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Aktürk H, Dura MC, Gürsoy B, Ikizoğlu F, Göl E, Alsalamin WOI, Ekin M. Comparison of Recurrence and Quality of Life Between Myoma Embolization and Myomectomy. Cureus 2023; 15:e40372. [PMID: 37456473 PMCID: PMC10345233 DOI: 10.7759/cureus.40372] [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: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Uterine myomas represent the most frequently diagnosed tumors among women of childbearing age. Symptoms often include profuse menstrual bleeding, diminished quality of life, and in some cases, infertility. The size and position of the fibroids typically influence the condition's manifestations. Moreover, symptomatology often varies depending on the fibroids' location. This investigation aimed to discern if there exists a significant correlation between life quality, reoccurrence rate, quality of life, and recurrence levels among patients who have undergone myomectomy and uterine fibroid embolization, respectively. METHODOLOGY A retrospective cross-sectional study was conducted to compare the rates of recurrence and impacts on life quality between uterine fibroid embolization and myomectomy in women diagnosed with uterine myomas. Data were collected from 152 women who sought treatment at the Obstetrics and Gynecology clinic and also the Interventional Radiology clinic between January 2009 and January 2021. Thirteen participants were excluded due to the inability to maintain contact. The trial encompassed 76 patients who underwent myomectomy and 63 who had uterine fibroid embolization. In both groups, the life quality of 50 patients, five years postsurgery, was assessed using the UFS-QOL measure. Eligible participants were females between 20 and 40 years, with symptomatic Type 3-5 fibroids as per the FIGO classification, and with no comorbidities. Individuals under 20 or over 40 years, or those with fibroids classified as FIGO types 1,2,6,7,8, were not included. Other exclusion criteria included pregnancy status, abnormal endometrial biopsy results, abnormal smear tests, polyps, cancer, adenomyosis and coagulation disorders. RESULTS The recurrence of fibroids was identified through symptomatology and diagnostic radiological methods. The recurrence rate was found to be 31.6% (n=24) for myomectomy patients and 14.3% (n=9) for those who underwent uterine fibroid embolization, with no statistically significant difference between the two groups (p > 0.05). The group subjected to myomectomy exhibited fewer symptoms, lower anxiety, and better physical mood scores. The myomectomy group displayed higher average anxiety scores (p<0.01). There were no significant disparities in control, consciousness, sexual function, or overall scores between the two groups. Symptoms and anxiety saw a marked reduction in the first postoperative year compared to the preoperative period (p<0.01). Compared to presurgery, energy, mood, awareness, and sexual function exhibited significant improvements in the first and fifth postoperative years (p<0.01). CONCLUSIONS Our findings suggest a nonsignificant recurrence rate in the myomectomy group compared to the uterine artery embolization group. Notably, the decrease in symptom occurrence and anxiety following myomectomy was significantly favorable in terms of quality of life. While embolization was offered as a therapeutic option, myomectomy yielded more favorable results concerning quality of life.
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Affiliation(s)
- Hilal Aktürk
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Mustafa Cengiz Dura
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Berk Gürsoy
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Faruk Ikizoğlu
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Erkan Göl
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
| | - Waseem O I Alsalamin
- Medicine, University of Health Sciences, Istanbul, TUR
- Medicine, Al-Quds University, Abu Dis, PSE
| | - Murat Ekin
- Obstetrics and Gynaecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TUR
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Pilgrim J, Arismendi J, DeAngelis A, Lewis T, Britten J, Malik M, Catherino WH. Characterization of the role of Activator Protein 1 signaling pathway on extracellular matrix deposition in uterine leiomyoma. F&S SCIENCE 2020; 1:78-89. [PMID: 35559742 DOI: 10.1016/j.xfss.2020.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To characterize the role Activator Protein 1 (AP 1) family members play in mediating extracellular matrix deposition in uterine leiomyoma. DESIGN Laboratory study. SETTING University research laboratory. INTERVENTION(S) Exposure of leiomyoma and myometrial cell lines to either an AP 1 inhibitor alone, AP 1 inhibitor plus transforming growth factor (TGF)ß3, or TGFß3 alone. MAIN OUTCOME MEASURE(S) Western immunoblot analysis was performed to assess for changes in AP 1 family member protein expression. RESULT(S) In patient-matched myometrial and leiomyoma cell lines, the only AP 1 member found to be elevated significantly in leiomyoma compared with myometrium was FOSB (3.47 ± 0.12-fold), whereas others were decreased significantly: FRA1 (0.67 ± 0.02-fold), FRA2 (0.45 ± 0.01-fold), c FOS (0.37 ± 0.01-fold), Phos c FOS (0.19 ± 0.02-fold), Phos c JUN (0.75 ± 0.02-fold), JUNB (0.81 ± 0.04-fold), and JUND (0.65 ± 0.03-fold). c JUN (0.93 ± 0.03-fold) concentration was reduced but at nonsignificant levels. Following stimulation with TGF ß 3, fibronectin (2.16 ± 0.14-fold) and versican (4.71 ± 0.15-fold) protein concentrations were increased at 24 hours. Collagen 1A demonstrated a time-dependent significant increased concentration beginning at 6 hours (1.32 ± 0.01-fold) and increased to (6.49 ± 0.02-fold) at 24 hours. Following treatment with AP 1 inhibitor (SR11302), there were significant reductions in Collagen 1A concentration at 4 hours (0.59 ± 0.03-fold) and 6 hours (0.42 ± 0.05-fold). Activator Protein 1 inhibition did not reduce significantly versican concentration until 6 hours of treatment (0.84 ± 0.04-fold). SR11302 also decreased significantly fibronectin concentration (0.68 ± 0.05-fold) at 8 hours of treatment. CONCLUSION(S) Activator Protein 1 signaling is well described in fibrotic diseases, and, herein, we demonstrated that signaling via AP 1 family members promotes extracellular matrix deposition in leiomyoma.
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Affiliation(s)
- Justin Pilgrim
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Program in Reproductive Endocrinology and Gynecology, National Institutes of Health, Bethesda, Maryland; Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - Jacquel Arismendi
- Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - Anthony DeAngelis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Program in Reproductive Endocrinology and Gynecology, National Institutes of Health, Bethesda, Maryland; Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - Terrence Lewis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Program in Reproductive Endocrinology and Gynecology, National Institutes of Health, Bethesda, Maryland; Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - Joy Britten
- Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - Minnie Malik
- Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland
| | - William H Catherino
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Program in Reproductive Endocrinology and Gynecology, National Institutes of Health, Bethesda, Maryland; Uniformed Services University of the Health Sciences, Department of Obstetrics and Gynecology, Bethesda, Maryland.
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Farah-Gari Z, Khodja R, Lemkeddem Y, Zanoun N, Hadjar K, Agostini A. [Vaginal myomectomy: Feasibility and evaluation of the risk of postoperative adhesion]. ACTA ACUST UNITED AC 2020; 48:480-483. [PMID: 32278707 DOI: 10.1016/j.gofs.2020.04.001] [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: 02/27/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this series are to evaluate the results of vaginal myomectomy and to assess the postoperative adhesion risk. METHODS It was a prospective observational study of fifty patients. All patients underwent a vaginal myomectomy, followed six months after laparoscopy to assess and treat postoperative adhesions. RESULTS Myomectomies were performed via an anterior, posterior and mixed colpotomy in 42 %, 54 % and 4 % of the cases, respectively. Laparoconversion was necessary in three cases (6 %). Laparoscopic evaluation was performed in 24 patients (48 %). adhesions were present in 14 cases (58.33 %); the adhesions did not affect the Fallopian tubes and ovaries. CONCLUSION Vaginal myomectomy was feasible, not limited to single myomectomy this which is in agreement with previously published series. Post adhesion risk seems weaker and does not concern the appendices, but this requires to be confirmed.
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Affiliation(s)
- Z Farah-Gari
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - R Khodja
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - Y Lemkeddem
- Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - N Zanoun
- service d'épidémiologie, CHU Lamine Debaghine, Boulevard Said Touati, Bab-el-oued, 16000 Alger; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - K Hadjar
- Service de gynécologie - Obstétrique, hospital Ibn Ziri de Bologhine-Bologhine, 16000, Alger, Algérie; Faculté de Médecine d'Alger, 18, avenue Pasteur, 16100 Alger Centre, Algérie.
| | - A Agostini
- Service de gynécologie obstétrique, Hôpital La-Conception, 147, boulevard Baille, 13005 Marseille, France.
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Cao S, Liu Y, Bai X, Wang L. A Case Report Of Uterine Leiomyosarcoma. Onco Targets Ther 2019; 12:8583-8586. [PMID: 31802894 PMCID: PMC6801628 DOI: 10.2147/ott.s218222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022] Open
Abstract
Background Uterine leiomyoma is the most common benign tumor in women. Uterine sarcoma, though with very low incidence, has a high malignant degree and poor prognosis. It has difficulties in preoperative diagnosis, frozen pathological examination and postoperative treatment. Case report A 49-year-old woman presented with menstrual disorder. Magnetic resonance imaging showed a huge uterine mass. The patient underwent laparoscopic hysterectomy and part of the uterine tissue looked like fish. Specimens were sent to frozen pathological examination for four times, but none of the results showed malignancy certainly. Considering all abnormalities, we removed the uterine through vagina completely rather than morcellation and did pelvic lymph node biopsy. Postoperative pathological examination revealed uterine leiomyosarcoma and one pelvic lymph node had metastasized. Conclusion Uterine sarcoma is difficult to be diagnosed even frozen pathological examination has been performed. Unexpected uterine sarcoma should always be considered, and precautions should be taken if we find anything suspicious. Fortunately, the patient has avoided second operation.
