| LE Magazine October 2004 | |||||||
 | |||||||
| What You Don't Know About Estrogen | |||||||
There are many misconceptions about what estrogen really is and how it works in the body. This widespread confusion exists in the minds of the lay public as well as the medical community. The result is poor choices being made about what women should be doing to maintain youthful hormone balance while also protecting against cancer.
This article uncovers the basic facts about estrogen that are so often overlooked by doctors today. It then reveals dietary modifications that women should consider if they are taking an estrogen drug. The science underlying this article is extremely complex. In order to make this information comprehensible to the lay reader, we have made a special effort to translate these new findings about estrogen metabolism into a version that most people will understand.
Nevertheless, some people may have difficulty understanding a few technical areas of this article. This information is so critically important, however, that we urge you to re-read paragraphs you do not understand in order to gain a full grasp of these crucial anticancer concepts.
The word estrogen strikes fear into the hearts of many. Women equate it with breast cancer, scientists equate it with “endocrine disruptors,” and doctors equate it with hormone replacement. Are these perceptions accurate?Estrogen is many things. It includes the body’s natural estrogenic hormones and things that look like the body’s natural hormones. As long as something behaves like an estrogen in the body, it is an estrogen, or is, quite simply, “estrogenic.” The strongest natural estrogen in the human body is estradiol. Premarin® is an example of an unnatural estrogen—unnatural, at least, to the human body. It is made from estrogens excreted in the urine of pregnant horses. Chemical estrogens that behave badly once they are inside the body are known as “endocrine disruptors” for their adverse effects on development. All of these estrogens interact with the body’s innate hormonal system. They do not, however, provoke the same responses.
“Estrogen receptors” are rarely talked about unless a woman is diagnosed with breast cancer (or a man with prostate cancer), but they are critical to how an estrogen behaves. For example, tamoxifen is a “known human carcinogen” due to its estrogenic effects, yet it is marketed as an “estrogen blocker” because of its estrogen-blocking effects. It has beneficial effects on bone, but negative effects on the circulatory system.1,2 It blocks estrogen-driven breast cancer growth temporarily, yet later becomes estrogenic in the same tissue, promoting new breast cancer. How can one “estrogen” do all these things? The answer is, partly, estrogen receptors, which are proteins in the body that react to estrogen. Estrogen is like fuel, and estrogen receptors are like machines. When fuel meets machine, things happen. Unfortunately, what happens depends on which area of the body is in question. The receptors of different parts of the body are different. In other words, although all the machinery runs on some type of estrogen, not all the machinery does the same thing. Estrogen does different things in different parts of the body. It does one thing in the brain and another in the breast. It might surprise you to learn, for example, that the pituitary gland is second after the uterus as the most estrogen-responsive area of the body.3 So it is not accurate to think of estrogen as the thing that makes breast cancer cells grow. Just a few years ago, researchers believed that there were two types of estrogen receptors: alpha and beta. That made things fairly simple. Estrogen hits receptor alpha and Y happens. Research focused mostly on the strong estrogen—estradiol—and it seemed that progress could be made in understanding how estrogen affects at least breast tissue, though strange things continued to happen, such as the estrogen “blocker” tamoxifen causing the growth of tamoxifen-dependent cancers. With the discovery of a much larger picture, those days are over and a lot of research is now out the window. As a researcher at Columbia recently lamented, “where will it end?”4 There is more to it than anyone ever imagined. The Plot Thickens It has now been discovered that there is an entire new class of estrogen receptors called estrogen-receptor-related receptors. These receptors do not respond to the body’s natural estrogen.5,6 They are instead activated by xenoestrogens (estrogens from the outside, or from the environment).7 Pesticides and tamoxifen are two examples of xenoestrogens that activate estrogen-receptor-related receptors.8,9 The extraordinary thing about these receptors is that they represent a whole new class of estrogen machinery, previously unknown. Not only can these receptors do everything the estrogen receptors that respond to “natural” estrogen can do, but they also have a major impact on how an estrogen—any kind of estrogen—behaves.6 The discovery of this new class receptors will enable researchers to understand, for the first time, how environmental estrogens (“endocrine disruptors”) interfere with the body’s normal metabolism, and to better define the use of natural estrogen. Estradiol Stops Cancer Cell Growth How can this “strong” hormone—estradiol—stop hormonally responsive cancer cells from multiplying? The answer to that question first appeared in the Journal of the National Cancer Institute,10 and has been known since at least 1977.11 The cancer cells that estradiol stopped from growing had been treated with tamoxifen. Tamoxifen works two to five years after breast cancer treatment to block estrogen and prevent cancer recurrence, and then usually does the opposite.12-14 When it starts doing the opposite of what it is supposed to do, so does estradiol. How can this puzzle be solved? In 2001, researchers reported for the first time that tamoxifen breakdown products interact with one of the newly discovered estrogen-receptor-related receptors, and keeps it from activating certain genes normally activated by estrogen.8,15 This opened a whole new vista for understanding how tamoxifen and other synthetic estrogens work. Important clues have already been found. Estrogen Cofactors Discovered In addition to interacting with estrogen-receptor-related receptors, tamoxifen and other xeno-estrogens interact with yet another new discovery. In the laboratory, researchers can get estrogen, by itself, to activate estrogen receptors. In other words, in a laboratory setting, any estrogen fuel will activate the estrogen machinery and set things in motion. In real life, this does not happen. In real life, estrogen is only one of many factors that coordinate as a group to activate estrogen receptors. The body makes proteins known as “coactivators” and “corepressors.” These proteins attach themselves to estrogen and other hormones such as thyroid, creating big, complex “globs.” It is these globs—not estrogen alone—that activate or suppress what was previously attributed to estrogen alone. In other words, studies showing what an estrogen does in the laboratory may have little to do with what actually occurs in the human body; in real life, other proteins run the show. This is bold new territory for hormone research. Here is an example of just how important these coactivator and corepressor proteins are in determining how estrogen behaves. Corepressor SSN6 blocks estrogen’s effects in cells. In other words, the SSN6 protein shuts the machinery down. The estrogen fuel can be available (estrogen could be floating all around), but the machinery will not start as long as corepressor SSN6 is working. It neutralizes the effects of estrogen. If something interferes with this protein, however, instead of dampening the effects of estrogen, it enhances them. In addition, estrogen blockers turn into estrogen enhancers.16 Sound familiar? The importance of coactivators and corepressors cannot be overstated. They interact with both estrogen receptors and the newly discovered estrogen-receptor-related receptors. As you will soon read, there may be natural ways for women to regulate these “coactivators” in a manner that reduces breast cancer risk.
The three principal types of estrogen manufactured by the human body are estradiol (17 beta-estradiol), estriol, and estrone. Estradiol is the most feared because it is the strongest and is associated with the growth of cancer cells. Estrone is a metabolite of estradiol, and is less potent. Estriol is another metabolite, but is considered so mild mannered that it is recommended as a safe hormone replacement.17-19 In addition, the human body contains 11 other estradiol metabolites that hardly anyone ever mentions. Premarin® and Prempro™ are drugs made of 17 beta-estradiol and more than a dozen estrogen metabolites from horses.20 These manmade drugs should not be confused with any estrogen manufactured by the human body, with other estrogen drugs, or with estrogen in general. The data from studies of women taking these drugs cannot, and should not, be extrapolated to other hormone replacement drugs or therapy. This is an important point: Premarin® is not estrogen, but instead is an estrogen—one of many estrogens. Different estrogens produce different effects. The manufacturer of Premarin® and Prempro™ has argued that its horse estrogens have unique effects in humans, and undoubtedly they do. Dozens of studies demonstrate important differences between the effects of Premarin® on the human body and the effects of other estrogen products. Transdermal estradiol, for example, may decrease triglycerides and LDL oxidation, whereas Premarin® may do the opposite.21 Premarin® may increase C-reactive protein (a negative for the heart) while transdermal estradiol may not.22 Changing from Premarin® to transdermal estradiol may reduce triglycerides significantly.23 Estrogen patches may reduce blood pressure, whereas oral estrogen may not.24 These and dozens of other studies show different effects depending on which estrogen drug is being evaluated. Not only are there differences between Premarin®/Prempro™ and other drugs, but there are differences between other drugs as well.
