Send Orders of Reprints at reprints@benthamscience.net 392 Current Molecular Pharmacology, 2012, 5, 392-400 Estrogen Receptor Expression and its Relevant Signaling Pathway in Prostate Cancer: A Target of Therapy Yasuhiro Nakamura*, Keely M McNamara and Hironobu Sasano Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan Abstract: Estrogens have been recently postulated as potential agents in the development and progression of prostate cancer. Previous studies have demonstrated presence of both variants of estrogen receptor (ER); ER alpha (ER) and ER beta (ER) in differing proportions between normal prostate and prostate cancer. It has been previously suggested that estrogens may either accelerate or inhibit growth of prostate cancer cell growth, depending on ER status. In particular, ER is considered to have a growth inhibitory role in prostate tissue. ER is significantly expressed in human prostate cancer cells, and hence it is considered a key factor for anti-cancer therapy. Therefore, various types of ER ligands have been investigated to clarify the mechanism of ER-mediated pathway of inhibitory effects on prostate cancer cells. Herein, we review recent examinations of ERs in prostate cancer, and the significance of ER mediated signaling pathways, with a focus on ER, as prospective therapeutic targets in prostate cancer. Keywords: Estrogen receptor alpha(ER), estrogen receptor beta (ER), GRP30, prostate cancer, steroid metabolism. INTRODUCTION It has been previously suggested that in addition to the well characterized actions of androgens, estrogens may either accelerate or inhibit growth of prostate cancer cell growth, depending on ER status and ER subtype. Due to this it becomes very important to clarify the regulatory system(s), the signaling pathway(s) and ligands of ER in prostate cancer. In the present article, we focus on the previous and recent accumulating references regarding the expression and function of classical estrogen receptors (ER), mainly ER beta (ER), as well as a new plasma membrane receptor and discuss the possibility as prospective therapeutic targets in prostate cancer. ESTROGEN RECEPTOR: DISTRIBUTION, FUNCTION AND RESPONSIVE GENES There are two classical ERs; ER and ER. These proteins originate from two different genes (6q24-q27 and 14q22-24 respectively) [1, 2]. The two estrogen receptors have a different distribution pattern among different tissues in the body, between genders and between species [3-6]. ER and share a large degree of homology in the DNA binding domain (96% homology) but differ significantly in the N terminus (20% homology), hinge (30% homology) and ligand binding domains (53% homology) [7]. In addition to structural difference between wild type ER and , recent studies have found alternate isotypes of each receptor [7-9, 10-15] that have biological relevance to disease states [8, 16]. These alternate isotypes are achieved by different mechanistic means between ER and ER. While the principal alternate variants of ER appear to be formed by exon skipping [17] and hence not *Address correspondence to this author at the Department of Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980- 8575 JAPAN; Tel: +81-22-717-8050; Fax: +81-22-717-8051; E-mail: yasu-naka@patholo2.med.tohoku.ac.jp 1874-4702/12 $58.00+.00 concentrated to any domain, the most common ER variants, are formed by variation within the sequence of exon 8 [13, 18] (encoding the N terminus and ligand binding domain region). Estrogen receptors are suggested to have both genomic and non genomic mechanisms of action. In the genomic signaling pathway, ER agonists bind causing a structural change in the receptor that leads to loss of repressor protein, gain of co-activators and ultimately the receptors, translocation into the nucleus [19]. Antagonist binding leads to an alternate confirmation change resulting in further recruitment of receptor co-repressors and inhibition of signaling despite its inability to translocate and bind DNA [19]. Following nuclear translocation receptor agonists cause estrogen receptor to bind estrogen response elements in order to exert effects on genomic transcription [20]. The estrogen receptor can do this either as a homodimer (ERER or ERER) or a heterodimer (ERER) between the two ER variants depending on various local conditions [21, 22]. As some DNA binding sites are permissive of both ER and/or ER binding where as others are specific to ER variant [23], this explains one way in which different transcriptional programs can be enacted by the two receptors. In addition to variation in receptor binding sites each receptor also differs in