Medical management of endometriosis

Emerging bioengineering breakthroughs in precision diagnosis and therapy for endometriosis and adenomyosis

Endometriosis and adenomyosis are debilitating gynecological conditions that severely affect the quality of life of women. Traditional diagnostic and treatment methods, including laparoscopic surgery and hormonal therapy, face significant limitations such as incomplete lesion detection, high recurrence rates, and adverse side effects. Emerging bioengineering technologies offer promising solutions for precise diagnosis and therapy of these diseases. Advances in biomarker detection through electrochemical immunosensors, including specific molecular markers like cytokines and growth factors, have improved their early diagnosis. Innovative imaging techniques, such as near-infrared fluorescence imaging, magnetic resonance imaging, and photoacoustic imaging, enhance lesion visualization and surgical precision. In therapeutic applications, bioengineered drug delivery systems enable targeted therapy by modifying drug carriers with ligands targeting highly expressed receptors in endometriotic lesions. Such strategies could improve drug accumulation at target sites and reduce damage to healthy tissues. Integrating external energy (including lasers, focused ultrasound, and magnetic fields) with nanoplatforms offers key benefits for treating endometriosis and adenomyosis, allowing precise delivery of energy-responsive molecules to lesions and minimizing damage to healthy tissues. Additionally, novel approaches, such as immunotherapy, gene therapy, ferroptosis induction, and synthetic lethal activation, offer new avenues for effective treatment of endometriosis and adenomyosis. Significantly, this paper discusses the advantages of precision diagnosis and treatment of endometriosis in preserving the fertility of women of reproductive age. This review highlights the potential of bioengineering breakthroughs to transform the diagnosis and management of endometriosis and adenomyosis, emphasizing their role in advancing precision medicine and improving women's health.

Advances in the diagnosis and management of endometriosis: A comprehensive review

Endometriosis is a prevalent gynecological condition characterized by the presence of endometrial-like tissue outside the uterus, leading to chronic pelvic pain and infertility. This review aims to shed light on the latest advancements in diagnosing and managing endometriosis. It offers insight into the condition's pathogenesis, clinical symptoms, diagnostic techniques, and available treatment approaches. Furthermore, the article emphasizes innovative technologies and novel therapeutic strategies that promise to enhance patient outcomes significantly. This review aspires to empower clinicians to deliver the highest quality care to their patients affected by this challenging condition by consolidating the current understanding of endometriosis.

Peroxisome Proliferator-Activated Receptor Gamma Coactivator-1-Alpha in Endometriosis: Expression, Regulation, and Potential Role

OBJECTIVE

The present study was designed to comprehensively analyze the expression profiles of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), estrogen-related receptor-α (ERRα), estrogen receptor-β (ERβ), interleukin-6 (IL-6), cysteinyl-aspartic acid-specific protease-3 (caspase-3), and cysteinyl-aspartic acid-specific protease-9 (caspase-9) in endometriosis tissues. It also aimed to elucidate the hitherto unclarified role of PGC-1α in the processes of proliferation, apoptosis, and gene expression regulation of human endometrial stromal cells, thereby providing novel insights and identifying potential molecular targets for advancing endometriosis treatment modalities.

METHODS

A total of 49 ectopic endometrial tissue samples and 50 normal endometrial tissue samples were meticulously collected from patients who underwent gynecological surgeries in the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine in Fuzhou, China, between January 2022 and January 2023. Immunohistochemistry was used to detect protein expression levels. Human primary endometrial stromal cells were transfected and grouped for in-depth analysis. Real-time quantitative polymerase chain reaction (RT-qPCR) was utilized to measure gene expression, the cell counting kit 8 (CCK-8) assay was employed to evaluate cell proliferation, and the lactate dehydrogenase (LDH) method was used to determine cell death.

RESULTS

In endometriosis tissues, compared with normal endometrial tissues, the expression levels of PGC-1α, ERRα, and IL-6 were significantly increased. The expression of ERβ was also elevated, while the expression levels of caspase-3 and caspase-9 were decreased. In cell experiments, after transfection with interference plasmids to reduce PGC-1α expression, the expression levels of ERRα and ERβ were decreased, the expression of IL-6 was increased, and the expression levels of caspase-3 and caspase-9 were augmented. Conversely, after transfection with overexpression plasmids to enhance PGC-1α expression, the expression levels of ERRα and ERβ were elevated, the expression of IL-6 was diminished, and the expression levels of caspase-3 and caspase-9 were decreased. Moreover, when PGC-1α expression was interfered with by siRNA, cell proliferation was attenuated (albeit not statistically significant), and cell apoptosis was enhanced. Overexpression of PGC-1α promoted cell proliferation and inhibited cell apoptosis.

