L’endométriose concerne 8 à 10% des femmes en âge de procréer et est responsable de douleurs pelviennes chroniques et d’infertilité. Seule l’exérèse chirurgicale des lésions permet un traitement curatif de la maladie. Dans le cas de l’endométriose profonde avec atteinte rectale la chirurgie est extensive et associée à une morbidité significative. Les traitements médicaux reposent sur une hormonothérapie visant à bloquer la fonction ovarienne dont l’effet n’est que suspensif et transitoire. Il n’existe à ce jour aucun traitement ciblant les mécanismes à l’origine de la maladie. L’objectif de notre travail était d’explorer différents mécanismes potentiellement impliqués dans le développement de la maladie et d’identifier des molécules capables d’intervenir sur ces mécanismes. Dans un premier temps nous avons exploré le phénotype hyperprolifératif des cellules endométriosiques profondes et cherché un lien avec différentes voies métaboliques impliquées dans la prolifération cellulaire telles que le stress oxydant, la voie ERK et la voie Akt. Dans un deuxième temps, nous avons exploré le recrutement des cellules endométriales au sein de la cavité péritonéale au travers de l’interaction CXCR4-CXCL12. Des cultures cellulaires ont été réalisées à partir de prélèvements humains de nodules endométriosiques profonds, d’endomètre eutopique et d’endomètre sain. Des lames histologiques ont été préparées à partir de nodules endométriosiques profonds. Des prélèvements de liquide péritonéal de femmes endométriosiques et de témoins ont été congelés. La prolifération cellulaire a été étudiée par incorporation de thymidine tritiée. La production des FRO a été évaluée par spectrofluorimétrie. La voie ERK a été évaluée par western blot, ELISA et immunohistochimie. La voie Akt été évaluée par western blot et immunohistochimie. Nous avons montré un phénotype hyperprolifératif des cellules endométriosiques profondes en rapport avec une activation de la voie ERK par le biais du stress oxydant et à une activation de la voie Akt. Nous avons montré qu’un anti-oxydant (NAC), un inhibiteur de protéines kinases (A771726), un inhibiteur de Raf (sorafenib), un inhibiteur de mTOR (temsirolimus), un agoniste des cannabinoïdes (WIN 55212-2) et un anti-métabolite (5-FU) pouvaient contôler la prolifération des cellules endométriosiques profondes in vitro et la progression de nodules endométriosiques profonds implantés dans des souris Nudes. L’interaction CXCR4-CXCL12 a été étudiée par western blot, analyse de migration, cytométrie de flux et ELISA. Nous avons montré une attraction spécifique des cellules endométriosiques profondes sur-exprimant le CXCR4 par la chimiokine CXCL12 présente en quantité accrue dans le liquide péritonéal des femmes endométriosiques. En conclusion, nous avons montré que le traitement médical de l’endométriose pouvait être non hormonal et que le stress oxydant, la voie ERK et la voie Akt constituaient de nouvelles pistes thérapeutiques à évaluer dans le cadre d’essais cliniques. Nous avons également montré comment la modification constitutive des cellules de l’endomètre eutopique pouvait favoriser leur recrutement dans la cavité péritonéale. / Endometriosis, a common disease that affects approximately 8 to 10% of women of childbearing age, is responsible for chronic pelvic pain and infertility. There is currently no cure other than surgical removal of lesions. In the case of deep infiltrating endometriosis with rectal involvement, surgery is associated with a significant morbidity. Medical treatments are based on a hormone used to block ovarian function. Their effects are only transient and suspensive. There is currently no treatment targeting the mechanisms underlying the disease. The aim of our study was to explore different pathways potentially involved in the development of endometriosis and to identify molecules that act on these mechanisms. In a first step, we explored the hyperproliferative phenotype of deep infiltrating endometriosis cells and sought a link with different metabolic pathways involved in cell proliferation such as oxidative stress, ERK, and Akt pathways. In a second step, we explored the recruitment of endometrial cells in the peritoneal cavity through the CXCL12-CXCR4 interaction. Cell cultures were taken from deep infiltrating endometriosis nodules, eutopic endometrium and control endometrium. Histological slides were prepared from deep endometriotic nodules. Peritoneal fluid of women with deep infiltrating endometriosis, and of women without endometriosis were frozen. Cell proliferation was determined by [H3]thymidine incorporation. Cellular production of ROS was assessed by spectrofluorometry. ERK pathway was assessed by Western blot, ELISA assay and immunohistochemistry. The Akt pathway was assessed by Western blot and immunohistochemistry. We showed a hyperproliferative phenotype of deep infiltrating endometriosis cells in line with an activation of the ERK pathway through an up-regulation of oxidative stress, and activation of the Akt pathway. We have shown that an antioxidant (NAC), an inhibitor of protein kinases (A771726), a Raf inhibitor (sorafenib), an inhibitor of mTOR (temsirolimus), a cannabinoid agonist (WIN 55212-2) and an anti-metabolite (5-FU) could control the proliferation of endometriotic cells in vitro, and the growth of endometriotic nodules grafted in Nude mice. The CXCL12-CXCR4 interaction was studied by Western blot, Transwell migration assay, flow cytometry and ELISA assay. We showed a specific attraction of deep infiltrating endometriosis cells over-expressing the CXCR4 chemokine by CXCL12 present in increased amounts in the peritoneal fluid of endometriotic women. In conclusion, we have shown that medical treatment of endometriosis could be non-hormonal and that oxidative stress, ERK and Akt were new therapeutic approaches to assess in clinical trials. We also showed how the molecular changes of eutopic endometrial cells could facilitate their recruitment into the peritoneal cavity.

