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Kavas A, Cagatay ST, Banerjee S, Keskin D, Tezcaner A. Potential of Raloxifene in reversing osteoarthritis-like alterations in rat chondrocytes: an in vitro model study. J Biosci 2013; 38:135-47. [PMID: 23385821 DOI: 10.1007/s12038-012-9282-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to investigate the effects of Raloxifene (Ral) on degeneration-related changes in osteoarthritis (OA)-like chondrocytes using two- and three-dimensional models. Five-azacytidine (Aza-C) was used to induce OA-like alterations in rat articular chondrocytes and the model was verified at molecular and macrolevels. Chondrocytes were treated with Ral (1, 5 and 10 mu M) for 10 days. Caspase-3 activity, gene expressions of aggrecan, collagen II, alkaline phosphatase (ALP), collagen X, matrix metalloproteinases (MMP-13, MMP-3 and MMP-2), and MMP-13, MMP-3 and MMP-2 protein expressions were studied in two-dimensional model. Matrix deposition and mechanical properties of agarose-chondrocyte discs were evaluated in three-dimensional model. One mu M Ral reduced expression of OA-related genes, decreased apoptosis, and MMP-13 and MMP-3 protein expressions. It also increased aggrecan and collagen II gene expressions relative to untreated OA-like chondrocytes. In three-dimensional model, 1 mu M Ral treatment resulted in increased collagen deposition and improved mechanical properties, although a significant increase for sGAG was not observed. In summation, 1 mu M Ral improved matrix-related activities, whereas dose increment reversed these effects except ALP gene expression and sGAG deposition. These results provide evidence that low-dose Ral has the potential to cease or reduce the matrix degeneration in OA.
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Affiliation(s)
- Aysegul Kavas
- Department of Engineering Sciences, Center of Excellence in Biomaterials and Tissue Engineering, Middle East Technical University, Ankara 06800, Turkey
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Deal CL, Draper MW. Raloxifene: a selective estrogen-receptor modulator for postmenopausal osteoporosis - a clinical update on efficacy and safety. ACTA ACUST UNITED AC 2012; 2:199-210. [PMID: 19803890 DOI: 10.2217/17455057.2.2.199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Selective estrogen-receptor modulators are molecules with specific estrogen-receptor binding affinity. Each selective estrogen-receptor modulator induces a unique conformation in the ligand-receptor complex, which leads to transcriptional activation and/or inhibition. Raloxifene 60 mg/day, a benzothiophene selective estrogen-receptor modulator, is approved for the prevention and treatment of postmenopausal osteoporosis. This article provides an update on new studies and further analyses of clinical trial data for raloxifene. The Multiple Outcomes of Raloxifene Evaluation (MORE) trial of women with osteoporosis has described the efficacy of raloxifene in decreasing vertebral fracture risk over 4 years. The Continuing Outcomes Relevant to Evista((R)) (CORE) trial, designed to assess the effects of raloxifene on breast cancer prevention, is a 4-year continuation of MORE. The skeletal and cardiovascular effects of raloxifene in the CORE study were similar to those observed in MORE. The relative risk of developing breast cancer was significantly decreased in women treated with raloxifene, compared with placebo, after 4 years in MORE and 8 years in the CORE trial. The incidence of uterine bleeding, endometrial hyperplasia and endometrial cancer was similar between raloxifene and placebo after 8 years of treatment. Raloxifene use is associated with a higher incidence of hot flashes and leg cramps, and an increased risk of venous thromboembolic events.
