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Racial Diversity and Uterine Leiomyoma

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Ethnic Differences in Fertility and Assisted Reproduction

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Abstract

Uterine leiomyoma (ULM) represents the most frequent indication for hysterectomy in the USA. It costs the USA annually $5.9–34.4 billion in direct and indirect costs. The incidences of ULM in black races are higher compared to white races. Both estrogen and progesterone have a role in initiating and promoting ULM. Several important genetic variations have been connected to the higher prevalence of ULM in black women. The steady increase in serum estradiol and progesterone concentration among premenopausal women may depend on the number of CYP17 gene alleles that a woman carries. Catechol-O-methyltransferase (COMT) gene, which has an important role in the inactivation of catechol estrogens, may indirectly modulate the biological effects of estrogen and thus play an etiological role in leiomyoma formation. High-density tissue microarray has been used to identify the ethnic differences in the expression of selected gene products in ULM versus adjacent normal myometrium and showed a clear down-regulation of retinoic acid receptors (RAR-a and RXR-a) in ULM of Black women in comparison with their up-regulation in other ethnic groups. Finally, this chapter will try to discuss whether the function or the expression of steroid receptors is contributing to the racial differences in the incidence of ULM.

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References

  1. Walker CL, Stewart EA. Uterine fibroids: the elephant in the room. Science. 2005;308(5728):1589–92.

    Article  PubMed  CAS  Google Scholar 

  2. Cardozo ER et al. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206(3):211e1–9.

    Article  Google Scholar 

  3. Baird DD et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188(1):100–7.

    Article  PubMed  Google Scholar 

  4. Wise LA et al. Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol. 2004;159(2):113–23.

    Article  PubMed  Google Scholar 

  5. Huyck KL et al. The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyomata among affected sisters. Am J Obstet Gynecol. 2008;198(2):168e1–9.

    Article  Google Scholar 

  6. Peddada SD et al. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci U S A. 2008;105(50):19887–92.

    Article  PubMed  CAS  Google Scholar 

  7. Gross KL et al. Involvement of fumarate hydratase in nonsyndromic uterine leiomyomas: genetic linkage analysis and FISH studies. Genes Chromosome Canc. 2004;41(3):183–90.

    Article  CAS  Google Scholar 

  8. Taran FA, Brown HL, Stewart EA. Racial diversity in uterine leiomyoma clinical studies. Fertil Steril. 2010;94(4):1500–3.

    Article  PubMed  Google Scholar 

  9. Yoshida S et al. Cell-type specific actions of progesterone receptor modulators in the regulation of uterine leiomyoma growth. Semin Reprod Med. 2010;28(3):260–73.

    Article  PubMed  CAS  Google Scholar 

  10. Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1 Pt 1):14–8.

    Article  PubMed  CAS  Google Scholar 

  11. Marshall LM et al. Variation in the incidence of uterine leiomyoma among premenopausal women by age and race. Obstet Gynecol. 1997;90(6):967–73.

    Article  PubMed  CAS  Google Scholar 

  12. Chen I, Motan T, Kiddoo D. Gonadotropin-releasing hormone agonist in laparoscopic myomectomy: systematic review and meta-analysis of randomized controlled trials. J Minim Invasive Gynecol. 2011;18(3):303–9.

    Article  PubMed  Google Scholar 

  13. Lethaby A, Vollenhoven B, Sowter M. Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids. Cochrane Database Syst Rev. 2001;2:CD000547.

    PubMed  Google Scholar 

  14. Valladares F et al. Characterization of estrogen receptors alpha and beta in uterine leiomyoma cells. Fertil Steril. 2006;86(6):1736–43.

    Article  PubMed  CAS  Google Scholar 

  15. Bakas P et al. Estrogen receptor alpha and beta in uterine fibroids: a basis for altered estrogen responsiveness. Fertil Steril. 2008;90(5):1878–85.

    Article  PubMed  CAS  Google Scholar 

  16. Howe SR et al. Rodent model of reproductive tract leiomyomata. Establishment and characterization of tumor-derived cell lines. Am J Pathol. 1995;146(6):1568–79.

    PubMed  CAS  Google Scholar 

  17. Andersen J et al. Leiomyoma primary cultures have elevated transcriptional response to estrogen compared with autologous myometrial cultures. J Soc Gynecol Investig. 1995;2(3):542–51.

    Article  PubMed  CAS  Google Scholar 

  18. Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit. 2008;14(1):CR24–31.

    PubMed  Google Scholar 

  19. Balloch EA. The relative frequency of fibroid processes in the dark-skinned races. Med News. 1894;2:29–35.

    Google Scholar 

  20. Templeman C et al. Risk factors for surgically removed fibroids in a large cohort of teachers. Fertil Steril. 2009;92(4):1436–46.

