The nuclear receptors belong to a superfamily of proteins, many of which are ligand-regulated, that bind to specific DNA sequences and control specific gene transcription. Recent data show that, in addition to contacting the basal transcription machinery directly, nuclear receptors inhibit or enhance transcription by recruiting an array of coactivator or corepressor proteins to the transcription complex. In this review we define the properties of these putative coregulatory factors; we describe the basal and coregulatory factors that are currently known to interact with nuclear receptors; we suggest various mechanisms by which coactivators and corepressors act; we discuss issues that are raised by the presence of multiple, perhaps competing, coregulatory factors; and we speculate how these additional regulatory layers may explain the heterogeneity of hormone responses that are observed in normal and malignant tissues.

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Progesterone has biphasic effects on proliferation of breast cancer cells; it stimulates growth in the first cell cycle, then arrests cells at G 1 /S of the second cycle accompanied by up-regulation of the cyclin-dependent kinase inhibitor, p21. We now show that progesterone regulates transcription of the p21 promoter by an unusual mechanism. This promoter lacks a canonical progesterone response element. Instead, progesterone receptors (PRs) interact with the promoter through the transcription factor Sp1 at the third and fourth of six Sp1 binding sites located downstream of nucleotide 154. Mutation of Sp1 site 3 eliminates basal transcription, and mutation of sites 3 and 4 eliminates transcriptional up-regulation by progesterone. Progesterone-mediated transcription is further prevented by overexpression of E1A, suggesting that CBP/p300 is required. Indeed, in HeLa cells, Sp1 and CBP/p300 associate with stably integrated flagtagged PRs in a multiprotein complex. Since many signals converge on p21, cross-talk between PRs and other factors co-localized on the p21 promoter, may explain how progesterone can be either proliferative or differentiative in different target cells.Progesterone is a paradoxical hormone having either growth stimulatory effects or growth inhibitory and differentiative effects, depending on the tissue in question and the dose and treatment regimen (1, 2). In the uterus for example, progesterone inhibits epithelial growth and has differentiative effects (3). It is therefore used to counteract the proliferative and carcinogenic effects of unopposed estrogens in women prescribed hormone replacement therapy (4). In the breast, the role of progesterone is more complex. The hormone is required for terminal growth and differentiation of the mammary gland (2). Therefore, mice lacking progesterone receptors (PRs) 1 exhibit incomplete mammary gland ductal branching and failure of lobulo-alveolar development (5). In animal models of mammary carcinogenesis, progesterone, depending on the regimen used, can either inhibit or promote tumor formation (2). On the other hand, in animals with established PR-positive mammary tumors, progesterone is usually proliferative, and progesterone antagonists inhibit tumor growth (6). Despite this, in humans, second-line high dose progestin therapy effectively suppresses the growth of hormone-dependent PR-and estrogen receptorpositive breast cancers that have acquired resistance to the antiestrogen tamoxifen (6).How can these contradictory effects of progesterone be reconciled? Recent studies have dealt with the effects of progesterone on mitosis and key cell cycle regulatory proteins in cultured human breast cancer cells (1, 7-9). Treatment of such cells with progestins produces biphasic effects. Studies focusing on the initial growth stimulatory component show that progestin-induced entry of cells into S-phase is accompanied by transient increases of cyclin D1 and cyclin-dependent kinase 4 activity (1, 7). Indeed, cyclin D1 is a critical component of the mitogenic respon...

When antagonist-occupied steroid receptors have agonist-like effects, the clinical consequences are grave. We present evidence that human progesterone B-receptors (hPRB) when occupied by progesterone antagonists, inappropriately activate transcription by an unusual mechanism that does not require the canonical progesterone response element (PRE). In HeLa cells cotransfected with a PRE-tk-chloramphenicol acetyltransferase reporter and a hPRB expression vector, strong transcription is seen not only when receptors are activated by the agonist R5020, but also in the presence of the three antiprogestins, RU486, ZK112993, and ZK98299. Human PRB occupied by ZK98299 do not bind to a PRE, suggesting that the transcriptional stimulation is independent of DNA binding. Indeed, a tk-chloramphenicol acetyltransferase promoter-reporter lacking the PRE loses transcriptional activation by the agonist, but retains transactivation by the three antagonists. The PRE-independent antagonist-induced transcription requires that hPRB have an intact DNA-binding domain, but hPR target gene specificity is not required, because a hPRB mutant that binds an estrogen response element still activates transcription. It appears that antagonist-occupied hPR activate transcription without binding to a PRE, perhaps by interacting with tethering proteins instead. Even a gene that is not a normal progesterone target could be aberrantly activated. Human cells contain equimolar amounts of hPRB and the N-terminally truncated natural isotype, hPRA. Unlike hPRB, hPRA are not transcriptionally activated by progesterone antagonists. We, therefore, tested the effects of antagonists when the two receptor isotypes are coexpressed and found that A-receptors can annul the inappropriate transcription by B-receptors. Thus, when both receptor forms are present, the hPRA phenotype is dominant. Moreover, pure hPRB/hPRA heterodimers, produced by fos/jun leucine zipper domain-hPR chimeras, also have the inactive transcriptional phenotype of hPRA. Our studies suggest not only that the two hPR isotypes are functionally quite different, but also that some of the agonist-like transcriptional effects of antagonist-occupied B-receptors proceed through novel mechanisms.

Although most studies of progesterone receptors (PR) and their two isoforms, PR-