Christian J. Gruber, Doris M. Gruber, Isabel M.L. Gruber, Fritz Wieserand Johannes C. Huber
Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology,University of Vienna Medical School, Wa¨hringer Gu¨rtel 18 – 20, A-1090, Vienna, Austria
Estrogens exert their regulatory potential on gene
therefore yield different transcriptional effects at the same
expression through different nuclear and non-nuclear
site . On activation of the ER by agonist ligand binding,
mechanisms. A direct nuclear approach is the inter-
conformational changes are induced and intracytoplasmic
action of estrogen with specific target sequences of
chaperones, such as heat-shock proteins 70 and 90,
DNA, estrogen response elements (ERE) or units. EREs
dissociate from the receptor molecule The receptor
can be grouped into perfect and imperfect palindromic
then interacts with DNA and the transcriptional response
sequences with the imperfect sequences differing from
is modulated by the recruitment of co-regulatory proteins
the consensus sequence in one or more nucleotides and
. A site of attachment for nuclear co-activators within
being less responsive to the activated estrogen – estro-
the ligand-binding domain (LBD) of the ERa is formed by
gen receptor (ER) complex. Differences in the ERE
helix 12 when the receptor is occupied by an agonist ligand
sequence and the ER subtype involved can substantially
. Anti-estrogens displace part of the receptor, which
alter ER– ERE interaction. In addition, cross-talk between
then occludes the site and blocks co-activator access
ERs and other nuclear transcription factors profoundly
ERs are members of a large family of nuclear receptors
influences gene expression. Here, we focus on the
that probably arose from a common ancestral receptor
recent advances in the understanding of the structure
molecule . This hypothesis is supported by the similar
of EREs and how ERs are recruited to these. Identifying
modes of action of nuclear steroid receptors and a rather
known target genes for estrogen action could help us
conserved DNA-binding domain (DBD). The LBDs of
to understand the potential risks and benefits of the
nuclear steroid receptors differ markedly in structure,
administration of this steroid to humans.
even between the receptor subtypes ERa and ERb,reflecting different binding affinities for physiological
Estrogens are now known to influence the expression of a
ligands Glucocorticoid, mineralocorticoid, androgen
wide range of genes by different mechanisms in the
and progesterone receptors bind to derivatives of a
reproductive tract and other areas A direct genomic
interaction occurs between the estrogen receptor (ER)
different to this response element. However, when the
ligand complex and specific sequences of DNA known as
DBD of ERa is switched experimentally with the DBD of
estrogen response elements (ERE). Alternatively, ERs can
the glucocorticoid receptor, the chimeric receptor binds to
be activated independently of a hormonal ligand . However, the different anatomy of EREs, the two subtypesof ERs involved (ERa and ERb), the variety of interacting
–8–7–6–5–4–3–2 +2+3+4+5+6+7+8
nuclear co-regulatory proteins and the substantial cross-talk between nuclear transcription factors can yield
5′-C A G G T C A nnn T G A C C T G-3′
various responses to estrogen stimulation. By focusing
on the structure of natural EREs and on how ERs are
3′-G T C C A G T nnn A C T G G A C-5′
recruited to these, a better understanding of the complex-ity of the action of this steroid when administered tohumans can be achieved.
TRENDS in Endocrinology & Metabolism
Activated ERs are transcription factors that bind indimeric form to specific sequences of DNA in the
Figure 1. Sequence of the ERE and GRE. (a) A consensus ERE has been derived
regulatory region of target genes, the EREs. Generally,
from several highly estrogen-responsive sequences from the African clawed frogXenopus laevis genes encoding vitellogenin A1, A2, B1, B2 and the chicken apo-
ERa and ERb can form both homo- and heterodimers
VLDL II gene. It is a 13 bp perfect palindromic inverted repeat with a 3 bp spacing
before attaching to DNA Both receptor subtypes have
of variable bases (red). (b) The sequence of the consensus GRE . As indicated,
different affinities for different response elements and can
replacement of the adenine base at position þ 4 by thymine results in the gener-ation of a GRE. Positions þ 2, þ 3 and þ 6 are conserved in both the ERE and GRE. Abbreviations: ERE, estrogen response element; GRE, glucocorticoid response
Corresponding author: C.J. Gruber (christian_gruber@chello.at).
