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Turner JV, Garratt D, Barwick A, McLindon LA, Spark MJ, Smith A. Congenital and Fetal Effects After Mifepristone Exposure and Continuation of Pregnancy: A Systematic Review. Clin Pharmacol Ther 2024; 116:1207-1216. [PMID: 39049612 DOI: 10.1002/cpt.3392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/09/2024] [Indexed: 07/27/2024]
Abstract
Mifepristone is an anti-progestational drug that is the first component of the standard medical abortion regimen. For women who take mifepristone and then do not take misoprostol, which is the second component of the medical abortion regimen, it is possible that their pregnancy may continue to live birth. Since mifepristone is commonly used for medical abortion up to 9-10 weeks gestation, any adverse or teratogenic effects on the developing embryo/fetus must be considered, given exposure during the critical time of its development and organogenesis. Toxicology and teratology reports have cited studies demonstrating teratogenic effect of mifepristone in some animals. Current clinical guidelines for women exposed to mifepristone in the first trimester of pregnancy state that it is not known to be teratogenic based on limited published evidence from humans. The aim of this narrative systematic review was to investigate embryonic/fetal exposure to mifepristone and any association with congenital or fetal anomalies. This study was conducted by systematic searches of health databases from inception to February 2024. The references of relevant citations were manually searched to retrieve any additional citations not captured in database searching. Congenital anomalies and adverse outcomes were encountered at various doses of mifepristone exposure. A number of the congenital anomalies encountered in this review were explained by circumstances other than exposure to mifepristone. The present systematic review did not find data to support mifepristone being implicated as a teratogen.
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Affiliation(s)
- Joseph V Turner
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Deborah Garratt
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Anna Barwick
- School of Health-Pharmacy, University of New England, Armidale, New South Wales, Australia
| | - Lucas A McLindon
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Joy Spark
- School of Health-Pharmacy, University of New England, Armidale, New South Wales, Australia
| | - Angela Smith
- Hunter New England Local Health District, NSW Health, Newcastle, New South Wales, Australia
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Anderson ZS, Paulson RJ, Nguyen BT. Management of early pregnancy loss by reproductive endocrinologists: does access to mifepristone matter? F S Rep 2024; 5:252-258. [PMID: 39381661 PMCID: PMC11456648 DOI: 10.1016/j.xfre.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 10/10/2024] Open
Abstract
Objective To describe patterns and variations in the medical and procedural management of early pregnancy loss (EPL) among reproductive endocrinology and infertility specialists, with attention to mifepristone use. Design Cross-sectional. Setting Online survey. Patients Society for Reproductive Endocrinology and Infertility members. Intervention Not applicable. Main Outcome Measure Preferred management for EPL. Results Of 101 completed surveys (response rate: 12.2%), 70.3% of respondents reported diagnosing EPL at least once per week. Half (50.5%) of respondents preferred medical management compared with 27.7% who preferred procedural management and 21.8% who preferred expectant management. Approximately one-quarter (26.7%) of respondents offer mifepristone for medical management of EPL. The most common reason cited for not prescribing mifepristone was a lack of access to the medication. Mifepristone prescribers were more likely to work in a hospital or university setting than private practice. Increasing years in practice was also associated with mifepristone use. The use of mifepristone for EPL did not vary by the respondent's age, gender, prior abortion training, or practice region. Conclusion The most effective method of medical management uses both mifepristone and misoprostol. However, nearly three-quarters of reproductive endocrinology and infertility physicians do not offer mifepristone, which may be linked to access issues.
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Affiliation(s)
- Zachary S. Anderson
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Richard J. Paulson
- Section of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
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Shi Y, Xu N, Liu B, Ma Y, Fu X, Shang Y, Huang Q, Yao Q, Chen J, Li H. Mifepristone protects acetaminophen induced liver injury through NRF2/GSH/GST mediated ferroptosis suppression. Free Radic Biol Med 2024; 222:229-243. [PMID: 38906233 DOI: 10.1016/j.freeradbiomed.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
Ferroptosis is a form of iron-dependent cell death that has attracted significant attention for its potential role in numerous diseases. Targeted inhibition of ferroptosis could be of potential use in treating diseases: such as drug induced liver injury (DILI). Ferroptosis can be antagonized by the xCT/GSH/GPX4, FSP1/CoQ10, DHODH/CoQ10, GCH1/BH4, and NRF2 pathways. Identifying novel anti-ferroptosis pathways will further promote our understanding of the biological nature of ferroptosis and help discover new drugs targeting ferroptosis related human diseases. In this study, we identified the clinically used drug mifepristone (RU486) as a novel ferroptosis inhibitor. Mechanistically, RU486 inhibits ferroptosis by inducing GSH synthesis pathway, which supplies GSH for glutathione-S-transferase (GST) mediated 4-HNE detoxification. Furthermore, RU486 induced RLIP76 and MRP1 export 4-HNE conjugate contributes to its anti-ferroptosis activity. Interestingly, RU486 induced GSH/GSTs/RLIP76&MRP1 anti-ferroptosis pathway acts independent of classic anti-ferroptosis systems: including xCT/GSH/GPX4, FSP1, DHODH, GCH1, SCD1 and FTH1. Moreover, NRF2 was identified to be important for RU486's anti-ferroptosis activity by inducing downstream gene expression. Importantly, in mouse model, RU486 showed strong protection effect on acetaminophen (APAP)-induced acute liver injury, evidenced by decreased ALT, AST level and histological recovery after APAP treatment. Interestingly, RU486 also decreased oxidative markers, including 4-HNE and MDA, and induced NRF2 activation as well as GSTs, MRP1 expression. Together, these data suggest NRF2/GSH/GST/RLIP76&MRP1 mediated detoxification pathway as an important independent anti-ferroptosis pathway act both in vitro and in vivo.
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Affiliation(s)
- Yanyun Shi
- GuiZhou University Medical College, Guiyang, 550025, China
| | - Nahua Xu
- Department of Hematology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China
| | - Baiping Liu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, 401120, China
| | - Yanni Ma
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xuemei Fu
- Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, 401120, China
| | - Yingying Shang
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Qilin Huang
- GuiZhou University Medical College, Guiyang, 550025, China; Department of Neurosurgery, Guiqian International General Hospital, Changpo Road, Wudang District, Guiyang, 550000, China.
| | - Qi Yao
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Jieping Chen
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Hui Li
- Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China; Department of Obstetrics and Gynecology, Chongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University), Chongqing, 401120, China; Department of Hematology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, China.
