Journal of Reproduction & Infertility

Journal of Reproduction & Infertility

The Genetic Bases of Uterine Fibroids; A Review

Authors
1 Department of Genetics, Osmania University, Hyderabad, India
2 Center for Cellular and Molecular Biology, Habsiguda, Hyderabad, India
3 Institute of Genetics and Hospital for Genetic Diseases, Begumpet, Hyderabad, India
4 Infertility Institute and research Center, Secunderabad, India
Abstract
Uterine leiomyomas/fibroids are the most common pelvic tumors of the female genital tract. The initiators remaining unknown, estrogens and progesterone are considered as promoters of fibroid growth. Fibroids are monoclonal tumors showing 40-50% karyo-typically detectable chromosomal abnormalities. Cytogenetic aberrations involving chromosomes 6, 7, 12 and 14 constitute the major chromosome abnormalities seen in leiomyomata. This has led to the discovery that disruptions or dysregulations of HMGIC and HMGIY genes contribute to the development of these tumors. Genes such as RAD51L1 act as translocation partners to HMGIC and lead to disruption of gene structure leading to the pathogenesis of uterine fibroids. The mechanism underlying this disease is yet to be identified. The occurrence of PCOLCE amid a cluster of at least eight Alu sequences is potentially relevant to the possible involvement of PCOLCE in the 7q22 rearrangements that occur in many leiomyomata. PCOLCE is implicated in cell growth processes. Involvement of Alu sequences in rearrangements can lead to the disruption of this gene and, hence, loss of control for gene expression leading to uncontrolled cell growth. This can also lead to the formation of fibroids. Though, cytogenetics provides a broad perspective on uterine fibroid formation, further molecular analysis is required to understand the etiopathogenesis of uterine fibroids.
Keywords

  1. Center for Uterine Fibroids [Internet]. Boston: Brigham and Women’s Hospital; 2011. What are fibroids?; 2006 Sept 19 [cited 2011 Mar 13]; [about 3 screens]. Available from: http://www.fibroids. net/aboutfibroids.html
  2. Nivethithai P, Nikhat SR, Rajesh BV. Uterine Fibroids: A Review. Indian J Pharm Pract. 2010;3 (1):6-11.
  3. Blake RE. Leiomyomata uteri: hormonal and molecular determinants of growth. J Natl Med Assoc. 2007;99(10):1170-84.
  4. Luo X, Chegini N. The expression and potential regulatory function of microRNAs in the pathogenesis of leiomyoma. Semin Reprod Med. 2008;26 (6):500-14.
  5. Zavadil J, Ye H, Liu Z, Wu J, Lee P, Hernando E, et al. Profiling and functional analyses of microRNAs and their target gene products in human uterine leiomyomas. PLoS One. 2010;5(8):e12362.
  6. Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyoma. Cancer Genet Cytogenet. 2005;158(1): 1-26.
  7. Cramer SF, Horiszny JA, Leppert P. Epidemiology of uterine leiomyomas. With an etiologic hypothesis. J Reprod Med. 1995;40(8):595-600.
  8. Parazzini F, La Vecchia C, Negri E, Cecchetti G, Fedele L. Epidemiologic characteristics of women with uterine fibroids: a case-control study. Obstet Gynecol. 1988;72(6):853-7.
  9. Samadi AR, Lee NC, Flanders WD, Boring JR 3rd, Parris EB. Risk factors for self-reported uterine fibroids: a case-control study. Am J Public Health. 1996;86(6):858-62.
  10. Marshall LM, Spiegelman D, Goldman MB, Manson JE, Colditz GA, Barbieri RL, et al. A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil Steril. 1998;70(3):432-9.
  11. Zaitseva M, Vollenhoven BJ, Rogers PA. In vitro culture significantly alters gene expression profiles and reduces differences between myometrial and fibroid smooth muscle cells. Mol Hum Reprod. 2006;12(3):187-207.
  12. Marshall LM, Spiegelman D, Barbieri RL, Goldman MB, Manson JE, Colditz GA, et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90(6):967-73.
