Immune and endocrine regulation in endometriosis: what we know - 02/11/23

Doi : 10.1016/j.jeud.2023.100049

Haomeng Zhang ^a, Shuman Sheng ^b, Zhengwu Pan ^b, Lanlan Zhao ^b, Chunrun Yang ^a,^b, Changzhong Li ^c,^d,^e, Fei Wang ^a,^b,^⁎
^a Department of Gynecology, Shandong Provincial Hospital, Shandong University, Jinan, China
^b Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
^c Center of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
^d Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
^e Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China

^⁎Corresponding author.

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Highlights

•	Immune and endocrine mechanisms are strongly interconnected in the endometriosis development.
•	While estrogen and progesterone are known to play important roles in the pathogenesis and progression of endometriosis, there are other less studies hormones involved.
•	Cytokines are the bridges in the immune-endocrine mechanisms driving endometriosis.
•	Numerous deficiencies impair the integrity of mechanism exploration and clinical applications in endometriosis, which hinders the development of more targeted treatment programs in the endocrine–immune direction.

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Abstract

Endometriosis is an estrogen-dependent chronic inflammatory disease. The pathogenesis of endometriosis is affected by numerous factors including immune, endocrine, genetic, and environmental influences. The relative and absolute levels of various immune cells and factors that play key regulatory roles are altered in patients with endometriosis. Concurrently, hormones, which are important micro-regulatory factors targeting various organs and tissues in the body, also play critical roles in the course of endometriosis. However, the immune and endocrine regulatory mechanisms do not work independently of each other in the pathogenesis of endometriosis; indeed, the immune and endocrine systems share mutual regulatory pathways and influence each other. Herein, we discuss the roles of the immune and endocrine systems, and describe the mechanisms of immune–endocrine interaction, in the pathogenesis of endometriosis. We also address current problems, difficulties, and prospects for the future in the study of endometriosis pathogenesis. In this review, we summarize the immune–endocrine regulatory mechanisms in the pathogenesis of endometriosis, discuss new ideas for future in-depth research, and provide guidance for accurate and individualized treatment of patients with endometriosis.

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Keywords : Endometriosis, Immune mechanism, Endocrine mechanism, immune–endocrine mechanism, Estrogen, Progesterone, Cytokines, Inflammatory disease