В данной работе представлены результаты молекулярно-фармакологического анализа протромботического воздействия препаратов пероральных эстрогенов методами биоинформатики и системной биологии. В то же время трансдермальное введение эстрогенов позволяет не только поддерживать более стабильные концентрации в крови, но и практически полностью избежать печеночного метаболизма. Трансдермальные эстрогены характеризуются ярко выраженными фармакокинетическими преимуществами, что позволяет уменьшить дозировку эстрогена без потери эффективности, избежать нежелательного эффекта избыточной активации коагуляции крови.
This paper presents the results of a molecular pharmacologicalanalysis of prothrombotic effects of oral estrogen drugs,as well asthe actual problem resoving methods of bioinformatics and systems biology. At the same time, the transdermal administration of estrogensallows not only to maintain a stable blood concentration, but alsoalmost completely avoid liver metabolism. Transdermal estrogen ischaracterized by pronounced pharmacokinetic advantages that can reducethe dosage of estrogen without losing effectiveness; avoidingundesirable effects of excessive activation of blood coagulation. Key words: estrogen, estrogen receptors, thrombophilia,bioinformatics, securitytherapy, gel form of estrogen, Divigel.
1. Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med 2004; 164 (18): 1965–76.
2. Hulley S, Furberg C, Barrett-Connor E et al. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002; 288 (1): 58–66.
3. Lidegaard O, Edstrom B, Kreiner S. Oral contraceptives and venous thromboembolism. A case-control study. Contraception 1998; 57 (5): 291–301.
4. Laliberte F, Duh MS, Kahler KH et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause 2011; 18 (10): 1052–9.
5. Shufelt CL, Merz CN, Prentice RL, Pettinger MB. Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study. Menopause 2013; 1: 15–27.
6. Sweetland S, Beral V, Balkwill A et al. Venous thromboembolism risk in relation to use of different types of postmenopausal hormonetherapy in a large prospective study. J Thromb Haemost 2012; 101111/j1538-10111.
7. TorshinI Yu. Sensing the change from molecular genetics to personalized medicine. Nova Biomedical Books, NY, USA, 2009. In «Bioinformatics in the Post-Genomic Era» series.
8. Krieg AJ, Krieg SA, Ahn BS, Shapiro DJ. Interplay between estrogen response element sequence and ligands controls in vivo binding of estrogen receptor to regulated genes. J Biol Chem 2004; 279 (6): 5025–34.
9. Jegga AG, Chen J, Gowrisankar S et al. GenomeTrafac: awhole genome resource for the detection of transcription factor binding site clusters associated with conventionaland microRNA encoding genes conserved between mouse and human gene orthologs. Nucleic Acids Res 2007; 35 (Databas: D116–21).
10. Stepanova M, Lin F, Lin VC. Establishing a statistic model for recognition of steroid hormone response elements. Comput Biol Chem 2006; 30 (5): 339–47.
11. Lowe GD. Hormone replacement therapy: prothrombotic vs. protective effects. Pathophysiol Haemost Thromb 2002; 32 (5–6): 329–32.
12. Borgfeldt C, Samsioe G. Low-dose oral combination of 17beta-estradiol and norethisterone acetate in postmenopausal women decreases factor VII, fibrinogen, antithrombin and plasminogen activator inhibitor-1. Climacteric 2004; 7 (1): 78–85.
13. Zhao YY, Sun KL, Ashok K. Analysis of a cis-Acting Element Involved in Regulation by Estrogen of Human Angiotensinogen Gene Expression. Sheng Wu Hua Xue Yu Sheng Wu Wu Li Xue Bao (Shanghai) 1998; 30 (5): 445–8.
14. Zhang X, Bhavnani BR, Tam SP. Regulation of human apolipoprotein A-I gene expression by equine estrogens. J Lipid Res 2001; 42 (11): 1789–800.
15. Rickard DJ, Bonde SK. Bone morphogenetic protein-6 production in human osteoblastic cell lines. Selective regulation by estrogen. J Clin Invest 1998; 101 (2): 413–22.
16. Kanda N, Watanabe S. 17-beta-estradiol stimulates the growth of human keratinocytes by inducing cyclin D2 expression. J Invest Dermatol 2004; 123 (2): 319–28.
17. Tamura M, Deb S, Sebastian S et al. Estrogen up-regulates cyclooxygenase-2 via estrogen receptor in human uterine microvascular endothelial cells. Fertil Steril 2004; 81 (5): 1351–6.
18. Tsuchiya Y, Nakajima M, Kyo S et al. Human CYP1B1 is regulated by estradiol via estrogen receptor. Cancer Res 2004; 64 (9): 3119–25.
19. Chen CC, Lee WR, Safe S. Egr-1 is activated by 17beta-estradiol in MCF-7 cells by mitogen-activated protein kinase-dependent phosphorylation of ELK-1. J Cell Biochem 2004; 93 (5): 1063–74.
20. Kleinert H, Euchenhofer C, Ihrig-Biedert I et al. Estrogens increase transcription of the human endothelial NO synthase gene: analysis of the transcription factors involved. Hypertension 1998; 31 (2): 582–8.
