1
|
Gannesen AV, Schelkunov MI, Ziganshin RH, Ovcharova MA, Sukhacheva MV, Makarova NE, Mart'yanov SV, Loginova NA, Mosolova AM, Diuvenji EV, Nevolina ED, Plakunov VK. Proteomic and transcriptomic analyses of Cutibacterium acnes biofilms and planktonic cultures in presence of epinephrine. AIMS Microbiol 2024; 10:363-390. [PMID: 38919714 PMCID: PMC11194618 DOI: 10.3934/microbiol.2024019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Transcriptomic and proteomic analysis were performed on 72 h biofilms of the acneic strain Cutibacterium acnes and planktonic cultures in the presence of epinephrine. Epinephrine predominantly downregulated genes associated with various transporter proteins. No correlation was found between proteomic and transcriptomic profiles. In control samples, the expression of 51 proteins differed between planktonic cultures and biofilms. Addition of 5 nM epinephrine reduced this number, and in the presence of 5 µM epinephrine, the difference in proteomic profiles between planktonic cultures and biofilms disappeared. According to the proteomic profiling, epinephrine itself was more effective in the case of C. acnes biofilms and potentially affected the tricarboxylic acid cycle (as well as alpha-ketoglutarate decarboxylase Kgd), biotin synthesis, cell division, and transport of different compounds in C. acnes cells. These findings are consistent with recent research on Micrococcus luteus, suggesting that the effects of epinephrine on actinobacteria may be universal.
Collapse
Affiliation(s)
- AV Gannesen
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - MI Schelkunov
- Skolkovo Institute of Science and Technology, Moscow 121205, Russia
- Institute for Information Transmission Problems of Russian Academy of Sciences, Moscow 127051, Russia
| | - RH Ziganshin
- Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow 117997, Russia
| | - MA Ovcharova
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - MV Sukhacheva
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - NE Makarova
- Skolkovo Institute of Science and Technology, Moscow 121205, Russia
| | - SV Mart'yanov
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - NA Loginova
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - AM Mosolova
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
- Russian Biotechnological University, Moscow 125080, Russia
| | - EV Diuvenji
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - ED Nevolina
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| | - VK Plakunov
- Federal Research Centre “Fundamentals of Biotechnology” of Russian Academy of Sciences, Moscow 119071, Russia
| |
Collapse
|
2
|
Da Silva AS, Baines G, Araklitis G, Robinson D, Cardozo L. Modern management of genitourinary syndrome of menopause. Fac Rev 2021; 10:25. [PMID: 33718942 PMCID: PMC7946389 DOI: 10.12703/r/10-25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The genitourinary syndrome of menopause (GSM) is the accepted term used to describe the broad spectrum of genitourinary tract symptoms and signs caused by the loss of endogenous sex steroids that occurs at the time of and after the menopause. Global improvements in healthcare have resulted in an ageing population. Today, women are spending 40% of their lives in the postmenopausal state, and with 50–70% of postmenopausal women reporting symptomatic GSM, safe and efficacious treatments are needed for this troublesome condition. This article reviews current evidence for non-pharmacological and pharmacological treatments with a focus on novel and minimally invasive procedures such as energy-based devices (CO2 laser, YAG laser), hyaluronic acid, dehydroepiandrosterone, and selective oestrogen receptor modulators.
Collapse
Affiliation(s)
| | - Georgina Baines
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - George Araklitis
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Dudley Robinson
- Department of Urogynaecology, King’s College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King’s College Hospital, London, UK
| |
Collapse
|
3
|
Te West N, Day R, Graham G, Wright M, White C, Popovic G, Moore KH. Serum concentrations of estriol vary widely after application of vaginal oestriol cream. Br J Clin Pharmacol 2020; 87:2354-2360. [PMID: 33129232 DOI: 10.1111/bcp.14635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/28/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was to establish the pharmacokinetic profile of serum oestriol (E3 ) concentrations over 24 h following application of vaginal E3 in chronic users (>12 weeks of E3 use). The interindividual and intraindividual differences before and after E3 were examined. METHODS Ten women participated. Vaginal cream was omitted for ≥36 h prior to the study days. Blood sampling was performed for E3 , oestradiol and oestrone concentrations prior to cream application and at 1, 2, 3, 5, 8, 10, 12 and 24 h afterwards. In five women, all samples were repeated on a separate day. RESULTS E3 was absorbed rapidly in most women. Peak serum E3 concentration occurred around 2 h (range 1-5 h). The decline in E3 concentrations was also rapid: falling <100 pmol L-1 in six out of ten women within 8 h and returning to ≤ 10 pmol L-1 at 24 h in nine out of the ten patients. Interindividual variability for peak concentrations was considerable (mean 546 pmol L-1 ; 95% CI 349-743). Area under the concentration-time curve (AUC) values over a dosage interval also varied widely: mean 2145 pmol.h L-1 ; 95% CI 1422-3233. However, repeated measurements in the same woman were highly (peaks: ρ = 0.94) or moderately (AUC: P = 0.74) correlated. CONCLUSIONS Postmenopausal E3 concentrations are negligible. Serum E3 concentrations of chronic users of E3 cream varied greatly; however, concentrations declined rapidly within 8 h, generally reaching 'postmenopausal' levels by 24 h. The basis for the variation between subjects needs further elucidation. Additional research is required to establish the safety of topical E3 .
Collapse
Affiliation(s)
- Nèvine Te West
- Department of Urogynaecology, St George Hospital, School of Women's and Children's Health, University of NSW, Sydney, Australia
| | - Richard Day
- Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, Faculty of Medicine, University of NSW, Sydney, Australia
| | - Garry Graham
- Department of Clinical Pharmacology and Toxicology, St. Vincent's Hospital, Sydney, Australia
| | - Michael Wright
- NSW Health Pathology Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, Australia.,Drug Development Solutions, LGC, Fordham, UK
| | - Christopher White
- NSW Health Pathology Clinical Chemistry and Endocrinology, Prince of Wales Hospital, Sydney, Australia.,Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - Gordana Popovic
- Stats Central, Mark Wainwright Analytical Centre, University of NSW, Sydney, Australia
| | - Kate Hilda Moore
- Department of Urogynaecology, St George Hospital, School of Women's and Children's Health, University of NSW, Sydney, Australia
| |
Collapse
|
4
|
Simões BM, Kohler B, Clarke RB, Stringer J, Novak-Frazer L, Young K, Rautemaa-Richardson R, Zucchini G, Armstrong A, Howell SJ. Estrogenicity of essential oils is not required to relieve symptoms of urogenital atrophy in breast cancer survivors. Ther Adv Med Oncol 2018; 10:1758835918766189. [PMID: 29636827 PMCID: PMC5888815 DOI: 10.1177/1758835918766189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 02/12/2018] [Indexed: 01/05/2023] Open
Abstract
Background Urogenital atrophy (UA) is a common treatment-limiting side effect of endocrine therapies. Topical estrogen is effective but systemic absorption may counter aromatase inhibitor efficacy. Numerous complementary approaches are marketed for use in UA without rigorous testing of their estrogenicity. We tested multiple essential oils in cancer cell growth and estrogen reporter assays in vitro and assessed clinical outcomes with the essential oil pessaries (EOPs) in breast cancer survivors with UA. Methods Effects on cell growth were tested in hormone-dependent (MCF-7) and -independent (MDA-MB-231) cell lines using the sulforhodamine-B assay. An estrogen response element (ERE) luciferase reporter assay was used to assess estrogenicity directly. Antifungal activity against two common pathogenic yeasts was assessed using standard microdilution methods. EOPs were offered to breast cancer survivors with symptomatic UA and the service evaluated using serial questionnaires. Results Two essential oils, Cymbopogon martinii and Pelargonium graveolens, demonstrated marked estrogenicity, stimulating ER+ cell growth and ERE-luciferase reporter activity to levels seen with premenopausal estradiol concentrations. Additional oils were screened for estrogenicity and Lavandula angustifolia and Chamaemelum nobile identified as non/minimally estrogenic. The antifungal activity of this combination of oils was confirmed. A second cohort of breast cancer survivors with UA received the second generation EOP with comparable improvement in symptom scores suggesting that estrogenicity may not be required for optimal therapy of UA. Conclusion Certain essential oils demonstrate profound estrogenicity and caution should be exercised before their use in breast cancer survivors. Our minimally estrogenic pessary will be formally tested in clinical trials.
