1
|
Andreeva E, Absatarova Y. Triptorelin for the treatment of adenomyosis: A multicenter observational study of 465 women in Russia. Int J Gynaecol Obstet 2020; 151:347-354. [PMID: 32815156 PMCID: PMC7756635 DOI: 10.1002/ijgo.13341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/29/2020] [Accepted: 08/05/2020] [Indexed: 12/20/2022]
Abstract
Objective To evaluate the effectiveness of triptorelin for the treatment of adenomyosis, the benign invasion of endometrial tissue into the myometrium, as a fertility‐preserving alternative to the gold standard hysterectomy. Methods In this multicenter, open‐label, observational study in Russia, performed from November 3, 2011, to August 24, 2015, we assessed the efficacy and safety of triptorelin 3.75 mg administered intramuscularly every 28 days in Russian women who were gonadotropin‐releasing hormone agonist treatment‐naïve, aged 25–40 years, and had a diagnosis of endometriosis or adenomyosis with heavy menstrual bleeding. We performed a medical record review, interviews to assess symptom severity, and pelvic assessments including transvaginal ultrasound. Data were obtained at first injection of triptorelin (visit 1), on the day of last injection (visit 2), 6 months after last injection (visit 3), and 9 months after last injection (visit 4). Significance was assessed by Wilcoxon signed rank test. Results A total of 465 women were included. There was a significant improvement from baseline in severity of heavy menstrual bleeding in 390/463 (84.2%) of women 6 months after last injection (P<0.0001). Severity of dysmenorrhea, abnormal uterine bleeding, and pelvic pain was decreased at visit 3 compared with baseline (P<0.0001). Endometriosis symptoms stopped in 253/262 (96.6%) of women at visit 2 and in 243/263 (92.4%) of women at visit 3. Pregnancy was reported in 116/465 (24.9%) women within 9 months following the end of treatment. Conclusion Triptorelin has a favorable safety profile, is highly efficacious in treating clinical symptoms of adenomyosis, and improves reproductive function. ClinicalTrials.gov registration number: A‐38‐52014‐191, registered October 2011.
Collapse
Affiliation(s)
- Elena Andreeva
- Endocrinology Research Centre, Moscow, Russia.,Department of Reproductive Medicine and Surgery, Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | |
Collapse
|
2
|
Kossaï M, Penault-Llorca F. Role of Hormones in Common Benign Uterine Lesions: Endometrial Polyps, Leiomyomas, and Adenomyosis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1242:37-58. [PMID: 32406027 DOI: 10.1007/978-3-030-38474-6_3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Leiomyoma, adenomyosis, and endometrial polyps are benign uterine disorders which seem to develop in the context of hormonal imbalances, due to steroid hormones, estrogen and progesterone, in association with various factors ranging from genetic factors to modifiable lifestyle factors. A growing body of evidence suggests that those hormones and their receptors are key modulators in the genesis and the growth of those pathologic entities. Further studies are required to understand their involvement in the pathogenesis of those lesions and their link to other factors such as extracellular matrix components, growth factors, chemokines, cytokines, and tissue repair mechanisms.
Collapse
Affiliation(s)
- Myriam Kossaï
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France. .,UMR INSERM 1240, Universite Clermont Auvergne, Clermont-Ferrand, France.
| | - Frédérique Penault-Llorca
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France. .,UMR INSERM 1240, Universite Clermont Auvergne, Clermont-Ferrand, France.
