Endometriosis affects up to 1 in 10 women during their reproductive years between the ages of 15 to 49, which is approximately
176 million women in the world
Endometriosis results in severe pelvic pain and reduced fertility for millions of women worldwide. Our research in the Oxford Endometriosis CaRe Centre seeks to identify what causes this disease to help improve our understanding of its different forms and to help inform novel drug and non-invasive biomarker discovery programmes.
Clinical Service - World-leading Research
Endometriosis research has been well established over many years in the Nuffield Department of Obstetrics and Gynaecology. In addition, hundreds of women receive excellent clinical care by members of the Department and NHS colleagues each year at the John Radcliffe Hospital. Professors Becker and Zondervan have used this unique setup and are integrating world-leading research into the condition with highest-standard patient care at the Oxford Endometriosis CaRe Centre.
what we do
Endometriosis, defined as the presence of tissue resembling the uterine lining outside of the uterine cavity, is a common disease of women during their reproductive lifetime. Typical symptoms include abdominal pain, painful periods and sexual intercourse and it is associated with subfertility. Our work focuses on understanding the causes of endometriosis and subtypes of disease, its relation to symptomatology including pelvic pain, and identification of novel non-invasive diagnostic markers and treatments. The Team includes research groups led by Professors Krina Zondervan and Christian Becker and NDOG Pain Fellow Dr Katy Vincent.
Endometriotic tissue is commonly found in the abdominal cavity often involving pelvic organs. Laparoscopy (an abdominal endoscopic procedure to visualise disease) remains the gold standard for diagnosing of endometriosis, but it is an invasive procedure that can only be performed by gynaecologists, often causing substantial delays in diagnosis and treatment of the disease. We have demonstrated that no clinically relevant biomarkers exist that could identify the disease and/or predict its course and response to treatment. One key focus of our current work is to identify potential biomarkers through large collaborative studies (see below).
A second research focus is to uncover the causes and subtypes of endometriosis through large-scale genetic and molecular epidemiological studies. Genetic (heritable) factors are known to play a role in endometriosis, and – through collaborative studies involving thousands of women – we have led global research identifying DNA variants in the genome that are associated with disease risk. Current work involves understanding the biological mechanisms through which these DNA variants act, and expanding our world-wide genetic studies to find more risk variants.
How endometriosis generates pain is still poorly understood. A third focus of our work is to combine brain imaging techniques with clinical data, including detailed pain assessments, hormone measures and the results of surgery, to try to better understand the relationship between endometriosis and pain, and incorporate this knowledge into better targeted treatments as well as improve the way clinical trials for endometriosis-associated pain are designed.
With our integrated endometriosis research programme we hope to be able to re-classify the disease using a combination of biological and clinical parameters, to discover new, non-invasive biomarkers and to identify novel targets for more individualised treatments.
We are able to do this with the generous help of the many women with and without the disease undergoing laparoscopy at our Centre, who are willing to provide data and biological samples for our studies.
We strongly believe that collaborative research is essential for scientific advances.
Together with colleagues from Harvard University and the World Endometriosis Research Foundation, we recently initiated a worldwide collaboration, the WERF EPHect project, aimed at the harmonisation and standardisation of phenotypic data and biological sample collection and processing in endometriosis research. This global effort involved 30+ research centres and 3 industrial partners. Combining existing evidence and expert opinions resulted in the publication of protocols that are now the standard and form the basis for endometriosis research internationally. These freely available protocols are regularly updated as new evidence arises.
Nationally we are part of the UK Endometriosis Network. Regular meetings involving groups interested in basic, translational and clinical endometriosis research take place bi-annually to foster exchange of scientific ideas and encourage further collaborations between centres. Currently, the Network involves centres in Oxford, London (UCLH), Aberdeen, Liverpool and Edinburgh, but is explicitly open to anyone within the UK interested in advancing endometriosis research.
We have also a strong record of collaborative links with pharmaceutical and diagnostic companies. For instance, Oxford University signed a collaborative agreement with Bayer HealthCare on a programme of work to discover new drug targets for endometriosis and uterine fibroids. We play a key role in providing expertise as well as clinical data and samples for the work, in which we collaborate closely with the Target Discovery Institute, the Botnar Research Centre and the Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB).
Together with investigators at the QIMR Berghofer Institute for Medical Research in Brisbane and Harvard University, we have founded the International Endogene Consortium (IEC), which aims to improve understanding of endometriosis through large-scale genetic studies. With the IEC, we have discovered 7 out of the 9 known genetic variants associated with endometriosis to date. These studies have cemented the role of genetics in the development and establishment of the disease, and are shedding new light on causal biological pathways and potential subtypes of disease – important information for drug target discovery. Over the years the IEC has been expanding, and we are actively looking for further research groups with genetic data on women with endometriosis.
We have strong links with many research groups worldwide at e.g. Harvard University, Boston Center for Endometriosis (Boston, USA), QIMR Berghofer Institute for Medical Research (Brisbane, Australia), the University of Wisconsin-Madison (USA), Baylor College of Medicine (Houston, USA), the University of Tartu (Estonia), the University of Edinburgh (UK), the University of Liverpool (UK), and collaborators in the global WERF EPHect network.
We have founded the International Endometriosis Genomics Consortium (IEGC), which aims to improve understanding of endometriosis through large-scale genetic studies. With the IEC, we have discovered 19 genetic variants associated with endometriosis to date. These studies have cemented the role of genetics in the development and establishment of the disease, and are shedding new light on causal biological pathways and potential subtypes of disease – important information for drug target discovery. The IEGC has recently expanded to 16 centres from Australia, Belgium, Denmark, Estonia, Greece, Finland, Iceland, Japan, UK and USA, together contributing genotyping information from more than 60,000 women with endometriosis and more than 700,000 controls. Analyses led by our team are currently ongoing and will be published in 2018.
OUR TEAM - VISITors
Alongside our internal team, we also have two visitors working in our department
Dr. Nilufer Rahmioglu is a Senior research scientist from the Wellcome Centre for Human Genetics, at the Nuffield Department of Medicine. She had a genetic epidemiology and environmental health background, investigating genetic and environmental factors of complex traits, in particular women's health conditions with substantial public health impact.
Marina Maritati is a Research Technician fromThe Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences.