O objetivo deste trabalho foi avaliar alguns aspectos reprodutivos de éguas Crioulas a fim de verificar a influência destes nos índices de prenhez: idade das éguas, status reprodutivo, uso do cio do potro, presença de líquido intra-uterino (LIU), eficiência dos tratamentos pós-cobertura, presença de cistos endometriais, realização de vulvoplastia, incidência de ovulações duplas e gestações gemelares. Foram utilizados 517 ciclos de 406 éguas Crioulas de um rebanho comercial, com idades entre dois e vinte e dois anos. O índice de prenhez por ciclo foi de 80,5% aos 12 dias, 76,5% aos 42 dias e a mortalidade embrionária foi de 3,9%. O índice de prenhez foi influenciado pela idade das éguas (P < 0,01). O índice de prenhez no cio do potro foi de 85,4%, melhor que o índice obtido pelas éguas em que não se utilizou este cio e que foram cobertas no subseqüente (P = 0,07). O método de cobertura influenciou a prenhez, sendo a inseminação superior à monta natural (P = 0,01). A idade influenciou a presença de LIU sendo a incidência em éguas com mais de 12 anos maior que nas mais jovens (P < 0,01). A presença de cistos endometriais influenciou negativamente a taxa de prenhez aos 12 e aos 42 dias (P = 0,00). A correção cirúrgica da região perineal melhorou os índices de prenhez aos 12 e aos 42 dias (P < 0,05). A taxa de ovulações duplas foi de 4,84% e não influenciou os índices de prenhez aos 12 e aos 42 dias (P > 0,5). Em 6 ciclos (1,16%) de 5 éguas solteiras foram observadas gestações gemelares. Concluímos que a fertilidade das éguas Crioulas é influenciada pela idade das éguas, pela conformação vulvar, pela presença de cistos endometriais e pelo status reprodutivo. O acúmulo de LIU é um fator importante na reprodução da égua Crioula e deve ser observado e devidamente tratado para a obtenção de melhores índices de prenhez. / The aim of this study was to evaluate the reproductive aspects of Crioulo mares to verify the influence of the following aspects on the pregnancy rates: mare’s age, reproductive status, use of foal heat, presence of intrauterine fluid (IUF), efficiency of post-breeding treatments, presence of endometrial cysts, incidence of double ovulations and twin pregnancies. There were used 517 cycles of 406 Crioulo mares of a commercial herd, with ages varying from 2 to 22 years old. Pregnancy rate per cycle was 80.5% at 12 days, 76.5% at 42 days and embryo mortality was 3.9%. The pregnancy rate was influenced by the age of the mares (P < 0.01). Pregnancy rate on foal heat was 85.4%, better than the rate obtained by the mares which foal heat was not used and the subsequent cycle was (P = 0.07). The breeding method influenced pregnancy, being artificial insemination superior to natural breeding (P = 0.01). Age influenced the presence of IUF, once the incidence was higher in mares with more than 12 years old than in younger mares (P < 0.01). The presence of endometrial cysts negatively influenced the pregnancy rate at 12 and 42 days (P = 0.00). Surgical repair of perineal region improved the pregnancy rates at 12 and 42 days (P < 0.05). The rate of double ovulations was of 4.84% and did not influence the pregnancy rates either at 12 and 42 days (P > 0.5). In 6 cycles (1.16%) of 5 single mares there were observed twin pregnancies. We concluded that the fertility of Crioulo mares is influenced by the age of the mares, vulvar conformation, presence of endometrial cysts and reproductive status. The accumulation of IUF is an important factor on the reproduction of Crioulo mares and must be observed and correctly treated in order to obtain better pregnancy rates.

