Estrogen receptor-1 genotype is related to coronary intima thickness in young to middle-aged women

Risk of sudden coronary death based on genetic background in Chinese Han population

Associations between gene variations and sudden cardiac arrest or coronary artery disease have been reported by genome-wide association studies. However, the implication of the genetic status in cases of sudden coronary death (SCD) from the Chinese Han population has remained to be investigated. The present study established a mini-sequencing system to examine putative death-causing single nucleotide polymorphisms (SNPs) using multiplex PCR, single base extension reaction and capillary electrophoresis techniques. A total of 198 samples from the Chinese Han population (age range, 34-71 years; mean age, 53.86 years) were examined using this method. Samples were classified into three groups: Coronary heart disease (CHD, n=70), SCD (n=53) and control (n=75) group. Significant associations were identified for 10, 4 and 6 SNPs in CHD, SCD and sudden death from CHD, respectively, using the χ² test. The SNPs obtained by binary logistic regression may be used to assess and predict the risk of disease. The predictive accuracy of the SNPs in each prediction model and their area under the receiver operating characteristic curve (AUC) values were determined. The AUC of the four SNPs (rs12429889, rs10829156, rs16942421 and rs12155623) to predict CHD was 0.928, the AUC of the six SNPs (rs2389202, rs2982694, rs10183640, rs597503, rs16942421 and rs12155623) to predict SCD was 0.922 and the AUC of the four SNPs (rs16866933, rs4621553, rs10829156 and rs12155623) to predict sudden death from CHD was 0.912. The multifactor dimensionality reduction values were as follows: 0.8690 (prediction model of CHD), 0.7601 (prediction model of SCD) and 0.7628 (prediction model of sudden death from CHD). Taken together, the results of the present study suggested that these SNPs have considerable potential for application in genetic tests to predict CHD or SCD. However, further studies are required to investigate the putative functions of these SNPs.

Estrogen Receptors: Therapeutic Perspectives for the Treatment of Cardiac Dysfunction after Myocardial Infarction

Estrogen receptors (ER) mediate functions beyond their endocrine roles, as modulation of cardiovascular, renal, and immune systems through anti-inflammatory and anti-apoptotic effects, preventing necrosis of cardiomyocytes and endothelial cells, and attenuating cardiac hypertrophy. Estradiol (E2) prevents cardiac dysfunction, increases nitric oxide synthesis, and reduces the proliferation of vascular cells, yielding protective effects, regardless of gender. Such actions are mediated by ER (ER-alpha (ERα), ER-beta (ERβ), or G protein-coupled ER (GPER)) through genomic or non-genomic pathways, which regulate cardiovascular function and prevent tissue remodeling. Despite the extensive knowledge on the cardioprotective effects of estrogen, clinical studies conducted on myocardial infarction (MI) and cardiovascular diseases still include favorable and unfavorable profiles. The purpose of this review is to provide up-to-date information regarding molecular, preclinical, and clinical aspects of cardiovascular E2 effects and ER modulation as a potential therapeutic target for the treatment of MI-induced cardiac dysfunction.

Main active constituent identification in Guanxinjing capsule, a traditional Chinese medicine, for the treatment of coronary heart disease complicated with depression

Guanxinjing capsules (GXJCs) are used in traditional Chinese medicine as a common therapy for coronary heart disease (CHD) complicated with depression. In this study, we aimed to identify the main active constituents in GXJCs and to investigate the mechanisms of GXJC action on CHD complicated with depression. The chemical constituent profile of the GXJC was identified by UHPLC-LTQ-Orbitrap assay, and oral bioavailability was evaluated to screen the GXJC drug-like chemical constituents. A total of 16 GXJC drug-like chemical constituents were identified. Then, putative targets of the GXJC drug-like chemical constituents were predicted using MedChem Studio, with 870 genes found to be the putative targets of these molecules. After that, a GXJC putative target-known CHD/depression therapeutic target network was constructed, and four topological features, including degree, betweenness, closeness and K-coreness, were calculated. According to the topological feature values of the GXJC putative targets, 14 main active constituents were identified because their corresponding putative targets had topological importance in the GXJC putative target-known CHD/depression therapeutic target network, which were defined as the candidate targets of GXJC against CHD complicated with depression. Functionally, these candidate targets were significantly involved in several CHD/depression-related pathways, including repairing pathological vascular changes, reducing platelet aggregation and inflammation, and affecting patient depression. This study identified a list of main active constituents of GXJC acting on CHD complicated with depression using an integrative pharmacology-based approach that combined active chemical constituent identification, drug target prediction and network analysis. This method may offer an efficient way to understand the pharmacological mechanisms of traditional Chinese medicine prescriptions.

