M1 M2 macrophage expression in menstrual blood flakes of women with endometriosis

In: Majalah Obstetri & Ginekologi · 2018 · vol. 24(2) , pp. 64 · doi:10.20473/mog.v24i22016.64-69 · W4236987715
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AI-generated summary by claude@2026-06, 2026-06-17

This study found increased panmacrophage and M2 macrophage expression and a decreased M1/M2 ratio in menstrual blood flakes of women with endometriosis.

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This cross-sectional observational study measured pan-macrophage (CD68) and M2 macrophage expression (CD163) in menstrual blood flakes collected on cycle day 2–3 from 30 women with endometriosis and non-endometriosis, using immunohistochemical staining. The authors reported that expression levels were normally distributed and, in statistical testing, endometriosis was associated with higher pan-macrophage and higher M2 expression, while M1 expression did not significantly differ between groups; accordingly, the M1/M2 ratio was lower in the endometriosis group. They explicitly describe their statistical approach (including one-tailed α=0.05 and reporting p-values and 95% confidence intervals), but the abstract does not specify key limitations such as potential confounders or how “M1” was derived beyond the CD68/CD163 framework. This paper is centrally about endometriosis—specifically macrophage M1/M2 marker expression in menstrual blood flakes from women with endometriosis.

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Abstract

Objectives: to measure and prove the increase of panmacrophage, macrophages M1 and M2 expression and decrease of ratio of M1/M2 in menstrual blood flakes of women with endometriosis. Materials and Methods: This study was a cross sectional observational analytic study conducted on 30 subjects with endometriosis and non-endometriosis. Immunohistochemical staining was done on a sample of menstrual blood flakes of subjects study who were taken at the second or third day of menstrual cycles with CD68 and CD163 antibody to measure the expression of panmacrophage and M2 macrophages. Expression of M1 macrophages is the approach of a reduction expression of panmacrophage with M2 macrophages.Results: Expression of M1, M2 and the ratio M1/M2 in the both of groups had a normal distribution then continued by independent t-test with one-tailed α (0.05). Probability was considered statistically significant at p <0.05 with a confidence interval of 95%. Based on the statistical result, Mφ macrophage expression in endometriosis and control group amounted to 3.62 ± 0.50 and 2.80 ± 0.64 (p =0.0005) with non parametric test. The expression of M1 macrophages in endometriosis group and non endometriosis were respectively 1.40 ± 0.35 and 1.33 ± 0.40 (p =0.3005) and the expression of M2 in both of group, respectively of 2.23 ± 0.41 and 1.47 ± 0.36 (p =0.0005). The ratio of M1/M2, the endometriosis group and non endometriosis, respectively of 0.65 ± 0.20 and 0.92 ± 0.24 (p =0.0015).Conclusion: this study were significant increased in the panmacrophage Mφ, M2 macrophages expression on a woman's menstrual blood flakes endometriosis and significant decreased in ratio M1/M2 in the woman's menstrual blood flakes endometriosis.
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Objectives

to measure and prove the increase of panmacrophage, macrophages M1 and M2 expression and decrease of ratio of M1/M2 in menstrual blood flakes of women with endometriosis. Materials and Methods: This study was a cross sectional observational analytic study conducted on 30 subjects with endometriosis and non-endometriosis. Immunohistochemical staining was done on a sample of menstrual blood flakes of subjects study who were taken at the second or third day of menstrual cycles with CD68 and CD163 antibody to measure the expression of panmacrophage and M2 macrophages. Expression of M1 macrophages is the approach of a reduction expression of panmacrophage with M2 macrophages.

Results

Expression of M1, M2 and the ratio M1/M2 in the both of groups had a normal distribution then continued by independent t-test with one-tailed α (0.05). Probability was considered statistically significant at p <0.05 with a confidence interval of 95%. Based on the statistical result, Mφ macrophage expression in endometriosis and control group amounted to 3.62 ± 0.50 and 2.80 ± 0.64 (p =0.0005) with non parametric test. The expression of M1 macrophages in endometriosis group and non endometriosis were respectively 1.40 ± 0.35 and 1.33 ± 0.40 (p =0.3005) and the expression of M2 in both of group, respectively of 2.23 ± 0.41 and 1.47 ± 0.36 (p =0.0005). The ratio of M1/M2, the endometriosis group and non endometriosis, respectively of 0.65 ± 0.20 and 0.92 ± 0.24 (p =0.0015).