O embrião equino apresenta um desenvolvimento dinâmico por um longo período entre a fertilização, sua entrada no útero, fixação e posterior invasão trofoblástica após o 36º dia da gestação. Durante todo este período o concepto é sustentado pelo histotrofo endometrial. Estas características dos equídeos favorecem o seu uso com modelo experimental in vivo para estudos nos desenvolvimentos e interações fetal e maternal. Os estudos em endométrio equino tiveram foco em eventos fisiológicos nas diferentes fases do ciclo estral, enquanto os estudos aos primeiros momentos da gestação são escassos. O entendimento do processo de remodelação e morfofisiologia do endométrio após a entrada do embrião no útero não é completamente entendido. O objetivo deste trabalho foi estudar a morfofisiologia endometrial da gestação na égua envolvendo os períodos pós-fixação e peri-implantação, por histologia e microscopia eletrônica de varredura. A característica mais marcante da transformação ou adaptação endometrial à gestação foi o quase total desaparecimento das células ciliadas na superfície epitelial em ambos cornos uterinos. A capacidade de secreção das células microvilosas também passou por mudanças com o avanço gestacional. Muitas células secretórias ingurgitadas e protusas formam a maioria da população do epitélio, onde o histotrofo se acumula, e apresentaram erosões em sua superfície, provavelmente pela secreção apócrina de vesículas. A superfície epitelial apresentou pleomorfismo celular e pseudoestratificação, promovida por intensa hiperplasia celular, acompanhada de adensamento das glândulas endometriais, desde o 21º dia da gestação diminuído após o 36º dia. Linfócitos, provavelmente uNK, foram encontrados no epitélio luminal do endométrio já aos 21 dias de gestação em ambos cornos, gravídico e não gravídico. Foi evidenciado o septamento no epitélio luminal, com sulcos formados aos 35 e 36 dias, tornando-se mais profundos aos 42 dias de gestação. Toda esta evolução e adaptação contínua aconteceram principalmente no corno gravídico acompanhados em menor intensidade pelo corno não gravídico. / The equine embryo plays a dynamic development for a long period between fertilization, its entry into the uterus, fixes and subsequent trophoblastic invasion after day 36 of gestation. Throughout this period, the conceptus is supported by endometrial histotrophe. These equids characteristics favor their use as an in vivo experimental model for studying the changes and interactions in fetal and maternal development. Studies in equine endometrium were focused on physiological events in the different phases of the estrous cycle, while studies in early moments of pregnancy are scant. The process of endometrial remodeling and morphophysiology after the maternal recognition of pregnancy is not completely understood. The objective of this work was to study the endometrial morphophysiology in the mare comprising post-fixation and peri-implantation periods, by histology and scanning electron microscopy. The most striking feature of endometrial transformation or adaptation to pregnancy was the almost total ciliated cells disappearance of the epithelial surface in both uterine horns. In addition, the secretory capacity of microvillus cells underwent changes with gestational age. Many engorged and protruded secretory cells were the majority epithelium population where histotroph accumulates, and showed erosions on its surface, probably by apocrine vesicle secretion. The epithelial surface also showed cellular pleomorphic and pseudostratified epithelium as a result of intense cell hyperplasia. It was accompanied by thickening of the endometrial glands from day 21 of gestation, then decreasing after the 36th day. Lymphocytes, probably uNK, were found in the luminal epithelium of the endometrium since 21st day of gestation in both pregnant and not pregnant horns. Septation was evidenced in the luminal epithelium, with sulci formed at 35 days, becoming deeper at 42 days of pregnancy. All this continued evolution and adaptation occurred mainly in the gravid horn accompanied in less intensity by non-gravid horn.

A endometriose é uma doença ginecológica crônica que afeta pelo menos 10% das mulheres em idade reprodutiva. É caracterizada pelo crescimento de tecido endometrial fora da cavidade uterina. Embora sua etiologia permaneça controversa, estudos propõem que alterações imunológicas e inflamatórias estão correlacionadas com a causa da endometriose e podem contribuir para o crescimento e sobrevida de implantes ectópicos. Como parte integrante desse processo, um microambiente peritoneal anormal pode ser constituído por níveis aumentados de células imunológicas. Dentre estas, a elevação de citocinas pró-inflamatórias no ambiente peritoneal e sistêmico participariam desse processo. Citocinas incluindo a interleucina-6 (IL-6), uma glicoproteína com atuação na resposta imune e considerada como um marcador de inflamação tem sido proposta na patogênese da endometriose. Recentemente, demonstramos que as concentrações de IL-6 no fluído peritoneal (FP) apresentam-se elevadas em mulheres com endometriose em comparação com mulheres hígidas (Andrade et al., 2017, in press). No entanto, a fonte do aumento de IL-6 no FP ainda não foi totalmente elucidada e seu potencial envolvimento com a endometriose merece maior