CCAAT/enhancer binding protein β regulates aromatase expression via multiple and novel cis-regulatory sequences in uterine leiomyoma

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 1.3 and II regulate aromatase expression in vivo in uterine leiomyoma tissue. Here, we investigated the cellular and molecular mechanisms responsible for promoter 1.3/II usage. Results: In smooth muscle cells isolated from leiomyoma (LSMCs), dibutyryl cAMP significantly induced aromatase mRNA and enzyme activity. Reporter constructs of promoter 1.3/II deletion and site-directed mutants with selective disruption of cis-regulatory elements in the -517/-16 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 -245/-231 bp sequence, clearly associating with C/EBP beta. Chromatin immunoprecipitation assays revealed that C/EBP beta binds specifically to the promoter 1.3/II region in intact cells. Dibutyryl cAMP significantly induced nuclear C/EBP beta protein levels in LSMCs in a time-dependent manner. Conversely, knockdown of C/EBP beta dramatically suppressed cAMP-induced aromatase mRNA and enzyme activity. Conclusions: C/EBP beta, which binds to multiple cis-regulatory elements in promoter 1.3/II, is a key factor in the transcriptional complex controlling aromatase expression in uterine leiomyoma cells. Definition of this mechanism further may assist in designing inhibitors of aromatase specific for leiomyoma tissue.