Japanese women have been reported to have higher levels of estradiol in their blood than Americans, yet they have a much lower risk of breast cancer.25,26 Why? Researchers believe it has more to do with environmental factors than genetics. When Japanese and other Asians adopt a Western lifestyle, risk increases.27,28 The Asian diet may contain things that modulate the response to estrogen, and strong evidence indicates that how the body handles estrogen is far more important than how much estrogen it handles. Research indicates significant differences between Japanese and Western women in their number of estrogen receptors and in their response to xenoestrogens.29-31 These differences suggest the involvement of the newly discovered estrogen coregulators. Dietary factors can activate or deactivate these factors, which means that every woman can regulate her own estrogen, to a certain extent. Researchers have extensively investigated three aspects of the Asian advantage: soy, vegetables, and green tea. Each is associated with a dramatically lower risk of breast cancer. Drinking 36 ounces of soy milk a day can reduce levels of estradiol by 20-27% within weeks.32,33 Soy contains isoflavones that neutralize “strong” estrogens, converting them to estrogen metabolites that protect against breast cancer.34 When mice implanted with human breast tumors were given soy concentrate and green tea, tumor size was reduced by 72%.35 Estrogen receptor alpha was also reduced, an indication that the combination of soy and green tea was working at the genetic level, probably with estrogen cofactors. Forty milligrams of isoflavones a day significantly decreased “strong” estrogen levels in women, according to a study from the H. Lee Moffitt Cancer Center in Tampa, FL.36 These are only a few of the many studies demonstrating the beneficial effects of soy. In another experiment that shows the hormonal benefits of soy on the effects of chemical estrogens, when female monkeys were given birth control pills, their cortisol shot up, and their DHEA and testosterone plummeted. When they were given Premarin®, the same thing happened. When the monkeys were given soy protein with isoflavones, however, their hormones normalized.37 Several years ago, there was concern about genistein, an isoflavone in soy, when research showed that it activated estrogen-related genes. Some people took this to mean they should avoid consuming soy, which would be unfortunate given the overwhelmingly positive data about soy’s benefits to humans. Genistein has been called the “good estrogen” for its beneficial effects against estrogen-responsive breast cancer.38 It subsequently emerged that most of the negative research on genistein was generated by one researcher, under conditions that would not exist in real life (such as extremely high levels of genistein put into cancer cells that were deprived of all other estrogen). " The human body manufactures estrogen as a necessary component in many processes; estrogen is always in the body, even in postmenopausal women. Copper, too, is always in the body and is another example of something that can distort the way genistein behaves in a test tube.39 Researchers at the University of California, Davis, recently did the same test tube study on genistein and produced the same negative results. They then put genistein in a test tube with the cancer cells and environmental estrogens. The result showed that genistein suppressed cancer cell growth.40 These studies on pure genistein, however, do not accurately reflect what occurs in a complex environment such as the human body. Fortunately, the safety of soy isoflavones (including genistein) for human consumption has been confirmed by experiments with monkeys, the experimental model closest to humans.41 Monkeys treated for three years with soy or soy minus its isoflavones exhibited no abnormal cell growth; in fact, the result was just the opposite. The researchers concluded, “These findings suggest that high dietary levels of soy isoflavones do not stimulate breast or uterine proliferation in postmenopausal monkeys and may contribute to an estrogen profile associated with reduced breast cancer risk.” In addition, a new study clarifying the estrogenic effects of genistein on the uterus found that genistein may enhance cell growth for a few days, but then the effect stops. This is a new finding, and the results are different from those for estrogen drugs that perpetuate growth indefinitely.42 With any luck, issues surrounding how genistein behaves will be soon resolved. It is important to remember that genistein also blocks the growth of estrogen-receptor-negative breast cancer cells. By incorporating soy and isoflavones in her diet, a woman can potentially stop breast cancer before it develops.43 The one caveat is that genistein may interfere with tamoxifen, and thus should not be taken by itself with that drug.44 One of the most exciting new findings is that genistein keeps amyloid from killing brain cells (without any negative effects on uterine cells), and has been suggested as an alternative to synthetic estrogens for the prevention ofAlzheimer’s disease.45 Studies of the popular estrogen drugs Premarin® and Prempro™ show that they may actually increase the risk of dementia.46 Everybody knows that vegetables are good for you, and they are especially good for women who want to avoid breast cancer. Vegetables enable the body to rid itself of excess estrogens. Meat eaters have about 50% more estradiol and estrone in their blood than do vegetarians.47 Women who eat the most vegetables, beans such as lentils, and fiber reduce their risk of breast cancer risk by 50%.48 As you will read next, compounds found in vegetables favorably affect the way estrogen behaves in the body.
The way estrogen is metabolized is critical to how it behaves. Fortunately, we can do more than cross our fingers and hope for the best. Certain compounds found in plants turn harmful estrogen into a more beneficial version. Chief among them is indole-3-carbinol (I3C), a phytochemical found in cruciferous vegetables such as broccoli. In China, where the risk of breast and prostate cancers is minuscule, consumption of cruciferous vegetables is more than three times that of the US.49 I3C helps convert “strong” estrogens into benign or even helpful estrogens such as 2-hydroxyestrone.50,51 It also acts very much like tamoxifen in blocking undesirable estrogenic effects in breast cancer cells, and its antiestrogen effects are enhanced with genistein.52 When digested, I3C is converted to other substances, including diindolylmethane (DIM). Some earlier research suggested that I3C’s beneficial effects were due to DIM. New research shows this is not the case, and that there are important differences in the effects of I3C and DIM on the metabolism of estrogen. Researchers recently stated, “This finding [of I3C’s effects] is inconsistent with the claim that DIM is the biologically active metabolite of I3C with regard to its antiestrogenicity.” DIM does not increase beneficial 2-hydroxylation of estrogen (at least in rats), but it does lower harmful 4- and 6-hydroxylations.53 By contrast, I3C, which partially converts to DIM during digestion, affects all three in a positive way. Moreover, DIM does not have the anti-estrogen effects of I3C.54 Another potential supplement for breast cancer prevention that has drawn a lot of interest is melatonin. Melatonin is associated with sleep because it builds up during the night, but it may ultimately end up being more associated with estrogen than with sleep. Studies show that melatonin plays a major role in how estrogen behaves. In estrogen-receptor-positive breast cancer cells, melatonin can bring cell growth to a halt.55 Research indicates that melatonin controls estrogen, and vice versa.55-57 In studies of rodents, melatonin shows great promise with regard to its ability to prevent breast cancer when given continuously, before and after exposure to a carcinogen, and when given to mice with the HER2/neu genetic alteration.58,59 Researchers have been unsuccessful in correlating blood levels of melatonin with breast cancer.60 This reflects melatonin’s complexity as a hormone that, like estrogen, comes in various forms and has several receptors. Without a doubt, melatonin plays a major role in breast cancer through its effects on estrogen and other cancer-related phenomena. As an antioxidant, melatonin is not only powerful but also unique. Unlike vitamin E, which essentially has no further effects after it scavenges a radical, when melatonin gets a radical, it creates a new melatonin antioxidant; that is, it self-perpetuates. It also cooperates with other antioxidants like vitamins C and E.61 Antioxidants are very important in preventing cancer, and it has been reported that free radicals can activate or deactivate genes that are involved in breast cancer.62
Breast cancer is a serious concern for most women. Understanding that there are different types of estrogen, that different estrogens have different effects, and that women can, to a certain degree, control their own estrogen (through dietary modification and supplement use) will help women make informed choices about estrogen exposure and reduce their risk of breast cancer. Recent discoveries about estrogen receptors and how they interact may finally unlock the mysteries of how estrogens work, and provide the basis for nontoxic treatment and effective prevention." for more information see http://www.lef.org/Magazine/2004/10/report_estrogen/Page-02 |
Saturday, December 27, 2014
What You Don't Know About Estrogen
"What You Don't Know About Estrogen
Location of endo and pain felt
I am trying to decipher old notes about the location of endo or associated affected sites (i.e. muscles like the obturator and piriformis) and where the pain can be felt. Please correct and add! (And don't get me started on if it's the lesion itself or its effect on nerve growth, angiogenesis, prostaglandins, cytokines, etc etc!!)
