Ulrike Fuhrmann

The novel progestin drospirenone and its natural counterpart progesterone: Biochemical profile and antiandrogenic potential

Drospirenone is a novel progestin under clinical development that is similar to the natural hormone progesterone, combining potent progestogenic with antimineralocorticoid and antiandrogenic activities. This specific pharmacological profile of drospirenone is defined by its pattern of binding affinities to a variety of steroid hormone receptors. In the present study the affinity of drospirenone to the progesterone receptor (PR), the androgen receptor (AR), the glucocorticoid receptor (GR), the mineralocorticoid receptor (MR), and the estrogen receptor (ER) was re-evaluated by steroid binding assays and compared to those obtained for the natural hormone progesterone. Drospirenone displayed high affinity to PR and MR and low binding to AR, similar to progesterone. Unlike progesterone, which showed considerable binding to GR, drospirenone exhibited only low binding to this receptor. Neither drospirenone nor progesterone did bind to the ER. In addition to receptor binding studies, transactivation assays were carried out to investigate the effects of drospirenone and progesterone on AR-, GR-, and MR-mediated induction of transcription. Both progestins showed no androgenic but antiandrogenic activity by inhibiting AR-mediated transcription in a dose-dependent manner. This observation could be confirmed by in vivo experiments carried out with orchiectomized male rats, where the antiandrogenic potency of drospirenone was found to be about five- to ten-fold higher than that of progesterone. In contrast to progesterone, drospirenone was devoid of glucocorticoid activity. Both progestins did not show any antiglucocorticoid action. Furthermore, drospirenone and progesterone both showed considerable antimineralocorticoid activity and weak mineralocorticoid activity.

Drospirenone: a Novel Progestogen with Antimineralocorticoid and Antiandrogenic Activity

Drospirenone (ZK 30595; 6 beta, 7 beta, 15 beta, 16 beta-dimethylen-3-oxo-17 alpha-pregn-4-ene-21, 17-carbolactone) is a novel progestogen under clinical development. Drospirenone is characterized by an innovative pharmacodynamic profile which is very closely related to that of progesterone. Potential applications include oral contraception, hormone replacement therapy and treatment of hormonal disorders. The pharmacological properties of drospirenone were investigated in vitro by receptor binding and transactivation experiments and in vivo in appropriate animal models. In qualitative agreement with progesterone, the compound binds strongly to the progesterone and the mineralocorticoid receptor and with lower affinity to androgen and glucocorticoid receptors. There is no detectable binding to the estrogen receptor. Steroid hormone agonistic and antagonistic activities of progesterone and drospirenone were compared in transactivation experiments. Individual steroid hormone receptors were artificially expressed together with a reporter gene in appropriate cell lines. Both hormones were unable to induce any androgen receptor-mediated agonistic activity. Rather, both progesterone and drospirenone distinctly antagonized androgen-stimulated transcriptional activation. Likewise, both compounds only very weakly activated the mineralocorticoid receptor but showed potent aldosterone antagonistic activity. Drospirenone did not induce glucocorticoid receptor-driven transactivation. Progesterone was a weak agonist in this respect. Drospirenone exerts potent progestogenic and antigonadotropic activity which was studied in various animal species. It efficiently promotes the maintenance of pregnancy in ovariectomized rats, inhibits ovulation in rats and mice and stimulates endometrial transformation in the rabbit. Furthermore, drospirenone shows potent antigonadotropic, i.e., testosterone-lowering activity in male cynomolgus monkeys. The progestogenic potency of drospirenone was found to be in the range of that of norethisterone acetate. The majority of clinically used progestogens are androgenic. Drospirenone, like progesterone, has no androgenic but rather an antiandrogenic effect. This property was demonstrated in castrated, testosterone propionate substituted male rats by a dose-dependent inhibition of accessory sex organ growth (seminal vesicles, prostate). In this model, the potency of drospirenone was about a third that of cyproterone acetate. Drospirenone, like progesterone, shows antimineralocorticoid activity, which causes moderately increased sodium and water excretion. This is an outstanding characteristic which has not been described for any other synthetic progestogen before. Drospirenone is eight to ten times more effective in this respect than spironolactone. The natriuretic effect was demonstrable for at least three weeks upon daily treatment of rats with a dose of 10 mg/animal. Drospirenone is devoid of any estrogenic, glucocorticoid or antiglucocorticoid activity. In summary, drospirenone, like progesterone, combines potent progestogenic with antimineralocorticoid and antiandrogenic activity in a similar dose range.(ABSTRACT TRUNCATED AT 400 WORDS)

Antiproliferative effects of progesterone antagonists and progesterone receptor modulators on the endometrium