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Affiliation(s)
- Siyu Cao
- Department of Gynecology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yang Liu
- Department of Gynecology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xuechai Bai
- Department of Gynecology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Liang Wang
- Department of Gynecology, The 2nd Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Edwards TL, Giri A, Hellwege JN, Hartmann KE, Stewart EA, Jeff JM, Bray MJ, Pendergrass SA, Torstenson ES, Keaton JM, Jones SH, Gogoi RP, Kuivaniemi H, Jackson KL, Kho AN, Kullo IJ, McCarty CA, Im HK, Pacheco JA, Pathak J, Williams MS, Tromp G, Kenny EE, Peissig PL, Denny JC, Roden DM, Velez Edwards DR. A Trans-Ethnic Genome-Wide Association Study of Uterine Fibroids. Front Genet 2019; 10:511. [PMID: 31249589 PMCID: PMC6582231 DOI: 10.3389/fgene.2019.00511] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/10/2019] [Indexed: 01/02/2023] Open
Abstract
Uterine fibroids affect up to 77% of women by menopause and account for up to $34 billion in healthcare costs each year. Although fibroid risk is heritable, genetic risk for fibroids is not well understood. We conducted a two-stage case-control meta-analysis of genetic variants in European and African ancestry women with and without fibroids classified by a previously published algorithm requiring pelvic imaging or confirmed diagnosis. Women from seven electronic Medical Records and Genomics (eMERGE) network sites (3,704 imaging-confirmed cases and 5,591 imaging-confirmed controls) and women of African and European ancestry from UK Biobank (UKB, 5,772 cases and 61,457 controls) were included in the discovery genome-wide association study (GWAS) meta-analysis. Variants showing evidence of association in Stage I GWAS (P < 1 × 10-5) were targeted in an independent replication sample of African and European ancestry individuals from the UKB (Stage II) (12,358 cases and 138,477 controls). Logistic regression models were fit with genetic markers imputed to a 1000 Genomes reference and adjusted for principal components for each race- and site-specific dataset, followed by fixed-effects meta-analysis. Final analysis with 21,804 cases and 205,525 controls identified 326 genome-wide significant variants in 11 loci, with three novel loci at chromosome 1q24 (sentinel-SNP rs14361789; P = 4.7 × 10-8), chromosome 16q12.1 (sentinel-SNP rs4785384; P = 1.5 × 10-9) and chromosome 20q13.1 (sentinel-SNP rs6094982; P = 2.6 × 10-8). Our statistically significant findings further support previously reported loci including SNPs near WT1, TNRC6B, SYNE1, BET1L, and CDC42/WNT4. We report evidence of ancestry-specific findings for sentinel-SNP rs10917151 in the CDC42/WNT4 locus (P = 1.76 × 10-24). Ancestry-specific effect-estimates for rs10917151 were in opposite directions (P-Het-between-groups = 0.04) for predominantly African (OR = 0.84) and predominantly European women (OR = 1.16). Genetically-predicted gene expression of several genes including LUZP1 in vagina (P = 4.6 × 10-8), OBFC1 in esophageal mucosa (P = 8.7 × 10-8), NUDT13 in multiple tissues including subcutaneous adipose tissue (P = 3.3 × 10-6), and HEATR3 in skeletal muscle tissue (P = 5.8 × 10-6) were associated with fibroids. The finding for HEATR3 was supported by SNP-based summary Mendelian randomization analysis. Our study suggests that fibroid risk variants act through regulatory mechanisms affecting gene expression and are comprised of alleles that are both ancestry-specific and shared across continental ancestries.
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Affiliation(s)
- Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ayush Giri
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Katherine E Hartmann
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic, Rochester, MN, United States
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Michael J Bray
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah A Pendergrass
- Biomedical and Translational Informatics Institute, Geisinger Health System, Danville, PA, United States
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jacob M Keaton
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah H Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Radhika P Gogoi
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States
| | - Helena Kuivaniemi
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States.,SAMRC-SHIP South African Tuberculosis Bioinformatics Initiative, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kathryn L Jackson
- Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Abel N Kho
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Iftikhar J Kullo
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Catherine A McCarty
- Department of Family Medicine and Behavioral Health, University of Minnesota Medical School, Duluth, MN, United States
| | - Hae Kyung Im
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Jennifer A Pacheco
- Center for Genetic Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, United States
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Gerard Tromp
- Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States.,SAMRC-SHIP South African Tuberculosis Bioinformatics Initiative, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.,Center for Statistical Genetics, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Peggy L Peissig
- Biomedical Informatics Research Center, Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Joshua C Denny
- Department of Biomedical Informatics and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Dan M Roden
- Departments of Medicine, Pharmacology, and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Digna R Velez Edwards
- Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States.,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Alleyne AT, Bideau VS. Haplotypes of CYP1B1 and CCDC57 genes in an Afro-Caribbean female population with uterine leiomyoma. Mol Biol Rep 2019; 46:3299-3306. [PMID: 30989560 DOI: 10.1007/s11033-019-04790-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/28/2019] [Indexed: 11/24/2022]
Abstract
Uterine leiomyomas (UL) are prevalent benign tumors, especially among women of African ancestry. The disease also has genetic liability and is influenced by risk factors such as hormones and obesity. This study investigates the haplotypes of the Cytochrome P450 1B1 gene (CYP1B1) related to hormones and coiled-coil domain containing 57 gene (CCDC57) related to obesity in Afro-Caribbean females. Each haplotype was constructed from unphased sequence data using PHASE v.2.1 software and Haploview v.4.2 was used for linkage disequilibrium (LD) studies. There were contrasting LD observed among the single nucleotide polymorphisms of CYP1B1 and CCDC5. Accordingly, the GTA haplotype of CYP1B1 was significantly associated with UL risk (P = 0.02) while there was no association between CCDC57 haplotypes and UL (P = 0.2) for the ATG haplotype. As such, our findings suggest that the Asp449Asp polymorphism and GTA haplotype of CYP1B1 may contribute to UL susceptibility in women of Afro-Caribbean ancestry in this population.
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Affiliation(s)
- Angela T Alleyne
- Department of Biological and Chemical Sciences, Faculty of Science and Technology, University of the West Indies Cave Hill Campus, Bridgetown, Barbados.
| | - Virgil S Bideau
- Department of Biological and Chemical Sciences, Faculty of Science and Technology, University of the West Indies Cave Hill Campus, Bridgetown, Barbados
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Lewis TD, Malik M, Britten J, Parikh T, Cox J, Catherino WH. Ulipristal acetate decreases active TGF-β3 and its canonical signaling in uterine leiomyoma via two novel mechanisms. Fertil Steril 2019; 111:806-815.e1. [PMID: 30871768 DOI: 10.1016/j.fertnstert.2018.12.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To characterize the effect of ulipristal acetate (UPA) treatment on transforming growth factor (TGF) canonical and noncanonical signaling pathways in uterine leiomyoma tissue and cells. UPA decreased extracellular matrix in surgical specimens; we characterize the mechanism in this study. DESIGN Laboratory study. SETTING University. INTERVENTION(S) Exposure of leiomyoma cell lines to UPA. MAIN OUTCOME MEASURE(S) RNAseq was performed on matched myometrium and leiomyoma surgical specimens of placebo- and UPA-treated patients. Changes in gene expression and protein were measured using quantitative polymerase chain reaction and western immunoblot analysis, respectively. RESULT(S) In surgical specimen, mRNA for TGF-β3 was elevated 3.75-fold and TGFR2 was decreased 0.50-fold in placebo leiomyomas compared with myometrium. Analysis of leiomyomas from UPA-treated women by western blot revealed significant reductions of active TGF-β3 (0.64 ± 0.12-fold), p-TGFR2 (0.56 ± 0.23-fold), pSmad 2 (0.54 ± 0.04-fold), and pSmad 3 (0.65 ± 0.09-fold) compared with untreated leiomyomas. UPA treatment demonstrated statistically significant reduction in collagen 1, fibronectin, and versican proteins. Notably, there was a statistically significant increase of the extracellular matrix protein fibrillin in leiomyoma treated with UPA (1.48 ± 0.41-fold). Data from in vitro assays with physiologic concentrations of UPA supported the in vivo findings. CONCLUSION(S) TGF-β pathway is highly up-regulated in leiomyoma and is directly responsible for development of the fibrotic phenotype. UPA attenuates this pathway by reducing TGF-β3 message and protein expression, resulting in a reduction in TGF-β canonical signaling. In addition, UPA significantly increased fibrillin protein expression, which can serve to bind inactive TGF-β complexes. Therefore, UPA inhibits leiomyoma fibrosis by decreasing active TGF-β3 and diminishing signaling through the canonical pathway. CLINICAL TRIAL REGISTRATION NUMBER NCT00290251.
