The role of systemic and local immunity in the pathogenesis of endometriosis of varying degrees of prevalence of the process: a modern view

Krechetova L.V. Krechetova, E. V. Inviyaeva, T. D. Korotkova, Л. В. Ванько, L.V. Adamyan
In: Russian Journal of Human Reproduction · 2024 · vol. 30(5) , pp. 6 · doi:10.17116/repro2024300516 · W4404375782
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This study evaluated innate immune cell subpopulations and cytokine levels in peripheral blood and peritoneal fluid of women with endometriosis, finding evidence of inflammation, more prominent locally than systemically, suggesting immune dysfunction contributes to heterotopia development.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

The paper evaluated systemic (peripheral blood) and local (peritoneal fluid) innate immune cell subsets and cytokine levels in 67 women undergoing surgery, comparing those with endometriosis of I–II (n=20) versus III–IV (n=28) stages to a laparoscopically confirmed control group without endometriosis. Using flow cytometry for innate immune phenotypes and multiplex assays for a broad panel of soluble cytokines/growth factors, the authors report evidence of subclinical inflammation characterized by increased production of pro-inflammatory cytokines and impaired ability of immune cells to suppress inflammatory responses, with in vitro findings supporting that cells from ectopic lesions show markedly different cytokine/chemokine/growth-factor activity than cells from eutopic endometrium. The key limitation explicitly discussed is that the study is based on surgical sampling and focuses on a single-center cohort with careful exclusion criteria, which may constrain generalizability. This paper is centrally about endometriosis — it analyzes systemic and peritoneal innate immune dysregulation and soluble inflammatory factors across endometriosis prevalence/stage.

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Abstract

An abnormal subclinical inflammatory response and disturbances in the immune control system play a significant role in the appearance, progression and persistence of endometrial heterotopias. Objective. To evaluate the role of subclinical inflammatory reactions in the pathogenesis of endometriosis of varying degrees of prevalence based on the analysis of the content of subpopulations of innate immune cells and the level of cytokines in peripheral blood (PB) and peritoneal fluid (PF). Material and methods. Phenotyping of lymphocytes using flow cytometry and assessment of the content of immunoregulatory molecules (IL-1β, IL-1Rα, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-9, IL-10, IL-12(p70), IL-13, IL-15, IL-17A, IFN-γ, TNF-α, MCP-1, MIP-1α, MIP-1β, IP-10, G-CSF, GM-CSF, PDGF-bb, RANTES, Eotaxin, VEGF, FGF basic), TGF-β isoforms, the multiplex method was performed in women with external genital endometriosis (EGE) grades I—II (n= 20) and grades III—IV (n=28) in the PB before surgery and in the PF of the pancreas intraoperatively. The comparison group consisted of 19 women with no genital endometriosis. Results. The analysis of the subpopulation composition of cells and the level of cytokines in both the PC and the pancreas in women with EGE revealed signs of the presence of an inflammatory process, more pronounced at the local level than at the systemic level. Since identifying non-invasive markers of the prevalence of the process is of great importance, we analyzed the characteristics of correlations between the content of lymphocyte subpopulations and the level of soluble factors in PB. The results of assessing the correlations between the levels of the studied cells and soluble factors in the PB in patients with the early stage of endometriosis indicate dysfunction of the innate immune system, which contributes to the development of heterotopias, and in patients with a common process — the chronicity of the inflammatory process. Conclusions. It has been established that in the PB of women with EGE of varying degrees of prevalence of the process, different spectra of multidirectional strong correlations are revealed between the subpopulation composition and the content of soluble immunoregulatory molecules in it, reflecting signs of immune imbalance and inflammation.

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endometriosis

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