[Frontiers in Bioscience E3, 648-662, January 1, 2011]

Apoptosis and endometriosis

Fuminori Taniguchi1 Apostolos Kaponis2 Masao Izawa3 Tomoiki Kiyama1 Imari Deura1 Masayuki Ito1 Tomio Iwabe1 George Adonakis2 Naoki Terakawa1 Tasuku Harada1

1Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan, 2 Department of Obstetrics and Gynecology, Patra University Faculty of Medicine, Patra, Greece, 3 Department of Biosignaling, Tottori University Faculty of Medicine, Yonago, Japan


1. Abstract
2. Introduction
3.Molecular basis of apoptosis
3.1. Induction and execution of apoptosis
3.2. Bcl-2 family regulates the mitochondria pathways
4.Apoptosis in the normal endometrium
4.1. Bcl-2 family in normal endometrium
4.2. Fas/FasL in normal endometrium
5. Apoptosis in endometriosis
5.1. Apoptosis of eutopic and ectopic endometrium in endometriosis
5.2.Bcl-2 family in endometriosis
5.3. Fas/FasL system in endometriosis
5.4. Apoptosis in peritoneal macrophages from patients with endometriosis
5.5.Apoptosis in pathophysiology of endometriosis
5.6. Apoptosis and treatment of endometriosis
5.6.1. Hormone treatment
5.6.2. Other therapeutic alternatives


Apoptosis is a distinctive form of programmed cell death resulting in the efficient elimination of cells without eliciting an inflammatory response. Endometriosis is characterized by the presence of endometrial cells with capacity to avoid apoptosis outside the uterus. Apoptosis plays a fundamental role for the pathogenesis of endometriosis. Eutopic endometrium from women with endometriosis has increased expression of anti-apoptotic factor and decreased expression of pro-apoptotic factors compared with endometrium from healthy women. These differences could contribute to the survival of regurgitating endometrial cells into the peritoneal cavity and development of endometriosis. Increased apoptosis of Fas-bearing immune cells in the peritoneal cavity may leads to their decreased scavenger activity that eventually results in prolonged survival of ectopic endometrial cells in women with endometriosis. This study is a current review of the literatures focused on the physiological role of apoptosis in normal endometrium and alterations in regulation of apoptosis in eutopic and ectopic endometrium from women with endometriosis. The role of apoptosis in the treatment of endometriosis is also reviewed.