Endometriose

In: Der Gyn�kologe · 2004 · vol. 37(2) , pp. 116–122 · doi:10.1007/s00129-003-1478-3 · W3193023237
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This paper reviews current and potential future therapeutic strategies for endometriosis, including hormonal therapies, matrix metalloproteinase inhibitors, antiangiogenic agents, and cytokine inhibition.

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This paper (a review) discusses endometriosis as a common cause of infertility and chronic pain, focusing on emerging therapeutic concepts aimed at improving quality of life. It outlines combined operative and drug-based management, highlighting several mechanistic strategies including inhibiting estradiol biosynthesis, using selective estradiol receptor modulators, and applying selective progesterone receptor modulators with antiproliferative effects. It further describes approaches targeting implantation via matrix metalloproteinase inhibition, limiting angiogenesis through antiangiogenic substances, and reducing cytokine synthesis/secretion using anti-inflammatory drugs, antibodies, or binding proteins. As a narrative review, it does not provide a specific study population, primary outcomes, or an explicit limitation beyond summarizing existing therapeutic directions. This paper is centrally about endometriosis — it reviews molecularly guided therapeutic strategies in endometriosis.

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Zusammenfassung Endometriose ist ein häufiger Grund für unerfüllten Kinderwunsch und chronische Schmerzen. Die Erforschung neuer Therapiekonzepte dient in erster Linie der Verbesserung der Lebensqualität. Es ist denkbar, dass neue, spezifisch wirksame Substanzen auf der Basis molekularbiologischer Forschung in Zukunft dem Therapieziel der Heilung zumindest nahe kommen. Der klassische Weg der Therapie wird bisher häufig kombiniert operativ und medikamentös beschritten. Die Hemmung der Östradiolsynthese galt bislang als wichtigste Therapieoption. Mit selektiven Östradiolrezeptormodulatoren kann zudem die Wirkung des Östradiols deutlich gehemmt werden. Auch selektive Progesteronrezeptormodulatoren sind bei hoher Spezifität antiproliferativ wirksam. Mit der Hemmung von Matrixmetalloproteinasen wird die Implantation endometrioider Herde verhindert. Die Ausbildung neuer Gefäße, die die Proliferation ermöglichen, wird möglicherweise durch antiangiogenetisch wirksame Substanzen verhindert. Eine Hemmung der Synthese und Sekretion von Zytokinen wird mit Hilfe von antiinflammatorischen Substanzen, Antikörpern oder Bindungsproteinen angestrebt. Abstract Endometriosis is a common cause for infertility and chronic pain. Investigations for new therapeutic concepts are mainly aimed to achieve better life quality. New specific substances, based on molecular biological investigations, may be helpful to approach the goal of healing patients. The most common therapeutic concept is to combine operative treatment with drug therapy. The main therapeutic option today is to inhibit the estradiol biosynthesis. In addition, selective estradiol receptor modulators may inhibit the effects of estradiol. Also, selective progesterone receptor modulators are acting specifically against the proliferating potential of endometriosis. While inhibiting matrix metalloproteinases, the implantation of endometriotic tissue can be blocked. Sprouting of new vessels, which provides the potential of proliferation, could possibly be blocked by antiangiogenic substances. Using anti-inflammatory drugs, antibodies or binding proteins, the synthesis and secretion of cytokines could be inhibited. Similar content being viewed by others Literatur Bulun SE, Zeitoun KM, Takayama K, Simpson E, Sasano H (2000) Aromatase as a therapeutic target in endometriosis. Trends Endocrinol Metab 11: 22–27 Chwalisz K (2003) New selective progesterone receptor modulators (SPRMs) in the treatment of endometriosis. 19th ESHRE Annual Meeting 87–88 Dabrosin C, Gyorffy S, Margetts P, Ross C and Gauldie J (2002) Therapeutic effect of angiostatin gene transfer in a murine model of endometriosis. Am J Pathol 161: 909–918 D’Hooghe TM (2003) Immunomodulators and aromatase inhibitors: are they the next generation of treatment for endometriosis? 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Fertil Steril 72: 961–969 Interessenkonflikt: Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Finas, D., Friedrich, M., Diesing, D. et al. Endometriose. Gynäkologe 37, 116–122 (2004). https://doi.org/10.1007/s00129-003-1478-3 Issue date: DOI: https://doi.org/10.1007/s00129-003-1478-3

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