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Does dienogest influence the inflammatory response of endometriotic cells? A systematic review

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Abstract

Objective and design

A systematic review of all literature was done to assess the ability of the progestin dienogest (DNG) to influence the inflammatory response of endometriotic cells.

Main outcome measures

In vitro and in vivo studies report an influence of DNG on the inflammatory response in eutopic or ectopic endometrial tissue (animal or human).

Results

After strict inclusion criteria were satisfied, 15 studies were identified that reported a DNG influence on the inflammatory response in endometrial tissue. These studies identified a modulation of prostaglandin (PG) production and metabolism (PGE2, PGE2 synthase, cyclo-oxygenase-2 and microsomal PGE synthase-1), pro-inflammatory cytokine and chemokine production [interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α, monocyte chemoattractant protein-1 and stromal cell-derived factor-1], growth factor biosynthesis (vascular endothelial growth factor and nerve growth factor) and signaling kinases, responsible for the control of inflammation. Evidence supports a progesterone receptor-mediated inhibition of the inflammatory response in PR-expressing epithelial cells. It also indicated that DNG inhibited the inflammatory response in stromal cells, however, whether this was via a PR-mediated mechanism is not clear.

Conclusions

DNG has a significant effect on the inflammatory microenvironment of endometriotic lesions that may contribute to its clinical efficacy. A better understanding of the specific anti-inflammatory activity of DNG and whether this contributes to its clinical efficacy can help develop treatments that focus on the inhibition of inflammation while minimizing hormonal modulation.

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The authors of this review have received no payment in preparation of their manuscript.

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Authors and Affiliations

  1. Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy

    Giovanni Grandi, Angelo Cagnacci & Annibale Volpe

  2. Department of Obstetrics and Gynaecology, Inselspital, Berne University Hospital, Effingerstrasse 102, 3010, Berne, Switzerland

    Michael Mueller, Nick A. Bersinger & Brett McKinnon

  3. Department of Clinical Research, University of Berne, Murtenstrasse 35, 3010, Berne, Switzerland

    Giovanni Grandi, Michael Mueller, Nick A. Bersinger & Brett McKinnon

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  1. Giovanni Grandi
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  2. Michael Mueller
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Correspondence to Brett McKinnon.

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Grandi, G., Mueller, M., Bersinger, N.A. et al. Does dienogest influence the inflammatory response of endometriotic cells? A systematic review. Inflamm. Res. 65, 183–192 (2016). https://doi.org/10.1007/s00011-015-0909-7

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  • DOI: https://doi.org/10.1007/s00011-015-0909-7

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