LI scientists developing new test for endometriosis

An experimental, noninvasive method of diagnosing endometriosis is being developed by Long Island scientists who hope their procedure will lead to earlier detection of a condition that affects nearly 200 million women worldwide.

Endometriosis is a baffling disorder in which tissue that normally forms the uterine lining is found outside the uterus, often in the pelvic region but virtually anywhere in the body. This wayward tissue is formally called lesions, but sometimes may be referred to as cysts, or even chocolate cysts. They implant themselves on the ovaries, in the bowel and throughout the lining of the pelvic area.

Scientists at the Feinstein Institute for Medical Research in Manhasset are working on a method of identifying endometriosis through a test involving the analysis of menstrual blood. The team has declared its experimental method a dramatic improvement over current diagnostic techniques that rely on invasive abdominal surgery.

“We culture cells from fresh menstrual blood,” said Dr. Christine N. Metz, a professor of molecular medicine at the Feinstein Institute, a division of the Northwell Health network.

Metz and her colleagues search for stem-cell-like cellular components, which are telltale markers of endometriosis.

“We found that these cells in the menstrual blood of women with endometriosis are very different from those of healthy women,” Metz said.

She and her Feinstein collaborators recently published their research in the journal, Molecular Medicine, and say these stem cell-like components are known as stromal fibroblasts.

The test is being refined by Feinstein scientists so that it can be performed with more streamlined equipment and not require large flasks or other bulky lab equipment, Metz said.

Many women delay diagnosis for five to 10 years because of medicine’s reliance on laparoscopic surgery to reach a definitive diagnosis, she said.

Women from throughout Long Island are participating in the experimental work under way at the Feinstein not only to help develop the test, Metz said, but to further the understanding of endometriosis.

“It’s great that we have a cadre of women who want to help other women,” Metz said. “About 30 to 40 percent of unexplained female infertility is caused by endometriosis.”

Endometriosis is an incurable condition marked by excruciating pain. Decades ago, Marilyn Monroe was said to have been afflicted. The lesions that implant throughout the body also respond to hormonal cues, Metz said, and bleed cyclically in sync with the uterine lining, which is shed monthly.

The condition can run in families, suggesting a strong genetic component. Although doctors recommend painkillers and birth control pills as methods of coping, there is no cure. Hysterectomy, a surgical procedure in which all or part of the uterus is removed, is a choice of last resort, Metz said.

Lena Dunham the former lead actress in the HBO series Girls recently revealed that she had a hysterectomy because of the pain associated with the disorder.

Dr. Peter Gregersen, director of the Robert S. Boas Center for Genomics and Human Genetics at the Feinstein Institute, said the new research is opening new windows into the understanding of endometriosis and how to effectively diagnose it.

“We need to apply this test to hundreds, if not thousands of patients,” he said.

In addition to stromal fibroblasts in the menstrual effluent, Gregersen said, natural killer cells, key immune system components, are part of the uterine endometrial environment. Women with endometriosis have substantially fewer natural killer cells compared with healthy women, he said.

Along with a reduction in those immune system cells, women with endometriosis have impaired decidualization, a process that prepares the uterus for embryo implantation, he said.