Catechol estrogen

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Structure of 2-hydroxyestradiol, a catechol estrogen. 2-Hydroxyestradiol.svg
Structure of 2-hydroxyestradiol, a catechol estrogen.

A catechol estrogen is a steroidal estrogen that contains catechol (1,2-dihydroxybenzene) within its structure. [1] The catechol estrogens are endogenous metabolites of estradiol and estrone and include the following compounds: [1] [2]

The most abundant catechol estrogen in serum and urine is 2-hydroxyestrone, with 2-hydroxyestradiol and 2-hydroxyestriol also being formed, while the principal 4-hydroxy catechol estrogen, 4-hydroxyestrone, is present in only small amounts in urine. [1] 4-Hydroxyestriol has been detected in the urine of pregnant women. [3] The catechol estrogens are formed from estradiol and estrone by cytochrome P450 enzymes predominantly in the liver but also in extrahepatic tissues, and are metabolized by catechol O-methyltransferase (COMT) into methoxylated estrogens such as 2-methoxyestradiol and 4-methoxyestrone as well as by conjugation via other phase II enzymes. [1] [2] Under poor conditions of inactivation by phase II enzymes, catechol estrogens can undergo oxidation to reactive quinones and semiquinones, and this has been hypothesized to contribute to estrogen-induced carcinogenesis. [2]

Similarly to estradiol and estrone, catechol estrogens possess estrogenic activity. [1] 2-Hydroxylated catechol estrogens are weak and possibly antiestrogenic estrogens, whereas their 4-hydroxylated counterparts are more potent in their estrogenic activity. [1] For instance, 2-hydroxyestrone reportedly shows negligible uterotrophic effect in animals, whereas 4-hydroxy catechol estrogens show moderate changes in stimulating uterine weight. [1] In addition to being substrates for COMT similarly to catecholamines like dopamine, norepinephrine, and epinephrine, catechol estrogens are potent competitive inhibitors of COMT as well as of tyrosine hydroxylase, and may affect both catecholamine biosynthesis and metabolism. [1] [2]

