Abstract
Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leio-myomas; it treats all present uterine nodules at once, is less invasive than other procedures and effective in controlling symptoms, and does not require long term hospitalizations. Nevertheless, the potential impact on endometrial morphological and functional outcomes after the procedure is still controversial based on reports of endometritis or eventual transient ischemia. This study evaluated endometrial reorganization in uterine leiomyoma patients, before and after AEM, through gene expression analyses of extracellular matrix and cytokines genes in theendometrial tissue. Eight patients with leiomyomas were evaluated before AEM and 6 months after. The examinations included transvaginal pelvic ultrasonography, dosing of the follicle-stimulating hormone, and endometrial biopsy during the second phase of the menstrual cycle. RNA was extracted from endometrial samples, cDNA was synthesized, and applied on PCR arrayTM plates to evaluate the expression of extracellular matrix (ECM) genes and cytokines and their receptors’ genes (CYT). The ECM overexpressed genes were MMP (1, 3, 10, 11, and 14), CTGF1, ICAM1, TBHS1, ITGA2, ITGA3, ITGB3, COL7A1, COL12A, SPP1, and TNC; ADAMTS8 was underexpressed. The CYT overexpressed genes were SPP1, BCL6, CXCL12, IL-8, and CEBPB; CXCL13 and CCL21 were underexpressed. The ECM results showed overexpression of proteases that are responsible for dysfunctions in the ECM, and of genes responsible for adhesion and membrane components. The CYT results showed overexpression of chemokines responsible for endometrial repair, and underexpression of cytokines involved in inflammatory processes in the endometrial tissue. AEM treatment did not negatively affect the endometrial function at 6 months after embolization. This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients.
Highlights
Arterial embolization of myomas (AEM) is an established option for the conservative treatment of uterine leiomyomas because it treats all present uterine nodules at once, is less invasive than other procedures, is effective in controlling symptoms, does not require long term hospitalizations, and allows for fast patient recovery
This study broadens the knowledge about using a procedure that is relevant to the treatment of leiomyomas and contributes to the establishment of future guidelines for the decision making process for physicians and patients
We evaluated the endometrial reorganization in patients with uterine leiomyomas, before and after AEM, in prospective and experimental cases, through molecular analyses of gene expressions in the extracellular matrix (ECM) and of CYT genes in the endometrial tissue
Summary
AEM is an established option for the conservative treatment of uterine leiomyomas because it treats all present uterine nodules at once, is less invasive than other procedures, is effective in controlling symptoms, does not require long term hospitalizations, and allows for fast patient recovery. Despite the many studies reporting normal and uncomplicated pregnancies in patients who received this treatment [2]-[4], the main discussion around the use of AEM is about its possible effects on the endometrium that could lead to infertility. These controversies weights heavy on the decision making process that doctors and patients have to walk through; candidates for the procedure must be carefully evaluated, couples must be informed of risks, and informed voluntary consent statements must be signed before a decision is made to proceed to treatment. The molecular analysis of the endometrium allows the assessment of morphology and functionality; these on site factors have only been studied in the last two decades, and molecular studies correlating results with clinical post-AEM outcomes in the endometrium are still scarce
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