| |
Collapse
|
3
|
|
4
|
Melis GB, Neri M, Piras B, Paoletti AM, Ajossa S, Pilloni M, Marotto MF, Corda V, Saba A, Giancane E, Mais V. Vilaprisan for treating uterine fibroids. Expert Opin Investig Drugs 2018; 27:497-505. [DOI: 10.1080/13543784.2018.1471134] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Gian Benedetto Melis
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Manuela Neri
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Bruno Piras
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Anna Maria Paoletti
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Silvia Ajossa
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Monica Pilloni
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Maria Francesca Marotto
- Dipartimento Materno Infantile, clinica ostetrica e ginecologica, policlinico universitario Duilio Casula, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Valentina Corda
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Alessandra Saba
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Elena Giancane
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| | - Valerio Mais
- Dipartimento di Scienze Chirurgiche, Clinica Ostetrica e Ginecologica, Azienda Ospedaliero Universitaria di Cagliari, Policlinico Universitario Duilio Casula, University of Cagliari, Italy
| |
Collapse
|
5
|
Sinai Talaulikar V. Medical therapy for fibroids: An overview. Best Pract Res Clin Obstet Gynaecol 2018; 46:48-56. [DOI: 10.1016/j.bpobgyn.2017.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
|
6
|
Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J 2017; 28:31-3. [PMID: 27217916 DOI: 10.4314/mmj.v28i1.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- A Ernest
- Department of Surgery and Maternal Health, College of Health Sciences, University of Dodoma, Dodoma, Tanzania; Department of Obstetrics and Gynaecology, Iringa Regional Hospital, Iringa, Tanzania
| | - A Mwakalebela
- Department of Obstetrics and Gynaecology, Iringa Regional Hospital, Iringa, Tanzania
| | - B C Mpondo
- Department Internal Medicine, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
7
|
Borahay MA, Asoglu MR, Mas A, Adam S, Kilic GS, Al-Hendy A. Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. Reprod Sci 2016; 24:1235-1244. [PMID: 27872195 DOI: 10.1177/1933719116678686] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Uterine fibroids are the most common gynecologic tumors with a significant medical and financial burden. Several genetic, hormonal, and biological factors have been shown to contribute to the development and growth of fibroid tumors. Of these factors, estrogen is particularly critical since fibroids are considered estrogen dependent because no prepubertal cases have been described in the literature and tumors tend to regress after menopause. Understanding the role of estrogen in fibroids is not only important for understanding the pathobiology of fibroids but also for the development of successful therapeutics. In this review, we discuss the types and structure of estrogen receptors (nuclear and membrane bound, including α and β receptors and G protein-coupled estrogen receptor 1 GPER1). Estrogen-signaling pathways in fibroids include genomic (direct and indirect) and nongenomic including Ras-Raf-MEK (MAPK/Erk Kinase)-mitogen-activated protein kinase (MAPK) and phosphatidylinositide 3-kinase (PI3K)-phosphatidylinositol-3,4,5-trisphosphate (PIP3)-Akt (Protein kinase B)-mammalian target of rapamycin (mTOR) pathways; shortly Ras-Raf-MEK-MAPK and PI3K-PIP3-Akt-mTOR pathways. Several aberrations in estrogen receptors and signaling pathways are implicated in fibroid pathobiology. Current therapeutic and research agents targeting ERs/signaling include gonadotropin-releasing hormone (GnRH) agonists, GnRH antagonists, aromatase inhibitors, selective ER modulators, gene therapy, and others. Future research can identify potential targets for the development of novel treatments. In particular, epigenomics of estrogen activity and individualized (precision) medicine appear to be attractive areas for future research.
Collapse
Affiliation(s)
- Mostafa A Borahay
- 1 Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Mehmet R Asoglu
- 2 Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Aymara Mas
- 3 Department of Obstetrics & Gynecology, Georgia Regents University, Augusta, GA, USA
| | - Sarah Adam
- 4 Department of Obstetrics & Gynecology, Mercer University, Macon, GA, USA
| | - Gokhan S Kilic
- 2 Department of Obstetrics & Gynecology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ayman Al-Hendy
- 3 Department of Obstetrics & Gynecology, Georgia Regents University, Augusta, GA, USA
| |
Collapse
|
8
|
Awowole IO, Makinde ON, Badejoko OO, Omoniyi-Esan GO, Tijani AM, Ajenifuja KO, Loto OM. Clinical correlates of leiomyoma estrogen and progesterone receptors among Nigerian women. Int J Gynaecol Obstet 2016; 135:314-318. [PMID: 27599599 DOI: 10.1016/j.ijgo.2016.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/05/2016] [Accepted: 08/15/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the expression of estrogen receptor α (ERα) and progesterone receptor (PR) in myometrium and leiomyomata tissue, and to correlate their expression with symptoms of uterine leiomyomata. METHODS In a cross-sectional study, intraoperative biopsy samples of leiomyomata and adjacent myometrial specimens were obtained from premenopausal women with uterine leiomyomata treated at a center in Nigeria between September 2013 and August 2014. Immunohistochemistry for ERα and PR expression was performed on the samples. The immunoscores of both receptors were correlated with the size and symptoms of the leiomyomata. RESULTS Among 60 pairs of samples, leiomyomata had a higher mean expression of ERα (H-score 193.42±64.55 vs 153.29±69.13; P=0.01) and PR (214.86±66.56 vs 171.53±63.53; P<0.001) than did myometrial tissues. The tumor diameter correlated negatively with the immunoscores of both receptors irrespective of age, parity, and body mass index, but this was only significant for PR (ρ=-0.44; P<0.001). Downregulation of PR on leiomyomata was predicted to occur at a diameter of 11cm. Menorrhagia, dysmenorrhea, and infertility occurred independently of steroid-receptor expression. CONCLUSION Leiomyomata seem to depend on steroid hormones, but only during early tumor development. This could have implications for the selection of patients for medical management, especially with steroid-receptor modulators.
