Women with endometriosis show a defect in natural killer activity resulting in a decreased cytotoxicity to autologous endometrium
Open accessAbstract
Objective The role of natural killer (NK) cells in the decreased cellular immunity of women with endometriosis was investigated.Design, setting, patients Thirty-four women were investigated prospectively before a CO2-laser laparoscopy for infertility and/or pain at the University Hospital Gasthuisberg. Endometriosis was scored blindly.Main outcome measure The cytotoxicity, directed against the endometrium, was mediated by NK cells because this cytotoxicity could be removed by treating the effector cells with the NK-specific anti-Leu-11b monoclonal antibody. Consequently, we evaluated prospectively in those women the lymphocyte-mediated cytotoxicity toward NK sensitive (K562-assay) and autologous endometrial target cells.Results The NK activity (K562-assay) and the cytotoxicity against autologous endometrial cells were similarly decreased in women with endometriosis and correlated with the severity of the disease. Using heterologous effector cells, the decreased chromium release in women with endometriosis was less pronounced but still present.Conclusion The decreased cytotoxicity to endometrial cells in women with endometriosis is mainly because of a defect in NK activity but is also partially because of a resistance of the endometrium to NK cytotoxicity.
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Natural killer activity is decreased in peritoneal fluid and in plasma of women with endometriosis, and after excision of deep endometriosis their activity remains low, whereas elevated CA-125 concentrations return to normal.
“The natural killer activity is decreased in PF and in plasma of women with endometriosis (103-105) and after excision of deep endometriosis their activity remains low, whereas elevated CA-125 concentrations return to normal (106).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [103]
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“In endometriosis, the endometrium becomes resistant to the cytotoxicity of NK cells, as it is less efficiently destroyed by NK cells obtained from men, compared to endometrium of women without endometriosis (Oosterlynck et al., 1991).”
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Rock, J. A., & Markham, S. M. (1992) · The Lancet · doi:10.1016/0140-6736(92)92959-j · Cited by 110 · see citing works
Guo, S., Du, Y., & Liu, X. (2016) · Human Reproduction · doi:10.1093/humrep/dew057 · Cited by 111 · see citing works
Wu, M., Yang, J., Chao, K., Hwang, J.-L., Yang, Y., & Ho, H. (2000) · Fertility and Sterility · doi:10.1016/s0015-0282(00)01592-2 · Cited by 105 · see citing works
Implantation versus infiltration: the Sampson versus the endometriotic disease theory
Koninckx, P. R., Barlow, D., & Kennedy, S. (1999) · Gynecologic and Obstetric Investigation · doi:10.1159/000052853 · Cited by 100 · see citing works
Dmowski, W. P. (1998) · Human Reproduction Update · doi:10.1093/humupd/4.5.696 · Cited by 101 · see citing works
“More than 70 years ago, John Sampson (1925) proposed that endometriosis develops as a result of the ’retrograde tubal regurgitation’ of endometrial cells and tissue fragments followed by implantation of these cells and tissue fragments in the ectopic locations.”
BackgroundAnimal Studies in Endometriosis: A Review
Story, L., & Kennedy, S. (2004) · ILAR Journal · doi:10.1093/ilar.45.2.132 · Cited by 94 · see citing works
“…women may experience some degree of retrograde menstruation (Halme et al. 1984) yet not all develop endometriosis, which has led to the hypothesis that women with endometriosis have decreased immunological clearance of shed endometrial cells within the peritoneal cavity (Oosterlynck et al. 1991).”
Maeda, N., Izumiya, C., Yamamoto, Y., Oguri, H., Kusume, T., & Fukaya, T. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(01)02964-8 · Cited by 93 · see citing works
“In a previous report, NK cell activity in peritoneal blood similarly failed to recover after LASER cautery of the endometriotic lesion (33).”
BackgroundImplantation Defects in Infertile Women with Endometriosis
Lessey, B. A. (2002) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2002.tb02787.x · Cited by 92 · see citing works
Akoum, A., Lemay, A., Brunet, C., & Hébert, J. (1995) · Fertility and Sterility · doi:10.1016/s0015-0282(16)57363-4 · Cited by 92 · see citing works
Granulated metrial gland cells: A natural killer cell subset of the pregnant murine uterus
Croy, B. A., & Kiso, Y. (1993) · Microscopy Research and Technique · doi:10.1002/jemt.1070250302 · Cited by 92 · see citing works
“Indeed, endometriosis in women is reported to correlate with decreased NK cell activity (Oosterlynck et al., 1991).”
Background异常在位子宫内膜是内异症的病因吗？-在位内膜在内异症发病中的作用
Liu, H., & Lang, J. H. (2011) · Medical Science Monitor · doi:10.12659/msm.881707 · Cited by 93 · see citing works
“There is a decreased cytotoxic activity of NK cells in peripheral blood and peritoneal fluid from patients with endometriosis [9,10].”