investigação. No presente estudo, avaliamos a expressão proteica de IL-6 no tecido endometrial e sua concentração no FP de mulheres com endometriose pélvica e comparamos com mulheres hígidas. Um total de 18 pacientes com endometriose e 12 mulheres com pelve normal foram incluídas neste estudo caso-controle. Foram realizadas avaliações clínicas e laboratoriais. Os níveis de IL-6 no FP e a expressão proteica no tecido endometrial foram determinados utilizando ensaio imunoenzimático (ELISA) e imuno-histoquímica respectivamente. A concentração de IL-6 no FP foi significativamente mais elevada no grupo endometriose em comparação com o grupo controle [48,2 (36,7 - 89,9) ng/ml versus 23,1 (11,8 - 35,3) ng/ml, P = 0,002]. A expressão proteica de IL-6 foi positiva na maior parte das amostras de ambos os grupos sendo significativamente mais intensa no tecido endometriótico em comparação com a expressão no endométrio de mulheres com pelve normal (P < 0,05). Os resultados do presente estudo sugerem que a fonte da IL6 no FP de pacientes com endometriose possa ser, pelo menos em parte, proveniente dos focos endometrióticos. / Endometriosis is a chronic gynecological disease that affects at least 10% of women of reproductive age. It is characterized by growth of endometrial tissue outside the uterine cavity. Although its etiology remains controversial, studies suggest that immunological and inflammatory changes are associated with endometriosis and may contribute to the growth and survival of ectopic implants. As part of this process, an abnormal peritoneal microenvironment may be constituted by increased levels of immune cells. Among these, the elevation of proinflammatory cytokines in the peritoneal and systemic environment would participate in this process. Cytokines including interleukin-6 (IL-6), a glycoprotein that acts on the immune response and is considered as a marker of inflammation has been proposed to play a role in the pathogenesis of endometriosis. Recently, we have shown that IL-6 concentrations in the peritoneal fluid (PF) were higher in women with endometriosis compared to healthy women (Andrade et al., 2017, in press). However, the source of IL-6 in PF has not yet been fully elucidated and its potential involvement with endometriosis warrants further investigation. In the present study, we evaluated the protein expression of IL-6 in endometrial tissue and its concentration in PF of women with pelvic endometriosis and compared them with healthy women. A total of 18 patients with endometriosis and 12 women with normal pelvis were included in this case-control study. Clinical and laboratory evaluations were performed. IL-6 levels in PF and protein expression in endometrial tissue were determined using enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry respectively. The concentrations of IL-6 in PF were significantly higher in the endometriosis group compared to the control group [48.2 (36.7-89.9) ng / ml versus 23.1 (11.8-35, 3) ng / ml, P = 0.002]. Protein expression of IL-6 was positive in most samples from both groups being significantly more intense in the endometriotic tissue of patients with endometriosis compared to the endometrial expression in women with normal pelvis (P < 0.05). The results of the present study suggest that the source of IL6 in the PF of patients with endometriosis may come, at least in part, from the endometriotic focus.

Objetivo: avaliar a concordância da expressão imuno-histoquímica (IMH) da proteína p53 (p53) na amostra endometrial e na peça cirúrgica de histerectomia, associando-a a fatores como tipo histológico, grau tumoral e estadiamento, bem como analisar a concordância interobservador para expressão e intensidade de expressão da p53 entre biópsia diagnóstica e peça cirúrgica. Métodos: estudo transversal retrospectivo, no qual foram incluídas pacientes com carcinoma endometrial submetidas à biópsia de endométrio e tratamento cirúrgico primário na Unidade de Oncologia Genital do HCPA. As lâminas foram lidas por dois patologistas. O percentual de expressão da p53 foi avaliado em três categorias (<10%, 10-50% e >50%). A intensidade foi avaliada como fraca, média ou forte. Foram extraídos dados do prontuário eletrônico das pacientes. A concordância foi avaliada através do coeficiente Kappa ponderado. Resultados: 72 pacientes foram incluídas, com idade média de 65,5 anos. O percentual de expressão da p53 entre biópsia e peça cirúrgica apresentou uma taxa de concordância de 70,8%, com um índice de Kappa ponderado de 0,64 e a intensidade de expressão apresentou uma taxa de concordância de 69,4%, com Kappa ponderado de 0,65. A avaliação da concordância do percentual de expressão da p53 conforme tipo histológico e grau tumoral apresentou coeficientes de Kappa ponderado de 0,64 e 0,72, nos carcinomas não endometrioides e G3, respectivamente. Tais dados, com diferença estatística significativa. A concordância interobservador para a expressão e intensidade da p53 na biópsia apresentou índices de Kappa 9 ponderado de 0,77 e 0,75, respectivamente. Na peça cirúrgica, os índices de kappa ponderado foram de 0,85 e 0,88, para a expressão e intensidade, respectivamente. Conclusões: as taxas de concordância para a expressão e intensidade de expressão IMH da p53 entre biópsia endometrial e peça cirúrgica foram boas, podendo ser útil em