Effect of the progesterone antagonist RU486 on human myometrial spontaneous contractility and PGI2 release

The effect of mifepristone (RU486) on the endocannabinoid system in human plasma and first-trimester trophoblast of women undergoing termination of pregnancy

INTRODUCTION

High anandamide (AEA) concentrations are detrimental for implantation and early pregnancy. Progesterone, essential for pregnancy, may keep AEA levels low by increasing fatty acid amide hydrolase (FAAH) expression. Here the effect of RU486, a P4 antagonist used to initiate medical termination of pregnancy (MTOP), on plasma AEA concentrations and the endocannabinoid system (ECS) in trophoblasts was examined.

OBJECTIVE

Quantification of the endocannabinoid concentrations and expression of the ECS in trophoblast tissue of MTOP women and women undergoing surgical termination of pregnancy (STOP).

DESIGN AND SETTING

A prospective study at the University Hospitals of Leicester National Health Service Trust.

PATIENTS AND METHODS

AEA, N-oleoylethanolamine (OEA), and N-palmitolylethanolamine (PEA) concentrations in trophoblast tissues and blood samples from 68 MTOP and 15 STOP were analyzed by ultra-high-performance liquid chromatography-tandem mass spectrometry. ECS expression was determined by immunohistochemistry, quantitative RT-PCR, and Western blotting.

RESULTS

Concentrations of AEA, OEA, and PEA were significantly higher in MTOP than STOP trophoblasts (P = .0062, P = .016, and P = .0029, respectively), whereas no significant differences in plasma AEA, OEA, and PEA concentrations were observed even though plasma AEA and PEA concentrations were significantly (P = .005 and P = .025, respectively) increased the day after RU486 administration in women undergoing MTOP. Changes in the immunohistochemical densities of the AEA modifying enzymes N-acylphophatidylethanolamine-phospholipase D (NAPE-PLD) and FAAH, and the cannabinoid receptors (CB1 and CB2) were observed with increased NAPE-PLD, FAAH, and CB1 expression seen in the trophoblast of MTOP patients.

CONCLUSIONS

Trophoblast after MTOP demonstrated high AEA concentrations with increased expression of NAPE-PLD, FAAH, and CB1.

Nongenomic uterine relaxing effect of RU 486 (mifepristone) prior to its antiprogesterone activity in the human pregnancy

The antiprogestin mifepristone (RU 486) is used for termination of pregnancy, as RU 486 blocks the quiescent action of progesterone, increases uterine contractility, sensitizes the myometrium to prostaglandins, and elicits cervical ripening. Since RU 486 represents a class of compound that is structurally related to steroid hormones, some of which possess a nongenomic uterine relaxing effect, we investigated the potential nongenomic relaxing action of RU 486 on the human pregnant myometrium. Myometrial tissues were obtained from pregnant women undergoing elective cesarean section at term and were isometrically recorded. RU 486 caused relaxation on spontaneous contractility and high potassium-induced contractions with lower relaxing efficacy than progesterone. The progesterone receptor-blocking activity of RU 486 did not antagonize the uterine relaxation of progesterone. Moreover, contractions induced by oxytocin or different prostaglandins (PGF(2alpha), PGE(2), and a prostaglandin analogue, misoprostol) were inhibited rather than increased by RU 486. RU 486 induced a rapid and reversible relaxing effect, which was unaffected by inhibitors of protein synthesis and transcription, implying that RU 486 acts through a nongenomic mechanism. This study reveals that RU 486: (i) reduced high potassium-induced contraction and prevented calcium-induced contraction in depolarized tissue; and (ii) relaxed the oxytocin- and prostaglandin-induced contractions, indicating a blockade of voltage- and receptor-operated calcium channels by RU 486. These data show that this antiprogestin may induce a rapid nongenomic antiuterotonic effect prior to its antiprogesterone action.

Prostaglandin F2alpha-induced Ca++ oscillations in human myometrial cells and the role of RU 486

OBJECTIVE

We sought to examine the change of cytosolic calcium concentration caused by prostaglandin F(2)(alpha) and RU 486 in cultured human myometrial cells.

