The gonadal hormones & inhibitor. Huifang Tang tanghuifang@zju.edu.cn

Transcription

1 The gonadal hormones & inhibitor Huifang Tang

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3 Contents Sex hormones & contraceptives A. Estrogens & antiestrogens( 雌 激 素 类 药 及 抗 雌 激 素 类 药 ) B. Progestogens & antiprogestogens( 孕 激 素 类 药 及 抗 孕 激 素 类 药 ) C. Androgens & antiandrogens( 雄 激 素 类 药 及 抗 雄 激 素 类 药 ) (Supplement: Anabolic hormones( 同 化 激 素 )

4 Famle Hormones s

5 A. Estrogens & antiestrogens Estrogens( 雌 激 素 雌 激 素 ) including Natural estrogens: estradiol(e 2, 雌 二 醇 ); estrone(e 1, 雌 酮 ); estriol(e 3, 雌 三 醇 ). Synthetic estrogens: ethinylestradiol( 炔 雌 醇 ); quinestrol( 炔 雌 醚 ); diethystibestol( 己 烯 雌 酚 ); etc.

6 Estrogens( 雌 激 素 ) A. Estrogens & antiestrogens 雌 二 醇 雌 酮 雌 三 醇 炔 雌 醇 甲 炔 雌 醇 炔 雌 醚 己 烯 雌 酚 氯 烯 雌 醚 美 沙 雌 酸

7 A. Estrogens & antiestrogens Estrogen Receptors ER-α Uterus, testis, pituitary, ovary,, epididymis, and adrenal gland. ER-β (Kuiper et al ) brain, kidney, prostrate, ovary, lung, bladder, intestine, and epididymis. 88% identity with rat ER-b; 47% identity with human ER-a Both ERs are localized to membrane, cytosol, and nucleus. ERα and β differ in C-terminal ligand binding domains and N- terminal transactivation domains. Highest homology in DNA binding domain. Estrogen-related orphan receptors (ERR) α,β, γ

8 A. Estrogens & antiestrogens ERa ERb ERa ERb Lethality No No Fertility Infertile Females subfirtile, males fertile Female reproductive tract ERa bleeding follicles in ovary ERb problems with ovulation male reproductive tract ERa disrupted sperm function ERb No effect Cross sections of ovary. Note hemorrhaging follicles. Reproductive tracts normal postnatal but develop problems in both berko and aerko adults.

9 A. Estrogens & antiestrogens Estrogens Beneficial effects Breast Programs milk production Harmful effects Breast Increases cancer risk Liver and heart Controls cholesterol Uterus Prepares for fetus Uterus Increases cancer risk Bone Preserves strength

10 Estrogens A. Estrogens & antiestrogens 1. Pharmacological effects: (1)Development of female sexual organs and of female secondary sex charac-teristics; (2)Maintenance of both proliferation and thickening of uterine endometrium; (3)Ovulation: (small doses), or (larger doses) (4)Development of breast and lactation: (small doses), or (larger doses)

11 A. Estrogens & antiestrogens Estrogens (5)Other actions: 1) aldosterone excretion and causing water and Na + retention; 2) LDL and HDL levels in plasma, but plasma triglycerides; 3) calcium deposit of bone; 4) activity of factor Ⅱ, Ⅶ, Ⅸ, Ⅹ,, so that promoting coagulation; 5) postmenopausal sleep disturbances.

12 Estrogens A. Estrogens & antiestrogens 3. Adverse effects: (1)Oral administration: nausea, vomiting, diarrhea, etc. (2)Cardiovascular effects: risk of venous thromboembolisis; plasma triglycerides ; hypertension, edema. (3)Others: risk of breast & endometrial carcinoma.

