Matrix-Metalloproteinasen (MMPs) und deren Bedeutung für die Menstruation und Endometriose

Zusammenfassung

Die Endometriose ist neben der Ausbildung von Myomen die häufigste benigne proliferative Erkrankung der Frau im reproduktionsfähigen Alter. Obwohl die Entstehung als auch das weitere Wachstum von Endometrioseherden durch ovarielle Steroide wesentlich beeinflusst wird, ist die genauere Pathogenese dieser Erkrankung nach wie vor ungeklärt. Da der bereits vor 70 Jahren postulierte Mechanismus der retrograden Menstruation auch bei einer Vielzahl von gesunden Patientinnen beobachtet werden kann, dürfte die Implantations- und Invasionsfähigkeit von ektopen Endometriumzellen entscheidend für die Entstehung der Endometriose sein. In diesem Zusammenhang zeigen morphologische, immunologische und biochemische Untersuchungen eine direkte Korrelation zwischen Vorhandensein und Wachstum von Endometriose und der Expression von extrazellulärer-Matrix auflösenden Enzymen, so genannten Matrix-Metalloproteinasen, welche auch im Rahmen der Menstruation wesentlich an der Abstoßung des Stratum functionale beteiligt sind. Die Aktivität von MMPs wird hauptsächlich durch ovarielle Steroide und die lokale Sekretion von Zytokinen reguliert. Das Verständnis und die weitere Erforschung dieser und anderer assoziierter Substanzklassen kann weiter zur Klärung der Pathogenese der Endometriose beitragen und auf mögliche medikamentöse Therapieansätze hinweisen.

Abstract

Endometriosis is one of the most common benign proliferative disorders of the female genital tract and occurs in up to 20 % of women, leading to symptoms such as chronic pelvic pain, dyspareunia, dysmenorrhea but also sterility. Although retrograde menstruation represents a plausible explanation for the development of endometriosis, several additional factors have to contribute to the establishment, invasion and growth of endometriotic lesions since endometrial cells spilled into the peritoneal cavity can also be detected in the majority of women without evidence of disease. Within this, the ability of endometrial tissue to implant and invade the peritoneal surfaces and underlying tissues appears to be a pathogenic key mechanism for the growth of endometrium outside the uterine cavity. Matrix metalloproteinases (MMPs) constitute a group of enzymes that not only mediate physiologic tissue turnover such as endometrial breakdown at menstruation, but also have been shown to play important roles in the development of invasive and destructive diseases. The altered regulation of endometrial MMPs has therefore also been associated with the pathogenesis of endometriosis, linking the invasive potential of refluxed endometrium to the adhaesion and growth of endometriotic cells. The aim of present work is to review the role of MMPs in processes of menstruation and development of endometriosis.

Endometriose - Gewebsauflösung - MMP - Zytokine - Wachstum

endometriosis - menstruation - tissue degradation - MMPs

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