Human epididymal secretory protein E4 (HE4, also known as WAP four-disulphide core domain protein 2) is a new promising biomarker for ovarian cancer but its specificity against ovarian endometriotic cysts is only superficially known. We, thus, analysed serum HE4 concentrations together with a tumour marker CA125 in serum samples of women diagnosed with various types of endometriosis, endometrial cancer or ovarian cancer, and in samples from healthy controls. The mean serum concentration of HE4 was significantly higher in serum samples of patients with both endometrial (99.2 pM, Po0.001) and ovarian (1125.4 pM, Po0.001) cancer but not with ovarian endometriomas (46.0 pM) or other types of endometriosis (45.5 pM) as compared with healthy controls (40.5 pM). The serum CA125 concentrations were elevated in patients with ovarian cancer, advanced endometriosis with peritoneal or deep lesions, or ovarian endometriomas, but not in the patients with endometrial cancer. The microarray results revealed that the mRNA expression of the genes encoding HE4 and CA125 reflected the serum protein concentrations. Taken together, measuring both HE4 and CA125 serum concentrations increases the accuracy of ovarian cancer diagnosis and provides valuable information to discriminate ovarian tumours from ovarian endometriotic cysts.

FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.

The placenta expresses genes for insulin-like growth factors (IGFs) and possesses IGF-receptors, suggesting that placental growth is regulated by IGFs in an autocrine manner. We have previously shown that human decidua, but not placenta, synthesizes and secretes a 34 K IGF-binding protein (34 K IGF-BP) called placental protein 12. We now used human choriocarcinoma JEG-3 cell monolayer cultures and recombinant (Thr59)IGF-I as a model to study whether the decidual 34 K IGF-BP is able to modulate the receptor binding and biological activity of IGFs in trophoblasts. JEG-3 cells, which possess type I IGF receptors, were unable to produce IGF-BPs. Purified 34 K IGF-BP specifically bound [125I]iodo-(Thr59)IGF-I. Multiplication-stimulating activity had 2.5% the potency of (Thr59)IGF-I, and insulin had no effect on the binding of [125I] iodo-(Thr59)IGF-I. 34 K IGF-BP inhibited the binding of [125I] iodo-(Thr59)IGF-I to JEG-3 monolayers in a concentration-dependent manner by forming with the tracer a soluble complex that could not bind to the cell surface as demonstrated by competitive binding and cross-linking experiments. After incubating the cell monolayers with [125I]iodo-(Thr59)IGF-I in the presence of purified binding protein, followed by cross-linking, no affinity labeled bands were seen on autoradiography. In contrast, an intensely labeled band at 40 K was detected when the incubation medium was analyzed, suggesting that (Thr59)IGF-I and 34 K IGF-BP formed a complex in a 1:1 molar ratio. Also, 34 K IGF-BP inhibited both basal and IGF-I-stimulated uptake of alpha-[3H]aminoisobutyric acid in JEG-3 cells. RNA analysis revealed that IGF-II is expressed in JEG-3 cells. We conclude that decidual 34 K IGF-BP inhibits the cellular binding and biological action of IGFs in JEG-3 cells. Our data show that JEG-3 cells represent a cell type that can produce IGF, but not IGF-BPs. These cells may thus provide a useful model system for a better understanding of autocrine growth regulation mediated by the IGFs.

Every fourth woman suffers from uterine leiomyomas (ULs) -benign uterine wall tumors -at some point in premenopausal life. ULs can cause excessive bleeding, pain and infertility 1 , and are the most common cause of hysterectomy 2 . They emerge through at least three distinct genetic drivers: MED12 or FH mutation, or HMGA2 genomic rearrangement 3 . Here we created large genome-wide data sets by DNA, RNA, ATAC, ChIP and HiChIP sequencing of primary tissues to profoundly understand UL genesis. We discovered somatic mutations in genes encoding six members of the SRCAP histone loading complex 4 , and found that germline mutations in SRCAP complex members YEATS4 and ZNHIT1 predispose to UL. The mutant tumors displayed defective histone variant H2A.Z deposition. In ULs, H2A.Z occupancy correlated positively with chromatin accessibility and gene expression, and negatively with DNA methylation, but these correlations were weak in SRCAP complex mutant tumors. In such tumors, open chromatin emerged at transcription start sites where H2A.Z was lost, associated with upregulation of genes. Furthermore, YEATS4 defects associated with abnormal upregulation of bivalent embryonic stem cell genes, as previously shown in mice 5 . Our work describes a potential novel mechanism of tumorigenesis -epigenetic instability caused by deficient H2A.Z deposition -and suggests that ULs arise through an aberrant differentiation program driven by deranged chromatin, emanating from a small number of mutually exclusive genetic driver mutations.

Serum hCG levels were measured in apparently healthy nonpregnant women and men using a highly sensitive and specific time-resolved immunofluorometric assay. The sensitivity of the assay was 0.03 IU/L. The levels were low in women of fertile age (median, 0.05 IU/L) and in men less than 60 yr of age (median, 0.04 IU/L). In women the median level increased to 1.1 IU/L after the menopause (range, 0.17-4.8 IU/L), and a similar but smaller increase occurred in men after 60 yr of age (median, 0.20 IU/L; range, less than 0.03-2.3). Stimulation with GnRH caused a 2- to 3-fold increase in the hCG level in both men and women. Chronic treatment of postmenopausal women with a combination of estrogen and progestagen lowered their serum hCG levels to about 50% of the pretreatment values. The hCG in serum could be separated from LH by gel chromatography, and the hCG immunoreactivity measured by direct assay of serum corresponded to the immunoreactivity eluted in the hCG fractions after gel chromatography. Thus, the results were not due to cross-reaction with LH. We conclude that serum of nonpregnant women and men contains hCG-like material, whose production is modulated by GnRH and sex steroids.