CONCLUSION

PGC-1α potentially plays a crucial role in the pathogenesis of endometriosis by regulating ERRα, ERβ, IL-6, and apoptosis-related factors. This study provides a strong theoretical foundation and a novel direction for developing endometriosis treatment strategies. To the best of our knowledge, it is the first to systematically explore the relationship between PGC-1α and these key factors in endometriosis, filling a knowledge gap. Future studies are needed to further dissect its mechanism and realize its clinical application potential.

Pilot Study of IL-1 Antagonist Anakinra for Treatment of Endometriosis

Purpose

To evaluate the impact of an interleukin-1 (IL-1) antagonist anakinra (Kineret®) on endometriosis-related quality of life (QoL), pain, and inflammatory biomarkers.

Methods

This was a single-site, randomized, double-blinded, placebo-controlled, cross-over pilot clinical study of patients recruited at an academic specialty clinic. Eligible participants were females aged 18-45 years with menstrual cycles every 24-32 days. Subjects had moderate to severe dysmenorrhea and either a surgical diagnosis of endometriosis or an endometrioma on imaging. Subjects were randomly assigned in a double-blind fashion to receive either the study drug or placebo administered as daily injections during the first 3 periods and then the alternate intervention for the next 3 periods.

Results

Fifteen subjects completed the 6 menstrual cycle study. After each period, they completed the Endometriosis Health Profile-30 (EHP-30) QoL questionnaire and an assessment of dysmenorrhea using a 0-100 Visual Analogue Scale (VAS). All domains of the EHP-30 showed a trend towards improvement, with significant improvements in powerlessness (54.5 vs 63.3, p = 0.04) and self-image (58.1 vs 66.7, p = 0.03) on the study drug compared to placebo. The mean dysmenorrhea VAS also trended toward improvement with a score of 37.5 during active treatment and 42.6 with placebo (p = 0.26). No difference in menstrual cycle length was detected (29.3 days vs 27.7 days, p = 0.56). There were significant differences in multiple inflammatory biomarkers between the study drug and placebo, including BDNF, IL-1, and IL-6 among certain groups.

Conclusion

With all EHP-30 domains and the dysmenorrhea VAS showing either a statistical improvement or trend towards improvement, there is justification for a larger study. As no impact on menstrual cycles was detected, anakinra may be a particularly impactful option for women desiring fertility. Additional evaluation is needed on the role of anakinra on inflammatory markers given significant reductions were identified in multiple biomarkers.

Assessment of Pain in Endometriosis: A Radiologic Perspective on Disease Severity

Background Endometriosis is a prevalent gynecological disorder characterized by extra-uterine endometrial-like tissue, causing substantial morbidity, including chronic pelvic pain and infertility. Little is known about the correlation between imaging findings and pain severity in endometriosis. Methods We conducted a prospective observational study, enrolling 150 women diagnosed with endometriosis. Clinical, imaging (MRI and transvaginal ultrasound (TVUS)), and histopathological criteria were used for diagnosis. Pain severity was assessed using the Visual Analog Scale (VAS). Statistical analysis included multivariate regression to identify predictors of pain severity. Results Imaging revealed common sites of endometriosis involvement, predominantly ovaries (73.3%) and rectovaginal septum (40%). Deep infiltrating endometriosis (DIE) was present in 30% of patients, predominantly affecting uterosacral ligaments (66.7% of DIE cases). Patients with ovarian endometriomas and DIE exhibited significantly higher VAS scores (7.6 ± 1.5 and 8.0 ± 1.2, respectively) compared to those without (6.5 ± 1.9 and 6.9 ± 1.8, respectively). Surgical intervention led to a significant reduction in VAS scores (from 7.4 ± 1.6 to 3.2 ± 1.7, p < 0.001), correlating with reductions in lesion size and extent observed in follow-up imaging. Conclusion Advanced imaging techniques, particularly MRI and TVUS, play a critical role in assessing pain severity in endometriosis. Ovarian endometriomas and DIE are independent predictors of increased pain severity, guiding personalized treatment strategies. Surgical excision of lesions, particularly in cases of DIE, offers substantial pain relief and improves quality of life, emphasizing the integration of imaging in clinical decision-making for optimal endometriosis management.

