Expression of Cannabinoid Receptors in Myometrium and its Correlation With Dysmenorrhea in Adenomyosis
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Expression of Cannabinoid Receptors in Myometrium and its Correlation With Dysmenorrhea in Adenomyosis
Reproductive Sciences 1-8 ยช The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1933719119833483 journals.sagepub.com/home/rsx
Xue Shen, MD1, Hua Duan, MD, PhD1 , Sha Wang, MD, PhD1, Wei Hong, MD2, Yu-Yan Wang, MD1, and Si-Li Lin, MD1
Abstract The myometrium, especially the junctional zone (JZ), is now well documented to have a role in the pathogenesis of adenomyosis. Cannabinoid receptors have been shown to participate in the establishment of endometriosis and its pain perception. However, its relation to adenomyosis has not been identified yet. The aim of this study was to investigate the expression of cannabinoid receptor type I (CB1) and type II (CB2) in myometrium of uteri with and without adenomyosis and determine the correlation between their levels and clinical parameters of adenomyosis. We collected tissue samples of JZ and the outer myometrium from 45 premenopausal women with adenomyosis and 34 women without adenomyosis. CB1 and CB2 messenger RNA (mRNA) and protein expression levels were evaluated by the use of Western blotting and real-time quantitative polymerase chain reaction from all samples. Clinical information on the severity of dysmenorrhea and other data were collected. We found both CB1 and CB2 mRNA and protein levels in women with adenomyosis were significantly higher than those of controls, and CB1 expression levels in JZ were positively correlated with the severity of dysmenorrhea. These data suggest that cannabinoid receptor CB1 may be involved in the pathogenesis of dysmenorrhea in adenomyosis and may be a potential therapeutic target. Keywords adenomyosis, endometriosis, dysmenorrhea, myometrium, cannabinoid receptor
Introduction Adenomyosis is a common chronic gynecological disorder characterized by symptoms of dysmenorrhea, abnormal uterine bleeding, and infertility.1 It refers to the presence of endometrial islands and stroma within the myometrium, while endometriosis is defined as the endometrial tissue outside the uterus. Owing to the lack of standard diagnostic criteria, the precise incidence of adenomyosis is unknown; correspondingly, its prevalence has been reported to vary widely from 5% to 70%.2 Although people have been paying great attention to adenomyosis, it remains an enigmatic disease without an adequate understanding of either its etiology or its physiopathology. Therefore, continued research based on its pathogenesis is needed urgently at present.3 As for the pathogenesis of adenomyosis, much of our understanding derives from studies on the eutopic and ectopic endometrium of uteri with adenomyosis, while many basic questions on it still remain unknown. In the recent years, with advances on magnetic resonance imaging as a noninvasive diagnostic technique for adenomyosis, the myometrium, especially the junctional zone (JZ; also known as the endometrial-myometrial interface or subendometrial myometrium) is now well documented to h
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