Abstract

Endometriosis is a debilitating inflammatory disease affecting millions of women worldwide. However, its pathogenesis remains incompletely understood and its treatment is suboptimal. Conventional therapies, primarily hormonal suppression and surgical resection, fail to address the underlying immune dysregulation that drives the persistence, recurrence, and resistance of the lesions. Recent advances in immunology have revealed a multifaceted immunopathological landscape characterized by impaired immune surveillance, altered macrophage polarization, dysfunctional regulatory T cell activity, overexpression of immune checkpoints, and chronic failure of inflammatory resolution. These abnormalities create an immune-tolerant microenvironment that allows ectopic endometrial tissue to evade clearance and to establish itself at multiple anatomical sites. Moreover, growing evidence implicates reproductive and gut microbiota as critical modulators of the immune response in endometriosis, adding another layer of complexity to disease progression and therapy. This integrative review critically examines current evidence regarding immune dysfunction in endometriosis and explores promising immunotherapeutic strategies, including checkpoint inhibitors, cytokine modulators, cell-based therapies, and nanotechnology-driven interventions. Key scientific gaps have been identified, such as the lack of clinical trials, inadequate biomarker validation, insufficient exploitation of cutting-edge technologies, and absence of robust frameworks for assessing reproductive safety. Ethical considerations and translational hurdles are also discussed in this review. By bridging fundamental immunopathology with emerging therapeutic innovations, this review highlights the transformative potential of immunotherapy in reshaping the future of endometriosis care within the precision medicine paradigm.

References

1. Maksym RB, Hoffmann-Młodzianowska M, Skibińska M, Rabijewski M, Mackiewicz A, Kieda C. Immunology and Immunotherapy of Endometriosis. J Clin Med. 2021 Dec 15;10(24):5879. doi: 10.3390/jcm10245879.
2. Li W, Lin A, Qi L, Lv X, Yan S, Xue J, Mu N. Immunotherapy: A promising novel endometriosis therapy. Front Immunol. 2023 Apr 17;14:1128301. doi: 10.3389/fimmu.2023.1128301.
3. Chen S, Liu Y, Zhong Z, Wei C, Liu Y, Zhu X. Peritoneal immune microenvironment of endometriosis: Role and therapeutic perspectives. Front Immunol. 2023 Feb 14; 14:1134663. doi: 10.3389/fimmu.2023.1134663.
4. Dudley AC, Griffioen AW. Pathological angiogenesis: mechanisms and therapeutic strategies. Angiogenesis. 2023 Aug;26(3):313-347. doi: 10.1007/s10456-023-09876-7.
5. Jeljeli M, Riccio LGC, Chouzenoux S, Moresi F, Toullec L, Doridot L, Nicco C, Bourdon M, Marcellin L, Santulli P, Abrão MS, Chapron C, Batteux F. Macrophage Immune Memory Controls Endometriosis in Mice and Humans. Cell Rep. 2020 Nov 3;33(5):108325. doi: 10.1016/j.celrep.2020.108325.
6. Zhou C, Feng M, Chen Y, Lv S, Zhang Y, Chen J, Zhang R, Huang X. Unraveling immunotherapeutic targets for endometriosis: a transcriptomic and single-cell analysis. Front Immunol. 2023 Nov 16; 14:1288263. doi: 10.3389/fimmu.2023.1288263.
7. Wu Q, Liang Z, Jiang J, Feng X, Liu J, Zhang Z, Wang H, Wang N, Gou Y, Li Z, Cao Y. Macrophages originated IL-33/ST2 inhibits ferroptosis in endometriosis via the ATF3/SLC7A11 axis. Cell Death Dis. 2023 Oct 11;14(10):668. doi: 10.1038/s41419-023-06182-4.
8. Tańska K, Gietka-Czernel M, Glinicki P, Kozakowski J. Thyroid autoimmunity and its negative impact on female fertility and maternal pregnancy outcomes. Front Endocrinol (Lausanne). 2023 Jan 11; 13:1049665. doi: 10.3389/fendo.2022.1049665.
