Expression of Interleukin 6 and Tumor Necrosis Factor Alpha in Endometriotic Tissues: An Immunohistochemical Study

OZET Amac: Endometriyozis, endometriyal dokunun normal uterus mukozasi disinda vucudun diger doku ve organlarina yerlesmesi sonucu olusan bir hastaliktir. Son yillarda yapilan calismalar, endometiyozis olusumu ile enflamatuvar reaksiyonlar arasinda yakin bir iliskinin varligini gostermektedir. Bugune kadar yapilan calismalarda, Tumor nekroz faktor-α (TNF-α) ve Interlokin-6 (IL-6) varligi endometriyozise sahip hastalarda, cesitli yontemlerle gosterilmis olmasina ragmen, normal ve endometriyotik dokulardaki varliklari ile hucre tiplerindeki dagilimlarini gosteren karsilastirmali immunohistokimyasal bir calismaya literaturde rastlanmamistir. Bu calismada, insanda normal endometriyum ve endometriyotik dokularda TNF-α ve IL-6 ekspresyonlarinin immunohistokimyasal yontemler ile arastirilmasi amaclandi. Yontem: Calismada incelenen doku kesitleri, 20-40 yaslari arasindaki 24 kadindan alinan ektopik endometriyum doku biyopsilerinden elde edildi. Ayrica herhangi bir endometriyal fonksiyon bozuklugu bulunmayan, ancak diletasyon veya kuretaj nedeniyle, 10 hastadan elde edilen endometriyum dokularindan alinan kesitler de kontrol grubu olarak degerlendirildi. Isik mikroskobik ve immunohistokimyasal yontemler ile hazirlanan doku kesitleri, isik mikroskopta incelendi. Bulgular: TNF-α ve IL-6 ekspresyonunun kontrol grubunda yuzey ve bez epitelinde zayiftan orta dereceye kadar degisen duzeylerde oldugu gozlendi. Buna karsin stromal hucrelerde belirgin bir boyanmaya rastlanmadi. TNF-α ve IL-6'nin endometriyotik dokulardaki immunreaktivitesinin kontrol endometriyum ile karsilastirildiginda, epitel hucreleri ile stromal hucreler ve makrofajlarda belirgin olarak artis gosterdigi bulundu. TNF-α ve IL-6 ekspresyonlarinin, ektopik endometriyal dokuda, guclu olarak eksprese olmasi, her iki sitokinin de hastaligin olusumu ve gelisimi surecinde, birbirleriyle paralel etkilere sahip olabileceklerini dusundurmektedir. Sonuclar: Sonuclar birlikte degerlendirildiginde, TNF-α ve IL-6’nin endometriyozis olusumu ve patogenezinde rol alan onemli sitokinler olduklari kanaatine varildi. ABSTRACT Objective: Endometriosis is a disease which occurs as a result of endometrial tissue settling outside the normal uterine mucosa, such as other tissues and organs of the body. In recent years, several studies indicate the existence of a relationship between the inflammatory reactions and pathogenesis of endometriosis. There is no comparative immunohistochemical study showing the presence of Tumor necrosis factor alpha (TNF-α) and Interleukin 6 (IL-6) in normal and endometriotic tissue and distribution in cell types. The aim of this study is to investigate TNF-α and IL-6 expressions in normal and endometriotic human tissue using immunohistochemical methods. Methods: This study examined tissue sections obtained from the tissue biopsies of ectopic endometrium taken from 24 women between the ages of 20 to 40 years. Additionally, the tissue sections taken from the normal endometrium obtained from 10 patients without any endometrial dysfunction due to dilation or curettage were also evaluated, as the control group. Results: In the control group TNF-α and IL-6 expressions were identified at varying levels, from weak to moderate, in surface and glandular epithelium; however, there was no evidence of a significant staining in the stromal cells. It is found that TNF-α and IL-6 immunoreactivity in the endometriotic tissues were significantly increased in the epithelial cells, stromal cells and macrophages compared to the control endometrium. Expressions of TNF-α and IL-6 were both strong in the ectopic endometrial tissues. Conclusions: Based on these results, we conclude that TNF-α and IL-6 are important cytokines involved in the pathogenesis of the endometriosis.