A calcified uterine fibroid. Photo: Wikimedia Commons
Fibroids or leiomyomas are tissue masses or growths on the connective tissue walls of the uterus. They comprise smooth muscle and connective tissue and cannot be confused with cancerous cells. Being non-cancerous, they are the benign growths in the uterus that have become a predominant health concern in women of reproductive age. It is noteworthy to state that fibroid cases are on a constant rise globally. Nearly 226.05 million women are diagnosed with fibroid presence in their uterus.
More importantly, a woman might develop fibroids only after puberty, and not before that. These may be intramural (within the uterine wall), submucosal (into the uterine cavity) or subserosal (projecting outside the uterine cavity). With regard to the numbers, fibroids can occur as single or many. Their size ranges variedly. Some are microscopic and hard to notice while some may be grape-sized. In some patients, fibroids may grow even larger, requiring surgical treatment.
Many women are asymptomatic to uterine fibroids, learning about their presence only during an incidental finding in an ultrasound scan. However, around 30% of women show severe symptoms of fibroids and require medical intervention.
Some severe symptoms include heavy bleeding, anaemia, pelvic and back pain, urinary frequency and constipation. In some women, fibroids may also interfere with childbearing ability based on the size and location within the uterus. In these cases, they distort the shape of the uterus and may require surgical removal.
Most of the present-day treatments aim at controlling heavy menstrual bleeding and mitigating the pain caused. In severe cases, surgical treatment or radiological intervention would serve better results. However, the disadvantage of fibroid removal or myomectomy is that the results are temporary. There are chances that the fibroids can grow again. Nevertheless, surgical removal may be a great option when the fibroid size is quite large and is interfering with the pregnancy.
The primary challenge in treating fibroids lies in the unclear understanding of their pathogenesis. While it is established that steroid hormones play a pivotal role as the primary growth factors for fibroids, the precise mechanisms still remain elusive! Extensive research has focused on the study of circulating estrogen, progesterone, and aromatase in fibroid development.
In light of this knowledge gap, medical treatment strategies aim to address the underlying steroid causes. Despite numerous efforts, only a limited number of treatments have demonstrated consistent success in achieving substantial size reduction with minimal or no discernible side effects.
Research studies aimed at identifying and studying the therapeutic targets are important for effective drug design and disease control. This is to design drugs that are specific towards the neoplasm without disturbing the surrounding healthy cells.
So the scientists started to focus on other aspects that play a pivotal role in the growth of fibroids. One of which is studying the fibroid cytoskeleton in response to mechanical or physical strain.
A recent study at the University of Cincinnati on uterine fibroid cells opens a newer approach to understanding cell proliferation.
Researchers cultured uterine fibroid cells and healthy uterine cells under aseptic conditions in plates having elastic bottoms. They subjected mechanical strain similar to the one that the uterine fibroid cells would encounter. They used a vacuum with a flexible tension device for this. The results amazed the researchers.
Fibroid cells were found to be sensitive to the strain and expanded in a single direction, unlike the healthy cells. Further, there was also a noticeable difference in the way that both the cell types held their shape. These results shed light on the role of the cytoskeleton in response to the strain.
Researchers at the biomedical engineering lab at the University of Cincinnati added that studying the mechanical strain alongside hormonal effects on fibroid growth would do great in finding effective strategies for fibroid treatment. They propose fibroid studies using 3D simulations and models that would help find effective treatment approaches.
Studying cellular microenvironments in response to physical strain is not new in the field of cancer biology. Researchers across the world adopt different approaches to cancer cell studies. They study the interstitial fluid pressure and sheer and compression stress on cells in controlled environments within labs. Previous studies on cancer cells suggest that physical strain can have a prominent effect on the extracellular matrix, cell behaviour and function.
Even endothelial cells were learned to show profound effects in response to mechanical stress by affecting the gene expression, cell proliferation and shape. This has paved a clear path for the study of vascular diseases like aortic aneurysms.
The evolving landscape of technology brings forth fresh possibilities in drug design, offering relief to those burdened by fibroid pain. The current in-vitro studies on uterine fibroids, while promising, are yet to yield immediate clinical benefits. Effective treatment methods for patients remain in the future, contingent upon the successful translation of laboratory cell experiments into targeted therapy for real human patients.
Prathyusha I.V.S.N. has an MSc and MPhil in biochemistry.