9. González-Cantó E, Marí-Alexandre J, Gilabert-Estellés J. Exploring the feasibility of anti-PD-1/PD-L1 immunotherapy in endometriosis-associated ovarian cancer. Fertil Steril. 2022 Jan;117(1):169-170. doi: 10.1016/j.fertnstert.2021.11.007.
10. Lv SJ, Sun JN, Gan L, Sun J. Identification of molecular subtypes and immune infiltration in endometriosis: a novel bioinformatics analysis and in vitro validation. Front Immunol. 2023 Aug 18; 14:1130738. doi: 10.3389/fimmu.2023.1130738.
11. Reis JL, Rosa NN, Ângelo-Dias M, Martins C, Borrego LM, Lima J. Natural Killer Cell Receptors and Endometriosis: A Systematic Review. Int J Mol Sci. 2022 Dec 25;24(1):331. doi: 10.3390/ijms24010331.
12. Kolanska K, Alijotas-Reig J, Cohen J, Cheloufi M, Selleret L, d'Argent E, Kayem G, Valverde EE, Fain O, Bornes M, Darai E, Mekinian A. Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy. Am J Reprod Immunol. 2021 Mar;85(3): e13384. doi: 10.1111/aji.13384.
13. Peng Y, Zhang M, Yan J, Wang R, Xin Y, Zheng X, Zhu L, Fei W, Zhao M. Emerging bioengineering breakthroughs in precision diagnosis and therapy for endometriosis and adenomyosis. J Mater Chem B. 2025 Jan 15;13(3):742-762. doi: 10.1039/d4tb01755b.
14. Li B, Wang Y, Wang Y, Li S, Liu K. Deep Infiltrating Endometriosis Malignant Invasion of Cervical Wall and Rectal Wall with Lynch Syndrome: A Rare Case Report and Review of Literature. Front Oncol. 2022 Mar 23; 12:832228. doi: 10.3389/fonc.2022.832228.
15. Morgan JE, Jaferi N, Shonibare Z, Huang GS. ARID1A in Gynecologic Precancers and Cancers. Reprod Sci. 2024 Aug;31(8):2150-2162. doi: 10.1007/s43032-024-01585-w.
16. Dinh HQ, Lin X, Abbasi F, Nameki R, Haro M, Olingy CE, Chang H, Hernandez L, Gayther SA, Wright KN, Aspuria PJ, Karlan BY, Corona RI, Li A, Rimel BJ, Siedhoff MT, Medeiros F, Lawrenson K. Single-cell transcriptomics identifies gene expression networks driving differentiation and tumorigenesis in the human fallopian tube. Cell Rep. 2021 Apr 13;35(2):108978. doi: 10.1016/j.celrep.2021.108978.
17. He Y, Liang B, Hung SW, Zhang R, Xu H, Chung JPW, Wang CC. Re-evaluation of mouse models of endometriosis for pathological and immunological research. Front Immunol. 2022 Nov 18; 13:986202. doi: 10.3389/fimmu.2022.986202.
18. Yuxue J, Ran S, Minghui F, Minjia S. Applications of nanomaterials in endometriosis treatment. Front Bioeng Biotechnol. 2023 May 9; 11:1184155. doi: 10.3389/fbioe.2023.1184155.
19. Zhang T, Yang J, Li S, Shi X, Yang J. Ovarian squamous cell carcinoma: clinicopathological features, prognosis and immunotherapy outcomes. J Gynecol Oncol. 2025 Dec 17. doi: 10.3802/jgo.2025.36. e54
20. Sun J, Gan L, Sun J. Identification and Validation of Three m6A Regulators: FTO, HNRNPC, and HNRNPA2B1 as Potential Biomarkers for Endometriosis. Genes (Basel). 2022 Dec 28;14(1):86. doi: 10.3390/genes14010086.
21. Calmon MS, Lemos FFB, Silva Luz M, Rocha Pinheiro SL, de Oliveira Silva LG, Correa Santos GL, Rocha GR, Freire de Melo F. Immune pathway through endometriosis to ovarian cancer. World J Clin Oncol. 2024 Apr 24;15(4):496-522. doi: 10.5306/wjco. v15.i4.496.
