Cited by 176Endometriosis Research and TreatmentGynecological conditions and treatmentsReproductive tract infections research

Bacterial contamination hypothesis: a new concept in endometriosis

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Khan, Khaleque N., Fujishita, Akira, Hiraki, Koichi, Kitajima, Michio, Nakashima, Masahiro, Fushiki, Shinji, Kitawaki, Jo·2018·Reproductive Medicine and Biology

Abstract

BACKGROUND: Endometriosis is a multifactorial disease that mainly affects women of reproductive age. The exact pathogenesis of this disease is still debatable. The role of bacterial endotoxin (lipopolysaccharide, LPS) and Toll-like receptor 4 (TLR4) in endometriosis were investigated and the possible source of endotoxin in the pelvic environment was examined. METHODS: The limulus amoebocyte lysate test was used to measure the endotoxin levels in the menstrual fluid and peritoneal fluid and their potential role in the growth of endometriosis was investigated. Menstrual blood and endometrial samples were cultured for the presence of microbes. The effect of gonadotrophin-releasing hormone agonist (GnRHa) treatment on intrauterine microbial colonization (IUMC) and the occurrence of endometritis was investigated. MAIN FINDINGS RESULTS: and the endometrial samples were colonized with other microbes. A cross-talk between inflammation and ovarian steroids or the stress reaction also was observed in the pelvis. Treatment with GnRHa further worsens intrauterine microbial colonization, with the consequent occurrence of endometritis in women with endometriosis. CONCLUSION: For the first time, a new concept called the "bacterial contamination hypothesis" is proposed in endometriosis. This study's findings of IUMC in women with endometriosis could hold new therapeutic potential in addition to the conventional estrogen-suppressing agent.

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Crossref · 10.1002/rmb2.12083

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  • Endometriosis is associated with higher concentrations of Escherichia coli in menstrual blood, with vaginal infections, and with chronic endometritis.

    “Endometriosis is associated with higher concentrations of Escherichia coli in menstrual blood (134, 135), with vaginal infections (136), and with chronic endometritis (137).”

    From Pathogenesis of endometriosis: The genetic/epigenetic theory (2019) · cites this paper as [135]

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  1. [35]Khan KN, Kitajima M, Fujishita A, Sekine I, Ishimaru T, Masuzaki H. Multifunctional role of hepatocyte growth factor (HGF) in the development of pelvic endometriosis. Am J Reprod Immunol. 2008; 60: 383‐ 404. 19238747
  2. [54]Khan KN, Kitajima M, Hiraki K, et al. Combined effect of estrogen and endotoxin on pelvic inflammation and growth of endometriosis. In: 64th Proceedings of Acta Obstretica et Gynecologica Japonica 2012: 813.
  3. [55]Cakmak H, Guzeloglu‐Kayisli O, Kayisli UA, Arici A. Immune–endocrine interactions in endometriosis. Front Biosci. 2009; E1: 429‐ 443. 19482657

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Authors
Khan, K. N., Fujishita, A., Hiraki, K., Kitajima, M., Nakashima, M., Fushiki, S., & Kitawaki, J.
Affiliations
  • Kyoto Prefectural University of Medicine (JP)
  • Department of Gynecology Saiseikai Nagasaki Hospital Nagasaki Japan
  • Nagasaki University (JP)
  • Atomic Bomb Disease Institute, Nagasaki University (JP)
Corresponding author
Khan, Khaleque N.
Venue
Reproductive Medicine and Biology
Publisher
Wiley
Published
2018-01-18
Volume
17
Issue
2
Pages
125-133
ISSN
  • 1445-5781 (ISSN-L)
  • 1447-0578
OpenAlex
W2789998895
Cited by
176
References
77
Citations by year
2026: 20 · 2025: 27 · 2024: 29 · 2023: 28 · 2022: 12 · 2021: 19 · 2020: 24 · 2019: 14 · 2018: 3
FWCI
2.26
Type
journal article
Language
en
Open access
Locations
  • Reproductive Medicine and Biology (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Japan Society for the Promotion of Science (24592474, 15K10675)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords
endometriosis, bacterial endotoxin, lipopolysaccharide, TLR4, endometritis, GnRH agonist, menstrual blood, peritoneal fluid, endometrial microbiota, endometriosis pathogenesis

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