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Chen S, Yoo JJ, Wang M. The application of tissue engineering strategies for uterine regeneration. Mater Today Bio 2025; 31:101594. [PMID: 40070871 PMCID: PMC11894340 DOI: 10.1016/j.mtbio.2025.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2025] [Revised: 02/13/2025] [Accepted: 02/17/2025] [Indexed: 03/14/2025] Open
Abstract
Uterine injuries, particularly damages to endometrium, are usually associated with abnormal menstruation, recurrent miscarriage, pregnancy complications, and infertility. Tissue engineering using cell-based, biomolecule-based, or biomaterial and scaffold-based strategies has emerged as a novel and promising approach for uterine regeneration. Stem cells, biomolecules, and porous scaffolds used alone or, very often, used in combination as a more effective treatment means have shown great potential in promoting uterine regeneration. The reported preclinical studies have indicated that appropriate tissue engineering strategies could safely and effectively reconstruct not only endometrium but also partial or even the whole uterine structure. However, the progress in the uterine regeneration area is slow in comparison to that of regenerating many other body tissues and hence it still remains a great challenge to apply uterine tissue engineering for clinical applications. In this review, conventional treatments for uterine-related diseases are briefly reviewed and discussed first. Subsequently, tissue engineering strategies (cell-based, biomolecule-based, biomaterial and scaffold-based, or their combinations) for uterine repair in preclinical studies and clinical trials are presented and analyzed. Finally, the challenges and perspectives in uterine regeneration are pointed and discussed. Despite various limitations and obstacles, the tissue engineering approach is viable and holds high promise for uterine regeneration.
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Affiliation(s)
- Shangsi Chen
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
| | - James J. Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest University Health Sciences, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Min Wang
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong
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2
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Ahmed S, Ahmed S, Gullabzada M, Gullabzada U, Jobanputra K. Abnormal Uterine Bleeding With Leiomyomas: A Case Report of Its Natural Course and Therapeutic Management. Cureus 2024; 16:e69153. [PMID: 39398676 PMCID: PMC11467766 DOI: 10.7759/cureus.69153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2024] [Indexed: 10/15/2024] Open
Abstract
Uterine fibroids (UFs), or leiomyomas, are common benign tumors affecting a significant proportion of women by the age of 50 years. While typically non-cancerous, UFs can severely impact the quality of life (QoL) through symptoms such as heavy menstrual bleeding (HMB) and pelvic pain. We report a case of a 45-year-old Hispanic female with a history of hypertension, diabetes, nephrolithiasis, and a solitary kidney, who presented with symptomatic UFs and an ovarian cyst. Despite initial pharmacological treatment with Ortho Micronor and Myfembree, the patient experienced persistent symptoms, prompting surgical intervention. A supracervical hysterectomy, bilateral salpingectomy, lysis of adhesions, and left ovarian cystectomy were performed, resulting in symptom relief and benign postoperative findings. This case report highlights the need for personalized treatment plans and comprehensive patient counseling to manage complex gynecological conditions effectively.
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Affiliation(s)
- Samreen Ahmed
- Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | - Saba Ahmed
- Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Uzma Gullabzada
- Cardiology, Washington University of Health and Sciences, San Pedro, BLZ
| | - Ketan Jobanputra
- Obstetrics and Gynecology, UChicago Medicine AdventHealth, Bolingbrook, USA
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3
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Martín-Biel L, Aguado-Agudo M, Carilla-Sanromán A. [Endobronchial leiomyoma in a patient of 19 years]. Med Clin (Barc) 2024; 163:214-215. [PMID: 38692988 DOI: 10.1016/j.medcli.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Laura Martín-Biel
- Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - María Aguado-Agudo
- Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, España
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4
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Szucio W, Bernaczyk P, Ponikwicka-Tyszko D, Milewska G, Pawelczyk A, Wołczyński S, Rahman NA. Progesterone signaling in uterine leiomyoma biology: Implications for potential targeted therapy. Adv Med Sci 2024; 69:21-28. [PMID: 38278085 DOI: 10.1016/j.advms.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Uterine leiomyomas (ULs) are the most common benign smooth muscle cell steroid-dependent tumors that occur in women of reproductive age. Progesterone (P4) is a major hormone that promotes the ULs development and growth. P4 action in ULs is mediated mainly by its nuclear progesterone receptors (PGRs), although rapid non-genomic responses have also been observed. Data on the membrane progesterone receptors (mPRs) regulated signaling pathways in ULs in the available literature is still very limited. One of the essential characteristics of ULs is the excessive production of extracellular matrix (ECM). P4 has been shown to stimulate ECM production and collagen synthesis in ULs. Recent research demonstrated that, despite their benign nature, ULs may present with abnormal vasculature. P4 has been shown to regulate angiogenesis in ULs through the upregulation of vascular endothelial growth factor (VEGF) and by controlling the secretion of permeability factors. This review summarizes the key findings regarding the role of PGRs and mPRs in ULs, especially highlighting the potential ECM and angiogenesis modulation by P4. An increased understanding of this mechanistic role of nuclear and specifically mPRs in the biology of P4-modulated ECM and angiogenesis in the growth of ULs could turn out to be fundamental for developing effective targeted therapies for ULs.
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Affiliation(s)
- Weronika Szucio
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Bernaczyk
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Donata Ponikwicka-Tyszko
- Department of Biology and Pathology of Human Reproduction, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland; Institute of Biomedicine, University of Turku, Turku, Finland
| | - Gabriela Milewska
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - Adam Pawelczyk
- Department of Plastic, Endocrine and General Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Sławomir Wołczyński
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland; Department of Biology and Pathology of Human Reproduction, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Nafis A Rahman
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland; Institute of Biomedicine, University of Turku, Turku, Finland.
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5
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Yang H, Chen X, Liu Y, Luo J, Huang R, Zhao Y, Li TC, Huang X. Does non-cavity distorting intramural fibroid affect endometrium around the time of embryo implantation? HUM FERTIL 2023; 26:712-719. [PMID: 37815345 DOI: 10.1080/14647273.2023.2264498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/17/2023] [Indexed: 10/11/2023]
Abstract
The effect of the intramural fibroids not distorting the cavity remains controversial on implantation and pregnancy. The aim of this study was to examine the impact of non-cavity distorting intramural fibroids on endometrium. Fifty-six women with non-cavity distorting intramural fibroid were recruited in this study. Paired endometrial specimens, one from beneath the fibroid (ipsilateral endometrium) and the other from the opposite side of uterine cavity, away from the fibroid (contralateral endometrium) were obtained 7-9 days after the luteinizing hormone surge in a natural cycle. Histological dating, Mucin1 and Glycodelin expression and uterine natural killer (uNK) cell density were compared between the paired samples. The median (IQR) H-score of Mucin1 staining in the ipsilateral luminal epithelium was 210% (142-230%), which was significantly (p < 0.05) higher than that of the contralateral luminal endometrium (157%, IQR 114-176%). There was no significant difference in Mucin1 expression in the glandular epithelium. There was no significant difference in Glycodelin expression in luminal and glandular epithelium, uNK cells density or histological dating results between the paired endometrial samples. In conclusion, it is uncertain whether the altered expression of Mucin1 in luminal epithelium alone may have impact on implantation when other markers are not changed.
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Affiliation(s)
- Haiyan Yang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Chen
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yingyu Liu
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jing Luo
- Department of Pathology, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Rui Huang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
| | - Yiwei Zhao
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin-Chiu Li
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
- Assisted Reproductive Center, Department of Obstetrics and Gynaecology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaowu Huang
- Hysteroscopic Center, Fu-Xing Hospital, Capital Medical University, Beijing, China
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6
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Rius M, Gracia M, Carmona F. Symptoms and clinical impact. Med Clin (Barc) 2023; 161 Suppl 1:S5-S7. [PMID: 37923513 DOI: 10.1016/j.medcli.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Mariona Rius
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España.
| | - Meritxell Gracia
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
| | - Francisco Carmona
- Departamento de Ginecología. Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Facultad de Medicina, Universidad de Barcelona, Barcelona, España
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7
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Sinha R, Rupa B, Reddy M. Beyond the learning curve: improving outcomes in Robotic myomectomy compared to laparoscopic myomectomy. J Robot Surg 2023; 17:847-852. [PMID: 36319791 DOI: 10.1007/s11701-022-01470-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/13/2022] [Indexed: 05/25/2023]
Abstract
Uterine myomas are benign tumours frequently seen in women of reproductive age. Myomectomy remains a viable option for treating this condition in women who wish to preserve their uterus. We undertook this study to compare the peri-operative surgical outcomes of Robotic myomectomy (RM) with laparoscopic myomectomy (LM) in Indian patients of uterine myomas after the initial learning curve of RM was achieved. A retrospective chart review was performed for the patients who underwent RM or LM for the treatment of uterine myomas. A total of 177 patients, 116 in the RM group and 61 in the LM group, were included in the study. The mean age in the RM and LM group was 34.31 ± 5.40 years and 33.54 ± 4.96 years, respectively (p = 0.355). The mean total operative time was marginally more in RM group (127.37 ± 110.67 vs. 120.66 ± 44.27, p = 0.650) but the difference was not statistically significant. Patients in the RM group had significantly less blood loss (115.43 ± 79.43 vs. 340.98 ± 453.9 ml, p = < 0.0001), hospital stay (1.28 ± 0.49 vs. 1.92 ± 1.05 days, p = < 0.0001), requirement of blood transfusion (93.97 vs. 81.97%, p = 0.031) and requirement of intravenous (IV) analgesia (41.38 vs. 34.43%, p = 0.019) as compared to the patients in the LM group. The Robotic myomectomy significantly reduces blood loss, the duration of hospital stay, and requirement of blood transfusions and IV analgesia as compared to the laparoscopic myomectomy.
