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Relationship: 2585


The title of the KER should clearly define the two KEs being considered and the sequential relationship between them (i.e., which is upstream and which is downstream). Consequently all KER titles take the form “upstream KE leads to downstream KE”.  More help

Increased, circulating estrogen levels leads to Hyperplasia, ovarian epithelium

Upstream event
Upstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help
Downstream event
Downstream event in the Key Event Relationship. On the KER page, clicking on the Event name under Upstream Relationship will bring the user to that individual KE page. More help

Key Event Relationship Overview

The utility of AOPs for regulatory application is defined, to a large extent, by the confidence and precision with which they facilitate extrapolation of data measured at low levels of biological organisation to predicted outcomes at higher levels of organisation and the extent to which they can link biological effect measurements to their specific causes. Within the AOP framework, the predictive relationships that facilitate extrapolation are represented by the KERs. Consequently, the overall WoE for an AOP is a reflection in part, of the level of confidence in the underlying series of KERs it encompasses. Therefore, describing the KERs in an AOP involves assembling and organising the types of information and evidence that defines the scientific basis for inferring the probable change in, or state of, a downstream KE from the known or measured state of an upstream KE. More help

AOPs Referencing Relationship

This table is automatically generated upon addition of a KER to an AOP. All of the AOPs that are linked to this KER will automatically be listed in this subsection. Clicking on the name of the AOP in the table will bring you to the individual page for that AOP. More help
AOP Name Adjacency Weight of Evidence Quantitative Understanding Point of Contact Author Status OECD Status
Hypothalamic estrogen receptors inhibition leading to ovarian cancer non-adjacent High Not Specified Cataia Ives (send email) Under development: Not open for comment. Do not cite

Taxonomic Applicability

Select one or more structured terms that help to define the biological applicability domain of the KER. In general, this will be dictated by the more restrictive of the two KEs being linked together by the KER. Authors can indicate the relevant taxa for this KER in this subsection. The process is similar to what is described for KEs (see pages 30-31 and 37-38 of User Handbook) More help
Term Scientific Term Evidence Link
human Homo sapiens High NCBI
rat Rattus norvegicus High NCBI
mice Mus sp. High NCBI

Sex Applicability

Authors can indicate the relevant sex for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of the User Handbook). More help
Sex Evidence
Female High

Life Stage Applicability

Authors can indicate the relevant life stage for this KER in this subsection. The process is similar to what is described for KEs (see pages 31-32 of User Handbook). More help
Term Evidence
Adult, reproductively mature High

Key Event Relationship Description

Provide a brief, descriptive summation of the KER. While the title itself is fairly descriptive, this section can provide details that aren’t inherent in the description of the KEs themselves (see page 39 of the User Handbook). This description section can be viewed as providing the increased specificity in the nature of upstream perturbation (KEupstream) that leads to a particular downstream perturbation (KEdownstream), while allowing the KE descriptions to remain generalised so they can be linked to different AOPs. The description is also intended to provide a concise overview for readers who may want a brief summation, without needing to read through the detailed support for the relationship (covered below). Careful attention should be taken to avoid reference to other KEs that are not part of this KER, other KERs or other AOPs. This will ensure that the KER is modular and can be used by other AOPs. More help

Hyperplasia of the ovarian epithelial cells characterized by aggregates of tubular like structures or cleft lines. In the mammalian ovary tissue presence of germ cells surrounded by the somatic cells is known as follicles. During the oestrous cycle early stage follicles either go through atresia or ovaluation to produce mature egg for fertilization. With the age ovaries run out of follicles and female undergo menopause. Repetitive rupture and repair of the epithelium tissue of the ovarian cells causes genetic aberrations causing the abnormal growth of these cells ultimately leads towards hyperplasia (Bajwa et al., 2016).

Yamagata et al., studied that the increased estrogen were reflected in such target tissues proliferation, hyperplasia, atypical hyperplasia of the endometrium were observed in patients with ovarian tumors (Yamagata et al., 1989). Goad et al., had shown that unopposed estrogen drives the endometrial hyperplasia leads towards the progression of endometrial cancer in the uterine epithelium (Goad et al., 2018). During the menstrual cycle, epithelium tissue of the ovary proliferate under the influence of higher estrogenic level, and the increased mitotic activity is likely to enhance the risk of the mutation in the cells (Harvey A. Risch, 1998b).

Evidence Supporting this KER

Assembly and description of the scientific evidence supporting KERs in an AOP is an important step in the AOP development process that sets the stage for overall assessment of the AOP (see pages 49-56 of the User Handbook). To do this, biological plausibility, empirical support, and the current quantitative understanding of the KER are evaluated with regard to the predictive relationships/associations between defined pairs of KEs as a basis for considering WoE (page 55 of User Handbook). In addition, uncertainties and inconsistencies are considered. More help

Nash et al., had shown 50% increase in the growth rate of the epithelial ovarian cancer cell line (PE04) with the treatment of 17β-estradiol in vitro cell culture study (Nash et al., 1989).