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Li L, An J, Wang Y, Liu L, Wang Y, Zhang X. Exosomes Derived from Mesenchymal Stem Cells Increase the Viability of Damaged Endometrial Cells via the miR-99b-5p/PCSK9 Axis. Stem Cells Dev 2024; 33:290-305. [PMID: 38573013 DOI: 10.1089/scd.2023.0259] [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] [Indexed: 04/05/2024] Open
Abstract
The aim of this article was to investigate whether exosomes derived from bone marrow mesenchymal stem cells repair damaged endometrial stromal cells (EnSCs) through the miR-99b-5p/PCSK9 axis. Exosomes derived from bone marrow mesenchymal stem cells (BMSC-exos) were isolated by ultracentrifugation and characterized using transmission electron microscopy and nanoflow cytometry. A mifepristone-induced EnSC injury model was established in vitro, and the uptake of BMSC-exos was assessed. EnSCs were divided into three groups: the normal group (ctrl), EnSC injury group (model), and BMSC-exo treatment group. The effects of BMSC-exos on EnSC proliferation, apoptosis, and vascular endothelial growth factor (VEGF) expression were assessed by coculturing MSC-exos with endometrial cells. Furthermore, high-throughput sequencing was used to identify differentially expressed genes (DEGs). Through bioinformatics analysis, reverse transcription-quantitative polymerase chain reaction, western blotting, the CCK8 assay, immunohistochemistry, and dual-luciferase experiments, the potential mechanism by which BMSC-exos-derived miRNAs repair EnSC injury was studied. BMSC-exos expressed the marker proteins CD9 and CD63. Laser confocal microscopy showed that BMSC-exos could enter damaged EnSCs. In the BMSC-exos-EnSC coculture group compared with the model group, BMSC-exos significantly increased the proliferation of damaged EnSCs and inhibited cell apoptosis in a dose-dependent manner. The expression levels of Caspase-3, Caspase-9, Bax, and VEGF mRNA were significantly downregulated in the BMSC-exos-EnSC coculture group, whereas Bcl-2 expression was upregulated. We identified 28 overlapping DEGs between the model and ctrl groups and between the BMSC-exo and model groups. Transfection with miR-99b-5p mimics significantly decreased PCSK9 gene expression and inhibited the expression of the autophagy-related proteins Beclin-1 and LC3-II/I and apoptosis, thereby promoting EnSC proliferation. Transfection with a miR-99b-5p inhibitor showed the opposite effects. Beclin-1, LC3-II/I, and PCSK9 expression in the thin endometrium was significantly increased. miR-99b-5p promoted cell proliferation by targeting PCSK9. BMSC-exos promoted endometrial proliferation, and miR-99b-5p inhibited cell apoptosis and promoted EnSC proliferation by targeting PCSK9, providing a new target for the treatment of thin endometrium.
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Affiliation(s)
- LiFei Li
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, People's Republic of China
| | - Junxia An
- College of Life Sciences, Northwest Normal University, Lanzhou, People's Republic of China
| | - Yan Wang
- Gansu Provincial People's Hospital, Lanzhou, People's Republic of China
| | - Lin Liu
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, People's Republic of China
| | - Yiqing Wang
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, People's Republic of China
| | - XueHong Zhang
- Reproductive Medicine Center, The First Hospital of Lanzhou University, Lanzhou, People's Republic of China
- Key Laboratory for Reproductive Medicine and Embryo, Lanzhou, Gansu, People's Republic of China
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Newton-Hoe E, Lee A, Fortin J, Goldberg AB, Janiak E, Neill S. Mifepristone Use Among Obstetrician-Gynecologists in Massachusetts: Prevalence and Predictors of Use. Womens Health Issues 2024; 34:135-141. [PMID: 38129219 DOI: 10.1016/j.whi.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/06/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES We estimated the prevalence of mifepristone use for evidence-based indications among obstetrician-gynecologists in independent practice in Massachusetts and explored the demographic and practice-related factors associated with use. METHODS We used data from a cross-sectional survey administered to Massachusetts obstetrician-gynecologists identified from the American Medical Association Physician Masterfile. We measured the prevalence of mifepristone use for four clinical scenarios: early pregnancy loss, medication abortion, cervical preparation before dilation and evacuation procedures, and cervical preparation before induction of labor. Multivariate regression was used to calculate the odds of mifepristone use for these scenarios based on practice type, years in practice, physician sex, and history of medication abortion training. RESULTS A total of 198 obstetrician-gynecologists responded to the survey (response rate = 29.0%); this analysis was limited to 158 respondents who were not in residency or fellowship. Overall, 46.0% used mifepristone for early pregnancy loss and 38.6% for medication abortion. Fewer used mifepristone for cervical preparation before dilation and evacuation (26.0%) or before induction of labor (26.4%). Respondents in academic practice settings, with more years in practice, of female sex, and with sufficient medication abortion training were significantly more likely to use mifepristone for one or more evidence-based clinical indications. CONCLUSIONS Sufficient medication abortion training during residency significantly predicts whether obstetrician-gynecologists use mifepristone in practice. The U.S. Supreme Court's overturning of Roe v. Wade will allow state-level abortion bans and restrictions to be in effect, which will reduce exposure to abortion training during residency. Increasing training in and utilization of mifepristone are critical for equitable access to reproductive health services. Further interventions may need to be developed to increase mifepristone use in nonacademic practice settings.
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Affiliation(s)
- Emily Newton-Hoe
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Alice Lee
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jennifer Fortin
- Planned Parenthood League of Massachusetts, Boston, Massachusetts
| | - Alisa B Goldberg
- Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Janiak
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham & Women's Hospital, Boston, Massachusetts; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Sara Neill
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Gore IR, Gould E. Developmental and adult stress: effects of steroids and neurosteroids. Stress 2024; 27:2317856. [PMID: 38563163 PMCID: PMC11046567 DOI: 10.1080/10253890.2024.2317856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/03/2024] [Indexed: 04/04/2024] Open
Abstract
In humans, exposure to early life adversity has profound implications for susceptibility to developing neuropsychiatric disorders later in life. Studies in rodents have shown that stress experienced during early postnatal life can have lasting effects on brain development. Glucocorticoids and sex steroids are produced in endocrine glands and the brain from cholesterol; these molecules bind to nuclear and membrane-associated steroid receptors. Unlike other steroids that can also be made in the brain, neurosteroids bind specifically to neurotransmitter receptors, not steroid receptors. The relationships among steroids, neurosteroids, and stress are multifaceted and not yet fully understood. However, studies demonstrating altered levels of progestogens, androgens, estrogens, glucocorticoids, and their neuroactive metabolites in both developmental and adult stress paradigms strongly suggest that these molecules may be important players in stress effects on brain circuits and behavior. In this review, we discuss the influence of developmental and adult stress on various components of the brain, including neurons, glia, and perineuronal nets, with a focus on sex steroids and neurosteroids. Gaining an enhanced understanding of how early adversity impacts the intricate systems of brain steroid and neurosteroid regulation could prove instrumental in identifying novel therapeutic targets for stress-related conditions.
