Combinatory effects of current regimens and Guizhi Fuling Wan on the development of endometriosis

Objective: Endometriosis, defined as the growth of endometrial glands and stromal cells in a heterotopic location under the cyclic influence of ovarian hormones, is a common gynecological disorder manifested by chronic pelvic pain and infertility. In traditional Chinese medicine, endometriosis is characterized by stagnation of vital energy (qi) and blood stasis. Guizhi Fuling Wan (GFW) was first described in Chinese canonical medicine to treat disorders associated with stagnation of qi and blood stasis, including endometriosis. Therefore, the current study aimed to test the effects of combining GFW with western medicine on the suppression of endometriosis. Materials and methods: Endometriosis was generated by suturing endometrial tissue on the peritoneal wall of C57BL/6JNarl mice. The mice were subsequently treated with either GFW or current hormonal therapies or in combination for 28 days. Results: Endometriosis development was inhibited by GFW, Gestrinone, Visanne, GFW thorn Gestrinone or GFWthorn medroxyprogesterone acetate (MPA). The expression of intercellular adhesion molecule 1 (ICAM-1) was inhibited by GFW, Gestrinone, MPA, Visanne, GFW thorn Gestrinone, GFW thorn MPA and GFWthorn Visanne. Vascular endothelial growth factor (VEGF) expressionwas inhibited by GFW, Gestrinone, Visanne, GFW thorn Gestrinone and GFW thorn MPA. Both ICAM-1- and VEGF-reducing effects of GFW were attenuated by western medicines. Administration of GFW, MPA, Visanne, GFW thorn MPA and GFW thorn Visanne also correspondingly reduced macrophage population in peritoneal fluid. GFW, MPA, Visanne, GFW thorn MPA and GFW thorn Visanne enhanced B-cell population in peritoneal fluid. Conclusion: The current study reveals the therapeutic effects of GFW on endometriosis. However, the combination of GFW and current hormonal therapies potentially impedes the efficacy of each individual agent in treating endometriosis. (C) 2022 Taiwan Association of Obstetrics & Gynecology. Publishing services by Elsevier B.V.