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Affiliation(s)
- Rooma Sinha
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India.
| | - Bana Rupa
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India
| | - Mamatha Reddy
- Department of Gynaecology, Laparoscopic and Robotic Surgery, Apollo Hospital, Hyderabad, Telangana, India
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Gonadotropin-Releasing Hormone Antagonists Revolutionizing Gynecology. Obstet Gynecol 2022; 140:917-919. [PMID: 36357969 DOI: 10.1097/aog.0000000000005012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Lin J, Wu X. Halofuginone inhibits cell proliferation and AKT/mTORC1 signaling in uterine leiomyoma cells. Growth Factors 2022; 40:212-220. [PMID: 36001478 DOI: 10.1080/08977194.2022.2113394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The present study aimed to explore the effects of antifibrotic agent halofuginone on uterine leiomyomas (ULs) cells. The survival of the uterine smooth muscle (UtSMC) cells and UL ELT3 cells were measured. Flow cytometry was used to assess the cell cycle distribution and apoptosis. Effects of halofuginone on the state of AKT/mTOR pathway were evaluated. Xenograft animal model was applied to explore the effects of halofuginone in vivo. Halofuginone inhibited the proliferation of ELT3 cells dose-dependently without obvious influence on UtSMC cells. Halofuginone suppressed cell cycle progression and promoted apoptosis of ELT3 cells dose-dependently. Also, p-AKT/AKT and p-p70S6/p70S6 were significantly lowered after treatment with 20 nM halofuginone. Additionally, halofuginone reduced ELT3 tumor growth in xenograft tumor animal model. The present study illustrates that halofuginone inhibits cell proliferation of ULs with low side effects on normal smooth muscle cells, and AKT/mTOR signaling pathway was inactivated meanwhile.
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Affiliation(s)
- Jing Lin
- Department of Gynecology, Longyan People Hospital, Longyan, Fujian Province, China
| | - Xiaochun Wu
- Department of Gynecology, Longyan People Hospital, Longyan, Fujian Province, China
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10
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Zheng L, Liu D, Hu C. Effects of total laparoscopic hysterectomy on the clinical outcomes of patients with uterine fibroids. Am J Transl Res 2022; 14:2402-2409. [PMID: 35559408 PMCID: PMC9091122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To clarify the effects of total laparoscopic hysterectomy (TLH) on sex hormone levels, quality of life (QOL) and complications such as lower-extremity deep vein thrombosis (DVT) in patients with uterine fibroids (UFs). METHODS In this retrospective study, 136 patients with UFs treated in Hainan General Hospital from March 2018 to December 2020 were collected as research participants, of which 65 patients received total abdominal hysterectomy (TAH) were included in the control group and 71 patients who received TLH were assigned to the research group. The two groups were compared regarding the following items: response rate, surgical indexes, rehabilitation indicators, changes in sex hormone levels and QOL, and the occurrence of lower-extremity DVT. RESULTS The research group showed a significantly higher response rate, and better indicators of surgical treatment and rehabilitation than the control group (P<0.05). The sex hormones in the research group were more stable than that in the control group. The QOL was also significantly better and the incidence of total complications was statistically lower in the research group compared with the control group (both P<0.05). CONCLUSIONS TLH is a feasible and safe alternative than traditional TAH for UFs, as it can effectively improve patients' sex hormone levels and QOL, and reduce the incidence of complications, which is worthy of clinical promotion.
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Affiliation(s)
- Lang Zheng
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
| | - Dan Liu
- Department of Hematology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
| | - Chunyan Hu
- Department of Gynecology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University)Haikou 571003, Hainan Province, China
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11
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Kho RM, Desai VB, Schwartz PE, Wright JD, Gross CP, Hutchison LM, Boscoe FP, Lin H, Xu X. Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma. J Minim Invasive Gynecol 2022; 29:119-127. [PMID: 34265441 PMCID: PMC8752465 DOI: 10.1016/j.jmig.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To examine the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identify factors associated with missed diagnosis, and compare the outcomes of patients who had a preoperative diagnosis with those of patients who had a missed diagnosis. DESIGN Retrospective cohort study using linked data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry from 2003 to 2015. SETTING Inpatient and outpatient encounters at civilian hospitals and ambulatory surgery centers in New York State. PATIENTS Women with uterine leiomyosarcoma who underwent a hysterectomy and a preoperative endometrial sampling within 90 days before the hysterectomy. INTERVENTIONS Endometrial sampling. MEASUREMENTS AND MAIN RESULTS A total of 79 patients with uterine leiomyosarcoma met the sample eligibility criteria. Of these patients, 46 (58.2%) were diagnosed preoperatively, and 33 (41.8%) were diagnosed postoperatively. Patients in the 2 groups did not differ significantly in age, race/ethnicity, bleeding symptoms, or comorbidities assessed. In multivariable regression analysis, women who had endometrial sampling performed with hysteroscopy (compared with women who had endeometrial sampling performed without hysteroscopy) had a higher likelihood of preoperative diagnosis (adjusted risk ratio [aRR] 3.03; 95% confidence interval [CI], 1.43-6.42). Patients with localized stage (vs distant stage) or tumor size >11 cm (vs <8 cm) were less likely to be diagnosed preoperatively (aRR 0.50; 95% CI, 0.28-0.89, and aRR 0.54; 95% CI, 0.30-0.99, respectively). Supracervical hysterectomy was not performed in any of the patients whose leiomyosarcoma was diagnosed preoperatively compared with 21.2% of the patients who were diagnosed postoperatively (p = .002). CONCLUSION Endometrial sampling detected leiomyosarcoma preoperatively in 58.2% of the patients. The use of hysteroscopy with endometrial sampling improved preoperative detection of leiomyosarcoma by threefold. Patients with a missed diagnosis had a higher risk of undergoing suboptimal surgical management at the time of their index surgery.
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Affiliation(s)
- Rosanne M. Kho
- Women’s Health Institute, Department of Obstetrics
and Gynecology, Cleveland Clinic, Cleveland, OH
| | - Vrunda B. Desai
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT,CooperSurgical Inc, Trumbull, CT
| | - Peter E. Schwartz
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia
University College of Physicians and Surgeons, New York, NY
| | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine,
New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness
Research (COPPER) Center, New Haven, CT
| | | | - Francis P. Boscoe
- New York State Cancer Registry, New York State Department
of Health, Albany, NY
| | - Haiqun Lin
- Division of Nursing Science, Rutgers University School of
Nursing, Newark, NJ,Department of Biostatistics and Epidemiology, Rutgers
School of Public Health, Newark, NJ
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness
Research (COPPER) Center, New Haven, CT,Corresponding Author: Xiao Xu, PhD,
Yale University School of Medicine, LSOG 205B, 310 Cedar Street, New Haven, CT
06520; Phone: (203) 737-1655; Fax: (203) 785-6586;
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12
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Aleksandrovych V, Bereza T, Ulatowska-Białas M, Pasternak A, Walocha JA, Pityński K, Gil K. Identification of PDGFRα+ cells in uterine fibroids - link between angiogenesis and uterine telocytes. Arch Med Sci 2022; 18:1329-1337. [PMID: 36160340 PMCID: PMC9479735 DOI: 10.5114/aoms.2019.86795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Telocytes (TCs), also called interstitial Cajal-like cells (ICLC), CD34+ cells or PDGFRα+ cells (platelet-derived growth factor receptor α positive cells), a new type of cell of mesenchymal origin, were described over one decade ago. The unique nature of these cells still deserves attention from the scientific community. Telocytes make homo- and heterocellular contact with myocytes, immunocytes and nerves, have their own immunohistochemical and secretome profiles and thus might regulate local regenerative processes including angiogenesis and fibrosis. The aim of our study was to observe the missing link between angiogenesis and telocytes in leiomyoma, the most common benign tumors affecting women of reproductive age. MATERIAL AND METHODS We observed uterine tissue samples from leiomyoma, adjacent myometrium and unchanged tissue from patients with leiomyoma and control subjects using routine histology, histochemistry, immunofluorescence (CD117, CD31, CD34, PDGFRα, tryptase, sFlt-1) and image analysis methods. RESULTS The decline of the telocyte density in the foci of fibroids correlated with poor vascularization inside the leiomyoma. Moreover, the expression of sFlt-1 (anti-angiogenic-related factor) significantly increased inside a fibroid. In leiomyoma the decrease of telocyte and blood micro-vessel density was accompanied by prevalence of collagen deposits, unlike the unchanged myometrium. CONCLUSIONS Our results demonstrate TCs in human uterine fibroids and highlight their possible involvement in the pathogenesis of myometrial pathology in the context of angiogenesis.
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Affiliation(s)
| | - Tomasz Bereza
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | | | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A. Walocha
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Kazimierz Pityński
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
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13
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Roșu GA, Ionescu CA, Călin FD, Dimitriu M, Pleș L, Matei A, Navolan DB. Prognostic value of the location of submucosal uterine leiomyomas in infertility. Exp Ther Med 2021; 22:1482. [PMID: 34765023 DOI: 10.3892/etm.2021.10917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022] Open
Abstract
Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.
