Expression And Roles Of Estrogen Receptor-related Receptor Alpha(ERRα) In Ovarian Endometriosis

Objective: The aims of this study were to investigate the expression of estrogen receptorrelated receptor alpha(ERRα)in patients with ovarian endometriosis,to explore the relationship between ERRα and the development of ovarian endometriosis,and to assess the value of ERRα in the progression of ovarian endometriosis.Methods: In the study group,a total number of 47 cases with ovarian endometriosis confirmed by histology were recruited from Fujian Provincial Maternity and Children’s Hospital from January 2016 to May 2017.The ectopic endometria and corresponding eutopic endometria were collected from all the cases.The cases were further divided into three subgroups: mild(stage I,II),moderate(stage III)and severe(stage IV)stages according to the revision of endometriosis staging;and were divided into two subgroups: proliferating stage and secretory stage according to the history of menstruation and the histological examination.In the control group,normal endometria were collected from 32 patients without endometriosis and malignant tumors.Sera were collected from all subjects before surgery.RNA was extracted from each endometrium tissues.1.The expression levels of ERRα mRNA in different tissues of each groups was detected by fluorescence quantitative PCR.2.The levels of serum ERRα and HE4 were measured by ELISA,and the levels of serum CA125 and CA199 were detected by chemiluminescence immunoassay.3.The different levels of ERRα expression among different parts in the study group and the control group and the different levels of ERRα expression among various subgroups were analyzed.The roles of serum CA125,CA199,HE-4 alone and their combination with ERRα in the development of ovarian endometriosis were assessed.Results1.Our study showed that the expression level of ERRα mRNA in ectopic endometrial tissue(0.650±0.431)was significantly lower than that in eutopic endometrium(1.025±0.342)in the study group and the normal endometrium in the control group(1.000±0.313)(P < 0.05).There was no statistical difference in the expression of ERRα mRNA between the eutopic endometrial tissue in the study group and that of normal endometrium in the control group(P > 0.05).2.The ratio of ectopic endometrium ERRα mRNA to eutopic endometrium in the study group was significantly different among the mild stage(I,II)(0.99±0.37),stage III(0.66±0.23)and stage IV(0.52±0.18)(P < 0.05).That is,the ratio of ectopic endometrium ERRα mRNA to eutopic endometrium decreased as the stages rose.There was no remarkable difference in the ratio of ectopic endometrium ERRα mRNA to eutopic endometrium in different menstrual cycles subgroups(P > 0.05).3.The serum ERRα levels in the study group(0.679±0.121)ng/ml was significantly lower than those in the control group(1.000±0.337)ng/ml(P < 0.05).In consistent with the mRNA levels,the serum ERRα levels were different in the mild stage(I,II)(1.000±0.422)ng/ml,stage III(0.711±0.346)ng/ml and stage IV(0.606±0.217)ng/ml(P < 0.05).4.The serum CA125 levels,ratio of CA125 to ERRα,serum CA199 levels and ratio of CA199 to ERRα in the study group were significantly higher than those in the control group.(P < 0.05).5.The serum CA125 and ratio of CA125 to ERRα increased as the stages rose in the study group(P < 0.05).The serum CA199 and ratio of CA199 to ERRα in patients at stage IV was significantly higher than that in mild stage(I,II)and stage III(P < 0.05),while there was no significant difference between mild stage(I,II)and stage III(P > 0.05).6.There was no statistical difference in the serum HE-4 levels between the study group and the control group(P > 0.05),while the ratio of HE-4 to ERRα in the study group was remarkable higher than that of the control group(P < 0.05).There was no statistical difference in the serum HE-4 levels among different stages(P > 0.05),while the ratio of HE-4 to ERRα in patients at stage IV was significantly higher than that at mild stage(I,II)(P < 0.05).7.Serum ERRα was negatively correlated with CA125 with a r value of-0.394 in the study group(P < 0.05).And there was no correlation between CA199 and HE-4(P > 0.05).Conclusions1.The level of ERRα is correlated with the development of ovarian endometriosis.To a certain extent,it can reflect the severity of disease and can be used to be a biomarker for evaluating the progression of ovarian endometriosis.2.The serum CA125 and CA199 levels are positively associated with the severity and the progression of ovarian endometriosis.3.The ratio of HE-4 to ERRα is positively related with the progression of ovarian endometriosis,while HE-4 alone is not.4.ERRα is negatively correlated with CA125 in ovarian endometriosis.