[Tissue culture and estrogen, to clarify the roles of estrone sulfate]

Estrone sulfate (E1-S) has been shown to be quantitatively the most important estrogen in peripheral blood. But, the physiological and/or pathological role of E1-S is not yet clarified. At present, we tried to clarify it using tissue cultures. In tissue cultures of human endometrium, secretory endometrium showed higher activity of estrone sulfatase (E1----E1-S) than proliferative endometrium. Progesterone added in the medium induced an increase of estrone sulfotransferase in the proliferative endometrium. The results suggest a reducing effect of estrogen by progesterone in secretory endometrium in physiological conditions. Estrogen dependent malignant tumors (breast cancer, endometrial cancer) have high estrone sulfatase. It converts E1-S to E1 (----E2) which are abundant in these tumors. Ishikawa cell line increased estrone sulfotransferase activity with progesterone, somewhat like the physiological conditions. From out study in vivo, there is a possibility of some ameliorative effects of E1-S on the central nervous system of patients with senile dementia (Alzheimer's type). Effects of E1-S on central nerves were investigated using tissue cultures.

In vivo effects by estrone sulfate on the central nervous system-senile dementia (Alzheimer's type)

Seven women with senile dementia-Alzheimer's type (SDAT) were treated with conjugated estrogen [main content: estrone sulfate (E1-S)], at a dose of 1.25 mg/day over a 6-week period. A New Screening Test for Dementia developed by Japanese National Institute of Mental Health (NS) and the scores of Hasegawa Scale for dementia (HS) were performed every 3 weeks. Six women showed improvements in NS (P less than 0.05) and 5 women showed improvements in HS. Untreated women with SDAT did not show any improvement. Serum E1-S was measured by a direct radioimmunoassay. Serum E1-S was 911 +/- 156 pg/ml in 7 women with SDAT and lower than that of 7 normal women (1020 +/- 216 pg/ml). Following the treatment, serum E1-S increased to a level of 21.1 +/- 8.1 ng/ml. Estrone and estradiol-17 beta also increased. The results suggest a possibility for the future clinical use of estrogen for senile dementia, after careful clinical research trials including the side effects.

Tamoxifen and natural progesterone as supplements to low-dose postmenopausal estrogen therapy

Postmenopausal women received 1 mg estrone sulfate a day for 3 weeks in 12 sequences separated by a 7-day interval without medication and every second time by a 10-day treatment with natural progesterone, 100 mg 2 times daily (n = 16), or tamoxifen, 10 mg 2 times daily (n = 17). Both treatments alleviated climacteric symptoms, maturated the vaginal epithelium, and decreased follicle-stimulating hormone, luteinizing hormone, and prolactin concentrations while lipid metabolism remained unaltered. In the estrogen-progesterone group 4 women (25%) were persistently amenorrheic, 12 (75%) experienced 1-5 bleedings per year, and 4 women had proliferative endometrium after treatments. In the estrogen-tamoxifen group 11 women (65%) were amenorrheic, 6 (35%) had 1-4 bleedings per year, and 5 had proliferative endometrium. With the present treatment schedules, tamoxifen was more effective than natural progesterone in inhibiting estrogen stimulation of postmenopausal endometrium.

Treatment with oral piperazine oestrone sulphate for genuine stress incontinence in postmenopausal women

The use of oestrogens in the treatment of genuine stress incontinence was assessed by a double-blind prospective trial in 36 postmenopausal women with genuine stress incontinence who received 3 months of cyclical treatment with either piperazine oestrone sulphate or a matching placebo. Patients were assessed subjectively and objectively before and after treatment by 7-day bladder charts, urethral pressure profiles (UPP), the Urilos nappy test, vaginal cytology and hormone assays (plasma oestrogens and gonadotrophins). There was no statistical difference in the subjective response to treatment between the two groups. After 6 weeks of treatment there was a greater reduction in the number of pad changes/24 h in the oestrogen-treated patients that approached statistical significance but, because of a marked response in the placebo group, this difference was not significant after 3 months of treatment. There were also no significant differences between the two groups with respect to the UPP or Urilos measurements but the vaginal cytology and hormone profiles were significantly affected by oestrogens. In view of the possible risks of oestrogen therapy its use in genuine stress incontinence is limited.