Collapse
Affiliation(s)
- Ibraheem O Awowole
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
| | - Olufemiwa N Makinde
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusegun O Badejoko
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Ganiyat O Omoniyi-Esan
- Department of Morbid Anatomy and Cellular Histopathology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Aramide M Tijani
- Department of Obstetrics and Gynaecology, Ladoke Akintola University of Technology, Ogbomosho, Nigeria
| | - Kayode O Ajenifuja
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olabisi M Loto
- Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
9
|
Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers 2016; 2:16043. [PMID: 27335259 DOI: 10.1038/nrdp.2016.43] [Citation(s) in RCA: 270] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are common clonal neoplasms of the uterus. Fibroids have both smooth muscle and fibroblast components, in addition to a substantial amount of fibrous extracellular matrix, which all contribute to the pathogenetic process. Fibroids are extremely heterogeneous in their pathophysiology, size, location and clinical symptomatology. They are also a part of a range of disease in which some variants have facets of malignant behaviour but overall are benign. Risk for fibroids is associated with race; black women have a higher risk of developing fibroids earlier in life than their white counterparts and also develop more-severe forms of the disease. Clinically, fibroids account for one-third to half of all hysterectomies and are associated with substantial morbidity and health care costs for women of reproductive age. Indeed, current treatments are primarily surgical and interventional; approximately three-quarters of all fibroid treatments are hysterectomies. However, clinical innovations are emerging in the use of progesterone receptor modulators as a medical therapy. New information is rapidly accumulating about the genetic subgroups that lead to fibroid formation, which might aid further understanding of the clinical heterogeneity of this disease and lead to individualized treatments. This information is a crucial development given the current lack of high-quality evidence on which to base therapeutic decisions.
Collapse
Affiliation(s)
- Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - Shannon K Laughlin-Tommaso
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sujata Lalitkumar
- Department of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Devashana Gupta
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia.,Women's Program, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Clayton, Victoria, Australia
| | - Beverley Vollenhoven
- Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia.,Women's Program, Monash Health, Melbourne, Victoria, Australia.,Monash IVF, Clayton, Victoria, Australia
| |
Collapse
|
10
|
Shalaby SM, Khater MK, Perucho AM, Mohamed SA, Helwa I, Laknaur A, Lebedyeva I, Liu Y, Diamond MP, Al-Hendy AA. Magnetic nanoparticles as a new approach to improve the efficacy of gene therapy against differentiated human uterine fibroid cells and tumor-initiating stem cells. Fertil Steril 2016; 105:1638-1648.e8. [PMID: 27020169 DOI: 10.1016/j.fertnstert.2016.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study whether efficient transduction and subsequent elimination of fibroid tumor-initiating stem cells during debulking of tumor cells will aid in completely eradicating the tumor as well as decreasing the likelihood of recurrence. DESIGN Case control study. SETTING Research laboratory. PATIENT(S) None. INTERVENTION(S) Magnetic nanoparticles (MNPs) complexed to adenovirus (Ad-GFP) or (Ad-LacZ) used to transfect differentiated human fibroid cells in vitro. MAIN OUTCOME MEASURE(S) Rate of transduction and tumor growth inhibition. RESULT(S) We have developed a localized nonsurgical adenovirus-based alternative for the treatment of uterine fibroids that combines viral-based gene delivery with nanotechnology for more efficient targeting. Magnetic nanoparticles complexed to adenovirus, in the presence of an external magnetic field, accelerate adenovirus transduction. We observed a statistically significant increase in transduction efficiency among differentiated human fibroid cells at two different multiplicities of infection (MOI), 1 and 10, respectively, with MNPs as compared with adenovirus alone. Human fibroid stem cells transfected with Ad-LacZ expressed β-galactosidaze at a MOI of 1, 10, and 50 at 19%, 62%, and 90%, respectively, which were statistically significantly enhanced with MNPs. CONCLUSION(S) When applied with adenovirus herpes simplex thymidine kinase, magnetofection statistically significantly suppressed proliferation and induced apoptosis in both cell types. Through the use of magnetofection, we will prove that a lower viral dose will effectively increase the overall safety profile of suicide gene therapy against fibroid tumors.
