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Author Spotlight: Advancing Reproductive Immunology with a Protocol for the Quantitative Evaluation of Endometrial Immune Cells
Published on: October 13, 2023
Macrophages and Natural Killer Cells Characteristics in Variously Colored Endometriotic Lesions: A Cross-Sectional
Areepan Sophonsritsuk1, Nipawan Attawattanakul1, Morakot Sroyraya2
1Reproductive Endocrinology and Infertility Unit, Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Immune cell counts in endometriosis lesions varied by color. Macrophages (CD68) were highest in red lesions, suggesting dynamic immune changes in early endometriosis, while natural killer (NK) cells (CD56) showed no significant difference.
Area of Science:
- Gynecology
- Immunology
- Pathology
Background:
- Endometriosis involves immune system dysregulation.
- Macrophages and natural killer (NK) cells are key immune cells implicated in endometriosis.
- Lesion color (red, black, white) may reflect disease progression and immune cell infiltration.
Purpose of the Study:
- To investigate the numbers of macrophages (CD68) and NK cells (CD56) in endometriotic lesions of different colors.
- To determine the association between immune cell counts and endometriotic lesion color.
- To explore the role of immune cells in the pathogenesis of endometriosis.
Main Methods:
- A cross-sectional study involving women with suspected endometriosis undergoing laparoscopic surgery.
- Excision and classification of endometriotic lesions into red, black, and white types.
- Immunohistochemistry staining to quantify CD68 macrophages and CD56 NK cells in lesion tissues.
Main Results:
- CD68 macrophage counts were significantly higher in red lesions compared to black and white lesions (P=0.001).
- No significant differences in CD56 NK cell counts were observed among red, black, and white lesions (P=1.000 and P=0.617).
- Red lesions, representing earlier disease, showed the highest macrophage infiltration.
Conclusions:
- Immune cell dynamics in endometriosis are specific to macrophages, not NK cells.
- The elevated macrophage presence in red lesions suggests their role in early endometriosis development.
- NK cells may play a role in the uterus rather than in ectopic endometrial implants.
Background:
Dysregulation of the immune response contribute to a significant role in endometriosis. This research examined macrophages and natural killer (NK) cells numbers in endometriotic lesions and their association with the different lesion colors: red, black, and white. To investigate the amount of the CD68 and CD56 in eutopic endometrium and different type of the endometriotic lesions.
Materials And Methods:
A cross-sectional analytic study was conducted. Women suspected endometriosis requiring laparoscopic surgery between July 2016 and January 2017 were recruited. Their lesions were classified as red, black, or white and these lesions were excised by standard laparoscopic surgery. Twenty-four endometriotic lesions from each color group were obtained from 45 women who met the inclusion criteria. One type of lesion was collected from 25 women. Two different lesion types and three-color lesion types were collected from the same women in 13 and 7 subjects, respectively. Immunohistochemistry staining with anti-human mouse cluster of differentiation (CD) 68 monoclonal antibody for macrophages and mouse anti-human CD56 monoclonal antibody for NK cells were performed.
Results:
The number of CD68 macrophages in red lesions was higher than in black and white lesions [median (25th-75th percentile); 10 (5-19.4), 0 (0-6.9), 0 (0-2.5) cells per mm2, respectively, adjusted P=0.001 for red vs. black lesions and red vs. white lesions, and adjusted P=1.000 for black and white lesions]. The number of CD56 NK cells was not significantly different among red, black, and white lesions [median (25th-75th percentile; 5 (2-16.5), 3.8 (0-14.4), 1.3 (0-6.9) respectively, adjusted P=1.000 for red vs. black lesions and black vs. white lesions, and adjusted P=0.617 for red vs. white lesions].
Conclusion:
The dynamic changes in the immune cells in ectopic endometrium were specific to the macrophages but not to the NK cells, as demonstrated by the highest number of CD68 macrophages in the red lesion, the earliest established ectopic endometrium. NK cells in endometriosis may have a role in the uterus.
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