Collapse
Affiliation(s)
- Bruno M Simões
- Breast Cancer Now Research Unit, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Bertram Kohler
- Breast Cancer Now Research Unit, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Robert B Clarke
- Breast Cancer Now Research Unit, Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Jacqui Stringer
- Department of Complementary Health & Wellbeing, The Christie NHS Foundation Trust, Manchester, UK
| | - Lily Novak-Frazer
- Infectious Diseases and Mycology Reference Centre Manchester, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Keely Young
- Infectious Diseases and Mycology Reference Centre Manchester, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Riina Rautemaa-Richardson
- Infectious Diseases and Mycology Reference Centre Manchester, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Giorgia Zucchini
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Anne Armstrong
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Sacha J Howell
- Breast Cancer Now Research Unit, Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, 555 Wilmslow Road, Manchester M20 4GJ, UK
| |
Collapse
|
5
|
Lee A, Lee MR, Lee HH, Kim YS, Kim JM, Enkhbold T, Kim TH. Vitamin D Proliferates Vaginal Epithelium through RhoA Expression in Postmenopausal Atrophic Vagina tissue. Mol Cells 2017; 40:677-684. [PMID: 28843271 PMCID: PMC5638775 DOI: 10.14348/molcells.2017.0026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/25/2017] [Accepted: 07/14/2017] [Indexed: 01/17/2023] Open
Abstract
Postmenopausal atrophic vagina (PAV) is the thinning of the walls of the vagina and decreased lugae of the vagina. PAV is caused by decreased estrogen levels in postmenopausal women. However, the harmful effects of hormone replacement therapy (HRT) have resulted in considerable caution in its use. Various estrogen agonist treatment options are available. Vitamin D is influences the regulation of differentiation and proliferation of various cells, especially tissues lining stratified squamous epithelium, such as the vaginal epithelium. In this study, we hypothesized that vitamin D could provide an alternative and a safe treatment option for PAV by promoting the proliferation and differentiation of the vaginal epithelium. Thirty six patients were enrolled in this case-control study. Vitamin D associated proteins in a vitamin D and sex hormone treated vaginal epithelial cell line as well as normal and PAV tissues were measured. To confirm of cell-to-cell junction protein expression, cell line and tissue studies included RT-PCR, immunohistochemistry staining, and immunoblot analyses. The expression of cell-to-cell junction proteins was higher in women with symptoms of atrophic vagina tissue compared to women without the symptoms. Vitamin D stimulated the proliferation of the vaginal epithelium by activating p-RhoA and Erzin through the vitamin D receptor (VDR). The results suggest that vitamin D positively regulates cell-to-cell junction by increasing the VDR/p-RhoA/p-Ezrin pathway. This is the first study to verify the relationship of the expression of RhoA and Ezrin proteins in vaginal tissue of PAV.
Collapse
Affiliation(s)
- Arum Lee
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan 31538,
Korea
| | - Man Ryul Lee
- Soonchunhyang Institute of Medi-bio Science (SIMS) and Institute of Tissue Regeneration, College of Medicine, Soon Chun Hyang University, Cheonan 31151,
Korea
| | - Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon 14584,
Korea
| | - Yeon-Suk Kim
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan 31538,
Korea
| | - Jun-Mo Kim
- Departments of Urology, Soonchunhyang University College of Medicine, Bucheon 14584,
Korea
| | - Temuulee Enkhbold
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan 31538,
Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon 14584,
Korea
| |
Collapse
|
6
|
Araklitis G, Cardozo L. Safety issues associated with using medication to treat overactive bladder. Expert Opin Drug Saf 2017; 16:1273-1280. [PMID: 28889761 DOI: 10.1080/14740338.2017.1376646] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The mainstay of overactive bladder treatment is the use of anticholinergic medication with its common side effects well known. This review focused on three less well-known safety issues when treating OAB. Areas covered: Patients with increased anticholinergic load are at risk of cognitive decline, dementia or even death. The elderly are particularly at risk due to polypharmacy. Botulinum toxin carries the risk of high urinary residuals, urinary tract infection and need to self catheterise. The use of vaginal oestrogens may improve OAB symptoms, but there is concern in those with a history of breast cancer. Studies have shown that the systemic absorption is negligible and does not increase the risk of recurrence. Expert Opinion: Improvement in assessing anticholinergic load is needed with the development of a universal drug scale. To avoid increasing load, Mirabegron or botulinum toxin can be used instead. There is no consensus of the use of prophylactic antibiotics when injecting botulinum toxin and at what residual to initiate self catheterisation. Despite evidence showing that the use of vaginal oestrogens is safe in those with a history of cancer, it is not fully supported by any health body. Further work is needed in those using aromatase inhibitors.
Collapse
Affiliation(s)
- George Araklitis
- a Department of Urogynaecology , King's College Hospital , London , UK
| | - Linda Cardozo
- a Department of Urogynaecology , King's College Hospital , London , UK
| |
Collapse
|
7
|
Dessie SG, Armstrong K, Modest AM, Hacker MR, Hota LS. Effect of vaginal estrogen on pessary use. Int Urogynecol J 2016; 27:1423-9. [PMID: 26992727 DOI: 10.1007/s00192-016-3000-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 03/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Many providers recommend concurrent estrogen therapy with pessary use to limit complications; however, limited data exist to support this practice. We hypothesized that vaginal estrogen supplementation decreases incidence of pessary-related complications and discontinuation. METHODS We performed a retrospective cohort study of women who underwent a pessary fitting from 1 January 2007 through 1 September 2013 at one institution; participants were identified by billing code and were eligible if they were postmenopausal and had at least 3 months of pessary use and 6 months of follow-up. All tests were two sided, and P values < 0.05 were considered statistically significant. RESULTS Data from 199 women were included; 134 used vaginal estrogen and 65 did not. Women who used vaginal estrogen had a longer median follow-up time (29.5 months) compared with women who did not (15.4 months) and were more likely to have at least one pessary check (98.5 % vs 86.2 %, P < 0.001). Those in the estrogen group were less likely to discontinue using their pessary (30.6 % vs 58.5 %, P < 0.001) and less likely to develop increased vaginal discharge than women who did not [hazard ratio (HR) 0.31, 95 % confidence interval (CI) 0.17-0.58]. Vaginal estrogen was not protective against erosions (HR 0.93, 95 % CI 0.54-1.6) or vaginal bleeding (HR 0.78, 95 % CI 0.36-1.7). CONCLUSIONS Women who used vaginal estrogen exhibited a higher incidence of continued pessary use and lower incidence of increased vaginal discharge than women who did not.
