The Endocrine and Reproductive System: Adverse Effects of Hormonally Active Substances?

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The Endocrine and Reproductive System: Adverse Effects of Hormonally Active Substances? The Endocrine and Reproductive System: Adverse Effects of Hormonally Active Substances? Helmut A. Greim, MD ABSTRACT. Chemicals that have the intrinsic property Our Fertility, Intelligence, and Survival? A Scientific to modulate or even disrupt the endocrine system are Detective Story. present in the human environment. Because it is the Originally, Carlsen et al2 evaluated a total of 61 potency of such chemicals that determines the toxicologic studies on sperm count and established that there relevance, assessment of the risk to human health must was a decrease from 113 million to 66 million consider both the endocrine disrupting potential and the potency. Usually in vitro assays are applied to detect the sperm/ml of semen between 1938 and 1990. On this 3 potential of a hormone-like effect, and such data are basis, Sharpe and Skakkebaek presented the hy- considered useful to set priorities for additional testing pothesis that the dysfunctions and diseases of the and for mechanistic studies. However, such data allow male sex organs (as testicular cancer, malformations only determination of relative potency of a chemical as of the urethra, or cryptorchidism), which have been compared with other xenobiotics, natural compounds, or described with increasing frequency in the course of endogenous hormones. Relevant information on the en- the past 3 to 5 decades, could be associated with docrine-disrupting potency can be taken only from in chemicals that mimic the action of estrogen. In par- vivo assays, eg, the Hershberger (male reproductive or- gans) and uterotrophic (female reproductive organs) as- ticular, medications that mimic the action of estro- says, the updated versions of the 28- and 90-day toxicity gen, phytoestrogens, estrogens in cow milk, and cer- studies in rodents, and the 2-generation studies in ro- tain industrial chemicals have been considered. This dents. With the use of this information and the concen- assumption is supported by observations in wild tration of these chemicals in humans, the potency of the animals. Dichlorodiphenyltrichloroethane (DDT), for effect as compared with endogenous hormone activity example, accumulated in the bodies of birds of prey, can be estimated. So far, the relative potencies of chem- which are at the end of the food chain, and led to icals tested in in vitro systems as compared with estradiol reproductive disorders. Colborn et al4 described are several orders of magnitude smaller, whereas potency of the phytoestrogen, eg, isoflavones such as genistein or smaller penises in alligators and unfertilized eggs daidzein, can even exceed that of estradiol, especially in that had been laid as the result of an industrial infants who are fed soy-based formula as a sole source of accident in Florida, in which large quantities of the nutrition. Although there are still open questions regard- insecticide dicofol were discharged into a lake. In ing in utero or early postnatal exposure, the low poten- other regions, more female than male offspring were cies and concentrations of manmade chemicals as com- counted in several species of fish and the gulls that pared with the endogenous hormones in humans make it ate these fish. These observations and hypotheses unlikely that adverse effects occur at common exposure. resulted in a multitude of studies to identify hormon- Pediatrics 2004;113:1070–1075; endocrine disrupters, xe- ally active chemicals and to explain their mechanism noestrogens, phytoestrogens, adverse effects, test systems. of action and their significance for humans and the environment. ABBREVIATIONS. DDT, dichlorodiphenyltrichloroethane; PCB, The different effects have been described and dis- polychlorinated biphenyl; OECD, Organisation for Economic Co- cussed by various authors and committees,5–14 as operation and Development. have the consequences for appropriate testing.15,16 A continuous flow of reports describe an association of eports of decreased sperm counts and in- chemical exposure of children to hormone-related creased incidences of testicular cancer in men disorders. These are birth defects, developmental Rand breast tumors in women have aroused disorders, declining proportion of male newborns, intense discussions in the general public and the neuromental deficits in families of pesticide work- scientific community. This became common knowl- ers,17,18 testicular dysgenesis syndrome as a result of edge in 1996 with the publication of the book by disruption of embryonal programming and gonadal Colborn et al,1 Our Stolen Future: Are We Threatening development during fetal life by adverse environ- mental influences,19 and insufficient androgen action From the Institute of