An overview of endometriosis and molecular target-based therapeutic approach

Abstract Background Endometriosis has become a global concern. Fifty percent of the affected women become infertile. Ten percent of the female population, which represents women in their reproductive age and girls, is affected globally. It shows a strong correlation with thyroid, endometrial, and breast cancer. It disrupts the psychological, social, and economic wellbeing and sexual life of women. Main body Modern hormonal therapy relies upon estrogen–progestin combinations. Other drugs include progestins, gonadotropin-releasing hormone agonists and antagonists. Some patients remain non-responsive to these therapies, and others show adverse effects such as intolerance, weight gain, acne, and seborrhea. Similarly, surgery has its own complications which include late bowel, ureteral perforations, recto-vaginal, and uretero-vaginal fistulas. Neither modern therapeutic nor surgical approaches could alleviate endometriosis. Besides, the cost of treatment is overburdening. This necessitates the designing of an alternative therapeutic approach which could alleviate endometriosis. This has led to the identification of molecular targets and the exploration of different phytoconstituents that could modulate these targets. Conclusion Formulation containing different phytoconstituents such as apigenin, genistein, resveratrol, 5α-hydroxycostic acid, hydroxyisocostic acid, anthocyanins, quercetin, naringenin, kaempferol, withaferin-A, ursolic acid, shogaol, curcumin, demethoxycurcumin, capsaicin, ellagic acid, 6‐paradol, 6‐gingerol, carnosic acid, tuberostemonine-O, rosmarinic acid, luteolin, granatin-B, and licochalcone-A may be useful in the treatment of emdometriosis. This formulation may decrease the proliferation of ectopic endometrial stromal cells, their invasion, vascularization, pain sensation, inflammation, gestational diabetes mellitus, and fetal growth restriction. There may be an increase in the fertility rate also. This is due to its ability to regulate the expression of many molecular targets such as VEGF-A/VEGFR2 pathway, p38MAPK/ERK-1/2/PI3K/protein kinase B (AKT), HIF-1α, IL-1β, IL-2, IL-6, IL-8, IL-10, IL-17A, IL-18, IL-33, TNF-α, NF-kB, IFN-γ, IGF-1-induced activation of IGF-1R, ER-α, and ER-β receptors, miR-95, miR-103, miRNA-138, miRNA-155, miR-183, miR-223, MMP-1, MMP-2, MMP-3, MMP-9, lncRNA-MEG3, lncRNA-H19, Ang-1 mRNA, Ang-2 mRNA, mRNA of urokinase plasminogen activator, mRNA expression and secretion of leptin, CD31, Tie-2, MCP-1 mRNA and protein, HGF, Nrf2, HO1, Keap1, COX-2, PGE-2, MKNK1, and human DNA TOP3A. However, further research is required to determine the safety, compatibility, and therapeutic efficacy of this formulation.