So far I have:
Obturator internus- hip pain
Levator ani- rectal pain
Uterosacral ligaments- low back and SI joint (hard to differentiate from US endo vs adeno), down legs, painful sex
Round ligament- groin or lateral lower quadrant
Side wall of pelvis- pain or cramps radiating down the leg
Posterior cul de sac- low back, pain with/after sex, GI symptoms, pain with defecation (esp. during menstruation), sits on the piriformis muscle and can cause spasms and sciatic type pain
Recto-vaginal septum- low back
Bladder- functional urinary tract symptoms
Hip issues and pelvic obliquities (like pelvis torsion where the hips are not level) can cause piriformis spasm
"The most common physical finding is discomfort during the pelvic examination, particularly with stretching of the uterosacral ligaments and palpation of the posterior cul-de-sac. There may be some induration or nodularity of the uterosacral ligaments and in severe cases there may be a very firm palpable mass in the posterior vaginal fornix." http://www.parkhurstexchange.com/clinical-review/feb09-endometriosis
“What is most interesting is that right-left orientation of the pelvis does not exist in some patients. That is to say, palpation of a lesion of endometriosis on the left side of the pelvis may produce pain that the patient perceives as being on the right side of the abdomen, and the opposite is also true.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015350/
Pelvic Congestion Syndrome
"Which Options Are Best for Pelvic Congestion Syndrome?
Which Options Are Best for Pelvic Congestion Syndrome?
Pelvic congestion syndrome (PCS) is a poorly understood and often overlooked etiology of chronic pelvic pain. Millions of women worldwide may develop chronic pelvic pain at some time in their life, and the occurrence may be as high as 39.1%.1
Chronic pelvic pain can be debilitating and accounts for 10% to 15% of all gynecologic visits.1 Managing this complex condition can be a challenge for the primary-care provider. When clinical and ultrasound examinations are normal, further diagnostic imaging can helpful to obtain the diagnosis. Once identified, PCS can be treated successfully with embolization therapy.
PCS is associated with dilated pelvic varices with reduced venous clearance, most often as a result of retrograde flow in an incompetent ovarian vein. The condition is seen more often in multiparous premenopausal women. A relationship between PCS and endogenous estrogen levels is suggested, as estrogen is known to weaken the vein walls.1
The venous congestion stretches the inner surface of the ovarian vein, distorting both the endothelial and smooth-muscle cells. It is postulated that kinking of the ovarian vein leads to venous stasis, flow reversal, and subsequent varicosities.2 PCS can also be caused by external compression, such as that seen in nutcracker syndrome (compression of the left renal vein between the aorta and superior mesenteric artery) and May-Thurner syndrome (compression of the left iliac vein beneath the iliac artery).
PCS is not easy to diagnose. Women typically complain of a dull, throbbing and achy pain in the vulvar region. This pain often worsens during or after intercourse or just before the onset of menses and/or increases throughout their day. Typically, women with PCS will not be symptomatic in the morning but will become so with prolonged standing or sitting.
The typical PCS patient may or may not have vulvar varicosities but often has varicose veins with the left leg presenting greater than the right. The varicosities usually extend along the medial aspect of the medial to posterior upper thigh and along the buttocks.
Making the diagnosis more challenging is the vast array of the associated symptoms, including cyclic pain (with menstrual periods), dyspareunia, bladder irritability, GI symptoms and low back pain. Hemorrhoids and/or varicose veins of the perineum, buttocks or lower extremities may also be noted.1 Ovarian point tenderness on examination with a history of postcoital ache is said to be 94% sensitive and 77% specific for PCS.3
PCS is often diagnosed in women younger than age 45 years who have had more than one pregnancy. The ovarian veins increase in size during each pregnancy and do not return to normal in women with PCS. PCS is rarely diagnosed in nulliparous women."
Chronic pelvic pain can be debilitating and accounts for 10% to 15% of all gynecologic visits.1 Managing this complex condition can be a challenge for the primary-care provider. When clinical and ultrasound examinations are normal, further diagnostic imaging can helpful to obtain the diagnosis. Once identified, PCS can be treated successfully with embolization therapy.
Etiology
PCS is associated with dilated pelvic varices with reduced venous clearance, most often as a result of retrograde flow in an incompetent ovarian vein. The condition is seen more often in multiparous premenopausal women. A relationship between PCS and endogenous estrogen levels is suggested, as estrogen is known to weaken the vein walls.1
The venous congestion stretches the inner surface of the ovarian vein, distorting both the endothelial and smooth-muscle cells. It is postulated that kinking of the ovarian vein leads to venous stasis, flow reversal, and subsequent varicosities.2 PCS can also be caused by external compression, such as that seen in nutcracker syndrome (compression of the left renal vein between the aorta and superior mesenteric artery) and May-Thurner syndrome (compression of the left iliac vein beneath the iliac artery).
Clinical Presentation
PCS is not easy to diagnose. Women typically complain of a dull, throbbing and achy pain in the vulvar region. This pain often worsens during or after intercourse or just before the onset of menses and/or increases throughout their day. Typically, women with PCS will not be symptomatic in the morning but will become so with prolonged standing or sitting.
The typical PCS patient may or may not have vulvar varicosities but often has varicose veins with the left leg presenting greater than the right. The varicosities usually extend along the medial aspect of the medial to posterior upper thigh and along the buttocks.
Making the diagnosis more challenging is the vast array of the associated symptoms, including cyclic pain (with menstrual periods), dyspareunia, bladder irritability, GI symptoms and low back pain. Hemorrhoids and/or varicose veins of the perineum, buttocks or lower extremities may also be noted.1 Ovarian point tenderness on examination with a history of postcoital ache is said to be 94% sensitive and 77% specific for PCS.3
PCS is often diagnosed in women younger than age 45 years who have had more than one pregnancy. The ovarian veins increase in size during each pregnancy and do not return to normal in women with PCS. PCS is rarely diagnosed in nulliparous women."
Please see http://www.empr.com/which-options-are-best-for-pelvic-congestion-syndrome/article/313701/ for more.
