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Endocrinology Vol. 141, No. 10 3657-3667
Copyright © 2000 by The Endocrine Society


ARTICLES

Resveratrol Acts as a Mixed Agonist/Antagonist for Estrogen Receptors {alpha} and ß1

Jennifer L. Bowers, Valentyn V. Tyulmenkov, Sarah C. Jernigan and Carolyn M. Klinge

Department of Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, Kentucky 40292

Address all correspondence and requests for reprints to: Carolyn M. Klinge, Department of Biochemistry and Molecular Biology, University of Louisville School of Medicine, Louisville, Kentucky 40292. E-mail carolyn.klinge{at}louisville.edu


    Abstract
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Epidemiological evidence indicates that phytoestrogens inhibit cancer formation and growth, reduce cholesterol levels, and show benefits in treating osteoporosis. At least some of these activities are mediated through the interaction of phytoestrogens with estrogen receptors {alpha} and ß (ER{alpha} and ERß). Resveratrol, trans-3,5,4'-trihydroxystilbene, is a phytoestrogen in grapes that is present in red wine. Resveratrol was shown to bind ER in cytosolic extracts from MCF-7 and rat uteri. However, the contribution of ER{alpha} vs. ERß in this binding is unknown. Here we report that resveratrol binds ERß and ER{alpha} with comparable affinity, but with 7,000-fold lower affinity than estradiol (E2). Thus, resveratrol differs from other phytoestrogens that bind ERß with higher affinity than ER{alpha}. Resveratrol acts as an estrogen agonist and stimulates ERE-driven reporter gene activity in CHO-K1 cells expressing either ER{alpha} or ERß. The estrogen agonist activity of resveratrol depends on the ERE sequence and the type of ER. Resveratrol-liganded ERß has higher transcriptional activity than E2-liganded ERß at a single palindromic ERE. This indicates that those tissues that uniquely express ERß or that express higher levels of ERß than ER{alpha} may be more sensitive to resveratrol’s estrogen agonist activity. For the natural, imperfect EREs from the human c-fos, pS2, and progesterone receptor (PR) genes, resveratrol shows activity comparable to that induced by E2. We report that resveratrol exhibits E2 antagonist activity for ER{alpha} with select EREs. In contrast, resveratrol shows no E2 antagonist activity with ERß. These data indicate that resveratrol differentially affects the transcriptional activity of ER{alpha} and ERß in an ERE sequence-dependent manner.


    Introduction
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
RESVERATROL is a bioflavonoid found naturally in grapes that has both chemopreventive (1, 2, 3) and cardioprotective activities (4) in vitro and in animal models. Red wine that contains 1–10 mg/liter and can be a major dietary source of resveratrol (5). Studies on the bioavailability of resveratrol in rats lead to the conclusion that even an average consumer of red wine, particularly over the long term, can absorb quantities of resveratrol that correlate with the beneficial health effects of red wine consumption observed in epidemiological studies (6, 7, 8).

Resveratrol is a stilbene that exists as cis- and trans-isomers. The trans-isomer appears to have greater anticancer and cardio-protective properties than the cis-isomer (9). Resveratrol has been characterized as a phytoestrogen based on its ability to bind to and activate estrogen receptor (ER) (10). ER is a nuclear steroid receptor that binds estrogens and regulates the transcription of estrogen-responsive genes by either binding directly to DNA, at particular sequences called estrogen response elements (EREs), or by interacting with other transcription factors, e.g. Sp1 (11), bound to their cognate sites on DNA. When activated by an agonist ligand, ER{alpha} interacts with coactivators, e.g. SRC-1 and CBP, that either acetylate lysine residues in histones to alter chromatin conformation and/or interact with components of the RNA polymerase II initiation complex to enhance target gene transcription (12).

There are two known ER subtypes, ER{alpha} and the more recently identified ERß (8). Because ER{alpha} and ERß exhibit different patterns of tissue distribution and have select differences in biochemical properties (13), it is important to determine which form mediates the effects of resveratrol. While both ER isoforms bind E2 with comparable affinity, some phytoestrogens, e.g. genistein and coumestrol, show higher affinity for ERß than ER{alpha} (5), suggesting that resveratrol may show selectivity for ERß. Resveratrol was shown to compete with [125I]E2 for binding ER in an extract from MCF-7 human breast cancer cells with an IC50 value of ~10 µM (10). More recently, resveratrol was reported to compete with [3H]E2 for binding to rat uterine ER with an IC50 value of ~100 µM (14). Because MCF-7 cells and uterus reportedly express ERß as well as ER{alpha} (15, 16), it is important to determine the affinity of resveratrol interaction with ERß and with ER{alpha}.

Ligands that bind ER can act as agonists, antagonists, or mixed agonist/antagonists. The archetype mixed agonist/antagonist is tamoxifen (TAM), used clinically to prevent breast cancer promotion and recurrence. TAM has both estrogen agonist and antagonist activity depending on the cell type and gene promoter (reviewed in Ref. 17). Resveratrol showed estrogen agonist activity in MCF-7 cells, i.e. activating the expression of progesterone receptor (PR) and pS2 genes (2). However, resveratrol elicited only weak agonist activity in both a yeast hER{alpha} transcription assay and in transient transfections with ER{alpha} in COS-1 cells. In another study, resveratrol antagonized E2-stimulated growth and inhibited transcription of PR in MCF-7 cells (18). In animal studies, oral administration of resveratrol to weanling rats had no significant effect on estrogenic responses such as serum cholesterol or messenger RNA (mRNA) for insulin-like growth factor I, but gave a slight increase in uterine wet weight (19). The same study showed that resveratrol antagonized the effect of E2 on serum cholesterol (19). Thus, the relative estrogen agonist/antagonist activity of resveratrol remains to be determined.

This study examined the relative agonist/antagonist activity of resveratrol in defined assays using ER{alpha} and ERß. We examined whether resveratrol preferentially binds ER{alpha} or ERß, the effect of resveratrol on the proliferation of cells expressing ER{alpha} or ERß, how resveratrol impacts ER-ERE binding in vitro, and how resveratrol affects the expression of reporter gene activity from a consensus and naturally occurring EREs from estrogen- responsive genes in transiently transfected CHO-K1 cells. Our results show that resveratrol binds ER{alpha} and ERß with comparable affinity, but with much lower affinity than E2. Resveratrol-occupied ER{alpha} and ERß bind an ERE in vitro, but resveratrol inhibits ER-ERE binding in a concentration-dependent manner. Resveratrol exhibits agonist activity in transiently transfected cells using a variety of ERE-driven reporter constructs and shows differences in activity depending on the ERE sequence and on which ER is expressed. With ER{alpha}, but not ERß, resveratrol shows E2 antagonist activity from certain EREs, including a consensus ERE. Thus, the mechanism of action of resveratrol is unique for ER{alpha} and ERß.