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Affiliation(s)
- Terrence D Lewis
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 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
| | - Toral Parikh
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jeris Cox
- Fort Belvoir Community Hospital, Fort Belvoir, Virginia
| | - William H Catherino
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
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Althobaiti FA, Alsaadi KK, Althobaiti AA. A Case of Hemoperitoneum Due to Spontaneous Bleeding from a Uterine Leiomyoma. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:167-170. [PMID: 30733430 PMCID: PMC6375281 DOI: 10.12659/ajcr.914573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Female, 26 Final Diagnosis: Uterine leiomyoma Symptoms: Abdomen distension • acute abdomen Medication: — Clinical Procedure: Exploratory laparotomy Specialty: Obstetrics and Gynecology
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Affiliation(s)
| | - Khulod Khaled Alsaadi
- Department of Obstetrics and Gynecology, King Abdulaziz Hospital, Jeddah, Saudi Arabia
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Lewis TD, Malik M, Britten J, San Pablo AM, Catherino WH. A Comprehensive Review of the Pharmacologic Management of Uterine Leiomyoma. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2414609. [PMID: 29780819 PMCID: PMC5893007 DOI: 10.1155/2018/2414609] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/13/2017] [Indexed: 12/22/2022]
Abstract
Uterine leiomyomata are the most common benign tumors of the gynecologic tract impacting up to 80% of women by 50 years of age. It is well established that these tumors are the leading cause for hysterectomy with an estimated total financial burden greater than $30 billion per year in the United States. However, for the woman who desires future fertility or is a poor surgical candidate, definitive management with hysterectomy is not an optimal management plan. Typical gynecologic symptoms of leiomyoma include infertility, abnormal uterine bleeding (AUB)/heavy menstrual bleeding (HMB) and/or intermenstrual bleeding (IMB) with resulting iron-deficiency anemia, pelvic pressure and pain, urinary incontinence, and dysmenorrhea. The morbidity caused by these tumors is directly attributable to increases in tumor burden. Interestingly, leiomyoma cells within a tumor do not rapidly proliferate, but rather the increase in tumor size is secondary to production of an excessive, stable, and aberrant extracellular matrix (ECM) made of disorganized collagens and proteoglycans. As a result, medical management should induce leiomyoma cells toward dissolution of the extracellular matrix, as well as halting or inhibiting cellular proliferation. Herein, we review the current literature regarding the medical management of uterine leiomyoma.
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Affiliation(s)
- Terrence D. Lewis
- Program in Adult & Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA
| | - Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Joy Britten
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
| | - Angelo Macapagal San Pablo
- Program in Adult & Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, USA
| | - William H. Catherino
- Program in Adult & Reproductive Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA
- Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD, USA
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Bray MJ, Edwards TL, Wellons MF, Jones SH, Hartmann KE, Velez Edwards DR. Admixture mapping of uterine fibroid size and number in African American women. Fertil Steril 2017; 108:1034-1042.e26. [PMID: 29202956 PMCID: PMC5728674 DOI: 10.1016/j.fertnstert.2017.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate the relationship between genetic ancestry and uterine fibroid characteristics. DESIGN Cross-sectional study. SETTING Not applicable. PATIENT(S) A total of 609 African American participants with image- or surgery-confirmed fibroids in a biorepository at Vanderbilt University electronic health record biorepository and the Coronary Artery Risk Development in Young Adults studies were included. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Outcome measures include fibroid number (single vs. multiple), volume of largest fibroid, and largest fibroid dimension of all fibroid measurements. RESULT(S) Global ancestry meta-analyses revealed a significant inverse association between percentage of European ancestry and risk of multiple fibroids (odds ratio: 0.78; 95% confidence interval 0.66, 0.93; P=6.05 × 10-3). Local ancestry meta-analyses revealed five suggestive (P<4.80 × 10-3) admixture mapping peaks in 2q14.3-2q21.1, 3p14.2-3p14.1, 7q32.2-7q33, 10q21.1, 14q24.2-14q24.3, for number of fibroids and one suggestive admixture mapping peak (P<1.97 × 10-3) in 10q24.1-10q24.32 for volume of largest fibroid. Single variant association meta-analyses of the strongest associated region from admixture mapping of fibroid number (10q21.1) revealed a strong association at single nucleotide polymorphism variant rs12219990 (odds ratio: 0.41; 95% confidence interval 0.28, 0.60; P=3.82 × 10-6) that was significant after correction for multiple testing. CONCLUSION(S) Increasing African ancestry is associated with multiple fibroids but not with fibroid size. Local ancestry analyses identified several novel genomic regions not previously associated with fibroid number and increasing volume. Future studies are needed to explore the genetic impact that ancestry plays into the development of fibroid characteristics.
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Affiliation(s)
- Michael J Bray
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee
| | - Todd L Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee; Department of Medicine, Vanderbilt University, Nashville, Tennessee; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Division of Epidemiology, Vanderbilt University, Nashville, Tennessee
| | | | - Sarah H Jones
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
| | - Katherine E Hartmann
- Department of Medicine, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, Tennessee; Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee; Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee; Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee.
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11
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Hellwege JN, Jeff JM, Wise LA, Gallagher CS, Wellons M, Hartmann KE, Jones SF, Torstenson ES, Dickinson S, Ruiz-Narváez EA, Rohland N, Allen A, Reich D, Tandon A, Pasaniuc B, Mancuso N, Im HK, Hinds DA, Palmer JR, Rosenberg L, Denny JC, Roden DM, Stewart EA, Morton CC, Kenny EE, Edwards TL, Velez Edwards DR. A multi-stage genome-wide association study of uterine fibroids in African Americans. Hum Genet 2017; 136:1363-1373. [PMID: 28836065 PMCID: PMC5628188 DOI: 10.1007/s00439-017-1836-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022]
Abstract
Uterine fibroids are benign tumors of the uterus affecting up to 77% of women by menopause. They are the leading indication for hysterectomy, and account for $34 billion annually in the United States. Race/ethnicity and age are the strongest known risk factors. African American (AA) women have higher prevalence, earlier onset, and larger and more numerous fibroids than European American women. We conducted a multi-stage genome-wide association study (GWAS) of fibroid risk among AA women followed by in silico genetically predicted gene expression profiling of top hits. In Stage 1, cases and controls were confirmed by pelvic imaging, genotyped and imputed to 1000 Genomes. Stage 2 used self-reported fibroid and GWAS data from 23andMe, Inc. and the Black Women's Health Study. Associations with fibroid risk were modeled using logistic regression adjusted for principal components, followed by meta-analysis of results. We observed a significant association among 3399 AA cases and 4764 AA controls at rs739187 (risk-allele frequency = 0.27) in CYTH4 (OR (95% confidence interval) = 1.23 (1.16-1.30), p value = 7.82 × 10-9). Evaluation of the genetic association results with MetaXcan identified lower predicted gene expression of CYTH4 in thyroid tissue as significantly associated with fibroid risk (p value = 5.86 × 10-8). In this first multi-stage GWAS for fibroids among AA women, we identified a novel risk locus for fibroids within CYTH4 that impacts gene expression in thyroid and has potential biological relevance for fibroids.
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Affiliation(s)
- Jacklyn N Hellwege
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Janina M Jeff
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | | | - Melissa Wellons
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine E Hartmann
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah F Jones
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric S Torstenson
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott Dickinson
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Nadin Rohland
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Alexander Allen
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - David Reich
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Arti Tandon
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Bogdan Pasaniuc
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicholas Mancuso
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hae Kyung Im
- Section of Genetic Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Joshua C Denny
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Dan M Roden
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Elizabeth A Stewart
- Departments of Obstetrics and Gynecology and Surgery, Mayo Clinic and Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Cynthia C Morton
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- University of Manchester Academic Health Science Centre, Manchester, England, UK
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eimear E Kenny
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Todd L Edwards
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
- Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Velez Edwards DR, Hartmann KE, Wellons M, Shah A, Xu H, Edwards TL. Evaluating the role of race and medication in protection of uterine fibroids by type 2 diabetes exposure. BMC Womens Health 2017; 17:28. [PMID: 28399866 PMCID: PMC5387248 DOI: 10.1186/s12905-017-0386-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine fibroids (UF) affect 77% of women by menopause, and account for $9.4 billion in annual healthcare costs. Type-2-diabetes (T2D) has inconsistently associated with protection from UFs in prior studies. To further evaluate the relationship between T2D and UFs we tested for association between T2D and UF risk in a large clinical population as well as the potential differences due to T2D medications and interaction with race. METHODS This nested case-control study is derived from a clinical cohort. Our outcome was UF case-control status and our exposure was T2D. UF outcomes and T2D exposure were classified using validated electronic medical record (EMR) algorithms. Logistic regression, adjusted for covariates, was used to model the association between T2D diagnosis and UF risk. Secondary analyses were performed evaluating the interaction between T2D exposure and race and stratifying T2D exposed subjects by T2D medication being taken. RESULTS We identified 3,789 subjects with UF outcomes (608 UF cases and 3,181 controls), 714 were diabetic and 3,075 were non-diabetic. We observed a nominally significant interaction between T2D exposure and race in adjusted models (interaction p = 0.083). Race stratified analyses demonstrated more protection by T2D exposure on UF risk among European Americans (adjusted odds ratio [aOR] = 0.50, 95% CI 0.35 to 0.72) than African Americans (aOR = 0.76, 95% CI 0.50 to 1.17). We also observed a protective effect by T2D regardless of type of T2D medication being taken, with slightly more protection among subjects on insulin treatments (European Americans aOR = 0.42, 95% CI 0.26 to 0.68; African Americans aOR = 0.60, 95% CI 0.36 to 1.01). CONCLUSIONS These data, conducted in a large population of UF cases and controls, support prior studies that have found a protective association between diabetes presence and UF risk and is further modified by race. Protection from UFs by T2D exposure was observed regardless of medication type with slightly more protection among insulin users. Further mechanistic research in larger cohorts is necessary to reconcile the potential role of T2D in UF risk.
