Systemic Iron Deficiency in a Nonhuman Primate Model of Endometriosis

Area of Science:

• Reproductive biology
• Hematology
• Gastroenterology

Background:

• Endometriosis involves endometrial tissue outside the uterus, often with inflammation and bleeding.
• Anemia and iron depletion are not typically associated with endometriosis in women.
• Understanding iron kinetics in endometriosis is crucial for diagnosing and managing associated hematologic abnormalities.

Purpose of the Study:

• To investigate iron kinetics in a non-human primate (NHP) model of endometriosis.
• To elucidate the mechanisms behind abnormal hematologic values in women with endometriosis.
• To determine if iron loss or inflammation is the primary driver of these changes.

Main Methods:

• Hematologic analysis of 46 macaques with endometriosis.
• Assessment of bone marrow, liver, and serum for iron levels.
• Evaluation of serum markers and intestinal biopsies for iron absorption capacity and kinetics.
• Analysis of ferroportin 1 expression in the intestine.

Main Results:

• Nearly half of the NHPs with endometriosis exhibited anemia.
• NHPs showed decreased red blood cell counts, increased mean corpuscular volume, and elevated reticulocyte percentage.
• Reduced serum hepcidin and lower iron stores in the liver and bone marrow were observed.
• Increased intestinal ferroportin 1 expression indicated impaired iron absorption despite adequate dietary intake.

Conclusions:

• Iron loss, rather than inflammation alone, significantly impacts hematologic parameters in endometriosis.
• Oral iron supplementation may not effectively restore iron stores in endometriosis patients.
• Routine evaluation of iron stores is recommended for women with endometriosis, irrespective of anemia presence.