title: Alternative activation of macrophages in rhesus macaques (Macaca mulatta) with endometriosis.
abstract: Endometriosis is one of the most frequently encountered gynecologic diseases and a common cause of chronic pelvic pain and infertility. The pathophysiology of this syndrome can best be described as the presence of ectopic endometrium and a pelvic inflammatory process with associated  immune dysfunction and alteration in the peritoneal environment. Macrophages play an important role in the progression and propagation of endometriosis. Alternative macrophage activation occurs in rodents and women with endometriosis but had not been examined previously in nonhuman primates.  This case-control study aimed to characterize macrophage polarization in the ectopic and eutopic endometrial tissue of nonhuman primates with and without endometriosis. In addition, circulating cytokines in endometriosis cases and normal controls were investigated in an effort to identify  serum factors that contribute to or result from macrophage polarization. Endometriosis lesions demonstrated increased infiltration by macrophages polarized toward the M2 phenotype when compared with healthy control endometrium. No serum cytokine trends consistent with alternative macrophage  activation were identified. However, serum transforming growth factor α was elevated in macaques with endometriosis compared with healthy controls. Findings indicated that the activation state of macrophages in endometriosis tissue in nonhuman primates is weighted toward the M2 phenotype.  This important finding enables rhesus macaques to serve as an animal model to investigate the contribution of macrophage polarization to the pathophysiology of endometriosis.
authors.affiliation: New England Primate Research Center, Harvard Medical School, Southborough, Massachusetts, USA. kumari.a.smith@emory.edu
authors.forename: Kumari A
authors.initials: KA
authors.lastname: Smith
authors.forename: Christine B
authors.initials: CB
authors.lastname: Pearson
authors.forename: Audra M
authors.initials: AM
authors.lastname: Hachey
authors.forename: Dong-Ling
authors.initials: DL
authors.lastname: Xia
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Wachtman
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D004715:Endometriosis / Q000276:immunology / Q000503:physiopathology / Q000662:veterinary*; D005260:Female; D007150:Immunohistochemistry / Q000662:veterinary; D008253:Macaca mulatta; D008262:Macrophage Activation / Q000502:physiology*; D008992:Monkey Diseases / Q000276:immunology* / Q000503:physiopathology; D016211:Transforming Growth Factor alpha / Q000097:blood
chemical_list: D016207:Cytokines; D016211:Transforming Growth Factor alpha