The Role of Monocyte to High-Density Lipoprotein Cholesterol Ratio in Prediction of increased systemic inflammation and the risk of cardiovascular disease in endometriosis

Abstract

Background and objectives Endometriosis occurs in about 5-10 in 100 women of reproductive age. The pathophysiology of endometriosis is controversial. Some studies claimed an association between endometriosis and increased levels of inflammatory factors in peritoneal fluid and/or peripheral blood. Monocyte / HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) are inflammatory markers and are used as predictors and prognostic indicators of mortality and morbidity in many diseases. In this study, we aimed to investigate whether Monocyte / HDL cholesterol ratio (MHR) and neutrophil/lymphocyte ratio (NLR) are increased in endometriosis as in patients with chronic inflammation and cardiovascular diseases. Materials and Methods This is a retrospective case-control study conducted with 87 women, 45 in the endometriosis group and 42 in the control group. The demographic data, biochemical, complete blood count parameters and lipid profile of the cases were recorded and compared between the groups. Results The mean age of the endometriosis group was 33.88 years and was older than the control group. In terms of other demographic data, there were no difference between the two groups. Although the platelet distribution width and triglyceride values of the endometriosis group were higher than controls, they were interpreted as clinically insignificant. There were no significant differences between the groups in terms of other laboratory parameters including MHR and NLR. Conclusions In this study, MHR and NLR are found similar in endometriosis and control groups. Further studies are needed to investigate the relationship between increased systemic inflammation.

Keywords

• Endometriosis,monocyte/HDL cholesterol ratio,neutrophil/lymphocyte ratio

References

1. Abrao, M.S., Podgaec, S., Filho, B.M., Ramos, LO., Pinotti, JA., de Oliveira, R.M., 1997. The use of biochemical markers in the diagnosis of pelvic endometriosis. Hum Reprod. 12, 2523– 2527.
2. Akoum, A., Lemay, A., Paradis, I., 1996. Secretion of interleukin-6 by human endometriotic cells and regulation by proinflammatory cytokines and sex steroids. Hum Reprod. 11, 2269– 2275.
3. Auffray, C., Sieweke, M.H., Geissmann, F., 2009. Blood monocytes: development, heterogeneity, and relationship with dendritic cells. Annu Rev Immunol. 27, 669–92.
4. Aydin, E,. Ates, I., Fettah Arikan, M., Yilmaz, N., Dede, F., 2017. The ratio of monocyte frequency to HDL cholesterol level as a predictor of asymptomatic organ damage in patients with primary hypertension. Hypertens Res. 40, 758–64.
5. Barrier, B.F, 2010. Immunology of endometriosis. Clin Obstet Gynecol. 53, 397-402.
6. Bedaiwy, M.A., Falcone, T., Sharma, R.K., Goldberg, J.M., Attaran, M., Nelson, D.R, Agarwal, A., 2002. Prediction of endometriosis with serum and peritoneal fluid markers: a prospective controlled trial. Hum Reprod. 17, 426–431.
7. Canpolat, U., Çetin, E.H., Cetin, S., Aydin, S., Akboga, M.K., Yayla, C., Turak, O., Aras, D., Aydogdu S., 2016. Association of Monocyte-to-HDL cholesterol ratio with slow coronary flow is linked to systemic inflammation. Clin Appl Thromb. 22, 476–82.
8. Coutinho, LM., Ferreira, M.C., Rocha, A.L.L., Carneiro, M.M., Reis, F.M., 2019. New biomarkers in endometriosis. Adv Clin Chem. 89, 59–77.

