Endometriosis highlights from ESHRE2016

26 July 2016

ESHRE2016
The 32nd annual meeting of ESHRE was held in Helsinki on 3-6 July 2016 with a stupendous attendance of 9000+ scientists, medical doctors, and industry partners.

There was a pre-congress special interest group (SIG) course, an invited session on pain mechanisms, and two scientific communications sessions dedicated to endometriosis, where 22 researchers presented the updates on research efforts to better understand the underlying mechanisms of endometriosis:

  • SIG Endometriosis pre-congress course
    Endometriosis – getting research from bench to bedside (8 lectures)
  • 1 invited session
    Endometriosis, how does it hurt? (2 presentations on pain mechanisms)
  • 2 scientific communication sessions
    (1) Advances in understanding of endometriosis and endometrial biology
    (2) Endometriosis in the clinic (13 presentations)
  • 86 poster presentations on endometriosis and endometrium biology

All the endometriosis sessions were highly attended and well received. Here are some highlights from selected presentations from the meeting.

Endometriosis, how does it hurt?

Dr Katy Vincent, from John Radcliffe Hospital, University of Oxford, was one of the invited pain experts. She gave a talk on central pain mechanisms relevant to endometriosis-associated pain.

Dr Vincent showed from previous findings that the severity of pain experienced by women with endometriosis correlates poorly with the extent of disease identified at surgery. Her research investigating functional brain imaging scans of women with endometriosis-associated pain has revealed that factors other than the lesions in the pelvis are involved in the generation and amplification of pain.

Amalgamating evidence shows that the experience of pain is both sensory and emotional and involves coordinated activity within a distributed network of brain regions.

Slide courtesy of Katy Vincent, MD

Slide courtesy of Katy Vincent, MD

Dr Vincent presented data, which revealed that the brains of patients with chronic pain exhibit both structural and functional differences when compared to pain-free controls. Moreover, these changes were remarkably similar across chronic pain conditions, no matter what the underlying pathology. Dr Vincent delivered the following key messages:

We need to consider the role of the central nervous system as well as the pelvis in generating and amplifying pain in endometriosis.

Emerging evidence that the brains of women with endometriosis-associated pain are similar to those of patients with other chronic pain conditions.

Dr Vincent also proposed that

Pain relief might be achieved by considering centrally acting drugs as used in other chronic pain conditions.

Endometriosis and long-term mental distress

Dr Terhi Piltonen presented the data from the North Finland Birth cohort (1966) on the association of endometriosis with long-lasting depression and anxiety.

Dr Terhi Piltonen, Oulu University, Finland

Dr Terhi Piltonen, Oulu University, Finland

The study population consisted of 258 endometriosis cases and 3090 endometriosis-free controls from which symptoms of mental distress and depression were collected at ages 31 and 46. The results show that history of endometriosis is associated with more symptoms for mental distress and anxiety both at age 31 and 46. Moreover, a history of endometriosis was associated with higher lifetime incidence of depression diagnosis and prevalence of women having depression diagnosis at age 31 and 46 was higher among women with endometriosis.

The overall evidence from the 1966 North Finland Birth cohort:

Women with endometriosis are likely to suffer from long-lasting increased mental distress therefore women with endometriosis history should be screened for mental distress beyond the fertile age and offered the needed care.

Endometriosis and assisted reproductive technology (ART)

Dr Bourdon from Dr Charles Chapron’s group in France presented evidence from a matched cohort study on ART outcomes in women with endometriosis after fresh versus frozen embryo transfer cycles.

The cohort included 270 women, broken into two groups of 135 matched by age, number of previous ART cycles and respective endometriosis sub-types. The study compared the implantation rate and pregnancy rates between groups received (1) frozen-thawed embryos and (2) fresh embryos. The results evocated frozen-embryos as an attractive option that increased the ART success rate.

However, randomised control trials are required to confirm these findings.

Endometriosis and paramedics

Dr Apers presented results from a cross-sectional study, including 109 Dutch women with endometriosis treated by laparoscopy for pain and infertility, for quality of life association with patient centeredness of care.

