mRNA expression of transcription factors and cytokines in immune cells of ovarian endometrioma from women with endometriosis.

Introduction and aim. In endometriosis (E), regurgitating endometrial cells implant outside the uterus causing changes in the microenvironment leading to abnormal recruitment of immune cells. The released cytokines drive the differentiation programs of CD4+T cells toward Th1, Th2 and Th17 and Tregs. Th1 are characterized by T-bet and STAT1 and 6, and the production of IL-2, IFN-γ, and TNF-alfa. Th2 cells are characterized by GATA-3 and STAT5 and 6, and the production of IL-4, IL-5, IL-13. Th17 are characterized by RORC and produce IL-17A, IL-17F and IL-22. Tregs are characterized by Foxp3 and produce IL-10 and TGF-β. Since the eutopic endometrium behaves like an immune regulatory tissue, the specific activities of these immune cells are crucial. In E, the endometriotic cells provokes changes in the microenvironment leading to abnormal recruitment of immune cells. Aim of this work is to verify the presence and levels of T-bet+, GATA-3+, RORc+ or Foxp3+ cells and IFN-γ, IL-4, IL-17A or IL-10 producing cells by evaluating gene expression at mRNA production in ovarian endometrioma samples (OES) from women with E and ovarian functional cysts (OFC) from women without E as controls (C). Materials and Methods. We collected OES from 60 women with E at severe stages and 10 OFC as C, during laparoscopy. Total RNA was isolated from tissues for PCR real time analysis of T-bet, GATA-3, RORc, Foxp3, IFN-γ, IL-4, IL-17A, IL-10 and β-actin as endogenous control. PCR Real Time was performed by means of ready-to-use assays (Assays on demand, Applied Biosystems) on both targets and endogenous control. Results. Our results showed that T-bet mRNA was present in 92% of OES and slightly higher than C. 60% of OE was IFN-γ mRNA+ and upregulated. All the OES were GATA-3-mRNA+ and slightly higher than C. 81% of OE was IL-4 mRNA+ and upregulated. Our results showed that RORc- and IL-17A-mRNAs were present and slightly upregulated respect to C in 61% and 68% of OES, respectively. Foxp3 mRNA was present in 52% of OES with levels almost overlapping to C Indeed, IL-10 mRNA was present and strongly overexpressed in 100% of OES. Conclusions. We hypothesize that, in the positive OES, T-bet, RORC, IFN-γ and IL-17A mRNA presence may represent a hallmark of inflammation. Since only half of OES comprised Foxp3+ cells, the upregulated presence of GATA-3 mRNA may account for IL-10 mRNA overexpression. This, together with IL-4 mRNA overexpression, could be represent a sign of Th2 polarization. These apparently contradictory results could be due to coexistence of inflammatory and reparative phenomena in E, responsible of the disturbance of the immunological equilibrium in ectopic endometrium.