    Materials and Methods
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Cell maintenance
Chinese Hamster Ovary cells (CHO-K1) were purchased from ATCC (Manassas, VA) and maintained in Iscove’s Modified Dulbecco’s Medium (IMDM) (Life Technologies, Inc., Grand Island, NY) supplemented with 10% calf serum (CS). All other cell culture reagents were purchased from Life Technologies, Inc.

Plasmid preparation
The sequences of EREs used are: EREc38: 5'-CCAGGTCAGAGTGACCTGAGCTAAAATAACACATT-3'; PR1148: 5'-AGCCCTCCCTCCTGCGAGGTCACCAGCTCTTGGTGCCTGTTT-3'; pS2: 5'-CTTCCCCCTGCAAGGTCAGCGTGGCCACCCCGTGAGCCACT-3'; and Fos-1211: 5'-AGCTTGGGCTGAGCCGGCAGCGTGACCCCGCATG-3'.

The underlined nucleotides correspond to the minimal core consensus ERE. The nucleotides in bold indicate an alteration in the consensus ERE. EREc38, PR-1148, pS2, and Fos-1211 were cloned into the pGL3-promoter luciferase reporter vector (Promega Corp., Madison, WI) as described (20). A mammalian expression vector containing the sequence for recombinant human (rh) rhER{alpha} was generously supplied by Dr. Benita Katzenellenbogen (21). An expression vector containing the sequence for recombinant rat (rr) ERß was generously provided by Dr. J.-A. Gustafsson (22).

Nuclear extract preparation
Baculovirus-expressed rhER{alpha} and rrERß were prepared as nuclear extracts (NE) from Sf-21 cells as previously described (23, 24).

Competition binding experiments
Aliquots of NE from Sf-21 cells containing 6 nM (monomer) rhER{alpha} or rrERß were incubated in TEGK100 buffer (40 mM Tris-HCl (pH 7.4), 1 mM EDTA, 10% (vol/vol) glycerol, 100 mM KCl, 0.5 mM PMSF, 2 µg/ml aprotinin, 0.5 µg/ml leupeptin, 0.75 µg/ml pepstatin, 1 mM DTT) with 15.5 nM [3H]E2 (NEN Life Science Products, Boston, MA) and the indicated concentrations of trans-resveratrol (generously provided by Pharma Science, Montréal, Québec, Canada or purchased from Sigma, St. Louis, MO), or E2 (Sigma). Unless specifically stated, all references to resveratrol in this manuscript indicate trans-resveratrol (see Fig. 1Go). NE isolated form Sf-21 cells expressing ER{alpha} or ERß were used as the source of receptors and nonspecific ligand binding was determined using a NE Sf-21 cells expressing alkaline phosphatase. Nonspecific binding varied between 7.6 and 15.5%. ER-bound and unbound [3H]E2 were separated by hydroxyapatite (HAP) (Bio-Rad Laboratories, Inc., Hercules, CA) (25). Radioactivity in the HAP pellet was counted in a liquid scintillation counter (Wallac, Inc. 1409, Turku, Finland). Specific [3H]E2 binding was calculated, graphed, and analyzed using a GraphPad Software, Inc. prism (San Diego, CA). Ki was estimated by the formula described in (26).



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Figure 1. The chemical structure of trans-resveratrol.

 
Determination of resveratrol solubility
The solubility of resveratrol has not been published. We determined resveratrol solubility in 5% ethanol/95% H2O at room temperature by dissolving different amounts of resveratrol in the solvent, followed by centrifugation and measuring the resulting absorbance at 217 and 304 nm. No additional increase in the absorbance was observed when the resveratrol concentration exceeded 250 µM, indicating that 250 µM is the limit of resveratrol solubility.

Electrophoretic mobility shift assay (EMSA)
An EREc38 oligomer, 77 nucleotides in length, which includes sequences flanking the ERE between the EcoRI and HindIII sites in pGEM-7Zf(+), which do not bind ER (27), was prepared and fill-in labeled with [32P]{alpha}-dATP (800 Ci/mmol) (NEN Life Science Products) using Klenow large fragment DNA polymerase I (New England Biolabs, Inc., Beverly, MA) (20). Unincorporated nucleotides were removed by centrifugation through a Centri-Spin 20 column (Princeton Separations, Adelphia, NJ). Labeled EREc38 (50,000 cpm) was incubated for 2 h at 4 C with a nuclear extract of baculovirus-expressed rhER{alpha} or rrERß. Binding reactions were performed in TDPEKG buffer (40 mM Tris-HCl (pH 7.5), 1 mM DTT, 0.5 mM PMSF, 1 mM EDTA, 111 mM KCl, 10% vol/vol glycerol) and included 5 µg poly(deoxyinosine-deoxycytidine) (Midland Certified Reagent Co., Midland, TX), 10 µg purified BSA (New England Biolabs, Inc.)/reaction, in a total reaction volume of 30 µl, with a final salt concentration of 92 mM KCl. An ER{alpha}-specific antibody H222, generously provided by Abbott Laboratories (Abbott Park, IL), was diluted 1:10 in TE buffer (10 mM Tris-HCl (pH 8.0), 1 mM EDTA) and 1 µl of the diluted H222 was added to selected samples in each experiment to confirm the identity of ER{alpha} protein in the shifted ER-ERE complexes. ERß-specific antibodies PA1–310 (Affinity BioReagents, Inc., Golden, CO) and Y-19 (Santa Cruz Biotechnology, Inc., Santa Cruz, CA) were used undiluted in select samples to confirm the identity of ERß protein in shifted ER-ERE complexes. After incubation, the protein-DNA mixture was loaded onto 4% nondenaturing polyacrylamide gels and electrophoresed as described (20). Gels were dried under vacuum and autoradiographed on Kodak X-Omat film with an intensifying screen (Lightning Plus from DuPont Co., Wilmington, DE). The ratio of ER-bound to free DNA was determined using a Packard Instruments InstantImager and associated software, Packard Imager for Windows v 2.04 (Packard Instrument Co., Meriden, CT).

