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Role of nuclear progesterone receptor isoforms in uterine pathophysiology
Open accessAbstract
BACKGROUND: Progesterone is a key hormonal regulator of the female reproductive system. It plays a major role to prepare the uterus for implantation and in the establishment and maintenance of pregnancy. Actions of progesterone on the uterine tissues (endometrium, myometrium and cervix) are mediated by the combined effects of two progesterone receptor (PR) isoforms, designated PR-A and PR-B. Both receptors function primarily as ligand-activated transcription factors. Progesterone action on the uterine tissues is qualitatively and quantitatively determined by the relative levels and transcriptional activities of PR-A and PR-B. The transcriptional activity of the PR isoforms is affected by specific transcriptional coregulators and by PR post-translational modifications that affect gene promoter targeting. In this context, appropriate temporal and cell-specific expression and function of PR-A and PR-B are critical for normal uterine function. METHODS: Relevant studies describing the role of PRs in uterine physiology and pathology (endometriosis, uterine leiomyoma, endometrial cancer, cervical cancer and recurrent pregnancy loss) were comprehensively searched using PubMed, Cochrane Library, Web of Science, and Google Scholar and critically reviewed. RESULTS: Progesterone, acting through PR-A and PR-B, regulates the development and function of the endometrium and induces changes in cells essential for implantation and the establishment and maintenance of pregnancy. During pregnancy, progesterone via the PRs promotes myometrial relaxation and cervical closure. Withdrawal of PR-mediated progesterone signaling triggers menstruation and parturition. PR-mediated progesterone signaling is anti-mitogenic in endometrial epithelial cells, and as such, mitigates the tropic effects of estrogen on eutopic normal endometrium, and on ectopic implants in endometriosis. Similarly, ligand-activated PRs function as tumor suppressors in endometrial cancer cells through inhibition of key cellular signaling pathways required for growth. In contrast, progesterone via PR activation appears to increase leiomyoma growth. The exact role of PRs in cervical cancer is unclear. PRs regulate implantation and therefore aberrant PR function may be implicated in recurrent pregnancy loss (RPL). PRs likely regulate key immunogenic factors involved in RPL. However, the exact role of PRs in the pathophysiology of RPL and the use of progesterone for therapeutic benefit remains uncertain. CONCLUSIONS: PRs are key mediators of progesterone action in uterine tissues and are essential for normal uterine function. Aberrant PR function (due to abnormal expression and/or function) is a major cause of uterine pathophysiology. Further investigation of the underlying mechanisms of PR isoform action in the uterus is required, as this knowledge will afford the opportunity to create progestin/PR-based therapeutics to treat various uterine pathologies.
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“Proinflammatory factors (like heme and iron) and cytokines (like tumor necrosis factor-alpha (TNFα) and interleukin 1 beta (IL1β)) may also disrupt PR function and play a role in progesterone resistance which finally leads to increased nuclear factor kappa B (NF-kB) activity, which is involved in endometriosis development [27,33,34].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [33]
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Zondervan, K. T., Becker, C. M., Koga, K., Missmer, S. A., Taylor, R. N., & Viganò, P. (2018) · Nature Reviews Disease Primers · doi:10.1038/s41572-018-0008-5 · Cited by 1,257
Hormonal treatments for endometriosis: The endocrine background
Vannuccini, S., Clemenza, S., Rossi, M., & Petraglia, F. (2022) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-021-09666-w · Cited by 336
“Changes in promoter methylation may be a cause for the increased ERβ/ERα ratio in endometriotic cells, since regions of the ERα promoter become hypermethylated leading to a decreased expression, whereas a CpG island in the ERβ promoter becomes hypomethylated causing an increased expression [41, 42] (Fig.”
BackgroundProgesterone resistance in endometriosis: origins, consequences and interventions
Patel, B. G., Rudnicki, M., Yu, J., Shu, Y., & Taylor, R. N. (2017) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13156 · Cited by 336
Self-citationLessey, B. A., & Kim, J. J. (2017) · Fertility and Sterility · doi:10.1016/j.fertnstert.2017.05.031 · Cited by 286
Donnez, J., & Dolmans, M.-M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10051085 · Cited by 182
Metadata
- Authors
- Patel, B., Elguero, S., Thakore, S., Dahoud, W., Bedaiwy, M., & Mesiano, S.
- Affiliations
- Case Western Reserve University (US)
- University of British Columbia (CA)
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2014-11-18
- Volume
- 21
- Issue
- 2
- Pages
- 155-173
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- PMC
- PMC4366574
- OpenAlex
- W2019792229
- Cited by
- 353
- References
- 296
- Citations by year
- 2026: 17 · 2025: 36 · 2024: 31 · 2023: 38 · 2022: 33 · 2021: 49 · 2020: 34 · 2019: 34 · 2018: 23 · 2017: 25 · 2016: 19 · 2015: 13
- FWCI
- 2.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Human Reproduction Update (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Case Western Reserve University
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD069819)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Endocrinology › Estrogen and related hormone effects
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Keywords
- progesterone receptor, progesterone receptor A, progesterone receptor B, uterine physiology, endometrium, endometriosis, uterine fibroids, endometrial cancer, cervical cancer, recurrent pregnancy loss, implantation, pregnancy maintenance, myometrial relaxation, transcriptional coregulators, post-translational modification, progesterone signaling, tumor suppression
- MeSH terms
- Abortion, Habitual, Uterine Cervical Neoplasms, Endometriosis, Female, Humans, Leiomyoma, Menstrual Cycle, Models, Biological, Embryo Implantation, Progesterone, Receptors, Progesterone, Uterine Diseases, Uterus, Signal Transduction, Endometrial Neoplasms, Protein Isoforms
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