The significance of immune microenvironment in patients with endometriosis

Ioana Păvăleanu, Raluca Anca Balan, Raluca Bălan, Adriana Grigoraş, Teodora Ana Balan, Cornelia Amălinei
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie · 2023 · vol. 64(3) , pp. 343–354 · doi:10.47162/rjme.64.3.06 · PMID:37867352 · PMC10720939 · W4387865891
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study analyzed immune cell profiles and specific protein expressions in endometriosis tissues, finding increased T-cells and macrophages, and a correlation between CD68 and PR expression.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This retrospective study analyzed immune microenvironment and related molecular features in 53 patients with ovarian or abdominal wall cutaneous endometriosis, using histology, immunohistochemistry for CD4+ T-cells, CD8+ T-cells, CD68+ macrophages, and adhesion/hormone markers (E-cadherin, β-catenin, ERα, PR), alongside serological inflammatory markers (CRP, fibrinogen, ESR) and blood counts. The authors found increased densities of CD4+ and CD8+ T-cells and CD68+ macrophages, with variable increased expression of E-cadherin, β-catenin, ERα, and PR. Statistical correlation testing showed an intense positive correlation between CD68 and PR expression (p<0.05), with no other significant correlations between IHC markers or between IHC and serological parameters. The paper’s main caveat is that it reports limited statistical associations and, based on its retrospective design and tissue heterogeneity (ovarian vs cutaneous), cannot establish causal relationships in the observed immune and molecular patterns. This paper is centrally about endometriosis — it investigates the immune microenvironment (T-cells and macrophages) and its association with adhesion and steroid hormone receptor markers in endometriotic tissues.

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Abstract

Endometriosis represents an estrogen-dependent disease of the female reproductive system and intra- and extraperitoneal regions, with chronic feature. Currently, immune cells, such as macrophages and lymphocytes, are considered to play a pivotal role in angiogenesis and invasion of endometriotic cells through matrix remodeling. Additionally, various studies have revealed the role of E-cadherin, β-catenin, along with steroid hormone receptors in endometriosis development. In this context, our study aimed to analyze the relationship between the cellular immune profile and E-cadherin, β-catenin, estrogen receptor alpha (ERα), and progesterone receptor (PR) immunoexpression in endometriosis tissues, along with an analysis of the possible association between serological parameters and immunohistochemical (IHC) markers. The study included 53 patients diagnosed with ovarian or cutaneous abdominal wall endometriosis, which have been investigated by routine histology, immunohistochemistry, and serum analysis. The IHC exam showed an increased density of cluster of differentiation (CD)4+ T-cells, CD8+ T-cells, and CD68+ macrophages, along with variable increased expressions of E-cadherin, β-catenin, ERα, and PR. Statistical analysis revealed an intense positive correlation between CD68 and PR expression (p<0.05), without any other statistically significant correlations between IHC markers or between IHC and serological markers. Our study supports that endometriosis is an immune-dependent disease characterized by an abnormal morphological profile of T-cells and macrophages in endometriotic implants. Our study provides additional data useful in the understanding the immune milieu of endometriosis in the context of its complex pathogenic molecular mechanism. Further research is needed to develop new immunological therapeutic approaches, like immune checkpoint inhibitors administration or T-cell-targeted immunotherapy in these patients.

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Condition tags

endometriosis

MeSH descriptors

beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin beta Catenin Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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