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Affiliation(s)
- Chad L Deal
- Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatic and Immunology Diseases/A50, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Miksztowicz V, Siseles N, Fernandez Machulsky N, Schreier L, Berg G. Increase in MMP-2 activity in overweight and obese women is associated with menopausal status. Climacteric 2012; 15:602-6. [PMID: 22642972 DOI: 10.3109/13697137.2012.667174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Metalloproteinases (MMPs) are synthesized in the subendothelium and are involved in the atherosclerosis and cardiovascular disease process because of their major significance in vascular remodeling and plaque rupture. MMPs are also synthesized in adipose tissue during angiogenesis; however, the role of these enzymes in obesity and insulin-resistant states is still controversial. OBJECTIVE To evaluate MMP-2 activity in the circulation of overweight and obese women and in normal-weight controls, and to associate the levels of these factors with metabolic, adipose tissue and inflammation biomarkers. METHODS Plasma MMP-2 activity, adiponectin and C-reactive protein concentration, lipoprotein profile and HOMA were determined in 39 healthy women (13 normal weight and 26 overweight/obese). RESULTS Overweight/obese women were older (p < 0.001) than normal-weight women; 20/26 of overweight/obese women were postmenopausal compared with 4/13 of normal-weight women. Overweight/obese women had significantly higher plasma activity of MMP-2 than controls (mean relative area: 0.81 (range 0.4-1.92) vs. 1.33 (range 0.4-3.1); p < 0.005); this difference was lost after adjusting for menopausal status. MMP-2 activity positively correlated with waist circumference (p < 0.002), HOMA (p < 0.003), and high-sensitivity C-reactive protein (p < 0.05), apolipoprotein B (p = 0.006) and triglyceride/high density lipoprotein (HDL) cholesterol index (p < 0.001), and negatively with HDL cholesterol (p < 0.001), HDL2 cholesterol (p < 0.008), HDL3 cholesterol (p < 0.05) and adiponectin (p < 0.05). The association with HOMA and adiponectin persisted even after adjusting for menopausal status. CONCLUSION Our finding of increased plasma activity of MMP-2 in overweight/obese women, associated with menopausal status, is important given that it fits in with an early stage of cardiovascular disease; the association of MMP-2 activity with obesity markers may be a link between adipose tissue and risk for cardiovascular disease.
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Affiliation(s)
- V Miksztowicz
- Laboratory of Lipids and Lipoproteins, Department of Clinical Biochemistry, Faculty of Pharmacy and Biochemistry, INFIBIOC, University of Buenos Aires, Argentina
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Pompei LM, Steiner ML, Theodoro TR, Souza PZ, Romanini ACA, Coulson-Thomas V, Pinhal MAS, Fernandes CE. Effect of estrogen therapy on vascular perlecan and metalloproteinases 2 and 9 in castrated rats. Climacteric 2012; 16:147-53. [DOI: 10.3109/13697137.2012.667173] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L. M. Pompei
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André
| | - M. L. Steiner
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André
| | - T. R. Theodoro
- Department of Biochemistry, Faculdade de Medicina do ABC, Santo André
| | - P. Z. Souza
- Graduate Student, Faculdade de Medicina do ABC, Santo André
| | | | - V. Coulson-Thomas
- Department of Biochemistry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M. A. S. Pinhal
- Department of Biochemistry, Faculdade de Medicina do ABC, Santo André
| | - C. E. Fernandes
- Department of Gynecology and Obstetrics, Faculdade de Medicina do ABC, Santo André
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Alexandersen P, Karsdal MA, Christiansen C. Long-Term Prevention with Hormone-Replacement Therapy after the Menopause: Which Women should be Targeted? WOMENS HEALTH 2009; 5:637-47. [DOI: 10.2217/whe.09.52] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
For decades, hormone-replacement therapy (HRT) was considered safe and was the first choice in prevention of postmenopausal osteoporosis induced by estrogen deficiency. Numerous experimental and epidemiological studies further supported a protective effect of exogenous female sex hormones on atherogenesis and coronary heart disease (CHD) in women after the menopause. However, the fact that these promising results were not translated into lower incidences of CHD events in hormone-treated women compared with placebo in subsequent, large, randomized studies of healthy subjects as well as women with known CHD raised a very intense debate concerning the safety of HRT in terms of cardiovascular risk. A critical mass of data points toward a protective influence of HRT on cardiovascular disease end points in early postmenopausal women, but increased harm in elderly women, especially those with abdominal adiposity or metabolic syndrome. Once the quasi-hysterical reaction to the largest of the randomized studies (the Women's Health Initiative) has abated, a future strategy should be to concentrate on identifying those relatively few individuals who are not suitable for HRT, as HRT still remains the most thoroughly investigated pharmacological prevention strategy of osteoporosis.
