O papel da dieta na etiologia da endometriose / The role of diet in the etiology of endometriosis

Introdução: A endometriose é uma condição inflamatória crônica e hormônio-dependente. Fatores genéticos, imunológicos e ambientais podem estar implicados na patogênese da endometriose. Nesse sentido, esse estudo tem por objetivo descrever o papel da dieta na etiologia da endometriose. Método: Foi realizada uma busca eletrônica no PubMed, no período entre 1 de janeiro de 2012 e 31 de dezembro de 2016, empregando os termos "endometriosis and diet" e "endometriosis and food". Os critérios de inclusão foram: relação direta com o tema, publicação no idioma inglês, disponibilidade da versão completa do artigo e artigo original/pesquisa. Foram selecionadas 12 publicações que cumpriram os critérios previamente estabelecidos. Resultados: Houve predomínio de estudos que avaliaram a contribuição de ácidos graxos poli-insaturados para o desenvolvimento da endometriose (6/12), seguido pelas vitaminas B, C, D, E, cálcio e magnésio (4/12) e apenas dois artigos investigaram xantohumol e café/cafeína, sendo um artigo cada. A maioria desses compostos atuou na redução das lesões endometriais, uma vez que exibiram efeitos anti-inflamatório e antiangiogênico e são antioxidantes. No entanto, as pesquisas foram conduzidas em modelos animais e, apesar dos achados promissores, é necessário cautela ao extrapolar os resultados para o estudo da endometriose em humanos. Conclusões: Foi demonstrado um papel significativo da dieta no desenvolvimento e progressão da endometriose, sendo que a maioria exibe efeito protetor. Nesse sentido, é pertinente, adequado e justificável o acompanhamento nutricional às pacientes portadoras de endometriose.

Introduction: Endometriosis is a chronic inflammatory condition and hormone dependent. Genetic, immunological, and environmental factors may be implicated in the pathogenesis of endometriosis. Thus, this study aims to describe the role of diet in the etiology of endometriosis. Methods: An electronic search was conducted in PubMed in the period from January 1, 2012 to December 31, 2016, using the terms "endometriosis and diet" and "endometriosis and food." Inclusion criteria were directly related to the subject, published in English, availability of the full version of the article and original/research article. We selected 12 publications that met the criteria previously established. Results: There was a predominance of studies have evaluated the contribution of polyunsaturated fatty acids for the development of endometriosis (6/12) followed by vitamins B, C, D, E, calcium, and magnesium (4/12) and only two articles investigated xantohumol and coffee/caffeine, one article each. Most of these compounds reduced endometrial lesions once they exhibit effects anti-inflammatory, anti-angiogenic and are antioxidants. However, studies were conducted in animal models and despite the promising findings, it is necessary to exercise caution when extrapolating the results for the study of endometriosis in humans. Conclusions: A significant role of diet in the development and progression of endometriosis was demonstrated, most of which exhibits a protective effect. In this sense, it is relevant, appropriate, and justifiable nutritional monitoring of patients with endometriosis.

Curcumin delays endometriosis development by inhibiting MMP-2 activity.

Endometriosis is a common reproductive disorder believed to be associated with matrix metalloproteinases (MMPs) activities for invasion and remodeling of endometrial tissues. Ectopic endometrium has higher capacity to produce proMMP-2 than eutopic tissues; however, the role of MMP-2 during early phase of endometriosis development is still unclear. In the present study, we investigated the role of MMP-2 in establishment and development of endometriosis in mouse model. The effect of curcumin on regression of endometriosis through protease/antiprotease balance between MMP-2 and TIMP-2 was also examined. After endometrial inoculation into peritoneum, we observed a significant elevation of proMMP-2 activity from day 2 onwards. This increased MMP-2 activity was associated with decreased expression of tissue inhibitor of MMP (TIMP)-2, while a significant up-regulation of active MMP-2 activity was observed from day 3 onwards. The activation of proMMP-2 to active MMP-2 was associated with increased expression of membrane type 1 matrix metalloproteinase (MT1MMP). Curcumin at a dose of 48 mg/kg b.w. repressed the MMP-2 activity via up-regulation of bound TIMP-2 expression, thus delayed endometriosis development. In addition, curcumin inhibited production of active MMP-2 by down-regulating MT1MMP expression. Moreover, endometriotic progression was directly linked with increased MMP-2/TIMP-2 ratio which was delayed by curcumin pretreatment. In summary, our study documents the regulation of MMP-2 activity by TIMP-2 during the early phase of endometriosis development and inhibitory action of curcumin thereon.