Ketoconazole is a broad-spectrum antifungal with oral activity and is documented to block steroid biosynthesis in fungi and mammals. Estradiol-primed ovariectomized rats lose the estradiol-induced, cornified layer of the vaginal epithelium as a result of ketoconazole treatment. This effect is not explained by current knowledge of ketoconazole's mechanism of action. Ketoconazole's effect on estradiol's binding to either receptors in target tissues (target-cell receptors) or serum-estradiol-carrying proteins in the aforementioned rats was investigated. The uterus is responsive to estradiol treatment, which causes an increase in uterine size and weight. This tissue is a sensitive means of studying the effects of ketoconazole on target-cell estradiol receptors. Tamoxifen, documented to block the effects of estradiol by binding to target-cell estradiol receptors, was used as a control drug. Uterine weight and horn diameter were measured in estradiol-treated, ovariectomized rats after 7 days of oral, twice-a-day, drug treatment. Ketoconazole had no effect on mean uterine weights and uterine horn diameters at any of the doses tested; however, tamoxifen at a dose of 10 mg/kg caused a significant reduction in uterine weight and horn diameter. Vaginal histopathology showed that ketoconazole and tamoxifen caused decornification. The percentage of unbound estradiol in the serum was measured in estradiol-treated, ovariectomized rats treated with ketoconazole orally, twice-a-day for 3 days to determine the effects of ketoconazole on the serum binding of estradiol. The results of vaginal cytology showed that ketoconazole caused normal decornification. In comparison with control animals, the results of the serum percent-unbound estradiol assays showed that ketoconazole caused a dose-related increase in the percent-unbound estradiol in the blood. The dose required to cause a 5 percent increase in serum unbound estradiol was approximately 6 times greater than the minimum dose required to cause decornification. Ketoconazole's effects on target-cell estradiol receptors and serum estradiol-carrying proteins do not appear to have any relationship to its effects in causing vaginal decornification in this model.

Os tumores de endométrio fazem parte do espectro de tumores de inúmeras síndromes neoplásicas hereditárias (SNH). Entretanto, tais tumores, quando proficientes para o sistema de reparo incorreto de DNA (MMR), geralmente são classificados como cânceres esporádicos. Contudo, mesmo diante de uma provável classificação esporádica, a história familiar (HF) de portadoras dessas neoplasias pode apresentar indícios de componentes genéticos hereditários associados ao seu desenvolvimento. Para tanto, tivemos como objetivo principal, caracterizar a HF de mulheres diagnosticadas com tumores de endométrio, com estabilidade de microssatélites, proficientes para o sistema de reparo de pareamento incorreto de DNA, com a finalidade de avaliar o seu risco para síndromes neoplásicas hereditárias. Trata-se de um estudo descritivo de caráter populacional. A amostra inicial (n=58) foi acessada e caracterizada por meio da colaboração com um estudo maior, que investigou tumores de endométrio, quanto à proficiência do sistema de reparo MMR em uma casuística brasileira, a partir de dados coletados no biobanco do Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo. A coleta da HF teve início em abril de 2018 e foi finalizada em julho do mesmo ano. Nossa casuística final foi composta por 42 mulheres que atenderam aos critérios de inclusão/exclusão. Por meio de contato telefônico foi aplicado o Questionário de Rastreamento Primário e, posteriormente, desenhado o heredogramas das famílias, com a utilização do software PedigreeDraw. Após a coleta e o registro da HF, os heredogramas foram analisados pela pesquisadora principal deste trabalho e as famílias foram classificadas quanto ao seu risco de possuírem uma SNH. Nosso estudo possibilitou a identificação de 27 mulheres (64% da nossa casuística) que podem estar em risco para SNH. Dentre essas, no que se refere às SNH que têm o câncer colorretal no seu espectro de tumores, 26% preencheram critérios de Bethesda e 15% preencheram critérios de Amsterdam, sendo que 4% preencheram critérios para FAP atenuada. Já 11% preencheram critérios para síndrome de Câncer de Mama e Ovário Hereditários e 22% preencheram critérios para síndrome Li-Fraumeni Like tipo 1. Ressaltamos que 33% apresentaram história pessoal de câncer abaixo dos 50 anos. Os resultados aqui apresentados reforçam a importância da HF e precisam encorajar os profissionais de saúde a realizar com maior frequência a coleta e o registro da HF, ainda que seja autorreferida. Mesmo diante das novas tecnologias genômicas e do crescente conhecimento dos aspectos genéticos e de testes, a HF continua a destacar informações de risco, extremamente significativas, que vão além da suscetibilidade genética. Portanto, os indivíduos e suas famílias devem ser acompanhados com base na história pessoal e familiar para identificação de suspeitas de SNH / Endometrial tumors are part of the spectrum of tumors of innumerable hereditary neoplastic syndromes (SNH). However, such tumors, when proficient for the DNA mismatch repair (MMR), are usually classified as sporadic cancers. However, even though they are characterized as sporadic, the family history (HF) of carriers of these neoplasms may present evidence of hereditary genetic components associated with its onset and development. In order to study such evidences, we aimed to characterize the HF of women diagnosed with endometrial tumors and microsatellite stability, proficient for the DNA mismatch repair system, in order to evaluate their risk for hereditary neoplastic syndromes. This is a descriptive population-based study. The initial sample (n = 58) was reached and characterized by collaboration with a larger study, which investigated endometrial tumors, regarding the proficiency of the MMR system in a Brazilian sample. We collected data in the Pathology Center of the Hospital das Clínicas of the Medical School of Ribeirão Preto of the University of São Paulo. The HF collection began in April 2018 and was completed in July of the same year. Our final sample consisted of 42 women who met the inclusion / exclusion criteria. By telephone, the Primary Tracking Questionnaire was applied and, afterwards, the families\' pedigrees were drawn using the PedigreeDraw software. After HF collection and registration, the pedigrees were analyzed by the main researcher of this study and the families were classified according to their risk of having an NHS. Our study allowed the identification of 27 women (64% of our sample) who may be at risk for SNH. For samples who have colorectal cancer in their tumor spectrum and suspicion for NHS, 26% met Bethesda criteria and 15% met Amsterdam criteria, and 4% met criteria for attenuated FAP. 11% of our sample met criteria for Hereditary Breast and Ovarian Cancer syndrome and 22% met criteria for Li-Fraumeni Like type 1 syndrome. We pointed out that 33% had a personal history of cancer under 50 years. The results presented here support the importance of HF and the need to encourage health professionals to perform HF collection and registration more frequently, even if it is self-referenced. Even in the face of new genomic technologies and growing knowledge of genetic and testing aspects, HF continues to highlight extremely significant risk information beyond genetic susceptibility. Therefore, not only the individuals but also their families should be monitored on the basis of personal and family history to identify suspected SNH

