Uterine leiomyomas express a molecular pattern that lowers retinoic acid exposure

Objective: To analyze expression of the retinoic acid signaling pathway genes that are involved in retinol metabolism, transport, transcriptional activation, and transcriptional products in spontaneous human leiomyomas, Design: Laboratory study of human leiomyoma and patient-matched myometrial tissue. Patient(s): Eight women undergoing hysterectomy for symptomatic leiomyomas. Intervention(s): Confirmation of an altered retinoic acid pathway analyzed by microarray, real time reverse transcription-polymerase chain reaction, Western blot, immunohistochemistry, and high-performance liquid chromatography (HPLC). Main Outcome Measure(s): Gene and protein expression. Result(s): Regardless of patient demographics and leiomyoma location and size, we found decreased expression of the major genes involved in retinoic acid pathway including alcohol dehydrogenase-1 (-3.97- +/- 0.03-fold), aldehyde dehydrogenase-1 (-3.1- +/- 0.07-fold), cellular retinol binding protein-1 (-2.62- +/- 0.04-fold), and cellular retinoic acid binding protein-1 (-2.42- +/- 0.20-fold). Cytochrome P450 (CYP 26A1), which is responsible for retinoic acid metabolism, was highly up-regulated in leiomyomas (+5.4- +/- 0.53-fold). Nuclear receptors demonstrated a complex pattern of under-expression (RAR alpha, RAR beta, RXR alpha, RXR gamma) and overexpression (RAR gamma, RXR beta) at both the mRNA and protein level. Differences in protein amounts were confirmed by Western blot. Finally, a reduced amount of cellular ATRA and 9-cis retinoic acid was confirmed by HPLC in leiomyomas compared with myometrial tissues. Conclusion(s): Molecular alterations in the retinoic acid pathway of leiomyomata result in a decrease in retinoic acid exposure.