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Ivanova M, Soule A, Pudwell J, Bougie O. The Association of Vitamin D with Uterine Fibroids in Premenopausal Patients: a Systematic Review and Meta-Analysis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024:102632. [PMID: 39128544 DOI: 10.1016/j.jogc.2024.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
OBJECTIVE This study aims to consolidate existing literature regarding the association between vitamin D and uterine fibroid presence and growth. DATA SOURCES A comprehensive search across databases including MEDLINE, Embase, CINAHL, Web of Science, ClinicalTrials.gov, and grey literature was conducted from inception to February 2023, using relevant keywords. Authors were contacted for unpublished data. STUDY SELECTION From 9931 studies screened based on title and abstract, those evaluating serum vitamin D levels or vitamin D treatment effects, using ultrasonography for diagnosis, and involving at least 25 pre-menopausal participants were included. Case reports, case series, and reviews were excluded. DATA EXTRACTION AND SYNTHESIS Data were extracted using a predefined form. Methodological quality was assessed through the Newcastle-Ottawa Scale and the Risk of Bias-2 tools. Evidence quality was evaluated using Grading of Recommendations Assessment, Development, and Evaluation. Data from three randomized controlled trials (n = 328) and 23 observational studies (n = 5650) were meta-analyzed via random effects modeling. Patients receiving oral vitamin D supplementation had a significantly different change in fibroid size (SMD -5.7%, CI -10.63 to -0.76, P = 0.02, I2 = 99%), as measured by percentage change in diameter or volume, compared to controls, over the span of 2-6 months. Those receiving supplementation had vitamin D insufficiency; regimens varied between 50 000 IU weekly for 12 weeks, 50 000 IU weekly for 8 weeks, and 50 000 IU biweekly for 10 weeks. Patients with fibroids exhibited lower serum vitamin D concentrations (MD -5.50 ng/mL, CI 6.99 to -4.01, P < 0.001, I2 = 87%) and higher odds of vitamin D deficiency (OR 3.71, CI 1.90-7.24, P < 0.001, I2 = 80%). CONCLUSION This review underscores the potential of vitamin D in mitigating fibroid development and growth. While promising, further research is warranted to optimize dosage and treatment duration, potentially offering a non-invasive solution for at-risk patients. Continued exploration of vitamin D's role in fibroid treatment is encouraged. OBJECTIF Cette étude vise à consolider la littérature existante concernant l'association entre la vitamine D et la présence et la croissance des fibromes utérins. SOURCE DES DONNéES: Une recherche exhaustive a été réalisée dans les bases de données MEDLINE, Embase, CINAHL, Web of Science et ClinicalTrials.gov et dans la littérature à l'aide de mots-clés pertinents pour la période allant de leur création à février 2023. Les auteurs ont été contactés pour obtenir des données non publiées. SéLECTION DES éTUDES: Dans les 9 931 études sélectionnées d'après leurs titre et résumé, seules celles ayant évalué les taux sériques de vitamine D ou les effets d'un traitement à la vitamine D, utilisé l'échographie pour le diagnostic et comptant au moins 25 participantes non ménopausées ont été retenues. Les études de cas, les études de série de cas et les revues n'ont pas été retenues. EXTRACTION DES DONNéES ET SYNTHèSE: Les données ont été extraites au moyen d'un formulaire prédéfini. La qualité méthodologique a été évaluée au moyen de l'échelle de Newcastle-Ottawa et de l'outil d'évaluation du risque de biais RoB-2. La qualité des données a été évaluée à l'aide de la méthodologie GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Les données de trois essais cliniques randomisés (n = 328) et de 23 études observationnelles (n = 5650) ont été méta-analysées à l'aide d'une modélisation à effets aléatoires. Les patientes recevant une supplémentation orale en vitamine D ont présenté un changement significativement différent de la taille des fibromes (différence des moyennes standardisées : -5,7 %; IC : -10,63 à -0,76; P = 0,02; I2 = 99 %), tel que mesuré par le changement en pourcentage du diamètre ou du volume, par rapport aux témoins, sur une période de 2 à 6 mois. Les personnes recevant une supplémentation présentaient une insuffisance en vitamine D; les schémas posologiques étaient de 50 000 UI par semaine pendant 12 semaines, 50 000 UI par semaine pendant 8 semaines ou 50 000 UI toutes les deux semaines pendant 10 semaines. Les patientes atteintes de fibromes avaient des concentrations sériques de vitamine D plus faibles (différence moyenne : -5,50 ng/mL; IC : 6,99 à -4,01; P < 0,001; I2 = 87 %) et un risque plus élevé de carence en vitamine D (RC : 3,71; IC : 1,90-7,24; P < 0,001; I2 = 80 %). CONCLUSION Cette étude souligne le potentiel de la vitamine D dans l'atténuation du développement et de la croissance des fibromes. Bien que ces conclusions soient prometteuses, la recherche doit se poursuivre afin d'optimiser le dosage et la durée du traitement, ce qui pourrait constituer une solution non invasive pour les patientes à risque. La poursuite de l'étude du rôle de la vitamine D dans le traitement des fibromes est encouragée.
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Affiliation(s)
- Marina Ivanova
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Allison Soule
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Jessica Pudwell
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Olga Bougie
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada.
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Capezzuoli T, Aslan B, Vannuccini S, Orlandi G, La Torre F, Sorbi F, Fambrini M, Petraglia F. Recurrence of Uterine Fibroids After Conservative Surgery or Radiological Procedures: a Narrative Review. Reprod Sci 2024; 31:1171-1178. [PMID: 38110820 DOI: 10.1007/s43032-023-01418-2] [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: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023]
Abstract
The present narrative review aims to discuss the available data on the incidence and the risk factors of uterine fibroids (UFs) recurrence after different types of conservative surgical or radiologic procedures in women wishing to preserve their uterus. UFs are the most common benign tumors in women all over the world. Clinical presentation, including abnormal uterine bleeding (AUB), pelvic pain, bulky symptoms, and infertility affect patients' quality of life, and a large variety of conservative treatments are available especially for those with desire of pregnancy. Fertility sparing surgery, by either laparoscopy, hysteroscopy or laparotomy, or radiological interventions (uterine artery embolization, high-intensity focused ultrasound or magnetic resonance-guided focused ultrasound), are the most common therapeutic approaches. However, the genetic or acquired predisposition to UFs remain despite the treatments, and the recurrences are frequently described in a large percentage of patients. The most relevant risk factors for recurrence of UFs are young age at the first surgery, incomplete fibroid resection, the presence of multiple lesions, an enlarged uterus, and the coexistence with other pelvic diseases. The discussion on the possible medical strategy to reduce the recurrence is an open field of clinical investigation, in particular by using hormonal drugs.
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Affiliation(s)
- Tommaso Capezzuoli
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Batuhan Aslan
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey
| | - Silvia Vannuccini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Gretha Orlandi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Francesco La Torre
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Massimiliano Fambrini
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Viale Morgagni 44, 50134, Florence, Italy.
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Noel NL, Abrams J, Mudafort ER, Babu A, Forbes E, Hill L, Hill CC, Valbrun TG, Osian N, Wise LA, Kuohung W. Study protocol for the implementation of Centering Patients with Fibroids, a novel group education and empowerment program for patients with symptomatic uterine fibroids. Reprod Health 2024; 21:41. [PMID: 38561795 PMCID: PMC10983732 DOI: 10.1186/s12978-024-01777-2] [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: 03/02/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Black women and people with uteri have utilized collectivistic and relational practices to improve health outcomes in the face of medical racism and discrimination for decades. However, there remains a need for interventions to improve outcomes of uterine fibroids, a condition that disproportionately impacts Black people with uteri. Leveraging personalized approaches alongside evidence that demonstrates the positive impact of social and peer support on health outcomes, we adapted from CenteringPregnancy, an evidence based group prenatal care intervention, for the education and empowerment of patients with uterine fibroids. METHODS The present report provides an overview of the study design and planned implementation of CPWF in cohorts at Boston Medical Center and Emory University / Grady Memorial Hospital. After receiving training from the Centering Healthcare Institute (CHI), we adapted the 10-session CenteringPregnancy curriculum to an 8-session hybrid group intervention called Centering Patients with Fibroids (CPWF). The study began in 2022 with planned recruitment of six cohorts of 10-12 participants at each institution. We will conduct a mixed methods evaluation of the program using validated survey tools and qualitative methods, including focus groups and 1:1 interviews. DISCUSSION To date, we have successfully recruited 4 cohorts at Boston Medical Center and are actively implementing BMC Cohort 5 and the first cohort at Emory University / Grady Memorial Hospital. Evaluation of the program is forthcoming.
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Affiliation(s)
- Nyia L Noel
- Department of Obstetrics & Gynecology, Chobanian and Avedisian School of Medicine, Boston University, Boston Medical Center, Boston, MA, USA.
| | - Jasmine Abrams
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Estefania Rivera Mudafort
- Department of Obstetrics & Gynecology, Chobanian and Avedisian School of Medicine, Boston University, Boston Medical Center, Boston, MA, USA
| | - Anagha Babu
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Emma Forbes
- Department of Obstetrics & Gynecology, Chobanian and Avedisian School of Medicine, Boston University, Boston Medical Center, Boston, MA, USA
| | | | - Cherie C Hill
- Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Nkem Osian
- The White Dress Project, Atlanta, GA, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Wendy Kuohung
- Department of Obstetrics & Gynecology, Chobanian and Avedisian School of Medicine, Boston University, Boston Medical Center, Boston, MA, USA
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Alsharif SA, Baradwan S, Alshahrani MS, Khadawardi K, AlSghan R, Badghish E, Bukhari IA, Alyousef A, Khuraybah AM, Alomar O, Abu-Zaid A. Effect of Oral Consumption of Vitamin D on Uterine Fibroids: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutr Cancer 2024; 76:226-235. [PMID: 38234246 DOI: 10.1080/01635581.2023.2288716] [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: 08/24/2023] [Revised: 11/12/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
Impaired vitamin D status is highly prevalent among women with UFs. The objective of this first-ever systematic review and meta-analysis was to summarize the effect of vitamin D supplementation on the size of uterine fibroids (UFs). We performed a comprehensive literature search for published randomized controlled trials (RCTs) in Medline, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from inception to September 2022. Five trials including 511 participants (256 cases and 255 controls) were included. Pooling results from five trials, which compared size of UFs between experimental and placebo groups, revealed that vitamin D supplementation could significantly decrease the size of UFs (standardized mean difference [SMD]: -0.48, 95% confidence interval [CI]: -0.66, -0.31) and cause improvement in serum level of vitamin D compared to placebo group (SMD: 3.1, 95% CI: 0.66, 5.55). A significant effect was observed in the subset of trials administering vitamin D supplementation for >8 wk (SMD: -0.62, 95% CI: -0.88, -0.37). In conclusion, vitamin D supplementation significantly increases serum levels of vitamin D and reduces the size of UFs. However, larger, well-designed RCTs are still needed to determine the effect of vitamin D on other parameters of UFs.
