VivaCell platform to analyse and develop products to treat menopause symptoms

To study the effects of products on various parameters to be targeted in Menopause treatment, we designed several objectives/tasks.

Modul Activity 1:
Effects on receptors/parameters involved in mood problems associated with menopause

  • Serotonin 5-HT1C receptor
  • Serotonin 5-HT2A receptor
  • Serotonin 5-HT2C receptor
  • Serotonin re-uptake
  • Serotonin transporter

Modul Activity 2:
Effects on receptors/parameters involved in menopause symptoms hyperthermia and hot flushes

  • Serotonin 5-HT7 receptor
  • Dopamine Receptor (D2)
  • Adrenergic receptor alpha 2
  • Opioid Receptor (Delta, mu and kappa opioid receptors)
  • PGE2

Estrogen pathway

  • Agonistic or antagonistic effects of the test item on estradiol receptor alpha (hERa)
  • Agonistic or antagonistic effects of the test item on estradiol receptor beta (hERb)
  • Effects on breast cancer cell proliferation
  • Agonistic effects of the test items on farnesoid receptor activity (FXR)

Estrogen deficiency in the postmenopausal woman usually first manifests as vasomotor symptoms. The hot flushes can be disruptive and disturb sleep patterns, outcomes resulting in fatigue, depression, insomnia, and irritability. Absence of estrogen action occurs at other target sites such as bone, heart, and brain, although clinical manifestations may not become apparent until years later. The effect of estrogen on the preservation of bone is well documented, and bone loss begins with a decrease in estrogen levels during the perimenopausal period. The possible resultant fractures can lead to severe disability with pulmonary, gastrointestinal, or bladder symptoms and loss of independence due to compression fractures of the spine and hip fractures. Observational studies have indicated an increased risk of cardiovascular disease in estrogen-deficient women. In Western society, cardiovascular disease is the most common cause of death in women older than 50 years. Studies of cognition have also implicated a positive influence of estrogen.

Because life expectancy is age 80 years for women in Western countries and the average age of menopause is close to age 50 years, approximately 30 years can be associated with an “estrogen-deficiency” state. Use of estrogen in the postmenopausal woman clearly has health benefits but, as with many pharmacological interventions, also has attendant risks. Unopposed estrogen therapy in standard doses is associated with an increased risk of endometrial hyperplasia and cancer, which can be attenuated by concurrent administration of a progestin.

Recently, a meta analysis was published in Lancet (Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidenceCollaborative Group on Hormonal Factors in Breast Cancer* Lancet 2019; 394: 1159–68). Researchers found that compared with women who never used MHT (menopausal hormone therapy), women who did had a significantly higher risk of developing invasive breast cancer. They estimated that 6.3% of women who never used MHT developed breast cancer, compared to 8.3% of women who used the combination drug continually for five years. That’s roughly one extra cancer diagnosis for every 50 users.

The longer women used MHT, the greater their risk of breast cancer. Women who were no longer using MHT had a lower relative risk than women who were currently using it — but they remained at an elevated risk for more than a decade after they stopped taking the drug. The level of risk was dependent on how long a woman took MHT. The study also found that women who took the combination drug were more likely to develop cancer than women who took the estrogen-only drug

The two isoforms of estrogen receptor (ER) alpha and beta play opposite roles in regulating proliferation and differentiation of breast cancers, with ER-alpha mediating mitogenic effects and ER-beta acting as a tumor suppressor.

ER alpha mediates cancer-promoting effects of estrogen and has been shown to be an effective therapeutic target for decades. In contrast, ER beta has a well known growth and invasion inhibitory activity in ERα-positive breast cancer cells, at least in part due to ER beta’s inhibition of ER alpha selective target gene expression, and can be considered as an endogenous partial dominant negative receptor.

Besides this function, Estrogen receptor beta plays a key role in skin and in the cardiovascular system to reduce oxidative stress but also inflammation.

Thus, there is a huge demand for estrogen replacement therapeutics acting on beta estradiol receptors but not activating alpha estrogen receptors and thus increasing the risk to develop cancer. Plant derived therapeutics might be such desirable therapeutic since usually they do have a broad range of activities, which could be used for the various symptoms occurring with menopause.

Phytoestrogens have long had a role in the treatment of various disorders. Hippocrates used Queen Anne’s lace, a plant phytoestrogen, to enhance contraception. The estrogenic effect of phytoestrogens was first recognized as a reproductive disorder in sheep after the sheep ingested a specific type of clover. Many phytoestrogens with mixed estrogen agonist and antagonist properties have been identified. In general, phytoestrogens are more soluble than estrogens but also are capable of exerting systemic effects. A wide variety of commonly consumed foods contain appreciable amounts of different phytoestrogens. Phytoestrogens consist of at least 20 compounds from 300 plants and are found in such common foods as parsley, garlic, soybeans, wheat, rice, dates, pomegranates, cherries, and coffee. In general, they are weaker than natural estrogens, easily broken down, and not stored in tissue. Accumulating evidence from molecular and cellular experiments and animal studies may confirm health benefits of phytoestrogens in relation to cardiovascular diseases, cancer, osteoporosis, and menopausal symptoms.

We therefor designed a platform to study the effects of products on menopause symptoms including various models and parameters shown to be involved in the symptoms accompanied with menopause.