In vitro synergism between estrogens and cytotoxic agents

Two lines of research intending to achieve synergism between cytotoxic agents and estrogens for breast cancer treatment are pursued in our laboratory. According to a screening procedure we select cytotoxic-linked estrogens which bind to estrogen receptors and thereby would be specifically concentrated into the tumor cells. A mesylate derivative of estrone has emerged from our investigations. This compound displays a very strong binding affinity for the receptors and inhibits the growth of the receptor-positive MCF-7 breast cancer cell line. The lack of growth inhibition in the receptor-negative line Evsa-T indicates that it is devoid of major non-specific cytotoxicity. We attempt to enhance the vulnerability of the tumor cells by producing an estrogen-induced modification of their chromatin. The in vitro exposure of isolated uterine nuclei to uterine cytosol preincubated with estradiol increases their ability to bind [3H]actinomycin D. Identical results are obtained with MXT mouse mammary tumors. Experiments are in progress to settle whether these changes are associated with enhanced cell killing.

The effect of low-dose piperazine oestrone sulphate and low-dose levonorgestrel on blood lipid levels in post-menopausal women

Prolonged used of oestrogens has been shown to reduce the risk of arteriosclerotic heart disease by increasing the levels of circulating high density lipoprotein cholesterol. It has also been shown that progestogens derived from the 19-nortestosterone molecule will reverse this beneficial effect when given in 250-500 mg doses. When levonorgestrel was used in doses as low as 30 micrograms daily, there was no change in cholesterol levels over a period of 6 mth, suggesting that the adverse effect of the androgenic type progestogens is dose-related and is probably only significant when extremely high dosages are administered.

Effect of oestrogen replacement therapy on blood coagulation factors in postmenopausal women

Natural oestrogens "Premarin", (Ayerst, conjugated equine oestrogens) "Harmogen", (Abbott, piperazine oestrone sulphate) and "Progynova" (Schering, oestradiol valerate) alone and in combination with proestational agents such as "Primolut N", (Schering, norethisterone) "Neogest", (Schering, norgestrel), "Norgeston", (Schering, levonorgestrel), "Duphaston" (Duphar, dydrogesterone) did not have adverse effects on clotting factors. One patient developed deep vein thrombosis following treatment using "Progynova" (oestradiol valerate) alone and a second patient suffered from mild myocardial infarction following the use of "Premarin" (conjugated equine oestrogens) alone.

Conservative treatment of urinary incontinence in women with special reference to the use of oestrogens

Urinary incontinence was treated conservatively in 100 patients. The follow-up period was 12-24 mth. For post-menopausal women, the oestrogen therapy consisted of oral oestradiol valerate or vaginal oestrone sulphate combined with emepronium bromide. In post-menopausal patients the best results were noted when incontinence had begun at the menopause and when the duration of the complaint was not more than 3 yr. For pre-menopausal patients, the treatment given was generally emepronium bromide. During the follow-up period 15 of the patients, 11 of whom were post-menopausal, became symptomless and 77 improved; that is, the incontinence was only slight and occasional. The treatment was without any effect in 8 of the patients. Oestrogen therapy was successful in most post-menopausal women. In these patients, the best results were obtained when the duration of the incontinence was not more than 3 yr.

[Effectiveness of amphoglucamine in experimental candidiasis in sex hormone administration]

The efficacy of amphoglucamine was tested on male and female albino mice infected intravenously with Candida albicans and treated with testosterone and folliculin in doses of 1 mg and 10 units per mouse respectively. It was shown that 0.25 per cent of the experimental mice treated with testosterone alone survived, while the use of amphoglucamine alone in a dose of 1 mg/kg per os provided the survival of 0.5 per cent of the animals. With the use of the both drugs in combination almost all animals survived. Combined treatment with amphoglucamine and folliculin was not effective: isolation of Candida from all organs persisted, the spleen index changed insignificantly. Under the effect of testosterone the level of the spleen contamination was lower as compared to the control. The use of testosterone for a definite period of time promoted elimination of Candida from the internal organs. No significant difference in the titers of the complement-binding antibodies in the group of the mice treated with both the drugs was observed. It is suggested that the effect of the sex hormones on the fungus infection is associated with changing of the cell protective mechanisms.

Is oestrogen therapy effective in the treatment of menopausal depression?