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Affiliation(s)
- Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN 37203 USA
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN 37203 USA
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Melissa Wellons
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Anushi Shah
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN USA
| | - Hua Xu
- The University of Texas School Health Science Center, School of Biomedical Informatics, Houston, TX USA
| | - Todd L. Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN 37203 USA
- Institute of Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center , Nashville, TN USA
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN USA
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Feingold-Link L, Edwards TL, Jones S, Hartmann KE, Velez Edwards DR. Enhancing uterine fibroid research through utilization of biorepositories linked to electronic medical record data. J Womens Health (Larchmt) 2015; 23:1027-32. [PMID: 25495367 DOI: 10.1089/jwh.2014.4978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Uterine leiomyomata (fibroids) affect up to 77% of women by menopause and account for $9.4 billion in yearly healthcare costs. Most studies rely on self-reported diagnosis, which may result in misclassification of controls since as many as 50% of cases are asymptomatic and thus undiagnosed. Our objective was to evaluate the performance and accuracy of a fibroid phenotyping algorithm constructed from electronic medical record (EMR) data, limiting to subjects with pelvic imaging. METHODS Our study population includes women from a clinical population at Vanderbilt University Medical Center (2008-2012). Analyses were restricted to women 18 years and older with at least one fibroid diagnosis confirmed by imaging for cases or at least two separate pelvic imaging procedures without a diagnosis for controls. We randomly reviewed 218 records to evaluate the accuracy of our algorithm and assess the indications for pelvic imaging. Participant characteristics and indications for imaging were compared between cases and controls in unadjusted and adjusted logistic regression analyses. RESULTS Our algorithm had a positive predictive value of 96% and negative predictive value of 98%. Increasing age (odds ratio=1.05, 95% confidence interval 1.03-1.08) and Black race (odds ratio=2.15, 95% confidence interval 1.18-3.94) were identified as risk factors for fibroids. The most common indications for imaging in both cases and controls were pain, bleeding, and reproductive factors, and the most common imaging modality was a pelvic ultrasound. CONCLUSIONS These data suggest that using biorepositories linked to EMR data is a feasible way to identify populations of imaged women that facilitate investigations of fibroid risk factors.
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What are MRI findings of Spine Benign Metastasizing Leiomyoma? Case report with literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 4:S600-5. [PMID: 25632838 DOI: 10.1007/s00586-015-3774-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/07/2014] [Accepted: 01/18/2015] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Benign Metastasizing Leiomyoma (BML) is a rare disease that results from metastasis of uterine leiomyoma to distant sites with benign pathologic features. Spine BML is very rare so the information of its features and pathophysiology is seldom known. MATERIALS AND METHODS We experienced a case of 42-year-old woman who presented with right buttock and leg pain with paresthesia. She had a surgical history of uterine myomectomy. Magnetic resonance imaging (MRI) of the lumbar spine revealed a well-circumscribed mass lesion in the posterior compartment of the L4 vertebral body, with extension into the ventral epidural space and both foramina. The mass showed hypointensity on T1-, T2-weighted images and strong homogeneous enhancement on gadolinium enhanced T1-weighted images. Tumor removal was conducted, and permanent biopsy revealed the mass as leiomyoma. Nine previous spine BML reports, which are known for all, were reviewed along with our case. We collated the clinical information and MRI findings of spine BML to figure out its common denominators. RESULTS Premenopausal women, previous history of uterine myoma, myomectomy/hysterectomy, and lung BML seemed to be predisposing clinical factors. For the imaging findings, posterior vertebral body invasion with bony destruction, neural foramen invasion, and canal encroachment were shown as common denominators. Especially in MRI findings, low T1 and T2 signal intensities with strong homogeneous enhancement were their common features. CONCLUSION We gathered the fragmentary information of the spine BML for the first time, especially the MRI findings. Although spine BML is rare, it surely exists. Accordingly, spine surgeons should be suspicious of spine BML given its typical clinical history and MRI findings.
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Salimi S, Mohammadoo-Khorasani M, Namazi L, moossavi M, Naghavi A, Yaghmaei M. Association Between Interleukin 4 Gene Seventy-Base-Pair Variable Number of Tandem Repeats Polymorphism and Uterine Leiomyoma. ACTA ACUST UNITED AC 2014. [DOI: 10.17795/gct-19462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Bestel E, Donnez J. The potential of selective progesterone receptor modulators for the treatment of uterine fibroids. Expert Rev Endocrinol Metab 2014; 9:79-92. [PMID: 30743741 DOI: 10.1586/17446651.2014.862495] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In addition to the estrogen receptor, the progesterone receptor plays an important role in the growth of uterine fibroids. Several selective progesterone receptor modulators (SPRMs) have been evaluated for medical treatment of uterine fibroids and, because of safety issues, some molecules were stopped during clinical development. However, in 2012, ulipristal acetate received the approval for a pre-surgical treatment of uterine fibroids. Clinical trials with ulipristal acetate for long-term medical treatment of uterine fibroids are ongoing. This review article describes the action of SPRMs at the progesterone receptor level and the mechanism of action on the fibroid tissue. A review of the published clinical trials is performed, including the current evidence of efficacy on uterine fibroid symptom management, size reduction and tolerability. The therapeutic potential of SPRMs for uterine fibroids is discussed.
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Affiliation(s)
- Elke Bestel
- a PregLem. S.A., Chemin du PréFleuri, 3, 1228 Plan-Les-Ouates, Geneva, Switzerland
| | - Jacques Donnez
- b Société de Recherche pour l'Infertilité, Av. Grandchamp, 143, 1150 Brussels, Belgium
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Edwards TL, Michels KA, Hartmann KE, Edwards DRV. BET1L and TNRC6B associate with uterine fibroid risk among European Americans. Hum Genet 2013; 132:943-53. [PMID: 23604678 PMCID: PMC3715562 DOI: 10.1007/s00439-013-1306-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 04/10/2013] [Indexed: 01/19/2023]
Abstract
Uterine fibroid (UFs) affect 77 % of women by menopause and account for $9.4 billion in healthcare costs each year. Although UFs are heritable, genetic risk is poorly understood. The first genome-wide association study (GWAS) of UFs was recently performed in a Japanese population, with reported genome-wide significance for single nucleotide polymorphisms (SNPs) across three chromosomal regions. We tested these SNPs for association with UFs in US cohorts. Women were enrolled in the Right from the Start (RFTS) cohort and the BioVU DNA repository. UF status in both cohorts was determined by pelvic imaging. We tested 65 candidate and haplotype-tagging SNPs for association with UFs presence using logistic regression in RFTS and the top three GWAS-associated SNPs in BioVU. We also combined association results from both cohorts using meta-analysis. 1,086 European American (EA) cases and 1,549 controls were examined. Two SNP associations replicated [blocked early in transport 1 homolog (BET1L) rs2280543, RFTS-BioVU meta-odds ratio (OR) = 0.67 95 % confidence interval (CI) 0.38-0.96, Q = 0.70, I = 0, p = 6.9 × 10⁻³; trinucleotide repeat containing 6B (TNRC6B) rs12484776, RFTS-BioVU meta-OR = 1.21, 95 % CI 1.07-1.35, Q = 0.24, I = 28.37, p = 8.7 × 10⁻³). Meta-analyses combining evidence from RFTS, BioVU, and prior GWAS showed little heterogeneity in effect sizes across studies, with meta-p values between 7.45 × 10⁻⁸ and 3.89 × 10⁻⁹, which were stronger than prior GWAS and supported associations observed for all previously identified loci. These data suggest common variants increase risk for UF in both EA and Japanese populations. However, further research is needed to assess the role of these genes across other racial groups.
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Affiliation(s)
- Todd L. Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee
- Division of Epidemiology, Department of Medicine, Vanderbilt University, Nashville, TN
| | - Kara A. Michels
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University, Nashville, Tennessee
- Institute for Medicine and Public Health, Vanderbilt University, Nashville, Tennessee
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN
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Edwards TL, Hartmann KE, Velez Edwards DR. Variants in BET1L and TNRC6B associate with increasing fibroid volume and fibroid type among European Americans. Hum Genet 2013; 132:1361-9. [PMID: 23892540 DOI: 10.1007/s00439-013-1340-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 07/14/2013] [Indexed: 12/18/2022]
Abstract
Uterine fibroids (UFs) affect 77 % of women by menopause and account for $9.4 billion in yearly healthcare costs. We recently replicated findings from the first UF genome-wide association study (GWAS), conducted in the Japanese. Here we tested these GWAS-discovered SNPs for association with UF characteristics to further assess whether risk varies by sub-phenotypes of UFs. Women were enrolled in Right from the Start (RFTS) and the BioVU DNA repository (BioVU). UF status was determined by pelvic imaging. We tested the top GWAS-associated SNPs for association with UF characteristics (RFTS: type, number, volume; BioVU: type) using covariate adjusted logistic and linear regression. We also combined association results of UF type using meta-analysis. 456 European American (EA) cases and 1,549 controls were examined. Trinucleotide repeat containing 6B (TNRC6B) rs12484776 associated with volume in RFTS (β = 0.40, 95 % CI 0.05-0.75, p = 0.024). RFTS analyses evaluating stratified quartiles of volume showed the strongest OR at rs12484776 for the largest volume (16.6-179.1 cc, odds ratio (OR) = 2.19, 95 % confidence interval (CI) 1.07-4.46, p = 0.031). Meta-analysis showed a strong association at blocked early in transport 1 homolog (BET1L) rs2280543 for intramural UFs (meta-OR = 0.51, standard error (SE) = 0.14, Q = 0.590, I = 0, p = 2.48 × 10(-6)), which is stronger than the overall association with UF risk. This study is the first to evaluate these SNPs for association with UF characteristics and suggests these genes associate with increasing UF volume and protection from intramural UF in EAs.
