Abstract
BackgroundThe coexistence of endometrial and immune cells during decidualization is preserved by the ability of endometrial cells to regulate the cytotoxic immune activity and their capability to be resistant to immune-mediated apoptosis. These phenomena enable the survival of endometrial ectopic cells. RCAS1 is responsible for regulation of cytotoxic activity. Metallothionein expression seems to protect endometrial cells against apoptosis. The aim of the present study was to evaluate RCAS1 and metallothionein expression in human ovarian and scar endometriomas in relation to the presence of immune cells and their activity.MethodsMetallothionein, RCAS1, CD25, CD69, CD56, CD16, CD68 antigen expression was assessed by immunohistochemistry in ovarian and scar endometriomas tissue samples which were obtained from 33 patients. The secretory endometrium was used as a control group (15 patients).ResultsThe lowest metallothionein expression was revealed in ovarian endometriomas in comparison to scar endometriomas and to the control group. RCAS1 expression was at the highest level in the secretory endometrium and it was at comparable levels in ovarian and scar endometriomas. Similarly, the number of CD56-positive cells was lower in scar and ovarian endometriomas than in the secretory endometrium. The highest number of macrophages was found in ovarian endometriomas. RCAS1-positive macrophages were observed only in ovarian endometriomas. CD25 and CD69 antigen expression was higher in scar and ovarian endometriomas than in the control group.ConclusionThe expression of RCAS1 and metallothionein by endometrial cells may favor the persistence of these cells in ectopic localization both in scar following cesarean section and in ovarian endometriosis.
Highlights
The coexistence of endometrial and immune cells during decidualization is preserved by the ability of endometrial cells to regulate the cytotoxic immune activity and their capability to be resistant to immune-mediated apoptosis
RCAS1 immunopositivity was revealed in 57% of ovarian endometriosis tissue samples, in 60% of scar endometrioma tissue samples and in all examined secretory endometrial tissue samples (Figure 1.) The differences in the distribution of MT immunoreactivity were found between stromal cells and glandular cells in the tissue samples derived from the scar and ovarian endometriosis
No such alterations in MT distribution were observed between samples in the control group (Figure 2.) Metallothionein immunoreactivity was observed in glandular epithelium of 21% ovarian endometriosis tissue samples, 94% scar endometriomas and in all secretory endometrium tissue samples
Summary
The coexistence of endometrial and immune cells during decidualization is preserved by the ability of endometrial cells to regulate the cytotoxic immune activity and their capability to be resistant to immune-mediated apoptosis These phenomena enable the survival of endometrial ectopic cells. The aforementioned two hypotheses in combination with the current opinion indicating that the endometrial tissue acquires a secondary gestagen resistance [4] indicates the natural ability of endometrial cells to coexist with adjacent activated immune cytotoxic cells within the decidua. This phenomenon is secondary to the participation of endometrial cells in reproduction and enables the creation of maternal immune tolerance against fetal antigens
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