Literatura académica sobre el tema "Glucocorticoids bioavailabilty"

Glucocorticoids are steroid hormones with key roles in the regulation of many physiological systems including energy homeostasis and immunity. However, chronic glucocorticoid excess, highlighted in Cushing’s syndrome, is established as being associated with increased cardiovascular disease (CVD) risk. Atherosclerosis is the major cause of CVD, leading to complications including coronary artery disease, myocardial infarction and heart failure. While the associations between glucocorticoid excess and increased prevalence of these complications are well established, the mechanisms underlying the role of glucocorticoids in development of atheroma are unclear. This review aims to better understand the importance of glucocorticoids in atherosclerosis and to dissect their cell-specific effects on key processes (e.g., contractility, remodelling and lesion development). Clinical and pre-clinical studies have shown both athero-protective and pro-atherogenic responses to glucocorticoids, effects dependent upon their multifactorial actions. Evidence indicates regulation of glucocorticoid bioavailability at the vasculature is complex, with local delivery, pre-receptor metabolism, and receptor expression contributing to responses linked to vascular remodelling and inflammation. Further investigations are required to clarify the mechanisms through which endogenous, local glucocorticoid action and systemic glucocorticoid treatment promote/inhibit atherosclerosis. This will provide greater insights into the potential benefit of glucocorticoid targeted approaches in the treatment of cardiovascular disease.

Synthetic glucocorticoids are among the most widely prescribed medications by physicians. Although they have a vast array of beneficial effects such as immunosuppression and anti-inflammation, excess glucocorticoids can lead to iatrogenic Cushing’s syndrome, which includes hypertension and cardiovascular disease. The exact mechanism by which glucocorticoids elevate blood pressure is not completely understood, but it appears to be a complex pathology that involves increased responsiveness to vasoconstrictors and decreased vasodilator production. Nitric oxide is a vasodilator that plays a key role in blood pressure regulation, and previous studies have shown that a reduction in nitric oxide production or bioavailability contributes to hypertension. Tetrahydrobiopterin, a necessary cofactor for nitric oxide synthase activity, can affect nitric oxide production and bioavailability, with low levels causing decreased nitric oxide production. However, little is known about the interaction between glucocorticoids and tetrahydrobiopterin levels. In this review, the roles of nitric oxide and tetrahydrobiopterin in the pathogenesis of glucocorticoid hypertension will be discussed. Furthermore, the authors propose that glucocorticoids exert a genomic effect to decrease guanosine triphosphate cyclohydrolase I, the rate-limiting enzyme in the production of tetrahydrobiopterin. In the future, tetrahydrobiopterin supplementation in patients with iatrogenic Cushing’s syndrome may prove to be beneficial and decrease mortality attributed to cardiovascular disease.

ABSTRACT Corticosteroid binding globulin (CBG) is the carrier for glucocorticoids in plasma. The protein is believed to keep the steroids inactive and to regulate the amount of free hormone acting on target tissues (free hormone hypothesis). Here, we generated a mouse model genetically deficient for CBG to test the contribution of the carrier to glucocorticoid action and adrenocortical stress response. The absence of CBG resulted in a lack of corticosterone binding activity in serum and in an ∼10-fold increase in free corticosterone levels in CBG-null mice, consistent with its role in regulation of circulating free hormone levels. Surprisingly, cbg − / − animals did not exhibit features seen in organisms with enhanced glucocorticoid signaling. Rather, the mice exhibited increased activity of the pituitary axis of hormonal control, normal levels of gluconeogenetic enzymes, and fatigue, as well as an aggravated response to septic shock, indicating an inability to appropriately respond to the excess free corticosterone in the absence of CBG. Thus, our data suggest an active role for CBG in bioavailability, local delivery, and/or cellular signal transduction of glucocorticoids that extends beyond a function as a mere cargo transporter.

