Endometriosis is defined as endometrial-like tissue outside the uterine cavity. It is a chronic inflammatory disease dependent on estrogen causing pain and infertility in about 10% of women of reproductive age. Currently, treatment consists of medical and surgical therapies. However, treatments are based on analgesics and hormone treatments. To date, none of the medical treatments have managed to cure the disease and symptoms reappear as soon as the medication is discontinued. Therefore, the search for new therapies is studied in order to improve the quality of affected women. Study more about non-hormonal treatment for endometriosis in the following article!
Resveratrol to non-hormonal treatment for endometriosis
Resveratrol is a natural polyphenol with antiproliferative and anti-inflammatory action. Growing evidence suggests that it has antineoplastic, anti-inflammatory and antioxidant properties, as well as inhibition of cell growth and induction of apoptosis. Currently, resveratrol is widely used as a dietary supplement, but has not yet been approved for a specific clinical application and its long-term safety has not been established. Treatment with resveratrol resulted in a reduction in both the number and size of endometriosis implants and a reduction in the invasion of endometrial cells in a mouse model.
In addition, endometriosis lesions exposed to resveratrol showed an increase in apoptotic activity and a decrease in the invasion capacity of human endometrial cells. However, the precise mechanisms by which resveratrol interacts with endometrial cells are still unknown. Further studies are needed to evaluate the effects of resveratrol on endometrial tissues of patients with endometriosis.
Retinoic acid
When non-hormonal treatment for endometriosis is evaluated, retinoic acid is a powerful modulator of gene transcription involved in cell growth, differentiation and apoptosis. The absorption, metabolism and activity of retinoic acids are reduced in endometriosis implants, weakening estrogen metabolism and increasing resistance to apoptosis. The retinoic acid signaling pathway is a promising new target for the treatment of endometriosis. Fenretinide is a synthetic analogue of the retonoid that promotes apoptosis and is less toxic than other retonoids. The effect of fenretinide treatment on endometrial cells in vivo demonstrated a significant reduction in the total number of endometrial cells and the expression of antigens. Fenretinide also reduces the activity of aromatase in vitro. However, retonoids are teratogenic molecules, so their use in patients of reproductive age requires a combination with contraceptives.
Quercetin to non-hormonal treatment for endometriosis
Endometriosis is associated with increased oxidative stress and inflammation. Among antioxidant defenses, nuclear erythroid factor 2 (Nrf2) is a transcription factor involved in the positive regulation of several antioxidant enzymes, such as quinone oxidoreductase (NQO1), glutamate cysteine ligase (GCL) and heme oxygenase-1 (HO-1). The expression of the Nrf2 and GCL genes is reduced in the endometrium of patients with endometriosis. The activity of the mammalian target of rapamycin (mTOR), a potent inhibitor of autophagy, is significantly increased in the endometrium of patients with endometriosis. Quercetin is a natural flavonoid contained in various fruits and vegetables. It has anti-inflammatory, antioxidant, antitumor, antidiabetic, cardioprotective and hepatoprotective activities. In addition, it can increase autophagy and apoptosis.
Clinical practice
Numerous molecules targeting angiogenesis, fibrosis, migration, apoptosis and signaling processes involved in endometriosis are currently under investigation. While most of them yielded good in vitro results, extended in vivo studies are still needed. Non-coding RNAs are emerging as key factors in the development of human diseases and play an important role in the pathogenesis of endometriosis. Several miRNAs are involved in endometriotic cells, such as migration, proliferation and proliferation resistance.
referencesBody
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Article: Endometriosis
– Brichant G, Laraki I, Henry L, Munaut C, Nisolle M. New Therapeutics in Endometriosis: A Review of Hormonal, Non-Hormonal, and Non-Coding RNA Treatments. Int J Mol Sci
. 2021;22(19):10498. Published 2021 Sep 28. Doi:10.3390/ijms221910498
