ECTOPIC GROWTH OF ENDOMETRIUM DEPENDS ON ITS STRUCTURAL INTEGRITY ANDPROTEOLYTIC ACTIVITY IN THE CYNOMOLGUS MONKEY (MACACA-FASCICULARIS) MODEL OF ENDOMETRIOSIS

Objective: To identify factors influencing the development of endometr ial autografts in a monkey model of endometriosis. Design: Prospective , comparative study. Setting: Animal research unit. Subjects: Thirty r egularly cycling cynomolgus monkeys in three groups of 10 each. Interv entions: Endometrium was minced and spilled into the cul-de-sac in gro up 1, In group 2, the tissue additionally was digested enzymatically. In group 3, the tissue was incubated with a protease inhibitor. Main O utcome Measures: Staging laparotomies after 3 weeks and 3 months. Resu lts: In groups 1, 2, and 3, moderate or severe disease was seen in eig ht, two, and four monkeys, respectively, after 3 weeks and in eight, t hree, and two monkeys, respectively, at 3 months. Conclusion: An intac t structure leads to ectopic implantation of endometrial Fragments in most cases. Conversely, enzymatic digestion of endometrial fragments a nd treatment with proteinase inhibitor impair ectopic growth. Intrinsi c endometrial factors that influence extracellular matrix remodeling m ay play a role in the pathogenesis of human endometriosis.