Pathogenesis of Endometriosis: The Role of Peritoneal Fluid

Koninckx PR; Philippe R. Koninckx; P R Koninckx; Stephen Kennedy; Kennedy SH; S H Kennedy; Barlow DH; D H Barlow

doi:10.1159/000052856

Pathogenesis of Endometriosis: The Role of Peritoneal Fluid

Koninckx PR, Philippe R. Koninckx, P R Koninckx, Stephen Kennedy, Kennedy SH, S H Kennedy, Barlow DH, D H Barlow

Gynecologic and obstetric investigation · 1999 · vol. 47(Suppl. 1) , pp. 23–33 · doi:10.1159/000052856 · PMID:10087425 · W2050800902

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Peritoneal fluid, ovarian milieu, and blood influence endometrial cell behavior, potentially differentiating superficial endometriosis from pathological deep or cystic ovarian endometriosis.

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Abstract

Peritoneal fluid is a specific microenvironment. It originates mainly as an ovarian exudation product due to increased vascular permeability, and contains large amounts of macrophages and their secretion products, which include growth factors, cytokines and angiogenic factors. Similarly, within the ovary, there is also a specific microenvironment, best characterised by the follicular milieu with steroid hormone concentrations that are 1,000 times higher than in plasma. Since endometrial cells in peritoneal fluid and superficially implanted cells will be influenced by peritoneal fluid concentrations, any differences found between minimal endometriosis and eutopic endometrium could be the consequence of their different local environments, rather than inherent cellular differences. Superficial endometrial implants may be regulated by factors in peritoneal fluid, while deep endometriosis and cystic ovarian endometriosis may be under the influence of factors in blood and within the ovary, in which case minimal endometriosis may be physiologic only, while deep endometriosis and cystic ovarian endometriosis, both associated with pelvic pain and infertility, may be a pathological state. In conclusion, the local endocrine environment, that is, in blood, peritoneal fluid, and within the ovary, should be taken into account to explain the differences between superficial, deep and cystic ovarian endometriosis, together with inherent differences in the endometrial cells of women with and without endometriosis.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Extracellular Space Peritoneum Animals Cell Adhesion Molecules Cell Adhesion Molecules Cysts Cysts Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Endometrium Extracellular Space Female Humans Killer Cells, Natural Killer Cells, Natural

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Cited by (50)

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[1] 46,XY Pure Gonadal Dysgenesis via openalex

[2] A comparison of cathepsin D levels in endometriotic tissue and in uterine endometrium. via openalex

[3] A mid-luteal phase comparison of V76 peritoneal fluid volume and its content of PGF2α and PGE2 in women with minimal stage endometriosis and a normal pelvis via openalex

[4] Angiogenesis in Endometriosis via openalex

[5] Angiogenic activity of peritoneal fluid from women with endometriosis via openalex

[6] Aromatase expression in endometriosis. via openalex

[7] A STUDY OF PLASMA PROGESTERONE, OESTRADIOL‐l7β, PROLACTIN AND LH LEVELS, AND OF THE LUTEAL PHASE APPEARANCE OF THE OVARIES IN PATIENTS WITH ENDOMETRIOSIS AND INFERTILITY via openalex

[8] Basal and stimulated secretion of cytokines by peritoneal macrophages in women with endometriosis via openalex

[9] Biases in the endometriosis literature via openalex

[10] Biochemical Characterization of Peritoneal Fluid in Women during the Menstrual Cycle* via openalex

[11] Chemotaxis of macrophages by a peritoneal fluid protein in women with endometriosis via openalex

[12] Comparison of cytokine levels and embryo toxicity in peritoneal fluid in infertile women with untreated or treated endometriosis via openalex

[13] Cytokine-induced secretion of monocyte chemotactic protein-1 by human endometriotic cells in culture via openalex

[14] Cytolysis of Eutopic and Ectopic Endometrial Cells by Peripheral Blood Monocytes and Peritoneal Macrophages in Women with Endometriosis via openalex

[15] Decreased levels of the potent regulator of monocyte/macrophage activation, interleukin-13, in the peritoneal fluid of patients with endometriosis via openalex

[16] Deficient cellular immunity in endometriosis via openalex

[17] Differential Expression of IGF‐I and IGF‐II in Eutopic and Ectopic Endometria of Women With Endometriosis and in Women Without Endometriosis via openalex

[18] Distribution of heat shock proteins in eutopic and ectopic endometrium in endometriosis and adenomyosis via openalex

