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Net amino acid flux across the fetal liver and placenta during spontaneous ovine parturition.

The uptake and/or release of amino acids across the fetal liver and the placenta were studied in 8 pregnant sheep during the 5 days preceding delivery of the lamb. During spontaneous parturition, there was a significant decrease in fetal hepatic glutamine uptake, in fetal hepatic glutamate release and in placental glutamate uptake. The fetal plasma concentrations of glutamate, leucine, isoleucine, valine, phenylalanine, serine and tyrosine also decreased significantly in the 5 days preceding delivery. There was no significant net output of glucose from the fetal liver nor any change in net lactate uptake by the liver. During this same time period there was a significant increase in the fetal plasma cortisol concentration and a decrease in progesterone output by the pregnant uterus. The results are compared to the previously reported amino acid changes during dexamethasone-induced parturition.

Amino Acids↗

Morphology of the porcine myometrium during parturition.

The ultrastructure of the porcine myometrium collected at well-defined stages during parturition was investigated by transmission electron microscopy. The morphology of the parturient myometrium resembled in general that in pregnant and non-pregnant pigs. The diameter of the smooth muscle cells was, however, about twice that of non-pregnant myometrium. Thick myofilaments were numerous. The number of caveolae seemed to be higher in parturient compared with non-pregnant and pregnant cells. Gap junctions occurred richly and were large, while the intrinsic innervation was very scanty. To conclude, the endocrinological changes in the pig taking place just prior to parturition, are translated into morphological changes by stimulating the formation of uterine gap junctions. This provides low-resistance pathways between the muscle cells and activates the myometrium for the delivery process.

Animals↗

Tissue polypeptide antigen during parturition and puerperium.

The tumour and cytoskeleton protein tissue polypeptide antigen (TPA) was determined in maternal serum taken during the second stage of labour and on the 4th postpartum day. Pregnant women at term (weeks 38-42) served as a control group. TPA levels of women during parturition (median 169 U/l) were higher than those of the control group (median 108.5 U/l) and those of women on the 4th postpartum day (median 66.5 U/l); p < 0.0001 in each case. The correlation between duration of labour and TPA concentration was positive and significant (rs = 0.3; p = 0.03). A significant negative correlation was found between placental weight and maternal serum TPA levels during parturition (rs = -0.3; p = 0.03). The decline of TPA after delivery indicated a serum half-life for TPA of less than 4 days.

Female↗

Expression and localization of human oxytocin receptor mRNA and its protein in chorion and decidua during parturition.

Oxytocin (OT) is widely used to induce labor in the clinical setting. However, its physiological role in normal human parturition remains unclear. We demonstrated the enhanced expression of OT receptor (OTR) mRNA in chorio-decidual tissue, using the polymerase chain reaction after the reverse transcriptase reaction (RT-PCR) and Northern blot analysis. OTR gene expression in chorio-decidual tissue increased fivefold during the course of parturition. In situ hybridization of fetal membrane revealed the expression of OTR mRNA in maternally derived decidual cells. The OTR mRNA was also detected in fetally derived chorionic trophoblast cells. Immunohistochemistry, using a newly developed anti-OTR monoclonal antibody, demonstrated the distribution of OTR protein in fetal membrane. The distribution pattern of OTR protein and OTR mRNA was identical, indicating that the regulation of OTR expression occurs mainly at the transcriptional level. These results support the idea that the expression of decidual OTR regulates the initiation and amplification of labor. The implications of these findings with regard to the pathogenesis of preterm labor are also discussed.

Base Sequence↗

Effect of tetracosactid on post partum cyclicity in cows after induction of parturition with PGF2 alpha.

Parturition and retention of fetal membranes were induced with PGF2 alpha in 3 primiparous dairy cows. Starting on day 12 post partum (PP) the cows were treated with 500 micrograms i.m. of ACTH-analogue (tetracosactid) every 6 h for 6 times. Changes in plasma concentrations of cortisol, progesterone and 15-ketodihydro-PGF2 alpha were evaluated immediately after treatment. The effects on the resumption of ovarian activity were evaluated by clinical and ultrasound examinations and by progesterone and 15-ketodihydro-PGF2 alpha analyses for 56 days after parturition. Treatment was able to induce a statistically significant (p < 0.01) similar increase in cortisol and progesterone after both the 1st and the 6th injections, in all cows. No changes in 15-ketodihydro-PGF2 alpha concentrations were seen after any of the injections of ACTH-analogue. The first corpus luteum (CL) was seen on day 18 PP (cow A), and 28 (cow B) and in both cases it was followed by a normal ovarian cyclicity. No CL was observed during the whole period of study in cow C. Progesterone profiles confirmed these clinical and ultrasonographic findings. The steroid output, especially progesterone, induced by the ACTH-analogue might be a stimulus for the onset of ovarian cyclicity, since 2 of the 3 animals ovulated earlier than expected. These findings point to the fact that interference with the stress system might have a positive effect on ovarian cyclicity. The different pattern of response does however demand further studies.

