Dysregulated endometrial podocalyxin and LIF expression in women with ovarian endometrioma

To investigate whether ovarian endometrioma is associated with disruption of the endocrine-regulated transition between the anti-adhesive modulator podocalyxin (PCX) and the adhesive modulator leukemia inhibitory factor (LIF) in the endometrium.

This cross-sectional study included 42 women (32 infertile, 10 fertile controls). Among infertile participants, 17 had ovarian endometrioma (EOC), seven had non-endometriotic cysts, and eight had prior infertility treatment failure. Endometrial tissue obtained via laparoscopy or hysteroscopy was analyzed in 30 women with mid- or late-luteal endometrium. PCX mRNA, PCX protein, and LIF mRNA levels were assessed using qRT-PCR and ELISA.

LIF mRNA expression was significantly lower in the EOC group compared to all other groups (p < 0.001), while PCX mRNA and protein levels were higher (p < 0.001). Progesterone levels negatively correlated with PCX mRNA (r = -0.48, p = 0.007) and protein (r = -0.45, p = 0.012). LIF expression showed strong negative correlations with PCX mRNA (r = -0.81) and protein (r = -0.82) (p < 0.001). No associations were found with cyst characteristics.

Ovarian endometrioma is associated with disruption of the PCX-LIF transition, suggesting impaired endometrial progesterone responsiveness.