Roughly 200 million women around the world suffer from endometriosis, a condition that causes tissue from the lining of the uterus to grow in places outside of the uterus. The condition can be exceptionally painful and contributes to infertility.
Endometriosis is as common as Type 2 diabetes, rheumatoid arthritis and migraines in the U.S., although there is less awareness of this condition. This lack of familiarity with endometriosis among the general population and health care providers means this condition is not well understood.
“Endometriosis is an understudied disease,” said Asgerally Fazleabas, professor and associate chair of research in the Department of Obstetrics, Gynecology and Reproductive Biology in the Michigan State University College of Human Medicine. “Unless you go to a physician who knows what endometriosis is, it may be misinterpreted as a gastrointestinal problem or inflammatory bowel disease.”
New findings from a team that includes MSU researchers points the way to developing new non-hormonal therapies which could be a game changer for endometriosis patients, some of whom wait seven to 10 years for a diagnosis. This research was funded by the National Institutes of Health and the Endometriosis Foundation of America.
Endometriosis starts early for most patients
“Endometriosis begins for most girls in adolescence — when they start having their periods, sometimes as early as eight years old,” Fazleabas said. “Many of these girls have periods complicated with very severe pelvic pain that lasts throughout their teenage years. It affects so much of their normal life. Many of them cannot even go to school when the pain is intense, and it also significantly affects their social life.
“The only way to conclusively diagnose endometriosis is to have a laparoscopy and most physicians are reluctant to perform a surgical procedure on a young girl,” said Fazleabas, who is also director of the Center for Women's Health Research and co-director of the Reproductive and Developmental Sciences Training Program at MSU.
For older women, gynecological complications like fibroids or adenomyosis can make an endometriosis diagnosis more difficult.
Study provides baseline for novel non-hormonal treatments
This study by Fazleabas and his co-researchers provides a baseline for understanding the signals, or cross talk, between the immune system’s macrophage cells and cells in endometriosis lesions. Their findings have been published in iScience and could help lead to better non-hormonal treatments for endometriosis.
“What we were able to show is that the epithelium — a layer of cells within an endometriosis lesion — is able to selectively communicate with the macrophages and alter their function within the immune system,” Fazleabas explained. “In general, macrophages are immune cells whose role is to help protect the body by detecting and removing harmful substances, controlling inflammation and aiding in tissue repair.
“But macrophages can take on different forms,” he added. “Other researchers have shown that macrophages found within the lesions tend to be pro-tissue repair. So, rather than clearing the tissue, they are contributing to the development of endometriosis. Instead of taking out the trash, so to speak, they are making the problem worse.
“What we've shown in this paper is that the epithelial cells can communicate with the macrophages,” concludes Fazleabas. “Our hypothesis is that their cross talk potentially provides an environment that's conducive to the development of the disease.”
This baseline for understanding cellular cross talk provides a foundation for further research that could lead to better therapies for the treatment of endometriosis.