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Ulipristal acetate (UPA), a selective progesterone receptor modulator (SPRM), offers new therapeutic options for the clinical management of large uterine fibroids associated with heavy menstrual bleeding or with other moderate or severe symptoms (bulk symptoms, pelvic pain, decreased quality of life). SPRM are synthetic compounds that exert an agonist or antagonist effect on target tissues by their binding to progesterone receptors. UPA reduces fibroid size, controls bleeding in a high percentage of women and significantly improves quality of life. The present review aims to provide insights into UPA indications and its mechanism of action.

RESEARCH QUESTION: Does ulipristal acetate (UPA) modify the expression of genes related to apoptosis or the extracellular matrix in uterine myomas and are any modifications associated with a clinical response? DESIGN: Targeted analysis of 176 apoptosis- or extracellular-matrix-related genes was conducted using polymerase chain reaction (PCR) arrays. Relevant results were validated by quantitative PCR. Four groups were established: responsive short-term (one course, n = 9), responsive long-term (two to four courses, n = 9), non-responsive (n = 9), and the control group who was not given any hormone therapy (n = 9). The clinical response was monitored by medical imagery and considered significant when volume reduction was greater than 25%. RESULTS: Compared with untreated myomas, significant changes in expression of four genes were found in UPA-treated myomas. Gene expression of integrin subunit beta 4 was repressed by UPA treatment (fold change [FC] = -12.50, P < 0.001, q < 0.001), tenascin-C expression was downregulated in UPA-responsive patients (FC = -2.50, P = 0.010, q = 0.090), survivin was repressed in short-term UPA-responsive tumours (FC = -7.69, P < 0.001, q = 0.010), and catenin delta 2 gene expression was upregulated in non-responsive myomas (FC = +7.36, P < 0.001, q = 0.010). CONCLUSION: This characterization provides the first molecular distinction between myomas responsive or non-responsive to UPA treatment.

Introduction Vascular hyperpermeability is a major aspect of sepsis pathophysiology. We previously demonstrated that AMPK protects against sepsis induced vascular hyperpermeability by mechanisms involving interendothelial junctions (IEJs) regulation. The SGLT2 inhibitor Canagliflozin, prescribed in diabetes and known for its cardiovascular protective properties, has recently been shown to activate AMPK in different cell types. Objectives Here, we show that Canagliflozin might be considered as a new therapeutic approach against sepsis induced vascular hyperpermeability. We also decipher molecular mechanisms underlying this protective effect. Methods In vivo experiments were performed on endothelial-specific α1AMPK knockout (e-AMPK KO) mice. Canagliflozin administration was achieved by oral gavage (100 mg/kg) and validated by plasmatic dosages. LPS was administered by intraperitoneal injection (10 mg/kg). Myocardial edema was assessed by Evans Blue Dye extravasation measurement. In vitro experiments were performed in Human Dermal Blood Endothelial Cells (HDBEC). α1AMPK was invalidated with a specific siRNA or activated by Canagliflozin (10 μM). Results We show that Canagliflozin activates AMPK in HDBEC at physiological concentrations. Canagliflozin administration strongly protects against LPS induced vascular leakage in WT but not in e-AMPK KO mice. Accordingly, albuminemia is preserved by Canagliflozin treatment in septic WT mice. More interestingly, Canagliflozin treatment increases survival in response to sepsis injury. In vitro, AMPK activation by Canagliflozin preserves the integrity of IEJs (Cx43, VeCad, ZO1). Conclusion Our work demonstrates the protective effects of Canagliflozin on sepsis induced vascular hyperpermeability and mortality, and highlights key molecular mechanisms involved in this protection. This should open the field to consider Canagliflozin as a new therapeutic support of sepsis induced vascular hyperpermeability.