Heat shock protein 90 (Hsp90) is an essential and conserved chaperone, required for the conformational maturation and stability of many signaling kinases. We hypothesized that the functional pleiotropism of Hsp90 can be exploited during pharmacological inhibition causing simultaneous restraint of tumor growth as well as suppression of distant spread. Recognizing the lack of therapeutic options in advanced and metastatic squamous cell carcinomas (SCC) of the uterine cervix as well as the oral cavity, this dual concept was tested in corresponding cell lines and xenografts, and correlated with clinical data on client protein expression. Examination of the cell cycle response to Hsp90 inhibition revealed a G2/M-arrest in a panel of four cervical cancer cell lines and a contribution of abnormal mitosis to apoptosis induction in vitro. Although limited to intraperitoneal application, in vivo evidence of biological activity including heat shock response and decreased client kinase phosphorylation was seen with the geldanamycin derivative 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17-DMAG). Importantly, focal adhesion kinase (FAK) signaling and associated functional parameters were inhibited by the drug treatment. Functional significance of FAK as a client was confirmed using a molecular model based on FAK-related non-kinase (FRNK) expression. Dependency on FAK appeared to be a requirement for full response to FRNK as well as 17-DMAG, and was observed in the mesenchymal-like cervical cell line SiHa. FAK expression and E-cadherin loss were features found in both cervical and oral malignancies, but absent from normal mucosa of either anatomic site. Particularly high FAK expression was noted in oral SCC with sarcomatoid features. Thus, we conclude that Hsp90 inhibition has potential in the treatment of advanced and metastatic SCC of cervical and oral origin. The further examination of novel Hsp90-targeting compounds as well as strategies focused on other components of the Hsp90 chaperone complex seems warranted.