Thursday, December 25, 2014
Addback therapy shows no difference in 24 month follow up
When you sit down to talk with your doctor about treatment for endometriosis or adenomyosis or what have you, keep this in mind if they mention Lupron, Zoladex, or any of the GNRH medications:
"Gonadotrophin-releasing hormone analogues for endometriosis: bone mineral density.
Abstract
BACKGROUND:
OBJECTIVES:
SEARCH STRATEGY:
SELECTION CRITERIA:
DATA COLLECTION AND ANALYSIS:
MAIN RESULTS:
REVIEWER'S CONCLUSIONS:
Saturday, December 13, 2014
The Complex Role of Estrogens in Inflammation
The Complex Role of Estrogens in Inflammation
"There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox.
"Estrogens influence systemic response systems by reducing the cytokine-stimulated ACTH and cortisol release, by increasing substance P signaling and sensitization to painful stimuli (increase of neurogenic inflammation), and by increasing signaling through proinflammatory α-adrenergic pathways (Fig. 4). These estrogen effects can partly explain the sexual dimorphism in chronic inflammatory diseases."
"In conclusion, immune stimuli (foreign antigens or autoantigens) and respective immune responses, the cell types involved (not only immune cells), the target organ, the reproductive status in a woman and timing of E2 administration in relation to the disease process, concentration of estrogens (dual effects), expression of ERα and ERβ (and their isoforms) depending on the microenvironment and the cell type, and intracellular metabolism of estrogens all play important roles in inflammatory diseases. In addition, systemic supersystems such as the HPA axis, the sensory nervous system, and the SNS can be influenced by estrogens to establish a proinflammatory milieu.
This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned influencing factors. This review also explains that a uniform concept for the action of estrogens cannot be found for all known chronic inflammatory diseases (Figs. 3 and 5). Nevertheless, for strictly B cell-dependent diseases such as those shown in Fig. 5, the female to male preponderance can be explained by the propagating effects of estrogens (but possibly also of progesterone). The smaller the influence of B cells and the bigger the weight of T cells and other cells, the less evident is the sex dimorphism in chronic inflammatory diseases (Fig. 5). In addition, because men never experience high estrogen (or progesterone) levels like women during pregnancy, the apparent gender dimorphism of chronic inflammatory diseases during the reproductive period of women can be explained. In addition, and this was not reported here, higher androgen levels in men most often exert inhibitory effects on many immune phenomena, which is an other important argument for why women with low androgen levels are protected from infectious diseases but more prone to B cell-dependent autoimmunity. Finally, we should not forget that sexual dimorphism of diseases may also depend on factors independent of sex hormones (588)."
Fig. 3. Relation between estrogen levels and inflammatory diseases. Red indicates that estrogens at respective concentrations exert proinflammatory effects, whereas green demonstrates estrogen levels with an antiinflammatory effect. In this summary, RA and MS (upper block) are divided according to the underlying dominant cell type involved. Today, we know that in a fraction of patients B cells play a dominant role, whereas in another group of patients macrophages, dendritic cells, T cells, and other non-B cells are predominant (164 165 166 167 ). In diseases with a B cell predominance, estrogens at all levels stimulate the proinflammatory process, whereas in disease without a strong B cell involvement, estrogens demonstrate a dual role: at low concentrations estrogens stimulate, and at high levels, estrogens inhibit the disease process. A somewhat different picture appears for prostatitis and LPS-induced Kupffer cell-dependent shock where estrogens seem to sensitize the inflammatory response. DC, Dendritic cell; NK cell, natural killer cell.
"There is still an unresolved paradox with respect to the immunomodulating role of estrogens. On one side, we recognize inhibition of bone resorption and suppression of inflammation in several animal models of chronic inflammatory diseases. On the other hand, we realize the immunosupportive role of estrogens in trauma/sepsis and the proinflammatory effects in some chronic autoimmune diseases in humans. This review examines possible causes for this paradox.
This review delineates how the effects of estrogens are dependent on criteria such as: 1) the immune stimulus (foreign antigens or autoantigens) and subsequent antigen-specific immune responses (e.g., T cell inhibited by estrogens vs. activation of B cell); 2) the cell types involved during different phases of the disease; 3) the target organ with its specific microenvironment; 4) timing of 17β-estradiol administration in relation to the disease course (and the reproductive status of a woman); 5) the concentration of estrogens; 6) the variability in expression of estrogen receptor α and β depending on the microenvironment and the cell type; and 7) intracellular metabolism of estrogens leading to important biologically active metabolites with quite different anti- and proinflammatory function. Also mentioned are systemic supersystems such as the hypothalamic-pituitary-adrenal axis, the sensory nervous system, and the sympathetic nervous system and how they are influenced by estrogens.
This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned criteria. It also explains that a uniform concept as to the action of estrogens cannot be found for all inflammatory diseases due to the enormous variable responses of immune and repair systems."
"Estrogens influence systemic response systems by reducing the cytokine-stimulated ACTH and cortisol release, by increasing substance P signaling and sensitization to painful stimuli (increase of neurogenic inflammation), and by increasing signaling through proinflammatory α-adrenergic pathways (Fig. 4). These estrogen effects can partly explain the sexual dimorphism in chronic inflammatory diseases."
"In conclusion, immune stimuli (foreign antigens or autoantigens) and respective immune responses, the cell types involved (not only immune cells), the target organ, the reproductive status in a woman and timing of E2 administration in relation to the disease process, concentration of estrogens (dual effects), expression of ERα and ERβ (and their isoforms) depending on the microenvironment and the cell type, and intracellular metabolism of estrogens all play important roles in inflammatory diseases. In addition, systemic supersystems such as the HPA axis, the sensory nervous system, and the SNS can be influenced by estrogens to establish a proinflammatory milieu.
This review reinforces the concept that estrogens have antiinflammatory but also proinflammatory roles depending on above-mentioned influencing factors. This review also explains that a uniform concept for the action of estrogens cannot be found for all known chronic inflammatory diseases (Figs. 3 and 5). Nevertheless, for strictly B cell-dependent diseases such as those shown in Fig. 5, the female to male preponderance can be explained by the propagating effects of estrogens (but possibly also of progesterone). The smaller the influence of B cells and the bigger the weight of T cells and other cells, the less evident is the sex dimorphism in chronic inflammatory diseases (Fig. 5). In addition, because men never experience high estrogen (or progesterone) levels like women during pregnancy, the apparent gender dimorphism of chronic inflammatory diseases during the reproductive period of women can be explained. In addition, and this was not reported here, higher androgen levels in men most often exert inhibitory effects on many immune phenomena, which is an other important argument for why women with low androgen levels are protected from infectious diseases but more prone to B cell-dependent autoimmunity. Finally, we should not forget that sexual dimorphism of diseases may also depend on factors independent of sex hormones (588)."
Fig. 3. Relation between estrogen levels and inflammatory diseases. Red indicates that estrogens at respective concentrations exert proinflammatory effects, whereas green demonstrates estrogen levels with an antiinflammatory effect. In this summary, RA and MS (upper block) are divided according to the underlying dominant cell type involved. Today, we know that in a fraction of patients B cells play a dominant role, whereas in another group of patients macrophages, dendritic cells, T cells, and other non-B cells are predominant (164 165 166 167 ). In diseases with a B cell predominance, estrogens at all levels stimulate the proinflammatory process, whereas in disease without a strong B cell involvement, estrogens demonstrate a dual role: at low concentrations estrogens stimulate, and at high levels, estrogens inhibit the disease process. A somewhat different picture appears for prostatitis and LPS-induced Kupffer cell-dependent shock where estrogens seem to sensitize the inflammatory response. DC, Dendritic cell; NK cell, natural killer cell.