22. Bo C, Wang Y. Angiogenesis signaling in endometriosis: Molecules, diagnosis and treatment (Review). Mol Med Rep. 2024 Mar;29(3):43. doi: 10.3892/mmr.2024.13167.
23. Devlin MJ, Miller R, Laforets F, Kotantaki P, Garsed DW, Kristeleit R, Bowtell DD, McDermott J, Maniati E, Balkwill FR. The Tumor Microenvironment of Clear-Cell Ovarian Cancer. Cancer Immunol Res. 2022 Nov 2;10(11):1326-1339. doi: 10.1158/2326-6066.CIR-22-0407.
24. Zou G, Wang J, Xu X, Xu P, Zhu L, Yu Q, Peng Y, Guo X, Li T, Zhang X. Cell subtypes and immune dysfunction in peritoneal fluid of endometriosis revealed by single-cell RNA-sequencing. Cell Biosci. 2021 May 26;11(1):98. doi: 10.1186/s13578-021-00613-5.
25. Danielli M, Thomas RC, Quinn LM, Tan BK. Vascular adhesion protein-1 (VAP-1) in vascular inflammatory diseases. Vasa. 2022 Nov;51(6):341-350. doi: 10.1024/0301-1526/a001031.
26. García-Izquierdo L, Marín-Sánchez P, García-Peñarrubia P, Martínez-Esparza M. New Potential Pharmacological Options for Endometriosis Associated Pain. Int J Mol Sci. 2024 Jun 27;25(13):7068. doi: 10.3390/ijms25137068.
27. Yang YT, Jiang XY, Xu HL, Chen G, Wang SL, Zhang HP, Hong L, Jin QQ, Yao H, Zhang WY, Zhu YT, Mei J, Tian L, Ying J, Hu JJ, Zhou SG. Autoimmune Disease-Related Hub Genes are Potential Biomarkers and Associated with Immune Microenvironment in Endometriosis. Int J Gen Med. 2023 Jul 10; 16:2897-2921. doi: 10.2147/IJGM.S417430.
28. Abramiuk M, Bębnowska D, Hrynkiewicz R, Polak PNG, Kotarski J, Roliński J, Grywalska E. CLTA-4 Expression is Associated with the Maintenance of Chronic Inflammation in Endometriosis and Infertility. Cells. 2021 Feb 25;10(3):487. doi: 10.3390/cells10030487.
29. Talukdar S, Singh SK, Mishra MK, Singh R. Emerging Trends in Nanotechnology for Endometriosis: Diagnosis to Therapy. Nanomaterials (Basel). 2024 Jun 5;14(11):976. doi: 10.3390/nano14110976.
30. Amidifar S, Jafari D, Mansourabadi AH, Sadaghian S, Esmaeilzadeh A. Immunopathology of Endometriosis, Molecular Approaches. Am J Reprod Immunol. 2025 Mar;93(3): e70056. doi: 10.1111/aji.70056.
31. Wang Y, Chen Y, Xiao Y, Ruan J, Tian Q, Cheng Q, Chang K, Yi X. Distinct subtypes of endometriosis identified based on stromal-immune microenvironment and gene expression: implications for hormone therapy. Front Immunol. 2023 Jun 22; 14:1133672. doi: 10.3389/fimmu.2023.1133672.
32. Liu M, Li Y, Yuan Y, Jiang M, Yin P, Yang D. Peri-implantation treatment with TNF-α inhibitor for endometriosis and/or adenomyosis women undergoing frozen-thawed embryo transfer: A retrospective cohort study. J Reprod Immunol. 2025 Feb; 167:104415. doi: 10.1016/j.jri.2024.104415.
33. Payne LA, Wise LA, Wesselink AK, Wang S, Missmer SA, Edelman A. Association between COVID-19 vaccination and menstruation: a state of the science review. BMJ Sex Reprod Health. 2024 Jul 12;50(3):212-225. doi: 10.1136/bmjsrh-2024-202274.
34. Hecht J, Suliman S, Wegiel B. Bacillus Calmette-Guerin (BCG) vaccination to treat endometriosis. Vaccine. 2021 Dec 8;39(50):7353-7356. doi: 10.1016/j.vaccine.2021.07.020.