tempo pré-operatório, para a seleção de pacientes candidatas a uma cirurgia mais extensa, principalmente quando os dados anatomopatológicos da biópsia forem insuficientes para tal decisão. Devemos, no entanto, levar em consideração que existem muitos outros marcadores moleculares para a neoplasia endometrial, sendo provável futuramente o estudo da concordância deles em associação ao da p53. / Objective: To evaluate the agreement of the immunohistochemical (IMH) expression of the p53 protein (p53) in preoperative endometrial tissues and in surgical specimens obtained during hysterectomy, to determine the association of this agreement with factors such as histological type, tumor grade and stage and to evaluate interobserver agreement for the expression and intensity of p53 between the diagnostic biopsy and the surgical specimen. Methods: Retrospective cross-sectional study. Patients with endometrial carcinoma who submitted to endometrial biopsy and primary surgical treatment at the HCPA Genital Oncology Unit were included. The slides were assessed by two pathologists. The percentage of p53 expression was evaluated and categorized into one of three groups (<10%, 10-50% and >50%). The intensity was evaluated as weak, medium or strong. The agreement was assessed by the weighted Kappa coefficient. Results: 72 patients with a mean age of 65.5 years were included. The percentage of p53 expression between the biopsy and the surgical specimen presented an agreement rate of 70.8%, with a weighted Kappa index of 0.64. The intensity of expression had an agreement rate of 69.4% with a weighted Kappa of 0.65. When evaluated according to histological type and tumor grade, the agreement for p53 expression showed weighted Kappa indexes of 0.64 and 0.72 in non-endometrioid and G3 carcinomas, respectively (p<0.001). With respect to the biopsy, the interobserver agreement for the expression and intensity of p53 had weighted Kappa indexes of 0.77 and 0.75, respectively. With respect to the surgical specimen, the weighted Kappa indexes were 0.85 and 0.88 for expression and intensity, respectively. 11 Conclusions: This study found good agreement rates for the expression and intensity of p53 IMH expression between the endometrial biopsy specimen and the surgical specimen, which may be useful in a preoperative setting for the selection of patients who are candidates for more extensive surgery, especially when anatomopathological biopsy data are insufficient for such a decision.

Gynecological cancers present a tremendous disease burden worldwide. Endometrial cancer, the most common gynecological malignancy, is predominantly a disease of deranged glandular function. The mechanisms by which known environmental risk factors influence the mutational profile of endometrial cancer are poorly understood. Non-HPV vulvar cancer, on the other hand, is a very rare gynecological malignancy of vulvar squamous cells with little known about its pathogenesis. Surgical resection of vulvar cancer is associated with high post-surgical morbidity. Pivotal to improving treatment and outcomes for patients with gynecological cancers is an understanding of the molecular drivers unique to each tumor type. To inform our understanding of endometrial gland regulation, I began my investigations with an assessment of normal endometrial adenogenesis in vivo and present the first evidence implicating the necessity of Sox17 in endometrial gland development. My data suggest Sox17 mediates adenogenesis via a non-cell autonomous mechanism from within the stromal compartment of the endometrium. I then interrogated the contribution of SOX17 to dysregulated glandular function in Type I endometrial adenocarcinoma in vitro. My findings reveal an oncogenic role of SOX17 in the Ishikawa Type 1 endometrial cancer cell line, with homozygous loss of SOX17 impairing cellular proliferation, blunting the cancer phenotype of these cells. The majority of cancers, including gynecological cancers, develop from the accumulation of genetic mutations that occur sporadically in cells over time. The complexity and heterogeneity of solid tumors, however, renders the identification of mutations responsible for driving tumorigenesis difficult. The Sleeping Beauty (SB) insertional mutagenesis system can be used to streamline sporadic tumor formation and driver mutation identification. I present results from an initial attempt to develop an SB model of endometrial cancer and discuss ways in which the SB system can be harnessed to evaluate tumorigenesis in a variety of tissue types and microenvironmental contexts. Finally, I present an SB model of metastatic vulvar cancer. Primary tumors from this model resulted in the identification of 76 novel candidate drivers of vulvar cancer, with the ubiquitin-specific peptidase, Usp9x, the most commonly disrupted gene in our screen. I show data suggesting that differential expression of Usp9x isoforms may underlie Usp9x-mediated tumorigenesis and preliminary data demonstrating the relevance of USP9X to human vulvar cancer. Taken as a whole, these data contribute to our scientific understanding of gynecological tissue homeostasis and cancers, lay the foundation for the development of an SB model of endometrial cancer, and describe the first reported model system for studying HPV-naive vulvar cancer in vivo.

