QC: Understanding Why Endometriosis Lesions Grow, Bleed, And Change Color

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Alanna
0:00

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Guest Introduction

Alanna
0:41

Today's

guest

is

someone

who

is

truly

changing

the

landscape

of

endometriosis

care.

Professor

Gaby

Moawad

is

a

globally

recognized

leader

in

robotic

surgery

and

endometriosis

management.

He's

a

board-certified

gynecologic

surgeon

and

the

founder

of

the

Center

for

Endometriosis

and

Advanced

Pelvic

Surgery

in

Washington,

D.C.

Dr.

Moawad

has

dedicated

his

career

to

advancing

minimally

invasive

and

robotic

techniques,

combining

surgical

innovation

with

deep,

compassionate,

patient-centered

care.

As

director

of

robotic

gynecologic

surgery

and

associate

professor

at

George

Washington

University,

he's

trained

surgeons

worldwide

and

helped

redefine

how

we

approach

complex

pelvic

disease.

He's

been

named

Top

Doctor

in

Washington,

D.C.

for

nearly

a

decade

and

has

authored

over

125

peer-reviewed

publications

leading

global

conversations

on

endometriosis

and

surgical

innovation.

It's

an

honor

to

sit

down

and

welcome

a

true

pioneer

and

advocate

for

better

outcomes

for

women

everywhere.

Please

help

me

in

welcoming

Dr.

Gaby

Moawad.

How Endometriosis Builds Blood Supply

Alanna
1:56

And

lymphatic

pathways

and

how

they

might

actually

feed

or

spread

with

endometriosis.

Dr. Moawad
2:02

Well,

if

you

you're

looking

for

complexity,

here's

your

complex

answer.

So

there

are

there

are

a

few

substances

that

I

think

every

endometriosis

patient

should

at

least

try

to

remember

some

names

or

understand

what

they

do

in

endometriosis.

Every

endometriotic

cell

needs

oxygen

to

grow,

needs

nutrients

to

grow,

and

then

needs

blood

vessels

to

evacuate

their

waste.

This

is

part

of

almost

every

cell

in

the

body

rather

than

endometriosis

cells

only.

So

in

endometriosis

cells,

there

are

what

we

call

VEGF,

vascular

endothelial

growth

factor,

and

then

VEGF

receptors.

So

there

is

a

more

a

higher

prevalence

of

VEGF

that

help

producing

what

we

call

angiogenesis

and

vasculogenesis.

Angiogenesis

creating

new

blood

vessels.

So

those

lesions,

because

of

the

scarring

that

happens,

they

are

in

a

hypoxic

state

or

poor

oxygen

comes

there.

So

they

develop

what

we

call

hypoxia

induced

factor,

HIF

alpha.

That

what

this

produces,

it

upregulates

the

receptor

to

attract

more

VEGF

to

produce

more

blood

vessels.

So

that

HIF

is

a

substance

that

says,

I

don't

have

any

vessels

coming

to

bring

me

oxygen,

so

let's

bring

in

more

of

the

vascular

and

telial

growth

factor

so

they

produce

more

blood

vessels.

Now,

in

addition

to

that,

the

inflammatory

mediators,

interleukin

A,

Why Lesions Bleed And Change Color

Dr. Moawad
3:45

tumor

necrosis

factor,

they

also

promote

inflammation

and

increase

the

VEGF

in

the

endometriosis

cells.

So

you

can

see

how

the

circles

is

doing

things,

and

the

estrogen

is

present

in

high

concentration

in

endometriosis

lesions

because

there

is

the

aromatase.

They

produce

their

own

estrogen,

the

endometriosis

cells.

Now

add

to

this

through

all

that

concoction,

there

is

what

we

call

MMPs.

This

is

metalloproteinase.

These

are

substances

that

break

down

the

matrix

around

the

cells

for

endometriosis,

break

down

those

proteins

to

create

space

for

blood

vessels

to

form.

So

now

we

see

all

those

blood

vessels

have

space

to

form,

they

start

forming.

And

we

can

see

a

higher

density

even

on

imaging

of

endometriosis

lesions

when

we

do

the

contrast

on

MRI,

they're

hypervascularized.

Now,

throughout

that

whole

medium,

what

happens?

Those

inflammation

start

promoting

the

bone

marrow

to

produce

EPCs,

EPC

endothelial

progenitor

cells.

So

these

are

cells

that

come

and

shear

lead

the

formation

of

vessels.

So

you

have

a

higher

number

of

those

cells,

so

everybody

is

engaged

to

produce

more

vessels

in

the

endometriosis

lesions.

Then

we

do

say,

oh,

endometriosis

lesions

bleeds.

Why?

Because

there

is

on

every

blood

vessel

a

lining

of

cells.

We

can

call

them

pericytes.

Peri

means

near,

they

lines,

those

sites

mean

cells,

they

line

the

blood

vessels.

So

there

is

an

immature

support

of

those

pericytes.

That's

why

those

blood

vessels

are

leaky,

and

that's

why

they

they

tend

to

leak

blood

outside,

and

that's

what

they

bleed.

So

you

can

see

how

that

angiogenesis

or

the

formation

of

blood

vessel

is

led

by

inflammation,

by

hyperestrogenism,

local

hyperestrogenism

in

the

lesions,

by

all

those

substances

created

to

promote

from

the

body,

from

the

bone

marrow,

to

promote

further

formations

of

immature

cells

that

leads

to

bleeding

and

then

engage

further

the

body

to

inflame

more.

Alanna
6:12

Is

that

why

we

get

variation

in

color

for

the

lesions

as

well?

Dr. Moawad
6:18

Yes,

yes,

yes,

yes.

Alanna
6:19

And

you

know,

we

hear

about

the

powder

burn

lesions,

but

there's

also

a

rainbow

of

color

in

lesions.

Dr. Moawad
6:26

So

when

the

blood

leaks

from

those

vessels,

it

is

digested

by

the

enzymes,

and

they're

part

of

the

metabolites

of

the

digestion

is

hemofiderin,

and

they

deposit

there,

and

it

gives

the

color

of

purple

or

powder

burn

lesion.

And

then

you

can

have

a

different

level

of

vascular

or

scarring

because

whenever

you

produce

inflammation,

your

body

reacts

to

scarring.

And

since

we

have

an

immune

dysfunction

with

endometriosis,

so

the

scarring

is

there

is

an

over-reaction

to

the

inflammation

with

extensive

scarring.

Targeted Therapies And Research Directions

Alanna
6:59

Yeah.

Dr. Moawad
7:00

So

it's

mostly

really

well

understood

on

the

molecular

level,

and

this

is

help

us

a

lot

in

trying

to

figure

out

therapeutic

approaches.

So

there

have

been

trials

that

did

target

the

VEGF

or

anti-angiogenic

therapeutic

medication.

These

showed

promising

results,

but

they

led

to

poor

wound

healing,

and

then

their

impact

on

fertility

is

unknown.

So

further

study

maybe

about

the

delivery

method

of

those

substances,

maybe

direct

delivery

through

the

lesions,

might

help

improving

with

minimizing

the

systemic

side

effects.

So

when

we

understand

what's

causing

what,

we

can

further

our

research

to

try

to

help

through

targeted

therapies

or

cellular

therapies

for

endometriosis.

Closing And How To Submit Questions

Alanna
7:53

That's

a

wrap

for

this

quick

connect.

I

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