Use of immunomodulators to treat endometriosis

Both animal and human studies have demonstrated that endometriosis involves numerous levels of immune dysfunction. From aberrant cytokine signaling to shifts in immune cell populations, it is clear that endometriosis develops in the setting of an elevated pro-inflammatory state. This elevated level of inflammation could exacerbate the morbidity seen in this chronic disease. Consequently, numerous immunomodulating therapies have been tested in both animal models and limited human trials. This review seeks to summarize the in vitro and in vivo studies used to test these agents for the treatment of endometriosis. These agents include small-molecule and antibody-based disease-modifying antirheumatic drugs (DMARD5), cytokines, mTOR inhibitors, nucleotide analogs, and various other small molecules. Although many of these agents have had promising results in in vitro and animal studies, few of them have been tested in humans. For the agents that were studied in women with endometriosis-associated pain, little benefit has been seen in symptom control to date. Nevertheless, there remains the potential that these agents may offer a new pathway in the treatment of the chronic, costly, and debilitating disease. (C) 2019 Published by Elsevier Ltd.