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Affiliation(s)
- Peter Alexandersen
- Peter Alexandersen, Center for Clinical & Basic Research a/s, Ballerup Byvej 222, DK-2750 Ballerup, Denmark, Tel.: +45 44 684 600, Fax: +45 44 684 220,
| | - Morten A Karsdal
- Morten A Karsdal, Nordic Bioscience a/s, Herlev Hovedgade 207, 2730 Herlev, Denmark, Tel.: +45 44 525 252, Fax: +45 44 535 251,
| | - Claus Christiansen
- Claus Christiansen, Nordic Bioscience a/s, Herlev Hovedgade 207, 2730 Herlev, Denmark, Tel.: +45 44 525 252, Fax: +45 44 535 251,
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Christodoulakos GE, Lambrinoudaki IV, Botsis DC. The Cardiovascular Effects of Selective Estrogen Receptor Modulators. Ann N Y Acad Sci 2006; 1092:374-84. [PMID: 17308162 DOI: 10.1196/annals.1365.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Coronary artery disease (CAD) is the main contributor of mortality among postmenopausal women. Menopause-associated estrogen deficiency has both metabolic and vascular consequences that increase the risk for CAD. Hormone therapy (HT) has been reported to have a beneficial effect on metabolic and vascular factors influencing the incidence of CAD. Although observational studies have reported that HT reduces significantly the risk for CAD, randomized clinical trials (WHI, HERS, ERA) have questioned the efficacy of HT in primary and secondary CAD prevention despite confirming the lipid-lowering effect of HT. In the aftermath of the WHI, increased interest has been given to the action of selective estrogen receptor modulators (SERMs) and their effect on the cardiovascular system. The chemical structure of SERMs, either triphenylethilyn (tamoxifen) or benzothiophene (raloxifene) derivatives, differs from that of estrogens. SERMs are nonsteroidal molecules that bind, with high affinity, to the ER. SERMs induce conformational changes to the ligand-binding domain of the ER that modulate the ability of the ER to interact with coregulator proteins. The relative balance of coregulators within a cell determines the transcriptional activity of the receptor-ligand complex. SERMs therefore may express an estrogen-agonist or estrogen-antagonist effect depending on the tissue targeted. SERMs express variable effects on the metabolic and vascular factors influencing the incidence of CAD. SERMs have been reported to modulate favorably the lipid-lipoprotein profile. Toremifene expresses the most beneficial effect followed by tamoxifene and raloxifene, while ospexifene and HMR-3339 have the least effect and may even increase triglycerides. Raloxifene and tamoxifene decrease serum homocysteine levels and C-reactive proteins (CRP), which are both markers of CAD risk. Raloxifene has been reported to increase the nitric oxide (NO)-endothelin (ET)-1 ratio and, thus, contribute to proper endothelial function and vasodilation. Toremifene has no effect on the NO-ET-1 ratio. Finally, raloxifene decreases the vascular cell adhesion molecules and the inflammatory cytokines TNF-alpha and IL-6. Of the SERMs, raloxifene has had the most extensive evaluation regarding the effect on the vascular wall of endothelium. Although not confirmed by large clinical trials, raloxifene has been reported to have an effect on the cohesion of the intercellular junction (VE-cadherin) and the synthesis-degradation of extracellular matrix (MMP-2). The Multiple Outcomes Raloxifene Evaluation (MORE) study has reported that raloxifene may have a cardioprotective effect when administered to postmenopausal women at high risk for CAD disease.
