The role of immunity in endometriosis

Endometriosis and immune sytem, which came first: the chicken or the egg ?

Key Points

Highlights :

• Innate immunity plays a pivotal place in the pelvic environmental milieu, especially in retrograde menstruation.
• Scientific research related to immunological factors in endometriosis has been restricted to observational papers.

Importance:

• Whether immune cells have the first place, or just act as secondary cells and /or helpers maintaining endometriotic lesions and facilitating their development is an unsettled question.

What's done here :

• This is a comprehensive review of contemporary issues related to endometriosis.

Main key feature :

• Following retrograde menstruation, endometrial micro fragments in the pelvis possibly trigger variable inflammatory responses and local interaction between Tregs and effector cells such as CD4 lymphocyte subsets may determine the outcome.

Lay Summary

Academicians from Japan and China have recently published their comprehensive updated immunological review for endometriosis in the Journal of Reproductive Immunology. 

Endometriosis is a multifactorial condition with multiple theories of pathogenesis. The role of innate and adaptive immunology in this regard has not been unveiled yet. However, scientific research related to immunity in endometriosis has been restricted to observational papers. Innate immunity seems to play an important role in the pelvic environmental milieu, especially in retrograde menstruation of endometrial cells.

In unilateral ovariectomized animals the growth and progression of endometriosis continue which means that along with ovarian hormones, endometriotic progression well could be regulated by the immune environment of the pelvic milieu. Cumulative observations are pointing to the pivotal role of immune Th1/Th2/Th17/Treg cells in the initiation and development of endometriosis.

In this regard, a low level of CD4 + Th-17A + cells in the peritoneal tissues as compared with Tregs may disturb the balance between pro-inflammatory and anti-inflammatory response and start the initial early endometriotic lesions.

Even manipulation of Tregs to suppress Th17 cells to improve the peritoneal milieu may well be a potential therapeutic target in endometriosis.

Research Source: https://pubmed.ncbi.nlm.nih.gov/38503076/