ABSTRACT
Uterine leiomyomas (fibroids, myomas) are benign tumors that develop from smooth muscle
cells. Although the most common gynecologic tumor in premenopausal women, there is
still little known of the etiology, the genetics and basic/molecular biology, or the
influence of the environment on the development and growth of these tumors. The fact
that fibroids occur during the reproductive years and regress after menopause indicates
a growth dependent on ovarian hormones. Studies have supported a role of estrogen
and progesterone in leiomyoma growth possibly through regulating growth factors and
their signaling pathways. Activation of steroid hormone receptors can have a myriad
of effects and include upregulation of growth factors and receptor tyrosine kinases
(RTKs), which through downstream effector proteins such as mitogen-activated protein
kinase p44/42, can mediate transcription, translation, and cell proliferation. Due
to their hormonal dependency, fibroids may also be targeted by environmental chemicals
whose biological effects are mediated through the estrogen and/or progesterone receptors.
This review focuses on the role of growth factors and their receptors (RTKs) in uterine
leiomyoma growth and their regulation by ovarian hormones. It also presents data on
specific signaling pathways activated in uterine leiomyomas and the “cross talk” between
the estrogen receptor α and RTK signaling pathways.
KEYWORDS
Receptor tyrosine kinases (RTKs) - hormonal regulation - uterus - leiomyoma - growth
factors - fibroids
REFERENCES
1
Li E, Hristova K.
Role of receptor tyrosine kinase transmembrane domains in cell signaling and human
pathologies.
Biochemistry.
2006;
45(20)
6241-6251
2
Bennasroune A, Gardin A, Aunis D, Crémel G, Hubert P.
Tyrosine kinase receptors as attractive targets of cancer therapy.
Crit Rev Oncol Hematol.
2004;
50(1)
23-38
3
Ferrara N.
VEGF and the quest for tumour angiogenesis factors.
Nat Rev Cancer.
2002;
2(10)
795-803
4
Yu L, Saile K, Swartz C D et al..
Differential expression of receptor tyrosine kinases (RTKs) and IGF-I pathway activation
in human uterine leiomyomas.
Mol Med.
2008;
14(5–6)
264-275
5
Wang J, Ohara N, Wang Z et al..
A novel selective progesterone receptor modulator asoprisnil (J867) down-regulates
the expression of EGF, IGF-I, TGFbeta3 and their receptors in cultured uterine leiomyoma
cells.
Hum Reprod.
2006;
21(7)
1869-1877
6
Flake G P, Andersen J, Dixon D.
Etiology and pathogenesis of uterine leiomyomas: a review.
Environ Health Perspect.
2003;
111(8)
1037-1054
7
Shushan A, Ben-Bassat H, Mishani E, Laufer N, Klein B Y, Rojansky N.
Inhibition of leiomyoma cell proliferation in vitro by genistein and the protein tyrosine
kinase inhibitor TKS050.
Fertil Steril.
2007;
87(1)
127-135
8
Mangrulkar R S, Ono M, Ishikawa M, Takashima S, Klagsbrun M, Nowak R A.
Isolation and characterization of heparin-binding growth factors in human leiomyomas
and normal myometrium.
Biol Reprod.
1995;
53(3)
636-646
9
Wolańska M, Bańkowski E.
Fibroblast growth factors (FGF) in human myometrium and uterine leiomyomas in various
stages of tumour growth.
Biochimie.
2006;
88(2)
141-146
10
Liang M, Wang H, Zhang Y, Lu S, Wang Z.
Expression and functional analysis of platelet-derived growth factor in uterine leiomyomata.
Cancer Biol Ther.
2006;
5(1)
28-33
11
Van der Ven L T, Roholl P J, Gloudemans T et al..
Expression of insulin-like growth factors (IGFs), their receptors and IGF binding
protein-3 in normal, benign and malignant smooth muscle tissues.
Br J Cancer.
1997;
75(11)
1631-1640
12
Crosier P S, Freeman S A, Orlic D, Bodine D M, Crosier K E.
The Dtk receptor tyrosine kinase, which binds protein S, is expressed during hematopoiesis.
Exp Hematol.
1996;
24(2)
318-323
13
Motoyoshi K.
