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Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives

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Abstract

Purpose

Endometriosis is defined as the presence of endometrial-like endometrial cells, glands and stroma outside the uterus, causing a strong inflammatory-like microenvironment in the affected tissue. This may provoke a breakdown in the peritoneal cavity homeostasis, with the consequent processes of immune alteration, documented by peripheral mononuclear cells recruitment and secretion of inflammatory cytokines in early phases and of angiogenic and fibrogenic cytokines in the late stages of the disease. Considering the pivotal role of interaction between immune and endometriotic cells, in this paper, we aim to shed light about the role of apoptosis pathways in modulating the fine-regulated peritoneal microenvironment during endometriosis.

Methods

Narrative overview, synthesizing the findings of literature retrieved from searches of computerized databases.

Results

In normal conditions, endometriotic cells, refluxed through the fallopian tubes into the peritoneal cavity, should be attacked and removed by phagocytes and NK cells. During endometriosis, the breakdown of peritoneal homeostasis causes the failure of scavenging mechanisms, allowing the survival of endometriotic cells. The consequent so-called “immunoesca**” of endometriotic cells could be due, at least in part, to the reduction of apoptotic-mediated pathways previously described.

Conclusion

Considering the large amount of evidence retrieved from in vitro as well as in vivo models, the reduced apoptosis of endometriotic cells together with the increased apoptosis of peritoneal fluid mononuclear cells may address the peritoneal homeostasis to a permissive environment for the progression of the disease.

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Authors and Affiliations

  1. Department of Pathology, University of Louisville, Louisville, KY, 40202, USA

    Vaclav Vetvicka

  2. Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Antonio Simone Laganà, Onofrio Triolo, Vittorio Italo Palmara & Salvatore Giovanni Vitale

  3. Department of Biomedical Sciences, Dentistry and Morphological and Functional Imaging, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Francesca Maria Salmeri & Vincenza Sofo

  4. Department of Histology and Embryology, Faculty of Medicine, Charles University, Pilsen, Czech Republic

    Milena Králíčková

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  1. Vaclav Vetvicka
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  2. Antonio Simone Laganà
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Correspondence to Antonio Simone Laganà.

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Vetvicka, V., Laganà, A.S., Salmeri, F.M. et al. Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet 294, 897–904 (2016). https://doi.org/10.1007/s00404-016-4195-6

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