Open AccessBacterial contamination hypothesis: a new concept in endometriosis
Author(s) -
Khan Khaleque N.,
Fujishita Akira,
Hiraki Koichi,
Kitajima Michio,
Nakashima Masahiro,
Fushiki Shinji,
Kitawaki Jo
Publication year - 2018
Publication title -
reproductive medicine and biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.005
H-Index - 22
eISSN - 1447-0578
pISSN - 1445-5781
DOI - 10.1002/rmb2.12083
Subject(s) - endometriosis , lipopolysaccharide , medicine , endometritis , pathogenesis , physiology , immunology , biology , pregnancy , genetics
Abstract Background Endometriosis is a multifactorial disease that mainly affects women of reproductive age. The exact pathogenesis of this disease is still debatable. The role of bacterial endotoxin (lipopolysaccharide, LPS ) and Toll‐like receptor 4 ( TLR 4) in endometriosis were investigated and the possible source of endotoxin in the pelvic environment was examined. Methods The limulus amoebocyte lysate test was used to measure the endotoxin levels in the menstrual fluid and peritoneal fluid and their potential role in the growth of endometriosis was investigated. Menstrual blood and endometrial samples were cultured for the presence of microbes. The effect of gonadotrophin‐releasing hormone agonist (Gn RH a) treatment on intrauterine microbial colonization ( IUMC ) and the occurrence of endometritis was investigated. Main findings (Results) Lipopolysaccharide regulates the pro‐inflammatory response in the pelvis and growth of endometriosis via the LPS / TLR 4 cascade. The menstrual blood was highly contaminated with Escherichea coli and the endometrial samples were colonized with other microbes. A cross‐talk between inflammation and ovarian steroids or the stress reaction also was observed in the pelvis. Treatment with Gn RH a further worsens intrauterine microbial colonization, with the consequent occurrence of endometritis in women with endometriosis. Conclusion For the first time, a new concept called the “bacterial contamination hypothesis” is proposed in endometriosis. This study's findings of IUMC in women with endometriosis could hold new therapeutic potential in addition to the conventional estrogen‐suppressing agent.