Epidemiological findings and experimental studies in animals have shown that individual tissues and whole organ systems can be programmedin uteroduring critical periods of development with adverse consequences for their function in later life. Detailed morphometric analyses of the data have shown that certain patterns of intrauterine growth, particularly growth retardation, can be related to specific postnatal outcomes. Since hormones regulate fetal growth and the development of individual fetal tissues, they have a central role in intrauterine programming. Hormones such as insulin, insulin-like growth factors, thyroxine and the glucocorticoids act as nutritional and maturational signals and adapt fetal development to prevailing intrauterine conditions, thereby maximizing the chances of survival bothin uteroand at birth. However, these adaptations may have long-term sequelae. Of the hormones known to control fetal development, it is the glucocorticoids that are most likely to cause tissue programmingin utero. They are growth inhibitory and affect the development of all the tissues and organ systems most at risk of postnatal pathophysiology when fetal growth is impaired. Their concentrationsin uteroare also elevated by all the nutritional and other challenges known to have programming effects. Glucocorticoids act at cellular and molecular levels to alter cell function by changing the expression of receptors, enzymes, ion channels and transporters. They also alter various growth factors, cytoarchitectural proteins, binding proteins and components of the intracellular signalling pathways. Glucocorticoids act, directly, on genes and, indirectly, through changes in the bioavailability of other hormones. These glucocorticoid-induced endocrine changes may be transient or persist into postnatal life with consequences for tissue growth and development both before and after birth. In the long term, prenatal glucocorticoid exposure can permanently reset endocrine systems, such as the somatotrophic and hypothalamic–pituitary–adrenal axes, which, in turn, may contribute to the pathogenesis of adult disease. Endocrine changes may, therefore, be both the cause and the consequence of intrauterine programming.

Abstract Glucocorticoids (GCs) exert powerful anti-inflammatory effects that may relate in part to their ability to restrict the differentiation and function of dendritic cells (DCs). Although these inhibitory effects are dependent upon GCs binding to nuclear glucocorticoid receptors (GRs), fine-tuning of GR signaling is achieved by prereceptor interconversion of cortisol that binds GRs with high affinity and cortisone that does not. We show for the first time that human monocyte-derived DCs are able to generate cortisol as a consequence of up-regulated expression of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Immature DCs demonstrate selective enhancement of 11β-HSD1 reductase activity, leading to increased conversion of inactive cortisone to active cortisol. Enhancement of GC bioavailability is maintained or increased upon terminal differentiation induced by signals associated with innate immune activation. In marked contrast, maturation induced by CD40 ligation leads to a sharp reduction in cortisol generation by DCs. The differentiation of DCs from monocyte precursors is inhibited at physiologic concentrations of inactive cortisone, an effect that requires activity of the 11β-HSD1 enzyme. In conclusion, prereceptor regulation of endogenous GCs appears to be an important determinant of DC function and represents a potential target for therapeutic manipulation.

The anti-inflammatory actions of endogenous glucocorticoids (GCs) are regulated by the activities of the GC-activating and -inactivating enzymes, 11β-hydroxysteroid dehydrogenase (11β-HSD)-1 and 11β-HSD2, respectively, that catalyze the interconversion of the inert GC, cortisone, and its bioactive derivative, cortisol. Proinflammatory cytokines regulate 11β-HSD1 expression in various cell types and thereby modulate the bioavailability of cortisol to the glucocorticoid receptor (GR). Since endogenous GCs reportedly attenuate the airway asthmatic response to allergen exposure, we investigated whether airway smooth muscle (ASM) exhibits cytokine-induced changes in 11β-HSD1 expression that enable the ASM to regulate its own bioavailability of GC and, accordingly, the protective effect of GR signaling on airway function under proasthmatic conditions. Human ASM cells exposed to the primary proasthmatic T helper type 2 (Th2) cytokine, IL-13, exhibited upregulated expression of 11β-HSD1, an effect that was attributed to activation of the transcription factor, AP-1, coupled to MAPK signaling via the ERK1/2 and JNK pathways. The induction of 11β-HSD1 expression and its oxoreductase activity by IL-13 (also IL-4) served to amplify the conversion of cortisone to cortisol by the cytokine-exposed ASM and, hence, heighten GR-mediated transcriptional activation. Extended studies demonstrated that this amplified 11β-HSD1-dependent GC activation enabled physiologically relevant concentrations of cortisone to exert enhanced protection of ASM tissues from the proasthmatic effects of IL-13 on ASM constrictor and relaxation responsiveness. Collectively, these novel findings identify a Th2 cytokine-driven homeostatic feedback mechanism in ASM that enhances its responsiveness to endogenous GCs by upregulating 11β-HSD1 activity, thereby curtailing the adverse effects of the proasthmatic cytokine on airway function.

