5 Peritoneal Macrophages of Women with Endometriosis as a Possible Target for Immunomodulatory Drugs

At this time, the sphere of immunomodulatory drugs application is being significantly extended, as recent investigations have clearly shown that the impairment of immune response is associated with the development of a large number of pathological conditions and gynecological diseases. It has been shown that immune mechanisms participate in the pathogenesis of a widely spread gynecological disease such as endometriosis.

Endometriosis affects at least 10% of reproductive-age women [115]. It is characterized by the growth of endometrial tissue outside the uterine cavity, where the endometrium normally is located. The endometrial deposits are mostly found in the pelvis (preferably on the ovaries and peritoneum). But deposits have also been found in the rectum and bladder and even within the lungs and brain [116]. Endometriosis is an enigmatic disease because since endometriosis being first described its pathogenesis and treatment options have been debated [115,117]. The most widely accepted theory was offered by Sampson (1924), and this theory proposes that in women with endometriosis there is a reflux of endometrial tissue via the fallopian tubes into the abdominal cavity, where the viable endometrial fragments can implant [115]. Cells of the implanted endometrium proliferate, grow and develop the ectopic endometrial lesions, which is morphologically and functionally similar to the uterine endometrium. Due to the high invasive and proliferative activity of cells of endometriotic lesions, endometriosis often is described as a benign tumor [115]. It must be noted however, that women with endometriosis are at increased risk of malignant tumors of the pelvis [118]. Endometriosis is the most common cause of pelvic pain and occurs in 30–40% of women with infertility [119]. Current medical treatment has rather little to offer patients with endometriosis. The most popular method of endometriosis treatment is the surgical laparoscopic ablation of endometriosis lesions [120]. But the efficacy of the surgical treatment of endometriosis and endometriosis-associated infertility is comparatively low and does not exceed 30–40% [120]. So, the necessity of the development of new medical methods of endometriosis treatment is obvious.