DeCure's autonomous Rare AI scientist is researching a drug-repurposing hypothesis for exstrophy-epispadias complex — screening already-approved drugs against its 10-gene Open Targets disease module to publish open-access research. Research is fast; the path to publication is funded in milestone stages.
Disease moduleExstrophy-epispadias complex maps to a 10-gene Open Targets module — the target space DeCure's AI scientist screens approved drugs against.
DeCure.ai methodSignature reversal (LINCS) plus network proximity (STRING) rank already-approved drugs likely to perturb this module — the same engine that produces DeCure.ai's repurposing hypotheses.
Repurposing thesisScreening approved medicines against this disease module, then publishing the evidence for the strongest candidate. Known pharmacology and human exposure data make the first question sharper — they do not establish safety or efficacy in a new indication.
Research record
01
ResearchComing soon
Candidate research + dossier — target rationale, drug-repurposing thesis and evidence pack.proof: Published dossier + on-chain hash
02
ValidationComing soon
In-vitro biological validation at a contract research org (CRO).proof: CRO contract + in-vitro report
03
Peer review & paperComing soon
Peer-reviewed paper published open-access (preprint + journal).proof: DOI + open-access link + on-chain hash
Current lead
No approved-drug candidate for exstrophy-epispadias complex is corroborated in the literature DeepSearch retrieved. Some conditions are managed with non-pharmacological care — a device, surgery or physical therapy — rather than a medicine; that may be the case here, or the literature we found may simply be too sparse yet to support a drug-repurposing angle.
Molecular view
hydroxysteroid 11-beta dehydrogenase 1 (HSD11B1) — HSD11B1 is one of the genes genetically linked to this disease in Open Targets — shown as context, not as a drug target we're pursuing: no approved-drug candidate for this disease is yet corroborated in the literature we found.
Loading structure…
helix sheet napdrag to rotate · scroll to zoom
RCSB Protein Data Bank · entry 4BB5 · 2.2 Å · ligand NADP NICOTINAMIDE-ADENINE-DINUCLEOTIDE PHOSPHATE (NAP). Experimental structure, not a prediction.
What the evidence adds up to
The exstrophy-epispadias complex is a rare spectrum of malformations affecting the genitourinary system, anterior abdominal wall, and pelvis. A 2021 analysis of German public health insurance data covering roughly 87% of the population (71 million people) estimated a live prevalence of 1:11,000 (95% CI: 1:14,700 to 1:8,400) for the complex as a whole. Specifically, the prevalence for epispadias was 1:17,142 and for exstrophy 1:30,675. The male-to-female ratio for exstrophy was 1.4:1 in infants and 1.6:1 in all minors. Annually, 126 persons of all ages with epispadias and 244 with exstrophy were treated as inpatients; 34 infants with epispadias and 19 with exstrophy were treated as outpatients each year. The authors note that the prevalence of epispadias was higher than in previous European reports, possibly because milder phenotypes (grade 1 or 2) were not always included in earlier registers.
A 2014 review states that historically, surgical outcomes were poor for classic bladder exstrophy and cloacal exstrophy, the two more severe presentations. Modern techniques for repairing epispadias, classic bladder exstrophy, and cloacal exstrophy have increased the success of achieving urinary continence, satisfactory cosmesis, and quality of life, but the review notes that these procedures are not without their own complications. The review provides an overview of management and potential surgical complications but gives no quantitative success rates or survival figures.
A 2013 study evaluated penile reconstruction in 23 adults (median age 27 years, range 17 to 41) who had complications after multiple failed childhood epispadias repairs. The surgical approach involved penile disassembly with complete straightening and lengthening, followed by urethral reconstruction 3 to 6 months later using buccal mucosa graft and genital skin flaps. After a mean follow-up of 33 months (range 14 to 78), 19 of 23 patients had a completely straightened and lengthened penis; improved length of the erect penis ranged from 2.7 to 6.6 cm. Four patients developed mild curvature that did not require additional correction. Urethral fistula occurred in 3 patients; 2 were repaired 6 months after urethroplasty and 1 closed spontaneously. All 21 sexually active patients reported good erectile function. The authors conclude that adults with complications after childhood epispadias repair remain a difficult population to treat and that a radical surgical approach is necessary.
What is still missing are prospective, multi-centre trials with standardised outcome measures for both paediatric and adult surgical repairs, long-term follow-up data on continence and quality of life beyond single-centre case series, and any pharmacological or non-surgical interventions that might reduce the need for repeated operations. The rarity of the condition makes patient stratification and adequately powered studies difficult without coordinated international registries and dedicated funding.
Evidence
Retrieved by DeepSearch across 234,678,978 indexed works and resolved on OpenAlex — ranked by citations, including the results that did not work.
