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Nagai K, Asano R, Sekiguchi F, Asai-Sato M, Miyagi Y, Miyagi E. MED12 mutations in uterine leiomyomas: prediction of volume reduction by gonadotropin-releasing hormone agonists. Am J Obstet Gynecol 2023; 228:207.e1-207.e9. [PMID: 36150519 DOI: 10.1016/j.ajog.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/11/2022] [Accepted: 09/09/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists are used to treat premenopausal uterine leiomyomas; however, leiomyoma volume reduction is not always achieved. The reduction rate after this treatment varies for each leiomyoma, even in the same patient. Therefore, an effective method for predicting uterine leiomyoma volume reduction is required to reduce the adverse hypoestrogenic effects and drug-related economic burden related to gonadotropin-releasing hormone agonists. OBJECTIVE This study aimed to determine the predictive use of MED12 mutations for evaluating the effect of gonadotropin-releasing hormone agonist treatment concerning reducing uterine leiomyoma volume and to predict the MED12 mutation status based on the findings of magnetic resonance imaging performed before treatment. STUDY DESIGN MED12 exon 2 mutation and erythropoietin expression in uterine leiomyomas were evaluated concerning volume reduction, as measured using magnetic resonance imaging. We developed a system for classifying leiomyomas according to T2-weighted magnetic resonance imaging signals to noninvasively predict the presence or absence of MED12 mutations in leiomyomas. Leiomyoma samples (>5 cm) were obtained from 168 patients during surgery (hysterectomy or myomectomy) between 2005 and 2021 at Yokohama City University Hospital. To analyze the rate of leiomyoma volume reduction, 41 patients had been preoperatively administered the gonadotropin-releasing hormone agonist (leuprorelin acetate 3.75 mg, monthly subcutaneous injection) for 3 months; magnetic resonance imaging was performed before and after treatment without contrast material. RESULTS Patients with MED12 exon 2 mutations had smaller volume reduction after treatment with the gonadotropin-releasing hormone agonist (P<.001, Mann-Whitney U test) and displayed lower signal intensity on T2-weighted images than those with leiomyomas expressing wild-type MED12 exon 2. The newly proposed magnetic resonance imaging-based classification system showed that MED12 exon 2 mutations were more frequent in the low-signal group than in the high-signal group, with nearly equal proportions of mutated and wild-type MED12 exon 2 leiomyomas noted in the intermediate group. The low-signal group had significantly lower erythropoietin expression levels than the high-signal group (P<.001, Kruskal-Wallis test with the Dunn posthoc analysis). CONCLUSION MED12 mutation status can be a candidate marker for predicting the effect of gonadotropin-releasing hormone agonists on uterine leiomyoma reduction. Magnetic resonance imaging findings can be used to determine MED12 mutation status as a noninvasive strategy to select patients who will most likely benefit from gonadotropin-releasing hormone agonist treatment.
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Affiliation(s)
- Koichi Nagai
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryoko Asano
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Gynecology, Yokohama City University Medical Center, Yokohama, Japan.
| | - Futoshi Sekiguchi
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Yohei Miyagi
- Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Etsuko Miyagi
- Department of Obstetrics, Gynecology and Molecular Reproductive Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Dynamic fluorescent imaging with the activatable probe, γ-glutamyl hydroxymethyl rhodamine green in the detection of peritoneal cancer metastases: Overcoming the problem of dilution when using a sprayable optical probe. Oncotarget 2018; 7:51124-51137. [PMID: 27286461 PMCID: PMC5239463 DOI: 10.18632/oncotarget.9898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/22/2016] [Indexed: 01/27/2023] Open
Abstract
Optical fluorescence-guided imaging is increasingly used to guide surgery and endoscopic procedures. Activatable probes are particularly useful because of high target-to-background ratios that increase sensitivity for tiny cancer foci. However, green fluorescent activatable probes suffer from interference from autofluorescence found in biological tissue. The purpose of this study was to determine if dynamic imaging can be used to differentiate specific fluorescence arising from an activated probe in a tumor from autofluorescence in background tissues especially when low concentrations of the dye are applied. Serial fluorescence imaging was performed using various concentrations of γ-glutamyl hydroxymethyl rhodamine green (gGlu-HMRG) which was sprayed on the peritoneal surface with tiny implants of SHIN3-DsRed ovarian cancer tumors. Temporal differences in signal between specific green fluorescence in cancer foci and non-specific autofluorescence in background tissue were measured at 5, 10, 20 and 30 min after application of gGlu-HMRG and were processed into three kinetic maps reflecting maximum fluorescence signal (MF), wash-in rate (WIR), and area under the curve (AUC), respectively. Using concentrations up to 10 μM of gGlu-HMRG, the fluorescence intensity of cancer foci was significantly higher than that of small intestine but only at 30 min. However, on kinetic maps derived from dynamic fluorescence imaging, the signal of cancer foci was significantly higher than that of small intestine after only 5 min even at concentrations as low as 2.5 μM of gGlu-HMRG (p < 0.01). At lower concentrations, kinetic maps derived from dynamic fluorescence imaging were superior to unprocessed images for cancer detection.
