Ectopic Pregnancy as a Model to Identify Endometrial Genes and Signaling Pathways Important in Decidualization and Regulated by Local Trophoblast

The endometrium in early pregnancy undergoes decidualization and functional changes induced by local trophoblast, which are not fully understood. We hypothesized that endometrium from tubal ectopic pregnancy (EP) could be interrogated to identify novel genes and pathways involved in these processes. Gestation-matched endometrium was collected from women with EP (n = 11) and intrauterine pregnancies (IUP) (n = 13). RNA was extracted from the tissue. In addition, tissues were prepared for histological analysis for degree of decidualization. We compared a) the samples from EP that were decidualized (n = 6) with non-decidualized samples (n = 5), and b) the decidualized EP (n = 6) with decidualization-matched IUP (n = 6) samples using an Affymetrix gene array platform, with Ingenuity Pathway Analysis, combined with quantitative RT-PCR. Expression of PRL and IGFBP1 was used to confirm the degree of decidualization in each group. There were no differences in PRL or IGFBP1 expression in the decidualization-matched samples but a marked reduction (P<0.001) in the non-decidualized samples. Decidualization was associated with increased expression of 428 genes including SCARA5 (181-fold), DKK1 (71-fold) and PROK1 (32-fold), and decreased expression of 230 genes including MMP-7 (35-fold) and SFRP4 (21-fold). The top canonical pathways associated with these differentially expressed genes were Natural Killer Cell and Wnt/b-Catenin signaling. Local trophoblast was associated with much less alteration of endometrial gene expression with an increase in 56 genes, including CSH1 (8-fold), and a reduction in 29 genes including CRISP3 (8-fold). The top associated canonical pathway was Antigen Presentation. The study of endometrium from tubal EP may promote novel insights into genes involved in decidualization and those influenced by factors from neighboring trophoblast. This has afforded unique information not highlighted by previous studies and adds to our understanding of the endometrium in early pregnancy

Chronic low back pain: course of disease from the patient’s perspective

Chronic back pain often leads to permanent disability and—apart from significant human suffering—also creates immense economic costs. There have been numerous epidemiological studies focussing on the incidence and the course of chronic low back pain. Less attention has been paid to the impact of subjective perception of the disease and the degree of healthcare use of these patients. The aim of this study was to gather data about patients with chronic low back pain and compare these data with patients suffering from chronic pain in other body regions. The first 300 pain questionnaires collected by the interdisciplinary pain centre at the University Hospital in Freiburg between January 2000 and September 2001 were analysed. This pain questionnaire is a modified version of the pain questionnaire of the DGSS (Deutsche Gesellschaft zum Studium des Schmerzes—German Chapter of the IASP). It collects demographic and socioeconomic information, as well as information regarding the course of the disease, and the subjective description of pain and the pain-related impairment. The subjective view of the course of disease, shows differences between patients with low back pain and patients with chronic pain of other origin, particularly regarding physical strain as the assumed cause of pain, but also regarding the frequency of prior treatments and cures. The subjective perception of the course of the pain disorder in patients with low back pain compared to patients with chronic pain in other parts of the body shows differences mainly related to the capacity for physical exertion. The frequency of ineffective prior treatments and cures underlines the necessity for early initiation of effective pain treatment aimed at prevention of the pain disorder becoming chronic