Affinities of estrogen receptor ligands for the ERα and ERβ
Ligand Other names Relative binding affinities (RBA, %)a Absolute binding affinities (Ki, nM)aAction
ERα ERβ ERα ERβ
Estradiol E2; 17β-Estradiol1001000.115 (0.04–0.24)0.15 (0.10–2.08)Estrogen
Estrone E1; 17-Ketoestradiol16.39 (0.7–60)6.5 (1.36–52)0.445 (0.3–1.01)1.75 (0.35–9.24)Estrogen
Estriol E3; 16α-OH-17β-E212.65 (4.03–56)26 (14.0–44.6)0.45 (0.35–1.4)0.7 (0.63–0.7)Estrogen
Estetrol E4; 15α,16α-Di-OH-17β-E24.03.04.919Estrogen
Alfatradiol 17α-Estradiol20.5 (7–80.1)8.195 (2–42)0.2–0.520.43–1.2Metabolite
16-Epiestriol 16β-Hydroxy-17β-estradiol7.795 (4.94–63)50??Metabolite
17-Epiestriol 16α-Hydroxy-17α-estradiol55.45 (29–103)79–80??Metabolite
16,17-Epiestriol 16β-Hydroxy-17α-estradiol1.013??Metabolite
2-Hydroxyestradiol 2-OH-E222 (7–81)11–352.51.3Metabolite
2-Methoxyestradiol 2-MeO-E20.0027–2.01.0??Metabolite
4-Hydroxyestradiol 4-OH-E213 (8–70)7–561.01.9Metabolite
4-Methoxyestradiol 4-MeO-E22.01.0??Metabolite
2-Hydroxyestrone 2-OH-E12.0–4.00.2–0.4??Metabolite
2-Methoxyestrone 2-MeO-E1<0.001–<1<1??Metabolite
4-Hydroxyestrone 4-OH-E11.0–2.01.0??Metabolite
4-Methoxyestrone 4-MeO-E1<1<1??Metabolite
16α-Hydroxyestrone 16α-OH-E1; 17-Ketoestriol2.0–6.535??Metabolite
2-Hydroxyestriol 2-OH-E32.01.0??Metabolite
4-Methoxyestriol 4-MeO-E31.01.0??Metabolite
Estradiol sulfate E2S; Estradiol 3-sulfate<1<1??Metabolite
Estradiol disulfate Estradiol 3,17β-disulfate0.0004???Metabolite
Estradiol 3-glucuronide E2-3G0.0079???Metabolite
Estradiol 17β-glucuronide E2-17G0.0015???Metabolite
Estradiol 3-gluc. 17β-sulfate E2-3G-17S0.0001???Metabolite
Estrone sulfate E1S; Estrone 3-sulfate<1<1>10>10Metabolite
Estradiol benzoate EB; Estradiol 3-benzoate10???Estrogen
Estradiol 17β-benzoate E2-17B11.332.6??Estrogen
Estrone methyl ether Estrone 3-methyl ether0.145???Estrogen
ent-Estradiol 1-Estradiol1.31–12.349.44–80.07??Estrogen
Equilin 7-Dehydroestrone13 (4.0–28.9)13.0–490.790.36Estrogen
Equilenin 6,8-Didehydroestrone2.0–157.0–200.640.62Estrogen
17β-Dihydroequilin 7-Dehydro-17β-estradiol7.9–1137.9–1080.090.17Estrogen
17α-Dihydroequilin 7-Dehydro-17α-estradiol18.6 (18–41)14–320.240.57Estrogen
17β-Dihydroequilenin 6,8-Didehydro-17β-estradiol35–6890–1000.150.20Estrogen
17α-Dihydroequilenin 6,8-Didehydro-17α-estradiol20490.500.37Estrogen
Δ8-Estradiol 8,9-Dehydro-17β-estradiol68720.150.25Estrogen
Δ8-Estrone 8,9-Dehydroestrone19320.520.57Estrogen
Ethinylestradiol EE; 17α-Ethynyl-17β-E2120.9 (68.8–480)44.4 (2.0–144)0.02–0.050.29–0.81Estrogen
Mestranol EE 3-methyl ether?2.5??Estrogen
Moxestrol RU-2858; 11β-Methoxy-EE35–435–200.52.6Estrogen
Methylestradiol 17α-Methyl-17β-estradiol7044??Estrogen
Diethylstilbestrol DES; Stilbestrol129.5 (89.1–468)219.63 (61.2–295)0.040.05Estrogen
Hexestrol Dihydrodiethylstilbestrol153.6 (31–302)60–2340.060.06Estrogen
Dienestrol Dehydrostilbestrol37 (20.4–223)56–4040.050.03Estrogen
Benzestrol (B2) 114???Estrogen
Chlorotrianisene TACE1.74?15.30?Estrogen
Triphenylethylene TPE0.074???Estrogen
