Hormone replacement therapy

Estrogen receptor ligands. Part 3: The SAR of dihydrobenzoxathiin SERMs

A series of 3-alkyl, 3-cycloalkyl, and 3-heteroaryl dihydrobenzoxathiin analogs 1 were prepared and evaluated for estrogen/anti-estrogen activity in both in vitro and in vivo models. In general, the compounds were found to exhibit a high degree of selectivity for ER alpha over ER beta, but were less potent than the original lead compound 1a in the inhibition of estradiol-driven uterine proliferation.

Comparison of 2-phenylspiroindenes and 2-phenylspiroindenediones as estrogen receptor ligands--modeling and binding data don't agree!

A series of 2-phenylspiroindenediones was prepared. The spiroindenediones were found to be less active than the corresponding spiroindenes as estrogen receptor ligands and failed to demonstrate the receptor subtype selectivity that had been anticipated from molecular modeling.

Molecular Mechanisms, Physiological Consequences and Pharmacological Implications of Estrogen Receptor Action

The estrogen receptors (ERs), ERalpha and ERbeta, play a central role in mediating the biological effects of estrogen. The transcription rate of estrogen target genes is determined by several parameters including the type of ligand, estrogen receptor subtype and isoform, as well as interactions with receptor-binding cofactor proteins. The ERs regulate gene expression by binding to specific response element sequences in the promoters of estrogen target genes. Alternative pathways have also been described in which the ERs modulate transcription indirectly, via protein : protein interactions. In this regulatory mode, which has been traced to activator protein (AP)-1-, cyclic adenosine monophosphate (cAMP)-, and Sp1-response elements, the ERs appear to be tethered to target gene promoters via heterologous transcription factors. It has been found that ERalpha and ERbeta have opposite effects on transcription mediated via the indirect mode of action. Moreover, recent studies suggest that ERbeta may inhibit the stimulatory effects of ERalpha on cellular proliferation. Estrogen is a key regulatory hormone that affects numerous physiological processes. Estrogen is required for female pubertal development and affects growth, differentiation and function of the female reproductive system. It has recently been suggested that estrogen also has an important role in the male urogenital tract. In addition, estrogens have profound effects in other tissues. For instance, in the skeleton estrogen prevents bone-resorption by inhibition of osteoclast function. Numerous reports have suggested that estrogen has a beneficial effect in the cardiovascular system and in the CNS; however, this has not been confirmed in randomized clinical trials. In fact, a large randomized trial on healthy postmenopausal women receiving oral estrogen plus progestin showed an increased incidence of cardiovascular disease. In addition, this study revealed an increased risk for dementia and impaired cognitive function in the group receiving oral estrogen/progestin. Additional clinical trials are required to determine which hormonal component causes these health risks or whether the effects were due to the combination of estrogen and progestin.

2-Phenylspiroindenes: a novel class of selective estrogen receptor modulators (SERMs)

A series of 2-phenylspiroindenes was prepared. The most active analogue (2) was found to be comparable in potency to raloxifene (1) as an estrogen receptor ligand.

An in vitro long-term culture model for normal human mammary gland: expression and regulation of steroid receptors

Steroids and their nuclear receptors play crucial roles in the development and maintenance of normal functions of the human mammary gland (HMG). They have also been implicated in breast carcinogenesis. However, the study of steroid action in normal HMG has been hampered by experimental difficulties. By using a newly established in vitro long-term culture method, we successfully cultured normal HMG tissue for more than 2 months without detriment to its morphology or steroid receptor expression. Expression of the cellular structural and extracellular matrix proteins was similar to that prior to culture, and HMG tissue retained its properties of steroid receptor expression and regulation. Addition of 17-beta estrogen to mammary tissues markedly increased the expression of progesterone receptor (PR) but only slightly affected that of the estrogen receptor (ER). Medroxyprogesterone acetate down-regulated the expression of PR within 24-48 h and also increased the expression of androgen receptor. When HMG tissue was cultured in medium containing normal or dextran-coated charcoal-stripped fetal calf serum or normal human serum, the expression and regulation of steroid hormone receptors were similar, although different in extent. When serum was omitted, the morphology of HMG was normal after 1 week, but the expression and regulation of ER and PR were altered. Thus, as HMGs retain the capacity to express steroid receptors in culture, this long-term culture system is probably a good model for studying the regulation of the mammary gland by steroids.

Selective estrogen receptor modulators and coronary heart disease

The vasculature has been recognized as an important target of estrogen action through rapid non-genomic effects and/or via the classic pathway (genomic effects) involving estrogen receptors (ER-alpha and ER-beta). Multiple mechanisms participate in the regulation of different estrogen-controlled genes, providing a wide spectrum of possibilities for development of drugs, including pure agonists or antagonists or mixed agonists/antagonists, the so-called selective estrogen receptor modulators (SERM). In theory, an ideal SERM should reduce the risks of coronary heart disease (CHD) and preserve bone density, without or with very low incidences of breast and endometrial neoplasms or venous thromboembolism (VTE). The precise mechanism for the protective effects of estrogens and their receptors on cardiovascular diseases is not yet fully established. In this review, we summarize the recent advances in understanding the action of ERs/ligands, the therapeutic implications for CHD, and highlight the recent progress of both clinical and basic studies on the protection issue. Finally, a number of newly developed SERMs and their clinical applications as well as the laboratory investigations are discussed.

Sex differences in 'climacteric symptoms' with increasing age? A hypothesis-generating analysis of cross-sectional population surveys

Are the established clinical symptoms of the female climacteric really specific for women? We were interested to compare the prevalence of these symptoms across age and sex. In the absence of longitudinal (cohort) studies, we tried to find cross-sectional, population-based studies with a broad age span to find a preliminary answer. We obtained six surveys that contained information for at least some of the symptoms. We re-analyzed these databases, which included over 8000 males and 8000 females, in a pooled fashion. Sixteen symptoms of predominantly somatic, psychological and urogenital origin were identified and the age-dependent increase of the relative frequencies was compared between genders. A general tendency for women to report more symptoms was confirmed; however, no significant differences were found between genders regarding the time trend of these symptoms. The analyses suggest that males experience a similar symptomatology in the same age span as women. One may thus be tempted to conclude that aging males experience similar phenomena to women during their menopausal transition. This should be confirmed in a specifically designed study.