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La recherche sur l’endométriose à l’AP-HP

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Introduction

L’objectif de ce travail consiste à illustrer le dynamisme de l’AP-HP en dressant une rétrospective des études menées ces cinq dernières années et en recensant les études prospectives actuellement en cours à l’AP-HP. Il pourra ainsi servir de support aux confrères désireux de participer à la Recherche en endométriose. Enfin, il tentera de préfigurer les futures recherches qui pourront être menées à l’AP-HP grâce notamment au développement de l’EDS (entrepôt de données de santé).

Recensement de la Recherche clinique :

Recherche Pubmed

La recherche bibliographique non exhaustive a été basée sur la recherche sur Pubmed du mot clé endometriosis associé aux principaux auteurs reconnus de l’AP-HP et des centres associés (CHI Poissy, CH Versailles, Hopital Foch). Cette recherche retrouve 138 publications sur les presque 5 dernières années (depuis le premier janvier 2015). Parmi ces 138 publications référencées,  102 sont en langues anglaises et 84 sont des articles originaux. Il est à noter que de nombreux cliniciens ont pris part à la rédaction des recommandations de prises en charge de l’endométriose de l’HAS. L’analyse qualitative des travaux retrouvent de nombreuses publications dans des revues de rang A avec cependant très peu de collaborations entre les différents centres prenant en charge de l’endométriose sur le plan de la recherche.

Recherche Clinical trial, SIGREC

Une requête effectuée sur Clinical Trial, qui recense l’intégralité des études financées au titre de la Recherche, illustre également le dynamisme de l’AP-HP dans la recherche sur l’endométriose. Avec 14 projets identifiés ces dernières années, la volonté de progresser dans la prise en charge des patientes souffrant d’endométriose concerne plusieurs domaines. Si la majorité des études sont promues par l’AP-HP, certaines sont à l’initiative de services hospitalo-universitaires de Province ou de laboratoire pharmaceutique.

Concernant l’identification de facteurs de risque et le diagnostic d’endométriose, deux projets investiguent les caractéristiques cliniques et les origines génétiques de l’endométriose (FEELING, AP-HP180171). Deux autres évaluent l’intérêt de biomarqueurs ou de l’imagerie par émissions de positrons pour le diagnostic d’endométriose (ENDODIAG, ENDOTEP). Le projet de recherche DEVA a pour objectif de mettre en œuvre le diagnostic précoce d’endométriose à l’aide d’un autoquestionnaire court de symptômes douloureux permettant le repérage des patientes en soin premier. L’évaluation du handicap lié à l’endométriose et aux conséquences de sa prise en charge fait également l’objet de deux projets de recherche spécifiques (ENDOQUAL et ENDOCAP). Il faut souligner que certains de ces projets de recherche associent les associations de patientes comme ENDOFRANCE.

Sur le plan pharmacologique, trois études évaluent l’acétate d’ullipristal (FRA ITT UPA), de diénogest (VISADO) et de BAY1128688 (AKRENDO1) pour le traitement médicamenteux des symptômes de l’endométriose ou de l’adénomyose.

Sur le versant chirurgical et interventionnel, quatre projets évaluent la place, l’efficacité et les conséquences d’une résection d’endométriose profonde (ENDOFERT, MESURE, ENDORE, P050501) ou de la destruction de nodules d’endométriose pariétale (CRYOENDOMET).

Sur le plan de la fertilité et des possibles conséquences obstétricales, les projets d’étude investiguent la préservation de la Fertilité Féminine en cas d’endométriose (PREFENDO), les implications de l’endométriose sur la cohorte ovocytaire après stimulation ovarienne (EndOvo) et les conséquences périnatales de l'endométriose (ENDOBST).
Voir si évaluation HIFU débutée à l’AP-HP (demander à Hervé Fernandez : Professeur Gil Dubernard)

Recherche fondamentale

Un programme de recherche fondamentale est mené depuis une dizaine d’années à l’AP-HP, sous l’égide des équipes INSERM de l’Institut Cochin en collaboration étroite avec le service de chirurgie gynécologique et médecine de la reproduction de l’Hôpital Cochin. Ce programme s’intéresse tant au versant génétique de l’endométriose (génomique, transcriptomique, méthylome, micro-ARNs, etc.) qu’à son versant immunologique (inflammation, auto-immunité, modèles cellulaires et murins, etc.). Il a donné lieu à 46 publications dans des revues internationales, 8 thèses de sciences et 2 habilitations à diriger des recherches.

URMS938 : angiogénèse, développement endométriose, impact sur la fertilité (études in vivo), échec de PMA et d’implantation. Secteur Sofiane : épidémiologie et endométriose (GRC6).
2 thèses de science et 3 master

EDS et perspectives

Proposer un calque simple et consensuel « de base » pour la recherche en endométriose pour ORBIS (Sofiane BENDIFALLAH)  sur le la demande d’avis de RCP (demander à Geoffroy Canlorbe)

Evoquer la possibilité pour les patientes prises en charge à l’AP-HP de prélèvements systématiques implémentant les travaux de recherche actuellement en cours à l’AP-HP (Bruno Borghese)

Lecture automatisée de l‘imagerie (intelligence artificielle) : accord développés avec Central, Supelec, Polytechnique.

Contacts académiques et privés (Claire HASSEN-KHODJA)

Medifirst (possible de l’intégrer dans l’EDS) (Claire HASSEN-KHODJA)

EDS : permet de faire des requetes

Bibliographie

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  71. Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers. Bendifallah S, Roman H, Rubod C, Leguevaque P, Watrelot A, Bourdel N, Ballester M, Darai E. Surg Endosc. 2018 Apr;32(4):2003-2011
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