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Affiliation(s)
- Saud Abdullah Alsharif
- Department of Obstetrics and Gynecology, College of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, Alkharj, Saudi Arabia
| | - Ehab Badghish
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah, Saudi Arabia
| | - Ibtihal Abdulaziz Bukhari
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdullah Alyousef
- Department of Obstetrics and Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | | | - Osama Alomar
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Ali M, Ciebiera M, Wlodarczyk M, Alkhrait S, Maajid E, Yang Q, Hsia SM, Al-Hendy A. Current and Emerging Treatment Options for Uterine Fibroids. Drugs 2023; 83:1649-1675. [PMID: 37922098 DOI: 10.1007/s40265-023-01958-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
Uterine fibroids are the most common benign neoplasm of the female reproductive tract in reproductive age women. Their prevalence is age dependent and can be detected in up to 80% of women by the age of 50 years. Patients affected by uterine fibroids may experience a significant physical, emotional, social, and financial toll as well as losses in their quality of life. Unfortunately, curative hysterectomy abolishes future pregnancy potential, while uterine-sparing surgical and radiologic alternatives are variously associated with reduced long-term reproductive function and/or high tumor recurrence rates. Recently, pharmacological treatment against uterine fibroids have been widely considered by patients to limit uterine fibroid-associated symptoms such as heavy menstrual bleeding. This hormonal therapy seemed effective through blocking the stimulatory effects of gonadal steroid hormones on uterine fibroid growth. However, they are contraindicated in women actively pursuing pregnancy and otherwise effective only during use, which is limited because of long-term safety and other concerns. Accordingly, there is an urgent unmet need for safe, durable, and fertility-compatible non-surgical treatment options for uterine fibroids. In this review article, we cover the current pharmacological treatments for uterine fibroids including their comparable efficacy and side effects as well as emerging safe natural compounds with promising anti-uterine fibroid effects.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, 11566, Egypt
| | - Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, 00-189, Poland
| | - Marta Wlodarczyk
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy, Medical University of Warsaw, Banacha 1B, Warsaw, 02-097, Poland
- Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Samar Alkhrait
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Elise Maajid
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Shih-Min Hsia
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei, 11031, Taiwan
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
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Combs A, Singh B, Nylander E, Islam MS, Nguyen HV, Parra E, Bello A, Segars J. A Systematic Review of Vitamin D and Fibroids: Pathophysiology, Prevention, and Treatment. Reprod Sci 2023; 30:1049-1064. [PMID: 35960442 DOI: 10.1007/s43032-022-01011-z] [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: 03/31/2022] [Accepted: 06/12/2022] [Indexed: 10/16/2022]
Abstract
Uterine fibroids are the most common tumor of reproductive-age women worldwide and cause significant morbidity in affected women. Vitamin D has emerged as a potential therapy for uterine fibroids based on experimental and epidemiologic evidence. The objective of this systematic review was to evaluate the role of vitamin D in the pathophysiology of uterine fibroids and its efficacy for prevention and treatment of fibroids. A comprehensive search was conducted of Cochrane Library, Embase, PubMed, Scopus, and Web of Science from inception to March 2022. English-language publications that evaluated vitamin D and uterine fibroids in humans, whether experimental or clinical, were considered. The search yielded 960 publications, and 89 publications met inclusion criteria: 23 preclinical studies, 25 clinical studies, and 41 review articles. Preclinical studies indicated that the vitamin D receptor was decreased in fibroid cells. Vitamin D treatment of fibroid cells decreased proliferation, extracellular matrix protein expression, and Wnt/β-catenin signaling. Fourteen clinical studies (n = 3535 participants) assessed serum vitamin D level in women with ultrasound-proven fibroids, and all found an inverse correlation between serum vitamin D level and presence of fibroids. Five clinical studies (n = 472 patients) evaluated treatment of fibroids with vitamin D. Four of five studies showed vitamin D significantly inhibited fibroid growth. One pilot study (n = 109 patients) of vitamin D for secondary prevention of fibroids demonstrated smaller recurrent fibroids in the treated group. These studies provide evidence for vitamin D as a therapy for uterine fibroids and underscore the need for well-designed, randomized, placebo-controlled clinical trials.
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Affiliation(s)
- Abigail Combs
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bhuchitra Singh
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Elisabeth Nylander
- Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Md Soriful Islam
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Ha Vi Nguyen
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Elissa Parra
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - Ameerah Bello
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA
| | - James Segars
- Division of Reproductive Sciences and Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Ross Research Building, 720 Rutland AvenueRoom 624, Baltimore, MD, USA.
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Elkafas H, Walls M, Al-Hendy A, Ismail N. Gut and genital tract microbiomes: Dysbiosis and link to gynecological disorders. Front Cell Infect Microbiol 2022; 12:1059825. [PMID: 36590579 PMCID: PMC9800796 DOI: 10.3389/fcimb.2022.1059825] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Every year, millions of women are affected by genital tract disorders, such as bacterial vaginosis (BV), endometrial cancer, polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids (UFs). These disorders pose a significant economic burden on healthcare systems and have serious implications for health and fertility outcomes. This review explores the relationships between gut, vaginal, and uterine dysbiosis and the pathogenesis of various diseases of the female genital tract. In recent years, reproductive health clinicians and scientists have focused on the microbiome to investigate its role in the pathogenesis and prevention of such diseases. Recent studies of the gut, vaginal, and uterine microbiomes have identified patterns in bacterial composition and changes across individuals' lives associated with specific healthy and diseased states, particularly regarding the effects of the estrogen-gut microbiome axis on estrogen-driven disorders (such as endometrial cancer, endometriosis, and UFs) and disorders associated with estrogen deficiency (such as PCOS). Furthermore, this review discusses the contribution of vitamin D deficiency to gut dysbiosis and altered estrogen metabolism as well as how these changes play key roles in the pathogenesis of UFs. More research on the microbiome influences on reproductive health and fertility is vital.
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Affiliation(s)
- Hoda Elkafas
- Department of Pharmacology and Toxicology, Egyptian Drug Authority [EDA; formerly The National Organization for Drug Control and Research (NODCAR)], Cairo, Egypt
| | - Melinique Walls
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, United States
| | - Nahed Ismail
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, United States
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Paul EN, Grey JA, Carpenter TJ, Madaj ZB, Lau KH, Givan SA, Burns GW, Chandler RL, Wegienka GR, Shen H, Teixeira JM. Transcriptome and DNA methylome analyses reveal underlying mechanisms for the racial disparity in uterine fibroids. JCI Insight 2022; 7:160274. [PMID: 36066972 PMCID: PMC9714787 DOI: 10.1172/jci.insight.160274] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
Uterine fibroids (leiomyomas) affect Black women disproportionately compared with women of other races and ethnicities in terms of prevalence, incidence, and severity of symptoms. The causes of this racial disparity are essentially unknown. We hypothesized that myometria of Black women are more susceptible to developing fibroids, and we examined the transcriptomic and DNA methylation profiles of myometria and fibroids from Black and White women for comparison. Myometrial samples cluster by race in both their transcriptome and DNA methylation profiles, whereas fibroid samples only cluster by race in the latter. More differentially expressed genes (DEGs) were detected in the Black and White myometrial sample comparison than in the fibroid comparison. Leiomyoma gene set expression analysis identified 4 clusters of DEGs, including a cluster of 24 genes with higher expression in myometrial samples from Black women. One of the DEGs in this group, von Willibrands factor (VWF), was significantly hypomethylated in both myometrial samples from Black women and in all fibroids at 2 CpG probes that are near a putative enhancer site and that are correlated with VWF expression levels. These results suggest that the molecular basis for the disparity in fibroid disease between Black and White women could be found in the myometria before fibroid development and not in the fibroids themselves.
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Affiliation(s)
- Emmanuel N. Paul
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Joshua A. Grey
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Tyler J. Carpenter
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Zachary B. Madaj
- Bioinformatics and Biostatistics, Van Andel Institute, Grand Rapids, Michigan, USA
| | - Kin H. Lau
- Bioinformatics and Biostatistics, Van Andel Institute, Grand Rapids, Michigan, USA
| | - Scott A. Givan
- Bioinformatics and Biostatistics, Van Andel Institute, Grand Rapids, Michigan, USA
| | - Gregory W. Burns
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Ronald L. Chandler
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Ganesa R. Wegienka
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hui Shen
- Department of Epigenetics, Van Andel Institute, Grand Rapids, Michigan, USA
| | - Jose M. Teixeira
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Ouh YT, Min KJ, Lee S, Hong JH, Song JY, Lee JK, Lee NW. Analysis of the Relationship between Socioeconomic Status and Incidence of Hysterectomy Using Data of the Korean Genome and Epidemiology Study (KoGES). Healthcare (Basel) 2022; 10:997. [PMID: 35742048 PMCID: PMC9223165 DOI: 10.3390/healthcare10060997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/05/2023] Open
Abstract
Hysterectomy remains a frequent gynecologic surgery, although its rates have been decreasing. The aim of this study was to investigate whether socioeconomic status affected the risk of hysterectomy in Korean women. This prospective cohort study used epidemiologic data from 2001 to 2016, from the Korean Genomic and Epidemiology Study (KoGES). Multivariate logistic regression analyses were performed to estimate the association between household income or education level and hysterectomy. Among 5272 Korean women aged 40−69 years, 720 who had a hysterectomy and 4552 controls were selected. Variable factors were adjusted using logistic regression analysis (adjusted model). Adjusted odds ratios (aORs) for insurance type and hysterectomy were not statistically significant. The aOR was 1.479 (95% confidence interval (CI): 1.018−2.146, p < 0.05) for women with education of high school or lower compared to college or higher. Women whose monthly household income was
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Affiliation(s)
- Yung-Taek Ouh
- Department of Obstetrics and Gynecology, School of Medicine, Kangwon National University, Chuncheon 24289, Korea;
| | - Kyung-Jin Min
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea;
| | - Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul 02841, Korea; (S.L.); (J.Y.S.)
| | - Jin-Hwa Hong
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (J.-H.H.); (J.-K.L.)
| | - Jae Yun Song
- Department of Obstetrics and Gynecology, Korea University Anam Hospital, Seoul 02841, Korea; (S.L.); (J.Y.S.)
| | - Jae-Kwan Lee
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul 08308, Korea; (J.-H.H.); (J.-K.L.)
| | - Nak Woo Lee
- Department of Obstetrics and Gynecology, Korea University Ansan Hospital, Ansan 15355, Korea;
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10
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Relation between vitamin D and uterine fibroid. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background; Uterine fibroids (UFs) are benign tumors that develop from the uterus' smooth muscle cells and are mostly found in the pelvic. Aim of the work; we aimed to compare serum vitamin D level between patients, have uterine fibroids and those without. Subjects and methods; our current study included 90 females and was conducted as a case control study; 50 were diagnosed with uterine fibroid and 40 were healthy volunteers (control) during the period from July 2019 to July 2020. they were recruited from Al Zahra’a University Hospital. Serum vitamin D level was measured by ELISA. Results; Vitamin D serum concentrations were significantly lower in the studied females with UFs compared to healthy controls (mean 19.24 ±16.0 vs. 33.83 ±17.5) ng/mL in cases and controls, respectively, with a statistically significant p-value <0.001. Serum vitamin D levels have a significant, linear, negative, moderate association with uterine fibroids size. Conclusion; in our study group, reduced serum vitamin D levels were found to be inversely related to UF burden. A lack of vitamin D may be a risk factor for the incidence of uterine fibroids.
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11
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The Impact of Uterine Fibroids on Fertility: How the Uncertainty Widens the Gap in Reproductive Outcomes in Black Women. Reprod Sci 2022; 29:1967-1973. [PMID: 35211882 DOI: 10.1007/s43032-022-00882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Uterine fibroids (UFs) are the most common pelvic tumor in women. While the decreased quality of life and significant morbidity has been implicated with UFs, several important questions regarding the effect of UFs on reproductive outcomes remain unanswered. Furthermore, there is a disproportionate impact of UFs in Black women, in whom these tumors are known to be more common and more severe. The racial difference in UF burden is heightened during prime reproductive years, during which Black women undergo surgical intervention at an astoundingly increased rate compared to other races. Despite this, Black women are underrepresented in UF and treatment outcome research, and thus the uncertainty of the impact of UFs and UF treatment on fertility and pregnancy outcomes in this population is less defined. The purpose of this review article is to discuss recent findings in the literature regarding the impact of uterine UFs on reproductive outcomes with a primary focus on the implications for Black women. Additionally, we briefly discuss the importance of increased UF research funding and investigation and propose actionable items to help increase the representation of Black women in UF research.