Triphenylbromoethylene TPBE2.69???Estrogen
Tamoxifen ICI-46,4743 (0.1–47)3.33 (0.28–6)3.4–9.692.5SERM
Afimoxifene 4-Hydroxytamoxifen; 4-OHT100.1 (1.7–257)10 (0.98–339)2.3 (0.1–3.61)0.04–4.8SERM
Toremifene 4-Chlorotamoxifen; 4-CT??7.14–20.315.4SERM
Clomifene MRL-4125 (19.2–37.2)120.91.2SERM
Cyclofenil F-6066; Sexovid151–152243??SERM
Nafoxidine U-11,000A30.9–44160.30.8SERM
Raloxifene 41.2 (7.8–69)5.34 (0.54–16)0.188–0.5220.2SERM
Arzoxifene LY-353,381??0.179?SERM
Lasofoxifene CP-336,15610.2–16619.00.229?SERM
Ormeloxifene Centchroman??0.313?SERM
Levormeloxifene 6720-CDRI; NNC-460,0201.551.88??SERM
Ospemifene Deaminohydroxytoremifene2.631.22??SERM
Bazedoxifene ??0.053?SERM
Etacstil GW-56384.3011.5??SERM
ICI-164,384 63.5 (3.70–97.7)1660.20.08Antiestrogen
Fulvestrant ICI-182,78043.5 (9.4–325)21.65 (2.05–40.5)0.421.3Antiestrogen
Propylpyrazoletriol PPT49 (10.0–89.1)0.120.4092.8ERα agonist
16α-LE2 16α-Lactone-17β-estradiol14.6–570.0890.27131ERα agonist
16α-Iodo-E2 16α-Iodo-17β-estradiol30.22.30??ERα agonist
Methylpiperidinopyrazole MPP110.05??ERα antagonist
Diarylpropionitrile DPN0.12–0.256.6–1832.41.7ERβ agonist
8β-VE2 8β-Vinyl-17β-estradiol0.3522.0–8312.90.50ERβ agonist
Prinaberel ERB-041; WAY-202,0410.2767–72??ERβ agonist
ERB-196 WAY-202,196?180??ERβ agonist
Erteberel SERBA-1; LY-500,307??2.680.19ERβ agonist
SERBA-2 ??14.51.54ERβ agonist
Coumestrol 9.225 (0.0117–94)64.125 (0.41–185)0.14–80.00.07–27.0Xenoestrogen
Genistein 0.445 (0.0012–16)33.42 (0.86–87)2.6–1260.3–12.8Xenoestrogen
Equol 0.2–0.2870.85 (0.10–2.85)??Xenoestrogen
Daidzein 0.07 (0.0018–9.3)0.7865 (0.04–17.1)2.085.3Xenoestrogen
Biochanin A 0.04 (0.022–0.15)0.6225 (0.010–1.2)1748.9Xenoestrogen
Kaempferol 0.07 (0.029–0.10)2.2 (0.002–3.00)??Xenoestrogen
Naringenin 0.0054 (<0.001–0.01)0.15 (0.11–0.33)??Xenoestrogen
8-Prenylnaringenin 8-PN4.4???Xenoestrogen
Quercetin <0.001–0.010.002–0.040??Xenoestrogen
Ipriflavone <0.01<0.01??Xenoestrogen
Miroestrol 0.39???Xenoestrogen
Deoxymiroestrol 2.0???Xenoestrogen
β-Sitosterol <0.001–0.0875<0.001–0.016??Xenoestrogen
Resveratrol <0.001–0.0032???Xenoestrogen
α-Zearalenol 48 (13–52.5)???Xenoestrogen
β-Zearalenol 0.6 (0.032–13)???Xenoestrogen
Zeranol α-Zearalanol48–111???Xenoestrogen
Taleranol β-Zearalanol16 (13–17.8)140.80.9Xenoestrogen
Zearalenone ZEN7.68 (2.04–28)9.45 (2.43–31.5)??Xenoestrogen
Zearalanone ZAN0.51???Xenoestrogen
Bisphenol A BPA0.0315 (0.008–1.0)0.135 (0.002–4.23)19535Xenoestrogen
Endosulfan EDS<0.001–<0.01<0.01??Xenoestrogen
Kepone Chlordecone0.0069–0.2???Xenoestrogen
o,p'-DDT 0.0073–0.4???Xenoestrogen
p,p'-DDT 0.03???Xenoestrogen
Methoxychlor p,p'-Dimethoxy-DDT0.01 (<0.001–0.02)0.01–0.13??Xenoestrogen
HPTE Hydroxychlor; p,p'-OH-DDT1.2–1.7???Xenoestrogen
Testosterone T; 4-Androstenolone<0.0001–<0.01<0.002–0.040>5000>5000Androgen
Dihydrotestosterone DHT; 5α-Androstanolone0.01 (<0.001–0.05)0.0059–0.17221–>500073–1688Androgen
Nandrolone 19-Nortestosterone; 19-NT0.010.2376553Androgen
Dehydroepiandrosterone DHEA; Prasterone0.038 (<0.001–0.04)0.019–0.07245–1053163–515Androgen