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Affiliation(s)
- Isha R Gore
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - Elizabeth Gould
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
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7
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Zhu A, Yao F, Shen M. Oxycodone alleviates mifepristone-stimulated human endometrial stromal cell injury by activating the Keap1/Nrf2/HO-1 signaling pathway. Immun Inflamm Dis 2023; 11:e1008. [PMID: 37773689 PMCID: PMC10510466 DOI: 10.1002/iid3.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/16/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Endometrial injury is a common disease in women caused by intrauterine inflammation, infections, and endocrine disorders. Human endometrial stromal cells (hEndoSCs) can maintain endometrial homeostasis and play an important role in repairing endometrial injury. Mifepristone, a steroidal anti-progesterone drug, is widely used in the field of reproductive medicine worldwide. Mifepristone-induced hEndoSC injury has been used to study endometrial injury in vitro. At present, the pathogenesis and potential regulatory mechanisms of oxycodone in endometrial injury remain unknown. AIMS We aimed to evaluate the functions of oxycodone in mifepristone-stimulated hEndoSC injury and analyze its potential molecular mechanism. MATERIALS & METHODS hEndoSC viability, cytotoxicity, and apoptosis were analyzed using the methyl thiazolyl tetrazolium assay, the lactate dehydrogenase assay, and flow cytometry, respectively. Furthermore, the levels of cleaved-Caspase3, Keap1, Nrf2, HO-1, and NQO1 were assessed using reverse transcription quantitative polymerase chain reaction and western blot analysis, and the release of inflammatory cytokines was determined using the enzyme-linked immunosorbent assay. RESULTS We observed that oxycodone had no adverse effects on hEndoSCs; rather, it protected hEndoSCs against mifepristone-induced endometrial damage, as confirmed by the enhanced cell viability, reduced number of apoptotic cells, decreased Caspase3 activity and inflammatory cytokine secretion, and increased Keap1/Nrf2/HO-1 pathway-related protein expression. In addition, we found that the protective effects of oxycodone on mifepristone-induced hEndoSC injury were inhibited by ML385 (a Keap1/Nrf2/HO-1 inhibitor). CONCLUSION In summary, we confirmed that oxycodone alleviates mifepristone-induced hEndoSC injury by activating the Keap1/Nrf2/HO-1 signaling pathway.
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Affiliation(s)
- Aibing Zhu
- Department of AnesthesiologyWuxi Maternity and Child Health Care HospitalWuxiChina
| | - Fei Yao
- Department of AnesthesiologyWuxi Maternity and Child Health Care HospitalWuxiChina
| | - Mingkun Shen
- Department of AnesthesiologyWuxi Maternity and Child Health Care HospitalWuxiChina
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Camilleri C, Sammut S. Progesterone-mediated reversal of mifepristone-induced pregnancy termination in a rat model: an exploratory investigation. Sci Rep 2023; 13:10942. [PMID: 37414825 PMCID: PMC10325991 DOI: 10.1038/s41598-023-38025-9] [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: 03/15/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023] Open
Abstract
Globally, a substantial proportion of pregnancies end in induced (particularly medication) abortion. However, data also indicates a percentage of women who seek assistance in potentially reversing the medication abortion process. While previous literature has suggested the potential for progesterone-mediated reversal of mifepristone-induced abortion, this process has not been effectively investigated pre-clinically. Our study explored the potential reversal of mifepristone-induced pregnancy termination using progesterone in a rat model, following a clear initiation of pregnancy termination. Female Long-Evans rats were divided into three groups (n = 10-16/group): Pregnant control (M-P-), mifepristone-only/pregnancy termination (M+P-) and mifepristone + progesterone (M+P+). Drug/vehicle administration occurred on day 12 of gestation (first-trimester human equivalent). Rat weight was measured throughout gestation. Uterine blood, collected post-drug/vehicle administration, was analyzed spectrophotometrically to measure blood loss. Additionally, at the end of gestation (day 21), ultrasound was utilized to confirm pregnancy and measure fetal heart rate. Number of gestational sacs, uterine weights and diameters were obtained following tissue collection. Our results indicate that progesterone administration following initiation of mifepristone-induced pregnancy termination (indicated by weight loss and uterine bleeding) reversed the process in 81% of rats in the M+P+ group. Following the initial weight loss, these rats proceeded to gain weight at a similar rate to the M-P- group, in contrast to the continued decrease displayed by the M+P- group (and unsuccessful reversals). Moreover, while uterine blood loss was similar to that of the M+P- group (confirming pregnancy termination initiation), number of gestational sacs, uterine weights, diameters, approximate fetal weights and fetal heart rates were similar to the M-P- group. Thus, our results indicate a clear progesterone-mediated reversal of an initiated mifepristone-induced pregnancy termination in a rat model at first-trimester human equivalent, with resultant fully developed living fetuses at the end of gestation, clearly indicating the necessity for further pre-clinical investigation to assist in better informing the scientific/medical communities of the potential implications in humans.
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Affiliation(s)
- Christina Camilleri
- Department of Psychology, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH, 43952, USA
| | - Stephen Sammut
- Department of Psychology, Franciscan University of Steubenville, 1235 University Blvd, Steubenville, OH, 43952, USA.
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Che X, Wang J, Sun W, He J, Wang Q, Zhu D, Zhu W, Zhang J, Dong J, Xu J, Zheng F, Zhou J, Zhao W, Lin Q, Ye L, Zhao X, Xu Z, Chen Y, Wang J, Wu W, Zhai L, Zhou Y, Zheng J, Zhang X. Effect of Mifepristone vs Placebo for Treatment of Adenomyosis With Pain Symptoms: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2317860. [PMID: 37307001 PMCID: PMC10261993 DOI: 10.1001/jamanetworkopen.2023.17860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/25/2023] [Indexed: 06/13/2023] Open
Abstract
Importance Adenomyosis is a common chronic gynecological disorder, and its treatment is an unmet need. New therapies need to be developed. Mifepristone is being tested for adenomyosis treatment. Objective To determine whether mifepristone is effective and safe for adenomyosis treatment. Design, Setting, and Participants This multicenter, placebo-controlled, double-blind randomized clinical trial was conducted in 10 hospitals in China. In total, 134 patients with adenomyosis pain symptoms were enrolled. Trial enrollment began in May 2018 and was completed in April 2019, and analyses were conducted from October 2019 to February 2020. Interventions Participants were randomized 1:1 to receive mifepristone 10 mg or placebo orally once a day for 12 weeks. Main Outcomes and Measures The primary end point was the change in adenomyosis-associated dysmenorrhea intensity, evaluated by the visual analog scale (VAS) after 12 weeks of treatment. Secondary end points included the change in menstrual blood loss, increased level of hemoglobin in patients with anemia, CA125 level, platelet count, and uterine volume after 12 weeks of treatment. Safety was assessed according to adverse events, vital signs, gynecological examinations, and laboratory evaluations. Results In total, 134 patients with adenomyosis and dysmenorrhea were randomly assigned, and 126 patients were included in the efficacy analysis, including 61 patients (mean [SD] age, 40.2 [4.6] years) randomized to receive mifepristone and 65 patients (mean [SD] age, 41.7 [5.0] years) randomized to received the placebo. The characteristics of the included patients at baseline were similar between groups. The mean (SD) change in VAS score was -6.63 (1.92) in the mifepristone group and -0.95 (1.75) in the placebo group (P < .001). The total remission rates for dysmenorrhea in the mifepristone group were significantly better than those in the placebo group (effective remission: 56 patients [91.8%] vs 15 patients [23.1%]; complete remission: 54 patients [88.5%] vs 4 patients [6.2%]). All the secondary end points showed significant improvements after mifepristone treatment for menstrual blood loss, hemoglobin (mean [SD] change from baseline: 2.13 [1.38] g/dL vs 0.48 [0.97] g/dL; P < .001), CA125 (mean [SD] change from baseline: -62.23 [76.99] U/mL vs 26.89 [118.70] U/mL; P < .001), platelet count (mean [SD] change from baseline: -28.87 [54.30]×103/µL vs 2.06 [41.78]×103/µL; P < .001), and uterine volume (mean [SD] change from baseline: -29.32 [39.34] cm3 vs 18.39 [66.46] cm3; P < .001). Safety analysis revealed no significant difference between groups, and no serious adverse events were reported. Conclusions and Relevance This randomized clinical trial showed that mifepristone could be a new option for treating patients with adenomyosis, based on its efficacy and acceptable tolerability. Trial Registration ClinicalTrials.gov Identifier: NCT03520439.
