Chemotaxis of macrophages by a peritoneal fluid protein in women with endometriosis

Objective: To expand on a preliminary study comparing the chemotactic potential of peritoneal fluid (PF) from women with and without endometriosis and to characterize this activity via immunosuppressants and a protease. Design: Case control study. Setting: University center. Patient(s): Fifty-nine women with endometriosis and 44 without, undergoing laparoscopy. Intervention(s): Collection of PF, endometriotic, ovarian, and endometrial biopsies at laparoscopy. Main Outcome Measure(s): Chemotactic activity of PF was tested via an in vitro assay alone and in the presence of immunosuppressants cyclosporin A (CSA), FK506, rapamycin, and type XVII-b(S-V8) protease and in media incubated with endometriotic, ovarian, or endometrial biopsy specimens. Result(s): The PF from women with endometriosis had significantly greater chemotactic activity (cells per well, mean ± SD) than without endometriosis (142 ± 39 versus 48 ± 17). Cyclosporin A significantly inhibited the chemotactic activity of the endometriotic PF; FK506 and rapamycin did not. Incubation of media with endometriotic tissue, but not ovarian or endometrial, for ≥ 7 hours displayed chemotactic activity. Protease type XVII-b(S-V8) added to endometriotic PF inhibited this chemotactic activity. Conclusion(s): Peritoneal fluid from patients with endometriosis contains a protein chemotactic factor attracting inflammatory cells into the peritoneal cavity, possibly secreted by endometriotic implants. This chemotactic factor may be a member of the immunophilin family because of its inhibition profile.