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Tinelli A, Kosmas IP, Mynbaev OA, Malvasi A, Sparic R, Vergara D. The Biological Impact of Ulipristal Acetate on Cellular Networks Regulating Uterine Leiomyoma Growth. Curr Pharm Des 2020; 26:310-317. [PMID: 31987017 DOI: 10.2174/1381612826666200121141533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022]
Abstract
Uterine Fibroids (UFs), or leiomyomas, represent the most frequent pelvic tumor in reproductive-aged women. Although of benign origin, UFs decrease fertility and cause significant reproductive dysfunctions. Compared to normal myometrium, UFs are characterized by a clinical and molecular heterogeneity as demonstrated by the presence of multiple genetic alterations and altered signaling pathways. Recently, selective progesteronereceptor modulators (SPRM), as ulipristal acetate (UPA), have demonstrated their clinical benefits by reducing tumor growth and extracellular matrix deposition. For these reasons, UPA is used in the clinical practice as an intermittent treatment for women symptomatic for UFs or, sometimes, before a myomectomy. However, drug effects on signaling pathways frequently upregulated in UFs remain largely unknown. In fact, the mechanisms of action of the UPA on UFs and on the surrounding areas are not yet understood. To learn more about UPA molecular mechanisms, UF samples were treated ex vivo with UPA and profiled for drug effects on selected markers. During this preliminary ex vivo UPA administration, significant changes were observed in the expression levels of proteins related to cell cycle regulation, cytoskeleton remodeling, and drug resistance. The UPA administration reduced cofilin, Erk and Src phosphorylation, p27 and ezrin protein levels, but not Akt phosphorylation and cyclin D1 and β-catenin levels. This preliminary ex vivo biological analysis provided new insights into the mechanism of action of UPA in the treatment of UFs, which could better explain the biological functioning of the drug on UFs.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, P.zza Muratore, Lecce, Italy
| | - Ioannis P Kosmas
- Ioannina State General Hospital G. Hatzikosta, Department of Obstetrics and Gynecology, University of Ioannina, Greece
| | - Ospan A Mynbaev
- Laboratory of Human Physiology, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | - Antonio Malvasi
- Department of Obstetrics & Gynecology, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Radmila Sparic
- Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Višegradska 26, 11000 Belgrade, Serbia
| | - Daniele Vergara
- Department of Biological and Environmental Sciences and Technologies, University of Salento, Lecce, Italy
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Yan Y, Yu H, Sun L, Liu H, Wang C, Wei X, Song F, Li H, Ge H, Qian H, Li X, Tang X, Liu P. Laminin α4 overexpression in the anterior lens capsule may contribute to the senescence of human lens epithelial cells in age-related cataract. Aging (Albany NY) 2020; 11:2699-2723. [PMID: 31076560 PMCID: PMC6535067 DOI: 10.18632/aging.101943] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 04/27/2019] [Indexed: 12/16/2022]
Abstract
Senescence is a leading cause of age-related cataract (ARC). The current study indicated that the senescence-associated protein, p53, total laminin (LM), LMα4, and transforming growth factor-beta1 (TGF-β1) in the cataractous anterior lens capsules (ALCs) increase with the grades of ARC. In cataractous ALCs, patient age, total LM, LMα4, TGF-β1, were all positively correlated with p53. In lens epithelial cell (HLE B-3) senescence models, matrix metalloproteinase-9 (MMP-9) alleviated senescence by decreasing the expression of total LM and LMα4; TGF-β1 induced senescence by increasing the expression of total LM and LMα4. Furthermore, MMP-9 silencing increased p-p38 and LMα4 expression; anti-LMα4 globular domain antibody alleviated senescence by decreasing the expression of p-p38 and LMα4; pharmacological inhibition of p38 MAPK signaling alleviated senescence by decreasing the expression of LMα4. Finally, in cataractous ALCs, positive correlations were found between LMα4 and total LM, as well as between LMα4 and TGF-β1. Taken together, our results implied that the elevated LMα4, which was possibly caused by the decreased MMP-9, increased TGF-β1 and activated p38 MAPK signaling during senescence, leading to the development of ARC. LMα4 and its regulatory factors show potential as targets for drug development for prevention and treatment of ARC.