Animals↗

Release of vasopressin by the fetal lamb during premature parturition induced with corticotropin.

These studies were implemented to assess the relationship between fetal vasopressin secretion and the progression of parturition as well as the contribution of specific stimuli to vasopressin release during labor. In chronically catheterized fetal lamb preparations, labor was induced by infusion of adrenocorticotropin (12.5 mg/kg/hr) to seven fetuses at 130 +/- 1 day of gestation. Before labor, fetal plasma vasopressin concentrations were 2.1 +/- 1.4 pg/ml and remained low (5.3 +/- 3.4 pg/ml) during prodromal and early phases of labor, but rose significantly in the active and expulsive phases (39.6 +/- 27.5 and 173.3 +/- 152.9 pg/ml) to reach peak values at delivery (584.2 +/- 433 pg/ml) and decrease by 30 min after birth (359.8 +/- 90.0 pg/ml). At delivery, fetal plasma vasopressin concentrations were strongly correlated (P less than 0.001) with hormone values obtained during the latter phases of labor. Fetal arterial pH and oxygen tension was inversely correlated with plasma vasopressin (P less than 0.01). No similar correlations were found with arterial PCO2, K, Na, Cl, osmolality, or packed cell volume. Unexpectedly, we observed a significant (P less than 0.001) and progressive decrease in fetal oxygen tension during the induction process. Other characteristics of adrenocorticotropin-induced parturition seemed to mimic those of spontaneous labor.

Adrenocorticotropic Hormone↗

Metabolic alterations in the fetal hepatic and umbilical circulations during glucocorticoid-induced parturition in sheep.

Fetal hepatic amino acid metabolism has unique features in comparison to postnatal life. Thus, it seemed likely that this metabolism might be changed by the endocrine changes which precede birth. To explore the changes in placental and fetal carbohydrate and amino acid metabolism that occur during parturition, labor was induced in six ewes at 131 +/- 1 d gestation with a fetal infusion of dexamethasone. For purpose of chemical analysis, blood was withdrawn before and approximately 3 and 25 h from the start of the infusion from maternal arterial, uterine venous, umbilical venous, fetal arterial, and left hepatic venous catheters. Fetal oxygenation remained normal. At 25 h, both fetal and maternal arterial plasma glucose concentrations increased (p < 0.01 and p < 0.02, respectively) and umbilical glucose uptake decreased (p < 0.05). Fetal glutamate showed a significant reduction in its hepatic output (p < 0.05) with a concomitant reduction in fetal arterial plasma concentration (p < 0.05) and placental uptake (p < 0.01). Fetal plasma concentrations of several other amino acids were markedly increased. The reduction in placental glutamate uptake was temporally associated with a decline in progesterone release by the pregnant uterus. These data suggest the hypothesis that glutamate plays a role in integrating the complex changes in placental and fetal hepatic metabolism that occur during parturition.

Animals↗

The Shc 66 and 46 kD isoforms are differentially downregulated at parturition in the fetal mouse lung.

Many of the signaling pathways regulating fetal lung mesenchymal cell proliferation are mediated by the Shc intracellular signaling proteins. Shc is expressed as three isoforms: 52 kD and 46 kD proteins (Shc 52 and Shc 46, respectively) translated from the same mRNA, and a 66 kD form (Shc 66) translated from a separate mRNA. Shc 52 is an activator of Ras and mitogen-activated protein kinase, whereas Shc 66 antagonizes Ras activation. The function of Shc 46 is unclear. We hypothesized that the Shc isoforms are differentially regulated during fetal mouse lung morphogenesis. Relative Shc 66 and Shc 46 protein expression are high until parturition (term = 18.5 d), when a dramatic decrease begins; by postconceptual d 20, relative Shc 66 and Shc 46 expression have fallen by 75 and 69%, respectively. A similar pattern of decreasing Shc 66 mRNA expression in the peripartum period was detected by reverse transcription and competitive polymerase chain reaction during the same period. By isoform-specific immunohistochemistry, Shc 66 is widely distributed in the embryonic lung but becomes restricted to the bronchial smooth muscle and overlying epithelia, periarterial smooth muscle, and the interlobar pleura late in gestation. After parturition, Shc 66 is virtually absent from the lung. All three Shc isoforms are phosphorylated by epidermal growth factor stimulation in fetal lung mesenchymal cells, indicating that Shc 66 is functional in these cells. These data indicate that Shc isoforms are differentially regulated during lung development.