Role of Estrogen Receptor-β in Endometriosis
Role of Estrogen Receptor-β in Endometriosis
Serdar E. Bulun, M.D., Diana Monsavais, B.S., [...], and Emily J. Su, M.D., M.S.
"Endometriosis-related pain has conventionally been treated with endocrine agents such as synthetic progestins, oral contraceptives, or gonadotropin-releasing hormone analogs.1 These treatments, which interrupt ovulation and ovarian estrogen production, are successful in only half of the patients treated, however.9–11 Treatment with aromatase inhibitors in combination with an ovulation suppressor has successfully been used in cases refractory to these conventional measures of pain management.12 Patients often develop resistance to repeated treatments with the same agent over a period of 6 months to 3 years....
"Endometriotic tissue in ectopic locations, such as the peritoneum or ovary, is fundamentally different from eutopic endometrium within the uterus in terms of the production of cytokines and prostaglandins, estrogen biosynthesis and metabolism, and clinical response to progestins.11,22,23 There are substantial molecular differences with regard to progesterone response between normal endometrium and eutopic and ectopic tissues from women with endometriosis.17,24,25... Circumstantial and laboratory evidence strongly support the notion that estradiol is a key hormone for the growth and persistence of endometriotic tissue as well as inflammation and pain associated with it. Estradiol, which reaches endometriosis by circulation or is produced locally in endometriotic tissue, acts as a steroid hormone to regulate growth of endometriotic tissue. Estradiol enters cells and binds to the ER in estrogen-responsive cells. ER subtypes α and β are proteins with high affinity for estradiol and are encoded by separate genes....
"Despite its sensitivity to estrogen, endometriosis appears to contain a unique complement of steroid hormone receptors compared with that of its normal tissue counterpart, the eutopic endometrium. For example, several investigators reported markedly higher levels of ERβ and lower levels of ERα in human endometriotic tissues and primary stromal cells compared with eutopic endometrial tissues and cells.31,32 The levels of both isoforms of PR, particularly PR-B, are significantly lower in endometriosis compared with eutopic endometrium.6,33 The estradiol-receptor complex acts as a transcription factor that becomes associated with the promoters of estradiol-responsive genes via direct DNA binding or binding to other docking transcription factors at basal promoter regions.34 This interaction brings about ER-specific initiation of gene transcription, which promotes the synthesis of specific mRNAs and proteins.34 PR is one of many estradiol-responsive genes, and estradiol acts in eutopic endometrial tissues and stromal cells to promote endometrial responsiveness to progesterone.35 In contrast, PR mRNA and protein levels are not elevated in biopsied endometriotic tissues exposed to high estradiol levels during late proliferative phase or in endometriotic cells treated with estradiol, indicating that estradiol-induction PR expression in endometriosis is markedly blunted.33
"In addition to ERα, ERβ, and PR, the orphan nuclear receptor SF1 is also differentially regulated in endometriosis versus eutopic endometrium (Fig. 2). SF1 is responsible for coordinately activating the full steroidogenic cascade of genes including aromatase. The protein products of this set of steroidogenic genes are capable of converting cholesterol to estradiol locally in endometriotic tissue.36 We recently used real-time polymerase chain reaction (RT-PCR) to compare tissue mRNA levels of these key nuclear receptors in endometriosis and eutopic endometrium (Fig. 2). Ovarian endometriotic tissue SF1 and ERβ mRNA levels were >12,000 times and 142 times higher than in endometrium, respectively. In contrast, ERα, PR, and PR-B levels were remarkably lower in endometriotic tissue (Fig. 2).... ERα mRNA and protein levels are several fold lower in endometriotic tissue and stromal cells compared with endometrial tissue and stromal cells. ERα deficiency in endometriosis may be responsible for the failure of estradiol to induce PR expression, thus contributing to secondary PR deficiency and progesterone resistance in women with this disease. In vivo observations strongly suggest that estradiol induces ERα expression in mouse uterine tissue.39 It is quite likely that estradiol also plays a key role in regulating ERα expression in human endometrial stromal cells. However, strikingly high quantities of estradiol produced via local aromatase activity in addition to high ERβ levels in stromal cells of endometriosis may perturb this regulation and may suppress ERα expression.26,38...
"Summary:
High estrogen production is a consistently observed endocrine feature of endometriosis. Expression of steroid receptors and other nuclear receptors are strikingly different between endometriotic and eutopic endometrial tissues. Among these nuclear receptors, ERβ expression is maybe >100 times higher in endometriotic tissue than in endometrium. Defective DNA methylation and other accompanying epigenetic mechanisms may be responsible for strikingly high ERβ expression in endometriosis. ERβ suppresses ERα expression and results in strikingly high ERβ-to-ERα ratios in endometriotic cells. We speculate that a strikingly lower ERα-to-ERβ ratio in endometriotic stromal cells may cause a shift from estradiol stimulation to inhibition of PR expression in endometriotic stromal cells under in vivo circumstances (Fig. 3). This proposed mechanism may explain severely deficient PR-B in endometriotic stromal cells, which contributes to progesterone resistance in women with endometriosis. ERβ overexpression in endometriosis possibly has other broad effects important in the pathology of endometriosis. It is likely that ERβ simulates prostaglandin production in endometriotic tissues and cells via inducing COX2 expression."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034571/...
Increased expression of antimüllerian hormone and its receptor in endometriosis.
Increased expression of antimüllerian hormone and its receptor in endometriosis.
Abstract
OBJECTIVE:
DESIGN:
SETTING:
PATIENTS:
INTERVENTIONS:
MAIN OUTCOME MEASURE(S):
RESULT(S):
CONCLUSION(S):
Saturday, November 15, 2014
company looking at developing a blood test for endometriosis
"VolitionRx Enters Agreement with University of Oxford to Initiate Endometriosis Study
Study will assess VolitionRx's proprietary Nucleosomics® platform for non-invasive diagnosis of endometriosis
November 11, 2014: 08:00 AM ET
NAMUR, Belgium, Nov. 11, 2014/PRNewswire/ -- VolitionRx Limited(OTCQB: VNRX), a life sciences company focused on developing blood-based diagnostic tests, today announced that it has entered an agreement with the University of Oxford, United Kingdom, to initiate a clinical study that will assess VolitionRx's proprietary Nucleosomics® platform technology for the diagnosis of endometriosis through a simple blood test. Under the agreement, The University of Oxford will provide VolitionRx with serum and plasma samples from approximately 350 patients with endometriosis and 150 control patients over a period of two years. The samples are donated by participating women through the biospecimen repository of the Oxford Endometriosis CaRe Centre.
Endometriosis is a common and painful condition in which endometrial tissue, which normally lines the cavity of the uterus, grows in other parts of the body[1]. It is a benign condition with a strong inflammatory component, which makes the disease a good candidate for Volition's NuQ® assays. The condition mostly affects women during their reproductive life span, and is a leading cause of difficulty conceiving. Unfortunately, there are currently no clinically useful biomarkers available for this condition, meaning diagnosis is only possible by performing minimally invasive surgery (laparoscopy). Across the world, this typically results in a delay in diagnosis of nearly 7 years[2].
