Idhaliz Flores

Ponce Health Sciences University · Basic Sciences

Objective: To demonstrate that shared antibody responses in endometriosis and endometriosis-associated ovarian cancer spontaneously antagonize malignant progression and can be leveraged to develop future immunotherapies. Methods: B cells from cyopreserved clear cell ovarian carcinoma (CCC, n = 2), endometrioid ovarian carcinoma (EC, n = 2), and...

Abstract Introduction Endometriosis impacts 1 in 10 women and can be a debilitating disease. Late diagnosis is a major challenge with Endometriosis, contributing further to the exacerbation of symptoms and suboptimal clinical management. Regardless of the commonality of the condition, public awareness and research around endometriosis is severely...

Introduction We have previously shown that Environmental Enrichment (EE)-consisting of social support, novelty, and open spaces—decreased disease progression and anxiety in a rat model of endometriosis. We developed a novel EE intervention to be tested in a pilot randomized clinical trial (RCT) in patients with endometriosis, a painful, stressful d...

Objectives: The Puerto Rico Biobank (PRBB) is a tissue biorepository that collects biospecimens and associated data for cancer research investigations. One of its purposes is to acquire and provide data regarding cancers within the the Hispanic/Latino and Puerto Rican population not otherwise available. Herein we report on data from a self-administ...

Introduction: There are known disparities in outcome among breast cancer patients from different ancestral backgrounds that may relate to differences in socio-cultural factors and biological factors, such as hormone receptor expression. The Puerto Rico Biobank (PRBB) of the NCI-funded Ponce Health Sciences University (PHSU) - Moffitt Cancer Center...

Endometriosis is a complex disease affecting approximately 5–10% individuals worldwide. Prevalence rates in Latin-America and the Caribbean are largely unknown, with published data only from Puerto Rico and Chile. Pain associated with endometriosis negatively affects patients’ health and quality of life. However, there is a need to better understan...

e14507 Background: We hypothesized that tumor-infiltrating B cells in endometriosis and endometriosis-associated ovarian cancer can be used to identify novel, targetable antigen domains to inhibit the progression of ovarian carcinomas. We aimed to identify targets that are spontaneously recognized by B-cell-derived antibodies within ovarian clear c...

Introduction Endometriosis is a chronic gynecological disorder characterized by the growth of endometrial glands and stroma outside the endometrial cavity producing inflammation and pain. Previously we demonstrated that modulation of the hypothalamic pituitary adrenal (HPA) axis exacerbates the development and severity of this condition. A physical...

Citation: Castro-Figueroa, E.M.; Acevedo, K.I.; Peña-Vargas, C.I.; Torres-Blasco, N.; Flores, I.; Colón-Echevarria, C.B.; Maldonado, L.; Rodríguez, Z.; Aquino-Acevedo, A.N.; Jim, H.; et al. Depression, Anxiety, and Social Environmental Adversity as Potential Modulators of the Immune Tumor Microenvironment in Breast Cancer Patients. Med. Sci. 2021,...

Background: Mounting data suggest that exposure to chronic stress is associated with worse breast cancer outcomes. This study aimed to explore the impact of social environmental adversity (SEA, e.g., child abuse, crime, sexual, and physical violence), depressive symptomatology, and anxiety on immune cell infiltration into the breast tumor microenvi...

Background: An international collaborative study was conducted to determine the demographic and clinical profiles of Hispanic/Latinx endometriosis patients from Latin America and Spain using the Minimal Clinical Questionnaire developed by the World Endometriosis Research Foundation (WERF) Endometriosis Phenome and Biobanking Harmonization Project (...

Introduction Monitoring the impact of natural disasters such as pandemics on health and wellbeing is a public health priority. Stress is proven to affect pain intensity and quality of life of endometriosis patients. A cross-sectional study was conducted to determine whether the measures implemented to mitigate COVID-19 infections had a substantial...

Endometriosis may exert a profound negative influence on the lives of individuals with the disorder, adversely affecting quality of life, participation in daily and social activities, physical and sexual functioning, relationships, educational and work productivity, mental health, and well-being. Over the course of a lifetime, these daily challenge...

Introduction: Endometriosis is a chronic inflammatory gynecologic disease affecting 5-10% of women of reproductive age of all ethnicities. Symptoms of this painful condition impact the physical, mental health, and quality of life of patients. Stigma is a social determinant of health documented to negatively impact people living with chronic condit...

Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation on the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer survivors, were significantly affected. The goal of this study was to assess the impact of HM on barriers to car...

We previously demonstrated the negative impact of stress in an animal model of endometriosis. Although its role is unclear, altered levels of vitamin D (VitD) have been found in patients with this condition. VitD signaling through the VitD receptor (VDR) has anti-proliferative properties and induces an anti-inflammatory phenotype in macrophages. We...