1043-2760/$ - see front matter q 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.tem.2004.01.008
the glucocorticoid response element (GRE) but is activated
within the ERE are contacted with highest affinity by the
by 17b-estradiol . This indicates the high specificity of
P-Box amino acids because different laboratory techniques
give different results However, recent studies
Highly conserved regions in the DBD of ERa and ERb
indicate that both ERa and ERb contact the same
are the two cysteine – cysteine zinc fingers which allow
nucleotides in the consensus ERE . It is therefore
contact between the major groove of DNA and the sugar–
assumed at this time that the two ER subtypes interact
phosphate backbone. The resulting ER – ERE complex is
stabilized by ligand binding and the high mobility
As mentioned previously, ER conformation differs when
group proteins 1 and 2 which are architectural
occupied by different ligands. Also, the structure of the
proteins that facilitate chromatin function.
ERE alters the conformation of the receptor. As seen incrystallographic studies, the ERa reacts to a specific single
nucleotide alteration within the ERE by changing its DBD
Highly estrogen-responsive and perfectly palindromic
conformation by means of a side-chain rearrangement
sequences have been found in the African clawed frog
With these modifications, a rearrangment in the local
Xenopus laevis genes encoding vitellogenin A1, A2, B1 and
hydrogen bond network between DNA bases and receptor
B2 From these natural EREs and similar sequences
amino acids is achieved and alternative base contacts
a minimal consensus sequence for EREs has been
derived At position þ 2, the ER attaches to
Thus, ER conformation is dependent on two factors:
the first thymine base of a half site by interacting with the
(i) the ligand and (ii) the specific ERE sequence. As
50-methyl group. The thymine base at this position is also
indicated by protease sensivity assays, which rely on the
conserved in thyroid hormone and glucocorticoid/pro-
ability of a protease to cleave the receptor protein at
gesterone response elements (GRE/PRE). At position þ 3,
accessible amino acids, the ERa obtained a different
the guanine base is also conserved throughout all three
conformation when complexed with the different EREs
hormone reponse elements but the adenine at position þ 4
from the Xenopus laevis vitellogenin A2 and B1 genes and
of the half site is crucial for discrimination between the
the genes encoding human pS2 and human oxytocin
three . Replacement of the adenine base by thymine is
This can yield a differential recruitment of co-regulatory
incompatible with ER binding, resulting in the generation
proteins to the ER – ERE complex and might therefore
of a GRE. An ERE with a cytosine or guanine base at
constitute a mechanism for modulation of gene transcrip-
position þ 3 is still functional although it is less tran-
tion at different EREs. The recruitment of activation
scriptionally active. In all EREs position þ 5 is occupied by
function 2 (AF-2) dependent cofactor to ERa and ERb, for
a cytosine in at least one-half-palindrome. Position þ 6 is
instance, is affected by both the ligand and the ERE sequence
occupied by a cytosine in both ERE and GRE
When the ERs are liganded with 17b-estradiol (E
However, in the human genome, most estrogen target
the recruitment is primarily dependent on the ERE
genes do not contain an ERE palindrome in their promoter
sequence. By contrast, when the ERs are occupied by
but have non-palindromic EREs through which estrogenregulation is mediated Sequence requirements for
anti-estrogens, the ERE sequence loses its influence on
imperfect EREs have been determined in vitro . If an
ERa homodimer attempts to bind to an ERE differing in asingle base pair from the consensus sequence, binding is
ER affinity and transcriptional activation from different
abolished unless rescued by appropriate flanking. A
purine base immediately flanking the element on the 50
Few natural EREs have been examined with respect to their
side at position 2 7 of each strand is required in an ERE
exact ER affinity and strength of transcriptional activation.
with one base mutation. Two, but not three mutations can
These points are especially difficult to summarize because of
be compensated for by appropriate 2 7 and 2 8 flanking.
the multiple detection systems that have been used.
