Endometrial cells can originate from donor-derived bone marrow cells

07/02/04

New Haven, Conn. -- Donor derived endometrial cells were detected in biopsy samples of four women who received bone marrow transplants to treat leukemia, according to a Yale study published in the Journal of the American Medical Association.

This is the first known report of circulating stem cells of extrauterine origin differentiating into human endometrial tissue and contributing to endometrial regeneration, said the author, Hugh Taylor, M.D., associate professor in the Division of Reproductive Endocrinology at Yale School of Medicine and attending physician in the section of Reproductive Endocrinology in the Department of Obstetrics and Gynecology at Yale-New Haven Hospital.

"These preliminary findings suggest that bone marrow-derived cells can generate endometrium, which may have clinical implications for establishing and maintaining pregnancy and treating uterine disorders, such as abnormal uterine bleeding, infertility, endometriosis and cancer," Taylor said.

Endometriosis affects up to 15 percent of women of reproductive age and consists of endometrial tissue outside of the uterus, which causes pain and infertility. The findings in this paper suggest a new theory for the etiology of endometriosis, which is that it may arise from ectopic differentiation of stem cells, rather than just retrograde flow through the fallopian tubes, Taylor said.

In this study, four women of reproductive age received marrow from a related donor who had a single mismatched antigen and therefore had an HLA (human leukocyte antigen) type that allowed determination of the origin of any cell. HLA are the markers used for tissue typing and organ transplant. They vary considerably from one person to another and can be used to determine if a cell's origin is from the donor or the recipient.

Endometrial biopsies were performed on each of the women with leukemia. An equal number of endometrial biopsies were obtained from healthy women of similar age who had not undergone bone marrow transplants, but none of their biopsies showed evidence of a discrepant HLA type.

Taylor said the findings also may explain the high failure rate of alternative procedures to a hysterectomy, or complete removal of the uterus. "Even if the alternative method is done perfectly and every endometrial cell is destroyed, based on this finding, the cells can come back," Taylor said.

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