    Article  PubMed  Google Scholar 

  21. Faerstein E, Szklo M, Rosenshein N. Risk factors for uterine leiomyoma: a practice-based case-control study. I. African-American heritage, reproductive history, body size, and smoking. Am J Epidemiol. 2001;153(1):1–10.

    Article  PubMed  CAS  Google Scholar 

  22. Kjerulff KH et al. Uterine leiomyomas. Racial differences in severity, symptoms and age at diagnosis. J Reprod Med. 1996;41(7):483–90.

    PubMed  CAS  Google Scholar 

  23. Jacoby VL et al. Racial and ethnic disparities in benign gynecologic conditions and associated surgeries. Am J Obstet Gynecol. 2010;202(6):514–21.

    Article  PubMed  Google Scholar 

  24. Bower JK et al. Black-White differences in hysterectomy prevalence: the CARDIA study. Am J Public Health. 2009;99(2):300–7.

    Article  PubMed  Google Scholar 

  25. Powell LH et al. Ethnic differences in past hysterectomy for benign conditions. Womens Health Issues. 2005;15(4):179–86.

    Article  PubMed  Google Scholar 

  26. Kjerulff KH et al. Hysterectomy and race. Obstet Gynecol. 1993;82(5):757–64.

    PubMed  CAS  Google Scholar 

  27. Weiss G et al. Racial differences in women who have a hysterectomy for benign conditions. Womens Health Issues. 2009;19(3):202–10.

    Article  PubMed  Google Scholar 

  28. Othman EE, Al-Hendy A. Molecular genetics and racial disparities of uterine leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2008;22(4):589–601.

    Article  PubMed  Google Scholar 

  29. Bach PB et al. Survival of blacks and whites after a cancer diagnosis. JAMA. 2002;287(16):2106–13.

    Article  PubMed  Google Scholar 

  30. Albain KS et al. Racial disparities in cancer survival among randomized clinical trials patients of the Southwest Oncology Group. J Natl Cancer Inst. 2009;101(14):984–92.

    Article  PubMed  Google Scholar 

  31. Brentano ST, Picado-Leonard J, Mellon SH, et al. Tissue-specific cyclic adenosine 30,50-monophosphate-induced, and phorbol sterrepressed transcription from the human P450cl7 promoter in mouse cells. Mol Endocrinol. 1990;4:1972–9.

    Article  PubMed  CAS  Google Scholar 

  32. Carey AH, Waterworth D, Patel K, et al. Polycystic ovaries and premature male pattern baldness are associated with one allele of the steroid metabolism gene CYP17. Hum Mol Genet. 1994;3:1873–6.

    Article  PubMed  CAS  Google Scholar 

  33. Feigelson HS, Shames LS, Pike MC, et al. Cytochrome P450c17alpha gene (CYP17) polymorphism is associated with serum estrogen and progesterone concentrations. Cancer Res. 1998;58:585–7.

    PubMed  CAS  Google Scholar 

  34. Amant F et al. A possible role of the cytochrome P450c17alpha gene (CYP17) polymorphism in the pathobiology of uterine leiomyomas from black South African women: a pilot study. Acta Obstet Gynecol Scand. 2004;83(3):234–9.

    PubMed  Google Scholar 

  35. Tsujino T et al. The CYP17 MspA1 polymorphism is not associated with an increased risk of uterine leiomyomas in a Japanese population. Gynecol Endocrinol. 2006;22(2):87–91.

    Article  PubMed  CAS  Google Scholar 

  36. Vieira LC et al. Association of the CYP17 gene polymorphism with risk for uterine leiomyoma in Brazilian women. Gynecol Endocrinol. 2008;24(7):373–7.

    Article  PubMed  CAS  Google Scholar 

  37. van Duursen MB et al. Phytochemicals inhibit catechol-O-methyltransferase activity in cytosolic fractions from healthy human mammary tissues: implications for catechol estrogen-induced DNA damage. Toxicol Sci. 2004;81(2):316–24.

    Article  PubMed  Google Scholar 

  38. Lachman HM et al. Human catechol-O-methyltransferase pharmacogenetics: description of a functional polymorphism and its potential application to neuropsychiatric disorders. Pharmacogenetics. 1996;6(3):243–50.

    Article  PubMed  CAS  Google Scholar 

  39. Mitrunen K et al. Polymorphic catechol-O-methyltransferase gene and breast cancer risk. Cancer Epidemiol Biomarkers Prev. 2001;10(6):635–40.

    PubMed  CAS  Google Scholar 

  40. Al-Hendy A, Salama SA. Catechol-O-methyltransferase polymorphism is associated with increased uterine leiomyoma risk in different ethnic groups. J Soc Gynecol Investig. 2006;13(2):136–44.

    Article  PubMed  CAS  Google Scholar 

  41. de Oliveira E et al. The catechol-O-methyltransferase (COMT) gene polymorphism and prevalence of uterine fibroids. Maturitas. 2008;60(3–4):235–8.