Collapse
Affiliation(s)
- Sybil G Dessie
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA, USA.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Katherine Armstrong
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Anna M Modest
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Lekha S Hota
- Division of Urogynecology, Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, MA, USA. .,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA. .,Boston Urogynecology Associates/Mount Auburn Hospital, 725 Concord Ave. Suite #1200, Cambridge, MA, 02138, USA.
| |
Collapse
|
8
|
Hosseinzadeh P, Ghahiri A, Daneshmand F, Ghasemi M. A comparative study of vaginal estrogen cream and sustained-release estradiol vaginal tablet (Vagifem) in the treatment of atrophic vaginitis in Isfahan, Iran in 2010-2012. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:1160-5. [PMID: 26958050 PMCID: PMC4766822 DOI: 10.4103/1735-1995.172983] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Atrophic vaginitis is a disease, which affects up to 50% of postmenopausal women. This study compared the effectiveness and user-friendliness of Vagifem (an estradiol vaginal tablet) and vaginal estrogen cream in the treatment of atrophic vaginitis. Materials and Methods: One hundred and sixty postmenopausal women with symptoms of atrophic vaginitis were randomly divided into two groups of treatment with Vagifem or with vaginal estrogen cream for 12 weeks. Patients used the medication daily for the first 2 weeks of the study, and twice weekly. Severity of vaginal atrophy and four main symptoms of atrophic vaginitis including dysuria, dyspareunia, vaginal itching, and dryness were evaluated and compared before and after treatment. In addition, patients were asked regarding user-friendliness and hygienic issues of medications. Results: Both vaginal estrogen cream and Vagifem significantly improved symptoms of atrophic vaginitis but in terms of effectiveness for the treatment symptoms of atrophic vaginitis, there was no significant difference between the two medications. Vagifem compared to estrogen cream resulted in significantly lower rate of hygienic problems (0% versus 23%, P < 0.001), and was reported by the patients as a significantly easier method of treatment (90% versus 55%, P < 0.0001). Conclusion: This investigation showed that Vagifem is an appropriate medication for the treatment of atrophic vaginitis, which is as effective as vaginal estrogen creams and is more user-friendly.
Collapse
Affiliation(s)
- Pardis Hosseinzadeh
- Intern, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atallah Ghahiri
- Department of Obstetrics and Gynecology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Mojdeh Ghasemi
- Midwife in Research Office, Department of Obstetrics and Gynecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
9
|
|
10
|
Pines A, Sturdee DW. Personal opinion: Treatment of vulvovaginal atrophy--are hidden interests and misinformation preventing better management? Climacteric 2015; 18:802-4. [PMID: 26397968 DOI: 10.3109/13697137.2015.1090149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Menopausal women very often complain of vulvovaginal atrophy (VVA)-related symptoms, which mainly include dryness, irritation, dyspareunia and pain. The ideal therapeutic approach is to use systemic or intravaginal estrogen, which has proved to be effective. However, because of safety concerns that were raised after the publication of the Women's Health Initiative data, non-estrogenic and non-hormonal therapies for VVA have been developed and heavily promoted. Many menopause specialists believe that the flow of information on the newer products indicated for VVA seems to include an inaccurate message, which downgrades the use of estrogenic preparations and upgrades modern non-estrogenic therapies. Both media and medical sources have created an atmosphere of exaggerated worries over intravaginal estrogen therapies, which are not substantiated by hard clinical facts.
Collapse
Affiliation(s)
- A Pines
- a Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel
| | | |
Collapse
|
11
|
Liu SB, Liu SL, Gan XL, Zhou Q, Hu LN. The effects of hyaluronic acid vaginal gel on the vaginal epithelium of ovariectomized rats. Gynecol Endocrinol 2015; 31:208-13. [PMID: 25366523 DOI: 10.3109/09513590.2014.975689] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hyaluronic acid is one of the best materials of water retention which can be used in vaginal atrophy. This study is to evaluate the role and mechanism of the hyaluronic acid vaginal gel (Hyalofemme) in the vaginal epithelium of ovariectomized rats. MATERIALS AND METHODS Sixty SD rats were randomly divided into control group (Sham ovariectomy, Sham-OVX), tendency group (ovariectomy, OVX), and experiment group (ovariectomy+Hyalofemme, OVX+Hyalofemme). The hyaluronic acid vaginal gel was administered local vaginal therapy to the experiment group with cytologicaly confirmed vaginal atrophy. The doses were adjusted by animal weight according to human dosage. After daily treatment for 14 days, VEGF and P-AKT activations were detected by Western blot in the experiment group. RESULTS The hyaluronic acid vaginal gel proved to be very effective in the cytological reversal of vaginal atrophy but did not increase uterine weight. Vaginal microecosystem indicators were negative in the control group and the experiment group. By contrast, the indicators were positive in the tendency group. CONCLUSION Hyaluronic acid vaginal gel is effective in the reversal of vaginal atrophy and is beneficial for improving vaginal microecosystem in the postmenopausal rat model. The hyaluronic acid vaginal gel can also improve the repair capacity of the vaginal epithelium.
Collapse
Affiliation(s)
- Shuai-Bin Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chongqing Medical University , Chongqing , P.R. China , and
| | | | | | | | | |
Collapse
|
12
|
Bertin J, Ouellet J, Dury AY, Pelletier G, Labrie F. Expression of the estrogen receptors and steroidogenic enzymes involved in estradiol formation in the monkey vagina. Am J Obstet Gynecol 2014; 211:499.e1-9. [PMID: 24928055 DOI: 10.1016/j.ajog.2014.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/21/2014] [Accepted: 06/05/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Estrogens are well recognized to have beneficial effects on vulvovaginal atrophy because of menopause. The distribution of estrogen receptors and enzymes responsible for estradiol (E2) formation within the vagina may provide insight into how dehydroepiandrosterone, a precursor of both estrogens and androgens, improves vulvovaginal atrophy. STUDY DESIGN The purpose of the study was to determine where the steroidogenic enzymes responsible for E2 formation as well as estrogen receptors are localized in vaginal specimens collected from cynomolgus monkeys (Macaca fascicularis), the closest model to the human. HSD3B1, HSD17B1, HSD17B5, HSD17B12, aromatase (CYP19A1), estrogen receptor (ER)-α, and ER-β were measured or localized by quantitative real-time polymerase chain reaction, immunohistochemistry, and immunofluorescence. Estrogens were quantified by liquid chromatography/tandem mass spectrometry. RESULTS All steroidogenic enzymes and estrogen receptors are localized mainly in the superficial layer of the stratified squamous epithelium, blood vessel walls, and muscle fibers of the vagina. Immunolabeling of HSD17B5 and HSD17B12 shows that these enzymes are uniformly distributed from the basal membrane to the superficial keratinized cells, whereas HSD3B1 and aromatase are particularly localized in the outer (external) portion of the epithelial layer. ER-α and ER-β are also distributed within the vaginal epithelium, with expression especially elevated at the basal membrane level. CONCLUSION The enzymes responsible for E2 formation as well as ERs are expressed mainly in the superficial layer of the stratified epithelium as well as the muscle layer of the vagina. The present data provide morphologic and biochemical support for the role of local dehydroepiandrosterone transformation into estrogens in regulating epithelial cell maturation, pH, fluid secretion, smooth muscle activity, and blood flow regulation in the primate vagina.