There is strong evidence from humans and animal models showing that abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis and/or the inflammatory response system disrupts feedback regulation of both neuroendocrine and immune systems, contributing to disease. Stress is known to affect the physiology of pelvic organs and to disturb th...

p>Background: Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation in the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer patients and survivors, were significantly affected. The goal of the current study was to assess t...

INTRODUCTION This study was conducted to determine for the first time the demographic and clinical profile of women with endometriosis of Hispanic/Latina background, a patient population not well represented in databases and cohort studies. In order to gather standardized, comparable data we used the Clinical Questionnaire developed by the Endometr...

Skin cancer risk information based on melanocortin-1 receptor (MC1R) variants could inform prevention and screening recommendations for Hispanics, but limited evidence exists on the impact of MC1R variants in Hispanic populations. We studied Hispanic subjects, predominately of Puerto Rican heritage, from Tampa, Florida, US, and Ponce, PR. Blood or...

Cancer is the leading cause of death in Puerto Rico (PR). Hurricane Maria (HM) and its aftermath lead to widespread devastation in the island, including the collapse of the healthcare system. Medically fragile populations, such as cancer survivors, were significantly affected. The goal of this study was to assess the impact of HM on barriers to car...

Background: The goals of health disparities research are to identify facilitators and barriers to healthcare use to help eliminate health inequalities. There are few studies on disparities in healthcare access and use trends for patients with endometriosis that may lead to differences in appropriate care based on socioeconomic status. Objective:...

Endometriosis is a painful gynecological disease with no cure and limited therapeutic options. It has been hypothesized that epigenetic drugs can be used as a nonhormonal treatment for endometriosis. This study was conducted to study the efficacy of an inhibitor of the histone methyltransferase EZH2 using an established rat model of endometriosis....

Endometriosis is an inflammatory, painful gynecologic disease with no cure and limited treatment options. Epigenetics, including histone modifications, play a key role in the etiology of endometriosis, therefore it has been hypothesized that epigenetic drugs can be used as a non‐hormonal therapeutic alternative for endometriosis. Following up on ou...

Endometriosis is a disorder in which endometrial tissue is found outside the uterus causing pain, infertility and stress. Finding effective, non-hormonal and long-term treatments for endometriosis still remains one of the most significant challenges in the field. Corticotropin releasing hormone (CRH) is one of the main signaling peptides within the...

Morphological characteristics of endometriosis vesicles illustrated by the stage of estrous cycle at sacrifice. (A) Percent developed vesicles. (B) Group means of the total vesicle weight per rat. (C) Group means for the total vesicle volume per rat. (D) Group means for the total vesicle area per rat. The table illustrates the statistical results o...

Estrous cycle distribution for experiment 1 and experiment 2. (A) The number of rats that were at each stage of the estrous cycle the day of behavioral testing and sacrifice for experiment 1. Estrous cycle before endometriosis surgery was not assessed in these rats. (B) Estrous cycle in rats for experiment 2 was assessed for 10 days prior to induct...

Anxiety behaviors at 7 days after endometriosis induction surgery for experiment 1. Estrous cycle stage at the time of sacrifice was measured by vaginal smear. We did not pre-planned to sacrifice at any particular stage of the cycle but rather at exactly 7 days after the endometriosis induction. (A and B) Total distance traveled in the open field a...

Anxiety behaviors at 60 days after endometriosis induction or sham surgery for experiment 2. Similar to experiment 1, estrous cycle stage at the time of sacrifice was measured by vaginal smear. We did not pre-planned to sacrifice at any particular stage of the cycle but rather at 60 days after the endometriosis induction. (A and B) Total distance t...

Background Endometriosis, defined as the growth and development of endometrial like tissue, ( i.e., glands and stroma) outside the uterine cavity, is a gynecological condition that affects 10% of women in their reproductive age. Cumulative evidence has demonstrated that candidate genes which are related with cellular behaviors characteristic of end...

Objectives • Describe natural disaster outcomes of Hurricane Maria on cancer patients and non-cancer participants. • Describe perceived stress levels after Hurricane Maria on cancer patients and non-cancer participants.

Endometriosis is a disorder in which endometrial tissue is found outside the uterus causing pain, infertility and stress. Finding an effective and long-term treatment for endometriosis still remains one of the most significant challenges in the field. Corticotropin releasing hormone (CRH) is one of the main signaling peptides within the hypothalami...

Purpose: Endometriosis is a hormone-dependent, inflammatory, painful condition affecting 1 in 10 women during their reproductive years. The symptoms of endometriosis—dysmenorrhea, dyspareunia, infertility—negatively impact the quality of life (QoL) of the affected women. Few studies have been conducted on mental health and QoL impact in a younger e...