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Affiliation(s)
- Todd L Edwards
- Vanderbilt Epidemiology Center, Vanderbilt University, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA
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Fontarensky M, Cassagnes L, Bouchet P, Azuar AS, Boyer L, Chabrot P. Acute complications of benign uterine leiomyomas: treatment of intraperitoneal haemorrhage by embolisation of the uterine arteries. Diagn Interv Imaging 2013; 94:885-90. [PMID: 23602591 DOI: 10.1016/j.diii.2013.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- M Fontarensky
- Radiology Department B, Vascular and Visceral, CHU Gabriel-Montpied, rue Montalembert, 63000 Clermont-Ferrand, France.
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Sivri N, Yalta T, Sayın C, Yalta K, Ozpuyan F, Taştekin E, Yetkin E. Evaluation of cardiovascular risk factors in women with uterine leimyoma: is there a link with atherosclerosis? Balkan Med J 2012; 29:320-3. [PMID: 25207023 DOI: 10.5152/balkanmedj.2012.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 02/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Both uterine leimyoma (UL) and cardiovascular disease are public health problems affecting women at different age ranges. Smoking, obesity, and hypertension have been shown to be associated with UL in different random studies. However cardiovascular risk factors have not been evaluated systematically in patients with UL. Accordingly, we aimed to evaluate the cardiovascular risk factors and their relation with the presence of UL. MATERIAL AND METHODS One hundred and eighty nine patients with the pathological diagnosis of UL and one hundred and eighty nine age matched control subjects without UL were retrospectively included in the study from our data base of the pathology and gynecology departments. Controls were patients with intact uteri who had visited the same physicians for a routine checkup that included a pelvic examination and uterine sonogram and without mention of physical findings consistent with UL. The following clinical and demographic parameters were recorded; age, sex, hypertension, diabetes mellitus, and hypercholesterolemia. Current cigarette smoking was defined as active smoking within the past 12 months. RESULTS Comparison of cardiovascular risk factors between with and without UL revealed that the presence of hypertension (80 (42.3%) vs 53 (28%) p=0.004) diabetes mellitus (33 (17.4%) vs. 16 (8.4%) p=0.009), smoking (31 (16.4%) vs. 11 (5.8%) p=0.001), were significantly higher in patients with UL than in control subjects. The mean-age and presence of hyperlipidemia were comparable between the two groups. Logistic regression analysis revealed an independent and positive association of UL with the presence of hypertension (odds ratio 2.02 CI: 1.25-3.27 p=0.004), diabetes mellitus (odds ratio 2.43 CI: 1.23-4.79 p=0.010), and smoking status (odds ratio 3.46 CI: 1.65-7.22 p=0.001). CONCLUSION We have shown that major cardiovascular risk factors namely, hypertension, diabetes mellitus and smoking are significantly and independently associated with UL. Our findings highlight the possible association of UL with atherosclerosis.
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Affiliation(s)
- Nasir Sivri
- Department of Cardiology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Tülin Yalta
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Cenk Sayın
- Department of Gynecology and Obstetrics, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Kenan Yalta
- Department of Cardiology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Fulya Ozpuyan
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Ebru Taştekin
- Department of Pathology, Faculty of Medicine, Trakya Univeristy, Edirne, Turkey
| | - Ertan Yetkin
- Department of Cardiology, IMC Hospital, Mersin Turkey
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Eke AC, Chawla M, Bridges N, Ezebialu I. Progestogen only versus combined oral contraceptive pills for fibroid related heavy menstrual bleeding. Hippokratia 2012. [DOI: 10.1002/14651858.cd009737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Ahizechukwu C Eke
- Harvard School of Public Health (HSPH); Department of Health Policy and Management, Masters in Public Health (MPH); 677 Huntington Avenue Boston Massachusetts USA 02115
| | - Manupreet Chawla
- Harvard University School of Public Health; Quantitative Methods Concentration, Masters in Public Health (MPH) Program; 677 Huntington Avenue Boston Massachusetts USA 02115
| | - Naima Bridges
- Harvard School of Public Health; Global Health and Population; 677 Huntington Avenue Boston USA
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Sanci M, Dikis C, Inan S, Turkoz E, Dicle N, Ispahi C. Immunolocalization of VEGF, VEGF receptors, EGF-R and Ki-67 in leiomyoma, cellular leiomyoma and leiomyosarcoma. Acta Histochem 2011; 113:317-25. [PMID: 20106509 DOI: 10.1016/j.acthis.2010.01.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/27/2009] [Accepted: 12/29/2009] [Indexed: 11/15/2022]
Abstract
Angiogenic factors, such as vascular endothelial growth factor (VEGF), its receptors and epidermal growth factor receptor (EGF-R), are involved in increased progression in many carcinomas. The aim of this study was to investigate the role of angiogenesis and immunolocalization of VEGF, its receptors, EGF-R and Ki 67 in leiomyomas and leiomyosarcomas using an indirect immunohistochemical method. Samples from patients with leiomyoma, cellular leiomyoma and cellular leiomyosarcoma (n=20 per group) were fixed in 10% formalin and processed using routine paraffin protocols. Following initial histological analysis, samples were immunostained with primary antibodies for VEGF, VEGFR-1, VEGFR-2, EGF-R and Ki-67 using an indirect avidin-biotin peroxidase method. Immunostaining intensities were evaluated as mild, moderate or strong and a semi-quantitative method (H-Score) was used to compare the samples. While mild/moderate EGF-R immunostaining and moderate immunostaining for VEGF and its receptors were observed in samples of leiomyomas, much less immunoreactivity was observed in cellular leiomyomas. All immunoreactivities and immune-stained cells increased in leiomyosarcomas. When scores of intensity and percentage of positive staining cells were compared, all immunoreactivities were shown to be significantly increased in leiomyosarcomas compared to leiomyomas. These results suggest that in leiomyosarcoma, angiogenic factors, such as VEGF, its receptors and EGF-R, may be involved in tumor angiogenesis. Active tumor cells can trigger angiogenesis, interaction with surrounding tissue and in the tissue itself initiating angiogenic activity. Angiogenic growth factors play an important role and induce malignant transformation through both autocrine and paracrine mechanisms. Anti-angiogenic agents may provide a novel therapeutic approach for the treatment of leiomyosarcoma.
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Affiliation(s)
- Muzaffer Sanci
- Department of Obstetrics and Gynecology, Ege Maternity Hospital, Izmir, Turkey
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Casadio P, Youssef AM, Spagnolo E, Rizzo MA, Talamo MR, De Angelis D, Marra E, Ghi T, Savelli L, Farina A, Pelusi G, Mazzon I. Should the myometrial free margin still be considered a limiting factor for hysteroscopic resection of submucous fibroids? A possible answer to an old question. Fertil Steril 2011; 95:1764-8.e1. [DOI: 10.1016/j.fertnstert.2011.01.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/31/2010] [Accepted: 01/07/2011] [Indexed: 11/17/2022]
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Richardson TI, Clarke CA, Yu KL, Yee YK, Bleisch TJ, Lopez JE, Jones SA, Hughes NE, Muehl BS, Lugar CW, Moore TL, Shetler PK, Zink RW, Osborne JJ, Montrose-Rafizadeh C, Patel N, Geiser AG, Galvin RJS, Dodge JA. Novel 3-aryl indoles as progesterone receptor antagonists for uterine fibroids. ACS Med Chem Lett 2011; 2:148-53. [PMID: 24900294 PMCID: PMC4017981 DOI: 10.1021/ml100220b] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 11/27/2010] [Indexed: 11/29/2022] Open
Abstract
We report the synthesis and characterization of novel 3-aryl indoles as potent and efficacious progesterone receptor (PR) antagonists with potential for the treatment of uterine fibroids. These compounds demonstrated excellent selectivity over other steroid nuclear hormone receptors such as the mineralocorticoid receptor (MR). They were prepared from 2-bromo-6-nitro indole in four to six steps using a Suzuki cross-coupling as the key step. Compound 8f was orally active in the complement 3 model of progesterone antagonism in the rat uterus and demonstrated partial antagonism in the McPhail model of progesterone activity.