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Affiliation(s)
- Xuan Che
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Jianzhang Wang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenting Sun
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiayi He
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiming Wang
- Ningbo Women and Children’s Hospital, Ningbo, China
| | - Danyang Zhu
- The First People’s Hospital of Taizhou City, Taizhou, China
| | - Weili Zhu
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Jing Zhang
- The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
| | - Jie Dong
- Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Jingui Xu
- Quzhou People’s Hospital, Quzhou, China
| | - Feiyun Zheng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianwei Zhou
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hanzhou, China
| | | | - Qiao Lin
- Taizhou Cancer Hospital, Taizhou, China
| | - Lingfang Ye
- Ningbo Women and Children’s Hospital, Ningbo, China
| | - Xiumin Zhao
- The First People’s Hospital of Taizhou City, Taizhou, China
| | - Zhengfen Xu
- Jiaxing University Affiliated Women and Children Hospital, Jiaxing, China
| | - Yunyan Chen
- Huzhou Maternity & Child Health Care Hospital, Huzhou, China
| | - Jing Wang
- Quzhou People’s Hospital, Quzhou, China
| | - Wenlie Wu
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lingyun Zhai
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hanzhou, China
| | | | | | - Xinmei Zhang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Jaundoo R, Bohmann J, Gutierrez GE, Klimas N, Broderick G, Craddock TJA. Towards a Treatment for Gulf War Illness: A Consensus Docking Approach. Mil Med 2020; 185:554-561. [PMID: 32074351 PMCID: PMC7029833 DOI: 10.1093/milmed/usz299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/02/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Gulf War Illness (GWI) currently has no known cure and affects soldiers deployed during the Persian Gulf War. It is thought to originate from exposure to neurotoxicants combined with battlefield stress, and previous research indicates that treatment first involves inhibition of interleukin-2 and tumor necrosis factor alpha, followed by the glucocorticoid receptor. However, the off-target effects of pharmaceuticals hinder development of a drug treatment therapy. Materials and Methods AutoDock 4.2, AutoDock Vina, and Schrodinger’s Glide were used to perform consensus docking, a computational technique where pharmaceuticals are screened against targets using multiple scoring algorithms to obtain consistent binding affinities. FDA approved pharmaceuticals were docked against the above-mentioned immune and stress targets to determine a drug therapy for GWI. Additionally, the androgen and estrogen targets were screened to avoid pharmaceuticals with off-target interactions. Results While suramin bound to both immune targets with high affinity, top binders of the hormonal and glucocorticoid targets were non-specific towards their respective proteins, possibly due to high structure similarity between these proteins. Conclusions Development of a drug treatment therapy for GWI is threatened by the tight interplay between the immune and hormonal systems, often leading to drug interactions. Increasing knowledge of these interactions can lead to break-through therapies.
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Affiliation(s)
- Rajeev Jaundoo
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
| | - Jonathan Bohmann
- Pharmaceuticals and Bioengineering Department, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Gloria E Gutierrez
- Pharmaceuticals and Bioengineering, Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Miami Veterans Affairs Medical Center, 1201 N.W. 16th Street, Miami, FL 33125
| | - Gordon Broderick
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Rochester Institute of Technology, One Lomb Memorial Drive, Rochester, NY 14623-5603.,Centre for Clinical Systems Biology, Rochester General Hospital Research Institute, 100 Kings Highway South, Rochester, NY 14617
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Psychology & Neuroscience, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Clinical Immunology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796.,Department of Computer Science, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314-7796
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11
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Llaguno-Munive M, Romero-Piña M, Serrano-Bello J, Medina LA, Uribe-Uribe N, Salazar AM, Rodríguez-Dorantes M, Garcia-Lopez P. Mifepristone Overcomes Tumor Resistance to Temozolomide Associated with DNA Damage Repair and Apoptosis in an Orthotopic Model of Glioblastoma. Cancers (Basel) 2018; 11:cancers11010016. [PMID: 30583528 PMCID: PMC6356343 DOI: 10.3390/cancers11010016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 12/20/2022] Open
Abstract
The standard treatment for glioblastoma multiforme (GBM) is surgery followed by chemo/radiotherapy. A major limitation on patient improvement is the high resistance of tumors to drug treatment, likely responsible for their subsequent recurrence and rapid progression. Therefore, alternatives to the standard therapy are necessary. The aim of the present study was to evaluate whether mifepristone, an antihormonal agent, has a synergistic effect with temozolomide (used in standard therapy for gliomas). Whereas the mechanism of temozolomide involves damage to tumor DNA leading to apoptosis, tumor resistance is associated with DNA damage repair through the O6-methylguanine-DNA-methyltransferase (MGMT) enzyme. Temozolomide/mifepristone treatment, herein examined in Wistar rats after orthotopically implanting C6 glioma cells, markedly reduced proliferation. This was evidenced by a decreased level of the following parameters: a proliferation marker (Ki-67), a tumor growth marker (18F-fluorothymidine uptake, determined by PET/CT images), and the MGMT enzyme. Increased apoptosis was detected by the relative expression of related proteins, (e.g. Bcl-2 (B-cell lymphoma 2), Bax (bcl-2-like protein 4) and caspase-3). Thus, greater apoptosis of tumor cells caused by their diminished capacity to repair DNA probably contributed significantly to the enhanced activity of temozolomide. The results suggest that mifepristone could possibly act as a chemo-sensitizing agent for temozolomide during chemotherapy for GBM.
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Affiliation(s)
- Monserrat Llaguno-Munive
- Laboratorio de Farmacología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.
- Posgrado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico.
| | - Mario Romero-Piña
- Laboratorio de Farmacología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.
| | - Janeth Serrano-Bello
- Facultad de Odontología, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico.
| | - Luis A Medina
- Instituto de Física, Universidad Nacional Autónoma de México (UNAM), Unidad de Investigación Biomédica en Cáncer INCan-UNAM, Ciudad de México, 14080, Mexico.
| | - Norma Uribe-Uribe
- Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico.
| | - Ana Maria Salazar
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Ciudad de México 04510, Mexico.
| | | | - Patricia Garcia-Lopez
- Laboratorio de Farmacología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología, Ciudad de México 14080, Mexico.
