Immunotherapy in endometriosis: a challenging research topic

Could immunotherapy be possible for endometriosis in the near future?

Key Points

Highlights:

• Among the therapeutic modalities under research, immunotherapy seems to be promising due to the suitability of the pathophysiology of endometriosis.

Importance:

• It is possible that immunotherapy may become a part of the treatment of endometriosis in the future, especially where surgery is inadvisable or not applicable for various reasons.

What's done here:

• The authors have made a comprehensive review on endometriosis and immunological aspects of the disease, in particular, aiming to shed light on future therapeutic research topics.

Key results:

• Limited research in animal models, besides few human studies regarding the immune factors in endometriosis, our current knowledge is still developing on the immunological aspects of endometriosis.
• In endometriosis patients, the immunological milieu of the peritoneal cavity allows survival of ectopic endometrial tissues that could be cleared otherwise. 
• As an animal model of human disease, female olive baboons under immunosuppression by pharmacologic agents show an increase in endometriotic lesions.
• The prospect of research for a therapeutic algorithm in this field seems very promising.
• Further, methodologically reliable studies to assess the safety and effectiveness of immunotherapeutic methods are needed.

Lay Summary

Dr. Maksym and associates from academic centers in Poland have published their comprehensive review on endometriosis emphasizing the immunological aspects of the disease in a recent issue of the "Journal of Clinical Medicine".

Even though endometriosis is a multifactorial disease, it is well known that the appearance of ectopic endometrial implants in the peritoneal cavity is possible due to immunological defects allowing the survival of abnormal tissues which would otherwise be cleared.

It is well known that endometriosis is characterized by polyclonal lymphocyte B activation, lymphocyte T (Th1) and B cell dysfunction, impaired apoptosis, and NK cell activity. Besides, there is a significant increase of immune-related disorders in patients with endometriosis, particularly autoimmune diseases and celiac disease, frequently latent, or a genetic predisposition to the disease.

As an animal model of human disease, spontaneous endometriosis in female olive baboons show increase in their lesions under immunosuppression by pharmacologic agents. Numerous immunotherapy trials, including vaccines, were conducted on animals with encouraging results. Additionally among the promising methods of non-specific immunotherapy is the administration of an ethiodized oil contrast.

Noticing the significant successes of immunotherapy in oncology, the possibility of immunotherapy affecting NK cells has been postulated in endometriosis also. NK cells are responsible for the surveillance and apoptosis of ectopic endometrial cells.

Widening the therapeutic modalities in endometriosis by immunotherapy is promising due to the significant contribution of immunological factors and the limitations of current treatments. 

Immunotherapy also may be useful in the treatment of endometriosis, especially for patients where surgery is inadvisable or not applicable for various reasons. The prospect of research for a therapeutic algorithm in endometriosis looks very promising. Additional methodologically reliable research to assess the safety and effectiveness of immunotherapeutic methods is needed.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34945174/