Endometriosis Redefined as an Autoimmune Disease

Endometriosis is a chronic inflammatory gynecological disease, characterized by endometrial tissue growing outside of the uterus in lesions. It is predominantly a women's disease but has been found in men in rare cases. There is not a known pathogenesis, although there are multiple theories. The most accepted is retrograde menstruation; however, there are limitations to the theory due to its inability to account for endometriosis in men and ectopic lesions. Currently, it is debated and unclear if endometriosis should be labeled as an autoimmune disease. The purpose of my project was to research specifically autoimmunity in relation to immune responses to endometriosis and its immune dysfunction to provide a recommendation as to whether it should be relabeled as an autoimmune disease. The main argument for why endometriosis is not an autoimmune disease is that immune cells are not primarily attacking the normal endometrial tissue self-antigens. Instead, due to immune dysfunction, there is reduced apoptosis of the endometrial cells shed during menstruation, leading to their persistence, migration and invasion into different tissues, and proliferation into lesions. The immune response to lesions leads to production of autoantibodies that recognize and attack the self-antigens of the endometrial cells in the lesions. The presence of autoantibodies against endometrial self-antigens would provide support for it being an autoimmune disease. Multiple factors of autoimmune diseases are also associated with endometriosis: increased likelihood of developing other autoimmune diseases, similar immune cell populations, imbalance in Th1 and Th2 lymphocytes, dysfunction of cell apoptosis, immune dysfunction, genetic contributors, high risk HLAs, autoantibodies, polyclonal B cell activation, and responsiveness to immunomodulatory treatments. Due to these factors and the immune system's ability to recognize and attack the self-antigens in the lesion, endometriosis should be considered an autoimmune disease.