As I write this blog about endometriosis I find myself feeling for the women who struggle with this painful disease. For those unfamiliar with the disease, endometriosis is defined as the presence of endometrial tissue outside the uterus and affects approximately 10% of women of reproductive age.
Current research is focused on identifying biomarkers which would allow easier and earlier detection in the hopes of preventing long term complications. Biomarkers gauge biological processes, for example, Hba1c is a biomarker used to evaluate how well sugar levels are controlled in people with diabetes.
The benefits of biomarker identification, if a strong one can be identified, are the potential for its use in early diagnosis and in developing effective therapies for the treatment of endometriosis.
A review assessing over 200 potential biomarkers, including hormones and their receptors, cytokines, proteomic fragments and compounds identified by histological analysis of endometrial tissue was reported this year (May et.al). The researchers were able to identify six possible biomarkers related to nerve fiber growth or cell cycle control. Both nerve fiber growth and cell cycle control are important in endometriosis. Nerve fiber growth is implicated in the increasing pain women feel as the disease progresses. Cell cycle control, through the regulation of key hormones (e.g. estrogen and progesterone) and hormone receptors, is one of the processes by which endometriosis and infertility are caused.
Because of its ability to enhance tissue growth, estrogen has long been implicated in the growth of endometrial lesions. Recently, researchers have identified genes related to estrogen metabolism and action as potential biomarkers (Vouk et.al.). These genes encode potential novel biomarkers and may lead to the development of new and more effective drugs.
In other research, biomarkers from urine were investigated and 3 peptides were observed at much higher concentrations in women with endometriosis than those without (El-Kasti et.al). If these findings can be validated in future, this may lead to a non-invasive diagnostic.
A second area of current research is focused on endometriosis in adolescents. Identification of endometriosis in adults is a challenge often taking 6-8 years to be diagnosed. Diagnosis in adolescents is even more challenging as the majority of pelvic pain is associated with normal ovulatory cycles. Therefore, it is important to be able to distinguish between what is “normal” and endometriosis. It is hypothesized that the diagnosis and treatment of endometriosis in adolescents has the potential to mitigate long-term complications often seen with this disease such as infertility. Interestingly, researchers have shown it that there are differences in the endometrial lesions between adults and adolescents, perhaps suggesting a different disease process or different therapeutic options for adolescents.
May KE et.al. Endometrial alterations in endometriosis: a systematic review of putative biomarkers. Hum Reprod Update. 2011 Sep-Oct;17(5):637-53.
Vouk K et.al. Novel estrogen-related genes and potential biomarkers of ovarian endometriosis identified by differential expression analysis. J Steroid Biochem Mol Biol. 2011 Jul;125(3-5):231-42.
El-Kasti MM et.al. Urinary peptide profiling identifies a panel of putative biomarkers for diagnosing and staging endometriosis. Fertil Steril. 2011 Mar 15;95(4):1261-6.e1-6.
Tokushige N et.al. Discovery of a novel biomarker in the urine in women with endometriosis. Fertil Steril. 2011 Jan;95(1):46-9.
Socolov R et.al. The value of serological markers in the diagnosis and prognosis of endometriosis: a prospective case-control study. Eur J Obstet Gynecol Reprod Biol. 2011 Feb;154(2):215-7.
He RH et.al. Highly elevated serum CA-125 levels in patients with non-malignant gynecological diseases.
Arch Gynecol Obstet. 2011 Mar;283 Suppl 1:107-10. Epub 2010 Nov 11.
Ballweg ML Treating endometriosis in adolescents: does it matter? J Pediatr Adolesc Gynecol. 2011 Oct;24(5 Suppl):S2-6.
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