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12
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Dietary Natural Compounds and Vitamins as Potential Cofactors in Uterine Fibroids Growth and Development. Nutrients 2022; 14:nu14040734. [PMID: 35215384 PMCID: PMC8880543 DOI: 10.3390/nu14040734] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/03/2022] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
An analysis of the literature generated within the past 20 year-span concerning risks of uterine fibroids (UFs) occurrence and dietary factors was carried out. A link between Vitamin D deficiency and UFs formation is strongly indicated, making it a potent compound in leiomyoma therapy. Analogs of the 25-hydroxyvitamin D3, not susceptible to degradation by tissue 24-hydroxylase, appear to be especially promising and tend to show better therapeutic results. Although research on the role of Vitamin A in the formation of fibroids is contradictory, Vitamin A-enriched diet, as well as synthetic retinoid analogues, may be preventative or limit the growth of fibroids. Unambiguous conclusions cannot be drawn regarding Vitamin E and C supplementation, except for alpha-tocopherol. Alpha-tocopherol as a phytoestrogen taking part in the modulation of estrogen receptors (ERs) involved in UF etiology, should be particularly avoided in therapy. A diet enriched in fruits and vegetables, as sources of carotenoids, polyphenols, quercetin, and indole-3-carbinol, constitutes an easily modifiable lifestyle element with beneficial results in patients with UFs. Other natural substances, such as curcumin, can reduce the oxidative stress and protect against inflammation in leiomyoma. Although the exact effect of probiotics on uterine fibroids has not yet been thoroughly evaluated at this point, the protective role of dairy products, i.e., yogurt consumption, has been indicated. Trace elements such as selenium can also contribute to antioxidative and anti-inflammatory properties of a recommended diet. In contrast, heavy metals, endocrine disrupting chemicals, cigarette smoking, and a diet low in antioxidants and fiber were, alongside genetic predispositions, associated with UFs formation.
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13
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Guo W, Dai M, Zhong Z, Zhu S, Gong G, Chen M, Guo J, Zhang Y. The association between vitamin D and uterine fibroids: A mendelian randomization study. Front Genet 2022; 13:1013192. [PMID: 36212159 PMCID: PMC9532761 DOI: 10.3389/fgene.2022.1013192] [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: 08/06/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Uterine fibroids (UFs), the most common benign gynecological tumor, can bring severe negative impacts on a woman's life quality. Vitamin D, is thought to play an important role in regulating cell proliferation and differentiation. In recent years, several studies suggested that higher level of vitamin D has a negative effect on the occurrence of UFs, but the results of studies on the relationship between them are conflicting and further evidence needs to be studied. Here in, we used a two-sample Mendelian Randomization (2SMR) study to explore the causal relationship between genetically predicted vitamin D levels and the risk of UFs. The exposure data comes from a genome-wide association study (GWAS) summary dataset consisting of 441,291 individuals, which includes datasets from United Kingdom Biobank, FinnGen Biobank and the corresponding consortia. Single-nucleotide polymorphisms (SNPs) associated with vitamin D at a significant level of p < 5 × 10-8 and low linkage disequilibrium (LD) level (r2 < 0.01) were selected. The outcome data comes from a GWAS dataset of IEU analysis of United Kingdom Biobank phenotypes consisting of 7,122 UFs cases and 455,811 controls. Our inverse-variance weight (IVW) analysis results support the causal association of genetically predicted vitamin D with the risk of UFs (OR = 0.995,95% CI = 0.990-0.999, p = 0.024). In addition, heterogeneity and pleiotropy were not observed in statistical models. In summary, our results indicate that elevated serum vitamin D levels are in strong relationship with reduction of the risk of UFs, which indicates that the clinical treatment of UFs may have a new and excellent option.
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Affiliation(s)
- Weijie Guo
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Mengyuan Dai
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Zhuoling Zhong
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - San Zhu
- Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Guidong Gong
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Mei Chen
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Junling Guo
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China.,State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, Sichuan, China
| | - Yaoyao Zhang
- Department of Obstetrics and Gynecology of West China Second University Hospital, BMI Center for Biomass Materials and Nanointerfaces, College of Biomass Science and Engineering, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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14
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Abstract
Uterine fibroids (leiomyomas) are present in >75% of women and can cause serious morbidity. They are by far the leading cause of hysterectomy. Fibroids are a complex mixture of cells that include fibroblasts and smooth muscle cells. Rich in extracellular matrix, they typically arise through somatic mutations, most commonly MED12. Their lack of growth inhibition and their ability to have facets of malignancy yet be histologically and biologically benign provide opportunities to explore basic processes. To date, the mechanisms responsible for growth and development of leiomyomas are an enigma. This review provides an overview of current understanding and future directions for clinical and basic research of fibroids.
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Affiliation(s)
- Elizabeth A. Stewart
- 1Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota,2Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota,3Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota,4Department of Surgery, Mayo Clinic, Rochester, Minnesota,5Women’s Health Research Center, Mayo Clinic, Rochester, Minnesota
| | - Romana A. Nowak
- 6Department of Animal Sciences, University of Illinois, Urbana, Illinois,7Institute for Genomic Biology, University of Illinois, Urbana, Illinois
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15
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Aninye IO, Laitner MH. Uterine Fibroids: Assessing Unmet Needs from Bench to Bedside. J Womens Health (Larchmt) 2021; 30:1060-1067. [PMID: 34410867 PMCID: PMC8432600 DOI: 10.1089/jwh.2021.0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Uterine fibroids (leiomyomas) are noncancerous growths that can have deleterious effects on the health and quality of life for millions of women. Attempts to better understand the factors that influence prevalence and disparities associated with fibroids have been made; however, significant knowledge gaps continue to persist, which hinder care for individuals living with fibroids. The Society for Women's Health Research convened an interdisciplinary Uterine Fibroids Working Group to review the current state of knowledge about uterine fibroids and recommend areas in which to prioritize efforts to address research gaps and improve diagnosis, treatment, and access to care for patients with this chronic disease. Throughout a 2-day roundtable meeting, participants discussed updates on key literature, research, clinical practice, and public health data on uterine fibroids. Overarching themes and recommendations were identified and determined by consensus agreement of the participants at the conclusion of the meeting. Systematic studies of the etiology and pathology of uterine fibroids are needed to address important knowledge gaps and unmet clinical needs regarding the multifaceted management of fibroids and their effects on overall health and quality of life. The Working Group recommends addressing key deficits within the spheres of research, clinical care, and federal policy. Immediate needs include increasing research investment, improving fibroid assessment using pelvic imaging, implementing longitudinal study designs, addressing factors that contribute to disease disparities (especially among women of color), developing fertility-friendly treatment options, expanding awareness and education beyond gynecologic specialists, and advancing personalized patient care through shared decision-making approaches.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, Washington, District of Columbia, USA
| | - Melissa H Laitner
- Society for Women's Health Research, Washington, District of Columbia, USA
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16
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Uterine Fibroids and Infertility. Diagnostics (Basel) 2021; 11:diagnostics11081455. [PMID: 34441389 PMCID: PMC8391505 DOI: 10.3390/diagnostics11081455] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/29/2021] [Accepted: 08/10/2021] [Indexed: 02/01/2023] Open
Abstract
Infertility is a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Uterine fibroids are the most common tumor in women, and their prevalence is high in patients with infertility. Fibroids may be the sole cause of infertility in 2–3% of women. Depending on their location in the uterus, fibroids have been implicated in recurrent pregnancy loss as well as infertility. Pregnancy and live birth rates appear to be low in women with submucosal fibroids; their resection has been shown to improve pregnancy rates. In contrast, subserosal fibroids do not affect fertility outcomes and their removal does not confer any benefit. Intramural fibroids appear to reduce fertility, but recommendations concerning their treatment remain unclear. Myomectomy should be discussed individually with the patient; other potential symptoms such as dysmenorrhea or bleeding disorders should be included in the indication for surgery.
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17
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Ciebiera M, Ali M, Prince L, Zgliczyński S, Jakiel G, Al-Hendy A. The Significance of Measuring Vitamin D Serum Levels in Women with Uterine Fibroids. Reprod Sci 2021; 28:2098-2109. [PMID: 33108619 PMCID: PMC8262605 DOI: 10.1007/s43032-020-00363-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
Abstract
Uterine fibroids (UFs) are benign tumors originating from smooth muscle cells and are considered a common pathology that affects numerous women which is a notable socio-economic problem. Several UF risk factors have been identified including black race, obesity, and vitamin D deficiency. Vitamin D is steroid compound with pleiotropic effects on the human body. Vitamin D deficiency is a major public health concern worldwide. Several studies have shown that the majority of UF patients experienced hypovitaminosis D. In addition, sufficient vitamin D serum levels are associated with the reduced risk of UFs. In this review, we present available data highlighting the importance of measuring vitamin D serum levels in women with UFs and women at a high risk for UF development. We proposed a preliminary clinical instruction of 25-hydroxyvitamin D measurements and vitamin D supplementation for clinicians who are involved in the treatment of patients with UFs. Achieving sufficient serum levels of vitamin D might be of interest in patients with UFs. Screening, supplementation, treatment guidelines, and public health strategies for vitamin D deficiency in women with UFs as well as women at a high risk of UF development might be of potential importance as well.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, ul. Cegłowska 80, 01-809, Warsaw, Poland.
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - Mohamed Ali
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Lillian Prince
- Biological Sciences Division: Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Stanisław Zgliczyński
- Department of Internal Diseases and Endocrinology, Central Teaching Clinical Hospital, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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18
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Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies. Nutrients 2021; 13:nu13061747. [PMID: 34063835 PMCID: PMC8224039 DOI: 10.3390/nu13061747] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/17/2022] Open
Abstract
A healthy lifestyle and a balanced diet play a paramount role in promoting and maintaining homeostatic functions and preventing an array of chronic and debilitating diseases. Based upon observational and epidemiological investigations, it is clear that nutritional factors and dietary habits play a significant role in gynecological disease development, including uterine leiomyoma, endometriosis, polycystic ovary syndrome, and gynecological malignancies. Diets rich in fruits and vegetables, Mediterranean diets, green tea, vitamin D, and plant-derived natural compounds may have a long-term positive impact on gynecological diseases, while fats, red meat, alcohol, and coffee may contribute to their development. Data regarding the association between dietary habits and gynecological disorders are, at times, conflicting, with potential confounding factors, including food pollutants, reduced physical activity, ethnic background, and environmental factors limiting overall conclusions. This review provides a synopsis of the current clinical data and biological basis of the association between available dietary and nutritional data, along with their impact on the biology and pathophysiology of different gynecological disorders, as well as an outlook on future directions that will guide further investigational research.
