• Ovarian cysts, irritable bowel syndrome and pelvic inflammatory disease are predictive in the diagnosis of endometriosis among patients seeking medical treatment.
• Scientists both local and international have categorically linked lack of awareness to the current endometriosis problems.
Image: COURTESY
Endometriosis is a chronic inflammatory disease exhibited by growth of endometrial glands and stroma outside the uterine cavity.
According to scientists at least 10 per cent of the world's female population who are in their reproductive age are affected by endometriosis.
Scientists have also affirmed that abdominopelvic pain, dysmenorrhea, heavy menstrual bleeding, infertility, painful sexual intercourse and/or post-coital bleeding among many other symptoms.
Ovarian cysts, irritable bowel syndrome and pelvic inflammatory disease are predictive in the diagnosis of endometriosis among patients seeking medical treatment.
Scientists both local and international have categorically linked lack of awareness to the current endometriosis problems.
However, the good news is a team of local Scientists from the University of Nairobi, Department of Biochemistry, Kirinyaga University and their Germany counterparts from the Department of Obstetrics and Gynaecology, have discovered new molecules which have been found to be highly expressive in the endometriotic tissues, blood and virginal mucous secretions of woman who are suffering from endometriosis in comparison to omen without endometriosis.
The molecules include clustering (CLU)/clusterin receptors, Transforming Growth Factor Βetas (TGF-β)/ TGF-β Receptors and Plasminogen Activator Inhibitor-1 (PAI-1). Dr Ezekiel Mecha from UoN and other scientists have shown that endometriosis pain is similar to adenomyosis pain and the two sets of conditions may be the main cause of extremely painful periods.In their paper published in the highly rated Reproductive Biomedicine Online journal (RBMO) a subsidiary of Elsevier and Science direct titled “ Adenomyotic glands are highly related to endometrial glands” published in November 2019, the researchers showed that endometriosis glands are the main source of adenomyotic glands. The two conditions are normally the main cause of extreme pain which is normally experienced before, during and after menstruation for those people who are suffering from them. The Dr Mecha-led team are also investigating earlier diagnostic markers for endometriosis.
In another similar study published in the American Journal of Translational Research (2016) by the local team of scientists lead by Dr. Ezekiel Onyonka Mecha of the Department of Biochemistry, University of Nairobi and Prof. Charles Omwandho of Kirinyaga University together with the Germany scientists found Plasminogen Activator Inhibitor-1 (PAI-1) levels to be highly elevated in tissues and blood of patients with endometriosis compared with those without endometriosis.
The lead local scientist Dr. Ezekiel Mecha said that two of his PhD students who he sent to the University of Giessen, Germany are trying to investigate if PAI-1 and other molecules levels are also elevated in the mucous samples of patients suffering from endometriosis as compared to those without endometriosis.Mecha, while conducting his research in the University of Giessen also established that Transforming Growth Factor Βetas (TGF-β)/ TGF-β Receptors are significantly increased in the tissues and body fluids of patients who are suffering from endometriosis as compared to those without endometriosis and this data has been published in international journals and presented in a number of conferences both locally and internationally.
In the study published earlier in January 2018 in the Journal of reproductive Sciences, the researchers also assessed the cell morphology in endometriotic tissues as compared with normal tissues so that they can find out if the normal cell morphology (epithelial phenotype) changes into the abnormal (mesenchymal phenotype) in the pathogenesis of endometriosis, a similar scenario which is found in cancer pathogenesis. The researchers found partial change of cell morphology from epithelial to mesenchymal phenotype.
“We are talking about a great potential of the above three molecules used as earlier diagnostic markers for endometriosis and effective therapeutic intervention. We are still at the earlier stages of establishing non-penetrative, simple and cheap way of diagnosing endometriosis,” says Dr. Mecha. Dr. Mecha who with other researchers have been studying the pathogenesis of endometriosis for more than a decade say now it time to look at this markers locally using local patients suffering from endometriosis and those without endometriosis for comparison with the published results from European studies . “We also intend to evaluate more markers both locally and in Germany to get a panel of markers which can be used as earlier diagnostic markers and possible targets for therapeutic intervention” explains Dr. Mecha
Given the fact that prevalence of endometriosis in Kenya and to a large extent in Africa is unknown and this is attributed to lack of clinical and scientific research in the area of endometriosis. In Kenya, many women are suffering in silence since many of them don’t know that they are suffering from this condition due to it’s symptomatic similarity with other diseases which most of them take as “ normal”. In addition, there are no statistics available locally regarding the number of woman who are suffering from the condition since most women are afraid of speaking up to the doctors due to the stigma attached to it and also some are unable to afford the laparoscopic procedure hence goes undiagnosed.
In addition to the heavy burden, psychological and social effects associated with endometriosis coupled with lack of active research in Kenya, the department of Biochemistry, University of Nairobi together with the department of Obstetrics and Gynecology of Justus-Liebig University, Giessen, Germany has been having a collaborative endometriosis research for about 10 years. The research has been conducted in the Justus-Liebig University Giessen using samples obtained from the University of Giessen women hospital. A number of Kenyan students and researchers have been trained in Giessen, Germany.
“Due to the increased number of women suffering from endometriosis in Kenya coupled with lack of endometriosis research in Kenya, a multi-institutional endometriosis collaborative research is vital between the local universities, hospitals and research institutes” explains Dr. Mecha.
When we caught him in his office last week, he explained to us that the studies which have been done in Europe needs to be tried again in Kenya with an aim of finding earlier diagnostic markers for endometriosis and effective treatment strategies, He further explained that locally based research should be conducted using endometrial tissue, blood and cervical mucus samples obtained locally.
If a marker is found which can be expressed in endometriosis tissues, blood and mucous secretions, then a less expensive and a non-invasive method of diagnosis of endometriosis will be obtained. This means that endometriosis can be diagnosed earlier in blood or mucous secretions which are less expensive and faster.
Although the above study can be conducted in Kenya, Dr Mecha explains the need for increased support from both private and government inform of material and financial support to find earlier diagnostic markers in Kenya since many women in Kenya are suffering in silence from endometriosis. In this regard, Dr Mecha has reached out to Endometriosis Foundation of Kenya and other top notch obstetrics and gynecologists specialists with a view of increasing endometriosis awareness and research in Kenya together with his European collaborators from the University of Giessen, Germany. The esteemed collaboration will bring on board Dr Charles Muteshi of Aga Khan University hospital and Miss Elsie Wandera of Endometriosis Foundation of Kenya.