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Biological Mechanisms Underlying the Clinical Effects of RU 486: Modulation of Cultured Endometrial Stromal Cell Stromelysin-1 and Prolactin Expression¹

Department of Obstetrics and Gynecology, New York University Medical Center, New York, New York 10016

Address all correspondence and requests for reprints to: Frederick Schatz, Department of Obstetrics and Gynecology, New York University Medical Center, 550 First Avenue, New York, New York 10016.

During in vitro decidualization of human endometrial stromal cells (HESCs), medroxyprogesterone acetate (MPA) inhibits expression of the potent extracellular matrix (ECM)-degrading protease stromelysin-1 (MMP-3), but enhances PRL expression. Consistent with its priming role in vivo, estradiol (E₂) augments these effects. In the current study, immunoblot analysis revealed that coincubation with 10^-6 M RU 486 blocked the inhibition in HESC-secreted MMP-3 levels (50,000 mol wt) evoked by 10^-8 M E₂ + 10^-7 M MPA. Although MPA can act as a glucocorticoid, the HESCs were refractory to 10^-7 M dexamethasone added alone or with E₂. Because E₂ elevates progesterone but not glucocorticoid receptor levels, MPA and RU 486 control MMP-3 expression as a progestin and antiprogestin, respectively. To study RU 486 involvement in steroid withdrawal leading to menstruation, HESCs were decidualized during 10 days incubation with E₂ + MPA, and parallel cultures were kept in E₂ + MPA or withdrawn to either control or RU 486-containing medium. Compared with E₂ + MPA-suppressed HESCs, increases in levels of secreted MMP-3 (2.0-fold), and its 2.1-kilobase messenger RNA (10-fold) were observed in HESCs after 4 days of withdrawal to control medium, with much greater increases seen in RU 486-containing medium (10-fold protein, 100-fold messenger RNA). Previously, we showed that RU 486 up-regulated E₂ + MPA-inhibited plasminogen activator expression in the cultured HESCs. Extrapolation of these in vitro observations to endometrial events following RU 486 administration suggests that coordinate enhancement of MMP-3 and plasminogen activator expression promotes proteolysis of the stromal/decidual ECM, which leads to endometrial sloughing. Moreover, destabilization of endometrial microvessels resulting from degradation of their surrounding ECM is consistent with the heavy menstrual bleeding stemming from RU 486 administration. However, in contrast to the marked RU 486-initiated reversal of MMP-3 expression, RU 486 did not significantly reverse E₂ + MPA-enhanced PRL secretion by the cultured HESCs. Interestingly, decidual PRL, unlike decidual MMP-3, does not appear to play a role in menstruation. Interleukin-1ß counteracted E2 + MPA-mediated inhibition of secreted MMP-3 levels, implying that leukocyte/trophoblast-derived cytokines can modulate steroid-regulated MMP-3 expression by stromal/decidual cells during menstruation and pregnancy.

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