INTRODUÇÃO: Apesar de a endometriose profunda (EPF) ser a forma da doença de maior repercussão clínica, os estudos sobre a doença costumam ser baseados em lesões de endometriose ovariana (EOV) e peritoneal (EPT). A patogênese da EPF ainda é objeto de amplo debate, pois há poucos estudos feitos exclusivamente com lesões de EPF. O fator de transcrição codificado pelo gene homeobox A10 (HOXA10) regula a conferência de identidade tecidual de útero ao ducto paramesonéfrico indiferenciado durante o período embrionário. O gene mantém um padrão de expressão temporal e espacial bem definido e, durante a fase adulta, continua expresso no miométrio e endométrio. Sugere-se que HOXA10 esteja implicado na patogênese da endometriose, pois é expresso em EOV, EPT, endometriose pulmonar e endometriose retovaginal, um tipo de EPF. Possivelmente, o gene HOXA10 seja necessário para conferir identidade de endometriose a um tecido indiferenciado. O estradiol e a progesterona ativam a transcrição do gene HOXA10 e regulam diretamente sua ação. Esses hormônios estão envolvidos na patogênese da EPF, e suas atividades podem ser inferidas pelo estudo da expressão tecidual de seus receptores. A endometriose de reto-sigmoide (ERS) é um modelo representativo para o estudo da EPF. Neste estudo, avaliamos a expressão proteica do fator de transcrição HOXA10, das isoformas ? (ER-alfa) e beta (ER-beta) dos receptores de estrogênio, e do receptor de progesterona AB (PR-AB) e sua isoforma B (PR-B) na lesão (LES) e no tecido muscular liso perilesional (TMLP) de ERS de pacientes inférteis, durante as fases proliferativa e secretora do ciclo menstrual. MÉTODOS: amostras de LES e TMLP de ERS de 18 pacientes (9 operadas em cada fase do ciclo menstrual) foram agrupadas em blocos de microarranjos de tecidos (tissue microarray). As amostras foram coradas com anticorpos específicos para análise imunoistoquímica de cada uma das proteínas. Foram então avaliadas por microscopia ótica (MO) e pela análise das imagens digitalizadas das lâminas com por um software específico, a análise morfométrica (AM). RESULTADOS: HOXA10 foi expresso no estroma de LES de ERS durante a fase secretora, de acordo com a MO. ER-alfa e ER-betaforam expressos em glândulas e estroma de LES e TMLP de ERS durante ambas as fases do ciclo, de acordo com a MO e a AM. PR-AB e PR-B foram expressos em glândulas e estroma de LES de ERS durante ambas as fases do ciclo, de acordo com a MO. PR-B foi mais expresso durante a fase secretora, independentemente do local de expressão, segundo a AM. A expressão de HOXA10 correlacionou-se diretamente com PR-AB e PR-B na ERS, segundo a AM. Não houve correlação entre ER-alfa e ER-beta com HOXA10, PR-AB ou PR-B em nenhuma fase do ciclo ou local de expressão de ERS. CONCLUSÕES: HOXA10 é expresso em ERS, um local fora do seu eixo espacial de expressão. A presença de HOXA10 pode ser necessária para conferir a identidade \"de novo\" na EPF, incluindo ERS. A progesterona pode ativar o gene HOXA10 e regular esta ação, possivelmente mediada por PR-B. O estradiol exerce sua ação mitógena na ERS através ER-alfa e ER-beta / INTRODUCTION: Although deep endometriosis (DE) is the major clinical form of endometriosis, studies regarding the disease are typically based on ovarian (OE) and peritoneal (PE) lesions. DE pathogenesis is still a matter of great discussion because there are few studies exclusively involving DE lesions. The transcription factor encoded by the homeobox gene A10 (HOXA10) regulates the identity imparted to the undifferentiated paramesonephric duct during embryogenesis. The gene is expressed in the myometrium and endometrium during adult life in a well-defined spatial and temporal mode. It has been suggested that HOXA10 plays a role in endometriosis pathogenesis because it is expressed in OE, PE, pulmonary endometriosis, and rectovaginal endometriosis, which is a clinical form of DE. Thus, HOXA10 may be necessary for \"de novo\" endometrial