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Zhang YL, Xie L, Wu FL, Ding X, Hernández-Wolters B, Găman MA, Kord-Varkaneh H. Comprehensive meta-analysis of the effects of oral medroxyprogesterone acetate plus conjugated equine oestrogens on the lipid profile in women: Insights from randomized controlled trials. Eur J Clin Invest 2024; 54:e14211. [PMID: 38726889 DOI: 10.1111/eci.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Menopause is associated with elevated cardiovascular risk due to the loss of the cardioprotective effect of oestrogens. Postmenopausal women are often prescribed hormone replacement therapy (HRT) in order to control menopause symptoms and correct hormone imbalances; however, HRT can impact serum lipids' concentrations. At present, data on the effect of the administration of medroxyprogesterone acetate plus conjugated equine oestrogens (MPACEE) on the lipid profile in females are uncertain, as the investigations conducted so far have produced conflicting results. Thus, we aimed to clarify the impact of MPACEE prescription on the serum lipids' values in women by means of a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We employed a random-effects model based on the DerSimonian and Laird method to determine the combined estimates of the intervention's impact on the lipid profile. The computation of the weighted mean difference (WMD) and its corresponding 95% confidence interval (CI) relied on the mean and standard deviation values from both the MPACEE and control group, respectively. RESULTS A total of 53 RCTs were included in the meta-analysis with 68 RCT arms on total cholesterol (TC), 70 RCT arms on low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and 69 RCT arms on high-density lipoprotein cholesterol (HDL-C). Administration of MPACEE resulted in a significant reduction of TC (WMD = -11.93 mg/dL; 95% CI: -13.42, -10.44; p < .001) and LDL-C (WMD = -16.61 mg/dL; 95% CI: -17.97, -15.26; p < .001) levels, and a notable increase in HDL-C (WMD = 3.40 mg/dL; 95% CI: 2.93, 3.86; p < .001) and TG (WMD = 10.28 mg/dL; 95% CI: 7.92, 12.64; p < .001) concentrations. Subgroup analysis revealed that changes in the lipid profile were influenced by several factors: body mass index (for TC, HDL-C, TG), MPACEE dosages (for TC, LDL-C, HDL-C, TG), age (for TC, LDL-C, HDL-C, TG), durations of the intervention (for TC, LDL-C, HDL-C, TG), continuous/sequential administration of MPACEE (continuous for TC; sequential for LDL-C, TG) administration of MPACEE and serum lipids' concentrations before enrolment in the RCT (for TC, LDL-C, HDL-C, TG). CONCLUSIONS MPACEE administration can influence serum lipids' concentrations in females by raising HDL-C and TG levels and reducing LDL-C and TC values. Therefore, postmenopausal women who suffer from hypercholesterolaemia might benefit from this type of HRT.
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Affiliation(s)
- Yi Lin Zhang
- Department of Obstetrics and Gynecology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lei Xie
- Department of Obstetrics and Gynecology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Fen Lan Wu
- Department of Obstetrics and Gynecology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiaomei Ding
- Department of Obstetrics and Gynecology, Suzhou BenQ Medical Center, The Affiliated BenQ Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | | | - Mihnea-Alexandru Găman
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Hamed Kord-Varkaneh
- Department of Nutrition and Food Hygiene, School of Medicine, Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Kuryłowicz A. Estrogens in Adipose Tissue Physiology and Obesity-Related Dysfunction. Biomedicines 2023; 11:biomedicines11030690. [PMID: 36979669 PMCID: PMC10045924 DOI: 10.3390/biomedicines11030690] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
Menopause-related decline in estrogen levels is accompanied by a change in adipose tissue distribution from a gynoid to an android and an increased prevalence of obesity in women. These unfavorable phenomena can be partially restored by hormone replacement therapy, suggesting a significant role for estrogen in the regulation of adipocytes' function. Indeed, preclinical studies proved the involvement of these hormones in adipose tissue development, metabolism, and inflammatory activity. However, the relationship between estrogen and obesity is bidirectional. On the one hand-their deficiency leads to excessive fat accumulation and impairs adipocyte function, on the other-adipose tissue of obese individuals is characterized by altered expression of estrogen receptors and key enzymes involved in their synthesis. This narrative review aims to summarize the role of estrogen in adipose tissue development, physiology, and in obesity-related dysfunction. Firstly, the estrogen classification, synthesis, and modes of action are presented. Next, their role in regulating adipogenesis and adipose tissue activity in health and the course of obesity is described. Finally, the potential therapeutic applications of estrogen and its derivates in obesity treatment are discussed.