Collapse
Affiliation(s)
| | | | | | - Georges Pelletier
- Oncology, Molecular Endocrinology, and Human Genomics Research Center, Laval University, Quebec, QC, Canada
| | | |
Collapse
|
13
|
Santen RJ. Vaginal administration of estradiol: effects of dose, preparation and timing on plasma estradiol levels. Climacteric 2014; 18:121-34. [DOI: 10.3109/13697137.2014.947254] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
14
|
Simonsen MH, Erichsen R, Frøslev T, Rungby J, Sørensen HT. Postmenopausal estrogen therapy and risk of gallstone disease: a population-based case-control study. Drug Saf 2014; 36:1189-97. [PMID: 24174288 DOI: 10.1007/s40264-013-0118-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Female gender and increasing age are key risk factors for gallstone disease; therefore, postmenopausal women are at high risk. Estrogen increases cholesterol saturation of bile and may further increase gallstone risk, but population-based evidence is sparse. OBJECTIVE Our objective was to examine the association between postmenopausal estrogen therapy and risk of gallstone disease and the impact of duration of treatment and use of opposing progestin. STUDY DESIGN We conducted a population-based case-control study. Cases were postmenopausal women (defined as aged ≥45 years) with gallstone disease identified in the period 1996-2010. For each case, we selected ten population controls matched to cases by age and sex. We defined exposure as any use of estrogen (opposed and unopposed by progestin). Cases/controls were categorized as current estrogen users if their last prescription was redeemed <90 days before gallstone diagnosis (or corresponding date for controls); all other users were categorized as former users. The reference group consisted of cases/controls with no/rare estrogen use. SETTING Medical databases covering the population of Northern Denmark (2.4 million inhabitants through the period 1996-2010). MAIN OUTCOME MEASURE We used conditional logistic regression to compute adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) of gallstone disease in women treated with estrogen. The ORs were adjusted for relevant comorbidity, other drugs known to influence gallstone risk, and parity. RESULTS We identified 16,386 cases with gallstone disease and 163,860 controls. A total of 1,425 cases (8.7 %) and 8,930 controls (5.4 %) were current estrogen users, yielding an adjusted OR for gallstone disease of 1.74 (95 % CI 1.64-1.85) compared with non-users. The corresponding adjusted OR for former users was 1.35 (95 % CI 1.28-1.42). The results suggested a duration response for current users. Use of unopposed estrogen was associated with higher adjusted ORs than estrogen opposed by progestin. CONCLUSION Postmenopausal estrogen therapy was associated with increased risk of gallstone disease in current and former estrogen users. Use of unopposed estrogen was associated with higher risk than use of estrogen opposed by progestin; this finding needs to be confirmed and explored further in future studies.
Collapse
Affiliation(s)
- Maja Hellfritzsch Simonsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Oluf Palmes Allé 43-45, 8200, Aarhus N, Denmark,
| | | | | | | | | |
Collapse
|
15
|
Ultra-low-dose estriol and Lactobacillus acidophilus vaginal tablets (Gynoflor(®)) for vaginal atrophy in postmenopausal breast cancer patients on aromatase inhibitors: pharmacokinetic, safety, and efficacy phase I clinical study. Breast Cancer Res Treat 2014; 145:371-9. [PMID: 24718774 PMCID: PMC4025172 DOI: 10.1007/s10549-014-2930-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/18/2014] [Indexed: 12/14/2022]
Abstract
Phase I pharmacokinetic (PK) study assessed circulating estrogens in breast cancer (BC) patients on a non-steroidal aromatase inhibitor (NSAI) with vaginal atrophy using vaginal ultra-low-dose 0.03 mg estriol (E3) and Lactobacillus combination vaginal tablets (Gynoflor®). 16 women on NSAI with severe vaginal atrophy applied a daily vaginal tablet of Gynoflor® for 28 days followed by a maintenance therapy of 3 tablets weekly for 8 weeks. Primary outcomes were serum concentrations and PK of E3, estradiol (E2), and estrone (E1) using highly sensitive gas chromatography–mass spectrometry. Secondary outcomes were clinical measures for efficacy and side effects; microscopic changes in vaginal epithelium and microflora; and changes in serum FSH, LH, and sex hormone-binding globulin. Compared with baseline, serum E1 and E2 did not increase in any of the women at any time following vaginal application. Serum E3 transiently increased after the first application in 15 of 16 women, with a maximum of 168 pg/ml 2–3 h post-insertion. After 4 weeks, serum E3 was slightly increased in 8 women with a maximum of 44 pg/ml. The vaginal atrophy resolved or improved in all women. The product was well tolerated, and discontinuation of therapy was not observed. The low-dose 0.03 mg E3 and Lactobacillus acidophilus vaginal tablets application in postmenopausal BC patients during AI treatment suffering from vaginal atrophy lead to small and transient increases in serum E3, but not E1 or E2, and therefore can be considered as safe and efficacious for treatment of atrophic vaginitis in BC patients taking NSAIs.
Collapse
|
16
|
Estrogenic action on innate defense mechanisms in the urinary tract. Maturitas 2013; 77:32-6. [PMID: 24296328 DOI: 10.1016/j.maturitas.2013.10.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/27/2013] [Indexed: 02/08/2023]
Abstract
Clinical data suggest an impact of estrogen on the pathogenesis of urinary tract infections (UTI). In particular, women after menopause often suffer from recurrent UTI, characterized by at least three acute UTI episodes within a year. Aside from bacterial factors promoting persistence within the urinary bladder, the low estrogen levels induce structural and chemical changes in the urogenital tract which facilitate UTI. Increased residual urine volume and changes in the vaginal microflora are well documented risk factors. Local supplementation with estrogen can at least partly reverse these changes. Treatment allows the re-establishment of a lactobacilli-dominated vaginal microflora and improves epithelial differentiation and integrity in the urogenital tract. This estrogenic effect on the epithelium is marked by an increased production of antimicrobial peptides and a tighter intercellular connection, preventing bacteria from reaching cells where they can hide and later emerge and cause a new infection. Estrogen in the dosages and applications used to date is considered safe for the endometrium in the majority of women. Based on the actions and safety of estrogen, local supplementation thus offers a treatment option for postmenopausal women suffering from recurrent UTI.