Transient transfection experiments
CHO-K1 cells were plated in 12-well plates at 2 x 105 cells/well with IMDM (-phenol red) supplemented with 10% charcoal-stripped CS. The cells were transfected with 0.6 µg reporter construct containing the ERE, 0.1 µg pCMV ß-gal, 10 ng pCMV-ER{alpha} or pCMV-ERß, and 0.49 µg pGEM-7Zf(+) (Promega Corp., Madison, WI) when 80% confluent. The transient transfection was performed using Transfast (Promega Corp.) according to directions supplied by Promega Corp. Cells were treated, in triplicate, 24 h later with resveratrol, E2 (Sigma), or 4-hydroxytamoxifen (4-OHT) (Research Biochemicals International, Natick, MA) diluted in phenol-red-free IMDM (-). The cells were harvested 30 h later, and the luciferase and ß-galactosidase (ß-gal) activities were assayed (20). All data for transient transfections were normalized by ß-gal to account for transfection efficiency. Statistical analyses were performed using Student’s t test in Microsoft Corp. Excel ‘97.

Cell proliferation
Cell proliferation was determined using the Cell Proliferation Kit 1 (MTT) according to the directions provided by the supplier (Roche Molecular Biochemicals, Indianapolis, IN). Briefly, 2 x 104 CHO-K1 cells/well were plated in 96-well plates and treated as described above for the transient transfection experiments. Mock transfected cells were incubated with Transfast without added plasmid DNA and then treated with hormones or vehicle as described above. Cell proliferation experiments were conducted concomitantly with transient transfection experiments. Cells were transfected with 60 ng 1EREc38, 10 ng ß-gal, 1 ng rhER{alpha} or rrERß, and 49 ng of pGEM-7Zf(+). Cells cotransfected with ER{alpha} or ERß and treated with 0.1 nM E2, 50 µM resveratrol, 0.1 nM E2 and 50 µM resveratrol, 100 µM resveratrol, 1 µM 4-OHT, 1 µM 4-OHT and 1 nM E2, 1 µM 4-OHT and 50 µM resveratrol, and EtOH for control. At the time that the transfection was harvested, the MTT assay was performed according to manufacturer’s instructions. The absorbance of solubilized crystals was measured at 595 nm in a Molecular Devices SpectraMAX250 plate reader. The means from three separate experiments were analyzed using Student’s t test for two samples assuming unequal variances in GraphPadPrism.


    Results
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Resveratrol binds ER{alpha} and ERß with comparable affinity
Resveratrol was shown to bind ER in MCF-7 (10) and rat uterine cytosol extracts (14). However, the contribution of ER{alpha} vs. ERß for this binding is unknown. Competition binding experiments were used to determine the relative binding affinity of resveratrol for ER{alpha} and ERß. Resveratrol binds to rhER{alpha} (Fig. 2AGo) and rrERß (Fig. 2BGo). The relative binding affinities (RBA) of resveratrol for ER{alpha} and ERß are not statistically different (Table 1Go). The equilibrium dissociation constants (KI) are different, reflecting higher affinity of E2 binding to ER{alpha} than ERß (Table 1Go). However, since the 95% confidence intervals for KI overlap, the difference in KI for resveratrol between ERß and ER{alpha} is not statistically significant. This is the first demonstration of resveratrol interaction with ERß.



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Figure 2. Resveratrol competes with [3H]E2 for binding rhER{alpha} and rrERß. Competition binding experiments were performed with baculovirus expressed rhER{alpha} (A) and rrERß (B) as described in Materials and Methods. Increasing concentrations of either E2 (closed squares) or resveratrol (closed diamonds) were mixed with 15.5 nM [3H]E2, and incubated in triplicate with 6 nM monomer rhER{alpha} or rrERß. [3H]E2-ER binding was determined by HAP assay (25 ). Data were graphed as percent of saturation of the specific [3H]E2 binding capacity vs. competitor concentration. These data indicate that resveratrol binds ER{alpha} and ERß with an affinity approximately 117,000- and 108,000- fold lower than E2, respectively.

 

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Table 1. Resveratrol binds ER{alpha} and ERß

 
The IC50 values obtained from these experiments indicate that resveratrol binds both ER{alpha} and ERß with lower affinity than E2 (Table 1Go). The estimated IC50 values for resveratrol of 58.5 µM and 130 µM for ER{alpha} and ERß, respectively, are in agreement with the value of 100 µM reported for ER in MCF-7 cell extract (14). Together, these data indicate that resveratrol binds ER{alpha} and ERß with comparable binding affinity.

Resveratrol has no effect on CHO-K1 cell proliferation unless cells are cotransfected with ER{alpha} or ERß
Resveratrol has been reported to inhibit the proliferation of ER positive and negative cultured human breast cancer cells (10, 28). To determine the effect of resveratrol on CHO-K1 cell proliferation in a receptor-isoform-dependent assay, cells were transfected with expression vectors for either ER{alpha} or ERß. The proliferation of untransfected, "mock-transfected," and ER{alpha} or ERß transfected CHO-K1 cells treated with EtOH, E2, or resveratrol was determined using the MTT assay (Fig. 3Go and data not shown). The mock transfected cells showed no alteration in proliferation regardless of cell treatment, indicating that TransFast is not toxic to the cells (data not shown). Cells transfected with ER{alpha} or ERß showed no alteration in cell proliferation with or without treatment with E2 or 4-OHT (Fig. 3Go and data not shown). However, cells transfected with ER{alpha} or ERß and treated with 100 µM resveratrol showed decreased proliferation. Untransfected or mock-transfected cells showed no decrease in proliferation with 100 µM resveratrol treatment, indicating the effect is dependent upon ER expression (Fig. 3Go and data not shown). Similarly, cells transfected with pCMV-ß-gal and treated 100 µM resveratrol show no decrease in cell proliferation. Cells treated with E2 showed no decrease in viability. These data indicate that 100 µM resveratrol decreases cell proliferation only when the CHO-K1 cells are transfected with ER{alpha} or ERß.



