Hyperinnervation in Intestinal Deep Infiltrating Endometriosis
Abstract
Study objective To investigate the extent and types of innervation of endometriotic lesions in various regions of the bowel.Design Retrospective nonrandomized immunohistochemical study (Canadian Task Force classification II-3.Setting University-based laboratory.Patients Thirty-six women undergoing laparoscopy or laparotomy because of deep infiltrating endometriosis in various regions of the bowel, including the sigmoid colon, appendix, and rectum.Interventions Immunohistochemical staining of endometriotic specimens with antibodies against protein gene product 9.5, neurofilament, nerve growth factor, nerve growth factor receptors tyrosine kinase receptor A and p75, growth-associated protein 43, substance P, neuropeptide Y, and vasoactive intestinal peptide to demonstrate myelinated, unmyelinated, sensory, and autonomic nerve fibers.Measurements and main results There were significantly more nerve fibers in intestinal deep infiltrating endometriosis (mean [SD] 172.6 [94.2]/mm(2)) than in other deep infiltrating endometriotic lesions (e.g., cul-de-sac and uterosacral ligament) (67.6 [65.1]/mm(2); p<.01). Intestinal deep infiltrating endometriosis was innervated abundantly by sensory Adelta,sensory C, cholinergic, and adrenergic nerve fibers. Nerve growth factor, tyrosine kinase receptor A, and p75 were strongly expressed in endometriotic lesions, and growth-associated protein-43 was also strongly expressed in the endometriosis-associated nerve fibers.Conclusion The hyperinnervation in intestinal deep infiltrating endometriosis may help to explain why patients with this type of lesion have more severe pain.
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Deep endometriosis (DE) lesions are frequently hyperinnervated.
“More strikingly, DE lesions are frequently hyperinnervated29–34.”
From Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis (2019) · cites this paper as [30]
DE lesions are typically in close proximity to various sensory nerve plexuses and have higher density of sensory nerves than other subtypes.
“The answer simply lies in the locations of the DE lesions: unlike other subtypes, these lesions typically are in close proximity to various sensory nerve plexuses and additionally have higher density of sensory nerves than other subtypes29,30,85,86.”
From Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis (2019) · cites this paper as [30]
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- Authors
- Wang, G., Tokushige, N., Russell, P., Dubinovsky, S., Markham, R., & Fraser, I. S.
- Affiliations
- Shandong University (CN)
- The University of Sydney (AU)
- Corresponding author
- Wang, Guoyun
- Venue
- Journal of Minimally Invasive Gynecology
- Publisher
- Elsevier BV
- Published
- 2009-11
- Volume
- 16
- Issue
- 6
- Pages
- 713-719
- ISSN
- 1553-4650 (ISSN-L)
- OpenAlex
- W2015421305
- Cited by
- 85
- References
- 47
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 10 · 2020: 6 · 2019: 6 · 2018: 6 · 2017: 5 · 2016: 5 · 2015: 9 · 2014: 7 · 2013: 3 · 2012: 9
- FWCI
- 5.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Minimally Invasive Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Sydney
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Plant and fungal interactions
- Keywords
- deep infiltrating endometriosis, intestinal endometriosis, hyperinnervation, nerve fibers, sensory nerve fibers, cholinergic fibers, adrenergic nerve fibers, nerve growth factor, p75 neurotrophin receptor, growth-associated protein 43, substance P, neuropeptide Y, vasoactive intestinal peptide, endometriosis-associated pain, sigmoid colon, appendix, rectum
- MeSH terms
- Adult, Endometriosis, Female, Humans, Immunohistochemistry, Intestine, Large, Middle Aged, Retrospective Studies, GAP-43 Protein, Receptor, Nerve Growth Factor, Receptor, trkA, Nerve Growth Factor, Young Adult
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