Collapse
|
17
|
Labrie F, Martel C, Bérubé R, Côté I, Labrie C, Cusan L, Gomez JL. Intravaginal prasterone (DHEA) provides local action without clinically significant changes in serum concentrations of estrogens or androgens. J Steroid Biochem Mol Biol 2013; 138:359-67. [PMID: 23954500 DOI: 10.1016/j.jsbmb.2013.08.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/10/2013] [Accepted: 08/05/2013] [Indexed: 10/26/2022]
Abstract
In order to avoid the risks of non-physiological systemic exposure, serum concentrations of estradiol (E2) and testosterone (as measured by mass spectrometry-based assays) should remain below the 95th centiles measured at 9.3pg/ml and 0.26ng/ml for these respective sex steroids in normal postmenopausal women. To document the possibility of achieving this therapeutic objective, we have measured individual 24h serum E2 and testosterone concentrations in women with vulvovaginal atrophy (VVA) receiving daily intravaginal administration of a clinically effective dose of 6.5mg prasterone (dehydroepiandrosterone, DHEA). Serum E2 and testosterone, as well as DHEA and nine of its other metabolites, were assayed at ten time intervals over 24h on the first and seventh days of daily vaginal administration of 6.5mg prasterone. No significant change from baseline of average 24h serum E2 or testosterone concentrations was observed. Moreover, average 24h serum DHEA remained within the normal postmenopausal range. Estrone sulfate and the androgen metabolites androsterone glucuronide and androstane-3α, 17β-diol glucuronide did not change, thus confirming the absence of any biologically relevant systemic exposure to estrogens and androgens, respectively. Serum concentrations of metabolites of both estrogens and androgens remain within the normal postmenopausal range following daily intravaginal administration of 6.5mg prasterone. As other studies have shown, local formation of sex steroids in peripheral tissues without significant release of E2 or testosterone in the circulation can be achieved with intravaginal prasterone. Thus, prasterone is a promising physiological and attractive solution to treating VVA symptoms.
Collapse
Affiliation(s)
- Fernand Labrie
- EndoCeutics Inc., Quebec City, Quebec, G1V 4M7, Canada; Research Center in Molecular Endocrinology, Oncology and Human Genomics, Laval University, Quebec City, Quebec, G1V 4G2, Canada.
| | | | | | | | | | | | | |
Collapse
|
18
|
Lima SMRR, Yamada SS, Reis BF, Postigo S, Galvão da Silva MAL, Aoki T. Effective treatment of vaginal atrophy with isoflavone vaginal gel. Maturitas 2013; 74:252-8. [PMID: 23312487 DOI: 10.1016/j.maturitas.2012.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/11/2012] [Accepted: 11/24/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess efficacy and tolerability of a isoflavone (Glycine max L. Merr.) vaginal gel to the treatment of vaginal atrophy in postmenopausal women. METHODS The double-blind, randomized, placebo-controlled, clinical trial. Ninety women were treated for 12 weeks with isoflavone vaginal gel 4% (1g/day) and a placebo gel and conjugated equine estrogen cream (0.3mg/day). After 4 and 12 weeks, the vaginal atrophy symptoms were classified at none, mild, moderate and severe and the vaginal cytology were taken to determine the maturation value. The endometrial safety (by transvaginal ultrasonography) was evaluated through at screening and the end of the trial. RESULTS Isoflavone vaginal gel appears to be effective for relief of vaginal dryness and dyspareunia symptoms and an increase in the intermediate and superficial cells was noted. These results were similar to the effects with use of conjugated equine estrogens and superior to placebo gel. No changes in endometrial thickness, sera FSH and estradiol levels were observed at study endpoint. CONCLUSION Glycine max (L.) Merr. at 4% vaginal gel on a daily basis in postmenopausal women led to improvements in vaginal atrophy symptoms and a significant increase in cell maturation values. Isoflavones proved good treatment options for relief of vulvovaginal symptoms especially in women who do not wish to use hormonal therapy or have contra-indications for this treatment.
Collapse
Affiliation(s)
- Sonia M Rolim Rosa Lima
- Department of Gynecology and Obstetrics, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Silvia Saito Yamada
- Department of Gynecology and Obstetrics, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Benedito Fabiano Reis
- Department of Gynecology and Obstetrics, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Gynecology and Obstetrics, Vale do Sapucaí University, Pouso Alegre, Minas Gerais, Brazil.
| | - Sostenes Postigo
- Department of Gynecology and Obstetrics, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Tsutomu Aoki
- Department of Gynecology and Obstetrics, Santa Casa of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
19
|
Aida-Yasuoka K, Peoples C, Yasuoka H, Hershberger P, Thiel K, Cauley JA, Medsger TA, Feghali-Bostwick CA. Estradiol promotes the development of a fibrotic phenotype and is increased in the serum of patients with systemic sclerosis. Arthritis Res Ther 2013; 15:R10. [PMID: 23305385 PMCID: PMC3672719 DOI: 10.1186/ar4140] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 12/10/2012] [Accepted: 12/21/2012] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Systemic sclerosis (SSc) is more prevalent in women. Our goal is to determine the effects of 17β-estradiol (E2) on the development of fibrosis and to compare circulating levels of estrogens in SSc patients and healthy controls. METHODS Using primary human dermal fibroblasts, we evaluated the effect of E2 on fibronectin (FN) expression with and without the estrogen receptor (ER) antagonist ICI 182,780, inhibitors of signaling, propyl-pyrazole-triol, an ERα specific ligand, and genistein, an ERβ selective ligand, to identify the signaling pathways mediating E2's effect. We confirmed the fibrotic effect of E2 in human skin using an ex vivo organ culture model. Lastly, we measured levels of E2 and estrone in serum samples from SSc patients with diffuse cutaneous involvement and healthy controls using mass spectrometry. RESULTS E2 increased expression of FN in dermal fibroblasts. ICI 182,780, inositol-1,4,5-triphosphate inhibitor, and p38 mitogen-activated protein kinase inhibitor blocked the effects of E2 on FN. Propyl-pyrazole-triol, but not genistein, significantly increased FN expression. Ex vivo, E2 induced fibrosis of human skin. The effects of E2 were abrogated by ICI 182,780. Circulating levels of E2 and estrone were significantly increased in sera of patients with diffuse cutaneous SSc. CONCLUSION Our findings implicate estrogens in the fibrotic process and may explain the preponderance of SSc in women. ICI 182,780 or other ER signaling antagonists may be effective agents for the treatment of fibrosis.
Collapse
Affiliation(s)
- Keiko Aida-Yasuoka
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW MUH, Pittsburgh, PA 14213, USA
| | - Christine Peoples
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, BST South 7th floor, Pittsburgh, PA 15261, USA
| | - Hidekata Yasuoka
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW MUH, Pittsburgh, PA 14213, USA
| | - Pamela Hershberger
- Department of Pharmacology and Therapeutics, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA
| | - Katelynn Thiel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW MUH, Pittsburgh, PA 14213, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, A510 Crabtree Hall, Pittsburgh, PA 15261, USA
| | - Thomas A Medsger
- Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh School of Medicine, BST South 7th floor, Pittsburgh, PA 15261, USA
| | - Carol A Feghali-Bostwick
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, 3459 Fifth Avenue, 628 NW MUH, Pittsburgh, PA 14213, USA
| |
Collapse
|
20
|
Abstract
Cancer patients suffer from vaginal dryness and dyspareunia earlier and longer than the general population, with more severe and distressing symptoms. Life-style advices are the first step and vaginal lubricants can be tried, but they can't completely relieve atrophic symptoms. The most effective therapy is use of vaginal estrogens, but compliance and management are particularly difficult in estrogen sensitive cancer patients because of their systemic absorption. Compliance can be improved if they are begun at a very low dose and gradually increased until the lowest effective dose is reached. Promestriene only possesses an intramucosal effect, it can be used at very low doses in cancer patients suffering from urogenital symptoms.
