Pathogenetic therapy of genital endometriosis

Understanding important role of immune system in the development of genital endometriosis has outlined new ways of studying pathogenesis of the disease and new approaches to treatment strategies. Alterations of antiproliferative components of immune system (reduction of cytotoxic activity of NK cells in peripheral blood and peritoneal fluid and loss of ability of leukocytes in peripheral blood to produce IFN-α/β and IFN-γ) are marked as a mechanism of development of endometriosis. We revealed the rise of the amount of peritoneal macrophages and proinflammatory cytokines and chemokines in peritoneal fluid and in endometriotic lesions, which proves important role of inflammatory reaction in the genesis of genital endometriosis. Genital endometriosis is characterized by immune response of predominantly Th2 type, especially pronounced in cases of recurrence of the disease and combination of endometriosis with adenomyosis, which means ineffectiveness of inflammatory reaction in this disease. We found high angiogenic potential of peritoneal fluid of patients with endometriosis, which manifests as strengthening of proliferative activity of endothelial cells and increase of angiogenic growth factors, which contribute to development of endometriotic lesions. The obtained data allowed us to include immunomodulation therapy in combined treatment of genital endometriosis (interferon inducers, interferon-replacement therapy, recombinant interleukin-2). The effectiveness of this approach was confirmed by clinical, laboratory data and control laparoscopies.

It was determined that endometriotic implants have the ability to hypersecrete aromatases. After surgical treatment of 39 patients with recurrent endometriosis they were prescribed aromatase inhibitors in combination with progestagens (19-norsteroids) in continuous regimen for a period of 6 months. During the course of treatment positive dynamics was stated (decrease or absence of pain syndrome, absence of recurrence proved by laparoscopic examination).