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Affiliation(s)
- Alina Kuryłowicz
- Department of Human Epigenetics, Mossakowski Medical Research Centre PAS, 02-106 Warsaw, Poland
- Department of General Medicine and Geriatric Cardiology, Medical Centre of Postgraduate Education, 00-401 Warsaw, Poland
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Morán-Costoya A, Proenza AM, Gianotti M, Lladó I, Valle A. Sex Differences in Nonalcoholic Fatty Liver Disease: Estrogen Influence on the Liver-Adipose Tissue Crosstalk. Antioxid Redox Signal 2021; 35:753-774. [PMID: 33736456 DOI: 10.1089/ars.2021.0044] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significance: Nonalcoholic fatty liver disease (NAFLD) is a hepatic and systemic disorder with a complex multifactorial pathogenesis. Owing to the rising incidence of obesity and diabetes mellitus, the prevalence of NAFLD and its impact on global health care are expected to increase in the future. Differences in NAFLD exist between males and females, and among females depending on their reproductive status. Clinical and preclinical data show that females in the fertile age are more protected against NAFLD, and studies in postmenopausal women and ovariectomized animal models support a protective role for estrogens. Recent Advances: An efficient crosstalk between the liver and adipose tissue is necessary to regulate lipid and glucose metabolism, protecting the liver from steatosis and insulin resistance contributing to NALFD. New advances in the knowledge of sexual dimorphism in liver and adipose tissue are providing interesting clues about the sex differences in NAFLD pathogenesis that could inspire new therapeutic strategies. Critical Issues: Sex hormones influence key master regulators of lipid metabolism and oxidative stress in liver and adipose tissue. All these sex-biased metabolic adjustments shape the crosstalk between liver and adipose tissue, contributing to the higher protection of females to NAFLD. Future Directions: The development of novel drugs based on the protective action of estrogens, but without its feminizing or undesired side effects, might provide new therapeutic strategies for the management of NAFLD. Antioxid. Redox Signal. 35, 753-774.
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Affiliation(s)
- Andrea Morán-Costoya
- Energy Metabolism and Nutrition Group, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Ana M Proenza
- Energy Metabolism and Nutrition Group, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Center for Biomedical Research in the Pathophysiology of Obesity and Nutrition Network, Carlos III Health Institute, Madrid, Spain
| | - Magdalena Gianotti
- Energy Metabolism and Nutrition Group, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Center for Biomedical Research in the Pathophysiology of Obesity and Nutrition Network, Carlos III Health Institute, Madrid, Spain
| | - Isabel Lladó
- Energy Metabolism and Nutrition Group, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Center for Biomedical Research in the Pathophysiology of Obesity and Nutrition Network, Carlos III Health Institute, Madrid, Spain
| | - Adamo Valle
- Energy Metabolism and Nutrition Group, Department of Fundamental Biology and Health Sciences, Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain.,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,Center for Biomedical Research in the Pathophysiology of Obesity and Nutrition Network, Carlos III Health Institute, Madrid, Spain
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Lee SR, Cho MK, Cho YJ, Chun S, Hong SH, Hwang KR, Jeon GH, Joo JK, Kim SK, Lee DO, Lee DY, Lee ES, Song JY, Yi KW, Yun BH, Shin JH, Chae HD, Kim T. The 2020 Menopausal Hormone Therapy Guidelines. J Menopausal Med 2020; 26:69-98. [PMID: 32893509 PMCID: PMC7475284 DOI: 10.6118/jmm.20000] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Sa Ra Lee
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moon Kyoung Cho
- Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Busan, Korea
| | - Sungwook Chun
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seung Hwa Hong
- Department of Obstetrics and Gynecology, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyu Ri Hwang
- Department of Obstetrics & Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gyun Ho Jeon
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Jong Kil Joo
- Department of Obstetrics and Gynecology, Pusan National University Hospital, Busan, Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ock Lee
