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Causes of Endometriosis: Immunology
Reversal flow of menstrual blood with endometrium is not bound to cause endometriosis; in fact, only a few of them have endometriosis(EMS). So, why would this happen?
It has been found that the number and activity of macrophages in the peritoneal fluid of patients with EMS are significantly increased, and the cytokines produced by macrophages and other immune cells, such as interleukin-1 (IL-1), tumor necrosis factor - α (TNF - α), are also increased. In addition, the number of helper T cells increased, and the number of inhibitory T cells decreased.
The increase of IgG and IgA in the endometrium, serum, and cervical secretion, and the increase of some antibodies in serum suggest that EMS is an autoimmune disease.
At present, it is believed that the reason why the endometrium with reversal flow of menstrual blood can be implanted in the abdominal cavity may be related to some defects in the immune mechanism of the patients, at least to some immune defects in the local abdominal cavity.
The cytotoxic effect of immunosurveillance and immune killer cells such as NK cells and macrophages was weakened, which promoted the transplantation and localization of ectopic endometrium. The cytokines released by immunoreactive cells promoted the survival and proliferation of ectopic endometrium.


Macrophages are the dominant cells in peritoneal fluid leukocytes. They play an important role in the immune response. Many studies have shown that the number and activity of macrophages in the peritoneal fluid of patients with endometriosis are increased, and the secretion of il-l, TNF, PG, and other active mediators are significantly increased.
These substances can promote the division and proliferation of endometrial cells and fibroblasts and the deposition of fibrinogen, which is conducive to the growth of endometrium in ectopic implantation and the continuous expansion of lesions, which may be the occurrence of EMS The key to development.
Many studies have reported the relationship between endometriosis and cellular immune deficiency. It is believed that the abnormal immune mechanism of endometriosis can not prevent the implantation of the endometrium, and lead to its further localization and proliferation.
Now the question is, if EMS happens first, these immune changes are not the cause of disease, but only a pathological change; if immune changes are the first, what are the trigger factors?


People have noticed that the incidence rate of vaginal Candida in EMs patients is higher than that in the normal population. Further studies have found that the immunological changes of Candida albicans infection and EMS are surprisingly similar.
Candida albicans infection can activate macrophages, increase IL-1, TNF - α, IL-6, and prostaglandin E2, and inhibit C3 mediated phagocytosis. These phenomena suggest that there is a certain relationship between Candida infection and EMS.
It was found that there was a cross-reaction between the anti-Candida Albicans antibody and some helper T cells and ovarian cells. The anti ovarian antibody also played a role in the relationship between candidiasis and female autoimmune diseases. Therefore, some scholars hypothesized that Candida albicans infection might be the trigger factor of the change of EMS autoimmunity.
Recently, people have noticed that EMS patients and their relatives are allergic. They are prone to allergic reactions to allergens such as dust, pollen, penicillins, perfume, and other chemicals and cause allergic diseases such as urticaria, asthma, allergic enteritis, etc.
Like these allergic diseases, EMS and Candida albicans also have IgE mediated anaphylaxis. Therefore, whether the pathogenesis of EMS is similar to that of allergic diseases is one of the topics of interest.
In conclusion, endometriosis is closely related to immune factors. The change of the immune factors in the abdominal cavity is one of the important mechanisms of the disease. There are a lot of active immune cells in the peritoneal fluid, which can produce the function of immune monitoring, immune defense, and immune clearance for the antigens entering the abdominal cavity.
However, the cause of the immune abnormality is the immune damage caused by the abnormal immune signal carried by endometrium, or the immune system defect in the body, that is, whether the immune damage is the cause or the result of the disease, these problems need to be further studied.
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