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Progesterone and estradiol synergistically promote the lung metastasis of tuberin-deficient cells in a preclinical model of lymphangioleiomyomatosis.
[lymphangioleiomyomatosis]
Lymphangioleiomyomatosis
(
LAM
)
is
a
female
-predominant
lung
disease
that
can
lead
to
respiratory
failure
.
LAM
cells
typically
have
inactivating
tuberous
sclerosis
2
(
TSC
2
)
mutations
,
leading
to
mTORC
1
hyperactivation
.
The
gender
specificity
of
LAM
suggests
that
female
hormones
contribute
to
disease
progression
.
Clinical
findings
indicate
that
estradiol
exacerbates
LAM
behaviors
and
symptoms
.
Although
hormonal
therapy
with
progesterone
has
been
employed
,
the
benefit
in
LAM
improvement
has
not
been
achieved
.
We
have
previously
found
that
estradiol
promotes
the
survival
and
lung
metastasis
of
cells
lacking
tuberin
in
a
preclinical
model
of
LAM
.
In
this
study
,
we
hypothesize
that
progesterone
alone
or
in
combination
with
estradiol
promotes
metastatic
behaviors
of
TSC
2
-
deficient
cells
.
In
cell
culture
models
of
TSC
2
-
deficient
LAM
patient-derived
and
rat
uterine
leiomyoma
-derived
cells
,
we
found
that
progesterone
treatment
or
progesterone
plus
estradiol
resulted
in
increased
phosphorylation
of
Â
Protein
Kinase
B
(
Akt
)
and
Â
Extracellular
signal-regulated
kinases
1
/
2
(
ERK
1
/
2
)
,
induced
the
proliferation
,
and
enhanced
the
migration
and
invasiveness
.
In
addition
,
treatment
of
progesterone
plus
estradiol
synergistically
decreased
the
levels
of
reactive
oxygen
species
and
enhanced
cell
survival
under
oxidative
stress
.
In
a
murine
model
of
LAM
,
treatment
of
progesterone
plus
estradiol
promoted
the
growth
of
xenograft
tumors
;
however
,
progesterone
treatment
did
not
affect
the
development
of
xenograft
tumors
of
Tsc
2
-
deficient
cells
.
Importantly
,
treatment
of
progesterone
plus
estradiol
resulted
in
alteration
of
lung
morphology
and
significantly
increased
the
number
of
lung
micrometastases
of
Tsc
2
-
deficient
cells
compared
with
estradiol
treatment
alone
.
Collectively
,
these
data
indicate
that
progesterone
increases
the
metastatic
potential
of
Tsc
2
-
deficient
LAM
patient-derived
cells
in
vitro
and
lung
metastasis
in
vivo
.
Thus
,
targeting
progesterone-mediated
signaling
events
may
have
therapeutic
benefit
for
LAM
and
possibly
other
hormonally
dependent
cancers
.
Diseases
Validation
Diseases presenting
"deficient cells"
symptom
child syndrome
esophageal adenocarcinoma
gm1 gangliosidosis
junctional epidermolysis bullosa
kindler syndrome
lymphangioleiomyomatosis
neonatal adrenoleukodystrophy
werner syndrome
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