Function, molecular structure and gene expression of macrophage colony-stimulating
factor [in Japanese].
Nippon Rinsho.
1992;
50(8)
1861-1866
14
Pützer B M, Drosten M.
The RET proto-oncogene: a potential target for molecular cancer therapy.
Trends Mol Med.
2004;
10(7)
351-357
15
Forrester W C.
The Ror receptor tyrosine kinase family.
Cell Mol Life Sci.
2002;
59(1)
83-96
16
Hoch W.
Molecular dissection of neuromuscular junction formation.
Trends Neurosci.
2003;
26(7)
335-337
17
Brantley-Sieders D M, Chen J.
Eph receptor tyrosine kinases in angiogenesis: from development to disease.
Angiogenesis.
2004;
7(1)
17-28
18
Sun W S, Fujimoto J, Tamaya T.
Clinical implications of coexpression of growth arrest-specific gene 6 and receptor
tyrosine kinases Axl and Sky in human uterine leiomyoma.
Mol Hum Reprod.
2003;
9(11)
701-707
19
Schlessinger J, Lemmon M A.
Nuclear signaling by receptor tyrosine kinases: the first robin of spring.
Cell.
2006;
127(1)
45-48
20
McKay M M, Morrison D K.
Integrating signals from RTKs to ERK/MAPK.
Oncogene.
2007;
26(22)
3113-3121
21
Barbarisi A, Petillo O, Di Lieto A et al..
17-beta estradiol elicits an autocrine leiomyoma cell proliferation: evidence for
a stimulation of protein kinase-dependent pathway.
J Cell Physiol.
2001;
186(3)
414-424
22
Levin E R.
Integration of the extranuclear and nuclear actions of estrogen.
Mol Endocrinol.
2005;
19(8)
1951-1959
23
Mesquita F S, Dyer S N, Heinrich D A et al..
Reactive oxygen species mediate mitogenic growth factor signaling pathways in human
leiomyoma smooth muscle cells.
Biol Reprod.
2010;
82(2)
341-351
24
Orcy R B, Brum I, da Silva R S, Kucharski L C, Corleta H E, Capp E.
Insulin receptor tyrosine kinase activity and substrate 1 (IRS-1) expression in human
myometrium and leiomyoma.
Eur J Obstet Gynecol Reprod Biol.
2005;
123(1)
107-110
25
Cook J D, Walker C L.
Treatment strategies for uterine leiomyoma: the role of hormonal modulation.
Semin Reprod Med.
2004;
22(2)
105-111
26
Sozen I, Arici A.
Interactions of cytokines, growth factors, and the extracellular matrix in the cellular
biology of uterine leiomyomata.
Fertil Steril.
2002;
78(1)
1-12
27
Buttram Jr V C, Reiter R C.
Uterine leiomyomata: etiology, symptomatology, and management.
Fertil Steril.
1981;
36(4)
433-445
28
Dixon D, Flake G P, Moore A B et al..
Cell proliferation and apoptosis in human uterine leiomyomas and myometria.
Virchows Arch.
2002;
441(1)
53-62
29
Lannigan D A.
Estrogen receptor phosphorylation.
Steroids.
2003;
68(1)
1-9
30
Bunone G, Briand P A, Miksicek R J, Picard D.
Activation of the unliganded estrogen receptor by EGF involves the MAP kinase pathway
and direct phosphorylation.
EMBO J.
1996;
15(9)
2174-2183
31
Hermon T L, Moore A B, Yu L, Kissling G E, Castora F J, Dixon D.
Estrogen receptor alpha (ERalpha) phospho-serine-118 is highly expressed in human
uterine leiomyomas compared to matched myometrium.
Virchows Arch.
2008;
453(6)
557-569
32
Shimomura Y, Matsuo H, Samoto T, Maruo T.
Up-regulation by progesterone of proliferating cell nuclear antigen and epidermal
growth factor expression in human uterine leiomyoma.
J Clin Endocrinol Metab.
1998;
83(6)
2192-2198
33
Yamada T, Nakago S, Kurachi O et al..
Progesterone down-regulates insulin-like growth factor-I expression in cultured human
uterine leiomyoma cells.
Hum Reprod.
2004;
19(4)
815-821
34
Swartz C D, Afshari C A, Yu L, Hall K E, Dixon D.