BackgroundAnti-TNF-α treatment for pelvic pain associated with endometriosis
Lu, D., Song, H., & Shi, G. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008088.pub3 · Cited by 91 · see citing works
Characterization of Lymphocyte Subpopulations and T Cell Activation In Endometriosis
Witz, C. A., Montoya, I. A., DEY, T. D., & Schenken, R. S. (1994) · American Journal of Reproductive Immunology · doi:10.1111/j.1600-0897.1994.tb01110.x · Cited by 90 · see citing works
Characterization of endometriosis-associated immune cell infiltrates (EMaICI)
Scheerer, C., Bauer, P., Chiàntera, V., Sehouli, J., Kaufmann, A. M., & Mechsner, S. (2016) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-016-4142-6 · Cited by 88 · see citing works
“Although in other studies [22], NK cells were present in the overall decreased numbers as scattered cells within the endometrial epithelium and stroma, their activity was reduced [6, 22, 23], and they were not capable of gathering in clusters.”
ResultHii, L. L., & Rogers, P. A. W. (1998) · Human Reproduction · doi:10.1093/humrep/13.4.1030 · Cited by 88 · see citing works
Suppression of natural killer cell activity by sera from patients with endometriosis
Kanzaki, H., Wang, H.-S., Kariya, M., & Mori, T. (1992) · American Journal of Obstetrics and Gynecology · doi:10.1016/s0002-9378(11)91670-6 · Cited by 87 · see citing works
Effects of dienogest, a synthetic steroid, on experimental endometriosis in rats
Katsuki, Y., Takano, Y., Futamura, Y., Shibutani, Y., Aoki, D., Udagawa, Y., & Nozawa, S. (1998) · European Journal of Endocrinology · doi:10.1530/eje.0.1380216 · Cited by 84 · see citing works
NK Cells as Potential Targets for Immunotherapy in Endometriosis
Ścieżyńska, A., Komorowski, M., Soszyńska, M., & Malejczyk, J. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8091468 · Cited by 85 · see citing works
“Unfortunately, endometrial cells were used as targets only in two independent studies [69,80].”
BackgroundThe non-human primate model of endometriosis: research and implications for fecundity
Braundmeier, A. G., & Fazleabas, A. T. (2009) · Molecular Human Reproduction · doi:10.1093/molehr/gap057 · Cited by 85 · see citing works
“It is known that endometriosis induces an inflammatory environment in the peritoneal cavity of women (Oosterlynck et al., 1991, 1994; D’Hooghe et al., 2001; Gazvani and Templeton, 2002; Umezawa et al., 2009), but does the presence of ectopic lesions also induce an inflammatory environment in the…”
BackgroundPathogenesis of Endometriosis: The Role of Peritoneal Fluid
Koninckx, P. R., Kennedy, S., & Barlow, D. (1999) · Gynecologic and Obstetric Investigation · doi:10.1159/000052856 · Cited by 85 · see citing works
A Novel Noninvasive Model of Endometriosis for Monitoring the Efficacy of Antiangiogenic Therapy
Becker, C. M., Wright, R. D., Satchi‐Fainaro, R., Funakoshi, T., Folkman, J., Kung, A. L., & D’Amato, R. J. (2006) · American Journal Of Pathology · doi:10.2353/ajpath.2006.051133 · Cited by 84 · see citing works
“It has been reported that impaired immunity may be responsible for the local attachment and invasion of endometrial tissue.(12,13) Aromatase was found to be overexpressed in endometriotic lesions, while at the same time, production of 17- -hydroxysteroid dehydrogenase type 2 is reduced.”
BackgroundTreatment strategies for endometriosis
Rodgers, A. K., & Falcone, T. (2008) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.9.2.243 · Cited by 72 · see citing works
“Any decrease in these cells may lead to an increase in the number of active endometrial cells in the peritoneal cavity [14] .”
BackgroundWitz, C. A. (2002) · Gynecologic and Obstetric Investigation · doi:10.1159/000049425 · Cited by 73 · see citing works
- Authors
- Oosterlynck, D. J., Cornillie, F. J., Waer, M., Vandeputte, M., & Koninckx, P. R.
- Affiliations
- Rega Institute for Medical Research (BE)
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 1991-07
- Volume
- 56
- Issue
- 1
- Pages
- 45-51
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W141728048
- Cited by
- 441
- References
- 13
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 11 · 2023: 6 · 2022: 13 · 2021: 12 · 2020: 18 · 2019: 12 · 2018: 11 · 2017: 7 · 2016: 12 · 2015: 14 · 2014: 21 · 2013: 16 · 2012: 13
- FWCI
- 16.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Life Sciences › Immunology and Microbiology › Immunology › Immune Cell Function and Interaction
- Keywords
- endometriosis, natural killer cells, NK cell cytotoxicity, cell-mediated immunity, infertility, disease severity
- MeSH terms
- Chromium Radioisotopes, Cytotoxicity, Immunologic, Endometriosis, Endometrium, Female, Flow Cytometry, Humans, Immunity, Cellular, Killer Cells, Natural, Leukocyte Count, Prospective Studies
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