Affecting around 190 million women and girls globally, endometriosis is caused by growths of tissue – similar to those in the lining of the uterus – outside the uterus, which causes debilitating pelvic pain during sex and menstruation – which is usually a heavy flow.
Since 50% of endometriosis patients deal with fertility issues, the economic cost of the condition in the US alone – both in terms of medical care and lost productivity – is estimated to be around $78-120 billion annually, according to Somer Baburek, CEO and co-founder of Hera Biotech , a US-based women’s health company that is developing a diagnostic test for endometriosis.
Baburek explained that despite these huge challenges to women’s health, patients suffer an average 8 year delay to diagnosis, which can only be done surgically.
Although hormonal therapy can help relieve symptoms, it fails to treat infertility. Plus, surgical removal of the lesions is often temporary as the lesions return 50% of the time, according to Baburek.
“The main reason why we don’t have better options yet is the chronic shortage of funds for research in this area. Similar common diseases, such as diabetes and breast cancer (affecting 12-15% of the population) receive 15 and 30 times more funding from the NIH, respectively. A rarer and similar disease is not as deadly as Crohn’s disease, receiving 65 times more funding per patient,” Baburek said.
“Despite these limitations, we have seen some significant advances in endometriosis studies over the last 5-10 years.”
Because unraveling the complexity of the gut microbiome is essential for healing inflammatory diseases, the intriguing relationship between microflora and endometriosis could look to potential drug targets for treating the condition.
“Real therapeutics to halt or prevent disease itself will require much broader studies of the cellular pathophysiology underlying lesion formation, and the signaling pathways leading to disease development. This is a strategy that has resulted in major advances recently in cancer research, but it will require concurrent changes in research funding for endometriosis to match the extent and severity of this disease,” Baburek said.
Today, with many promising clinical trials and with the discovery of new drug targets, there is hope for the treatment of endometriosis. As we observe the International Day of Action for Women’s Health on May 28, let’s take a look at some of the latest advances in endometriosis research.
A potential breakthrough drug to start clinical trials soon
While treatment for endometriosis depends on factors such as age and the extent of symptoms, surgery and hormone treatment are usually the only options. And the fact that there hasn’t been a new treatment in 40 years, reveals how difficult it is to treat this disease. But now, that’s all about to change.
The new drug, dichloroacetate, has the potential to be the first non-hormonal, non-surgical treatment for endometriosis. Researchers from the University of Edinburgh found that when cells from the pelvic wall in people with endometriosis were treated with dichloroacetate, the amount of lactate that was produced before administration of the drug decreased. This is key to the treatment of endometriosis because increased lactate production in these cells has been linked to manifestations of endometriosis, according to previous research funded by Wellbeing of Women, a UK-based charity focused on reproductive health and gynecology. As a result, dichloroacetate is able to reduce the size of endometriosis lesions.
Calling out prospective treatment is long overdue, Janet Lindsay, chief executive of Women’s Welfare, said: “Too many women and girls suffer from debilitating symptoms, such as chronic pelvic pain, fatigue and even fertility issues, and current hormonal and surgical treatments are not suitable. for everyone. Dichloroacetate has the potential to be the first non-hormonal, non-invasive treatment for endometriosis, which will truly be a breakthrough.”
For progress in clinical trials, £250,000 has been awarded by Women’s Welfare and the Scottish Government to the Universities of Edinburgh, Aberdeen and Birmingham, the study’s main collaborators.
New research will explore cannabis as a treatment for endometriosis
Medical cannabis has studied for its anti-inflammatory properties and is used to relieve side effects caused by chemotherapy, and has been prescribed to treat epilepsy and multiple sclerosis. An upcoming clinical trial by Western Sydney University in Australia will investigate its potential benefits for the treatment of endometriosis.
The research, for which the university will receive $660,000 from the Wilson Foundation, will look at cannabis’s effects on the endocannabinoid cell signaling system (ECS), as well as markers of inflammation. A double-blind randomized controlled trial will evaluate whether medicinal cannabis – in the form of cannabidiol isolate (CBD) or a balanced oil containing CBD and delta-9-tetrahydrocannabinol (THC) – can counteract symptoms such as pain caused by endometriosis against a placebo.
As 59% of women who used cannabis for pain relief related to endometriosis reported that they are no longer reliant on pain killers, this trial builds on evidence from previous research showing that cannabis can regulate inflammation and immune function, through interactions with the ECS.