The association between the rs2234693 and rs9340799 estrogen receptor alpha gene polymorphisms and risk factors for cardiovascular disease: a review

Although estrogen is primarily thought of as the hormone involved in female reproduction, it also plays a role in many additional physiological and pathological processes. Recent studies have demonstrated an association between estrogen and clustered risk factors for cardiovascular disease (CVD), such as lipid and glucose metabolism and obesity-related phenotypes, as well as occurrence and severity of CVD. Evidence suggesting a genetic basis for this link is accumulating. Several polymorphisms of the estrogen receptor (ER) alpha (ESR1) gene exist that may influence the impact of estrogen, leading to clinically relevant phenotypes. Based on the relationship ERS1 seems to exhibit with CVD risk factors, these polymorphisms may play a role in the mediation of vasoprotective effects, modulation of cardiovascular physiology, and development of risk factors for CVD. The two most frequently studied polymorphisms located in ESR1 are often identified by their restriction endonucleases Pvull (rs2234693) and Xbal (rs9340799). ln this review, we have evaluated and summarized the results of studies involving rs2234693 and rs9340799 and clustered risk factors accompanying development of CVD. Despite inconsistent findings, together these studies provide some support for a relationship between polymorphisms in ESR1 and risk factors for CVD. These summarized findings do not yet support inclusion of ESR1 genotypes in genetic testing algorithms for predisposition to CVD, but they do indicate that further investigation into the potential connection between ESR1 and risk factors for CVD is warranted.

Time dependence of estrogen receptor expression in human hearts

OBJECTIVES AND AIMS

Transcriptional effects of estrogens are primarily mediated by the two nuclear estrogen receptors (ER), ERalpha and ERbeta. Both receptors are present in the vasculature and in the human heart and have been shown to act antiatherogenic and to be protective against the development of cardiac hypertrophy. The aim was to quantify ER mRNA expression in left ventricular specimens from patients with coronary heart disease (CHD, n=15) and dilated cardiomyopathy (CMP, n=38) and compare their levels with those from healthy heart donors (n=9). Additionally, a possible variation of ERmRNA expression in human hearts in respect to time of day was studied.

METHODS AND RESULTS

mRNA expression of both ER receptors was detected by real-time PCR in all of the human specimens. There was no difference in the relative quantity of the receptors between CHD and CMP patients. However, control specimens showed significant lower levels of either receptor in the healthy myocardium (p<.001 each). Analyzing the time dependency of receptor expression with a cosinor analysis showed a significant 8-hour period rhythm for ERbeta in CMP- but no rhythm in CHD patients. Due to the low patient number, rhythmic analysis was not possible in controls.

CONCLUSIONS

The increased ERalpha and ERbeta mRNA expression in left ventricular specimens from CHD and CMP patients might reflect a compensatory mechanism to counteract the decline in ventricular function. Furthermore, we provided evidence for a time dependent variation of ERbeta receptor expression in the human heart.