[19] Dysregulation of interleukin-6 responses in ectopic endometrial stromal cells: correlation with decreased soluble receptor levels in peritoneal fluid of women with endometriosis. via openalex

[20] Elevation of the phospholipase A2 activity in peritoneal fluid cells from women with endometriosis via openalex

[21] Endometrial vascular and glandular expression of integrin alpha(v)beta3 in women with and without endometriosis via openalex

[22] Endometriosis: Expression of the 60 kDa heat shock protein in peritoneal fluids from women with endometriosis: implications for endometriosis-associated infertility via openalex

[23] Endometriosis in Rhesus Monkeys (Macaca mulatta) Following Chronic Exposure to 2,3,7,8-Tetrachlorodibenzo-p-dioxin via openalex

[24] Endometriotic disease: the role of peritoneal fluid via openalex

[25] Epithelial cells in peritoneal fluid—of endometrial origin? via openalex

[26] Expression of estrogen receptor wild type and exon 5 splicing variant mRNAs in normal and endometriotic endometria during the menstrual cycle via openalex

[27] Expression of integrins E-cadherin in cells from menstrual effluent, endometrium, peritoneal fluid, peritoneum, endometriosis via openalex

[28] Familial inheritance of endometriosis in a British population. A case control study via openalex

[29] Heparin-sepharose binding growth factors in peritoneal fluid of women with endometriosis via openalex

[30] Heparin-sepharose binding growth factors in peritoneal fluid of women with endometriosis via openalex

[31] Heritable aspects of endometriosis via openalex

[32] IL‐1β TNF‐α, and IL‐2 in Peritoneal Fluid and Macrophage‐Conditioned Media of Women With Endometriosis via openalex

[33] IL6 and acute phase plasma proteins in peritoneal fluid of women with endometriosis via openalex

[34] Immunolocalization and Regulation of the Chemokine RANTES in Human Endometrial and Endometriosis Tissues and Cells<sup>1</sup> via openalex

[35] Immunolocalization of the apoptosis regulating proteins Bcl-2 and Bax in human endometrium and isolated peritoneal fluid macrophages in endometriosis via openalex

[36] Immunologic Aspects of Human Endometriosis via openalex

[37] IMMUNOLOGY AND ENDOMETRIOSIS via openalex

[38] Immunology: Anti-endometrial lymphocytotoxicity and natural killer cell activity in baboons (Papio anubis and Papio cynocephalus) with endometriosis* via openalex

[39] Immunosuppressive activity of peritoneal fluid in women with endometriosis. via openalex

[40] Increased chemotactic activity of peritoneal fluid in patients with endometriosis via openalex

[41] Increased Mast Cell Density in Peritoneal Endometriosis Compared with Eutopic Endometrium with Endometriosis via openalex

[42] Interferon‐Gamma (IFN‐γ) and Interleukin‐6 (IL‐6) in Peritoneal Fluid and Macrophage‐Conditioned Media of Women With Endometriosis via openalex

[43] Interleukin-6 and soluble interleukin-6 receptor in peritoneal fluid and serum of patients with endometriosis. via openalex

[44] Intrapelvic injection of menstrual endometrium causes endometriosis in baboons (Papio cynocephalus and Papio anubis) via openalex

[45] In vitro culture of endometrial stromal and gland cells as a model for endometriosis: The effect of peritoneal fluid on proliferation via openalex

[46] Localization of laminin, fibronectin, E-cadherin, and integrins in endometrium and endometriosis via openalex

[47] Luteinized unruptured follicle syndrome in mild endometriosis. Assessment with biochemical parameters. via openalex

[48] Lysophosphatidyl Choline, a Chemotactic Factor for Monocytes/T-Lymphocytes Is Elevated in Endometriosis via openalex

[49] Macrophage Scavenger Receptor(s) and Oxidatively Modified Proteins in Endometriosis via openalex

[50] Minimal and mild endometriosis. Nd:YAG laser treatment and changes in prostaglandin concentrations in peritoneal fluid. via openalex

[51] New aspects of the pathophysiology of endometriosis and associated infertility. via openalex

[52] Nonmalignant epithelial cells, potentially invasive in human endometriosis, lack the tumor suppressor molecule E-cadherin. via openalex

[53] Nonpigmented endometriosis: Clinical, laparoscopic, and pathologic definition via openalex

[54] N-terminal truncated forms of insulin-like growth factor binding protein-3 in the peritoneal fluid of women without laparoscopic evidence of endometriosis via openalex

