Semin Reprod Med 2017; 35(06): 499-509
DOI: 10.1055/s-0037-1607265
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Activin A in Inflammation, Tissue Repair, and Fibrosis: Possible Role as Inflammatory and Fibrotic Mediator of Uterine Fibroid Development and Growth

Olga Protic1, Md Soriful Islam1, 2, Stefania Greco1, Stefano Raffaele Giannubilo3, Pasquale Lamanna4, Felice Petraglia5, Andrea Ciavattini3, Mario Castellucci1, Boris Hinz6, Pasquapina Ciarmela1
  • 1Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
  • 2Biotechnology and Microbiology Laboratory, Department of Botany, University of Rajshahi, Rajshahi, Bangladesh
  • 3Department of Clinical Science, Università Politecnica delle Marche, Ancona, Italy
  • 4Obstetrics and Gynecology Unit, Profili Hospital, Fabriano, Italy
  • 5Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” University of Florence, Florence, Italy
  • 6Laboratory of Tissue Repair and Regeneration, Matrix Dynamics Group, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
03 November 2017 (online)


The growth factor activin A belongs to the transforming growth factor-β superfamily and was initially isolated as an inducer of follicle-stimulating hormone secretion. Activin A was later found to play roles in cell proliferation, differentiation, apoptosis, and metabolism. More recently, activin A has also been recognized as a novel player in mediating inflammation, immunity, wound repair, and fibrosis. Elevated levels of activin A during inflammation are responsible for the increased production of extracellular matrix in different pathological conditions, including fibroids. Our group has demonstrated a profibrotic role of activin A in leiomyoma growth. Uterine leiomyoma can be considered as a fibrotic disorder that initiates from myometrial smooth muscle layer of uterus in reproductive-age women and that is driven by a strong inflammatory component. In fertile women, transient inflammation is a physiological and essential process during menstruation, ovulation, and parturition. However, tissue injury from extravasated menstrual blood and/or an altered response to harmful stimuli, such as pathogens, damaged cells, or irritants, can establish chronic inflammation in the uterus, ultimately leading to dysregulated tissue repair. Myofibroblasts are key cells in normal repair and the chronic tissue remodeling characteristic for fibrosis and uterine leiomyoma. In this review, we discuss the role of activin A in inflammation, tissue repair, and fibrosis and we elaborate the hypothesis that it plays a central role in myofibroblast activation and leiomyoma development and growth.