Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology
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Journal of Translational Medicine Open Access
REVIEW
Endometriosis: current challenges in modeling a multifactorial disease of unknown etiology Helena Malvezzi1* , Eliana Blini Marengo2, Sérgio Podgaec1 and Carla de Azevedo Piccinato1*
Abstract Endometriosis is a chronic inflammatory hormone-dependent condition associated with pelvic pain and infertility, characterized by the growth of ectopic endometrium outside the uterus. Given its still unknown etiology, treatments usually aim at diminishing pain and/or achieving pregnancy. Despite some progress in defining mode-of-action for drug development, the lack of reliable animal models indicates that novel approaches are required. The difficulties inherent to modeling endometriosis are related to its multifactorial nature, a condition that hinders the recreation of its pathology and the identification of clinically relevant metrics to assess drug efficacy. In this review, we report and comment endometriosis models and how they have led to new therapies. We envision a roadmap for endometriosis research, integrating Artificial Intelligence, three-dimensional cultures and organ-on-chip models as ways to achieve better understanding of physiopathological features and better tailored effective treatments. Keywords: Endometriosis, Animal model, Drug efficacy, Organ-on-chip, Cell culture, Artificial intelligence Background: setting and disease Endometriosis is a reproductive age-associated disease [1, 2] that has become the target of intense investigation, as indicated by the increasing number of scientific papers published. In the last 10 years, indeed, more than 75% of endometriosis-related papers, appeared during that period according to Web of Science data. This surge of information directed to both laypersons and healthcare professionals improved the identification of symptoms, augmented the odds of correct diagnosis as well as the awareness of available medical treatment [3]. Worldwide epidemiological studies show a mean prevalence of 10% of endometriosis in the pre-menopausal population [4], with annual incidences in specific populations varying from 0.112% [5] to 0.72% [6]. The difficulties to reach the diagnosis comprise the need for clinical and surgical expertise to evaluate correctly the *Correspondence: [email protected]; [email protected] 1 Hospital Israelita Albert Einstein, São Paulo, SP 05652‑900, Brazil Full list of author information is available at the end of the article
clinical symptoms and to detect the presence of ectopic endometrial implants (so-called lesions) in the peritoneal cavity and on pelvic organs [7]. Although imaging methods such as transvaginal ultrasonography with bowel preparation and magnetic resonance are common diagnostic tools, the gold standard diagnostic method for endometriosis is still the histopathological analysis of lesions collected during laparoscopic surgery [8]. The etiopathogenesis of endometriosis is not known. However, there are theories on the origin of endometriotic lesions in the peritoneal cavity.
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