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Published on: July 6, 2014
Cellular immune environment in endometrial polyps
Tania El-Hamarneh1, Alison J Hey-Cunningham, Marina Berbic
1Department of Obstetrics, Gynaecology and Neonatology, Queen Elizabeth II Research Institute for Mothers and Infants, University of Sydney, Sydney, New South Wales, Australia.
Insights
Endometrial polyps (EPs) show increased mast cells (MCs) and regulatory T cells (Tregs), indicating an inflammatory environment. These immune disturbances may contribute to abnormal bleeding and infertility in women with EPs.
Area of Science:
- Reproductive immunology
- Gynecologic pathology
- Cellular immunology
Background:
- Endometrial polyps (EPs) are common gynecologic lesions.
- Their role in abnormal uterine bleeding and infertility is not fully understood.
- The local immune microenvironment of EPs warrants investigation.
Purpose of the Study:
- To investigate the immune cell composition within endometrial polyps (EPs).
- To compare the immune environment of EPs with normal endometrium.
- To explore the potential role of immune cells in EP-associated symptoms.
Main Methods:
- Prospective case-control study involving reproductive-age women.
- Immunohistochemical analysis of endometrial samples for mast cells (MCs) and regulatory T cells (Tregs).
- Quantification of MC subtypes (tryptase+, chymase+, c-Kit+) and Tregs (Foxp3+) in EPs and various endometrial regions.
Main Results:
- Significantly increased densities of all MC types were observed in EPs compared to control endometrium.
- Elevated chymase+, c-Kit+ MCs, and Foxp3+ Tregs were found in EPs.
- Immune cell alterations extended to polyp-adjacent and polyp-distant endometrium.
Conclusions:
- Endometrial polyps exhibit an inflammatory microenvironment characterized by MC overactivity.
- Regulatory T cells appear to be recruited to EPs, likely to modulate the inflammatory response.
- These immune disturbances may contribute to abnormal bleeding and infertility in women with EPs, necessitating further research.
Study Objective:
To investigate the immune environment of endometrial polyps (EPs).
Design:
Prospective case-control study.
Setting:
Teaching hospital and university research laboratory.
Patient(S):
Reproductive-age women undergoing hysteroscopy dilation and curettage for benign indications. Samples were collected from women with (n = 23) and without (n = 40) EPs.
Intervention(S):
Endometrial samples were immunohistochemically stained with antibodies against mast cells (MCs) and regulatory T cells (Tregs).
Main Outcome Measure(S):
Tryptase+, chymase+, and c-Kit+ MCs and Foxp3+ Tregs were quantified in EPs and polyp-adjacent, polyp-distant, and control endometrium.
Result(S):
Densities of all MC types were highly significantly increased in EPs compared with adjacent, distant, and control endometrium. Chymase+ and c-Kit+ MCs were increased in density in adjacent compared with control endometrium. c-Kit+ MCs were also increased in distant compared with control endometrium. Foxp3+ Treg density was increased in EPs compared with distant and control endometrium and decreased in distant compared with control endometrium.
Conclusion(S):
This study provides novel insights into localized disturbances in the cellular immune environment within EPs consistent with EPs being inflammatory lesions associated with MC overactivity. Tregs are likely to be recruited to EPs in an attempt to suppress the inflammatory process due to the greatly increased presence of MCs. These immunologic disturbances are likely to be involved in the causation of abnormal bleeding and infertility in premenopausal women with EPs, and their role in the pathophysiology requires further research.