Heat shock protein 90 (Hsp90) is an essential and conserved chaperone, required for the conformational maturation and stability of many signaling kinases. We hypothesized that the functional pleiotropism of Hsp90 can be exploited during pharmacological inhibition causing simultaneous restraint of tumor growth as well as suppression of distant spread. Recognizing the lack of therapeutic options in advanced and metastatic squamous cell carcinomas (SCC) of the uterine cervix as well as the oral cavity, this dual concept was tested in corresponding cell lines and xenografts, and correlated with clinical data on client protein expression. Examination of the cell cycle response to Hsp90 inhibition revealed a G2/M-arrest in a panel of four cervical cancer cell lines and a contribution of abnormal mitosis to apoptosis induction in vitro. Although limited to intraperitoneal application, in vivo evidence of biological activity including heat shock response and decreased client kinase phosphorylation was seen with the geldanamycin derivative 17-dimethylaminoethylamino-17-demethoxygeldanamycin (17-DMAG). Importantly, focal adhesion kinase (FAK) signaling and associated functional parameters were inhibited by the drug treatment. Functional significance of FAK as a client was confirmed using a molecular model based on FAK-related non-kinase (FRNK) expression. Dependency on FAK appeared to be a requirement for full response to FRNK as well as 17-DMAG, and was observed in the mesenchymal-like cervical cell line SiHa. FAK expression and E-cadherin loss were features found in both cervical and oral malignancies, but absent from normal mucosa of either anatomic site. Particularly high FAK expression was noted in oral SCC with sarcomatoid features. Thus, we conclude that Hsp90 inhibition has potential in the treatment of advanced and metastatic SCC of cervical and oral origin. The further examination of novel Hsp90-targeting compounds as well as strategies focused on other components of the Hsp90 chaperone complex seems warranted.

This study assesses the vulnerability of Haitian women to cervical cancer by looking at the distribution of socio-demographic factors that might prevent their access to health services. Predictor variables of access to health services and variables known to be directly associated to an increased risk for cervical cancer were derived from the Haitian Demographic Health Survey (2005-2006). Five socio demographic predictors of access to health services were considered: Education, wealth index, distance to health services, type of place of residence and whether or not money was a problem to get medical help. The dependent variable used to categorize women into low risk group and high risk group to cervical cancer was created from three variables: young age at first sexual intercourse, more than two sexual partners and can the woman ask her partners to use condom. To study the association between the socio-demographic and economic predictors to access to health services and high risk group of women to cervical cancer, binary logistic regression was conducted. The univariate analysis performed showed that women who were in the high risk group to cervical cancer were more likely to be uneducated (OR= 2.447; p-value<0.0001), poor (OR=2.372; p-value<0.0001), to have economic barriers that prevent their access to health services (OR=1.566; p-value<0.05) and were more likely to live in rural areas (OR=1.705; p-value<0.0001). However, after running the multivariate analysis to control for the other predictors, only level of education (OR= 1.991; p-value<0.0001) and wealth status (OR=1.727; p-value<0.05) were still associated to the dependent variable. These findings proved that interventions that aimed at controlling cervical cancer among Haitian women should take into consideration these indirect socio-demographic and most important economic factors that might prevent the high risk group of women to benefit from the appropriate screening and treatment services, provided that they are available. Finally recommendations to find a better approach to address the cervical cancer burden in Haiti are made. INDEX WORDS: Uterine cervical neoplasmas, risk factors, accessibility to health services, developing countries

In pregnancy, the maternal cardiovascular and placental circulation undergoes structural and functional changes to accommodate the growing fetus, but the mechanisms involved are not fully understood. Nitric oxide (NO) increases in normal pregnancy and lack of NO has been implicated in pregnancy related complications, preeclampsia and fetal growth restriction. Thus, the objective of the thesis was to determine if cardiovascular, uteroplacental and fetoplacental changes observed in human pregnancy also occur in mice and to assess the obligatory role of eNOS in mediating these changes. I showed that like humans, mice exhibit increases in maternal cardiac output, stroke volume, plasma volume, and uterine arterial blood flow, and a transient decrease in arterial pressure during pregnancy. Importantly, I showed that endothelial nitric oxide synthase (eNOS) plays an important role in promoting the progressive increase in maternal cardiac chamber dimensions and output and the enlargement of the aorta during pregnancy in mice. Another novel finding was that eNOS plays an important role in remodeling of the uterine and umbilical vasculatures during pregnancy. The remodeling of the uterine vasculatures, including the uterine and spiral arteries, were blunted in the eNOS KO mice with ko fetuses (KO(ko)) and this likely contributed to elevated vascular resistance and reduced perfusion of the uterine circulation during pregnancy. Impaired spiral artery remodeling may be caused by a deficiency in decidual uterine natural killer cells. Fetal placental vascularization was also impaired in eNOS KO(ko) mice, which likely increased vascular resistance and thereby reduced fetoplacental perfusion. Reduced vascularization may be due to decreased VEGF mRNA and protein expression in KO(ko) placentas. Decreased perfusion in both the uterine and umbilical circulations most likely contributed to elevated placental and fetal hypoxia in the eNOS KO(ko) mice. Interestingly, despite placental hypoxia, eNOS KO(ko) mice do not show the classical signs of preeclampsia including hypertension and proteinuria nor are maternal plasma sFlt1 levels elevated. Nevertheless, eNOS KO(ko) pups are growth restricted at term, and this is mainly due to the fetal genotype. These findings suggest that eNOS plays an essential role during pregnancy in remodeling of the maternal heart, aorta, and uterine and umbilical vasculatures thereby augmenting blood flow to the maternal and fetal sides of the placenta and thereby promoting fetal growth in mice.