Mutations in both halves of the element also abolished
Generally, mutant variants of the consensus sequence
receptor binding in this study In accordance, natural
function with less transcriptional potency and their ability to
EREs in vivo lose affinity for the ER with increasing
bind the ER is significantly weaker For the few genes
numbers of nucleotide changes from the consensus
that have been examined that contain natural EREs, a direct
sequence, particularly if these alterations affect both
correlation between ER–ERE binding affinity and tran-
halves of the ERE palindrome The flanking sequence
scriptional activation has been observed for both ER
immediately adjacent to the ERE was also shown in vivo to
subtypes . In a further study, it was confirmed that
impact the transcriptional potency of the element. An
both ERa and ERb bind to the same EREs but that ERa does
enhancement of the transcriptional potency was particu-
so with an approximately twofold higher affinity
larly noticeable with a AT-rich flanking DNA
When the Xenopus laevis vitellogenin A2 and B1 ERE
were compared with the human pS2 and oxytocin ERE by
means of transient co-transfection and chloramphenicol
Three specific amino acids within the proximal box (P-Box)
acetyltransferase assay in HeLa cells, the most potent
of the first zinc finger of the ER bind to the ERE in a
transcriptional activation (10.5-fold) was observed with
sequence-specific manner The second zinc finger is
vitellogenin A2, followed by a 9.5-fold induction with the
involved in receptor molecule dimerization and ERE half-
oxytocin ERE, a 2.7-fold induction with the pS2 ERE and
site spacing recognition. It is unclear which nucleotides
1.6-fold induction with the vitellogenin B1 ERE
enhance the transcriptional activity of AP-1. In this path-
Often more than one ERE-like sequence is seen in the
way, the ER is part of the co-activator complex for Jun/Fos
regulatory region of estrogen target-genes, which lead to
without binding to the AP-1 response element . It
the concept of the estrogen response unit (ERU) . An
thereby confers estrogen responsiveness to genes encoding
ERU comprises imperfect palindromic elements or even
human ovalbumin, c-fos, collagenase, and insulin-like
half elements, sometimes separated by hundreds of base
growth factor . Interestingly, estrogenic activity at AP-1
pairs. Estrogenic inducibility of gene transcription is then
sites depends on both the ER subtype and the ligand, and can
accomplished by transcriptional synergism of these separ-
either yield induction or inhibition of transcription
Similarily to AP-1, the binding of ERa and ERb to the
reported for ER binding to natural ERUs, such as the
nuclear transcription factor Sp-1 and the transcriptional
Xenopus laevis vitellogenin B1 ERU , and also to
effect of this interaction is cell type-, ligand- and promoter-
synthetic ERUs The exact mechanism of transcrip-
dependent. The ER – Sp-1 complex binds to a consensual
tional synergism remains to be elucidated, but might
GC-rich promoter sequence of a gene in which only the
include cooperative recruitment of co-activators, direct
Sp-1 protein attaches to DNA . Physical interaction
interaction between ER dimers, and allosteric modu-
between ERs and AP-1 or Sp-1 proteins is mediated by the
lations between the DNA – ER complexes. Sometimes,
ER domains that harbour the transactivation function
EREs overlap with other hormone response-elements,
(AF) 1 and 2. Binding of Sp-1 to its recognition site confers
creating elements that mediate multihormonal sensitivity
estrogen responsiveness to the human creatine kinase B,
Additionally, ERa was shown to bind to direct repeats
c-myc, retinoic acid receptor a, heat shock protein 27,
of ERE half-sites and activate transcription, presumably
with highest affinity when the direct repeats are separated
Another pathway of estrogen action involves the
ER-related receptors (ERR), nuclear orphan receptors
Because rules for sequence requirements of ERUs
with significant homology to ERs, which do not bind
await further clarification, putative estrogen responsive
estrogen and have unknown physiological ligands. ERRs
sequences must be verified experimentally to determine
are known to bind to the steroidogenic factor 1 response
their biological importance . Multiple systems have been
element (SFRE), an ERE half-site preceeded by a
used to demonstrate the functionality of EREs or ERUs.