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Affiliation(s)
- Timothy I Richardson
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Christian A Clarke
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Kuo-Long Yu
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Ying K Yee
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Thomas J Bleisch
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Jose E Lopez
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Scott A Jones
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Norman E Hughes
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Brian S Muehl
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Charles W Lugar
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Terry L Moore
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Pamela K Shetler
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Richard W Zink
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - John J Osborne
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Chahrzad Montrose-Rafizadeh
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Nita Patel
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Andrew G Geiser
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Rachelle J Sells Galvin
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
| | - Jeffrey A Dodge
- Lilly Research Laboratories, Eli Lilly & Co., Lilly Corporate Center, Indianapolis, Indiana 46285, United States
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Millo N, Boroditsky R, Lyons EA. Fibroids Treated With Uterine Artery Embolization: Do Imaging Findings Correlate With Patient Outcomes? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:460-466. [DOI: 10.1016/s1701-2163(16)34500-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rupture rates after laparoscopic myomectomy using single stitches in only one layer. ACTA ACUST UNITED AC 2010. [DOI: 10.1007/s10397-010-0580-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Uterine fibroids (UFs) are benign growths within the uterine muscle and are present in 30% of women during their reproductive years. With the exception of hysterectomy, there are no effective medical and surgical treatments for women with uterine fibroids . Acupuncture is an ancient Chinese method which has been used for both the prevention and treatment of diseases for over three thousand years. There are many types of acupuncture used to manage UFs, with body acupuncture being the most commonly used. The literature reporting the benefits or harms of acupuncture for the management of UFs has not yet been systematically reviewed. OBJECTIVES To assess the benefits and harms of acupuncture in women with uterine fibroids SEARCH STRATEGY The following electronic databases were searched 21st May 2009: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; the Menstrual Disorders and Subfertility Group's Specialised Register of Trials; Chinese Biomedical Literature Database (CBM); Traditional Chinese Medical Literature Analysis and Retrieval System (TCMLARS); Chinese Medical Current Contents (CMCC) and China National Knowledge Infrastructure(CNKI). Citation lists, experts in the field and grey literature were also referred to. No restrictions such as language were applied. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing acupuncture management with placebo acupuncture, no management, Chinese medication, Western medication or other managements of uterine fibroids were considered for inclusion. Acupuncture management included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation (for example, body, electro, scalp, elongated, fire, hand, fine needle, moxibustion). Acupuncture management without needling was excluded. DATA COLLECTION AND ANALYSIS Two review authors assessed trial risk of bias according to our a priori criteria. No trials were included in this version of the review, therefore no data was collected. MAIN RESULTS No randomized double-blind controlled trials met the inclusion criteria . AUTHORS' CONCLUSIONS The effectiveness of acupuncture for the management of uterine fibroids remains uncertain. More evidence is required to establish the efficacy and safety of acupuncture for uterine fibroids.There is a continued need for well designed RCTs with long term follow up.
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Affiliation(s)
- Yan Zhang
- Guang An Men Hospital, China Academy of Chinese Medical SciencesDepartment of Acupuncture and MoxibustionNo. 5, Bei Xian Ge StreetBeijingChina100053
| | - Weina Peng
- Guang An Men Hospital, China Academy of Chinese Medical SciencesDepartment of Acupuncture and MoxibustionNo. 5, Bei Xian Ge StreetBeijingChina100053
| | - Jane Clarke
- University of AucklandObstetrics and GynaecologyFMHS Grafton CampusPark RoadAucklandNew Zealand1
| | - Liu Zhishun
- Guang An Men Hospital, China Academy of Chinese Medical SciencesDepartment of Acupuncture and MoxibustionNo. 5, Bei Xian Ge StreetBeijingChina100053
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Tinelli A, Malvasi A, Rahimi S, Negro R, Cavallotti C, Vergara D, Vittori G, Mettler L. Myoma pseudocapsule: a distinct endocrino-anatomical entity in gynecological surgery. Gynecol Endocrinol 2009; 25:661-7. [PMID: 19526398 DOI: 10.1080/09513590903015502] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The myoma pseudocapsule is a structure formed surrounding the uterine fibroid, that in the uterus separates the myoma from normal tissue; because literature is lack of detailed information concerning myoma pseudocapsule, the author reviewed this important topic. METHODS An extensive literature review from 1980 to 2008 was performed on the myoma pseudocapsule, using: fibroid, myoma, myomectomy and reproductive outcome, as keywords. RESULTS The fibroid removal should always be performed inside its pseudocapsule and with a careful stretching, to extract fibroid from the surrounding fibromuscular skeleton, breaking up the fibrous bridges; because the vascular network generally surrounds the myoma, detachment of the myoma occurring inside the pseudocapsule should cause less bleeding. The maintenance of myometrial integrity during myomectomy allows the facilitation of uterine healing and is of benefit for future reproductive outcome. CONCLUSION The benefits of intracapsular myomectomy are evident, because it preserves myometrial integrity and allows for restoration of the uterine musculature. This correct myomectomy, if done by laparoscopy, confers significant advantages in less intraoperative blood loss, short duration of hospital stay, few therapeutic antibiotic administration and better future fertility.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Vito Fazzi Hospital, Piazza Muratore, Lecce 73100, Italy.
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Chemoprevention of fibroid tumors by [-]-epigallocatechin-3-gallate in quail. Nutr Res 2009; 28:92-7. [PMID: 19083394 DOI: 10.1016/j.nutres.2007.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 11/29/2007] [Accepted: 11/30/2007] [Indexed: 12/31/2022]
Abstract
Spontaneous leiomyomas of the oviduct are common tumors of the Japanese quail (Coturnix coturnix japonica), and fibroid tumors in the laying hen are similar to human fibroid tumors with respect to estrogen and progesterone receptors. This makes the quail a good animal model for screening potential agents for that aid in the prevention and treatment of human myoma uteri. We have previously reported a decreased incidence of leiomyomas in the oviduct of Japanese quail with antioxidant supplementation, for example, lycopene and soy isoflavones. Most of the health benefits associated with green tea consumption is attributed to EGCG, one of 4 major catechins found in green tea. This study investigated the effects of epigallocatechin-3-gallate supplementation on the development of leiomyomas in the oviduct of Japanese quail. We also measured serum and tissue levels of malondialdehyde and TNF-alpha. One hundred eighty quail (8 months old) were assigned to 3 treatment groups consisting of 6 replicates of 10 quail in each group. Animals were fed either a basal diet (control group) or the basal diet supplemented with 200 or 400 mg of EGCG/kg of diet. The animals were euthanized at the end of the 12-month study period, and the tumors were characterized. Epigallocatechin gallate supplementation significantly decreased the number of leiomyomas as compared with the controls (P = .001). The tumors in the EGCG fed birds were smaller than those found in the control birds (P = .001). Serum and liver malondialdehyde and TNF-alpha concentrations decreased (P = .001) with EGCG supplementation. The results indicate that dietary supplementation with EGCG reduces the incidence and size of spontaneously occurring leiomyoma of the oviduct in Japanese quail. Clinical trials should be conducted to investigate the efficacy of EGCG supplementation in the prevention and treatment of uterine leiomyoma in humans.
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Abstract
OBJECTIVE To estimate the efficacy of daily administration of 5 mg compared with 10 mg of mifepristone for the treatment of uterine myomas. METHODS One hundred women were randomly assigned to receive oral mifepristone 5 mg or 10 mg daily for 3 months (50 per group). Abdominal ultrasonography was performed before treatment, at 45 days, and at 3 months to evaluate leiomyoma and uterine volumes. Endometrial biopsy specimens were taken before and after treatment. Efficacy was estimated by the reduction percentages of the leiomyoma and uterine volumes. RESULTS After 90 days treatment there was a 45% (95% confidence interval [CI] 37-54, P<.001) and a 57% (95% CI 48-67, P<.001) reduction in the leiomyoma volume in the 10-mg and 5-mg groups, respectively, and one of 40% (95% CI 34-46, P=.002), and 36% (95% CI 31-40, P<.001), respectively, in the uterine volume. Symptomatic improvement was noted, and the prevalence of symptoms diminished significantly. There were no significant differences in reduction of volume and symptoms in the treatment groups, P>.05 in all cases. After treatment, 44 of 49 (89.8%) women from the mifepristone 10 mg group and 45 of 50 (90.0%) from the 5-mg group, respectively, were amenorrheic (P=.487). Endometrial biopsy after treatment showed simple hyperplasia in 1 of 50 (2.0%) in the mifepristone 10 mg group. CONCLUSION Five-milligram doses of mifepristone produce reductions in leiomyoma and uterine volumes and symptomatic improvement similar to 10-mg doses. LEVEL OF EVIDENCE I.
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Estrogen receptor alpha (ERalpha) phospho-serine-118 is highly expressed in human uterine leiomyomas compared to matched myometrium. Virchows Arch 2008; 453:557-69. [PMID: 18853184 DOI: 10.1007/s00428-008-0679-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 09/12/2008] [Accepted: 09/16/2008] [Indexed: 10/21/2022]
Abstract
It is thought that the growth of uterine leiomyomas may be mediated by the interaction of estrogen receptor alpha (ERalpha) and growth factor pathways and that phosphorylation of ERalpha at serine 118 (ERalpha-phospho-Ser118) is important in this interaction. In this study, immunoblotting and immunohistochemistry were used to investigate the expression of ERalpha-phospho-Ser118, phosphorylated p44/42 mitogen-activated protein kinase (phospho-p44/42 MAPK), and proliferating cell nuclear antigen (PCNA) in human leiomyoma and myometrial tissues during the proliferative and secretory phases of the menstrual cycle. We found that tumors taken from the proliferative phase expressed significantly higher levels of ERalpha-phospho-Ser118, phospho-p44/42 MAPK, and PCNA compared to patient-matched myometria and had significantly higher ERalpha-phospho-Ser118 and PCNA expression compared to secretory phase tumors. Also, enhanced colocalization and association of phospho-p44/42 MAPK and ERalpha-phospho-Ser118 were observed in proliferative phase tumors by confocal microscopy and immunoprecipitation, respectively. These data suggest that ERalpha-phospho-Ser118 may be important in leiomyoma growth and is possibly phosphorylated by phospho-p44/42 MAPK.
