Estrogen receptors and proliferation markers in primary and recurrent breast cancer.

To elucidate the clinical importance of estrogen receptor (ER) beta in breast cancer, 29 archival primary breast cancer specimens, six locally recurrent cancers, and five benign mammary tumors were examined histochemically for ERalpha, ERbeta and the proliferation markers Ki67 and cyclin A. In benign tumors, most epithelial cells contained ERbeta, but ERalpha was rare. In primary cancers, both ERalpha and ERbeta occurred in epithelial cells, the presence of ERbeta being associated with elevated expression of Ki67 and cyclin A, and ERalpha with decreased levels. Thus, the highest content of proliferation markers was seen in primary cancers that were ERalpha(-) ERbeta(+). Most Ki67-containing cells coexpressed ERbeta, but few showed ERalpha. In locally recurring cancers, ERalpha, ERbeta, and Ki67 were more highly expressed than in the corresponding primary tumors, and many cells containing ERbeta, but few with ERalpha, expressed Ki67. Surprisingly, ERbeta, but not ERalpha, was seen in the stromal cells of both primary and recurrent cancers. Because the response of breast cancers to tamoxifen therapy is correlated with the presence of ERalpha, cancer cells that lack ERalpha but contain ERbeta and proliferation markers represent a novel population of apparently proliferating cells that probably are not targeted by the current antiestrogens. Thus, appropriate ERbeta-specific ligands, perhaps in combination with tamoxifen, may be useful in improving the treatment of breast cancers.

A role for estrogen receptor beta in the regulation of growth of the ventral prostate.

In normal rats and mice, immunostaining with specific antibodies revealed that nuclei of most prostatic epithelial cells harbor estrogen receptor beta (ERbeta). In rat ventral prostate, 530- and 549-aa isoforms of the receptor were identified. These sediment in the 4S region of low-salt sucrose gradients, indicating that prostatic ERbeta does not contain the same protein chaperones that are associated with ERalpha. Estradiol (E(2)) binding and ERbeta immunoreactivity coincide on the gradient, with no indication of ERalpha. In prostates from mice in which the ERbeta gene has been inactivated (BERKO), androgen receptor (AR) levels are elevated, and the tissue contains multiple hyperplastic foci. Most epithelial cells express the proliferation antigen Ki-67. In contrast, prostatic epithelium from wild-type littermates is single layered with no hyperplasia, and very few cells express Ki-67. Rat ventral prostate contains an estrogenic component, which comigrates on HPLC with the testosterone metabolite 5alpha-androstane-3beta,17beta-diol (3betaAdiol). This compound, which competes with E(2) for binding to ERbeta and elicits an estrogenic response in the aorta but not in the pituitary, decreases the AR content in prostates of wild-type mice but does not affect the elevated levels seen in ERbeta knockout (BERKO) mice. Thus ERbeta, probably as a complex with 3betaAdiol, is involved in regulating the AR content of the rodent prostate and in restraining epithelial growth. These findings suggest that ligands specific for ERbeta may be useful in the prevention and/or clinical management of prostatic hyperplasia and neoplasia.

Estrogen receptor (ER) beta, a modulator of ERalpha in the uterus.

Many of the effects of estrogens on the uterus are mediated by ERalpha, the predominant ER in the mature organ. Because of the poor reproductive capacity of ERbeta knockout (BERKO) female mice (small litter size, multiple-resorbed fetuses), the role of uterine ERbeta was explored. In the immature uterus, ERalpha and ERbeta are expressed at comparable levels in the epithelium and stroma, and 17beta-estradiol (E(2)) treatment decreases ERbeta in the stroma. The immature uterus of untreated BERKO mice exhibits elevated levels of progesterone receptor (PR) and the proliferation-associated protein, Ki-67. It also exhibits exaggerated responsiveness to E(2), as indicated by enlargement of the lumen, increase in volume and protein content of uterine secretion, induction of the luminal epithelial secretory protein, complement C3, and its regulatory cytokine IL-1beta, and induction of vascular endothelial growth factor and insulin-like growth factor 1 but not its receptor. As expected, E(2) increased PR in the stroma and decreased it in the luminal epithelium of wild-type mice. In the BERKO uterus, E(2) induced PR in the stroma but did not down-regulate it in the epithelium. Increased cell proliferation and exaggerated response to E(2) in BERKO suggest that ERbeta plays a role in modulation of the effects of ERalpha and in addition (or as a consequence of this) has an antiproliferative function in the immature uterus.

Estrogen receptors alpha and beta in the rodent mammary gland.