Estrogen-induced changes in IGF-I, Myb family and MAP kinase pathway genes in human
uterine leiomyoma and normal uterine smooth muscle cell lines.
Mol Hum Reprod.
2005;
11(6)
441-450
35
Chegini N, Luo X, Ding L, Ripley D.
The expression of Smads and transforming growth factor beta receptors in leiomyoma
and myometrium and the effect of gonadotropin releasing hormone analogue therapy.
Mol Cell Endocrinol.
2003;
209(1-2)
9-16
36
Kato S, Endoh H, Masuhiro Y et al..
Activation of the estrogen receptor through phosphorylation by mitogen-activated protein
kinase.
Science.
1995;
270(5241)
1491-1494
37
Zhao Y, Zhang W, Wang S.
The expression of estrogen receptor isoforms alpha, beta and insulin-like growth factor-I
in uterine leiomyoma.
Gynecol Endocrinol.
2008;
24(10)
549-554
38
Hassan M H, Salama S A, Arafa H M, Hamada F M, Al-Hendy A.
Adenovirus-mediated delivery of a dominant-negative estrogen receptor gene in uterine
leiomyoma cells abrogates estrogen- and progesterone-regulated gene expression.
J Clin Endocrinol Metab.
2007;
92(10)
3949-3957
39
Dixon D, He H, Haseman J K.
Immunohistochemical localization of growth factors and their receptors in uterine
leiomyomas and matched myometrium.
Environ Health Perspect.
2000;
108(Suppl 5)
795-802
40
Di X, Yu L, Moore A B et al..
A low concentration of genistein induces estrogen receptor-alpha and insulin-like
growth factor-I receptor interactions and proliferation in uterine leiomyoma cells.
Hum Reprod.
2008;
23(8)
1873-1883
41
van der Ven L T, Gloudemans T, Roholl P J et al..
Growth advantage of human leiomyoma cells compared to normal smooth-muscle cells due
to enhanced sensitivity toward insulin-like growth factor I.
Int J Cancer.
1994;
59(3)
427-434
42
Murphy L J, Ghahary A.
Uterine insulin-like growth factor-1: regulation of expression and its role in estrogen-induced
uterine proliferation.
Endocr Rev.
1990;
11(3)
443-453
43
Adesanya O O, Zhou J, Bondy C A.
Sex steroid regulation of insulin-like growth factor system gene expression and proliferation
in primate myometrium.
J Clin Endocrinol Metab.
1996;
81(5)
1967-1974
44
Giudice L C, Irwin J C, Dsupin B A et al..
Insulin-like growth factor (IGF), IGF binding protein (IGFBP), and IGF receptor gene
expression and IGFBP synthesis in human uterine leiomyomata.
Hum Reprod.
1993;
8(11)
1796-1806
45
Newbold R R.
Lessons learned from perinatal exposure to diethylstilbestrol.
Toxicol Appl Pharmacol.
2004;
199(2)
142-150
46
Newbold R R, Banks E P, Bullock B, Jefferson W N.
Uterine adenocarcinoma in mice treated neonatally with genistein.
Cancer Res.
2001;
61(11)
4325-4328
47
Hunter D S, Hodges L C, Eagon P K et al..
Influence of exogenous estrogen receptor ligands on uterine leiomyoma: evidence from
an in vitro/in vivo animal model for uterine fibroids.
Environ Health Perspect.
2000;
108(suppl 5)
829-834
48
Adlercreutz H, Markkanen H, Watanabe S.
Plasma concentrations of phyto-oestrogens in Japanese men.
Lancet.
1993;
342(8881)
1209-1210
49
Wang T T, Sathyamoorthy N, Phang J M.
Molecular effects of genistein on estrogen receptor mediated pathways.
Carcinogenesis.
1996;
17(2)
271-275
Darlene DixonD.V.M. Ph.D.
Cellular and Molecular Pathology Branch, National Toxicology Program, National Institute
of Environmental Health Sciences, National Institutes of Health, Department of Health
and Human Services
111 T.W. Alexander Drive, P.O. Box 12233, Bldg. 101/Rm C254A/MD C209, Research Triangle
Park, NC 27709
eMail: dixon@niehs.nih.gov