ABSTRACT Selective progesterone receptor modulators (SPRM) represent a new class of synthetic steroids which can interact with the progesterone receptor (PR) and can exert agonist, antagonist or mixed effects on various progesterone target tissues in vivo. VA-2914 is a selective progesterone receptor modulator with potential contraceptive activity. We evaluated VA 2914 for ovulation inhibition in women, using three experimental doses ( 2,5 mg/d, 5 mg/d, 10 mg/d ) given continuously for three months. We examined the endometrial impact in each group. Anovulation (defined by absence of progesterone above 3 ng/ml ) was obtained in nearly 80% women in the 5 and 10 mg/d groups with a great rate of amenorrhea ( 81.2 and 90% cases in the 5 and 10 mg/d groups ). Estradiol levels remained in the physiological follicular phase range. Endometrial histological analysis show predominantly usual patterns of secretory phase. Some cystic glandular dilatations are observed in rare cases ; any hyperplasia was detected. VA-2914 induces amenorrhea while progestins cause endometrial spotting and bleeding. This abnormal bleeding due to progestins is a consequence of focal stromal proteolysis by increase in naked vessel size and density. We quantified the effects of VA 2914 on endometrial vascularisation, fibrillar matrix and VEGF-A expression in endometrial biopsies from 41 women before and after 12 weeks daily treatment (2,5 , 5 or 10 mg/d VA 2914 versus placebo). We did not observed changes in endometrial vessels, collagen network and VEGF-A distribution between the luteal phase at baseline and under VA 2914. From these observations, we can assess that VA 2914 does not behave like a progestin since it does not alter the endometrial matrix nor the pattern of endometrial vessels. Résumé : Les modulateurs sélectifs du récepteur de la progestérone ( SPRMs) constituent une nouvelle famille de stéroïdes présentant des propriétés mixtes agonistes ou antagonistes en fonction des gènes cibles, du contexte cellulaire, de la présence simultanée dautres ligands du récepteur de la progestérone (Spitz 2003). Le chef de file de cette famille, la mifépristone, est utilisé depuis plusieurs décennies pour ses propriétés abortives. Son intérêt dans la contraception post coïtale a été démontré. Des molécules aux propriétés abortives réduites sont à létude ou en cours de développement dans les domaines de la contraception, du cancer du sein, du traitement médical de lendométriose et des fibromes utérins (Pintiaux et al. 2009). Le VA2914 que nous étudions, fait partie de ces SPRMs en cours de développement. Nous avons démontré sa capacité à inhiber lovulation à partir de 5 mg administrés par voie orale quotidiennement. Il exerce une action endométriale participant vraisemblablement à leffet contraceptif . Il ninhibe pas le développement folliculaire et permet déviter la carence estrogénique observée sous progestatif antigonadotrope. A partir de la dose de 5 mg par jour, son utilisation saccompagne dun haut taux daménorrhée (Chabbert-Buffet et al. 2007). Lutilisation dun SPRM au long cours pose le problème dun endomètre soumis aux estrogènes endogènes sans opposition progestative. Limpact dun SPRM sur lendomètre varie en fonction de la molécule, de son dosage, de la présence concomitante dautres stéroïdes et de lespèce à laquelle ce SPRM est administré (Chwalisz et al. 2000). Des aspects histologiques particuliers sont décrits dans les endomètres soumis aux SPRMs. Il sagit de la coexistence daspects histologiques non présents de façon simultanée physiologiquement ( aspects sécrétoires et prolifératifs coexistant au sein du même endomètre, signes dapoptose et dactivité mitotique au sein dune même glande) (Mutter et al. 2008). La persistance dune activité mitotique est observée dans les glandes endométriales des patientes anovulatoires soumises au VA2914 (Chabbert-Buffet et al. 2007). Lutilisation de cette molécule quotidiennement et à long terme nest donc pas dactualité contrairement à son utilisation ponctuelle dans le cadre de la contraception postcoïtale (Creinin 2006). La place des SPRMs en contraception classique doit être définie. Différents schémas dadministration et différents dosages devront être évalués en termes defficacité et de sécurité. Lutilisation des SPRMs pourrait être utile pour contrer les saignements indésirables observés lors de la prise de progestatif seul. Contrairement aux patientes soumises aux progestatifs seuls, les patientes sous VA2914 présentent un haut taux d'aménorrhée. Lors du saignement physiologique menstruel comme lors de l'administration de progestatif seul, la dégradation locale du stroma endométrial et une lyse du réseau fibrillaire riche en collagène sont classiquement observées (Galant et al. 2000). Sous VA2914, nous nobservons pas de