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Affiliation(s)
- Yu Yan
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Haiyang Yu
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Liyao Sun
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Lab, Beijing, 100000, China
| | - Chao Wang
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Xi Wei
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Fanqian Song
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.,Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Hulun Li
- Department of Neurobiology, Neurobiology Key Laboratory, Harbin Medical University, Harbin, 150081, China
| | - Hongyan Ge
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
| | - Hua Qian
- Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Xiaoguang Li
- Department of Pharmacology, College of Pharmacy, Harbin Medical University, and Heilongjiang Academy of Medical Sciences, Harbin, 150081, China
| | - Xianling Tang
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
| | - Ping Liu
- Eye Hospital, First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China
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Differences in fibroid vascularity after three months of pre-treatment with leuprolide acetate or ulipristal acetate: A pilot study. Eur J Obstet Gynecol Reprod Biol 2019; 245:186-192. [PMID: 31679806 DOI: 10.1016/j.ejogrb.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate differences in volume and fibroid vascularity expressed in vascular index after three months of (pre-)treatment with leuprolide acetate (LPA) or ulipristal acetate (UPA). STUDY DESIGN Prospective pilot study of 23 premenopausal women with uterine fibroids. Patients who started with LPA or UPA and had at least one fibroid with a size between 3 and 12 cm, were included consecutively. Per patient one fibroid was evaluated. The ultrasound was performed at baseline and after three months using LPA or UPA using a standardized protocol. 3D scans were evaluated using VOCAL software to calculate outcomes of volume, vascular index (VI) without shell ("shell off") and of the inner shell. RESULTS Four patients in the LPA group were additionally excluded from analyses due to insufficient quality of 3D scans. In the ten remaining patients (pre-)treated with LPA both volume and vascular indices of the fibroid reduced significantly after three months from a median of 224.3 cm3 (IQR 338.0) to 124.8 cm3 (IQR 186.1) (p = 0,05); median VI fibroid (shell off) reduced from 4.30 (IQR 4.72) to 0.93 (IQR 1.54) (p = 0,05); and VI inner capsule from 6.34 (IQR 7.51) to 1.28 (IQR 2.13) (p = 0,05). After UPA (n = 9) changes in fibroid volume and vascular indices did not reach statistical significance. Volume reduced from 248.5 cm3 (IQR 271.9) to 140.7 cm3 (IQR 209.4) (p > 0,05); median VI fibroid (shell off) from 2.97 (IQR 3.81) to 2.90 (IQR 4.82) (p > 0,05); and VI inner capsule from 2.56 (IQR 7.48) to 2.89 (IQR 4.83) (p > 0,05). A strong positive correlation was found between the VI of the fibroid (shell off) at baseline with the volume change after three months of LPA use (LPA r = 0.636, p = 0.048, 95% CI = -0.03 - 1.00). CONCLUSION In this pilot study we observed a consistent and statistically significant decrease in VI and fibroid volume after three months of LPA treatment in patients with uterine fibroids. The decrease in fibroid volume and VI was less consistent after UPA use. The strong correlation between the VI at baseline and volume reduction, may in theory be used to predict the volume reduction after LPA.
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Submucous Fibroids, Fertility, and Possible Correlation to Pseudocapsule Thickness in Reproductive Surgery. BIOMED RESEARCH INTERNATIONAL 2018; 2018:2804830. [PMID: 30250847 PMCID: PMC6140098 DOI: 10.1155/2018/2804830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 06/24/2018] [Indexed: 11/18/2022]
Abstract
Background and Objectives Fibroids are related to infertility. Fibroid pseudocapsule is a neurovascular bundle surrounding leiomyomas rich of neurofibers involved in myometrial biology. Authors evaluated, by a case-control study, the fibroid pseudocapsule (FP) thickness by ultrasound (US) and the histological measurements, according to uterine location of fibroids. Methods 137 consecutive patients undergoing hysterectomy for uterine myomas were enrolled and 200 myomas were evaluated. Before surgery, patients underwent an ultrasound (US) investigation to evaluate the number, the size, and the location of fibroids. After surgery, myoma-pseudocapsule-myometrium specimens were measured and evaluated by a single expert pathologist. Both US and histological data were collected and statistically analyzed. Results Our results confirm the relevant difference of FP thickness, particularly represented under the endometrium for submucous LMs. FPs near the endometrial cavity were considerably thicker than those of both intramural fibroids and subserous fibroids measured by US (P=0.0001) and histology (P=0.0001). A clear cut-off measurement at 2 mm (P=0.0001) was found between endometrial FPs and all other FPs for either US or histology measurements. Conclusion The thickness of FP is considerably higher near the endometrial cavity when compared to those of both intramural and subserous LMs, suggesting a potential role either in fertility or in myometrial healing.
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Abstract
A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately.