Surgery Research and Practice · 2014 · 69 citations · open access
Modern Management of the Exstrophy-Epispadias Complex
AbstractThe exstrophy-epispadias complex is a rare spectrum of malformations affecting the genitourinary system, anterior abdominal wall, and pelvis. Historically, surgical outcomes were poor in patients with classic bladder exstrophy and cloacal exstrophy, the two more severe presentations. However, modern techniques to repair epispadias, classic bladder exstrophy, and cloacal exstrophy have increased the success of achieving urinary continence, satisfactory cosmesis, and quality of life. Unfortunately, these procedures are not without their own complications. This review provides readers with an overview of the management of the exstrophy-epispadias complex and potential surgical complications.
Frontiers in Pediatrics · 2021 · 12 citations · open access
A Prevalence Estimation of Exstrophy and Epispadias in Germany From Public Health Insurance Data
AbstractIntroduction: The prevalence of rare diseases is very important for health care research. According to the European Surveillance of Congenital Anomalies (EUROCAT) registers, the live prevalence for exstrophy and/or epispadias (grades 1–3) is reported with 1:23,255 (95% CI: 1:26,316; 1:20,000). A Europe-wide prevalence evaluation based on reports from excellence centers estimates a prevalence for exstrophies of 1:32,200 and for isolated epispadias of 1:96,800 in 2010. However, the frequency of exstrophy [International Statistical Classification of Diseases and Related Health Problems revision 10 (ICD-10): Q64.1] and epispadias (ICD-10: Q64.0) treated in different age groups in Germany remains unclear. Material and Method: Public health insurance data from 71 million people (approximately 87% of the population) were provided by the German Institute for Medical Documentation and Information (DIMDI) in accordance to the German Social Insurance Code for this research purpose. DIMDI analyzed the data source for the ICD diagnoses exstrophy and epispadias between 2009 and 2011. As provided data were robust over the years, averaged data are mentioned. Detailed subgroup analysis of small numbers was forbidden due to privacy protection. Results: Annually, 126 persons of all ages with epispadias and 244 with exstrophy are treated as inpatients. In the observed population, 34 infants (<1 year of age) with epispadias and 19 with exstrophy (58% male) are treated as outpatients each year. This corresponds to an estimated live prevalence of 1:11,000 (95% CI: 1:14,700; 1:8,400) for EEC (exstrophy–epispadias complex), more specifically a prevalence of 1:17,142 for epispadias and of 1:30,675 for exstrophy. The male-to-female ratio for exstrophy is 1.4:1 for infants and 1.6:1 for all minors. In children and adolescents, 349 epispadias and 393 exstrophies (up to the age of 17) are treated annually, whereas adults with exstrophy and even more with epispadias make comparatively less use of medical care. Conclusion: With the help of DIMDI data, the live prevalence of bladder exstrophy and epispadias in Germany could be estimated. The prevalence of epispadias was higher than in previous reports, in which milder epispadias phenotypes (grade 1 or 2) may not have been included. These analyses might enlighten knowledge about nationwide incidence and treatment numbers of rare diseases such as the EEC.
Treatment for Failed Epispadias Repair Presenting in Adults
AbstractPURPOSE: We evaluated the results of 1-stage and multistage penile reconstruction in adults with complications after multiple failed epispadias repairs. MATERIALS AND METHODS: A total of 23 adults underwent penile disassembly for repeat epispadias repair from February 2006 to June 2011. Median age at surgery was 27 years (range 17 to 41). Surgical treatment included penile disassembly with complete straightening and lengthening of the penis, followed by urethral reconstruction. The corpora cavernosa were completely separated from the glans cap with the neurovascular bundles and from the urethra. The urethra, which was short in all cases, was divided at the glans level. Penile straightening and lengthening were achieved by tunica albuginea incision and grafting. The urethra was reconstructed 3 to 6 months later using combined buccal mucosa graft and genital skin flaps. Success was defined as a functional penis without urethral fistula or stricture, or residual chordee as well as a cosmetically acceptable penile appearance. RESULTS: Mean followup was 33 months (range 14 to 78). Of the patients 19 had a completely straightened and lengthened penis. Improved length of the erect penis was 2.7 to 6.6 cm. In 4 patients mild curvature developed without the need for additional correction. Urethral fistula in 3 cases was repaired 6 months after urethroplasty in 2, while it closed spontaneously in 1. All 21 sexually active patients reported good erectile function. CONCLUSIONS: Adults with complications after childhood epispadias repair are still a difficult population to treat. A radical surgical approach must be used to achieve a successful outcome.
Disease module: DeepOracle (Open Targets). Structures: RDKit from PubChem SMILES. Literature: retrieved by DeepSearch across 234,678,978 indexed works (targeted per-candidate search), resolved on OpenAlex.
DeCure is a research and publication project, not medical advice and not a treatment. "DeCure for X" describes a research goal, not a claim that a cure exists. Backing a cure is a contribution to fund the research — it is not an investment, and confers no yield, royalty, equity or IP ownership. Papers are published open-access by the DeCure.ai DAO.
