Our Summary

This research paper is about endometriosis, a painful disease affecting many women and transgender men. Current treatments don’t work well for a lot of people, so the researchers are looking for new ways to treat this disease. One way they’re looking at is through something called CGRP, which is a kind of chemical that nerves release, and that is involved in the communication between the nervous and immune systems.

The researchers noticed that people with endometriosis often also have migraines, and that the immune system and inflammation are really important in endometriosis. So, they decided to study the role of CGRP in endometriosis. Using samples from eight endometriosis patients and a mouse model of the disease, they found that the disease lesions (damaged tissue) in both mice and humans contain CGRP and a related molecule (RAMP1).

In the mice, getting rid of the nerves that release CGRP reduced pain, the number of certain immune cells, and the size of the lesions. This suggests that these nerves and the CGRP they release contribute to the growth and pain of endometriosis lesions.

The researchers also found that CGRP changes the behavior of macrophages (a type of immune cell) in a way that supports endometriosis. When macrophages were stimulated with CGRP, they were less able to remove dead cells and they supported the growth of endometrial cells (the kind of cells found in endometriosis lesions).

The researchers then treated mice with endometriosis lesions using drugs that block CGRP and RAMP1. These drugs reduced pain and lesion size in the mice. These results suggest that targeting CGRP and RAMP1 might be a new way to treat endometriosis in people. Furthermore, these drugs are already approved by the US Food and Drug Administration, which could potentially make it easier to start using them in patients.

FAQs

  1. What is the role of CGRP-mediated neuroimmune communication in endometriosis?
  2. How does the CGRP/RAMP1 blockade provide relief in a mouse model of endometriosis?
  3. Can drugs that block CGRP-RAMP1 signaling be a potential treatment for endometriosis in humans?

Doctor’s Tip

A helpful tip a doctor might tell a patient about uterine ablation is to follow post-procedure instructions carefully, including taking any prescribed pain medication and avoiding strenuous activities for a certain period of time. It is also important to attend all follow-up appointments to monitor healing and ensure the procedure was successful in reducing symptoms.

Suitable For

Patients with endometriosis who have not responded well to current treatments, patients with severe pain and discomfort related to endometriosis, and patients who are looking for non-hormonal and non-opioid treatment options may be recommended uterine ablation as a potential therapy.

Timeline

Before uterine ablation:

  1. Patient experiences symptoms of endometriosis such as pelvic pain, heavy periods, and infertility.
  2. Patient undergoes diagnostic tests such as pelvic exams, ultrasounds, and possibly laparoscopic surgery to confirm the presence of endometriosis.
  3. Patient may try various treatments such as hormonal therapies, pain medications, or surgery to manage their symptoms.

After uterine ablation:

  1. Patient undergoes uterine ablation procedure to destroy the endometrial lining of the uterus.
  2. Patient may experience some cramping and spotting after the procedure, but this typically resolves within a few days.
  3. Patient’s symptoms of endometriosis, such as pelvic pain and heavy periods, are significantly reduced or eliminated.
  4. Patient may need to follow up with their healthcare provider for monitoring and management of any remaining symptoms or complications.

What to Ask Your Doctor

  1. What is uterine ablation and how does it work to treat conditions like heavy menstrual bleeding or endometriosis?
  2. What are the potential risks and side effects of uterine ablation?
  3. How long does it take to recover from uterine ablation and what can I expect during the recovery process?
  4. Are there any restrictions or limitations on activities after undergoing uterine ablation?
  5. Will uterine ablation affect my fertility or ability to become pregnant in the future?
  6. What is the success rate of uterine ablation in treating my specific condition?
  7. Are there any alternative treatments or therapies that I should consider before deciding on uterine ablation?
  8. How often will I need to follow up with you after undergoing uterine ablation?
  9. Are there any long-term effects or complications associated with uterine ablation that I should be aware of?
  10. Can you provide me with more information about the potential benefits and risks of uterine ablation based on my individual health history and condition?

Reference

Authors: Fattori V, Zaninelli TH, Rasquel-Oliveira FS, Heintz OK, Jain A, Sun L, Seshan ML, Peterse D, Lindholm AE, Anchan RM, Verri WA Jr, Rogers MS. Journal: Sci Transl Med. 2024 Nov 6;16(772):eadk8230. doi: 10.1126/scitranslmed.adk8230. Epub 2024 Nov 6. PMID: 39504351