Collapse
Affiliation(s)
- Lino Del Pup
- Gynecological Oncology, National Cancer Institute, Aviano, PN, Italy.
| |
Collapse
|
21
|
Griesser H, Skonietzki S, Fischer T, Fielder K, Suesskind M. Low dose estriol pessaries for the treatment of vaginal atrophy: A double-blind placebo-controlled trial investigating the efficacy of pessaries containing 0.2mg and 0.03mg estriol. Maturitas 2012; 71:360-8. [DOI: 10.1016/j.maturitas.2011.12.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 12/20/2011] [Accepted: 12/24/2011] [Indexed: 11/30/2022]
|
22
|
Simon JA. Identifying and Treating Sexual Dysfunction in Postmenopausal Women: The Role of Estrogen. J Womens Health (Larchmt) 2011; 20:1453-65. [DOI: 10.1089/jwh.2010.2151] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- James A. Simon
- George Washington University and Women's Health & Research Consultants, Washington, District of Columbia
| |
Collapse
|
23
|
Abstract
Vulvovaginal atrophy [VVA] is defined as inflammation of the vaginal epithelium due to atrophy secondary to decreased levels of circulating estrogen. There is currently only one approved method for the treatment of VVA, and that is the administration of exogenous estrogens. Overall, the ideal VVA treatment must have benefits, minimize risks, and enhance compliance in the patient while optimizing cost-effectiveness. Unfortunately, of the approximate 25% of symptomatic women that are thought to seek medical help, the proportion that receives hormone therapy may be small and its duration of use is short. Women have been very reluctant to take hormone therapy due to widely publicized results of the risks associated with hormone therapy. Thus, while menopausal hormone therapy was once accepted as the ideal approach for optimizing changes associated with menopause, prospective randomized clinical trials have challenged that view and have led to a marked decrease in the use of such therapy and increased search for low-dose therapies. This article will highlight the efficacy and safety of recently FDA-approved Vagifem (10 mcg) in treatment of VVA.
Collapse
Affiliation(s)
- Janet A Chollet
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Pear Tree Pharmaceuticals, Waltham, MA, USA
- Correspondence: Janet A Chollet, ObGyn, Beth Israel Deaconess Medical Center, Boston, and Director and Founder, Pear Tree Pharmaceuticals, Waltham, MA, USA, Tel +1 617 276 5207, Fax +1 617 521 6795, Email
| |
Collapse
|
24
|
Biglia N, Peano E, Sgandurra P, Moggio G, Panuccio E, Migliardi M, Ravarino N, Ponzone R, Sismondi P. Low-dose vaginal estrogens or vaginal moisturizer in breast cancer survivors with urogenital atrophy: a preliminary study. Gynecol Endocrinol 2010; 26:404-12. [PMID: 20196634 DOI: 10.3109/09513591003632258] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The study aim is to evaluate the efficacy and safety of two low-dose vaginal estrogen treatments (ETs) and of a non-hormonal vaginal moisturizer in postmenopausal breast cancer survivors with urogenital atrophy. Eighteen patients receiving estriol cream 0.25 mg (n = 10) or estradiol tablets 12.5 microg (n = 8) twice/week for 12 weeks were evaluated and compared with eight patients treated with polycarbophil-based moisturizer 2.5 g twice/week. Severity of vaginal atrophy was assessed using subjective [Vaginal Symptoms Score (VSS), Profile of Female Sexual Function (PFSF)] and objective [Vaginal Health Index (VHI), Karyopycnotic Index (KI)] evaluations, while safety by measuring endometrial thickness and serum sex hormones levels. After 4 weeks, VSS and VHI were significantly improved by both vaginal ETs, with further improvement after 12 weeks. PFSF improved significantly only in estriol group (p = 0.02). Safety measurements did not significantly change. Vaginal moisturizer improved VSS at week 4 (p = 0.01), but score returned to pre-treatment values at week 12; no significant modification of VHI, KI, PFSF was recorded. Both low-dose vaginal ET are effective for relieving urogenital atrophy, while non-hormonal moisturizer only provides transient benefit. The increase of serum estrogens levels during treatment with vaginal estrogen at these dosages is minimal.
Collapse
Affiliation(s)
- Nicoletta Biglia
- Department of Oncological Gynaecology, University of Turin, Institute for Cancer Research and Treatment of Candiolo (IRCC), Turin, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Ibe C, Simon JA. Continuing Medical Education: Vulvovaginal Atrophy: Current and Future Therapies (CME). J Sex Med 2010; 7:1042-50; quiz 1051. [DOI: 10.1111/j.1743-6109.2009.01692.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
The comparison of hyaluronic acid vaginal tablets with estradiol vaginal tablets in the treatment of atrophic vaginitis: a randomized controlled trial. Arch Gynecol Obstet 2010; 283:539-43. [DOI: 10.1007/s00404-010-1382-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
|
27
|
Abstract
Vulvovaginal atrophy (VVA) is a common and underreported condition associated with decreased estrogenization of the vaginal tissue. Symptoms include dryness, irritation, soreness, and dyspareunia with urinary frequency, urgency, and urge incontinence. It can occur at any time in a woman's life cycle, although more commonly in the postmenopausal phase, during which the prevalence is close to 50%. Clinical findings include the presence of pale and dry vulvovaginal mucosa with petechiae. Vaginal rugae disappear, and the cervix may become flush with the vaginal wall. A vaginal pH of 4.6 or more supports the diagnosis of VVA. Even while taking systemic estrogen, 10% to 20% of women may still have residual VVA symptoms. Breast cancer treatment increases the prevalence of VVA because the surgical, endocrine, and chemotherapeutic agents used in its treatment can cause or exacerbate VVA. Local estrogen treatment for this group of women remains controversial.
Collapse
Affiliation(s)
- Maire B Mac Bride
- Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
28
|
Al-Baghdadi O, Ewies AAA. Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview. Climacteric 2009; 12:91-105. [PMID: 19117185 DOI: 10.1080/13697130802585576] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
29
|
Krause M, Wheeler TL, Snyder TE, Richter HE. Local Effects of Vaginally Administered Estrogen Therapy: A Review. JOURNAL OF PELVIC MEDICINE & SURGERY 2009; 15:105-114. [PMID: 22229022 PMCID: PMC3252029 DOI: 10.1097/spv.0b013e3181ab4804] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The results of the Women's Health Initiative (WHI) led to a distinct decline in the routine use of estrogen as preventive therapy for vasomotor symptoms, osteoporosis, and cardiovascular disease in postmenopausal women. Without estrogen replacement, one third of women experience symptoms of atrophic vaginitis including dryness, irritation, itching and or dyspareunia. Local application of estrogen has been shown to relieve these symptoms and improve quality of life for these women. In addition, local estrogen therapy may have a favorable effect on sexuality, urinary tract infections, vaginal surgery, and incontinence. This review examines the effects of vaginally applied estrogen on the vaginal epithelium, urethra and endometrium. An accompanying review examines the systemic effects of vaginally applied estrogen.
