Potential involvement of hemoglobin and heme in the pathogenesis of peritoneal endometriosis
Open accessAbstract
Objective To test whether hemoglobin may accumulate in the peritoneal cavity in case of endometriosis and to assess whether heme oxygenases (HO), detoxifying heme, are expressed in ectopic endometrium and peritoneal cells.Design Prospective study involving patients with and without endometriosis.Setting Department of gynecology in a university hospital.Patient(s) Seventy-six patients undergoing laparoscopy for tubal sterilization or infertility and/or pelvic pain.Intervention(s) Collection of peritoneal fluid (PF), blood samples, and biopsies from endometrium and peritoneum.Main outcome measure(s) Measurement of free hemoglobin and its byproduct, total and direct bilirubin, in serum and PF and analysis of HO-1 and HO-2 expression in biopsies by reverse transcription polymerase chain reaction and semiquantitative immunohistochemistry.Result(s) Higher levels of hemoglobin were found in the PF of patients with endometriosis. There was no concomitant increase in bilirubin concentrations in the PF, and HO-1 was poorly expressed in peritoneal mesothelium and macrophages. Heme oxygenase-1 and HO-2 were strongly expressed in ectopic endometrium, especially in red lesions.Conclusion(s) Our results suggest that heme may be involved in the pathogenesis and/or development of endometriosis and that the HO system, although expressed, might be insufficient to detoxify heme in women with endometriosis.
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Retrograde menstruation and bleeding of endometriotic lesions are responsible for erythrocytes in the pelvic cavity, which release pro-oxidant and proinflammatory factors like hemoglobin and its byproducts heme and iron.
“Retrograde menstruation and bleeding of endometriotic lesions are responsible for the presence of erythrocytes in the pelvic cavity, which are likely to release pro-oxidant and proinflammatory factors like hemoglobin and its highly toxic byproducts heme and iron [27,28,29,30].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [28]
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- Authors
- Van Langendonckt, A., Casanas-Roux, F., Dolmans, M.-M., & Donnez, J.
- Affiliations
- UCLouvain (BE)
- Corresponding author
- Donnez, Jacques
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2002-03
- Volume
- 77
- Issue
- 3
- Pages
- 561-570
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2070522963
- Cited by
- 91
- References
- 30
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 2 · 2019: 3 · 2018: 5 · 2017: 3 · 2016: 1 · 2015: 7 · 2014: 4 · 2013: 5 · 2012: 5
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Heme Oxygenase-1 and Carbon Monoxide
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- peritoneal endometriosis, hemoglobin, heme, heme oxygenase-1, heme oxygenase-2, peritoneal fluid, ectopic endometrium, peritoneal mesothelium, macrophages, bilirubin, endometriosis pathogenesis, heme detoxification
- MeSH terms
- Adult, Ascitic Fluid, Bilirubin, Biopsy, Endometriosis, Female, Heme, Heme Oxygenase (Decyclizing), Hemoglobins, Humans, Immunohistochemistry, Membrane Proteins, Peritoneal Diseases, Prospective Studies, RNA, Messenger, DNA, Complementary, Statistics, Nonparametric, Reverse Transcriptase Polymerase Chain Reaction, Heme Oxygenase-1
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