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Molecular basis for treating endometriosis with aromatase inhibitors
S E Bulun1, K M Zeitoun, K Takayama
1Department of Obstetrics and Gynecology, University of Illinois at Chicago, 60612, USA. sbulun@uic.edu
Abstract:
Although treatment of one unusually aggressive case of postmenopausal endometriosis with an aromatase inhibitor has been strikingly successful, large clinical trials are required to establish whether aromatase inhibitors will have a significant role in the medical management of endometriosis. Introduction of aromatase inhibitors into the treatment of endometriosis underscores the importance of basic research leading to the development of novel strategies in reproductive disorders. It was shown earlier that aromatase activity was not detectable in normal endometrium. Aromatase, however, is expressed inappropriately in endometriosis and stimulated by prostaglandin E2. Aromatase activity gives rise to local biosynthesis of oestrogen, which, in turn, stimulates prostaglandin E2 production, thus establishing a positive feedback cycle. This favours accumulation of oestrogen and prostaglandins in endometriosis, which is an inflammatory disorder dependent on oestrogen for growth.
Insights
Aromatase inhibitors show promise for treating aggressive endometriosis by blocking estrogen production. Further clinical trials are needed to confirm their role in endometriosis management.
Area of Science:
- Reproductive Endocrinology
- Oncology
- Inflammation Research
Background:
- Aromatase activity is typically undetectable in normal endometrium.
- Aromatase is inappropriately expressed in endometriosis and stimulated by prostaglandin E2.
- This creates a positive feedback loop, increasing local estrogen and prostaglandin levels.
Purpose of the Study:
- To investigate the potential role of aromatase inhibitors in managing endometriosis.
- To highlight the importance of basic research in developing novel reproductive disorder treatments.
Main Methods:
- Case study of an aggressive postmenopausal endometriosis treated with an aromatase inhibitor.
- Review of existing research on aromatase activity in normal and endometriotic tissues.
Main Results:
- Striking success was observed in one case of postmenopausal endometriosis treated with an aromatase inhibitor.
- Aromatase activity in endometriosis contributes to local estrogen biosynthesis and prostaglandin E2 production.
Conclusions:
- Aromatase inhibitors represent a potential novel therapeutic strategy for endometriosis.
- Large clinical trials are necessary to establish the efficacy and safety of aromatase inhibitors for endometriosis treatment.