Elucidation of the Working Mechanism of Lipiodol on Healthy and Endometriotic Endometrium

Abstract

Endometriosis is a complex syndrome strongly associated with infertility. Lipiodol is a contrast medium used for hysterosalpingography, which has been shown to increase fertility in women with endometriosis. However, the mechanism of this is unknown. Recently, it was shown lipiodol treatment can affect endometrial gene expression. In a study by Johnson et al, twelve genes that play a role in in endometriosis, implantation, or inflammation were found to be significantly up or downregulated. A pilot study by our own group with endometrial receptivity markers showed lipiodol might also affect expression of four of these markers. Additionally, lipiodol has been shown to affect the number and activity of uterine immune cells. We aim to elucidate the mechanism of lipiodol on healthy and endometriotic endometrium, with a focus on the mentioned biomarkers. In vitro, we will test the effect of lipiodol on the expression of the biomarkers in endometrial cell lines and patient-derived organoids, determine the role and amount of iodine uptake from lipiodol, test the effect of lipiodol the role of the inflammation-related biomarkers in this on natural killer cells and test the effect of lipiodol and the role of the implantation-related biomarkers on blastocyst adhesion and invasion. In a clinical trial, we will perform pre- and post-lipiodol endometrial biopsies and measure pregnancy rates, change in biomarker levels, uterine and circulating immune cell number and cytotoxicity, hormone levels, and iodine levels. Together, this will allow us to clarify the mechanism of lipiodol in endometriosis.