Toxicology and Environmental Hygiene, Technical in the male fetus with subsequent undervirilization University of Munich, Munich, Germany. and hypospadias in the newborn as a result of intra- Received for publication Oct 7, 2003; accepted Oct 20, 2003. uterine exposure to environmental hormonal disrup- Reprint requests to (H.A.G.) Institute of Toxicology and Environmental tors.20 However, except for high-exposure scenarios ␤ Hygiene, Technical University of Munich, Hohenbachernstra e 15–17, such as Yusho disease after high exposure to poly- D-85354 Freising-Weihenstephan. E-mail: [email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2004 by the American Acad- chlorinated biphenyls (PCBs), dibenzodioxins, and emy of Pediatrics. dibenzofurans,21,22 none of these suggested associa- 1070 PEDIATRICS Vol.Downloaded 113 No. 4 from April www.aappublications.org/news 2004 by guest on September 30, 2021 tions demonstrated a sufficiently robust correlation Replacement of a physiologic ligand, eg, an estro- between exposure and effects, so, increasingly, other gen from the receptor by a competitor, eg, a xe- causes for the observed effects are discussed, such as noestrogen, depends on its relative affinity to the sociodemographic characteristics23 or combinations receptor and its concentration. For example, replace- of Ͼ1 problem.19 ment of the physiologic ligand from the receptor by It is impossible to review all information and add a compound of 1000-fold lower affinity requires a to the elaborate reports of the different review pan- 1000-fold higher concentration. Although this over- els. Therefore, possible mechanisms and criteria to simplifies competitive interaction of compounds at a evaluate the plausibility of a correlation between receptor, it demonstrates the need for information on adverse effects in children and exposure to endo- the relative binding affinities of the compounds in crine-disrupting chemicals are described. question and their concentration in the organism. The Scientific Committee on Toxicology, Ecotoxi- cology and the Environment of the European Com- SUBSTANCES THAT MIMIC THE ACTION OF mission has compared the potency of xenoestrogen HORMONES concentrations detected in human blood as a surro- In principle, an “endocrine disrupter” is defined as gate for concentrations at the receptor with the po- an exogenous substance or mixture that alters func- tency of estradiol concentrations in blood.7 It seemed tion(s) of the endocrine system and consequently that the relative potency of o,pЈ-DDT, 4-nonylphenol causes adverse health effects in an intact organism, or bisphenol A are approximately 1 million-fold or its progeny, or (sub)populations.7,24 In the case of lower than that of estradiol. Only the phytoestrogen xenoestrogens, it is the stimulation of mitotic activity genistein showed a potency that exceeded that of in the tissue of the female genital tract. Many chem- estradiol. From this it was concluded that an inter- icals that humans ingest with their diet have estro- action of the compounds at the receptor with phys- gen-like effects, which have been identified in a mul- iologic consequences is unlikely. titude of test systems.25 Among them are industrial In addition to the reproductive organs, the liver, chemicals such as certain herbicides, fungicides, or- kidney, adrenal gland, central nervous system, im- ganochlorine insecticides, nematocides, organophos- mune system, cardiovascular system, and bones are phates, pyrethroids, heavy metals, PCBs, and phtha- target tissues of the effect of steroid hormones. The lates. Colborn et al4 compiled 45 chemicals, including corresponding receptors have been identified in the PCBs, dibenzodioxins, dibenzofurans, and DDT, these tissues. Moreover, there are indications of a to which they attribute an influence on the reproduc- concentration-dependent stimulation (low concen- tive system in humans. Also included are the phy- trations) or inhibition (high concentrations) of tumor toestrogens, ie, naturally occurring plant substances. growth by steroid hormones.10,26,27 Interaction with endogenous hormones may occur via different mechanisms. Xenobiotics can influence TEST SYSTEMS FOR IDENTIFICATION OF hormone synthesis—the release, the transport, the ENDOCRINE-DISRUPTING CHEMICALS effect, the metabolism, and the excretion of hor- A great variety of test systems are being used with mones. Another group of natural and synthetic sub- different experimental modifications, which makes it stances interferes with the hormones at receptors. difficult to compare the results directly.15,25 In most Phytoestrogens such as coumestrol, daidzein, and cases, standardization is required. The in vitro tests genistein; medications such as diethylstilbestrol, are able to identify the intrinsic hormone-like poten- ethinyl estradiol, and tamoxifen; and industrial
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