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Affiliation(s)
- Mayra J Thompson
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce R Carr
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Knapp P, Chabowski A, Posmyk R, Górski J. Expression of the energy substrate transporters in uterine fibroids. Prostaglandins Other Lipid Mediat 2016; 123:9-15. [PMID: 26932421 DOI: 10.1016/j.prostaglandins.2016.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/16/2023]
Abstract
Proliferating cells exhibit accelerated rates of substrate utilization, favoring glucose over fatty acids (FA's) oxidation. Protein-mediated transport is thought to play a predominant role in facilitating either glucose or FA routing into the cells. In the present study, we examined the expression of glucose transporters (GLUT-1, GLUT-4) and fatty acids transporters (FAT/CD36, FATP-1, FATP-4) at transcript and protein levels as well as cytosolic fatty acid binding proteins (H-FABP, ACBP) in human fibroids (n=74, size up to 3cm diameter) and compared with pair-matched healthy myometrium. Additionally lipid content (diacylglycerols, triacylglycerols and ceramide) was estimated by gas liquid chromatography (GLC). Uterine fibroids displayed decreased expression of both FAT/CD36 and FATP-1 proteins along with lower diacylglycerol (DAG) and triacylglycerol (TAG) content as compared to healthy pair-matched myometrium. The expression of glucose transport proteins (GLUT-4 and GLUT-1) remained relatively constant, although the higher expression of GLUT-1 in uterine fibroids did not reach the minimum significance threshold (p=0.056). However, no change in either cytochrome c oxidase (COX IV) or hydroxyacyl-CoA dehydrogenase (HADHSC) was observed and these data confirm a possible metabolic shift favoring glucose utilization over fatty acid oxidation in human uterine fibroids.
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Affiliation(s)
- Paweł Knapp
- Department of Gynecology and Gynecologic Oncology, Medical University of Bialystok, 24a Sklodowskiej-Curie Str., 15-269 Bialystok, Poland.
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, 2c Mickiewicza Str., 15-222 Bialystok, Poland
| | - Renata Posmyk
- Department of Perinatology, Medical University of Bialystok, 24a Sklodowskiej-Curie Str., 15-269 Bialystok, Poland
| | - Jan Górski
- Department of Physiology, Medical University of Bialystok, 2c Mickiewicza Str., 15-222 Bialystok, Poland
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Di Tommaso S, Massari S, Malvasi A, Vergara D, Maffia M, Greco M, Tinelli A. Selective genetic analysis of myoma pseudocapsule and potential biological impact on uterine fibroid medical therapy. Expert Opin Ther Targets 2014; 19:7-12. [DOI: 10.1517/14728222.2014.975793] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Tinelli A, Mynbaev OA, Mettler L, Hurst BS, Pellegrino M, Nicolardi G, Kosmas I, Malvasi A. A combined ultrasound and histologic approach for analysis of uterine fibroid pseudocapsule thickness. Reprod Sci 2014; 21:1177-86. [PMID: 24879045 DOI: 10.1177/1933719114537719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Authors investigated 75 patients with uterine myomas, appraising whether fibroid pseudocapsule (FP) thickness varies depending on fibroid location, by a prospective cohort trial (level of evidence II-2) settled in University-affiliated Hospitals. Uteri were scanned via bidimensional and power Doppler ultrasound (US) to map the fibroids and record the FP thickness, prior to hysterectomy for symptomatic uterine fibroids. After hysterectomy, FP specimens were sampled and analyzed by pathologists. Ultrasound and histology data were matched. Pseudocapsule thickness of 108 fibroids was measured: subserosal fibroids (SSFs), intramural fibroids (IMFs), and fibroids near the endometrial cavity (FEC). The FEC's pseudocapsules were considerably thicker than those of IMF and SSF measured by US and histology (P = .001). A clear cutoff existed between FEC pseudocapsule thickness and all other pseudocapsules, with significant differences observed at 2 mm (P = .001). Similarity between histological and US measurements was observed only with IMF pseudocapsules, whereas FEC or SSF showed significant differences. The pseudocapsule of fibroids is considerably thicker near the endometrial cavity when compared to those of both IMFs and SSFs. Since fibroids closest to the endometrial cavity are the most involved in fertility and infertility and FP is considerably thicker near the endometrial cavity, it is possible to hypothesize an involvement of FP of fibroid near the endometrium since FP contains many neuropeptides and neurotransmitters that are physiologically active, even if these data may take on a broader meaning in a study on a larger number of patients.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Lecce, Italy
| | - Ospan A Mynbaev
