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Semin Reprod Med 2020; 38(02/03): 201-215
DOI: 10.1055/s-0040-1713429
Review Article

Cellular Origins of Endometriosis: Towards Novel Diagnostics and Therapeutics

Caitlin E. Filby
1   The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
,
Luk Rombauts
2   Department of Obstetrics and Gynaecology, Monash University, Reproductive Medicine at Women's Health, Monash Health, Monash IVF, Melbourne, Victoria, Australia
,
Grant W. Montgomery
3   UQ Genome Innovation Hub, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
,
Linda C. Giudice
4   Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Reproductive Sciences, University of California, San Francisco, California
,
Caroline E. Gargett
1   The Ritchie Centre, Hudson Institute of Medical Research, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
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Abstract

Endometriosis remains an enigmatic disease of unknown etiology, with delayed diagnosis and poor therapeutic options. This review will discuss the cellular, physiological, and genomic evidence of Sampson's hypothesis of retrograde menstruation as a cause of pelvic endometriosis and as the basis of phenotypic heterogeneity of the disease. We postulate that collaborative research at the single cell level focused on unlocking the cellular, physiological, and genomic mechanisms of endometriosis will be accompanied by advances in personalized diagnosis and therapies that target unique subtypes of endometriosis disease. These advances will address the clinical conundrums of endometriosis clinical care—including diagnostic delay, suboptimal treatments, disease recurrence, infertility, chronic pelvic pain, and quality of life. There is an urgent need to improve outcomes for women with endometriosis. To achieve this, it is imperative that we understand which cells form the lesions, how they arrive at distant sites, and what factors govern their ability to survive and invade at ectopic locations. This review proposes new research avenues to address these basic questions of endometriosis pathobiology that will lay the foundations for new diagnostic tools and treatment pathways.

Keywords

endometriosis - retrograde menstruation - pathogenesis - stem/progenitor cells - endometrial waves

Authors' Contributions

C.E.F. and C.E.G. defined the scope of the review. L.C.G., G.M., and L.R. advised on the scope of the review and contributed to the interpretation of the literature. L.C.G. and L.R. provided input from a clinical perspective. G.M. provided input on the genomics sections. C.E.F. drafted the review. All authors edited and approved the final manuscript.




Publication History

Article published online:
11 November 2020

© 2020. Thieme. All rights reserved.

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