Proliferative and apoptotic changes in the healthy canine endometrium and in cystic endometrial hyperplasia

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Proliferation and apoptosis play an important role in cyclic changes in the healthy canine endometrium. Proteins of the Bcl-2-family are known to be involved in the regulation of apoptosis. However, only few reports mention their expression patterns during cystic endometrial hyperplasia (CEH). In order to correlate proliferative and apoptotic processes, expression of the apoptosis-regulatory proteins Bcl-2 (anti-apoptotic) and Bax (pro-apoptotic) in healthy and cystic hyperplastic endometrial tissue as well as in pyometra was investigated. Uteri from 33 bitches were assigned to three groups: group 1 - healthy endometrium (n = 12), group 2 – CEH (n = 17) and group 3 - pyometra (n = 4). Markers for proliferation (Ki-67) and apoptosis (activated caspase-3 and TUNEL-method) as well as expression of Bcl-2 and Bax were determined in all endometrial layers. For groups 1 and 2 this was done during endometrial gland secretion in mid and late luteal phase (mLP, lLP), endometrial reparation in early anestrus (eAE) and in the regenerated endometrium in late anestrus (lAE). For group 3 only the late luteal phase was investigated.In group 1, cyclic proliferation patterns were found predominantly in superficial glands (SG) and stroma, whereas progesterone-mediated low expression levels coincided with high apoptosis rates in the basal glands (BG). In eAE, higher apoptotic activity was detected compared to lLP and lAE. Bcl-2 and Bax expression levels showed an inverse cyclic relationship in all tissue layers. In the stroma, in eAE, a rise in proliferative activity and concomitant increase in anti-apoptotic Bcl-2 expression levels was found, indicating that this layer serves as a source for endometrial regeneration.In CEH, no or limited cyclic patterns of proliferation, apoptosis, Bcl-2 and Bax were found. Increased proliferation rates coincided with deregulated apoptosis. Besides the glandular compartments, the stroma played an important role in the pathogenesis of canine CEH. In case of pyometra, both proliferation and apoptosis increased, indicating irreversible damage of the inflamed canine endometrium.In conclusion Bcl-2 and Bax play a role both in the physiological regenerative processes of the cyclic canine endometrium and in deregulating proliferation and apoptosis in CEH and pyometra.