5-Androstenediol A5; Androstenediol6173.60.9Androgen
4-Androstenediol 0.50.62319Androgen
4-Androstenedione A4; Androstenedione<0.01<0.01>10000>10000Androgen
3α-Androstanediol 3α-Adiol0.070.326048Androgen
3β-Androstanediol 3β-Adiol3762Androgen
Androstanedione 5α-Androstanedione<0.01<0.01>10000>10000Androgen
Etiocholanedione 5β-Androstanedione<0.01<0.01>10000>10000Androgen
Methyltestosterone 17α-Methyltestosterone<0.0001???Androgen
Ethinyl-3α-androstanediol 17α-Ethynyl-3α-adiol4.0<0.07??Estrogen
Ethinyl-3β-androstanediol 17α-Ethynyl-3β-adiol505.6??Estrogen
Progesterone P4; 4-Pregnenedione<0.001–0.6<0.001–0.010??Progestogen
Norethisterone NET; 17α-Ethynyl-19-NT0.085 (0.0015–<0.1)0.1 (0.01–0.3)1521084Progestogen
Norethynodrel 5(10)-Norethisterone0.5 (0.3–0.7)<0.1–0.221453Progestogen
Tibolone 7α-Methylnorethynodrel0.5 (0.45–2.0)0.2–0.076??Progestogen
Δ4-Tibolone 7α-Methylnorethisterone0.069–<0.10.027–<0.1??Progestogen
3α-Hydroxytibolone 2.5 (1.06–5.0)0.6–0.8??Progestogen
3β-Hydroxytibolone 1.6 (0.75–1.9)0.070–0.1??Progestogen
Footnotes:a = (1) Binding affinity values are of the format "median (range)" (# (#–#)), "range" (#–#), or "value" (#) depending on the values available. The full sets of values within the ranges can be found in the Wiki code. (2) Binding affinities were determined via displacement studies in a variety of in-vitro systems with labeled estradiol and human ERα and ERβ proteins (except the ERβ values from Kuiper et al. (1997), which are rat ERβ). Sources: See template page.
Selected biological properties of endogenous estrogens in rats
Estrogen ER RBA (%) Uterine weight (%) Uterotrophy LH levels (%) SHBG RBA (%)
Control100100
Estradiol 100506 ± 20+++12–19100
Estrone 11 ± 8490 ± 22+++?20
Estriol 10 ± 4468 ± 30+++8–183
Estetrol 0.5 ± 0.2?Inactive?1
17α-Estradiol 4.2 ± 0.8????
2-Hydroxyestradiol 24 ± 7285 ± 8+b31–6128
2-Methoxyestradiol 0.05 ± 0.04101Inactive?130
4-Hydroxyestradiol 45 ± 12????
4-Methoxyestradiol 1.3 ± 0.2260++?9
4-Fluoroestradiol a180 ± 43?+++??
2-Hydroxyestrone 1.9 ± 0.8130 ± 9Inactive110–1428
2-Methoxyestrone 0.01 ± 0.00103 ± 7Inactive95–100120
4-Hydroxyestrone 11 ± 4351++21–5035
4-Methoxyestrone 0.13 ± 0.04338++65–9212
16α-Hydroxyestrone 2.8 ± 1.0552 ± 42+++7–24<0.5
2-Hydroxyestriol 0.9 ± 0.3302+b??
2-Methoxyestriol 0.01 ± 0.00?Inactive?4
Notes: Values are mean ± SD or range. ERRBA = Relative binding affinity to estrogen receptors of rat uterine cytosol. Uterine weight = Percentage change in uterine wet weight of ovariectomized rats after 72 hours with continuous administration of 1 μg/hour via subcutaneously implanted osmotic pumps. LH levels = Luteinizing hormone levels relative to baseline of ovariectomized rats after 24 to 72 hours of continuous administration via subcutaneous implant. Footnotes:a = Synthetic (i.e., not endogenous). b = Atypical uterotrophic effect which plateaus within 48 hours (estradiol's uterotrophy continues linearly up to 72 hours). Sources: See template.

