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Early Testing for Endometriosis: Brenda Krishnacoumar Wants to Buy Women Time
Dr Brenda Krishnacoumar wants to replace the laparoscope, an instrument used to perform a laparoscopy, with a blood test. For her presentation at Postdoc Pitch Day, she recreated the instrument using a 3D printer, among other things.
Sharp pain, chronic inflammation and infertility – these are just a few examples of what endometriosis can do. It is a chronic disease in which tissue similar to the uterine lining attaches to organs outside the uterus. Endometriosis is insidious, because the symptoms are multifaceted and often ambiguous. As a result, the path to diagnosis is often an odyssey. According to the World Health Organisation (WHO), some 190 million women worldwide suffer from endometriosis, and it can take up to ten years to diagnose the disease. This is a long time during which the quality of life deteriorates, and it can also represent a valuable window of time that may be lost by women who wish to have children. Dr Brenda Krishnacoumar wants to change that. During the first Postdoc Pitch Day at ISAS in October 2021, she presented the approach by which she hopes to
buy women time with her research into the incurable disease (S. 54).
“Although endometriosis affects ten to 15 percent of all women of childbearing age in Germany, the research into the mechanisms of the disease have been insufficient up to now. And because the symptoms of endometriosis vary, it often goes undetected for a long time,” says the 31-year-old. Krishnacoumar would like to do something about the emotional strain and the additional stress caused by uncertainty. What is currently lacking is a non-invasive method for early detection of endometriosis – before the disease breaks out. “This is exactly where I would like to start with my research and develop an early test,” explains the biologist. For example, she plans to look for markers in blood and for biopsy testing that will allow screening for endometriosis even in young women.
Bioimaging Research Group
Prof Dr Anika Grüneboom T: +49 (0)231 1392-239 E: anika.grueneboom@isas.de
Early testing should bring quality of life & facilitate family planning
At present, by the time women are diagnosed, endometriosis has often already caused irreparable damage. Examples: Ovaries can become adhered, endometrial cysts can limit ovarian function, or endometrial lesions in the pelvis can reduce fertility. According to Charité – Universitätsmedizin Berlin, 30 to 50 percent of women with endometriosis suffer from an unfulfilled desire to have children.
Although some women’s fertility improves after the surgical removal of the misplaced tissue, others remain childless even after additional fertility treatment, and some sufferers are helped by artificially induced menopause. Krishnacoumar does not consider this to be an optimal solution: “Even if disease symptoms improve, hormonal menopause still puts stress on family planning.” That said, surgery and hormone therapy are not a guaranteed cure-all; endometriosis can come back, she explains.
Early testing: understanding the unknown cause to facilitate a cure
Although there are several hypotheses on the genesis of endometriosis, they do not provide a valid explanation as to why the disease breaks out in some women and spares others. To help in her development of the early test, Krishnacoumar has been intensively studying what she calls the pathomechanism of endometriosis since Postdoc Pitch Day. To understand which processes in the body trigger the disease, the biologist first examines the uteri of mice and samples from endometriosis patients under light sheet fluorescence and confocal microscopes. Future analyses will also use spectral flow cytometry. If Krishnacoumar succeeds in finding out whether, for example, certain proteins or altered or special cell types can be used as biomarkers for her early test, this will also be an important step in the direction of a cure.
Scientists like Krishnacoumar still have a lot of work to do before endometriosis can one day become a curable or even preventable disease. There is a lack of education about endometriosis and an even greater lack of research, Krishnacoumar laments. Diseases such as endometriosis which, although not fatal, are associated with severe physical and concomitant psychological suffering, should not be ignored. “For science to be sex-appropriate, we need more research for women,” the biologist insists.
SALIVA TEST VERSUS BLOOD TEST?
In February 2022, the French company Ziwig announced that it had developed a saliva test based on micro-RNA for the diagnosis of endometriosis. The test is based on 109 micro-RNAs which are associated with endometriosis. According to initial data, it is expected to be effective in patients who already have the disease. Once the saliva test is approved, it could significantly shorten the suffering of women with symptoms. However, it is unsuitable for early-detection screening. For this purpose, Krishnacoumar wants to find markers in the blood that can provide information about the risk of disease even before the onset of menstruation and in women without symptoms.
Clear the stage for new ideas at the first Postdoc Pitch Day
Krishnacoumar has been a postdoctoral fellow at ISAS since September 2021. The biologist attaches great importance to being able to pursue her own research questions. That is why she has been working on her research idea for the endometriosis early test for several months. “Postdoc Pitch Day was a great opportunity to find out if my project idea had any potential,” Krishnacoumar reports. The researcher was among those who presented their ideas to a panel made up of five research group leaders from various disciplines who served as mentors. After a five-minute pitch followed by a Q&A and discussion session, the mentors provided feedback to the postdocs. The postdocs and mentors also discussed opportunities for cooperation within and outside the institute. The presenters said the different perspectives and opinions were helpful in looking at their ideas from different angles. “I now have precise items that I can address, so I can apply for project funding later,” Krishnacoumar is pleased to say.
Laparoscope from the 3D printer
Krishnacoumar came up with something special to help the mentors understand the patients’ situation. She recreated a laparoscope using the 3D printers at ISAS and simple tools from the hardware store (see photo p. 08). The mentors at her presentation should be as surprised by this as Krishnacoumar was when she learned that minimally invasive surgery such as laparoscopy (abdominal endoscopy) is the gold standard for making a reliable diagnosis. Krishnacoumar would like to see the topic of endometriosis have more of a presence, not only in medical education and research, but also in the general public. “It’s not always about publishing papers that are only read by the professional community. You have to reach people,” she stresses. With her research idea for an early test, she hopes to contribute to exactly that.
(CMP/SR)
»NACHGEFORSCHT – DIE LIVESCHALTE INS LABOR« FOLGE 1 – Endometriose: Auf die Ursache kommt es an!
www.isas.de/kompakt/ nachgeforscht-folge1-endometriose
