ArticlePloS one2026
Drospirenone promotes apoptosis in ectopic but inhibits proliferation in eutopic human endometrial stromal cells.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEndometriosis is a complex gynecological condition characterized by endometrial tissue growing outside the uterus. In many in vitro studies, almost all progestins have indicated the anti-proliferation and apoptosis of endometriotic stromal cells. Drospirenone, a synthetic progestin structurally distinct from traditional progestins, still lacks sufficient data regarding its effects on endometriosis, particularly in terms of antiproliferative and pro-apoptotic activity. This study investigates the antiproliferative effects of drospirenone on eutopic (EU-ESCs) and ectopic human endometrial stromal cells (EC-ESCs), and compare its impact on apoptotic effects in both cell types. METHODS AND
findingsIn the study, paired EU-ESCs and EC-ESCs were obtained from patients diagnosed with endometriosis (n = 12). EU-ESCs and EC-ESCs were treated with and without drospirenone. Antiproliferative markers and apoptotic markers were evaluated and compared between the two groups. Interestingly, drospirenone at a concentration of 1 µM significantly affected cell viability in both EU-ESCs and EC-ESCs. In EU-ESCs, Ki-67 expression was significantly reduced compared to controls (0.17 vs. 1; p = 0.003), while in EC-ESCs, the reduction was not statistically significant. Caspase-3 expression was significantly increased in both EU-ESCs (1.13 vs. 1) and EC-ESCs (1.57 vs. 1) (p= 0.02 and p = 0.05, respectively). Additionally, BCL2 expression decreased in both cell types following treatment. BAX expression increased in both EU-ESCs and EC-ESCs. Expression levels of PTEN and P53 also increased in both cell types, with statistical significance observed only in EC-ESCs (p = 0.03 and p = 0.04, respectively). BAK expression decreased in EU-ESCs but increased in EC-ESCs compared to controls.
conclusionsDrospirenone exhibits an antiproliferative effect on EU-ESCs and induces a more pronounced apoptotic response in EC-ESCs.
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