Role of angiogenesis in endometrial repair of patients with severe intrauterine adhesion

Abstract

Objective: To detect vascular endothelial growth factor (VEGF) expression and micro-vessel density (MVD) in patients with severe intrauterine adhesion before and after therapy, and to preliminarily explore the role of angiogenesis in the therapy of severe intrauterine adhesion.

Methods: A total of 36 patients with severe intrauterine adhesion were prospectively recruited into the treatment group. In the control group, 20 patients with normal uterine were recruited. Patients with severe intrauterine adhesion received transcervical resection of adhesions under hysteroscope and then received artificial hormone therapy for 3 months.

Methods: The changes in the organelles of endometrial cells were evaluated under an electric microscope; Immunohistochemistry was done to detect the VEGF expression and MVD in patients with severe intrauterine adhesion, which was compared with that in the control group; VEGF expression and MVD were compared among patients with different prognoses.

Results: Electric microscopy showed vascular closure and hypoxic changes in the endometrial tissues of patients with intrauterine adhesion. After treatment, angiogenesis was observed, and the hypoxic changes in the endometrial glands and interstitium were also improved. Moreover, the VEGF expression and score of MVD also increased significantly when compared with those before treatment and in the control group. The VEGF expression and MVD score in intrauterine adhesion patients recovering from treatment were significantly higher than those in patients non-responding to treatment.

Conclusion: In patients with intrauterine adhesion, the endometrial tissues present with vascular closure, and angiogenesis will be present in the endometrial tissues after treatment. The angiogenesis in the endometrial tissues may affect the endometrial repair.

Keywords: Intrauterine adhesion; angiogenesis; micro-vessel density; vascular endothelial growth factor.

Figures

Figure 1

A: Evident expansion of endoplasmic reticulum, loss of ribosome, swelling of mitochondria, shortening and reduction in mitochondrial cristae, and vacuolized mitochondria; B: In the matrix, the capillaries were closed and presented with stenosis, no blood cells were found in the capillaries, the tight junction between endothelial cells was evident, and a large amount of collagens surrounded the blood vessels; C: The endoplasmic reticulum in the fibroblasts expanded and a large amount of collages surrounded these fibroblasts.

Figure 2

A: the morphology of endoplasmic reticulum and mitochondria was nearly normal in the glandular epithelial cells. B: There were newly generated capillaries, the tight junction between endothelial cells was evident, the nucleus of endothelial cells was large, and these cells were rich in euchromatin.

Figure 3

A: VEGF expression in the endometrium of IUA patients (IHC; ×40, scare bar: 100 μm); B: VEGF expression in the endometrium of IUA patients (IHC; ×100, scare bar: 30 μm).

Figure 4

A: VEGF expression in the normal endometrium (IHC; ×40, scare bar: 100 μm); B: VEGF expression in the normal endometrium (IHC; ×100, scare bar: 30 μm).