The prospective study will focus on the development of a simple blood test to help clinicians diagnose endometriosis at an earlier stage. The 350-patient sample collection, supplemented with approximately 150 retrospectively-collected samples, will comprise healthy and endometriosis-positive individuals confirmed by laparoscopy. Differences in circulating nucleosomes will be evaluated across the menstrual cycle using VolitionRx's Nucleosomics® technology platform.
Collection of the samples will be led by Prof Christian Becker and Prof Krina Zondervan, of the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, who are co-Directors of the Endometriosis CaRe Centre, Oxford. The Centre is a world leader in endometriosis research and clinical care and is dedicated to improve the life of women affected by the disease. The study will assess the samples collected from patients undergoing laparoscopic surgery for endometriosis-related symptoms or patients undergoing laparoscopic tubal sterilisation. Sample collection is anticipated to end in 2016 as part of an ongoing biospecimen collection and biobanking program.
"We are excited to sign this agreement with the University of Oxford," commented Dr. Mark Eccleston, VolitionRx's Collaborations Manager. "We look forward to assessing the potential of our test in the diagnosis of endometriosis and to build on our ongoing work in cancer screening by exploring applications of our NuQ® assays in diseases beyond cancer."
Prof Becker said: "We are looking forward to the results of this study. It compliments our ongoing efforts in the Endometriosis CaRe Centre of identifying non-invasive biomarkers for endometriosis which will be an essential step towards improved patient care."
In addition to this study, other clinical trials assessing the effectiveness of VolitionRx's assays include:
A 4,800 patient retrospective study and an 14,000 patient prospective study in colorectal cancer at Hvidovre Hospital,University of Copenhagen, DenmarkA 4,000 patient prospective study that involves patients with the 20 most prevalent cancers at University Hospital in Bonn,GermanyA 250 patient study in colorectal cancer at CHU-UCL Mont Godinne Hospital, BelgiumA study with MD Anderson, Texas, to establish the efficacy of VolitionRx's NuQ® tests to distinguish anaplastic prostate cancer, a particularly aggressive form of the disease, from typical castration resistant prostate cancer (CRPC), the less aggressive form.
[1]
Office of Women's Health. Endometriosis Fact Sheet. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html
[2]
Nnoaham, K.E. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.
-End-
About VolitionRx
VolitionRx is a life sciences company focused on developing blood-based diagnostic tests. The tests are based on the science of Nucleosomics which is the practice of identifying and measuring nucleosomes in the bloodstream – an indication that cancer is present.
VolitionRx's goal is to make the tests as common and simple to use, for both patients and doctors, as existing diabetic and cholesterol blood tests. VolitionRx's research and development activities are currently centred in Belgium as the company focuses on bringing its diagnostic products to market first inEurope, then in the US and ultimately, worldwide.
Visit VolitionRx's website (www.volitionrx.com) or connect with us via Twitter, LinkedIn or Facebook.
Media Contacts
Charlotte Reynolds, VolitionRx
Charlotte.Reynolds@volitionrx.com
Telephone: +44 (0) 795 217 7498
Kirsten Thomas, The Ruth Group
kthomas@theruthgroup.com
Telephone: +1 (646) 536-7014
Investor Contacts
Scott Powell, Investor Relations
S.Powell@volitionrx.com
Telephone: +1 (646) 650-1351
Lee Roth, The Ruth Group
lroth@theruthgroup.com
Telephone: +1 (646) 536-7012" http://money.cnn.com/news/newsfeeds/articles/prnewswire/CN62698.htm
Study will assess VolitionRx's proprietary Nucleosomics® platform for non-invasive diagnosis of endometriosis
November 11, 2014: 08:00 AM ET
NAMUR, Belgium, Nov. 11, 2014/PRNewswire/ -- VolitionRx Limited(OTCQB: VNRX), a life sciences company focused on developing blood-based diagnostic tests, today announced that it has entered an agreement with the University of Oxford, United Kingdom, to initiate a clinical study that will assess VolitionRx's proprietary Nucleosomics® platform technology for the diagnosis of endometriosis through a simple blood test. Under the agreement, The University of Oxford will provide VolitionRx with serum and plasma samples from approximately 350 patients with endometriosis and 150 control patients over a period of two years. The samples are donated by participating women through the biospecimen repository of the Oxford Endometriosis CaRe Centre.
Endometriosis is a common and painful condition in which endometrial tissue, which normally lines the cavity of the uterus, grows in other parts of the body[1]. It is a benign condition with a strong inflammatory component, which makes the disease a good candidate for Volition's NuQ® assays. The condition mostly affects women during their reproductive life span, and is a leading cause of difficulty conceiving. Unfortunately, there are currently no clinically useful biomarkers available for this condition, meaning diagnosis is only possible by performing minimally invasive surgery (laparoscopy). Across the world, this typically results in a delay in diagnosis of nearly 7 years[2].
The prospective study will focus on the development of a simple blood test to help clinicians diagnose endometriosis at an earlier stage. The 350-patient sample collection, supplemented with approximately 150 retrospectively-collected samples, will comprise healthy and endometriosis-positive individuals confirmed by laparoscopy. Differences in circulating nucleosomes will be evaluated across the menstrual cycle using VolitionRx's Nucleosomics® technology platform.
Collection of the samples will be led by Prof Christian Becker and Prof Krina Zondervan, of the Nuffield Department of Obstetrics & Gynaecology, University of Oxford, who are co-Directors of the Endometriosis CaRe Centre, Oxford. The Centre is a world leader in endometriosis research and clinical care and is dedicated to improve the life of women affected by the disease. The study will assess the samples collected from patients undergoing laparoscopic surgery for endometriosis-related symptoms or patients undergoing laparoscopic tubal sterilisation. Sample collection is anticipated to end in 2016 as part of an ongoing biospecimen collection and biobanking program.
"We are excited to sign this agreement with the University of Oxford," commented Dr. Mark Eccleston, VolitionRx's Collaborations Manager. "We look forward to assessing the potential of our test in the diagnosis of endometriosis and to build on our ongoing work in cancer screening by exploring applications of our NuQ® assays in diseases beyond cancer."
Prof Becker said: "We are looking forward to the results of this study. It compliments our ongoing efforts in the Endometriosis CaRe Centre of identifying non-invasive biomarkers for endometriosis which will be an essential step towards improved patient care."
In addition to this study, other clinical trials assessing the effectiveness of VolitionRx's assays include:
A 4,800 patient retrospective study and an 14,000 patient prospective study in colorectal cancer at Hvidovre Hospital,University of Copenhagen, DenmarkA 4,000 patient prospective study that involves patients with the 20 most prevalent cancers at University Hospital in Bonn,GermanyA 250 patient study in colorectal cancer at CHU-UCL Mont Godinne Hospital, BelgiumA study with MD Anderson, Texas, to establish the efficacy of VolitionRx's NuQ® tests to distinguish anaplastic prostate cancer, a particularly aggressive form of the disease, from typical castration resistant prostate cancer (CRPC), the less aggressive form.
[1]
Office of Women's Health. Endometriosis Fact Sheet. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/endometriosis.html
[2]
Nnoaham, K.E. et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.
-End-
About VolitionRx
VolitionRx is a life sciences company focused on developing blood-based diagnostic tests. The tests are based on the science of Nucleosomics which is the practice of identifying and measuring nucleosomes in the bloodstream – an indication that cancer is present.
VolitionRx's goal is to make the tests as common and simple to use, for both patients and doctors, as existing diabetic and cholesterol blood tests. VolitionRx's research and development activities are currently centred in Belgium as the company focuses on bringing its diagnostic products to market first inEurope, then in the US and ultimately, worldwide.
