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DOI: 10.1055/s-2001-16282
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
Die implantationsgerechte Lutealphase des Endometriums.
Zum Stand der molekularen und zellbiologischen Forschung
The receptive luteal phase of the endometrium. Current aspects of molecular and cell biological research
Publication History
Publication Date:
31 December 2001 (online)
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Zusammenfassung
Biologisch ist die Reifung des Endometriums in jedem Zyklus darauf gerichtet, einer Blastozyste günstige Bedingungen für die Implantation zu bieten. Infertilität und frühes Ende einer Schwangerschaft beruhen nicht selten auf einer unvollkommenen Reifung des Endometriums. Bereits eine mangelhafte Rezeptivität des Endometriums führt zum Scheitern der Implantation. Um die endometriale Ursache einer Infertilität zu erkennen, werden die normalen zyklischen Veränderungen des Endometriums studiert. Morphologische VerÌnderungen bilden bis heute in diesem Bemühen der Gynäkologen noch die Grundlage der klassischen histologischen Diagnostik nach Noyes et al. Da jedoch evident ist, dass molekulare Defizite des Endometriums sich nicht unmittelbar histologisch erfassen lassen, werden neue Methoden und signifikante Parameter gesucht, die diese Art funktioneller Defekte diagnostisch erfassen lassen. Histochemische Lokalisierungen von definierten Proteinen, von Adhäsionsmolekülen und Zytokinen, erlauben bereits eine detailliertere und aussagekräftigere molekulare Analyse, als es die klassische Morphologie ermöglicht. Überzeugende Argumente sprechen inzwischen dafür, mit einfachen biochemischen Analysen die Proteine des Uterussekrets als weitergehende signifikante Parameter zu nutzen. Die elektrophoretische Auftrennung des Uterussekrets ergibt typische Proteinmuster, welche die zyklischen Funktionsphasen des Endometriums darstellen. Das adäquate Proteinmuster der Lutealphase ist als das Produkt eines rezeptiven Endometriums zu betrachten und repräsentiert das für diese molekulare Analytik charakteristische „Implantationsfenster”. Es wird bereits 2 Tage post ovulationem exprimiert und bei ungestörtem Zyklusverlauf acht Tage aufrechterhalten (15. bis 24. Zyklustag).
The receptive luteal phase of the endometrium. Current aspects of molecular and cell biological research
Summary
The biological aim of the differentiation and maturation of endometrial tissue compartments during any menstrual cycle is the achievement of suitable conditions for blastocyst implantation and the establishment of pregnancy. Infertility and early embryonic loss are frequently caused by insufficient endometrial differentiation. Even any incomplete receptivity stage of the luteal phase endometrium will prevent attachment and implantation. We have studied the physiological changes throughout an endometrial cycle to elucidate causes of endometrial insifficiencies leading to subfertility or infertility. Up to now, the histological changes described by Noyes et al. are understood as classical diagnostic approaches. However, evidence is accumulating that molecular deficits of endometrial differentiation are by no means detectable histologically, and consequently ask for the research on new diagnostic methods and parameters. There are histochemical localizations of specific protein molecules, adhesion molecules and cytokines, which permit by far more detailled and significant molecular analyses than any classical morphological means could yield. Moreover, there are convincing arguments to use further biochemical assessments on proteins of the uterine secretions as specific diagnostic parameters. The electrophoretical resolution presents typical protein patterns, which in turn can be interpreted as characteristic reflexions of the functional phases of the endometrial cycle. What is demonstrated as the so-called adequate luteal phase protein pattern clearly is the product of the receptive endometrium, reflecting the “implantation window”. This is established already two days after ovulation and persists usually eight further days, if the endometrial cycle is undisturbed (15th to 24th day of the cycle).
Schlüsselwörter
Endometrium - Implantation der Blastozyste - Uterussekretproteine - Uteroglobin - Zytokine - Leptin/Leptinrezeptor
Key words
Endometrium - Implantation of the blastocyst - Uterussekretproteine - Uteroglobin - Cytokines - Leptin/Leptinreceptor
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Prof. Dr. med. Dr. rer. nat. Henning M. Beier
Institut für Anatomie und Reproduktionsbiologie
Medizinische Fakultät, Universitätsklinikum der RWTH Aachen
Wendlingweg 2
D-52057 Aachen