13 Estrogens A. Estrogens & antiestrogens 2. Clinical uses: (1)Postmenopausal syndrome( 绝 经 期 综 合 征 ): Hormone replacement therapy(hrt) in postmenpause Female elder osteoporosis; Prevention of cardiovascular disease for women(small doses). (2) 2)Hypo-ovarianism & amenorrhea( 闭 经 ); (3)Dysfunctional uterine bleeding;( 功 能 性 子 宫 出 血 ) (4)Inhibition of lactation; (5)Advanced breast cancer( 晚 期 乳 腺 癌 ); (6)Prostatic cancer; (7)Acne( 痤 疮 ); (8)Contraception: Combination with Progestogens

14 Antiestrogens ntiestrogens--- A. Estrogens & antiestrogens Ovulation-Inducing Agents Clomifene( 氯 米 芬 氯 米 芬, 克 罗 米 酚 ) Its chemical structure is similar to diethystibestol( 己 烯 雌 酚 ). 1. Pharmacological effects: Partial agonist for estrogen receptor. Clomiphene has also been shown to effectively inhibit the action of stronger estrogens. In humans it leads to an increase in the secretion of gonadotropins and estrogens by inhibiting estradiol's negative feedback effect on the gonadotropins 2. Clinical uses: (1)Functional(anovulatory) infertility; (2)Menstrual disorders; (3)Advance breast cancer. 3. Adverse effects: (1)Multiple ovulation with multiple pregnancy; (2)Ovarian hypertrophy and carcinoma following multiple exposure.

15 A. Estrogens & antiestrogens ---Selective estrogen receptor modulator (SERM) Antiestrogens ntiestrogens--- Tamoxifen( 他 莫 昔 芬, 三 苯 氧 胺 ) 1. Pharmacological effect: A non-steroid competitive partial agonist inhibitor of estradiol at the estrogen receptor. As an antagonist of the estrogen receptor in breast tissue via its active metabolite, but as an agonist in the endometrium. 2. Clinical uses: Tamoxifen is currently used for the treatment of both early and advanced ER+ (estrogen receptor positive) breast cancer in pre- and post-menopausal women

16 A. Estrogens & antiestrogens ---Selective estrogen receptor modulator (SERM) Antiestrogens ntiestrogens--- Raloxifene( 雷 诺 昔 芬 ) 1. Pharmacological effect: another partial estrogen agonist- antagonist (SERM) at some but not all target tissues. It has estrogenic actions on bone and anti-estrogenic actions on the uterus and breast. 2. Clinical uses: Raloxifene has been approved in the USA for the prevention of postmenopausal osteoporosis and prophylaxis of breast cancer in women with risk factors.

17 A. Estrogens & antiestrogens Comparison of tamoxifen and raloxifene Prophylaxis of breast cancer Prevention of postmenopausal osteoporosis Major adverse effect Tamoxifen 49%(5 years) yes uterine cancer the risk of cataracts strokes blood clots in vein Raloxifene 74%(4 years) yes No No No blood clots in vein target tissue as agonist target tissue as antagonist Bone; lipid; uterus bone;lipid breast. uterus; breast.

18 A. Estrogens & antiestrogens The Ideal Selective Ostrogen The perfect SERM Receptor Modulator The Search goes on TISSUE Endometrium Breast Vagina Bone Liver/CVS CNS Perfect AE AE E E E E E-Estrogenic, AE-Anti Estrogenic Ormelo Ralo AE a AE AE a AE E a AE E a E E a E+ E a E? Ormeloxifene( 奥 美 昔 芬 ) Tamo E AE AE E E AE

19 A. Estrogens & antiestrogens Others ( 阿 那 曲 唑 ) 非 类 固 醇 芳 香 酶 抑 制 剂 --pure estrogen receptor antagonist

20 B. Progestogens and antiprogestogens

21 Progestogens( 孕 激 素 ) B. Progestogens & antiprogestogens Natural progestogens: progesterone( 黄 体 酮, 孕 酮 ) Synthetic progestogens : megestrol( 甲 地 孕 酮 ) medroxyprogesterone( 甲 羟 孕 酮, 安 宫 黄 体 酮 ) norethisterone( 炔 诺 酮 ) norgesterel( 炔 诺 孕 酮 ), etc.

