Endometrial cancer is well known to be estrogen-dependent. Two estrogen receptor types, ER␣ and ER, are major mediators of a diversity of biologic functions of estrogen and play an important role in estrogen-dependent tissues and cancers. Cloning of ER was followed by the discovery of a variety of its isoforms. Using real-time RT-PCR, the relative expression levels of ER1, ER2 (ERcx), ER3, ER4 and ER5 were studied. We observed coexpression of ER isoforms in the endometrium and upregulation of the ER5 transcript in malignant endometrium. We also observed downregulation of ER2⌬5 transcript in neoplastic endometrium, using a semiquantitative method. Our results suggest that analyzing the changes in ER and its isoforms may be important in the diagnosis, prognosis and treatment of endometrial cancer. © 2004 Wiley-Liss, Inc.
Key words: endometrial cancer; real-time RT-PCR; estrogen receptor; isoformsEstrogens exert very powerful effects on the growth, differentiation and function of many target tissues in female and male reproductive organs. Their best-described mechanism of action is through ER-mediated gene transcription. This ligand-activated transcription factor is known to exist as ␣ and  proteins, products of 2 separate genes and multiple splice variants of both, 1-7 present in varying cellular patterns. The above accounts for the high complexity of ER action, which is cell-and tissue-specific and may modulate a specific response to estrogen.Estrogen has long been known to stimulate cellular proliferation in the uterus. Indeed, hyperestrogenism is strictly connected with a major risk of endometrial cancer, 8 which is the most common female genital track malignancy in Europe. 9 ER␣ and ER have been identified in normal and neoplastic endometrium. 10 -13 Yet, no conclusive data regarding alterations in their expression in tumors were obtained, as was the case with breast and ovarian tumors, where the levels of ER decline in invasive breast cancer 7,14 -16 as well as in ovarian 17-20 and colon 21,22 cancers. With the increasing knowledge of the mechanism of steroid receptors, the analysis of isoforms, products of alternative splicing of ER␣ and ER, is steadily gaining acceptance as a marker for tumor prognosis and a guide for best choice of treatment. For example, ER␣, which lacks exon 5, has been associated with breast cancer, 23 as have the ER isoforms ER2 (also named ERcx) and ER2⌬5. 24,25 This suggests that changes in transcript levels of the ER isoforms take place during tumorigenesis and are important both in etiology and in the assessment of cancer invasiveness.We evaluated the mRNA expression of all ER isoforms (referred to as "total ER") and of ER1, ER2, ER2⌬5, ER3, ER4 and ER5 in normal and neoplastic endometrium. We refer our findings to histopathologic data (FIGO 1988 criteria 26 ) as well as to menstrual status. We also examined expression of ER␣ and compared the expression of 2 estrogen-dependent genes, AR and PR, between normal and tumor tissues. Our aim was to determine ...