Biomarker Aids Personalized Treatment for Endometriosis

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Highlights:

• Measurement of progesterone receptor (PR) status at sites of endometriosis lesions can predict whether a woman will benefit from first-line treatment namely hormone therapy or not
• Endometriosis is a fairly common condition that affects women predominantly in the reproductive age group (16 to 50 years) causing extremely painful periods and inability to conceive
• Knowing progesterone receptor status can help provide personalized treatment with best results and lower chances of disease recurrence

Estimating the levels of progesterone receptors at the sites of endometriosis by specialized histological techniques can predict if a woman will respond to first-line hormone treatment or not.

The study was led by A. Flores, M.D., of the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale University, in New Haven, Connecticut, and the findings of the study appear in the Endocrine Society's publication, Journal of Clinical Endocrinology Metabolism.

‘Measuring progesterone receptor levels in patients with endometriosis can help provide customized and targeted therapy with an improved patient response and reduced chances of disease recurrence.’

According to Flores, "Receptor status in endometriosis could be used in a similar way to how estrogen receptor and progesterone receptor status is used in breast cancer for personalizing treatment options Such an approach to endometriosis management could better determine which medication each individual patient responds to and minimize delays in providing the optimal medical therapy."

What is Endometriosis?

Endometriosis is a debilitating condition that affects women in the reproductive age group that causes extremely painful periods and the inability to conceive. In this condition, the lining of the uterus or endometrium is found in sites outside the uterus as well, such as ovary, tubes, and pelvis. These endometrial tissues also bleed during menstruation causing severe lower abdominal pain and discomfort. It is a common condition affecting nearly 10 percent of women between 16 to 50 years and can severely affect the quality of their life.

The main forms of treatment include progestin-based hormone therapies and surgery. Unfortunately, response to hormonal treatment is highly variable and recurrence rates of the condition remain high

Measuring Progesterone Receptor (PR) Status in Endometriosis
In this retrospective cohort study, the study team analyzed progesterone receptor status in 52 women diagnosed with endometriosis and found that levels of progesterone receptor could predict a woman's responsiveness to hormone based therapy

What is PR and How is it Important in Endometriosis?

• The hormone progesterone mediates its effects by interacting with progesterone receptors present in the tissues
• However, the expression of progesterone receptors in endometriosis lesions vary greatly in different patients. Unfortunately, hormone-based therapies do not take into consideration these differing rates of PR expression when treating the condition
• Endometriosis lesions are known to be estrogen-dependent meaning they increase in size and number in response to estrogen hormone. However, they decrease in size and number in response to progesterone. Thus, progestin based hormone treatment is a preferred form of treatment in endometriosis.
• Measuring the status of PR in women before starting hormone therapy can therefore, predict whether or not they will respond to hormone treatment

Says Flores "Receptor status in endometriosis could be used in a similar way to how the estrogen receptor and progesterone receptor status is used in breast cancer for personalizing treatment options. Such an approach to endometriosis management could better determine which medication each individual patient responds to and minimize delays in providing the optimal medical therapy."

Effects of Progesterone in Endometriosis

The exact manner in which progesterone works in women with endometriosis is not fully clear, but the following mechanisms are suggested:

• Reduces pain and discomfort associated with endometriosis by reducing inflammation
• Suppresses the growth of new endometriosis lesions and destroys existing lesions
• Prevents menstruation and thus, controls the associated symptoms

Conclusion

Although more research is needed to confirm and validate that hormone receptor status can predict response to treatment, the study helps clinicians to choose the best possible treatment that will offer women with endometriosis the best outcome with least side effects and lesser chances of disease recurrence based on her progesterone receptor status

According to Flores, "Examining progesterone receptor status in endometriotic lesions may allow for a novel, targeted approach to treating endometriosis,"

References:

1. Progesterone Receptor Status Predicts Response to Progestin Therapy in Endometriosis - (https:academic.oup.com/jcem/advance-article-abstract/doi/10.1210/jc.2018-01227/5139742?redirectedFrom=fulltext)
2. Reproductive functions of progesterone receptors - (https:www.ncbi.nlm.nih.gov/pubmed/12017551)
3. Progestins - (http://endometriosis.org/treatments/progestins/)

Source: Medindia

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