Targeting Mast Cells as a Viable Therapeutic Option in Endometriosis

Abstract

Endometriosis is a chronic condition that affects ˜10% of young women worldwide. Pain and infertility are the two most common features of the disease. The condition appears to be sex hormone-dependent, although a subset of females with the condition still experience symptoms post-menopause. The aetiology of endometriosis induction still remains elusive, and surgery to remove the lesions often fails to cure the condition, as the lesions often reappear. The lesions contain stromal cells, blood vessels, nerves, and numerous mast cells. In some respects, endometrial lesions resemble a chronic fibrotic scar-like tissue that does not resolve. Studies in other fibrotic abnormal healing conditions have revealed that targeting mast cells, as a central component of what is called a ‘neural–mast cell–fibroblast’ axis, by repurposing asthma drugs can prevent induction of the abnormal healing phenotype. Given the similarities between conditions with abnormal healing phenotypes and endometrial lesions, it is postulated that taking a similar approach to target endometrial lesion mast cells could exert a benefit for patients with endometriosis. This review also outlines approaches to assess the likelihood that targeting mast cells could lead to clinical trials using such ‘repurposed’ mast cell targeted drugs.