Endocrine Abstracts (2019) 65 SE1.2 | DOI: 10.1530/endoabs.65.SE1.2

Is the estrogenic component of Premarin all bad?

Richard Santen


University of Virginia, Charlottesville, USA


The Women’s Health Initiative studies reported that the menopausal hormone therapy (MHT) regimen containing conjugated equine estrogen (CEE) and medroxyprogesterone acetate increased, whereas CEE alone reduced breast cancer incidence. These observations suggest the possibility that CEE might exert unique actions on breast and also suggest the need to eliminate the progestogen from MHT regimens. A MHT regimen called a tissue selective estrogen complex (TSEC), containing CEE plus bazedoxifene (BZA), to avoid the need for a progestogen, was developed and FDA approved. We testing the effects of this TSEC in vitro and in vivo, we found unique properties of CEE which could make if a much more favorable estrogen formulation for women starting on menopausal hormone therapy. We asked whether CEE exerts effects on breast cancer which differ from those of estradiol (E2) A human breast cancer cell line (MCF-7) and wo rodent models (NMU and ACI) were used to compare the effect of CEE with E2 on mammary tumor formation, proliferation and apoptosis. In both the NMU and ACI models, E2 significantly increased tumor incidence and multiplicity whereas in striking contrast CEE did not, even though the estrogenic effects of CEE and E2 on uterine weight were identical. Mechanistically E2 blocked whereas CEE stimulated apoptosis (cleaved caspase-3) in ACI animals and only E2 stimulated proliferation (Ki67). BZA exerted highly potent anti-estrogenic effects on tumors by completely blocking palpable tumor formation. These data suggest that the CEE/BZA TSEC may be a safer, breast-antagonistic, MHT agent for women and might have potential to prevent breast cancer while relieving menopausal symptoms.

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