[Frontiers in Bioscience E1, 444-454, June 1, 2009]

Role of cytokines in the endometrial-peritoneal cross-talk and development of endometriosis

Cleophas M. Kyama1,3, Attila Mihalyi1, Peter Simsa1,4, Henrik Falconer2, Vilmos Fulop4, Jason M. Mwenda3, Karen Peeraer1, Carla Tomassetti1, Christel Meuleman1, Thomas M. D'Hooghe1, 3

1Leuven University Fertility Centre, Department of Obstetrics and Gynaecology, University Hospital Gasthuisberg, Herestraat 49, B3000 Leuven, Belgium, 2Department of Obstetrics and Gynaecology, Karolinska Hospital, Stockholm, Sweden, 3Division of Reproductive Biology, Institute of Primate Research, P.O Box 24481, Karen 00502, Nairobi, Kenya, 4Department of Obstetrics and Gynaecology, National Health Center, Budapest, Hungary


1. Abstract
2. Introduction
3. Role of endometrium in endometrial-peritoneal adhesion and invasion
3.1. Eutopic endometrial factors promoting adhesion: integrins and CD44
3.2. Eutopic endometrial factors promoting invasion: metalloproteinases and cytokines
3.3. Ectopic endometrial factors promoting invasion: metalloproteinases, angiogenic factors and cytokines
4. Role of pelvic peritoneum in endometrial-peritoneal adhesion and invasion
4.1. Pelvic inflammation and endometriosis
4.2. Active role of normal pelvic peritoneum
5. Role of Cytokines and chemokines in endometrial-peritoneal attachment and invasion
6. Animal models for endometrial-peritoneal interactions
7. Conclusions
8. Acknowledgment
9. References


A clear picture of the dynamic relationship between the endometrium and peritoneum is emerging as both tissues may participate in the spontaneous development of endometriosis. Various adhesion molecules, pro-inflammatory cytokines and chemoattractants cytokines have emerged as central coordinators of endometrial-peritoneal interactions. The peritoneal microenvironment which consists of the peritoneal fluid, normal peritoneum and peritoneal endometriotic lesions may play an active role in the pathogenesis of endometriosis, by harbouring most inflammatory responses that are triggered by the presence of endometrial cells, leading to recruitment of activated macrophages and leukocytes locally. Menstrual endometrium has the ability to bond and invade the peritoneal tissue. In baboons intrapelvic injection of menstrual endometrium permits the study of early endometrial-peritoneal interaction in an in vivo culture microenvironment and can lead to important insight in the early development of endometriotic lesions. In this review, we discuss the roles of the endometrial-peritoneal interactions, not only in disease development but also in the broader process of aetiopathogenesis.