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Wnt/β-catenin signaling pathway in uterine leiomyoma: role in tumor biology and targeting opportunities

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Abstract

Uterine leiomyoma is the most common tumor of the female reproductive system and originates from a single transformed myometrial smooth muscle cell. Despite the immense medical, psychosocial, and financial impact, the exact underlying mechanisms of leiomyoma pathobiology are poorly understood. Alterations of signaling pathways are thought to be instrumental in leiomyoma biology. Wnt/β-catenin pathway appears to be involved in several aspects of the genesis of leiomyomas. For example, Wnt5b is overexpressed in leiomyoma, and the Wnt/β-catenin pathway appears to mediate the role of MED12 mutations, the most common mutations in leiomyoma, in tumorigenesis. Moreover, Wnt/β-catenin pathway plays a paracrine role where estrogen/progesterone treatment of mature myometrial or leiomyoma cells leads to increased expression of Wnt11 and Wnt16, which induces proliferation of leiomyoma stem cells and tumor growth. Constitutive activation of β-catenin leads to myometrial hyperplasia and leiomyoma-like lesions in animal models. Wnt/β-catenin signaling is also closely involved in mechanotransduction and extracellular matrix regulation and relevant alterations in leiomyoma, and crosstalk is noted between Wnt/β-catenin signaling and other pathways known to regulate leiomyoma development and growth such as estrogen, progesterone, TGFβ, PI3K/Akt/mTOR, Ras/Raf/MEK/ERK, IGF, Hippo, and Notch signaling. Finally, evidence suggests that inhibition of the canonical Wnt pathway using β-catenin inhibitors inhibits leiomyoma cell proliferation. Understanding the molecular mechanisms of leiomyoma development is essential for effective treatment. The specific Wnt/β-catenin pathway molecules discussed in this review constitute compelling candidates for therapeutic targeting.

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Funding

This work was supported, in part, by NIH Grant 1R01HD094380 to Mostafa Borahay.

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  1. Malak El Sabeh and Subbroto Kumar Saha have contributed equally to this manuscript.

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  1. Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD, 21205, USA

    Malak El Sabeh, Subbroto Kumar Saha, Sadia Afrin, Md Soriful Islam & Mostafa A. Borahay

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  1. Malak El Sabeh
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  2. Subbroto Kumar Saha
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  3. Sadia Afrin
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ME performed literature review, manuscript drafting, and critical discussion; SKS and MAB contributed to study design, literature review, manuscript drafting, and critical discussion; SA and MSI performed manuscript drafting and critical discussion.

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Correspondence to Mostafa A. Borahay.

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El Sabeh, M., Saha, S.K., Afrin, S. et al. Wnt/β-catenin signaling pathway in uterine leiomyoma: role in tumor biology and targeting opportunities. Mol Cell Biochem 476, 3513–3536 (2021). https://doi.org/10.1007/s11010-021-04174-6

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