Objective To study the role of endometriosis-inducing factor on the differentiation of cultured stem cells into endometrial cells.Methods This was a multicenter prospective cohort casecontrol study where 323 women were examined, but only 134 infertile women were recruited and compiled with the inclusion criteria. The study group comprised 64 women in whom laparoscopy showed endometriotic lesions, and the control group included 70 women free of endometriotic implants. The women's sera were cocultured with mesenchymal stem cells, which were followed up weekly by quantitative real-time PCR to examine the expression of SPARC (secreted protein, acidic, cysteine-rich) and MYC (myelocytomatosis) genes using the 2 ÀDDCt method.Results By coculturing the serum of women with endometriosis and the control group with stem cells, none of the cultures of the sera of women within the control group showed any changes in the normal expression of either SPARC or MYC gene levels. Furthermore, the stem cells were normally multiplying in the same cell line during the entire duration of the study. Nevertheless, stem cells that were cocultured with sera from women with endometriosis showed upregulation of the SPARC gene mRNA with mean respiratory quotient of 3.534 ± 1.129, whereas the MYC gene mRNA was downregulated with a mean respiratory quotient of 0.488 ± 0.104. ConclusionThe sera of women with endometriosis were able to induce transformation of mesenchymal stem cells into endometrial-like cells on a molecular basis. This evidence supports the endometriosis-inducing factor theory of endometriosis and may have tremendous effect on the therapeutic implications of this debilitating condition.Endometriosis and mir-130a as a potent regulator of gene expression Azmy et al. 3The distribution of mRNA expression of the MYC gene within the study group. There is a decrease in the expression of the MYC gene compared with the control group with a mean RQ of 0.488 ± 0.104. MYC, myelocytomatosis; RQ, respiratory quotient.

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