3T3 Cells↗

Brain beta-endorphin during pregnancy, parturition, and the postpartum period.

Brain beta-endorphin (beta-EP) was measured in the rat during pregnancy, parturition, and the postpartum period. beta-EP increased in the hypothalamus, midbrain, and amygdala during gestation and remained elevated through delivery until 1-2 days postpartum. The concentration of beta-EP increased in the hypothalamus from 31.8 +/- 1.4 (+/- SE) ng/mg protein in nonpregnant controls to 41.4 +/- 1.8 and 39.2 +/- 1.9 during early (8-10 days) and late (18-20 days) pregnancy, respectively, and in the midbrain from 3.20 +/- 0.17 to 5.21 +/- 0.30 and 5.25 +/- 0.64 ng/mg protein (P less than 0.01). In another experiment, the brain content of beta-EP expressed as nanograms per region, increased from 12.6 +/- 0.29 to 14.7 +/- 0.33 in the hypothalamus, from 4.09 +/- 0.44 to 6.03 +/- 0.34 in the midbrain, and from 0.93 +/- 0.11 to 1.32 +/- 0.06 ng in the amygdala at 16-17 days of gestation compared with that in nonpregnant controls (P less than 0.01). When hypothalamic beta-EP was measured 1 week postpartum in lactating and nonlactating rats, a significant decline in the beta-EP concentration of both groups was noted compared with that measured during pregnancy; beta-EP levels were similar in the lactating and nonlactating rats. We conclude that pregnancy and parturition are associated with significant changes in brain beta-EP and suggest that beta-EP of central rather than peripheral origin may mediate changes in pain perception and maternal behavior during pregnancy.

Animals↗

Insensitivity of near-term fetal sheep to cortisol: possible relation to the control of parturition.

In ruminants, parturition is stimulated by increased cortisol secretion by the fetal adrenal in the last few days of fetal life. Before this preparturient surge in fetal plasma cortisol, fetal ACTH and renin secretion are suppressed by small physiological increases in the fetal plasma cortisol concentration. The purpose of this study was to investigate the possibility that the sensitivity of ACTH and renin to cortisol inhibition is reduced at term. Fetal sheep, chronically catheterized at least 4 days before the first experiment, were subjected to iv infusion of cortisol at rates of 0 (n = 5), 1 (n = 4), 2 (n = 4), 5 (n = 5), and 10 (n = 5) micrograms/min for 5 h. One hour after the end of the cortisol infusion, fetal ACTH secretion was stimulated by fetal iv infusion of sodium nitroprusside (50 micrograms/min). In all groups, fetal plasma ACTH increased during the cortisol infusions, perhaps reflecting a circadian variation in fetal ACTH secretion which was not suppressed by cortisol. The endogenous increase in fetal ACTH during cortisol infusions produced apparently nonsteady state changes in fetal plasma cortisol concentrations. Cortisol infusion produced dose-related increases in the fetal plasma cortisol concentration. The highest rate of cortisol infusion increased fetal plasma cortisol to between 50 and 60 ng/ml. However, none of the cortisol infusions significantly suppressed fetal PRA or reduced the magnitude of the ACTH response to nitroprusside. The results demonstrate that acutely stimulated fetal ACTH secretion is not regulated by cortisol negative feedback in the last few days of fetal life. Reduction in negative feedback efficacy may allow the preparturient rise in cortisol secretion that is responsible for stimulating parturition in this species.

Adrenocorticotropic Hormone↗

Immunochemical and immunohistochemical evidence of estrogen-mediated collagenolysis as a mechanism of cervical dilatation in the guinea pig at parturition.