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Lima MSO, da Silva BB, de Medeiros ML, Dos Santos AR, do Nascimento Brazil ED, Filho WMNE, Ibiapina JO, Brito AGA, Costa PVL. Evaluation of vitamin D receptor expression in uterine leiomyoma and nonneoplastic myometrial tissue: a cross-sectional controlled study. Reprod Biol Endocrinol 2021; 19:67. [PMID: 33952298 PMCID: PMC8097942 DOI: 10.1186/s12958-021-00752-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Uterine myomas are the most frequent benign solid pelvic tumors in women of reproductive age. At present, uterine myomas are the most common indication for hysterectomy because of the morbidity they cause, including intense bleeding, compression of adjacent organs, pain, and infertility. Some studies show that vitamin D receptor (VDR) expression is correlated with the etiology of uterine leiomyomas. This study aimed to assess the expression of VDR in uterine leiomyoma and nonneoplastic myometrial tissue. METHODS A controlled cross-sectional study involving 40 women who underwent abdominal hysterectomy the Department of Gynecology of the Getúlio Vargas Hospital of Federal University of Piauí, Brazil, was performed to compare the immunohistochemical expression of VDR in samples of uterine leiomyoma tissue with adjacent nonneoplastic myometrial tissue. The mean percetages of stained nuclei in the two groups was compared by Student's t teste, with significance established at p < 0.05. RESULTS The percentage of cells with nuclei stained by anti-VDR in the myometrial and leiomyoma tissue was 79.52 % (± 4.32) and 60.22 % (± 7.24), respectively (p < 0.0001). CONCLUSIONS The mean percentage of nuclei expressing VDR was significantly lower in the uterine leiomyoma than in nonneoplastic myometrial tissue.
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Affiliation(s)
- Maria Simone Oliveira Lima
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil
| | - Benedito Borges da Silva
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil
| | - Menandro Lima de Medeiros
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil
| | - Alesse Ribeiro Dos Santos
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil
| | | | | | - Jerusia Oliveira Ibiapina
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil
| | | | - Pedro Vitor Lopes Costa
- Department of Gynecology, Federal University of Piauí, Rua Doutor Anisio Maia, 1261, Ininga, Piauí, 64049-810, Teresina, Brazil.
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20
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Suneja A, Faridi F, Bhatt S, Guleria K, Mehndiratta M, Sharma R. Effect of Vitamin D3 Supplementation on Symptomatic Uterine Leiomyoma in Women with Hypovitaminosis D. J Midlife Health 2021; 12:53-60. [PMID: 34188427 PMCID: PMC8189330 DOI: 10.4103/jmh.jmh_90_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 04/04/2020] [Accepted: 11/21/2020] [Indexed: 01/14/2023] Open
Abstract
Objective The objective of this study is to evaluate the effect of Vitamin D3 on symptoms, uterine and leiomyoma volume in women with symptomatic leiomyoma and hypovitaminosis D. Materials and Methods In this pilot, interventional, prospective study, 30 premenopausal women with uterine leiomyoma and concomitant hypovitaminosis D (<30 ng/ml) received Vitamin D3 in doses of 60,000 IU weekly for 8 weeks followed by 60,000 IU every 2 weeks for another 8 weeks. Change in symptoms, uterine, and leiomyoma volume was evaluated at 8 weeks and 16 weeks. Serum Vitamin D3 levels were repeated at 16 weeks of therapy. Results A significant negative correlation was observed between the baseline 25-hydroxy Vitamin D (25(OH) Vitamin D3) and leiomyoma volume (r = -0.434, P < 0.001). There was significant reduction of menstrual blood loss by 29.89% (P = 0.003) and severity of dysmenorrhea, pelvic pain, and backache by 44.12%, 35%, and 50% (P < 0.001, 0.019, and 0.002), respectively, at 16 weeks. At end of therapy, there was 6% reduction in mean uterine volume and 11% in leiomyoma volume which was not significant. Serum 25(OH) Vitamin D3 was significantly higher than baseline level (17.44 ± 5.82 vs. 39.38 ± 8.22, P < 0.001) at end of therapy. Conclusion Vitamin D3 supplementation is effective in reducing leiomyoma-related symptoms and stabilizing uterine and leiomyoma volume.
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Affiliation(s)
- Amita Suneja
- Department of Gynecology and Obstetrics, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Fahmina Faridi
- Department of Gynecology and Obstetrics, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Kiran Guleria
- Department of Gynecology and Obstetrics, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Mohit Mehndiratta
- Department of Biochemistry, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
| | - Richa Sharma
- Department of Gynecology and Obstetrics, University College of Medical Sciences and GTB Hospital, University of Delhi, Delhi, India
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21
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Li S, Chen B, Sheng B, Wang J, Zhu X. The associations between serum vitamin D, calcium and uterine fibroids in Chinese women: a case-controlled study. J Int Med Res 2021; 48:300060520923492. [PMID: 32458705 PMCID: PMC7273764 DOI: 10.1177/0300060520923492] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective To investigate the associations between serum vitamin D, calcium and uterine
fibroids in a Chinese female population. Methods In this case-control study, adult female patients with fibroids (cases) were
compared with females without fibroids (controls) in terms of serum
25-hydroxyvitamin D (25OHD) and calcium levels. Results Out of 546 total participants (mean age, 41.68 ± 5.99 years; 279 with
fibroids and 267 without fibroids), only 232 had serum 25OHD levels above
the sufficient threshold (>20 ng/ml). In addition, females with fibroids
had lower serum 25OHD levels versus those without fibroids. The prevalence
of fibroids in females with deficient (<12 ng/ml) and insufficient
(12–20 ng/ml) 25OHD levels were significantly higher than in females with
sufficient (>20 ng/ml) 25OHD levels. Serum calcium levels were within
normal range in both groups. Conclusion Hypovitaminosis D was highly prevalent among a population of Chinese females
of reproductive-age, and serum 25OHD levels were lower in female patients
with fibroids.
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Affiliation(s)
- Saisai Li
- Department of Obstetrics and Gynaecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Beilei Chen
- Department of Obstetrics and Gynaecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bo Sheng
- Department of Obstetrics and Gynaecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Wang
- Department of Obstetrics and Gynaecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xueqiong Zhu
- Department of Obstetrics and Gynaecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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22
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Uterine Fibroids and Diet. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031066. [PMID: 33504114 PMCID: PMC7908561 DOI: 10.3390/ijerph18031066] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 12/26/2022]
Abstract
Uterine myomas or fibroids are the most common benign female tumors of the reproductive organs, associated with significant morbidity and quality of life impairment. Several epidemiological risk factors for their occurrence have been identified so far, including nutrition and dietary habits. In this investigation, authors reviewed, as a narrative review, the data about diet and uterine myoma development in order to homogenize the current data. A PubMed search was conducted for the years 1990–2020, using a combination of keywords of interest for the selected topic. The authors searched the databases, selecting the randomized clinical studies, the observational studies, and the basic (experimental), clinical, and epidemiological researches. Once they collected the articles, they analyzed them according to the number of citations of each article, starting from the most cited to the least cited articles. Subsequently, authors collected the data of each article and inserted them in the various research paragraphs, summarizing the data collected. In this way, they crossed the available data regarding the association between nutrition habits and dietary components and myoma onset and growth. Many nutrients and dietary habits are associated with myoma development risk. These factors include low intakes of fruit, vegetables, and vitamin D, as well as pollutants in food. Despite the available data on the influence of some foods on the development of fibroids, further research is mandatory to understand all the nutrition risk factors which contribute to myoma growth and how exactly these risk factors influence myoma pathogenesis.
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Ciebiera M, Wrzosek M, Wojtyła C, Zaręba K, Nowicka G, Jakiel G, Włodarczyk M. Vitamin D receptor gene polymorphisms and uterine fibroid incidence in Caucasian women. Arch Med Sci 2021; 17:1643-1650. [PMID: 34900044 PMCID: PMC8641505 DOI: 10.5114/aoms.2019.81748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 11/03/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Uterine fibroids (UFs) are benign tumors which are derived from the smooth muscle cells of the uterus. Recent studies have demonstrated that the development of UFs can be particularly related to vitamin D and its receptor. Vitamin D comprises a group of fat-soluble steroid compounds which exert powerful, pleiotropic effects all over the human body. These actions are mediated by a specific type of receptor - vitamin D receptor (VDR). Recent findings have focused on the possible role of VDR genetic variations in the development of several types of diseases, e.g. autoimmune system diseases, various cancers and infections. MATERIAL AND METHODS The aim of the study was to evaluate the association between rs731236, rs1544410, and rs2228570 polymorphisms in the VDR (vitamin D receptor) gene and the incidence of UFs in Caucasian women. A total of 197 patients (114 fibroid-positive and 83 controls) were included in this retrospective cohort study. VDR gene polymorphisms rs731236 (TaqI), rs1544410 (BsmI) and rs2228570 (FokI) were determined using TaqMan and Simple Probes. RESULTS No statistically significant differences in the occurrence of selected VDR polymorphisms were observed between UF-positive women and healthy controls. CONCLUSIONS We found no association between rs731236, rs1544410, and rs2228570 VDR polymorphisms and UF incidence in Caucasian women. Larger sample size and multi-ethnic studies are necessary to investigate the matter further.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Małgorzata Wrzosek
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Cezary Wojtyła
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
- European Observatory of Health Inequalities, State University of Applied Sciences, Kalisz, Poland
| | - Kornelia Zaręba
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Grazyna Nowicka
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Jakiel
- First Department of Obstetrics and Gynecology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, Warsaw, Poland
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Mohammadi R, Tabrizi R, Hessami K, Ashari H, Nowrouzi-Sohrabi P, Hosseini-Bensenjan M, Asadi N. Correlation of low serum vitamin-D with uterine leiomyoma: a systematic review and meta-analysis. Reprod Biol Endocrinol 2020; 18:85. [PMID: 32795307 PMCID: PMC7427296 DOI: 10.1186/s12958-020-00644-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/10/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is a growing body of evidence on low serum vitamin-D levels and the risk of uterine leiomyomas (UL). Therefore, this systematic review and meta-analysis was conducted to investigate the association between serum vitamin D levels and UL occurrence. METHODS Searches were systematically conducted of the electronic databases PubMed, Scopus, EMBASE, Web of Science (ISI), Cochrane library, Ovid, and Google Scholar to identify relevant studies from inception until February 6, 2020. Heterogeneity across the included studies was examined using Cochran's Q and I-square (I2). Data was pooled using random effects modeling and expressed as standardized mean differences (SMDs). RESULTS Nine eligible studies with a total of 1730 participants (835 patients with UL and 895 controls) were included in the current meta-analysis. Pooled results with random effects modeling indicated that serum vitamin D levels were significantly lower in patients with UL than in the control group (n = 9, SMD = - 0.67; 95% CI, - 0.98, - 0.35, p < 0.001; I2 = 89.3%, p < 0.001). Based on the findings of subgroup analyses, it was found that the SMD values across the included studies from Asia (n = 4, SMD = - 1.20; 95% CI, - 1.45, - 0.96, p < 0.001; I2 = 30.6%, p = 0.229) were lower than those from Europe (n = 3, SMD = - 0.34; 95% CI, - 0.49, - 0.18, p < 0.001; I2 = 0.0%, p = 0.602) and Africa (n = 2, SMD = - 0.13; 95% CI, - 0.29, 0.04, p = 0.128; I2 = 0.0%, p = 0.417), although the difference was not significant in Africa. Publication year was also found to be a potential contributor's variable in the pooled SMD using the meta-regression method (t = - 3.00, p = 0.02). CONCLUSIONS To the best of our knowledge, the current meta-analysis showed for the first time that serum vitamin D levels were significantly lower in women with UL in selected populations.
