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15 December 2018

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Int J Med Sci 2013; 10(9):1199-1208. doi:10.7150/ijms.5169

Research Paper

Increased Expression of Pattern Recognition Receptors and Nitric Oxide Synthase in Patients with Endometriosis

Seung Geun Yeo1*, Yong Sung Won2*, Ho Yun Lee1, Young Il Kim1, Jin-Woo Lee1, Dong Choon Park3✉

1. East-West Medical Research Institute, Kyung Hee University
2. Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea
3. Department of Obstetrics and Gynecology, St. Vincent's Hospital, The Catholic University of Korea
* Yeo, SG and Won, YS contributed equally to this work.


Objective: Endometriosis is characterized by repeated inflammatory changes and serious adhesions, inducing innate and adaptive immune responses within the abdominal cavity. To assess these immune responses, we evaluated the levels of expression of Toll-like receptors (TLR)-1, -2, -4, -5, and -9; nucleotide-binding oligomerization domains (NOD)-1 and -2; interleukins-1β, -6, -8, -10, and -12; interferon-γ; tumor necrosis factor-α; inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS); and immunoglobulins (Igs) in patients with endometriosis.

Methods: The levels of TLRs, NODs, cytokines, and NOS mRNAs in peritoneal effusions were assessed by real time reverse transcription-polymerase chain reaction; and IgG, IgA and IgM concentrations were measured by enzyme-linked immunosorbent assays (ELISA) in 40 patients with and 40 without endometriosis. Findings from the two groups were compared.

Results: We observed expression of all pattern recognition receptors (PRRs), cytokines, and NOS mRNAs and Igs in the effusion fluid of patients with and without endometriosis. The levels of TLR-2 and -9; NOD-1 and -2; iNOS and eNOS mRNAs and CA 125 were significantly higher in the endometriosis than in the non-endometriosis group (p<0.05 each). Moreover, PRR, cytokine, and NOS expression showed significant correlations (p<0.05).

Conclusions: PRRs, cytokines, and NOS, which act cooperatively in the innate immune response, are closely associated with endometriosis. Increased expression of TLR-2, TLR -9, NOD-1, NOD-2, and NOS mRNA in peritoneal fluid may be associated with endometriosis.

Keywords: Endometriosis - Pattern Recognition Receptors, Toll-like receptors - Nitric oxide synthase, cytokine, Immunoglobulin

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How to cite this article:
Yeo SG, Won YS, Lee HY, Kim YI, Lee JW, Park DC. Increased Expression of Pattern Recognition Receptors and Nitric Oxide Synthase in Patients with Endometriosis. Int J Med Sci 2013; 10(9):1199-1208. doi:10.7150/ijms.5169. Available from