Fifty-five depressed menopausal patients took part in a randomized double-blind cross-over trial using ;Harmogen' (piperazine oestrone sulphate) and placebo. The Beck depression inventory, hot flush counts, and patients' subjective assessment of well-being were used to assess clinical status. Hormonal, biochemical and coagulation profiles were carried out. Hot flushes improved significantly on oestrogen compared with placebo. Depression scores and well-being showed significant and equal improvement on oestrogen and placebo. Significant improvement in flushes in patients on placebo was observed in the first half of the trial but did not occur in the second half, in patients who had previously taken oestrogen. No significant changes occurred in biochemistry. Coagulation tests showed acceleration of the prothrombin time in patients taking ;Harmogen' compared with those on placebo. Piperazine oestrone sulphate is a relatively weak but safe oestrogen preparation, effective in treatment of vasomotor symptoms but no more effective than placebo in the treatment of depression.

Treatment with oral estrone sulphate in the female climacteric. III. Effects on bone density and on certain biochemical parameters

Thirty-eight women were treated with estrone sulphate over a period of 30 months for climacteric problems. A random control group of 29 women were given methyl scopolamine. Bone mineral assays were performed by means of dual photon absorptiometry before the start of treatment and after 6, 12, 18, and 30 months. There was a difference in the mineral loss of trabecular bone between the two groups after 30 months of treatment, that the control group being significantly higher (p less than 0.001). In the estrogen-treated group there was a decrease in serum phosphorus (p less than 0.01), alkaline phosphatase activity (p less than 0.001), and albumin (p less than 0.001). In the control group, serum albumin showed the same decrease, while the other factors either showed no differences or even increased. The urinary excretion of calcium was not significantly reduced in the estrogen group, whereas there was an increase in the control group (p less than 0.01). There was an increase in hematocrit in both groups. Positive correlation was found between parity and loss of trabecular bone mineral (p less than 0.01).U

Oestrone sulphate in plasma from postmenopausal women and the effects of oestrogen and androgen therapy

The concentration of oestrone sulphate in peripheral plasma from postmenopausal women was investigated using a method which involved extraction of the conjugate, which was then hydrolysed with acid, and determination (by radioimmunoassay) of the purified oestrone fraction obtained. The concentration of unconjugated oestrone in the same plasma samples was also measured. Postmenopausal women had concentrations of oestrone sulphate in plasma (1.1 +/- 0.36 nmol/l, mean +/- SD, n = 39) similar to those found in women in the follicular phase of the menstrual cycle and less than those found in males (3.2 +/- 0.61 nmol/l, n = 21). The mean ratio of the concentration of oestrone sulphate to that of oestrone in plasma from postmenopausal women (7.9 +/- 3.3) was significantly lower (P less than 0.001, t test) than the mean ratio in men (19.8 +/- 3.8). Treatment with conjugated oestrogens, oestradiol in a cream, oestradiol valerate or ethinyl oestradiol, increased the concentration of oestrone sulphate in the peripheral circulation. In contrast, chronic corticosteroid therapy reduced the level of oestrone sulphate (0.5 +/- 0.11 nmol/l, n = 10) but this was partly restored (to 0.7 +/- 0.13 nmol/l) by concomitant oral dehydroepiandrosterone. Ingestion of piperazine oestrone sulphate (Harmogen, 1.5 mg) by three fasting postmenopausal women was followed 4 h later by oestrone sulphate concentrations five to ten times those found at midcycle.

A double-blind cross-over study of piperazine oestrone sulphate and placebo with coagulation studies

A double-blind trial of piperazine oestrone sulphate was performed over a period of 14 months on 55 menopausal women complaining of depressiona and hot flushes. Depression was not affected but the hot flushes were significantly lessened by the oestrogen treatment. After three months of piperazine oestrone sulphate there were no significant accelerations of prothrombin time or increases in factors VII or X but, after six months, there was an acceleration in the prothrombin time. After 14 months those who received piperazine oestrone sulphate for the first six months showed a significant increase in alpha 1-antitrypsin and factor VIIR:AG. Oestrone piperazine sulphate appears to produce less marked changes in coagulation than oestrogen-containing oral contraceptives or conjugated equine oestrogens.