  13. Flake GP, Andersen J, Dixon D. Etiology and pathogenesis of uterine leiomyomas: a review. Environ Health Perspect. 2003;111(8):1037-54.
  14. Faerstein E, Szklo M, Rosenshein NB. Risk factors for uterine leiomyoma: a practice-based casecontrol study. II. Atherogenic risk factors and potential sources of uterine irritation. Am J Epidemiol. 2001;153(1):11-9.
  15. Rein MS. Advances in uterine leiomyoma research: the progesterone hypothesis. Environ Health Perspect. 2000;108 Suppl 5:791-3.
  16. Parker WH. Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril. 2007;87 (4):725-36.
  17. Romieu I, Walker AM, Jick S. Determinants of uterine fibroids. Post Marketing Surveill. 1991;5: 119-33.
  18. Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives. Br Med J (Clin Res Ed). 1986;293(6543):359-62.
  19. Friedman AJ, Harrison-Atlas D, Barbieri RL, Benacerraf B, Gleason R, Schiff I. A randomized, placebo-controlled, double-blind study evaluating the efficacy of leuprolide acetate depot in the treatment of uterine leiomyomata. Fertil Steril. 1989;51(2):251-6.
  20. Mashal RD, Fejzo ML, Friedman AJ, Mitchner N, Nowak RA, Rein MS, et al. Analysis of androgen receptor DNA reveals the independent clonal origins of uterine leiomyomata and the secondary nature of cytogenetic aberrations in the development of leiomyomata. Genes Chromosomes Cancer. 1994;11(1):1-6.
  21. GLOWM: The Global Library of Women’s Medicine [Internet]. London: The Foundation for The Global Library of Women’s Medicine; 2010. Genetics of uterine leiomyomas; 2009 May [cited 2011 Mar 13]. Available from: http://www.glowm. com/?p=glowm.cml/section_view&articleid=363
  22. Levy B, Mukherjee T, Hirschhorn K. Molecular cytogenetic analysis of uterine leiomyoma and leiomyosarcoma by comparative genomic hybridization. Cancer Genet Cytogenet. 2000;121(1):1-8.
  23. Packenham JP, du Manoir S, Schrock E, Risinger JI, Dixon D, Denz DN, et al. Analysis of genetic alterations in uterine leiomyomas and leiomyosarcomas by comparative genomic hybridization. Mol Carcinog. 1997;19(4):273-9.
  24. Hodge JC, Morton CC. Genetic heterogeneity among uterine leiomyomata: insights into malignant progression. Hum Mol Genet. 2007;16 Spec No 1:R7-13.
  25. Nibert M, Heim S. Uterine leiomyoma cytogenetics. Genes Chromosomes Cancer. 1990;2(1):3-13.
  26. El-Gharib MN, Elsobky ES. Cytogenetic aberrations and the development of uterine leiomyomata. J Obstet Gynaecol Res. 2010;36(1):101-7.
  27. Fusco A, Fedele M. Roles of HMGA proteins in cancer. Nat Rev Cancer. 2007;7(12):899-910.
  28. Kazmierczak B, Pohnke Y, Bullerdiek J. Fusion transcripts between the HMGIC gene and RTVLH-related sequences in mesenchymal tumors without cytogenetic aberrations. Genomics. 1996; 38(2):223-6.
  29. Ashar HR, Fejzo MS, Tkachenko A, Zhou X, Fletcher JA, Weremowicz S, et al. Disruption of the architectural factor HMGI-C: DNA-binding AT hook motifs fused in lipomas to distinct transcriptional regulatory domains. Cell. 1995;82(1):57-65.
  30. Schoenmakers EF, Van de Ven WJ. From chromosome aberrations to the high mobility group protein gene family: evidence for a common genetic denominator in benign solid tumor development. Cancer Genet Cytogenet. 1997;95(1):51-8.
