NUTRIGENOMICS: INTEGRATED APROACH TO BIOHRT & ESTROGEN METABOLISM. * NAINAMD BEVERLY HILLS *

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1 NUTRIGENOMICS: INTEGRATED APROACH TO BIOHRT & ESTROGEN METABOLISM * NAINAMD BEVERLY HILLS *

2 Nutrigenomics: an Integrated Approach in use with BHRT * Nutrigenomics: * Correlates the effects of nutrition to expression of genes. * Focuses on identifying and understanding molecular-level interactions between nutrients and other dietary bio-actives with the genome. Dr. Jack Vanden Heuvel * How does it integrate with BHRT? * Hormones stimulate selective gene expression to induct response and can be metabolized to DNA-adducting products, thus changing genomic expression activity.

3 Two pathways for estrogen: Estrogen Receptors: Induction of specific genes in response to ER activation Ligand(specific): Estrogen activation of ER s leading to increased cell proliferation. Estrogen Metabolism: SNPs Substrate(nonspecific): DNA damage due to formation of estrogen metabolic products that form DNA adducts. Pathway of Estrogens

4 Pathway of Estrogens * Two fates of ligand estrogens: * Activates membrane ER: preferred induction * Transcriptional regulation via secondary messenger systems, primarily through phosphorylating/dephosphorylating pathways. * Quick response. * Activates nuclear ER: preferred inhibition * Direct transcriptional regulator by interaction with various response elements and transcription factors. * Slower response, potential for greater gene regulation. * Primarily involved in activating higher rates of proliferation

5 Nutrigenomic Approaches * Nutrigenomics to BHRT * Dietary/supplemental based regulation of hormone induced gene expression and may do so selectively. * Alter metabolism of hormones, inhibiting the potency of many gene-altering derivatives. * What to target? * Promotion of compounds that down-regulate high cell proliferation rates in response to ER induction. * Proliferation of cells should be controlled and selective.

6 Nutrigenomic Factors * I3C Indole-3-carbinol DIM * Plant derived component of cruciferous (Brassica) vegetables: broccoli, brussel sprouts, cabbage, cauliflower. * In presence of adequate stomach acid 13C undergoes formation several significant products * Observed to effect estrogen metabolism by altering activity of phase I enzymes. * In presence of adequate stomach acid 13C undergoes formation several significant products.

7 Nutrigenomic Factors * I3C Components * HNTI hexadydrocylonatriindole binds to estrogen receptors and shows chemical structures similiarities to tamoxifen * ICZ indolo(3,2-b)carbazole exhibits antiestrogenic activity and supports phase 1 detoxification activities * DIM

8 Nutrigenomic Factors (updated) I3C strongly inhibits ERα expression and controls phosphorylation of Sp1, a transcription factor necessary to interact with ERE for proper transcription of ERα regulated genes. This results in induction of cell cycle arrest in breast cancer cells, causing anti-proliferative effects. DIM, in the presence of E2 shifts regulation E2-mediated genes towards a pro-apoptotic, antiproliferative, and moderated state. These observations indicate a preventative and protective potential of DIM to negative estrogenic effects.

9 Nutrigenomic Factors DIM-C derivatives induce apoptosis in colon cancer cells and in tumors through Endoplasmic reticulum stress-independent activation of JNK. ERβ, is the predominant estrogen receptor expressed in colorectal epithelium. Erβ induction causes changes in transcriptome that show anti-tumorigenic capabilities in colon cancer cell lines. This gives indication that enhancement of ERβ may be a preventitive and treatment method for colon cancer.

10 Nutrigenomic Factors DIM triggers ERβ-mediated transcriptional pathways rather than ERα mediated pathways. The activation of ERβ by DIM may also be linked to DIM-mediated activation of transcription. Lower concentrations of DIM show to decrease proliferative rates in MCF-7 cells, and induce high levels of apoptosis when concentration in increased. These observations were correlated with the DIM ligand-independent activation of ERs.

11 Nutrigenomic Factors JNK (c-jun N-terminal Kinases): Kinases that phosphorylate c-jun. Involved primarily in secondary response mechanisms JNK response known to contribute to imflammatory and pro-apoptotic responses. Activated by membrane ERβ induction and inhibited by ERα induction.

12 Nutrigenomic Factors * EREs(Estrogen Response Elements) * Gene promoter regions that bind estrogen receptors, allowing them to act as transcription factors. * AP-1transcription factor * Transcription factor that regulates gene expression in response to numerous stimuli. One such stimuli is nuclear ERβ which activates c-fos and c-jun pathways.

