{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T08:53:37Z","timestamp":1769849617504,"version":"3.49.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013238","name":"Faculty of Medicine Siriraj Hospital, Mahidol University","doi-asserted-by":"publisher","award":["R016631035"],"award-info":[{"award-number":["R016631035"]}],"id":[{"id":"10.13039\/501100013238","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Endometriosis is a complex gynecological condition characterized by endometrial tissue growing outside the uterus. In many\n                      <jats:italic>in vitro<\/jats:italic>\n                      studies, almost all progestins have indicated the anti-proliferation and apoptosis of endometriotic stromal cells. Drospirenone, a synthetic progestin structurally distinct from traditional progestins, still lacks sufficient data regarding its effects on endometriosis, particularly in terms of antiproliferative and pro-apoptotic activity. This study investigates the antiproliferative effects of drospirenone on eutopic (EU-ESCs) and ectopic human endometrial stromal cells (EC-ESCs), and compare its impact on apoptotic effects in both cell types.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and Findings<\/jats:title>\n                    <jats:p>\n                      In the study, paired EU-ESCs and EC-ESCs were obtained from patients diagnosed with endometriosis (n\u2009=\u200912). EU-ESCs and EC-ESCs were treated with and without drospirenone. Antiproliferative markers and apoptotic markers were evaluated and compared between the two groups. Interestingly, drospirenone at a concentration of 1 \u00b5M significantly affected cell viability in both EU-ESCs and EC-ESCs. In EU-ESCs, Ki-67 expression was significantly reduced compared to controls (0.17 vs. 1; p\u2009=\u20090.003), while in EC-ESCs, the reduction was not statistically significant. Caspase-3 expression was significantly increased in both EU-ESCs (1.13 vs. 1) and EC-ESCs (1.57 vs. 1) (p=\u20090.02 and p\u2009=\u20090.05, respectively). Additionally,\n                      <jats:italic>BCL2<\/jats:italic>\n                      expression decreased in both cell types following treatment.\n                      <jats:italic>BAX<\/jats:italic>\n                      expression increased in both EU-ESCs and EC-ESCs. Expression levels of\n                      <jats:italic>PTEN<\/jats:italic>\n                      and\n                      <jats:italic>P53<\/jats:italic>\n                      also increased in both cell types, with statistical significance observed only in EC-ESCs (p\u2009=\u20090.03 and p\u2009=\u20090.04, respectively).\n                      <jats:italic>BAK<\/jats:italic>\n                      expression decreased in EU-ESCs but increased in EC-ESCs compared to controls.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Drospirenone exhibits an antiproliferative effect on EU-ESCs and induces a more pronounced apoptotic response in EC-ESCs.<\/jats:p>\n                  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