Does Candida albicans play a role in the etiology of endometriosis?

Purpose: There is increasing evidence that immunologic mechanisms play a role in the pathogenesis of endometriosis. A high incidence of infection with Candida albicans in women with endometriosis has been reported. There is evidence to suggest that C. albicans may contribute to the pathogenesis of endometriosis possibly by modulating cytokine production. 

Methods: Endometrial tissue was obtained from eight women attending Aberdeen Royal Infirmary for laparoscopic sterilization or investigation of infertility (n=7 patients without endometriosis, n= 1 patient with endometriosis). Culture of endometrial cells with inactivated Candida/Candida product was performed. The endometrial tissue was processed using a number of different assays including Ki-67 cell proliferation assay, DELFIA Ki-67 assay, MTT cell viability assay, and BrdU incorporation proliferation assay. 

Results: The results from seven women without endometriosis showed that Candida product significantly (P<0.01) reduced both cell viability and cell proliferation in the presence and absence of estradiol. The effects of Candida product on endometrial cells from the patient with endometriosis differed from the average effect on seven women without endometriosis: stimulation of cell viability in the presence of estradiol and suppression of cell proliferation only at the highest dose. In terms of the effects of inactivated Candida, there was a reduction in cell viability by up to 60% (unlike in the normal women), but an increase in cell proliferation of cells both in the presence and absence of estradiol. 

Conclusions: Our preliminary observations suggest that C. albicans may stimulate cell proliferation of endometrial cells from women with endometriosis whilst it seems to have an opposite effect on cells from women with no endometriosis. Caution must be exercised in the interpretation of the latter data since only one woman with endometriosis was included, but the results suggest there may be differences in the way in which Candida product and inactivated Candida affect endometrial cell viability and proliferation between women with and without endometriosis.