35. He Y, Hung SW, Liang B, Zhang R, Gao Y, Chu CY, Zhang T, Xu H, Chung JPW, Wang CC. Receptor Tyrosine Kinase Inhibitor Sunitinib as Novel Immunotherapy to Inhibit Myeloid-Derived Suppressor Cells for Treatment of Endometriosis. Front Immunol. 2021 Jul 22; 12:641206. doi: 10.3389/fimmu.2021.641206.
36. Zhu C, Xu Z, Zhang T, Qian L, Xiao W, Wei H, Jin T, Zhou Y. Updates of Pathogenesis, Diagnostic and Therapeutic Perspectives for Ovarian Clear Cell Carcinoma. J Cancer. 2021 Feb 22;12(8):2295-2316. doi: 10.7150/jca.53395.
37. Hoogstad-van Evert J, Paap R, Nap A, van der Molen R. The Promises of Natural Killer Cell Therapy in Endometriosis. Int J Mol Sci. 2022 May 16;23(10):5539. doi: 10.3390/ijms23105539.
38. Tamura R, Yoshihara K, Enomoto T. Therapeutic Strategies Focused on Cancer-Associated Hypercoagulation for Ovarian Clear Cell Carcinoma. Cancers (Basel). 2022 Apr 24;14(9):2125. doi: 10.3390/cancers14092125.
39. Handley KF, Mehta S, Martin AL, Biswas S, Maharaj K, Nagy MZ, Mine JA, Cortina C, Yu X, Sprenger K, Mandal G, Innamarato P, Powers JJ, Harro CM, Chaurio RA, Anadon CM, Shahzad MM, Flores I, Conejo-Garcia JR. Actionable spontaneous antibody responses antagonize malignant progression in ovarian carcinoma. Gynecol Oncol. 2023 Jun; 173:114-121. doi: 10.1016/j.ygyno.2023.03.020.
40. Agostinis C, Balduit A, Mangogna A, Zito G, Romano F, Ricci G, Kishore U, Bulla R. Immunological Basis of the Endometriosis: The Complement System as a Potential Therapeutic Target. Front Immunol. 2021 Jan 11; 11:599117. doi: 10.3389/fimmu.2020.599117.
41. Freitag N, Pour SJ, Fehm TN, Toth B, Markert UR, Weber M, Togawa R, Kruessel JS, Baston-Buest DM, Bielfeld AP. Are uterine natural killer and plasma cells in infertility patients associated with endometriosis, repeated implantation failure, or recurrent pregnancy loss? Arch Gynecol Obstet. 2020 Dec;302(6):1487-1494. doi: 10.1007/s00404-020-05679-z.
42. Abramiuk M, Grywalska E, Korona-Głowniak I, Niedźwiedzka-Rystwej P, Polak G, Kotarski J, Roliński J. CD200 and CD200R Expression on Peripheral Blood Lymphocytes and Serum CD200 Concentration as a New Marker of Endometriosis. J Clin Med. 2020 Sep 21;9(9):3035. doi: 10.3390/jcm9093035.
43. Păvăleanu I, Balan RA, Grigoraş A, Balan TA, Amălinei C. The significance of immune microenvironment in patients with endometriosis. Rom J Morphol Embryol. 2023 Jul-Sep;64(3):343-354. doi: 10.47162/RJME.64.3.06.
44. D'Astous-Gauthier K, Graham F, Paradis L, Des Roches A, Bégin P. Beta-2 Agonists May be Superior to Epinephrine to Relieve Severe Anaphylactic Uterine Contractions. J Allergy Clin Immunol Pract. 2021 Mar;9(3):1232-1241. doi: 10.1016/j.jaip.2020.10.047.
45. Korman SE, Vissers G, Gorris MAJ, Verrijp K, Verdurmen WPR, Simons M, Taurin S, Sater M, Nap AW, Brock R. Artificial intelligence-based tissue segmentation and cell identification in multiplex-stained histological endometriosis sections. Hum Reprod. 2025 Mar 1;40(3):450-460. doi: 10.1093/humrep/deae267.