[55] ORIGIN OF PERITONEAL FLUID IN WOMEN: AN OVARIAN EXUDATION PRODUCT via openalex

[56] PATHOGENESIS OF ENDOMETRIOSIS via openalex

[57] Peritoneal fluid 6-keto prostaglandin F1α levels in women with endometriosis via openalex

[58] Peritoneal fluid 6‐keto‐prostaglandin FL<sub>α</sub>, thromboxane B2 in endometriosis and unexplained infertility via openalex

[59] Peritoneal fluid concentrations of interleukin-8 in women with endometriosis: relationship to stage of disease via openalex

[60] Peritoneal fluid concentrations of the cytokine RANTES correlate with the severity of endometriosis via openalex

[61] Peritoneal fluid prostaglandins and prostanoids in women with endometriosis, chronic pelvic inflammatory disease, and pelvic pain via openalex

[62] Peritoneal fluid prostanoids in unexplained infertility via openalex

[63] Peritoneal Fluid Volume, 17Beta-Estradiol and Progesterone Concentrations in Women with Endometriosis and/or Luteinized Unruptured Follicle Syndrome via openalex

[64] Peritoneal fluid volume and sex steroids in the preovulatory period in mild endometriosis via openalex

[65] Peritoneal fluid volume, estrogen, progesterone, prostaglandin, and epidermal growth factor concentrations in patients with and without endometriosis via openalex

[66] Peritoneal natural killer cytotoxicity and CD25+CD3+ lymphocyte subpopulation are decreased in women with stage III–IV endometriosis via openalex

[67] Platelet-activating factor acetylhydrolase activity in peritoneal fluids of women with endometriosis. via openalex

[68] Principles of management of endometriosis: surgical treatment via openalex

[69] Production of fibronectin by peritoneal macrophages and concentration of fibronectin in peritoneal fluid from patients with or without endometriosis. via openalex

[70] [Prostanoids of the peritoneal fluid and sterility with or without pelvic lesions (endometriosis, postinfectious adhesions)]. via openalex

[71] Protein, progesterone, and protease inhibitors in uterine and peritoneal fluids of women with endometriosis via openalex

[72] Proton irradiation and endometriosis. via openalex

[73] Release of tumor necrosis factor-α by human peritoneal macrophages in vivo and in vitro via openalex

[74] Retrograde menstruation in healthy women and in patients with endometriosis. via openalex

[75] Risk factors for endometriosis in the rhesus monkey (Macaca mulatta): a case-control study via openalex

[76] Secondary m&#x00FC;llerian system and endometriosis via openalex

[77] Spontaneous Apoptosis of Endometrial Tissue is Impaired in Women with Endometriosis via openalex

[78] Stereometric evaluation of peritoneal endometriosis and endometriotic nodules of the rectovaginal septum via openalex

[79] Suppression of matrix metalloproteinases inhibits establishment of ectopic lesions by human endometrium in nude mice. via openalex

[80] The acute-phase response in endometriosis of women via openalex

[81] The basement membrane in endometriosis via openalex

[82] The insulin-like growth factor system in human peritoneal fluid: its effects on endometrial stromal cells and its potential relevance to endometriosis. via openalex

[83] Theories on the pathogenesis of endometriosis via openalex

[84] The origin of estrogens, progesterone, androgens and sex hormone binding globulin in peritoneal fluid in the immediate postovulatory period in normal ovulating women via openalex

[85] The peritoneal environment in endometriosis via openalex

[86] The peritoneal environment in endometriosis via openalex

[87] The Role of Macrophage Colony Stimulating Factor in the Peritoneal Fluid in Infertile Patients with Endometriosis. via openalex

[88] The stimulus responsible for the peritoneal fluid inflammation observed in infertile women with endometriosis via openalex

[89] Tissue Inhibitor of Metalloproteinase-1 Concentrations are Attenuated in Peritoneal Fluid and Sera of Women with Endometriosis and Restored in Sera by Gonadotropin-Releasing Hormone Agonist Therapy via openalex

[90] Treatment of deeply infiltrating endometriosis via openalex

[91] Tumor Necrosis Factor in Plasma and Peritoneal Fluid of Women with and without Endometriosis via openalex

[92] Vascular endothelial growth factor is produced by peritoneal fluid macrophages in endometriosis and is regulated by ovarian steroids. via openalex

[93] W2107696143 via openalex

[94] W2089152593 via openalex

[95] W2087165249 via openalex

[96] W2003138212 via openalex

[97] W1969726399 via openalex

[98] W174381814 via openalex

[99] W2227136145 via openalex

[100] W2238870413 via openalex