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Zhang Y, Clarke J, Feng H, Liu Z, Weina P. Acupuncture for uterine fibroids. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee DW, Ozminkowski RJ, Carls GS, Wang S, Gibson TB, Stewart EA. The direct and indirect cost burden of clinically significant and symptomatic uterine fibroids. J Occup Environ Med 2007; 49:493-506. [PMID: 17495692 DOI: 10.1097/jom.0b013e31805f6cf2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate direct medical costs and indirect (productivity related) for women age 25 to 54 who had clinically significant and symptomatic uterine fibroids (UF). METHODS We compared direct medical expenditures among 30,659 women who had clinically significant and symptomatic UF to expenditures among an equal number of matched controls who did not. We also compared indirect costs for a sub-sample of 910 employed women in each group. Regression analyses controlled for demographic and casemix factors. RESULTS Mean 12-month direct medical costs for women with UF were $11,720 versus $3257 for controls, and mean 12-month indirect costs for women with UF were $11,752 versus $8083 for controls. Differences were statistically significant (P<0.0001). CONCLUSIONS UF is a costly disorder and merits thought as interventions are considered to improve women's health and productivity.
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Affiliation(s)
- David W Lee
- Health Economics and Outcomes Research, GE Healthcare, Waukesha, WI, USA
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Structure-activity relationships of SERMs optimized for uterine antagonism and ovarian safety. Bioorg Med Chem Lett 2007; 17:3544-9. [PMID: 17482463 DOI: 10.1016/j.bmcl.2007.04.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 04/16/2007] [Accepted: 04/18/2007] [Indexed: 11/30/2022]
Abstract
Structure-activity relationship studies are described, which led to the discovery of novel selective estrogen receptor modulators (SERMs) for the potential treatment of uterine fibroids. The SAR studies focused on limiting brain exposure and were guided by computational properties. Compounds with limited impact on the HPO axis were selected using serum estrogen levels as a biomarker for ovarian stimulation.
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Dixon D, Parrott EC, Segars JH, Olden K, Pinn VW. The second National Institutes of Health International Congress on advances in uterine leiomyoma research: conference summary and future recommendations. Fertil Steril 2006; 86:800-6. [PMID: 17027353 DOI: 10.1016/j.fertnstert.2006.02.116] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2005] [Revised: 02/24/2006] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To summarize the proceedings of the Advances in Uterine Leiomyoma Research: 2nd NIH International Congress, which was convened on February 24-25, 2005 by the Department of Health and Human Services (DHHS), National Institutes of Health (NIH) in Bethesda, Maryland. DESIGN Scientific information was presented at a 2-day conference, which was a collaborative effort of agencies across the DHHS and members of the academic, clinical, and medical communities involved in uterine leiomyoma research. CONCLUSION(S) The conference brought together scientists in biomedicine, epidemiology, basic research, therapeutics, and translational medicine and fostered an exchange of scientific information among members of the uterine leiomyoma research and health care communities. This document summarizes this exchange and outlines research needs and recommendations for future research directions.
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Affiliation(s)
- Darlene Dixon
- National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
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Valladares F, Frías I, Báez D, García C, López FJ, Fraser JD, Rodríguez Y, Reyes R, Díaz-Flores L, Bello AR. Characterization of estrogen receptors alpha and beta in uterine leiomyoma cells. Fertil Steril 2006; 86:1736-43. [PMID: 17011556 DOI: 10.1016/j.fertnstert.2006.05.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2005] [Revised: 05/12/2006] [Accepted: 05/12/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Cellular and subcellular localization of estrogen receptor alpha (ERalpha) and estrogen receptor beta (ERbeta) in uterine leiomyomas. DESIGN Retrospective study. SETTING University of La Laguna (ULL) and Canary University Hospital (HUC). PATIENT(S) Premenopausal and postmenopausal women with uterine leiomyomas. INTERVENTION(S) Hysterectomy and myomectomy. RESULT(S) Estrogen receptor alpha was only present in smooth muscle cells with variation in the subcellular location in different leiomyomas. Estrogen receptor beta was widely distributed in smooth muscle, endothelial, and connective tissue cells with nuclear location in all cases studied; variations were only found in the muscle cells for this receptor. CONCLUSION(S) Estrogens operate in leiomyoma smooth muscle cells through different receptors, alpha and beta. However they only act through the ERbeta in endothelial and connective cells.
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Affiliation(s)
- Francisco Valladares
- Departamento de Anatomía, Anatomía Patológica e Histología, Universidad de La Laguna, Tenerife, Spain
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Abstract
A 5-year review of management of uterine fibroids at the university of Nigeria Teaching Hospital Enugu revealed that symptomatic uterine fibroids constituted 9.8% of all gynaecological admissions. The peak incidence n = 51 (26.8%) was in the age range of 31 - 35 years and the majority of the women n = 77 (40.5%) were nulliparous. The main clinical features were lower abdominal discomfort, menorrhagia and associated infertility. There was no medical management. The surgical management consisted of myomectomy by laparotomy (60%); total abdominal hysterectomy (24.7%); total abdominal hysterectomy and bilateral salpingo-oophorectomy (12.1%), and polypectomy (3.2%). There was no endoscopic surgery available. Postoperative morbidity was high but there was no mortality. Uterine fibroids mostly managed by myomectomy at laparotomy remains a major public health problem in Enugu Nigeria.
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Affiliation(s)
- O Okezie
- Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Parazzini F. Risk factors for clinically diagnosed uterine fibroids in women around menopause. Maturitas 2006; 55:174-9. [DOI: 10.1016/j.maturitas.2006.01.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 01/30/2006] [Accepted: 01/31/2006] [Indexed: 11/24/2022]
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Hussein-Fikret S, Fuller PJ, Gargett CE. Expression of steroid receptor coactivators in cultured cells from paired myometrial and fibroid tissues. ACTA ACUST UNITED AC 2006; 12:445-51. [PMID: 15979354 DOI: 10.1016/j.jsgi.2005.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Fibroid tumor growth in the myometrium appears to be regulated by estrogens but the role of estrogen receptor (ER) coregulators, such as the steroid receptor coactivator (SRC) family members, in fibroid growth is currently unknown. The aims of this study were to compare the expression of the SRC-1, SRC-2, and SRC-3 coactivators between fibroids and normal myometrium in pure populations of cultured smooth muscle cells (SMC) and microvascular endothelial cells (MEC), and also between both cell types, and to identify any relationship between the SRC expression profiles and the known ER status of the SMC and MEC samples examined in this study. METHODS Reverse transcriptase-polymerase chain reaction (RT-PCR) coupled with Southern blot analysis was used to derive a semiquantitative estimate of the relative levels of SRC-1, SRC-2, and SRC-3 expression in pure populations of SMC (>98% alpha-smooth muscle actin [SMA](+)) and MEC (>99% CD31(+)) isolated and cultured from eight samples of paired human myometrial and fibroid tissue. RESULTS The mean levels of SRC-1, SRC-2, and SRC-3 were each similar in normal myometrium compared to fibroids for SMC and also for MEC. However, SRC-1, SRC-2, and SRC-3 levels were each significantly higher in SMC compared to MEC from both myometrial and fibroid samples, although for SRC-3 there was a trend for higher levels in myometrial samples that did not reach significance. While all SMC samples expressed ERalpha and high coactivator levels, there does not appear to be a relationship between coactivator expression levels and the presence or absence of ERalpha in MEC samples. CONCLUSION Coactivators may be more important in ERalpha-mediated growth of SMC than for MEC. Although the SRC family members are likely to play a role in the response of fibroid SMC to estrogen, via ERalpha, changes in their levels do not appear to contribute to the increased sensitivity of fibroid SMC to estrogen.
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Affiliation(s)
- Sonay Hussein-Fikret
- Prince Henry's Institute of Medical Research and Monash University Department of MedicineClayton, Victoria, Australia
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Randell KM, Honkanen RJ, Tuppurainen MT, Kröger H, Jurvelin JS, Saarikoski S. Fracture risk and bone density of peri- and early postmenopausal women with uterine leiomyomas. Maturitas 2005; 53:333-42. [PMID: 16019169 DOI: 10.1016/j.maturitas.2005.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 05/31/2005] [Accepted: 06/01/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Fracture risk and bone mineral density (BMD) among peri- and early postmenopausal women with leiomyomas requiring hysterectomy was evaluated. METHODS We counted fractures among women with or without leiomyomas using data from the Kuopio Osteoporosis Study. The study population consisted of 6086 women aged 47-56 years with never-use of hormone replacement therapy (HRT) responding to the baseline and 5-year follow-up inquiries. Part of the sample (n=1271) underwent bone densitometry. RESULTS Hysterectomy was carried out in 927 women, and 59% reported that this was attributable to leiomyomas. The hazard ratio (HR) was 0.68 (95% CI 0.49-0.94) for any and 0.73 (95% CI 0.43-1.26) for distal forearm fracture among women with leiomyomas compared to those without any. Among women postmenopausal at baseline, the corresponding HRs were 0.62 (95% CI 0.44-0.87) and 0.54 (95% CI 0.31-0.96); after adjusting for age, time since menopause weight, height and previous fracture 0.69 (95% CI 0.49-0.97) and 0.63 (95% CI 0.35-1.11). The baseline BMDs were 1.15 g/cm2 among hysterectomized leiomyoma and 1.12 g/cm2 (ns) among non-hysterectomized women at lumbar (L2-L4), and 0.94 and 0.93 g/cm2 (ns) at femoral sites. The follow-up lumbar BMDs were 1.13 and 1.09 g/cm2 (p<0.001) and the corresponding femoral values were 0.90 and 0.89 g/cm2 (ns), respectively. Among postmenopausal women, the corresponding baseline lumbar BMDs were 1.15 and 1.08 g/cm2 (p<0.001), femoral 0.93 and 0.90 g/cm2 (p=0.003); the follow-up lumbar BMDs 1.13 g/cm2 versus 1.07 g/cm2 (p<0.001); femoral BMDs 0.89 versus 0.87 (ns). CONCLUSIONS Peri- and early postmenopausal women with a history of leiomyomas seem to have better BMD and less fractures compared with those without leiomyomas. This may be mediated through higher estrogen levels leading to higher BMD and the growth of leiomyomas.
