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Mardon AK, Whitaker L, Farooqi T, Girling J, Henry C, Ee C, Tewhaiti-Smith J, Armour M. Investigational drugs for the treatment of dysmenorrhea. Expert Opin Investig Drugs 2024; 33:347-357. [PMID: 38436301 DOI: 10.1080/13543784.2024.2326627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Dysmenorrhea is the most common cause of gynecological pain among women that has considerable impact on quality of life and psychosocial wellbeing. Non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal therapies are most commonly used to treat dysmenorrhea. However, given these drugs are often associated with bothersome side effects and are less effective when there is an underlying cause contributing to dysmenorrhea (e.g. endometriosis), a patient-centered approach to managing dysmenorrhea is important. Various new drugs are currently being investigated for the treatment of primary and secondary dysmenorrhea. AREAS COVERED This review provides an updated overview on new therapeutic targets and investigational drugs for the treatment of primary and secondary dysmenorrhea. The authors describe the clinical development and implications of these drugs. EXPERT OPINION Among the investigative drugs discussed in this review, anti-inflammatories show the most promising results for the treatment of dysmenorrhea. However, given some trials have considerable methodological limitations, many drugs cannot be currently recommended. Research focused on understanding the mechanisms involved in menstruation and its associated symptoms will be important to identify new therapeutic targets for dysmenorrhea. Further robust clinical trials are required to better understand the efficacy and safety of investigational drugs for treating primary and secondary dysmenorrhea.
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Affiliation(s)
- Amelia K Mardon
- NICM Health Research Institute, Western Sydney University, NSW Australia; IIMPACT in Health, University of South Australia, Australia
| | - Lucy Whitaker
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, UK
| | - Toobah Farooqi
- NICM Health Research Institute, Western Sydney University NSW, Australia
| | - Jane Girling
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Claire Henry
- Department of Surgery & Anaesthesia, University of Otago Wellington Aotearoa, New Zealand
| | - Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Australia
| | | | - Mike Armour
- Reproductive Health, NICM Health Research Institute, Western Sydney University, Australia
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Forteza MJ, Berg M, Edsfeldt A, Sun J, Baumgartner R, Kareinen I, Casagrande FB, Hedin U, Zhang S, Vuckovic I, Dzeja PP, Polyzos KA, Gisterå A, Trauelsen M, Schwartz TW, Dib L, Herrmann J, Monaco C, Matic L, Gonçalves I, Ketelhuth DFJ. Pyruvate dehydrogenase kinase regulates vascular inflammation in atherosclerosis and increases cardiovascular risk. Cardiovasc Res 2023; 119:1524-1536. [PMID: 36866436 PMCID: PMC10318388 DOI: 10.1093/cvr/cvad038] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
AIMS Recent studies have revealed a close connection between cellular metabolism and the chronic inflammatory process of atherosclerosis. While the link between systemic metabolism and atherosclerosis is well established, the implications of altered metabolism in the artery wall are less understood. Pyruvate dehydrogenase kinase (PDK)-dependent inhibition of pyruvate dehydrogenase (PDH) has been identified as a major metabolic step regulating inflammation. Whether the PDK/PDH axis plays a role in vascular inflammation and atherosclerotic cardiovascular disease remains unclear. METHODS AND RESULTS Gene profiling of human atherosclerotic plaques revealed a strong correlation between PDK1 and PDK4 transcript levels and the expression of pro-inflammatory and destabilizing genes. Remarkably, the PDK1 and PDK4 expression correlated with a more vulnerable plaque phenotype, and PDK1 expression was found to predict future major adverse cardiovascular events. Using the small-molecule PDK inhibitor dichloroacetate (DCA) that restores arterial PDH activity, we demonstrated that the PDK/PDH axis is a major immunometabolic pathway, regulating immune cell polarization, plaque development, and fibrous cap formation in Apoe-/- mice. Surprisingly, we discovered that DCA regulates succinate release and mitigates its GPR91-dependent signals promoting NLRP3 inflammasome activation and IL-1β secretion by macrophages in the plaque. CONCLUSIONS We have demonstrated for the first time that the PDK/PDH axis is associated with vascular inflammation in humans and particularly that the PDK1 isozyme is associated with more severe disease and could predict secondary cardiovascular events. Moreover, we demonstrate that targeting the PDK/PDH axis with DCA skews the immune system, inhibits vascular inflammation and atherogenesis, and promotes plaque stability features in Apoe-/- mice. These results point toward a promising treatment to combat atherosclerosis.
