title: Evidence of ERalpha and ERbeta selectivity and partial estrogen agonism in traditional Chinese medicine.
abstract: The use of complementary and alternative medicine and herbal products, especially traditional Chinese medicines, is progressively rising for both adults and children. This increased use is based on the popular belief that these medicines are safe and harmless. In this report, we describe the results of a bedside-to-bench study that involved a short-statured 4-year-old boy with deficiencies in growth hormone, thyroid stimulating hormone, and adrenocorticotropic hormone due to an ectopic posterior pituitary gland and invisible pituitary stalk. Although the boy was given replacement therapy with hydrocortisone and L-thyroxin, the parents refused to treat him with growth hormone and consulted a naturopath who prescribed a traditional Chinese medicine (TCM) to stimulate the boy's growth. From the age of 20 months, the child's growth was regularly monitored while he was being treated with hydrocortisone, thyroxin, and the TCM. Over a 36-month period, the child's growth velocity accelerated (3 cm/year to 8 cm/year), his height increment substantially increased (-2 SD to -0.8 SD), and his bones matured. In the laboratory investigation, estrogen receptor (ER)alpha and ERbeta reporter cell lines were used to characterize the estrogenic activity of the TCM medicine and its 18 components, and the results established that the medicine and some of its components have estrogen receptor ERalpha and ERbeta selectivity and partial estrogen agonism. Partial estrogenic activity of the TCM was confirmed using whole-cell competitive binding, cell proliferation, and endogenous gene expression assays in the ERalpha-positive breast cancer cell lines. Although the presence of evidence is not always evidence of causality, we have concluded that this traditional Chinese medicine contains ingredients with estrogenic activity that can sustain bone growth and maturation without affecting other estrogen-dependent tissues.
authors.forename: Dov
authors.initials: D
authors.lastname: Tiosano
authors.forename: Françoise
authors.initials: F
authors.lastname: Paris
authors.forename: Marina
authors.initials: M
authors.lastname: Grimaldi
authors.forename: Vera
authors.initials: V
authors.lastname: Georgescu
authors.forename: Nadège
authors.initials: N
authors.lastname: Servant
authors.forename: Zeev
authors.initials: Z
authors.lastname: Hochberg
authors.forename: Patrick
authors.initials: P
authors.lastname: Balaguer
authors.affiliation: Unité d'Endocrinologie Pédiatrique, CHU Arnaud de Villeneuve, Montpellier, France. c-sultan@chu-montpellier.fr.
authors.forename: Charles
authors.initials: C
authors.lastname: Sultan
mesh_terms: D002675:Child, Preschool; D054333:Drug Partial Agonism; D004365:Drugs, Chinese Herbal / Q000494:pharmacology / Q000627:therapeutic use*; D047628:Estrogen Receptor alpha / Q000819:agonists* / Q000235:genetics / Q000378:metabolism; D047629:Estrogen Receptor beta / Q000819:agonists* / Q000235:genetics / Q000378:metabolism; D017930:Genes, Reporter / Q000187:drug effects; D006130:Growth Disorders / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D061986:MCF-7 Cells; D008297:Male; D010012:Osteogenesis / Q000187:drug effects; D048789:Phytoestrogens / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004365:Drugs, Chinese Herbal; C506487:ESR1 protein, human; D047628:Estrogen Receptor alpha; D047629:Estrogen Receptor beta; D048789:Phytoestrogens; C479998:estrogen receptor beta isoform M, human