Meissner et al., had shown the endometrial hyperplasias and cancers by excessive estrogenic stimulation in the female rabbit (Meissner et al., 1957).

Biological Plausibility
Define, in free text, the biological rationale for a connection between KEupstream and KEdownstream. What are the structural or functional relationships between the KEs? For example, there is a functional relationship between an enzyme’s activity and the product of a reaction it catalyses. Supporting references should be included. However, it is recognised that there may be cases where the biological relationship between two KEs is very well established, to the extent that it is widely accepted and consistently supported by so much literature that it is unnecessary and impractical to cite the relevant primary literature. Citation of review articles or other secondary sources, like text books, may be reasonable in such cases. The primary intent is to provide scientifically credible support for the structural and/or functional relationship between the pair of KEs if one is known. The description of biological plausibility can also incorporate additional mechanistic details that help inform the relationship between KEs, this is useful when it is not practical/pragmatic to represent these details as separate KEs due to the difficulty or relative infrequency with which it is likely to be measured (see page 40 of the User Handbook for further information).   More help

There are many kinds of ovarian tumors that are related with the estrogen or androgen levels. Granulosa cell tumor and thecoma are well-known estrogen-producing tumors. Metastatic ovarian tumors often have androgen-producing stroma and that mucinous cystadenoma produces estrogens. Many other ovarian tumors also can produce sexual hormones in their stroma (Tanaka et al., 2004).

Uncertainties and Inconsistencies
In addition to outlining the evidence supporting a particular linkage, it is also important to identify inconsistencies or uncertainties in the relationship. Additionally, while there are expected patterns of concordance that support a causal linkage between the KEs in the pair, it is also helpful to identify experimental details that may explain apparent deviations from the expected patterns of concordance. Identification of uncertainties and inconsistencies contribute to evaluation of the overall WoE supporting the AOPs that contain a given KER and to the identification of research gaps that warrant investigation (seep pages 41-42 of the User Handbook).Given that AOPs are intended to support regulatory applications, AOP developers should focus on those inconsistencies or gaps that would have a direct bearing or impact on the confidence in the KER and its use as a basis for inference or extrapolation in a regulatory setting. Uncertainties that may be of academic interest but would have little impact on regulatory application don’t need to be described. In general, this section details evidence that may raise questions regarding the overall validity and predictive utility of the KER (including consideration of both biological plausibility and empirical support). It also contributes along with several other elements to the overall evaluation of the WoE for the KER (see Section 4 of the User Handbook).  More help

Ho et al., had shown that steroid hormones, primarily estrogens and progesterone, are implicated in ovarian carcinogenesis and estrogens favor neoplastic transformation of the ovarian surface epithelium (Ho, 2003).

Response-response Relationship
This subsection should be used to define sources of data that define the response-response relationships between the KEs. In particular, information regarding the general form of the relationship (e.g., linear, exponential, sigmoidal, threshold, etc.) should be captured if possible. If there are specific mathematical functions or computational models relevant to the KER in question that have been defined, those should also be cited and/or described where possible, along with information concerning the approximate range of certainty with which the state of the KEdownstream can be predicted based on the measured state of the KEupstream (i.e., can it be predicted within a factor of two, or within three orders of magnitude?). For example, a regression equation may reasonably describe the response-response relationship between the two KERs, but that relationship may have only been validated/tested in a single species under steady state exposure conditions. Those types of details would be useful to capture.  More help

Vuong  et al., had shown estrogen replacement therapy in the primary culture of the mouse ovarian surface epithelium cells increases the risk of ovarian cancer.  Study had demonstrated that exogenous estradiol accelerates the onset of ovarian cancer in mouse models via the ESR1 pathway to result in the down-regulation of a tumour suppressor gene (Vuong et al., 2017).

This sub-section should be used to provide information regarding the approximate time-scale of the changes in KEdownstream relative to changes in KEupstream (i.e., do effects on KEdownstream lag those on KEupstream by seconds, minutes, hours, or days?). This can be useful information both in terms of modelling the KER, as well as for analyzing the critical or dominant paths through an AOP network (e.g., identification of an AO that could kill an organism in a matter of hours will generally be of higher priority than other potential AOs that take weeks or months to develop). Identification of time-scale can also aid the assessment of temporal concordance. For example, for a KER that operates on a time-scale of days, measurement of both KEs after just hours of exposure in a short-term experiment could lead to incorrect conclusions regarding dose-response or temporal concordance if the time-scale of the upstream to downstream transition was not considered. More help

Observed in months to years

Known modulating factors
This sub-section presents information regarding modulating factors/variables known to alter the shape of the response-response function that describes the quantitative relationship between the two KEs (for example, an iodine deficient diet causes a significant increase in the slope of the relationship; a particular genotype doubles the sensitivity of KEdownstream to changes in KEupstream). Information on these known modulating factors should be listed in this subsection, along with relevant information regarding the manner in which the modulating factor can be expected to alter the relationship (if known). Note, this section should focus on those modulating factors for which solid evidence supported by relevant data and literature is available. It should NOT list all possible/plausible modulating factors. In this regard, it is useful to bear in mind that many risk assessments conducted through conventional apical guideline testing-based approaches generally consider few if any modulating factors. More help