The role of estrogen receptor subtypes for vascular maintenance

Protective role of estrogens (E2) against cardiovascular disease has been appreciated for many years until the equivocal results of cardiovascular outcomes in clinical trials on hormone replacement therapy were reported. Although new ongoing trials aim to resolve these discrepancies, it is obvious that cardiovascular effects of E(2) are complex and diverse. To understand further the cardiovascular effects of E(2), the detailed knowledge on the specific role of both classical estrogen receptor (ER) subtypes and G protein-coupled receptor-30 in the vasculature are of importance. In this article, we review the current knowledge about the pattern of ERalpha and ERbeta expression in human vasculature, the genomic and non-genomic cardiovascular effects of E(2)versus subtype selective ERalpha and ERbeta stimulation on isolated arteries and in different knockout animal models. The results indicate that although ERalpha and ERbeta are expressed in the endothelium and media of human arteries, there is no definite evidence for predominant expression of one over another, the pattern depends on vascular bed, sex and diseased condition. Data from the experiments on isolated arteries and in ER knockout animal models may indicate that activation of specific ER subtypes could provide additional cardiovascular protective effects. However, a clear role for each ERs have to be finalised with focus on mechanisms and by exploring the potential of ERs-selective agonists for clinical utility.

Do Genetic Alterations in Sex Steroid Receptors Contribute to Lacrimal Gland Disease in Sjögren's Syndrome?

BACKGROUND: Defects in sex steroid receptors have been linked to the onset, progression and severity, as well as the sex-related prevalence, of a variety of autoimmune disorders, including lupus, rheumatoid arthritis, multiple sclerosis and diabetes. We hypothesize that defects in estrogen receptor alpha (ESR1), estrogen receptor beta (ESR2) and/or the androgen receptor (AR) may also contribute to the development of lacrimal gland autoimmune sequelae in Sjögren's syndrome. To begin to test this hypothesis, we examined whether mutations exist in the coding regions of ESR1, ESR2 and AR transcripts in lacrimal tissues of mouse models of Sjögren's syndrome. METHODS: Lacrimal and submandibular glands were collected from adult MRL/MpJ-Tnfrsf6(lpr), nonobese diabetic and/or BALB/c mice. Tissues were pooled according to sex and experiment and processed for cDNA generation. PCR primers were designed to amplify 566-875 base pair segments of the entire open reading frame of each receptor. Segments were amplified, purified and then sequenced. Receptor sequences were assembled and compared to each other and to known NCBI sequences. RESULTS: Our results show that almost all ESR1, ESR2 and AR sequences in exocrine tissues of male and female autoimmune and non-autoimmune mice were identical to those of NCBI standards. There was a G-->A shift at position 998 of the ESR2 complete coding sequence in all tissue samples when compared to NCBI reference sequence U81451.1, but this polymorphism was not found in other ESR2 reference sequences. CONCLUSIONS: Our findings indicate that defects in the coding region of sex steroid receptors do not contribute to the pathogenesis of lacrimal gland disease in mouse models of Sjögren's syndrome.

Rationale for low-dose systemic hormone replacement therapy and review of estradiol 0.5 mg/NETA 0.1 mg

The menopausal transition is associated with several symptoms, for which both non-pharmacological and pharmacological measures are available to provide relief. However, present knowledge indicates that the former is not highly effective, and that the latter, in terms of systemic oestrogen and progestogen-based hormone replacement therapy (HRT), although being effective (e.g. on vasomotor symptoms, bleeding control, bone mineral density, vaginal atrophy and quality of life), can be associated with some caveats. Amongst these are an increased risk for coronary heart disease, breast cancer, venous thromboembolism and stroke. In recent years, literature has indicated a dose dependency for HRT on some of the caveats, hence authorities (Food and Drug Administration, and the European Medicines Agency) and menopause societies (International Menopause Society and North American Menopause Society) now recommend that women deemed in need of HRT should receive the lowest possible dose without compromising the effect of symptom relief. Estradiol 0.5 mg/norethisterone acetate (NETA) 0.1 mg, despite being a lower dose than conventional hormones, is a compound, among a few other low-dose options, that can be used in such therapy. As a first-line oral option, it has demonstrated its effectiveness (which seems comparable to other compounds), with high tolerability and, apparently, no safety concerns, in a 6-month study. Further long-term clinical trials and observational studies are mandatory in order to capture any potential harm as well as to elucidate this compound's full potential. Following a thorough literature search using PubMed and MEDLINE from the earliest publication dates through to January 2008, including results from various types of clinical trials and statements on HRT, we review the rationale for these recommendations. We also review the effects and safety of a novel 'ultra-low-dose' oral continuous combined HRT tablet, estradiol 0.5 mg/NETA 0.1 mg.