Studying the pathology of atherosclerosis in humans is problematic due to the slow evolution of this disease. However, 2 decades ago an experimental model, transgenic apolipoprotein E knockout mice characterized by accelerated atherogenesis, was developed. The influence of estrogens on atherogenesis is complex. At the early stages of atherosclerosis, estrogens have a beneficial influence by diminishing plaque formation. At the later stages, when atherosclerotic plaques have been formed, estrogens augment the expression of metalloproteinases (MMPs) and increase the risk of plaque rupture. Furthermore, estrogens have thrombogenic properties. The effects of estrogens on cellular functions may be expressed through genetic, nongenetic, direct, and indirect action. The modifications of the expression of various genes which are affected by estrogens are mediated via 2 types of estrogen receptors (ERa or ER1 and ERb or ER2). The existence of ERs was reported in the early 1960s and the encoding of complementary DNA of ERs was achieved in the mid1980s. During the past decade, Thomas et al discovered another ER, GPR30 (G protein-coupled, 7-transmembrane receptor). This receptor is expressed in smooth muscle cells of arteries and veins. The cells of breast, ovaries, and endometrium also have ERs. Tumor necrosis factor a (TNF-a) is involved in atherogenesis by weakening endothelium-dependent and nitric oxide (NO)-mediated vasodilation, diminishing the production of NO, and enhancing the catabolism of NO. Women have lower TNF-a levels and a lower incidence of heart dysfunction and sepsis-related morbidity and mortality compared to men. In this issue of Angiology, Professor Palombo’s group reports that ER activation exerts a protective effect on endothelial cells by inhibiting TNF-a-induced expression of MMP-9 and suppression of endothelial NO synthase (eNOS) expression. The MMP-9, expressed in atherosclerotic plaques, contributes to the deterioration of many types of collagen. Estrogens seem to regulate the synthesis of MMP-9 through the inhibitors of MMPs. The NO regulates a number of mechanisms, including vascular tone, myocardial contractility, leucocyte–endothelial interactions, integrity and permeability of endothelium, proliferation of vascular smooth muscle cells (VSMCs), and antithrombotic action (inhibits platelet activation). The release of NO by a healthy endothelium induces relaxation of smooth muscle cells and inhibits platelet activation. Estrogens activate eNOS through 2 signaling pathways, the mitogen-activated protein kinase and the phosphatidylinositol 3-kinase/protein kinase B leading to increase NO release. The endothelium modulates vessel tone as well as platelet activity. The endothelium expresses both types of ERs and is a target for sex hormones. Opposite to premenopausal women, postmenopausal women have elevated TNF-a serum levels (increased TNF-a expression induces the production of reactive oxygen species, resulting in endothelial dysfunction). In vitro data showed that estrogen inhibits TNF gene transcription via ERs. Furthermore, others showed an additional capability of estrogens to inhibit the expression of VSMCs in cultured human endothelial cells and animal models of atherosclerosis. The mechanisms described above support that the ER activators such as apigenin may diminish endothelial dysfunction caused by TNF-a. Also, Choi has documented that treatment with apigenin decreased the TNF-a-induced production of NO in osteoblasts suggesting that apigenin may be a new pharmacological tool for the treatment of osteoporosis. Similar results were reported after evaluation of the antiinflammatory properties of apigenin in an in vitro model. They reported inhibition of gene expression of TNF and inducible NOS. However, Collins-Burow, after evaluation of the estrogenic and antiestrogenic activity of flavonoids in the ER-positive MCF-7 human breast cancer cell line, found that several flavonoids, including apigenin, did not appear to correlate with binding to ER. Therefore, their suppression of
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