STUDY DESIGN

Human myometrial cells obtained from 16 nonpregnant women were loaded with fura 2, and the intracellular cytosolic calcium concentrations were measured by the use of wavelength spectrophotofluorometry.

RESULTS

Application of prostaglandin F(2)(alpha) (2.8 micromol/L) caused an initial rapid rise in cytosolic calcium concentration followed by sustained cytosolic calcium oscillations at an average frequency of 0.43 +/- 0.04 min(-1) and an amplitude in the range of 296.82 +/- 27. 16 nmol/L. The oscillatory activity was not affected by increasing the concentration of prostaglandin F(2)(alpha) but varied by changing the concentration of extracellular cytosolic calcium concentration. The cytosolic calcium oscillations were suppressed by caffeine, 2,5-di-tert-butylhydroquinone, and lanthanum but not affected by ryanodine. Verapamil decreased the amplitude but not the frequency of oscillations. The progesterone antagonist RU 486 at a concentration of 10(-8) to 10(-5) mol/L had no significant effect on the basal intracellular cytosolic calcium. However, RU 486 (10(-5) mol/L) significantly increased the frequency but not the amplitude of intracellular cytosolic calcium oscillations induced by prostaglandin F(2)(alpha).

CONCLUSION

The results indicate that prostaglandin F(2)(alpha)-stimulated cytosolic calcium oscillations are mediated by an increase in both cytosolic calcium release from inositol 1,4,5-trisphosphate-sensitive cytosolic calcium stores and a cytosolic calcium influx from the extracellular space. Moreover, RU 486 seems to directly regulate prostaglandin F(2)(alpha)-induced intracellular cytosolic calcium in human myometrial cells.

RU 38486 inhibits intracellular calcium mobilization and PGI2 release from human myometrium: mechanisms of action

We previously demonstrated that the antiprogestogen RU 486, when superfused on myometrial strips, induces a rapid decrease in spontaneous uterine contractile frequency, an increase in amplitude and duration of contractions, and a concomitant decrease in 6-keto PGF(1alpha) release. In this study, we present further work on the role of calcium transients and the involvement of the PLC/PKC pathway in mediating RU 486 effects. We found no clear causal relationship between the spontaneous contractility controlled by external Ca++ concentration and 6-keto PGF(1alpha) release depending mostly on intracellular Ca++ mobilization. We show that RU 486 strengthened the inhibitory effect of TMB8, a potent inhibitor of internal calcium, on both spontaneous contractility and 6-keto PGF(1alpha), release and antagonized the stimulatory action of thapsigargin, a toxin blocking the endoplasmic reticulum calcium pump (ER Ca++ ATPase). These data indicate that RU 486 could act as an inhibitor of intracellular Ca++ mobilization. A slight but significant decrease of the prostanoid liberation was observed in the presence of U73122, an inhibitor of PLC, but not in the presence of neomycin, another PLC inhibitory compound. PKC inhibitors, staurosporine and H7 did not significantly affect spontaneous 6-keto PGF1alpha release, showing that PIP2 hydrolysis and PKC pathway were not involved in the basal release of the prostacyclin metabolite. Vasopressin (AVP), an agent known to induce contractility of the non-pregnant human uterus, markedly increased 6-keto PGF(1alpha) release in a dose-dependent manner. Stimulation of GTP-regulated proteins (G proteins) by ALF4 was accompanied by a rise in 6-keto PGF(1alpha) liberation and a high contractile activity. The effects of both vasopressin and ALF4- were not significantly opposed by RU 486, indicating that other sources of Ca++, not controlled by the steroid, were involved in the agonist-stimulated prostanoid release. Studies with structurally related RU 486 analogues showed that the steroid effects were not dependent on their antihormonal activity, but rather on a specific 11beta arylsubstitution and a 17beta-hydroxy-13beta-methyl configuration of the 4,9-estradien-3-one molecule.

The combined use of prostaglandin and antiprogestin in human fertility control

This paper is a short review of the combined use of RU486 and prostaglandins in human fertility control. It principally insists on the several prostaglandins which are currently used.