9. Daniel, Y., Geva, E., Amit, A., Eshed-Englender, T., Baram, A., Fait, G., Lessing, J.B., 2000. Do soluble cell adhesion molecules play a role in endometriosis? Am J Reprod Immunol. 2000, 160–166.
10. De Placido, G., Alviggi, C., Di Palma, G., Carravetta, C., Matarese, G., Landino, G., Racioopi L., 1998. Serum concentrations of soluble human leukocyte class I antigens and of the soluble intercellular adhesion molecule-1 in endometriosis: relationship with stage and non-pigmented peritoneal lesions. Hum Reprod. 13, 3206–3210.
11. Dhalla, N.S., Temsah, R.M., Netticadan, T., Role of oxidative stress in cardiovascular diseases. J Hypertens. 18, 655–673
12. Dunselman, G.A., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D'Hooghe, T., De Bie, B., Heikinheimo, O., Horne, A.W., Kiesel, L., Nap, A., Prentice, A., Saridogan, E., Soriano, D., Nelen, W., 2014. European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis. Hum Reprod. 29, 400-12.
13. Gupta, S., Agarwal, A., Krajcir, N., Alvarez, J.G., 2006. Role of oxidative stress in endometriosis. Reprod Biomed Online. 13, 126–134.;
14. Khan, K.N., Kitajima, M., Hiraki, H., Fujishita, A., Sekine, I., Ishimaru, T., Masuzaki, H., 2008. Immunopathogenesis of pelvic endometriosis: role of hepatocyte growth factor, macrophages and ovarian steroids. Am J Reprod Immunol. 60, 383-404.
15. Koumantakis, E., Matalliotakis, I., Neonaki, M., Froudarakis, G., Georgoulias, V., 1994. Soluble serum interleukin-2 receptor, interleukin-6 and interleukin- 1a in patients with endometriosis and in controls. Arch Gynecol Obstet. 255, 107–112.
16. Linker, R., Gold, R., Luhder, F., 2009. Function of neurotrophic factors beyond the nervous system: inflammation and autoimmune demyelination. Crit Rev Immunol. 29, 43–68.
17. Melo, A.S., Rosa-e-Silva, J.C., Rosa-e-Silva, A.C., Poli-Neto, O.B., Ferriani, R.A., Vieira, C.S., 2010. Unfavorable lipid profile in women with endometriosis. Fertil Steril. 93, 2433–2436.
18. Mu, F., Rich-Edwards, J., Rimm, E.B., Spiegelman, D., Missmer, S.A., 2016. Endometriosis and risk of coronary heart disease. Circ Cardiovasc Qual Outcomes. 9, 257–264
19. O, D.F., Waelkens, E., Peterse, D.P., Lebovic, D., Meuleman, C., Tomassetti, C., Peeraer K, Alvarez Real, A., Bosseloir, A., D'Hooghe, T., Fassbender, A., 2018. Evaluation of Total, Active, and Specific Myeloperoxidase Levels in Women with and without Endometriosis. Gynecol Obstet Invest. 83, 133-139.
20. Parthasarathy, S., Barnett, J., Fong, L.G., 1990. High-density lipoprotein inhibits the oxidative modification of low-density lipoprotein. Biochim Biophys Acta. 1044, 275–83.
21. Peiris, A.N., Chaljub, E., Medlock, D., 2018. Endometriosis. JAMA. 25, 320,2608.
22. Teng, S.W., Horng, H.C., Ho, C.H., Yen, M.S., Chao, H.T., Wang, P.H., 2016. Taiwan Association of Gynecology Systematic Review Group. Women with endometriosis have higher comorbidities: analysis of do mestic data in Taiwan. J Chin Med Assoc. 79, 577–582
23. Thubert, T., Santulli, P., Marcellin, L., Menard, S., M'Baye, M., Streuli, I., Borghese, B., de Ziegler, D., Chapron, C., 2014. Measurement of hs-CRP is irrelevant to diagnose and stage endometriosis: prospective study of 834 patients. Am J Obstet Gynecol. 210, 533.e1-533.e10.
24. Turgut. A., Hocaoglu, M., Ozdamar, O., Usta, A., Gunay, T., Akdeniz, E., 2019. Could hematologic parameters be useful biomarkers for the diagnosis of endometriosis? Bratisl Lek Listy. 120, 912-918
25. Usta, A., Avci, E., Bulbul, C.B., Kadi, H., Adali, E., 2018. The monocyte counts to HDL cholesterol ratio in obese and lean patients with polycystic ovary syndrome. Reprod Biol Endocrinol. 10;16, 34.
26. Vahit, D., Mehmet, K.A., Samet, Y., Hüseyin, E., 2017. Assessment of monocyte to high density lipoprotein cholesterol ratio and lymphocyte-to-monocyte ratio in patients with metabolic syndrome. Biomark Med. 11, 535–40.
27. Vercellini, P., Vigano, P., Somigliana, E., Fedele, L., 2014. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 10, 261–275.
28. Verit, F.F., Erel, O., Celik, N., 2008. Serum paraoxonase-1 activity in women with endometriosis and its relationship with the stage of the disease. Hum Reprod. 23, 100–104.
29. Westerterp, M., Gourion-Arsiquaud, S., Murphy, A.J., Shih, A., Cremers, S., Levine, R.L., Tall, A.R., Yvan-Charvet, L., 2012. Regulation of hematopoietic stem and progenitor cell mobilization by cholesterol efflux pathways. Cell Stem Cell. 11, 195–206.
30. Wilson, P.W., 2018 Evidence of systemic inflammation and estimation of coronary artery disease risk: a population perspective. Am J Med 2008;121(10, Suppl 1):S15–S20
31. Wu, MH., Yang, B.C., Hsu, C.C., Lee, Y.C., Huang, K.E., 1998. The expression of soluble intercellular adhesion molecule-1 in endometriosis. Fertil Steril. 70, 1139–1142.
32. Yavuzcan, A., Caglar, M., Ustun, Y., Dilbaz, S., Ozdemir, I., Yildiz, E., Ozkara, A., Kumru, S., 2013. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma. J Turk Ger Gynecol Assoc. 1; 14, 210-5.
33. Zhang, E., Gao, M., Gao, J., Xiao, J., Li, X., Zhao, H., Wang, J., Zhang, N., Wang, S., Liu, Y., 2020. Inflammatory and Hematological Indices as Simple, Practical Severity Predictors of Microdysfunction Following Coronary Intervention: A Systematic Review and Meta-Analysis. Angiology. 4, 3319719896472.