Yu Yu

Dr. Yu holds her Ph.D. in experimental pharmacology from University of Sydney, Australia and was a postdoctoral research fellow at Gynecologic Pathology Laboratory at the Johns Hopkins University School of Medicine. She was the previous recipient of Outside-the-Box Grant from the HERA Women’s Cancer Foundation and Ann Schreiber Mentored Investigator Award from Ovarian Cancer Research Foundation. Dr. Yu is currently a senior research fellow at the School of Pharmacy and Curtin Health Innovation Research Institute, Curtin University, Western Australia where her studies focus on therapeutics and biomarkers development for gynecological conditions.

Estrogen Receptors and Endometriosis: What do we know now?

It has been well known that endometriosis is closely associated with steroid hormone metabolism and pathways. Estradiol promotes the growth and progression of endometriotic tissue, together with the associated inflammation and pain-related symptoms. Excess estradiol in endometriosis is mainly produced locally by the endometriotic tissue. This is because of the higher expression of critical enzymes for estrogen biosynthesis in endometriotic tissue, including aromatase (CYP19A1) and steroidogenic acute regulatory protein (StAR). Unlike in endometriosis, normal endometrium does not have the ability…

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Opioids use in women with endometriosis, what does it tell us?

Endometriosis is a debilitating disease that can cause many painful symptoms such as dysmenorrhea, dyspareunia, infertility, chronic pelvic pain, abdominal pain, and sacral or low back pain. More than half of women diagnosed with endometriosis suffer from chronic pelvic pain. With the high frequency, health, societal, and economic burden, there are still limited medications that can effectively manage pain associated with endometriosis. Opioids are not clinically recommended for treating endometriosis pain as they have not been truly shown to be…

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White blood cell neutrophils link to immunosuppressive environment in ovarian endometrioma

Recently the contribution of neutrophils to the pathogenesis of endometriosis has been suggested. Several observations fuelled this suggestion, such as the accumulation of neutrophils in the peritoneal fluid of ovarian endometriosis; neutrophil extracellular traps were found in the peritoneal fluid of endometriosis patients; neutrophil regulation of cyclical endometrial vascular proliferation in human endometrium and neutrophil depletion reduced the severity of endometriotic lesions. So what are neutrophils? Neutrophils are white blood cells that form the first line of immune defense against microbial…

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Progressive nature of ovarian endometrioma

The effective management of endometriosis requires a proper understanding of how the condition progress as women age, especially for those women with early onset of endometriosis. Several studies have tried to characterize the evolution of endometriosis. Some of the key features that may convey about the history of ovarian endometriomas are color, size, and to a smaller extent, the invasion depth of the lesion. However, these factors are not always accurate. Previous studies suggested that asymptomatic endometriosis was rarely progressive,…

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Oxidative stress leads to elevated cytokines, excessive structural damage and angiogenesis

Endometriosis is characterized by elevated intracellular reactive oxygen species, which is then believed to upregulate inflammatory cytokines. Reactive oxygen species also regulate the activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), which is closely linked with immune responses.  Cytokines, which are secreted by immune cells, are produced by endometriotic implants, where they appear to have crucial roles in the development and progression of endometriosis.  Cytokines may induce degradation of the extracellular matrix, which is carried out by matrix…

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Fertility and Oxidative Stress

One of the characteristics of endometriosis is oxidative stress caused by an imbalance between the production of reactive oxygen species and their resolution by antioxidants. Increased oxidative stress can lead to the damage of proteins, lipids, DNA and other molecules. While current observation suggests that women with endometriosis have reduced fertility, the mechanisms for this, and the relation to oxidative stress is not clearly understood. Thus, it is difficult to develop effective pharmaceutical treatments to improve the natural fertility of…

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Endometrioma, follicular fluid, oocyte and embryo

It is estimated that infertility occurs in more than one-third of women with endometriosis. How endometriosis affects fertility, however, is not clearly known. The follicular fluid provides a microenvironment for oocyte development and impacts embryo quality. Thus, it is believed that changes in the composition of follicular fluid could affect fertility. The study by Yland et al. from the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, was published in Reproductive BioMedicine Online Journal and hypothesized that…

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Understanding endocannabinoid system in endometriosis

Endocannabinoids and their receptors are expressed throughout the body but have only been recently studied in depth since endocannabinoids were being discovered in 1992. In the female reproductive system, the cannabinoid receptor is expressed in the endometrium, the myometrium, the ovarian cortex, and the medulla and the uterine tubes, with functions in the menstrual cycle, ovarian maturation, embryo transplantation, and implantation. In addition, the endocannabinoid system has been shown to affect cell migration, cell proliferation, cell survival, and inflammation, which…

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Strength exercise may not be helpful for the management of endometriosis-related pain

Women with endometriosis often suffer from pelvic pain, although the disease severity is not correlated with pain intensity. Research in pain symptoms suggests that several neuromodulatory events are involved, including reduced peripheral induced pain thresholds and significant changes to the central nervous system. Interestingly, recent studies also suggested that physical exercise can reduce clinical pain. Reduced sensitivity to pain stimuli can be promoted by aerobic and anaerobic exercises, although it is yet unclear why this is the case. Therefore, physical…

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β-catenin signaling, a new therapeutic target in endometriosis

