The putative role of cell adhesion molecules in endometriosis: can we learn from tumour metastasis?

Endometriosis, one of the most frequent diseases in gynaecology, is a considerable threat to the physical, psychological and social integrity of women. The etiology and pathogenesis of this important disease, defined as the ectopic location of endometrium-like glandular epithelium and stroma outside the uterine cavity, is poorly understood. Clinical observations and in vitro experiments imply that endometriotic cells are invasive and able to metastasize. Analogous to tumour metastasis, it is likely that cell adhesion molecules are central for the invasion and metastasis of endometriotic cells. Investigation of these molecules in endometriosis should increase our understanding of the molecular mechanisms involved in the pathogenesis of this disease.

Tracing cellular and molecular mechanisms involved in endometriosis.

The aetiology and pathogenesis of endometriosis, defined as the presence of endometrium-like tissue outside the uterine cavity, is largely unknown. In this paper we present and discuss possibilities to study the putative pathogenic properties of endometriotic cells in vitro. The current focus of our investigations is on the invasive phenotype of the disease, assuming that this might contribute to the pathogenesis of endometriosis. So far, we have shown that: (i) cytokeratin-positive and E-cadherin-negative endometriotic cells have an invasive phenotype in a collagen invasion assay in vitro similar to metastatic carcinoma cells; (ii) the invasiveness of endometriotic but not of eutopic endometrial cells can be stimulated by a heat-stable protein present in peritoneal fluid; and (iii) the endometriotic cell line EEC145T, which we established, may be a useful tool for the identification of gene products which are, positively or negatively, invasion-related. Finally, our studies suggest that the invasive phenotype in endometriosis shares aspects with tumour metastasis, but might also have unique mechanisms.