William H. Catherino

Estrogenic activity is increased for an antiestrogen by a natural mutation of the estrogen receptor

The estrogen receptor (ER) functions as a ligand-activated transcription factor which mediates the actions of estrogens and antiestrogens in target tissues. Other investigators have shown that artificial point mutations in the transcriptional activation domain AF-2 of the ligand binding domain (LBD) of the ER can increase the estrogenic properties of antiestrogens, determined by transcriptional activation of estrogen-responsive reporter constructs cotransfected into cells. Although these data provide valuable information about ER function there is no evidence that these mutations occur naturally. We have taken a different approach and examined the naturally occurring codon 351 asp --> tyr mutation in the LBD of ER to stimulate the expression of an endogenous target gene. This approach avoids dependence on artificial reporter constructs and their idealized estrogen response elements (EREs). In this report we describe the regulation of transforming growth factor alpha (TGF alpha) mRNA by estradiol and the antiestrogens keoxifene and ICI 182,780 in our stable transfectants of ER-negative MDA-MB-231 breast cancer cells, which express either the wild-type (S30 cells) or codon 351 asp --> tyr mutant ER (BC-2 cells). The mutant receptor was identified in a tamoxifen-stimulated human breast tumor. Our results demonstrate, for the first time, that a naturally occurring mutation in the ER changes the pharmacology of the antiestrogen keoxifene by increasing estrogenic activity, and that keoxifene exhibits a gene-specific estrogen-like effect with mutant ER but not with wild-type ER. The pure antiestrogen ICI 182,780 maintained complete antagonistic activities in both ER transfectants, demonstrating that its action is unaffected by the mutation.

Increasing the number of tandem estrogen response elements increases the estrogenic activity of a tamoxifen analogue

There have been several reports of women who have tumor relapse while on tamoxifen therapy, followed by tumor regression after tamoxifen withdrawal. In such apparently tamoxifen-stimulated tumors, there is likely a genetic change which increases the estrogenicity of tamoxifen. In this study, we determine if increasing the number of estrogen response elements (EREs) in the promoter region of a reporter gene can alter the agonistic activity of fixed-ring 4-hydroxytamoxifen. We show that increasing the number of EREs in the promotor region increases the transcriptional response of the reporter plasmid to estradiol. We also find that while fixed-ring 4-hydroxytamoxifen is unable to stimulate transcription when one ERE is present, transcriptional activation can occur with multiple EREs. These results demonstrate that ERE amplification could explain the agonistic properties of tamoxifen, and suggests a novel mechanism to explain tamoxifen-stimulated breast cancer growth.

Nomegestrol acetate, a clinically useful 19-norprogesterone derivative which lacks estrogenic activity

The estrogenic activity of various 19-norprogestin derivatives has been identified by several laboratories. We have previously hypothesized that the estrogenic activity of these compounds stems from the absence of a methyl group at the 19 position, as various progestins that have a methyl group at this position are not estrogens. To test this hypothesis more directly, we now compare the progestin megestrol acetate against its 19-nor analogue nomegestrol acetate. We also compare these compounds to known estrogens (estradiol, norgestrel, RU486) as well as compounds known to be devoid of estrogenic activity at concentrations as high as 10(-6) M (medroxyprogesterone acetate, R5020, ICI 182780). In growth assays using the MCF-7 and T47D:A18 human breast cancer cell lines, we find that only estradiol, norgestrel and RU486 stimulate proliferation, and this effect can be blocked by the pure antiestrogen ICI 182780. Furthermore, in transient transfection studies using a luciferase reporter construct containing three tandem copies of the Xenopus vitellogenin A2 estrogen response element, estradiol, norgestrel and RU486 can stimulate transcription, while none of the other compounds act as estrogens. Transcriptional stimulation by the estrogenic compounds can be blocked by ICI 182780. Our results demonstrate that the lack of a 19-methyl is not the major determinant for estrogenic activity in 19-norprogestins. We suggest that the 17-hydroxyl group more accurately defines estrogenic action.

