Volume 9, Issue 4, Pages 540-547 (April 2004) Quantitative Assessment of Human Endometriotic Tissue Maintenance and Regression in a Noninvasive Mouse Model of Endometriosis  Marylène Fortin, Manon Lépine, Yannick Merlen, Isabelle Thibeault, Claudine Rancourt, Diane Gosselin, Patrice Hugo, Ann-Muriel Steff  Molecular Therapy  Volume 9, Issue 4, Pages 540-547 (April 2004) DOI: 10.1016/j.ymthe.2003.12.012 Copyright © 2004 The American Society of Gene Therapy Terms and Conditions

Fig. 1 Noninvasive in vivo imaging of fluorescent endometrial implants allows dynamic monitoring of lesion development. Endometrial fragments were incubated with AdGFP viral particles for 20 h. After washings, five fragments were injected subcutaneously into ovariectomized nude mice supplemented (N = 8) or not (N = 8) with E2-releasing pellets. Each mouse was repeatedly imaged in triplicate, and images acquired at days 4, 6, 8, 12, 14, 16, 19, 23, 27, and 29 posttransplantation are shown for one mouse in each group. Molecular Therapy 2004 9, 540-547DOI: (10.1016/j.ymthe.2003.12.012) Copyright © 2004 The American Society of Gene Therapy Terms and Conditions

Fig. 2 Quantification of endometriotic-like lesion size in ovariectomized mice supplemented or not with E2. Ovariectomized nude mice having received or not an E2 pellet (N = 8 for each group) were periodically imaged in triplicate, and endometriotic-like lesion size (number of pixels) was quantified by image analysis. Each symbol represents the mean of three measures for each animal at each time point. Bars indicate the mean surface of endometriotic implants for each group. Comparison of lesion size in estradiol-supplemented versus nonsupplemented animals was performed by a nonparametric Mann–Whitney test. A significant difference in size of lesions is observed between the two groups starting from day 12 (P ≤ 0.05 at days 12, 27, and 29; P ≤ 0.005 at days 13, 14, 16, 19, 21, and 23). These results are representative of six independent experiments. Molecular Therapy 2004 9, 540-547DOI: (10.1016/j.ymthe.2003.12.012) Copyright © 2004 The American Society of Gene Therapy Terms and Conditions

Fig. 3 Kaplan–Meier analysis of endometriotic-like lesion regression in mice lacking estradiol supplementation. Ovariectomized nude mice having received or not an E2 pellet (N = 8 for each group) were periodically imaged in triplicate, and endometriotic-like lesion size (number of pixels) was quantified with image analysis software. The time at which each mouse had a lesion with (A) a 75% or (B) a 50% reduction in its initial size was used to generate survival curves (Kaplan–Meier analysis). A significant difference was observed between E2-supplemented and nonsupplemented groups (log rank test, P = 0.0001 and P = 0.0002 for A and B, respectively). Molecular Therapy 2004 9, 540-547DOI: (10.1016/j.ymthe.2003.12.012) Copyright © 2004 The American Society of Gene Therapy Terms and Conditions

Fig. 4 Ganciclovir treatment induces cell death in an endometrial cell line expressing the thymidine kinase gene. HEC-1A cells were infected with either AdGFP or AdTK viral particles at an m.o.i. of 1. The proportions of cells expressing either GFP or TK 1 day prior to GCV treatment were 76 and 24%, respectively. Treatment with increasing doses of ganciclovir (GCV) was initiated 5 days postinfection and was pursued for 7 days. At the end of GCV treatment, cells were harvested and cell death was assessed by propidium iodide (PI) staining and flow cytometry. The percentage of apoptotic cells for each GCV dose is shown. Molecular Therapy 2004 9, 540-547DOI: (10.1016/j.ymthe.2003.12.012) Copyright © 2004 The American Society of Gene Therapy Terms and Conditions

Fig. 5 Ganciclovir treatment induces a significant regression of endometrial implants expressing the TK gene in nude mice. Endometrial fragments were incubated with AdGFP (m.o.i. 500) and AdTK (m.o.i. 25) viral particles for 20 h. After washings, five fragments were injected subcutaneously into 16 ovariectomized nude mice supplemented with E2-releasing pellets. Eight mice received an ip injection of GCV (50 mg/kg/day) on each weekday for a 2-week period, starting 4 days after tissue transplantation. Mice in the control group (N = 8) received PBS injections. Each mouse was imaged in triplicate at days 1, 4, 6, 8, 11, 13, 15, 18, 20, and 22 posttransplantation, and lesion size was quantified. (A) Each symbol represents the mean of three measures for each animal at each time point. Bars indicate the mean surface of endometriotic implants for each group. Comparison of lesion size (in pixels) in treated versus untreated animals was performed by a nonparametric Mann–Whitney test. A significant difference between GCV- and PBS-treated groups was observed (P ≤ 0.05 at days 8, 15, 18, 20, and 22; P ≤ 0.005 at days 11 and 13). (B and C) The time at which each mouse had a lesion with (B) a 75% or (C) a 50% reduction from its initial size was used to generate survival curves (Kaplan–Meier analysis). A significant difference was observed between GCV- and PBS-treated groups (log rank test, P = 0.004 and P = 0.006 for B and C, respectively). These results are representative of two independent experiments. Molecular Therapy 2004 9, 540-547DOI: (10.1016/j.ymthe.2003.12.012) Copyright © 2004 The American Society of Gene Therapy Terms and Conditions