Mast Cell Activation: The Complex Interplay of Endometriosis and Inflammation

While the pathology underlying endometriosis has been studied extensively, many questions remain about the cause and varied symptomology of this disease. It is unclear why some patients with extensive endometriosis implants have few symptoms while others present with debilitating pain and only have minimal disease on surgical exploration. One of the components that may explain this phenomenon is mast cell activation. 

Mast cells are immune cells (or white blood cells) that play a critical role in the body’s response to pathogens and foreign substances. These cells are well known for their role in allergic reactions where the body produces hives in response to an allergen. When mast cells are overactivated or dysregulated, they can start working out of control and result in damaging effects on the body. Mast cell activation has been implicated in conditions such as asthma, rheumatoid arthritis, inflammatory bowel syndrome, and most recently – endometriosis. 

Although the exact mechanisms underlying the relationship between mast cell activation and endometriosis are still unclear, mast cells have been shown to infiltrate the endometrial tissue and contribute to the chronic inflammation that characterizes the disease. Peritoneal fluid of patients with endometriosis shows an increased number of mast cells, suggesting that mast cell activation may be a key factor in the development and progression of the disease. Mast cells release a variety of inflammatory mediators, including histamine and prostaglandins, which can stimulate pain receptors and exacerbate pelvic pain. In addition, mast cells can also contribute to nerve sensitization and amplify pain signals in the nervous system, leading to the development of chronic pain.

While further research is needed to fully unravel the complex interactions between mast cells and endometriosis, patients should be aware that testing for mast cell activation may help elucidate the underlying cause of their symptoms.