The mechanism of dilatation of the uterine cervix at birth is poorly understood. Several indirect lines of evidence have suggested that cervical ripening is accompanied by collagen degradation. In this study, immunochemical methods have been developed to identify and analyze type I collage degradation in the cervix of the pregnant guinea pig. Using cyanogen bromide-derived peptides of purified guinea pig type I collagen as an immunogen, a polyclonal rabbit antiserum was prepared that recognizes epitopes on the denatured and degraded alpha 2 chain of type I collagen as demonstrated by enzyme-linked immunosorbant assay and immunoblotting. This antibody was used to demonstrate degradation of type I collagen in the extracellular matrix of the dilated cervix at parturition. Moreover, physiological concentrations of 17 beta-estradiol stimulated degradation of type I collagen in the nonpregnant cervix in organ culture. Collagenase degradation products were detected in the extracellular matrix and in the culture media. The effect of 17 beta-estradiol (10(-6) M) was completely blocked by progesterone (10(-4) M). These studies suggest that dilatation of the guinea pig cervix at parturition may be associated with estrogen-mediated degradation of type I collagen.

Animals↗

Induction of uterine activity with oxytocin in late pregnant rats replicates the expression of c-fos in neuroendocrine and brain stem neurons as seen during parturition.

We investigated whether delivery could be induced with pulsatile oxytocin and whether such treatment activated neurons in the supraoptic nucleus (SON) and putative afferent neurons in the nucleus tractus solitarii and ventrolateral medulla, as seen during spontaneous parturition. Rats were implanted with a jugular venous cannula 1 day before the expected term and on the next morning were given a pulse of oxytocin or saline every 10 min for 4 h. Pulses of 10 and 20 mU oxytocin induced delivery in 77% (14 of 18) of rats, whereas none of the control animals (0 of 9) gave birth during the treatment. Lower doses of oxytocin were not effective at this time in inducing delivery. Animals were killed either before (prepartum groups) or during (parturient groups) delivery, and the brains were processed for immunocytochemistry. Oxytocin treatment induced Fos expression in SON and brain stem neurons in both parturient rats and rats in which parturition was not induced. Fos expression in all sites was significantly higher than that in control prepartum rats, but was similar in extent and distribution to that in spontaneous parturient rats. In the brain stem, a substantial proportion of Fos-immunoreactive cells contained tyrosine hydroxylase-like immunoreactivity, and the number of these cells was increased in response to oxytocin treatment. As only very few Fos-immunoreactive nuclei in either the SON or the nucleus tractus solitarii were observed in virgin rats injected with oxytocin, we suggest that intermittent oxytocin injections in late pregnant rats induce strong uterine activity, which can stimulate magnocellular and putative afferent neurons even before the expulsion of pups.

Animals↗

Inhibitory effect of calcitonin gene-related peptide on myometrial contractility is diminished at parturition.

The uterus is innervated by calcitonin gene-related peptide (CGRP) immunoreactive neurons, and CGRP inhibits spontaneous and evoked contractions in the uterus and fallopian tubes. In the present study using isometric force measurements on myometrial strips, we determined that CGRP inhibition of acetylcholine-induced contractions was drastically reduced at parturition compared with earlier stages of pregnancy in mice. The levels of inhibition exerted by CGRP paralleled the expression of a novel protein recently implicated in CGRP receptor activation, the CGRP-receptor component protein (CGRP-RCP). The mouse CGRP-RCP complementary DNA was isolated from uterus, and expression of the CGRP-RCP was monitored during gestation by Northern and Western blot analysis. Although CGRP-RCP messenger RNA levels did not vary significantly during gestation and postpartum, CGRP-RCP protein was greatly diminished at parturition. This diminution correlated with the loss of CGRP inhibition of acetylcholine-induced contractions observed in the force experiments. A role for CGRP and CGRP-RCP in modulation of myometrial smooth muscle contractility during pregnancy and in labor is suggested.

Acetylcholine↗

Leptin is not necessary for gestation and parturition but regulates maternal nutrition via a leptin resistance state.

Leptin levels are significantly elevated in pregnant mice, rats and humans suggesting a critical role for leptin during gestation. To address whether leptin plays a putative role in the physiology of pregnancy, we asked whether a mouse pregnancy would be affected by the complete absence of leptin from both the mother and fetuses. Thus, leptin-deficient ob/ob females were first treated with exogenous leptin and then mated to similarly treated ob/ob males. All resulting fetuses have an ob/ob genotype and lack like their mothers any endogenous leptin production. Withdrawal of leptin treatment at 0.5, 6.5, 10.5 and 19.5 days p.c. did not affect any stage of the pregnancy despite a gradual return of the mothers to an obese state. However, some mice had delayed gestation periods of 21-23 days which were associated with prolonged parturition. The pups were normally delivered with no obvious signs of deformities although none survived beyond a day after delivery due to failure of lactation. Monitoring daily food intake of pregnant ob/ob females treated throughout gestation with leptin revealed significantly elevated levels of food intake from day 10 p.c. and onward demonstrating an attenuation of a leptin response during pregnancy and a leptin resistance effect. These studies demonstrate that in the mouse, leptin is not a critical molecule for implantation, gestation, fetal growth and parturition but that the leptin resistance effect at mid-gestation aims to stimulate food intake thus providing sustained energy resources for pregnancy.