No description available.

In pregnancy, the maternal cardiovascular and placental circulation undergoes structural and functional changes to accommodate the growing fetus, but the mechanisms involved are not fully understood. Nitric oxide (NO) increases in normal pregnancy and lack of NO has been implicated in pregnancy related complications, preeclampsia and fetal growth restriction. Thus, the objective of the thesis was to determine if cardiovascular, uteroplacental and fetoplacental changes observed in human pregnancy also occur in mice and to assess the obligatory role of eNOS in mediating these changes. I showed that like humans, mice exhibit increases in maternal cardiac output, stroke volume, plasma volume, and uterine arterial blood flow, and a transient decrease in arterial pressure during pregnancy. Importantly, I showed that endothelial nitric oxide synthase (eNOS) plays an important role in promoting the progressive increase in maternal cardiac chamber dimensions and output and the enlargement of the aorta during pregnancy in mice. Another novel finding was that eNOS plays an important role in remodeling of the uterine and umbilical vasculatures during pregnancy. The remodeling of the uterine vasculatures, including the uterine and spiral arteries, were blunted in the eNOS KO mice with ko fetuses (KO(ko)) and this likely contributed to elevated vascular resistance and reduced perfusion of the uterine circulation during pregnancy. Impaired spiral artery remodeling may be caused by a deficiency in decidual uterine natural killer cells. Fetal placental vascularization was also impaired in eNOS KO(ko) mice, which likely increased vascular resistance and thereby reduced fetoplacental perfusion. Reduced vascularization may be due to decreased VEGF mRNA and protein expression in KO(ko) placentas. Decreased perfusion in both the uterine and umbilical circulations most likely contributed to elevated placental and fetal hypoxia in the eNOS KO(ko) mice. Interestingly, despite placental hypoxia, eNOS KO(ko) mice do not show the classical signs of preeclampsia including hypertension and proteinuria nor are maternal plasma sFlt1 levels elevated. Nevertheless, eNOS KO(ko) pups are growth restricted at term, and this is mainly due to the fetal genotype. These findings suggest that eNOS plays an essential role during pregnancy in remodeling of the maternal heart, aorta, and uterine and umbilical vasculatures thereby augmenting blood flow to the maternal and fetal sides of the placenta and thereby promoting fetal growth in mice.

No description available.

Uterine Fibroids, medically termed uterine leiomyoma, are benign tumors of smooth muscle cells that grow in the uterus. While they are the most common pelvic neoplasm in women and fewer than 1 percent of fibroids develop into cancer, uterine fibroids can cause infertility, adverse pregnancy outcomes, and greatly affect one’s quality of life. Black women have been disproportionately affected by fibroids; when compared to white women, Black women are: 2-3 times more likely to have fibroids, diagnosed at a younger age, more likely to have 7 or more fibroids, more likely to have more severe and more troublesome symptoms (anemia, severe pelvic pain, constipation, and stomach aches), and have twice as many hysterectomies due to fibroids. Black women’s disproportionate affliction with uterine fibroids is particularly concerning given the historical medical injustices associated with Black women’s bodies and reproductive rights from slavery to present day. By placing Black women at the center of analysis and using a Black feminist epistemological framework, this study aims to make a unique contribution to medical sociology as well as literature on the theoretical and practical management of sickness and wellness among Black women in the United States. Using qualitative interviews and grounded theory methodology, the study examined how Black women frame the condition of having uterine fibroids. Specifically, the study investigated a) how Black women conceptualize having fibroids, b) how Black women’s conceptualizations of fibroids affect their feelings about selves or their lifestyles, c) the mechanisms, if any, by which Black women deal with uterine fibroids, d) how their multiple race, class, and gender identities affect their illness experiences and types of treatment that they seek, and e) how conventional and complementary/alternative medicine shapes Black women’s experiences with fibroids. Conceptualizations about fibroids are rooted in the race-gendered histories of Black women and the unique stressors that they face. Through interactions with doctors and among peers, Black women resist the unbearable burden of uterine fibroids through various coping strategies, but generally “keep it moving”. They avoid invasive surgeries through patient agency by being advocates for their medical treatment, self-researching, dialoguing with others, and directing doctor-patient interactions.