ASRM2008: Endometriosis at the 64th Annual Meeting of the ASRM

San Francisco, 12 NOVEMBER 2008

The 64th Annual Meeting of the ASRM had more emphasis than ever before on endometriosis, kicking off the scientific programme at San Francisco’s Congress Centre, with not one – but two – post graduate (PG) courses on endometriosis.

ASRM 2008The meeting brought together 10,160 delegates, 423 of which are members of the EndoSIG.

In addition to invited speakers there were eight oral abstracts on endometriosis and 41 posters.

Sunday’s PG course, addressing “Diagnosis and treatment”, was a joint effort with ESHRE and chaired by Thomas D’Hooghe, Charles Chapron, and Stephen Kennedy. The course discussed how new insights into the pathogenesis of endometriosis, including genetics, and the ontogenesis of endometriosis associated pain and new technological advances in proteomics have resulted in novel approaches to the non-invasive diagnosis and non-hormonal medical treatment of endometriosis.

On Saturday the topic was “Pathogenesis and research” chaired by Serdar Bulun, Asgi Fazleabas, Hugh Taylor, and Robert Taylor. This course offered a systematic review of the pathogenesis and treatment of endometriosis, and assessed novel concepts of the aetiology of endometriosis, and discussed the use of experimental therapies or off-label medications for patients not benefiting from current treatment options.

The ESHRE Guideline for the diagnosis and treatment of endometriosis was presented; according to the best available evidence, the annual estimated cost for endometriosis appears to be higher than the cost for Crohn’s disease. The relevance to diagnose minimal-mild endometriosis, and the place of surgical treatment were subjects for debate. The course benefited from lively interactions between speakers and audience, was well attended by about 70 registrants. The organisers were later informed by the ASRM Board that the course had been rated very highly by the participants.

From nerve fibres to tomatoes

Picture of Dr Attila Bokor
Dr Attila Bokor, Semmelweis University Budapest, Hungary and Leuven University Hospital, Belgium

The paper by Attila Bokor et al, Leuven University Hospital (Belgium), was short listed for the “In-training award for research”: Endometrial multiple small sensory nerve fibres in minimal and mild endometriosis.

In a prospective pilot study the authors were able to demonstrate that the functional layer of the endometrium of women with early stage endometriosis contains a higher density of small sensory nerve fibres compared to women with a normal pelvis, and that this difference can lead to the development of a semi-invasive diagnostic test for endometriosis.

A poster by T Dbouk et al, Wayne State University, Chicago (USA), hit the world press with their conclusion that lycopene, a powerful antioxidant, substantially reduces levels of adhesion-related markers in normal peritoneal and adhesion fibroblasts.

TomatoesReactive oxygen and nitrogen species play an important role in the development of the adhesion phenotype, and the team had previously identified phenotypic differences between fibroblasts isolated from normal peritoneum and adhesion tissues from the same patients. Specifically, adhesion fibroblasts manifested higher type I collagen, vascular endothelial growth factor (VEGF), and transforming growth factor-beta1 (TGF-ß1).

The results of their prospective experimental study may provide the molecular basis for therapeutic intervention for the reduction of fibrosis – which is a more “sober” conclusion to that of the press, which hailed a “cure for endometriosis if you eat more tomatoes”.

Interactive sessions between two SIGs

The Endometriosis SIG and Reproductive Immunology SIG had teamed up to develop an interactive session, targeted at both scientists and practitioners, to evaluate the role that the immune system plays in the pathogenesis and clinical manifestations of endometriosis.

The session was hosted by Kathy Sharpe-Timms, Thomas D’Hooghe and Breton Barrier, and not only did it spill out of the room in terms of volume of delegates, it could also have continued for much longer than the allocated time because of the “interactivity” which ensued following the faculty’s presentations.

The main issues raised were:

  • The immunology of endometriosis is a complex web with many pathways and major redundancy
  • Endometriosis-related inflammation is a logical target for biomarker discovery
  • Endometriosis-related inflammation is a logical target for new drug development, but so far not successful, partially related to concerns about side effects.

The ASRM EndoSIG gets basic

Picture of Professor Kathy Sharpe-Timms
Professor Kathy Sharpe-Timms, ASRM EndoSIG Chair

The ASRM Endometriosis SIG, formally recognised this year, also held its first oral platform session including basic and translational research chaired by Scott Lucidi and Kathy Sharpe-Timms. Highlights included:

  • Dependence on dendritic cells for the establishment of endometriosis in a mouse model
  • Ectopic endometrial cell COX-2 and PGE2 production induces macrophage inhibiting factor (MIF) which feeds back to endometriotic lesions playing a role in oestrogen production in endometriosis
  • Endometriosis alters peripheral expression of T-Reg cells in a non-human primate model
  • Peritoneal fluid from endometriosis inhibit mouse pre-implanation embryo development and alter the concentrations of EGF and IGF-1 in the culture media
  • Eutopic endometrial morphological and biochemical heterogeneity is observed in Stages I – III while Stage IV is associated failed endometrial maturation elicited by a glycan mediated mechanism

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