Immunopathology of Endometriosis, Molecular Approaches

Endometriosis (EMS) is a common chronic gynecological disorder affecting 5%-10% of reproductive-age women, often causing infertility, dyspareunia, pain, and limitations in physical and sexual activities. This condition is defined by the presence of endometrial tissue outside the uterus, commonly explained by Sampson's theory of retrograde menstruation. Although its etiology remains unclear, genetic, epigenetic, hormonal imbalances, oxidative stress, and immune factors play critical roles. Immune dysregulation, involving inflammatory factors, cytokines, and immune cells facilitates the implantation, proliferation, angiogenesis, and development of ectopic endometrial stromal cells (ESCs). Research indicates that the implantation of ESCs in the peritoneum triggers an inflammatory response, recruiting various immune cells and leading to a cycle of inflammation characterized by elevated growth factors and cytokines. In this review, we discuss the immune system's role in EMS pathogenesis, emphasizing the contributions of immune cells, inflammatory mediators, oxidative stress, and so forth. This review also highlights that while current treatments, including hormonal therapies and surgical interventions, aim to alleviate symptoms and improve fertility, emerging evidence suggests that advancements in immunotherapies targeting specific immune cell activities hold promise as innovative future treatment strategies enhancing healthcare management for affected women.