Etude phénotypique des cellules endométriosiques profondes

Abstract : Endometriosis, a common disease that affects approximately 8 to 10% of women of childbearing age, is responsible for chronic pelvic pain and infertility. There is currently no cure other than surgical removal of lesions. In the case of deep infiltrating endometriosis with rectal involvement, surgery is associated with a significant morbidity. Medical treatments are based on a hormone used to block ovarian function. Their effects are only transient and suspensive. There is currently no treatment targeting the mechanisms underlying the disease. The aim of our study was to explore different pathways potentially involved in the development of endometriosis and to identify molecules that act on these mechanisms. In a first step, we explored the hyperproliferative phenotype of deep infiltrating endometriosis cells and sought a link with different metabolic pathways involved in cell proliferation such as oxidative stress, ERK, and Akt pathways. In a second step, we explored the recruitment of endometrial cells in the peritoneal cavity through the CXCL12-CXCR4 interaction. Cell cultures were taken from deep infiltrating endometriosis nodules, eutopic endometrium and control endometrium. Histological slides were prepared from deep endometriotic nodules. Peritoneal fluid of women with deep infiltrating endometriosis, and of women without endometriosis were frozen. Cell proliferation was determined by [H3]thymidine incorporation. Cellular production of ROS was assessed by spectrofluorometry. ERK pathway was assessed by Western blot, ELISA assay and immunohistochemistry. The Akt pathway was assessed by Western blot and immunohistochemistry. We showed a hyperproliferative phenotype of deep infiltrating endometriosis cells in line with an activation of the ERK pathway through an up-regulation of oxidative stress, and activation of the Akt pathway. We have shown that an antioxidant (NAC), an inhibitor of protein kinases (A771726), a Raf inhibitor (sorafenib), an inhibitor of mTOR (temsirolimus), a cannabinoid agonist (WIN 55212-2) and an anti-metabolite (5-FU) could control the proliferation of endometriotic cells in vitro, and the growth of endometriotic nodules grafted in Nude mice. The CXCL12-CXCR4 interaction was studied by Western blot, Transwell migration assay, flow cytometry and ELISA assay. We showed a specific attraction of deep infiltrating endometriosis cells over-expressing the CXCR4 chemokine by CXCL12 present in increased amounts in the peritoneal fluid of endometriotic women. In conclusion, we have shown that medical treatment of endometriosis could be non-hormonal and that oxidative stress, ERK and Akt were new therapeutic approaches to assess in clinical trials. We also showed how the molecular changes of eutopic endometrial cells could facilitate their recruitment into the peritoneal cavity.
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Mahaut Leconte. Etude phénotypique des cellules endométriosiques profondes. Sciences agricoles. Université René Descartes - Paris V, 2012. Français. ⟨NNT : 2012PA05T084⟩. ⟨tel-00832636⟩

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