Deep immunophenotyping reveals endometriosis is marked by dysregulation of the mononuclear phagocytic system in endometrium and peripheral blood

Júlia Vallvé-Juanico, Ashley F George, Sushmita Sen, Reuben Thomas, Min-Gyoung Shin, Min‐Gyoung Shin, Divyashree Kushnoor, Joshua J Vásquez, Joshua Vasquez, Kim Chi Vo, Juan C Irwin, Nadia R Roan, Alexis J Combes, Linda C Giudice
BMC medicine · 2022 · vol. 20(1) · doi:10.1186/s12916-022-02359-4 · W4225350619
article OA: gold CC0 ⤵ 28 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

Endometriosis is characterized by dysregulated mononuclear phagocytic system cells in the endometrium and blood, showing increased inflammatory markers and reduced phagocytic capacity in endometrial macrophages.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This case-control study used mass cytometry (CyTOF) with broad and mononuclear phagocyte–focused protein panels to deep-immunophenotype immune cell composition, activation, and related functions in endometrial tissue and peripheral blood from women with endometriosis versus controls across proliferative and secretory cycle phases and across mild versus severe disease stages. The authors found that endometrial CD91+ macrophages in endometriosis overexpressed SIRPα (a phagocytosis inhibitor) and CD64, and these macrophages were more abundant in mild than severe disease, while in blood classical and intermediate monocytes were less abundant and plasmacytoid dendritic cells and non-classical monocytes were increased, with non-classical monocytes higher in severe disease. The study includes specific exclusion criteria and provides no direct functional assays beyond inferred phagocytic capacity from marker expression. This paper is centrally about endometriosis — it links dysregulated mononuclear phagocytic system/macrophage and monocyte phenotypes in endometrium and blood to endometriosis across cycle phases and disease severity.

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Abstract

Abstract Background Endometriosis is a chronic, estrogen-dependent disorder where inflammation contributes to disease-associated symptoms of pelvic pain and infertility. Immune dysfunction includes insufficient immune lesion clearance, a pro-inflammatory endometrial environment, and systemic inflammation. Comprehensive understanding of endometriosis immune pathophysiology in different hormonal milieu and disease severity has been hampered by limited direct characterization of immune populations in endometrium, blood, and lesions. Simultaneous deep phenotyping at single-cell resolution of complex tissues has transformed our understanding of the immune system and its role in many diseases. Herein, we report mass cytometry and high dimensional analyses to study immune cell phenotypes, abundance, activation states, and functions in endometrium and blood of women with and without endometriosis in different cycle phases and disease stages. Methods A case-control study was designed. Endometrial biopsies and blood ( n = 60 total) were obtained from women with ( n = 20, n = 17, respectively) and without ( n = 14, n = 9) endometriosis in the proliferative and secretory cycle phases of the menstrual cycle. Two mass cytometry panels were designed: one broad panel and one specific for mononuclear phagocytic cells (MPC), and all samples were multiplexed to characterize both endometrium and blood immune composition at unprecedented resolution. We combined supervised and unsupervised analyses to finely define the immune cell subsets with an emphasis on MPC. Then, association between cell types, protein expression, disease status, and cycle phase were performed. Results The broad panel highlighted a significant modification of MPC in endometriosis; thus, they were studied in detail with an MPC-focused panel. Endometrial CD91 + macrophages overexpressed SIRPα (phagocytosis inhibitor) and CD64 (associated with inflammation) in endometriosis, and they were more abundant in mild versus severe disease. In blood, classical and intermediate monocytes were less abundant in endometriosis, whereas plasmacytoid dendritic cells and non-classical monocytes were more abundant. Non-classical monocytes were higher in severe versus mild disease. Conclusions A greater inflammatory phenotype and decreased phagocytic capacity of endometrial macrophages in endometriosis are consistent with defective clearance of endometrial cells shed during menses and in tissue homeostasis, with implications in endometriosis pathogenesis and pathophysiology. Different proportions of monocytes and plasmacytoid dendritic cells in blood from endometriosis suggest systemically aberrant functionality of the myeloid system opening new venues for the study of biomarkers and therapies for endometriosis.

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Condition tags

mesh:D004715endometriosisinfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Case-Control Studies Case-Control Studies Case-Control Studies Case-Control Studies Case-Control Studies Case-Control Studies Endometrium Endometrium Endometrium Endometrium Endometrium Endometrium Endometrium

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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