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12
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Kapperman HE, Goyeneche AA, Telleria CM. Mifepristone inhibits non-small cell lung carcinoma cellular escape from DNA damaging cisplatin. Cancer Cell Int 2018; 18:185. [PMID: 30479564 PMCID: PMC6238342 DOI: 10.1186/s12935-018-0683-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/09/2018] [Indexed: 12/23/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer deaths in the world. The major histopathological subtype of lung cancer is non-small cell lung cancer (NSCLC). Platinum-based therapy is the standard of care for patients with advanced stage NSCLC. However, even with treatment, most patients will die of this disease within 5 years and most of these deaths are due to recurrence. One strategy to inhibit recurrence is to use cytostatic compounds following courses of lethal chemotherapy. We have shown in various cancer cell types that mifepristone (MF), an anti-progestin/anti-glucocorticoid, is a powerful cytostatic anti-cancer agent. Thus, in this work we tested the hypothesis that MF should be efficacious in inducing cytostasis and preventing repopulation of NSCLC following cisplatin (CDDP) therapy. Methods We established an in vitro approach wherein human NSCLC cells with different genetic backgrounds and sensitivities to CDDP (A549 and H23) were exposed to rounds of lethal concentrations of CDDP for 1 h followed or not by MF monotherapy. Every 2 days, cell number, cell viability, and colony-forming ability of viable cells were studied. Results CDDP killed the majority of cells, yet there were remnant cells escaping CDDP lethality and repopulating the culture, as evidenced by the improved clonogenic survival of viable cells. In contrast, when cells exposed to CDDP where further treated with MF following CDDP removal, their number and clonogenic capacity were reduced drastically. Conclusion This study reports that there is repopulation of NSCLC cells following a lethal concentration of CDDP monotherapy, that NSCLC cells are sensitive to the growth inhibition properties of MF, and that MF abrogates the repopulation of NSCLC cells following CDDP therapy. Our study supports further evaluating MF as an adjuvant therapy for NSCLC.
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Affiliation(s)
- Heather E Kapperman
- 2Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD 57069 USA.,3Present Address: Eisenhower Army Medical Center, Ft. Gordon, GA USA
| | - Alicia A Goyeneche
- 1Experimental Pathology Unit, Department of Pathology, Faculty of Medicine, McGill University, 3775 University Street, Montreal, QC H3A 2B4 Canada
| | - Carlos M Telleria
- 1Experimental Pathology Unit, Department of Pathology, Faculty of Medicine, McGill University, 3775 University Street, Montreal, QC H3A 2B4 Canada
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13
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Ponandai-Srinivasan S, Lalitkumar PG, Garcia L, Varghese SJ, Carlson JW, Gemzell-Danielsson K, Floter Radestad A. Mifepristone mediates anti-proliferative effect on ovarian mesenchymal stem/stromal cells from female BRCA 1-/2- carriers. Acta Obstet Gynecol Scand 2018; 98:250-261. [PMID: 30325501 DOI: 10.1111/aogs.13485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/03/2018] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Women with hereditary mutation in breast cancer-associated genes (BRCA1-/2- ) have a higher lifetime risk of developing ovarian cancer. Here, we aimed to investigate the effect of mifepristone, a selective progesterone receptor modulator of ovarian mesenchymal stem/stromal cells (MSC) from BRCA1-/2- carriers. MATERIAL AND METHODS Ovarian BRCA1-/2- MSC were positively selected using the markers CD90, CD73 and CD105 from nine healthy women. The effect of dose response and combination treatment with mifepristone and analogs of progesterone- or glucocorticoid-receptors were investigated on BRCA1-/2- MSC in vitro using a panel of markers for proliferation (ki67, BrdU, CDK2, p21CIP ), apoptosis (BAX, BCL2, CASPASE3), tumor suppression (TP53, PTEN) and cell survival (PI3KCA, MAPK3, mTOR). RESULTS The dose response with mifepristone treatment suggested an optimal effect with 10 μm mifepristone, exhibiting >90% viability and significantly reducing growth signaling markers (TP53 and MAPK3). Furthermore, combined treatment with progesterone plus mifepristone (PG+MIFE) gave an enhanced anti-proliferative effect in comparison with hydrocortisone plus mifepristone (HC+MIFE) by significantly reducing markers of proliferation (BrdU+ and Ki67 expression) and tumor suppressors (PTEN, TP53), and increasing the percentage of pro-apoptotic cells. Consequently, accumulation of p21CIP together with reduced levels of CDK2 confirms growth inhibition by reversibly arresting cell-cycle progression at the G1-S phase, not by inducing apoptosis. CONCLUSIONS Our study showed an anti-proliferative effect on ovarian BRCA1-/2- MSC on in vitro combined treatment with mifepristone and progesterone. These findings suggest that mifepristone or other selective progesterone receptor modulators could be developed as a preventive treatment and postpone early use of prophylactic salpingo-oophorectomy as well as reduce the risk of ovarian cancer.
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Affiliation(s)
- Sakthivignesh Ponandai-Srinivasan
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Parameswaran G Lalitkumar
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Laura Garcia
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Suby Jo Varghese
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Joseph W Carlson
- Division of Pathology and Cytology, Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Angelique Floter Radestad
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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14
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Vispute SG, Bu P, Le Y, Cheng X. Activation of GR but not PXR by dexamethasone attenuated acetaminophen hepatotoxicities via Fgf21 induction. Toxicology 2017; 378:95-106. [PMID: 28088388 DOI: 10.1016/j.tox.2017.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 11/18/2022]
Abstract
Glucocorticoid receptor (GR) signaling is indispensable for cell growth and development, and plays important roles in drug metabolism. Fibroblast growth factor (Fgf) 21, an important regulator of glucose, lipid, and energy metabolism, plays a cytoprotective role by attenuating toxicities induced by chemicals such as dioxins, acetaminophen (APAP), and alcohols. The present study investigates the impact of dexamethasone (DEX)-activated GR on Fgf21 expression and how it affects the progression of APAP-induced hepatotoxicity. Our results showed that DEX dose/concentration- and time-dependently increased Fgf21 mRNA and protein expression in mouse liver as well as cultured mouse and human hepatoma cells. By using PXR-null mouse model, we demonstrated that DEX induced Fgf21 expression by a PXR-independent mechanism. In cultured mouse and human hepatoma cells, inhibition of GR signaling, by RU486 (Mifepristone) or GR silencing using GR-specific siRNA, attenuated DEX-induced Fgf21 expression. In addition, DEX increased luciferase reporter activity driven by the 3.0-kb mouse and human Fgf21/FGF21 gene promoter. Further, ChIP-qPCR assays demonstrated that DEX increased the binding of GR to the specific cis-regulatory elements located in the 3.0-kb mouse and human Fgf21/FGF21 gene promoter. Pretreatment of 2mg/kg DEX ameliorated APAP-induced liver injury in wild-type but not Fgf21-null mice. In conclusion, via GR activation, DEX induced Fgf21 expression in mouse liver and human hepatoma cells.
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Affiliation(s)
- Saurabh G Vispute
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Pengli Bu
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA; Department of Biological Sciences, College of Liberal Arts and Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Yuan Le
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA
| | - Xingguo Cheng
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, USA.