development from undifferentiated tissues. Both estradiol and progesterone activate HOXA10 transcription and directly regulate its action. These hormones are involved in DE pathogenesis, and therefore their activities could be assessed by studying the tissue expression of their receptors. Rectosigmoid endometriosis (RE) is a representative model for studying DE. In this study, we evaluated the protein expression of HOXA10, the estrogen receptor (ER) isoforms alfa (ER-alfa) and beta (ER-beta), the progesterone receptor AB (PR), and the PR isoform B (PR-B) in lesions (LES) and adjacent smooth muscle (SM) of RE from infertile patients during the proliferative and secretory phases of the menstrual cycle. METHODS: LES and SM samples from RE patients were grouped in tissue microarray blocks. Each of the proteins was analyzed by immunohistochemistry using regular optical microscopy (OM) and a software-assisted analysis of digitalized images as well as morphometric analysis (MA). RESULTS: HOXA10 was expressed in the stroma of the LES during the secretory phase based on OM. ER-alfa and ER-beta were expressed in the glands and stroma of LES and SM during both phases based on OM and MA. PR and PR-B were expressed in the glands and stroma of LES during both phases; however, PR-B had higher expression during the secretory phase, independent of its expression in the LES or SM. HOXA10 expression was directly correlated with PR and PR-B expression in RE. In addition, there was no correlation between the expression of ER-alfa and ER-beta with HOXA10, PR, or PR-B during any phase of the menstrual cycle or site of expression. CONCLUSIONS: HOXA10 is expressed in RE outside of its spatial domain of expression, and may be necessary for \"de novo\" development of DE, including RE. Progesterone might stimulate HOXA10 expression and regulate this action, which is most likely mediated by PR-B. Moreover, estradiol exerts its mitogenic effect in RE though ER-alfa and ER-beta

INTRODUÇÃO: Apesar de a endometriose profunda (EPF) ser a forma da doença de maior repercussão clínica, os estudos sobre a doença costumam ser baseados em lesões de endometriose ovariana (EOV) e peritoneal (EPT). A patogênese da EPF ainda é objeto de amplo debate, pois há poucos estudos feitos exclusivamente com lesões de EPF. O fator de transcrição codificado pelo gene homeobox A10 (HOXA10) regula a conferência de identidade tecidual de útero ao ducto paramesonéfrico indiferenciado durante o período embrionário. O gene mantém um padrão de expressão temporal e espacial bem definido e, durante a fase adulta, continua expresso no miométrio e endométrio. Sugere-se que HOXA10 esteja implicado na patogênese da endometriose, pois é expresso em EOV, EPT, endometriose pulmonar e endometriose retovaginal, um tipo de EPF. Possivelmente, o gene HOXA10 seja necessário para conferir identidade de endometriose a um tecido indiferenciado. O estradiol e a progesterona ativam a transcrição do gene HOXA10 e regulam diretamente sua ação. Esses hormônios estão envolvidos na patogênese da EPF, e suas atividades podem ser inferidas pelo estudo da expressão tecidual de seus receptores. A endometriose de reto-sigmoide (ERS) é um modelo representativo para o estudo da EPF. Neste estudo, avaliamos a expressão proteica do fator de transcrição HOXA10, das isoformas ? (ER-alfa) e beta (ER-beta) dos receptores de estrogênio, e do receptor de progesterona AB (PR-AB) e sua isoforma B (PR-B) na lesão (LES) e no tecido muscular liso perilesional (TMLP) de ERS de pacientes inférteis, durante as fases proliferativa e secretora do ciclo menstrual. MÉTODOS: amostras de LES e TMLP de ERS de 18 pacientes (9 operadas em cada fase do ciclo menstrual) foram agrupadas em blocos de microarranjos de tecidos (tissue microarray). As amostras foram coradas com anticorpos específicos para análise imunoistoquímica de cada uma das proteínas. Foram então avaliadas por microscopia ótica (MO) e pela