Hubert Rytel

Background/Objectives: Endometriosis is a prevalent gynecological illness associated with chronic pain, inflammation, and infertility, as ectopic endometrial lesions are formed. No fully effective treatment is available, and the pathogenesis of this disease is unclear. The survival of ectopic endometrial cells is facilitated by their low susceptibility to apoptosis, an immunosuppressive environment, and local angiogenesis. Chromogranin A (CgA), a glycoprotein prohormone, modulates various processes including angiogenesis and innate immunity, and its higher levels are detected in neuroendocrine tumors and inflammatory disorders. Since endometriosis may be considered an autoinflammatory disorder, this study aimed to evaluate serum and peritoneal fluid concentrations of CgA and its derivatives, catestatin and pancreastatin, and to correlate these levels with disease severity. Methods: The study was conducted on samples of serum and peritoneal fluid (PF) obtained from 65 women diagnosed with endometriosis and from 60 control individuals who underwent surgery for other reasons. The concentrations of CgA, catestatin, and pancreastatin were assessed in the collected samples by specific enzyme-linked immunosorbent assays. Results: CgA, catestatin, and pancreastatin concentrations were significantly higher in the sera and PF of endometriosis patients compared to controls. There was a correlation between their serum and PF levels, and all tested factors were correlated with each other in both serum and PF. Serum concentrations of CgA, catestatin, and pancreastatin were also associated with disease progression. Receiver operating characteristic (ROC) analysis further confirmed that endometriosis is associated with increased circulating CgA, catestatin, and pancreastatin levels, suggesting that they may be considered markers of endometriosis. Conclusions: The upregulation of CgA and its derivatives in endometriosis may indicate their role in the disease pathogenesis and implicate them as potential diagnostic markers and/or therapeutic targets.

Delivery by caesarean section (CS) is increasingly common worldwide and has been associated with altered health outcomes in offspring, which can be partially mitigated with breastfeeding. Interestingly, the mode of delivery itself may influence the composition of human milk. The aim of this narrative review was to comprehensively examine current evidence on the impact of CS on breast milk composition and to discuss its potential implications for neonatal and infant health. A literature search of the MEDLINE database was conducted in July 2025. It identified 1212 studies addressing associations between mode of delivery and human milk components, of which 54 were included in the qualitative synthesis. Available evidence suggests that CS is associated with transient, lactation stage-dependent alterations in breast milk composition, most pronounced in colostrum and transitional milk. Reported changes include differences in macronutrients, mineral content, immune-related molecules, hormones, antioxidants, microbiota, microRNA profiles, and other bioactive components. Findings related to mature milk are less consistent and often influenced by confounding factors. While some CS-associated alterations may slightly reduce the beneficial effect of breastfeeding, e.g., reducing certain antimicrobial or nutritional components, other changes seem to be potentially advantageous for the neonate/infant after CS, in particular in immune-related factors. Overall, the clinical significance of these compositional differences remains unclear, as no studies have directly linked CS-related changes in milk composition to long-term infant outcomes. Further well-designed longitudinal studies are needed to clarify these associations. Regardless of delivery mode, breastfeeding remains the optimal feeding strategy and a key intervention to support infant health after CS.