Visit VolitionRx's website (www.volitionrx.com) or connect with us via Twitter, LinkedIn or Facebook.
Media Contacts
Charlotte Reynolds, VolitionRx
Charlotte.Reynolds@volitionrx.com
Telephone: +44 (0) 795 217 7498
Kirsten Thomas, The Ruth Group
kthomas@theruthgroup.com
Telephone: +1 (646) 536-7014
Investor Contacts
Scott Powell, Investor Relations
S.Powell@volitionrx.com
Telephone: +1 (646) 650-1351
Lee Roth, The Ruth Group
lroth@theruthgroup.com
Telephone: +1 (646) 536-7012" http://money.cnn.com/news/newsfeeds/articles/prnewswire/CN62698.htm
Saturday, November 1, 2014
Chronic Inflammation causes unwell feeling and depression
We have seen in several previous posts the numerous inflammatory markers seen in endometriosis.
This inflammation often gives rise to a general unwell feeling:
"Cytokines mediate and control immune and inflammatory responses. Complex interactions exist between cytokines, inflammation and the adaptive responses in maintaining homeostasis , health, and well-being. Like the stress response, the inflammatory reaction is crucial for survival and is meant to be tailored to the stimulus and time. A full-fledged systemic inflammatory reaction results in stimulation of four major programs: the acute phase reaction, the sickness syndrome, the pain program, and the stress response, mediated by the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Common human diseases such as atopy/allergy, autoimmunity, chronic infections and sepsis are characterized by a dysregulation of the pro- versus anti-inflammatory and T helper (Th)1versus Th2 cytokine balance. Recent evidence also indicates the involvement of pro-inflammatory cytokines in the pathogenesis of atherosclerosis and major depression, and conditions such as visceral-type obesity, metabolic syndrome and sleep disturbances. During inflammation, the activation of the stress system, through induction of a Th2 shift, protects the organism from systemic ‘overshooting’ with Th1/pro-inflammatory cytokines. Under certain conditions, however, stress hormones may actually facilitate inflammation through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor necrosis factor- and C-reactive protein production and through activation of the corticotropin releasing hormone/substance P-histamine axis. Thus, a dysfunctional neuroendocrine-immune interface associate with abnormalities of the systemic anti-inflammatory feedback’ and/or ‘hyperactivity’ of the local pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic and autoimmune diseases, obesity, depression, and atherosclerosis. These abnormalities and the failure of the adaptive systems to resolve inflammation affect the well-being of the individual, including behavioral parameters, quality of life and sleep, as well as indices of metabolic and cardiovascular health. These hypotheses require further investigation, but the answers should provide critical insights into mechanisms underlying a variety of common human immune-related diseases." http://www.depts.ttu.edu/animalwelfare/classes/ANSC%205318/Topics%20Stress%20&%20Immunity/Elenkovcytokineswellbeing2005.pdf
"Cytokine dysregulation, inflammation and well-being.
Abstract
"Anyone who has experienced a viral or bacterial infection knows what it means to feel sick. The behaviour of sick people changes dramatically; they often feel feverish and nauseated, ignore food and beverages, and lose interest in their physical and social environments. They tire easily and their sleep is often fragmented. In addition, they feel depressed and irritable, and can experience mild cognitive disorders ranging from impaired attention to difficulties in remembering recent events. Despite their negative impact on well-being, these symptoms of sickness are usually ignored. They are viewed as uncomfortable but banal components of infections1.
Sickness is a normal response to infection, just as fear is normal in the face of a predator. It is characterized by endocrine, autonomic and behavioural changes and is triggered by soluble mediators that are produced at the site of infection by activated accessory immune cells. These mediators are known as pro-inflammatory cytokines, and include interleukin-1α and β (IL-1α and IL-1β), tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6). They coordinate the local and systemic inflammatory response to microbial pathogens. However, these peripherally produced cytokines also act on the brain to cause the aforementioned behavioural symptoms of sickness. Recently, it has been suggested that ‘sickness behaviour’2,3, a term used to describe the drastic changes in subjective experience and behaviour that occur in physically ill patients and animals, is an expression of a previously unrecognized motivational state. It is responsible for re-organizing perceptions and actions to enable ill individuals to cope better with an infection4. During the last five years, it has been established that pro-inflammatory cytokines induce not only symptoms of sickness, but also true major depressive disorders in physically ill patients with no previous history of mental disorders. Some of the mechanisms that might be responsible for inflammation-mediated sickness and depression have now been elucidated. These findings suggest that the brain–cytokine system, which is in essence a diffuse system, is the unsuspected conductor of the ensemble of neuronal circuits and neurotransmitters that organize physiological and pathological behavior...." Please read the full article at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919277/ From inflammation to sickness and depression: when the immune system subjugates the brain: Robert Dantzer, Jason C. O’Connor, [...], and Keith W. Kelley
Thursday, October 30, 2014
Endometriosis and cancer risk
"Related to a number of hereditary, environmental, epigenetic, and menstrual characteristics and alterations, some sharing certain common processes with cancer,28 endometriosis remains the third leading cause of gynecologic hospitalization in United States29 and is considered a leading cause of female primary and secondary infertility, prevalent in 0.5% to 5.0% in fertile and 25% to 40% of infertile women.30 ...
Endometriosis, more than simply "killer cramps" as it is so often trivialized, may be related to a number of hereditary, environmental, epigenetic, and menstrual characteristics, some sharing certain common processes with cancer.28 Indeed, it is important to note that endometriosis is not cancer. The disease does, however, correspond to a variety of co-morbid conditions, ranging from autoimmune disease to food and environmental allergies to malignant concerns. Multiple prior studies have indicated an association between endometriosis and a number of autoimmune diseases, multiple chemical sensitivities, inflammatory bowel disease, food intolerances, allergies, and chronic fatigue.3,63,64
The risk of ovarian cancer among those patients with endometriosis is higher than those without the disease by 30% to 40%. One analysis of benign ovarian endometrioid tumors found frequent coexistence of endometriosis and endometrioid neoplasms, supporting a genetic link between the two. In an estimated 60% of endometriosis-associated ovarian cancers, the cancer is adjacent to or directly arising from the endometriotic tissue, lending credence to the fact that malignant transformation can and does occur.19
Endometriosis does present serious risk factors that can accelerate the development
of ovarian cancer by 5.5 years.19 Still, epidemiological findings on the association between endometriosis and cancer remain elusive, with modifications to the standard treatment regimens for the disease unjustified at this time.67 Nonetheless, providers from all disciplines should be aware of this increased risk profile and strive for early detection." https://www.apgo.org/elearn/endo/endomonon2.pdf <<<<<< A lot of good pearls from this so check it out!
Endometriosis, more than simply "killer cramps" as it is so often trivialized, may be related to a number of hereditary, environmental, epigenetic, and menstrual characteristics, some sharing certain common processes with cancer.28 Indeed, it is important to note that endometriosis is not cancer. The disease does, however, correspond to a variety of co-morbid conditions, ranging from autoimmune disease to food and environmental allergies to malignant concerns. Multiple prior studies have indicated an association between endometriosis and a number of autoimmune diseases, multiple chemical sensitivities, inflammatory bowel disease, food intolerances, allergies, and chronic fatigue.3,63,64
Less clear is the potential link between endometriosis and certain cancers. Much debate continues to surround the cancer-endometriosis link, with researchers calling the "histogenesis of endometriosis and endometriosis-associated ovarian cancer [one of the] most mysterious aspects of pathology."65 Current evidence is insufficient to draw any definitive conclusions whether this association represents causality or the sharing of similar risk factors and/or antecedent mechanisms.66 Nonetheless, it has been well established that the disease is indeed associated with an increased risk for non-Hodgkin lymphoma and certain malignant tumors, notably ovarian, with 15% to 40% of endometrioid ovarian carcinoma cases being associated with endometriosis. Based on this frequent association, many reports implicate endometriosis as a precursor lesion to ovarian cancer.