An obligatory role for estrogen in growth, development, and functions of the mammary gland is well established, but the roles of the two estrogen receptors remain unclear. With the use of specific antibodies, it was found that both estrogen receptors, ERalpha and ERbeta, are expressed in the rat mammary gland but the presence and cellular distribution of the two receptors are distinct. In prepubertal rats, ERalpha was detected in 40% of the epithelial cell nuclei. This decreased to 30% at puberty and continued to decrease throughout pregnancy to a low of 5% at day 14. During lactation there was a large induction of ERalpha with up to 70% of the nuclei positive at day 21. Approximately 60-70% of epithelial cells expressed ERbeta at all stages of breast development. Cells coexpressing ERalpha and ERbeta were rare during pregnancy, a proliferative phase, but they represented up to 60% of the epithelial cells during lactation, a postproliferative phase. Western blot analysis and sucrose gradient centrifugation confirmed this pattern of expression. During pregnancy, the proliferating cell nuclear antigen was not expressed in ERalpha-positive cells but was observed in 3-7% of ERbeta-containing cells. Because more than 90% of ERbeta-bearing cells do not proliferate, and 55-70% of the dividing cells have neither ERalpha nor ERbeta, it is clear that the presence of these receptors in epithelial cells is not a prerequisite for estrogen-mediated proliferation.

Partial antagonism between steroidal and nonsteroidal antiestrogens in human breast cancer cell lines.

Nonsteroidal antiestrogens, such as tamoxifen, are well established in the treatment of breast cancer. The development of new steroidal compounds without partial agonist activity allows deeper insights into the mechanism of antiestrogen action, but thus far, the combined use of steroidal and nonsteroidal antiestrogens has not been studied extensively. We compared the nonsteroidal 4-trans-hydroxytamoxifen (OHT) with the two steroidal antiestrogens, ICI 182780 and RU 58668, in the estrogen receptor-positive human breast cancer cell lines MCF-7 and T47D. The effect of each compound alone or of OHT in combination with one of the steroidal antiestrogens was studied in regard to cell proliferation, expression of estrogen receptors (ERs) and progesterone receptors, and secretion of transforming growth factor beta2 (TGF-beta2). All antiestrogens examined led to enhanced secretion of TGF-beta2, which is correlated with their individual growth-inhibitory potential. OHT partially counteracts the larger growth inhibition of human breast cancer cells exerted by the steroidal antiestrogens ICI 182780 and RU 58668. Also, OHT antagonizes the higher induction of TGF-beta2 seen after treatment of MCF-7 cells with steroidal antiestrogens. The loss of ER and down-regulation of progesterone receptor under treatment with the steroidal antiestrogens is prevented by OHT, whereas the steroidal antiestrogens prevent the ability of hydroxytamoxifen to increase the ER content. These results indicate that TGF-beta2 is a marker of action for both types of compounds, but steroidal and nonsteroidal antiestrogens partially antagonize each other in blocking ER-mediated cellular events. It would appear that no additive or synergistic effect of the two types of antiestrogens can be expected in the treatment of breast cancer.

Cytokine-mediated enhancement of epidermal growth factor receptor expression provides an immunological approach to the therapy of pancreatic cancer.

The increased expression of epidermal growth factor receptor induced by tumor necrosis factor alpha renders pancreatic cancer cells more susceptible to antibody-dependent cellular cytotoxicity by a mAb specific for this receptor. Laboratory studies with athymic mice bearing xenografts of human pancreatic cancer cells demonstrated a cytokine-induced ability of the mAb to cause significant tumor regression. In a phase I/II clinical trial, 26 patients with unresectable pancreatic cancer were enrolled into three cohorts receiving variable amounts of the antibody together with a constant amount of tumor necrosis factor alpha. With increasing doses of antibody, the growth of the primary tumor was significantly inhibited. This was reflected by a longer median survival, with one complete remission lasting for 3 years obtained with the highest dose of antibody employed. Thus, a combination of the cytokine, tumor necrosis factor alpha, with a mAb to the epidermal growth factor receptor offers a potentially useful approach for the treatment of pancreatic cancer.

Steroid hormones, receptors, and antagonists.

In the thirty-odd years since the first demonstration of estrogen-binding components in reproductive tissues, much has been learned about the molecular details of steroid hormone action. Facts still to be elucidated include the precise mechanism by which interaction with the steroid disrupts the native receptor complex to generate an active transcription factor, just how this activated receptor enhances expression of target genes, and the role of phosphorylation in these events. The concept of receptor-medicated steroid hormone action has provided useful methods for predicting the risk of metastatic recurrence of breast cancers and the response of disseminated disease to endocrine therapy. Application of immunochemical techniques for receptor assay and elucidation of the role of mutant receptors in hormone resistance promise to increase the utility of these diagnostic procedures. A better understanding of the molecular details of steroid hormone antagonism should be helpful in the search for new and more effective agents for the endocrine control of breast cancers.