the cofactors and co-repressor requirements [24], providing addition levels of control of genomic transcription. Aside from genomic pathways there are also suggested nongenomic pathways of estrogen action. While the extent and the role of these have continued to be controversial there is some evidence suggesting that the genomic and non-genomic pathways may be synergistic [25]. Estrogen responsive genes are many and vary between tissues. Some transcriptional programs are inducible by estrogen receptor while others are specific to receptor type [26]. In general, in hormone dependent tissues such as the prostate and breast, ER is thought to enact an antiproliferative gene expression program and ER enacts a proproliferative expression program [27] while the heterodimers © 2012 Bentham Science Publishers Estrogen Receptor Expression and its Relevant Signaling Pathway in Prostate Cancer of the two receptors are suggested to have anti-proliferative actions [28]. Specifically in the prostate it has been demonstrated that ER promotes abnormal differentiation [29-31] and in contrast ER action has been shown to act against proliferation via its regulation of epithelial differentiation [32-36]. In the prostate ER mediated growth inhibition mechanisms have been recently elucidated to be an AR independent via TNF, mediator of apoptosis in the epithelia and to a lesser extent in stromal cells [37], illustrating the fundamental importance of ER, independent of other nuclear receptors, to the regulation of growth in the prostate. ER EXPRESSION IN PROSTATE CANCER TISSUES AND CANCER CELL LINES Since the suggestion of estrogens as having a role in prostate cancer progression there have been a multitude of recent studies on ER expression in prostate cancer tissues across a number of species and human prostate cancer cell lines [38]. While the variation in detection methods used (RNA vs IHC vs western blotting) does not always allow direct comparisons and, particularly with studies involving ER the availability of a robust ER antibody has been problematic [39], a growing body of evidence detailed below, examining ER expression in normal and diseased prostate exists. In normal adult and fetal human prostate the predominate receptor expressed is ER [40-42]. In the adult its strongest expression is in the basal epithelial cells and the weakest in the luminal epithelial cells with some expression Current Molecular Pharmacology, 2012, Vol. 5, No. 3 393 in the stroma [40, 43]. ER is also expressed with strongest reactivity in the stromal cells with little reactivity observed in the epithelial layer of the prostate [43] and is variable between individuals well as between nationalities [44]. Both receptors have been shown to vary between the different zones of the human prostate [45]. In prostate pathology, ER and ER have been shown to be present in stromal and epithelial layers of the prostate [43, 45-48] (Fig. 1). In normal prostate and early disease the ratio of ER/ER in the epithelial layer has been stressed as an important predictor of the aggressiveness of epithelial carcinomas [49, 50], with higher levels of ER expression being beneficial, although this association is not as clear in later stage disease. In PIN lesions ER expression is thought to be decreased while ER expression increased [46] in the epithelial layer [45, 51]. In contrast to findings in PIN lesions, the patterns reported for estrogen receptor expression in prostate cancer grade are less consistent. Studies have suggested that ER expression may be increased in PCa tissues [46, 52, 53], in a manner akin to what is seen in PIN although this is not consistent in all papers. Likewise there has been variability reported in ER immunoreactivity including; decreased ER immunoreactivity with increasing grade of prostate cancer [43, 47, 48, 51-57], no significant change by grade [45, 58] and increase in ER [59-61] in cancer (mRNA expression). A possible explanation for the variance in reported ER expression with cancer progression is the differing specificity of ER antibodies used, and potential differential expression of ER subtypes. Recent studies have suggested that the expression pattern of subtypes 2 and 5 A C B D Fig. (1). Staining for ER (A,C) and ER (B,D)expression in normal (A,B) and cancerous (C,D) prostate. In the above photomicrographs the predominance of ER in normal and diseased prostate can be observed. 