See also

Related Research Articles

Estrogen Primary female sex hormone

Estrogen, or oestrogen, is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal activity: estrone (E1), estradiol (E2), and estriol (E3). Estradiol, an estrane, is the most potent and prevalent. Another estrogen called estetrol (E4) is produced only during pregnancy.

Estradiol

Estradiol (E2), also spelled oestradiol, is an estrogen steroid hormone and the major female sex hormone. It is involved in the regulation of the estrous and menstrual female reproductive cycles. Estradiol is responsible for the development of female secondary sexual characteristics such as the breasts, widening of the hips, and a female-associated pattern of fat distribution and is important in the development and maintenance of female reproductive tissues such as the mammary glands, uterus, and vagina during puberty, adulthood, and pregnancy. It also has important effects in many other tissues including bone, fat, skin, liver, and the brain. Though estradiol levels in males are much lower than in females, estradiol has important roles in males as well. Apart from humans and other mammals, estradiol is also found in most vertebrates and crustaceans, insects, fish, and other animal species.

Estrone

Estrone (E1), also spelled oestrone, is a steroid, a weak estrogen, and a minor female sex hormone. It is one of three major endogenous estrogens, the others being estradiol and estriol. Estrone, as well as the other estrogens, are synthesized from cholesterol and secreted mainly from the gonads, though they can also be formed from adrenal androgens in adipose tissue. Relative to estradiol, both estrone and estriol have far weaker activity as estrogens. Estrone can be converted into estradiol, and serves mainly as a precursor or metabolic intermediate of estradiol. It is both a precursor and metabolite of estradiol.

Estriol

Estriol (E3), also spelled oestriol, is a steroid, a weak estrogen, and a minor female sex hormone. It is one of three major endogenous estrogens, the others being estradiol and estrone. Levels of estriol in women who are not pregnant are almost undetectable. However, during pregnancy, estriol is synthesized in very high quantities by the placenta and is the most produced estrogen in the body by far, although circulating levels of estriol are similar to those of other estrogens due to a relatively high rate of metabolism and excretion. Relative to estradiol, both estriol and estrone have far weaker activity as estrogens.

Sex hormone

Sex hormones, also known as sex steroids, gonadocorticoids and gonadal steroids, are steroid hormones that interact with vertebrate steroid hormone receptors. The sex hormones include the androgens, estrogens, and progestogens. Their effects are mediated by slow genomic mechanisms through nuclear receptors as well as by fast nongenomic mechanisms through membrane-associated receptors and signaling cascades. The polypeptide hormones luteinizing hormone, follicle-stimulating hormone and gonadotropin-releasing hormone are usually not regarded as sex hormones, although they play major sex-related roles.

In enzymology, an estradiol 17alpha-dehydrogenase (EC 1.1.1.148) is an enzyme that catalyzes the chemical reaction

2-Hydroxyestradiol

2-Hydroxyestradiol (2-OHE2), also known as estra-1,3,5(10)-triene-2,3,17β-triol, is an endogenous steroid, catechol estrogen, and metabolite of estradiol, as well as a positional isomer of estriol.

16α-Hydroxyestrone

16α-Hydroxyestrone (16α-OH-E1), or hydroxyestrone, also known as estra-1,3,5(10)-triene-3,16α-diol-17-one, is an endogenous steroidal estrogen and a major metabolite of estrone, as well as an intermediate in the biosynthesis of estriol. It is a potent estrogen similarly to estrone, and it has been suggested that the ratio of 16α-hydroxyestrone to 2-hydroxyestrone, the latter being much less estrogenic in comparison and even antiestrogenic in the presence of more potent estrogens like estradiol, may be involved in the pathophysiology of breast cancer. Conversely, 16α-hydroxyestrone may help to protect against osteoporosis.

2-Hydroxyestrone

2-Hydroxyestrone (2-OHE1), also known as estra-1,3,5(10)-trien-2,3-diol-17-one, is an endogenous, naturally occurring catechol estrogen and a major metabolite of estrone and estradiol. It is formed irreversibly from estrone in the liver and to a lesser extent in other tissues via 2-hydroxylation mediated by cytochrome P450 enzymes, mainly the CYP3A and CYP1A subfamilies. 2-OHE1 is the most abundant catechol estrogen in the body.

4-Hydroxyestradiol

4-Hydroxyestradiol (4-OHE2), also known as estra-1,3,5(10)-triene-3,4,17β-triol, is an endogenous, naturally occurring catechol estrogen and a minor metabolite of estradiol. It is estrogenic, similarly to many other hydroxylated estrogen metabolites such as 2-hydroxyestradiol, 16α-hydroxyestrone, estriol (16α-hydroxyestradiol), and 4-hydroxyestrone but unlike 2-hydroxyestrone.

4-Hydroxyestrone

4-Hydroxyestrone (4-OHE1), also known as estra-1,3,5(10)-triene-3,4-diol-17-one, is an endogenous, naturally occurring catechol estrogen and a minor metabolite of estrone and estradiol. It is estrogenic, similarly to many other hydroxylated estrogen metabolites such as 2-hydroxyestradiol, 16α-hydroxyestrone, estriol (16α-hydroxyestradiol), and 4-hydroxyestradiol but unlike 2-hydroxyestrone.

