Revision as of 00:42, 19 October 2016

Background

What is endometriosis?

Endometriosis is generally characterized as the growth of tissue very similar to that of the inner lining of the uterus, the endometrium, growing elsewhere in the body. While it is similar in appearance, having the same glands as the correctly placed (eutopic) endometrium, the tissue behaves differently in response to hormones, as it cannot be shed at the end of the menstrual cycle. These poorly placed growths, called lesions, cause extreme pain, especially during an affected woman's period. The experience even has a name: "killer cramps." The pain may be related to the heightened inflammation around the lesions, as well as the scar tissue that the body creates to cover them. This scar tissue can have a devastating effect on the body, as it causes adhesions between abdominal organs, distorting their shape and affecting their function.
Symptoms of endometriosis include debilitating cramps, long (7+ days) heavy periods, fatigue, gastrointestinal disorders, chronic pelvic pain, pain during sexual activities, lost pregnancies, and infertility.

In summary, endometriosis is an incredibly painful, chronic disease that too often goes untreated. For a more detailed look at endometriosis, below is a video from the Endometriosis Foundation of America

Who gets endometriosis?

Endometriosis affects 1 in 10 women, including well-known figures like Daisy Ridley of Star Wars: Episode VIII and presidential nominee Hillary Clinton.

Endometriosis can appear when a person reaches puberty, as it is a very hormone-dependent disease. It's unknown exactly what causes endometriosis, though there are a number of theories, including retrograde menstruation, where tissue that is normally expelled during menses instead flows backwards and then cells embed in the surrounding tissue, or fetal development, which is supported by the fact that a number of infant autopsies have shown the signs of endometriosis. In the latter case, the misplaced tissue's disease characteristics would be activated by puberty, while the former may happen by chance at any point after puberty. There may also be a genetic component to endometriosis, as studies have found that girls with a close relative affected by endometriosis are 5-7X more likely to have it themselves.

Although endometriosis can affect any uterus-owning person after puberty, it's often thought to be more prevalent in older women, but this is a myth. Endometriosis can affect a girl immediately after puberty, but this myth may have spread because of the immense delay between the onset of symptoms and an accurate diagnosis. Affected women can wait, on average, between 7 and 10 years for an accurate diagnosis for their chronic pain.

How is endometriosis diagnosed and treated?

The diagnosis process begins with suspicion based on a description of symptoms like extended, painful menses and gastrointestinal discomfort. At this point, a woman might be prescribed low-level hormonal therapy in the form of a contraceptive pill, or be told to simply take pain relieving medications like ibuprofen. If painful symptoms persist, the situation becomes more complicated. The only totally accurate diagnostic method for endometriosis is a combination of laparoscopic surgery, to get sight of ectopic lesions of endometrial tissue, followed by obtaining a sample of that tissue and then sending it for pathologic confirmation in a lab. Laparoscopic surgery is no small procedure, and symptoms of endometriosis often very closely follow puberty. A doctor is thus unlikely to send a 14-year-old girl for diagnostic surgery, which may turn up nothing, when there are a variety of other, more easily diagnosed conditions that may also cause chronic abdominal pain. Beyond that, the steps toward laparoscopic diagnosis aren't always taken because providers underestimate the symptoms that a patient is presenting to them. Unfortunately, there is a stigma around menstrual disorders that is hard to get past.

This leads to the average 7- to 10- year wait between the onset of symptoms and a final diagnosis of endometriosis. However, the current diagnostic method is also lacking in accuracy because it assumes that endometriotic lesions will always be visible when in fact endometriosis can exist microscopically and still cause pain.

Once endometriosis is diagnosed, the most effective treatment is deep tissue excision to remove the growths of ectopic endometrium. Unfortunately, small lesions can be missed, causing further pain and requiring more surgery. Until recently, total hysterectomy (removal of uterus and ovaries) was used as a treatment for endometriosis, but it has not been proven effective and is going out of practice, as pain from endometriosis would often continue even after this extreme surgery.

We at MIT iGEM believe that if endometriosis could be diagnosed sooner, it would not give the disease as much time to progress, and it would alleviate years of chronic pain and distress from not knowing the cause. This led us to find a number of proven molecular markers of endometriosis that persist in endometrial biopsies that could be sensed with synthetic biology to give a diagnostic quickly and easily.

How can we help with synthetic biology?

Heyo what about molecular markers?
Link to those things experiments