Most women experience hot flushes when going through the menopause. They’re often described as a sudden feeling of heat that seems to come from nowhere and spreads throughout the body. They are typically experienced as a feeling of intense heat with sweating and rapid heartbeat, and may typically last from two to thirty minutes for each occurrence, ending just as rapidly as they began. Some women only have occasional hot flushes that do not really bother them, while others can have many a day and find them uncomfortable, disruptive and embarrassing. Hot flushes can start a few months or years before your periods stop (before you start the menopause) and usually continue for several years after your last period.
Hot flushes usually affect women who are approaching the menopause and are thought to be caused by changes in your hormone levels affecting your body’s temperature control.
Research on hot flashes is mostly focused on treatment options. The exact cause and pathogenesis, or causes of vasomotor symptoms (VMS)—the clinical name for hot flashes—has not yet been fully studied. There are hints at reduced levels of estrogen as the primary cause of hot flashes. There are indications that hot flashes may be due to a change in the hypothalamus’s control of temperature regulation.

The role of serotonin in thermoregulation is well-known. There is evidence for an efficacy of selective serotonin reuptake inhibitors in the treatment of vasomotor. The 5-HT7 has a very high expression rate in hypothalamus and is discussed in connection with thermoregulation, circadian rhythm and sleep. For the later there is data with extracts of Cimicifuga racemosa (black cohosh) – a drug traditionally used to treat hot flushes – displaying a strong affinity for the 5-HT7-receptor.

β-endorphines play a role in thermoregulation and – even more interesting – black cohosh extracts, frequently used in the treatment of hot flushes, have been recently found to bind to µ-opioid receptors.

Alpha 2 adrenergic mechanisms for the initiation of hot flushes are proposed, because clonidine – an alpha 2 adrenergic agonist reduces the number of provoked hot flushes.
Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risk of several cancers including breast cancer The chemopreventive actions of NSAIDs are mainly mediated by blocking cyclooxygenase-2 (COX-2) enzyme activity to suppress prostaglandin E2 synthesis. As a major COX-2-derived prostaglandin, PGE2 plays a key role in the acute and chronic inflammatory responses that promote cell proliferation and angiogenesis, and inhibit apoptosis PGE2 can also induce aromatase expression, leading to increased estrogen production in mammary adipose stromal cells. After menopause, estrogens are predominantly produced in peripheral tissues by the aromatization of adrenal and ovarian androgens. By inhibiting PGE2, and in turn aromatase induction, NSAIDs have been hypothesized to inhibit local estrogen biosynthesis and to decrease breast cancer risk particularly among postmenopausal women. PGE2 also plays a crucial role in themorregulation.

Although depression is not caused by menopause, some women exhibit the symptoms of depression during this time as well as worsening of existing depressive symptoms. In a pair of older studies from the early 2000s, published in the Archives of General Psychiatry, researchers found that perimenopausal women were twice as likely to be diagnosed with major depressive disorder (MDD) as those who hadn’t yet entered this hormonal transition. The studies also found that perimenopausal women were four times as likely to develop depressive symptoms as women who hadn’t gone through perimenopause. It is therefore desirable to also traget neurotransmitters and their receptors involved in the pathophysiology of depression especially the serotonergic pathway.

Bile acids are present at high concentrations in breast cysts and in the plasma of postmenopausal women with breast cancer. The farnesoid X receptor (FXR) is a member of the nuclear receptor superfamily that regulates bile acid homeostasis. FXR was detected in normal and tumor breast tissue, with a high level of expression in ductal epithelial cells of normal breast and infiltrating ductal carcinoma cells. Farnesoid X receptor (FXR) activation has been shown to inhibit estrogen signaling in breast cancer and testicular tumors.
FXR is also present in human breast carcinoma cells, such as MCF-7. Activation of FXR by high concentrations of ligands induced MCF-7 apoptosis. Therefore, FXR is a novel target to treat this special aspect of menopause.
One of the most commonly used approach is the measurement of the proliferative response of MCF-7 cells (ERa+/ERb+) treated with extract. In this model CR extract alone does not induce MCF-7 cell proliferation and also inhibit cell proliferation induced by 17-b-Estradiol, suggesting an antiestrogenic activity of CR extracts (Bodinet and Freudenstein, 2002, 76:1-10). However this study is very limited because proliferation has been measured only by uptake of [3H]-Thymidine by the cells. It has been demonstrated that some phytoestrogens such is genistein from soya inhibit tyrosine protein kinases, induce cell cycle arrest at the G2/M phase and p21waf-1. Moreover, the authors did not shown binding of CR to estrogen receptors or studied the function of ERs directly. Last but not least, the effect of CR extracts in ERa/ERbcells was not included in this study.

It is assumed that the estrogenic or anti-estrogenic activity of phytoestrogens are transmitted through the estrogen receptors, which are ligand-dependent transcription factors that belong to the steroid/thyroid hormone receptor superfamily. These ERs differ significantly in their primary sequences of their ligand-binding/domain activation function-2 region. This causes various chemical binding affinities and different agonist/antagonist characteristics for the two receptors. Indeed, isoflavones (a category of phytoestrogens) tend to preferentially bind to ERb. Moreover, the ligand-dependent transcription of the ERs is regulated by transcriptional coactivators (SRC-1, TIF-2, AIB1, p300/CBP and TRAP220), indicating that although a phytoestrogen binds to ERs the final conformation of the complex will regulate the estrogenic or anti-estrogenic activity of a plant derived  phytoestrogen.