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Figure 3. Effect of E2 or resveratrol on the proliferation of ER{alpha} or ERß- expressing CHO-K1 cells. The effect of the indicated concentrations of E2 or resveratrol on the proliferation of CHO-K1 cells transfected with ER{alpha} or ERß vs. nontransfected (treatment only) cells was measured by the tetrazolium dye (MTT) assay as described in Materials and Methods. Data are presented as the mean ± SEM of three different experiments in which each treatment was performed in triplicate. Asterisks indicate values that are statistically different (P < 0.001) from control (EtOH) values.

 
Resveratrol-liganded ER binds EREs
To determine if resveratrol affects the interaction of ER{alpha} or ERß with an ERE, ER{alpha} or ERß were incubated with E2, 4-OHT, or resveratrol and ERE binding was measured by EMSA (Fig. 4Go). ER{alpha} bound specifically to EREc38, as indicated by the supershift of the entire bound complex with ER{alpha}-specific antibody H222 (Fig. 4AGo). The multiple ER{alpha} bands are due to truncated ER{alpha} present in the NE. As anticipated from previous reports (29, 30, 31), preincubation of ER{alpha} with E2 accelerated the migration of the ER{alpha}-EREc38 complex, while addition of 4-OHT slowed the migration of the 4-OHT-ER{alpha}-EREc38 complex (compare Fig. 4Go, lanes 2, 3, and 4). Resveratrol had no apparent effect on the migration of the ER{alpha}-EREc38 complex. These data indicate differences in ER{alpha} conformation in the presence of these ligands. Likewise, resveratrol did not affect the binding of H222 to ER{alpha}-EREc38, generating a supershifted complex similar to that of the E2-ER{alpha}-EREc38 complexed with H222 (Fig. 4Go, lanes 6 and 1).



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Figure 4. ER{alpha} and ERß bind an ERE in the presence of resveratrol. A, A nuclear extract of rh ER{alpha} (6.67 nM dimer, final) was incubated with 30 µM E2 (E), 4-OHT (T), or resveratrol (R). The reactions in lanes 1 and 6 included H222 (H) antibody to ER{alpha}. B. A nuclear extract of rh ERß (1.9 nM dimer, final) was incubated with 16.7 µM E2 (E), 4-OHT (T), or resveratrol (R). The reactions in lanes 2 and 7 included 1 µl of PA1–310 and in lane 3, 1 µl of Y-19 anti-ERß antibodies. For the reaction in both gels, 50,000 cpm (3.5 nM) of [32P]EREc38 was added. Incubation and EMSA reaction conditions are described in Materials and Methods.

 
Similar results were detected for ERß. Preincubation of ERß with E2 accelerated the migration of the ERß-EREc38 complex, while addition of 4-OHT slowed the migration of the 4-OHT-ERß-EREc38 complex (compare Fig. 4BGo, lanes 1, 4, and 5). Resveratrol had no apparent effect on the migration of the ERß-EREc38 complex (compare Fig. 4BGo, lanes 1 and 6). These data indicate differences in ERß conformation in the presence of these ligands. Resveratrol did not affect the interaction of antibody PA1–310 with the resveratrol-ERß-EREc38 complex (Fig. 4BGo, lane 7).

While the concentration of resveratrol added was expected to fully occupy ER{alpha} or ERß, based on the data shown in Fig. 2Go, we cannot exclude the possibility that the receptor was not fully saturated with resveratrol in this experiment. Because resveratrol was recently reported to inhibit the binding of the arylhydrocarbon receptor (AHR)/AHR-nuclear translocator (ARNT) heterodimer to a xenobiotic response element in EMSA (32), we examined the effect of increasing concentrations of resveratrol and E2 on ER-ERE binding in vitro using EMSA (Fig. 5Go and data not shown). Quantitation of the amount of ER{alpha}-EREc38 or ERß-EREc38 complexes shows that resveratrol inhibits ER-ERE binding at concentrations > 10 µM, but that identical concentrations of E2 resulted in less inhibition of ER-EREc38 binding, until the final concentration reached 200 µM (Fig. 5CGo). This inhibition of ER-ERE binding by resveratrol can also be observed by noting the increased amount of free EREc38 at the bottom of the gel (Fig. 5Go, A and B). Resveratrol had a more pronounced inhibitory effect on ERß-EREc38 binding compared with ER{alpha}-EREc38 binding. Like resveratrol, E2 had more of an inhibitory effect on ERß-EREc38 binding compared with ER{alpha}-EREc38 binding. This observation indicates that ERß-EREc38 binding is more labile than ER{alpha}-EREc38 binding.



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Figure 5. Resveratrol inhibits ER{alpha} and ERß-EREc38 binding in vitro. Nuclear extracts of rh ER{alpha} (A) and rr ERß (B) (147 fmol) were incubated with the indicated volumes or concentrations of ethanol (EtOH), as vehicle control, or resveratrol (range 100 pM200 µM final). ER{alpha} antibody H222 and ERß antibody Y-19 were added to lane 1 in A and B, respectively. EMSA was performed as described in Fig. 4Go and Materials and Methods. C, The total amount of ER-EREc38 complex (all retarded ER{alpha}-ERE bands in A) formed with increasing concentrations of resveratrol or E2 was quantitated. There was no significant difference in the amount of either ER{alpha} or ERß bound to EREc38 when incubated with 0.6–1.5 µl of EtOH. Thus, the amount of ER-EREc38 complex formed in the presence of EtOH was set to 100% and the amounts of ER-EREc38 complexes formed with increasing concentrations of resveratrol or E2 was calculated relative to that amount. The data are the average ± SEM of 2–4 independent EMSAs. The fills and symbols are indicated at the top of panel C.

 
Resveratrol induces reporter gene activity with ER{alpha} from a consensus ERE
We used cotransfection assays in CHO-K1 cells to compare the transcriptional activities and ligand responsiveness of ER{alpha} and ERß. This cell line was selected because it requires exogenous ER{alpha} or ERß to activate ERE-driven reporter gene expression and thus allows evaluation of the transcriptional response of each ER isoform in isolation with each ERE. First, we examined the effect of resveratrol on reporter gene activity driven by one copy of a consensus ERE called EREc38 (sequence in Materials and Methods) with ER{alpha}. Resveratrol stimulated luciferase activity in a concentration-dependent manner up to 50 µM, but 100 µM resveratrol inhibited luciferase activity (Fig. 6AGo). Because results from the MTT assay indicate that 100 µM resveratrol decreased cell proliferation in ER{alpha}-expressing cells (Fig. 3Go), this is likely the explanation for the decreased reporter activity at this resveratrol concentration. E2, at concentrations of 1 or 10 nM, has higher agonist activity with ER{alpha} than 50 µM resveratrol. Resveratrol at concentrations of 1, 10, or 50 µM had no effect on basal luciferase activity from the pGL3-pro-luciferase parental vector (data not shown). Addition of 100 nM 4-OHT blocked resveratrol activity with ER{alpha} (Fig. 6AGo and data not shown). While the fold induction of E2-stimulated luciferase detected is low, we note that others have reported that single EREs show significantly lower levels of transcriptional activation in response to E2 compared with commonly used multiple tandem EREs (24, 33, 34). These results indicate that the estrogen agonist activity of resveratrol is mediated by ER{alpha}-ERE interaction in transiently transfected CHO-K1 cells.



