Apoptosis in normal ovaries of women with and without endometriosis Raffaella Depalo, Aldo Cavallini, Filomenamila Lorusso, Emma Bassi, Ilaria Totaro, Andrea Marzullo, Stefano Bettocchi, Luigi Selvaggi  Reproductive BioMedicine Online  Volume 19, Issue 6, Pages 808-815 (December 2009) DOI: 10.1016/j.rbmo.2009.09.024 Copyright © 2009 Reproductive Healthcare Ltd. Terms and Conditions

Figure 1 A schematic diagram of selected members of the BCL2 family in apoptotic signalling. The figure shows the actions of the pro- and anti-apoptotic factors considered in this study. The p53 molecule acts directly on the pro-apoptotic proteins or antagonizes the function of the anti-apoptotic proteins at the mitochondrial level in normal tissue. BCL2-associated X protein (BAX) and BCL2-like 1 (BCL-XL) mediators facilitate the permeabilization of the mitochondrial outer membrane that releases the apoptogenic factors such as cytochrome C. The apoptotic signal subsequently plans the cell death through a caspase-dependent mechanism. Another regulator of cell death is survivin. The normal endometrial stromal cells express survivin and its expression may antagonize caspase-3-mediated apoptosis and promote the development of endometriosis. Reproductive BioMedicine Online 2009 19, 808-815DOI: (10.1016/j.rbmo.2009.09.024) Copyright © 2009 Reproductive Healthcare Ltd. Terms and Conditions

Figure 2 Representative images showing immunohistochemical staining for the BCL2 protein. BCL2 staining in granulosa cells of a primordial follicle of unaffected ovarian cortex in women (a) with endometriosis and (b) without endometriosis. p53 positive staining in granulosa cells of a primary follicle of unaffected ovarian cortex in women (c) with endometriosis and (d) without endometriosis. Reproductive BioMedicine Online 2009 19, 808-815DOI: (10.1016/j.rbmo.2009.09.024) Copyright © 2009 Reproductive Healthcare Ltd. Terms and Conditions

Figure 3 Distribution of BAX, BCL2, BCL-XL, BAK and survivin (surv) mRNA concentrations in normal ovarian tissues (N) and in unaffected ovarian tissues of women with endometriosis (P). Bars are means±SD of relative values (target gene/ACTB mRNA) and probabilities were calculated using the Mann–Whitney two-tailed U-test. Reproductive BioMedicine Online 2009 19, 808-815DOI: (10.1016/j.rbmo.2009.09.024) Copyright © 2009 Reproductive Healthcare Ltd. Terms and Conditions

Figure 4 BCL2/BAX mRNA ratio between normal (N) and unaffected (P) tissue of the ovarian cortexes of women without and with endometriosis, respectively. The BCL2/BAX expression ratio was used as the apoptotic index. The increased value of the apoptotic index in unaffected ovarian cortex in endometriotic women reveals a partial inhibition of apoptosis in this tissue. Reproductive BioMedicine Online 2009 19, 808-815DOI: (10.1016/j.rbmo.2009.09.024) Copyright © 2009 Reproductive Healthcare Ltd. Terms and Conditions