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Dong Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyong Wook Yi
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Shin
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hee Dong Chae
- Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Noirrit E, Buscato M, Dupuis M, Payrastre B, Fontaine C, Arnal JF, Valera MC. Effects of conjugated estrogen and bazedoxifene on hemostasis and thrombosis in mice. Endocr Connect 2019; 8:788-795. [PMID: 31085766 PMCID: PMC6590204 DOI: 10.1530/ec-19-0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 11/09/2022]
Abstract
Estrogen-progestin therapy was previously considered as the standard of care for managing bothersome symptoms associated with menopause, but it increases risks of breast cancer and of thromboembolism. The combination of conjugated estrogen (CE) with bazedoxifene (BZA) named tissue-selective estrogen complex (TSEC) was designed to minimize or even abrogate the undesirable effects on breast, while maintaining the beneficial effects such as prevention of osteoporosis and suppression of climacteric symptoms. The risk on thromboembolism associated with TSEC is unknown, although the clinical available data are reassuring. The aim of this study was to define the impact of a chronic administration of CE, BZA or CE + BZA on hemostasis and thrombosis in ovariectomized mice. As expected, CE, but not BZA neither CE + BZA, induced uterine and vagina hypertrophy. As previously demonstrated for 17β-estradiol (E2), we found that CE (i) increased tail-bleeding time, (ii) prevented occlusive thrombus formation in injured carotid artery and (iii) protected against collagen/epinephrine-induced thromboembolism. Thus, whereas BZA antagonized CE action on reproductive tissues, it had no impact on the effect of CE on hemostasis, thromboembolism and arterial thrombosis in mice. CE + BZA shared the anti-thrombotic actions of CE in these mouse models. If a similar process is at work in women, CE combined with BZA could contribute to minimize the risk of thrombosis associated with hormone replacement therapy.
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Affiliation(s)
- Emmanuelle Noirrit
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
- Faculté de Chirurgie Dentaire, Université de Toulouse III, Toulouse, France
| | - Mélissa Buscato
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Marion Dupuis
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Bernard Payrastre
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
- CHU de Toulouse, Laboratoire d’Hématologie, Toulouse, France
| | - Coralie Fontaine
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Jean-François Arnal
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Marie-Cécile Valera
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
- Faculté de Chirurgie Dentaire, Université de Toulouse III, Toulouse, France
- Correspondence should be addressed to M-C Valera:
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Valéra MC, Fontaine C, Noirrit-Esclassan E, Boudou F, Buscato M, Adlanmerini M, Trémollières F, Gourdy P, Lenfant F, Arnal JF. [Towards an optimization of the modulation of the estrogen receptor during menopausal hormonal therapy]. Med Sci (Paris) 2019; 34:1056-1062. [PMID: 30623764 DOI: 10.1051/medsci/2018297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Women now live more than a third of their lives after the onset of menopause. The decline in endogenous estrogen production during this period is accompanied by functional disorders that affect quality of life. These symptoms may be relieved by menopausal hormone therapy (MHT) initially based on the administration of equine conjugated estrogens (mainly in the United States, oral route) or the natural estrogen, 17β-estradiol (in Europe, transdermal route). Estrogen receptor α (ERα), but not ERβ, mediates most of the physiological effects of estrogens. ERα belongs to the superfamily of nuclear receptors and regulates the transcription of genes via its activation functions AF1 and AF2. In addition to these classical genomic actions, estrogens can activate a subpopulation of ERα present at the cell membrane and thereby induce rapid signals. In this review, we will summarize the evolution of MHTs in last decades, as well as treatments that use various selective estrogen receptor modulators (SERMs). Next, we will describe recent advances in the understanding of the mechanisms of estrogen action, in particular the respective roles of nuclear and membrane ERα as well as the potential implications for future therapies.
