Tumor necrosis factor alpha secretion by peritoneal macrophages in patients with endometriosis

Introduction As a cytotoxic product of activated monocytes, macrophages, and lymphocytes, tumor necrosis factor alpha (TNF-α)—together with other cytokines and growth factors—is an important component in the immune response of the human organism. In addition, TNF-α plays a central role in neoangiogenesis. Because of its cytotoxicity with regard to several tumor cells and its motility-hindering effect on human sperm, TNF-α is considered to be a significant pelvic mediator of female sterility. Objective The goal of our study was to determine as to whether or not an increased TNF-α secretion by peritoneal macrophages (PM) can be measured in female patients with endometriosis compared with healthy subjects, and if TNF-α secretion can be correlated with the activity of endometriosis. Methods During infertility work-up, 100 female patients underwent a diagnostic laparoscopy. In accordance with the rAFS classification as well as from the macroscopic aspect of the degree of activity of the endometriosis, the patients were divided as follows: an endometriosis-free control group with a completely normal pelvic status ( n =35) and three groups with increasing stages of endometriosis ( n =65). In the control group (Group 1), the TNF-α concentrations (median values with minimum / maximum) were 6.2 pg/ml (1.9/10.2), in Group 2 with rAFS stage I/II less active endometriosis 56.33 pg/ml (39.5/71.2), in Group 3 with rAFS stage I/II but highly active endometriosis 81.41 pg/ml (68.4/98.7), while in Group 4 with rAFS stage III/IV 200,15 pg/ml (182.6/226.8), respectively. Conclusion In conclusion, we were able to show that the TNF-α secretion of PM was significantly higher in patients with proven endometriosis compared to the control group. These results were found to be statistically significant and were in accordance with the histological findings. Thus, due to its immunomodulating potential, TNF-α may be a marker of both activity and stage of endometriosis.