stromal cell clonogenicity, while HGF, SCF, LIF, and IGF- I were without effect. Small epithelial colonies expressed three epithelial markers but not stromal markers; however, large epithelial colonies showed little reactivity for all markers except alpha(6)-integrin. All stromal colonies contained fibroblasts, expressing stromal markers, and in some colonies, myofibroblasts were also identified. This analysis of human endometrium has demonstrated the presence of rare clonogenic epithelial and stromal cells with high proliferative potential, providing the first evidence for the existence of putative endometrial epithelial and stromal stem cells.
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            Co-expression of two perivascular cell markers isolates mesenchymal stem-like cells from human endometrium.

            Human endometrium has immense regenerative capacity, growing ~5 mm in 7 days every month. We have previously identified a small population of colony-forming endometrial stromal cells which we hypothesize are mesenchymal stem cells (MSC). The aim of this study was to determine if the co-expression of two perivascular cell markers, CD146 and platelet-derived growth factor-receptor beta (PDGF-Rbeta), will prospectively isolate endometrial stromal cells which exhibit MSC properties, and determine their location in human endometrium. Single cell suspensions of human endometrial stromal cells were fluorescence activated cell sorting (FACS) sorted into CD146(+)PDGF-Rbeta(+) and CD146(-)PDGF-Rbeta(-) populations and analysed for colony-forming ability, in vitro differentiation and expression of typical MSC markers. Full thickness human endometrial sections were co-stained for CD146 and PDGF-Rbeta. FACS stromal CD146(+)PDGF-Rbeta(+) stromal cells (1.5% of sorted population) were enriched for colony-forming cells compared with CD146(-)PDGF-Rbeta(-) cells (7.7 +/- 1.7 versus 0.7 +/- 0.2% P <0.0001), and also underwent differentiation into adipogenic, osteogenic, myogenic and chondrogenic lineages. They expressed MSC phenotypic surface markers and were located near blood vessels. This study shows that human endometrium contains a small population of MSC-like cells that may be responsible for its cyclical growth, and may provide a readily available source of MSC for tissue engineering applications.
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              Revised American Fertility Society classification of endometriosis: 1985.

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                Author and article information

                Journal
                Reprod Sci
                Reprod Sci
                RSX
                sprsx
                Reproductive Sciences
                SAGE Publications (Sage CA: Los Angeles, CA )
                1933-7191
                1933-7205
                April 2009
                April 2009
                : 16
                : 4
                : 335-346
                Affiliations
                [1-1933719108330568]Monash University Melbourne,(PAWR, CEG, LR)
                [2-1933719108330568]Leuven University, Leuven, Belgium (TMD)
                [3-1933719108330568]University of Illinois, Chicago, Illinois
                [4-1933719108330568]University of California San Francisco, California (LCG)
                [5-1933719108330568]Queensland Institute of Medical Research Brisbane, Australia (GWM)
                [6-1933719108330568]Prince Henry’s Institute of Medical Research Melbourne, Australia (LAS)
                [7-1933719108330568]Wellcome Trust Centre for Human Genetics Oxford, England (KTZ)
                Author notes
                [*]Peter A. W. Rogers, BSc, PhD, Monash University, Clayton, Melbourne, Australia 3168. E-mail: peter.rogers@ 123456med.monash.edu.au
                Article
                10.1177_1933719108330568
                10.1177/1933719108330568
                3682634
                19196878
                d54809bb-bfa4-4952-b005-5d60cf3e0174
                © The Author(s) 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Article

                endometriosis,research directions,international workshop,consensus report

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