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15
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Feiteiro J, Mariana M, Verde I, Cairrão E. Genomic and Nongenomic Effects of Mifepristone at the Cardiovascular Level: A Review. Reprod Sci 2016; 24:976-988. [DOI: 10.1177/1933719116671002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joana Feiteiro
- Centro de Investigação em Ciências da Saúde, University of Beira Interior, Covilhã, Portugal
| | - Melissa Mariana
- Centro de Investigação em Ciências da Saúde, University of Beira Interior, Covilhã, Portugal
| | - Ignacio Verde
- Centro de Investigação em Ciências da Saúde, University of Beira Interior, Covilhã, Portugal
| | - Elisa Cairrão
- Centro de Investigação em Ciências da Saúde, University of Beira Interior, Covilhã, Portugal
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16
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Wagenfeld A, Saunders PTK, Whitaker L, Critchley HOD. Selective progesterone receptor modulators (SPRMs): progesterone receptor action, mode of action on the endometrium and treatment options in gynecological therapies. Expert Opin Ther Targets 2016; 20:1045-54. [PMID: 27138351 PMCID: PMC4989858 DOI: 10.1080/14728222.2016.1180368] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: The progesterone receptor plays an essential role in uterine physiology and reproduction. Selective progesterone receptor modulators (SPRMs) have emerged as a valuable treatment option for hormone dependent conditions like uterine fibroids, which have a major impact on women’s quality of life. SPRMs offer potential for longer term medical treatment and thereby patients may avoid surgical intervention. Areas covered: The authors have reviewed the functional role of the progesterone receptor and its isoforms and their molecular mechanisms of action via genomic and non-genomic pathways. The current knowledge of the interaction of the PR and different SPRMs tested in clinical trials has been reviewed. The authors focused on pharmacological effects of selected SPRMs on the endometrium, their anti-proliferative action, and their suppression of bleeding. Potential underlying molecular mechanisms and the specific histological changes in the endometrium induced by SPRMs (PAEC; Progesterone receptor modulator Associated Endometrial Changes) have been discussed. The clinical potential of this compound class including its impact on quality of life has been covered. Expert Opinion: Clinical studies indicate SPRMs hold promise for treatment of benign gynecological complaints (fibroids, heavy menstrual bleeding; HMB). There however remains a knowledge gap concerning mechanism of action.
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Affiliation(s)
- Andrea Wagenfeld
- a Bayer HealthCare , Drug Discovery, TRG Gynecological Therapies , Berlin , Germany
| | - Philippa T K Saunders
- b MRC Centre for Inflammation Research , The University of Edinburgh , Edinburgh , UK
| | - Lucy Whitaker
- c MRC Centre for Reproductive Health , The University of Edinburgh , Edinburgh , UK
| | - Hilary O D Critchley
- c MRC Centre for Reproductive Health , The University of Edinburgh , Edinburgh , UK
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17
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LIU HAIYANG, MA WEI, LIU QI, WANG FASHAN, CAO LING, LI TIENAN, ZHANG NING, GENG FANG. Effect of Wujia Shenghua capsule on uterine bleeding following medically-induced incomplete abortion in rats during early pregnancy. Exp Ther Med 2015; 10:635-640. [PMID: 26622367 PMCID: PMC4509024 DOI: 10.3892/etm.2015.2548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 01/20/2015] [Indexed: 12/14/2022] Open
Abstract
The Wujia Shenghua capsule (WSC) is derived from Sheng-Hua-Tang, a well-known traditional Chinese medicine compound prescription that has been widely applied during the postpartum period in Chinese communities for a number of years. The aim of the present study was to investigate the effect of WSC on uterine bleeding following medically-induced incomplete abortion in rats during early pregnancy. Incomplete abortions were induced in Wistar rats during early pregnancy using mifepristone combined with misoprostol. The effects of WSC treatment were investigated in terms of the duration and volume of uterine bleeding, the uterine index and shape, and various hemodynamic indexes. In addition, blood samples were collected to measure the levels of estradiol (E2), fibronectin (FN) and laminin (LM) via a radioimmunoassay or enzyme-linked immunosorbent assay, while the expression levels of FN, estrogen receptor (ER) and progesterone receptor (PR) in the uterine tissues were determined by immunohistochemistry. The in vivo results demonstrated that WSC treatment markedly shortened the duration and reduced the volume of uterine bleeding when compared with the model group. Furthermore, WSC treatment significantly elevated the E2 level in the serum and the expression of the ER and PR in the uterine tissues, while notably decreasing the FN and LM levels in the serum and uterine tissues. In addition, the hemodynamic indexes were shown to improve with WSC treatment. These results demonstrated that WSC exerted an inhibitory effect on the bleeding caused by medical abortion, possibly through modulating the E2, ER, PR, FN and LM levels.
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Affiliation(s)
- HAIYANG LIU
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - WEI MA
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - QI LIU
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - FASHAN WANG
- Duoduo Pharmaceutical Co. Ltd., Jiamusi, Heilongjiang 154002, P.R. China
| | - LING CAO
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - TIENAN LI
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - NING ZHANG
- College of Jiamusi, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - FANG GENG
- College of Chemistry and Chemical Engineering, Harbin Normal University, Harbin, Heilongjiang 150025, P.R. China
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Muñoz-Hernando L, Muñoz-Gonzalez JL, Marqueta-Marques L, Alvarez-Conejo C, Tejerizo-García Á, Lopez-Gonzalez G, Villegas-Muñoz E, Martin-Jimenez A, Jiménez-López JS. Endometriosis: alternative methods of medical treatment. Int J Womens Health 2015; 7:595-603. [PMID: 26089705 PMCID: PMC4468987 DOI: 10.2147/ijwh.s78829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endometriosis is an inflammatory estrogen-dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The main purpose of endometriosis management is alleviating pain associated to the disease. This can be achieved surgically or medically, although in most women a combination of both treatments is required. Long-term medical treatment is usually needed in most women. Unfortunately, in most cases, pain symptoms recur between 6 months and 12 months once treatment is stopped. The authors conducted a literature search for English original articles, related to new medical treatments of endometriosis in humans, including articles published in PubMed, Medline, and the Cochrane Library. Keywords included "endometriosis" matched with "medical treatment", "new treatment", "GnRH antagonists", "Aromatase inhibitors", "selective progesterone receptor modulators", "anti-TNF α", and "anti-angiogenic factors". Hormonal treatments currently available are effective in the relief of pain associated to endometriosis. Among new hormonal drugs, association to aromatase inhibitors could be effective in the treatment of women who do not respond to conventional therapies. GnRH antagonists are expected to be as effective as GnRH agonists, but with easier administration (oral). There is a need to find effective treatments that do not block the ovarian function. For this purpose, antiangiogenic factors could be important components of endometriosis therapy in the future. Upcoming researches and controlled clinical trials should focus on these drugs.
