BACKGROUND Eukaryotic chromosomal ends are linear and are protected by nucleoprotein complexes known as telomeres. The complex structural anatomy and the diverse functions of telomeres as well as the unique reverse transcriptase enzyme, telomerase that maintains telomeres are under intensive scientific scrutiny. Both are involved in many human diseases including cancer, but also in ageing and chronic disease such as diabetes. Their intricate involvement in many cellular processes and pathways is being dynamically deciphered in many organs including the endometrium. This review summarizes our current knowledge on the topic of telomeres and telomerase and their potential role in providing plausible explanations for endometrial aberrations related to common gynaecological pathologies. OBJECTIVE AND RATIONALE This review outlines the recent major findings in telomere and telomerase functions in the context of endometrial biology. It highlights the contemporary discoveries in hormonal regulation, normal endometrial regeneration, stem cells and common gynaecological diseases such as endometriosis, infertility, recurrent reproductive failure and endometrial cancer (EC). SEARCH METHODS The authors carried out systematic PubMed (Medline) and Ovid searches using the key words: telomerase, telomeres, telomere length, human telomerase reverse transcriptase, telomeric RNA component, with endometrium, hormonal regulation, endometrial stem/progenitor cells, endometrial regeneration, endometriosis, recurrent miscarriage, infertility, endometrial hyperplasia, EC and uterine cancer. Publications used in this review date from 1995 until 31st June 2016. OUTCOMES The human endometrium is a unique somatic organ, which displays dynamic telomerase activity (TA) related to the menstrual cycle. Telomerase is implicated in almost all endometrial pathologies and appears to be crucial to endometrial stem cells. In particular, it is vital for normal endometrial regeneration, providing a distinct route to formulate possible curative, non-hormonal therapies to treat chronic endometrial conditions. Furthermore, our current understanding of telomere maintenance in EC is incomplete. Data derived from other malignancies on the role of telomerase in carcinogenesis cannot be extrapolated to EC because unlike in other cancers, TA is already present in proliferating healthy endometrial cells. WIDER IMPLICATIONS Since telomerase is pivotal to endometrial regeneration, further studies elucidating the role of telomeres, telomerase, their associated proteins and their regulation in normal endometrial regeneration as well as their role in endometrial pathologies are essential. This approach may allow future development of novel treatment strategies that are not only non-hormonal but also potentially curative.

中文翻译：

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端粒和端粒酶在子宫内膜病理学中的意义。

背景技术真核染色体末端是线性的，并被称为端粒的核蛋白复合物保护。端粒的复杂的结构解剖学和各种功能以及独特的逆转录酶（维持端粒的端粒酶）正在受到严格的科学审查。两者都涉及许多人类疾病，包括癌症，但也涉及衰老和慢性疾病，例如糖尿病。它们在许多细胞过程和途径中的复杂参与正在包括子宫内膜在内的许多器官中被动态地解密。这篇综述总结了我们对端粒和端粒酶这一主题的当前知识，以及它们在为常见妇科病理学相关的子宫内膜畸变提供合理解释方面的潜在作用。目的和理由本综述概述了子宫内膜生物学背景下端粒和端粒酶功能的最新主要发现。它强调了激素调节，正常子宫内膜再生，干细胞和常见妇科疾病（例如子宫内膜异位，不育，复发性生殖衰竭和子宫内膜癌（EC））的当代发现。搜索方法作者使用以下关键词进行了系统的PubMed（Medline）和Ovid搜索：端粒酶，端粒，端粒长度，人类端粒酶逆转录酶，端粒RNA成分，具有子宫内膜，激素调节，子宫内膜干/祖细胞，子宫内膜再生，子宫内膜异位，反复流产，不育，子宫内膜增生，EC和子宫癌。这篇综述中使用的出版物的发布日期为1995年至2016年6月31日。结果子宫内膜是一种独特的体细胞器官，显示与月经周期有关的动态端粒酶活性（TA）。端粒酶几乎涉及所有子宫内膜病理，并且似乎对子宫内膜干细胞至关重要。特别是，对于正常的子宫内膜再生至关重要，它提供了一条独特的途径来制定可能的治疗性，非激素疗法来治疗慢性子宫内膜疾病。此外，我们目前对EC中端粒维持的了解还不完整。不能将其他恶性肿瘤有关端粒酶在致癌作用中的作用的数据外推至EC，因为与其他癌症不同，TA已存在于健康的子宫内膜细胞中。对端粒的影响由于端粒酶对子宫内膜的再生至关重要，因此进一步研究阐明端粒，端粒酶，其相关蛋白及其在正常子宫内膜再生中的调控以及它们在子宫内膜病理中的作用至关重要。这种方法可以允许将来开发新的治疗策略，这些策略不仅是非荷尔蒙的，而且具有潜在的治疗作用。