Anti‐Angiogenic Alternative and Complementary Medicines for the Treatment of Endometriosis: A Review of Potential Molecular Mechanisms

Abstract

Endometriosis is caused by the growth or infiltration of endometrial tissues outside of the endometrium and myometrium. Symptoms include pain and infertility. Surgery and hormonal therapy are widely used in Western medicine for the treatment of endometriosis; however, the side effects associated with this practice include disease recurrence and menopause, which can severely influence quality of life. Angiogenesis is the main biological mechanism underlying the development of endometriosis. Numerous natural products and Chinese medicines with potent anti-angiogenic effects have been investigated, and the molecular basis underlying their therapeutic effects in endometriosis has been explored. This review aims to describe natural products and compounds that suppress angiogenesis associated with endometriosis and to assess their diverse molecular mechanisms of action. Furthermore, this review provides a source of information relating to alternative and complementary therapeutic products that mediate anti-angiogenesis. An extensive review of the literature and electronic databases, such as the China National Knowledge Infrastructure, PubMed, and Embase, was conducted using the keywords ‘endometriosis,' ‘traditional Chinese medicine,' ‘Chinese herbal medicine,' ‘natural compounds,' and ‘anti-angiogenic' therapy. Anti-angiogenic therapy is an emerging strategy for the treatment of endometriosis. Natural anti-angiogenic products and Chinese medicines provide several beneficial clinical effects, including pain relief. In this review, we summarize clinical trials and experimental studies of endometriosis using natural products and Chinese medicines. In particular, we focus on anti-angiogenic products and alternative and complementary medicines for the treatment of endometriosis and additionally examine their therapeutic efficacy and mechanisms of action. Anti-angiogenic natural products and/or compounds provide a new approach for the treatment of endometriosis. Future work will require randomized trials with larger numbers of subjects, as well as long-term follow-up to confirm the findings described here.

Biomarkers for the Noninvasive Diagnosis of Endometriosis: State of the Art and Future Perspectives

“…Endometriosis is characterized by chronic abdominal pain, infertility, dysmenorrhea, and sometimes anxiety, related to the degree of the pelvic pain [18,19]. This pathology is the result of interactions between various hormonal, immunological, and genetic factors, and it is characterized by an increased expression of inflammatory factors and angiogenesis [20].…”

Protective Effect of a Mixture of Astragalus membranaceus and Lithospermum erythrorhizon Extract against Hepatic Steatosis in High Fat Diet‐Induced Nonalcoholic Fatty Liver Disease Mice

“…ey also showed that the same sample prevented the hepatic fat accumulation, although detailed underlying action mechanism on its inhibitory activity against hepatic fat accumulation was not extensively addressed [29]. Like AM, LE has also garnered much attention as a complementary herb that can act simultaneously on various targets in diseased states [31,32]. A study by Roh [33] reported that Gangjihwan, a polyherbal drug composed of LE as the main ingredient, demonstrated a beneficial effect in NAFLD mice via the regulation of the genes involved in lipid metabolism and inflammation.…”

Novel Drug Targets with Traditional Herbal Medicines for Overcoming Endometriosis

“…According to previous studies, andrographolide was proven to decrease endometriotic lesion volume and improve in generalized hyperalgesia in an endometriosis rat model. This effect was mediated via COX-2, tissue factor and the phosphorylation of p50 and p65 (Table 1 ) [116, 117].…”

“…Diels root “dong quai” has been used in Chinese medicine to treat “blood stasis”. It has antispasmodic, analgesic, blood-enriching, blood circulating, and tonic effects, besides being an antioxidant, partly through the inhibition of anion radical formation [116]. A few studies have demonstrated its immunomodulatory and anti-inflammatory activities.…”

“…Di Paola et al . (2016) reported that co-micronized palmitoylethanolamide/polydatin (PEA/PLD) decreased endometriotic lesions due to its antiangiogenic effect and also this combination decreased the levels of nerve growth factor, intercellular adhesion molecule, MMP-9, and lymphocyte accumulation (Table 1 ) [116, 178].…”