Hypoxia: The force of endometriosis
Abstract
Aim: Summarize recent findings of how hypoxia regulates numerous important processes to facilitate the implantation, proliferation and progression of ectopic endometriotic lesions. Methods: Most up‐to‐date evidences about how hypoxia contributes to the disease pathogenesis of endometriosis and potential therapeutic approaches were collected by conducting a comprehensive search of medical literature electronic databases. Quality of data was analyzed by experienced experts including gynecologist and basic scientists. Results: Uterus is a highly vascularized organ, which makes endometrial cells constantly expose to high concentration of oxygen. When endometrial tissues shed off from the eutopic uterus and retrograde to the peritoneal cavity, they face severe hypoxic stress. Even with successful implantation to ovaries or peritoneum, the hypoxic stress remains as a critical issue because endometrial cells are used to live in the well‐oxygenated environment. Under the hypoxia condition, cells undergo epigenetic modulation and evolve several survival processes including steroidogenesis, angiogenesis, inflammation and metabolic switch. The complex gene regulatory network driven by hypoxia ensures endometriotic cells can survive under the hostile peritoneal microenvironment. Conclusion: Hypoxia plays critical roles in promoting pathological processes to facilitate the development of endometriosis. Targeting hypoxia‐mediated gene network represents an alternative approach for the treatment of endometriosis.
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Hypoxia, occurring to menstrual debris devoid of blood supply when regurgitated into peritoneal cavity, can dramatically turn endometrial stromal cells into endometriotic counterpart, causing completely different phenotypes.
“Recent studies have shown that hypoxia, occurred to menstrual debris that is devoid of blood supply when regurgitated into the peritoneal cavity, can dramatically turn endometrial stromal cells into endometriotic counterpart, causing completely different phenotypes39.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [39]
Activated platelets can directly induce a hypoxia state in endometriotic lesions, which subsequently cause further phenotypic changes.
“Third, our study provides evidence that activated platelets can directly induce a hypoxia state in endometriotic lesions, which subsequently cause further phenotypic changes39.”
From Platelets induce increased estrogen production through NF-κB and TGF-β1 signaling pathways in endometriotic stromal cells (2020) · cites this paper as [39]
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Self-citationYuguchi, H., Tanabe, A., Hayashi, A., Tanaka, Y., Okuda, K., Yamashita, Y., Terai, Y., & Ohmichi, M. (2013) · Endocrine Research · doi:10.3109/07435800.2013.774011 · Cited by 20 · see citing works
Endocrine targets of hypoxia-inducible factors
Lee, H.-C., & Tsai, S. (2017) · Journal of Endocrinology · doi:10.1530/joe-16-0653 · Cited by 20 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Qi, Q., Liu, X., Zhang, Q., & Guo, S.-W. (2020) · Scientific Reports · doi:10.1038/s41598-020-57997-6 · Cited by 44 · see citing works
Long noncoding RNAs in endometriosis: Biological functions, expressions, and mechanisms
Wang, X., Zhang, J., Liu, X., Wei, B., & Zhan, L. (2021) · Journal of Cellular Physiology · doi:10.1002/jcp.29847 · Cited by 24 · see citing works
Qi, Q.-M., Guo, S.-W., & Liu, X.-S. (2019) · Reproductive and Developmental Medicine · doi:10.4103/2096-2924.262390 · Cited by 15 · see citing works
“of HIF-1α.[9,12] This may explain why endometrial debris invades and establish endometriotic foci in ectopic sites.”
BackgroundResultInfluential
- Authors
- Wu, M., Hsiao, K., & Tsai, S.
- Affiliations
- National Cheng Kung University (TW)
- National Chung Hsing University (TW)
- Corresponding author
- Tsai, Shaw‐Jenq
- Venue
- Journal of Obstetrics and Gynaecology Research
- Publisher
- Wiley
- Published
- 2019-01-07
- Volume
- 45
- Issue
- 3
- Pages
- 532-541
- ISSN
- 1341-8076 (ISSN-L)
- 1447-0756
- OpenAlex
- W2909794175
- Semantic Scholar
- 32a95a5b855616a4ca477c00049b3873f2640784
- Cited by
- 88
- References
- 102
- Citations by year
- 2026: 12 · 2025: 9 · 2024: 14 · 2023: 7 · 2022: 8 · 2021: 21 · 2020: 17
- FWCI
- 1.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of obstetrics and gynaecology research (publishedVersion)
- PubMed (publishedVersion)
- NCHU Institutional Repository CRIS (submittedVersion)
- Funders
- Ministry of Science and Technology, Taiwan (MOST 106‐2320‐B‐006‐072‐MY3)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- endometriosis, hypoxia, endometriosis pathogenesis, peritoneal microenvironment, epigenetic regulation, angiogenesis, inflammation, metabolic switch, steroidogenesis, endometriosis treatment
- MeSH terms
- Hypoxia, Endometriosis, Endometrium, Female, Humans, Neovascularization, Pathologic
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