Not specified

Known Feedforward/Feedback loops influencing this KER
This subsection should define whether there are known positive or negative feedback mechanisms involved and what is understood about their time-course and homeostatic limits? In some cases where feedback processes are measurable and causally linked to the outcome, they should be represented as KEs. However, in most cases these features are expected to predominantly influence the shape of the response-response, time-course, behaviours between selected KEs. For example, if a feedback loop acts as compensatory mechanism that aims to restore homeostasis following initial perturbation of a KE, the feedback loop will directly shape the response-response relationship between the KERs. Given interest in formally identifying these positive or negative feedback, it is recommended that a graphical annotation (page 44) indicating a positive or negative feedback loop is involved in a particular upstream to downstream KE transition (KER) be added to the graphical representation, and that details be provided in this subsection of the KER description (see pages 44-45 of the User Handbook).  More help

Not specified

Domain of Applicability

As for the KEs, there is also a free-text section of the KER description that the developer can use to explain his/her rationale for the structured terms selected with regard to taxonomic, life stage, or sex applicability, or provide a more generalizable or nuanced description of the applicability domain than may be feasible using standardized terms. More help

Increase in circulating estrogen level causing  increase in the ovarian stromal cells observed in adult female (human) also in rabbit and rodents.


List of the literature that was cited for this KER description using the appropriate format. Ideally, the list of references should conform, to the extent possible, with the OECD Style Guide (OECD, 2015). More help

Bajwa, P., Nagendra, P., Nielsen, S., Sahoo, S., Bielanowicz, A., Lombard, J., et al. (2016). Age related increase in mTOR activity contributes to the pathological changes in ovarian surface epithelium. Oncotarget, 7. doi:10.18632/oncotarget.8468.

Goad, J., Ko, Y.-A., Kumar, M., Jamaluddin, M. F. B., & Tanwar, P. S. (2018). Oestrogen fuels the growth of endometrial hyperplastic lesions initiated by overactive Wnt/β-catenin signalling. Carcinogenesis, 39(9), 1105-1116.

Ho, S.-M. (2003). Estrogen, progesterone and epithelial ovarian cancer. Reproductive Biology and Endocrinology, 1(1), 1-8.

Meissner, W. A., Sommers, S. C., & Sherman, G. (1957). Endometrial hyperplasia, endometrial carcinoma, and endometriosis produced experimentally by estrogen. Cancer, 10(3), 500-509. doi:<500::AID-CNCR2820100312>3.0.CO;2-V.

Mirabolghasemi, G., & Kamyab, Z. (2017). Changes of the uterine tissue in rats with polycystic ovary syndrome induced by estradiol valerate. International journal of fertility & sterility, 11(1), 47.

Nash, J. D., Ozols, R. F., Smyth, J. F., & Hamilton, T. C. (1989). Estrogen and anti-estrogen effects on the growth of human epithelial ovarian cancer in vitro. Obstetrics and gynecology, 73(6), 1009-1016.

Nephew, K. P., Long, X., Osborne, E., Burke, K. A., Ahluwalia, A., & Bigsby, R. M. (2000). Effect of estradiol on estrogen receptor expression in rat uterine cell types. Biology of Reproduction, 62(1), 168-177.

Risch, H. A. (1998a). Hormonal etiology of epithelial ovarian cancer, with a hypothesis concerning the role of androgens and progesterone. Journal of the National Cancer Institute, 90(23), 1774-1786.

Risch, H. A. (1998b). Hormonal Etiology of Epithelial Ovarian Cancer, With a Hypothesis Concerning the Role of Androgens and Progesterone. JNCI: Journal of the National Cancer Institute, 90(23), 1774-1786. doi:10.1093/jnci/90.23.1774.

Tanaka, Y. O., Tsunoda, H., Kitagawa, Y., Ueno, T., Yoshikawa, H., & Saida, Y. (2004). Functioning Ovarian Tumors: Direct and Indirect Findings at MR Imaging. RadioGraphics, 24(suppl_1), S147-S166. doi:10.1148/rg.24si045501.

Vuong, N. H., Salah Salah, O., & Vanderhyden, B. C. (2017). 17β-Estradiol sensitizes ovarian surface epithelium to transformation by suppressing Disabled-2 expression. Scientific Reports, 7(1), 16702. doi:10.1038/s41598-017-16219-2.

Yamagata, S., Yamamoto, K., Tsuchida, S., Kawamura, N., Matsumoto, Y., Ueki, S., et al. (1989). Estrogen production in epithelial tumors of the ovary--clinical and endocrinological study in postmenopausal women. Nihon Sanka Fujinka Gakkai zasshi, 41(11), 1761-1768.