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Affiliation(s)
- Marie-Cécile Valéra
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Coralie Fontaine
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | | | - Frédéric Boudou
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Melissa Buscato
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Marine Adlanmerini
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Florence Trémollières
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Pierre Gourdy
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Françoise Lenfant
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
| | - Jean-François Arnal
- Inserm U1048 et université Toulouse III, I2MC, CHU Rangueil, BP 84225, 31432 Toulouse Cedex 4, France
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Buscato M, Fontaine C, Fabre A, Vinel A, Valera MC, Noirrit E, Guillaume M, Payrastre B, Métivier R, Arnal JF. The antagonist properties of Bazedoxifene after acute treatment are shifted to stimulatory action after chronic exposure in the liver but not in the uterus. Mol Cell Endocrinol 2018; 472:87-96. [PMID: 29183806 DOI: 10.1016/j.mce.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/25/2017] [Accepted: 11/23/2017] [Indexed: 01/16/2023]
Abstract
A promising alternative to conventional hormone therapy for postmenopausal symptoms is treatment combining Bazedoxifene (BZA), a third-generation selective estrogen receptor modulator (SERM), and conjugated equine estrogen (CE). This combination is also known as a tissue-selective estrogen complex (TSEC). Understanding the tissue-specific actions of SERMs and the TSEC remains a major challenge to try to predict their clinical effects. The aim of this study was to compare acute versus chronic treatment with BZA, CE or CE + BZA in two major targets of estrogens, the uterus and the liver. In these two tissues, acute treatment with CE, but not with BZA, induced similar gene expression change than the most important endogenous estrogen, 17-β estradiol (E2). Acute induction of gene expression by E2 or by CE was antagonized by the addition of BZA. Concomitantly, BZA alone or in combination with E2 or CE induced a partial degradation of ERα protein after acute exposure. In uterus, chronic treatment of BZA alone had no impact on tissue weight gain or on epithelial cell proliferation, and also antagonized CE-effect in uterus, thereby mimicking the acute effect. By contrast, in the liver, chronic BZA and CE + BZA elicited agonistic transcriptional effects similar to those of CE alone. In addition, at variance to BZA acute effect, no change in ERα protein abundance was observed after chronic treatment in this tissue. These experimental in vivo data highlight a new aspect of the time-dependent tissue-specific action of BZA or TSEC, i.e. they can act acutely as antagonists but become agonists after chronic treatment. This shift was observed in liver tissue, but not in proliferative sex target such as the uterus.
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Affiliation(s)
- Mélissa Buscato
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Coralie Fontaine
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Aurélie Fabre
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Alexia Vinel
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Marie-Cécile Valera
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France; Faculté de Chirurgie Dentaire, Université de Toulouse III, Toulouse, France
| | - Emmanuelle Noirrit
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France; Faculté de Chirurgie Dentaire, Université de Toulouse III, Toulouse, France
| | - Maeva Guillaume
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France
| | - Bernard Payrastre
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France; Laboratoire d'Hématologie, Toulouse, France
| | - Raphaël Métivier
- Equipe SPARTE, UMR CNRS 6290, Université de Rennes I, Rennes, France
| | - Jean-François Arnal
- Inserm U1048 (I2MC), CHU de Toulouse and Université Toulouse III, I2MC, Toulouse, France.
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Valéra MC, Fontaine C, Dupuis M, Noirrit-Esclassan E, Vinel A, Guillaume M, Gourdy P, Lenfant F, Arnal JF. Towards optimization of estrogen receptor modulation in medicine. Pharmacol Ther 2018; 189:123-129. [PMID: 29730442 DOI: 10.1016/j.pharmthera.2018.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Women now spend more than one-third of their lives in the postmenopausal years, and the decline of endogenous estrogen production during menopause is accompanied by a series of functional disorders that affect the quality of life. These symptoms could be alleviated or even totally suppressed by menopausal hormone therapy (MHT), initially based on natural estrogens extracted from the urine of pregnant mares (mainly in the USA, using the oral route) and later from the synthesis of the natural estrogen, 17β-estradiol (mainly in Europe, in particular using the transdermal route). Estrogen receptor (ER) α is the main receptor mediating the physiological effects of estrogens. ERα belongs to the nuclear receptor superfamily and activates gene transcription in a time and tissue-specific manner through two distinct activation functions (AF), AF1 and AF2. In addition to these classical genomic actions, ERα also mediates membrane initiated signaling enabling rapid actions of estrogen, potentially along or in interaction with other receptors. Here, we provide a brief historical overview of MHT, and we then highlight recent advances in the characterization of new treatments based on the association of estrogens with selective estrogen receptor modulators (SERMs) or on the modulation of nuclear or membrane ERα.