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Affiliation(s)
- Ramin Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hoda Ashari
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Nowrouzi-Sohrabi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Nasrin Asadi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Ciebiera M, Ali M, Zgliczyńska M, Skrzypczak M, Al-Hendy A. Vitamins and Uterine Fibroids: Current Data on Pathophysiology and Possible Clinical Relevance. Int J Mol Sci 2020; 21:ijms21155528. [PMID: 32752274 PMCID: PMC7432695 DOI: 10.3390/ijms21155528] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 01/27/2023] Open
Abstract
Uterine fibroid (UF) is the most common benign tumor pathology of the female reproductive organs. UFs constitute the main reason for a hysterectomy and hospitalization due to gynecological conditions. UFs consist of uterine smooth muscle immersed in a large amount of extracellular matrix (ECM). Genetic studies have demonstrated that UFs are monoclonal tumors originating from the myometrial stem cells that have underwent specific molecular changes to tumor initiating stem cells which proliferate and differentiate later under the influence of steroid hormones. There is growing interest in the role of micronutrients, for example, vitamins, in UFs. This article is a comprehensive review of publications regarding the available data concerning the role of vitamins in the biology and management of UFs. In summary, the results showed that some vitamins are important in the biology and pathophysiology of UFs. For example, vitamins A and D deserve particular attention following studies of their influence on the treatment of UF tumors. Vitamins B3, C, and E have not been as widely studied as the abovementioned vitamins. However, more research could reveal their potential role in UF biology.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland;
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (M.C.); (A.A.-H.); Tel.: +48-225690274 (M.C.); +1-312-996-7006 (A.A.-H.)
| | - Mohamed Ali
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, 11566 Cairo, Egypt
| | - Magdalena Zgliczyńska
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland;
| | - Maciej Skrzypczak
- Second Department of Gynecology, Medical University of Lublin, 20-954 Lublin, Poland;
| | - Ayman Al-Hendy
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Correspondence: (M.C.); (A.A.-H.); Tel.: +48-225690274 (M.C.); +1-312-996-7006 (A.A.-H.)
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Ciebiera M, Ali M, Prince L, Jackson-Bey T, Atabiekov I, Zgliczyński S, Al-Hendy A. The Evolving Role of Natural Compounds in the Medical Treatment of Uterine Fibroids. J Clin Med 2020; 9:E1479. [PMID: 32423112 PMCID: PMC7290481 DOI: 10.3390/jcm9051479] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroids (UFs) remain a significant health issue for many women, with a disproportionate impact on women of color, likely due to both genetic and environmental factors. The prevalence of UFs is estimated to be approximately 70% depending on population. UF-derived clinical symptoms include pelvic pain, excessive uterine bleeding, gastrointestinal and voiding problems, as well as impaired fertility. Nowadays numerous methods of UF treatment are available-from conservative treatment to invasive surgeries. Selecting an appropriate treatment option should be individualized and adjusted to the patient's expectations as much as possible. So far, the mainstay of treatment is surgery, but their negative impact of future fertility is clear. On the other hand, emerging new pharmaceutical options have significant adverse effects like liver function impairment, hot flashes, bone density loss, endometrial changes, and inability to attempt conception during treatment. Several natural compounds are found to help treat UFs and relieve their symptoms. In this review we summarize all the current available data about natural compounds that may be beneficial for patients with UFs, especially those who want to preserve their future fertility or have treatment while actively pursuing conception. Vitamin D, epigallocatechin gallate, berberine, curcumin, and others are being used as alternative UF treatments. Moreover, we propose the concept of using combined therapies of natural compounds on their own or combined with hormonal agents to manage UFs. There is a strong need for more human clinical trials involving these compounds before promoting widespread usage.
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Affiliation(s)
- Michał Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, 01-809 Warsaw, Poland;
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Mohamed Ali
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, 11566 Cairo, Egypt
| | - Lillian Prince
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Tia Jackson-Bey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Ihor Atabiekov
- Moscow Region Cancer Center, Balashikha 143900, Russian;
| | - Stanisław Zgliczyński
- Department of Internal Diseases and Endocrinology, Central Teaching Clinical Hospital, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Ayman Al-Hendy
- Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
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Abstract
Importance While it has long been known that polycystic ovarian syndrome is associated with cardiometabolic risk factors (CMRFs), there is emerging evidence that other benign gynecologic conditions, such as uterine leiomyomas, endometriosis, and even hysterectomy without oophorectomy, can be associated with CMRFs. Understanding the evidence and mechanisms of these associations can lead to novel preventive and therapeutic interventions. Objective This article discusses the evidence and the potential mechanisms mediating the association between CMRFs and benign gynecologic disorders. Evidence Acquisition We reviewed PubMed, EMBASE, Scopus, and Google Scholar databases to obtain plausible clinical and biological evidence, including hormonal, immunologic, inflammatory, growth factor-related, genetic, epigenetic, atherogenic, vitamin D-related, and dietary factors. Results Cardiometabolic risk factors appear to contribute to uterine leiomyoma pathogenesis. For example, obesity can modulate leiomyomatous cellular proliferation and extracellular matrix deposition through hyperestrogenic states, chronic inflammation, insulin resistance, and adipokines. On the other hand, endometriosis has been shown to induce systemic inflammation, thereby increasing cardiometabolic risks, for example, through inducing atherosclerotic changes. Conclusion and Relevance Clinical implications of these associations are 2-fold. First, screening and early modification of CMRFs can be part of a preventive strategy for uterine leiomyomas and hysterectomy. Second, patients diagnosed with uterine leiomyomas or endometriosis can be screened and closely followed for CMRFs and cardiovascular disease.
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Igboeli P, Walker W, McHugh A, Sultan A, Al-Hendy A. Burden of Uterine Fibroids: An African Perspective, A Call for Action and Opportunity for Intervention. ACTA ACUST UNITED AC 2019; 2:287-294. [PMID: 32647835 PMCID: PMC7344264 DOI: 10.18314/cogo.v2i1.1701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Black women carry the burden of uterine fibroids, (AKA uterine leiomyomas), at a much higher rate than their racial counterparts. Thus, increasing awareness and discovering a solution to an endemic problem that plagues Sub-Saharan Africa is of critical importance, not only for the region itself, but also for the medical community globally. A collaborative, patient oriented, cost effective, and culturally sensitive approach must be at the forefront of this endeavor. While the exact pathogenesis of uterine fibroid development remains elusive, the racial disparity is well documented. Moreover, in the developed world, women are able to seek treatment through surgical and non-surgical means; however, sub-Saharan regions face their own challenges that, if not addressed, can ultimately extinguish the lives of many suffering women. Unfortunately, the literature is scarce on how to prevent fibroid development, which may be critical for women who do not have access to effective interventions. Recent research from our group and others has shown that vitamin D deficiency plays an important role in fibroid development and may be a preventable risk factor. Daily vitamin D supplementation is a low cost, effective intervention that could be implemented throughout the Sub-Saharan region. Similarly, education and increased awareness as to the nature and symptoms of uterine fibroids could improve the quality of life, remove negative social stigma, and reduce morbidity and mortality rates in women who seek medical care with advanced uterine fibroids.
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Affiliation(s)
- P Igboeli
- University of Nigeria Teaching Hospital, Department of Obstetrics and Gynaecology, Enugu, Nigeria.,Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA.,Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - W Walker
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - A McHugh
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
| | - A Sultan
- Xavier University School of Medicine, Oranjestad, Aruba
| | - A Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, Illinois, USA
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Szafarowska M, Dziech E, Kaleta B, Kniotek M, Rogowski A, Segiet-Święcicka A, Jerzak M. Anti-Müllerian hormone level is associated with vitamin D receptor polymorphisms in women with polycystic ovary syndrome. J Assist Reprod Genet 2019; 36:1281-1289. [PMID: 31089932 PMCID: PMC6602978 DOI: 10.1007/s10815-019-01472-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/02/2019] [Indexed: 01/27/2023] Open
Abstract
Objective Our study aimed to investigate the relationship between polymorphisms (Apa1, Bsm1, Fok1, and Cdx2) in the VDR gene as well as AMH and AMHR2 genes and their influence on AMH and 25(OH)D levels in PCOS women. Study design Seventy-five patients with PCOS and 23 control women were included. Serum AMH and 25(OH)D levels in patients and controls were measured by enzyme-linked immunosorbent assay (ELISA). Polymorphisms in VDR gene Fok1 C/T (rs2228587), Bsm1 A/G (rs1544410), Apa1 A/C (rs7975232), and Cdx2 A/G (rs11568820) polymorphisms as well as AMH G/T (rs10407022) and AMHR2 A/G (rs2002555) were analyzed using real-time PCR. Results Analysis of the VDR Cdx2 polymorphism showed a significantly higher frequency of the homozygous GG (mutant) genotype in the PCOS group as compared with the control group (p < 0.05). The analysis revealed a statistically significant correlation between the presence of FokI and ApaI polymorphisms and AMH levels in PCOS women (p < 0.05). The presence of mutant genotypes (CT, TT) in the Fok1 and (CA, CC) in the Apa1 polymorphisms were associated with higher AMH level in PCOS women (p < 0.05). No statistically significant correlations between AMH and AMHR2 polymorphisms and AMH level were found. Moreover, there was no correlation between AMH and 25(OH)D levels in the PCOS or in the control group. Conclusion It seems that the elevated AMH level is associated with VDR Fokl and Apal polymorphisms, but not with 25(OH)D levels in PCOS women. Further research is needed to determine the role of VDR polymorphism in AMH level in PCOS.
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Affiliation(s)
- Monika Szafarowska
- Department of Gynecology and Oncological Gynecology, Military Institute of Medicine, 128 Szaserow Str, 04-141, Warsaw, Poland.
| | - Edyta Dziech
- Department of Gynecology and Oncological Gynecology, Military Institute of Medicine, 128 Szaserow Str, 04-141, Warsaw, Poland
| | - Beata Kaleta
- Department of Clinical Immunology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Monika Kniotek
- Department of Clinical Immunology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - Artur Rogowski
- Collegium Medicum, Cardinal Stefan Wyszynski University, Warsaw, Poland.,Department of Obstetrics and Gynecology, Mother and Child Institute, Warsaw, Poland
| | - Agnieszka Segiet-Święcicka
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Małgorzata Jerzak
- Department of Gynecology and Oncological Gynecology, Military Institute of Medicine, 128 Szaserow Str, 04-141, Warsaw, Poland
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Tayeb FA, Salman YJ, Ameen KM. The Impact of <i>Toxoplasma gondii</i> Infection on the Vitamin D3 Levels among Women in Childbearing Age in Kirkuk Province-Iraq. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/ojmm.2019.94015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Singh V, Barik A, Imam N. Vitamin D 3 Level in Women with Uterine Fibroid: An Observational Study in Eastern Indian Population. J Obstet Gynaecol India 2018; 69:161-165. [PMID: 30956471 DOI: 10.1007/s13224-018-1195-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/26/2018] [Indexed: 11/26/2022] Open
Abstract
Purpose Vitamin D deficiency has been proposed to be a risk factor in the pathogenesis of uterine fibroid in few recently published studies conducted in Europe and Africa. Nevertheless, no study has ever addressed similar query in Indian women where hypovitaminosis is very common. Methods A total of 144 women of age group 20-50 years belonging to Jamshedpur, Jharkhand, India, were included in the study. Out of which, 72 women had uterine fibroids and rest healthy women without fibroids served as controls. All women were subjected to ultrasound examination of uterus followed by measurement of serum FSH level (on 3rd day of menstruation) and serum vitamin D3. Results The mean serum concentration of vitamin D3 was significantly lower in women with uterine fibroids compared to controls (10.81 ± 6.18 vs. 22.91 ± 16.18, p < 0.0001). On further analysis, 62.5% of cases were found to be severely deficient (vitamin D3 < 10 ng/mL) as compared to 26.39% of controls (p < 0.0001). Besides that, only 2.77% of cases had sufficient vitamin D level as compared to 23.61% of controls (p = 0.0002). The odds ratio (OR) of occurrence of fibroid with serum vitamin D3 level of < 10 ng/dl compared to that of level > 10 ng/dl was 4.64 (95% confidence interval [CI] 2.28-9.44) (p = 0.0001). Conclusion Serum vitamin D3 level inversely correlated with burden of uterine fibroid and possibly its deficiency is a risk factor for uterine fibroid occurrence in eastern part of India.