Progesterone antagonists (PAs, antiprogestins) can modulate estrogenic effects in various estrogen-dependent tissues. These modulatory effects are complex and depend on species, tissue, type of compound, dose, and duration of treatment. In non-human primates, PAs, including mifepristone, ZK 137 316 and ZK 230 211, inhibit endometrial proliferation and induce amenorrhea. When administered chronically at relatively low doses, these compounds block the mitotic activity of endometrial epithelium and induce stromal compaction in a dose-dependent manner in both spayed and intact monkeys at high estradiol concentrations. These effects were accompanied by an atrophy of spiral arteries. The antiproliferative effects were endometrium-specific, since the estrogenic effects in the oviduct and vagina were not inhibited by PAs. Similar endometrial antiproliferative effects were also found after treatment with the progesterone receptor modulator (PRM), mesoprogestin J1042. The endometrial antiproliferative effects of PAs, particularly within the endometrial glands, were also observed in spayed rabbits. In spayed rats, however, the PAs did not inhibit, but rather enhanced, various estrogen responses, including endometrial proliferation, pointing to species-specific differences. In conclusion, our studies indicate that both pure PAs and PRMs selectively inhibit estrogen-dependent endometrial proliferation in the primate endometrium without affecting estrogenic response in other estrogen-dependent tissues or inducing unscheduled bleeding. Our studies indicate that the spiral arteries, which are unique to the primate endometrium, are the primary targets that are damaged or inhibited by PAs and PRMs. The damage to these unique vessels may underlay the paradoxical, endometrium-specific, antiproliferative effects of these compounds. Hence, the properties of PAs and PRMs (mesoprogestins) open up new applications in gynecological therapy and hormone replacement therapy.

Stable transfection of androgen receptor and MMTV-CAT into mammalian cells: Inhibition of cat expression by anti-androgens

A hormone-inducible transcriptional system has been established, based on the stable transfection of the rat androgen receptor (rAR) and a reporter plasmid containing the mouse mammary tumour virus promoter linked to the chloramphenicol acetyltransferase gene (pMMTV-CAT) into steroid receptor-negative CV-1 cells. First, the rAR was stably introduced into CV-1 cells. Single clones were tested for stable expression of functionally active AR by analysing the effect of dihydrotestosterone on induction of transiently transfected pMMTV-CAT. Stable transfection and the expression of AR was confirmed by steroid-binding assays. In a second step, a clone expressing physiological amounts of AR protein (30 fmol/mg protein) was stably transfected with pMMTV-CAT to yield a permanent cell line that stably expresses functional AR and MMTV-CAT sequences. This cell line provides a powerful tool for the efficient and accurate determination and quantification of the effects of androgens and anti-androgens on reporter gene transcription. This was demonstrated by investigating the action of the three anti-androgens hydroxyflutamide, casodex and cyproterone acetate. The three compounds were shown to reverse the effects of the androgen R1881 on gene expression but were themselves devoid of agonistic activity.

Misexpression of wild-type and truncated isoforms of the high-mobility group I proteins HMGI-C and HMGI(Y) in uterine leiomyomas.

High-mobility group I (HMGI) proteins are architectural transcription factors expressed predominantly during embryonic development. Their genetic loci are the most frequent targets of chromosomal rearrangements in uterine leiomyomas and other benign tumors. It was therefore suggested that both HMGI genes are involved in the neoplastic transformation of benign tumors. By Western analysis we found that 16 of 33 uterine leiomyomas expressed high levels of HMGI-C or HMGI(Y) proteins, whereas they were not detected in the corresponding myometrium. Immunohistochemistry demonstrated that the expression of HMGI-C is restricted to leiomyoma smooth muscle cells but is not expressed in vascular smooth muscle cells or the connective tissue of the tumor. Northern blotting confirmed the protein expression data for HMGI-C, whereas HMGI(Y) mRNA and protein levels did not correlate, suggesting that posttranscriptional mechanisms are involved in the regulation of HMGI(Y) expression. Three of the uterine leiomyomas analyzed expressed HMGI-C gene products with altered molecular weight. Two of them were proved to consist of the entire DNA-binding domain but lacked sequences of the C-terminal acidic tail. Conversely, other tumors expressed HMGI-C or HMGI(Y) genes that were not affected by mutations of the coding region. Thus we identified uterine leiomyomas that expressed mutated HMGI-C, whereas other uterine leiomyomas expressed wild-type HMGI-C or HMGI(Y). On the basis of our data we assume that the enhanced expression of functionally active HMGI proteins, whether they are wild-type or not, is important for the pathogenesis of uterine leiomyomas.

Characterization of the novel progestin gestodene by receptor binding studies and transactivation assays.

