Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review)
Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review)
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DOI：
10.3892/mmr.2013.1755
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发表时间：
2014-01-01
影响因子：
3.4
通讯作者：
Kajihara, Hirotaka
中科院分区：
文献类型：
--
作者：
Kobayashi, Hiroshi;Higashiura, Yumi;Kajihara, Hirotaka
子宫内膜异位症是一种常见的慢性炎症性疾病，具有免疫学背景。在这篇综述中，我们的目的是探讨支持子宫内膜异位症发病机制的感染和无菌性炎症的当代文献。本文回顾了与子宫内膜异位症相关的炎症、环境、免疫和氧化因素的英文文献，以确定导致子宫内膜异位症易感性的因素。子宫内微生物可能对子宫内膜异位症的发生至关重要;微生物刺激物对病原体识别受体的初始激活导致促炎途径和先天免疫的激活。Toll样受体（TLR）除了对各种外源性病原体相关分子模式产生应答外，还识别多种内源性病原体相关分子模式（DAMP）。DAMPs表达水平的增加可能参与了核转录因子B依赖性无菌性炎症的后续过程。氧化应激，继发于逆行月经期间铁的内流，参与子宫内膜异位症的进展。DAMP介导的危险信号和氧化应激在无菌炎症期间是双向的（危险信号螺旋）。这篇综述支持了子宫内膜异位症发展至少有两个不同阶段的假设：TLR激活调节先天免疫反应的第一波将是第二波无菌炎症。
Endometriosis is a common type of chronic inflammatory disease with an immunological background. In this review, we aimed to explore the contemporary literature on the infection and sterile inflammation that support the pathogenesis of endometriosis. This article reviews the English-language literature on inflammatory, environmental, immunological and oxidative factors associated with endometriosis in an effort to identify factors that cause a predisposition to endometriosis. Intrauterine microbes may be critical for the initiation of endometriosis; the initial activation of pathogen recognition receptors by microbial stimuli results in the activation of proinflammatory pathways and innate immunity. In addition to their response to various exogenous pathogen-associated molecular patterns, Toll-like receptors (TLRs) also recognize a wide range of endogenous danger-associated molecular patterns (DAMPs). The increased expression levels of DAMPs may be involved in the subsequent process of nuclear transcription factor-B-dependent sterile inflammation. Oxidative stress, secondary to the influx of iron during retrograde menstruation, is involved in the progression of endometriosis. DAMP-mediated danger signals and oxidative stress are bidirectional during sterile inflammation (danger signal spiral). This review supports the hypothesis that there are at least two distinct phases of endometriosis development: The initial wave of TLR activation in modulating innate immune responses would be followed by the second big wave of sterile inflammation.