The deviations of CD4 + T cells during peripheral blood and peritoneal fluid of endometriosis: a systematic review and meta-analysis

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This systematic review and meta-analysis found no significant deviations of CD4+ T cells in peripheral blood of endometriosis patients, but did find significant local deviations in peritoneal fluid.

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This systematic review and meta-analysis evaluated whether endometriosis is associated with systemic (peripheral blood) and local (peritoneal fluid) differences in CD4+ T-cell populations, including CD4+/CD8+ ratios. Across 32 case–control studies (1363 women with endometriosis and 1564 healthy controls) up to November 2022, pooled results showed no statistically significant deviations in CD4+ T cells or CD4+/CD8+ ratios in peripheral blood between endometriosis patients and healthy women, and no significant differences by mild versus severe endometriosis in those compartments. In peritoneal fluid, the frequency of CD4+ T cells and the CD4+/CD8+ ratio were significantly lower in endometriosis versus healthy controls, while mild versus severe endometriosis showed no significant difference for these local measures. The paper’s main limitation is that the conclusion about systemic effects is constrained by substantial between-study heterogeneity and the overall lack of functional subpopulation analysis beyond the measured phenotypes. This paper is centrally about endometriosis — it systematically synthesizes evidence that endometriosis is linked to local peritoneal (but not systemic) deviations of CD4+ T cells.

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Abstract

OBJECTIVE: To assess whether endometriosis (EMs) was related to systematic and/or local deviations of cluster of differentiation (CD)4 + T cells. METHODS: Until November 2022, we enrolled a total of 1363 EMs and 1564 healthy women from 32 studies who met the inclusion criteria. RESULTS: After systematically retrieving the literature, we identified 1086 citations and 32 case-control studies were enrolled. Cumulative results suggested that there were insignificant deviations of CD4 + T cells during peripheral blood (PB) between EMs and healthy women (RR: - 0.83, I2 = 99%, p = 0.65), also no statistically significant difference was found between mild and severe EMs (RR: 3.19, I2 = 94%, p = 0.19). We also found insignificant deviations of CD4 + /CD8 + during PB between EMs and healthy women (RR: 0.09, I2 = 99%, p = 0.39), and between mild and severe EMs (RR: - 0.16, I2 = 99%, p = 0.29). The results might suggest that there was no significant correlation between EMs and systematic deviations of CD4 + T cells. When it came to local deviation during peritoneal fluid (PF), the polled results suggested that the frequency of CD4 + T cells during EMs was significantly lower than healthy women (RR: - 5.38, I2 = 93%, p = 0.01), and the ratio of CD4 + /CD8 + during EMs was significantly lower than healthy women (RR: - 0.13, I2 = 0%, p < 0.0001). However, there were insignificant deviations of CD4 + during PF between mild and severe EMs (RR: 1.65, I2 = 53%, p = 0.15), also there was an insignificant difference of CD4 + /CD8 + between mild and severe EMs (RR: - 0.09, I2 = 14%, p = 0.19). EMs might be closely related to local deviations of CD4 + T cells. CONCLUSION: There was no obvious correlation between EMs and systematic deviations of CD4 + T cells, EMs might be closely related to local deviations of CD4 + T cells. Further study on the functional deviations and subpopulation distribution of CD4 + T cells is urgently needed.
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Abstract

Objective To assess whether endometriosis (EMs) was related to systematic and/or local deviations of cluster of differentiation (CD)4 + T cells.

Methods

Until November 2022, we enrolled a total of 1363 EMs and 1564 healthy women from 32 studies who met the inclusion criteria.

Results

After systematically retrieving the literature, we identified 1086 citations and 32 case–control studies were enrolled. Cumulative results suggested that there were insignificant deviations of CD4 + T cells during peripheral blood (PB) between EMs and healthy women (RR: − 0.83, I2 = 99%, p = 0.65), also no statistically significant difference was found between mild and severe EMs (RR: 3.19, I2 = 94%, p = 0.19). We also found insignificant deviations of CD4 + /CD8 + during PB between EMs and healthy women (RR: 0.09, I2 = 99%, p = 0.39), and between mild and severe EMs (RR: − 0.16, I2 = 99%, p = 0.29). The results might suggest that there was no significant correlation between EMs and systematic deviations of CD4 + T cells. When it came to local deviation during peritoneal fluid (PF), the polled results suggested that the frequency of CD4 + T cells during EMs was significantly lower than healthy women (RR: − 5.38, I2 = 93%, p = 0.01), and the ratio of CD4 + /CD8 + during EMs was significantly lower than healthy women (RR: − 0.13, I2 = 0%, p < 0.0001). However, there were insignificant deviations of CD4 + during PF between mild and severe EMs (RR: 1.65, I2 = 53%, p = 0.15), also there was an insignificant difference of CD4 + /CD8 + between mild and severe EMs (RR: − 0.09, I2 = 14%, p = 0.19). EMs might be closely related to local deviations of CD4 + T cells.

Conclusion

There was no obvious correlation between EMs and systematic deviations of CD4 + T cells, EMs might be closely related to local deviations of CD4 + T cells. Further study on the functional deviations and subpopulation distribution of CD4 + T cells is urgently needed. Similar content being viewed by others Data availability All data generated or analyzed during this study are included in this published article.

References

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Author information Authors and Affiliations Contributions HY and YZ were major contributor in writing the manuscript and retrieving the literature. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval and consent to participate Approval was obtained from the Institutional Review Board (IRB) of The Fifth Affiliated Hospital of Sun Yat-sen University for publishing this review of Literature. Consent for publication Informed written consent was provided by the author. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Yang, H., Zhuang, Y. The deviations of CD4 + T cells during peripheral blood and peritoneal fluid of endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 308, 1431–1446 (2023). https://doi.org/10.1007/s00404-023-06964-3 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-023-06964-3

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