[Ulipristal acetate, 5mg: a new alternative]. / Acetato de ulipristal 5mg: una nueva alternativa.

Fibroids have a high prevalence (approaching 50%) in the female population. Although they are a benign entity, they represent a health problem of considerable magnitude, causing hemorrhaging, pain and sterility. Surgical treatment is currently safe and effective, but in recent decades numerous less invasive alternatives have appeared, such as uterine artery embolization and thermal ablation (HIFU and radiofrequency). New possibilities for medical treatment have also emerged, such as GnRh analogues, aromatase inhibitors and selective progesterone receptor modulators (SPRMs). SPRMs act through progesterone receptors and behave as agonists or antagonists in various target organs. Among them, ulipristal acetate (UA) inhibits the proliferation and induction of apoptosis and cell death pathways in leiomyoma cells, translating at the clinical level to smaller fibroids and lower uterine volumes, with no significant side effects. UA also produces amenorrhea in most patients. Randomized, phase III (PEARL I and II) clinical trials have shown the efficacy and security of UA versus placebo and leuprolide acetate (LA). UA is similar to LA, and superior to placebo in controlling bleeding and decreasing the size of the fibroid, with fewer side effects than LA. The safety and tolerance of UA have been satisfactory. UA is a reality in the preoperative treatment of fibroids, with broad potential for further development.

Acetato de ulipristal 5 mg: una nueva alternativa / Ulipristal acetate, 5 mg: a new alternative

Los miomas presentan una elevada prevalencia, cercana al 50% de la población femenina. Aunque son una entidad benigna suponen un problema de salud de gran magnitud, causando hemorragia, dolor o esterilidad. Actualmente, el tratamiento quirúrgico es seguro y eficaz, pero en las últimas décadas han aparecido múltiples alternativas menos invasivas: embolización de las arterias uterinas o ablación térmica (HIFU o radiofrecuencia). Además surgen nuevas posibilidades de tratamiento médico como análogos de la GnRh, inhibidores de la aromatasa y moduladores selectivos del receptor de progesterona (SPRM). Los SPRM actúan a través de los receptores de progesterona comportándose como agonistas o antagonistas en distintos órganos diana. Entre ellos, el acetato de ulipristal (AU) produce inhibición de la proliferación e inducción de las vías de apoptosis y muerte celular en células de leiomioma, traduciéndose a nivel clínico en una disminución del tamaño de los miomas y del volumen uterino, sin efectos secundarios significativos. Además produce amenorrea en la mayoría de las pacientes. Los ensayos clínicos aleatorizados en fase III (PEARL I y II) han demostrado la eficacia y seguridad del AU frente a placebo y acetato de leuprolide (AL). AU es similar a AL y superior a placebo en el control del sangrado y la disminución del tamaño del mioma, con menores efectos secundarios que AL. La seguridad y tolerancia de AU han sido satisfactorias. AU constituye una realidad en el tratamiento prequirúrgico de los miomas, con un amplio potencial por desarrollar (AU)

Fibroids have a high prevalence (approaching 50%) in the female population. Although they are a benign entity, they represent a health problem of considerable magnitude, causing hemorrhaging, pain and sterility. Surgical treatment is currently safe and effective, but in recent decades numerous less invasive alternatives have appeared, such as uterine artery embolization and thermal ablation (HIFU and radiofrequency). New possibilities for medical treatment have also emerged, such as GnRh analogues, aromatase inhibitors and selective progesterone receptor modulators (SPRMs). SPRMs act through progesterone receptors and behave as agonists or antagonists in various target organs. Among them, ulipristal acetate (UA) inhibits the proliferation and induction of apoptosis and cell death pathways in leiomyoma cells, translating at the clinical level to smaller fibroids and lower uterine volumes, with no significant side effects. UA also produces amenorrhea in most patients. Randomized, phase III (PEARL I and II) clinical trials have shown the efficacy and security of UA versus placebo and leuprolide acetate (LA). UA is similar to LA, and superior to placebo in controlling bleeding and decreasing the size of the fibroid, with fewer side effects than LA. The safety and tolerance of UA have been satisfactory. UA is a reality in the preoperative treatment of fibroids, with broad potential for further development (AU)

Bone marrow-derived cells from male donors do not contribute to the endometrial side population of the recipient.

Accumulated evidence demonstrates the existence of bone marrow-derived cells origin in the endometria of women undergoing bone marrow transplantation (BMT). In these reports, cells of a bone marrow (BM) origin are able to differentiate into endometrial cells, although their contribution to endometrial regeneration is not yet clear. We have previously demonstrated the functional relevance of side population (SP) cells as the endogenous source of somatic stem cells (SSC) in the human endometrium. The present work aims to understand the presence and contribution of bone marrow-derived cells to the endometrium and the endometrial SP population of women who received BMT from male donors. Five female recipients with spontaneous or induced menstruations were selected and their endometrium was examined for the contribution of XY donor-derived cells using fluorescent in situ hybridization (FISH), telomapping and SP method investigation. We confirm the presence of XY donor-derived cells in the recipient endometrium ranging from 1.7% to 2.62%. We also identify 0.45-0.85% of the donor-derived cells in the epithelial compartment displaying CD9 marker, and 1.0-1.83% of the Vimentin-positive XY donor-derived cells in the stromal compartment. Although the percentage of endometrial SP cells decreased, possibly being due to chemotherapy applied to these patients, they were not formed by XY donor-derived cells, donor BM cells were not associated with the stem cell (SC) niches assessed by telomapping technique, and engraftment percentages were very low with no correlation between time from transplant and engraftment efficiency, suggesting random terminal differentiation. In conclusion, XY donor-derived cells of a BM origin may be considered a limited exogenous source of transdifferentiated endometrial cells rather than a cyclic source of BM donor-derived stem cells.