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Affiliation(s)
- Marie-Cécile Valéra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Coralie Fontaine
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Marion Dupuis
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Emmanuelle Noirrit-Esclassan
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Alexia Vinel
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Maeva Guillaume
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Pierre Gourdy
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Françoise Lenfant
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France
| | - Jean-François Arnal
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048 and Université Toulouse III, I2MC, Toulouse, France.
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Oral versus transdermal estrogens and venous thromboembolism in postmenopausal women: what is new since 2003? Menopause 2018; 23:587-8. [PMID: 27116463 DOI: 10.1097/gme.0000000000000665] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Timing and persistence of effect of conjugated estrogens/bazedoxifene in postmenopausal women. Menopause 2018; 23:1204-1213. [PMID: 27433860 DOI: 10.1097/gme.0000000000000688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine the time course of effect with conjugated estrogens/bazedoxifene (CE/BZA) in nonhysterectomized postmenopausal women in five phase 3 trials. METHODS This post hoc analysis identified when CE 0.45 mg/BZA 20 mg and CE 0.625 mg/BZA 20 mg first achieved a statistically significant difference (P < 0.05) versus placebo in individual trials and the duration the difference persisted for prespecified efficacy endpoints. RESULTS CE/BZA significantly reduced hot flush frequency beginning at weeks 2 to 4 and severity at weeks 3 to 6; benefits were maintained through month 24. Significant improvements in lumbar spine, total hip, femoral neck, and femoral trochanter bone mineral density were evident at month 6 or 12 and changes in bone turnover markers at month 3 or 6; benefits were maintained throughout the studies (12 or 24 mo). In symptomatic women with less than 5% vaginal superficial cells at baseline, vaginal maturation index was significantly improved by week 4. Reductions in parabasal cells were maintained throughout the studies (through months 3 and 24), but superficial cell count changes persisted only with the higher CE/BZA dose. Menopause-Specific Quality of Life total and vasomotor domain scores were improved at all assessments, from months 3 through 24. Some measures of sleep, especially quality and time to fall asleep, improved during weeks 4 to 8 and were maintained in a majority of weeks thereafter. CONCLUSIONS In the context of studies designed primarily to evaluate efficacy at final study endpoints, both doses of CE/BZA achieved significance versus placebo at early assessments for most outcomes, and benefits were well maintained.
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Time to first occurrence of breast pain and vaginal bleeding in phase 3 trials of CE/BZA. Menopause 2017; 24:1372-1377. [DOI: 10.1097/gme.0000000000000935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pickar JH, Archer DF, Kagan R, Pinkerton JV, Taylor HS. Safety and benefit considerations for menopausal hormone therapy. Expert Opin Drug Saf 2017; 16:941-954. [DOI: 10.1080/14740338.2017.1343298] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- James H Pickar
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - David F Archer
- Clinical Research Center, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Risa Kagan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco and East Bay Physicians Medical Group, Sutter East Bay Medical Foundation, Berkeley, CA, USA
| | - JoAnn V Pinkerton
- Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
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Chun SW. An Overview of the Clinical Efficacy and Safety of Tissue Selective Estrogen Complex: From the Selective Estrogens, Menopause, and Response to Therapy (SMART) Trials. KOSIN MEDICAL JOURNAL 2017. [DOI: 10.7180/kmj.2017.32.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hormone therapy (HT) is the most effective treatment for menopausal symptoms, and reduces both spinal and non-spinal postmenopausal osteoporotic fractures. However, a Women's Health Initiative (WHI) trial revealed that progestin-containing HT is associated with higher incidences of breast cancer and coronary heart disease than those associated with placebo. Tissue selective estrogen complex (TSEC) is a novel progestin-free HT option composed of conjugated estrogens (CE) and a selective estrogen receptor modulator. CE at a dose of 0.45 mg combined with 20 mg of bazedoxifene was the first TSEC medication approved in the United States and Korea for women with moderate to severe menopause-related vasomotor symptoms (VMS) and for preventing postmenopausal osteoporosis. This review summarizes the clinical efficacy, safety, and tolerability of TSEC as obtained from the five SMART clinical trials.
