Endometriosis immune microenvironment timing shifts: from immune escape to immune exhaustion

Abstract Endometriosis(EMS) symptoms, progression, and onset are all linked to the patient’s immune system dysfunction. Research on immune cells and their molecular mechanisms has long been a prime focus of EMS studies. Nonetheless, the immune environments of EMS patients and cells are constantly changing. How to effectively study and treat EMS depends on our ability to comprehend the temporal changes in immunity in EMS patients. Consequently, the immunological time sequence of endometriosis is methodically discussed and summarized in this article as four steps: 1) immune escape, in which Ectopic Endometrial Cells(EECs) evade immune surveillance and growth in the peritoneum; 2) pro-inflammatory immune response, immune killer cells are triggered, and the lesions show signs of inflammation; 3) immunological anti-inflammatory, which converts pro-inflammatory micro-environment to anti-inflammatory micro-environment and helps the body avoid excessive inflammation; 4) Immune exhaustion: Immune killer cells gradually lose their ability to attack EECs as they experience exhaustion and paralysis. In addition to providing a reference for future EMS staging treatments, this study offers a comprehensive understanding of the temporal alterations in EMS. It reveals cellular and molecular processes associated with immune exhaustion.