análise das imagens digitalizadas das lâminas com por um software específico, a análise morfométrica (AM). RESULTADOS: HOXA10 foi expresso no estroma de LES de ERS durante a fase secretora, de acordo com a MO. ER-alfa e ER-betaforam expressos em glândulas e estroma de LES e TMLP de ERS durante ambas as fases do ciclo, de acordo com a MO e a AM. PR-AB e PR-B foram expressos em glândulas e estroma de LES de ERS durante ambas as fases do ciclo, de acordo com a MO. PR-B foi mais expresso durante a fase secretora, independentemente do local de expressão, segundo a AM. A expressão de HOXA10 correlacionou-se diretamente com PR-AB e PR-B na ERS, segundo a AM. Não houve correlação entre ER-alfa e ER-beta com HOXA10, PR-AB ou PR-B em nenhuma fase do ciclo ou local de expressão de ERS. CONCLUSÕES: HOXA10 é expresso em ERS, um local fora do seu eixo espacial de expressão. A presença de HOXA10 pode ser necessária para conferir a identidade \"de novo\" na EPF, incluindo ERS. A progesterona pode ativar o gene HOXA10 e regular esta ação, possivelmente mediada por PR-B. O estradiol exerce sua ação mitógena na ERS através ER-alfa e ER-beta / INTRODUCTION: Although deep endometriosis (DE) is the major clinical form of endometriosis, studies regarding the disease are typically based on ovarian (OE) and peritoneal (PE) lesions. DE pathogenesis is still a matter of great discussion because there are few studies exclusively involving DE lesions. The transcription factor encoded by the homeobox gene A10 (HOXA10) regulates the identity imparted to the undifferentiated paramesonephric duct during embryogenesis. The gene is expressed in the myometrium and endometrium during adult life in a well-defined spatial and temporal mode. It has been suggested that HOXA10 plays a role in endometriosis pathogenesis because it is expressed in OE, PE, pulmonary endometriosis, and rectovaginal endometriosis, which is a clinical form of DE. Thus, HOXA10 may be necessary for \"de novo\" endometrial development from undifferentiated tissues. Both estradiol and progesterone activate HOXA10 transcription and directly regulate its action. These hormones are involved in DE pathogenesis, and therefore their activities could be assessed by studying the tissue expression of their receptors. Rectosigmoid endometriosis (RE) is a representative model for studying DE. In this study, we evaluated the protein expression of HOXA10, the estrogen receptor (ER) isoforms alfa (ER-alfa) and beta (ER-beta), the progesterone receptor AB (PR), and the PR isoform B (PR-B) in lesions (LES) and adjacent smooth muscle (SM) of RE from infertile patients during the proliferative and secretory phases of the menstrual cycle. METHODS: LES and SM samples from RE patients were grouped in tissue microarray blocks. Each of the proteins was analyzed by immunohistochemistry using regular optical microscopy (OM) and a software-assisted analysis of digitalized images as well as morphometric analysis (MA). RESULTS: HOXA10 was expressed in the stroma of the LES during the secretory phase based on OM. ER-alfa and ER-beta were expressed in the glands and stroma of LES and SM during both phases based on OM and MA. PR and PR-B were expressed in the glands and stroma of LES during both phases; however, PR-B had higher expression during the secretory phase, independent of its expression in the LES or SM. HOXA10 expression was directly correlated with PR and PR-B expression in RE. In addition, there was no correlation between the expression of ER-alfa and ER-beta with HOXA10, PR, or PR-B during any phase of the menstrual cycle or site of expression. CONCLUSIONS: HOXA10 is expressed in RE outside of its spatial domain of expression, and may be necessary for \"de novo\" development of DE, including RE. Progesterone might stimulate HOXA10 expression and regulate this action, which is most likely mediated by PR-B. Moreover, estradiol exerts its mitogenic effect in RE though ER-alfa and ER-beta