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Affiliation(s)
- Kaisa M Randell
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland.
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Boynton-Jarrett R, Rich-Edwards J, Malspeis S, Missmer SA, Wright R. A prospective study of hypertension and risk of uterine leiomyomata. Am J Epidemiol 2005; 161:628-38. [PMID: 15781952 PMCID: PMC4586055 DOI: 10.1093/aje/kwi072] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although uterine leiomyomata (also known as fibroids or myomas) affect the reproductive health and well-being of approximately 25% of premenopausal women, risk factors are poorly understood. Elevated diastolic blood pressure may increase fibroid risk through uterine smooth muscle injury, not unlike atherosclerosis. The authors prospectively examined the relation between diastolic blood pressure and incidence of clinically detected leiomyomata. The sample included 104,233 premenopausal nurses from 14 US states enrolled in the Nurses' Health Study II. Participants, aged 25-42 years, had intact uteri and no history of cancer or fibroids at enrollment in 1989. During the 827,348 woman-years of follow-up (1989-1999), 7,466 incident diagnoses of uterine leiomyomata, confirmed by ultrasound or hysterectomy, were reported. With a multivariable Cox proportional hazards model, the relative risk of self-reported ultrasound- or hysterectomy-confirmed uterine leiomyomata according to diastolic blood pressure in 1989 and time-varying antihypertensive use was estimated. With adjustment for age, race/ethnicity, body mass index, and reproductive history covariates, for every 10-mmHg increase in diastolic blood pressure, the risk of fibroids rose 8% (5-11%) and 10% (7-13%) among nonusers and users of antihypertensive medications, respectively. Elevated blood pressure has an independent, positive association with risk for clinically detected uterine leiomyomata among premenopausal women. Investigating this association may suggest possible pathways to prevent fibroids.
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Affiliation(s)
- Renée Boynton-Jarrett
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
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Marino JL, Eskenazi B, Warner M, Samuels S, Vercellini P, Gavoni N, Olive D. Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study. Hum Reprod 2004; 19:2350-5. [PMID: 15242998 DOI: 10.1093/humrep/deh407] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined the association of uterine leiomyoma with menstrual cycle characteristics in a population of non-care-seeking women. METHODS This cross-sectional study uses data from the Seveso Women's Health Study (SWHS), a population-based cohort in Italy. Participants included 341 premenopausal women, 30-60 years old, who had an intact uterus and were not pregnant, lactating, or using oral contraception or intra-uterine devices. We examined the presence of any ultrasound-detected uterine leiomyoma in relation to self-reported menstrual cycle length, flow length and heaviness of flow. The association of leiomyoma number, volume, tissue layer location and axial position with menstrual cycle characteristics was also examined. RESULTS Uterine leiomyomata were detected in 73 women (21.4%). After adjustment for covariates, the presence of a leiomyoma was not significantly related to menstrual cycle length, flow length or heaviness of flow [odds ratio (OR) for scanty flow =1.9, 95% confidence interval (CI) 0.8-4.3; OR for heavy flow =1.3, 95% CI 0.7-2.5; relative to moderate flow]. Number, volume, tissue layer location (subserosal or intramural) and axial position (anterior or posterior) of the leiomyoma were also not related to menstrual cycle characteristics. CONCLUSION In this Italian population of women not seeking gynaecological care, menstrual characteristics are not related to leiomyoma.
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Affiliation(s)
- J L Marino
- School of Public Health, University of California, Berkeley, California 94720-7360, USA
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Abstract
Since the first description of uterine artery embolization for the treatment of symptomatic fibroids of the uterus in 1994, this minimally invasive procedure has been increasingly performed in many Western countries. The method is characterized by a high technical success rate of about 85%, a highly significant relief of symptoms, and a very low rate of complications that make this method an appealing alternative to classic treatment options of surgical or laparoscopic myomectomy or hysterectomy. These characteristics have made the procedure well accepted by affected women. Nevertheless, indications and potential contraindications have to be evaluated carefully, especially in patients of childbearing age whenever a considerable number of deliveries is reported after uterine fibroid embolization. This article discusses the clinical background, indications and contraindications, angiographic techniques, potential complications and side effects, and the mid-term results known at present.
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Affiliation(s)
- T K Helmberger
- Department of Clinical Radiology, Klinikum Grosshadern Ludwig-Maximilians-Universität, Marchioninistr. 15, D-81366 Munich, Germany.
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Jakobs TF, Helmberger TK, Reiser MF. [State and development of uterine myoma embolization in Germany]. Radiologe 2003; 43:651-5. [PMID: 14504765 DOI: 10.1007/s00117-003-0937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To evaluate the current situation and implementation of embolization of uterine leiomyomas into the treatment concept in women with symptomatic uterine leiomyomas in Germany. MATERIAL AND METHODS A questionnaire addressing the clinical background of uterine myomas, recommended treatment concepts, preclinical evaluation, technical approach and complications was sent to 164 departments of gynecology and radiology in Germany. RESULTS 33 radiological departments and 19 gynecological departments submitted a completed questionnaire. Only 7 departments of radiology reported to have own experience with embolization of uterine leiomyomas, while only 2 departments of gynecology considered embolization as an alternative treatment option in patients with symptomatic leiomyomas. 18/33 radiological departments offer this treatment option but get no patient referrals. Agreement was found concerning the indications for treatment, preclinical evaluation by ultrasound and MRI, preferable location of treatable fibroids, technical approach and pain management. CONCLUSION The embolization of uterine leiomyomas in patients with symptomatic myomas is regardless of the well documented high efficacy and low complication rate not yet an established treatment option in Germany. Interventional radiologists and gynecologists have to evaluate the indications for the embolization of uterine leiomyomas together before the procedure is advised to the patient, because it seems mandatory to add this procedure to the standard armamentarium of treatment options in uterine myomas.
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Affiliation(s)
- T F Jakobs
- Institut für Klinische Radiologie, Klinikum der Universität München-Grosshadern, Munich.
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Helmberger TK, Jakobs TF, Reiser MF. [Technique and methods in uterine leiomyoma embolization]. Radiologe 2003; 43:634-40. [PMID: 14504763 DOI: 10.1007/s00117-003-0933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Uterine leiomyomas are the most common benign tumors of the female urogenital tract. Beside the classic surgical treatment options the minimal-invasive embolization therapy of the leiomyomas increasingly gains importance world-wide. Technique, complications, and results of uterine leiomyoma embolization will be presented. METHODS After careful evaluation of indications for embolization the procedure is mostly performed under conscious sedation. A single-sided femoral access route together with cross-over technique generally allows for a flow-directed embolization via both uterine arteries. After embolizing the vessels supplying the tumor, the uterine arteries should be still patent. RESULTS The success rate of embolization of uterine leiomyomas ranges between 85 and 100%, whereas a reduction in size of the tumors in 42 to 83% and a relief of symptoms in up to 96% can be achieved. The total complication rate is about 10% with mainly "minor complications". Worldwide only three deaths following embolization of uterine leiomyomas were reported. CONCLUSION The high technical and clinical success rate together with a low complication rate make the embolization of uterine leiomyomas a minimally-invasive alternative to the classic treatment. As long term results are not available indication to embolization of uterine leiomyomas must be carefully established in consensus with gynecologists.
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Affiliation(s)
- T K Helmberger
- Institut für Klinische Radiologie, Klinikum der Universität München-Grosshadern, Munich.
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Pron G, Cohen M, Soucie J, Garvin G, Vanderburgh L, Bell S. The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline patient characteristics, fibroid burden, and impact on life. Fertil Steril 2003; 79:112-9. [PMID: 12524073 DOI: 10.1016/s0015-0282(02)04539-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine baseline characteristics of women undergoing uterine artery embolization (UAE) for symptomatic fibroids. DESIGN Multicenter, prospective, single-arm clinical treatment trial. SETTING Eight Ontario university and community hospitals. PATIENT(S) Five hundred fifty-five women undergoing UAE for fibroids. INTERVENTION(S) Baseline questionnaires completed before UAE. MAIN OUTCOME MEASURE(S) Questionnaires were analyzed for demographic, medical, and gynecologic histories. Fibroid symptoms, impact of symptoms, previous consultations, and treatments were also analyzed. RESULT(S) The Ontario cohort (66% white, 23% black, 11% other races) had an average age of 43. Thirty-one percent were under age 40. Most women were university educated (68%) and working outside the home (85%). Women reported heavy menstrual bleeding (80%), urinary urgency/frequency (73%), pain during intercourse (41%), and work absences (40%). They experienced fibroid-related symptoms for an average of 5 years and consulted with on average of three gynecologists before UAE. High fibroid life-impact scores were reported by 58%. Black women were significantly younger (40.7 vs. 44.0 years), more likely to experience symptoms longer (7 vs. 5 years), and more likely to undergo myomectomy before UAE (24% vs. 9%) than white women. CONCLUSION(S) Our study illustrates that large numbers of women with highly symptomatic fibroid disease are averse to surgery despite their burden of suffering and are actively seeking alternatives to hysterectomy.
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Affiliation(s)
- Gaylene Pron
- Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada.
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