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EMT在子宫稳态维持与疾病发生的作用
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Abstract:
上皮–间充质转化(EMT)是子宫生理稳态维持与疾病发生中的核心动态过程。在生理状态下，EMT以高度可控、时空特异的方式参与关键生殖事件，如胚胎着床过程中滋养层细胞的侵袭、子宫内膜周期性再生与修复，以及蜕膜化过程中的细胞重塑。此类EMT通常可逆且受严格调控。然而，EMT的失调直接驱动多种子宫疾病的发生与发展。如在子宫内膜异位症中，EMT赋予异位上皮迁移与侵袭能力，驱动病灶形成与纤维化；在宫腔粘连中，异常EMT直接导致内膜纤维化及再生障碍；在子宫内膜癌中，EMT则增强肿瘤细胞的转移、干细胞特性及治疗抵抗。因此，EMT在子宫中扮演“双刃剑”角色，其精密调控是维持生殖功能与组织稳态的基础，而其失控则成为疾病演进的关键枢纽。本综述总结了EMT在子宫生理状态和病理状态下的双重作用。
Epithelial-mesenchymal transition (EMT) is a core dynamic process in maintaining uterine physiological homeostasis and driving disease development. Under physiological conditions, EMT participates in key reproductive events in a highly controlled, spatiotemporally specific manner, such as trophoblast invasion during embryo implantation, cyclic endometrial regeneration and repair, and cellular remodeling during decidualization. Such EMT is typically reversible and tightly regulated. However, dysregulation of EMT directly drives the onset and progression of various uterine diseases. For instance, in endometriosis, EMT endows ectopic epithelial cells with migratory and invasive capabilities, promoting lesion formation and fibrosis; in Asherman syndrome, aberrant EMT directly leads to endometrial fibrosis and regenerative dysfunction; in endometrial cancer, EMT enhances tumor cell metastasis, stem cell-like properties, and treatment resistance. Thus, EMT plays a “double-edged sword” role in the uterus: its precise regulation is fundamental for maintaining reproductive function and tissue homeostasis, while its dysregulation serves as a pivotal hub in disease progression. This review summarizes the dual roles of EMT in both physiological and pathological states of the uterus.
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