394 Current Molecular Pharmacology, 2012, Vol. 5, No. 3 Nakamura et al. varies in regard to cell layer specificity and sub-cellular localization [16]. In addition expression of types 2 and 5 is associated with worse survival in prostate cancer specimens [16, 62]. As different ER antibodies are directed against different regions of ER protein [63, 64] it is possible that patterns of specific subtypes may have been variably detected, hence explaining some of the variations observed in expression pattern with cancer progression. Further studies are needed to determine the exact expression patterns of ER, and specifically ER and its associated subtypes, with advancing grades of prostate cancer. lines. While the contradictory reports regarding ER may be explained by differences in antibodies and their ability to detect ER variants, further work is needed to fully characterize the ER balance in the most commonly used prostate cancer cell lines and reconcile the contradictions in the current literature. In addition to primary prostate cancer, studies have also examined the expression of ER in hormone refractory and metastatic disease. In the former, both ER and have been reported to be expressed [52, 57, 65, 61] and in the latter ER has been reported to be expressed despite loss of ER expression in progression of the original prostate cancer [66, 67]. This report suggests that ER may be a possible target even in advanced disease, although its underlying biological role is, at this point, unknown. It is known that the action of ERs, especially ER, is different depending on the ligand. While there are many different proposed ligands of the estrogen receptor, in this paper we are going to limit discussion to the effects of the two most widely studied naturally occurring ligands, E2 and 5-androstane-3,17-diol (3-adiol), in addition to a variety of synthetic compounds. The effects of various prostate cancer treatments on hormone receptor expression have also been examined. Following hormone deprivation and the subsequent emergence of hormone refractory disease ER is suggested to be increased relative to ER levels [57, 65, 52] implying that in hormone refractory disease a contributing factor may be loss of ER mediated suppression of proliferation, in addition to the well characterized changes in androgen dependent signaling suggesting a potential for targeting estrogen receptors following failure of androgen dependent therapy. Nonendocrine based therapy directed at primary cancers may also inadvertently act on the androgen-estrogen axis. Studies examining hormone receptor levels following radiation treatment showed increased levels of all steroid receptors including ER however these increases were at different rates with AR being the least affected. This is interesting as it suggests that radiation exposure may affect the balance of androgen and estrogen signaling in the prostate [68], thus suggesting even in treatments that do not specifically target the hormone receptors there may be residual effects on hormonal pathways through alteration of receptor levels. In addition to prostate cancer tissues a variety of prostate cancer cell lines have also been examined in regards to ER and ER expression. The most commonly examined cell lines are the PC3, LNCaP and DU145 [58, 61, 69-75] with other prostate cancer cell lines (i.e. JCA-1, ND1, DUPro, PC3M and 22Rv1) being examined in a limited number of studies [58, 61, 70, 71]. In general, all prostate cancer cell lines have been demonstrated to express ER [58, 61, 69-75] although some studies suggest that ER expression is reduced through methylation silencing [71] suggesting one way in which expression could be modulated in prostate cancer tissues. In contrast to ER, expression levels of ER have not been examined in too much depth and when examined are more contradictory. The majority of work looking at the expression of ER in prostate cancer cell lines has focused on the LNCaP and PC3 lines. Some [61, 71] but not all reports [58, 69, 70, 72-75] have reported detectable levels of ER expression although this is a limited panel of prostate cancer cell lines when compared to studies examining ER expression in cell LIGANDS OF ESTROGEN RECEPTOR IN PROSTATE CANCER AND THEIR PATHWAYS FOR ACTION There are two main naturally occurring estrogenic ligands that have been discussed in the context of the prostate. Estradiol (E2) is the steroid with the highest affinity for ER in vivo. While actions of estradiol in the prostate were historically a paradox due to the very low levels of serum estrogen in males, the demonstration of the importance of intracrinology in hormone dependent tissues and specifically the demonstration of in situ production of estrogen in prostate cancer tissues (Fig. 2), [76, 77] has lead to a burgeoning research field surrounding intracrine estrogen metabolism in the prostate. Research within this field, has suggested an alternate pathway of intracrine production of estrogenic ligand compounds in the prostate. 