Collapse
Affiliation(s)
- Megan Krause
- University of Kansas Medical Center, Kansas City, KS Department of Obstetrics and Gynecology
| | - Thomas L. Wheeler
- University of South Carolina Greenville Campus, Greenville, SC Department of Obstetrics and Gynecology
| | - Thomas E. Snyder
- University of Kansas Medical Center, Kansas City, KS Department of Obstetrics and Gynecology
| | - Holly E. Richter
- University of Alabama at Birmingham, Birmingham, AL Department of Obstetrics and Gynecology
| |
Collapse
|
30
|
|
31
|
Labrie F, Cusan L, Gomez JL, Côté I, Bérubé R, Bélanger P, Martel C, Labrie C. Effect of intravaginal DHEA on serum DHEA and eleven of its metabolites in postmenopausal women. J Steroid Biochem Mol Biol 2008; 111:178-94. [PMID: 18598765 DOI: 10.1016/j.jsbmb.2008.06.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 06/04/2008] [Accepted: 06/05/2008] [Indexed: 10/22/2022]
Abstract
The primary objective of this study was measurement of the systemic bioavailability of DHEA and its metabolites following daily intravaginal application of the sex steroid precursor. Forty postmenopausal women were randomized to receive a daily dose of one ovule of the following DHEA concentrations: 0.0%, 0.5%, 1.0% or 1.8%. After only 7 days of treatment, the maturation value of the vaginal epithelial cells was significantly increased while the vaginal pH was significantly decreased at all DHEA doses. These important local effects were observed while the serum concentrations of estradiol and testosterone remained within the values found in normal postmenopausal women at all DHEA doses. Similar observations were made for serum androstenedione, estrone, estrone-sulfate and DHEA-sulfate. Even at the highest 1.8% DHEA dose, serum DHEA was increased at the levels found in normal premenopausal women. The present data show that the intravaginal administration of DHEA permits to rapidly achieve the local beneficial effects against vaginal atrophy without significant changes in serum estrogens, thus avoiding the increased risk of breast cancer associated with the current intravaginal or systemic estrogenic formulations. In addition, the recent observation that DHEA is transformed into both androgens and estrogens in the vagina permits to exert benefits on all the three layers of the vaginal wall.
Collapse
Affiliation(s)
- Fernand Labrie
- Oncology and Molecular Endocrinology Research Center, Laval University Hospital Research Center (CRCHUL) and Laval University, 2705 Laurier Boulevard, Quebec City, Quebec G1V 4G2, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Wilson DP, Coplan PM, Wainberg MA, Blower SM. The paradoxical effects of using antiretroviral-based microbicides to control HIV epidemics. Proc Natl Acad Sci U S A 2008; 105:9835-40. [PMID: 18606986 PMCID: PMC2447864 DOI: 10.1073/pnas.0711813105] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Indexed: 11/18/2022] Open
Abstract
Vaginal microbicides, designed to prevent HIV infection in women, are one of the most promising biomedical interventions. Clinical trials of second-generation microbicides have begun; if shown to be effective, they could be licensed within 5-10 years. Because these microbicides contain antiretrovirals (ARVs), they could be highly effective. However, there is concern that, if used by HIV-positive women, ARV resistance may evolve. By analyzing a mathematical model, we find that adherence could have both beneficial and detrimental effects on trial outcomes. Most importantly, we show that planned trial designs could mask resistance risks and therefore enable high-risk microbicides to pass clinical testing. We then parameterize a transmission model using epidemiological, clinical, and behavioral data to predict the consequences of wide-scale usage of high-risk microbicides in a heterosexual population. Surprisingly, we show that reducing a participant's risk of resistance during a trial could lead to unexpectedly high rates of resistance afterward when microbicides are used in public health interventions. We also find that, paradoxically, although microbicides will be used by women to protect themselves against infection, they could provide greater benefit to men. More infections in men than in women will be prevented if there is a high probability that ARVs are systemically absorbed, microbicides are less than approximately 50% effective, and/or adherence is less than approximately 60%. Men will always benefit more than women in terms of infections prevented per resistant case; but this advantage decreases as the relative fitness of drug-resistant strains increases. Interventions that use ARV-based microbicides could have surprising consequences.
Collapse
Affiliation(s)
- David P. Wilson
- *National Centre in HIV Epidemiology and Clinical Research, Faculty of Medicine, University of New South Wales, Level 2, 376 Victoria Street, Sydney NSW 2010, Australia
| | - Paul M. Coplan
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104
| | - Mark A. Wainberg
- McGill University AIDS Centre, Jewish General Hospital, 3755 Côte-Ste.-Catherine Road, Montreal, QC, Canada H3T 1E2; and
| | - Sally M. Blower
- Semel Institute for Neuroscience and Human Behavior and UCLA AIDS Institute, David Geffen School of Medicine, University of California, Los Angeles, CA 90095
| |
Collapse
|
33
|
Shulman LP, Portman DJ, Lee WC, Balu S, Joshi AV, Cobden D, Wang Q, Pashos CL. A Retrospective Managed Care Claims Data Analysis of Medication Adherence to Vaginal Estrogen Therapy: Implications for Clinical Practice. J Womens Health (Larchmt) 2008; 17:569-78. [DOI: 10.1089/jwh.2007.0407] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lee P. Shulman
- Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Won Chan Lee
- HERQuLES, Abt Associates Inc., Bethesda, Maryland
| | - Sanjeev Balu
- HERQuLES, Abt Associates Inc., Lexington, Massachusetts
| | | | | | - Qin Wang
- HERQuLES, Abt Associates Inc., Bethesda, Maryland
| | | |
Collapse
|
34
|
Should Urogenital Atrophy in Breast Cancer Survivors Be Treated with Topical Estrogens? Oncologist 2008; 13:222-31. [DOI: 10.1634/theoncologist.2007-0234] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
35
|
Berger L, El-Alfy M, Labrie F. Effects of intravaginal dehydroepiandrosterone on vaginal histomorphology, sex steroid receptor expression and cell proliferation in the rat. J Steroid Biochem Mol Biol 2008; 109:67-80. [PMID: 18242978 DOI: 10.1016/j.jsbmb.2007.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 09/11/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Recent clinical studies have shown that postmenopausal hormone therapy with estrogen plus progestogen increases breast cancer risk. Moreover, intravaginal estrogen-containing pills, creams and rings lead to significant systemic exposure to estrogen, thus indicating the need for a completely novel approach to alleviate vaginal atrophy in postmenopausal women. DESIGN We have studied the effect of intravaginal application of dehydroepiandrosterone at daily doses of 0.33 mg, 0.66 mg or 1mg in ovariectomized animals for 2 weeks, with the objective of inducing local beneficial effects in the vagina without significant systemic action. RESULTS After 2 weeks, serum dehydroepiandrosterone, androst-5-ene-3beta,17beta-diol and dehydroepiandrosterone-sulfate were increased over a 4h time period, but serum testosterone, estradiol, estrone and dihydrotestosterone remained below detectable levels. The suppository vehicle alone produced minimal epithelial thickening limited to the vaginal distal half. The morphological effects of dehydroepiandrosterone on vaginal mucosa were observed at the lowest dose and consisted mainly of a typical androgenic effect of epithelial mucification. No change in morphological features related to cell proliferation was observed at any dehydroepiandrosterone dose on uterus, mammary gland and skin. At the highest dose, body weight showed a significant decrease, thus indicating a systemic effect on lipid accumulation. Immunohistochemistry for androgen, estrogen alpha and progesterone receptors did not reveal any significant systemic effects in the uterus, mammary gland and skin except some suggestion of increased androgen receptor labeling in mammary gland and skin at the highest dehydroepiandrosterone dose. CONCLUSION The present data show that intravaginal dehydroepiandrosterone can exert beneficial effects limited to the vagina.