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Li XS, Fan HX, Fang H, Song YL, Zhou CW. Value of R2* obtained from T2*-weighted imaging in predicting the prognosis of advanced cervical squamous carcinoma treated with concurrent chemoradiotherapy. J Magn Reson Imaging 2015; 42:681-8. [PMID: 25581675 DOI: 10.1002/jmri.24837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/11/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND To prospectively investigate the value of R2* in predicting the prognosis of advanced cervical squamous carcinoma treated with concurrent chemoradiotherapy. METHODS Sixty-five patients with biopsy-proven cervical squamous carcinoma were enrolled in our study. All these subjects underwent multi-echo T2*-weighted MR imaging on a 3.0 Tesla MR scanner, and tumor R2* was calculated. The patients were divided into the responders and the nonresponders according to treatment effect. Tumor R2* values of these two groups were compared. The relationship between tumor R2* and prognosis after therapy was analyzed. RESULTS The responder group had lower R2* value than the nonresponder group (P = 0.02). The area under the receiver operating characteristics curve for tumor R2* in discriminating responders from nonresponders was 0.769. A cutoff value of 23.87 Hz for tumor R2* resulted in a sensitivity of 78.3% and a specificity of 67.6%. The low R2* group (≤28.37 Hz) had longer median progression-free survival period and overall survival period (P = 0.01, 0.03). Multivariate analysis showed that tumor R2* was a significant prognostic factor for progression-free survival and overall survival (adjusted hazards ratio = 5.34, 4.78; P = 0.02, 0.01). CONCLUSION R2* value obtained from T2*-weighted imaging, as an imaging biomarker, may be an important predictor for the prognosis of advanced cervical squamous carcinoma treated with concurrent chemoradiotherapy.
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Affiliation(s)
- Xiang Sheng Li
- Department of MRI, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - Hong Xia Fan
- Department of MRI, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - Hong Fang
- Department of MRI, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - Yun Long Song
- Department of MRI, Air Force General Hospital, People's Liberation Army, Beijing, China
| | - Chun Wu Zhou
- Department of Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Thorne JT, Segal TR, Chang S, Jorge S, Segars JH, Leppert PC. Dynamic reciprocity between cells and their microenvironment in reproduction. Biol Reprod 2014; 92:25. [PMID: 25411389 DOI: 10.1095/biolreprod.114.121368] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Dynamic reciprocity (DR) refers to the ongoing, bidirectional interaction between cells and their microenvironment, specifically the extracellular matrix (ECM). The continuous remodeling of the ECM exerts mechanical force on cells and modifies biochemical mediators near the cell membrane, thereby initiating cell-signaling cascades that produce changes in gene expression and cell behavior. Cellular changes, in turn, affect the composition and organization of ECM components. These continuous interactions are the fundamental principle behind DR, and its critical role throughout development and adult tissue homeostasis has been extensively investigated. While DR in the mammary gland has been well described, we provide direct evidence that similar dynamic interactions occur in other areas of reproductive biology as well. In order to establish the importance of DR in the adaptive functioning of the female reproductive tract, we present our most current understanding of DR in reproductive tissues, exploring the mammary gland, ovary, and uterus. In addition to explaining normal physiological function, investigating DR may shed new light into pathologic processes that occur in these tissues and provide an exciting opportunity for novel therapeutic intervention.
