Heparin is a promising agent for the treatment of endometriosis-associated fibrosis

Objective: To assess the use of heparin for the medical treatment of endometriosis-associated fibrosis. Design: The effects of heparin on the endometriotic stromal cells (ECSCs)-mediated contractility were investigated. Setting: Research laboratory at a medical school. Patient(s): Endometriotic tissues from nine patients were used. Intervention(s): Endometriotic stromal cells were cultured three dimensionally in the presence of heparin. Main Outcome Measure(s): The contractility of ECSCs was assessed by collagen gel contraction assay. Heparininduced morphological changes of ECSCs were evaluated by laser scanning microscopy. The expression of contractility-related molecules in ECSCs was examined by Western blot analysis. Result(s): In the presence of 10% fetal bovine serum, treated ECSCs showed significant collagen gel contractility (75.9% decrease in surface area after 48 hour vs. 0 hour controls). Endometriotic stromal cell-mediated gel contraction was significantly attenuated in the presence of heparin in a dose-dependent manner (55.7% reduction of the gel contraction at a concentration of 100 mu g/mL of heparin sodium versus untreated controls after 48 hours). Heparin suppressed the ECSC attachment to collagen fibers. The expression of alpha-smooth muscle actin, Ras homology (Rho) A, Rho-associated coiled-coil-forming protein kinase (ROCK)-I, and ROCK-II was down-regulated by heparin administration. Conclusion(s): The present study suggests that heparin is a promising agent for the treatment of endometriosis-associated fibrosis. The inhibition of myofibroblastic differentiation, the attenuation of attachment to collagen fibers, and the suppression of Rho-ROCK-mediated pathway activation in ECSCs are involved in the action mechanisms of heparin. (Fertil Steril (R) 2010;94:46-51. (C) 2010 by American Society for Reproductive Medicine.)