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J Clin Endocrinol Metab. 2008 Jun;93(6):2375-82. doi: 10.1210/jc.2008-0136. Epub 2008 Apr 1.

Endometrial inhibin/activin beta-B subunit expression is related to decidualization and is reduced in tubal ectopic pregnancy.

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  • 1Obstetrics and Gynaecology, University of Edinburgh, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, United Kingdom. andrew.horne@ed.ac.uk

Abstract

CONTEXT:

Ectopic pregnancy is common but remains difficult to diagnose accurately. There is no serum test to differentiate ectopic from intrauterine gestation.

OBJECTIVE:

Our objective was to investigate differential gene expression in decidualized endometrium of ectopic pregnancy.

DESIGN:

Tissue and serum analysis informed by microarray study was performed.

SETTING:

The study was performed at a large United Kingdom teaching hospital.

PATIENTS OR OTHER PARTICIPANTS:

Women undergoing surgical termination of pregnancy (n = 8), evacuation of uterus for miscarriage (n = 6), and surgery for tubal ectopic pregnancy (n = 11) were included in the study. Endometrium was collected from normally cycling women undergoing hysterectomy.

INTERVENTIONS:

Decidualized endometrium was subjected to microarray analysis, morphological assessment, and immunohistochemistry. Endometrial stromal fibroblasts were cultured in the presence of decidualizing stimuli.

MAIN OUTCOME MEASURES:

Differential expression of potentially secreted molecules was calculated.

RESULTS:

Inhibin/activin beta-B expression was lower in decidualized endometrium from ectopic pregnancies when compared with that of ongoing pregnancies (P < 0.01) or miscarriages (P < 0.01). The localization of the beta-B subunit was more marked in decidualized than nondecidualized stroma. Decidualization of stromal fibroblasts in vitro was associated with increased beta-B expression (P < 0.05). Endometrial stroma of ectopic pregnancies was less decidualized morphologically (P < 0.05), with lower prolactin (P < 0.01) and IGF binding protein-1 (P < 0.005) expression. Serum activin B was lower in ectopic pregnancies (P < 0.005) than in intrauterine pregnancies, whereas there was no difference in progesterone concentrations.

CONCLUSIONS:

Despite similar concentrations of progesterone, the endometrium of ectopic pregnancies is less decidualized than intrauterine pregnancies. Expression of the beta-B subunit is related to decidualization and can be detected in the circulation as activin B. Serum activin B concentrations are lower in ectopic pregnancy.

[PubMed - indexed for MEDLINE]
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