REVIEW  UPDATES IN GYNECOLOGICAL MINIMALLY INVASIVE APPROACH AND MEDICAL THERAPY 

Minerva Obstetrics and Gynecology 2021 April;73(2):193-214

DOI: 10.23736/S2724-606X.21.04788-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Possible role of microbiome in the pathogenesis of endometriosis

Maurizio N. D’ALTERIO ¹ ✉, Carlotta GIULIANI ¹, Francesco SCICCHITANO ¹, Antonio S. LAGANÀ ², Noemi M. OLTOLINA ², Felice SORRENTINO ³, Luigi NAPPI ³, Germano ORRÙ ⁴, Stefano ANGIONI ¹

¹ Division of Obstetrics and Gynecology, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy; ² Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy; ³ Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy; ⁴ Molecular Biology Service Lab, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

INTRODUCTION: There is an urgent necessity to explore the complex pathophysiological nature of endometriosis, which may enable the rationale for new diagnostic and therapeutic strategies to be discovered. This systematic review aimed to clarify the bidirectional relationship between endometriosis and the microbiome and evaluate if the microbiome may be involved in endometriosis’s pathogenesis, establishing a potential connection between the different studies.
EVIDENCE ACQUISITION: Studies were identified through a systematic literature search of papers that evaluated the microbiomes of human or other animal species with endometriosis and of those without in the electronic database PubMed/Medline, and Embase without a date restriction. We included all cohort studies focusing on the interaction between endometriosis and the microbiomes of humans or other mammals, evaluating if the microbiome may be involved in endometriosis’s pathogenesis.
EVIDENCE SYNTHESIS: Endometriosis appears to be associated with elevated levels of different microorganisms across various microbiome sites. An ineffective immune response seems to play a key role in endometriosis pathogenesis, and there is some scientific proof to state that the immune response may be modulated by the microbiome. Interestingly, nine studies of our review detected species belonging to the phyla Proteobacteria, Bacteroidetes, and Negativicutes characterized by Gram-negative staining, that were significantly increased in endometriosis cohorts.
CONCLUSIONS: Laboratory and clinical investigations indicate that hosts’ microbiome profiles with and without endometriosis can be significantly different. To further our understanding of the relationships between endometriosis and the host microbiome, more studies are necessary.

KEY WORDS: Endometriosis; Microbiota; Etiology