Increase in Angiogenesis and Vascularization in Patient-Derived Endometriosis Tissue: Insights from a 3D In Vivo Model.

AIM: Endometriosis is a gynecological disorder characterized by endometrial-like tissue outside the uterus. This study evaluates the vascularization and proliferation of human endometriosis and endometrium tissues engrafted onto the chorioallantoic membrane of chicken embryos using immunohistochemistry and laser speckle contrast analysis imaging. For the assessment of clinical relevance, a comparison between laboratory and clinical data was performed. MATERIAL AND METHODS: Tissue samples from 10 patients categorized by #Enzian scores and undergoing endometriosis surgery were investigated in the chorioallantoic membrane model. Hematoxylin-eosin staining and immunohistochemical markers, including CD10, cytokeratin, Ki67, and Caspase-3, assessed cellular structures, proliferation, and apoptosis. Changes in blood perfusion, implemented as a surrogate marker for angiogenesis and vascularization, were analyzed over three days using laser speckle contrast analysis. The fertilized chicken eggs used for the chorioallantoic membrane model were stratified for their gender utilizing an in ovo sexing technique. RESULTS: Immunohistochemistry confirmed stromal and glandular cells in transplanted tissues. Ki67 indicated variable proliferation, while Caspase-3 identified apoptosis. Perfusion increased significantly in 75% of endometriosis samples. Endometrium from a patient with endometriosis showed increased perfusion, contrasting with stable perfusion in healthy endometrium. Higher #Enzian scores partly correlated with increased vascularization. SUMMARY: The chorioallantoic membrane model is a viable platform for studying endometriosis vascularization and angiogenesis. Endometriosis tissue showed enhanced vascularization influenced by lesion size and anatomical location, offering insights into disease progression and therapeutic strategies.