Objective To identify and characterize myometrial/fibroid stem cells by specific stem cell markers in human myometrium, and to better understand the stem cell contribution in the development of uterine fibroids. Design Prospective experimental human and animal study. Setting University research laboratory. Patients Women undergoing hysterectomy for treatment of symptomatic uterine fibroids. Animals Female NOD/SCID/IL-2Rγnull mice. Interventions Identification and isolation of stem cells from human fibroids (F) and adjacent myometrium (MyoF) tissues using Stro-1/CD44 specific surface markers. Main Outcome Measures Flow cytometry, semi- quantitative polymerase chain reaction, clonogenicity assays, cell culture, molecular analysis, immunocyto- histochemistry, in vitro differentiation, and xenotransplantation assays. Results Using Stro-1/CD44 surface markers, we were able to isolate stem cells from MyoF and F tissues. The undifferentiated status of isolated cells was confirmed by the expression of ABCG2 transporter, as well as additional stem cell markers OCT4, NANOG and GDB3, and the low expression of steroid receptors ERα and PR-A/PR-B. Mesodermal cell origin was established by the presence of typical mesenchymal markers (CD90, CD105, and CD73) and absence of hematopoietic stem cell markers (CD34, CD45), and confirmed by the ability of these cells to differentiate in vitro into adipocytes, osteocytes and chondrocytes. Finally, their functional capability to form fibroid-like lesions was established in xenotransplantation mouse model. The injected cells labeled with superparamagnetic iron oxide (SPIO) were tracked by both magnetic resonance imaging (MRI) and fluorescence imaging, thus demonstrating the regenerative potential of putative fibroid stem cells in vivo. Conclusion We have demonstrated that Stro-1/CD44 can be used as specific surface markers to enrich a subpopulation of myometrial/fibroids cells, exhibiting key features of stem/progenitor cells. These findings offer a useful tool to better understanding the initiation of uterine fibroids, and may lead the establishment of effective therapeutic options.

Uterine fibroids, or leiomyoma, are the most common benign tumors in women of reproductive age. In this work, the effect of silencing the mediator complex subunit 12 (Med12) gene in human uterine fibroid cells was evaluated. The role of Med12 in the modulation of Wnt/β-catenin and cell proliferation-associated signaling was evaluated in human uterine fibroid cells. Med12 was silenced in the immortalized human uterine fibroid cell line (HuLM) using a lentivirus-based Med12 gene-specific RNA interference strategy. HuLM cells were infected with lentiviruses carrying Med12-specific short hairpin RNA (shRNA) sequences or a nonfunctional shRNA scrambled control with green fluorescence protein. Stable cells that expressed low levels of Med12 protein were characterized. Wnt/β-catenin signaling, sex steroid receptor signaling, cell cycle-associated, and fibrosis-associated proteins were measured. Med12 knockdown cells showed significantly (P < 0.05) reduced levels of Wnt4 and β-catenin proteins as well as cell proliferation, as compared with scrambled control cells. Med12 knockdown cells also showed reduced levels of cell cycle-associated cyclin D1, Cdk1, and Cdk2 proteins as well as reduced activation of p-extracellular signal-regulated kinase, p-protein kinase B, and transforming growth factor (TGF)-β signaling pathways as compared with scrambled control cells. Moreover, TGF-β-regulated fibrosis-related proteins such as fibronectin, collagen type 1, and plasminogen activator inhibitor-1 were significantly (P < 0.05) reduced in Med12 knockdown cells as compared with scrambled control cells. Together, these results suggest that Med12 plays a key role in the regulation of HuLM cell proliferation through the modulation of Wnt/β-catenin, cell cycle-associated, and fibrosis-associated protein expression.

Although somatic mutations in exon 2 of the mediator complex subunit 12 (MED12) gene have been reported previously in uterine fibroids in women from Finland, South Africa, and North America, the status of these mutations was not reported in the Southern United States women. The aim of this study is to determine the MED12 somatic mutations in uterine fibroids of women from Southern Unites States, which will help to better understand the contribution of MED12 mutations in fibroid tumor biology. Herein, we determined the frequency of MED12 gene exon 2 somatic mutations in 143 fibroid tumors from a total of 135 women from the Southern United States and in 50 samples of the adjacent myometrium using PCR amplification and Sanger sequencing. We observed that the MED12 gene is mutated in 64.33 % (92/143) of uterine fibroid cases in the exon 2 (including deletion mutations). These mutations include 107T > G (4.3 %), 130G > C (2.8 %), 130G > A (7.0 %), 130G > T (2.8 %), 131G > C (2.1 %), 131G > A (20.2 %), and 131G > T (2.1 %). Interestingly, we identified four novel mutations in these patients: 107 T > C (12.8 %), 105A > T (2.1 %), 122T > A (2.1 %), and 92T > A (2.1 %). As expected, we did not observe any mutations in the normal myometrium. Moreover, we found a higher rate of deletion mutations (17.5 %, 25/143) in the above fibroid tumors. Our results clearly demonstrate that the MED12 gene exon 2 is frequently mutated in human uterine fibroids in Southern United States women. These results highlight the molecular pathogenesis of human uterine fibroids with the central role of MED12 somatic mutations.

OBJECTIVE Infection triggers inflammation which in turn enhances the expression of contractile associated factors in myometrium and increases the risk of preterm delivery. In this study we assessed vitamin D regulation of inflammatory markers, contractile-associated factors, steroid hormone receptors and NFκB pathway proteins in human uterine myometrial smooth muscle (UtSM) cells cultured in an inflammatory environment. STUDY DESIGN Inflammatory environment was simulated for UtSM cells by co-culturing them with monocyte lineage (THP1) cells. We measured the expression of inflammatory markers, contractile-associated factors, steroid hormone receptors and NFκB pathway proteins in UtSM cells cultured with THP1 cells in the presence and absence of vitamin D by RT-PCR and western analysis. RESULTS Monocytes secreted MIP-1α, MIP-1 β, IL-1β, IL6, and TNFα into the conditioned medium. In UtSM cells co-cultured with THP1 cells there was a significant (p<0.05) increase in the expression of inflammatory markers IL-1β, IL6, IL13 and TNFα; the contractile associated factors connexin-43, cox-2 and prostaglandin F2α receptor; the estrogen receptor α and progesterone receptors A and B. Vitamin D treatment of co-cultures decreased (p<0.05) the expression of inflammatory markers and contractile associated factors in UtSM cells. Similarly vitamin D decreased estrogen receptor α and progesterone receptors A to B ratio in UtSM cells co-cultured with THP1 cells. In addition, vitamin D treatment significantly (p<0.05) decreased monocyte induced p-IκBα in cytosol, NFκB-p65 in the nucleus and increased IκBα in cytosol in UtSM cells. CONCLUSION Our results suggest that vitamin D treatment decreases inflammation induced cytokines and contractile associated factors in the uterine myometrial smooth muscle cells via NFκB pathway.