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16 Nutrigenomic Factors * Epigallocatechin-3 gallate (EGCG) * Phytochemical in green tea that observed to inhibit growth of breast cancer cells. * Vitamin D3 * Uptaken from sun exposure and dietary sources. Has been observed to inhibit cell proliferation and mild induce cell apoptosis. * Ellagic acid * Natural Antioxidant found in many berries and other fruits. * Vitamin B12: Known to be involved in DNA methylation.

17 Nutrigenomic Factors EGCG suppresses E2-stimulated activation, proliferation and vascular endothelial growth factor expression of endometrial cells. This could be done by competitively binding to estrogen receptors. EGCG cytotoxicity was associated with presence of ERα, indicating mechanism of action involving blocking or inactivation of ERα. Other mechanisms for EGCG induced cell death also exist, as increased concentrations of EGCG can make up for the loss in activity due to absence of ERα.

18 Nutrigenomic Factors 1,25-dihydroxyvitamin D(3), a steroid hormone derived from Vitamin D(3), is a negative growth regulator of ER-positive breast cancer cells. Co-treatment with resveratrol(phytoestrogen), enhanced growth inhibitory effects of 1,25-dihydroxyvitamin D(3), giving evidence that such dietary factors could negatively impact the formation and maintenance of breast cancer cell lines. Vitamin D has been found to interfere with the transduction pathways of various growth factor(s)-activated receptors thereby modulating transcription and alteration of genomic functions resulting in inhibition of cell proliferation and angiogenesis and facilitation of cell differentiation and apoptosis.

19 Nutrigenomic Factors Ellagic acid was observed to down-regulate the E2 induced expression of the htert protein. Being a common biomarker for the onset and progression of cancers, the down-regulating effects of ellagic acid on htert may imply its involvement as a anticarcinogenic compound via the ER pathway.

20 Nutrigenomic Factors Increased concentration of folate and Vitamin B12 showed increased methylation rates of genes including that of ERα. Cells exhibiting higher concentrations of B12 showed a decrease in the expression of ERα as a result. Vitamin B12 and folate were inversely associated with risk of colorectal and breast cancers. This was observed to a even greater extent in patients known to have vitamin B deficiencies.

21 Nutrigenomic Factors * Conflicting results of folic acid. * Folate is an essential nutrient, must be uptaken through diet. * Other than natural foods, dietary folate is usually supplemented in its synthetic form, folic acid, which is a fully oxidized. * Folic acid is not metabolized as well as natural folates. Nonmetabolized folates are associated with increased incidence of colon cancer. * Greater sensitivity to folic acid concentrations than those of natural folates. * Discuss 5-MTHF and L-MTHF and breakdown of folic acid via 5-MTHF reductase

22 Negative Nutrigenomic Factors Polycyclic Aromatic Hydrocarbons: found in numerous fossil fuels as well as cooked food Toxicity of PAHs are structurally dependent. Polycyclic aromatic carbons that contained a hydroxy group competitively bound and activate estrogened receptors, inducing transcriptional responses observed by estrogen activation. Polycyclic aromatic hydrocarbons exhibited weakly estrogenic responses. Effect of PAHs give evidence of genotoxic roles.

23 Other Nutrigenomic Factors * Vitamin B6 * Zinc * CoQ10 * Omega-3 fatty acid * Curcumin * 5-methyl and5-formyltetrahydrofolic acid * Sulfaphrone * Calcium D-glucarate

24 Nutrigenomics: an Integrated Approach in use with BHRT Role of nutrigenomics in BHRT? * Nutrients clearly play a role in regulating response and potency a response due to hormonal actions, emphasizing the need for proper nutrient supplementation during BHRT for effective and preventative therapy. * Future studies and focus should be directed towards mode of action and targets for prevention of negative side affects associated with BHRT.

25 Two pathways for estrogen: Estrogen Receptors: Induction of specific genes in response to ER activation Ligand(specific): Estrogen activation of ER s leading to increased cell proliferation. Estrogen Metabolism: SNPs Substrate(non-specific): DNA damage due to formation of estrogen metabolic products that form DNA adducts. Inter-related effects of nutrients Pathway of Estrogens

26 Metabolism of Estrogens The body naturally produces three main estrogens: estrone (E1), estradiol (E2), estriol (E3). Estradiol most physiologically active form of estrogens. Synthesized in the ovaries, metabolized by the liver. Estrone is converted reversibly from estradiol in the liver and small intestine and increases after menopause when the adrenal glands play a more important role than ovaries

27 Hepatic Detoxification * High correlation between impaired hepatic detoxification and disease: * Cancer * Parkinson s disease * Fibromyalgia * Chronic fatigue * Immune dysfunction syndrome

28 Metabolism of Estrogens * What to consider: * Biosynthetic pathways of hormonal metabolism may be directed through various paths, some leading to the formation of genotoxic products. * Control and regulation of metabolic pathways essential for the effective and safe use of BHRT.