Most available therapies for endometriosis are hormone-based and generally broadly used without taking into consideration the ovarian hormone receptor expression status. This contrasts strikingly with the standard of care for other hormone-based conditions such as breast cancer. We therefore aimed to characterize the expression of ovarian steroid h...

A noninvasive biomarker-based test could help shorten the diagnostic delay for endometriosis. The most investigated biomarker sources are peripheral blood and endometrium. Discovery of endometriosis biomarkers is often hypothesis-driven, i.e. when one or a few biomarkers are investigated based on their role in the disease pathogenesis. Alternativel...

Although the histone methyltransferase EZH2 and its product H3K27me3 are well studied in cancer, little is known about their role and potential as therapeutic targets in endometriosis. We have previously reported that endometriotic lesions are characterized by global enrichment of H3K27me3. Therefore, we aimed to 1) characterize the expression leve...

Iron is proposed to contribute to the transition from endometriosis to specific subtypes of ovarian cancers (OVCAs). Regulation of intracellular iron occurs via a ferritinophagic process involving NCOA4 (Nuclear Receptor Coactivator 4), represented by two major isoforms (NCOA4a and NCOA4ß), whose contribution to ovarian cancer biology remains uninv...

High levels of inflammatory factors including chemokines have been reported in peritoneal fluid and blood of women with endometriosis. CXCL12 mediates its action by interaction with its specific receptor, CXCR4, which has been reported to be elevated in human endometriosis lesions and in the rat model of endometriosis. Activation of the CXCR4-CXCL1...

Treatments for endometriosis include pharmacological or surgical procedures that produce significant side effects. We aimed to determine how environmental enrichment (EE) could impact the progression of endometriosis using the autotransplantation rat model. Female rats were exposed to EE (endo-EE: toys and nesting materials, 4 rats per cage, larger...

Purpose: We have previously shown that stress prior to induction worsens clinical presentation and inflammatory parameters in a rat model of endometriosis. This study was designed to examine whether stress during the development of endometriosis can affect the growth of endometriotic implants through nerve growth and immune alterations. Methods:...

Background: The scarcity of tissues from racial and ethnic minorities at biobanks poses a scientific constraint to research addressing health disparities in minority populations. Methods: To address this gap, the Minority Biospecimen/Biobanking Geographic Management Program for region 3 (BMaP-3) established a working infrastructure for a "bioban...

There are currently 580 million people worldwide considered to be of Hispanic origin. In the US Hispanics represent 17% of the population and its largest ethnic minority. Funded by NIH, Moffitt Cancer Center (Florida) and Ponce School of Medicine (Puerto Rico) initiated a partnership that conducts high-quality research, training, and community outr...

Studies have examined how endometriosis interacts with the nervous system, but little attention has been paid to opioidergic systems, which are relevant to pain signaling. We used the autotransplantation rat model of endometriosis and allowed to progress for 60 days. The brain was collected and examined for changes in endogenous opioid peptides, mu...

There are currently 580 million people worldwide considered to be of Hispanic origin. In the US Hispanics represent 17% of the population and its largest ethnic minority. Funded by NIH, Moffitt Cancer Center (Florida) and Ponce School of Medicine (Puerto Rico) initiated a partnership that conducts high-quality research, training, and community outr...

In endometriosis, the increased survival potential of shed endometrial cells (which normally undergo anoikis) is suggested to promote lesion development. One mechanism that may alter anoikis is autophagy. Using an autophagic flux inhibitor hydroxychloroquine (HCQ), we identified that it reduces the in vitro survival capacity of human endometriotic...

Purpose: To describe lifetime differences in clinical characteristics of women with endometriosis between the USA and Puerto Rico. Methods: A descriptive study using self-administered demographic and clinical questionnaires was undertaken. Women with self-reported surgically diagnosed endometriosis who completed questionnaires from the Endometrios...

Purpose: To describe lifetime differences in clinical characteristics of women with endometriosis between the USA and Puerto Rico. Methods: A descriptive study using self-administered demographic and clinical questionnaires was undertaken. Women with self-reported surgically diagnosed endometriosis who completed questionnaires from the Endometriosi...

Background: Endometriosis is a benign gynecologic condition that is known to have transformation potential. Women with ovarian endometriosis have twice the risk for developing ovarian cancer of the endometrioid or clear cell types. However, the carcinogenic pathways by which endometriosis associated ovarian carcinoma (EAOC) develops remain poorly u...

Background: Endometriosis is an inflammatory disease that is defined by growth of endometrial tissue outside the uterus, resulting in pain, infertility, and emotional distress. Previous studies have shown that the HPA axis is compromised in patients with chronic, painful diseases, including endometriosis. However, the underlying mechanisms and the...

Lysyl oxidases (LOXs) are enzymes involved in collagen deposition, extracellular membrane remodeling, and invasive/metastatic potential. Previous studies reveal an association of LOXs and endometriosis. We aimed to identify the mechanisms activated by upregulation of lysyl oxidases (LOX) in endometriotic cells and tissues. We hypothesized that LOX...

