Hemoglobin-induced continuous activation of macrophages in endometriotic cysts: a potential mechanism of endometriosis development and carcinogenesis

Maki Kusunoki, Yukio Fujiwara, Yoshihiro Komohara, Yuko Imamura, Ritsuo Honda, Takashi Ohba, Hidetaka Katabuchi
Medical molecular morphology · 2021 · vol. 54(2) , pp. 122–132 · doi:10.1007/s00795-020-00272-4 · PMID:33392726 · W3118497657
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Macrophages in endometriotic cysts, activated by hemoglobin, release inflammatory cytokines like IL-6 and CCL2, potentially driving disease development and carcinogenesis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This thesis investigated how hemoglobin within endometriotic cysts may drive continuous macrophage activation, using an experimental/analytical approach described as relating to endometriotic lesion progression and malignant transformation. The central finding is that hemoglobin can induce sustained activation of macrophages in the context of endometriotic cysts, proposed as a mechanism that could contribute both to the development of endometriosis and to carcinogenesis. A key limitation is that the work is framed around a potential mechanistic pathway rather than definitive clinical causality. This paper is centrally about endometriosis — specifically, it focuses on hemoglobin-induced continuous macrophage activation in endometriotic cysts as a possible driver of progression and carcinogenic transformation.

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Abstract

Endometriosis is a chronic inflammatory disease. Endometriotic cysts contain hemoglobin (Hb) and infiltrated macrophages, indicating that the metabolism of Hb by macrophages may play an important role in the inflammation of endometriotic cysts. In this study, we investigated the distribution of immune cells and CD163 (Hb receptor)-positive cells in the endometriotic cyst wall using immunohistochemistry. We also examined the role of macrophage activation by Hb on the pathogenesis of endometriotic cysts by measuring the cytokine concentration in the cystic fluids and macrophage-culture supernatant using ELISA. Macrophages were the most prominent immune cells observed in the endometriotic cysts and were differentially distributed in the different histological areas of the cyst wall. The localization of CD163-positive macrophages was restricted to the hemorrhagic and outer areas in the cyst wall. High concentrations of IL-6 and CCL2 were found in the cystic fluids, and inflammatory cytokines (IL-6, TNF-α, and CCL2) were secreted from macrophages on stimulation by Hb. IL-6 is a promotional factor for endometriotic stromal cells and ovarian clear cell carcinoma, the most common histological subtype of endometriosis-related ovarian cancer, hence, the continuous activation of macrophages by Hb could be a potential mechanism underlying endometriosis development and carcinogenesis.

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Condition tags

endometriosis

MeSH descriptors

Antigens, CD Antigens, Differentiation, Myelomonocytic Carcinogenesis Endometriosis Hemoglobins Interleukin-6 Macrophages Receptors, Cell Surface Adenocarcinoma, Clear Cell Adult CD163 Antigen Cytokines Cytokines Endometriosis Endometriosis Female Hemoglobins Humans Immunohistochemistry Interleukin-6

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