Quantitative and qualitative peritoneal immune profiles, T-cell apoptosis and oxidative stress-associated characteristics in women with minimal and mild endometriosis

Objectives To assess immunological variables, T-cell apoptosis and oxidative stress markers in the peripheral blood and peritoneal fluid of women with (WEN) and without (WWE) endometriosis. Design Observational and transverse case-control study. Setting National Institute of Perinatology, Mexico City, Mexico. Population and sample Peripheral blood and peritoneal fluid obtained from 30 WWE and 32 WEN. Methods Blood was drawn before surgery and peritoneal fluid was collected during surgery but before any surgical procedure had been carried out. Flow cytometry, spectrophotometry, high-performance liquid chromatography and multiplex immunoassay analyses were performed. Main outcome measures Peripheral and peritoneal lymphocyte subpopulations (CD3+, CD4+ CD3+, CD8+ CD3+, CD16+ CD56+, human leucocyte antigen-DR+ CD3+ and CD19+), intracellular CD4+ CD3+ and CD8+ CD3+ cytokine synthesis (interleukin-2 [IL-2] and interferon-gamma [IFN-gamma]), CD3+ apoptosis, malondialdehyde and ascorbate concentrations and peritoneal cytokine concentrations. Results No differences were found in peripheral and peritoneal lymphocyte subsets between the groups. Peritoneal T lymphocytes from WEN produced less IL-2 and IFN-gamma than those from WWE. Peritoneal malondialdehyde concentrations were higher and ascorbate concentrations were lower in WEN than in WWE. Higher peritoneal concentrations of pro-inflammatory cytokines (IL-1 beta, tumour necrosis factor-alpha and IL-6) and chemokines (IL-10, IL-8, eotaxin, vascular endothelial growth factor, monocyte chemotactic protein-1 and regulated upon activation, normal T-cell expressed, and secreted) and lower concentrations of IFN-gamma, IL-1 receptor antagonist and IL-15 were found in WEN. No statistical differences were found in IL-2, IL-4, IL-12 and IL-13 concentrations. Conclusion The alterations observed in WEN were associated with a diminished peritoneal T helper type 1 immune response. Pro-inflammatory, chemotactic, angiogenic and oxidative stress markers were altered in the peritoneal milieu of WEN. These changes appeared to contribute to the peritoneal immune alterations found.