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Affiliation(s)
- George-Alexandru Roșu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Crîngu Antoniu Ionescu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Florin Daniel Călin
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Mihai Dimitriu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics, 'Bucur' Maternity, 'Sf. Ioan' Clinical Emergency Hospital, 040294 Bucharest, Romania
| | - Alexandra Matei
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sf. Pantelimon' Clinical Emergency Hospital, 021659 Bucharest, Romania
| | - Dan-Bogdan Navolan
- Department of Obstetrics and Gynecology, 'Victor Babes' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania.,Department of Maternal-Fetal Medicine, 'Dr. Dumitru Popescu' Obstetrics and Gynecology Hospital, 300172 Timisora, Romania
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14
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Boutry J, Tissot S, Ujvari B, Capp JP, Giraudeau M, Nedelcu AM, Thomas F. The evolution and ecology of benign tumors. Biochim Biophys Acta Rev Cancer 2021; 1877:188643. [PMID: 34715267 DOI: 10.1016/j.bbcan.2021.188643] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/22/2021] [Accepted: 10/23/2021] [Indexed: 12/12/2022]
Abstract
Tumors are usually classified into two main categories - benign or malignant, with much more attention being devoted to the second category given that they are usually associated with more severe health issues (i.e., metastatic cancers). Here, we argue that the mechanistic distinction between benign and malignant tumors has narrowed our understanding of neoplastic processes. This review provides the first comprehensive discussion of benign tumors in the context of their evolution and ecology as well as interactions with their hosts. We compare the genetic and epigenetic profiles, cellular activities, and the involvement of viruses in benign and malignant tumors. We also address the impact of intra-tumoral cell composition and its relationship with the tumoral microenvironment. Lastly, we explore the differences in the distribution of benign and malignant neoplasia across the tree of life and provide examples on how benign tumors can also affect individual fitness and consequently the evolutionary trajectories of populations and species. Overall, our goal is to bring attention to the non-cancerous manifestations of tumors, at different scales, and to stimulate research on the evolutionary ecology of host-tumor interactions on a broader scale. Ultimately, we suggest that a better appreciation of the differences and similarities between benign and malignant tumors is fundamental to our understanding of malignancy both at mechanistic and evolutionary levels.
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Affiliation(s)
- Justine Boutry
- CREEC/CANECEV, MIVEGEC (CREES), University of Montpellier, CNRS, IRD, Montpellier, France
| | - Sophie Tissot
- CREEC/CANECEV, MIVEGEC (CREES), University of Montpellier, CNRS, IRD, Montpellier, France
| | - Beata Ujvari
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin, University, Vic., Australia
| | - Jean-Pascal Capp
- Toulouse Biotechnology Institute, University of Toulouse, INSA, CNRS, INRAE, Toulouse, France
| | - Mathieu Giraudeau
- CREEC/CANECEV, MIVEGEC (CREES), University of Montpellier, CNRS, IRD, Montpellier, France; LIENSs, UMR 7266 CNRS-La Rochelle Université, 2 Rue Olympe de Gouges, 17000 La Rochelle, France
| | - Aurora M Nedelcu
- Department of Biology, University of New Brunswick, Fredericton, New Brunswick, E3B 5A3, Canada
| | - Frédéric Thomas
- CREEC/CANECEV, MIVEGEC (CREES), University of Montpellier, CNRS, IRD, Montpellier, France.
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15
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Uterine leiomyomas revisited with review of literature. Abdom Radiol (NY) 2021; 46:4908-4926. [PMID: 34057564 DOI: 10.1007/s00261-021-03126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023]
Abstract
Uterine leiomyomas, more commonly known as fibroids, are the most common neoplasms of the uterus. These tumors have a profound effect on health care and cost worldwide. Depending on the race, uterine leiomyomas can be seen in 70-80% of all women. Although majority of the women with uterine leiomyomas remain asymptomatic, approximately 30% can present with symptoms. Diagnosing typical leiomyomas on imaging is straightforward. However, when large, located extrauterine and especially with degeneration, the diagnosis can be challenging on imaging. In this article, apart from reviewing the demographics and management of patients with leiomyomas, we describe in detail the imaging appearance of various atypical leiomyomas, uncommon locations outside the uterus and their important differential diagnosis that can have a profound effect on patient management.
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16
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Schultze-Mosgau MH, Ploeger BA, Frei M, Höchel J, Rottmann A. Clinical Pharmacokinetics and Pharmacodynamics of the Selective Progesterone Receptor Modulator Vilaprisan: A Comprehensive Overview. Clin Pharmacokinet 2021; 61:1-16. [PMID: 34569009 PMCID: PMC8761719 DOI: 10.1007/s40262-021-01073-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/05/2022]
Abstract
Vilaprisan is a highly potent selective progesterone receptor modulator in development for the treatment of symptomatic uterine fibroids and endometriosis. Its pharmacokinetics are characterized by rapid absorption, almost complete bioavailability, and dose-proportional exposure. The intrinsic factors of age, bodyweight, and race have no clinically relevant effect on the pharmacokinetics and pharmacodynamics of vilaprisan and do not warrant a dose adjustment. Similarly, vilaprisan can be used in patients with mild or moderate renal or hepatic impairment without dose adjustment, but its use is not recommended in patients with severe organ impairment. Vilaprisan has no perpetrator potential on cytochrome P450 (CYP) enzymes or transporters and therefore restrictions in the concomitant use of their substrates are not required. Nonetheless, because it is a sensitive CYP3A4 substrate itself, concomitant use of vilaprisan with strong CYP3A inhibitors or inducers is not recommended. However, there is no risk for QTc prolongation when vilaprisan and a strong CYP3A inhibitor are administered concomitantly, as indicated by a vilaprisan concentration–QTc response analysis across all studies with triplicate electrocardiogram measurements. Furthermore, due to its mode of action, vilaprisan is also not recommended to be used together with progestin-containing oral contraceptives. Vilaprisan shows a steep exposure–response relationship for inducing amenorrhea in patients with uterine fibroids experiencing heavy menstrual bleeding. Based on simulations, a dose of 2 mg/day is expected to induce a maximum bleeding reduction and was thus selected for phase III.
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Affiliation(s)
| | | | | | | | - Antje Rottmann
- Drug Metabolism and Pharmacokinetics, Bayer AG, Berlin, Germany
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17
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Ciarmela P, Delli Carpini G, Greco S, Zannotti A, Montik N, Giannella L, Giuliani L, Grelloni C, Panfoli F, Paolucci M, Pierucci G, Ragno F, Pellegrino P, Petraglia F, Ciavattini A. Uterine fibroid vascularization: from morphological evidence to clinical implications. Reprod Biomed Online 2021; 44:281-294. [PMID: 34848152 DOI: 10.1016/j.rbmo.2021.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/24/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023]
Abstract
Uterine fibroids are the most common cause of solid pelvic tumours, occurring in 20-30% of fertile women and presenting clinical complications that seriously affect women's health. They commonly cause severe symptoms, such as heavy, prolonged menstrual bleeding and anaemia. The study of microscopic and macroscopic vascular aspects of uterine fibroids is important for understanding the clinical manifestations of uterine fibroids, for predicting the effectiveness of alternative treatments to surgery, i.e. uterine artery embolization, for improving surgery outcomes and for carrying out a differential diagnosis with other benign conditions, e.g. adenomyosis, or malignancy, e.g. leiomyosarcoma, and to develop new therapeutic approaches. In this review, current knowledge of how the vascular network and angiogenesis are implied in the formation of uterine fibroids and in the pathogenesis of related symptoms is explored, and evidence on the role of ultrasound in evaluating fibroid vascularization is summarized. This review combines anatomical, morphological and biomolecular information related to angiogenic mechanisms with diagnostic and clinical information, highlighting the various interconnections. Uterine and fibroid vascularization need further investigation to gain a deeper understanding of the pathogenetic elements that lead to the formation of uterine fibroids and their clinical manifestations.
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Affiliation(s)
- Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy.
| | - Giovanni Delli Carpini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Alessandro Zannotti
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy; Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Nina Montik
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Luca Giannella
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Lucia Giuliani
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Camilla Grelloni
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Francesca Panfoli
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Michela Paolucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gloria Pierucci
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Federica Ragno
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Felice Petraglia
- Department of Biomedical, Experimental and Clinical Sciences, Division of Obstetrics and Gynecology, University of Florence, Careggi University Hospital Florence, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department od Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona 60126, Italy
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18
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Salas A, López J, Reyes R, Évora C, de Oca FM, Báez D, Delgado A, Almeida TA. Organotypic culture as a research and preclinical model to study uterine leiomyomas. Sci Rep 2020; 10:5212. [PMID: 32251338 PMCID: PMC7090073 DOI: 10.1038/s41598-020-62158-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
Organotypic cultures of tissue slices have been successfully established in lung, prostate, colon, gastric and breast cancer among other malignancies, but until now an ex vivo model based on tissue slices has not been established for uterine leiomyoma. In the present study, we describe a method for culturing tumour slides onto an alginate scaffold. Morphological integrity of tissue slices was maintained for up to 7 days of culture, with cells expressing desmin, estrogen and progesterone receptors. Driver mutations were present in the ex vivo slices at all-time points analyzed. Cultivated tumour slices responded to ovarian hormones stimulation upregulating the expression of genes involved in leiomyoma pathogenesis. This tissue model preserves extracellular matrix, cellular diversity and genetic background simulating more in-vivo-like situations. As a novelty, this platform allows encapsulation of microspheres containing drugs that can be tested on the ex vivo tumour slices. After optimizing drug release rates, microspheres would then be directly tested in animal models through local injection.
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Affiliation(s)
- Ana Salas
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Judith López
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Ricardo Reyes
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Carmen Évora
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Universidad de la Laguna, Tenerife, Spain. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto de Tecnologías Biomédicas (ITB). C/Sta. María Soledad, s/n. Facultad de Ciencias. Sección de Medicina, 38200, San Cristóbal de La Laguna, Tenerife, Spain
| | - Francisco Montes de Oca
- Hospital Quironsalud, C/Poeta Rodríguez Herrera 1, Santa Cruz de Tenerife, Tenerife, 38006, Spain
| | - Delia Báez
- Departamento de Obstetricia y Ginecología, Facultad de Ciencias de La Salud, Universidad de La Laguna, Campus de Ofra s/n, San Cristobal de La Laguna, Tenerife, Spain
| | - Araceli Delgado
- Departamento de Ingeniería Química y Tecnología Farmacéutica, Universidad de la Laguna, Tenerife, Spain. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
- Instituto de Tecnologías Biomédicas (ITB). C/Sta. María Soledad, s/n. Facultad de Ciencias. Sección de Medicina, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
| | - Teresa A Almeida
- Departamento de Bioquímica, Microbiología, Biología Celular y Genética, Universidad de La Laguna. Facultad de Ciencias. Sección de Biología. Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC). Avda. Astrofísico Fco. Sánchez s/n, 38200, San Cristóbal de La Laguna, Tenerife, Spain.