Conclusion

this study were significant increased in the panmacrophage Mφ, M2 macrophages expression on a woman's menstrual blood flakes endometriosis and significant decreased in ratio M1/M2 in the woman's menstrual blood flakes endometriosis. Samsulhadi. Endometriosis: Dari biomolekuler sampai masalah klinis. Majalah Obstetri dan Ginekologi. 2002;10:43-50. Arruda MS, Petta CA, Abrao MS and Benetti Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Human Reproduction. 2003;18(4):756-9. Hendarto H. Endometriosis dari Aspek Teori sampai Penanganan Klinis. Patogenesis. Surabaya: Airlangga University Press; 2015. hal. 9-22. Da Silva CM, Belo AV, Andrade SP, Campos PP, Ferreira MCF, Da Silva-Filho AL and Carneiro MM. Identification of local angiogenic and inflammatory markers in the menstrual blood of women with endometriosis. Biomedicine & Pharmacotherapy. 2014;68(7):899-904. Capobianco, Annalisa and Patrizia Rovere-Querini. Endometriosis, a disease of the macrophage. Front Immunol, 2013;4(9). Sourial S, Tempest N and Hapangama D. K. Theories on the pathogenesis of endometriosis. International journal of reproductive medicine. 2014. Wang XQ, Yu J, Luo XZ, Shi YL, Wang Y, Wang L, Li DJ. The high level of RANTES in the ectopic milieu recruits macrophages and induces their tolerance in progression of endometriosis. J Mol Endocrinol. 2010;45:291-9. Wang N, Liang H and Zen K. Molecular mechanisms that influence the macrophage M1–M2 polarization balance. M1/M2 Macrophages: The Arginine Fork in the Road to Health and Disease. 2015;230. Brown MB, von Chamier M, Allam AB and Reyes L. M1/M2 macrophage polarity in normal and complicated pregnancy. M1/M2 Macrophages: The Arginine Fork in the Road to Health and Disease. 2015:205. Tran LVP, Tokushige N, Berbic M, Markham R and Fraser IS. Macrophages and nerve fibres in peritoneal endometriosis. Human reproduction. 2009 Khan KN, Masuzaki H, Fujishita A, Kitajima M, Sekine I and Ishimaru T. Differential macrophage infiltration in early and advanced endometriosis and adjacent peritoneum. Fertility and sterility. 2004;81(3):652-61. Berbic M, Schulke L, Markham R, Tokushige N, Russell P and Fraser IS. Macrophage expression in endometrium of women with and without endometriosis. Human reproduction. 2009;24(2) :325-32. Takahashi K, Nagata H and Kitao M. Clinical usefulness of determination of estradiol level in the menstrual blood for patients with endometriosis. Nihon Sanka Fujinka Gakkai Zasshi. 1989;41(11):1849-50. Molen Van Der RG, Schutten JHF, van Cranenbroek B, Ter Meer M, Donckers J, Scholten RR and Joosten I. Menstrual blood closely resembles the uterine immune micro-environment and is clearly distinct from peripheral blood. Human Reproduction. 2013:398. Lagana SA, Emanuele S, Giovanni R, Vincenza S and Onofrio T. Interplay between Misplaced Müllerian-Derived Stem Cells and Peritoneal Immune Dysregulation in the Pathogenesis of Endometriosis. Obstetrics and Gynecology International. 2013. Kumari SA, Pearson CB, Hachey AM, Xia DL and Wachtman LM. Alternative activation of macrophages in rhesus macaques (Macaca mulatta) with endometriosis. Comparative medicine. 2012;62(4):303-10. Zhang, Xiao and Lin Mu. Association between macrophage migration inhibitory factor in the endometrium and estrogen in endometriosis. Experimental and therapeutic medicine. 2015;10(2):787-91. Toniolo A, Fadini GP, Tedesco S, Cappellari R, Vegeto E, Maggi A and Cignarella A. Alternative activation of human macrophages is rescued by estrogen treatment in vitro and impaired by menopausal status. The Journal of Clinical Endocrinology & Metabolism. 2014;100(1):50-8. Jensen AL, Collins J, Shipman EP, Wira CR, Guyre PM and Pioli PA. A subset of human uterine endometrial macrophages is alternatively activated. American Journal of Reproductive Immunology. 2012;68(5):374-86. Zhang M, He Y, Sun X, Li Q, Wang W, Zhao A and Di W. A high M1/M2 ratio of tumor-associated macrophages is associated with extended survival in ovarian cancer patients. Journal of ovarian research. 2014;7(1):1. 1. Copyright of the article is transferred to the journal, by the knowledge of the author, whilst the moral right of the publication belongs to the author. 2. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution-Non Commercial-Share alike (CC BY-NC-SA), (https://creativecommons.org/licenses/by-nc-sa/4.0/) 3. The articles published in the journal are open access and can be used for non-commercial purposes. Other than the aims mentioned above, the editorial board is not responsible for copyright violation The manuscript authentic and copyright statement submission can be downloaded ON THIS FORM.

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