29 Hepatic Detoxification Enzymes Phase I System Most pharmaceuticals are metabolized thru this system Major P450 enzymes are CY1A1, CY1A2, CYP1B1, CYP2D6, CYP2C are involved in the metabolism of drugs or exogenous toxins Phase 1 activities are also involved in detoxifying endogenous molecules such as steroids and exogenous xenoestrogens Typical reaction CYP450 enzymes uses oxygen and NADH cofactor to add a reactive group such as hydroxyl radical hence this step may produce reactive molecules more toxic than the parent molecule and need to be metabolized by Phase 11 conjugation otherwise may cause damage to proteins, DNA within the cell.

30 Hepatic Detoxification Enzymes Phase II System Results in conjugation reactions that render water soluble compounds that can be excreted through urine or bile Several conjugation reactions include: glucoronidation (probiotics, B-glucoronate) sulfation (sulfaparone) glutathione and amino acid conjugation(nacetylcysteine) methylation(5-methyltetrahydrofolic acid and 5- formyltetrahydrofolic acid, SAME) Require cofactors thru dietary sources

31 Metabolism of Estrogens What to target? Promote: Phase II conjugating enzymes COMT, GSTP1. CYP1A1: responsible for 16-hydroxylation. CYP1A2: shunts towards 2-hydoxylation. Quinone reductase Downregulate: CYP1B1: promotes formation of 4-hydroxy products

32 Metabolic Regulating Factors * COMT(Catechol-O-methyl transferase): * Degrades cahtechols by conjugating, via methylation, active products of phase I enzyme products. Magnesium is an essential cofactor of the COMT, which optimizes methylation and excretion of cathecol estrogens. Slight increases in magnesium uptake may assist in higher activation levels of COMT, which in turn may increase the methylation rate of catechol estrogens.

33 Metabolic Regulating Factors I3C significantly increased the urinary excretion of C-2 estrogens, which resulted in a decreased level of all other estrogen metabolic products. Based on the effect of I3C on estrogen metabolism, I3C could have a chemoprotective role in reducing carcinogenic catechol concentrations as well as all other estrogen metabolites that may induce ER s. Activity of phase I enzymes CYP1A1 and CYP1A2 were significantly elevated. Phase II ezymes quinone reductase and glutathione transferase were also observed to be increased.

34 Metabolic Regulating Factors I3P shown to alter CYP1A1 activity towards more production of 2- hydroxyestrone rather than production of the 4-hydroxy product which commonly yield genotoxic effects. I3C treatment was observed to induce CYP1 family genes, but greatly favored CYP1A1 and CYP1A2 induction over CYP1B1. These results gave evidence of I3C playing a chemo-protective role in human breast cell lines.

35 Metabolic Regulating Factors * Other preventivive compounds * N-acetylcysteine: Pharmaceutical drug(mucomist) and nutritional supplement. * Ellagic Acid: natural phenol antioxidant found in many fruits and vegetables.

36 Metabolic Regulating Factors N-acetylcysteine is observed to protect cells from the cytotoxic effects of 4-OHE2 s by directing estrogen metabolism towards the protective pathways. NAcCys increased the level of methoxy conjugates by 40% and directly reacts itself with quinone conjugates to form precursors of GSH conjugation. N-acetylcysteine inhibited the oxidation of 4-OHE2 to its quinone product thus decreasing genotoxic levels in the cells. Due to these observations, N-acetylcysteine may be a novel and promising candidate for prevention of breast cancer.

37 Metabolic Regulating Factors Ellagic acid supplementation was shown to significantly increase the hepatic GST activity as well as hepatic GST mrna levels. Considering GST's role in safe detoxification of estrogens, Ellagic acid seems to be an effective genotoxic compound. Ellagic acid supplementation significantly reduces CYP1A1 and CYP1B1 levels, although it does not regulate it at the transcriptional level. Additionally, the formation of oxidative DNA adducts was significantly inhibited in response to ellagic acid supplementation.

38 Optimizing Estrogen Metabolism * Good estrogens vs Bad estrogens * Promotion for increase in 2-methoxyestrones/16-alpha hydroxyestrone ratio * Enhance hydroxylation and methylation reactions of estrogens in the liver * Golden flax meal, tumeric, green tea extracts, 5-methyltetrahydrofolic acid, selenium, indole 3-carbinol and DIM, omega-3 fatty acids, gamma tocopherols, vitamin E succinate, tocotreniols, flavanoids, and ellagic acid

39 Optimizing Estrogen Metabolism Pathways for both estrogen metabolism and receptor induction can be directed towards healthy responses by nutrigenomic compounds. Further, nutrigenomic compounds, such as IP3, participate in healthy shunting in both the metabolic and recetpor pathway. Such compounds could effectively limit the negative effects associated with estrogen therapy.

