ENHANCED INTERLEUKIN-4 EXPRESSION IN PATIENTS WITH ENDOMETRIOSIS

Objective: To investigate the expression of cytokines by T-helper cell s type 1 (interleukin [IL]-2 and interferon-gamma [IFN-gamma) and type 2 (IL-4 and IL-10) in peripheral blood monocytes and peritoneal fluid (PF) cells from patients with endometriosis. Design: Peripheral blood (PB) monocytes and PF cells from patients with endometriosis were iso lated and the expression of cytokines investigated. Setting: Institute for the treatment of endometriosis and research institute in universi ty based medical center. Patient(s): The study included 7 women with n ormal pelvic structure, 36 patients with endometriosis, and 7 women wi th pelvic adhesion but without apparent endometriotic lesion. The exis tence and severity of endometriosis was determined by laparoscopic exa mination. Intervention(s): All patients received laparoscopic operatio n to identify the existence and stages of endometriosis. Danazol (200 mg, twice daily) was prescribed for those with endometriosis. Main Out come Measure(s): Transcription of cytokines were directly analyzed usi ng the reverse transcriptase-polymerase chain reaction method. The con centrations of cytokines in peritoneal fluids and sera were analyzed b y the ELISA. Result(s): Levels of IL-4 messenger RNA (mRNA) and protei n in the PB and peritoneal cells of patients with endometriosis were h igher than those of normal patients, whereas levels of IFN-gamma mRNA and protein were suppressed. There were no significant changes in the mRNA or protein levels of IL-2 or IL-IO in both peritoneal fluids and sera. The level of IL-4 was reduced to normal after combined treatment with laparoscopic surgery and danazol. The secretion of IFN-gamma was elevated after treatment. Conclusion(s): Cytokine secretion by T-help er cells type 1 and type 2 is altered in women with endometriosis, sug gesting that these T-helper subsets play a role in the immunologic res ponses to endometriosis. (C) 1997 by American Society for Reproductive Medicine.