A Risk-Benefit Assessment of Tamoxifen Therapy

SummaryTamoxifen is the endocrine treatment of choice for all women with hormonally responsive breast cancer. 30 years of experience in both the laboratory and clinical setting have shown tamoxifen to be an effective adjuvant treatment with minor short term adverse effects. However, as therapeutic use has extended to 5 years and beyond, and as clinical trials begin which will assess the effectiveness of tamoxifen as a preventive treatment, concern about possible long term adverse effects is justified.Tamoxifen has an estrogen-like influence on the skeletal and cardiovascular systems, resulting in decreases in both postmenopausal bone loss and low density lipoprotein (LDL) levels. These effects will, it is hoped, result in decreases in the incidences of osteoporosis and coronary heart disease, which are major causes of morbidity and mortality in the postmenopausal age group. Tamoxifen therapy also results in decreased rates of contralateral breast cancer. Long term tamoxifen treatment may result in a small increase in the incidence of endometrial and/or hepatocellular carcinoma, but with millions of women taking tamoxifen for long periods, such small increases in incidence translate to a significant number of women at risk. Tamoxifen is clearly beneficial for short term treatment, but the clinical decision of tamoxifen use in the long term must be made on the individual benefits versus risks of tamoxifen treatment.

The biological action of cDNAs from mutated estrogen receptors transfected into breast cancer cells

While tamoxifen may inhibit breast cancer proliferation, mutations in the estrogen receptor could potentially result in breast cancer cells which can circumvent the tamoxifen blockade. Previously, we identified a mutation at codon 351 in the estrogen receptor from a tamoxifen-stimulated human breast cancer. This receptor was stably transfected into the estrogen receptor-negative human breast cancer cell line MDA-MB-231 (clone 10A). Clones were compared to stably transfected cell lines containing either the wild type or codon 400 mutant estrogen receptor to study the effect of either estradiol or the tamoxifen analogue, fixed-ring 4-hydroxytamoxifen ((fr)4-OH TAM), on cell growth and reporter gene activation. (fr)4-OH TAM reduced the growth rate in cell lines containing mutant estrogen receptors, while the cell line containing the wild type estrogen receptor is minimally influenced by (fr)4-OH TAM. We then needed to show that the ligand-estrogen receptor interaction resulted in estrogen receptor activation. As a ligand-dependent transcription factor, estrogen receptor activation is measured by its ability to stimulate reporter gene (luciferase) transcription when bound to an estrogenic ligand. We found that the wild type estrogen receptor is activated by estradiol but not by the tamoxifen analogue, while the codon 351 estrogen receptor is activated by both (fr)4-OH TAM and estradiol.

Understanding the antiestrogenic actions of raloxifene and a mechanism of drug resistance to tamoxifen

ConclusionThe recent crystallization of the estradiol and raloxifene ER complex19 has provided fascinating clues to the mechanism of action of antiestrogens and confirmed, for the first time, a mechanism of drug resistance for tamoxifen. The new strategy to prevent breast cancer as a beneficial side effect of the prevention of osteoporosis7.11 is poised to revolutionize health care for postmenopausal women. The convergence of molecular biology and medicine has the potential to open up new therapeutic opportunities for the discovery of novel targeted antiestrogens to either the ERα or the newly discovered ERβ. There is currently intense interest in describing the distribution of ERα and ERβ throughout the female and male organ systems. As a direct result of this research new targeted drugs hold the promise for the specific control of diseases not only in women but also in men.

Molecular, Cellular, and Systemic Mechanisms of Antiestrogen Action

Tamoxifen provides a survival advantage for women with breast cancer (Early Breast Trialists Collaborative Group, 1992). Because of its proven clinical efficacy, there are approximately 2 to 3 million women receiving treatment in more than 70 countries. With such widespread use, it is impera¬tive that the scientific community develop an understanding of tamoxifen’s molecular mechanism of action so as to exploit the antitumor effects while minimizing side effects. By studying this effective cancer therapeutic, investigators will develop a better understanding of breast carcinogenesis, which may translate to superior treatment regimens.