Sphingosine 1-phosphate signaling in uterine fibroids: implication in activin A pro-fibrotic effect

Fibrosis in uterine fibroids involves a dysregulation of sphingosine 1-phosphate signaling and metabolism, interacting with the profibrotic cue activin A and suggesting innovative pharmacologic targets.

VOLUME 115, ISSUE 6, P1576-1585


Caterina Bernacchioni, Ph.D., Pasquapina Ciarmela, Ph.D., Valentina Vannuzzi, B.Sc., Stefania Greco, Ph.D., Silvia Vannuccini, M.D., Francesca Malentacchi, Ph.D., Pamela Pellegrino, B.Sc., Tommaso Capezzuoli, M.D., Flavia Sorbi, M.D., Francesca Cencetti, Ph.D., Paola Bruni, Ph.D., Chiara Donati, Ph.D., Felice Petraglia, M.D.



To explore the link between sphingosine 1-phosphate (S1P) signaling and leiomyoma and the possible S1P cross-talk with the fibrotic effect of activin A.


Case-control laboratory study.


University institute and university hospital.


Patients with uterine fibroids (n = 26).


Tissue specimens of leiomyoma and normal myometrium were obtained from patients undergoing myomectomy or total hysterectomy.

Main Outcome Measure(s)

Expression of mRNA levels of the enzyme involved in S1P metabolism, S1P receptors, and S1P transporter Spns2 was evaluated in matched leiomyoma/myometrium specimens and cell populations. The effects of inhibition of S1P metabolism and signaling was evaluated on activin A–induced fibrotic action in leiomyoma cell lines.


The expression of the enzymes responsible for S1P formation, sphingosine kinase (SK) 1 and 2, and S1P2, S1P3, and S1P5 receptors was significantly augmented in leiomyomas compared with adjacent myometrium. In leiomyoma cells, but not in myometrial cells, activin A increased mRNA expression levels of SK1, SK2, and S1P2. The profibrotic action of activin A was abolished when SK1/2 were inhibited or S1P2/3 were blocked. Finally, S1P augmented by itself mRNA levels of fibrotic markers (fibronectin, collagen 1A1) and activin A in leiomyomas but not in myometrial cells.


This study shows that S1P signaling is dysregulated in uterine fibroids and involved in activin A–induced fibrosis, opening new perspectives for uterine fibroid treatment.