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Affiliation(s)
- Vinita Singh
- Department of Obstetrics and Gynaecology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur, Jharkhand 831001 India
| | - Archana Barik
- Department of Obstetrics and Gynaecology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur, Jharkhand 831001 India
| | - Nadia Imam
- Department of Obstetrics and Gynaecology, Tata Main Hospital, C Road West, Northern Town, Bistupur, Jamshedpur, Jharkhand 831001 India
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Elhusseini H, Elkafas H, Abdelaziz M, Halder S, Atabiekov I, Eziba N, Ismail N, El Andaloussi A, Al-Hendy A. Diet-induced vitamin D deficiency triggers inflammation and DNA damage profile in murine myometrium. Int J Womens Health 2018; 10:503-514. [PMID: 30214319 PMCID: PMC6120572 DOI: 10.2147/ijwh.s163961] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Previously, we reported a significantly higher prevalence of uterine fibroids (UFs) in African American women. This minority group also commonly suffers from vitamin D deficiency. We have demonstrated that 1,25(OH)2D3 attains a fibroid growth inhibitory impact through its ability to block the G1/S (gap 1/synthesis) phase of the cell cycle. Vitamin D is involved in DNA damage as well as in immune response regulation, anti-inflammation, autoimmunity and cancer. Since most of the prior data on vitamin D and UF were generated in vitro via established cell lines, it was necessary to verify and validate this observation in vivo using a diet-induced vitamin D-deficient mouse model. Materials and Methods Our model of vitamin D lacking function was established using 8-week exposure of C57/BL6 mice to vitamin D-deficient diet provides evidence of different functions accomplished by vitamin D in the regulation of myometrium homeostasis disrupted in the context of uterine fibroid. Results We found that vitamin D deficiency was associated with increased expression of sex steroid receptors in murine myometrium, increased expression of proliferation related genes, the promotion of fibrosis and enhanced inflammation, and promoted immunosuppression through Tregs expansion in murine myometrium. We also showed that a vitamin D deficient diet enhanced DNA damage in murine myometrium. Conclusion Our model mimics the effects in humans that a lack of vitamin D has and propels the study of in vivo interaction between inflammation, genomic instability and cell proliferation in the myometrium.
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Affiliation(s)
- Heba Elhusseini
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ;
| | - Hoda Elkafas
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ; .,Pharmacology and Toxicology Department, National Organization for Drug Control and Research, Cairo, Egypt
| | - Mohamed Abdelaziz
- Department of Obstetrics and Gynecology, Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Sunil Halder
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ;
| | - Ihor Atabiekov
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ;
| | - Noura Eziba
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ;
| | - Nahed Ismail
- Clinical Microbiology Division, University of Illinois of Chicago, Chicago, IL, USA
| | | | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Illinois of Chicago, Chicago, IL, USA, ;
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Alpha-Tocopherol Serum Levels Are Increased in Caucasian Women with Uterine Fibroids: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6793726. [PMID: 30140700 PMCID: PMC6081575 DOI: 10.1155/2018/6793726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/06/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
Abstract
Uterine fibroids (UFs) are benign tumors of the reproductive tract, arising from smooth muscle cells of the uterus. Steroid hormones, estrogen, and progesterone are considered to be the most important links in the pathophysiology of UFs. Alpha-tocopherol (AT) is the most active form of vitamin E. What is important as far as UFs are concerned is that ATs contain structural determinants, which makes them possible ligands for estrogen receptors (ERs). We present a retrospective cohort study performed in a university teaching hospital. We included a total of 162 patients divided into 2 groups: with UFs and controls. The effects of age, body mass index (BMI), positive medical history, parity, and AT serum concentrations on the risk for the development of UFs were investigated. Mean AT serum concentrations were 11.66 ± 4.97 μg/ml and 7.83 ± 3.13 μg/ml (medians 10.56 μg/ml and 7.42 μg/ml) in patients with UFs confirmed on ultrasound and controls, respectively. The presented difference was statistically significant. Higher BMI, positive family history, and low parity were found to be major risk factors for UFs. In our study, we confirmed that elevated serum AT concentration might be an important risk factor for UFs in Caucasian women. Further research in this area is necessary.
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Ciebiera M, Włodarczyk M, Ciebiera M, Zaręba K, Łukaszuk K, Jakiel G. Vitamin D and Uterine Fibroids-Review of the Literature and Novel Concepts. Int J Mol Sci 2018; 19:E2051. [PMID: 30011902 PMCID: PMC6073230 DOI: 10.3390/ijms19072051] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/06/2018] [Accepted: 07/12/2018] [Indexed: 02/08/2023] Open
Abstract
This article provides a detailed review of current knowledge on the role of vitamin D and its receptor in the biology and management of uterine fibroids (UFs). Authors present ideas for future steps in this area. A literature search was conducted in PubMed using the following key words: "uterine fibroid" and "vitamin D". The results of the available studies, published in English from January 2002 up to April 2018, have been discussed. Vitamin D is a group of steroid compounds with a powerful impact on many parts of the human body. This vitamin is believed to regulate cell proliferation and differentiation, inhibit angiogenesis, and stimulate apoptosis. Nowadays, hypovitaminosis D is believed to be a major risk factor in the development of UFs. In many studies vitamin D appears to be a powerful factor against UFs, resulting in inhibition of tumor cell division and a significant reduction in its size, however, the exact role of this compound and its receptor in the pathophysiology of UFs is not fully understood. According to available studies, vitamin D and its analogs seem to be promising, effective, and low-cost compounds in the management of UFs and their clinical symptoms, and the anti-tumor activities of vitamin D play an important role in UF biology. The synergy between vitamin D and selected anti-UF drugs is a very interesting issue which requires further research. Further studies about the biological effect of vitamin D on UF biology are essential. Vitamin D preparations (alone or as a co-drugs) could become new tools in the fight with UFs, with the additional beneficial pleiotropic effect.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Marta Włodarczyk
- Department of Biochemistry and Pharmacogenomics, Faculty of Pharmacy with Division of Laboratory Medicine, Medical University of Warsaw, 02-097 Warsaw, Poland.
- Center for Preclinical Research, Medical University of Warsaw, 02-097 Warsaw, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Kornelia Zaręba
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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Ali M, Al-Hendy A. Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids. Biol Reprod 2018; 97:337-352. [PMID: 29025038 PMCID: PMC5803778 DOI: 10.1093/biolre/iox094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility. Women with UF who desire to maintain future fertility potential face a dilemma because of the limited treatment choices that are currently available to help them achieve that goal. Recently, ulipristal acetate the first of the promising family of oral selective progesterone receptor modulators has been approved for UF treatment in Europe, Canada, and several other countries and is under review for possible approval in the USA. In this review article, we discuss recent advances in the management options against UF with a bend toward oral effective long-term treatment alternatives who are particularly suited for those seeking to preserve their future fertility potential. We also explore the transformative concept of primary and secondary UF prevention using these new anti-UF agents. We envision a remarkable shift in the management of UF in future years from surgical/invasive treatment to orally administrated options; clearly, this potential shift will require additional intense clinical research.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.,Clinical Pharmacy department, Faculty of pharmacy, Ain Shams University, Cairo, Egypt
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Güleç Yılmaz S, Gül T, Attar R, Yıldırım G, İşbir T. Association between fok1 polymorphism of vitamin D receptor gene with uterine leiomyoma in Turkish populations. J Turk Ger Gynecol Assoc 2018; 19:128-131. [PMID: 29391329 PMCID: PMC6085526 DOI: 10.4274/jtgga.2018.0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Objective: The aim of this research was to determine the association between the fok1 polymorphism and uterine leiomyomas. Material and Methods: For genotyping the fok1 polymorphism of the vitamin D receptor, real-time polymerase chain reaction was performed on blood samples of uterine leiomyoma (n=27) and control (n=33) groups. For statistical analyses, SPSS v.23 software (SPSS Inc., Chicago, IL, USA) was used. Results: A statistically significant difference was observed for the frequency of the CC genotype between the uterine leiomyoma and control groups, and the frequencies of the T allele in the uterine leiomyoma groups were significantly higher than in the control group. Conclusion: The presence of the fok1 CC genotype may be a risk-reducing factor and the T allele may be a potential risk factor for developing uterine leiomyoma.
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Affiliation(s)
- Seda Güleç Yılmaz
- Department of Molecular Medicine, Yeditepe University, Institute of Health Sciences, İstanbul, Turkey
| | - Tuğçe Gül
- Department of Molecular Medicine, Yeditepe University, Institute of Health Sciences, İstanbul, Turkey
| | - Rukset Attar
- Departments of Obstetrics and Gynecology, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Gazi Yıldırım
- Department of Molecular Medicine, Yeditepe University, Institute of Health Sciences, İstanbul, Turkey
| | - Turgay İşbir
- Department of Medical Biology, Yeditepe University School of Medicine, İstanbul, Turkey
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Ciebiera M, Łukaszuk K, Męczekalski B, Ciebiera M, Wojtyła C, Słabuszewska-Jóźwiak A, Jakiel G. Alternative Oral Agents in Prophylaxis and Therapy of Uterine Fibroids-An Up-to-Date Review. Int J Mol Sci 2017; 18:ijms18122586. [PMID: 29194370 PMCID: PMC5751189 DOI: 10.3390/ijms18122586] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 01/18/2023] Open
Abstract
Uterine fibroids (UFs) are the most common tumors of the female genital tract. The effect of UFs on the quality of life and the overall cost of treatment are significant issues worldwide. Tumor size and location are the two specific factors which influence the occurrence of symptoms, the need for, and method of, treatment (some tumors require surgery while some can be treated with selected drugs). Primary prevention and treatment of early UF disease are worthy goals that might have a great impact on health care systems. Several treatments and prophylactic methods can be used in this endeavor. This publication presents current data about lesser-known substances which may have a beneficial effect on the treatment or prophylaxis of UFs and can be administered orally, serving as an alternative to (or complement of) surgery or selective progesterone receptor modulators (SPRMs). Early prevention and treatment of UFs in women from high-risk groups should be our priority. Innovative forms of UF management are under intensive investigation and may be promising options in the near future. Many of them evaluated vitamin D, paricalcitol, epigallocatechin gallate (EGCG), elagolix, aromatase inhibitors (AIs), and cabergoline and deemed them to be safe and effective. The next step in such projects should be properly constructed randomized control trials (RCTs), carried out by successive phases.
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Affiliation(s)
- Michał Ciebiera
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Krzysztof Łukaszuk
- Department of Obstetrics and Gynecological Nursing, Faculty of Health Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland.
- INVICTA Fertility and Reproductive Center, 80-172 Gdansk, Poland.
| | - Błażej Męczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, 60-513 Poznan, Poland.
| | - Magdalena Ciebiera
- Students' Scientific Association at the I Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland.
| | - Cezary Wojtyła
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Aneta Słabuszewska-Jóźwiak
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
| | - Grzegorz Jakiel
- Department of Obstetrics and Gynecology, The Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland.
