The role of microbiota in the etiopathogenesis of endometriosis

Inflammation, microbiota, and endometriosis

Key Points

Highlights:

• The demonstration of different endometrial microbiota and inflammatory changes in the genital tract of women with endometriosis helps us understand an important mechanism involved in the pathogenesis of endometriosis.

 Importance:

• The microbiota in the genital tract of women with endometriosis should be investigated for the diagnosis, differential diagnosis and the prevention of poor outcomes associated with the disease.   

What’s done here?

• Despite extensive research, the exact mechanism of endometriosis still remains unclear.
• The role of the microbiota in the pathogenesis of endometriosis is not yet clearly understood.
• This article was conducted to clarify the importance of infectious, inflammatory and immunological changes in the etiopathogenesis of endometriosis.

Key results:

• Although there are many theories to explain the underlying pathophysiological mechanism of endometriosis, the exact mechanism has not been understood yet.
• The microorganisms in a specific location of the human body such as the genital tract called "Microbiota" and their characterization in endometriosis may contribute to the development of treatment options.
• Endometriosis is also associated with poor obstetric outcomes. When the bacteria located in the endometrium of these patients with endometriosis, it would also explain the relationship between microbiota changes and the development of endometriosis. 
• Demonstration of different microbiota in the pathogenesis of endometriosis will create new modalities in the management of endometriosis.

Lay Summary

Endometriosis is an estrogen-dependent disease that is commonly diagnosed in reproductive-aged women. Although many advanced types of research about the etiology, differential diagnosis and treatment have been performed, it still remains an enigmatic disease.

Dr. Bedaiwy, a scientist and physician from Canada, published a study titled “Endometrial macrophages, endometriosis, and microbiota: time to unravel the complexity of the relationship” in the journal named "Fertility and Sterility". The role of infectious, inflammatory and immunological changes in the etiopathogenesis of endometriosis is not adequately investigated. The effect of microbiota changes in the development of endometriosis is suspected based on recent literature.

Microbiota represents an ensemble of microorganisms that resides in a part of the body including the genital tract. Some differences have been shown in the eutopic endometrium of women with confirmed endometriosis and control subjects. Primary innate immune cells residing within the endometrium such as macrophages, uterine natural killer cells, and regulatory T cells also show some differences in women with and without endometriosis. This provides some clues for us to understand the importance of microbiota in the pathogenesis of endometriosis.

Besides this, it has been shown that endometriosis is associated with poor obstetric outcomes including pregnancy loss, ectopic pregnancy, gestational diabetes mellitus and hypertensive disorders of pregnancy. The risk for preterm birth, miscarriage, placenta previa, small for gestational age infants and cesarean delivery is also shown to be higher in women with endometriosis. The evaluation of bacterial changes in these women could also provide an explanation about the role of the microbiome in the etiopathogenesis of endometriosis. Understanding the importance of microbiota changes in endometriosis will result in the development of new modalities in the treatment of the disease.

“It is time to further investigate the uterine immune niche and microbiome to increase our understanding of reproductive disorders, including endometriosis, and to develop more personalized reproductive therapies.” the authors added.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31843078