Effects of tamoxifen on endometrial estrogen and progesterone receptor concentrations in women with fibrocystic disease of the breast

Tamoxifen up-regulates oestrogen receptor-alpha, c-fos and glyceraldehyde 3-phosphate-dehydrogenase mRNAs in ovine endometrium

Tamoxifen, the antiestrogen most widely used in medicine, was tested in ewes to determine whether it antagonizes oestradiol up-regulation of ER, PR, and other genes reported to be oestrogen-modulated (c-fos, oxytocin receptor (OTR), glyceraldehyde phosphate dehydrogenase (GAPDH), and apolipoprotein AI (apo AI)) in endometrium and liver. Ovariectomized ewes (n = 6 ewes per group) were injected with 20 mg tamoxifen (Tam) 24 h prior to tissue collection, 50 microg oestradiol (E2) 18 h prior to tissue collection, both drugs (T + E2) or drug vehicle (Con). E2 treatment resulted in 857 +/- 93 pg oestradiol/g endometrium. Gross uterine characteristics of Tam- and T + E2-treated ewes were intermediate to those in Con and E2 groups. In endometrium, Tam treatment mimicked E2 treatment in up-regulating ER, c-fos, and GAPDH mRNAs two- or three-fold. However, neither E2 nor Tam treatments affected concentrations of OTR mRNA in endometrium, or ER, c-fos, GAPDH, OTR and apo AI mRNAs in liver. Like oestradiol, tamoxifen stabilized endometrial ER mRNA more than 3-fold in endometrial explants cultured with the transcription inhibitor 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB). Thus, tamoxifen acts as an oestradiol agonist in ovine endometrium and shares a posttranscriptional mechanism with oestradiol in the up-regulation of ER gene expression.

Alterations in steroid hormone receptors in the tamoxifen-treated endometrium

OBJECTIVE

Our purpose was to evaluate whether tamoxifen has estrogenic endometrial effects as defined by histologic study or alterations in steroid hormone receptor expression.

STUDY DESIGN

Nineteen postmenopausal tamoxifen-treated breast cancer patients who also had endometrial sampling were identified from files in the Department of Obstetrics and Gynecology. To examine the subgroup of 15 polyps, age-matched, non-hormonally treated patients with polyps (n = 8) or atrophic endometria (n = 5) served as comparison groups. Proliferative (n = 3) and secretory (n = 5) endometria served as procedural controls. Immunohistochemical studies for steroid receptors (estrogen, progesterone) were performed.

RESULTS

Glandular cell progesterone receptor was significantly increased and stromal cell estrogen receptor was significantly decreased in tamoxifen-treated versus atrophic endometria. Progesterone receptor staining was not significantly different in tamoxifen-treated versus control polyps, although staining was high in both groups. Stromal cell estrogen receptor staining was significantly reduced in tamoxifen-treated versus control polyps, although there were no histologic differences. Reduced stromal cell estrogen receptor and increased glandular cell progesterone receptor staining was found in all tamoxifen-treated endometria regardless of the diagnosis.

CONCLUSION

The tamoxifen-associated changes in endometrial steroid receptors support an estrogenic effect that is independent of histologic diagnosis and duration of use. This may contribute to the pathogenesis of tamoxifen-associated polyps and carcinomas.