Updates in the Field of Endometriosis

This summary consolidates updates in the field of endometriosis research.

Key Points

Highlights: 

• There has undoubtedly been a lot of progress made in demystifying endometriosis; however, the molecular mechanisms that drive endometriosis disease progression has not been elucidated.
• This summary of updates delineates the progress made in the field of endometriosis research, also concentrates on the elucidating the molecular and genetic mechanism that underlies this disease.
• Throughout the article, the authors reiterate the fact that current treatment methods are not very effective at combating the disease.

Importance:

• It is important to understand the current state of endometriosis research as it brings to light existing treatments and elucidates the path forward.

What’s done here?

• This summary consolidates updates in the field of endometriosis research.

Key points:

• There is an obvious lack of medical therapies out there for women suffering from endometriosis. Oral contraceptives, progestins, and gonadotropin-releasing hormone agonists are not effective due to their side effects and their ability to limit the treatment options available to the patient. Selective progesterone receptor modulators look promising due to their ability to increase apoptosis and decrease the amount of prostaglandin produced; however, further research needs to be done in humans to understand the side effects and possible contraindications. Aromatase inhibitors have been used to decrease cell proliferation and have been shown to decrease certain forms of endometriosis related pain. Unfortunately, aromatase inhibitors are like the GnRH analogs in that they both result in some unwanted side effects.
• Researchers look for genes to better understand the pathogenesis of endometriosis since it has been found that endometriosis can be heritable. The researchers hope that they can then apply this knowledge to create therapies that can alter gene function. Thus far ten genetic loci have been found, but researchers worry about the small sample size in which these loci found.
• Next, the researchers need to understand the biochemical pathways influenced by the genes mentioned above. Additionally, it has been deduced that genes altered in endometriosis are in some way involved in the mitogen-activated protein kinase (MAPK) pathway and the vascular endothelial growth factor (VEGF) pathway, both of which mediate inflammation. Current pharmacological treatments used in murine models, such as Rapamycin and selective cyclooxygenase-2 inhibitor, target the desired genes and pathways but have countless side effects.
• Genetic testing for certain genes associated with the illness is only recommended if there are treatments or therapies in place. For instance, endometriosis is a risk factor for ovarian cancer and an altered gene can be found in individuals at risk for one or both of these illnesses.
• Nature and nurture are important for disease inception and progression, thus there is research that focuses on environmental factors and chemicals that can cause or exacerbate endometriosis. Bisphenol a (BPA) and phthalates have been found to change estrogen receptivity; however, conflicting studies make it hard to determine the exact effect these compounds have on endometriosis disease progression.

This summary, by Zolton and Decherney, primarily concentrated on the future of endometriosis research, whic summarises the progress made in this field. The developments have been delineated in a 2017 issue of Clinical Obstetrics and Gynecology. For updates specific to a given topic namely genetics, epigenetics, surgery, imaging, fertility and fertility preservation, one can consult the issue above of Clinical Obstetrics and Gynecology or please look at the summaries for each topic, found in Endonews.

Lay Summary

A lot of progress has been made thus far in the field of endometriosis. Research has discovered various genetic and epigenetic components involved in endometriosis. There has also been a progression in the diagnosis and treatment of the disease since there is currently a recommended protocol for imaging and surgical intervention. Additionally, the research has conducted on the link between endometriosis and infertility. This research has led to a better understanding of the relationship between the two and has created options for individuals with endometriosis and infertility who wish to conceive. A lot of progress has been made in the field of endometriosis, without doubt; however, the lack of effective medical therapies for the disease proves that there is still a ways to go.

Endometriosis research has yet to produce a treatment option that can completely eradicate the disease and its various symptoms. Therapies currently on the market include surgery and estrogen/progesterone-based treatments that inhibit unwanted cell growth. Additionally, the latter treatment option may result in numerous side effects and can potentially limit the repertoire of therapies that are available to the patient. Furthermore, there are some options out there for controlling the symptoms of the disease such as selective progesterone receptor modulators, aromatase inhibitors, and gonadotropin-releasing hormone antagonists. Indubitably, there is a need for more efficient and curativemedical therapies for women with endometriosis.

What is the reason that prevents researchers from creating a better, more specific treatment for individuals suffering from this cruel disease? The answer lies in the fact that the molecular and genetic mechanisms that drive disease progression remain elusive to this day. In other words, the pathogenesis of the disease is still unknown.

Researchers look for genes, epigenetic markers, and biochemical pathways that could potentially be involved in the progression of endometriosis. They also hope to understand better the inflammatory signaling pathways that result in the disease’s characteristic cell proliferation. Elucidating the players and pathways involved in the development of endometriosis will allow researchers to create more targeted therapies.

While this summary, by Zolton and Decherney, primarily concentrated on the future of endometriosis research, it is important to note that a lot of progress has already been made in this field. These developments have been delineated in a 2017 issue of Clinical Obstetrics and Gynecology. For updates specific to a given topic namely genetics, epigenetics, surgery, imaging, fertility and fertility preservation, one can consult the issue above of Clinical Obstetrics and Gynecology or look at the summaries for each topic, found in Endonews.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28742586