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Figure 6. Resveratrol acts as an ER{alpha} and ERß agonist in transient transfection assay. A, CHO-K1 cells were cotransfected with pGL3–1(EREc38) luciferase, pCMV-ßgal, and either pCMV-ER{alpha} or pCMV-ERß, indicated as different filled boxes, and treated with EtOH, as the vehicle control, or the indicated concentrations of E2, resveratrol, or resveratrol and 4-OHT. B, CHO-K1 cells were cotransfected with pGL3-luciferase reporter plasmid bearing the EREs from the human c-fos (FOS-1211, open bars), pS2 (closed bars), and PR (PR1148, hatched bars) genes, pCMV-ßgal, and pCMV-ER{alpha} and treated with EtOH, E2, or resveratrol at the indicated concentration. C, CHO-K1 cells were cotransfected with pGL3-luciferase reporter plasmid bearing the EREs from the human c-fos (FOS-1211), pS2, and PR (PR1148) genes, pCMV-ßgal, and pCMV-ERß and treated with EtOH, E2, resveratrol or resveratrol and 4-OHT at the indicated concentrations. The cells were transiently transfected and treated as described in Materials and Methods. Cells were harvested 30 h after starting treatment, and the cell extracts were assayed for luciferase and ß-gal activities. In each panel, the fold induction of luciferase activity was normalized for ß-gal and is expressed as the ratio of RLU between treatment groups and the ethanol control (which was set to 1). Data are the mean ± SEM from three to five different experiments in which each treatment was performed in triplicate within the experiment. Asterisks and open triangles indicate values that are significantly different (P < 0.05) from the control and 10 µM resveratrol values, respectively.

 
Resveratrol induces reporter gene activity with ER{alpha} from natural, imperfect EREs
Most estrogen-responsive genes contain one or more imperfect EREs and/or multiple ERE half-sites (35). Genes containing imperfect EREs, i.e. EREs that differ in one or more nucleotides in the inverted repeat of the consensus ERE, usually exhibit lower responsiveness to E2 in reporter gene assays in transfected cells, compared with a consensus ERE (24, 33). Furthermore, ER{alpha} binds these EREs with reduced affinity compared with binding to EREc38 (Refs. 36, 37) and data not shown). Therefore, to determine whether resveratrol activates ER{alpha}-mediated reporter gene activity from imperfect EREs, we performed transient transfection assays using luciferase reporter plasmids containing the imperfect EREs and their native flanking regions from the human c-fos, pS2, and PR genes (Fig. 6BGo, sequences in Materials and Methods).

E2 did not induce as much luciferase activity from the natural, imperfect EREs from the human pS2 and PR genes as from the consensus EREc38 (compare Fig. 6Go, A and B). However, the luciferase activity induced by E2 from the imperfect ERE from the human c-fos gene was similar than that induced from EREc38. While there was a significant increase in luciferase activity from pS2 when cells were treated with 10 nM E2, no significant dose-response relationship was detected for induction from Fos-1211 or PR1148. As seen for EREc38, resveratrol induced significantly lower luciferase expression from Fos-1211 and pS2 compared with E2. The luciferase activity induced by 50 µM resveratrol from PR1148 was comparable to that induced by 1 nM E2.

The induction of luciferase activity from the natural EREs by resveratrol was blocked by cotreatment with 4-OHT, indicating that ER{alpha} is responsible for resveratrol-induced reporter activity. As seen for EREc38, treatment of the CHO-K1 cells with 100 µM resveratrol inhibited luciferase activity from the pS2, FOS-1211, and PR1148 EREs (data not shown). In conclusion, the data from these transient transfection assays indicate that resveratrol acts as an estrogen agonist with ER{alpha}. These results are similar to those detected in transiently transfected, ER{alpha}-expressing COS-1 cells with either a vitellogenin ERE or LH-ß promoter-luciferase reporter plasmid (14).

Resveratrol induces reporter gene activity with ERß from a consensus ERE
ERß has been shown, in transient transfection assays using a single or multiple tandem copies of a consensus ERE, to have lower activity in response to E2 than ER{alpha} (31). However, in COS-1 cells, ERß induced higher reporter activity from the vitellogenin ERE than ER{alpha} in response to concentrations of E2 ranging from 0.01–1 µM (14). Here, we observed that cotransfection of CHO-K1 cells with ERß and EREc38 generated lower luciferase expression in response to E2 compared with ER{alpha} (Fig. 6AGo). Comparable protein expression levels of ER{alpha} and ERß were achieved in these cells (Western blot data not shown). ERß induced 61% of the activity of ER{alpha} with 1 nM E2. These data are consistent with the 59, 52, and 62% of ERß activity relative to ER{alpha} detected using reporters bearing one or 3 tandem consensus EREs in CEF, HeLa, and HepG2 cells, respectively (31, 38).

With ERß, resveratrol stimulated luciferase expression from EREc38 in a concentration-dependent manner up to 50 µM, whereas 100 µM resveratrol inhibited luciferase activity. These results are similar to those reported for ERß with a vitellogenin ERE reporter in transiently transfected COS-1 cells (14). In CHO-K1 cells, resveratrol-stimulated activity was inhibited by cotreatment with 4-OHT (Fig. 6AGo), which also blocked E2-induced activity from ERß (data not shown), indicating that direct interaction of resveratrol with ERß is responsible for the induction of luciferase activity from EREc38. Interestingly, in contrast to the differences in luciferase activity induced by E2 with ER{alpha} and ERß, resveratrol induced nearly identical levels of luciferase activity from EREc38 with either ER{alpha} or ERß (Fig. 6AGo). This indicates that resveratrol-liganded ERß has similar transcriptional activity to E2-ERß at a single perfect, palindromic ERE. These data differ from those for ERß expression in COS-1 cells in which 500 µM resveratrol showed higher induction of reporter activity from two tandem copies of the vitellogenin ERE than any of the concentrations of E2 (0.01–1 mM) examined (14). These findings indicate that cell-specific factors influence the agonist activity of resveratrol with ERß.

