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Approximately 190 million women worldwide suffer from endometriosis—a condition that causes the uterine lining to grow outside its boundaries. The condition can be extremely painful, leading to inflammation, and most importantly, it is the cause of up to half of all infertility cases. Therefore, endometriosis treatments remain one of the key research topics in contemporary medical science.
Global Diagnosis Challenges
The main challenge in effective therapy is that it may take up to ten years before the correct diagnosis is made. Women are often treated for other disorders for years, while the endometriosis itself progresses, causing complications and worsening life. When treatment finally begins, time, and most importantly, effectiveness, become crucial.
In their groundbreaking research, a team of scientists from the UK and the USA set out to decode the “language of cells” inside endometriosis lesions to explore new treatment avenues for endometriosis.
Endometriosis is an understudied disease. Unless you go to a physician who knows what endometriosis is, it may be misinterpreted as a gastrointestinal problem or inflammatory bowel disease.
Asgerally Fazleabas, professor and associate chair of research, Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine
According to Professor Fazlibas, who is also the corresponding author of the study, endometriosis can develop very early—even during menarche. Traditionally, laparoscopy is used to diagnose this disease, but doctors tend to avoid performing this surgical procedure on young girls. For older women, diagnosing endometriosis may be complicated by gynecological disorders, such as fibroids or adenomyosis.
New Approach to Endometriosis Treatments
The researchers used spatial transcriptomics to compare cellular activity in superficial peritoneal lesions with the normal endometrium from the same patients. The results were striking: the epithelium and connective tissue of the lesions were genetically very similar to the tissue of normal endometrium. The key difference, however, was the selective and enhanced interaction between the epithelium of the lesions and macrophages, which alters the function of the latter in the immune system.
Macrophages are immune cells that detect and remove harmful substances, controlling inflammation and aiding tissue repair. However, as Professor Fazlibas explains, macrophages come in various forms.
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.
Asgerally Fazleabas
The researchers discovered that macrophages in the affected tissue produced C3 protein at an elevated rate.
Main Suspect: C3 Component
C3 is one of the major proteins in the complement system, playing a crucial role in the innate immune response. According to the study results, C3 triggers a chain reaction of inflammation and activates the “recovery phenotype” of macrophages, promoting the growth of new blood vessels and tissue fibrosis. Communication between epithelial and immune cells in the lesions compared to normal uterine tissue increased nearly fourfold.
Simply put, the epithelium of endometrium lesions creates a favorable environment for its own survival by inducing inflammation and reprogramming immune cells to cooperate. Interestingly, the researchers found minimal genetic differences between normal uterine cells and their counterparts in the lesions. This confirms the long-standing theory that endometriosis develops from uterine tissue that migrates outside its boundaries during menstruation.
Moreover, this new discovery adds to previous findings regarding the elevated levels of C3 protein in the blood of women with endometriosis. The study authors propose this protein as a potential diagnostic biomarker for the disease.
More Effective Endometriosis Treatments Without Hormones
Understanding how cells within the lesions interact with each other opens a completely new pathway for targeted therapy of endometriosis. New treatment methods could focus not only on suppressing hormones but on blocking cellular signals—like C3 effect on macrophages. This approach offers the potential for less invasive yet more effective treatment with fewer side effects.
Although endometriosis remains challenging to treat, research of this caliber brings us closer to a deeper understanding of the disease mechanisms. It has been revealed that the epithelium plays a central role in driving the inflammatory process within the lesions. And it is this epithelium that is linked to the potential for new therapeutic strategies.
For more details on the symptoms, complications, and treatment of endometriosis, check out the article in our Women’s Health Encyclopedia.
You can consult with experienced doctors at the “Lior” Medical Center to manage endometriosis. To get more information or schedule an appointment, call +380 73 200 6198 or reach us via Telegram.