- Moscow Institute of Physics & Technology, State University, Moscow, Russia Laboratory of pilot projects Moscow State University of Medicine & Dentistry, Moscow, Russia Department of ObGyn and Reproductive Medicine, Peoples' Friendship University of Russia, Moscow, Russia
| | - Liselotte Mettler
- Department of Obstetrics and Gynaecology, Kiel School of Gynaecological Endoscopy, University, Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Brad S Hurst
- Assisted Reproduction Center, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Giuseppe Nicolardi
- Human Anatomy and Neuroscience Unit, University of Salento, Lecce, Italy
| | - Ioannis Kosmas
- Department of Obstetrics and Gynecology, University of Ioannina, Ioannina, Greece
| | - Antonio Malvasi
- Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy
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Tinelli A, Mettler L, Malvasi A, Hurst B, Catherino W, Mynbaev OA, Guido M, Alkatout I, Schollmeyer T. Impact of surgical approach on blood loss during intracapsular myomectomy. MINIM INVASIV THER 2013; 23:87-95. [DOI: 10.3109/13645706.2013.839951] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Malvasi A, Cavallotti C, Nicolardi G, Pellegrino M, Dell'Edera D, Vergara D, Kumakiri J, Greco M, Tinelli A. NT, NPY and PGP 9.5 presence in myomeytrium and in fibroid pseudocapsule and their possible impact on muscular physiology. Gynecol Endocrinol 2013; 29:177-81. [PMID: 22849656 DOI: 10.3109/09513590.2012.708803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The uterine myoma pseudocapsule is a neurovascular bundle surrounding fibroid, containing neuropeptides, probably involved in uterine scar healing. We studied neurotensin (NT), neuropeptide tyrosine (NPY), and protein gene product 9.5 (PGP 9.5) nerve fibres in the pseudocapsule neurovascular bundle of intramural uterine fibroids on 67 no pregnant women by intracapsular myomectomy sparing the neurovascular bundle, sampling full thickness specimens of the pseudocapsule of uterine fibroids (PUF) and normal myometrium (NM) obtained from the fundus uteri (FU) and the uterine body (UB). The samples were sent for histological and immunofluorescent analyses and compared by morphometrical quantification. The Conventional Unit (C.U.) difference of NT, NPY, and PGP 9.5 nerve fibres was statistically analyzed. Our results showed that NT, NPY, and PGP 9.5 neurofibers are almost equally present in PUF as in NM of a no pregnant uterus. As all of these neuropeptides are present in the uterine muscle and can affect muscle contractility, uterine peristalsis and muscular healing. A myomectomy respecting the pseudocapsule neurofibers should facilitate smooth muscle scarring and promote restoration of normal uterine peristalsis with a possible positive influence on fertility.
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Affiliation(s)
- Antonio Malvasi
- Department of Obstetric & Gynecology, Santa Maria Hospital, Bari, Italy
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Tinelli A, Hurst BS, Mettler L, Tsin DA, Pellegrino M, Nicolardi G, Dell'Edera D, Malvasi A. Ultrasound evaluation of uterine healing after laparoscopic intracapsular myomectomy: an observational study. Hum Reprod 2012; 27:2664-2670. [DOI: 10.1093/humrep/des212] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Malvasi A, Cavallotti C, Morroni M, Lorenzi T, Dell'Edera D, Nicolardi G, Tinelli A. Uterine fibroid pseudocapsule studied by transmission electron microscopy. Eur J Obstet Gynecol Reprod Biol 2012; 162:187-91. [PMID: 22445207 DOI: 10.1016/j.ejogrb.2012.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 12/05/2011] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The fibroid pseudocapsule is a structure which surrounds the uterine fibroid, separates it from the uterine tissue and contains a vascular network rich in neurotransmitters like a neurovascular bundle. The authors examined the composition of the fibroid pseudocapsule using electron microscopy. STUDY DESIGN Twenty non-pregnant patients were submitted to laparoscopic myomectomy by the intracapsular method and samples of the removed pseudocapsules were analyzed using transmission electron microscopy. RESULTS At the ultrastructural level the pseudocapsule cells have the features of smooth muscle cells similar to the myometrium. So, the pseudocapsules are part of the myometrium which compresses the leiomyoma. CONCLUSION This ultrastructural feature suggests that when removing fibroids their pseudocapsules should be preserved. This study confirms preliminary evidence that pseudocapsules contain neuropeptides together with their related fibers, as a neurovascular bundle. The surgeon's behavior should be directed to carefully control and spare this muscular surrounding tissue during fibroid excision, in order to preserve the myometrium as much as possible.
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Affiliation(s)
- Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy.
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