Increased systemic and peritoneal oxidative stress biomarkers in endometriosis are not related to retrograde menstruation

Araceli Montoya-Estrada,Cynthia F Coria-García,Oliver P Cruz-Orozco,Patricia Aguayo-González,Yessica D Torres-Ramos,Héctor Flores-Herrera,Juan J Hicks,Rafael Medina-Navarro,Alberto M Guzmán-Grenfell

doi:10.1080/13510002.2019.1632603

Abstract

ABSTRACTObjetives: The goal of this study was to determine if systemic and peritoneal oxidative stress biomarkers are related to each other and to retrograde menstruation in endometriosis.Methods: Plasma and peritoneal fluid oxidative stress biomarkers and hemoglobin and erythrocytes in peritoneal fluid as retrograde menstruation indicators, were measured in 28 patients with endometriosis and 23 without endometriosis.Results: In the peritoneal fluid, carbonyls and lipohydroperoxides, indicative of protein and lipid oxidative damage, were higher in endometriosis group (21%, p = 0.016 and 46%, p = 0.009, respectively). However, these biomarkers were not different in the blood plasma of both groups, and only protein dityrosine, was increased in the plasma of endometriosis group (31%, p = 0.04). The peritoneal fluid hemoglobin content was not higher in the endometriosis group, nor related to carbonyls and lipohydroperoxides. Additionally, the peritoneal fluid oxidative biomarkers were not correlated with the blood plasma ones, and only malondialdehyde, and ischemia-modified albumin were almost two times higher in peritoneal fluid.Discussion: Our results show a peritoneal and systemic oxidative stress biomarkers increase in endometriosis, but not related to each other, and do not support the hypothesis of an increase in hemoglobin-iron supply towards the peritoneal cavity that causes oxidative damage.

Highlights

Endometriosis is a gynecological disorder characterized by the growth of endometrial glands and stromal cells outside the uterus, generally in the peritoneal cavity, but it can occur in other places such as the liver, kidney, pleural cavity or bladder [1]
Oxidative stress is a condition that is caused by an imbalance between oxidants (ROS) and antioxidants in favor of the former, which leads to potential damage [4], and this condition has been documented in endometriosis [4,5]
We hypothesized that the inflammatory status of peritoneal cavity associated to endometriosis may oxidize diverse biomolecules, which can cross to the peripheral blood, and contribute to the increase of peripheral oxidative stress biomarkers

Summary

Introduction

Endometriosis is a gynecological disorder characterized by the growth of endometrial glands and stromal cells outside the uterus, generally in the peritoneal cavity, but it can occur in other places such as the liver, kidney, pleural cavity or bladder [1]. One mechanism is likely oxidative stress; that is, the imbalance between the production of reactive oxygen species (ROS) and antioxidant defense, which can result from diminished levels of antioxidants and/or an increased production of ROS, causing oxidative stress-dependent damage to biomolecules and immune inflammatory response [4,5] This condition is likely to exist in the peritoneal cavity because of the retrograde menstruation, an endometrial cells and tissue reflux through fallopian tubes into the peritoneal cavity causing leukocytosis and excessive iron liberated by erythrocyte lysis [6]. There is hard evidence of a large flux of endometrial and leukocyte cells and iron towards the peritoneal cavity by means of retrograde menstruation [8], and that the anatomical distribution of endometriotic lesions shows a linkage with the peritoneal fluid flow [9] It is not clear if the retrograde menstruation is increased in patients with endometriosis. We compared the levels of total proteins and human serum albumin concentrations between blood plasma and peritoneal fluid to determine possible changes in peritoneum permeability associated to endometriosis

Objectives

Methods

Conclusion