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19
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Gracia M, Carmona F. WITHDRAWN: Uterine myomas: Clinical impact and pathophysiological bases. Eur J Obstet Gynecol Reprod Biol 2020:S0301-2115(20)30052-X. [PMID: 32061414 DOI: 10.1016/j.ejogrb.2020.01.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/26/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Meritxell Gracia
- Division of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Francisco Carmona
- Division of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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20
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Schlaff WD, Ackerman RT, Al-Hendy A, Archer DF, Barnhart KT, Bradley LD, Carr BR, Feinberg EC, Hurtado SM, Kim J, Liu R, Mabey RG, Owens CD, Poindexter A, Puscheck EE, Rodriguez-Ginorio H, Simon JA, Soliman AM, Stewart EA, Watts NB, Muneyyirci-Delale O. Elagolix for Heavy Menstrual Bleeding in Women with Uterine Fibroids. N Engl J Med 2020; 382:328-340. [PMID: 31971678 DOI: 10.1056/nejmoa1904351] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Uterine fibroids are hormone-responsive neoplasms that are associated with heavy menstrual bleeding. Elagolix, an oral gonadotropin-releasing hormone antagonist resulting in rapid, reversible suppression of ovarian sex hormones, may reduce fibroid-associated bleeding. METHODS We conducted two identical, double-blind, randomized, placebo-controlled, 6-month phase 3 trials (Elaris Uterine Fibroids 1 and 2 [UF-1 and UF-2]) to evaluate the efficacy and safety of elagolix at a dose of 300 mg twice daily with hormonal "add-back" therapy (to replace reduced levels of endogenous hormones; in this case, estradiol, 1 mg, and norethindrone acetate, 0.5 mg, once daily) in women with fibroid-associated bleeding. An elagolix-alone group was included to assess the impact of add-back therapy on the hypoestrogenic effects of elagolix. The primary end point was menstrual blood loss of less than 80 ml during the final month of treatment and at least a 50% reduction in menstrual blood loss from baseline to the final month; missing data were imputed with the use of multiple imputation. RESULTS A total of 412 women in UF-1 and 378 women in UF-2 underwent randomization, received elagolix or placebo, and were included in the analyses. Criteria for the primary end point were met in 68.5% of 206 women in UF-1 and in 76.5% of 189 women in UF-2 who received elagolix plus add-back therapy, as compared with 8.7% of 102 women and 10% of 94 women, respectively, who received placebo (P<0.001 for both trials). Among the women who received elagolix alone, the primary end point was met in 84.1% of 104 women in UF-1 and in 77% of 95 women in UF-2. Hot flushes (in both trials) and metrorrhagia (in UF-1) occurred significantly more commonly with elagolix plus add-back therapy than with placebo. Hypoestrogenic effects of elagolix, especially decreases in bone mineral density, were attenuated with add-back therapy. CONCLUSIONS Elagolix with add-back therapy was effective in reducing heavy menstrual bleeding in women with uterine fibroids. (Funded by AbbVie; Elaris UF-1 and Elaris UF-2 ClinicalTrials.gov numbers, NCT02654054 and NCT02691494.).
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Affiliation(s)
- William D Schlaff
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Ronald T Ackerman
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Ayman Al-Hendy
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - David F Archer
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Kurt T Barnhart
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Linda D Bradley
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Bruce R Carr
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Eve C Feinberg
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Sandra M Hurtado
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - JinHee Kim
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Ran Liu
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - R Garn Mabey
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Charlotte D Owens
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Alfred Poindexter
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Elizabeth E Puscheck
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Henry Rodriguez-Ginorio
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - James A Simon
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Ahmed M Soliman
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Elizabeth A Stewart
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Nelson B Watts
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
| | - Ozgul Muneyyirci-Delale
- From Thomas Jefferson University (W.D.S.) and the University of Pennsylvania (K.T.B.), Philadelphia; Comprehensive Clinical Trials, West Palm Beach, FL (R.T.A.); University of Illinois at Chicago (A.A.-H.) and Northwestern University (E.C.F.), Chicago, AbbVie, North Chicago (R.L., C.D.O., A.M.S.), and InVia Fertility, Hoffman Estates (E.E.P.) - all in Illinois; Eastern Virginia Medical School, Norfolk (D.F.A.); Cleveland Clinic, Cleveland (L.D.B.); University of Texas Southwestern Medical Center, Dallas (B.R.C.); University of Texas Health Science Center at Houston (S.M.H.) and Advances in Health (A.P.), Houston; Columbia University (J.K.) and SUNY Downstate Health Sciences University (O.M.-D.), New York; private practice, Las Vegas (R.G.M.); Wayne State University, Detroit (E.E.P.); Torre de Auxilio Mutuo, San Juan, Puerto Rico (H.R.-G.); George Washington University, Washington, DC (J.A.S.); Mayo Clinic and Mayo Clinic Alix School of Medicine, Rochester, MN (E.A.S.); and Mercy Health, Cincinnati (N.B.W.)
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Miller CE, Osman KM. Transcervical Radiofrequency Ablation of Symptomatic Uterine Fibroids: 2-Year Results of the SONATA Pivotal Trial. J Gynecol Surg 2019; 35:345-349. [PMID: 32226268 PMCID: PMC7099422 DOI: 10.1089/gyn.2019.0012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To report 2-year results of sonography-guided transcervical fibroid ablation (TFA) using the Sonata® system in women with symptomatic uterine fibroids. Design: This is a prospective multicenter single-arm interventional trial. Methods: Premenopausal women with up to 10 clinically relevant uterine fibroids, each ranging from 1 to 5 cm in diameter, were treated with sonography-guided TFA on an outpatient basis and returned for regular follow-up visits for 2 years. Assessed outcomes included changes in symptom severity, heath-related quality of life, general health status, work and activity limitations, treatment satisfaction, adverse events, surgical reintervention, and occurrence of pregnancy and associated outcomes. Results: Among 147 enrolled women, 125 (85%) returned for follow-up at 2 years. Compared with baseline, symptom severity decreased from 55 ± 19 to 24 ± 18 (p < 0.001), health-related quality of life increased from 40 ± 21 to 83 ± 19 (p < 0.001), and EuroQol 5-Dimension scores increased from 0.72 ± 0.21 to 0.89 ± 0.14 (p < 0.001). Overall treatment satisfaction at 2 years was 94%. The mean percentage of missed work time, overall work impairment, and activity impairment significantly decreased at follow-up. Through 2 years, surgical reintervention for heavy menstrual bleeding was performed in 5.5% of patients. One singleton pregnancy occurred with a normal peripartum outcome. Conclusions: TFA treatment with the Sonata system provides significant clinical improvement through 2 years postablation, with a low incidence of surgical reintervention. Other favorable outcomes included a rapid return to work and substantial improvements in quality of life, symptom severity, work productivity, and activity levels.
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Affiliation(s)
- Charles E. Miller
- The Advanced Gynecologic Surgical Institute, Schaumburg, Illinois
- Address correspondence to: Charles E. Miller, MD, The Advanced Gynecologic Surgical Institute, 120 Osler Drive, Suite 100, Naperville IL 60540
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Elagolix Alone or With Add-Back Therapy in Women With Heavy Menstrual Bleeding and Uterine Leiomyomas: A Randomized Controlled Trial. Obstet Gynecol 2019; 132:1252-1264. [PMID: 30303923 DOI: 10.1097/aog.0000000000002933] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate elagolix, an oral gonadotropin-releasing hormone receptor antagonist, alone or with add-back therapy, in premenopausal women with heavy menstrual bleeding (greater than 80 mL per month) associated with uterine leiomyomas. METHODS This double-blind, randomized, placebo-controlled, parallel-group study evaluated efficacy and safety of elagolix in cohorts 1 (300 mg twice daily) and 2 (600 mg daily) with four arms per cohort: placebo, elagolix alone, elagolix with 0.5 mg estradiol/0.1 norethindrone acetate, and elagolix with 1.0 mg estradiol/0.5 mg norethindrone acetate. A sample size of 65 per group was planned to compare elagolix with add-back to placebo on the primary end point: the percentage of women who had less than 80 mL menstrual blood loss and 50% or greater reduction in menstrual blood loss from baseline to the last 28 days of treatment. Safety assessments included changes in bone mineral density. RESULTS From April 8, 2013, to December 8, 2015, 571 women were enrolled, 567 were randomized and treated (cohort 1=259; cohort 2=308), and 80% and 75% completed treatment, respectively. Participants had a mean±SD age of 43±5 years (cohort 2, 42±5 years), and 70% were black (cohort 2, 74%). Primary end point responder rates in cohort 1 (cohort 2) were 92% (90%) for elagolix alone, 85% (73%) for elagolix with 0.5 mg estradiol/0.1 mg norethindrone acetate, 79% (82%) for elagolix with 1.0 mg estradiol/0.5 mg norethindrone acetate, and 27% (32%) for placebo (all P<.001 vs placebo). Elagolix groups had significant decreases compared with placebo in lumbar spine bone mineral density, which was attenuated by adding 1.0 mg estradiol/0.5 mg norethindrone acetate. CONCLUSION Elagolix with and without add-back significantly reduced menstrual blood loss in women with uterine leiomyomas. Add-back therapy reduced hypoestrogenic effects on bone mineral density. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT01817530; EU Clinical Trial Register, 2013-000082-37.
