An experimental treatment for endometriosis, a painful gynecological disease that affects some 190 million people worldwide, may one day offer new hope for those with innocuous symptoms.
monthly antibody injection reverse signs of endometriosis in monkeys, Researchers report February 22 science translational medicine, The antibody targets IL-8, a molecule that kills inflammation inside the scattered, sometimes bleeding lesions that mark the disease. The team found that after neutralizing IL-8, those hallmark lesions shrink.
The “new treatment” is very powerful, says Philip Saunders, a reproductive scientist at the University of Edinburgh who was not involved in the work. She points out that the authors of the study didn’t report the treatment, but the effect of their antibodies. “I think it’s really very promising,” she says.
Many scientists think that endometriosis occurs when pieces of the lining of the uterus — the endometrium — are shed during menstruation. Instead of exiting through the vagina, they travel in the other direction: through the fallopian tubes. Those pieces of tissue then trespass through the body, sprouting wounds where they land. They will lodge in the ovaries, fallopian tubes, bladder, and other places outside the uterus and take on a life of their own, says Saunders.
The lesions can grow nerve cells, form hard nubs of tissue and may also bleed during the menstrual cycle. They can also trigger chronic attacks of pelvic pain. If you have endometriosis, you may experience “pain when you urinate, pain when you poop, pain when you have sex, pain when you move,” Saunders says. She adds that people with the disease may also struggle with infertility and depression. “it’s really bad.”
Once diagnosed, patients face a paucity of treatment options – there is no cure, only treatments to ease symptoms. Surgery to remove the lesions can help, but symptoms often return.
Saunders says the disease affects at least 10 percent of girls, women, and transgender men in their reproductive years. And people typically suffer for years — about eight on average — before diagnosis. “Doctors treat menstrual pain as a very common thing,” says Ayako Nishimoto-Kakiuchi, a pharmacologist at Chugai Pharmaceutical Co., Ltd. in Tokyo. Endometriosis is “underdiagnosed in the clinic,” she says. “I firmly believe that this disease has been studied.”
Serdar Bulun, MD, a reproductive endocrinologist at Northwestern University Feinberg School of Medicine in Chicago, says that hormonal drugs that block ovulation and menstruation may also provide relief. But those drugs have side effects and are not ideal for people trying to get pregnant. “I see these patients day in and day out,” he says. “I see how much they are suffering, and I feel we are not doing enough.”
Nishimoto-Kakiuchi’s team created an antibody that grabs onto the inflammatory factor IL-8, a protein that scientists previously fingered as a possible culprit in the disease. The antibody acts like a garbage collector, says Nishimoto-Kakiuchi. It captures IL-8, transports it to the cell’s waste disposal machinery, and then goes out to trap more IL-8.
The team tested the antibodies in cynomolgus monkeys that had been surgically modified to have the disease. (Endometriosis rarely appears spontaneously in these monkeys, the scientists previously discovered after screening more than 600 females.) The team treated 11 monkeys with antibody injections once a month for six months. In these animals, the wounds shrunk and the adhesive tissue that held them to the body also thinned. Before this study, says Nishimoto-Kakiuchi, the team did not think that such symptoms of endometriosis were reversible.
His company has now started a phase I clinical trial to test the therapy’s safety in humans. treatment is one of many Endometriosis Therapies Scientists Are Testing (No.: 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 clinical need.”