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Odejinmi F, Oliver R, Mallick R. Is ulipristal acetate the new drug of choice for the medical management of uterine fibroids? Res ipsa loquitur? ACTA ACUST UNITED AC 2017; 13:98-105. [PMID: 29105584 PMCID: PMC7789028 DOI: 10.1177/1745505717740218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ulipristal acetate (Esmya©) has been hailed the new wonder drug with regard to the medical management of uterine fibroids, and many postulate that it will remove the need for surgical treatment in the future. While the results from the PEARL studies are certainly promising and its amenorrhoeic rates and reduction in fibroid size are unquestionable, there is still a paucity of data with regard to its long-term effects, the effects on its usage prior to surgery and its variable efficacy in different ethnic populations. To facilitate our knowledge further, independent studies with clear outcome measures evaluating the long-term effects of the drug in a wider, more representative, ethnic minority population as well as assessing its true cost-effectiveness compared to surgery are needed. The aim of this article is to review the historical aspects with regard to the management of uterine fibroids to gain an understanding of where we are now and to evaluate the wider use of ulipristal acetate, both its benefits and limitations and postulate where to go in the future in order to allow our women to make safe and informed choices regarding their treatment options.
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Affiliation(s)
- Funlayo Odejinmi
- Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Reeba Oliver
- Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - Rebecca Mallick
- Department of Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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Abstract
AbstractUterine fibroids affect a wide cross-section of the population, with prevalence, symptom severity, and overall disease burden generally higher among black women, likely due to both genetic and environmental factors. Potential symptoms of uterine fibroids include painful and excessive uterine bleeding, interference with everyday life and self-image, and impaired fertility. Because of the high estimated prevalence and costs associated with treatments, the direct and indirect costs of uterine fibroids are substantial for both the health care system and the individual patient. Special patient populations—such as black women, women seeking to retain fertility, and women with asymptomatic fibroids—have particular treatment needs that require a variety of diagnostic methods and treatment options. Despite the widespread occurrence of uterine fibroids and newer treatment options, little high-quality data are available to formulate evidence-based guidelines that address these unmet patient needs. Specific areas in need of attention include improving diagnostic techniques, increasing patient access to early treatment, and identifying best practices for this diverse patient population.
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Affiliation(s)
- Ayman Al-Hendy
- Division of Translational Research, Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Evan Robert Myers
- Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth Stewart
- Department of Obstetrics and Gynecology and Surgery, Mayo Clinic, Rochester, Minnesota
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Sarais V, Cermisoni GC, Schimberni M, Alteri A, Papaleo E, Somigliana E, Vigano' P. Human Chorionic Gonadotrophin as a Possible Mediator of Leiomyoma Growth during Pregnancy: Molecular Mechanisms. Int J Mol Sci 2017; 18:E2014. [PMID: 28930160 PMCID: PMC5618662 DOI: 10.3390/ijms18092014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
Uterine fibroids are the most common gynecologic benign tumors. Studies supporting a strong pregnancy-related growth of leiomyomas generally claimed a crucial role of sex steroid hormones. However, sex steroids are unlikely the unique actors involved as estrogen and progesterone achieve a pick serum concentration in the last trimester while leiomyomas show a typical increase during the first trimester. Given the rapid exponential raise in serum human Chorionic Gonadotrophin (hCG) at the beginning of gestation, we conducted a review to assess the potential role of hCG in the striking growth of leiomyomas during initial pregnancy. Fibroid growth during initial pregnancy seems to correlate to the similar increase of serum hCG levels until 12 weeks of gestation. The presence of functional Luteinizing Hormone/human Chorionic Gonadotropin (LH/hCG) receptors was demonstrated on leiomyomas. In vitro treatment of leiomyoma cells with hCG determines an up to 500% increase in cell number after three days. Expression of cyclin E and cyclin-dependent kinase 1 was significantly increased in leiomyoma cells by hCG treatment. Moreover, upon binding to the receptor, hCG stimulates prolactin secretion in leiomyoma cells, promoting cell proliferation via the mitogen-activated protein kinase cascade. Fibroid enlargement during initial pregnancy may be regulated by serum hCG.
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Affiliation(s)
- Veronica Sarais
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Greta Chiara Cermisoni
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Matteo Schimberni
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Alessandra Alteri
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Enrico Papaleo
- Centro Scienze Natalità, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - Edgardo Somigliana
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico AND Università degli Studi di Milano, 20122 Milan, Italy.
| | - Paola Vigano'
- Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy.
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Torres-de la Roche LA, Becker S, Cezar C, Hermann A, Larbig A, Leicher L, Di Spiezio Sardo A, Tanos V, Wallwiener M, Verhoeven H, De Wilde RL. Pathobiology of myomatosis uteri: the underlying knowledge to support our clinical practice. Arch Gynecol Obstet 2017; 296:701-707. [PMID: 28864872 DOI: 10.1007/s00404-017-4494-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Uterine myomatosis, a benign condition, is the most common indication for hysterectomies worldwide, affecting the reproductive goals and quality of health of women. However, gynecologists have been provided with interesting insights on its pathobiology, which are the basis for uterine-preserving therapies. The aim of this paper is to discuss the latest evidence on these mechanisms and its importance in the clinical practice. METHOD A comprehensive literature search was made in Pubmed, Medline, the Cochrane Library, Orbis plus and Google Scholar for articles related to the epidemiological, biological, and genetic bases. RESULTS There is extensive evidence that genetic, epigenetic, hormonal, environmental, proinflamatory, angiogenetic, and growing factors are involved in the biology of myomatosis. Such factors are capable of activating and promoting inhibitory signaling pathways leading to initiation, development, and regression of myomata through changes in myometrial cells and myomata fibers, such as cellular proliferation, differentiation, apoptosis, angiogenesis, and changes in the surrounding environment. CONCLUSION A good understanding of the pathobiologic mechanisms of myomatosis gives reasons to physicians to elect conservative or combined therapies, and allow affected women to receive an individualized management, according to age, reproduction desire, and clinical condition.
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Affiliation(s)
- Luz Angela Torres-de la Roche
- Clinic for Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Sven Becker
- Clinic of Gynecology and Obstetrics, Universitäts Klinikum Frankfurt, Frankfurt, Germany
| | - Cristina Cezar
- Clinic for Gynecology and Obstetrics, Carl von Ossietzky University Medical School, Oldenburg, Germany
| | - Anja Hermann
- Clinic for Gynecology and Obstetrics, Carl von Ossietzky University Medical School, Oldenburg, Germany
| | - Angelika Larbig
- Clinic for Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Lasse Leicher
- Clinic for Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Georgstrasse 12, 26121, Oldenburg, Germany
| | | | - Vasilis Tanos
- Department of Surgery, Aretaeio Hospital, St. Georges Medical School, Nicosia University, Nicosia, Cyprus
| | - Markus Wallwiener
- Clinic of Gynecology and Obstetrics and Gynecological Oncology, University of Heidelberg, Heidelberg, Germany
| | - Hugo Verhoeven
- Clinic for Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Georgstrasse 12, 26121, Oldenburg, Germany
| | - Rudy Leon De Wilde
- Clinic for Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Georgstrasse 12, 26121, Oldenburg, Germany.
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Ciavattini A, Delli Carpini G, Serri M, Vignini A, Sabbatinelli J, Tozzi A, Aggiusti A, Clemente N. Hypovitaminosis D and "small burden" uterine fibroids: Opportunity for a vitamin D supplementation. Medicine (Baltimore) 2016; 95:e5698. [PMID: 28033263 PMCID: PMC5207559 DOI: 10.1097/md.0000000000005698] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to evaluate the effect of vitamin D supplementation in women with hypovitaminosis D and "small burden" uterine fibroids.This study focused on 208 women diagnosed with uterine fibroids and concomitant hypovitaminosis D, from January to December 2014. One hundred eight women of the initial study population were diagnosed with "small burden" uterine fibroids. Among them, those who underwent a proper vitamin D supplementation constituted the "study group" (n = 53), while women who spontaneously refused the therapy or did not perform it properly, constituted the "control group" (n = 55). The characteristics of uterine fibroids, the fibroid-related symptoms, and the vitamin D serum levels were evaluated 12 months after the initial diagnosis.In women with uterine fibroids, a negative correlation emerged between the baseline 25-hydroxy-cholecalciferol (25-OH-D3) concentration and both the volume of the largest fibroid (r = -0.18, P = 0.01) and the total volume of fibroids (r = -0.19, P = 0.01). No correlation was found between the baseline 25-OH-D3 levels and the number of fibroids per patient (r = -0.10, P = 0.16). In women of the "study group," a significant increase in the 25-OH-D3 serum level was observed after 12 months of supplementation, and a lower rate of surgical or medical treatment due to the "progression to extensive disease" was reported (13.2% vs 30.9%, P = 0.05).Supplementation therapy with 25-OH-D3 restores normal vitamin D serum levels in women with "small burden" fibroids. In these women, vitamin D supplementation seems to reduce the progression to an extensive disease, and thus the need of conventional surgical or medical therapy.
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Affiliation(s)
- Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Matteo Serri
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Arianna Vignini
- Department of Clinical Sciences, Section of Biochemistry, Biology and Physics, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Sabbatinelli
- Department of Clinical Sciences, Section of Biochemistry, Biology and Physics, Polytechnic University of Marche, Ancona, Italy
| | - Alessandra Tozzi
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Alice Aggiusti
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
| | - Nicolò Clemente
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche
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The Role of Complementary and Alternative Medicine for the Management of Fibroids and Associated Symptomatology. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016; 5:110-118. [PMID: 27217981 PMCID: PMC4859848 DOI: 10.1007/s13669-016-0156-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article discusses the role of complementary and alternative medicine (CAM) in the management of fibroids and associated symptomatology. Since there is such a paucity of direct research related to fibroids, conditions that are implicated in the causation of uterine fibroids and symptomatology that CAM treatments may or have been shown to make a difference are also considered.
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Al-Hendy A, Diamond MP, Boyer TG, Halder SK. Vitamin D3 Inhibits Wnt/β-Catenin and mTOR Signaling Pathways in Human Uterine Fibroid Cells. J Clin Endocrinol Metab 2016; 101:1542-51. [PMID: 26820714 PMCID: PMC4880168 DOI: 10.1210/jc.2015-3555] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CONTEXT Somatic mutations in the Med12 gene are known to activate Wnt/β-catenin signaling in human uterine fibroids (UFs). OBJECTIVE The objective of the study was to examine the role of vitamin D3 in the modulation of Wnt/β-catenin and mammalian target of rapamycin (mTOR) signaling in human UF cells. DESIGN Immortalized human UF cells (HuLM) and human primary UF (PUF) cells were treated with increasing concentrations of vitamin D3 and thereafter analyzed using Western blots and immunocytochemistry. MAIN OUTCOME MEASURES Wnt/β-catenin and mTOR signaling proteins in cultured HuLM and PUF cells were measured. RESULTS UF tumors with Med12 somatic mutations showed an up-regulation of Wnt4 and β-catenin as compared with adjacent myometrium. Vitamin D3 administration reduced the levels of Wnt4 and β-catenin in both HuLM and PUF cells. Vitamin D3 also reduced the expression/activation of mTOR signaling in both cell types. In contrast, vitamin D3 induced the expression of DNA damaged-induced transcription 4 (an inhibitor of mTOR) and tuberous sclerosis genes (TSC1/2) in a concentration-dependent manner in HuLM cells. Furthermore, we observed a concentration-dependent reduction of Wisp1 (Wnt induced signaling protein 1) and flap endonuclease 1 proteins in HuLM cells. Additionally, abrogation of vitamin D receptor expression (by silencing) in normal myometrial cells induces Wnt4/β-catenin as well as prompts a fibrotic process including an increase in cell proliferation and increased extracellular matrix production. Together these results suggest that vitamin D3 functions as an inhibitor of Wnt4/β-catenin and mTOR signaling pathways, which may play major roles in fibroid pathogenesis. CONCLUSIONS Vitamin D3 may have utility as a novel long-term therapeutic and/or preventive option for uterine fibroids.