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Affiliation(s)
- Maria J Forteza
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Martin Berg
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Andreas Edsfeldt
- Cardiovascular Research Translational Studies, Clinical Research Centre, Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 20 502, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21 428, Malmö, Sweden
- Wallenberg Center for Molecular Medicine, Lund University, Jan Waldenströms gata 35, 20 502, Malmö, Sweden
| | - Jangming Sun
- Cardiovascular Research Translational Studies, Clinical Research Centre, Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 20 502, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21 428, Malmö, Sweden
| | - Roland Baumgartner
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Ilona Kareinen
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Felipe Beccaria Casagrande
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Ulf Hedin
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Song Zhang
- Mayo Clinic Metabolomics Core, Mayo Clinic, 200, First St. SW Rochester, MN 55905, USA
- Department of Cardiovascular Medicine, Mayo Clinic, 200, First St. SW Rochester, MN 55905, USA
| | - Ivan Vuckovic
- Mayo Clinic Metabolomics Core, Mayo Clinic, 200, First St. SW Rochester, MN 55905, USA
| | - Petras P Dzeja
- Department of Cardiovascular Medicine, Mayo Clinic, 200, First St. SW Rochester, MN 55905, USA
| | - Konstantinos A Polyzos
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Anton Gisterå
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Mette Trauelsen
- Section for Metabolic Receptology, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen, Denmark
| | - Thue W Schwartz
- Section for Metabolic Receptology, Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3A, 2200, Copenhagen, Denmark
| | - Lea Dib
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Dr, Headington, Oxford OX3 7FY, UK
| | - Joerg Herrmann
- Department of Cardiovascular Medicine, Mayo Clinic, 200, First St. SW Rochester, MN 55905, USA
| | - Claudia Monaco
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Dr, Headington, Oxford OX3 7FY, UK
| | - Ljubica Matic
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
| | - Isabel Gonçalves
- Cardiovascular Research Translational Studies, Clinical Research Centre, Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 35, 20 502, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Carl-Bertil Laurells gata 9, 21 428, Malmö, Sweden
| | - Daniel F J Ketelhuth
- Center for Molecular Medicine, Department of Medicine, Solna, Karolinska University Hospital, Karolinska Instutet,BioClinicum, Solnavägen 30, Solna, 17 164, Stockholm, Sweden
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, J.B. Winsløws vej 21, 5000 Odense, Denmark
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Abstract
Endometriosis affects approximately 190 million women and people assigned female at birth worldwide. It is a chronic, inflammatory, gynecologic disease marked by the presence of endometrial-like tissue outside the uterus, which in many patients is associated with debilitating painful symptoms. Patients with endometriosis are also at greater risk of infertility, emergence of fatigue, multisite pain, and other comorbidities. Thus, endometriosis is best understood as a condition with variable presentation and effects at multiple life stages. A long diagnostic delay after symptom onset is common, and persistence and recurrence of symptoms despite treatment is common. This review discusses the potential genetic, hormonal, and immunologic factors that lead to endometriosis, with a focus on current diagnostic and management strategies for gynecologists, general practitioners, and clinicians specializing in conditions for which patients with endometriosis are at higher risk. It examines evidence supporting the different surgical, pharmacologic, and non-pharmacologic approaches to treating patients with endometriosis and presents an easy to adopt step-by-step management strategy. As endometriosis is a multisystem disease, patients with the condition should ideally be offered a personalized, multimodal, interdisciplinary treatment approach. A priority for future discovery is determining clinically informative sub-classifications of endometriosis that predict prognosis and enhance treatment prioritization.
