Sergio Podarich by Tamer Seckin

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I am Dr. Tamer Seckin.  We are at Sao Paulo, Brazil.  We are Brazilian Americas Society’s first annual meeting with ISGE and there first global meeting on the subject.  I am with Dr. Sergio Podarich who won the first prize about his molecular immunology research.  This was last year? Or this…

Last year we won the prize at the World _ Congress Award.  Yeah.

It is so important when we look for excellence in endometriosis care as far as the patient angle, we look at not only surgery, their diet, their pain specialists, their natural remedies, the surgeon, general surgeons being involved, the urologist being involved, but in formal research angle the perfection never ends.  We need to have our immunologist, right, researchers, geneticist and what I am missing.

There are some pathological frames.

Pathological, yes.

And there are lots of…

Okay, so the bottom line is perfection in an endometriosis, we are aspiring that this is one area that also you are bringing to the table.  I really want to talk about your research.  What was it about?

Yeah, I..

What else is in the horizon from this research coming?

My research was something about immunology and endometriosis.  We studied how the cells are important, immunological cells are imported in the pathogenesis of endometriosis.  There are two types of immune responses in our immune system and we studied in endometriosis which one is the main.

Okay, one is the antibodies.


The other is cells.  Can you tell us what did you find?

When there are antibodies involved, this is called Th2 response.  When there is a predominance of cells, it is Th1 response.  So it is Th1 against Th2 response.  Th is because of lymphocyte gene helper.


So it is Th.  So we studied Th1 and Th2 responses and we saw that in endometriosis there are both responses.

So, obviously there is a menstrual equivalence.


The menstrual implantation, it creates unwanted tissues there.


It calls for help.


It comes from peritoneum these T cells or from the peritoneal lining.  From all angles the attack starts.

Yeah this is the next step.  We just studied the peritoneal fluid and we saw that there are some cytokines, some inflammatory response.

Inflammatory response obviously

Inflammatory substances that try to eliminate the cells.  The cells should not be there and the immune response tries to eliminate it.  We saw that the cells, the cytokines, the Th1 response is present, but in some cases there are also antibodies.  So there is a..

So that is the first chemotaxis response..


Which comes from its contact with the peritoneal fluid before it sits down on the ______.

Yes, yes.

Okay.  The first fight starts there.  If the insult is so great the contact of peritoneum and the clot is right away obviously your immune response will come from the peritoneal layer, mesothelial layer.


Then probably this whole quagmire, the questions about the epithelial mesothelial...


transformation, the stem cells and the all immunological fight and your genesis I think this is the next step that you guys are going.

The next step is, we are going to study the cell.  The cell, not just the peritoneal fluid.  We are going to study the cell and to see if the cytokines are expressed by the cells, if the protein is spread in the cells.  So not just the environment but the cell.

In your study, how many cases did you look into?

Oh, we have, we studied 100 cases and now we are planning to study another 100, but different patients.

Will there be any different technology or techniques used when you are going to be doing peritoneal studies.  In ________ the fluid is different than the tissue.

It is different, yes.

Tell us what those are.

Because when we study the peritoneal fluid, we can measure the cytokines, the cytokines like cholesterol or any test, we are going to test it.  We test cytokines on the peritoneal fluid but inside the cell, we had to do another kind of test, it is called RT-PCR, a special test to see the gene and to amplificate, to over express the genes, to see if they are doing this specific protein cytokines anything that we want.  It is different from the peritoneal fluid.  It is a specific test for.

You see I am a surgeon, I am an endoscopic surgeon.

I am a surgeon too.

But that you have other qualities of being PHD or whatever you are doing, so I may ask you a simple question, in my mind the real question is to what portion do you think of the endometrial debris, the body, the immunological response directs to the glandular element or the stroma, because that in my mind as a surgeon, I consider the glands are my friends.  The stroma is my enemy because stroma is the one that is the evil force, because glands you see.


The fibrosis is the problem, it is always the reason for the complete surgery and not seeing everything.

We will try to answer this question separating the glands and the stroma.  We also think that the stroma is the enemy, but we will separate it with electronic microdissection.  It is a special kind of dissection that permits, that allows to separate glands and stroma.  So we will try to find this kind of immune response inside the gland, the cell, and inside the stroma.  So maybe the stroma, we are right, the stroma is the enemy and we do not know it.

Are there any sophisticated or recent immunological dyeing techniques that could be unique for our mesenchymal study or to expose the endometriosis or stromal elements or even adhesion formations that are unique to endometriosis.

Yeah, there lots of substances like _ and metal proteinases that are substances related to adhesion and there are no chemical or antibodies to study this.  So we have to use these kinds of tests that I told you.  It is the PCR, the polymerase chain reaction.


So this is a wide look out.

Thank you Sergio.  It is a pleasure and honor.

Okay, thank you.

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