Circ_0001495 influences the development of endometriosis through the miRNA-34c-5p/E2F3 axis

Endometriosis is a chronic gynecological condition characterized by the presence of endometrial glands and stroma outside the uterine cavity., accounting for 7% of all female malignant tumors and 20%- 30% of malignant tumors of the female reproductive system. Multiple studies have shown that circular RNA (circRNA) has the potential to become a targeted target and marker for EM. However, the roles of circ_0001495 in EM are still unclear. Our research aims to reveal the molecular mechanism of circ_0001495 in EM. In this study, RT-PCR or western blot were conducted to determine mRNA and protein expression. cell viability, proliferation, migration, invasion, and apoptosis were assessed by CCK-8, EdU, wound healing, transwell, and flow cytometry analyses, respectively. Additionally, the targeting relationship between miR-34c-5p and circ_0001495 or E2F3 was confirmed through dual-luciferase reporter gene assay. We found significant overexpression of circ_0001495 in EM tissues and cells. Knockdown of circ_0001495 inhibited the proliferation, migration and invasion of ectopic endometrial stromal cells (EESCs) and increased cell apoptosis. Moreover, we found that circ_0001495 regulated E2F3 levels by interacting with miR-34c-5p in EESC. Furthermore, in vitro, miR-34c-5p inhibition or E2F3 overexpression could attenuate the effect of circ_0001495 silencing on EM progression. In addition, the vivo experiment demonstrated that inhibition of circ_0001495 could repress the development of endometriosis by regulating the miR-34c-5p/E2F3 axis. In conclusion, our study suggested that circ_0001495 promoted EM progression in vitro and in vivo through the miR-34c-5p/E2F3 axis, which might be a potential therapeutic target for EM.

Treatment after endometrioma recurrence: a narrative review

INTRODUCTION

Ovarian endometrioma is a common subtype of endometriosis with a prevalence between 17 and 44%. The reported average recurrence of endometrioma after surgical management is 21.5% after 2 years and 40-50% after 5 years. The aim of this narrative review was to summarize the existing literature focusing on treatment options after endometrioma recurrence in order to provide an evidence-based approach for the clinical practice.

EVIDENCE ACQUISITION

Three electronic databases (MEDLINE, EMBASE and Cochrane) were searched until September 2022 for eligible studies.

EVIDENCE SYNTHESIS

The available studies showed that repeated surgery has a negative impact on ovarian function, without improving the fertility outcomes. Transvaginal aspiration as an alternative option for surgery has a high rate of recurrence, which varies from 8.20 to 43.5% depending on the technique used and on the study population. Pregnancy related outcomes were similar between transvaginal aspiration groups and no intervention groups in patients with endometrioma recurrence. Regarding medical treatments, only four studies were found, showing that progestins reduce the pain and the diameter of the ovarian cyst.

CONCLUSIONS

Recurrent endometrioma is a challenging condition which could be encountered during the care of women with endometriosis. The decision about the treatment-strategy has to be individualized considering family planning status, age, ovarian reserve and transvaginal ultrasound findings. Well-designed randomized clinical trials are needed to export safer conclusions about the most appropriate treatment in each specific condition after endometrioma recurrence.

Three Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art

At present, there is no curative treatment for endometriosis. Medical management and surgical treatment do not provide long-term relief. A detailed understanding of its pathophysiology is mandatory in order to facilitate both the diagnosis and treatment. The delay that typically precedes proper diagnosis (6 to 7 years) is probably one of the most challenging aspects of endometriosis management. In 2012, the total cost per woman due to endometriosis was estimated to be 9579€ per year in a multicenter study across the USA and Europe. According to their physiopathology and their localization, ectopic endometrial lesions, consisting of endometrial glands and stroma, can be divided into three different types: superficial peritoneal endometriosis (SPE), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). The following paper aims to review the available data in the literature on the pathogenesis, diagnosis, and treatment of different types of endometriosis.