Gestodene is a novel progestin used in oral contraceptives with an increased separation of progestogenic versus androgenic activity and a distinct antimineralocorticoid activity. This specific pharmacological profile of gestodene is defined by its pattern of binding affinities to a variety of steroid hormone receptors. In the present study the affinity of gestodene to the progesterone receptor (PR), the androgen receptor (AR), the glucocorticoid receptor (GR), the mineralocorticoid receptor (MR) and the estrogen receptor (ER) was re-evaluated by steroid binding assays and compared to those obtained for 3-keto-desogestrel and progesterone. The two synthetic progestins displayed identical high affinity to rabbit PR and similar marked binding to rat AR and GR, while progesterone showed high affinity to PR but only low binding to AR and GR. Furthermore, 3-keto-desogestrel exhibited almost no binding to MR, whereas gestodene, similar to progesterone, showed marked affinity to this receptor. In addition to receptor binding studies, transactivation assays were carried out to investigate the effects of gestodene on AR-, GR- and MR-mediated induction of transcription. In contrast to progesterone, which showed antiandrogenic activity, gestodene and 3-keto-desogestrel both exhibited androgenic activity. Furthermore, all three progestins exhibited weak GR-mediated antagonistic activity. In contrast to progesterone, which showed almost no glucocorticoid activity, gestodene and 3-keto-desogestrel showed weak glucocorticoid action. In addition, gestodene inhibited the aldosterone-induced reporter gene transcription, similar to progesterone, whereas unlike progesterone, gestodene did not induce reporter gene transcription. 3-Keto-desogestrel showed neither antimineralocorticoid nor mineralocorticoid action.

Mechanism of Action of Antiprogestins in the Pregnant Uterus

Progesterone plays a crucial role in nearly the entire female reproductive process in mammals. It most likely controls the final stages of folliculogenesis and regulates ovulation. In addition, progesterone stimulates epithelial proliferation in the mammary gland and controls lactogenesis. During the preimplantation phase of the fertile cycle it prepares the endometrium for implantation by inducing endometrial receptivity. The sudden withdrawal of progesterone action at the end of the luteal phase leads to a constriction of spiral arteries and in turn induces menstruation in primates. During early pregnancy, progesterone is essential for the entire implantation process. In more advanced stages progesterone is responsible for pregnancy maintenance, acting predominantly on the myometrium and the uterine cervix. In addition, there is some evidence that progesterone has an immunosuppressive effect and may regulate the cytokine network in the uterus. Finally, progesterone may play an important role in the maternal adaptation of the cardiovascular system during pregnancy. During the preimplantation period and early pregnancy progesterone targets the endometrium. During later stages of pregnancy the myometrium and the uterine cervix become the major targets. There is ample evidence that during advanced pregnancy progesterone predominantly controls myometrial responsiveness by suppressing both the excitability and the propagation of the uterine muscle. The second important function of progesterone is the control of cervical ripening. Progesterone functions during preg-

Recent developments in molecular action of antihormones

Abstract Antihormones are by definition antagonists of steroid hormone action. They interact with the ligand binding domains of steroid hormone receptors and competitively inhibit the action of the receptors by mechanisms that are not quite understood. In certain cases antihormones also exhibit agonistic activity especially in connection with certain naturally occurring receptor mutants. These observations together with findings of indiscriminate interaction of antihormones with several classes of steroid receptors have necessitated a search of more effective and reliable antihormones. Recent advances in the resolution of the crystal structure of the ligand binding domains of certain members of the steroid receptor family and identification of non-liganded activation of steroid receptors have produced considerable information that can be harnessed into a fruitful search for a new generation of antihormones.

DNA-binding of androgen receptor overexpressed in mammalian cells

In order to investigate the DNA-binding properties of the rat androgen receptor (rAR) in mammalian cells after addition of androgens and antiandrogens, we established a gel-shift assay with extract from COS-1 cells (CV-1 cells transformed with the DNA-tumour virus SV40) over-expressing the rAR. First, the rAR was overexpressed in COS-1 cells. Therefore the full-length AR cDNA was inserted immediately downstream from the SV40 early promoter of pECE to generate pECE-AR. Expression of the rAR driven by the SV40 early promoter yields constant and high levels of rAR protein. In addition, the vector contains the SV40 origin of replication for obtaining high copy vector numbers in COS-1 cells. The rAR-containing expression vector was transiently transfected into COS-1 cells using Transfectam Reagent, in order to achieve high transfection efficiency. Expression of biologically active receptor was tested by analyzing the effect of the synthetic androgen R1881 on induction of transiently transfected pMMTV-CAT. Steroid binding assays were carried out to confirm overexpression of biologically active AR and to determine the binding of different hormones and antihormones to AR in COS-1 cells transiently transfected with pECE-AR. Gel-shift experiments performed with whole cell extract of those cells, containing approximately 700 fmol AR/mg protein, and labeled AR-binding GRE (glucocorticoid responsive element) showed that R1881 induced the formation of a protein-GRE complex. Furthermore, the R1881-induced formation of the protein-GRE complex could be completed by addition of unlabeled excess of GRE but not of unspecific oligonucleotides, confirming sequence-specific binding of the R1881-induced protein-GRE complex.