Exogenous activated NK cells enhance trafficking of endogenous NK cells to endometriotic lesions

Bacillus Calmette-Guerin (BCG) vaccination to treat endometriosis

Bacille Calmette-Guérin (BCG), a vaccine intended to protect against tuberculosis disease, can elicit protection against heterologous infections, and even specific types of cancer. In this mini-review, we will address the possible use of BCG as a therapeutic for endometriosis, a syndrome of chronic pelvic pain due to ectopic growth of endometrial-type tissue outside of the uterine lining. These implanted tissues cycle synchronously with menses in pre-menopausal women, generating cellular debris inciting chronic inflammation and tissue scarring leading to pelvic pain and infertility. Further, these lesions may evolve into ovarian clear cell carcinoma. We hypothesize that implantation, survival and transformation of these implants is enabled by a form of immune suppression within the peritoneum, which may be overcome by BCG vaccination.

EPHA3 enhances macrophage autophagy and apoptosis by disrupting the mTOR signaling pathway in mice with endometriosis

Background: Endometriosis is a chronic fibrotic disease characterized by agonizing pelvic pain and low fertility, mainly affecting middle-aged women. The aim of the present study is to assess the potential effects of erythropoietin-producing hepatocellular carcinoma A3 (EPHA3) on endometriosis, with emphasis on the autophagy and apoptosis of macrophages via inhibition of the mammalian target of rapamycin (mTOR) signaling pathway.

Methods: The mouse models of endometriosis were established followed by culturing the macrophages and macrophage transfection via the EPHA3 vector, siRNA EPHA3, and RAPA (an inhibitor of the mTOR signaling pathway). The expression of EPHA3, related factors in the mTOR signaling pathway, macrophage autophagy (autophagy-related gene 3 (Atg3), light chain 3-I (LC3-I), light chain 3-II (LC3-II) and Beclin1) and apoptosis (B-cell lymphoma-2 (bcl-2), bax and fas) were all detected and documented, respectively. The changes of autophagic lysosomes and the apoptosis of macrophages in each group following transfection were also inspected and detected.

Results: The results of the in silico analysis ascertained EPHA3 to be a candidate gene of endometriosis. After successful modeling, the uterine tissues of endometriosis mice presented with a low expression of EPHA3 and activated mTOR signaling pathway. Overexpression of EPHA3 inhibited the activation of the mTOR signaling pathway, down-regulated bcl-2 expression, up-regulated the expression of Atg3, LC3-II/LC3-I, Beclin1, bax and fas, and also promoted the autophagy and apoptosis of macrophages in endometriosis mice.

Conclusion: Altogether, EPHA3 could potentially promote the autophagy and apoptosis of macrophages in endometriosis via inhibition of the mTOR signaling pathway, highlighting the potential of EPHA3 as the target to treat endometriosis.

Involvement of immune cells in the pathogenesis of endometriosis

Endometriosis is characterized by the implantation and growth of endometriotic tissues outside the uterus. It is widely accepted the theory that endometriosis is caused by the implantation of endometrial tissue from retrograde menstruation; however, retrograde menstruation occurs in almost all women and other factors are required for the establishment of endometriosis, such as cell survival, cell invasion, angiogenesis, and cell growth. Immune factors in the local environment may, therefore, contribute to the formation and progression of endometriosis. Current evidence supports the involvement of immune cells in the pathogenesis of endometriosis. Peritoneal neutrophils and macrophages secrete biochemical factors that help endometriotic cell growth and invasion, and angiogenesis. Peritoneal macrophages and NK cells in endometriosis have limited capability of eliminating endometrial cells in the peritoneal cavity. An imbalance of T cell subsets leads to aberrant cytokine secretions and inflammation that results in the growth of endometriosis lesions. It is still uncertain whether these immune cells have a role in the initial cause and/or stimulate actions that enhance disease; however, in either case, modulating the actions of these cells may prevent initiation or disease progression. Further studies are needed to deepen the understanding of the pathology of endometriosis and to develop novel management approaches of benefit to women suffering from this disease.

Sexual Function and Quality of Life in Patients Affected by Deep Infiltrating Endometriosis: Current Evidence and Future Perspectives

Endometriosis is one of the most common gynecological diseases and has an incidence of approximately 6%-10% in women of reproductive age. Deep infiltrating endometriosis (DIE) is considered the most aggressive form of endometriosis and is defined as a lesion that penetrates for more than 5 mm under the peritoneal surface. It has been demonstrated that DIE is associated with pelvic pain symptoms, and the intensity of pain is correlated with the depth of infiltration. Other symptoms are dysmenorrhea, deep dyspareunia, and painful defecation and urination. These symptoms are strongly associated with a significant reduction of the quality of life and a marked impairment of sexual function in the affected women. Therefore, a multidisciplinary approach and psychological support for women affected by DIE appear mandatory in order to reduce the impact of the disease on quality of life and sexual function as much as possible.