Collapse
Affiliation(s)
- Shahinaz Mahmood Shalaby
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia; Department of Pharmacology, Tanta Faculty of Medicine, Tanta, Egypt
| | - Mostafa K Khater
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Aymara Mas Perucho
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Sara A Mohamed
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia; Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Inas Helwa
- Department of Cell Biology and Anatomy, Georgia Regents University, Augusta, Georgia
| | - Archana Laknaur
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Iryna Lebedyeva
- Department of Chemistry and Physics, Georgia Regents University, Augusta, Georgia
| | - Yutao Liu
- Department of Cell Biology and Anatomy, Georgia Regents University, Augusta, Georgia
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Ayman A Al-Hendy
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia.
| |
Collapse
|
11
|
|
12
|
Dariushnia SR, Nikolic B, Stokes LS, Spies JB. Quality improvement guidelines for uterine artery embolization for symptomatic leiomyomata. J Vasc Interv Radiol 2014; 25:1737-47. [PMID: 25442136 DOI: 10.1016/j.jvir.2014.08.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 08/28/2014] [Accepted: 08/29/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Sean R Dariushnia
- Department of Radiology, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - LeAnn S Stokes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - James B Spies
- Department of Radiology, Medstar Georgetown University Hospital, Washington, DC
| | | |
Collapse
|
13
|
Pérez-López FR, Ornat L, Ceausu I, Depypere H, Erel CT, Lambrinoudaki I, Schenck-Gustafsson K, Simoncini T, Tremollieres F, Rees M. EMAS position statement: Management of uterine fibroids. Maturitas 2014; 79:106-16. [DOI: 10.1016/j.maturitas.2014.06.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
14
|
Fibroid growth and medical options for treatment. Fertil Steril 2014; 102:630-9. [DOI: 10.1016/j.fertnstert.2014.07.1238] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/15/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022]
|
15
|
Hart R, Doherty DA, Frederiksen H, Keelan JA, Hickey M, Sloboda D, Pennell CE, Newnham JP, Skakkebaek NE, Main KM. The influence of antenatal exposure to phthalates on subsequent female reproductive development in adolescence: a pilot study. Reproduction 2014; 147:379-90. [DOI: 10.1530/rep-13-0331] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We hypothesised that antenatal exposure to ubiquitous phthalates may lead to an earlier menarche and a lower prevalence of polycystic ovarian syndrome (PCOS) and polycystic ovarian morphology (PCO) in adolescence. The Western Australian Pregnancy Cohort (Raine) Study recruited 3000 women at 18 weeks of gestation in 1989–1991, 1377 had antenatal serum stored without thawing at −80 °C. An unselected subset was evaluated in the early follicular phase for PCO and PCOS by ultrasound and serum evaluation in adolescence. Serum was analysed for anti-Müllerian hormone (AMH), inhibin B, sex hormone binding globulin (SHBG), testosterone, androstenedione and DHEAS. Four hundred microlitres of the frozen maternal serum underwent isotope-diluted liquid chromatography–tandem mass spectrometry, with preceding enzymatic deconjugation followed by solid-phase extraction to determine phthalate exposure. Two hundred and forty four girls attended assessment and most common phthalate metabolites were detectable in the majority of the 123 samples available. Several phthalates were negatively associated with maternal SHBG, and associations with maternal androgens were less consistent. The sum of the metabolites of di-(2-ethylhexyl) phthalate was associated with a non-significant tendency towards an earlier age at menarche (P=0.069). Uterine volume was positively associated with mono-(carboxy-iso-octyl) phthalate (P=0.018). Exposure to monoethyl phthalate (MEP) and the sum of all phthalate metabolites (Σall phth.m) were protective against PCOS in adolescence (P=0.001 and P=0.005 respectively). There were negative associations of MEP with PCO (P=0.022) and of MEP with serum AMH (P=0.031). Consequently, our data suggest that antenatal exposure to environmental phthalates may be associated with oestrogenic and/or anti-androgenic reproductive effects in adolescent girls.
