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Neuroimmune communication via calcitonin gene-related peptide (CGRP) and its coreceptor RAMP1 promotes macrophage recruitment and phenotypic shifts toward a “pro-endometriosis” state, characterized by impaired efferocytosis and enhanced support of endometrial cell growth ( Natural killer (NK) cell function is severely compromised, with reduced cytotoxicity of the CD56dimCD16+ subset in peripheral blood and peritoneal fluid, enabling immune escape of ectopic cells ( T-cell subsets are dysregulated, with increased Th2, Th17, and regulatory T (Treg) cells in the peritoneal microenvironment (25).Recent evidence further implicates neuroimmune crosstalk via CGRP/RAMP1 in macrophage polarization, as detailed in Section 6.1
