Clinical Response, Vascular Change, and Angiogenesis in Gonadotropin-Releasing Hormone Analogue-Treated Women with Uterine Myomas

Abstract

This study confirms the clinical response of uterine shrinkage after GnRH-a treatment. A pathogenetic role of bFGF, VEGF, and PDGF in myoma growth and vascularization is suggested. Finally, this study indirectly confirms the importance of the vasculature in leiomyoma growth.

Uterine myomas: management

“…Treatment with GnRH-a leads to decreased expression of basic fibroblast growth factor, vascular endothelial growth factor, and platelet-derived growth factor, growth factors that have been implicated in myoma vascular supply and growth, and to decreased numbers of vessels and angiogenic vessels (12).…”

Gonadotropin-releasing hormone analogues inhibit leiomyoma extracellular matrix despite presence of gonadal hormones

“…Clinically, the use of GnRH-a as a part of an adjunct presurgical approach to reduce the size of leiomyomas and increase hematocrit in affected patients has been reported (21). The mechanism of action of the GnRH agonist LA to reduce tumor volume is thought to decrease the expression of basic fibroblast growth factor (FGF) (22), and by exhibiting a negative impact on various signal transduction pathways stimulated by gonadal hormones (23). Short-term use of the GnRH antagonist cetrorelix acetate before a surgical procedure rapidly reduces uterine volume, but is associated with substantial hypoestrogenic side effects (24,25).…”

Fibroid growth and medical options for treatment

“…In line with the already discussed pathophysiology, additional biologic effects related to low E 2 and P levels have been described. In addition to their effects on circulating steroid levels, GnRH analogues have been shown to decrease different paracrine mitogenic and angiogenic factor expression, such as vascular endothelial growth factor, fibroblastic growth factor, and plateletderived growth factor (104,105). In vitro GnRH analogues inhibit cell proliferation and induce apoptosis (106).…”