Executive Editor-in-Chief’s introduction for This Special Issue : Reproductive and Developmental Medicine

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Special Issue: Adenomyosis and Endometriosis

Executive Editor-in-Chief’s introduction for This Special Issue

Li, Da-Jin*

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Reproductive and Developmental Medicine: September 2022 - Volume 6 - Issue 3 - p 131-132
doi: 10.1097/RD9.0000000000000036
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Prof. Da-Jin Li is a chief physician and senior scientist at Shanghai Medical College of Fudan University. Prof. Li is elected chairman of the Obstetrics and Gynecology Division of the Chinese Association of Integrative Medicine and vice president of the American Society for Reproductive Immunology. Prof. Li, former vice president of the Obstetrics and Gynecology Hospital of Fudan University Shanghai Medical School, is the director of the Institute of Obstetrics and Gynecology of Fudan University. He has been committed to basic and clinical research in female reproductive immunology. Prof. Li is chief scientist of the National 973 Program. For many years, he has undertaken many major national programs, and has led his research team to publish up to 300 peer-reviewed papers in core journals. Prof. Li has served as Editor for many international academic journals such as the American Journal of Reproductive Immunology, Chinese Journal of Cellular and Molecular Immunology, etc. In 2015, for his outstanding achievements in the regulatory mechanisms of maternal-fetal immunology, Prof. Li was honored with the J. Christian Herr Award by the American Society for Reproductive Immunology. Currently, Prof. Li and his lab members are working on the etiology and early intervention related to recurrent pregnancy loss.

Dear Colleagues,

As an Executive Editor-in-Chief, I have edited this Special Issue, entitled “Endometriosis and adenomyosis” in the journal Reproductive and Developmental Medicine (RDM, ISSN: 2096-2924, CN:10-1442/R), the first ever English journal in the field of reproductive medicine and developmental biology in mainland China. Since its launch in 2017, RDM has been dedicated to providing a good platform for academic exchanges among scientists, both at home and abroad.

Endometriosis (EM) and adenomyosis are chronic inflammatory gynecological diseases characterized by the presence of endometrial tissue outside the uterine cavity or within the uterine myometrium, and are also disorders of reproductive endocrine-immune regulation. EM affects 6%–10% of reproductive-aged women. Endometrial fragments from the uterine cavity attach to and invade the peritoneum or the uterine myometrium, where the microenvironment prevents the immune system from eliminating the ectopic fragments. EM manifests in the form of pelvic pain and infertility, and its pathogenesis has not been fully elucidated. Current treatment strategies are usually hormonal or surgical, and can have serious side effects. These strategies need to be urgently improved to achieve better outcomes in patients with EM.

In this special issue, we will discuss four recent publications on the pathogenesis and treatment of EM.The first publication is a review by Prof. Xue et al. that describes the role of non-coding RNAs in the occurrence and development of EM. MicroRNAs (miRNAs) and long non-coding RNAs (lncRNAs) are the main members of the non-coding RNA family that contribute to various aspects of EM progression, such as cell proliferation, apoptosis, invasion, and angiogenesis. Angiogenesis plays a pivotal role in the initiation and development of EM, and enables the invasion, proliferation, and long-term growth of endometriotic implants. This review examines the specific role of angiogenesis and its related genes and pathways in EM to explain how several miRNAs and lncRNAs can affect endometriosis through supporting angiogenic activities. These miRNAs and lncRNAs could be used in diagnostic and therapeutic strategies for endometriosis.

The second review by Dr. Mei’s group is on the impact of coronavirus disease 2019 (COVID-19) on EM. The cytokine storm (CS) caused by COVID-19 may induce the occurrence and progression of EM, and the associated immunosuppression may protect ectopic endometrium escape from immune clearance. The occurrence and development of COVID-19 and EM are accompanied by immune system abnormalities. Many inflammatory factors are released during the progression of COVID-19, which may increase the risk of EM occurrence, or aggravate the severity of EM. Simultaneously, patients with COVID-19 are severely immunosuppressed, which also provides a suitable environment for ectopic endometrium to escape immune clearance. The impact of COVID-19 on the endometrial microenvironment, and if it can contribute to the occurrence and development of EM, requires further investigation. On the other hand, the occurrence of COVID-19 has no association with sex and age, while EM mostly occurs in women of gestational age. The review summarizes how COVID-19 impacts the occurrence and development of EM, and also affects the typical clinical symptoms of EM. Mandatory isolation and increased psychological pressure during the COVID-19 pandemic may aggravate the feeling of pelvic pain from EM. For patients with EM who are infertile, delayed ART treatment could cause increased psychological pressure and even promote the development of EM. In conclusion, the COVID-19 pandemic has had a significant impact on patients with EM. More attention should be paid to people who are at risk of developing EM, or have EM already, and methods should be explored to reduce the impact of the pandemic on these people.

In the next article, Prof. Guo’ group induced external adenomyosis-like lesions using an estrogen receptor β (ERβ) agonist in ICR mice. All tamoxifen-treated mice developed adenomyosis, as well as 4 mice (50%) in the DPN (an ERβ agonist)-treated group. This result should be considered as significant, given that mice in the control group did not develop adenomyosis. No mice in the PPT (an ERα agonist) or G-1 (a GPR30 agonist)-treated groups developed adenomyosis. Remarkably, all lesions in the DPN group were observed exclusively near the uterine serosa, and were dramatically different from those observed in the TAM-treated mice, which was reminiscent of extrinsic or external adenomyosis in humans.

The final clinical retrospective study by Prof. Zhang’s group evaluates the efficacy and safety of low-dose mifepristone for the treatment of painful adenomyosis. The VAS scores in both experimental groups at all time points during treatment and follow-up were significantly lower than those before treatment. Uterine size was significantly reduced and endometrial thickness was distinctly thicker after 12 months of treatment compared to before receiving 5 mg/d of mifepristone. The immunohistochemical expression of NGF and COX-2 decreased in both eutopic and ectopic endometrial tissue after treatment, whereas that of Ki-67 slightly increased in eutopic endometrium after treatment and rapidly recovered to the baseline value after stopping mifepristone. There were no signs of hyperplasia, atypical hyperplasia, or malignancy in the endometrial biopsies. These results suggest that a daily dose of 5 mg mifepristone for 12 months could be effective for the treatment of painful adenomyosis, with few side effects.

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