Collapse
|
16
|
Biglia N, Carinelli S, Maiorana A, D'Alonzo M, Lo Monte G, Marci R. Ulipristal acetate: a novel pharmacological approach for the treatment of uterine fibroids. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:285-92. [PMID: 24591818 PMCID: PMC3934585 DOI: 10.2147/dddt.s54565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Uterine fibroids are the most common benign tumors of the female genital tract. The management of symptomatic fibroids has traditionally been surgical; however, alternative pharmacological approaches have been proposed to control symptoms. To date, gonadotropin-releasing hormone analogs are the only available drugs for the preoperative treatment of fibroids. However, the US Food and Drug Administration recently authorized ulipristal acetate (UPA), an oral selective progesterone-receptor modulator, for the same indication. UPA is a new, effective, and well-tolerated option for the preoperative treatment of moderate and severe symptoms of uterine fibroids in women of reproductive age. According to clinical data, UPA shows several advantages: it is faster than leuprolide in reducing the fibroid-associated bleeding, it significantly improves hemoglobin and hematocrit levels in anemic patients, and it grants a significant reduction in the size of fibroids, which lasts for at least 6 months after the end of the treatment. Furthermore, UPA displays a better tolerability profile when compared to leuprolide; in fact, it keeps estradiol levels at mid follicular phase range, thereby reducing the incidence of hot flushes and exerting no impact on bone turnover. On the grounds of this evidence, the administration of 5 mg/day ulipristal acetate for 3 months is suggested for different patient categories and allows for planning a treatment strategy tailored to meet an individual patient's needs.
Collapse
Affiliation(s)
- Nicoletta Biglia
- Department of Obstetrics and Gynaecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | | | - Antonio Maiorana
- Department of Obstetrics and Gynecology, ARNAS Civico Hospital, Palermo, Italy
| | - Marta D'Alonzo
- Department of Obstetrics and Gynaecology, Mauriziano "Umberto I" Hospital, University of Turin, Turin, Italy
| | - Giuseppe Lo Monte
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Infertility Unit, University of Ferrara, Ferrara, Italy
| | - Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Infertility Unit, University of Ferrara, Ferrara, Italy
| |
Collapse
|
17
|
Fröling V, Kröncke TJ, Schreiter NF, Scheurig-Muenkler C, Collettini F, Hamm B, Beck A. Technical eligibility for treatment of magnetic resonance-guided focused ultrasound surgery. Cardiovasc Intervent Radiol 2013; 37:445-50. [PMID: 23839005 DOI: 10.1007/s00270-013-0678-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study was designed to evaluate the technical eligibility for magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment of women with symptomatic fibroids. METHODS Technical eligibility for MRgFUS treatment without mitigation techniques was evaluated retrospectively in 783 premenopausal women (median age, 44.2 years) with symptomatic fibroids who applied for uterine artery embolization (UAE) at our institution from 2001 to 2012. Technical eligibility for MRgFUS was defined as primary study endpoint. Technical ineligibility was assessed on the basis of MRI criteria, such as bowel interposition/foreign material in the ultrasound beam path, more than five fibroids, distance from fibroid to sacral bone surface, fibroid size/shape, severe concomitant adenomyosis or extensive cutaneous scars in accordance to the US Food and Drug Administration approvals. Secondary study endpoint was defined as evaluation of the most frequent exclusion criteria and differences in technical eligibility for MRgFUS and UAE. RESULTS On the basis of MRI, 38.9% of women who applied for UAE were found to be technically eligible for MRgFUS treatment without mitigation techniques. Most frequent reason for ineligibility was bowel interposition in the ultrasound beam path (60.4%). Differences in technical eligibility for MRgFUS (38.9%) and UAE (99.2%) were significant (P < 0.001). CONCLUSIONS MRgFUS treatment is technically possible in up to 40% of women with symptomatic fibroids. The most frequent exclusion criterion is the presence of bowel in the ultrasound beam path.
