Abstract. Uterine leiomyoma is the most common benign tumor in women. Although responsible gene mutations have not been found in leiomyomas, they represent a progressive disease with irreversible symptoms. To characterize epigenetic features of uterine leiomyomas, the DNA methylation status of a paired sample of leiomyoma and normal myometrium was subjected to a microarray-based DNA methylation analysis with restriction tag-mediated amplification (D-REAM). In the leiomyoma, we identified an aberrant DNA methylation status for 463 hypomethylated and 318 hypermethylated genes. Although these changes occurred on all chromosomes, aberrantly hypomethylated genes were preferentially located on the X chromosome. Using paired samples of normal myometrium and leiomyoma from 6 hysterectomy patients, methylation-sensitive quantitative real-time PCR revealed 14 shared X chromosome genes with an abnormal DNA hypomethylation status (FAM9A, CPXCR1, CXORF45, TAF1, NXF5, VBP1, GABRE, DDX53, FHL1, BRCC3, DMD, GJB1, AP1S2 and PCDH11X) and one hypermethylated locus (HDAC8). Expression of XIST, which is involved in X chromosome inactivation, was equivalent in the normal myometrium and leiomyoma, indicating that the epigenetic abnormality on the X chromosome did not result from aberration of XIST gene expression. Based on these data, a unique epigenetic signature for uterine leiomyomas has emerged. The 14 hypomethylated and one hypermethylated loci provide valuable biomarkers for understanding the molecular pathogenesis of leiomyoma. Key words: Disease-dependent differently methylated regions (D-DMRs), DNA methylation, Epigenetics, Leiomyoma, X chromosome (J. Reprod. Dev. 57: 604-612, 2011) terine leiomyomas are the most common uterine tumors in reproductive-age women with a prevalence of 20-25% [1]. Leiomyomas frequently cause serious gynecological problems such as pelvic pain, menorrhagia, dysmenorrhea, infertility and recurrent pregnancy loss [2,3]. In addition, uterine leiomyomas are the most common indication for hysterectomy.Despite their high prevalence rate and distressing effect on women's reproduction, the pathogenesis of uterine leiomyomas remains unclear. Factors such as African descent, high body mass index, meat consumption, early menarche, hypertension and a history of pelvic inflammatory disease place women at greater risk for uterine leiomyoma. In contrast, women using hormonal contraception, who smoke, are parous and who consume green vegetables have lower risk [4][5][6]. These findings suggest that uterine leiomyomas develop not only by inherited genomic abnormalities but also by unfavorable environmental exposures.DNA methylation is one of the most well-characterized epigenetic marks. It is involved in gene-silencing, gene-stability and DNA duplication [7][8][9]. DNA methylation profiles define and distinguish between each type of normal cell [10,11] and have been used to characterize abnormal cells [8]. For each cell type, establishing and maintaining the specific DNA methylation profile of the cells is nece...