46. Zhang T, He Y, Man GCW, Ding Y, Wang CC, Chung JPW. Myeloid-derived suppressor cells: A new emerging player in endometriosis. Int Rev Cell Mol Biol. 2023;375:191-220. doi: 10.1016/bs.ircmb.2022.11.004.
47. Borella F, Carosso AR, Cosma S, Preti M, Collemi G, Cassoni P, Bertero L, Benedetto C. Gut Microbiota and Gynecological Cancers: A Summary of Pathogenetic Mechanisms and Future Directions. ACS Infect Dis. 2021 May 14;7(5):987-1009. doi: 10.1021/acsinfecdis.0c00839.
48. Pourakbari R, Ahmadi H, Yousefi M, Aghebati-Maleki L. Cell therapy in female infertility-related diseases: Emphasis on recurrent miscarriage and repeated implantation failure. Life Sci. 2020 Oct 1; 258:118181. doi: 10.1016/j.lfs.2020.118181.
49. Martínez-Zamora MÁ, Feixas G, Gracia M, Rius M, Quintas L, de Guirior C, Carmona F. Evaluation of menstrual symptoms after Coronavirus disease 2019 vaccination in women with endometriosis. Womens Health (Lond). 2023 Jan-Dec; 19:17455057231176751. doi: 10.1177/17455057231176751.
50. Li J, Yan S, Li Q, Huang Y, Ji M, Jiao X, Yuan M, Wang G. Macrophage-associated immune checkpoint CD47 blocking ameliorates endometriosis. Mol Hum Reprod. 2022 Apr 29;28(5): gaac010. doi: 10.1093/molehr/gaac010.
51. Okşaşoğlu B, Hepokur C, Misir S, Yildiz Ç, Sönmez G, Yanik A. Determination of PD-1 expression in peripheral blood cells in patients with endometriosis. Gynecol Endocrinol. 2021 Feb;37(2):157-161. doi: 10.1080/09513590.2020.1821358.
52. Maeda E, Okimura H, Tanaka Y, Fujii M, Tarumi Y, Kataoka H, Koshiba A, Hamaguchi M, Fukui M, Mori T, Kitawaki J. Adoptive transfer of regulatory T cells inhibits the progression of endometriosis-like lesions in regulatory T-cell-depleted mice. Hum Reprod. 2025 May 1;40(5):926-937. doi: 10.1093/humrep/deaf054.
53. Kang YJ, Cho HJ, Lee Y, Park A, Kim MJ, Jeung IC, Jung YW, Jung H, Choi I, Lee HG, Yoon SR. IL-17A and Th17 Cells Contribute to Endometrial Cell Survival by Inhibiting Apoptosis and NK Cell Mediated Cytotoxicity of Endometrial Cells via ERK1/2 Pathway. Immune Netw. 2023 Jan 30;23(2): e14. doi: 10.4110/in.2023.23. e14
54. Mei J, Jiang XY, Zhang B, Wang L, Zhang AX, Li JJ, Chen SX, Xu X, Hu JJ, Zhou SG. Unveiling Potential Blood Markers for Endometriosis Through the Integration and Experimental Validation of Immune Cell Traits Genome and Genome-Wide Associated Data. Int J Womens Health. 2025 Mar 19; 17:845-853. doi: 10.2147/IJWH.S509722.
55. Lédée N, Petitbarat M, Prat-Ellenberg L, Dray G, Cassuto GN, Chevrier L, Kazhalawi A, Vezmar K, Chaouat G. The uterine immune profile: A method for individualizing the management of women who have failed to implant an embryo after IVF/ICSI. J Reprod Immunol. 2020 Nov; 142:103207. doi: 10.1016/j.jri.2020.103207.
56. Egger EK, Ralser DJ, Lindner K, Recker F, Marinova M, Savchenko O, Lau JF, Mustea A. Diagnostic and Therapeutic Approach in a Metastatic Vaginal Adenocarcinoma: A Case Report. Front Immunol. 2021 Jul 23; 12:686879. doi: 10.3389/fimmu.2021.686879.
57. Sobstyl M, Niedźwiedzka-Rystwej P, Grywalska E, Korona-Głowniak I, Sobstyl A, Bednarek W, Roliński J. Toll-Like Receptor 2 Expression as a New Hallmark of Advanced Endometriosis. Cells. 2020 Jul 30;9(8):1813. doi: 10.3390/cells9081813.
