Disrupted iron metabolism in peritoneal fluid may induce oxidative stress in the peritoneal cavity of women with endometriosis

Abstract

Introduction and objective. Data on the possible role of peritoneal fluid free radical-mediated oxidative damage in the pathogenesis of endometriosis still remains inconsistent. The aim of the study was to determine iron metabolism markers and their influence on oxidative stress parameters in the peritoneal fluid of women with endometriosis. Materials and method. 110 women with endometriosis and 119 patients with benign ovarian cysts were included in the study. All visible peritoneal fluid was aspirated during laparoscopy from the anterior and posterior cul-de-sacs. under direct vision to avoid blood contamination. Haemoglobin, iron, total oxidative status, and total antioxidant status were measured using standard colourimetric kits. Results. Haemoglobin, iron levels, as well as total oxidative status values were significantly higher, whereas total antioxidant status values were significantly lower in the peritoneal fluid of patients with endometriosis, in comparison to the reference groups. No differences were observed in peritoneal fluid concentrations of all parameters measured in relation to the phase of the menstrual cycle. Conclusions. Peritoneal fluid of women with endometriosis is characterized by disrupted iron metabolism. This is most likely related to an increased number of erythrocytes in the peritoneal cavity of endometriotic women, which leads to a higher concentration of haemoglobin in this environment. Impaired iron homeostasis may have a significant influence on the pathophysiology of peritoneal endometriosis by the direct impact of haemoglobin derivatives and/or formation of the pro-inflammatory and pro-oxidative environment. Peritoneal cavity oxidative stress occurs predominantly in women in advanced stages of the disease.

Molecular and Clinical Insights on the Complex Interaction between Oxidative Stress, Apoptosis, and Endobiota in the Pathogenesis of Endometriosis

“…In this way, Alizadeh et al [26] showed that serum iron levels in patients with EMS were significantly increased and suggested that this metal ions could be a potent promoter of OS in EMS. The accumulation of iron ions was also reported by Polak et al [30] while studying the overall oxidative status of peritoneal fluid of EMS patients suggesting that iron metabolism could be disrupted in this disease. Furthermore, since iron could catalyze many ROS species production and was also implicated in cellular dysfunction, necrosis, and apoptosis, Chen, Hayashi, and co-authors [31,32] investigated the mitochondrial structure and function of endometrial stromal cells (ESCs) in ovarian endometriosis (OE) in relation to mitochondrial and iron metabolism.…”

Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature)

“…Women with endometriosis have increased oxidative stress in the peritoneal cavity. Data indicate that oxidative stress occurs mainly in the peritoneal cavity in women with advanced stage of the disease [ 154 ].…”

“…Polak et al showed that the peritoneal fluid of women with endometriosis is characterized by impaired iron metabolism [ 154 ]. This is most likely related to the increased number of erythrocytes in the peritoneal cavity of women with endometriosis, which leads to a higher haemoglobin concentration in this environment.…”

Environmental Factors and Endometriosis

“…Haem is involved in the initiation of lipid peroxidation, in which unsaturated fatty acids or other lipids are oxidated by free radicals to their respective peroxides [ 34 ]. Disturbances of the pro-/antioxidant balance that lead to oxidative stress are a recognized mechanism responsible for the development of endometriosis [ 35 ]. A diet rich in red meat can also be responsible for higher estradiol levels by which it leads to endometriosis.…”