21. Lopez D, Sanchez MD, Shea-Eaton W, McLean MP. Estrogen activatesthehigh-density lipoprotein receptorgenevia binding toestrogenresponse elements and interactionwith sterol regulatory elementbindingprotein-1A. Endocrinology 2002; 143 (6): 2155–68.
22. Seely J, Amigh KS, Suzuki T. Transcriptional regulation of dehydroepiandrosteronesulfotransferase (SULT2A1) by estrogen-related receptor alpha. Endocrinology 2005; 146 (8): 3605–13.
23. Reddy Kilim S, Chandala SR. A comparative study of lipid profile and oestradiol in pre- and post-menopausal women. J Clin Diagn Res 2013; 7 (8): 1596–8 doi.
24. Maximov PY, Lee TM, Jordan VC. The discovery and development of selective estrogen receptor modulators (SERMs) for clinical practice. Curr Clin Pharmacol 2013; 8 (2): 135–55.
25. Citarella F, Felici A, Farsetti A, Pontecorvi A, Fantoni A. Estrogen induction and contact phase activation of human factor XII. Steroids 1996; 61 (4): 270–6.
26. Громова О.А., Торшин И.Ю., Лиманова О.А. и др. Сравнительное исследование доказательной базы эффективности и безопасности применения пероральной и трансдермальной форм заместительной гормональной терапии эстрогенами у женщин в различные возрастные периоды. Проблемы репродукции. 2013; 6: 86–96.
27. Travassos de Figueiredo Alves, Amelia Sobreira Gomes M, Clapauch R. Comparison of gel and patch estradiol replacement in Brazil, a tropical country. Maturitas 2000; 36 (1): 69–74.
28. Wells BJ, Kattan MW, Cooper GS et al. ColoRectal Cancer Predicted Risk Online (CRC-PRO) Calculator Using Data from the Multi-Ethnic Cohort Study. J Am Board Fam Med 2014; 27 (1): 42–55.
29. Gingras D, Béliveau R. Colorectal cancer prevention through dietary and lifestyle modifications. Cancer Microenviron 2011; 4 (2): 133–9.
30. Coyne MJ, Bonorris GG, Chung A et al. Estrogen enhances dietary cholesterol induction of saturated bile in the hamster. Gastroenterology 1978; 75 (1): 76–9.
31. Громова О.А., Торшин И.Ю., Лиманова О.А. Сравнительное исследование доказательной базы эффективностии безопасности применения пероральной и трансдермальной форм заместительной гормональной терапии эстрогенами у женщин в различные возрастные периоды. Проблемы репродукции. 2013; 6: 86–96.
32. Jarvinen A, Granander M, Nykanen S et al. Steady-state pharmacokinetics of oestradiol gel in post-menopausal women: effects of application area and washing. Br J ObstetGynaecol 1997; 104 (Suppl.): 14–8.
________________________________________________
1. Gomes MP, Deitcher SR. Risk of venous thromboembolic disease associated with hormonal contraceptives and hormone replacement therapy: a clinical review. Arch Intern Med 2004; 164 (18): 1965–76.
2. Hulley S, Furberg C, Barrett-Connor E et al. Noncardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA 2002; 288 (1): 58–66.
3. Lidegaard O, Edstrom B, Kreiner S. Oral contraceptives and venous thromboembolism. A case-control study. Contraception 1998; 57 (5): 291–301.
4. Laliberte F, Duh MS, Kahler KH et al. Does the route of administration for estrogen hormone therapy impact the risk of venous thromboembolism? Estradiol transdermal system versus oral estrogen-only hormone therapy. Menopause 2011; 18 (10): 1052–9.
5. Shufelt CL, Merz CN, Prentice RL, Pettinger MB. Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study. Menopause 2013; 1: 15–27.
6. Sweetland S, Beral V, Balkwill A et al. Venous thromboembolism risk in relation to use of different types of postmenopausal hormonetherapy in a large prospective study. J Thromb Haemost 2012; 101111/j1538-10111.
7. TorshinI Yu. Sensing the change from molecular genetics to personalized medicine. Nova Biomedical Books, NY, USA, 2009. In «Bioinformatics in the Post-Genomic Era» series.
8. Krieg AJ, Krieg SA, Ahn BS, Shapiro DJ. Interplay between estrogen response element sequence and ligands controls in vivo binding of estrogen receptor to regulated genes. J Biol Chem 2004; 279 (6): 5025–34.
9. Jegga AG, Chen J, Gowrisankar S et al. GenomeTrafac: awhole genome resource for the detection of transcription factor binding site clusters associated with conventionaland microRNA encoding genes conserved between mouse and human gene orthologs. Nucleic Acids Res 2007; 35 (Databas: D116–21).
10. Stepanova M, Lin F, Lin VC. Establishing a statistic model for recognition of steroid hormone response elements. Comput Biol Chem 2006; 30 (5): 339–47.
11. Lowe GD. Hormone replacement therapy: prothrombotic vs. protective effects. Pathophysiol Haemost Thromb 2002; 32 (5–6): 329–32.
