Selective estrogen receptor modulator

Selective Estrogen Receptor Modulators (SERMs) are a class of medication that acts on the estrogen receptor.cite journal |author=Riggs BL, Hartmann LC|title=Selective estrogen-receptor modulators -- mechanisms of action and application to clinical practice|journal= N Engl J Med |volume= 348 |issue= 7 |pages= 618–29 |year= 2003 | doi = 10.1056/NEJMc030651 |pmid= 12584371] A characteristic that distinguishes these substances from pure receptor agonists and antagonists is that their action is different in various tissues, thereby granting the possibility to selectively inhibit or stimulate estrogen-like action in various tissues. Phytoserms are scientificaly accepted SERMs from a botanical source.

Members

Members include:
* afimoxifene (4-hydroxytamoxifen)
* arzoxifene
* bazedoxifene
* clomifene
* femarelle (DT56a)cite journal | author = Somjen D, Katzburg S, Knoll E, Hendel D, Stern N, Kaye AM, Yoles I | title = DT56a (Femarelle): a natural selective estrogen receptor modulator (SERM) | journal = J. Steroid Biochem. Mol. Biol. | volume = 104 | issue = 3-5 | pages = 252–8 | year = 2007 | month = May | pmid = 17428655 | doi = 10.1016/j.jsbmb.2007.03.004 | url = ]
* lasofoxifene
* ormeloxifene
* raloxifene
* tamoxifen
* toremifene

Uses

SERMs are used dependent on their pattern of action in various tissues:
* clomifene is used in anovulation
* femarelle is used for managing menopause symptoms and maintaining bone health
* ormeloxifene is used for contraception
* raloxifene is used for osteoporosis and reducing risk of invasive breast cancer
* tamoxifen and toremifene are used for breast cancer

Some SERMs may be good replacements for hormone replacement therapy (HRT), which had been commonly used to treat menopause symptoms until the publication of wide scale studies showing that HRT increases the risk of breast cancer cite journal | author = Reeves GK, Beral V, Green J, Gathani T, Bull D | title = Hormonal therapy for menopause and breast-cancer risk by histological type: a cohort study and meta-analysis | journal = Lancet Oncol. | volume = 7 | issue = 11 | pages = 910–8 | year = 2006 | month = November | pmid = 17081916 | doi = 10.1016/S1470-2045(06)70911-1 | url = ] and thrombosis.cite journal | author = Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators | title = Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial | journal = JAMA | volume = 288 | issue = 3 | pages = 321–33 | year = 2002 | month = July | pmid = 12117397 | doi = | url = http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12117397 | issn = ] Some of the above agents still have significant side-effects to allow for widespread use.

SERMs are also commonly used during PCT or Post Cycle Therapy after the use of anabolic steroids. Bodybuilders who take testosterone supplements will often experience gynecomastia, also known as man-boobs, after a steroid cycle, because the body will attempt to balance estrogen with increased testosterone levels. This increase in estrogen can produce gynecomastia, so body builders will usually cycle a SERM after a steroid cycle to ensure that their body is not flooded with excess estrogen.

Mechanism of action

Estrogenic compounds span a spectrum of activity ranging from:
* full agonists (agonistic in all tissues) such as the natural endogenous hormone estrogen
* mixed agonists/antagonistics (agonistic in some tissues while antagonist in others) such as tamoxifen (a SERM)
* pure antagonists (antagonistic in all tissues) such as fulvestrant (ICI-182780).

The mechanism of mixed agonism/antagonism may differ depending on the chemical structure of the SERM, but for at least for some SERMs, it appears to be related to (1) the ratio of co-activator to co-repressor proteins in different cell types and (2) the conformation of the estrogen receptor induced by drug binding which in turn determines how strongly the drug/receptor complex recruits co-activators (resulting in an agonist response) relative to co-repressors (resulting in antagonism). For example, the prototypical SERM tamoxifen acts as an antagonist in breast and conversely an agonist in uterus. The concentration of steroid receptor co-activator 1 (SRC-1; Gene|NCOA1) is higher in uterus than in breast, therefore SERMs such as tamoxifen are more agonistic in uterus than in breast. In contrast, raloxifene behaves as an antagonist in both tissues. It appears that raloxifene more strongly recruits co-repressor proteins and consequently is still an antagonist in the uterus despite the higher concentration of co-activators relative to co-repressors.cite journal |author=Shang Y, Brown M|title=Molecular determinants for the tissue specificity of SERMs|journal= Science |volume= 295 |issue= 5564 |pages= 2465–8 |year= 2002 | doi = 10.1126/science.1068537 |pmid= 11923541] cite journal |author=Smith CL, O'Malley BW|title=Coregulator function: a key to understanding tissue specificity of selective receptor modulators|journal= Endocr Rev |volume= 25 |issue= 1 |pages= 45–71 |year= 2004 | doi = 10.1210/er.2003-0023 |pmid= 14769827]

Actions

The actions of SERMs on various tissues:
* Bone turnover and postmenopausal osteoporosis respond favorably to most SERMs.
* Breast - all SERMs decrease breast cancer risk, and tamoxifen is mainly used for its ability to inhibit growth in estrogen receptor-positive breast cancer.
* Cholesterol and triglycerides - levels respond favorably to SERMs.
* Deep venous thrombosis - the risk may be elevated in at least some SERMs.
* Hot flashes are increased by some SERMs.
* Pituitary gland - clomifene blocks estrogen action, leading to an increase of follicle-stimulating hormone.
* Uterus - tamoxifen may increase endometrial carcinoma risk, but raloxifene and femarelle do not. Data on toremifene and clomifene is insufficient.

References

ee also

* Selective androgen receptor modulator
* Selective progesterone receptor modulator
* Phytoserm
* Femarelle
* Lasofoxifene
* Ormeloxifene
* Raloxifene
* Tamoxifen
* Toremifene

External links

* [http://www.aacr.org/home/public--media/for-the-media/fact-sheets/cancer-concepts/serms.aspx AACR Cancer Concepts Factsheet on SERMs]
* [http://www.nsabp.pitt.edu/STAR/Index.html STAR: a head-to-head comparison of tamoxifen and raloxifene as breast-cancer preventatives]
* [http://www.femarelle.com Femarelle official site]
* [http://www.evista.com Raloxifene (Evista) official site]