Nuclear factor-kappaB: a main regulator of inflammation and cell survival in endometriosis pathophysiology

Fertil Steril. 2012 Sep;98(3):520-8. doi: 10.1016/j.fertnstert.2012.06.021. Epub 2012 Jul 6.


Objective: To update, analyze, and summarize the literature concerning nuclear factor-kappaB (NF-κB) participation in endometriosis pathophysiology.

Design: Review.

Result(s): Nuclear factor-kappaB is physiologically activated in the human endometrium, showing variable activity. A cyclic p65-DNA binding pattern was shown in the endometrium of healthy women. This cyclic pattern was altered in the endometrium of patients with endometriosis. Nuclear factor-kappaB is basally activated in peritoneal endometriotic lesions, showing higher p65 activity in red endometriotic lesions than in black lesions. In vivo and in vitro studies show up-regulation of inflammation and cell proliferation and down-regulation of apoptosis by NF-κB activity. Iron overload has been shown in the pelvic cavity of endometriosis patients, and iron overload and oxidative stress activate NF-κB in macrophages, which have been shown to participate in the endometriosis-associated inflammatory reaction.

Conclusion(s): Nuclear factor-kappaB activation dysregulation in the endometrium of endometriosis patients may explain some endometrial biological alterations associated with endometriosis. The scientific evidence strongly suggests that NF-κB activity in endometriotic cells stimulates inflammation and cell proliferation and inhibits apoptosis, favoring the development and maintenance of endometriosis. Iron overload in the pelvic cavity of endometriosis patients could be a main factor enhancing oxidative stress and activating NF-κB in a chronic manner, contributing to endometriosis establishment and growth.

Publication types

  • Review

MeSH terms

  • Animals
  • Apoptosis
  • Cell Proliferation
  • Cell Survival
  • Endometriosis / etiology*
  • Endometriosis / physiopathology
  • Female
  • Humans
  • Inflammation / etiology*
  • Iron / metabolism
  • NF-kappa B / physiology*


  • NF-kappa B
  • Iron