ОСОБЕННОСТИ МИКРОБИОТЫ РЕПРОДУКТИВНОГО ТРАКТА У ПАЦИЕНТОК С РЕЦИДИВИРУЮЩИМ ТЕЧЕНИЕМ ГЛУБОКОГО ЭНДОМЕТРИОЗА

The completed international project “Human Microbiome” and the theory of bacterial infection made it possible to look at the problem of recurrent endometriosis from a different angle, thanks to the study of the connection between the microbiota and various pathological conditions. The study of the endometrial microbiota opens up new opportunities in elucidating the pathogenesis of endometriosis, and some studies may have an impact on the support and regulation of the immune response, as well as ensure the progression and recurrent course of the disease. The purpose of the study – to determine the features of the clinical picture and microbiota of the reproductive tract in patients with recurrent deep endometriosis.

and methods. The main group consisted of 32 patients of reproductive age who underwent repeated surgery due to relapse of deep endometriosis. The comparison group included 51 women without relapse of the disease within a year after the primary operation. Surgical treatment was carried out laparoscopically and consisted of the maximum possible excision of endometrioid infiltrates and ovarian endometriomas within healthy tissue. An analysis of the somatic and gynecological anamnesis and a questionnaire on the visual analogue scale (VAS) for pelvic pain syndrome were carried out. The composition of the microbiota of the genital tract from the uterine cavity and vagina was assessed using quantitative real-time PCR using standard methods.

and discussion. The results of the study indicate that patients with recurrent deep endometriosis have distinctive clinical manifestations of the disease and significant differences in the spectrum of microbiota of the genital tract. A significant increase in the total volume of bacterial mass (TBM) was found in patients with relapse of deep endometriosis in the uterine cavity and vagina, p < 0.05. Against the background of an increase in the volume of bacterial mass (MBV), a significant decrease in Lactobacillus spp. in the uterine cavity and vagina in patients with recurrent deep endometriosis and a significant predominance of representatives of opportunistic bacteria. Conclusions. The recurrent course of deep endometriosis is accompanied by quantitative changes in the balance of the microbiota of the genital tract, and the regulation of normobiota may be a key point in the application of methods for preventing relapses of the disease, and certain microorganisms can become a promising diagnostic marker of endometriosis.

Article Details Information about financing and conflict of interests The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article. This work is licensed under a Creative Commons Attribution 4.0 License. How to Cite