3b-adiol is known as a putative natural ERb-ligand, albeit with a lower affinity for ER than E2. 3b-adiol is a metabolite of DHT, produced by 17b-hydroxysteroid dehydrogenases and is further metabolized to triols by CYP7B1 [78, 79]. The local level of 3b-adiol is reported to be much higher than that of E2 in the prostate [33, 79] and due to this it has been proposed that 3diol may be the more physiologically relevant ligand of ERs in prostate tissue. Based on the above findings, while the exact estrogenic ligand is unclear it is reasonably postulated that locally produced estrogens play a role in prostate cancer cell biology via ERb. One very interesting aspect of the E2 vs 3diol controversy is the suggestion that the two different ligands may mediate different biological outcomes. This suggestion comes from studies across a number of cell lines. E2 administration has been shown to mediate effects associated with proliferation in a number of cell lines including the induction of PSA mRNA in response to E2-ER interaction in LNCaP cells [80] and the induction of cell proliferation mediated through E2 induced proteasome-dependent degradation of KLF5 in DU145 cells [81]. In contrast to the effects of E2 in prostate cancer cell lines 3b-adiol has been demonstrated to inhibit the proliferation of DU-145 and PC-3 cells [82, 83] suggesting a ligand specific effect of estrogen actions. When compared to expected observations based on clinical samples the effects of 3diol seem to match the lower proliferation and better outcome observed in ER+ prostate cancer patients. However further studies are needed to fully understand if the effects of E2 and 3diol administration are a faithful model of cell line effects in prostate cancer. Estrogen Receptor Expression and its Relevant Signaling Pathway in Prostate Cancer Vessel 395 Prostate cancer tissue Aromatase Androstendione (inactive) E1S (inactive) Current Molecular Pharmacology, 2012, Vol. 5, No. 3 17β-HSD type 1 E1 E2 (active) STS ER β Fig. (2). The postulated scheme representing local production of estrogens in human prostate cancer tissue. High concentration of circulating inactive steroids, androstenedione, and estrone-sulfate (E1S), are major precursor substrates of local estrogen production in the tissue. Aromatase catalyzes androstenedione into estrone (E1), and Steroid sulfatase (STS) hydrolyzes estrone-sulfate (E1S) to E1. E1 is subsequently converted to potent estradiol (E2) by 17 hydroxysteroid dehydrogenase type 1 (17-HSD-1), and acts on target cells via ER in prostate cancer cells. These three enzymes are expressed in human cancer cells. This figure was referred to in previous reports [76, 77]. Finally, the effects of a number of synthetic agonists and antagonists, with different affinities for ER and , have been examined across various prostate cancer cell lines. In many cases these reagents offer an excellent opportunity to dissect ER action in the prostate due to the targeted nature of these agents. Two of these agents are non ER type specific (ICI 182,720, raloxifine) and one has a very high degree of specificity to ER (8-VE2). ICI182,780 (ICI), an inhibitor of ER, has been demonstrated to activate ER resulting in proliferation of DU145 cells [84]. In contradiction to the ICI results Kim et al. demonstrated that raloxifene, a mixed estrogen agonist/antagonist, promotes activation of caspases 8 and 9 in PC3 and DU145 cells and induces their apoptosis [70] a finding which is possible explained by the preference of raloxifine for binding to ER [85] compared to the non specific antagonism of ICI. The final synthetic agent, and some of the strongest cell study based evidence for ER as a suppressor of cellular proliferation, is a selective ER agonist (8-VE2) reported in McPherson et al [37]. In prostate cancer cells, administration of 8-VE2 activates apoptosis via TNF [37]. While the results from synthetic ligands are mixed it would appear that specific activation of ER results in the activation of apoptosis through various cellular pathways. ligands of ER have been those using E2. These studies have shown that E2 binding causes ER to bind at the ERE, but inhibits its activity at AP1 sites [78]. In contrast to endogenous E2 the synthetic ligand, ICI182,780 (ICI), an inhibitor of ER, has been demonstrated to activate ERb by involving NFkB complex resulting in proliferation [84]. At the moment there is insufficient data to correlate any one or combination of