22 黄 体 酮 ( 孕 酮 ) 醋 酸 甲 地 孕 酮 醋 酸 甲 羟 孕 酮 19- 去 甲 睾 酮 炔 诺 酮 二 醋 酸 炔 诺 酮 炔 诺 孕 酮 去 氧 孕 烯 诺 孕 酯

23 Progestogens B. Progestogens & antiprogestogens 1. Pharmacological effects: (1)Converting the uterine epithelium from the proliferative to the secretory phase; (2)Inhibiting LH secretion and ovulation; (3)Development of mammary acinus( 乳 腺 腺 泡 ); (4)Affecting thermoregulation.

24 2. Clinical uses: B. Progestogens & antiprogestogens (1)Menstrual disorders: Dysunctional uterine bleeding, dysme-norrhea( 痛 经 ); Postmenopausal syndrome, secondary amenorrhae( 闭 经 ), etc. Endometriosis( 子 宫 内 膜 异 位 症 ), Premature pregnancy( 先 兆 流 产 ), etc. (2)Cancers: Endometrial cancer Prostatic cancer. (3)Others: Contraception: Combination with Estrogens

25 B. Progestogens & antiprogestogens 3. Adverse effects: GI reactions; Virilization in female fetus( 女 性 胎 儿 男 性 化 ); Acne( 痤 疮 ); Hirsulism( 多 毛 ),, etc.

26 B. Progestogens & antiprogestogens Antiprogestogens( 抗 孕 激 素 药 ) (1) Antagonists of progestogen receptor Gestrinone( 孕 三 烯 酮 ) Mifeprisone( 米 非 司 酮 ) (2) 3β-SDH inhibitor (3β- 羟 甾 脱 氢 酶 抑 制 剂 ) Trilostane( 曲 洛 司 坦 ) Epostane( 环 氧 司 坦 ) azastene( 阿 扎 斯 丁 )

27 B. Progestogens & antiprogestogens Antiprogestogens( 抗 孕 激 素 药 ) Mifeprisone( 米 非 司 酮 ) A derivation of synthetic progestogens norethindrone( 炔 诺 酮 ). It can antagonize the receptor of progestogen. Use for termination of early pregnancy.

28 B. Progestogens & antiprogestogens Selective progesterone receptor modulator Ulipristal acetate ("Ella") Asoprisnil (J867; status uncertain) CDB-4124 (Proellex, Progenta; under development) SPRMs are under development for the following uses: Asoprisnil and CDB-4124 are both under investigation (2005) for the medical treatment of uterine leiomyoma( 子 宫 肌 瘤 ). Proellex has completed a number of clinical trials to treat endometriosis( 子 宫 内 膜 异 位 症 ) and uterine fibroids( 子 宫 肌 瘤 ). While these SPRMs have been effective for the treatment of uterine fibroids, development of side effects such as endometrial thickening has limited their administration to no longer than three to four months.

29 D. Contraceptives Female Contraceptives( 女 性 避 孕 药 女 性 避 孕 药 ) Combination contraceptives: Estrogens + Pregestogens 1. Pharmacoligical effects: (1)Inhibition of ovulation; (2)Prevention of fertilization; (3)Inhibition of implantation.

30 Female contraceptive

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32 2. Adverse effcts: (1)Gastrointestinal reactions; (2)Menstrual disorders; (3)Increased coagulation; (4)Contraindication: Acute hepatitis, acute nephritis, and mastoplastia( 乳 房 组 织 增 生 ), etc. 3. Drug interactions: D. Contraceptivs Female Contraceptives Hepatic enzyme inducers can attenuate the effect of contraceptive drugs.