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Parish SJ, Gillespie JA. The evolving role of oral hormonal therapies and review of conjugated estrogens/bazedoxifene for the management of menopausal symptoms. Postgrad Med 2017; 129:340-351. [PMID: 28132583 DOI: 10.1080/00325481.2017.1281083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This review describes the evolving role of oral hormone therapy (HT) for treating menopausal symptoms and preventing osteoporosis, focusing on conjugated estrogens/bazedoxifene (CE/BZA). Estrogens alleviate hot flushes and prevent bone loss associated with menopause. In nonhysterectomized women, a progestin should be added to estrogens to reduce the risk of endometrial cancer. Use of HT declined since the Women's Health Initiative (WHI) studies showed that HT does not prevent coronary heart disease (CHD) and that conjugated estrogens/medroxyprogesterone acetate increased the risk of invasive breast cancer after nearly 5 years of use. However, re-analyses of the WHI data suggest that some risks (eg, CHD, all-cause mortality) may be reduced when HT is initiated in women <60 years of age and <10 years since menopause, compared with later. CE/BZA is the first menopausal HT without a progestogen for nonhysterectomized women. Instead, BZA, a selective estrogen receptor modulator, in combination with CE, protects against estrogenic effects on uterine and breast tissue. Data from 5 large, randomized clinical trials show that CE/BZA reduces hot flush frequency/severity, prevents bone loss, reduces bone turnover, improves the vaginal maturation index and ease of lubrication, and improves some measures of sleep and menopause-specific quality of life. In studies of up to 2 years, there was no increase in endometrial hyperplasia, vaginal bleeding, breast density, or breast pain/tenderness compared with placebo. Venous thromboembolism and stroke are risks of all estrogen-based therapies. The choice of HT should be individualized, with consideration of the risk/benefit profile and tolerability of therapy, as well as patient preferences.
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Affiliation(s)
- Sharon J Parish
- a Departments of Psychiatry and Internal Medicine , Weill Cornell Medical College , New York , NY , USA
| | - John A Gillespie
- b Pfizer Global Innovative Pharma , Pfizer Inc , Collegeville , PA , USA
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Sánchez-Rodríguez MA, Zacarías-Flores M, Castrejón-Delgado L, Ruiz-Rodríguez AK, Mendoza-Núñez VM. Effects of Hormone Therapy on Oxidative Stress in Postmenopausal Women with Metabolic Syndrome. Int J Mol Sci 2016; 17:E1388. [PMID: 27563883 PMCID: PMC5037668 DOI: 10.3390/ijms17091388] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to determine the effect of oral hormone therapy (HT) on oxidative stress (OS) in postmenopausal women with metabolic syndrome (MetS). A randomized, double blind, placebo-controlled trial was carried out. We formed four groups of 25 women each; healthy (HW) and MetS women (MSW) were assigned to HT (1 mg/day of estradiol valerate plus 5 mg/10 day of medroxiprogesterone) or placebo. We measured plasma lipoperoxides, erythrocyte superoxide dismutase and glutathione peroxidase, total plasma antioxidant status and uric acid, as OS markers. Alternative cut-off values of each parameter were defined and a stress score (SS) ranging from 0 to 7 was used as total OS. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Participants were seen at baseline, 3 and 6 months. After 6 months, MetS decreased in MSW-HT (48%), their triglycerides and high-density lipoprotein cholesterol (HDL-c) improved; in the other groups no difference was found. SS in MSW-HT decreased (3.8 ± 0.3 to 1.7 ± 0.3, p < 0.05) and OS was also reduced (44%), this effect was evident since 3 mo. HW-HT with high OS also decreased (40%). In placebo groups there was no change. Our findings suggest that HT improve lipids and OS associated to MetS in postmenopausal women.
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Affiliation(s)
- Martha A Sánchez-Rodríguez
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Guelatao No. 66, Col. Ejército de Oriente, Ciudad de México, México CP 09230, Mexico.
| | - Mariano Zacarías-Flores
- División de Ginecología y Obstetricia, Hospital General Dr. Gustavo Baz Prada, Instituto de Salud del Estado de México, Av. Bordo de Xochiaca esq. Adolfo López Mateos S/N, Col. Tamaulipas, Nezahualcóyotl, Estado de México, México CP 57300, Mexico.
| | - Lizett Castrejón-Delgado
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Guelatao No. 66, Col. Ejército de Oriente, Ciudad de México, México CP 09230, Mexico.
| | - Ana Karen Ruiz-Rodríguez
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Guelatao No. 66, Col. Ejército de Oriente, Ciudad de México, México CP 09230, Mexico.
| | - Víctor Manuel Mendoza-Núñez
- Unidad de Investigación en Gerontología, Facultad de Estudios Superiores Zaragoza, Universidad Nacional Autónoma de México, Guelatao No. 66, Col. Ejército de Oriente, Ciudad de México, México CP 09230, Mexico.