Collapse
Affiliation(s)
- V Fröling
- Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany,
| | | | | | | | | | | | | |
Collapse
|
18
|
GnRH agonists: do they have a place in the modern management of fibroid disease? J Obstet Gynaecol India 2012; 62:506-10. [PMID: 24082548 DOI: 10.1007/s13224-012-0206-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/26/2012] [Indexed: 10/27/2022] Open
Abstract
In the management of women with fibroid disease, GnRH agonists (GnRHa) are frequently used to reduce volume and vascularity before myomectomy, apparently to render the operation easier and reduce operative blood loss, and to enable a transverse supra-pubic incision instead of a midline vertical one. They induce amenorrhoea and thus aid in the correction of pre-operative anaemia. Other gynaecologists use GnRHa to shrink sub mucous fibroids greater than 5 cm in diameter to facilitate access and reduce blood loss and operating time at transcervical resection. GnRHa are also occasionally used as a temporizing measure in women with symptomatic fibroids within the climacteric. We argue against the use of GnRHa in the management of fibroid disease because they are not cost effective, render myomectomy more difficult to apply because they destroy tissue planes, the more difficult enucleation in fact increasing rather than reducing peri-operative blood loss and operating time. When used before myomectomy, they increase the risk of 'recurrence' because they obscure smaller fibroids that 'recur' when the effects of the GnRHa wear off, and are associated with side effects in situations where they confer no benefits, or where alternative cheaper drugs with fewer side effects are available.
Collapse
|
19
|
Medical Management of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2012. [DOI: 10.1007/s13669-012-0008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Abstract
Uterine leiomyomas (also called myomata or fibroids) are the most common gynecologic tumors in the United States. The prevalence of leiomyomas is at least 3 to 4 times higher among African American women than in white women. Pathologically, uterine leiomyomas are benign tumors that arise in any part of the uterus under the influence of local growth factors and sex hormones, such as estrogen and progesterone. These common tumors cause significant morbidity for women and they are considered to be the most common indication for hysterectomy in the world; they are also associated with a substantial economic impact on health care systems that amounts to approximately $2.2 billion/year in the United States alone. Uterine myomas cause several reproductive problems such as heavy or abnormal uterine bleeding, pelvic pressure, infertility, and several obstetrical complications including miscarriage and preterm labor. Surgery has traditionally been the gold standard for the treatment of uterine leiomyomas and has typically consisted of either hysterectomy or myomectomy. In recent years, a few clinical trials have evaluated the efficacy of orally administered medications for the management of leiomyoma-related symptoms. In the present review, we will discuss these promising medical treatments in further detail.
Collapse
Affiliation(s)
- Mohamed Sabry
- Center for Women Health Research (CWHR), Meharry Medical College, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Faculty of Medicine, Sohag University, Egypt
| | - Ayman Al-Hendy
- Center for Women Health Research (CWHR), Meharry Medical College, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Center for Women Health Research, Meharry Medical College, Nashville, TN, USA
| |
Collapse
|
21
|
Innovative oral treatments of uterine leiomyoma. Obstet Gynecol Int 2012; 2012:943635. [PMID: 22518167 PMCID: PMC3306913 DOI: 10.1155/2012/943635] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022] Open
Abstract
Uterine fibroids (leiomyoma), the benign tumors of the uterine wall, are very common cause of morbidity in reproductive age women usually in the form of excessive vaginal bleeding, chronic pelvic pain, miscarriage and infertility. These tumors are the leading indication for hysterectomy in the United States. Uterine fibroids are about 4 times higher in blacks compared to whites and constitute a major health disparity challenge. The estimated cost of uterine fibroids is up to $34.4 billion annually. Additionally, women who suffer from this disease and desire to maintain their future fertility have very limited treatment choices. Currently, there is no effective long-term medicinal treatment for uterine fibroids. While surgery has traditionally been the gold standard for the treatment of uterine fibroids, there is growing interest towards orally administered medications for the management of leiomyoma-related symptoms. In this paper, we will discuss these promising innovative oral medical treatments in detail.
