Research Program Overview
The overarching goals of our research program are to expand our understanding of the disease process; identify innovative diagnostic procedures; elucidate novel educational and therapeutic strategies.
The program consists of 2 main components:
After obtaining informed consent, patients will complete a disease-specific patient outcome tool, quality of life questionnaire and satisfaction survey at the first visit and continuously thereafter every six months. All multi-disciplinary surgical and medical treatments will be documented and linked. Survey tools are specifically designed on user-friendly interfaces on iPads and on our website.
Translational Research Database
Consent for use of blood and tissue for ongoing and future research will be obtained upon registration. Blood will be drawn and banked at the first visit. Should patients undergo a surgical procedure at our center, blood, peritoneal fluid, endometrial biopsy and tissue will be banked.
Research to identify a clinical marker of endometriosis.
Background: Currently, there are no clinically available blood tests that can be used to diagnose endometriosis. A definitive diagnosis of endometriosis can only be achieved through surgery during which endometrial tissue can be seen growing outside of the uterus in abnormal locations. Samples of this abnormal tissue can be removed at the time of surgery and provided to a pathologist for confirmation of disease. Although risks to patients from surgery for endometriosis are rare, they are significant and women with endometriosis can have multiple diagnostic and operative laparoscopies over the course of their disease. Sadly, lack of a blood test for endometriosis results in significant delays in diagnosis of up to 12 years before a definitive diagnosis is achieved. Thus, there is an urgent need to identify a clinical marker of endometriosis that will permit diagnosis of disease earlier and provide clear guidance for doctors monitoring patient response to endometriosis treatments.
Approach: Our research team has found that several proteins, involved in nerve growth, are also found in cells that line the uterus and the endometrial cells from endometriosis growths. Preliminary research by our team has found a significantly higher level of one of these proteins in the blood of women with endometriosis compared to women without endometriosis. In addition, our research team has found that the concentrations of this protein are lower in women receiving treatment for endometriosis compared to women without treatment suggesting that this protein could be used as a useful test for endometriosis. Consequently, we are currently recruiting women undergoing surgery to participate in this study and provide a blood sample to help us determine the clinical value of this blood protein as a potential diagnostic tool for women with endometriosis. All women interested in participating or learning more about this study are encouraged to discuss this project with their physician or health care team.
Importance: Successful completion of this project will show that our protein marker in blood can be used to distinguish between women with and without endometriosis. Not only does our research group believe that our new blood test could be used for the initial diagnosis of endometriosis, which would improve care for women, we also believe that this simple blood test could be helpful in guiding treatment decisions after surgery and thereby delay the need for future surgeries. This study will provide the foundation necessary for a further study designed to validate or confirm the levels of this protein in patients from different clinical and geographic settings. This step is necessary to show that the test is reliable and can be applied by health care providers in multiple different settings. We also predict that measurement of this protein will allow physicians to monitor patient response to treatment and identify disease progression providing important insight to direct clinical decisions that could help reduce the need for follow up surgeries.
Funding: Canadian Institutes of Health Research provide financial support for this project
Dietary treatments for endometriosis.
Background: Endometriosis affects between 7% of women in the general population and greater than 30% of women undergoing laparoscopy for pelvic pain. Current treatments are aimed at hormonal suppression of the endometrial implants which is thought to decrease the size of these implants. All of the drugs used to treat endometriosis prevent pregnancy and thus a woman must choose between family planning and managing her pain. Therefore, alternative treatment strategies are needed to better suppress endometriosis while maintaining fertility in women with this painful disease. Several recent studies have demonstrated that dietary chemicals can decrease the number of estrogen receptors in target cells, decrease growth of cells that are dependent on this hormone for growth, and enhance death of these cells; all of which are key processes that we think are also important for women with endometriosis. Therefore, we propose that these same dietary chemicals could have a place in the treatment of endometriosis, a hypothesis that we are testing in this study.