thymine – cytosine – adenine trinucleotide but they
Band-shift assays and electrophoretic gel mobility-shift
also bind to classic EREs, in which they exert a con-
assays test the binding of the ER protein to a putative ERE
stitutive transcriptional activity. In turn, ERa but not the
sequence in vitro and the specificity of the reaction can be
ERb homodimers can activate transcription through
enhanced by ER-reactive antibodies. However, these assays
binding to SFREs. This alternative mode of action has
do not demonstrate whether a putative ERE is biologically
been demonstrated for the murine osteopontin gene
functional or not. Functionality can be verified in transient
Similar cross-talk between ERs and ERRs has been
transfection experiments by fusing the putative ERE
observed in the transcriptional regulation of the human
sequence with a reporter gene (chloramphenicol acetyl-
breast cancer marker gene pS2, the promoter of which is
transferase assay, luciferase assay) and measuring the
not only activated by ERs but also by ERRs, particularly
resulting enzyme activity. Subsequent deletion or mutagen-
ERRa. Consistent with the well-characterized ERE, a
esis of the tested sequence in the transient transfection assay
functional SFRE is present in the pS2 promoter at position
further increases the specificity of the result.
2 269 to 2 260. Both the ERE and the SFRE are required
However, multiple genes known to be influenced by the
for full response to ER and ERR pathways
action of the ER and its ligand lack classic EREs or ERUs.
Here, we summarize examples of natural EREs and
Here, we summarize alternative pathways of ER action.
ERUs in human DNA. It has become evident in recentyears that substantial cross-talk between the classic ERE-
mediated pathway and alternative pathways can occur.
Some genes are regulated by an estrogenic pathwayreferred to as tethering, in which the ER does not neces-
EREs differing by one to three nucleotides from the
sarily bind to DNA but interacts with another DNA-bound
transcription factor. Well-characterized examples of these
Examples of EREs differing by one to three nucleotides
include the transcription factors activating protein (AP)-1
from the consensus sequence are described below and
and specificity protein 1 (Sp-1). No direct receptor binding,
listed in . As indicated above, base mutations from
but E2-dependent loading of the upstream stimulatory
the consensus sequence decrease the binding affinity
factors (USF)-1 and -2 to the promoter is required for
activation of the gene encoding cathepsin D, which is also
(i) Oxytocin: An early characterized ERE differing in one
nucleotide is the human oxytocin ERE. Optimal function of
The AP-1 transcription factor is the heterodimer from
this sequence is independent of other regulatory elements in
the Jun/Fos gene products that binds to the phorbol diester
the promoter in transient transfection experiments
(TPA) response element as well as to the AP-1 binding site
(ii) pS2: Another example of this category is the gene
of DNA. Activated ERs directly interact with the nuclear co-
encoding human pS2, in which expression is controlled by
activators CREB-binding protein (CBP) and gluco-
estrogens in human breast cancer cells via mediation of an
corticoid receptor interacting protein (GRIP) recruited
imperfect ERE (2405 to 2394) In transfected HeLa
by Jun/Fos, which completes the co-activator complex to
cells a 4,5-fold increase in the estrogen induction of a
Table 1. EREs differing from consensus ERE in 1, 2 or 3 nucleotides in humans
ERE consensus sequence: 50- G G T C A nnn T G A C C - 30Peptide/protein
No. of nucleotides differing from the consensus
reporter gene was observed with the pS2–ERE .
was observed in cells co-transfected with ERb. Site-
Additionally, a cooperative SFRE is required in the promoter
directed mutagenesis of this sequence abolished induc-
region for full response to ER and ERR pathways .
tion of gene expression by estradiol.
sequence at positions 2 24 to 2 11 between the TATA box
Half-palindromic elements that mediate estrogen
and transcriptional initiation site of the gene encoding
human angiotensinogen contains a cytosine/adenine poly-
Although half-EREs only confer weak estrogen respon-
morphism at 2 20. When adenine is present at 2 20, the
siveness, genes are known for which transcription is
sequence binds to the estrogen receptor and increases
induced by two or more ERE half-sites. Examples are
(iv) Cathepsin D: Estrogens induce the expression of
(i) Corticotropin-releasing hormone (CRH): Four half
the gene encoding cathepsin D, a lysosomal proteinase
EREs sites occur in the promoter of human CRH gene
produced in excess in human breast cancer cell-lines .
that respond to estrogen administration. In co-transfected
Within the proximal promoter sequence, three EREs have
been found, among which one is functional (2 270 to 2 249)
analysis, these five half-elements induced estrogen
. This sequence requires cooperation with other regu-
responsiveness by , 10% – 20% of the strength of the
latory elements, a homologous sequence upstream, general
regulatory sites downstream (e.g. Sp1) and a TATA box .
