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New treatment for endometriosis preserves fertility14:05 02 February 2015 byHelen ThomsonTwo new drugs are the first to treat endometriosis without harming fertility. Researchers hope they will one day help the 10 per cent of women of reproductive age who suffer from the condition, which can cause infertility and chronic pain, and costs the US $20 billion dollars each year. Endometriosis is a relatively common condition in which cells that normally grow only in the uterus travel into the abdominal cavity, where they form lesions and cysts, scarring organs such as the ovaries, fallopian tubes, bladder and rectum. These lesions also lead to inflammation and nerve growth, causing abdominal pain. The condition causes infertility in up to 50 per cent of women who have it. Surgically removing lesions or cysts can temporarily relieve pain until they grow back, but a longer-term solution is to reduce levels of the hormone oestrogen throughout the body. Like healthy endometrial tissue in the uterus, the lesions and cysts rely heavily on oestrogen to grow and survive, but reducing the hormone throughout the body has unfortunate side effects, such as menopausal symptoms and infertility. Women with endometriosis who want to have children may face a catch 22 situation – they need to treat their condition to conceive, but this hormonal treatment makes them infertile. Stop the treatment and fertility may return, but so too do the lesions. But there might be a solution. Through several experiments, Benita Katzenellenbogen of the University of Illinois at Urbana-Champaign and her colleagues discovered that the oestrogen receptors in lesions are different from those found in normal reproductive tissue. Because of this, she and her team have been able to develop two drugs that only affect those receptors in the wayward endometrial tissue. Avoiding surgery When given to mice, the drugs – called chloroindazole and oxabicycloheptene sulfonate – reduced the size of existing endometrial lesions and stopped the growth of new lesions. The team thinks that the drugs work in part by interfering with inflammation pathways. The compounds prevented the development of new nerves in the lesions and also decreased pain. Crucially, neither of the drugs altered the rodents' fertility or the health of their pups. The drugs also had a similar effect on human endometrial tissue taken from cysts that had been removed from patients. "We are hopeful that these compounds will prove to be useful for women with this common disease," says Katzenellenbogen, although she adds that it may be several years before human trials can start. Christian Becker, a consultant gynaecologist and endometriosis specialist at the University of Oxford, says the research is encouraging. "It's fascinating to see the drugs had very little effect on the [normal] endometrial tissue and the pups, but we have to wait to see whether this will hold up in humans." He says it would be good to avoid surgery if possible – he has seen people who have had to endure ten rounds of keyhole surgery to treat the condition. "It's good that this is getting some attention as it affects so many people, but it's not historically been a cool thing to talk about," he says. Journal reference: Science Translational Medicine, DOI: 10.1126/scitranslmed.3010626
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(Image: A project by Irene Cheng in collaboration with Dr Issam Hussain and Dr Francesco Proto) This is what bone cancer looks like as it takes over the body – as interpreted by the artistic eye of Irene Cheng, who studies architecture at the University of Lincoln, UK. Cheng used current knowledge about how the cancer mutates bone structure over time, acquired in a collaboration with Issam Hussain of the university's school of life sciences, to portray its extreme effects, as shown below in historical photos. 
Cheng's project explores how the human body's adaptations to deformations could influence architecture. "It's not about trying to say that cancer is a good thing," she says. Rather, it's about learning from how the structure of the human body can accommodate such fast-growing, extensive changes – and what that could mean for buildings inspired by imperfection, adds Francesco Proto, who is supervising the project. The project will culminate in April 2015 with a design for a building. Proto, Cheng and colleagues previously won an honorary mention for their design for a new natural science museum in Berlin, Germany. That building was inspired by another extreme example of biological development: a butterfly's growth inside its cocoon. Correction, 2 February 2015: The type of data underlying the illustration has been clarified since this article was first published. 
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