    Article  PubMed  Google Scholar 

  42. Vandewalle B, Lefebvre J. Opposite effects of estrogen and catecholestrogen on hormone-sensitive breast cancer cell growth and differentiation. Mol Cell Endocrinol. 1989;61(2):239–46.

    Article  PubMed  CAS  Google Scholar 

  43. Reddy VV, Hanjani P, Rajan R. Synthesis of catechol estrogens by human uterus and leiomyoma. Steroids. 1981;37(2):195–203.

    Article  PubMed  CAS  Google Scholar 

  44. Chegini N et al. Gene expression profile of leiomyoma and myometrium and the effect of gonadotropin releasing hormone analogue therapy. J Soc Gynecol Investig. 2003;10(3):161–71.

    Article  PubMed  CAS  Google Scholar 

  45. Sadan O et al. Ethnic variation in estrogen and progesterone receptor concentration in leiomyoma and normal myometrium. Gynecol Endocrinol. 1988;2(4):275–82.

    Article  PubMed  CAS  Google Scholar 

  46. Amant F et al. Ethnic variations in uterine leiomyoma biology are not caused by differences in myometrial estrogen receptor alpha levels. J Soc Gynecol Investig. 2003;10(2):105–9.

    Article  PubMed  CAS  Google Scholar 

  47. Wei JJ et al. Ethnic differences in expression of the dysregulated proteins in uterine leiomyomata. Hum Reprod. 2006;21(1):57–67.

    Article  PubMed  Google Scholar 

  48. Arslan AA et al. Gene expression studies provide clues to the pathogenesis of uterine leiomyoma: new evidence and a systematic review. Hum Reprod. 2005;20(4):852–63.

    Article  PubMed  CAS  Google Scholar 

  49. Quade BJ et al. Molecular pathogenesis of uterine smooth muscle tumors from transcriptional profiling. Genes Chromosome Canc. 2004;40(2):97–108.

    Article  CAS  Google Scholar 

  50. Al-Hendy A, Salama SA. Ethnic distribution of estrogen receptor-alpha polymorphism is associated with a higher prevalence of uterine leiomyomas in black Americans. Fertil Steril. 2006;86(3):686–93.

    Article  PubMed  CAS  Google Scholar 

  51. Weel AE et al. Estrogen receptor polymorphism predicts the onset of natural and surgical menopause. J Clin Endocrinol Metab. 1999;84(9):3146–50.

    Article  PubMed  CAS  Google Scholar 

  52. Kobayashi S et al. Association of bone mineral density with polymorphism of the estrogen receptor gene. J Bone Miner Res. 1996;11(3):306–11.

    Article  PubMed  CAS  Google Scholar 

  53. Alvarez-Garcia I, Miska EA. MicroRNA functions in animal development and human disease. Development. 2005;132:4653–62.

    Article  PubMed  CAS  Google Scholar 

  54. He H, Jazdzewski K, Li W, et al. The role of microRNA genes in papillary thyroid carcinoma. Proc Natl Acad Sci U S A. 2005;102(52):19075–80.

    Article  PubMed  CAS  Google Scholar 

  55. Pron G, Mocarski E, Bennett J, et al. Pregnancy after uterine artery embolization for leiomyomata: the Ontario multicenter trial. Obstet Gynecol. 2005;105:67–76.

    Article  PubMed  Google Scholar 

  56. Lewis BP, Shih IH, Jones-Rhoades MW, et al. Prediction of mammalian microRNA targets. Cell. 2003;115:787–98.

    Article  PubMed  CAS  Google Scholar 

  57. Wang TZX, Obijuru L, et al. A micro DNA signature associated with race tumor size, and target gene activity in human uterine leiomyoma. Genes Chromosome Canc. 2007;46:336–47.

    Article  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, IBN-SINA IVF/ICSI Center, Sohag University Hospitals, Naser City, Sohag, 82524, Egypt

    Mohamed Sabry M.D., A.R.D.M.S.

  2. Department of Obstetrics and Gynecology, Center for Women Health Research, George Hubbard Hospital, Meharry Medical College, 1005 Drive D.B. Todd Jr. Blvd., Nashville, TN, 37208, USA

    Ayman Al-Hendy M.D., Ph.D.

Authors
  1. Mohamed Sabry M.D., A.R.D.M.S.
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  2. Ayman Al-Hendy M.D., Ph.D.
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Corresponding author

Correspondence to Ayman Al-Hendy M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. , Department of Ob/Gyn, George Washington University, Sunset Hills Road 11150, Reston, 20190, Virginia, USA

    Fady I. Sharara

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Sabry, M., Al-Hendy, A. (2013). Racial Diversity and Uterine Leiomyoma. In: Sharara, F. (eds) Ethnic Differences in Fertility and Assisted Reproduction. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7548-4_13

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  • DOI: https://doi.org/10.1007/978-1-4614-7548-4_13

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