Endometriosis is characterized by cell proliferation, resistance to cell death and fibrotic scarring. It is treated by surgical removal of the peritoneal lesions and ovarian cysts or using hormonal agents. However, the success of the current treatment is limited by high recurrence. Thus, there is a need for more effective therapy. This article published in "Scientific Reports" by Harakawa et al. from the Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan investigated new inhibitors, ICG-001 and…

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Endometriosis signaling: the role of IL-34

An increasing number of studies have suggested that the pathogenesis of endometriosis is mediated by cytokines, such as interleukin (IL)−17, which promoted the formation and progression of endometriosis by up-regulating angiogenesis and pro-inflammatory cytokines secretion. IL-34 is a newly described cytokine. It regulates the differentiation and proliferation of monocytes. It can trigger multiple cellular processes such as cell proliferation, differentiation, apoptosis, angiogenesis, inflammation, and immunoregulation by triggering phosphorylation signaling cascades. The current article by Lin et al. from Zhejiang University…

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Natural killer cells receptor expression in endometriosis

Increasingly, studies have reported that endometriosis pathogenesis is related to defect in immune functions. The data also points to the impaired function of natural killer (NK) cells, leading to less cytotoxic NK cell activity in endometriosis. Similar to B and T lymphocytes, NK cells generally have a crucial function in human immunity, as they represent the third largest lymphocyte population in the peripheral blood. To identify NK cells, researchers have used the positive expression of surface markers. In a normal…

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Circulating Endometrial Cells

Endometriosis is difficult to diagnose because of non-specific symptoms. Currently, there is no biomarker that allows for non-invasive diagnosis of the condition.  Surgical laparoscopy remains the standard for diagnosis. Circulating endometrial cells (CECs) is the lymphovascular spread of endometrial cells. It was first reported by Halban J. in 1925, who discovered endometrial cells in the lymphatic system of the uterus in women with endometriosis. Since then, endometrial cells from peripheral blood and peritoneal washings from women with endometriosis have been…

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Immune environment of endometriosis

The results from the past decade of research have shown that an altered pro-inflammatory immune environment in endometriosis is believed to contribute to the pathophysiology of the disease. Because of changes in the immune microenvironment in the disease state, the reproductive function of the endometrium is also compromised. The menstrual cycle has several phases, which include the proliferative, secretory, menstrual and regenerative phases. Despite changes of immune cells in endometriosis, it is important to note that the immune environment of…

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M1 and M2 macrophages in ovarian endometriomas

Macrophages play an essential role in the immune response during inflammation and have been implicated in diseases such as inflammatory conditions and cancers. Broadly, macrophages are classified into M1 and M2. The M1 macrophages are pro-inflammatory, and in contrast, the M2 is anti-inflammatory and profibrotic. The M2 macrophages are also able to induce immunotolerance and angiogenesis. While the number and roles of these subpopulations of macrophages have been extensively studied in tumors, little is known about them in endometriosis. The…

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Optimal Management of Endometriosis and the associated pain

Around 5–10 million reproductive-aged women suffer from endometriosis in the United States. The condition is hard to diagnose due to large variation in symptoms, though most women experience pain that can either be cyclical pelvic pain with menses or noncyclic pelvic pain, such as dyspareunia, dyschezia, and dysuria. In addition, many women present with unexplained infertility. Because of these factors that markedly affect a woman’s quality of life, optimal management of endometriosis is crucial. The current article published in Obstetrics…

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Yogurt and ice cream consumption during adolescence may reduce endometriosis

Dietary factors may affect the development and severity of endometriosis because of estrogen, prostaglandin metabolism, inflammation, or smooth muscle contractility. Studies investigating the relationship between diet and endometriosis have focused on women’s dietary intake during adulthood. For example, the higher intake of dairy in adulthood has been shown to be associated with a lower risk of endometriosis. On the contrary, the current article studied diet during adolescence because the onset of endometriosis is probably during adolescence. Nodler et al. from…

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Endometriosis Knowledgebase

Several studies have pointed to possible genetic factors in endometriosis. Targeted gene-based and high-throughput methods such as Genome-Wide Association Studies (GWAS) have been previously employed to identify endometriosis-associated genes. However, the accuracy of these data are difficult to evaluate and can vary when studies in other larger cohorts. Therefore, endometriosis is genetically complex and require a more integrated method to provide meaningful study outcome. The current study by Joseph et al. from the National Institute for Research in Reproductive Health,…

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Clinical trial for the use of oral lactobacillus on endometriosis pain severity

The standard treatment of endometriosis consists of surgery and hormonal based treatment. There is evidence for the efficacy of these types of treatment, although their side effects remain a critical consideration for women. Based on molecular studies, changes in the function of immunologic cells like monocytes, macrophages, natural killer cells (NK), cytotoxic T cells and B cells have been detected in the peritoneal fluid of women with endometriosis. Lactobacillus bacteria consist of a number of species with Lactobacillus Aci­dophilus, Lactobacillus…

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A miniaturized version of endometrium: organoids for endometriosis research

Organoids are a miniaturized version of a tissue that is produced in culture through three dimensions techniques in order to better mimic the tissues of origin. These cultures are supposed to better replicate the complexity of a biological organ/disease. Endometrial disorders are a major problem in women’s health and one of the main causes of infertility. Some of the most common conditions include endometriosis and endometrial cancer. However, the pathogenesis of these conditions is not fully understood. In addition, there…

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