Levonorgestrel, medroxyprogesterone and progesterone cause a concentration-dependent reduction in endometrial cancer (Ishikawa) cell density, and high concentrations of progesterone and mifepristone act in synergy

Abstract

Endometrial hyperplasia is a precursor lesion of endometrial carcinoma. Clinical studies of endometrial hyperplasia have shown that levonorgestrel (LNG) is more therapeutically effective than medroxyprogesterone acetate (MPA). The present pharmacological in vitro study was performed to compare progestin effects on human endometrial cancer (Ishikawa) cells. Supraphysiological concentrations of progesterone (PG) and high concentrations of LNG and MPA were employed to determine the order of potency in reducing cell density. The order of potency was LNG>MPA>PG with respective 50% inhibitory concentrations (IC(50)) of 3.9+/-0.4, 30.4+/-3.4 and 45.3+/-2.7 microM. Mifepristone (MF) is a potent antiprogestin, but was unable to antagonize the PG-induced cell density reduction. For MF concentrations from 0.2 to 70 microM alone, a PG-mimetic effect was observed with an IC(50) value of 19.0+/-1.7 muM. When PG and MF were combined, a marked reinforcement of the effect was seen. These observations indicate that extranuclear initiated signaling pathways are involved in the reduction of endometrial cancer cells exposed to high concentrations of PG and MF.