Collapse
Affiliation(s)
- Louise Berger
- Oncology and Molecular Endocrinology Research Center, Laval University Medical Center CHUL and Laval University, Quebec G1V 4G2, Canada
| | | | | |
Collapse
|
36
|
Cicinelli E. Intravaginal oestrogen and progestin administration: advantages and disadvantages. Best Pract Res Clin Obstet Gynaecol 2007; 22:391-405. [PMID: 17981510 DOI: 10.1016/j.bpobgyn.2007.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The vagina provides a local and a systemic route for delivering hormones for systemic effects and uterine targeting. Due to the 'uterine first-pass effect', hormones concentrate in the uterus and nearby tissues with low systemic exposure. Vaginal oestrogens, progesterone/progestins and danazol are currently used to obtain local (vagina and urethra), regional (uterus, pelvic structures) and systemic effects or contraception. Very low dosages of transvaginal oestrogens in the forms of creams, tablets and rings are effective for vaginal atrophy and urinary incontinence. To avoid endometrial stimulation, no deep vaginal application of low dosages for less than 6 months is recommended. For postmenopausal hormonal therapy by the vaginal route, progesterone is delivered directly to the uterus; the target organ for which it is designed. Worldwide, vaginal progesterone is employed for luteal phase support. Contraceptive vaginal rings offer the advantages of non-oral administration and sustained release. Vaginal administration of steroids is a promising option for the treatment of endometriosis.
Collapse
Affiliation(s)
- Ettore Cicinelli
- 4th Department of Obstetrics and Gynecology, University of Bari, Policlinico, Piazza Giulio Cesare, 70124 Bari, Italy.
| |
Collapse
|
37
|
Affiliation(s)
- Heidi Doyle
- The author practices at North Hills Internal Medicine, Raleigh, NC, USA
| |
Collapse
|
38
|
Ponzone R, Biglia N, Jacomuzzi ME, Maggiorotto F, Mariani L, Sismondi P. Vaginal oestrogen therapy after breast cancer: is it safe? Eur J Cancer 2005; 41:2673-81. [PMID: 16239103 DOI: 10.1016/j.ejca.2005.07.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 07/26/2005] [Accepted: 07/28/2005] [Indexed: 02/07/2023]
Abstract
The increasing number of breast cancer patients who suffer from menopausal symptoms is mainly due to the extensive use of adjuvant treatments in the younger women. Both short and long-term side effects of oestrogen deficiency may severely impact on the quality of life of these women and should not be underestimated. Hormonal treatments are contraindicated in breast cancer survivors mainly due to the concern that dormant micrometastases may be stimulated to grow. Alternative non-hormonal remedies are now available to alleviate symptoms and to prevent chronic diseases associated with oestrogen deficiency. Urogenital atrophy is an important consequence of oestrogen deprivation that can be effectively treated by vaginal estrogens, although systemic absorption occurs with conventional doses. Preliminary data suggest that much lower doses of vaginal estrogens can alleviate urogenital atrophy without influencing serum estrogenic levels. Further research is warranted to confirm whether vaginal estrogens are safe in symptomatic breast cancer patients who are non-responsive to alternative treatments.
Collapse
Affiliation(s)
- Riccardo Ponzone
- Academic Department of Gynaecological Oncology, University of Turin, Mauriziano Umberto I Hospital of Turin and Institute for Cancer Research and Treatment of Candiolo, Largo Turati 62, Turin 10129, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Dmitrovic R, Klobucar A, Bauman R, Cvitkovic-Kuzmic A, Skalko D, Sonicki Z. Long-term treatment with vaginal estradiol tablets—an impact on uterine artery blood flow. Maturitas 2005; 50:300-4. [PMID: 15780530 DOI: 10.1016/j.maturitas.2004.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 06/19/2004] [Accepted: 07/12/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE We investigated, using color Doppler ultrasound, possible detectable blood changes of prolonged treatment with 17-beta-estradiol tablets on uterine artery blood flow, in a cohort of low risk postmenopausal women. METHODS 39 postmenopausal women, who were taking local estrogen therapy for at least 6 months, were examined in the study group. Forty-two women who never used hormone replacement therapy consisted a control group. They were examined with color Doppler ultrasound and the pulsatility index of the uterine artery was measured. The groups were divided into three subgroups (the age, the duration of the postmenopause, and the duration of the treatment) and the data were compared among groups and within subgroups. RESULTS The overall mean age of the patients was 66 years, the mean duration of the postmenopause was 15 years, the overall mean PI was 1.96 +/- 0.90, and the mean duration of taking vaginal estradiol tablets was 1.97 years for the study group; and 64 years, 13 years and 2.88 +/- 0.96 for the control group, respectively. There was a difference in the mean PI among groups. No significant differences in pulsatility index values in the subgroups were found. CONCLUSION Long-term treatments with vaginal estradiol tablets in low risk women causes lowering of the uterine artery PI values compared to the women who are not receiving hormone replacement therapy.
Collapse
Affiliation(s)
- Romana Dmitrovic
- Department of Reproductive Endocrinology, University Hospital "Sveti Duh", Sveti Duh 64, 10000 Zagreb, Croatia.
| | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Alexander NJ, Baker E, Kaptein M, Karck U, Miller L, Zampaglione E. Why consider vaginal drug administration? Fertil Steril 2004; 82:1-12. [PMID: 15236978 DOI: 10.1016/j.fertnstert.2004.01.025] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Revised: 01/04/2004] [Accepted: 01/04/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the anatomy and physiology of the vagina, the merits of vaginal drug administration, and the currently available vaginal drug-administration systems. DESIGN Review of basic and clinical research. RESULT(S) Although clinicians commonly use topically administered drugs in the vagina, this route for systemic drug administration is somewhat novel. Experience with a variety of products demonstrates that the vagina is a highly effective site for drug delivery, particularly in women's health. The vagina is often an ideal route for drug administration because it allows for the administration of lower doses, steady drug levels, and less frequent administration than the oral route. With vaginal drug administration, absorption is unaffected by gastrointestinal disturbances, there is no first-pass effect, and use is discreet. Knowledge of anatomy, physiology, histology, and immunology of the vagina should allow clinicians to reassure their patients concerning this mode of delivery. Greater understanding and experience by clinicians should lead to increased use and acceptance of the vagina as a route for drug administration. CONCLUSION(S) The safety and efficacy of vaginal administration have been well established. The vaginal route of drug delivery is acceptable and may even be a preferable route of administration for many drugs, particularly hormones, whether for contraception or postmenopausal estrogen therapy.
Collapse
|
42
|
Mikkola TS, Clarkson TB, Notelovitz M. Postmenopausal hormone therapy before and after the women's health initiative study: what consequences? Ann Med 2004; 36:402-13. [PMID: 15513292 DOI: 10.1080/07853890410035430] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
This review focuses on the question of whether the Women's Health Initiative (WHI) was a test of primary versus secondary cardiovascular benefits of postmenopausal hormone therapy. Evidence is presented to support the conclusion that the WHI was a secondary intervention trial and that primary cardiovascular benefits of hormone therapy are rational, likely, but not yet proven. The review makes clear that hormone therapy is not a 'cardiovascular drug' for the treatment of coronary heart disease; but rather that the public health debate is whether hormone therapy, used for the treatment of menopausal symptoms, provides any cardiovascular benefits that might offset its risk.
Collapse
Affiliation(s)
- Tomi S Mikkola
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
| | | | | |
Collapse
|