A new interpretation of antiestrogen action.

Despite differences in their pharmacological behavior, type I and type II antiestrogens have certain important properties in common. Both differ from estradiol in that they enhance the immunoreactivity of estrogen receptors, apparently by inducing conformational change that exposes an additional epitope for a particular monoclonal antibody. Moreover, both types of antihormones not only compete with estradiol for its binding to the receptor but they also react with another domain not recognized by the hormone. The binding capacity for either type of antiestrogen is nearly twice that for estradiol, providing definitive evidence for the existence of specific antiestrogen-binding sites that are postulated to be important in antagonist action. These findings suggest a unified two-site model which helps explain how the same substance can be both an agonist and an antagonist; why there may be species variations in the agonist/antagonist relationship of type I compounds; and why type II agents show only antagonistic properties. It is suggested that interaction with secondary, antagonist-specific binding sites may provide a useful screen in the search for new and improved antihormonal agents.

Steroid hormone receptors.

In the three decades since the original discovery of receptors for steroid hormones, much has been learned about the biochemical processes by which these regulatory agents exert their effects in target tissues. The intracellular receptor proteins are potential transcription factors, needed for optimal gene expression in hormone-dependent cells. They are present in an inactive form until association with the hormone converts them to a functional state that can react with target genes. Transformation of the receptor protein to the nuclear binding form appears to involve the removal of both macromolecular and micromolecular factors that act to keep the receptor form reacting with DNA. Much of the native receptor is present in the nucleus, loosely bound and readily extractable, but for some and possibly all steroid hormones, some receptor is in the cytoplasm, perhaps in equilibrium with a nuclear pool. Methods have been developed for the stabilization, purification, and characterization of receptor proteins, and through cloning and sequencing of their cDNAs, primary structures for these receptors are now known. This has led to the recognition of structural similarities among the family of receptors for the different steroid hormones and to the identification of regions in the protein molecule responsible for the various aspects of their function. Monoclonal antibodies recognizing specific molecular domains are available for most receptors. Despite the knowledge that has been acquired, many important questions remain unsolved. How does association with the steroid remove factors keeping the receptor protein in its native state, and how does binding of the transformed receptor to the response element in the promoter region enhance gene transcription? Once it has converted the receptor to the nuclear binding state, is there a further role for the steroid in modulating transcription? Still not entirely clear is the involvement of phosphorylation and/or dephosphorylation in hormone binding, receptor transformation, and transcriptional activation. Less vital to basic understanding but important in the overall picture is whether the native receptors for gonadal hormones are entirely confined to the nucleus or whether there is an intracellular distribution equilibrium. With the effort now being devoted to this field, and with the application of new experimental techniques, especially those of molecular biology, our understanding of receptor function is progressing rapidly. The precise mechanism of steroid hormone action should soon be completely established.

Binding of antiestrogens exposes an occult antigenic determinant in the human estrogen receptor.

Treatment of human breast cancer cytosol with tamoxifen (Tam) or 4-monohydroxytamoxifen (MHT) enhances the immunoreactivity of the estrogen receptor toward monoclonal antibody H222 but not monoclonal antibodies D547 or D75. This effect is evident from an increase in the apparent receptor content measured by the Abbott enzyme immunoassay, which uses peroxidase-labeled H222 as the chromogenic marker, and in the rate and size of the sedimentation peak of the immune complex of the receptor with radiolabeled H222. In contrast, MHT shows no effect in reversed immunoassay systems that use peroxidase-labeled D547 or D75 as chromogenic markers, nor does it affect the sedimentation peak of the complex of D547 with the receptor. MHT can exert its action on receptor bound to immobilized antibody. These results indicate that reaction with antiestrogens causes a change, probably conformational, in the receptor protein that exposes an occult antigenic determinant recognized uniquely by H222. Since this can occur in cytosol previously treated with excess estradiol in the cold, it appears to result from an interaction of antiestrogens with a region of the receptor distinct from the estrogen-binding site, suggesting that agonist and antagonist actions may involve different parts of the receptor molecule.

Immunochemical studies of estrogen receptors.

The preparation of specific antibodies, and especially monoclonal antibodies, to human estrophilin has furnished a means of detecting and studying receptor localization, structure and function, independent of its ability to bind labeled steroid. These reagents have been especially useful in providing improved methods for the determination of estrogen receptors in human breast cancers, as a guide to clinical prognosis and therapy, and in facilitating the cloning of estrophilin cDNA leading to an elucidation of the aminoacid sequence of the receptor molecule.

