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Background Researchers have found that macrophages are the predominant cells in the peritoneal fluid (PF) of endometriosis patients. CSF-1 has been found to accumulate in the lesions and PF of endometriosis patients, and CSF-1 induces THP-1-derived macrophages to polarize toward a CD169 +  DC-SIGN +  phenotype. Does the cytokine CSF-1 induce monocytes to differentiate into macrophages with a DC-SIGN +  phenotype in endometriosis? Methods The level of CSF-1 in the endometrium of control subjects, and the eutopic, and ectopic endometrium of endometriosis patients was evaluated by real-time polymerase chain reaction (qRT–PCR) and was determined by enzyme-linked immunosorbent assay (ELISA) in the PF of control and endometriosis patients. CSF-1 expression was examined with a MILLIPLEX MAP Mouse Cytokine/Chemokine Magnetic Bead Panel. DC-SIGN +  macrophages were detected by immunohistochemical staining of tissues and flow cytometric analysis of the PF of control subjects ( N  = 25) and endometriosis ( N  = 35) patients. The phenotypes and biological activities of CSF-1 -induced macrophages were compared in an in vitro coculture system with peripheral blood lymphocytes from control subjects. Results In this study, we found that the proportion of DC-SIGN +  CD169 +  macrophages was higher in the abdominal immune microenvironment of endometriosis patients. CSF-1 was primarily secreted from ectopic lesions and peritoneum in mice with endometriosis. In addition, CSF-1 induced the polarization of macrophages toward a DC-SIGN +  CD169 +  phenotype; this effect was abolished by the addition of an anti-CSF-1R antibody. CSF-1 induced the generation of DC-SIGN +  macrophages, leading to a depressed status of peripheral blood lymphocytes, including a high percentage of Treg cells and a low percentage of CD8 +  T cells. Similarly, blockade with the anti-CSF-1R antibody abrogated this biological effect. Conclusions This is the first study on the role of DC-SIGN +  macrophages in the immune microenvironment of endometriosis. Further study of the mechanism and biological activities of CSF-1-induced DC-SIGN +  macrophages will enhance our understanding of the physiology of endometriosis. Graphical Abstract

CSF-1-induced DC-SIGN+ macrophages are present in the ovarian endometriosis