Impaired bone morphogenetic protein (BMP) signaling pathways disrupt decidualization in endometriosis

• Published in: Communications biology 2024-02, Vol.7 (1), p.227-19, Article 227
• Main Authors: Liao, Zian, Tang, Suni, Jiang, Peixin, Geng, Ting, Cope, Dominique I., Dunn, Timothy N., Guner, Joie, Radilla, Linda Alpuing, Guan, Xiaoming, Monsivais, Diana
• Format: Article
• Language: English
• Subjects: 13/106; 14/63; 38/91; 631/337/2019; 631/80/304; Biomedical and Life Sciences; Bone morphogenetic proteins; Bone Morphogenetic Proteins - genetics; Bone Morphogenetic Proteins - metabolism; Decidua; Decidua - metabolism; Endometriosis; Endometriosis - genetics; Endometriosis - metabolism; Endometrium; Female; Humans; Infertility; Infertility - metabolism; Life Sciences; Pregnancy; Pregnancy complications; Pregnancy Complications - metabolism; Signal Transduction; Smad protein; Smad4 protein; Transcriptomics; Transforming Growth Factor beta - metabolism; Transforming growth factor-b
• ISSN: 2399-3642; 2399-3642
• DOI: 10.1038/s42003-024-05898-z

Endometriosis is linked to increased infertility and pregnancy complications due to defective endometrial decidualization. We hypothesized that identification of altered signaling pathways during decidualization could identify the underlying cause of infertility and pregnancy complications. Our study reveals that transforming growth factor β (TGFβ) pathways are impaired in the endometrium of individuals with endometriosis, leading to defective decidualization. Through detailed transcriptomic analyses, we discovered abnormalities in TGFβ signaling pathways and key regulators, such as SMAD4, in the endometrium of affected individuals. We also observed compromised activity of bone morphogenetic proteins (BMP), a subset of the TGFβ family, that control endometrial receptivity. Using 3-dimensional models of endometrial stromal and epithelial assembloids, we showed that exogenous BMP2 improved decidual marker expression in individuals with endometriosis. Our findings reveal dysfunction of BMP/SMAD signaling in the endometrium of individuals with endometriosis, explaining decidualization defects and subsequent pregnancy complications in these individuals. Transcriptomic and genomic studies indicate that disrupted bone morphogenetic protein pathways may be a root cause of flawed endometrial decidualization in individuals with endometriosis. Enhancing these pathways with BMP2 supplementation shows promise in mitigating these defects.