Increased expression of antimullerian hormone and its receptor in endometriosis

Capsule:
Endometrium and endometriotic lesions express high levels of antim€ullerian hormone and its receptor, without any contribution to circulatory levels.

Authors:
Patrizia Carrarelli, M.Sc., Ana Luiza Lunardi Rocha, M.D., Giuseppe Belmonte, M.Sc., Errico Zupi, M.D., Mauricio Simoẽs Abrão, M.D., Felice Arcuri, Ph.D., Paola Piomboni, Ph.D., Felice Petraglia, M.D.

Volume 101, Issue 5, Pages 1353–1358

Abstract:

Objective:
To evaluate antimüllerian hormone (AMH) and AMH receptor II (AMHRII) mRNA and protein expression in endometrium and in ovarian or deep lesions of women with endometriosis.

Design:
Prospective study.

Setting:
University hospitals in Italy and Brazil.

Patients:
Patients with endometriosis (n = 55) and healthy women (n = 45).

Interventions:
Specimens of endometrium obtained by hysteroscopy from patients with endometriosis and from healthy control subjects; specimens of ovarian endometriosis (n = 29) or of deep endometriosis (n = 26) were collected by laparoscopy. Serum samples were collected in some endometriotic patients (n = 23) and healthy control subjects (n = 20).

Main Outcome Measure(s):
AMH and AMHRII mRNA levels were evaluated by quantitative reverse-transcription polymerase chain reaction and protein localization by immunohistochemistry. AMH levels in tissue homogenates and in serum were assessed by ELISA.

Result(s):
Endometrium from women with endometriosis showed higher AMH and AMHRII mRNA levels than control women, with no significant differences between proliferative and secretory phases. Specimens collected from ovarian or deep endometriosis showed the highest AMH and AMHRII mRNA expression. Immunolocalization study confirmed the high AMH and AMHRII protein expression in endometriotic lesions. No difference of serum AMH levels between the groups was found.

Conclusion(s):
The increased AMH and AMHRII mRNA and protein expression in endometrium and in endometriotic lesions suggests a possible involvement of AMH in endometriosis.

  • Pedro Da Rocha Olsen

    Carla Regina Schmitz Vigo, M.D.; Pedro da Rocha Olsen; João Sabino Lahorgue da
    Cunha Filho, M.D.

    We have read with great interest the article entitled “Increased expression of anti-Mullerianhormone and its receptor in endometriosis” [1]. The authors have shown in a very convincing way that AMH and AMHII have increased expression in the endometriumand endometriotic lesions of endometriosis patients. We think this study brings an important contribution to the understanding of endometriosis pathogenesis.

    Nevertheless, the study claimed that there was no difference between AMH serum levels of endometriosis and control group. Our group has previously shown that patients with infertility and peritoneal endometriosis have poorer ovarian reserve than
    non-endometriosis patients, by showing they have lower AMH levels [2].

    Furthermore,we have several comments regarding statistics: i) authors demonstrated SEM as a form to show a parametric distribution of their data; ii) sample size
    calculation for AMH was not provided; iii) assuming their data the power was
    0.11 for AMH comparison, In fact, the authors should include 314 patients to
    properly compare serum AMH levels. All parametric data should be expressed as
    means and SD. However, AMH showed a non-parametric characteristic, therefore,
    should be expressed as median and range or interquartile [3].

    To conclude, we have found the paper very helpful to elucidate endometriosis
    pathogenesis. However, we also think it is important to clarify the possible
    mistaken information about serum AMH levels difference between groups.

    1. Carrarelli P, et al. Increased expression of antimullerian hormone and its receptor in endometriosis. Fertil Steril, 2014. 101(5): p. 1353-8.

    2. Lemos NA, et al. Decreased anti-Mullerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis. Fertil Steril, 2008.
    89(5): p. 1064-8.

    3. Rosner B. Hypothesis testing: Two-sampleinference – Estimation of Sample Size and power for Comparing Two means. Rosner B, editor. Fundamentals of Biostatistics. Harvard University: Cengage Learning; 2010. p. 301-4

  • Juan Garcia-Velasco, MD

    Very interesting work, Prof Petraglia. Still enigmatic on how this relates to plasma AMH, levels tend to be lower in women with ovarian endometriosis as ovarian reserve is usually compromised. However, do you think this may make a promising marker for the disease, or even a distinctive marker for adenomyosis? Thanks!

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