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Malik M, Britten J, Borahay M, Segars J, Catherino WH. Simvastatin, at clinically relevant concentrations, affects human uterine leiomyoma growth and extracellular matrix production. Fertil Steril 2019; 110:1398-1407.e1. [PMID: 30503138 DOI: 10.1016/j.fertnstert.2018.07.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To observe the antifibroid effects of therapeutic concentrations of simvastatin, which interferes with cholesterol biosynthesis, a known precursor of five major classes of steroid hormones, including progesterone and estrogen, which play a major role in the development and growth of uterine leiomyomas. DESIGN Two-dimensional and three-dimensional cell culture study of immortalized human leiomyoma and patient-matched myometrium cells treated with simvastatin. SETTING University laboratory. PATIENT(S) None. INTERVENTIONS(S) None. MAIN OUTCOME MEASURE(S) Cell proliferation, alteration in apoptotic signaling pathways, and extracellular matrix (ECM) protein production. RESULT(S) Simvastatin demonstrated a concentration-dependent antiproliferative effect on both the leiomyoma cells and the patient-matched myometrium cells, but a higher inhibitory effect at lower concentrations of simvastatin was observed in leiomyoma cells. Simvastatin also regulated leiomyoma cell apoptosis through a concentration-dependent increase in activity of caspase-3. Simvastatin significantly inhibited expression of major ECM proteins collagen I, collagen III, fibronectin, versican, and brevican in leiomyoma cells at concentrations as low as 10-9 mol/L within 48 hours of exposure. CONCLUSION(S) Simvastatin induces apoptosis in uterine leiomyoma cells at low concentrations, as evidenced by increased active caspase levels. Furthermore, inhibited production of the ECM proteins may lead to reduction in tumor size. Simvastatin may represent a novel therapeutic treatment strategy for uterine leiomyomas.
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Affiliation(s)
- Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joy Britten
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Mostafa Borahay
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland
| | - James Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, Maryland
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Kogan EA, Zharkov NV, Askolskaya SI, Popov YV, Krot MA, Demura TA. [Growth mechanisms and morphological structural features of large uterine leiomyoma]. Arkh Patol 2018; 80:16-22. [PMID: 30335056 DOI: 10.17116/patol20188005116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the growth mechanisms of large uterine leiomyoma (LULM) on the basis of a clinical morphology examination, by providing immunohistochemical (IHC) characteristics of the expression of growth factors (transforming growth factor-beta (TGFβ) and platelet-derived endothelial cell growth factor (PD-ECGF)) and markers of stemness (CD117/c-kit, Connexin 43, Nestin) and proliferation (Ki-67). SUBJECT AND METHODS The investigators examined surgical specimens from 38 women diagnosed with simple uterine leiomyoma (ULM), who had been divided into two groups: 1) 21 patients with LULM (>6 cm in diameter) (a study group); 2) 17 patients with small ULM (<4 cm in diameter) (a comparison group). Each group was also divided into two age subgroups (younger (<45 years) and older (≥45 years) subgroups (1a (n=12), 1b (n=9), 2a (n=8) and 2b (n=9), respectively. Histological specimens were used to make IHC examination with antibodies against TGFβ, PD-ECGF, CD117/c-kit, Connexin 43, Nestin, and Ki-67. RESULTS The growth mechanisms of LULM of simple histological structure were found to be associated with the larger number of growth zones in the tumors, with their enhanced cellular proliferative activity, and with the appearance of cells with signs of stemness, which is combined with the preserved subsequent maturation of tumor cells and determines the benign nature of LULM. CONCLUSION There were differences in the molecular profile of LULM and small ULM, as well as LULM in perimenopausal and young women by the expression levels of Ki-67, TGFβ, PD-ECGF, CD117, and Connexin 43, which can be used for diagnosis, prediction, and development of targeted therapies.
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Affiliation(s)
- E A Kogan
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - N V Zharkov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - S I Askolskaya
- Federal Research and Clinical Center for Special Medical Care and Medical Technologies, Federal Biomedical Agency of Russia, Moscow, Russia
| | - Yu V Popov
- Federal Research and Clinical Center for Special Medical Care and Medical Technologies, Federal Biomedical Agency of Russia, Moscow, Russia
| | - M A Krot
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - T A Demura
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Park MJ, Shen H, Spaeth JM, Tolvanen JH, Failor C, Knudtson JF, McLaughlin J, Halder SK, Yang Q, Bulun SE, Al-Hendy A, Schenken RS, Aaltonen LA, Boyer TG. Oncogenic exon 2 mutations in Mediator subunit MED12 disrupt allosteric activation of cyclin C-CDK8/19. J Biol Chem 2018; 293:4870-4882. [PMID: 29440396 DOI: 10.1074/jbc.ra118.001725] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/28/2018] [Indexed: 01/26/2023] Open
Abstract
Somatic mutations in exon 2 of the RNA polymerase II transcriptional Mediator subunit MED12 occur at high frequency in uterine fibroids (UFs) and breast fibroepithelial tumors as well as recurrently, albeit less frequently, in malignant uterine leimyosarcomas, chronic lymphocytic leukemias, and colorectal cancers. Previously, we reported that UF-linked mutations in MED12 disrupt its ability to activate cyclin C (CycC)-dependent kinase 8 (CDK8) in Mediator, implicating impaired Mediator-associated CDK8 activity in the molecular pathogenesis of these clinically significant lesions. Notably, the CDK8 paralog CDK19 is also expressed in myometrium, and both CDK8 and CDK19 assemble into Mediator in a mutually exclusive manner, suggesting that CDK19 activity may also be germane to the pathogenesis of MED12 mutation-induced UFs. However, whether and how UF-linked mutations in MED12 affect CDK19 activation is unknown. Herein, we show that MED12 allosterically activates CDK19 and that UF-linked exon 2 mutations in MED12 disrupt its CDK19 stimulatory activity. Furthermore, we find that within the Mediator kinase module, MED13 directly binds to the MED12 C terminus, thereby suppressing an apparent UF mutation-induced conformational change in MED12 that otherwise disrupts its association with CycC-CDK8/19. Thus, in the presence of MED13, mutant MED12 can bind, but cannot activate, CycC-CDK8/19. These findings indicate that MED12 binding is necessary but not sufficient for CycC-CDK8/19 activation and reveal an additional step in the MED12-dependent activation process, one critically dependent on MED12 residues altered by UF-linked exon 2 mutations. These findings confirm that UF-linked mutations in MED12 disrupt composite Mediator-associated kinase activity and identify CDK8/19 as prospective therapeutic targets in UFs.
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Affiliation(s)
- Min Ju Park
- Departments of Molecular Medicine, San Antonio, Texas 78229
| | - Hailian Shen
- Departments of Molecular Medicine, San Antonio, Texas 78229
| | - Jason M Spaeth
- Departments of Molecular Medicine, San Antonio, Texas 78229
| | - Jaana H Tolvanen
- Genome-Scale Biology Program and Department of Medical Genetics, Haartman Institute, University of Helsinki, Biomedicum, P.O. Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - Courtney Failor
- Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Jennifer F Knudtson
- Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Jessica McLaughlin
- Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Sunil K Halder
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia 30912
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia 30912
| | - Serdar E Bulun
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia 30912
| | - Robert S Schenken
- Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229
| | - Lauri A Aaltonen
- Genome-Scale Biology Program and Department of Medical Genetics, Haartman Institute, University of Helsinki, Biomedicum, P.O. Box 63 (Haartmaninkatu 8), Helsinki FIN-00014, Finland
| | - Thomas G Boyer
- Departments of Molecular Medicine, San Antonio, Texas 78229.
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Abstract
AbstractUterine fibroids affect a wide cross-section of the population, with prevalence, symptom severity, and overall disease burden generally higher among black women, likely due to both genetic and environmental factors. Potential symptoms of uterine fibroids include painful and excessive uterine bleeding, interference with everyday life and self-image, and impaired fertility. Because of the high estimated prevalence and costs associated with treatments, the direct and indirect costs of uterine fibroids are substantial for both the health care system and the individual patient. Special patient populations—such as black women, women seeking to retain fertility, and women with asymptomatic fibroids—have particular treatment needs that require a variety of diagnostic methods and treatment options. Despite the widespread occurrence of uterine fibroids and newer treatment options, little high-quality data are available to formulate evidence-based guidelines that address these unmet patient needs. Specific areas in need of attention include improving diagnostic techniques, increasing patient access to early treatment, and identifying best practices for this diverse patient population.
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Affiliation(s)
- Ayman Al-Hendy
- Division of Translational Research, Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Evan Robert Myers
- Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth Stewart
- Department of Obstetrics and Gynecology and Surgery, Mayo Clinic, Rochester, Minnesota
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González-Santana A, Marrero-Hernández S, Dorta I, Hernández M, Pinto FM, Báez D, Bello AR, Candenas L, Almeida TA. Altered expression of the tachykinins substance P/neurokinin A/hemokinin-1 and their preferred neurokinin 1/neurokinin 2 receptors in uterine leiomyomata. Fertil Steril 2016; 106:1521-1529. [DOI: 10.1016/j.fertnstert.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/17/2016] [Accepted: 07/06/2016] [Indexed: 12/24/2022]
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Abstract
PURPOSE OF REVIEW This article reviews fibroids management in the perimenopausal period, and addresses future directions in care. RECENT FINDINGS Aromatase inhibitors, selective estrogen receptor modulators and antiprogestogens for medical management and minimally surgical techniques are promising treatments. SUMMARY The disease and the symptoms may persist in the peri and postmenopausal periods. The assumption that they will resolve with the onset of the menopause is too simplistic and not always valid. The number of perimenopausal women who wish to retain their uterus for reasons other than childbearing is increasing. The accurate diagnosis of these conditions may result in minor surgical or medical treatments being directed at the specific pathology and may avoid the need for major surgery.