12. Borgfeldt C, Samsioe G. Low-dose oral combination of 17beta-estradiol and norethisterone acetate in postmenopausal women decreases factor VII, fibrinogen, antithrombin and plasminogen activator inhibitor-1. Climacteric 2004; 7 (1): 78–85.
13. Zhao YY, Sun KL, Ashok K. Analysis of a cis-Acting Element Involved in Regulation by Estrogen of Human Angiotensinogen Gene Expression. Sheng Wu Hua Xue Yu Sheng Wu Wu Li Xue Bao (Shanghai) 1998; 30 (5): 445–8.
14. Zhang X, Bhavnani BR, Tam SP. Regulation of human apolipoprotein A-I gene expression by equine estrogens. J Lipid Res 2001; 42 (11): 1789–800.
15. Rickard DJ, Bonde SK. Bone morphogenetic protein-6 production in human osteoblastic cell lines. Selective regulation by estrogen. J Clin Invest 1998; 101 (2): 413–22.
16. Kanda N, Watanabe S. 17-beta-estradiol stimulates the growth of human keratinocytes by inducing cyclin D2 expression. J Invest Dermatol 2004; 123 (2): 319–28.
17. Tamura M, Deb S, Sebastian S et al. Estrogen up-regulates cyclooxygenase-2 via estrogen receptor in human uterine microvascular endothelial cells. Fertil Steril 2004; 81 (5): 1351–6.
18. Tsuchiya Y, Nakajima M, Kyo S et al. Human CYP1B1 is regulated by estradiol via estrogen receptor. Cancer Res 2004; 64 (9): 3119–25.
19. Chen CC, Lee WR, Safe S. Egr-1 is activated by 17beta-estradiol in MCF-7 cells by mitogen-activated protein kinase-dependent phosphorylation of ELK-1. J Cell Biochem 2004; 93 (5): 1063–74.
20. Kleinert H, Euchenhofer C, Ihrig-Biedert I et al. Estrogens increase transcription of the human endothelial NO synthase gene: analysis of the transcription factors involved. Hypertension 1998; 31 (2): 582–8.
21. Lopez D, Sanchez MD, Shea-Eaton W, McLean MP. Estrogen activatesthehigh-density lipoprotein receptorgenevia binding toestrogenresponse elements and interactionwith sterol regulatory elementbindingprotein-1A. Endocrinology 2002; 143 (6): 2155–68.
22. Seely J, Amigh KS, Suzuki T. Transcriptional regulation of dehydroepiandrosteronesulfotransferase (SULT2A1) by estrogen-related receptor alpha. Endocrinology 2005; 146 (8): 3605–13.
23. Reddy Kilim S, Chandala SR. A comparative study of lipid profile and oestradiol in pre- and post-menopausal women. J Clin Diagn Res 2013; 7 (8): 1596–8 doi.
24. Maximov PY, Lee TM, Jordan VC. The discovery and development of selective estrogen receptor modulators (SERMs) for clinical practice. Curr Clin Pharmacol 2013; 8 (2): 135–55.
25. Citarella F, Felici A, Farsetti A, Pontecorvi A, Fantoni A. Estrogen induction and contact phase activation of human factor XII. Steroids 1996; 61 (4): 270–6.
26. Громова О.А., Торшин И.Ю., Лиманова О.А. и др. Сравнительное исследование доказательной базы эффективности и безопасности применения пероральной и трансдермальной форм заместительной гормональной терапии эстрогенами у женщин в различные возрастные периоды. Проблемы репродукции. 2013; 6: 86–96.
27. Travassos de Figueiredo Alves, Amelia Sobreira Gomes M, Clapauch R. Comparison of gel and patch estradiol replacement in Brazil, a tropical country. Maturitas 2000; 36 (1): 69–74.
28. Wells BJ, Kattan MW, Cooper GS et al. ColoRectal Cancer Predicted Risk Online (CRC-PRO) Calculator Using Data from the Multi-Ethnic Cohort Study. J Am Board Fam Med 2014; 27 (1): 42–55.
29. Gingras D, Béliveau R. Colorectal cancer prevention through dietary and lifestyle modifications. Cancer Microenviron 2011; 4 (2): 133–9.
30. Coyne MJ, Bonorris GG, Chung A et al. Estrogen enhances dietary cholesterol induction of saturated bile in the hamster. Gastroenterology 1978; 75 (1): 76–9.
31. Громова О.А., Торшин И.Ю., Лиманова О.А. Сравнительное исследование доказательной базы эффективностии безопасности применения пероральной и трансдермальной форм заместительной гормональной терапии эстрогенами у женщин в различные возрастные периоды. Проблемы репродукции. 2013; 6: 86–96.
32. Jarvinen A, Granander M, Nykanen S et al. Steady-state pharmacokinetics of oestradiol gel in post-menopausal women: effects of application area and washing. Br J ObstetGynaecol 1997; 104 (Suppl.): 14–8.
1. ГБОУ ВПО Ивановская государственная медицинская академия Минздрава России;
2. РСЦ института микроэлементов ЮНЕСКО;
3. ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва;
4. Российское общество акушеров-гинекологов