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Valéra MC, Chantalat E, Vinel A, Benoit T, Guillaume M, Game X, Gourdy P, Trémollières F, Payrastre B, Arnal JF. L’association estrogènes et modulateurs sélectifs du récepteur des estrogènes : un renouveau du traitement hormonal ? Presse Med 2015; 44:805-11. [DOI: 10.1016/j.lpm.2015.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 11/24/2022] Open
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Xu B, Lovre D, Mauvais-Jarvis F. Effect of selective estrogen receptor modulators on metabolic homeostasis. Biochimie 2015; 124:92-97. [PMID: 26133657 DOI: 10.1016/j.biochi.2015.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/24/2015] [Indexed: 12/22/2022]
Abstract
Selective estrogen receptor modulators (SERMs) are estrogen receptor (ER) ligands that exhibit either estrogen agonistic or antagonistic activity in a tissue-specific manner. The first and second generation SERMs, tamoxifen and raloxifene, are used for treatment of ER positive breast cancer and postmenopausal osteoporosis respectively. The third-generation SERM, bazedoxifene (BZA), effectively prevents osteoporosis while blocking the estrogenic stimulation in breast and uterus. Notably, BZA combined with conjugated estrogens (CE) in a tissue-selective estrogen complex (TSEC) is a new menopausal treatment. Postmenopausal estrogen deficiency predisposes to metabolic syndrome and type 2 diabetes, and therefore the effects of SERMs and TSECs on metabolic homeostasis are gaining attention. In this article, we summarize current knowledge about the impact of SERMs on metabolic homeostasis and metabolic disorders in animal models and postmenopausal women.
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Affiliation(s)
- Beibei Xu
- Department of Medicine, Section of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, USA
| | - Dragana Lovre
- Department of Medicine, Section of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, USA
| | - Franck Mauvais-Jarvis
- Department of Medicine, Section of Endocrinology and Metabolism, Tulane University Health Sciences Center, School of Medicine, New Orleans, LA, USA.
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Pazhekattu R, Lau AN, Adachi JD. The Tissue-Selective Estrogen Complex: A Review of Current Evidence. Rheumatol Ther 2015; 2:47-58. [PMID: 27747497 PMCID: PMC4883253 DOI: 10.1007/s40744-015-0013-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Indexed: 11/28/2022] Open
Abstract
The tissue-selective estrogen complex (TSEC) has recently entered the market for the treatment of postmenopausal osteoporosis, and is particularly targeted to women with significant vasomotor symptoms. This review appraises the evidence behind the only approved TSEC to-date, a combination of bazedoxifene and conjugated estrogens, with regards to its efficacy and relevant safety concerns. The majority of evidence that has led to its approval is derived from the SMART study. This large phase III trial with several substudies was aimed at discerning the effects of the TSEC on various estrogen-responsive tissues in comparison to raloxifene and placebo. Overall, the evidence thus far suggests a superior improvement in lumbar bone mineral density of 1.01% ± 0.28% as well as decrease in the frequency of hot flushes. Regarding safety concerns, endometrial thickness did not change over the treatment course, and investigators also identified a modest reduction in breast density. While there was no difference in rates of venous thromboembolism between treatment and placebo groups in a 2-year follow-up period, the effects of the drug on coagulation profiles are similar to those seen with hormone replacement therapy. Thus, the drug's effects on venous thromboembolism risk over a longer treatment course remain unclear. In conclusion, the actual efficacy of the TSEC for postmenopausal osteoporosis remains as yet undefined, given the lack of fracture prevention data. The evidence thus far does seem to suggest a beneficial effect on vasomotor symptoms and a generally favorable side effect profile. However, it should be noted that only one study has addressed this question thus far, and so the repeatability of the findings is still in question.
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Affiliation(s)
- Rinu Pazhekattu
- PGY1 Internal Medicine, McMaster University, Hamilton, ON Canada
| | - Arthur N. Lau
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Jonathan D. Adachi
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, ON Canada
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