Binding of corticosteroids by plasma proteins. V. Corticosteroid-binding globulin activity in normal human beings and in certain disease states

A role for corticosteroid-binding globulin variants in stress-related disorders

Primary stress-related diseases such as chronic fatigue syndrome, fibromyalgia or chronic widespread pain have been associated with altered activity of the hypothalamic-pituitary-adrenal axis due to measured relative hyper- or hypo-cortisolism in basal or experimentally stimulated states. A hereditary risk to development of these diseases has been proposed. Corticosteroid-binding globulin (CBG), a plasma transport vehicle for cortisol, may play a more active role in the hypothalamic-pituitary-adrenal axis. Chronically altered hypothalamic-pituitary-adrenal axis has been associated with common medical problems. Hypocortisolism has been observed in kindred studies of rare mutations of the SERPIN A6 (CBG) gene and more common SERPIN A6 polymorphisms associated with reduced CBG levels or CBG:cortisol-binding affinity. Over the last decade, studies of five different CBG gene mutations in humans, human genetic associations and transgenic mouse models have suggested that CBG may have hitherto unexpected roles in modulation of the stress response. Naturally occurring CBG variants may alter susceptibility to disorders associated with chronic stress and relative hypocortisolism. On the other hand, hypercortisolism has been linked with Cushing's disease and metabolic syndrome and CBG gene polymorphisms have been linked to obesity in animal models. In this article, we look at the evidence suggesting a role for CBG in stress-related disorders, focusing particularly on CBG gene polymorphisms and chronic pain/fatigue syndromes.

Prevention of immune-mediated arthritis in cholestatic rats: involvement of endogenous glucocorticoids

BACKGROUND/AIMS

Hyporesponsiveness of the hypothalamic-pituitary-adrenal axis to stress is implicated in the development of immune-mediated arthritis in rats. This study investigated whether the documented hyporesponsiveness of the hypothalamic-pituitary-adrenal axis in cholestatic rats predisposes them to immune-mediated arthritis.

METHODS

Bile duct-resected (BDR) and sham-resected rats were injected with either complete Freund's adjuvant (CFA; to induce immune-mediated arthritis) or incomplete Freund's adjuvant (IFA) at the time of laparotomy. Arthritis development was then assessed using a clinical arthritis score, and plasma corticosterone levels were determined.

RESULTS

CFA-injected sham-resected rats developed arthritis, whereas CFA-injected BDR rats did not. CFA- and IFA-injected BDR rats had 14- and 6-fold higher levels of plasma free corticosterone than respective sham-resected controls. In addition, CFA-injected BDR rats treated with the glucocorticoid receptor antagonist RU 486 developed severe arthritis.

CONCLUSIONS

Cholestasis because of BDR prevents the occurrence of immune-mediated arthritis and is associated with elevated plasma free corticosterone levels. Furthermore, CFA-injected BDR rats treated with RU 486 developed severe arthritis. Therefore, high-circulating glucocorticoid levels seem to result in a relative state of immunosuppression in BDR rats.

Dose-dependent pharmacokinetics of dexamethasone

The dose dependency of the pharmacokinetics of dexamethasone and its influence on the endogenous secretion of cortisol has been studied in healthy females. The maximum plasma level occurred between 1.6 and 2.0 h after doses of 0.5-3.0 mg independent of the type of administration. AUC, distribution volume, plasma clearance and cmax did not increase in proportion to the dose but only by the factor of about 0.6-0.7 after the oral administration of 0.5-1.5 mg. Comparatively high values were reached after 3.0 mg i.m. This may be due to reduced bioavailability of the oral doses. Within the first 12 h after the administration of 0.5-3.0 mg, endogenous cortisol secretion was influenced independent of dose. However, the suppressive effect after 24 h was dose dependent and amounted to approximately 24% for 0.5 mg p.o., 62% for 1.5 mg p.o. and 90% for 3.0 mg i.m. In the case of administration every second day, the integral reduction within 24 h after the administration of 0.5 mg dexamethasone was 44 to 65% and for 1.5 mg between 59 and 62%.

