{"paper_id":"b2754d66-422f-45ae-a6af-21c0547c11a9","body_text":"Abstract\nPurpose\nEndometriosis is defined as the presence of endometrial-like endometrial cells, glands and stroma outside the uterus, causing a strong inflammatory-like microenvironment in the affected tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease. Considering the pivotal role of interaction between immune and endometriotic cells, in this paper, we aim to shed light about the role of apoptosis pathways in modulating the fine-regulated peritoneal microenvironment during endometriosis.\nMethods\nNarrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.\nResults\nIn normal conditions, endometriotic cells, refluxed through the fallopian tubes into the peritoneal cavity, should be attacked and removed by phagocytes and NK cells. During endometriosis, the breakdown of peritoneal homeostasis causes the failure of scavenging mechanisms, allowing the survival of endometriotic cells. The consequent so-called “immunoescaping” of endometriotic cells could be due, at least in part, to the reduction of apoptotic-mediated pathways previously described.\nConclusion\nConsidering the large amount of evidence retrieved from in vitro as well as in vivo models, the reduced apoptosis of endometriotic cells together with the increased apoptosis of peritoneal fluid mononuclear cells may address the peritoneal homeostasis to a permissive environment for the progression of the disease.\nSimilar content being viewed by others\nReferences\nGiudice LC, Kao LC (2004) Endometriosis. Lancet 364:1789–1799. doi:10.1016/S0140-6736(04)17403-5\nBulun SE (2009) Endometriosis. N Engl J Med 360:268–279. doi:10.1056/NEJMra0804690\nMeuleman C, Vandenabeele B, Fieuws S et al (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. 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Neuro Endocrinol Lett 27:779–785\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nFunding\nThis article was not supported by any fund/grant.\nConflict of interest\nThe authors declare that they have no conflict of interest.\nEthical approval\nThis article does not contain any studies with human participants or animals performed by any of the authors.\nRights and permissions\nAbout this article\nCite this article\nVetvicka, V., Laganà, A.S., Salmeri, F.M. et al. Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet 294, 897–904 (2016). https://doi.org/10.1007/s00404-016-4195-6\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-016-4195-6","source_license":"CC0","license_restricted":false}