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Affiliation(s)
- Jeffrey T Thorne
- Department of Obstetrics & Gynecology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Thalia R Segal
- Department of Obstetrics & Gynecology, North Shore - Long Island Jewish Hospital, Manhasset, New York
| | - Sydney Chang
- Unit of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina
| | - Soledad Jorge
- Unit of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland Yale University School of Medicine, New Haven, Connecticut
| | - James H Segars
- Unit of Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health & Human Development, National Institutes of Health, Bethesda, Maryland
| | - Phyllis C Leppert
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, North Carolina
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Jorge S, Chang S, Barzilai JJ, Leppert P, Segars JH. Mechanical signaling in reproductive tissues: mechanisms and importance. Reprod Sci 2014; 21:1093-107. [PMID: 25001021 DOI: 10.1177/1933719114542023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The organs of the female reproductive system are among the most dynamic tissues in the human body, undergoing repeated cycles of growth and involution from puberty through menopause. To achieve such impressive plasticity, reproductive tissues must respond not only to soluble signals (hormones, growth factors, and cytokines) but also to physical cues (mechanical forces and osmotic stress) as well. Here, we review the mechanisms underlying the process of mechanotransduction-how signals are conveyed from the extracellular matrix that surrounds the cells of reproductive tissues to the downstream molecules and signaling pathways that coordinate the cellular adaptive response to external forces. Our objective was to examine how mechanical forces contribute significantly to physiological functions and pathogenesis in reproductive tissues. We highlight how widespread diseases of the reproductive tract, from preterm labor to tumors of the uterus and breast, result from an impairment in mechanical signaling.
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Affiliation(s)
- Soledad Jorge
- CRTP Scholars, NIH, Bethesda, MD, USA Yale University School of Medicine, New Haven, CT, USA
| | - Sydney Chang
- CRTP Scholars, NIH, Bethesda, MD, USA Duke University School of Medicine, Durham, NC, USA
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Leppert PC, Jayes FL, Segars JH. The extracellular matrix contributes to mechanotransduction in uterine fibroids. Obstet Gynecol Int 2014; 2014:783289. [PMID: 25110476 PMCID: PMC4106177 DOI: 10.1155/2014/783289] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/28/2014] [Accepted: 06/11/2014] [Indexed: 02/02/2023] Open
Abstract
The role of the extracellular matrix (ECM) and mechanotransduction as an important signaling factor in the human uterus is just beginning to be appreciated. The ECM is not only the substance that surrounds cells, but ECM stiffness will either compress cells or stretch them resulting in signals converted into chemical changes within the cell, depending on the amount of collagen, cross-linking, and hydration, as well as other ECM components. In this review we present evidence that the stiffness of fibroid tissue has a direct effect on the growth of the tumor through the induction of fibrosis. Fibrosis has two characteristics: (1) resistance to apoptosis leading to the persistence of cells and (2) secretion of collagen and other components of the ECM such a proteoglycans by those cells leading to abundant disposition of highly cross-linked, disoriented, and often widely dispersed collagen fibrils. Fibrosis affects cell growth by mechanotransduction, the dynamic signaling system whereby mechanical forces initiate chemical signaling in cells. Data indicate that the structurally disordered and abnormally formed ECM of uterine fibroids contributes to fibroid formation and growth. An appreciation of the critical role of ECM stiffness to fibroid growth may lead to new strategies for treatment of this common disease.
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Affiliation(s)
| | | | - James H. Segars
- Unit on Reproductive Endocrinology and Infertility, Program on Pediatric and Adult Endocrinology, NICHD, NIH, Bethesda, MD 20892-1109, USA
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Okuda S, Oshio K, Asada H, Tanimoto A, Jinzaki M, Furuya M, Yoshimura Y, Kuribayashi S. Reduction in the vascular bed volume of uterine fibroids after hormonal treatment: evaluation with dynamic double-echo R₂* imaging. Magn Reson Med Sci 2012; 11:283-9. [PMID: 23269015 DOI: 10.2463/mrms.11.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To demonstrate the reduction in vascular bed volume (VBV) of uterine fibroids after administration of gonadotropin-releasing hormone analogue (GnRHa) using magnetic resonance (MR) imaging including dynamic double-echo R₂* imaging (DDE-R₂*I) and to assess the value of DDE-R₂*I as a predictor of such reduction. METHODS Twenty-one women with uterine intramural fibroids underwent MR imaging including DDE-R₂*I before GnRHa treatment. DDE-R₂*I was acquired using a single-section, double-echo, fast spoiled gradient recalled acquisition in the steady state (SPGR) sequence. We calculated the area under the curve (AUC) of the signal intensity on R₂*I within a 3×3-cm²region of interest that served to represent the VBV. We repeated MR imaging after 2 administrations of GnRHa and repeated image analyses. We statistically analyzed correlations between (A) pre-treatment AUC (AUC(pre)) and AUC reduction and (B) AUC(pre) and volume reduction. RESULTS The interval between the 2 MR studies ranged from 56 to 119 days (mean: 80.4 days). The average volume of the fibroids before GnRHa treatment was 647.8 mL compared with 463.4 mL after the therapy (decreased by an average of 28.5%; P<0.0001). Meanwhile, measured AUC was reduced by 55.3% (483.4 vs. 206.5; P<0.0001). AUC(pre) correlated with volume reduction (r=0.68), but not AUC reduction. CONCLUSIONS We confirmed reduction in the VBV of fibroids using DDE-R₂*I. The measurement of AUC(pre) on DDE-R₂*I aids prediction of fibroid volume reduction but correlates poorly with the percentage of AUC reduction.