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Affiliation(s)
- G E Christodoulakos
- Second Department of Obstetrics and Gynecology, Aretaieion Hospital, University of Athens, Athens, Greece
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Christodoulakos GE, Lambrinoudaki IV, Economou EV, Papadias C, Vitoratos N, Panoulis CP, Kouskouni EE, Vlachou SA, Creatsas GC. Circulating chemoattractants RANTES, negatively related to endogenous androgens, and MCP-1 are differentially suppressed by hormone therapy and raloxifene. Atherosclerosis 2006; 193:142-50. [PMID: 16842799 DOI: 10.1016/j.atherosclerosis.2006.05.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 05/22/2006] [Accepted: 05/24/2006] [Indexed: 12/24/2022]
Abstract
BACKGROUND The cardinal role of chronic inflammation in the development of atherosclerosis is increasingly being recognized. Estrogens may prevent the evolution of atherosclerosis by suppressing immune response. Furthermore, the conflicting reports on the cardiovascular effects of hormone therapy between observational and clinical trials have triggered interest on the effect of alternative therapies on the cardiovascular system. OBJECTIVE The aim of this study was to assess the effect of estrogen, estrogen-progestin, tibolone and raloxifene therapy on circulating markers of chemotaxis in healthy postmenopausal women. METHODS Eighty-eight postmenopausal women aged 44-62 years were randomly allocated to daily: (1) conjugated equine estrogens 0.625 mg (CEE), (2) 17beta-estradiol 1mg plus norethisterone acetate 0.5mg (E(2)/NETA), (3) tibolone 2.5mg, (4) raloxifene HCl 60 mg or (5) no treatment. Serum monocyte chemoattractant protein-1 (MCP-1) and regulated upon activation, normal T-cell expressed and secreted (RANTES) were measured at baseline and at 3 months. RESULTS Endogenous testosterone and free androgen index (FAI) correlated negatively, while SHBG correlated positively with serum RANTES (testosterone: r=-0.27, p=0.033; FAI: r=-0.43, p=0.004: SHBG: r=0.34, p=0.026). Serum MCP-1 decreased significantly in the CEE group (baseline 125.3+/-51 pg/ml, 3 months 84.5+/-36.1 pg/ml, p=0.043), while no difference was detected between baseline and post-treatment levels in the other groups. Furthermore, a significant decrease in serum RANTES was observed at the end of 3 months only in the E2/NETA and the raloxifene group (E2/NETA baseline 8690.6+/-3880.0 pg/ml, 3 months 6894.0+/-1720.0 pg/ml, p=0.007; raloxifene baseline 9042.4+/-3765.6 pg/ml, 3 months 6718.1+/-2366.2 pg/ml, p=0.011). CONCLUSION Endogenous androgens may suppress chemotactic response. Postmenopausal hormone therapy and raloxifene may inhibit the expression of chemoattractant molecules and thus attenuate inflammation. The relevance of these findings in terms of clinically established caridoprotection remains to be clarified.
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Affiliation(s)
- George E Christodoulakos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, Athens, Greece
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Hsia J. Assessing drug risks and benefits: lessons from postmenopausal hormone therapy studies. Clin Breast Cancer 2006; 6 Suppl 2:S65-70. [PMID: 16595029 DOI: 10.3816/cbc.2006.s.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The issue of safety standards for new drugs remains unsettled. Limitations of biomarker or observational studies for assessing global safety and efficacy of postmenopausal hormone therapy are highlighted by contrast with randomized clinical trial results. On the other hand, requiring large-scale, long-term outcome trials for every new drug might not be practical. Randomized trials with intermediate outcomes such as coronary angiography, coronary or carotid ultrasound, or coronary calcification present attractive alternatives. Trials with intermediate outcomes can be conducted with much smaller sample sizes and shorter duration, but the adequacy of these types of trials for assessment of safety and efficacy remains a topic of ongoing discussion in the scientific and regulatory communities.
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Affiliation(s)
- Judith Hsia
- Division of Cardiology, George Washington University, Washington, DC 20037, USA.
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Du XJ, Fang L, Kiriazis H. Sex dimorphism in cardiac pathophysiology: experimental findings, hormonal mechanisms, and molecular mechanisms. Pharmacol Ther 2006; 111:434-75. [PMID: 16439025 DOI: 10.1016/j.pharmthera.2005.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Accepted: 10/25/2005] [Indexed: 11/30/2022]
Abstract
The higher cardiovascular risk in men and post-menopausal women implies a protective action of estrogen. A large number of experimental studies have provided strong support to this concept. However, the recent clinical trials with negative outcomes regarding hormone replacement therapy call for "post hoc" reassessment of existing information, models, and research strategies as well as a summary of recent findings. Sex steroid hormones, in particular estrogen, regulate numerous processes that are related to the development and progression of cardiovascular disease through a variety of signaling pathways. Use of genetically modified models has resulted in interesting information on diverse actions mediated by steroid receptors. By focusing on experimental findings, we have reviewed hormonal, cellular, and signaling mechanisms responsible for sex dimorphism and actions of hormone replacement therapy and addressed current limitations and future directions of experimental research.
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Affiliation(s)
- Xiao-Jun Du
- Experimental Cardiology Laboratory, Baker Heart Research Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia.