Resveratrol induces reporter gene activity with ERß from natural, imperfect EREs
Next we examined the induction of luciferase activity from the EREs from the human c-fos, pS2, and PR genes with ERß (Fig. 6BGo). Please note that the scale for fold-induction of luciferase activity for revised Fig. 6CGo is one half the scale used for Fig. 6Go, A and B. As seen for ER{alpha}, E2 induced lower activity from each of the imperfect EREs than from EREc38 (compare Fig. 6Go, A and C). Unlike ER{alpha} for which E2 stimulated more activity from Fos-1211 than the other natural EREs, there was no difference in the luciferase activity induced by ERß with 10 nM E2 from the imperfect EREs. These data indicate that ER{alpha} and ERß transactivate reporter gene expression differentially in response to E2 from natural imperfect EREs in CHO-K1 cells.

Resveratrol stimulated ERß-driven reporter activity from each natural-occurring ERE in a concentration-dependent manner, although the response with PR1148 was not statistically different between resveratrol concentrations. For both ER{alpha} and ERß, PR1148 was least responsive to resveratrol. As anticipated, the luciferase activity from the three imperfect EREs was lower than that induced from EREc38 (compare Fig. 6Go, A and C). However, for Fos-1211 and pS2, the luciferase activity induced by 50 µM resveratrol was greater than that stimulated by 1 or 10 nM E2. As seen with ER{alpha}, treatment of the ERß-transfected CHO-K1 cells with 100 µM resveratrol inhibited luciferase activity from all EREs due to decreased CHO-K1 cell proliferation (Fig. 3Go and data not shown). The induction of luciferase activity from each of the natural EREs by resveratrol with ERß was blocked by cotreatment with 4-OHT, indicating that ERß is responsible for resveratrol-induced reporter activity.

At 50 µM, resveratrol induced identical levels of reporter activity from EREc38, Fos-1211, and pS2 with ER{alpha} and ERß. However, E2 induced higher reporter activity from all EREs with ER{alpha} than ERß. For PR1148, ERß was less active than ER{alpha} with resveratrol and E2. Taken together, these results imply that resveratrol-liganded ER{alpha} and ERß are equivalently transcriptionally active with the Fos-1211 and pS2 EREs. In contrast, E2-liganded ERß interacts with EREc38 and the imperfect EREs from the human c-fos, pS2, and PR genes less productively than ER{alpha}. Finally, these data indicate that the ER agonist activity of resveratrol is not identical for ER{alpha} and ERß and varies with ERE sequence.

Resveratrol antagonizes E2 activity at select EREs with ER{alpha}
Resveratrol was reported to display "superagonist" activity in MCF-7 cells transfected with an ERE-driven luciferase reporter plasmid, i.e. greater activity than with 0.1 nM E2 treatment (9, 10). This phenomenon is not understood because these two reports show different definitions of superagonist activity. In the first report (10), "superagonist" activity was not the equivalent of synergy since the responses of E2 and resveratrol were additive (10). In the more recent report, the reporter activity detected in MCF-7 cells treated with 0.1 nM E2 plus 25 µM resveratrol was 2-fold greater than the anticipated additive activity of the two ligands (9). We evaluated how resveratrol impacted E2-stimulated luciferase activity from EREc38 or the natural EREs from the human c-fos, pS2, and PR genes in CHO-K1 cells expressing either ER{alpha} (Fig. 7AGo) or ERß (Fig. 7BGo). No additive activity was detected with ER{alpha} and 0.1 nM E2. Interestingly, 50 µM resveratrol had E2 antagonist activity for EREc38 and PR1148, but not Fos-1211 or pS2. Thus, variations in the ERE sequence appear to influence the agonist/antagonist activity of resveratrol with ER{alpha} in E2-treated CHO-K1 cells. We note that the relatively low fold induction that we observed with single EREs is similar to that reported by other investigators (33, 34).



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Figure 7. Resveratrol exhibits little or no antagonist activity with ER{alpha} and additive agonist activity with ERß at various EREs. CHO-K1 cells were cotransfected with pGL3-luciferase reporter plasmid bearing 1(EREc38) or the EREs from the human c-fos (FOS-1211), pS2, and PR (PR1148) genes, pCMV-ßgal, and pCMV-ER{alpha} (A) or pCMV-ERß (B). In both panels, cells were treated with 0.1 nM E2 or 0.1 nM E2, plus the indicated concentrations of resveratrol. The transient transfection, treatment, and assay conditions were as described in Materials and Methods and in Fig. 6Go. The fold induction of luciferase activity was normalized for ß-gal and is expressed as the ratio of RLU between treatment groups and the vehicle control (which was set to 1). Data are the mean ± SEM from three different experiments in which each treatment was performed in triplicate within the experiment. In both panels, asterisks indicate values that are significantly different (P < 0.05) from the values observed with 1 nM E2 for the cognate ERE.

 
In contrast to ER{alpha}, with ERß the luciferase activity stimulated by 1 nM E2 from EREc38 and PR1148 was not antagonized by cotreatment with 50 µM resveratrol. As seen for ER{alpha}, resveratrol had no effect on E2-induced reporter activity from pS2. The results for Fos-1211 were similar for ER{alpha} and ERß: increased activity with E2 plus resveratrol. In no case was the activity of E2 and resveratrol additive. The activity induced by E2 plus resveratrol for each ERE with ERß was blocked by 4-OHT, indicating that it is dependent on ERß AF-2 (data not shown).

To examine the relative agonist/antagonist activity with a stronger ERE promoter, we evaluated the induction of luciferase activity from two tandem, head-to-tail, copies of EREc38, called 2(EREc38), with 10 nM E2, resveratrol, or E2 + resveratrol in CHO-K1 cells transfected with ER{alpha} or ERß (Fig. 8Go). As seen with the single EREs (Figs. 6Go and 7Go), ER{alpha} had higher transcriptional activity than ERß in response to E2. Resveratrol showed weak agonist activity for both ER{alpha} and ERß. Similar to the data for a single copy of EREc38, resveratrol suppressed E2-ER{alpha}-stimulated luciferase activity from 2(EREc38) in a concentration-dependent manner. In contrast, resveratrol did not inhibit E2-ERß activity. This result indicates that ER{alpha} and ERß respond differently to resveratrol at the same ERE. Resveratrol, when combined with E2 exhibits antagonist activity with ER{alpha}, but no antagonist activity with ERß.