dégradation de la matrice extracellulaire (Ravet et al. 2009). Le rôle des métalloprotéases matricielles dans les saignements normaux et pathologiques de l'endomètre humain est bien connu . Le profil d'expression des métalloprotéases matricielles dans l'endomètre des patientes traitées par VA2914 à différents dosages peut contribuer à lintégrité endométriale observée. Une angiogenèse aberrante est observée sous progestatif. Une modification de la densité vasculaire endométriale et une altération de la maturation de la paroi des vaisseaux, déficitaire en péricytes et en cellules musculaires lisses ont été décrites (Hickey et al. 1999; Hickey et al. 2000; Jondet et al. 2005; Rogers et al. 1993; Stephanie et al. 2007). L'observation de la vascularisation de lendomètre exposé au dispositif intrautérin au lévonorgestrel durant 1 à 3 mois montre une augmentation très importante (11,5 fois) des petits vaisseaux non matures constitués exclusivement d'un endothélium. Le nombre de vaisseaux partiellement matures est augmenté de 6 fois. Au plus long cours, ces vaisseaux immatures ou partiellement matures restent néanmoins 4 fois plus fréquents que dans les endomètres non soumis à cette thérapeutique. La surface vasculaire et la densité augmentent au cours du temps sous ce dispositif hormonal (Stephanie et al. 2007). De telles modifications ne sont pas observées sous VA2914 et peuvent contribuer à l'absence de saignement. Au cours du cycle témoin, nous avons observé la présence de vaisseaux matures, représentant 80 % de la surface vasculaire totale. Après 3 mois de traitement sous VA2914 aux différentes doses, aucun changement vasculaire n'est observé. Sous VA2914, nous ne constatons pas de modification de l'expression du VEGFA ni de modification de sa distribution qui apparaît prédominante au niveau de la portion apicale des cellules épithéliales de surface et glandulaires. L'absence de modification de la distribution et de l'intensité du marquage du VEGFA (Vascular endothelial growth factor) et la stabilité du rapport Ang-1/Ang-2 avant et sous traitement par VA2914 n'est pas en faveur d'un remodelage vasculaire important (Ravet et al. 2009). Au niveau du réseau vasculaire endométrial, le VA2914 ne paraît donc pas se comporter comme un agoniste du récepteur de la progestérone.

Evidence from an abundant number of studies suggests that human female reproductive functions have become impaired over the past half century and that there might be a relationship between endocrine disrupting chemicals (EDCs) and reduced fertility. It is, however, not known by what mechanisms EDCs affect different reproductive functions such as endometrial receptivity, embryo implantation and placentation. The endometrium is continuously changing its morphological and functional properties, responding to cyclic changes of oestrogen and progesterone levels during the menstrual cycle. These changes include monthly preparation for embryo implantation through changed endometrial angiogenic activity and consequent changes in endometrial vasculature. Use of primary human endometrial endothelial cells (HEECs) in this work was evaluated as a possible screening tool for effects caused by EDCs on human endometrial vasculature and subsequently on various endometrial functions. In this study HEEC and endometrial stromal cells were isolated. HEECs were grown in monocultures, and together with stromal cells in co-cultures, and exposed to endocrine active substances. These were cadmium, which has oestrogenic properties, tamoxifen, with anti-oestrogenic effects, mifepristone, which is an anti-progestin, and bisphenol A, with oestrogenic properties. The effects were evaluated by using proliferation and viability assays, migration and tube formation assays, quantitative PCR (qPCR), immunohistochemistry and western blot. Cadmium affected the expression of angiogenesis-related genes, and caused different effects in HEECs cultured alone vs. HEECs co-cultured with stromal cells. Tamoxifen altered the expression of angiogenesis-related genes and reduced HEEC migration, thus having an anti-angiogenic effect. Mifepristone caused reduced formation of tubular structures in tube-formation assays involving HEECs co-cultured with stromal cells. Bisphenol A promoted tube formation in co-cultured HEECs which was related to changes in the expression of several angiogenesis-related genes as well as up-regulated expression of VEGF-D protein. In conclusion, we showed that EDCs have the ability to induce changes in endometrial angiogenic activity in vitro and may thus disturb normal endometrial functions related to fertility and pregnancy. HEECs grown in vitro may provide valuable information on the effects of EDCs on human endometrial functions. However, this model is not suitable as a large-scale screening tool.