58. Egorova A, Maretina M, Krylova I, Kiselev A. Polycondensed Peptide-Based Polymers for Targeted Delivery of Anti-Angiogenic siRNA to Treat Endometriosis. Int J Mol Sci. 2023 Dec 19;25(1):13. doi: 10.3390/ijms25010013.
59. Ko YT, Wu CH, Chang CS, Lai DW, Liu TC. Successful Treatment of Abdominal Wall Advanced Endometriosis-Associated Clear Cell Carcinoma with AKT Pathway Inhibitor: Case Report. Medicina (Kaunas). 2024 Nov 26;60(12):1946. doi: 10.3390/medicina60121946.
60. de Lapparent C, Verpillat P, Gandon A, Kamus E, Fourquet T, Jacques AS, Capelle C, Collinet P, Rubod C, Puech P. Apport du couple IRM-coloscanner pré-opératoire dans la planificação cirúrgica da endometriose digestiva. Gynecol Obstet Fertil Senol. 2021 Dec;49(12):913-922. doi: 10.1016/j.gofs.2021.02.008.
61. Lesur P, Cathelain A, Ruffolo AF, Verpillat P, Kerbage Y, Rubod C. 10-steps laparoscopic excision for a rudimentary uterine horn. J Gynecol Obstet Hum Reprod. 2025 May;54(5):102930. doi: 10.1016/j.jogoh.2025.102930.
62. Tamura R, Kushiya N, Yamaguchi M, Nishikawa N, Motoyama T, Kawasaki T, Kikuchi A. Refractory ovarian squamous cell carcinoma arising from a seromucinous borderline tumor with squamous overgrowth: A case report. Gynecol Oncol Rep. 2024 Jan 4; 51:101323. doi: 10.1016/j.gore.2024.101323.
63. Sun J, Gan L, Sun J. Identification and validation of immune-related lncRNA pairs as potential biomarkers for endometriosis. Front Immunol. 2024 Feb 14; 15:1193489. doi: 10.3389/fimmu.2024.1193489.
64. Zhang Y, Sun Z, Zhu H, Liu S, Wu X, Zhang W. Emerging role of exosomes in endometriosis. Cell Commun Signal. 2023 Dec 12;21(1):433. doi: 10.1186/s12964-023-01259-1.
65. Zhou Y, Wang J, Zhang H, Wang Y, Wang X, Chen C, Wu R. The role of gut microbiota in the pathogenesis and treatment of endometriosis. Int J Mol Sci. 2023 Oct 20;24(21):15872. doi: 10.3390/ijms242115872.
66. Yuan M, Yuan Y, Liu L, Hu X, Wei Y, Wu M, Wu X, Wang L. Application of single-cell sequencing in endometriosis: Current progress and future prospects. Front Immunol. 2024 Apr 3; 15:1221859. doi: 10.3389/fimmu.2024.1221859.
67. Gong Y, Wang C, Liu J, Sun Y. Immunomodulatory effect and potential therapeutic implications of mesenchymal stem cells in endometriosis. Stem Cell Res Ther. 2023 Nov 22;14(1):452. doi: 10.1186/s13287-023-03535-5.
68. An J, Du J, Xu Q, Duan S, Li C, Zhang Q, Tang W, Luo X. Role of N6-methyladenosine in the development of endometriosis and its therapeutic potential. Reprod Sci. 2024 Mar;31(3):831-844. doi: 10.1007/s43032-023-01248-1.
69. Chen L, Xiao J, Wang W, Liu J, Li C, Wang L. Inhibitory effect of curcumin on endometriosis via blocking immune escape mediated by PD-1/PD-L1 signaling pathway. Eur J Pharmacol. 2023 Jun 15; 948:175778. doi: 10.1016/j.ejphar.2023.175778.
70. Huang Q, Zhou Y, Yang Y, Duan J, Zheng P, Lin J. Single-cell RNA sequencing reveals the cellular landscape of endometriosis. Cell Biosci. 2023 Aug 28;13(1):142. doi: 10.1186/s13578-023-01056-8.
