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EXPPECT innovative treatments for endometriosis

14 Apr 2023

Endometriosis is a chronic inflammatory pain condition that affects one in ten females and those assigned female at birth. It costs the UK economy £8.2 billion a year in treatment, loss of work and healthcare costs.

Endometriosis is a condition where cells similar to those that line the womb grow in other parts the body (usually the abdominal cavity) as lesions. The hormones that regulate periods regulate this tissue too, and endometriosis lesions cause inflammation and can lead to scarring.  For patients, this results in infertility issues, pain that can often be severe, fatigue, and can lead to feelings of isolation and depression.  

Currently, the only way to receive a definitive diagnosis is via laparoscopy and the average time from symptom onset to diagnosis is eight-and-a-half years. The treatments currently available for patients can be effective in some cases, however identifying which patients will respond to a particular treatment available can be a case of trial and error, with limited information available to drive precision medicine approaches. Moreover, many existing treatments for endometriosis symptoms are hormone-based and, with many patients affected being within reproductive age, these can be unsuitable options for a large number of patients.

Although endometriosis is as common in women as diabetes and asthma, it has failed to attract the same attention, support and research funding as those diseases. There is a clear need for further endometriosis research to aid the development of both better diagnostics and non-hormonal treatments to improve quality of life for the many women affected by the condition.  

At the MRC Centre for Reproductive Health at the University of Edinburgh, the EXPPECT Endometriosis team, led by Professor Andrew Horne and Professor Philippa Saunders, is working hard to improve the lives of women with endometriosis by advancing research into pelvic pain and endometriosis and their management.

EXPPECT is a diverse team, spanning all aspects of clinical care, discovery and data science. Underpinned by support from a group of experienced research and trial managers, the team can provide expertise and support for translational research from basic science using novel in-vitro ‘lesion in a dish’ and animal models, through to the delivery of early and late-stage clinical trials.

Patients are at the centre of EXPEECT’s research and the team works in partnership with patients to understand what matters most to them and to involve them in research. The involvement of patients has also helped the team create an invaluable research resource with tissue and fluid samples and both clinical and quality-of-life data from women with endometriosis made available for ethically approved research. 

The EXPPECT team are pioneering new and innovative approaches to improve the diagnosis and treatment of endometriosis through academically led research and collaborations with industry. Examples of their current studies include the UK-wide multicentre NIHR-funded ESPriT2 trial, which will determine if surgical removal of superficial peritoneal endometriosis (SPE) is effective in the treatment of chronic pelvic pain.

The trial also aims to improve quality of life; reduce the use of hormones, analgesics and post-op pain; and improve reproductive outcomes.  The team is also investigating novel therapeutic approaches for endometriosis-associated pain using re-purposed existing treatments, such as dichloroacetate (EPiC trials) and cannabinoids (ENDOCAN trial). In addition to investigating new potential treatments, the team is also investigating a wide range of approaches to speed up and improve diagnosis, and to enable precision medicine approaches for the treatment of endometriosis.

Through research to identify new and novel biomarkers in blood and urine, and also using data-driven approaches using wearables such as smart watches together with AI, they hope to be able to identify new non-invasive markers to diagnose, stratify and monitor patients. For example, the smartwatch technology might be useful to assess different aspects of pelvic pain that sometimes women with endometriosis themselves might not be reporting (or be aware of), such as disturbed sleep and immobility. 

The team is committed to the goals of improving care for endometriosis patients and, with world-leading expertise in the field and cutting-edge research infrastructure provided through EXPPECT, it is well placed to achieve this. However, to fully realise this vision, collaboration with industry will also be key to maximise research potential through sharing of expertise, ideas, skills and resources.  

Professor Andrew Horne and Professor Philippa Saunders will be hosting the 15th World Congress on Endometriosis in Edinburgh from 3 to 6 May in 2023. Come and chat to us about collaboration at the Edinburgh Innovations stand.   

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