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Menon DV, Vongpatanasin W. Effects of Transdermal Estrogen Replacement Therapy on Cardiovascular Risk Factors. ACTA ACUST UNITED AC 2006; 5:37-51. [PMID: 16396517 DOI: 10.2165/00024677-200605010-00005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The prevalence of hypertension and cardiovascular disease increases dramatically after menopause in women, implicating estrogen as having a protective role in the cardiovascular system. However, recent large clinical trials have failed to show cardiovascular benefit, and have even demonstrated possible harmful effects, of opposed and unopposed estrogen in postmenopausal women. While these findings have led to a revision of guidelines such that they discourage the use of estrogen for primary or secondary prevention of heart disease in postmenopausal women, many investigators have attributed the negative results in clinical trials to several flaws in study design, including the older age of study participants and the initiation of estrogen late after menopause.Because almost all clinical trials use oral estrogen as the primary form of hormone supplementation, another question that has arisen is the importance of the route of estrogen administration with regards to the cardiovascular outcomes. During oral estrogen administration, the concentration of estradiol in the liver sinusoids is four to five times higher than that in the systemic circulation. This supraphysiologic concentration of estrogen in the liver can modulate the expression of many hepatic-derived proteins, which are not observed in premenopausal women. In contrast, transdermal estrogen delivers the hormone directly into the systemic circulation and, thus, avoids the first-pass hepatic effect.Although oral estrogen exerts a more favorable influence than transdermal estrogen on traditional cardiovascular risk factors such as high- and low-density lipoprotein-cholesterol levels, recent studies have indicated that oral estrogen adversely influences many emerging risk factors in ways that are not seen with transdermal estrogen. Oral estrogen significantly increases levels of acute-phase proteins such as C-reactive protein and serum amyloid A; procoagulant factors such as prothrombin fragments 1+2; and several key enzymes involved in plaque disruption, while transdermal estrogen does not have these adverse effects.Whether the advantages of transdermal estrogen with regards to these risk factors will translate into improved clinical outcomes remains to be determined. Two ongoing clinical trials, KEEPS (Kronos Early Estrogen Prevention Study) and ELITE (Early versus Late Intervention Trial with Estradiol) are likely to provide invaluable information regarding the role of oral versus transdermal estrogen in younger postmenopausal women.
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Affiliation(s)
- Dileep V Menon
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Christodoulakos G, Lambrinoudaki I, Panoulis C, Papadias C, Economou E, Creatsas G. Effect of hormone therapy and raloxifene on serum VE-cadherin in postmenopausal women. Fertil Steril 2004; 82:634-8. [PMID: 15374707 DOI: 10.1016/j.fertnstert.2004.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2003] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the effect of continuous combined hormone therapy and raloxifene on serum VE-cadherin. DESIGN The study was double blinded, with a placebo run-in period of 28-50 days. SETTING University menopause clinic. PATIENT(S) Twenty-eight healthy postmenopausal women devoid of climacteric complaints. INTERVENTION(S) Subjects were randomized to 17beta-estradiol (2 mg) + norethisterone acetate (1 mg; E(2)-NETA) or raloxifene hCL (60 mg) for a period of 6 months. MAIN OUTCOME MEASURE(S) Serum VE-cadherin, which was estimated at baseline and at month 6. RESULT(S) Serum VE-cadherin decreased significantly in both E(2)-NETA and raloxifene groups (raloxifene baseline +/- SD: 1.17 +/- 0.44 ng/mL, 6 months: 0.82 +/- 0.29 ng/mL; E(2)-NETA baseline: 1.19 +/- 0.47 ng/mL, 6 months: 0.92 +/- 0.49 ng/mL). Percentage changes from baseline were -21.7 +/- 24.3 for E(2)-NETA and -26.0 +/- 20.6 for raloxifene. CONCLUSION(S) The effect of E(2)-NETA and raloxifene suggests that these drugs may preserve interendothelial junction integrity and control vascular permeability. Although this effect may influence the progress of the atheromatous lesion, its clinical impact on coronary artery disease (CAD) remains uncertain.
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Affiliation(s)
- George Christodoulakos
- Second Department of Obstetrics and Gynecology, University of Athens, Aretaieion Hospital, Athens, Greece
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