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Figure 8. Combined E2 and resveratrol have different effects on ER{alpha} and ERß. CHO-K1 cells were cotransfected with pGL3-luciferase reporter plasmid bearing 2(EREc38), pCMV-ßgal, and pCMV-ER{alpha} (black bars) or pCMV-ERß (hatched bars). The cells were treated with 10 nM E2, 10 nM E2 + 100 nM 4-OHT, the indicated concentrations of resveratrol (µM), or 10 nM E2 plus resveratrol at the indicated concentrations. The transient transfection, treatment, and assay conditions were as described in Materials and Methods and in Fig. 6Go. The fold induction of luciferase activity was normalized for ß-gal and is expressed as the ratio of RLU between treatment groups and the vehicle control (which was set to 1). Data are the mean ± SEM from three to five different experiments in which each treatment was performed in triplicate within the experiment. The asterisks and the closed triangles indicate values that are significantly different from the EtOH control and stimulated by E2 alone for ER{alpha} and ERß, respectively (P < 0.05).

 

    Discussion
 Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Epidemiological evidence indicates that phytoestrogens have biological activities including inhibition of cancer initiation and growth, reduction of serum cholesterol levels, and benefits in treating osteoporosis (39, 40). Resveratrol is a bioflavonoid that occurs naturally in grapes and is especially prevalent in red wine that contains 1–10 mg/liter (5). This gives a concentration of trans-resveratrol of 0.1–10 µM and cis-resveratrol of 0.5–10 µM. Given the daily recommended dose of wine is 250 ml (41), it is estimated that a person would ingest 0.025–2.5 µmol (6 µg-0.6 mg) of trans-resveratrol daily (9). Based on pharmacokinetic studies performed in rats (7), these amounts can provide serum concentrations that correspond to the concentrations at which the estrogenic/antiestrogenic effects of resveratrol were observed here.

Resveratrol has chemopreventive and chemotherapeutic activities (1, 2) and has been classified as a phytoestrogen because it binds to ER{alpha} with low affinity (10). Here we evaluated the estrogen agonist/antagonist activity of resveratrol with ER{alpha} and ERß in vitro and in transiently transfected cells. Our results show that resveratrol binds ER{alpha} and ERß with comparable affinity, but with much lower affinity than E2. This finding contrasts with data showing that several phytoestrogens bind ERß with higher affinity than ER{alpha} (42). One possible explanation for the lower affinity of resveratrol binding to ERß compared with other phytoestrogens is its structural similarity with diethylstilbestrol (DES) (10), which binds ERß with lower affinity than ER{alpha} (43).

Whether resveratrol-occupied ER{alpha} has agonist or antagonist activity has been controversial (10, 14, 18). Resveratrol was first reported to be a relatively weak ER ligand but showed "superagonist" activity, i.e. higher reporter activity than E2, in ER{alpha}-expressing MCF-7 cells (9, 10). However, another report found no evidence of superagonism in COS cells with either ER{alpha} or ERß (14). Data from our transient transfection assays in CHO-K1 cells using a consensus ERE or the natural imperfect EREs from the human c-fos, pS2, or PR genes indicate that resveratrol acts as an estrogen agonist with ER{alpha} and ERß. However, resveratrol does not display superagonist activity either alone or in combination with E2. These results are similar to those detected in COS-1 cells transfected with ER{alpha} and either a vitellogenin ERE or LH-ß promoter-luciferase reporter plasmid (14).

Our results demonstrate that the agonist activity of resveratrol with ERß is fundamentally different from E2 agonist activity because, in contrast to E2 which induces higher activity of ER{alpha} than ERß, resveratrol activated equal reporter activity from EREc38 with both ER{alpha} and ERß. In contrast, 500 µM resveratrol was reported to induce higher ERE-driven reporter activity by ERß than any concentration of E2 (0.01–1 mM) examined in COS-1 cells (14). Because both we and Ashby et al. (14) used human ER{alpha} and rat ERß expression vectors and pGL3-luciferase vectors in our experiments, we conclude that the difference between our findings and those reported by Ashy et al. (14) is likely due to differences in the expression of coregulators between CHO-K1 and COS-1 cells. Importantly, our data indicate that resveratrol-liganded ERß has higher transcriptional activity than E2- liganded ERß at a single palindromic ERE. This indicates that those tissues that uniquely express ERß or that express more ERß than ER{alpha} may be more sensitive to resveratrol’s estrogen agonist activity.

Biochemical (29, 30, 44, 45) and crystal structure (46, 47) studies indicate ligand-specific differences in ER{alpha} conformation that impact interaction with coactivators. We observed clear differences in the migration of ERE-bound ER{alpha} and ERß either unoccupied or occupied by E2, 4-OHT, or resveratrol. These data indicate differences in ER conformation in the presence of resveratrol compared with E2 or 4-OHT. The concentrations at which resveratrol inhibited ERE binding by ER{alpha} and ERß in vitro are concentrations at which resveratrol exhibited agonist activity in transiently transfected cells. Further experiments, e.g. in vivo DNase I footprinting, are needed to determine in vivo effects of resveratrol on ER-ERE binding. The crystal structure of the ERß LBD occupied by the phytoestrogen genistein showed that helix 12 did not adopt the distinctive "agonist" position seen with E2 binding to the ER{alpha} LBD, but lay in an orientation similar to that observed when the ERß LBD was occupied by the select estrogen receptor modulator (SERM) raloxifene (48). The authors concluded that this positioning of the transactivational helix 12 was consistent with the partial agonist activity of genistein (48). Given the pharmacological activities of resveratrol observed here, we predict that resveratrol-bound ERß LBD may show a structure similar to that of the genistein-occupied ERß. Because alterations in LBD conformation impact the interaction of ER{alpha} and ERß with coactivators, further experiments are needed to assess coactivator effects on resveratrol-liganded ERß activity.

