In vivo mechanisms of uterine myoma volume reduction with ulipristal acetate treatment.

Abstract

OBJECTIVE:

To study the in vivo mechanisms of action of ulipristal acetate (UPA) on uterine myomas.

DESIGN:

Retrospective histologic and immunohistochemical (IHC) study of myomas.

SETTING:

Academic research unit.

PATIENT(S):

Among 59 women with symptomatic myomas who underwent myomectomy, 42 were treated preoperatively with UPA, while 17 were not.

INTERVENTION(S):

Histology and IHC were analyzed on tissue microarrays obtained from surgical specimens.

MAIN OUTCOME MEASURE(S):

Proliferation, apoptosis, extracellular matrix (ECM) remodeling, and matrix metalloproteinase 2 (MMP-2) expression.

RESULT(S):

Proliferation was low in all conditions, with no statistical difference between groups. Terminal deoxynucleotide transferase-mediated dUTP nick-end labeling assay showed an increase in cell death in UPA-treated myomas compared with untreated myomas, but only after short-term treatment; this was not associated with elevated levels of cleaved caspase-3. After long-term treatment, cell density was higher and the ECM volume fraction lower in UPA-treated myomas than in untreated myomas. MMP-2 expression was found to be increased after treatment, showing the highest level after long-term treatment, compared with untreated myomas.

CONCLUSION(S):

Regarding sustained clinical volume reduction of myomas, this study strongly points to multifactorial mechanisms of action of UPA, involving: 1) a persistently low cell proliferation rate; 2) a limited period of cell death; and 3) ECM remodeling concomitant with stimulation of MMP-2 expression.

• Authors: Guillaume E Courtoy, Jacques Donnez, Etienne Marbaix, Marie-Madeleine Dolmans
• Journal: Fertility and sterility (Fertil Steril) Vol. 104 Issue 2 Pg. 426-34.e1 (Aug 2015) ISSN: 1556-5653 [Electronic] United States
• PMID: 26003270 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Chemical References

• Contraceptive Agents
• Norpregnadienes
• ulipristal acetate

Topics

• Adult
• Contraceptive Agents (administration & dosage)
• Double-Blind Method
• Female
• Humans
• Leiomyoma (diagnosis, drug therapy, surgery)
• Middle Aged
• Myoma (diagnosis, drug therapy, surgery)
• Norpregnadienes (administration & dosage)
• Preoperative Care (methods)
• Treatment Outcome
• Uterine Neoplasms (diagnosis, drug therapy, surgery)