Endometriosis is defined as the presence of endometrial glands and stroma outside of the uterine musculature and endometrial lining. Regulation of gene expression is a flexible, yet stable, mechanism that maintains a cellular memory that could result in a disease state. The aim of this study was to analyze mRNA levels expression in endometrial tiss...

Endometriosis is defined as the presence of endometrial glands and stroma outside of the uterine musculature and endometrial lining. Regulation of gene expression is a flexible, yet stable, mechanism that maintains a cellular memory that could result in a disease state.The aim of this study was to analyse mRNA levels expression in endometrial tissu...

Epigenetic mechanisms may play an important role in the etiology of endometriosis. The modification of histones by methylation of lysine residues has been shown to regulate gene expression by changing chromatin structure. We have previously shown that endometriotic lesions had aberrant levels of histone acetylation (lower) and methylation (higher)...

The 1 st Puerto Rico Biobanking Workshop took place on August 20 st , 2014 in the Auditorium of the Comprehensive Cancer Center of the University of Puerto Rico, Medical Sciences Campus in San Juan Puerto Rico. The program for this 1-day, live workshop included lectures by three biobanking experts, followed by presentations from existing biobanks i...

The 1st Puerto Rico Biobanking Workshop took place on August 20th, 2014 in the Auditorium of the Comprehensive Cancer Center of the University of Puerto Rico, Medical Sciences Campus in San Juan Puerto Rico. The program for this 1-day, live workshop included lectures by three biobanking experts, followed by presentations from existing biobanks in P...

Introduction: The Ponce School of Medicine and Health Sciences (PSMHS), in Ponce, Puerto Rico (PR), has established a partnership with the Moffitt Cancer Center (MCC) in Tampa, Florida with the primary goal of fostering high quality basic, clinical and community outreach research in cancer-related health disparities. Central to this research collab...

Introduction: The geographic proximity and large Hispanic populations in Florida and Puerto Rico (PR) have driven the formation of an academic partnership between the Ponce School of Medicine and Health Sciences in Ponce, PR and Moffitt Cancer Center in Tampa, FL. The complementary expertise at both institutions provides a synergistic means of stud...

Objective To harmonize standard operating procedures (SOPs) and standardize the recording of associated data for collection, processing, and storage of fluid biospecimens relevant to endometriosis. Design An international collaboration involving 34 clinical/academic centers and 3 industry collaborators from 16 countries on 5 continents. Setting I...

Objective: To standardize the recording of surgical phenotypic information on endometriosis and related sample collections obtained at laparoscopy, allowing large-scale collaborative research into the condition. Design: An international collaboration involving 34 clinical/academic centers and three industry collaborators from 16 countries. Setting:...

We have previously shown detrimental effects of stress in an animal model of endometriosis. We now investigated whether the ability to control stress can affect disease parameters. Endometriosis was surgically induced in female Sprague-Dawley rats before exposing animals to a controllable (submerged platform) or uncontrollable (no platform) swim st...

Recently, epigenetic factors, including histone modifications, and environmental factors have shown to play an active role in endometriosis. We have recently shown that the levels of histone de‐acetylates (HDACs) are higher and that histone acetylation marks are decreased in endometriosis lesions. Also, stress contribute to the development of highe...

The significance of epigenetic changes in the etiology and pathogenesis of endometriosis is being progressively recognized. However, the function of lysine‐histone epigenetic modifications and furthermore, their role in the pathology of this disease remains unclear. We lead a study aimed to identify specific epigenetic profiles and evaluate possibl...

Endometriosis a benign gynaecological disease, associated with chronic inflammation and increased levels of chemokines. Lesions are composed of endometrial stroma and glands localized outside the uterus. In a rat model of endometriosis, we showed high CXCR4 mRNA levels in endometriotic lesions and in high protein expression levels in human endometr...

Endometriosis is characterized by peritoneal inflammation, infertility and chronic pelvic pain that substantially affect quality of life. Since stress can affect the immune system and recruitment of inflammatory cells it may contribute to this condition. Vitamin D receptor (VDR) is associated with anti‐proliferative and anti‐inflammatory properties...

Introduction: Breast cancer (BC) and endometriosis are important reproductive health diseases for women. Although endometriosis is not a malignant condition, some of its characteristics mimic that of a malignancy. Endometriosis is associated with increased risk of certain cancers; however, whether it alters BC risk is unclear. This study evaluates...

Background: The histone modification patterns in endometriosis have not been fully characterized. This gap in knowledge results in a poor understanding of the epigenetic mechanisms (and potential therapeutic targets) at play. We aimed to (1) assess global acetylation status of histone 3 (H3) and histone 4 (H4), (2) measure levels of H3 and H4 lysi...