  31. Tallini G, Vanni R, Manfioletti G, Kazmierczak B, Faa G, Pauwels P, et al. HMGI-C and HMGI(Y) immunoreactivity correlates with cytogenetic abnormalities in lipomas, pulmonary chondroid hamartomas, endometrial polyps, and uterine leiomyomas and is compatible with rearrangement of the HMGI-C and HMGI(Y) genes. Lab Invest. 2000;80(3):359-69.
  32. Gross KL, Neskey DM, Manchanda N, Weremowicz S, Kleinman MS, Nowak RA, et al. HMGA2 expression in uterine leiomyomata and myometrium: quantitative analysis and tissue culture studies. Genes Chromosomes Cancer. 2003;38(1): 68-79.
  33. Quade BJ, Weremowicz S, Neskey DM, Vanni R, Ladd C, Dal Cin P, et al. Fusion transcripts involving HMGA2 are not a common molecular mechanism in uterine leiomyomata with rearrangements in 12q15. Cancer Res. 2003;63(6):1351-8.
  34. Peng Y, Laser J, Shi G, Mittal K, Melamed J, Lee P, et al. Antiproliferative effects by Let-7 repression of high-mobility group A2 in uterine leiomyoma. Mol Cancer Res. 2008;6(4):663-73.
  35. Wang T, Zhang X, Obijuru L, Laser J, Aris V, Lee P, et al. A micro-RNA signature associated with race, tumor size, and target gene activity in human uterine leiomyomas. Genes Chromosomes Cancer. 2007;46(4):336-47.
  36. Kazmierczak B, Bol S, Wanschura S, Bartnitzke S, Bullerdiek J. PAC clone containing the HMGI(Y) gene spans the breakpoint of a 6p21 translocation in a uterine leiomyoma cell line. Genes Chromosomes Cancer. 1996;17(3):191-3.
  37. Dal Cin P, Wanschura S, Christiaens MR, Van den Berghe I, Moerman P, Polito P, et al. Hamartoma of the breast with involvement of 6p21 and rearrangement of HMGIY. Genes Chromosomes Cancer. 1997;20(1):90-2.
  38. Williams AJ, Powell WL, Collins T, Morton CC. HMGI(Y) expression in human uterine leiomyomata. Involvement of another high-mobility group architectural factor in a benign neoplasm. Am J Pathol. 1997;150(3):911-8.
  39. Xiao S, Lux ML, Reeves R, Hudson TJ, Fletcher JA. HMGI(Y) activation by chromosome 6p21 rearrangements in multilineage mesenchymal cells from pulmonary hamartoma. Am J Pathol. 1997; 150(3):901-10.
  40. Schoenmakers EF, Huysmans C, Van de Ven WJ. Allelic knockout of novel splice variants of human recombination repair gene RAD51B in t(12;14) uterine leiomyomas. Cancer Res. 1999;59(1):19-23.
  41. Ingraham SE, Lynch RA, Kathiresan S, Buckler AJ, Menon AG. hREC2, a RAD51-like gene, is disrupted by t(12;14) (q15;q24.1) in a uterine leiomyoma. Cancer Genet Cytogenet. 1999;115(1): 56-61.
  42. Takahara K, Kessler E, Biniaminov L, Brusel M, Eddy RL, Jani-Sait S, et al. Type I procollagen COOH-terminal proteinase enhancer protein: identification, primary structure, and chromosomal localization of the cognate human gene (PCOL CE). J Biol Chem. 1994;269(42):26280-5.
  43. Xing YP, Powell WL, Morton CC. The del(7q) subgroup in uterine leiomyomata: genetic and biologic characteristics. Further evidence for the secondary nature of cytogenetic abnormalities in the pathobiology of uterine leiomyomata. Cancer Genet Cytogenet. 1997;98(1):69-74.
  44. Scott IC, Clark TG, Takahara K, Hoffman GG, Greenspan DS. Structural organization and expression patterns of the human and mouse genes for the type I procollagen COOH-terminal proteinase enhancer protein. Genomics. 1999;55(2):229-34.
  45. Stewart EA, Nowak RA. Leiomyoma-related bleeding: a classic hypothesis updated for the molecular era. Hum Reprod Update. 1996;2(4): 295-306.