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Affiliation(s)
- Leticia Muñoz-Hernando
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose L Muñoz-Gonzalez
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Laura Marqueta-Marques
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carmen Alvarez-Conejo
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Álvaro Tejerizo-García
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Gregorio Lopez-Gonzalez
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Emilia Villegas-Muñoz
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Carlos Haya, Malaga, Spain
| | - Angel Martin-Jimenez
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - Jesús S Jiménez-López
- Endometriosis Unit, Service of Obstetrics and Gynecology, Hospital Universitario 12 de Octubre, Madrid, Spain
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Anti-Markovnikov stereoselective addition of bis(trimethylsilyl)octadiene to ketal obtained by unprecedented retro-Claisen condensation of 3-hydroxy-2,4-pentanedione bis-ketal. CR CHIM 2014. [DOI: 10.1016/j.crci.2014.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Chen J, Wang J, Shao J, Gao Y, Xu J, Yu S, Liu Z, Jia L. The Unique Pharmacological Characteristics of Mifepristone (RU486): From Terminating Pregnancy to Preventing Cancer Metastasis. Med Res Rev 2014; 34:979-1000. [DOI: 10.1002/med.21311] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Jianzhong Chen
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
- School of Pharmacy; Fujian University of Traditional Chinese Medicine; Fuzhou 350108 China
| | - Jichuang Wang
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
| | - Jingwei Shao
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
| | - Yu Gao
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
| | - Jianguo Xu
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
| | - Suhong Yu
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
| | - Zhenhua Liu
- Department of Clinical Oncology; Fujian Province Hospital; Fuzhou 350004 China
| | - Lee Jia
- Cancer Metastasis Alert and Prevention Center; College of Chemistry and Chemical Engineering; Fuzhou University; Fuzhou 350002 China
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21
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Sun Y, Fang M, Davies H, Hu Z. Mifepristone: a potential clinical agent based on its anti-progesterone and anti-glucocorticoid properties. Gynecol Endocrinol 2014; 30:169-73. [PMID: 24205903 DOI: 10.3109/09513590.2013.856410] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Nowadays, unwanted pregnancy is a major globe tragedy for millions of women, associated with significant direct and indirect costs, no matter for individuals or society. The progesterone receptor antagonist steroid, mifepristone has been widely and effectively using throughout the world for medical abortion, but to a lesser extent for emergency contraception. In this review, we hope to explore the role of mifepristone as a contraceptive, particularly for emergency contraception. Studies of mifepristone have also been expanding to the fields of endometriosis and uterine fibroids. Furthermore, this initially considered reproductive medicine has been investigated in some psychotic diseases and various disorders of hypercortisolism, because of its glucocorticoid receptor antagonism. Mifepristone was approved suitable for patients with hyperglycemia secondary to Cushing's syndrome by the United States Food and Drug Administration (FDA) in 2012. The aim of this article is to review published reports on the anti-progesterone and anti-glucocorticoid properties of mifepristone as a clinical agent. There is a new insight into systematically describing and evaluating the potential efficiency of mifepristone administrated in the field of endocrine and neuroendocrine, not only in obstetrics and gynecology.
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MESH Headings
- Abortifacient Agents, Steroidal/adverse effects
- Abortifacient Agents, Steroidal/pharmacology
- Abortifacient Agents, Steroidal/therapeutic use
- Antidepressive Agents/adverse effects
- Antidepressive Agents/pharmacology
- Antidepressive Agents/therapeutic use
- Contraceptives, Oral, Synthetic/adverse effects
- Contraceptives, Oral, Synthetic/pharmacology
- Contraceptives, Oral, Synthetic/therapeutic use
- Contraceptives, Postcoital, Synthetic/adverse effects
- Contraceptives, Postcoital, Synthetic/pharmacology
- Contraceptives, Postcoital, Synthetic/therapeutic use
- Cushing Syndrome/drug therapy
- Cushing Syndrome/physiopathology
- Endometriosis/drug therapy
- Female
- Humans
- Hyperglycemia/etiology
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/pharmacology
- Hypoglycemic Agents/therapeutic use
- Leiomyoma/drug therapy
- Male
- Mifepristone/adverse effects
- Mifepristone/pharmacology
- Mifepristone/therapeutic use
- Mood Disorders/drug therapy
- Receptors, Glucocorticoid/antagonists & inhibitors
- Receptors, Progesterone/antagonists & inhibitors
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Affiliation(s)
- Yayi Sun
- Institute of Neuroscience, Zhejiang University School of Medicine , Hangzhou , China and
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22
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Jurka P, Szulc-Dąbrowska L, Borkowska J, Winnicka A. Lack of in vitro effect of aglepristone on IFN-γ and IL-4 production by resting and mitogen-activated T cells of luteal bitches. BMC Vet Res 2013; 9:220. [PMID: 24284004 PMCID: PMC3818567 DOI: 10.1186/1746-6148-9-220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 10/24/2013] [Indexed: 12/16/2022] Open
Abstract
Background Aglepristone (RU534) is an antiprogestin used for pregnancy termination, parturition induction and conservative pyometra treatment in bitches. Its molecular structure is similar to mifepristone, an antiprogestin used in human medicine. Mifepristone has been shown to suppress proliferation and cytokine production by T cells, whereas the effect of aglepristone on T cell function remains elusive. The purpose of this project was to investigate the in vitro influence of RU534 on IFN-γ and IL-4 synthesis by peripheral blood T cells isolated from healthy bitches (N = 16) in luteal phase. The peripheral blood mononuclear cells (PBMCs) were incubated with three different dosages of aglepristone, or dimethyl sulfoxide (DMSO), with or without mitogen. The production of cytokines by resting or mitogen-activated T cells was determined by intercellular staining and flow cytometry analysis or ELISA assay, respectively. Results Our results showed no statistically significant differences in the percentage of IFN-γ and IL-4-synthesizing CD4+ or CD8+ resting T cells between untreated and aglepristone-treated cells at 24 and 48 hours post treatment. Moreover, mitogen-activated PBMCs treated with RU534 displayed similar concentration of IFN-γ and IL-4 in culture supernatants to those observed in mitogen-activated DMSO-treated PBMCs. Presented results indicate that administration of aglepristone for 48 hours has no influence on IFN-γ and IL-4 synthesis by resting and mitogen-activated T cells isolated from diestral bitches. Conclusions We conclude that antiprogestins may differentially affect T cell function depending on the animal species in which they are applied.
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Affiliation(s)
- Piotr Jurka
- Department of Small Animal Diseases with Clinic, Laboratory of Small Animal Reproduction, Warsaw, Poland.
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23
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Valles SL, Benlloch M, Rodriguez ML, Mena S, Pellicer JA, Asensi M, Obrador E, Estrela JM. Stress hormones promote growth of B16-F10 melanoma metastases: an interleukin 6- and glutathione-dependent mechanism. J Transl Med 2013; 11:72. [PMID: 23517603 PMCID: PMC3608962 DOI: 10.1186/1479-5876-11-72] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 03/12/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Interleukin (IL)-6 (mainly of tumor origin) activates glutathione (GSH) release from hepatocytes and its interorgan transport to B16-F10 melanoma metastatic foci. We studied if this capacity to overproduce IL-6 is regulated by cancer cell-independent mechanisms. METHODS Murine B16-F10 melanoma cells were cultured, transfected with red fluorescent protein, injected i.v. into syngenic C57BL/6J mice to generate lung and liver metastases, and isolated from metastatic foci using high-performance cell sorting. Stress hormones and IL-6 levels were measured by ELISA, and CRH expression in the brain by in situ hybridization. DNA binding activity of NF-κB, CREB, AP-1, and NF-IL-6 was measured using specific transcription factor assay kits. IL-6 expression was measured by RT-PCR, and silencing was achieved by transfection of anti-IL-6 small interfering RNA. GSH was determined by HPLC. Cell death analysis was distinguished using fluorescence microscopy, TUNEL labeling, and flow cytometry techniques. Statistical analyses were performed using Student's t test. RESULTS Plasma levels of stress-related hormones (adrenocorticotropin hormone, corticosterone, and noradrenaline) increased, following a circadian pattern and as compared to non-tumor controls, in mice bearing B16-F10 lung or liver metastases. Corticosterone and noradrenaline, at pathophysiological levels, increased expression and secretion of IL-6 in B16-F10 cells in vitro. Corticosterone- and noradrenaline-induced transcriptional up-regulation of IL-6 gene involves changes in the DNA binding activity of nuclear factor-κB, cAMP response element-binding protein, activator protein-1, and nuclear factor for IL-6. In vivo inoculation of B16-F10 cells transfected with anti-IL-6-siRNA, treatment with a glucocorticoid receptor blocker (RU-486) or with a β-adrenoceptor blocker (propranolol), increased hepatic GSH whereas decreased plasma IL-6 levels and metastatic growth. Corticosterone, but not NORA, also induced apoptotic cell death in metastatic cells with low GSH content. CONCLUSIONS Our results describe an interorgan system where stress-related hormones, IL-6, and GSH coordinately regulate metastases growth.