40 Nutrigenomics: Integrated Approach with BioHRT References: Zhang, S.M; Cook, N.R; Albert, C.M; Manson, J.E. Effect of Combined Folic Acid, Vitamin B6, and Vitamin B12 on Cancer Risk in Women. JAMA, November 5, 2008 Vol. 300, No. 17 Harris, H.A; Albert, L.M; Keith, J.C. Evaluation of an Estrogen Receptror-β Agonist in Animal Models of Human Disease. Endocrinology 144(10): , 2008 Edvarsson, K; Strom, A, Jonsson, P; Williams, C. Estrogen Receptor β Induces Antiinflammatory and Antitumorigenic Networks in Colon Cancer Cells. Mol Endocrinol, June 2011, 25(6): Janakiram, N.B; Steele, V.E; Rao, C.V. Estrogen Receptor- β as a Potential Target for Colon Cancer Prevention: Chemoprevention of Azoxymethane-Induced Colon Carcinogenesis by Raloxifene in F344 Rats. Cancer Prev Res 2009;2:52-59 Vivar, O.L; Saunier, E.F; Leitman, D.C; Bjeldanes, L.F. Selective Activation of Estrogen Receptor- β Target Genes by 3,3-Diindolylmethane. Endocrinology 151: , Riby, J.E; Chang, G.H; Bjeldanes, L.F. Ligand-Independent Activation of Estrogen Receptor Function by 3,3-Diindolylmethane in Human Breast Cancer Cells. Biochemical Pharmacology, Vol. 60, pp , 2000 Lei, P; Abdelrahim, M; Safe, S. 1,1-Bis(3-indolyl)-1-(p-substituted phenyl)methanes inhibit colon cancer cell and tumor growth through activation of c-jun N-terminal kinase. Carcinogenesis vol. 29, no. 6, pp , 2008

41 Nutrigenomics: an Integrated Approach in use with BHRT References: Strati, A; Papoutsi, Z; Lianidou, E; Moutsatsou, P. Effect of ellagic acid on the expression of human telomerase reverse transcriptase(htert) α+β+ transcript in estrogen receptor-positive MCF-7 breast cancer cells. Clinical Biochemistry 42 (2009) Laschke, M.W; Schwender, C; Scheuer, C; Menger, M.D. Epigallocatechin-3-gallate inhibits estrogen-induced activation of endometrial cells in vitro and causes regression of endometriotic lesions in vivo. Human Reproduction Vol. 23, No.10, pp , 2008 Thangapazham, R.L; Singh, A. K; Sharma, A; Gaddipati, J.P; Maheshwari, R.K. Green tea polyphenols and its constituent eppigallocatechin gallate inhibits proliferation of human breast cancer cell in vitro and in vivo. Cancer Letters 245 (2007) Farabegoli, F; Barbi, C; Lambertini, E; Piva, R. (-)-Epigallocatechin-3-gallate downregulates estrogen receptor alpha function in MCF-7- breast carcinoma cells. Cancer Detection and Prevention 31 (2007) Marconett, C.N; Sundar, S.N; Tseng, M; Firestone, G.L. Indole-3-carbonol downregulation of telomerase gene expression requires the inhibition of estrogen receptor-alpha and Sp1 transcription factor interaction within the htert promoter and mediates the G1 cell cycle arrest of human breast cancer cells. Carcinogenesis vol.0, no.0, pp.1-9, 2011

42 Nutrigenomics: an Integrated Approach in use with BHRT References: Al-Ghnaniem, R; Peters, J; Foresti, R; Heaton, N; Pufulete, M. Methylation of estrogen receptor α and mutl homolog 1 in normal mucosa: association with folate and vitamin B-12 status in subjects with and without colorectal neoplasia. Am J Clin Nutr 2007;86: Samuel, S; Sltrin, M. Vitamin D s role in cell proliferation and differentiation. Nutrition Reviews Vol. 66(Suppl.2):S116-S124. Santodonato, J. Review of the estrogenic and antiestrogenic activity of polycyclic aromatic hydrocarbons: relationship to carcinogenity. Chemosphere 1997, Feb;34(4): Fertuck, K.C; Kumar, S; Sikka, H.C; Matthews, J.B; Zacharewski, T.R. Interaction of PAH-related compounds with the alpha and beta isoforms of the estrogen receptor. Zhao, C; Gao, H; Liu, Y. Genome-wide Mapping of Estrogen Receptor-beta-Binding Regions Reveals Extensive Cross-Talk with Transcription Factor Activator Protein-1. Cancer Res 2010;70: Levin, E.R. Cellular functions of plasma membrane estrogen receptors. Steroids 67 (2002) Carrol, J.S; Meyer, C.A; Song, J; Brown, M. Genome-wide analysis of estrogen receptor binding sites. Nature Genetics Volume 38, Number 11, 2006