Novel Approaches to Possible Targeted Therapies and Prophylaxis of Uterine Fibroids

Abstract

Uterine leiomyomas are the most common benign tumors in women of childbearing age. They may lead to problems of conception or complications during the gestational period. The methods of treatment include surgical (myomectomy and hysterectomy, embolization of arteries) and therapeutic treatment (ulipristal acetate, leuprolide acetate, cetrorelix, goserelin, mifepristone). Both approaches are efficient but incompatible with pregnancy planning. Therefore, there is a call for medical practice to develop therapeutical means of preventing leiomyoma onset in patients planning on becoming pregnant. Based on the analysis of GWAS data on the search for mononucleotide polymorphisms associated with the risk of leiomyoma, in meta-transcriptomic and meta-methylomic studies, target proteins have been proposed. Prospective therapeutic treatments of leiomyoma may be based on chemical compounds, humanized recombinant antibodies, vaccines based on markers of the uterine leiomyoma cells that are absent in the adult organism, or DNA and RNA preparations. Three different nosological forms of the disease associated with driver mutations in the MED12, HMGA2, and FH genes should be considered when developing or prescribing drugs. For example, synthetic inhibitors and vaccines based on matrix metalloproteinases MMP11 and MMP16 are expected to be effective only for the prevention of the occurrence of MED12-dependent nodules.

Currently Available Treatment Modalities for Uterine Fibroids

“…For such patients, the optimal treatment opportunity involves the control and stabilization of hormone levels in fibroid cells with different medications. In addition, medicamentous treatment can serve as a presurgical adjuvant to decrease fibroid mass [ 9 , 10 ]. Medicamentous therapy yields effective results, and symptoms usually improve after one year of treatment.…”

“…Progesterone has both proliferative and antiproliferative effects that are still being investigated. Therefore, these two hormones and their receptors are the central target for medicamentous fibroid therapy [ 10 ].…”