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Affiliation(s)
- Soraya L Valles
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - María Benlloch
- Faculty of Medicine, San Vicente Martir Catholic University, 2 Calle Quevedo, 46001, Valencia, Spain
| | - María L Rodriguez
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - Salvador Mena
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - José A Pellicer
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - Miguel Asensi
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - Elena Obrador
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
| | - José M Estrela
- Department of Physiology, University of Valencia, 15 Av. Blasco Ibañez, 46010, Valencia, Spain
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24
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Micks E, Shekell T, Stanley J, Zelinski M, Martin L, Riefenberg S, Adevai T, Jensen J. Medical termination of pregnancy in cynomolgus macaques. J Med Primatol 2012; 41:394-402. [PMID: 23078537 DOI: 10.1111/jmp.12019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although pregnancy is expected during studies of novel contraceptives in non-human primates, gestation, delivery, and lactation remove females from groups for prolonged intervals. As the macaque cervix does not facilitate transcervical surgical termination of pregnancy, we sought to establish a medical termination protocol. METHODS A descriptive case series of outcomes of medical termination of pregnancy up to 32 days gestation in cynomolgus monkeys. Efficacy and time to uterine resolution were determined according to medication, dose, and route of administration. RESULTS Thirty-seven macaques underwent 65 medical terminations. Over 80% of animals terminated after initial treatment with mifepristone 20 mg intramuscularly (IM). Intrafetal methotrexate was effective for salvage treatment. Medical termination regimens were less effective for animals receiving investigational contraceptive agents. CONCLUSIONS Medical termination for macaques is safe and effective. We recommend a protocol with mifepristone 20 mg IM and misoprostol 200 µg buccally as initial treatment.
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Affiliation(s)
- Elizabeth Micks
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA 98195-6460, USA.
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25
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Cork DMW, Lennard TWJ, Tyson-Capper AJ. Progesterone receptor (PR) variants exist in breast cancer cells characterised as PR negative. Tumour Biol 2012; 33:2329-40. [PMID: 22956396 DOI: 10.1007/s13277-012-0495-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/16/2012] [Indexed: 01/18/2023] Open
Abstract
Progesterone receptor (PR) expression is measured in breast cancer by immunohistochemistry using N-terminally targeted antibodies and serves as a biomarker for endocrine therapeutic decisions. Extensive PR alternative splicing has been reported which may generate truncated PR variant proteins which are not detected by current breast cancer screening or may alter the function of proteins detected in screening. However, the existence of such truncated PR variants remains controversial. We have characterised PR protein expression in breast cancer cell lines using commercial PR antibodies targeting different epitopes. Truncated PR proteins are detected in reportedly PR negative MDA-MB-231 cells using a C-terminally targeted antibody. Antibody specificity was confirmed by immunoblotting following siRNA knockdown of PR expression. We have further demonstrated that alternatively spliced PR mRNA is present in MDA-MB-231 cells and in reportedly PR-negative breast tumour tissue which could encode the truncated PR proteins detected by the C-terminal antibody. The potential function of PR variant proteins present in MDA-MB-231 cells was also assessed, indicating the ability of these PR variants to bind progesterone, interact with a nuclear PR co-factor and bind DNA. These findings suggest that alternative splicing may generate functional truncated PR variant proteins which are not detected by breast cancer screening using N-terminally targeted antibodies leading to misclassification as PR negative.
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Affiliation(s)
- David M W Cork
- Reproductive and Vascular Biology Research Group, Institute of Cellular Medicine, Medical School, Newcastle University, 3rd Floor William Leech Building, Framlington Place, Newcastle-upon-Tyne NE2 4HH, UK
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26
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Synthesis and antihormonal properties of novel 11β-benzoxazole-substituted steroids. Bioorg Med Chem Lett 2011; 22:1705-8. [PMID: 22260770 DOI: 10.1016/j.bmcl.2011.12.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Revised: 12/20/2011] [Accepted: 12/21/2011] [Indexed: 11/22/2022]
Abstract
Early studies led to the identification of 11β-aryl-4',5'-dihydrospiro[estra-4,9-diene-17β,4'-oxazole] analogs with potent and more selective antiprogestational activity compared to antiglucocorticoid activity than mifepristone. In the present study, we replaced the 4'-dimethylaminophenyl group of mifepristone with the benzoxazol group to give 5a-d. We also prepared the 17β-formamido analogs 6a,b using a new synthetic strategy via the intermediate epoxide 21. These compounds were evaluated for their antagonist hormonal properties using the T47D cell-based alkaline phosphatase assay and the A549 cell-based functional assay. Compound 5c showed potent antagonist activity at GR with better selectivity for GR versus PR than mifepristone and is a promising lead for further development.
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Bouchard P, Chabbert-Buffet N, Fauser BCJM. Selective progesterone receptor modulators in reproductive medicine: pharmacology, clinical efficacy and safety. Fertil Steril 2011; 96:1175-89. [PMID: 21944187 DOI: 10.1016/j.fertnstert.2011.08.021] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/08/2011] [Accepted: 08/12/2011] [Indexed: 11/19/2022]
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Progesterone analogs influence germination of Clostridium sordellii and Clostridium difficile spores in vitro. J Bacteriol 2011; 193:2776-83. [PMID: 21478359 DOI: 10.1128/jb.00058-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clostridium sordellii and Clostridium difficile are closely related anaerobic Gram-positive, spore-forming human pathogens. C. sordellii and C. difficile form spores that are believed to be the infectious form of these bacteria. These spores return to toxin-producing vegetative cells upon binding to small molecule germinants. The endogenous compounds that regulate clostridial spore germination are not fully understood. While C. sordellii spores require three structurally distinct amino acids to germinate, the occurrence of postpregnancy C. sordellii infections suggests that steroidal sex hormones might regulate its capacity to germinate. On the other hand, C. difficile spores require taurocholate (a bile salt) and glycine (an amino acid) to germinate. Bile salts and steroid hormones are biosynthesized from cholesterol, suggesting that the common sterane structure can affect the germination of both C. sordellii and C. difficile spores. Therefore, we tested the effect of sterane compounds on C. sordellii and C. difficile spore germination. Our results show that both steroid hormones and bile salts are able to increase C. sordellii spore germination rates. In contrast, a subset of steroid hormones acted as competitive inhibitors of C. difficile spore germination. Thus, even though C. sordellii and C. difficile are phylogenetically related, the two species' spores respond differently to steroidal compounds.
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Burton TJ, Azizan EA, Brown MJ. Investigating the function of an aldosterone response pathway in primary human adrenocortical cells obtained from Conn's and phaeochromocytoma patients. Eur J Pharmacol 2011; 657:184-9. [DOI: 10.1016/j.ejphar.2011.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 01/06/2011] [Accepted: 01/25/2011] [Indexed: 11/25/2022]
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