Esta tesis tuvo cinco objetivos principales: 1) conocer el grado de asociación entre los resultados del grado de inflamación subclínica obtenidos mediante la técnica de cytobrush (CB) y los cambios en la histología uterina mediante la evaluación de biopsias uterinas (BU); 2) estudiar las variaciones fisiológicas del porcentaje de polimorfo nucleares neutrófilos (PMN) en la citología endometrial durante el ciclo estral por medio de la técnica de CB; 3) validar la técnica de CB en nuestro país y determinar la prevalencia de ES y los niveles de corte del porcentaje PMN que se correspondan con una disminución de la eficiencia reproductiva; 4) determinar los agentes bacteriológicos involucrados en la ES; 5) demostrar que la histeroscopía (HI) puede ser usada para evaluar métodos de diagnóstico de EC y ES en vacas de tambo. Para cumplir con estos cinco objetivos se realizaron cinco experimentos. Los principales resultados obtenidos en esta tesis fueron que se validó por primera vez en nuestro país la técnica del CB para realizar el diagnostico de ES, y se determinaron los puntos de corte del porcentaje de PMN para diagnosticar a campo la prevalencia de ES. Durante el ciclo estral, el porcentaje de PMN nunca superó el 2% de PMN, mientras que con porcentajes de PMN superiores al 8%, 6%, 4% y 5% a los 21-33, 34 a 47, 48 a 62 y 21 a 62 dpp se comienza a observar una disminución de la eficiencia reproductiva. Este ha sido el primer trabajo en nuestro país en demostrar que las vacas con ES tuvieron 16,2% de reducción en la tasa de concepción al primer servicio, 16,8% de reducción en la cantidad de vacas preñadas a los 100 días de lactancia y 29 días de aumento de días abiertos comparado con vacas sin ES. Otro hallazgo importante de este trabajo fue que no existe relación entre ES y aislamiento bacteriano. Por último, se demostró que la HI es una técnica eficiente para el diagnóstico de EC pero ineficiente para el diagnóstico de ES.

Human telomerase is a ribonucleoprotein complex that adds hexameric TTAGGG repeats to the ends of chromosomes in order to prevent their shortening. Telomerase activity has been evaluated for its diagnostic and prognostic value in cancer since it is observed in most malignancies but not in most normal somatic tissues. In this study telomerase activity was examined in tumor specimens obtained from cervix, endometrium and their non-cancerous regions by an improved telomeric repeat amplification protocol (TRAP) &ndash / silver staining assay. Appearance of characteristic TRAP leader with 6 base pair increments indicate a positive result and was observed in all cancerous and some of the non-cancerous tissues. Telomerase activities of carcinoma tissues and normal counterparts were compared by densitometric analysis after PCR. Significantly higher telomerase activity was observed in cervical carcinoma samples compared to normal adjacent tissue. No significant difference was observed between endometrium carcinomas and normal endometrial tissue in terms of telomerase activity. High telomerase activity in normal endometrium restricts the use of assay for detection of carcinogenesis. However, in cervical tissues an accurate quantification of telomerase activity by TRAP &ndash / silver stain assay may be valuable as a confirmatory assay.