(ii) Platelet-activating factor receptor (PAFR): The gene
(v) Glial fibrillary acidic protein (GFAP): The induction
encoding the human PAFR has two different promoters,
of transcription of the GFAP is consistent with the
which yield two transcripts of the receptor DNA in a
presence of a functionally imperfect ERE (2 149 to
tissue-specific manner In PAFR transcript 2, an ERU
2 137) in the upstream region of the rat gene promoter
occurs in the gene promoter, comprising two half ERE
The identical sequence is present in the human GFAP
sites separated by 153 bp (2 257 to 2 93) In a
promoter region (at 2 150) and verified by site-directed
chloramphenicol acetyltransferase assay of transfected
JR-St cells, estrogen induced transcriptional activity 2.5-
(vi) Complement C3: The human complement C3 ERE
is located at position 2 226 to 2 214. Another sequence in
(iii) Prothymosin a: Prothymosin a gene expression is
that promoter (þ 33 to þ 45) also exhibits similarity to the
consensus ERE, but has been characterized as nonfunc-
contains two half-palindromic EREs at position 2 750
tional In transfected HeLa cells a fourfold activation
(vii) Vascular endothelial growth factor (VEGF): A
Combinations with half-palindromic elements mediating
variant ERE (2 1560 to 2 1548), differing by three
nucleotides from the consensus sequence, is located
ERE half-sites can act in synergy with other regulatory
1.5 kb upstream from the transcriptional start site of the
elements within the promoter region of a gene. Examples
gene encoding human VEGF In cells co-trans-
fected with ERa, estradiol induced 3.2-fold induction in
(i) Lactoferrin: In the lactoferrin gene promoter, a
VEGF-promoter luciferase activity. A 2.3-fold increase
composite hormone-response element can be found that
Table 2. Half-palindromic elements and combinations that mediate estrogen inducibility
ERE consensus sequence: 50- G G T C A nnn T G A C C - 30Peptide/protein
(a) Half-palindromic elementsCorticotropin releasing hormone
Platelet activating receptor transcript 2
(b) Combinations with half-palindromic elementsLactoferrin
Table 3. Other variations involving ERE-like sequences
ERE consensus sequence: 50- G G T C A nnn T G A C C - 30Protein/peptide
CGGCA gcg TGACC overlapping with two sequences
homologous to the core sequence of AP-1 transcriptionbinding sites
comprises a retinoic acid response element that overlaps
estrogen regulation occur other than those currently known?
with an ERE (2 349 to 2 337). The two AGGTCA motifs
Second, more insight into the nuclear environments and the
can be activated by the retinoic acid X receptor and one
mechanisms leading to estrogen-induced gene stimulation
AGGTCA half also responds to estrogen application
or restriction is needed. From these points, a better under-
(ii) Heat shock protein (HSP) 27: In the promoter of the
standing of the tissue-selective effects of estrogenic com-
gene encoding HSP 27, an ERE half-element (2 88) is
pounds can be achieved and the knowledge more easily
present, which acts synergistically with a GGGCGGG Sp1
transferred to clinical settings. Because estrogens have
direct access to the human genome, administration of thissteroid in humans should therefore occur with care. Under-
Other variations involving ERE- like sequences
standing the molecular actions of estrogens and the variety
Often ERE-related sequences display synergistic action
of genes affected might help us to understand the potential
with or overlap with other regulatory elements within the
risks and benefits of hormone replacement therapy and of
promoter region of a gene. Examples are described below
(i) c-fos: Functional EREs have been identified in the
c-fos 50-flanking DNA, comprising one imperfect palin-
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