The Expression And Significance Of VEGF, PEDF And Survivin In Adenomyosis

Objective: To count the microvessel density（MVD）andapoptosis index（AI）in endometriotic tissues of adenomyosis（AM）, detect theexpression of vascular endothelial growth factor （VEGF）,pigmentepithelium-derived factor（PEDF）and Survivin in AM and explore the roles ofVEGF, PEDF and Survivin in the pathogenesis of AM.Methods:36uterussamples were collected from patients with AM, then the ectopic endometrium(ectopic endometrium group) and eutopic endometrium (eutopic endometriumgroup) were respectively taken. Meanwhile30cases of eutopic endometriumtissues (control endometrium group) were collected from fibroid patients whohad hysterectomy in the same phase. CD34was measured byimmunohistochemistry assay to detect MVD in endometrium. Spontaneousapoptosis was evaluated using TdT-mediated dUTP-biotin nickend-labelling(TUNEL)assay． Immunohistochemical technique was used tomeasure the expression of VEGF, PEDF and Survivin in the three groups. Datawas analyzed with SPSS15.0and the significant level was defined as P<0.05.Results:1.The MVD value presented an ascending tendency in control, eutopicand ectopic endometrium in sequence (P<0.05).2. The AI value presented adescending tendency in control, eutopic and ectopic endometrium (P<0.05).3.The expression of VEGF in the three groups: the expression of VEGF inectopic and eutopic endometrium was apparently higher than that in control endometrium (P<0.05) and no difference was shown in ectopic and eutopicendometrium (P>0.05).4. The expression of PEDF in the three groups: theexpression of PEDF in ectopic and eutopic endometrium was apparently lowerthan that in control group(P<0.05) and no difference was shown in ectopic andeutopic endometrium (P>0.05).5.The expression of Survivin in the threegroups: the expression of Survivin in ectopic and eutopic endometrium isapparently higher than that in control group(P<0.05) and no difference wasshown in ectopic and eutopic endometrium (P>0.05).6. Correlation:(1) Theexpression of VEGF and PEDF was in negative correlation in controlgroup(r=-0.510, P=0.004), eutopic endometrium(r=-0.622, P<0.001) andectopic endometrium(r=-0.700, P<0.001).(2) The expression of VEGF andSurvivin has no correlation in control group(r=0.289, P=0.122＞0.05) and wasin positive correlation in both eutopic endometrium(r=0.756, P<0.001) andectopic endometrium(r=0.783, P<0.001).(3) The expression of PEDF andSurvivin in control group has no correlation (r=-0.201，P=0.286) and was innegative correlation in both eutopic endometrium(r=-0.563，P<0.001) andectopic endometrium(r=-0.658，P<0.001).Conclusion:1.The MVD in control,eutopic and ectopic endometrium was in an ascending tendency, indicating thatthere was unusual increase of new vessels in the development of AM.2. Thedescending tendency of AI in control, eutopic and ectopic endometirumindicated that apoptosis may play an important role in the development of AM.3. The expression of VEGF was high and PEDF was low in eutopic and ectopic endometrium. There was a negative correlation between the expression ofVEGF and PEDF in all three groups, which suggested that their expressions hada negative feedback or mutual antagonism relation. The low-expression ofPEDF may directly or indirectly cause the over-expression of VEGF and theover-expression of VEGF might decrease the expression of PEDF, whichsubsequently broke the original balance of angiogenic regulatory factors,promoted the angiogenesis and provided conditions for the ectopicendometrium development in muscular layer.4. The expression of VEGF andSurvivin was increased in the ectopic and eutopic endometrium ofadenomyosis,and there was a positive correlation between the expression ofVEGF and Survivin in both eutopic and ectopic endometrium, which indicatedthat the angiogenesis-promoting function of VEGF and theapoptosis-restraining function of Survivin may have a positive synergy, jointlypromoting the occurrence of AM.5. The expression of PEDF was low andSurvivin was high in eutopic and ectopic endometrium. There was a negativecorrelation between the expression of PEDF and Survivin in both eupotic andectopic endometrium, which indicated that these two may have an antagonisticrelation, consequently increased the anti-apoptosis ability of ectopicendometrium and played an crucial role in the ectopic endometrium survivaland the development of AM.