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Affiliation(s)
- Andrew W Horne
- EXPPECT Edinburgh and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Stacey A Missmer
- Michigan State University, Grand Rapids, MI, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Assaf L, Eid AA, Nassif J. Role of AMPK/mTOR, mitochondria, and ROS in the pathogenesis of endometriosis. Life Sci 2022; 306:120805. [PMID: 35850246 DOI: 10.1016/j.lfs.2022.120805] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 12/19/2022]
Abstract
Endometriosis is the presence of endometrial tissue outside the uterine cavity usually in the ovaries, fallopian tube, and pelvic cavity. It's a chronic enigmatic gynecological condition associated with dysmenorrhea, dyspareunia, pelvic pain, and infertility. Endometriosis lesions exist in a unique microenvironment characterized by increased concentrations of hormones, inflammation, and oxidative stress. This environment promotes cell survival through the binding of membrane receptors and subsequent cascading activation of intracellular kinases that stimulate a cellular response. In endometriosis, well-established signaling pathways, mTOR and AMPK, are altered via steroid hormones and other factors to promote cell growth, migration, and proliferation. This is accompanied by dysfunction in the mitochondria that increase energy production to sustain proliferation demands consequently leading to reactive oxygen species overproduction. This review aims to summarize the role of altered mTOR/AMPK signaling pathway, mitochondrial dysfunction, and reactive oxygen species overproduction along with providing therapeutic and diagnostic approaches. Highlighting these factors would provide a better understanding to reach a coherent theory for the pathogenesis of endometriosis.
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Affiliation(s)
- Lama Assaf
- Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon; AUB Diabetes, American University of Beirut, Beirut, Lebanon
| | - Assaad A Eid
- Department of Anatomy, Cell Biology, and Physiological Sciences, Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon; AUB Diabetes, American University of Beirut, Beirut, Lebanon.
| | - Joseph Nassif
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
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Gołąbek-Grenda A, Olejnik A. In vitro modeling of endometriosis and endometriotic microenvironment - Challenges and recent advances. Cell Signal 2022; 97:110375. [PMID: 35690293 DOI: 10.1016/j.cellsig.2022.110375] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/26/2022]
Abstract
Endometriosis is a chronic condition with high prevalence in reproductive age women, defined as the growth of endometrial tissue outside the uterine cavity, most commonly on the pelvic peritoneum. The ectopic endometrial lesions exist in a unique microenvironment created by the interaction of epithelial, stromal, endothelial, glandular, and immune cell components, dominated by inflammatory, angiogenic, and endocrine signals. Current research is directed at understanding the complex microenvironment of the lesions and its relationship with different endometriosis stages, phenotypes, and disease symptoms and at the development of novel diagnostic and therapeutic concepts that minimalize the undesirable side effects of current medical management. Recreating pathophysiological cellular and molecular mechanisms and identifying clinically relevant metrics to assess drug efficacy is a great challenge for the experimental disease models. This review summarizes the complete range of available in vitro experimental systems used in endometriotic studies, which reflect the multifactorial nature of the endometriotic lesion. The article discusses the simplistic in vitro models such as primary endometrial cells and endometriotic cell lines to heterogeneous 2D co-cultures, and recently more common, 3D systems based on self-organization and controlled assembly, both in microfluidic or bioprinting methodologies. Basic research models allow studying fundamental pathological mechanisms by which menstrual endometrium adheres, invades, and establishes lesions in ectopic sites. The advanced endometriosis experimental models address the critical challenges and unsolved problems and provide an approach to drug screening and medicine discovery by mimicking the complicated behaviors of the endometriotic lesion.
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Affiliation(s)
- Agata Gołąbek-Grenda
- Department of Biotechnology and Food Microbiology, Poznan University of Life Sciences, 48 Wojska Polskiego St., 60-627 Poznan, Poland
| | - Anna Olejnik
- Department of Biotechnology and Food Microbiology, Poznan University of Life Sciences, 48 Wojska Polskiego St., 60-627 Poznan, Poland.
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