“Various phytochemicals, especially CBD, from cannabis have been well described as analgesic, anti-inflammatory, and antidepressant, and can also reduce anxiety and nausea. Cannabis use in other chronic pain conditions has resulted in a “substitution effect” of drugs, usually opioid analgesics, by cannabis,” said Mike Armor, the study’s principal investigator, and professor at the NICM Health Research Institute at Western Sydney University, who explained that people -people in Australia who have used cannabis to treat symptoms of the condition found that it improves sleep and digestive function.
“However, there is still much we don’t know about how or why cannabis might affect endometriosis symptoms and the progression of the lesions may be slow. The trials will allow us to determine the range of effective doses, the ideal THC to CBD ratio, duration of treatment, and so on,” said Armor.
Tapping into the potential target of ECS – after the brain, the female reproductive system has the most endocannabinoid receptors – Israel-based startup Gynica is developing cannabinoid-based therapies to treat endometriosis symptoms such as chronic menstrual pain and painful intercourse. Studies for therapy are ongoing.
Drug candidates for endometriosis show higher efficacy than current treatments in animal studies
Meanwhile, the discovery of proteins that are overexpressed in endometriotic cells by startup Fimmcyte, based in biotech startup hotspot Basel, has sparked a potentially revolutionary therapy for endometriosis.
This observed overexpression, which otherwise has low expression in the lining of the uterus and other parts of the body, has paved the way for possible drug targets, which Fimmcyte is currently exploring. Companies are developing highly specific antibodies that label endometriosis cells for the immune system to clear, according to Mohaned Shilaih, co-founder of FimmCyte.
Over the last 18 months, the young biotech conducted several studies in mice in which patient-derived materials were implanted, and found the treatment to be “highly effective and reduced the burden of disease,” according to Shilaih. The therapy not only showed higher efficacy than treatment with gonadotropin-releasing hormone (GnRH) antagonists, which is the current standard of care, but also did not affect hormone balance, cycles, and ovarian weight in mice.
Shilaih said: “Endometriosis affects one in 10 women globally, with more than 30% reporting dissatisfaction with hormonal interventions and/or surgery due to side effects and lack of efficacy. FimmCyte treatment will provide much needed non-hormonal therapy for women with endometriosis that is safe and effective without unwanted side effects.”
The company aims to continue research into its therapy and obtain funding for studies enabling Investigational New Drug / Clinical Trial Authorization (IND/CTA), and hopes to start clinical trials in 2025.
Managing endometriosis: benefits of pelvic floor therapy
As there have been many studies proving the effectiveness of physiotherapy for pelvic floor rehabilitation for those with bowel and bladder problems and for recovery from labour, recent studies have shown that physiotherapy could be the key to managing pain from endometriosis, which has been proven so far. described as a sharp, piercing sensation.
a 2021 Study showed that after incorporating pelvic floor therapy as part of their lifestyle, 17 women with deep infiltrative endometriosis (DIE) – a type of endometriosis that can affect organs near the uterus – showed an increased levator hiatus area, as observed on ultrasound. The area of the levator hiatus is the area associated with the hip and is the largest potential hernia portal. The result causes relaxation of the pelvic floor, improves superficial dyspareunia – which causes pain in the vaginal opening during sex – and helps manage chronic pelvic pain.
Since then, pelvic floor therapy for patients with endometriosis has paved the way for pain management for endometriosis and other pelvic pain-related problems – with around 80% of chronic pelvic pain caused by endometriosis.
A more recent review also confirmed the effect of physiotherapy for treating endometriosis pain. Physiotherapy for endometriosis patients includes kinesiotherapy, physical therapy, and balneology. These steps are effective in relieving pain through exercises and movements that target the pelvic area.
A correlation between endometriosis and other inflammatory diseases was found
Because inflammation has been known to trigger endometriosis-associated cell proliferation, recent studies have found that the condition may be linked to other inflammation and pain-inducing diseases.
“Several laboratories around the world have collaborated on genome sequencing studies to identify variants associated with endometriosis. This study mainly identified advanced endometriosis changes associated with pain and swelling, both of which are consequences, but not causes of endometriosis,” Baburek said.
Collaborative Study by US-based biotech Celmatix and genomics company 23andMe along with researchers, is a meta-analysis of genomic association studies of 60,674 cases and 701,926 controls of people of European and East Asian descent. 42 genome-wide significant loci comprising 49 different association signals were identified that explain up to 5.01% of disease variant and gene methylation in the endometrium and blood, many of which are related to pain perception, according to the study.
Research has found that endometriosis can be associated with 11 conditions including migraines, back pain and chronic multisite pain (MCP), and inflammatory conditions such as asthma and osteoarthritis.
Further research could explore potential drug targets that could accelerate intervention not only for endometriosis but also other chronic pain-inducing conditions.
New technologies related to endometriosis (Supported by IN-PART)