Collapse
|
22
|
Behera MA, Leong M, Johnson L, Brown H. Eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of uterine leiomyomas. Fertil Steril 2010; 94:1864-8. [PMID: 19931074 DOI: 10.1016/j.fertnstert.2009.09.063] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 08/29/2009] [Accepted: 09/28/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate patient eligibility and accessibility of magnetic resonance-guided focused ultrasound (MRgFUS) for women with symptomatic uterine leiomyomas who desire conservative therapy. DESIGN Retrospective analysis of 169 patients referred for minimally invasive treatment of leiomyomas between November 2007 and February 2009. Clinical eligibility for MRgFUS was determined by Food and Drug Administration-based treatment guidelines. All patients underwent pretreatment pelvic imaging to determine candidacy for the procedure. PATIENT(S) Premenopausal women with symptomatic uterine leiomyomas. SETTING Academic medical center. MAIN OUTCOME MEASURE(S) Eligibility for MRgFUS based on clinical and anatomic patient criteria. RESULT(S) Forty-seven percent of patients (80/169) were determined clinically eligible for the procedure. Of these, 16% of patients (27/169) were found to be eligible for MRgFUS based on imaging results. Overall, the main reasons for ineligibility were very large leiomyomas (8%; 14/169), cost (12%; 21/169), and desired fertility (14%; 23/169). An additional 48% of patients declined MRgFUS for unstated reasons, often after obtaining financial and insurance coverage information. CONCLUSION(S) Currently, many women with leiomyomas are unable to obtain MRgFUS treatment for multiple reasons, including uterine size, desire for fertility, and, most commonly, financial limitations. With increasing clinical experience, further research, and broadened insurance coverage, it may be possible to increase accessibility and expand eligibility criteria for this minimally invasive therapy.
Collapse
Affiliation(s)
- Millie A Behera
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27713, USA. 33199
| | | | | | | |
Collapse
|
23
|
Innervation of endometrium and myometrium in women with painful adenomyosis and uterine fibroids. Fertil Steril 2010; 94:730-7. [DOI: 10.1016/j.fertnstert.2009.03.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 03/01/2009] [Accepted: 03/05/2009] [Indexed: 11/19/2022]
|
24
|
|
25
|
Current World Literature. Curr Opin Obstet Gynecol 2009; 21:353-63. [DOI: 10.1097/gco.0b013e32832f731f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Suo G, Sadarangani A, Lamarca B, Cowan B, Wang JYJ. Murine xenograft model for human uterine fibroids: an in vivo imaging approach. Reprod Sci 2009; 16:827-42. [PMID: 19516078 DOI: 10.1177/1933719109336615] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uterine fibroids are the most prevalent benign tumors in women of reproductive age. The current knowledge on the fibroid disease mechanism has derived from studies of the Eker rat model where a unique germ line defect in the tuberous sclerosis 2 (Tsc2) tumor suppressor gene leads to the development of leiomyosarcoma, leiomyoma, and renal cancer. To study fibroids of human origin, we sought to establish fibroid xenografts in immune-compromised mice. We determined that lentiviral-mediated transduction of a green fluorescence protein (GFP)-luciferase (LUC) fusion gene and bioluminescence-based whole animal imaging allowed for the monitoring of transplanted fibroid cells in mice. We used this in vivo imaging approach to test a series of transplantation protocols and found that only freshly dissociated fibroid cells, but not the fibroid-derived smooth muscle cells grown in ex vivo cultures, can generate stable xenografts in subcutaneous Matrigel implants. Formation of the fibroid-xenografts requires the implantation of 17betaestradiol-releasing pellets in the recipient mice. Furthermore, freshly dissociated myometrial cells do not form xenografts under the experimental conditions. The xenograft protocol developed from this study provides an avenue for investigating the pathogenesis and drug responses of human fibroids.
Collapse
Affiliation(s)
- Guangli Suo
- Department of Medicine, Division of Hematology-Oncology, Moores Cancer Center, University of California, San Diego, School of Medicine, La Jolla, California 92093-0820, USA
| | | | | | | | | |
Collapse
|
27
|
Aromatase inhibitors prevent the estrogen rise associated with the flare effect of gonadotropins in patients treated with GnRH agonists. Fertil Steril 2009; 91:1574-7. [DOI: 10.1016/j.fertnstert.2008.09.077] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 09/25/2008] [Accepted: 09/26/2008] [Indexed: 11/24/2022]
|
28
|
HICKEY M, HAMMOND I. What is the place of uterine artery embolisation in the management of symptomatic uterine fibroids? Aust N Z J Obstet Gynaecol 2008; 48:360-8. [DOI: 10.1111/j.1479-828x.2008.00886.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|