Surgical removal of endometriotic lesions alters local and systemic proinflammatory cytokines in endometriosis patients

Capsule:
Excising endometriotic lesions significantly decreased circulating levels of inflammatory cytokines. Levels were also higher than in normal women, dissimilar in eutopic versus ectopic endometrium, and influenced by disease stage.

Authors:
Stephany P. Monsanto, M.Sc., Andrew K. Edwards, Ph.D., Juhua Zhou, Ph.D., Prakash Nagarkatti, Ph.D., Mitzi Nagarkatti, Ph.D., Steven L. Young, M.D., Ph.D., Bruce A. Lessey, M.D., Ph.D., Chandrakant Tayade, D.V.M., Ph.D.

Volume 105, Issue 4, Pages 968-977

Abstract:

Objective:
To determine the impact of endometriotic lesion removal on local and systemic inflammation.

Design:
Multiplex cytokine analysis on samples from endometriosis patients before surgery, 2 weeks after surgery, and 3 months after surgery.

Setting:
Academic teaching hospital and university.

Patient(s):
A total of 43 endometriosis patients before and after excision of lesions by means of laparoscopic surgery, and 25 normal women.

Intervention(s):
None.

Main Outcome Measure(s):
Plasma, eutopic and ectopic tissue, and peritoneal fluid cytokine levels.

Result(s):
Compared with presurgery plasma samples, levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin (IL) 2, IL-8, and IL-10 decreased significantly by 2 weeks after surgery in endometriosis patients. Interestingly, levels began to rise at 3 months after surgery in most cases. In tissue, levels of GM-CSF and IL-15 were lower in eutopic tissue, while levels of basic fibroblast growth factor, interferon-inducible protein 10, IL-1 receptor antagonist, granulocyte colony–stimulating factor, macrophage inflammatory protein 1β, IL-7, and IL-5 were higher in eutopic than in ectopic tissue. In peritoneal fluid, levels of IL-5 and IL-12 were higher in early versus advanced stages of endometriosis. Compared with normal women, plasma from endometriosis patients had higher levels of inflammatory cytokines.

Conclusion(s):
Endometriotic lesion removal significantly alters the inflammatory profile both locally and systemically in women with endometriosis. Our findings indicate that ectopic lesions are the major drivers of systemic inflammation in endometriosis. The transitory nature of the change may reflect the recurrence of the condition and the influence of systemic factors in its onset.

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