O papel da vitamina D na fisiopatologia dos miomas uterinos: revisão sistemática em modelos animais, estudos in vitro e observações clínicas

• Ano de defesa: 2020
• Autor(a) principal: Barillari, Priscila Cristina Souza Giolo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Fibroids; Fibroid Therapy; D Vitamin; Vitamin D Receptor; Leiomyoma; Miomas; Terapêutica Dos Miomas; Vitamina D; Receptor De Vitamina D; Leiomioma
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=10291954; https://hdl.handle.net/11600/64824

Fibroids are benign tumors in women of reproductive age and although associated with hormonal, genetic and molecular factors, the exact factor leading to its development is unknown. About 50% of patients are asymptomatic, but the other 50% may have symptoms such as abnormal uterine bleeding, pelvic pressure or pain, compressive symptoms, causing significant morbidity and affecting their quality of life, as well as infertility. Treatment of this condition should be individualized depending on various factors such as number, size and location of the tumor. In most cases, the treatment is performed surgically, either by myomectomy or hysterectomy. Over the years, a search for less aggressive treatments in the medical area using medications that can prevent growth and problems caused by fibroids are on course. Within the pharmacological options there are several therapeutic classes of medications such as steroid synthesis inhibitors and steroid receptor modulators that control the symptoms and decrease the volume of the fibroid. However, surgical treatment remains the most effective and definitive treatment when pharmacological therapy is not sufficient to control symptoms. Several studies have now shown the role of vitamin D in the development of fibroids and studies are demonstrating the reduction in fibroid size when myomatous cells are brought into contact with high doses of vitamin D. The presence of vitamin D was able to prevent and decrease the proliferation of fibroids and their cells. The mechanisms by which vitamin D influences the development of fibroids are not yet fully known. This systematic review suggests that the hormone (1,25 (OH)2 D3) plays an important role in controlling cell growth, programmed cell death, damage to DNA, and low levels of vitamin D appears to be a critical factor for the etiopathogenesis of uterine fibroids. Currently, there are several attempts to create a drug that is safe, effective and inexpensive for the treatment and prevention of fibroids and the identification of modifiable risk factors, such as 1,25 (OH)2 D3 deficiency is promising. In addition, it is assumed that vitamin D can regulate the excess of specific proteins present in tumor cells, proteins that would be at high levels compared to uterine cells without fibroids. These proteins are known as metalloproteinases and are enzymes that degrade extracellular material, leading to tumor growth, when in excess.