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Endometrial BCL6 Overexpression in Eutopic Endometrium of Women With Endometriosis

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Abstract

The objective of this study was to examine B-cell CLL/lymphoma 6 (BCL6) expression in human eutopic endometrium across the menstrual cycle in women with and without endometriosis and to establish a cutoff for future studies. This design was a series of case-control studies in tertiary University teaching hospitals. We examined BCL6 expression by messenger RNA and immu-nohistochemically in prospectively collected samples in both the proliferative (P) and the secretory phases. BCL6 is minimally increased in the mid-secretory phase of the menstrual cycle compared to the P phase in normal patients. BCL6 protein expression was significantly higher in the secretory phase of patients with endometriosis (n = 29) versus fertile controls without endometriosis at laparoscopy (n = 20; P <.0001). Normal fertile controls (n = 28) recruited for endometrial biopsy also had low levels of secretory phase BCL6 expression compared to women with unexplained infertility (Ul; n = I 19). A receiving-operator characteristic analysis of these data revealed an area under the curve of 94% (95% confidence interval 85%-100%; P <.0001) with an HSCORE cutoff of 1.4 to differentiate cases with and without endometriosis. Using this cutoff value, BCL6 was positive in 88% of cases with Ul. Laparoscopic examination of a subset of 65 patients confirmed abnormalities in 98% of cases; 61 (93.8%) were found to have endometriosis, 3 (4.6%) with hydrosalpinx, and I (1.5%) with a normal pelvis. These data suggest that BCL6 is a promising candidate as a Single diagnostic biomarker for detection of endometriosis in women with otherwise Ul and may be associated with endometrial dysfunction, including progesterone resistance.

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Authors and Affiliations

  1. Obstetrics and Gynecology, University of North Carolina-Chapel Hill, 101 Manning Drive, CB #7570, Chapel Hill, NC, 27514, USA

    Emily Evans-Hoeker MD, Lingwen Yuan PhD & Steven L. Young MD, PhD

  2. Obstetrics and Gynecology, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA

    Emily Evans-Hoeker MD

  3. Obstetrics and Gynecology, Greenville Health System, Greenville, SC, USA

    Bruce A. Lessey MD, PhD

  4. Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI, USA

    Jae Wook Jeong PhD

  5. Department of Women’s Health, Spectrum Health System, Grand Rapids, MI, USA

    Jae Wook Jeong PhD

  6. Departamento de Ginecologia e Obstetricia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Ricardo F. Savaris MD, PhD

  7. Institute for Maternal and Child Research, University of Chile, Santiago, Chile

    Wilder A. Palomino MD

  8. Pathology Associates, Greenville Health System, Greenville, SC, USA

    David P. Schammel MD

Authors
  1. Emily Evans-Hoeker MD
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  2. Bruce A. Lessey MD, PhD
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  3. Jae Wook Jeong PhD
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  7. David P. Schammel MD
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  8. Steven L. Young MD, PhD
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Correspondence to Steven L. Young MD, PhD.

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Evans-Hoeker, E., Lessey, B.A., Jeong, J.W. et al. Endometrial BCL6 Overexpression in Eutopic Endometrium of Women With Endometriosis. Reprod. Sci. 23, 1234–1241 (2016). https://doi.org/10.1177/1933719116649711

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