Context:Control of aromatase expression in uterine leiomyoma has significant clinical implications because aromatase inhibitors reduce tumor growth and associated irregular uterine bleeding. The mechanisms that regulate aromatase expression in leiomyoma are unknown.
Objectives:We previously demonstrated that the cAMP-responsive proximal promoters I.3 and II regulate aromatase expression in vivo in uterine leiomyoma tissue. Here, we investigated the cellular and molecular mechanisms responsible for promoter I.3/II usage.
Results:In smooth muscle cells isolated from leiomyoma (LSMCs), dibutyryl cAMP significantly induced aromatase mRNA and enzyme activity. Reporter constructs of promoter I.3/II deletion and site-directed mutants with selective disruption of cis-regulatory elements in the Ϫ517/Ϫ16 bp region revealed that five out of seven elements, including three CCAAT/enhancer binding protein (C/EBP) binding sites and two cAMP response elements, were essential for cAMP-induced promoter activity. EMSAs demonstrated that nuclear extracts from LSMCs contain complexes assembled on four of the five cis-elements, with C/EBP binding sites, including a novel Ϫ245/Ϫ231 bp sequence, clearly associating with C/EBP. Chromatin immunoprecipitation assays revealed that C/EBP binds specifically to the promoter I.3/II region in intact cells. Dibutyryl cAMP significantly induced nuclear C/EBP protein levels in LSMCs in a time-dependent manner. Conversely, knockdown of C/EBP dramatically suppressed cAMP-induced aromatase mRNA and enzyme activity. R ecent clinical data indicate that aromatase plays a significant role in the pathophysiology of uterine leiomyomata because therapeutic targeting of aromatase effectively reduces the size of these tumors and associated symptoms such as uterine bleeding in premenopausal and perimenopausal women (1-4). Uterine leiomyomata, benign smooth muscle tumors originating from the uterus, are the most common solid tumors in reproductive age women and the most frequently reported indication for surgery in women. Leiomyoma generally causes abnormal uterine bleeding, menorrhagia, pressure-related symptoms, and recurrent pregnancy loss. Abnormal uterine bleeding represents the major complaint in women and is the primary indication for surgical intervention (5). Each leiomyoma represents a monoclonal proliferation of a transformed myocyte derived from myometrium (6). Although the pathogenesis of leiomyoma transformation from myometrium remains unknown, laboratory and