Immunocytochemical assay for estrogen receptor: relationship to outcome of therapy in patients with advanced breast cancer.

We have used an immunoperoxidase technique utilizing a monoclonal antibody to the estradiol receptor to identify immunoreactive estradiol receptor in breast carcinomas and have examined the relationship between the immunoreactive estradiol receptor and response to therapy in patients with advanced breast cancer. Fifty-six patients were found to be assessable for response to endocrine therapy. Twenty-two showed an objective response to some form of endocrine manipulation, and all these had positively stained carcinomas. None of the 17 patients with negatively stained carcinomas responded to endocrine therapy. We conclude that the monoclonal antibody to estradiol receptor can help identify breast cancer patients who may respond to endocrine therapy.

A controlled pore glass bead assay for the measurement of cytoplasmic and nuclear glucocorticoid receptors.

An assay for the quantitation of cytoplasmic and nuclear glucocorticoid receptors in lymphoid tissue has been developed using controlled pore glass (CPG) beads. Soluble receptor--3H-steroid complex (cytosol or nuclear extract) is adsorbed quantitatively within the crevasses of porous glass beads. Excess labeled steroid as well as most non-specifically bound steroid is easily washed away, leaving the hormone-receptor complex retained by the beads. Bound 3H-steroid is eluted with ethanol and measured for radioactivity. This procedure which is simple, rapid, and highly reproducible is carried out using frozen samples (stable for many months) containing as few as 1 X 10(7) cells. A comparison of the CPG assay to dextran coated charcoal and a whole cell assay demonstrates that CPG and dextran coated charcoal give equivalent measurements of cytosolic receptor concentration, while the CPG and whole cell assays provide equivalent values for total receptor content.

Comparison of immunocytochemical and steroid-binding assays for estrogen receptor in human breast tumors.

An estrogen receptor immunocytochemical assay which uses monoclonal antibodies to the estrogen receptor protein [Nature (Lond.), 307: 745-747, 1984] was applied to several human tissues, including human breast tumors, and the results were compared to those of steroid-binding assays performed on cytosol extracts of the same tissues. Specific immunoperoxidase staining in fixed, frozen sections was confined to the nucleus of selected cell populations within each tissue examined. In 117 human breast cancers, the presence or absence of nuclear staining was significantly associated with the concentration of cytosolic estrogen receptor. Thirty-eight estrogen receptor immunocytochemical assay-positive tumors were further assessed for several quantifiable features of the staining, including intensity, cellularity, and the proportion of tumor cells stained. Of these, epithelial cellularity showed the highest degree of correlation with the results of steroid-binding assays.

Differences between estrogen- and antiestrogen-estrogen receptor complexes from human breast tumors identified with an antibody raised against the estrogen receptor.

Radiolabeled estrogens 17 beta-[3H]estradiol and diethylstilbestrol ( [3H]DES) and the antiestrogen [3H]monohydroxytamoxifen ( [3H]MHT) all bind with high affinity to the extranuclear estrogen receptor (ER) from the MCF-7 human breast tumor cell line (Kd = 3 X 10(-10), 2 X 10(-10), and 0.63 X 10(-10) M, respectively). A polyclonal antibody raised in a goat to the calf nuclear ER selectively decreased the binding affinity and number of binding sites for 17 beta-[3H]estradiol, but did not appear to affect these binding parameters for [3H]MHT. In the presence of goat antibody, the binding of the nonsteroidal estrogen DES was so perturbed that it was not possible to quantitate the decreased number of binding sites or affinity of this compound as assessed by Scatchard saturation analysis. These results were confirmed in human breast tumor cytosols by sucrose density gradient analysis. The binding of 17 beta-[3H]-estradiol and [3H]DES to the ER was significantly reduced by preincubation with the polyclonal antibody, whereas the binding of [3H]MHT was reduced only when the tumor cytosol was preincubated with a very high concentration of antibody. At these concentrations of antibody, the binding of 17 beta-[3H]estradiol and [3H]DES to the receptor was prevented completely. In contrast, when the antibody was added to the tumor cytosol after the 3H-ligand had bound to the receptor, the binding properties of all 3H-ligands were unaffected. The [3H]MHT-ER antibody complex consistently sedimented as a higher-molecular-weight complex on sucrose density gradients than did the corresponding estrogenic complexes. The decrease in the affinity of estrogenic ligands can be explained in part by an increase in the dissociation rate at 4 degrees of these compounds from the ER. The dissociation rate of MHT was unaffected by the goat antibody. These results imply that there are important differences in the binding of antiestrogen and estrogens to the tumor cytosol ER. A ligand-binding model is proposed that may aid in the understanding of antiestrogen action.