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Koohestani F, Qiang W, MacNeill AL, Druschitz SA, Serna VA, Adur M, Kurita T, Nowak RA. Halofuginone suppresses growth of human uterine leiomyoma cells in a mouse xenograft model. Hum Reprod 2016; 31:1540-51. [PMID: 27130615 DOI: 10.1093/humrep/dew094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/06/2016] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION Does halofuginone (HF) inhibit the growth of human uterine leiomyoma cells in a mouse xenograft model? SUMMARY ANSWER HF suppresses the growth of human uterine leiomyoma cells in a mouse xenograft model through inhibiting cell proliferation and inducing apoptosis. WHAT IS KNOWN ALREADY Uterine leiomyomas are the most common benign tumors of the female reproductive tract. HF can suppress the growth of human uterine leiomyoma cells in vitro. The mouse xenograft model reflects the characteristics of human leiomyomas. STUDY DESIGN, SIZE, DURATION Primary leiomyoma smooth muscle cells from eight patients were xenografted under the renal capsule of adult, ovariectomized NOD-scid IL2Rγ(null) mice (NSG). Mice were treated with two different doses of HF or vehicle for 4 weeks with six to eight mice per group. PARTICIPANTS/MATERIALS, SETTING, METHODS Mouse body weight measurements and immunohistochemical analysis of body organs were carried out to assess the safety of HF treatment. Xenografted tumors were measured and analyzed for cellular and molecular changes induced by HF. Ovarian steroid hormone receptors were evaluated for possible modulation by HF. MAIN RESULTS AND THE ROLE OF CHANCE Treatment of mice carrying human UL xenografts with HF at 0.25 or 0.50 mg/kg body weight for 4 weeks resulted in a 35-40% (P < 0.05) reduction in tumor volume. The HF-induced volume reduction was accompanied by increased apoptosis and decreased cell proliferation. In contrast, there was no significant change in the collagen content either at the transcript or protein level between UL xenografts in control and HF groups. HF treatment did not change the expression level of ovarian steroid hormone receptors. No adverse pathological effects were observed in other tissues from mice undergoing treatment at these doses. LIMITATIONS, REASONS FOR CAUTION While this study did test the effects of HF on human leiomyoma cells in an in vivo model, HF was administered to mice whose tolerance and metabolism of the drug may differ from that in humans. Also, the longer term effects of HF treatment are yet unclear. WIDER IMPLICATIONS OF THE FINDINGS The results of this study showing the effectiveness of HF in reducing UL tumor growth by interfering with the main cellular processes regulating cell proliferation and apoptosis are in agreement with previous studies on the effects of HF on other fibrotic diseases. HF can be considered as a candidate for reducing the size of leiomyomas, particularly prior to surgery. STUDY FUNDING/COMPETING INTERESTS This project was funded by NIH PO1HD057877 and R01 HD064402. Authors report no competing interests.
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Affiliation(s)
- Faezeh Koohestani
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA Present address: Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Wenan Qiang
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA Department of Pathology, Northwestern University, Chicago, IL 60611, USA Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Amy L MacNeill
- Department of Pathobiology, College of Veterinary Medicine, University of Illinois, Urbana, IL 61801, USA Present address: Department of Microbiology, Immunology and Pathology, Colorado State University, Ft. Collins, CO 80523, USA
| | - Stacy A Druschitz
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA
| | - Vanida A Serna
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA Present address: Department of Molecular & Cellular Biochemistry, The Comprehensive Cancer Center, Ohio State University, Columbus, OH 43210, USA
| | - Malavika Adur
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
| | - Takeshi Kurita
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA Present address: Department of Molecular & Cellular Biochemistry, The Comprehensive Cancer Center, Ohio State University, Columbus, OH 43210, USA
| | - Romana A Nowak
- Department of Animal Sciences, University of Illinois, Urbana, IL 61801, USA
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Levy G, Dreiling J, DeCherney AH, Egbuniwe MN, Elkas J, Armstrong AY, Nieman LK. Endometrial Effects of Prolonged Therapy with the Selective Progesterone Receptor Modulator Ulipristal Acetate: A Case Report. THE JOURNAL OF REPRODUCTIVE MEDICINE 2016; 61:159-162. [PMID: 27172639 PMCID: PMC9552277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Prolonged exposure to a selective progesterone receptor modulator (ulipristal acetate) in a patient with benign metastasizing leiomyoma did not result in endometrial hyperplasia or neoplasia. CASE A woman with history of benign metastasizing leiomyoma underwent medical treatment for 5 years with ulipristal acetate. Endometrial biopsies were performed at established intervals to monitor for intraepithelial neoplasia or progesterone receptor modulator-associated endometrial changes (PAECs). The patient tolerated UPA therapy well; there was no evidence of hyperplasia or proliferative changes associated with progesterone-associated endometrial changes. CONCLUSION In this case prolonged exposure to ulipristal acetate did not result in premalignant or malignant endometrial pathology.
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Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Dreiling
- Department of Pathology, National Cancer Institute, Bethesda, Maryland
| | - Alan H. DeCherney
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Mary N. Egbuniwe
- Department of Obstetrics, Gynecology, and Reproductive Science, The Mount Sinai Hospital, New York, New York
| | - John Elkas
- Northern Virginia Pelvic Surgery Associates, P.C., Annandale, Virginia
| | - Alicia Y. Armstrong
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Lynnette K. Nieman
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Tsuji I, Fujinami N, Kotani Y, Tobiume T, Aoki M, Murakami K, Kanto A, Takaya H, Ukita M, Shimaoka M, Nakai H, Suzuki A, Mandai M. Reproductive Outcome of Infertile Patients with Fibroids Based on the Patient and Fibroid Characteristics; Optimal and Personalized Management. Gynecol Obstet Invest 2015; 81:325-32. [DOI: 10.1159/000441788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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von Horn K, Depenbusch M, Schultze-Mosgau A, Griesinger G. Kinderwunsch und Uterus myomatosus. GYNAKOLOGISCHE ENDOKRINOLOGIE 2015. [DOI: 10.1007/s10304-015-0018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Radhika BH, Naik K, Shreelatha S, Vana H. Case series: Pregnancy Outcome in Patients with Uterine Fibroids. J Clin Diagn Res 2015; 9:QR01-4. [PMID: 26557577 DOI: 10.7860/jcdr/2015/14375.6621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022]
Abstract
Fibroids in pregnancy is a commonly encountered clinical entity. Objective of this study was to evaluate the maternal and fetal outcome in women having pregnancy with uterine fibroids. We present the clinical, obstetric data, perinatal outcomes of 15 patients from a prospective study. Fifteen pregnant women with fibroid >3cm were prospectively included in study. Major proportion of patient with fibroids were in younger age group of 25-30 years when compared to older age group of 31-35 years (66% vs 33%). Fibroids were more frequent in multi-gravidae, compared to primigravidae. In almost half of patients, (53.3%) fibroids were diagnosed before pregnancy. Common complications encountered during pregnancy in decreasing order of frequency were pain abdomen (46.6%), followed by threatened preterm labour (26.6%) and anaemia (26.6%). Out of 15, three (20%) women had abortion. In remaining, 11/12 patients attained term pregnancy between 37 to 40 weeks. Two patients required antenatal myomectomy. Caesarean section was done in 75% of women who attained term pregnancy and one patient had technical difficulty during caesarean section. Post partum heamorrhage was seen in 5/15 (33.3%) of patients. Out of 12, five babies were low birth weight. Four babies required NICU admission. There was no perinatal mortality. In our small patient series high incidence of caesarean section rates and increased incidence of threatened preterm labour, anaemia, and postpartum haemorrhage, was observed in pregnant patients with fibroids and hence, the pregnancy with fibroids should be considered as high risk pregnancy.
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Affiliation(s)
- B H Radhika
- Senior Resident, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - Kusuma Naik
- Assistant Professor, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - S Shreelatha
- Associate Professor, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
| | - Harshini Vana
- Senior Resident, Department of Obstetrics and Gynecology, ESI Post Graduate Institute of Medical Science and Research , Bangalore, India
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Transforming growth factor-β signaling pathway cross-talking with ERα signaling pathway on regulating the growth of uterine leiomyoma activated by phenolic environmental estrogens in vitro. Tumour Biol 2015. [PMID: 26224478 DOI: 10.1007/s13277-015-3813-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The aim of this paper is to study the participation of transforming growth factor-β (TGF-β) signaling pathway in mediating the growth of human uterine leiomyoma (UL) activated by phenolic environmental estrogens (EEs), via the interaction between TGF-β and ER signaling pathways. The UL cells were prepared by primary culture and subculture methods. To validate the role of TGF-β3 (5 ng/ml) for the viability of human uterine leiomyoma cells, CCK-8 assay was performed in each of five treatment groups including E2 group (E2 10(9) mol/l), BPA group (bisphenol A 10 μmol/l), NP group (nonylphenol 32 μmol/l), OP group (octylphenol 8 μmol/l), or control group (DMSO only). Subsequently, qRT-PCR was applied to detect mRNA expressions of ERα and c-fos, while western blot assay was used to test the expressions of p-Smad3, SnoN, and c-fos proteins in all settings mentioned above; the expressions were compared among different groups, and also in settings with and without synchronous treatment of ICI 182,780. Primarily cultured UL cells were successfully established. Compared with the control group, there were statistically significant increases in the proliferation rate of the UL cells in all EE groups or treated with TGF-β3 only (p < 0.05). Nevertheless, a slight decrease in proliferation rate of UL was detected in coexistence with TGF-β3 in all EE groups (p > 0.05). Interestingly, mRNA expressions of ERα and c-fos reduced in the setting of coexistence of TGF-β3 and EEs compared to isolated EE treatment (p < 0.05). Compared with the control group, the expression of p-Smad3 and c-fos proteins significantly decreased (p < 0.05) in each of E2, BPA, NP, and OP group, and the expression of SnoN protein also significantly reduced only in BPA and NP groups (p < 0.05), followed by TGF-β3 treatment. When adding ICI 182,780, the expression of p-Smad3 protein significantly increased in OP group (p < 0.05), but slightly increased in E2, BPA, NP, and OP groups (p > 0.05). However, compared with the control group, the expressions of SnoN and c-fos proteins significantly decreased (p < 0.05) after adding ICI182,780. Moreover, there was a significant statistical difference in the expression of p-Smad3, SnoN, and c-fos proteins between pre- and post-treatment of ICI 182,780 in all groups (p < 0.05). The ERα signaling pathway and TGF-β signaling pathway have different roles in the control of UL cell proliferation. The phenolic EEs can be a promoter of UL cell proliferation, which is mediated by ERα signaling pathway and its cross-talking with TGF-β signaling pathway. Both less exposure to EEs and blockade of TGF signaling pathway are necessary strategies to prevent UL.
