An experimental treatment for endometriosis, a troublesome gynecological disease that affects some 190 million people worldwide, may someday offer new hope for relieving symptoms.
Monthly antibody injections reverse telltale signs of endometriosis in monkeys, researchers report February 22 in Science Translational Medicine. Antibody targets II.-8, the molecules that ignite the inflammation scattered inside, sometimes the bleeding lesions that mark the disease. II.-8 after the neutral, those ideas shrink the injuries, the team is found.
The new treatment is “pretty powerful,” says Philippa Saunders, a reproductive scientist at the University of Edinburgh who was not involved with the work. The authors of the study did not report a cure, she points out, but their antibody appears to have an impact. “I think it’s promising,” he said.
Many scientists believe that endometriosis occurs when the lining of the uterus — the endometrium — is shed during menstruation. Instead of going out through the sheath, they sail in the other direction: through the trumpet tubes. Those woven lamellae then pass through the body, causing lesions where they touch the ground. They clog the ovaries, fallopian tubes, bladder, and other spots outside the womb and take on a life of their own, says Saunders.
Nerve cell lesions can grow, form hard tissue clouds and even bleed during menstrual cycles. They can also kick off chronic pelvic pain. If you have endometriosis, you may experience “pain with periods, pain when you poop, pain when you have sex, pain when you move,” says Saunders. People with the disease may also struggle with infertility and depression, he adds. “It’s really bad.”
Once diagnosed, patients begin with a dearth of treatment options – there is no cure, only therapy to relieve symptoms. Surgery to remove the lesions can help, but symptoms often return.
The disease affects at least 10 percent of girls, women and transgender men in their reproductive years, Saunders says. And people typically suffer for about eight years on average – before diagnosis. “Doctors consider menstrual pelvic pain to be very common,” says Ayako Nishimoto-Kakiuchi, a pharmacologist at Chugai Pharmaceutical Co. Ltd. in Tokyo. Endometriosis is “underestimated in the clinic,” he says. “I strongly believe that this disease is misunderstood.”
Hormonal drugs that stop ovulation and menstruation can provide relief, says Serdar Bulun, a reproductive endocrinologist at Northwestern University Feinberg School of Medicine in Chicago, who was not involved with the new study. But those drugs come with side effects and are not ideal for people trying to get pregnant. “I see them every day,” he said. “I see how much they suffer, and I don’t think we are doing enough.”
Nishimoto-Kakiuchi’s team engineered an antibody that targets inflammatory factor II-8, a protein scientists had previously pinpointed as one potential culprit in the disease. The antibody acts like a garbage collector, Nishimoto-Kakiuchi says. He grabs II.-8, delivers it to the cell’s waste disposal machine, and then traps several more. II.-VIII.
The team tested the antibody in cynomolgus monkeys that had the disease surgically altered. (Endometriosis rarely shows up spontaneously in these monkeys, scientists previously discovered by screening more than 600 women.) The team treated 11 monkeys with an injection of the antibody once a month for six months. In these animals, the twisted and sticky tissue that binds them to the body also thins out. Before this study, Nishimoto-Kakiuchi says, the team didn’t think such symptoms of endometriosis were reversible.
A monkey that spontaneously developed endometriosis had a lesion (indicated by the blue arrow on the left side) that regressed (blue arrow on the right image) after 12 months of treatment with an antibody that targets inflammatory factor II-8. sweepsA. NISHIMOTO-KAKIUCHI et al/Science Translational Medicine 2023A monkey that spontaneously developed endometriosis had the lesion (red arrow near blue, left image) shrink (blue arrow in right image) after 12 months of treatment with an antibody to inflammatory factor II-8. sweepsA. NISHIMOTO-KAKIUCHI et al/Science Translational Medicine 2023His company has already begun a Phase I clinical trial to test the therapy’s safety in humans. The treatment is one of several endometriosis therapies scientists are trying (SN: 7/19/19) . Other trials will test new hormonal drugs, robot-assisted surgery and behavioral interventions.
Doctors need new options to help people with the disease, Saunders says. “There is a huge need for clinical unmet.”
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