Endometriosis is a common condition where the lining of the uterus grows in other locations, such as the ovaries and the intestines. This disease is extremely painful and often associated with infertility. Despite the high prevalence of the disease (an estimated 10% of women deal with endometriosis during their reproductive years), this condition remains challenging to diagnose and treat. As a result, most treatments for the endometriosis are not curative and have a high number of associated side-effects. Unfortunately, very little is known about the disease at the molecular level, partially due to the lack of suitable experimental models needed to study the disease.
This is where research in bioengineering plays a roll. To provide some insight into this field, we checked in with one of our 2018/2019 WiRe fellows, Dr. Anna Stejskalová, whose research at the University of Münster focused on designing a 3D model of early endometrial lesions.
Anna is now studying the vaginal and cervical microbiome and their role in preterm birth at Harvard Wyss Institute. We are happy to have her back on the WiRe blog; for this interview we asked her a few questions regarding her work on Endometriosis and bioengineering.
How can research in the field of bioengineering in general contribute to a better understanding and treatment of endometriosis?
AS: Bioengineering approaches make it possible to model the disease Endometriosis in the laboratory. Endometriosis is characterized by the growth of endometrium that lines the womb in other parts of the body. It is unclear, how the endometrial tissue gets to these so called ectopic locations, but the leading hypothesis is that it implants there during menstruation when part of the menstrual effluent does not leave the body and flows back through the fallopian tubes to the peritoneal cavity. A typical bioengineered model would consist of a small number of patient-derived cells collected during an operation that would be otherwise disposed of. Such models can then be tailored to recapitulate specific aspects of the disease, such as the growth of endometrium in the abdomen, and to test which drugs potentially slow down or inhibit the disease.
What insights did you gain from your research during your time as a WiRe Fellow for the understanding of endometriosis?
AS: My background is in biomaterials and being awarded the WiRe fellowship enabled me to gain new skills in women’s health research, an area of research I am particularly interested in. As a WiRe fellow I was investigating how endometriosis-derived cells interact with the surrounding tissues which we modelled using extracellular matrix components normally present in these tissues such as collagen.
What ideas for therapeutic approaches can be derived from the findings for endometriosis?
AS: Part of developing drugs for a certain disease is to discover signaling pathways that are either upregulated or downregulated in the diseased tissue when compared to a healthy tissue. These altered pathways can then be targeted by drugs. One hurdle with this approach is, however, that a screening might reveal hundreds of potential targets most of which will not affect the course of the disease. Another equally important step is therefore to evaluate whether therapeutically interfering with the potential targets reduces some of the unwanted characteristics of the disease, such as the growth of the endometrium at ectopic (different parts of the body than the uterus) locations. This can be done either using animal models or ‘disease in a dish’ created from patient-derived cells. The experimental system we developed at WWU Munster uses cells from endometriosis patients and visually resembles endometrial lesions and responds to different treatments by, for example, growing or shrinking in size and can thus be used as an additional functional assay in the drug development pipeline.
A look into the future: What forms of treatment for endometriosis do you think will be possible in 10 years’ time?
AS: Endometriosis has been an enigmatic disease and the exact cause of the disease unfortunately still remains unknown. While finding a cure or even prevent the disease from occurring might still take some time, one really exciting approach pioneered in the UK is to focus on better understanding and treating endometriosis-related pain. While it does not cure the disease, such approach can have a real impact on the well-being of the affected women and enable them to have more control over their personal and working lives, as the endometriosis-related pain is frequently extremely debilitating.