Animal Nutritional Physiological Phenomena↗

Suppression subtractive hybridization identified a marked increase in thrombospondin-1 associated with parturition in pregnant sheep myometrium.

Changes in several extracellular matrix proteins, such as fibronectin in fetal membrane and cervical collagens, occur at term and preterm delivery. However, no studies have evaluated changes in extracellular matrix proteins, in relation to myometrial activation recorded using invasive techniques during parturition in any species. We used suppression subtractive hybridization (SSH), to demonstrate the dramatic increases in one extracellular matrix protein, thrombospondin-1 (TSP1), in the pregnant ovine myometrium associated with parturition. Myometrial poly-A- RNA, extracted from term control ewes not in labor at 143-147 days of gestational age (dGA, n = 4), and from ewes in spontaneous term labor (STL) at 145-147 dGA (n 4), was subjected to SSH to construct a subtracted myometrial complementary DNA library. A complementary DNA clone from myometrial subtracted library, representing differentially expressed gene in the pregnant sheep myometrium during STL, was identified as TSP1 by sequence analysis and Blastn search. This cloned TSP1 was used to perform Northern blot analysis on total RNA isolated from five early controls, not in labor, at 130 dGA, five pregnant ewes in betamethasone-induced premature labor (BPL) at 130 dGA (betamethasone administered i.v. to the fetus at 0.48 mg over 48 h), six term-control-not-in-labor ewes at 143-147 dGA, and six pregnant ewes in STL. Northern blot analysis demonstrated that TSP1 increased significantly, associated with both BPL and STL. TSP1 protein level paralleled the increase of TSP1 messenger RNA during BPL and STL. To determine whether increase in this gene paralleled the increased strength of myometrial contractility, six ewes were treated with nimesulide, a selective PG synthase 2 inhibitor, at 147-148 dGA. Nimesulide infusion to the ewe i.v. to inhibit myometrial contraction (30 mg bolus, followed by 5 h infusion, 30 mg/h) commenced 9 h after onset of labor at 147-148 dGA. TSP1 in the myometrium decreased when myometrial contraction was inhibited by nimesulide. Both in situ hybridization and immunocytochemistry demonstrated that fibroblasts and the smooth muscle cells contained TSP1 messenger RNA and protein. TSP1 was also localized in the extracellular matrix. Our conclusions are: 1) our data provide the first evidence that changes in TSP1 are associated with myometrial activation in pregnant sheep during term and preterm labor; 2) myometrial fibroblasts and the smooth muscle cells are responsible for producing TSP1; and 3) SSH is a powerful technique that enables us to study differentially regulated genes during labor.

Animals↗

Prostaglandin production at the onset of ovine parturition is regulated by both estrogen-independent and estrogen-dependent pathways.

