Background: Oxidative stress has been identified in the peritoneal fluid and peripheral blood of women with endometriosis. However, there is little information on the antioxidant intake for this group of women. The objectives of this work were 1) to compare the antioxidant intake among women with and without endometriosis and 2) to design and apply a high antioxidant diet to evaluate its capacity to reduce oxidative stress markers and improve antioxidant markers in the peripheral blood of women with endometriosis.

Please cite this paper as: Mier‐Cabrera J, Jiménez‐Zamudio L, García‐Latorre E, Cruz‐Orozco O, Hernández‐Guerrero C. Quantitative and qualitative peritoneal immune profiles, T‐cell apoptosis and oxidative stress‐associated characteristics in women with minimal and mild endometriosis. BJOG 2011;118:6–16. Objectives  To assess immunological variables, T‐cell apoptosis and oxidative stress markers in the peripheral blood and peritoneal fluid of women with (WEN) and without (WWE) endometriosis. Design  Observational and transverse case–control study. Setting  National Institute of Perinatology, Mexico City, Mexico. Population and sample  Peripheral blood and peritoneal fluid obtained from 30 WWE and 32 WEN. Methods  Blood was drawn before surgery and peritoneal fluid was collected during surgery but before any surgical procedure had been carried out. Flow cytometry, spectrophotometry, high‐performance liquid chromatography and multiplex immunoassay analyses were performed. Main outcome measures  Peripheral and peritoneal lymphocyte subpopulations (CD3+, CD4+ CD3+, CD8+ CD3+, CD16+ CD56+, human leucocyte antigen‐DR+ CD3+ and CD19+), intracellular CD4+ CD3+ and CD8+ CD3+ cytokine synthesis (interleukin‐2 [IL‐2] and interferon‐γ [IFN‐γ]), CD3+ apoptosis, malondialdehyde and ascorbate concentrations and peritoneal cytokine concentrations. Results  No differences were found in peripheral and peritoneal lymphocyte subsets between the groups. Peritoneal T lymphocytes from WEN produced less IL‐2 and IFN‐γ than those from WWE. Peritoneal malondialdehyde concentrations were higher and ascorbate concentrations were lower in WEN than in WWE. Higher peritoneal concentrations of pro‐inflammatory cytokines (IL‐1β, tumour necrosis factor‐α and IL‐6) and chemokines (IL‐10, IL‐8, eotaxin, vascular endothelial growth factor, monocyte chemotactic protein‐1 and regulated upon activation, normal T‐cell expressed, and secreted) and lower concentrations of IFN‐γ, IL‐1 receptor antagonist and IL‐15 were found in WEN. No statistical differences were found in IL‐2, IL‐4, IL‐12 and IL‐13 concentrations. Conclusion  The alterations observed in WEN were associated with a diminished peritoneal T helper type 1 immune response. Pro‐inflammatory, chemotactic, angiogenic and oxidative stress markers were altered in the peritoneal milieu of WEN. These changes appeared to contribute to the peritoneal immune alterations found.

Vitamins C and E supplementation was associated with a decrease in the concentration of oxidative stress markers in women with endometriosis. The pregnancy rate, however, did not improve during or after the intervention.

Using a murine model, we evaluated the growth of ectopic endometrial tissue in the presence of T helper 1 (Th1) or Th2 cytokines or a nitric oxide donor (S-nitroso-N-acetyl-penicillamine [SNAP]). Female mice were autografted with endometrial tissue in the peritoneum. Different combinations and concentrations of cytokines or SNAP were injected intraperitoneally for 8 weeks. Implants were recovered, measured, and weighed. Cytokines were determined in plasma. Implants (weight and area) were smaller in mice that received interferon γ plus interleukin 2 (IFN-γ + IL-2) compared to mice treated with IL-2, IL-4 + IL-10 or saline solution, and saline solution compared to different concentrations of SNAP. The IL-2, IFN-γ, and IL-4 concentrations in plasma decreased in accordance with the increase in SNAP concentrations compared to saline solution. The promotion of a Th1 milieu in the peritoneum reduced the weight and area of the implant. Different concentrations of SNAP suppressed Th1 and Th2 cytokines and enabled the growth of the implant in this murine model.