{"title":"Uncovering immune signatures of the endometrium in heavy menstrual bleeding: a cross-sectional study.","authors":"Mishu Mangla, Seetu Palo, Poojitha Kalyani Kanikaram, Raja Shekar P, Aparna Setty","doi":"10.5468/ogs.25196","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Dysregulation of leukocyte cell number as a cause of heavy menstrual bleeding (HMB) has not been investigated much. The present study compares the changes in the number of uterine natural killer (uNK) cells, T cells, and macrophages in endometrial samples from women with normal menstrual cycles versus those with HMB.</p><p><strong>Methods: </strong>We analyzed endometrial tissue from 98 patients (73 with HMB; 25 with normal cycles) using immunohistochemistry to semi-quantitatively estimate the degree of cluster of differentiation (CD)56+, CD8+, CD4+, and CD68+ cell infiltration.</p><p><strong>Results: </strong>No statistically significant differences were observed in the CD4+, CD8+, CD56+, or CD68+ cell counts between women with HMB and controls during either the proliferative or secretory phases of the menstrual cycle. CD56+ natural killer cells were relatively reduced in the HMB group during the proliferative phase, with higher counts in the control group (P=0.071). CD68+ macrophages/high-power field (hpf) showed a strong positive correlation with CD4+ T cells (r, 0.481; P<0.001), CD8+ T cells (r, 0.641; P<0.001), and CD56+ uNK cells (r, 0.404; P<0.001). CD8+ cells/hpf demonstrated a significant positive correlation with uterine volume, CD4+ cells/hpf, CD68+ cells/hpf, and CD56+ cells/hpf.</p><p><strong>Conclusion: </strong>Although no single immune cell type was independently associated with HMB compared with controls, the observed significant correlations among CD4+, CD8+, CD56+, and CD68+ highlight the interconnected nature of endometrial immune activity.</p>","PeriodicalId":37602,"journal":{"name":"Obstetrics and Gynecology Science","volume":" ","pages":"72-84"},"PeriodicalIF":2.5000,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12862149/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Obstetrics and Gynecology Science","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5468/ogs.25196","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/11/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Dysregulation of leukocyte cell number as a cause of heavy menstrual bleeding (HMB) has not been investigated much. The present study compares the changes in the number of uterine natural killer (uNK) cells, T cells, and macrophages in endometrial samples from women with normal menstrual cycles versus those with HMB.
Methods: We analyzed endometrial tissue from 98 patients (73 with HMB; 25 with normal cycles) using immunohistochemistry to semi-quantitatively estimate the degree of cluster of differentiation (CD)56+, CD8+, CD4+, and CD68+ cell infiltration.
Results: No statistically significant differences were observed in the CD4+, CD8+, CD56+, or CD68+ cell counts between women with HMB and controls during either the proliferative or secretory phases of the menstrual cycle. CD56+ natural killer cells were relatively reduced in the HMB group during the proliferative phase, with higher counts in the control group (P=0.071). CD68+ macrophages/high-power field (hpf) showed a strong positive correlation with CD4+ T cells (r, 0.481; P<0.001), CD8+ T cells (r, 0.641; P<0.001), and CD56+ uNK cells (r, 0.404; P<0.001). CD8+ cells/hpf demonstrated a significant positive correlation with uterine volume, CD4+ cells/hpf, CD68+ cells/hpf, and CD56+ cells/hpf.
Conclusion: Although no single immune cell type was independently associated with HMB compared with controls, the observed significant correlations among CD4+, CD8+, CD56+, and CD68+ highlight the interconnected nature of endometrial immune activity.
期刊介绍：
Obstetrics & Gynecology Science (NLM title: Obstet Gynecol Sci) is an international peer-review journal that published basic, translational, clinical research, and clinical practice guideline to promote women’s health and prevent obstetric and gynecologic disorders. The journal has an international editorial board and is published in English on the 15th day of every other month. Submitted manuscripts should not contain previously published material and should not be under consideration for publication elsewhere. The journal has been publishing articles since 1958. The aim of the journal is to publish original articles, reviews, case reports, short communications, letters to the editor, and video articles that have the potential to change the practices in women''s health care. The journal’s main focus is the diagnosis, treatment, prediction, and prevention of obstetric and gynecologic disorders. Because the life expectancy of Korean and Asian women is increasing, the journal''s editors are particularly interested in the health of elderly women in these population groups. The journal also publishes articles about reproductive biology, stem cell research, and artificial intelligence research for women; additionally, it provides insights into the physiology and mechanisms of obstetric and gynecologic diseases.
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