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Affiliation(s)
- Ayman Al-Hendy
- Department of Obstetrics and Gynecology (A.A.-H., M.P.D., S.K.H.), Georgia Regents University, Medical College of Georgia, Augusta, Georgia 30912; and Department of Molecular Medicine (T.G.R.), Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900
| | - Michael P Diamond
- Department of Obstetrics and Gynecology (A.A.-H., M.P.D., S.K.H.), Georgia Regents University, Medical College of Georgia, Augusta, Georgia 30912; and Department of Molecular Medicine (T.G.R.), Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900
| | - Thomas G Boyer
- Department of Obstetrics and Gynecology (A.A.-H., M.P.D., S.K.H.), Georgia Regents University, Medical College of Georgia, Augusta, Georgia 30912; and Department of Molecular Medicine (T.G.R.), Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900
| | - Sunil K Halder
- Department of Obstetrics and Gynecology (A.A.-H., M.P.D., S.K.H.), Georgia Regents University, Medical College of Georgia, Augusta, Georgia 30912; and Department of Molecular Medicine (T.G.R.), Institute of Biotechnology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229-3900
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Baird DD, Harmon QE, Upson K, Moore KR, Barker-Cummings C, Baker S, Cooper T, Wegienka G. A Prospective, Ultrasound-Based Study to Evaluate Risk Factors for Uterine Fibroid Incidence and Growth: Methods and Results of Recruitment. J Womens Health (Larchmt) 2015; 24:907-15. [PMID: 26334691 DOI: 10.1089/jwh.2015.5277] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Uterine fibroids are common, benign, smooth-muscle tumors that can cause major morbidity for reproductive-age women, often requiring invasive treatment. Despite this personal and public health burden, no prior study has attempted to periodically screen fibroid-free women with ultrasound to detect incident disease and identify risk factors. METHODS We designed a study to prospectively investigate development of fibroids by enrolling women without a clinical diagnosis of fibroids and screening for fibroids with ultrasound at baseline. Enrollment procedures included extensive questionnaires and specimen collection (blood, urine, vaginal swabs). The cohort is followed at approximately 20-month intervals. At each follow-up there are updates to the questionnaire data, further specimen collection, and an ultrasound examination. We identify incident disease and measure tumor growth. The two exposures of primary interest are vitamin D insufficiency and reproductive tract infections. This manuscript provides a detailed description of the study methods, recruitment results, and participant characteristics. RESULTS The Study of Environment, Lifestyle and Fibroids enrolled 1,696 African American women aged 23-34 years. "Family and friends" was a leading recruitment source. More than 95% of participants contributed all the requested biological specimens at baseline. Study ultrasound examinations revealed undiagnosed fibroids in 378 women (22% of participants). The retention rate for the first follow-up was 87%. CONCLUSIONS Study design aspects likely to be important for long-term studies in young African Americans include personalized recruitment, multiple steps to the enrollment process that rely on the initiative of the participant, and methods for tracing highly mobile study subjects.
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Affiliation(s)
- Donna D Baird
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | - Quaker E Harmon
- 2 Social and Scientific Systems, Inc. , Durham, North Carolina
| | - Kristen Upson
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | - Kristen R Moore
- 1 Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health , Research Triangle Park, North Carolina
| | | | - Susan Baker
- 2 Social and Scientific Systems, Inc. , Durham, North Carolina
| | - Tracy Cooper
- 3 Department of Radiology, Division of Ultrasound, Henry Ford Health System , Detroit, Michigan
| | - Ganesa Wegienka
- 4 Department of Public Health Sciences, Henry Ford Hospital , Detroit, Michigan
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Brakta S, Diamond JS, Al-Hendy A, Diamond MP, Halder SK. Role of vitamin D in uterine fibroid biology. Fertil Steril 2015; 104:698-706. [PMID: 26079694 PMCID: PMC4561014 DOI: 10.1016/j.fertnstert.2015.05.031] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To provide a detailed summary of current scientific knowledge on uterine fibroids (leiomyomas) in vitro and in in vivo animal models, as well as to postulate the potential role of vitamin D3 as an effective, inexpensive, safe, long-term treatment option for uterine fibroids. DESIGN PubMed search articles were used to identify the most relevant studies on uterine fibroids, as well as effects of vitamin D3 on uterine fibroid cells and fibroid tumor growth in in vivo animal models. SETTING University research laboratory. PATIENT(S) Not applicable. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Not applicable. RESULT(S) Despite numerous publications available on uterine fibroids, information about the role that vitamin D3 plays in the regulation of uterine fibroids is limited. Most of the recent vitamin D3-related studies on uterine fibroids were published from our group. Recent studies have demonstrated that vitamin D deficiency plays a significant role in the development of uterine fibroids. Our recent studies have demonstrated that vitamin D3 reduces leiomyoma cell proliferation in vitro and leiomyoma tumor growth in in vivo animal models. These results postulate the potential role of vitamin D3 for an effective, safe, nonsurgical medical treatment option for uterine fibroids. CONCLUSION(S) This article reviews human and animal studies and uncovers new possibilities for understanding the vitamin D-based therapeutic option for an effective, safe, long-term treatment of uterine fibroids. On the basis of these results, a clinical trial with vitamin D3 or a hypocalcemic analog, paricalcitol, may be warranted for nonsurgical medical treatment of uterine fibroids.
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Affiliation(s)
- Soumia Brakta
- Department of Obstetrics and Gynecology, Georgia Regents University, Medical College of Georgia, Augusta, Georgia
| | - Justin S Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Medical College of Georgia, Augusta, Georgia
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Georgia Regents University, Medical College of Georgia, Augusta, Georgia
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Medical College of Georgia, Augusta, Georgia
| | - Sunil K Halder
- Department of Obstetrics and Gynecology, Georgia Regents University, Medical College of Georgia, Augusta, Georgia.
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Affiliation(s)
- Ayman Al-Hendy
- Georgia Regents University, Division of Translational Research, Department of Obstetrics & Gynecology, Medical College of Georgia, 1120 15th Street, BA-7300, Augusta, GA 30912, USA
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Taylor DK, Holthouser K, Segars JH, Leppert PC. Recent scientific advances in leiomyoma (uterine fibroids) research facilitates better understanding and management. F1000Res 2015; 4:183. [PMID: 26236472 PMCID: PMC4513689 DOI: 10.12688/f1000research.6189.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 01/12/2023] Open
Abstract
Uterine leiomyomas (fibroids) are the most prevalent medical problem of the female reproductive tract, but there are few non-surgical treatment options. Although many advances in the understanding of the molecular components of these tumors have occurred over the past five years, an effective pharmaceutical approach remains elusive. Further, there is currently no clinical method to distinguish a benign uterine leiomyoma from a malignant leiomyosarcoma prior to treatment, a pressing need given concerns about the use of the power morcellator for minimally invasive surgery. This paper reviews current studies regarding the molecular biology of uterine fibroids, discusses non-surgical approaches and suggests new cutting-edge therapeutic and diagnostic approaches.
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Affiliation(s)
- Darlene K Taylor
- Department of Chemistry, North Carolina Central University, Durham, NC, 27707, USA
| | - Kristine Holthouser
- Department of Obstetrics and Gynecology, University of Louisville, Louisville, KY, USA
| | - James H Segars
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Phyllis C Leppert
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, 27710, USA
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Commandeur AE, Styer AK, Teixeira JM. Epidemiological and genetic clues for molecular mechanisms involved in uterine leiomyoma development and growth. Hum Reprod Update 2015; 21:593-615. [PMID: 26141720 DOI: 10.1093/humupd/dmv030] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 06/09/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Uterine leiomyomas (fibroids) are highly prevalent benign smooth muscle tumors of the uterus. In the USA, the lifetime risk for women developing uterine leiomyomas is estimated as up to 75%. Except for hysterectomy, most therapies or treatments often provide only partial or temporary relief and are not successful in every patient. There is a clear racial disparity in the disease; African-American women are estimated to be three times more likely to develop uterine leiomyomas and generally develop more severe symptoms. There is also familial clustering between first-degree relatives and twins, and multiple inherited syndromes in which fibroid development occurs. Leiomyomas have been described as clonal and hormonally regulated, but despite the healthcare burden imposed by the disease, the etiology of uterine leiomyomas remains largely unknown. The mechanisms involved in their growth are also essentially unknown, which has contributed to the slow progress in development of effective treatment options. METHODS A comprehensive PubMed search for and critical assessment of articles related to the epidemiological, biological and genetic clues for uterine leiomyoma development was performed. The individual functions of some of the best candidate genes are explained to provide more insight into their biological function and to interconnect and organize genes and pathways in one overarching figure that represents the current state of knowledge about uterine leiomyoma development and growth. RESULTS In this review, the widely recognized roles of estrogen and progesterone in uterine leiomyoma pathobiology on the basis of clinical and experimental data are presented. This is followed by fundamental aspects and concepts including the possible cellular origin of uterine fibroids. The central themes in the subsequent parts are cytogenetic aberrations in leiomyomas and the racial/ethnic disparities in uterine fibroid biology. Then, the attributes of various in vitro and in vivo, human syndrome, rodent xenograft, naturally mutant, and genetically modified models used to study possible molecular mechanisms of leiomyoma development and growth are described. Particular emphasis is placed on known links to fibrosis, hypertrophy, and hyperplasia and genes that are potentially important in these processes. CONCLUSIONS Menstrual cycle-related injury and repair and coinciding hormonal cycling appears to affect myometrial stem cells that, at a certain stage of fibroid development, often obtain cytogenetic aberrations and mutations of Mediator complex subunit 12 (MED12). Mammalian target of rapamycin (mTOR), a master regulator of proliferation, is activated in many of these tumors, possibly by mechanisms that are similar to some human fibrosis syndromes and/or by mutation of upstream tumor suppressor genes. Animal models of the disease support some of these dysregulated pathways in fibroid etiology or pathogenesis, but none are definitive. All of this suggests that there are likely several key mechanisms involved in the disease that, in addition to increasing the complexity of uterine fibroid pathobiology, offer possible approaches for patient-specific therapies. A final model that incorporates many of these reported mechanisms is presented with a discussion of their implications for leiomyoma clinical practice.
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Affiliation(s)
- Arno E Commandeur
- Center for Reproductive Medicine, Women's and Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aaron K Styer
- Vincent Center for Reproductive Biology, Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jose M Teixeira
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, 333 Bostwick Ave NE, 4018A, Grand Rapids, MI, USA Department of Women's Health, Spectrum Health Systems, Grand Rapids, MI, USA
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Vitamin D and uterine leiomyoma among a sample of US women: Findings from NHANES, 2001-2006. Reprod Toxicol 2015; 57:81-6. [PMID: 26047529 DOI: 10.1016/j.reprotox.2015.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/05/2015] [Accepted: 05/26/2015] [Indexed: 11/22/2022]
Abstract
Scientific understanding of the etiology of uterine leiomyomata (UL) remains incomplete, but recent investigations have suggested an association between low Vitamin D and UL risk. In this study, we conducted a cross-sectional analysis of Vitamin D exposure, measured using serum levels of 25(OH)D (a Vitamin D metabolite), and self-reported UL diagnosis among 3590 women aged 20-54 in the National Health and Nutrition Examination Survey (NHANES 2001-2006). Multivariate logistic regression models comparing each quartile of 25(OH)D to the lowest quartile indicated no relationship between 25(OH)D and odds of UL in the whole population (Ptrend=0.37), or in sensitivity analyses. However, a probabilistic analysis correcting outcome misclassification indicated that insufficient 25(OH)D was associated with UL in white (Odds ratio (OR) median estimate: 2.17; 2.5, 97.5 percentiles: (1.26, 23.47)), but not black women (OR median estimate: 1.70; 2.5, 97.5 percentiles: (0.89, 3.51)), suggesting misclassification may have driven some of the null findings.
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