To compare pharmacokinetics of liquid prednisolone and prednisone solutions and to assess relative bioavailability, six healthy adult men were administered 15 mg of each formulation. Blood samples were obtained and assayed for plasma prednisolone concentrations by high‐performance liquid chromatography. Peak concentration was significantly higher with liquid prednisolone (mean ± SD 430.3 ± 62.5 vs 333.0 ± 27.8 ng/ml, p=0.013), with similar times to peak concentration. Prednisolone liquid gave higher concentrations at every time point (statistically significant for all except 0.25 hrs after the dose), resulting in a significantly greater total area under the curve (2029.8 ± 246.9 vs 1633.3 ± 221.1 ng/ml•hour, respectively, p=0.002). Clearance was slower for prednisolone (128.3 ± 15.1 vs 149.1 ± 17.6 ml/min/1.73 m2, p=0.01), and the relative bioavailability of the prednisolone liquid using prednisone liquid as the reference standard was 116 ± 14%. Thus, prednisolone liquid has similar pharmacokinetic characteristics as prednisone liquid, with improved bioavailability.

Abstract Context The Short Synacthen Test (SST) is the gold standard for diagnosing adrenal insufficiency. It requires invasive administration of Synacthen, venous sampling, and is resource-intensive. Objective To develop a nasally administered SST, with salivary glucocorticoids measurement, to assess the adrenal response. Design We conducted 5 studies: 4 open-label, sequence-randomized, crossover, pharmacodynamic studies testing 6 doses/formulations and a repeatability study. Additionally, pharmacokinetic analysis was undertaken using our chosen formulation, 500 µg tetracosactide with mucoadhesive chitosan, Nasacthin003, in our pediatric study. Setting Adult and children’s clinical research facilities. Participants A total of 36 healthy adult males and 24 healthy children. Intervention We administered all 6 nasal formulations using an European regulator endorsed atomization device. The IV comparators were 250 µg or 1 µg SST. Main Outcome Measures We analyzed paired blood and saliva samples for plasma cortisol and salivary cortisol and cortisone. Results The addition of chitosan to tetracosactide and dose escalation increased peak cortisol response (P = 0.01 and 0.001, respectively). The bioavailability of Nasacthin003 was 14.3%. There was no significant difference in plasma cortisol at 60 minutes between 500 µg Nasacthin003 and 250 µg IV Synacthen (P = 0.17). The repeatability coefficient at 60 minutes was 105 nmol/L for IV Synacthen and salivary cortisol and cortisone was 10.3 and 21.1 nmol/L, respectively. The glucocorticoid response in children was indistinguishable from that of adults. Conclusions Nasal administration of Nasacthin003 generates equivalent plasma cortisol values to the 250-µg IV SST and, with measurement at 60 minutes of salivary cortisol or cortisone, provides a noninvasive test for adrenal insufficiency.

