A 2-in-1 discovery for diagnosing and treating endometriosis

17 Oct 2024

Written by Emma Hall (Contributing Editor)

Researchers at Baylor College of Medicine (TX, USA), along with collaborators from the University of Arizona (AZ, USA) and Washington University (MO, USA), have shared some promising discoveries that could transform the diagnosis and treatment of endometriosis, a condition affecting ~10% of women worldwide.

What is endometriosis?

Endometriosis is a chronic gynecological condition that occurs when tissue similar to the lining of the uterus, the endometrium, grows outside the uterus. The main symptoms involve severe pelvic pain during menstrual periods, sexual intercourse and urination or bowel movements. Endometriosis can also cause excessive bleeding, fatigue, bloating, nausea, anxiety and infertility.

With up to one in 10 women of reproductive age affected by this condition, it’s important to educate ourselves about it.

Why is there such an urgent need for new treatments?

We don’t really understand what causes endometriosis, which makes it particularly difficult to diagnose, treat and prevent. Unfortunately, endometriosis takes a global average of almost 7 years to diagnose, further hampering disease management and treatment. Delays in diagnosis are even longer in low- and middle-income countries.

Currently, the only way to definitively diagnose endometriosis is via a laparoscopy, an invasive surgical procedure that involves using a camera to look inside the pelvis. Although numerous screening assessments have been proposed, none of these are validated to accurately identify individuals with endometriosis, prompting an urgent need for better diagnostic methods and treatments.

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The nitty-gritty of this new study

The researchers drew inspiration from previous research indicating that the microbiome may be associated with endometriosis.

“Our previous studies in mice have shown that the microbiome, the communities of bacteria living in the body, or their metabolites, the products they produce, can contribute to endometriosis progression,” explained Dr Rama Kommagani, Associate Professor in the Department of Pathology and Immunology at Baylor. “In the current study, we took a closer look at the role of the microbiome in endometriosis by comparing the bacteria and metabolites present in stools of women with the condition with those of healthy women. We discovered significant differences between them.”

Their findings were extremely interesting: there is indeed a combination of bacterial metabolites unique to endometriosis. Using unbiased metabolomics and 16S bacteria sequencing, they identified key differences in women with the condition, including reduced levels of the bacterial metabolite 4-hydroxyindole, a compound produced by ‘good bacteria.’

Upon further investigation, the researchers discovered that administering this metabolite to animal models of endometriosis prevented disease progression, showing potential as a future treatment.

Why is it important?

What’s special about this research? For starters, it’s a two-in-one solution involving both a novel diagnostic test, as well as a potential treatment to reduce disease progression. Secondly, it’s non-invasive. Last but not least, these findings have implications for not only endometriosis but also another condition:

“The metabolite profile we identified in endometriosis is similar to that observed in inflammatory bowel disease, revealing intriguing connections between these two conditions,” Kommagani commented. “Our findings support a role for the microbiome in endometriosis and inflammatory bowel disease.”

With these encouraging findings, the team is now focused on developing a stool-based diagnostic test and further evaluating the safety and efficacy of 4-hydroxyindole as a therapeutic option.