Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review)

Abstract

Abstract. Endometriosis is a common type of chronic inflammatory disease with an immunological background. In this review, we aimed to explore the contemporary literature on the infection and sterile inflammation that support the pathogenesis of endometriosis. This article reviews the English-language literature on inflammatory, environmental, immunological and oxidative factors associated with endometriosis in an effort to identify factors that cause a predisposition to endometriosis. Intrauterine microbes may be critical for the initiation of endometriosis; the initial activation of pathogen recognition receptors by microbial stimuli results in the activation of proinflammatory pathways and innate immunity. In addition to their response to various exogenous pathogen-associated molecular patterns, Toll-like receptors (TLRs) also recognize a wide range of endogenous danger-associated molecular patterns (DAMPs). The increased expression levels of DAMPs may be involved in the subsequent process of nuclear transcription factor-κB-dependent sterile inflammation. Oxidative stress, secondary to the influx of iron during retrograde menstruation, is involved in the progression of endometriosis. DAMP-mediated danger signals and oxidative stress are bidirectional during sterile inflammation (danger signal spiral). This review supports the hypothesis that there are at least two distinct phases of endometriosis development: The initial wave of TLR activation in modulating innate immune responses would be followed by the second big wave of sterile inflammation.

CRISPLD2 Is a Target of Progesterone Receptor and Its Expression Is Decreased in Women with Endometriosis

“…A key difference in women with endometriosis appears to be that retrograde menstruation alters the inflammatory response and immunosurveillance within the peritoneal fluid, facilitating proliferation and recurrence of new disease [27], [53], [54]. In affected women, maladaptive inflammatory responses are seen both systemically and within the eutopic endometrium, which is populated by inflammatory leukocytes.…”

Endometriosis-Associated Ovarian Cancer: Population Characteristics and Prognosis

“…2 Endometriosis is considered a benign disease, but many cases present with features commonly found in malignancies, such as invasion of surrounding tissues, atypical histology, metastasis to distant locations, and recurrence following treatment. 3 However, the catabolic states associated with malignancy are seldom found in women with endometriosis. 4,5 Some of these characteristics, especially atypical histology, in addition with the observation that up to 29% of ovarian cancer may present with surrounding endometriosis 6 and the historical records of reports on ovarian cancer arising from endometriotic tissue 7 substantiate its possible role as a precursor of ovarian cancer.…”

Fatores ambientais e endometriose: um ponto de vista

“…A exposição a microorganismos poderia estimular vias pró-inflamatórias e a resposta imune inata 24 , sendo, desta forma, o ponta-pé inicial para que a endometriose se instale e desenvolva.…”