The Expression Of Toll-like Receptors In Eutopic And Ectopic Endometrium And Its Implication In The Inflammatory Pathogenesis Of Adenomyosis

Objective: To investigate the expression profiles of Toll-like receptors(TLRs)in eutopic endometrium(EU)and ectopic endometrium(EC)and its implication in the inflammatory pathogenesis of adenomyosis.Methods: A total of 24 adenomyosis patients who underwent laparoscopy were recruited in this study.Before surgery,the patients were interviewed personally with respect to the sociodemographic characteristics and clinical symptoms.The m RNA and protein expressions of TLRs,and the m RNA expression of IL-6 and IL-8 in EU and EC of adenomyosis patients,and the control endometrium without adenomyosis(CE)from healthy women were detected by RT-PCR and Western blot.Intragroup differences were investigated using Student t test.Correlations of the expression of TLRs with the inflammatory pathogenesis and clinical features of adenomyosis for each group were determined using Pearson correlation coefficient.Results:(1)The m RNA expression of IL-6,IL-8 in EU was significantly higher than that in CE,and was the highest in EC(P<0.01).The m RNA expression of TLR1-6,8,9 in EU was significantly higher than that in CE(P<0.05 or P<0.01),and were the highest in EC except TLR2(P<0.01).The m RNA expression of TLR7 in EU was significantly higher than that in CE(P<0.05),but there was no significant difference in TLR7 expression between EC vs CE,EU vs EC.The protein expression of TLR1,2,4-6,8,9 in EU was significantly higher than that in CE(P<0.05 or P<0.01),and were the highest in EC except TLR2(P<0.01).The protein expression of TLR3,7 in EC was significantly higher than that in EU and CE(P<0.05),but there was no significant difference between EU vs CE.(2)Pearson correlation analysis showed that the expression of TLR2,4 and 5 in EU and EC was positively correlated with that of IL-6 and IL-8(P<0.01 or P<0.05).(3)Patients were divided into several subgroups according to the clinical features:(a)The gene and protein expression of TLRS in severe dysmenorrhea group was significantly higher than that in minimal and moderate dysmenorrhea group in EU(P<0.01).The protein expression of TLRS was significantly increased in severe dysmenorrhea group in comparison to minimal dysmenorrhea group in EC(P<0.01).(b)The gene and protein expression of TLRS in menorrhagia group were significantly higher than that in normal group in EU(P<0.01 or P<0.05).The protein expression of TLRS was significantly increased in menorrhagia group in comparison to normal group in EC(P<0.05).Conclusions: Our results showed that adenomyosis was a state of inflammatory pathology.Rises in dysmenorrhea and menstrual capacity paralleled increase in the expression of TLRs,and high expression of TLRs in EU and EC were positively correlated with IL-6 and IL-8,which may be involved in the inflammatory pathogenesis of adenomyosis.