Persistent Pelvic Adhesions and Fibrotic Remodeling Following Ectopic Lesion Ablation in a Mouse Model of Endometriosis.
Yun Sohyeon S, So Kyeong A KA, Jeong Eunhee M EM, Hoover Marissa G MG et al.
Endometriosis is a chronic, estrogen-dependent inflammatory disorder characterized by ectopic endometrial-like lesions, fibrosis, and persistent pelvic pain. Although ectopic lesions are important contributors to pain, symptom severity often correlates poorly with lesion burden, suggesting lesion-independent mechanisms. Here, we investigated the contribution of ectopic lesion-derived cells to persistent pelvic adhesions, fibrotic remodeling, and endometriosis-associated behavioral alterations using a mouse model. A syngeneic model combined with inducible diphtheria toxin receptor (iDTR)-mediated cell ablation was used to selectively eliminate donor-derived progesterone receptor-expressing ectopic cells. Endometriosis was induced by transplantation of uterine tissue from Pgrcre/+Rosa26iDTR/mTmG donor mice into recipients, followed by diphtheria toxin-mediated lesion ablation. Lesion burden, pelvic adhesions, and fibrotic remodeling were assessed by imaging, histology, and molecular analyses, while behavioral outcomes were evaluated using non-evoked assays. Selective ablation eliminated detectable GFP-positive ectopic lesions. Histological and molecular analyses demonstrated significantly reduced collagen deposition and α-SMA-positive fibrotic remodeling within adhesion-associated tissues relative to established ectopic lesions, although these measures remained elevated above sham controls. However, despite lesion ablation, no statistically significant differences were detected between DT- and vehicle-treated mice in nesting or marble-burying performance, although the modest cohort size may have limited detection of partial behavioral effects. These findings indicate that, although fibrosis in adhesion-associated tissues was reduced relative to established ectopic lesions, residual fibrotic remodeling persisted above sham levels, whereas behavioral outcomes showed variable responses without a significant, uniform reversal, highlighting the potential importance of targeting fibrotic and adhesive remodeling in addition to ectopic lesions.