The effect of various regimens of hormone therapy on serum cholesterol and triglyceride concentrations in postmenopausal women

The serum cholesterol and triglyceride concentrations of 84 postmenopausal women both before and after 2, 6 and 12 months therapy with various regimens of hormone therapy were measured. There was little alteration in mean serum cholesterol concentration with cyclical oestrogens but both sequential mestranol and norethisterone and sequential oestradiol valerate and norgestrel significantly reduced the mean serum cholesterol concentration to a level similar to that found in age-matched premenopausal women. There was a small and sometimes significant rise in serum triglyceride concentration with cyclical oestrogens. Sequential mestranol and norethisterone significantly elevated serum triglyceride levels, but sequential oestradiol valerate and norgestrel significantly depressed them. The results suggest that the progestogenic agent norgestrel has an important role to play in reducing both serum cholesterol and triglyceride levels, and that the sequential preparations, by virtue of their greater cholesterol lowering effect, should perhaps be preferred to cyclical oestrogens.

Effect of estrogen on fasting serum cholesterol and triglyceride levels in postmenopausal women

Sixty postmenopausal women with climacteric symptoms were treated with either clonidine hydrochloride or piperazine estrone sulfate in two different dosage strengths. Neither drug had an adverse effect on serum lipid levels and there was no significant change in the serum cholesterol and triglyceride levels during treatment.

Oestrogen therapy in the peri-menopause: A practical approach

The many preparations available for the treatment of women in the peri-menopause make the prescribing of a therapy both easy and difficult for the physician. It is easy because the number and variety of preparations available permit him, at least in theory, to prescribe an ideal, almost personalized, therapy for each patient, but the situation is difficult because he is required to understand and appreciate the individual properties of a large number of similar but different products. The oestrogen preparations available, the dosage schemes, and the modes of administration are the main aspects of therapy which will be discussed in this paper.

Effect of a sequential oestrogen-progestin therapy on the plasma level of oestrogens and lipids in post-menopausal women

With the aim of minimizing side effects of substitution therapy a natural synthetic oestrogen, oestrone sulphate, and norethisterone acetate were administered to 6 oophorectomized women and 4 women with physiological menopause cyclically in order to follow the pattern of physiological variations during the menstrual cycle as closely as possible, without causing bleedings. In addition to assessing the clinical effects and analyses of plasma oestrone and oestradiol-17β, the metabolic effects on plasma triglycerides, cholesterol and individual phospholipid levels, as well as on the fatty acid composition of lecithin were followed.

The oral administration of oestrone sulphate in doses varying with the "cycle" from 0.5 to 1.5 mg/day gave in these women plasma concentrations of oestrone in the lower pre-menopausal physiological range causing cyclic variations in plasma lipids similar to those during a physiological menstrual cycle but did not normalize the plasma oestradiol concentrations and did not give acceptable therapeutic effect. Total phospholipids, total and free cholesterol, triglycerides and the percentage of lecithin were higher, and the percentage of lysolecithin lower in the oestrogen phase, than in the progestin phase. The changes in linoleic acid in lecithin varied inversely with changes in arachidonic acid in lecithin and cyclic variations also occurred in the content of palmitic and stearic acid in lecithin.

When previous treatment with ethinyloestradiol was exchanged with oestrone sulphate the total cholesterol values in plasma varied in the opposite direction. The results obtained in this and previous studies suggest different effects of ethinyloestradiol and oestrone (oestrone sulphate?) in the metabolism of certain sterols, and that the effect of oestrone (or oestrone sulphate?) on plasma cholesterol dominates during physiological condition in the follicular phase of the menstrual cycle.

Hormone replacement therapy in the menopause: a suitable animal model

Female CBA mice, aged 11 months, were treated cyclically with oral ethynyl oestradiol or oestrone sulphate for 3 months. The ovaries of all animals appeared to be atrophied. Target tissues throughout the genital tract showed a response to both oestrogens. Electron microscopy of both the endometrium and the urothelium demonstrated morphological changes characteristic of increased cellular metabolic activity in the treated mice. Endometrial hyperplasia developed in both treatment groups but more pronounced epithelial changes occurred with oestrone sulphate. This hyperplasia was accompanied by a doubling in the number of uterine cytoplasmic oestrogen receptors. A 50% fall in serum levels of luteinizing hormone in the treated mice revealed that the hypothalamic-pituitary system was still intact. Both oestrogens improved skeletal balance by changes in cortical-endosteal bone remodelling. The results suggest that the CBA strain of mouse is a suitable model for the study of the human climacteric and its response to hormone replacement therapy.