4-Hydroxyestriol

4-Hydroxyestriol, also known as estra-1,3,5(10)-triene-3,4,16α,17β-tetrol, is an endogenous catechol estrogen and metabolite of estriol. It has been found in pregnancy urine.

4-Methoxyestradiol

4-Methoxyestradiol (4-ME2) is an endogenous, naturally occurring methoxylated catechol estrogen and metabolite of estradiol that is formed by catechol O-methyltransferase via the intermediate 4-hydroxyestradiol. It has estrogenic activity similarly to estrone and 4-hydroxyestrone.

4-Methoxyestrone

4-Methoxyestrone (4-ME1) is an endogenous, naturally occurring methoxylated catechol estrogen and metabolite of estrone that is formed by catechol O-methyltransferase via the intermediate 4-hydroxyestrone. It has estrogenic activity similarly to estrone and 4-hydroxyestrone.

Hydroxylation of estradiol

The hydroxylation of estradiol is one of the major routes of metabolism of the estrogen steroid hormone estradiol. It is hydroxylated into the catechol estrogens 2-hydroxyestradiol and 4-hydroxyestradiol and into estriol (16α-hydroxyestradiol), reactions which are catalyzed by cytochrome P450 enzymes predominantly in the liver, but also in various other tissues.

Estrone (medication)

Estrone (E1), sold under the brand names Estragyn, Kestrin, and Theelin among many others, is an estrogen medication and naturally occurring steroid hormone which has been used in menopausal hormone therapy and for other indications. It has been provided as an aqueous suspension or oil solution given by injection into muscle and as a vaginal cream applied inside of the vagina. It can also be taken by mouth as estradiol/estrone/estriol and in the form of prodrugs like estropipate and conjugated estrogens.

Estradiol 3-glucuronide

Estradiol 3-glucuronide (E2-3G), also known as 17β-estradiol 3-(β-D-glucuronide), is a naturally occurring and endogenous estrogen conjugate. It is specifically the C3 glucuronide conjugate of estradiol, the major estrogen in the body. It is formed from estradiol in the liver by UDP-glucuronosyltransferase via attachment of glucuronic acid and is eventually excreted in urine and bile. Similarly to estrogen sulfates like estrone sulfate, estrogen glucuronides have much higher water solubility than do unconjugated estrogens like estradiol.

16β-Hydroxyestrone (16β-OH-E1) is an endogenous estrogen which serves as a metabolite of estrone as well as a metabolic intermediate in the transformation of estrone into epiestriol (16β-hydroxyestradiol). 16β-Hydroxyestrone has similar estrogenic activity to that of 16α-hydroxyestrone. It is less potent than estradiol or estrone but can produce similar maximal uterotrophy at sufficiently high doses, suggesting a fully estrogenic profile.

16-Ketoestrone (16-keto-E1), or 16-oxoestrone (16-oxo-E1), is an endogenous estrogen related to 16α-hydroxyestrone and 16β-hydroxyestrone. In contrast to 16α-hydroxyestrone and 16β-hydroxyestrone, but similarly to 16-ketoestradiol, 16-ketoestrone is a very weak estrogen with less than 1/1000th the estrogenic potency of estrone in the uterus. 16-Ketoestrone has been reported to act as an inhibitor of 17β-hydroxysteroid dehydrogenases. 16-Ketoestrone can be converted by 16α-hydroxysteroid dehydrogenase into estriol in the body.

15α-Hydroxyestradiol (15α-OH-E2) is an endogenous estrogen which occurs during pregnancy. It is structurally related to estriol (16α-hydroxyestradiol) and estetrol.

References

  1. 1 2 3 4 5 6 7 8 H.J. Buchsbaum (6 December 2012). The Menopause. Springer Science & Business Media. pp. 65–. ISBN   978-1-4612-5525-3.
  2. 1 2 3 4 Shufeng Zhou (6 April 2016). Cytochrome P450 2D6: Structure, Function, Regulation and Polymorphism. CRC Press. pp. 241–242. ISBN   978-1-4665-9788-4.
  3. Fotsis T, Järvenpää P, Adlercreutz H (1980). "Identification of 4-hydroxyestriol in pregnancy urine". J. Clin. Endocrinol. Metab. 51 (1): 148–51. doi:10.1210/jcem-51-1-148. PMID   6892918.