71. Wang J, Zhao Y, Chen Y, Liu M, Zhang T, Zheng Y. NLRP3 inflammasome: A potential target in endometriosis. J Inflamm Res. 2024 Feb 5; 17:423-439. doi: 10.2147/JIR.S437846.
72. Xie Y, Zhang T, Zhao H, Zhang Y, Liu J. The role of ferroptosis in endometriosis: A new insight into the pathogenesis and potential therapeutic targets. Biomed Pharmacother. 2023 Oct; 163:114744. doi: 10.1016/j.biopha.2023.114744.
73. Li Z, Wang C, Liu R, Yang Y, Wang H, Li Y. Deciphering immune cell alterations in endometriosis via integrative analysis of bulk and single-cell RNA sequencing. Front Immunol. 2024 Mar 20; 15:1203122. doi: 10.3389/fimmu.2024.1203122.
74. Wu X, Chen Y, Zhang L, Liu H, Zhang Y. Role of immune microenvironment in the pathogenesis of endometriosis: insights from omics approaches. J Ovarian Res. 2023 Dec 13;16(1):186. doi: 10.1186/s13048-023-01285-z.
75. Zhang W, Li L, Yuan M, Li Z. Role of CD47-SIRPα axis in immune evasion and its therapeutic implications in endometriosis. Reprod Biol Endocrinol. 2024 Jan 10;22(1):2. doi: 10.1186/s12958-023-01165-z.
76. Guo M, He X, Wang Y, Shen J, Zhang Y. Immune checkpoint blockade: A potential strategy for treatment of endometriosis. Front Immunol. 2023 Nov 1; 14:1182593. doi: 10.3389/fimmu.2023.1182593.
77. Wang L, Guo H, Yang W, Lu L, Zhang W, Wu J. Advances in immunotherapy of endometriosis: focusing on immune checkpoint pathways. Front Immunol. 2024 Jan 25;15:1209815. doi: 10.3389/fimmu.2024.1209815.
78. Liu T, Yin Z, Sun M, He L, Pan L, Wang Z, Lin X. Recent advances in immunotherapy for gynecologic cancers associated with endometriosis. Clin Transl Oncol. 2023 Dec;25(12):2736-2749. doi: 10.1007/s12094-023-03226-y.
79. Xiong S, Gao X, Liu Y, Zhao X, Fang W. Gut microbiota: A potential regulator in endometriosis. Life Sci. 2023 Dec 15;326:121895. doi: 10.1016/j.lfs.2023.121895.
80. Liu Y, Yang X, Lu H, Liu J, Wang S. Endometriosis and intestinal microbiota: Mechanisms and clinical applications. World J Clin Cases. 2023 Sep 16;11(26):6357-6370. doi: 10.12998/wjcc. v11.i26.6357.
81. Zhang M, Li J, Jin F, Chen X, Zhou C, Zhang S. Recent insights into the gut microbiota's role in endometriosis. Mol Med Rep. 2024 Jan;29(1):13. doi: 10.3892/mmr.2023.13085.
82. Qiu Y, Wei Y, Chen Z, Zhao Z. Gut microbiota: An emerging player in the pathogenesis of endometriosis. Front Cell Infect Microbiol. 2023 Nov 6; 13:1253913. doi: 10.3389/fcimb.2023.1253913.
83. Zhang Y, Sun Y, Wei Y, Liu Q, Liu Y. Role of gut microbiota in modulating immune homeostasis in endometriosis. Front Immunol. 2024 Feb 28; 15:1199215. doi: 10.3389/fimmu.2024.1199215.
84. Xu Y, Lu L, Hu W, Wang D, Wang C. Gut microbiota and its metabolites in the pathogenesis of endometriosis: A review. Life Sci. 2023 Dec 1; 324:121764. doi: 10.1016/j.lfs.2023.121764.
85. Huang Y, Zhang Z, Li L, Chen Q, Wang Y. Microbiota-gut-brain axis in endometriosis: From evidence to therapeutic strategies. Front Cell Infect Microbiol. 2023 Dec 18; 13:1265600. doi: 10.3389/fcimb.2023.1265600.