[TNF-alpha secretion by peritoneal macrophages in endometriosis]

Beside of other cytokines and growth-factors Tumor Necrosis Factor Alpha (TNF-alpha) exerts as a macrophage-derived cytotoxic product a variety of immunologic effects in the human organism. It is also an important angiogenetic factor and regarding its cytotoxicity toward gametes TNF-alpha plays an essential role as pelvine mediator of sterility. The purpose of our study was to evaluate the TNF-alpha-synthesis of Peritoneal-Macrophages (PM) in patients with and without endometriosis and to determine if a correlation exists between TNF-alpha-synthesis and various degrees of the activity of endometriosis. For reasons of sterility 40 women underwent diagnostic laparoscopy and were staged according to the rAFS-classification as well as the macroscopic aspect of activity into a control group with endometriosis-free pelvic situs (n = 14) and three subgroups characterized by the increasing stage of the disease (n = 26). The TNF-alpha-concentrations (median) in the control group were 3.3 pg/ml, in group 2 with stage I/II rAFS and only low active endometriosis 60.2 pg/ml, in group 3 with stage I/II rAFS but high active endometriosis 83.2 pg/ml and in group 3 with stage III/IV rAFS 168 pg/ml. These data were statistically high significant and showed good conformity with the histological findings. We found significant higher TNF-alpha-concentrations in the peritoneal fluid of patients with endometriosis than in the peritoneal fluid of healthy women. There is a correlation between TNF-alpha-concentrations and the degree of disease.