A current hypothesis of ovine parturition proposes that fetal adrenal cortisol induces placental E2 production, which, in turn, triggers intrauterine PG production. However, recent evidence suggests that cortisol may directly increase PG production in trophoblast-derived tissues. To separate cortisol-dependent and estrogen-dependent PG production in sheep intrauterine tissues, we infused singleton, chronically catheterized fetuses beginning on day 125 of gestation (term, 147-150 days) with 1) cortisol (1.35 mg/h; n = 5); 2) cortisol and 4-hydroxyandrostendione, a P450aromatase inhibitor (4-OHA: 1.44 mg/h; n = 5); 3) saline (n = 5); or 4) saline and 4-OHA (n = 5). Fetal and maternal arterial blood samples were collected at 12-h intervals starting 24 h before infusion and continuing during treatment for 80 h or until active labor. Uterine contractility was measured by electromyogram recording of myometrial activity. Plasma E2, progesterone (P4), PGE2, and 13,14-dihydro- 15-keto-PGF2alpha were quantified by RIA. PGHS-II messenger RNA (mRNA) and protein expression were determined by in situ hybridization and Western blot analysis, respectively. Data were analyzed by ANOVA (P < or = 0.05). Labor-type uterine contractions were present after 68 h of cortisol infusion and had increased significantly by 80 h. Labor-type uterine contractions were induced after 68 h of cortisol plus 4-OHA infusion, but the contraction frequency remained less than that in the cortisol-treated animals. Fetal cortisol infusion increased fetal and maternal plasma E2 concentrations and decreased the maternal plasma P4 concentration significantly; concurrent 4-OHA infusion attenuated the increase in fetal and maternal plasma E2, but not the decrease in maternal plasma P4. The fetal plasma PGE2 concentration increased after both cortisol and cortisol plus 4-OHA infusion. The maternal plasma 13,14-dihydro-15-keto-PGF2alpha concentration rose after fetal cortisol infusion, but not after cortisol plus 4-OHA infusion. Placental trophoblast PGHS-II mRNA and protein expression were increased significantly after both cortisol and cortisol plus 4-OHA infusion. Endometrial PGHS-II mRNA and protein expression increased after cortisol infusion, but not after cortisol plus 4-OHA infusion. Plasma steroid and PG concentrations, uterine activity pattern, and intrauterine PGHS-II expression were not altered in either control group. We conclude that these data suggest distinct pathways of intrauterine PG synthesis: a cortisol-dependent/E2-independent mechanism within trophoblast tissue leading to elevations in fetal plasma PGE2, and an E2-dependent mechanism within maternal endometrium that leads to increased maternal plasma PGF2alpha and appears necessary for uterine activity and parturition.

Animals↗

Plasma and amniotic fluid immunoreactive neuropeptide-Y level changes during pregnancy, labor, and at parturition.

This study was designed to determine the presence of and possible changes in plasma and amniotic fluid immunoreactive neuropeptide-Y (irNPY) levels in pregnant women during gestation and at parturition. We studied 127 healthy pregnant and 12 nonpregnant women. The peptide was extracted from plasma or amniotic fluid with a propanolformic acid mixture and measured by RIA. The mean plasma irNPY concentration in 15 pregnant women during the first trimester of gestation was 129 +/- 12 (+/- SE) pmol/L, compared to 40 +/- 8 pmol/L in nonpregnant women (p less than 0.01). The mean values were 144 +/- 13 and 156 +/- 24 pmol/L, respectively, in 15 pregnant women during the second trimester and 33 women during the third trimester. These values did not differ from that during the first trimester. Amniotic fluid irNPY levels were similar to those in plasma and did not vary among the 3 groups of women studied during the various trimesters of gestation. During labor, plasma irNPY levels progressively increased, reaching the highest levels at the most advanced stages of cervical dilatation (greater than 8 cm, 351 +/- 38 pmol/L) and at the time of vaginal delivery (416 +/- 73 pmol/L). Plasma irNPY levels then decreased significantly 2 h after vaginal delivery. The amniotic fluid irNPY levels in women during the early or late stages of labor were similar. Moreover, plasma and amniotic fluid irNPY levels at the time of elective cesarean section also were similar. These results indicate that pregnant women have high plasma and amniotic fluid irNPY levels and that the stress of labor results in a further increase in plasma levels, suggesting a possible role of NPY in human pregnancy and parturition.

Adult↗

Pregnancy, parturition, and prostaglandins: defining uterine leiomyomas.

Leiomyomas, benign smooth muscle tumors of the uterus, are the most common gynecologic neoplasm in women. Studies with surgically resected human tissues and primary cultures have revealed that several genes are differentially expressed in leiomyomas compared to matched normal myometrium. An estrogen-driven pattern of gene expression in leiomyomas, similar to that seen in normal myometrium during pregnancy and parturition, is associated with a persistent inappropriate response of neoplastic myometrial smooth muscle cells to ovarian hormones. This is possibly due to aberrant expression levels or signaling via estrogen and progesterone receptors. We propose the hypothesis that uterine leiomyomas mimic a differentiated myometrial cell at pregnancy and exhibit a hypersensitivity to sex steroid hormones that prevents the cells from responding to normal apoptotic or dedifferentiation signals and from returning to a nongravid phenotype. Support of this hypothesis is derived from experimental studies in female Eker rats that develop uterine leiomyomas with many similarities to the human disease. Our hypothesis accounts for the benign nature of these tumors and their high incidence in women during the reproductive years. By identifying the factors that participate in parturition and involution of the pregnant myometrium, we may better define uterine leiomyomas and thus identify novel targets for therapeutic strategies to treat these tumors.

Animals↗