Giudice LC, Kao LC. Endometriosis. Lancet. 2004; 364(9447): 1789-1799. doi: 10.1016/S0140-6736(04)17403-5 Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med. 2020; 382(13): 1244-1256. doi: 10.1056/NEJMra1810764 Saunders PTK, Horne AW. Endometriosis: Etiology, pathobiology, and therapeutic prospects Cell. 2021; 184(11): 2807-2824. doi: 10.1016/j.cell.2021.04.041 Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021; 397(10276): 839-852. doi: 10.1016/S0140-6736(21)00389-5 Sobstyl A, Chałupnik A, Mertowska P, Grywalska E. How Do Microorganisms Influence the Development of Endometriosis? Participation of Genital, Intestinal and Oral Microbiota in Metabolic Regulation and Immunopathogenesis of Endometriosis. Int J Mol Sci. 2023; 24(13): 10920. doi: 10.3390/ijms241310920 Horne AW, Daniels J, Hummelshoj L, Cox E, Cooper KG. Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink? BJOG. 2019; 126(12): 1414-1416. doi: 10.1111/1471-0528.15894 Zakhari A, Delpero E, McKeown S, Tomlinson G, Bougie O, Murji A. Endometriosis recurrence following post-operative hormonal suppression: a systematic review and meta-analysis. Hum Reprod Update. 2021; 27(1): 96-107. doi: 10.1093/humupd/dmaa033 Turnbaugh PJ, Ley RE, Hamady M, Fraser-Liggett CM, Knight R, Gordon JI. The human microbiome project. Nature. 2007; 449(7164): 804-810. doi: 10.1038/nature06244 Khan KN, Fujishita A, Hiraki K, Kitajima M, Nakashima M, Fushiki S, Kitawaki J. Bacterial contamination hypothesis: a new concept in endometriosis. Reprod Med Biol. 2018; 17(2): 125-133. doi: 10.1002/rmb2.12083 Guo J, Yan X, Han L. The potential role of gut microbiota in the occurrence and development of endometriosis. Front Cell Infect Microbiol. 2024; 14: 1454931. doi: 10.3389/fcimb.2024.1454931 Colonetti T, Saggioratto MC, Grande AJ, Colonetti L, Denoni JCJ, Ceretta LB et al. Gut and Vaginal Microbiota in the Endometriosis: Systematic Review and Meta-Analysis. Biomed Res Int. 2023; 2023: 2675966. doi: 10.1155/2023/2675966 Symons LK, Miller JE, Kay VR, Marks RM, Liblik K, Koti M, Tayade C. The Immunopathophysiology of Endometriosis. Trends Mol Med. 2018; 24(9): 748-762. doi: 10.1016/j.molmed.2018.07.004 Kamińska D, Gajecka M. Is the role of human female reproductive tract microbiota underestimated? Benef Microbes. 2017; 8(3): 327-343. doi: 10.3920/BM2015.0174 Ma B, Forney LJ, Ravel J. Vaginal microbiome: rethinking health and disease. Annu Rev Microbiol. 2012; 66: 371-89. doi: 10.1146/annurev-micro-092611-150157 Salliss ME, Farland LV, Mahnert ND, Herbst-Kralovetz MM. The role of gut and genital microbiota and the estrobolome in endometriosis, infertility and chronic pelvic pain. Hum Reprod Update. 2021; 28(1): 92-131. doi: 10.1093/humupd/dmab035 Huang L, Liu B, Liu Z, Feng W, Liu M, Wang Y, et al. Gut Microbiota Exceeds Cervical Microbiota for Early Diagnosis of Endometriosis. Front Cell Infect Microbiol. 2021; 11: 788836. doi: 10.3389/fcimb.2021.788836 Nisolle M, Casanas-Roux F, Donnez J. Immunohistochemical analysis of proliferative activity and steroid receptor expression in peritoneal and ovarian endometriosis. Fertil Steril. 1997; 68(5): 912-919. doi: 10.1016/s0015-0282(97)00341-5 Crispim PCA, Jammal MP, Murta EFC, Nomelini RS. Endometriosis: What is the Influence of Immune Cells? Immunol Invest. 2021; 50(4): 372-388. doi: 10.1080/08820139.2020.1764577 Chen C, Song X, Wei W, Zhong H, Dai J, Lan Z, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun. 2017; 8(1): 875. doi: 10.1038/s41467-017-00901-0 Moreno I, Codoñer FM, Vilella F, Valbuena D, Martinez-Blanch JF, Jimenez-Almazán J, et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016; 215(6): 684-703. doi: 10.1016/j.ajog.2016.09.075 Jiang I, Yong PJ, Allaire C, Bedaiwy MA. Intricate Connections between the Microbiota and Endometriosis. Int J Mol Sci. 2021; 22(11): 5644. doi: 10.3390/ijms22115644 Hernandes C, Silveira P, Sereia AFR, Christoff AP, Mendes H, de Oliveira LFV, Podgaec S. Microbiome Profile of Deep Endometriosis Patients: Comparison of Vaginal Fluid, Endometrium and Lesion. Diagnostics (Basel). 2020; 10(3): 163. doi: 10.3390/diagnostics10030163 Khan KN, Kitajima M, Hiraki K, Yamaguchi N, Katamine S, Matsuyama T, et al. Escherichia coli contamination of menstrual blood and effect of bacterial endotoxin on endometriosis. Fertil Steril. 2010; 94(7): 2860-3.e1-3. doi: 10.1016/j.fertnstert.2010.04.053 Ata B, Yildiz S, Turkgeldi E, Brocal VP, Dinleyici EC, Moya A, Urman B. The Endobiota Study: Comparison of Vaginal, Cervical and Gut Microbiota Between Women with Stage 3/4 Endometriosis and Healthy Controls. Sci Rep. 2019; 9(1): 2204. doi: 10.1038/s41598-019-39700-6 Sessa R, Filardo S, Viscardi MF, Brandolino G, Muzii L, Di Pietro M, Porpora MG. Characterization of the vaginal microbiota in Italian women with endometriosis: preliminary study. Arch Gynecol Obstet. 2024; 310: 2141-2151. doi: 10.1007/s00404-024-07631-x