Differential Expression of Granulysin, MHC Class I-Related Chain A, and Perforin in Serum and Peritoneal Fluid: Immune Dysregulation in Endometriosis-Related Infertility

Introduction: Endometriosis is a chronic inflammatory disease characterized by endometrial-like tissue outside the uterus. Molecules linked to natural killer (NK) and cytotoxic T cells, including granulysin (GNLY), MHC class I-related chain A (MICA), and perforin (PRF1) support immune surveillance, though their roles in endometriosis remain unclear. This study investigates the association of these molecules with clinical parameters in infertile women with endometriosis. Methods: Eighty-seven infertile women undergoing diagnostic laparoscopy were included: 44 with endometriosis and 43 with benign gynecologic disorders. Serum and peritoneal molecules were measured using ELISA. Statistical analyses compared groups and correlated immune markers with clinical parameters. Results: Endometriosis patients displayed significantly higher PRF1 levels in serum (p =.038) and peritoneal fluid (p =.002), particularly in late-stage disease. Serum and peritoneal PRF1 levels correlated positively with the rASRM adhesion scores. Elevated serum PRF1 was observed in ovarian endometrioma (p =.021). Peritoneal MICA was higher in late-stage endometriosis (p =.013). Serum MICA was elevated in the follicular phase compared to the luteal phase (p =.008). Conclusion: Elevated PRF1 and MICA levels were associated with endometriosis severity, indicating their potential as biomarkers. Future studies should validate this finding and explore its therapeutic role in endometriosis.