Evaluation Of Endometrioma Pathophysiology And Related Ovarian Damage By Pten / Akt Apoptosis Signaling Pathway.

To investigate the role and significance of PTEN/AKT apoptosis signaling pathway in the occurrence and changes in ovarian reserve for patients with endometriosis in the manner of ovarian reserve markers. Prospective Cohort Study. This prospective study was conducted at a tertiary University Hospital between May 2019 and April 2020. Patients between 18-38 years old, who underwent cystectomy for benign ovarian pathologies were included in the study. Patients were divided into two groups according to their ovarian pathologies, respectively; endometrioma and the other benign cysts (control). Tissue samples were collected from the cyst wall right after the surgery, and gene expression of PTEN/AKT for the tissue samples were interpreted with real-time PCR analyses. Gene expressions of two groups were compared. Additionally, PTEN/AKT expressions were evaluated between patients with diminished and normal ovarian reserve markers (evaluated with serum Anti-mullerian hormone (AMH) levels and antral follicle counts) for all samples. A total of 40 age matched patients with endometrioma (n=20), and with the other benign ovarian cysts (dermoid, serous, mucinous, hemorrhagic cyst). (n=20) were included for tissue sample evaluation. The mean (SD) age was 31.1 (±5,8) and 31.2 (±6,0) years in endometrioma and other cyst groups respectively (p:0,937). The mean antral follicle count of the endometrioma group was significantly lower than the control group. (p:0,028). In the Endometrioma group, PTEN expression ratio was higher 1,69-fold than the other group with no statistical significance. For AKT gene expression there was a significant 5,99-fold increase in the endometrioma group (p<0.01). When patients totally were divided by diminished versus normal ovarian reserve, the PTEN expression ratio of patients with diminished ovarian reserve was 4,92-fold lower than the normal ovarian reserve group (p<0.01) PTEN expression showed a positive correlation with serum AMH levels overall. (r:0.48, p<0.01). The alteration of PTEN expression may be a vital part of the pathological and physiological mechanisms in endometriosis and related diminished ovarian reserve. However, the potential mechanisms underlying abnormal expression the pathway and its role have not been thoroughly elucidated. In this study, AKT expression was found higher in the endometrioma group. Meanwhile, PTEN expression was lower for DOR patients overall. Our results suggest that these expression alterations for the PTEN/AKT apoptosis signaling pathway should be considered for further investigation for the prevention of endometriomas and related ovarian damage.