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Su SY, Muo CH, Morisky DE. Use of Chinese medicine correlates negatively with the consumption of conventional medicine and medical cost in patients with uterine fibroids: a population-based retrospective cohort study in Taiwan. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:129. [PMID: 25902837 PMCID: PMC4414285 DOI: 10.1186/s12906-015-0645-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/13/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chinese medicine is commonly used and covered by health insurance to treat symptoms of uterine fibroids in Taiwan. This retrospective cohort study compared the consumption of conventional western medicine and medical cost between Chinese medicine (CM) users and nonusers among patients with uterine fibroids. METHODS We extracted 44,122 patients diagnosed with uterine fibrosis between 1996 and 2010 from the National Health Insurance reimbursement database, which is a population-based database released by a government-run health insurance system. Multivariate linear regression models were used to find association between using Chinese medicine and the consumption of conventional medicine, and between using Chinese medicine and medical cost. RESULTS The total fibroid-related conventional western medicine consumed by CM users was less than that by nonusers (β = -10.49, P < 0.0001). Three categories of conventional medicines, including antianemics (-3.50 days/year/patient, P < 0.0001), hemostatics (- 1.89 days/year/patient, P < 0.0001), and hormone-related agents (-3.13 days/year/patient, P < 0.0001), were used less in patients who were CM users. Moreover, although using CM increased 16.9 USD per patient in CM users annually (P < 0.0001), the total annual medical cost for treating fibroid was 5610 USD less in CM users than in nonusers (P < 0.0001). CONCLUSIONS Our results suggested that CM reduced the consumption of conventional medicine, and might be a potential therapeutic substitute for conventional western medicines to treat uterine fibroids with low cost.
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Tadakawa M, Takeda T, Li B, Tsuiji K, Yaegashi N. The anti-diabetic drug metformin inhibits vascular endothelial growth factor expression via the mammalian target of rapamycin complex 1/hypoxia-inducible factor-1α signaling pathway in ELT-3 cells. Mol Cell Endocrinol 2015; 399:1-8. [PMID: 25179820 DOI: 10.1016/j.mce.2014.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 12/11/2022]
Abstract
The aim of this study was to elucidate whether metformin can regulate the expression of vascular endothelial growth factor (VEGF) in rat-derived uterine leiomyoma cells (ELT-3 cells). In vitro studies were conducted using ELT-3 cells. Under normoxic conditions, metformin suppressed VEGF protein levels in the supernatant and cells in a dose-dependent manner. In hypoxia-mimicking conditions, VEGF and hypoxia-inducible factor-1α (HIF-1α) proteins were both highly expressed and were suppressed by the metformin treatment. Metformin did not affect HIF-1α mRNA levels, which indicated that its effects occurred at the post-translational level. Metformin inhibited mammalian target of rapamycin complex 1 (mTORC1) activity by phosphorylating the mTORC1 component raptor. This study revealed the anti-angiogenic activity of metformin in ELT-3 cells by suppressing the expression of VEGF via the mTORC1/HIF-1α pathway. These results indicate that metformin may represent an effective alternative in the future treatment of uterine leiomyomas.
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Affiliation(s)
- Mari Tadakawa
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Aobaku, Seiryo-cho, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Takeda
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Aobaku, Seiryo-cho, Sendai, Miyagi, 980-8574, Japan; Division of Women's Health, Research Institute of Traditional Asian Medicine, Kinki University School of Medicine, 377-2 Oono-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Bin Li
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Aobaku, Seiryo-cho, Sendai, Miyagi, 980-8574, Japan
| | - Kenji Tsuiji
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Aobaku, Seiryo-cho, Sendai, Miyagi, 980-8574, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 1-1 Aobaku, Seiryo-cho, Sendai, Miyagi, 980-8574, Japan
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Lu N, Wang Y, Su YC, Sun YP, Guo YH. Effects of the distance between small intramural uterine fibroids and the endometrium on the pregnancy outcomes of in vitro fertilization-embryo transfer. Gynecol Obstet Invest 2014; 79:62-8. [PMID: 25427667 DOI: 10.1159/000363236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
AIM To explore the effects of the distance between small intramural uterine fibroids (≤4 cm) and the endometrium on the outcomes of in vitro fertilization-embryo transfer (IVF-ET). METHODS We prospectively analyzed pregnancy outcomes in 117 infertile women with small intramural uterine fibroids and 117 infertile women without uterine fibroids who all underwent IVF-ET. The size and number of small intramural uterine fibroids and the shortest distance between the small intramural uterine fibroids and the endometrium were measured by transvaginal three-dimensional ultrasound. The endometrial and subendometrial blood flow parameters, implantation rate, clinical pregnancy rate, abortion rate and live birth rate were compared between the women with and without small uterine fibroids and among the different shortest distances (≤1, 1-3 and >3 mm). The effects of the size and number of small intramural uterine fibroids on IVF-ET outcomes were observed. RESULTS The endometrial volume on ET day, the implantation rate and the live birth rate were significantly lower, but the abortion rate was significantly higher, in the women with small intramural uterine fibroids than in those without uterine fibroids (p < 0.05). The endometrial flow index was higher in the shortest distance ≤1-mm group than in the groups with 1-3 and >3 mm, and the implantation rate was higher in ≤1-mm group than in the >3-mm group (p < 0.05). There were no significant differences in clinical outcomes between different sizes and numbers of small intramural uterine fibroids. CONCLUSION Small intramural uterine fibroids can affect IVF-ET outcomes. Compared with other shortest distances (1-3 and >3 mm), the shortest distance of ≤1 mm has a higher implantation rate.
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Affiliation(s)
- Na Lu
- Reproductive Medical Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Brunengraber LN, Jayes FL, Leppert PC. Injectable Clostridium histolyticum collagenase as a potential treatment for uterine fibroids. Reprod Sci 2014; 21:1452-9. [PMID: 25332216 DOI: 10.1177/1933719114553449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purified Clostridium histolyticum collagenase (CHC), an Food and Drug Administration-approved drug that does not affect nerves or blood vessels, was assessed as a potential treatment for fibroids in this proof-of-principle study. Fibroids (1-4 cm, capsules intact) and myometrial specimens from 5 patients were injected posthysterectomy with CHC or vehicle containing methylene blue and incubated for 24 hours. Percentage of collagen-stained area was estimated using Masson-Trichrome-stained slides. Collagen fibers were observed with picrosirius staining. Tissue stiffness was objectively measured by rheometry (complex shear modulus [Pa]). Injected materials spread within and beyond fibroids as visualized by methylene blue. Of the 8 treated fibroids, 7 were softened and some contained liquefied centers. Relative percentage of collagen-stained area (mean ± standard deviation) in treated fibroids (38 ± 12%; n = 7) was less than that in control fibroids (66 ± 17%; n = 5). Treated myometrium (40 ± 30% collagen; n = 3) was similar to control myometrium (53 ± 8%; n = 2). Picrosirius staining demonstrated loss of collagen fibers in treated fibroids. Treated fibroids were less stiff (3630 ± 2410 Pa; n = 4) than controls (5930 ± 830 Pa; n = 4). Treated and control myometrium had similar stiffness (2149 ± 927 Pa; n = 3 and 3314 ± 494 Pa; n = 2, respectively) and were never liquefied. In conclusion, injections of CHC into encapsulated fibroids are feasible and effective. Heterogeneity of collagen types and quantities within individual fibroids may contribute to varied responses and need additional investigation. Further study of collateral effects on myometrium is indicated. Injected CHC has potential for treatment of fibroids.
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Affiliation(s)
- Lisa N Brunengraber
- Department of Obstetrics and Gynecology, Duke University Medical Center, Reproductive Biology and Perinatal Laboratory, Durham, NC, USA
| | - Friederike L Jayes
- Department of Obstetrics and Gynecology, Duke University Medical Center, Reproductive Biology and Perinatal Laboratory, Durham, NC, USA Department of Pathology, Duke University Medical Center, Durham, NC, USA
| | - Phyllis C Leppert
- Department of Obstetrics and Gynecology, Duke University Medical Center, Reproductive Biology and Perinatal Laboratory, Durham, NC, USA Department of Pathology, Duke University Medical Center, Durham, NC, USA
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Malik M, Britten J, Segars J, Catherino WH. Leiomyoma cells in 3-dimensional cultures demonstrate an attenuated response to fasudil, a rho-kinase inhibitor, when compared to 2-dimensional cultures. Reprod Sci 2014; 21:1126-38. [PMID: 25084783 PMCID: PMC4212347 DOI: 10.1177/1933719114545240] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Uterine leiomyomata are common benign tumors in women of reproductive age and demonstrate an attenuated response to mechanical signaling that involves Rho and integrins. To further characterize the impairment in Rho signaling, we studied the effect of Rho-kinase inhibitor, fasudil, on extracellular matrix production, in 2-dimensional (2D) and 3-dimensional (3D) cultures of leiomyoma and myometrial cells. Leiomyoma 2D cultures demonstrated a rapid decrease in gene transcripts and protein for fibronectin, procollagen 1A, and versican. In 3D cultures, fibronectin and procollagen 1A proteins demonstrated increased levels at lower concentrations of fasudil, followed by a concentration-dependent decrease. Versican protein increased up to 3-fold, whereas fibromodulin demonstrated a significant decrease of 1.92-fold. Myometrial 2D or 3D cultures demonstrated a decrease in all proteins after 72 hours of treatment. The 3D leiomyoma cultures demonstrated a significant increase in active RhoA, followed by a concentration-dependent decrease at higher concentrations. A concentration-dependent increase in phospho-extracellular regulated signal kinase and proapoptotic protein Bax was observed in 3D leiomyoma cultures. Fasudil relaxed the contraction of the 3D collagen gels caused by myometrium and leiomyoma cell growth. These findings indicate that the altered state of Rho signaling in leiomyoma was more clearly observed in 3D cultures. The results also suggest that fasudil may have clinical applicability for treatment of uterine leiomyoma.
