Endometriosis and Autoimmunity

Srinu Pathivada, Thomas D’Hooghe
In: Endometriosis · 2011 · pp. 483–500 · doi:10.1002/9781444398519.ch48 · W1550361571
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Women with endometriosis show altered immune surveillance and autoantibody levels, potentially contributing to disease development, while also appearing more susceptible to other autoimmune disorders.

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Abstract

Although retrograde menstruation occurs in 76–90% of women, only 8–10% are known to develop endometriosis, which probably suggests that other factors might be involved in determining the susceptibility to endometriosis. The prevailing evidence indicates that women with defective immune surveillance and alterations of autoantibody levels are more susceptible to develop endometriosis. In this chapter, we briefly review the literature on the role of defective immune mechanisms, development of immune tolerance and autoimmunity in endometriosis. Both organ-specific and organ non-specific endometrial antibodies and high serum concentrations of antiphospholipid and antinuclear antibodies may play a role in the onset and development of endometriosis and endometriosis-related infertility. The novel expression of immune modulator molecules such as human leukocyte antigen-G, soluble intercellular adhesion molecule 1 and FasL by endometrium and endometriotic lesions may offer another protective mechanism in the maintenance of immune tolerance of endometrial cells in the peritoneal environment. Women with endometriosis and autoimmune diseases such as Crohn disease, rheumatoid arthritis and psoriasis share important features including elevated levels of inflammatory cytokines, matrix metalloproteinases and altered apoptosis. In addition, patients with endometriosis appear to be more susceptible to other autoimmune and endocrinological disorders. In order to better understand the complex relationship between endometriosis, autoimmunity and autoantibodies, more research is needed in well-defined patient populations (endometriosis, normal pelvis, other pelvic pathology) with or without pain and/or infertility, applying robust and reproducible assays in peripheral blood, peritoneal fluid and both eutopic and ectopic endometrium. Although substantial evidence suggests that immune tolerance and autoantibodies play an important role in the development of endometriosis, it is unclear whether these alterations induce endometriosis or are a consequence of its presence.

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endometriosisinfertility

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