E2 binding sites with proliferative or suppressive actions of ER however this remains an exciting future prospect. Adding to the complexity in examining the interaction of ER ligands and receptor, ERb has several binding motifs including estrogen responsive element (ERE), AP1 and NFB. As there may be ligand specific actions of ER one possible mechanism that it could act through is causing the receptors to undergo a conformational change that gives specificity to one or more ER binding motifs while restricting access to others. At the moment the study of the correlation between ligand and binding motif is in its infancy however initial results suggest there may be some significance in this hypothesis. To the best of our knowledge the only studies concerning endogenous REGULATION OF ER IN PROSTATE CANCER CELLS Finally, non genomic pathways of ER signaling have also proved to be relevant in a prostate cancer setting, although to the best of our knowledge E2 is the only ligand investigated in this setting. E2 actions on ER-mediated nongenomic pathway have also been demonstrated as to be relevant as Pandini et al. found that E2 markedly upregulates insulin-like growth factor -I receptor (IGF-IR) mRNA and protein expression in both LNCaP and PC-3 cells in a non genomic manner and this increases mitogenic and motogenic activities of cancer cells [86]. While the investigations of ER-E2 interaction are still in their infancy, and the exact relevant balance between genomic and non genomic actions is unclear this initial finding suggests this may be an avenue for further investigation. In addition to varied estrogen receptor ligands, regulatory factors also play a role in both expression and activity of ER. While not exhaustive we will briefly discuss some of the ER co-regulators that have recently been shown to be important in the regulation of growth in prostate cancer cell lines in the hope of illustrating the myriad of cofactors that may affect ER actions and highlighting an area of further research. 396 Current Molecular Pharmacology, 2012, Vol. 5, No. 3 Nakamura et al. Steroid receptor coactivators p300 and CBP, are highly expressed in advanced prostate cancer, have been shown to potentiate ER signaling and through this pathway inhibit cellular migration [87]. Peptide hormones such as human growth hormone (hGH) can stimulate/modulate insulin-like growth factor (IGF) and ER gene expressions in the androgen sensitive lines LNCaP and PC3 [88]. In addition to stimulating ER expression, co-administration of IGF-I and E2 stimulates androgen-dependent LNCaP cell proliferation, suggesting a synergistic effect between growth factor and estrogen signaling pathways [88]. Finally, recent studies examining interactions between ER established markers of tissue hypoxia and adverse outcome (eNOS and HIF) have suggested that ER acts in association with these markers to initiate transcription and that ER expression in combination with marker predicts for a worse clinical outcome [89]. While this is a subset, focused on recent research, of all studies looking at the association between ER expression and co-regulatory proteins they illustrate the complexity and plasticity in ER action, depending on its associations. ER RESPONSIVE GENES Many studies have studied the downstream effects of ER and ER activation in estrogen dependent cancers such as breast. These studies can use provide useful information when trying to extrapolate an understanding of the roles of ER and in prostate cancer. While specific ER responsive genes have mainly been studied in relation to ER signaling, the vast majority of investigations into downstream effect of ER have been achieved by the study of E2 dependent gene expression profiles. Such gene expression profiles have revealed links, at least in breast cancer, between ER signaling, cell cycle regulators [90] and TGF signaling [91]. Of these, the latter is the most interesting as there is a link to patterns found in prostate cancer cell line studies. By using microarray analysis, Chang et al. investigated gene regulatory effects of ER in the MCF7 breast cancer cell line. In this study of all the genes modulated by ER, the greatest numbers were associated with transcriptional factors and signal transduction pathways, including TGF, semaphorin and SDF1 signaling pathways [91]. As TGF is normally associated with the suppression of cell proliferation in breast cancer cell lines the down regulation of multiple elements of the TGF pathway by ER signaling [91] is potentially interesting in view of the interactions between TGF-1 and prostate cancer cell growth. It is reported