Ziel der Studie war die morphologisch-funktionelle Charakterisierung der Endometrose mittels konventioneller histopathologischer und neuer immunhistologischer Methoden. Die Ergebnisse wurden mit den Abfohlraten der untersuchten Stuten verglichen, um eine genauere Prognose hinsichtlich der Fertilität zu erhalten. Innerhalb der physiologischen Decksaison wurden von 159 klinisch gesunden, östrischen Stuten (3 bis 21 Jahre alt) Endometriumbioptate entnommen. Die Stuten wurden danach im selben Jahr besamt und nach Erfassen der Abfohlraten im folgenden Jahr in zwei Gruppen eingeteilt: güste Stuten und nicht güste Stuten. Im Rahmen einer Doppelblind-Studie wurden endometriale Alterationen lichtmikroskopisch erfasst sowie Grad und Qualität der Endometrose histomorphologisch definiert. Repräsentativ ausgewählte Bioptate (n=82) wurden immunhistologisch auf die Expression der Steroidhormonrezeptoren (Östrogenrezeptor, ER; Progesteronrezeptor, PR) und ausgewählter endometrialer Proteine (Uteroglobin, UG; Uterokalin, UK; CalbindinD9k, CAL; Uteroferrin, UF) untersucht. 101/159 Stuten zeigen eine, qualitativ und quantitativ variierende, Endometrose. Die fibrotischen Uterindrüsen weisen, im Vergleich zu unveränderten Drüsen, ein zyklusasynchrones, teilweise innerhalb eines Drüsenquerschnittes ungleichmäßiges endometriales Proteinmuster auf. Das ungleichmäßige Expressionsmuster kann als Zeichen einer endometrialen Fehldifferenzierung innerhalb fibrotischer Areale interpretiert werden. Die Aktivität der Endometrose hat keinen Einfluss auf das endometriale Proteinmuster. Güste Stuten besitzen häufiger einemittelgradige, vorwiegend destruierende, inaktive oder gemischte Endometrose. Insbesondere in Arealen mittelgradiger destruierender Endometrosen ist eine deutlich verminderte Expression von UG und UK nachweisbar. Auch in der geringgradigen Endometrose werden häufiger beide Proteine gleichzeitig zyklusasynchron exprimiert. UF wird innerhalb höhergradiger destruierender fibrotischer Herde überweigend intensiver exprimiert als in den unveränderten Epithelien, während CAL vielfach ein variables Proteinmuster besitzt. Nicht güste Stuten hingegen zeigen häufig eine geringgradige aktive oder inaktive Endometrose. Bei diesen Stuten weist ein hoher Anteil betroffener glandulärer Epithelien in der mittelgradigen Endometrose entweder eine zyklussynchrone oder geringgradig zyklusasynchrone Expression von UG, UK und CAL auf. UF wird auch in dieser Gruppe häufig intensiver in fibrotischen Drüsen exprimiert. Zwischen güsten und nicht güsten Stuten bestehen charakteristische Unterschiede im Expressionsmuster von UG und UK: nicht güste Stuten besitzen in gering- und mittelgradig fibrotisch veränderten Uterindrüsen häufiger eine zyklussynchrone Proteinexpression als güste Stuten und seltener deutliche Abweichungen in der Expression von entweder UG oder UK. Stuten beider Gruppen besitzen eine zyklusasynchrone Expression der ER und PR sowohl in den periglandulären fibrotischen Stromazellen als auch im Drüsenepithel. Die glanduläre Hormonrezeptorexpression ist tendenziell abhängig von der Aktivität der Endometrose. Diese Resultate sprechen für eine Abkopplung fibrotischer Areale von den uterinen Kontrollmechanismen. Im Rahmen dieser Studie konnte überwiegend bei güsten Stuten in der Endometrose, im Vergleich zu unveränderten Drüsen, ein deutlich abweichendes endometriales Proteinmuster von UG und UK dargestellt werden. Insbesondere bei Tieren, die an einer mittelgradigen destruierenden Endometrose leiden, könnte diese Tatsache als Hinweis auf eine fertilitätsmindernde Beeinflussung des uterinen Mikromilieus im Rahmen der Endometrose interpretiert werden. Die vorliegende Untersuchung unterstreicht die Notwendigkeit einer genaueren Klassifizierung der Endometrose und empfiehlt, zusätzlich zum Grad auch die Qualität der Endometrose sowie das endometriale Expressionsmuster von UG und UK in der Epikrise für eine präzisere Fertilitätsprognose zu berücksichtigen.