The risk of ovarian cancer among those patients with endometriosis is higher than those without the disease by 30% to 40%. One analysis of benign ovarian endometrioid tumors found frequent coexistence of endometriosis and endometrioid neoplasms, supporting a genetic link between the two. In an estimated 60% of endometriosis-associated ovarian cancers, the cancer is adjacent to or directly arising from the endometriotic tissue, lending credence to the fact that malignant transformation can and does occur.19
Animal studies suggest that common molecular genetic pathways, specifically K-RAS/MAPK and PTEN/PI13, are involved in the pathogenesis of both endometriosis and endometrioid ovarian carcinoma. Separate studies have identified upregulation of multiple genes within the RAS/RAF/MAPK and P13K pathways in endometriosis patients, as compared to controls. Of note, PTEN and K-RAS mutations were found to play a role in the development of low-grade ovarian endometrioid carcinomas; synchronous mutations were also identified in uterine and ovarian endometrioid carcinomas associated specifically with endometriosis. Moreover, loss of the PTEN tumor suppressor gene has been implicated in progression from endometriosis to endometrioid ovarian cancer.19
Endometriosis does present serious risk factors that can accelerate the development
of ovarian cancer by 5.5 years.19 Still, epidemiological findings on the association between endometriosis and cancer remain elusive, with modifications to the standard treatment regimens for the disease unjustified at this time.67 Nonetheless, providers from all disciplines should be aware of this increased risk profile and strive for early detection." https://www.apgo.org/elearn/endo/endomonon2.pdf <<<<<< A lot of good pearls from this so check it out!
Thursday, October 23, 2014
How Endo Tissue Is Influenced
We've looked at several articles on the research behind the Mullerian/organogenesis theory to endometriosis. (http://www.hindawi.com/journals/ogi/2013/527041/, http://www.ncbi.nlm.nih.gov/pubmed/23314961, http://webcache.googleusercontent.com/search...)
Here's a little explanation of how that misplaced tissue is influenced:
So you have this misplaced tissue sittin' there, just waiting around. Many things influence how it behaves. Estrogen makes it become like the Hulk- it doesn't replicate, just gets bigger and angrier.
Through complicated processes, the increased estrogen B receptors can make the tissue less responsive to progesterone (which would calm it down a bit- this may be why some women don't respond to progesterone driven drugs). So more estrogen=more tissue activation=more symptoms. The tissue can also have its own nerves (unmylenated sensory C nerves) and blood vessels- after all it needs some nourishment! Endo is a chronic , INFLAMMATORY disease, so all these immune cells come to party (remember the MIT study ID'd 13 macrophages in endo patients), they bring along the cytokines and they just party on down (causing pain, scarring, overall unwell feelings). As the cycle of inflammation, pain, endocrine alterations continues, you may see more far reaching consequences, like pelvic floor muscle spasms, bowel symptoms, bladder irritation, etc. Then you add in that when we don't feel well we may not eat as well, be as active, then everything continues to feel worse. The longer chronic pain continues then the more speedy and strong the pain nerve signals get (central sensitization), and the harder it is to control. Some will try to treat endo by lowering the estrogen in the body; however estrogen protects the heart, brain, bones, and metabolism, so lowering it in the long term can be detrimental to our overall health. (They've even shown how removing endo can result in lowered heart risk! "Surgical treatment of endometriosis leads to endothelial function improvement, resulting in reduction of cardiovascular risk." http://m.humrep.oxfordjournals.org/content/29/6/1205) This is why excision of all the endometriosis is being strongly advocated these days. http://endocomprehensive.blogspot.com/2014/07/why-excision-is-recommended.html
Here's a little explanation of how that misplaced tissue is influenced:
So you have this misplaced tissue sittin' there, just waiting around. Many things influence how it behaves. Estrogen makes it become like the Hulk- it doesn't replicate, just gets bigger and angrier.
Through complicated processes, the increased estrogen B receptors can make the tissue less responsive to progesterone (which would calm it down a bit- this may be why some women don't respond to progesterone driven drugs). So more estrogen=more tissue activation=more symptoms. The tissue can also have its own nerves (unmylenated sensory C nerves) and blood vessels- after all it needs some nourishment! Endo is a chronic , INFLAMMATORY disease, so all these immune cells come to party (remember the MIT study ID'd 13 macrophages in endo patients), they bring along the cytokines and they just party on down (causing pain, scarring, overall unwell feelings). As the cycle of inflammation, pain, endocrine alterations continues, you may see more far reaching consequences, like pelvic floor muscle spasms, bowel symptoms, bladder irritation, etc. Then you add in that when we don't feel well we may not eat as well, be as active, then everything continues to feel worse. The longer chronic pain continues then the more speedy and strong the pain nerve signals get (central sensitization), and the harder it is to control. Some will try to treat endo by lowering the estrogen in the body; however estrogen protects the heart, brain, bones, and metabolism, so lowering it in the long term can be detrimental to our overall health. (They've even shown how removing endo can result in lowered heart risk! "Surgical treatment of endometriosis leads to endothelial function improvement, resulting in reduction of cardiovascular risk." http://m.humrep.oxfordjournals.org/content/29/6/1205) This is why excision of all the endometriosis is being strongly advocated these days. http://endocomprehensive.blogspot.com/2014/07/why-excision-is-recommended.html
Wednesday, October 22, 2014
Your bacteria and endometriosis
Better bacteria=better estrogen clearance.
"Since the 1970s, it has been known that in addition to supporting digestion, the intestinal bacteria that make up the gut microbiome influence how women's bodies process estrogen, the primary female sex hormone. The colonies of bacteria determine whether estrogen and the fragments left behind after the hormone is processed continue circulating through the body or are expelled through urine and feces..." http://www.sciencedaily.com/rele.../2014/09/140911135316.htm "In the blood, estrogens circulate either bound to proteins or free. The liver inactivates estrogens by conjugation...; conjugated estrogens are then finally excreted with bile acids and are transported into the intestinal lumen [71]. Once in the intestinal lumen, the fate of these conjugated estrogens depends on the composition of the intestinal microbiota present in the host. Individuals with an intestinal microbiome capable of deconjugating estrogens will reabsorb the free estrogen via the enterohepatic circulation, increasing the estrogenic potency in the host. Those with an intestinal microbiome less favorable to deconjugation will promote estrogen excretion in feces [72]." http://www.hindawi.com/journals/isrn/2013/693920/
Also, could the inflammation from endo also alter the microbiome? "On the basis of the role of inflammation in the induction of a progesterone-resistant endometrium, we hypothesize that failure of implantation might be explained, perhaps in part, by alteration in the uterine microbiome in response to inflammation.This hypothesis finds support in the ability of environmental factors to alter progesterone sensitivity....Therefore, we conclude that the association between the microbiome of the reproductive tract and circulating serum E2 concentrations may reflect the environment and availability of glycogen. However, progesterone resistance, albeit an unproven relationship to the microbiome, might contribute to implantation failure and infertility. " http://www.medscape.com/viewarticle/819586_9
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