Interrelationships between sodium clearance, plasma aldosterone, plasma renin activity, renal hemodynamics and blood pressure in renal disease

This study was designed to evaluate the role of aldosterone, glomerular filtration and blood pressure on sodium excretion in renal disease. Sodium clearance (CNa), plasma aldosterone (PA), plasma renin activity (PRA), glomerular filtration rate (GF), paraaminohippurate clearance (CPAH) and blood pressure were measured simultaneously in 19 normal subjects, 38 patients with benign essential hypertension, 3 with renal artery stenosis, 48 with chronic glomerulonephritis, 20 with the nephrotic syndrome, 24 with tubulo-interstitial disease and 21 with a renal homograft. CNa was significantly depressed in patients with the nephrotic syndrome. Mean PA and PRA were increased in renal artery stenosis but within the normal range in other groups. CNa correlated inversely with PA in all groups but one (tubulo-interstitial disease). CNa correlated directly with GF in the nephrotic syndrome and with the mean blood pressure (mBP) in chronic glomerulonephritis and tubulo-interstitial disease. PA correlated directly with PRA and inversely with GF or CPAH in most groups. It is concluded that PA is an important determinant of the basal natriuresis in renal disease with the exception of tubulo-interstitial nephropathies. In the nephrotic syndrome sodium retention is largely determined by the interaction of PA and GF. In chronic nephropathies, but not in benign essential hypertension, the fractional sodium excretion is partly blood pressure-dependent. Impairment of renal function is often accompanied by a rise in PA.

The localization over time of exogenous aldosterone and angiotensin II in various organs

Central nervous system effects have been demonstrated for angiotensin II and suggested for aldosterone. In order to determine whether either of these chemicals naturally crosses the blood-brain barrier, radioactive aldosterone and angiotensin II were introduced via intracardiac injections in rats. Samples of blood, liver, kidney, adrenals, cerebral cortex, and hypothalamus were collected at three, 15, and 60 minutes, frozen, dissolved, and counted. Blood levels for aldosterone and angiotensin II remained constant over 60 minutes. Aldosterone accumulated in the liver, kidney, adrenals and hypothalamus three minutes after injection, and levels diminished over time. Angiotensin II levels peaked in the adrenal, kidney, and liver after three minutes, and in the hypothalamus after 15 minutes. Cerebral cortex levels were lower than hypothalamic levels by 30% for aldosterone and 50% for angiotensin II. This suggests that both drugs may enter the central nervous system and selectively accumulate in the hypothalamus.

Cannabinoid effects on plasma corticosterone and uptake of 3H-corticosterone by mouse brain

The effects of three cannabinoids, 11-hydroxy-delta9-tetrahydrocannabinol (11-HO-delta9-THC), delta9-THC and cannabinol (CBN), ranging in behavioral activity from high to low, were studied on two aspects of pituitary--adrenal function. Plasma corticosterone levels were used as an index of adrenocorticotropic hormone (ACTH) release. All three cannabinoids elicited an increase in plasma corticosterone elvels in a manner similar to their behavioral potency. These cannabinoids also elicited an increase in the concentration of 3H-corticosterone taken up by the brains of adrenalectomized mice in a manner similar to their potency in elevating plasma corticosterone levels. The significance and possible underlying mechanism of the apparent correlation resulting between these effects and the behavioral effects of cannabinoids are discussed.

Plasma corticosterone concentrations in the perinatal rat

1. Plasma corticosterone concentrations were determined in the foetal rat during the gestational period from day 18.5 to term and in postnatal rats over the first few hours after delivery. 2. The plasma corticosterone concentrations in foetal rats are as high as six times maternal values at day 19 of gestation and are approximately equal to maternal values from day 20 to term. 3. In postnatal rats the plasma corticosterone concentrations rise 3.5-fold on average within 5hr. of delivery. 4. The results are discussed in relation to the function of adrenal steroids in postnatal liver development.