The results show suggestive evidence that providing patient-centered care may improve quality of life in women with endometriosis. Most important dimensions of the patient-centered care were identified as

  1. respect for patients’ values, preferences and expressed needs, and
  2. information, communication and education.

Large-scale longitudinal research is needed to investigate this suggestive finding further.

LAROSE: Laparoscopy vs. robotic surgery for endometriosis

Dr Soto presented a multi-centre randomised controlled trial from the USA, investigating clinical outcomes between robotic surgery and laparoscopy for treatment of endometriosis in 73 patients.

The results show no clinically significant difference between the two operative treatments with regards to operative time, post-operative pain or quality of life when surgery is performed by surgeons that are proficient in both approaches. However, larger studies are required to investigate the differences in the secondary outcomes that may be not detected in this study due to sample size.

The gold standard for endometriosis remains laparoscopic surgery until then.

Challenges of moving endometriosis research from lab into the clinic

Drug development process starts with good science and ends with good medicine [1]

Patrick Groothuis, PhD, Synthon Biopharmaceuticals, The Netherlands

Patrick Groothuis, PhD, Synthon Biopharmaceuticals, The Netherlands

At the SIG Endometriosis – getting research from bench to bedside – course, Dr Patrick Groothuis gave a sobering overview of major reasons for the slow drug development in endometriosis. Dr Groothuis, highlighted the importance and factors the impede academic and industry collaborations in pushing research results into clinic.

Mismatch of research focus in academia and industry:

Academia: publication/hypothesis driven and funding funded → aims for acquisition and dissemination of knowledge.

Industry: compound/patent driven and market oriented → aims to develop and market novel, better, safer drugs.

Poor reproducibility of findings reported in scientific literature:

25-50% of published data cannot be repeated by industry labs and is therefore viewed with caution.

The causes of poor reproducibility are: small sample sizes, small effect sizes, flexibility in study designs, incoherent definitions, outcomes and analytical modes, selective outcome reporting, conflicts of interest and prejudice, personal motives (career).

In studies where results could the repeated, the authors paid close attention to; definition of controls, reagents, investigator bias and describing the complete dataset.

Dr Groothuis also summarised the factors slowing down drug development in endometriosis as following:

  • Limited insight in the pathogenesis of endometriosis
  • Lack of innovative targets
  • No predictive animal models
  • No biomarkers for safety and efficacy
  • Lack of diagnostic tools
  • Subjective clinical endpoints

Summary

Dr Nilufer Rahmioglu, the author of this congress report, concluded that:

The endometriosis-related sessions at 32rd ESHRE annual meeting were thought-provoking and highlighted how much more collaborative standardised basic scientific research is needed to better understand underlying mechanisms of endometriosis and to translate the findings into clinic.

Reference
  1. Reichert JM and Milne CP. Public and private sector contributions to the discovery and development of “impact” drugs. Am J Ther 2002;9(6):543-555.
About the author

Dr. Nilufer Rahmioglu is a senior research scientist, investigating genetic and environmental risk factors of endometriosis and related co-morbidities at the Wellcome Trust Center for Human Genetics, University of Oxford.

Dr Nilufer Rahmioglu, Wellcome Trust Center for Human Genetics, University of Oxford, United Kingdom

Dr Nilufer Rahmioglu, Wellcome Trust Center for Human Genetics, University of Oxford, United Kingdom

Her research involves, (1) elucidation of the underlying genetic mechanisms of endometriosis through genome-wide association studies, transcriptomic and epigenomic profiling of endometrium and fat tissues, (2) investigation of phenotypic and shared genetic associations between endometriosis and obesity-related traits, gynaecological disorders and other chronic pain conditions, (3) development of global consensus on standardised data and sample collection protocols, the WERF endometriosis phenome and biobanking harmonization project (EPHect), (4) establishment of an eastern Mediterranean women’s health study to investigate the influence of the ‘Mediterranean lifestyle’ and the genetic factors on women’s health from this region.

See also

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