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Affiliation(s)
- Shigeo Okuda
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
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Norian JM, Owen CM, Taboas J, Korecki C, Tuan R, Malik M, Catherino WH, Segars JH. Characterization of tissue biomechanics and mechanical signaling in uterine leiomyoma. Matrix Biol 2012; 31:57-65. [PMID: 21983114 PMCID: PMC3576015 DOI: 10.1016/j.matbio.2011.09.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 09/12/2011] [Accepted: 09/16/2011] [Indexed: 01/18/2023]
Abstract
Leiomyoma are common tumors arising within the uterus that feature excessive deposition of a stiff, disordered extracellular matrix (ECM). Mechanical stress is a critical determinant of excessive ECM deposition and increased mechanical stress has been shown to be involved in tumorigenesis. Here we tested the viscoelastic properties of leiomyoma and characterized dynamic and static mechanical signaling in leiomyoma cells using three approaches, including measurement of active RhoA. We found that the peak strain and pseudo-dynamic modulus of leiomyoma tissue was significantly increased relative to matched myometrium. In addition, leiomyoma cells demonstrated an attenuated response to applied cyclic uniaxial strain and to variation in substrate stiffness, relative to myometrial cells. However, on a flexible pronectin-coated silicone substrate, basal levels and lysophosphatidic acid-stimulated levels of activated RhoA were similar between leiomyoma and myometrial cells. In contrast, leiomyoma cells plated on a rigid polystyrene substrate had elevated levels of active RhoA, compared to myometrial cells. The results indicate that viscoelastic properties of the ECM of leiomyoma contribute significantly to the tumor's inherent stiffness and that leiomyoma cells have an attenuated sensitivity to mechanical cues. The findings suggest there may be a fundamental alteration in the communication between the external mechanical environment (extracellular forces) and reorganization of the actin cytoskeleton mediated by RhoA in leiomyoma cells. Additional research will be needed to elucidate the mechanism(s) responsible for the attenuated mechanical signaling in leiomyoma cells.
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Affiliation(s)
- John M. Norian
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Carter M. Owen
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Juan Taboas
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Cartilage Biology and Orthopedic Branch, National Institute for Arthritis and Musculoskeletal Skin Diseases, National Institutes, of Health, Bethesda, MD, United States
| | - Casey Korecki
- Cartilage Biology and Orthopedic Branch, National Institute for Arthritis and Musculoskeletal Skin Diseases, National Institutes, of Health, Bethesda, MD, United States
| | - Rocky Tuan
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Cartilage Biology and Orthopedic Branch, National Institute for Arthritis and Musculoskeletal Skin Diseases, National Institutes, of Health, Bethesda, MD, United States
| | - Minnie Malik
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - William H. Catherino
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - James H. Segars
- Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
- Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Hecht EM, Do RK, Kang SK, Bennett GL, Babb JS, Clark TW. Diffusion-weighted imaging for prediction of volumetric response of leiomyomas following uterine artery embolization: A preliminary study. J Magn Reson Imaging 2011; 33:641-6. [DOI: 10.1002/jmri.22459] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Sipola P, Ruuskanen A, Yawu L, Husso M, Vanninen R, Hippeläinen M, Manninen H. Preinterventional quantitative magnetic resonance imaging predicts uterus and leiomyoma size reduction after uterine artery embolization. J Magn Reson Imaging 2010; 31:617-24. [DOI: 10.1002/jmri.22063] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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