that TGF-1 locally produced by prostate cancer cells can result in suppression of a paracrine dependent ER mediated inhibition of cell motility [92]. The reciprocal regulation of ER by TGF in breast cancer may suggest that, at least in part, the tumor cells motility is controlled by the balance between these two signaling molecules, although this requires study of ER regulation of TGF signaling pathways in prostate cancer cell lines for confirmation. Likewise the presence of ER E2 inhibition of cell cycle regulators and other aspect of cell growth and metabolism observed in the breast should also be tested in prostate cancer cell lines. GPR30, A NOVEL PROSTATE ESTROGEN RECEPTOR CAPABLE OF INHIBITING PROSTATE CANCER GROWTH? While studies have focused on the classical ERs, there are other cellular proteins capable of mediating estrogen dependent signaling. Recently, an orphan G protein–coupled receptor (GPR30), capable of E2 binding [93], has been found at both the plasma membrane and the endoplasmic Better prognosis ERK1/2 p21 GRP30 Cjun/cfos Cox2 TGFβ Semaphorin SDF1 ERβ p300 ERβ CBP ERα ERβ Hif Proliferation ERβ eNOS Worse prognosis Fig. (3). Suggested pathways of ER action in prostate carcinoma cells. A diagrammatic summary of the suggested pathways of estrogen signaling in prostate cancer cells. The upper half of the section (light gray) illustrates interaction of estrogenic receptors with downstream pathways that have a beneficial effect on prostate cancer cells, usually through the inhibition of proliferation. The lower section (dark gray) illustrates the interactions that have an adverse effect on prostate cancer, through a variety of mechanisms. Estrogen Receptor Expression and its Relevant Signaling Pathway in Prostate Cancer reticulum [94]. The function of GPR30 in cancer cell proliferation has been reported to be different among various types of cancers [93, 95-99, 100, 101], including prostate cancer. Chan et al. demonstrated that when a non-estrogenic ligand (G1) bound to GPR30 it induced inhibition of PC-3 cell growth. The mechanism of this GPR30 mediated growth suppression was through a sustained activation of Erk1/2 and a c-jun/c-fos-dependent upregulation of p21 [94] leading to the inhibition of cell growth. While this suggests GPR30 as a potential inhibitor of prostate cancer growth further studies are needed to clarify the significance of GPR30 expression in the prostate, the biological effect of estrogenic compounds on this receptor and the interaction, if any, between ER and GPR30 in prostate. CONCLUSION In conclusion, ER in prostate cancer is involved in various signaling pathways, has many levels of regulation (summarized in Fig. 3). It is postulated that ER may be a potential target for prostate cancer therapy, although to allow the development of useful therapeutic agents more work needs to be done in order to understand the inherent mechanisms in ER specific regulation of prostate growth. IGF = Insulin Growth factor IGF-IR = Insulin-like growth factor -I receptor IHC = Immunohistochemistry mRNA = Messenger ribonucleic acid NFB = Nuclear factor kappa B PCa = Prostate cancer PIN = Prostate intraepithelial neoplasia PSA = Prostate specific antigen RNA = Ribonucleic acid SDF1 = Stromal cell-derived factor 1 TNF = Tumor necrosis factor alpha [1] [2] [3] The authors confirm that this article content has no conflicts of interest. [4] ACKNOWLEDGEMENTS [5] ABBREVIATIONS 397 REFERENCES CONFLICT OF INTEREST KM is supported by a Japan Society for the Promotion of Science-Australian Academy of Science postdoctoral fellowship. Current Molecular Pharmacology, 2012, Vol. 5, No. 3 [6] [7] 3adiol = 5-androstane-3,17-diol AP-1 = Transactivating function 1 [8] CBP = cAMP response element-binding protein binding protein [9] CYP7B1 = Cytochrome P450 71 [10] DNA = Deoxyribonucleic Acid eNOS = Endothelial Nitric Oxide Synthase E2 = Estradiol ER = Estrogen receptor ER = Estrogen receptor alpha ER = Estrogen receptor beta ERE = Estrogen responsive element GPR30 = Orphan G protein–coupled receptor 30 HIF = Hypoxia inducible factor hGH = Human Growth Hormone ICI = ICI 182,720 [11] [12] [13] [14] Gosden, J.R.; Middleton, P.G.; Rout, D. Localization of the human oestrogen receptor gene to chromosome 6q24----q27 by in situ hybridization. Cytogenet. Cell Genet., 1986, 43(3-4), 218-220. Enmark, E.; Pelto-Huikko, M.; Grandien, K.; Lagercrantz, S.; Lagercrantz, J.; Fried, G.; Nordenskjold, M.; Gustafsson, J.A. Human estrogen receptor beta-gene structure, chromosomal localization, and expression pattern. J. Clin. Endocrinol. 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