While resveratrol reportedly gave a dose-dependent increase in reporter activity with concentrations as high as 500 µM with both ER{alpha} and ERß in transiently transfected COS cells (14), we observed that 100 µM resveratrol inhibited ERE-driven reporter activity in CHO-K1 cells. Because the limit of resveratrol solubility is 250 µM in 5% EtOH, we are uncertain as to the soluble concentration of resveratrol in the COS cell assays (14). Moreover, we observed decreases cell proliferation in CHO-K1 cells expressing ER{alpha} or ERß and treated with 100 µM resveratrol. There was no significant decrease in CHO-K1 cell proliferation in cells treated with 100 µM resveratrol and expressing ß-galactosidase or in mock-transfected cells under the same conditions. While others have reported that E2 treatment of cells stably overexpressing ER{alpha} inhibits cell proliferation (49, 50, 51, 52, 53), E2 at concentrations that stimulate reporter activity in transiently transfected CHO-K1 cells had no effect on cell proliferation in the presence or absence of transfected ER{alpha} or ERß. Therefore, stable expression of ER{alpha} in ER{alpha} negative cells appears to be required for E2-induced inhibition of cell proliferation in response to E2, but not resveratrol. We conclude that expression of ER{alpha} or ERß is involved in the decrease in CHO-K1 cell proliferation with 100 µM resveratrol. Others reported that 100 µM resveratrol inhibited the growth of ER{alpha}-expressing MCF-7 cells (18). However, the mechanism for inhibition of MCF-7 cell proliferation may not be ER{alpha}-mediated since resveratrol also inhibited the growth of ER-negative breast cancer cells (28).

In addition to its agonist activity, resveratrol exhibited antiestrogenic activity in MCF-7 cells (18). Resveratrol decreased the levels of transcription of PR, insulin-like growth factor-receptor, and transforming growth factor-{alpha} genes and stimulated the expression of transforming growth factor-ß2, results similar to those elicited by tamoxifen in these cells (18). While the authors concluded that the most likely mechanism for the antiestrogenic effect of resveratrol is its direct competition with E2 for ER binding, they also suggested that resveratrol might prevent ER binding to EREs (18). Our data support both suggestions because we observed that resveratrol competes with E2 for ER{alpha} and ERß binding and inhibited ER{alpha} and ERß binding to EREc38 in vitro. The concentrations at which resveratrol inhibited ER-ERE binding in vitro are those at which resveratrol exhibits agonist/antagonist activity in CHO-K1 cells.

We observed both ER isoform-specific and ERE-specific differences in the agonist activity induced by resveratrol in CHO-K1 cells. For example with ER{alpha}, the activity induced by E2 was greater than that stimulated by any concentration of resveratrol for EREc38, Fos-1211, and pS2, but not PR1148. In contrast, resveratrol and E2 were equally transcriptionally active with ERß at all EREs tested. With ER{alpha} and PR1148, although the induction levels are low, they are significantly above the ethanol control values, and resveratrol-induced luciferase activity was comparable to that induced by E2. This result implies that, when bound to the PR1148 ERE, resveratrol-liganded and E2-liganded ER{alpha} and ERß are equally effective at recruiting components of the coactivator/RNA polymerase II preinitiation complex.

In addition to estrogen agonist activity, we also report that resveratrol has estrogen antagonist activity in CHO-K1 cells. However, resveratrol’s antagonist activity was only observed with ER{alpha} and not ERß. These data are reminiscent of the lack of 4-OHT agonist activity with ERß (54). We speculate that the antagonist activity of resveratrol may be mediated by AF-1, which appears to be absent in ERß. Interestingly, the antagonist activity of resveratrol was only observed with EREc38, whether as a single or two tandem copies, and PR1148. These data indicate that the ERE alters the pharmacological properties of resveratrol mediated by ER{alpha}. This result agrees with our postulate that the ERE sequence acts as an allosteric modulator of ER activity (29). Further experiments are needed to define exactly what regions of ER{alpha} and ERß are necessary for resveratrol agonist and antagonist activity and to define the exact ERE sequence requirements for resveratrol antagonist activity with ER{alpha}.

In addition to its direct ER binding, resveratrol has many non-ER-mediated cellular activities that may influence ER transcriptional activation through "cross-talk" mechanisms. For example, resveratrol induces phosphorylation of the mitogen-activated protein (MAP) kinase family members, extracellular regulated kinase 1 (ERK1), and ERK2, in neuroblastoma SH-SY5Y cells (55) Activation of the MAP kinase pathway has been shown to activate unliganded ER{alpha} through phosphorylation of serine 118 in AF-1 (56). However, this ligand-independent pathway does not appear to be important in our experiments because 4-OHT blocked both E2 and resveratrol activity, indicating that direct activation of ER{alpha} through the LBD was responsible for the activity reported here. Moreover, because the transcriptional effects of resveratrol vary with alterations of the ERE sequence, resveratrol’s activity appears to be mediated by direct interaction of the resveratrol-occupied ER with EREs.

While the pharmacokinetics of resveratrol metabolism have not yet been examined in humans, results from rodent studies indicate that two servings of red wine may provide two-digit micromolar serum concentrations of resveratrol (1), i.e. concentrations identical to those at which the pharmacological activities of resveratrol were observed here as well as reported by others (10, 14, 18). The cell-type and ERE-sequence dependence of the transcriptional activity of resveratrol with ER{alpha} and ERß may be related to cell-specific differences in the activity of enzymes that modulate ER function, e.g. protein kinases, and in the expression of coactivator or corepressor proteins. Continued analysis of ER{alpha} and ERß interaction with estrogenic ligands, estrogen-regulated genes, and coregulator proteins is necessary to gain a better understanding of how these receptors regulate estrogenic activity at the cellular and molecular level and whether the anticancer and cardioprotective activities of resveratrol are mediated by ER.


    Acknowledgments
 
We thank the following companies for supplying reagents used in this study: resveratrol: Pharma Science, Montréal, Québec, Canada; and H222: Abbott Laboratories (Abbott Park, IL). We thank Rosemary L. Sims for her assistance in some of the experiments reported here. We thank Drs. Barbara J. Clark and Peter C. Kulakosky for their contributions to the experimental design and for reviewing this manuscript.


    Footnotes
 
1 Supported by NIH Grant R-01-DK-53220, the Cancer Research Foundation of America, and a University of Louisville School of Medicine Research Grant (to C.M.K.). Back

Received May 9, 2000.


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 Introduction
 Materials and Methods
 Results
 Discussion
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