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Affiliation(s)
- Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA
| | - Joy Britten
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - James Segars
- Department of Obstetrics and Gynecology, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services, University of the Health Sciences, Bethesda, MD, USA Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Fujisawa C, Castellot JJ. Matrix production and remodeling as therapeutic targets for uterine leiomyoma. J Cell Commun Signal 2014; 8:179-94. [PMID: 25012731 DOI: 10.1007/s12079-014-0234-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/22/2014] [Indexed: 01/06/2023] Open
Abstract
Uterine leiomyoma, commonly known as fibroids, is a benign neoplasm of smooth muscle in women. The incidence of clinically symptomatic fibroids in reproductive-age women is approximately 20 %, with nearly 80 % of black women suffering from this condition. Symptoms include severe pain and hemorrhage; fibroids are also a major cause of infertility or sub-fertility in women. Uterine leiomyoma consist of hyperplastic smooth muscle cells and an excess deposition of extracellular matrix, specifically collagen, fibronectin, and sulfated proteoglycans. Extracellular matrix components interact and signal through integrin-β1 on the surface of uterine leiomyoma smooth muscle cells, provide growth factor storage, and act as co-receptors for growth factor-receptor binding. ECM and growth factor signaling through integrin-β1 and growth factor receptors significantly increases cell proliferation and ECM deposition in uterine leiomyoma. Growth factors TGF-β, IGF, PDGF, FGF and EGF are all shown to promote uterine leiomyoma progression and signal through multiple pathways to increase the expression of genes encoding matrix or matrix-modifying proteins. Decreasing integrin expression, reducing growth factor action and inhibiting ECM action on uterine leiomyoma smooth muscle cells are important opportunities to treat uterine leiomyoma without use of the current surgical procedures. Both natural compounds and chemicals are shown to decrease fibrosis and uterine leiomyoma progression, but further analysis is needed to make inroads in treating this common women's health issue.
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Affiliation(s)
- Caitlin Fujisawa
- Public Heath and Professional Degrees Program, Tufts University School of Medicine, Boston, MA, 02111, USA
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Shen Y, Ren ML, Feng X, Cai YL, Gao YX, Xu Q. An evidence in vitro for the influence of bisphenol A on uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol 2014; 178:80-3. [DOI: 10.1016/j.ejogrb.2014.03.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Levy G, Malik M, Britten J, Gilden M, Segars J, Catherino WH. Liarozole inhibits transforming growth factor-β3--mediated extracellular matrix formation in human three-dimensional leiomyoma cultures. Fertil Steril 2014; 102:272-281.e2. [PMID: 24825427 DOI: 10.1016/j.fertnstert.2014.03.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/20/2014] [Accepted: 03/20/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate the impact of liarozole on transforming growth factor-β3 (TGF-β3) expression, TGF-β3 controlled profibrotic cytokines, and extracellular matrix formation in a three-dimensional (3D) leiomyoma model system. DESIGN Molecular and immunohistochemical analysis in a cell line evaluated in a three-dimensional culture. SETTING Laboratory study. PATIENT(S) None. INTERVENTION(S) Treatment of leiomyoma and myometrial cells with liarozole and TGF-β3 in a three-dimensional culture system. MAIN OUTCOME MEASURE(S) Quantitative real-time reverse-transcriptase polymerase chain reaction and Western blotting to assess fold gene and protein expression of TGF-β3 and TGF-β3 regulated fibrotic cytokines: collagen 1A1 (COL1A1), fibronectin, and versican before and after treatment with liarozole, and confirmatory immunohistochemical stains of treated three-dimensional cultures. RESULT(S) Both TGF-β3 gene and protein expression were elevated in leiomyoma cells compared with myometrium in two-dimensional and 3D cultures. Treatment with liarozole decreased TGF-β3 gene and protein expression. Extracellular matrix components versican, COL1A1, and fibronectin were also decreased by liarozole treatment in 3D cultures. Treatment of 3D cultures with TGF-β3 increased gene expression and protein production of COL1A1, fibronectin, and versican. CONCLUSION(S) Liarozole decreased TGF-β3 and TGF-β3-mediated extracellular matrix expression in a 3D uterine leiomyoma culture system.
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Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Joy Britten
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Melissa Gilden
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - James Segars
- Program in Reproductive and Adult Endocrinology Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - William H Catherino
- Program in Reproductive and Adult Endocrinology Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Almeida TA, Quispe-Ricalde A, Montes de Oca F, Foronda P, Hernández MM. A high-throughput open-array qPCR gene panel to identify housekeeping genes suitable for myometrium and leiomyoma expression analysis. Gynecol Oncol 2014; 134:138-43. [PMID: 24768852 DOI: 10.1016/j.ygyno.2014.04.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate 51 different housekeeping genes for their use as internal standards in myometrial and matched leiomyoma samples in proliferative and secretory phases. METHODS RNA from 6 myometrium and matched leiomyoma samples was obtained from pre-menopausal women who underwent hysterectomy. Reverse-transcription and real-time quantitative PCR were achieved using TaqMan high-density open-array human endogenous control panel. RESULTS Expression stability of 51 candidate genes was determined by GeNorm and NormFinder softwares. We identified 10 housekeeping genes, ARF1, MRPL19, FBXW2, PUM1, UBE2D2, EIF2B1, HPRT1, GUSB, ALAS1, and TRIM27, as the best set of normalization genes for comparing relative expression between leiomyoma and myometrium samples in proliferative and secretory phases. CONCLUSIONS Adequate reference genes for accurate normalization are essential to compare gene expression between leiomyoma and myometrial samples. Ideal housekeeping genes must have stable expression patterns regardless of the sample type and menstrual cycle phase. In this study, we propose a set of 10 candidate genes with greater expression stability than those housekeeping genes commonly used in leiomyoma and myometrium tissues. Their use will improve the sensitivity and specificity of the gene expression analysis in these tissues.
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Affiliation(s)
- Teresa A Almeida
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Campus de Anchieta, Avda. Astrofísico Francisco Sánchez s/n, La Laguna, Tenerife 38071, Spain.
| | - Antonieta Quispe-Ricalde
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Campus de Anchieta, Avda. Astrofísico Francisco Sánchez s/n, La Laguna, Tenerife 38071, Spain.
| | | | - Pilar Foronda
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Campus de Anchieta, Avda. Astrofísico Francisco Sánchez s/n, La Laguna, Tenerife 38071, Spain.
| | - Mariano M Hernández
- Instituto de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Campus de Anchieta, Avda. Astrofísico Francisco Sánchez s/n, La Laguna, Tenerife 38071, Spain.
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Tal R, Segars JH. The role of angiogenic factors in fibroid pathogenesis: potential implications for future therapy. Hum Reprod Update 2013; 20:194-216. [PMID: 24077979 DOI: 10.1093/humupd/dmt042] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND It is well established that tumors are dependent on angiogenesis for their growth and survival. Although uterine fibroids are known to be benign tumors with reduced vascularization, recent work demonstrates that the vasculature of fibroids is grossly and microscopically abnormal. Accumulating evidence suggests that angiogenic growth factor dysregulation may be implicated in these vascular and other features of fibroid pathophysiology. METHODS Literature searches were performed in PubMed and Google Scholar for articles with content related to angiogenic growth factors and myometrium/leiomyoma. The findings are hereby reviewed and discussed. RESULTS Multiple growth factors involved in angiogenesis are differentially expressed in leiomyoma compared with myometrium. These include epidermal growth factor (EGF), heparin-binding-EGF, vascular endothelial growth factor, basic fibroblast growth factor, platelet-derived growth factor, transforming growth factor-β and adrenomedullin. An important paradox is that although leiomyoma tissues are hypoxic, leiomyoma feature down-regulation of key molecular regulators of the hypoxia response. Furthermore, the hypoxic milieu of leiomyoma may contribute to fibroid development and growth. Notably, common treatments for fibroids such as GnRH agonists and uterine artery embolization (UAE) are shown to work at least partly via anti-angiogenic mechanisms. CONCLUSIONS Angiogenic growth factors play an important role in mechanisms of fibroid pathophysiology, including abnormal vasculature and fibroid growth and survival. Moreover, the fibroid's abnormal vasculature together with its aberrant hypoxic and angiogenic response may make it especially vulnerable to disruption of its vascular supply, a feature which could be exploited for treatment. Further experimental studies are required in order to gain a better understanding of the growth factors that are involved in normal and pathological myometrial angiogenesis, and to assess the potential of anti-angiogenic treatment strategies for uterine fibroids.
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Affiliation(s)
- Reshef Tal
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Islam MS, Protic O, Stortoni P, Grechi G, Lamanna P, Petraglia F, Castellucci M, Ciarmela P. Complex networks of multiple factors in the pathogenesis of uterine leiomyoma. Fertil Steril 2013; 100:178-93. [DOI: 10.1016/j.fertnstert.2013.03.007] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 01/07/2023]
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Cañete H, Dorta I, Hernández M, Cejudo Roman A, Candenas L, Pinto FM, Valladares F, Báez D, Montes de Oca F, Bello AR, Almeida TA. Differentially regulated expression of neurokinin B (NKB)/NK3 receptor system in uterine leiomyomata. Hum Reprod 2013; 28:1799-808. [DOI: 10.1093/humrep/det128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Biomarkers are biologic compounds that are easily accessible and reflect normal physiology or pathology. They are useful in a variety of clinical situations that involve detection of subclinical disease, risk stratification, preoperative planning, and monitoring treatment. A useful intervention needs to exist for a biomarker to be an effective tool. Many compounds have been investigated as potential biomarkers for the diagnosis and surveillance of uterine leiomyomas. Most of these compounds demonstrate subtle differences among patients when leiomyomas are compared with controls. The compounds investigated lack the diagnostic accuracy necessary to add any benefit to the current available modalities used to diagnose and monitor uterine leiomyomas.
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Affiliation(s)
- Gary Levy
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-1109, USA
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