The Implication of Angiogenesis in Endometriosis

Endometriosis is a common gynecological condition, associated with significant morbidity and having a strong social-economic impact. The widely accepted etiopathogenetic factor at the basis of endometriosis is the cyclical arrival of endometrial cells into the abdominal cavity through retrograde flux at menstruation. However, the endometriotic implants need neovascularization in their process of proliferation and invasion into ectopic sites within the host. Recent data suggest that the development and subsequent growth of endometriotic lesions is strongly influenced by the balance of local pro-antiangiogenic factors, a concept which is also widely accepted in tumor growth. In fact, various proand antiangiogenic molecules have been reported in the lesions and the peritoneal fluid of women. Out of all these molecules, VEGF proved to be the prototypical, most potent and most highly regulated endothelial cell mitogen among the angiogenic proteins synthesized by endometrial and endometriosis cells, as well as by the activated peritoneal macrophages and neutrophils. Thus, identifying the molecular mechanisms of angiogenesis and vasculogenesis in endometriotic lesions will lead to new, promising therapeutic approaches in this disease, such as antiangiogenic drugs.