Approach: To show that the dietary chemicals can inhibit the growth and survival of endometriosis cells, we are using a special mouse model of endometriosis that reproduces all the features of endometriosis in women. Mice with endometriosis are fed a diet containing natural chemicals that inhibit the production of estrogen (test group) while a second group of mice (control group) are fed the same diet without the test chemicals. The effect of these diets on the growth and survival of endometriosis is then measured 1 and 2 months later. It is our belief that this study will show that dietary changes can result in a decrease in endometriosis. We plan to follow successful completion of this project with a second animal study aimed at examining the fertility of animals on this special diet. We anticipate that the fertility rates in mice treated with our test diet will be the same as in mice eating the control diet.
Importance: This study is important because it could provide a simple dietary method that women could follow on their own, to either reduce their risk of developing endometriosis, or prevent the recurrence of the disease.
Funding: Financial support for this project has been provided by startup funds from Concourse Health Sciences LLC
Projects Actively Recruiting
Randomized control trials for Fibroids
Pelvic pain, painful menstruation, and infertility are the hallmarks of endometriosis, but not all pelvic pain is endometriosis.
We are conducting a clinical research study where we are testing four doses of a new drug and a placebo against symptoms caused by uterine fibroids. The primary purpose of the study is to examine the bleeding intensity in women using this new study drug over 12 weeks.
We are looking for women who are:
- 18-50 years old
- Generally healthy
- Not pregnant or breast feeding
- With Uterine Fibroids
- With heavy menstrual bleeding
- Who would accept assignment to either treatment by chance
If you are interested in participating or learning more about the study or have questions, please contact us via phone or email: Pam Singh, e-mail: firstname.lastname@example.org, Tel: (905) 525-9140, Ext. 21334.
- Berger RG, Foster WG, deCatanzaro D. (2010) Bisphenol-A exposure during the period of blastocyst implantation alters uterine morphology and perturbs measures of estrogen and progesterone receptor expression in mice. Reprod. Toxicol. 30(3):393-400.
- Foster WG, Boutross-Tadross O, Elias R, Faghih N, Elit L. (2009) Immunolocalization of tyrosine kinase receptors Trk A and Trk B in endometriosis associated ovarian cancer (EAOC). Histopathol. 54:907-912.
- Anger DL and Foster WG. (2008) The link between environmental toxicant exposure and endometriosis re-examined. Frontiers in Bioscience. 13:1578-1593.
- Holloway AC, Anger DL, Crankshaw DJ, Foster WG. (2008) Effect of atrazine on aromatase activity in estrogen sensitive target tissues. J. Appl. Toxicol. 28:260-270.
- Anger DL, Zhang B, Boutross-Tadross O, Foster WG. (2007) Expression of tyrosine receptor kinase B (TrkB) in human endometrium. Endocrine. 31:167-173
- Agarwal SK, Estrada S, Foster WG, Wall LL, Brown D, Revis E, Rodriguez S. (2007) What motivates women to take part in clinical and basic science endometriosis research? Bioethics. 21:263-269.
- Edmunds KM, Holloway AC, Crankshaw DJ, Beecroft ML, Agarwal SK, Daya S, Foster WG. (2005) The effects of dietary phytoestrogens on aromatase activity in human endometrial stromal cells. Reprod. Nutr. Develop. 45:709-720.
- Holloway AC, Zhang B, Stys KA, Foster WG. (2005) DDE-induced changes in aromatase activity in estrogen sensitive target tissues. Endocrine. 27:45-50.
- Rier S and Foster WG. (2003) Environmental dioxins and endometriosis. Semin. Reprod. Med. 21(2):145-154.
- Van Vugt DA, Krzemien A, Foster W, Lundhal S, Marcus S, Reid RL. (2000) Photodynamic endometrial ablation in onon-human primates. In: Photomedicine in Gynecology and Reproduction (P. Wyss, Tadir Y, Tromberg BJ, Haller U, eds.) Karger, Basal, Switzerland, 213-218.