33 Gonadal hormones & inhibitor C. Androgens, anabolic hormones and antiandrogens

34 I.. Androgens( 雄 激 素 ) C. Androgens & antiandrogens Natural androgens: Testosterone( 睾 酮, 睾 丸 酮 ) Synthetic androgens: Methyltestosterone( 甲 睾 酮, 甲 基 睾 酮 ) Testosterone propionate( 丙 酸 睾 酮, 丙 酸 睾 丸 ) Testosterone phenylacetate( 苯 乙 酸 睾 酮, 苯 乙 酸 睾 丸 素 ) Testosterone undecanoate( 十 一 酸 睾 酮 )

35 C. Androgens & antiandrogens Androgens( 雄 激 素 ) 1. Pharmacological effects: (1) Development of the male sexual organs and secondary sex characteristics; (2) Necessary for normal spermatogenesis; (3) Promoting growth of blood cells in bone marrow, especially for red blood cells (by increasing EPO) (4) Increasing protein anabolism. (5) Enhance immunological function, anti anti-inflammation inflammation (6) Cardiac vascular modification: lower cholesterol, vascular dilation vascular dilation

36 Androgens C. Androgens & antiandrogens 2. Clinical uses: (1)Replacement therapy: male hypogonadism( 男 性 性 腺 发 育 不 全 ) (2)Female disorders: dysfunctional uterine bleeding, advanced breast and ovarian cancers. (3)Anemia: aplastic anemia( 再 生 障 碍 性 贫 血 ). (4)Others: infirmity( 体 质 虚 弱 ), etc.

37 Androgens C. Androgens & antiandrogens 3. Adverse effects: (1)Sex dysfunction: virilescence in female( 女 性 男 性 化 ), increased libido( 性 欲 ) in male. (2)Hepatic toxicity. Contraindications : pregnant women, with pregnant women, with prostatic cancer, hypertension, heart failure, kidney disease kidney disease

38 C. Androgens & antiandrogens II.. Anabolic hormones( 同 化 激 素 类 药 ) Nandrolonpheypropionate( 苯 丙 酸 诺 龙 ) Metandienone( 美 雄 酮, 去 氢 甲 基 睾 丸 素 ) Stanozolol( 司 坦 唑 醇, 康 力 龙 ), etc. 1. Pharmacological effects: (1)Promoting synthesis of protein; (2)Inhibiting protein catabolism. 2. Clinical uses: Serious malnutrition; cachexia( 恶 病 质 ); serious burn; senile osteoporosis; etc. 3. ADRs: Water and Na + retention, virilescence in female, etc.

39 III.Antiandrogens (1), competitive inhibition of GnRH receptors; (2), stimulation (+, pulsatile administration) or inhibition via desensitization of GnRH receptors (,, continuous administration); (3), decreased synthesis of testosterone in the testis; (4), decreased synthesis of dihydrotestosterone by inhibition of 5 -reductase; (5), competition for binding to cytosol androgen receptors.

40 C. Androgens & antiandrogens III.. Antiandrogens( 抗 雄 激 素 药 ) Receptor inhibitor: Cyproterone( 环 丙 孕 酮 ) 1. Pharmacological effects: (1)inhibit the action of androgen at the target organ (2) marked progestational effect Inhibiting hypothalamus-pituitary axis, LH,, FSH, testosterone. 2. Clinical uses: Prostatic cancer, Severe acne and hersutism( 女 性 多 毛 症 ), Contraception. 3. ADRs: Suppression of sex function, Affecting hepatic function, etc.

41 D. Contraceptives Male Contraceptives( 男 性 避 孕 药 男 性 避 孕 药 ) Gossypol ( 棉 酚 ): inhibit spermatogenesis Progesterone and androgen mixture: inhibit HPA at large dose Gn-RH similar and androgen mixture Cyproterone acetate( 环 丙 氯 地 孕 酮 ): competently bind androgen receptor, inhibit Gn-RH at large dose; Androgen, e.g. 庚 酸 睾 酮