Une exposition excessive aux glucocorticoïdes (GC), comme observée chez les patients recevant une corticothérapie, peut entraîner un dysfonctionnement des cellules β et un diabète chez jusqu'à 40% des patients. Dans l'obésité, une surexposition locale au cortisol secondaire à une altération du métabolisme du cortisol contribue à l'apparition du diabète. Des doses élevées de GC comme la dexaméthasone (DEX) inhibent la sécrétion d'insuline stimulée par le glucose (SISG), mais les effets de doses plus faibles et des autres GC, tels que l'hydrocortisone (HC) et la prednisone (PRED), restent peu étudiés. L'enzyme 5α-réductase de type 1 (SRD5A1) est une enzyme cruciale pour la dégradation des GC, modulant ainsi leur biodisponibilité. L'inhibition de SRD5A1 est associée à une altération de la sensibilité à l'insuline et à un risque accru de diabète. La première partie de ma thèse étudie l'impact de doses "thérapeutiques faibles" de PRED (équivalentes à 5 à 10 mg par voie orale) et d'autres GC sur la SISG étudiée par périfusion dans des îlots isolés de pancréas humains. Tous les GCs diminuent significativement la SISG, la DEX ayant un impact plus important que la PRED et l'HC. L'IMC, l'âge ou le sexe n'influencent pas significativement l'impact de la PRED sur la sécrétion d'insuline. La deuxième partie du travail caractérise le métabolisme des GC dans les îlots humains. SRD5A1 est la seule réductase A-ring dans les îlots, et son expression, ainsi que celle de HSD11B1, est localisée dans les cellules β des îlots. Nous avons démontré l'existence d'un métabolisme intracrine du cortisol dans des cultures primaires d’îlots humains. L’expression de HSD11B1 et SRD5A1 est significativement diminuée dans les îlots des donneurs atteints de DT2 par rapport aux donneurs normoglycémiques. La dernière partie visait à prouver que la diminution de la biodisponibilité du cortisol via la surexpression de SRD5A1 dans les îlots humains atténue l'effet inhibiteur des GC sur la SISG. La surexpression de SR5DA1 a permis d’atténuer l'impact de l'HC sur la première phase de la SISG, mais pas de la PRED. En conclusion, même à faibles doses, les GC altèrent la SISG. La diminution de l'expression de SRD5A1 dans les îlots peut contribuer au développement du diabète dans un contexte métabolique. La surexpression de SRD5A1 protège contre l'impact délétère du cortisol sur la SISG. Ces résultats supportent le rôle de SRD5A1 dans la surexposition locale au cortisol et le développement du diabète. Cependant, l'augmentation de l'activité de SRD5A1 ne semble pas efficace pour protéger contre les complications métaboliques induites par la corticothérapie. D'autres aspects de la fonction des cellules β, en particulier la viabilité cellulaire, vont être étudiés. Par ailleurs, le bénéfice potentiel de SRD5A1 dans la modulation de la résistance à l'insuline et de la stéatose hépatique doivent être étudiés. Ces études complémentaires permettront de mieux comprendre le potentiel du gène SRD5A1 dans la modulation de la résistance à l'insuline et de la maladie du foie gras
Excessive glucocorticoid (GC) exposure, as seen in patients receiving GC therapy, can lead to β-cell dysfunction and diabetes in up to 40% of the cases. In obesity, increased local cortisol exposure due to altered metabolism contributes to diabetes onset. High doses of GCs like dexamethasone (DEX) are known to inhibit glucose-stimulated insulin secretion (GSIS), but the effects of lower doses and other GCs, such as hydrocortisone (HC) and prednisone (PRED), remain underexplored. The enzyme 5α-reductase type 1 (SRD5A1) is a crucial enzyme for GC degradation, modulating their bioavailability. Inhibition or knockout of SRD5A1 is associated with impaired insulin sensitivity and increased diabetes risk. This first part of my thesis investigates the impact of “low therapeutic” doses of PRED (equivalent to 5 to 10 mg administrated orally) and other GCs on glucose stimulated insulin secretion (GSIS). We showed that PRED significantly decreases GSIS, with DEX having a worse effect compared to PRED and HC. BMI, age, or sex do not significantly influence the direct impact of PRED on insulin secretion. The second part of the work aimed to characterize GC metabolism in human islets. SRD5A1 is the only A-ring reductase expressed in islets, and its expression, along with HSD11B1, is localized within the β-cells of human islets. We demonstrated evidence of intracrine metabolism of cortisol in intact primary human islets cultured under dynamic experimental settings. Expression data reveals significantly diminished expression of both HSD11B1 and SRD5A1 in T2D donors compared to normoglycemic donors. The last part aimed to provide proof of concept that decreased cortisol bioavailability via the overexpression of SRD5A1 in human islets mitigates the inhibitory effect of GCs on GSIS. SR5DA1 overexpression attenuated the impact of HC on the first phase of insulin secretion, but not the PRED impact. To conclude, even at low doses, GCs impair GSIS. The decrease in SRD5A1 expression in islets may contribute to the development of diabetes in metabolic context. SRD5A1 overexpression protects against the deleterious impact of cortisol on GSIS, providing additional evidence to support the enzyme's role in local cortisol overexposure and the development of diabetes. However, increasing SRD5A1 activity may not be an effective approach to protect against metabolic complications induced by GC therapy. Other aspects of β-cell function, especially cell viability, need to be studied. Moreover, the potential benefits of SRD5A1 in modulating insulin resistance and fatty liver disease should be investigated. These further studies will provide more insight into the potential of SRD5A1 as a therapeutic target