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Devine K, Villalobos E, Kyle CJ, Andrew R, Reynolds RM, Stimson RH, Nixon M, Walker BR. The ATP-binding cassette proteins ABCB1 and ABCC1 as modulators of glucocorticoid action. Nat Rev Endocrinol 2023; 19:112-124. [PMID: 36221036 DOI: 10.1038/s41574-022-00745-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/24/2023]
Abstract
Responses to hormones that act through nuclear receptors are controlled by modulating hormone concentrations not only in the circulation but also within target tissues. The role of enzymes that amplify or reduce local hormone concentrations is well established for glucocorticoid and other lipophilic hormones; moreover, transmembrane transporters have proven critical in determining tissue responses to thyroid hormones. However, there has been less consideration of the role of transmembrane transport for steroid hormones. ATP-binding cassette (ABC) proteins were first shown to influence the accumulation of glucocorticoids in cells almost three decades ago, but observations over the past 10 years suggest that differential transport propensities of both exogenous and endogenous glucocorticoids by ABCB1 and ABCC1 transporters provide a mechanism whereby different tissues are preferentially sensitive to different steroids. This Review summarizes this evidence and the new insights provided for the physiology and pharmacology of glucocorticoid action, including new approaches to glucocorticoid replacement.
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Affiliation(s)
- Kerri Devine
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elisa Villalobos
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Catriona J Kyle
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Ruth Andrew
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Rebecca M Reynolds
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Roland H Stimson
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Mark Nixon
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Brian R Walker
- BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.
- Translational & Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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2
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Hoeflich A, Fitzner B, Walz C, Hecker M, Tuchscherer A, Bastian M, Brenmoehl J, Schröder I, Willenberg HS, Reincke M, Zettl UK. Systemic Effects by Intrathecal Administration of Triamcinolone Acetonide in Patients With Multiple Sclerosis. Front Endocrinol (Lausanne) 2020; 11:574. [PMID: 32982971 PMCID: PMC7481359 DOI: 10.3389/fendo.2020.00574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 12/11/2022] Open
Abstract
In patients suffering from multiple sclerosis (MS), intrathecal injection of triamcinolone acetonide (TCA) has been shown to improve symptoms of spasticity. Although repeated intrathecal injection of TCA has been used in a number of studies in late-stage MS patients with spinal cord involvement, no clinical-chemical data are available on the distribution of TCA in cerebrospinal fluid (CSF) or serum. Moreover, the effects of intrathecal TCA administration on the concentrations of endogenous steroids remain poorly understood. Therefore, we have quantified TCA and selected endogenous steroids in CSF and serum of TCA-treated MS patients suffering from spasticity. Concentrations of steroids were quantified by LC-MS, ELISA, or ECLIA and compared with the blood-brain barrier status, diagnosed with the Reibergram. The concentration of TCA in CSF significantly increased during each treatment cycle up to >5 μg/ml both in male and female patients (p < 0.001). Repeated TCA administration also evoked serum concentrations of TCA up to >30 ng/ml (p < 0.001) and severely depressed serum levels of cortisol and corticosterone (p < 0.001). In addition, concentrations of circulating estrogen were significantly suppressed (p < 0.001). Due to the potent suppressive effects of TCA on steroid hormone concentrations both in the brain and in the periphery, we recommend careful surveillance of adrenal function following repeated intrathecal TCA injections in MS patients.
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Affiliation(s)
- Andreas Hoeflich
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
- *Correspondence: Andreas Hoeflich
| | - Brit Fitzner
- Neuroimmunological Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Christina Walz
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Michael Hecker
- Neuroimmunological Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Armin Tuchscherer
- Institute of Genetics and Biometry, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Manuela Bastian
- Institute for Clinical Chemistry and Laboratory Medicine, Rostock University Medical Center, Rostock, Germany
| | - Julia Brenmoehl
- Institute of Genome Biology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Ina Schröder
- Neuroimmunological Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Holger S. Willenberg
- Division of Endocrinology and Metabolism, Rostock University Medical Center, Rostock, Germany
| | - Martin Reincke
- Department of Endocrinology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Uwe Klaus Zettl
- Neuroimmunological Section, Department of Neurology, Rostock University Medical Center, Rostock, Germany
- Uwe Klaus Zettl
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Gilbert C, Provost PR, Tremblay Y. Dynamic modulation of Cyp21a1 (21-hydroxylase) expression sites in the mouse developing lung. J Steroid Biochem Mol Biol 2017; 168:102-109. [PMID: 28216153 DOI: 10.1016/j.jsbmb.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/31/2017] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
21-hydroxylase is expressed in the developing lung where it is proposed as a local source of glucocorticoids playing important roles in lung development. We have studied the precise sites of Cyp21a1 expression in the developing mouse lung from the pseudoglandular stage (gestation day (GD) 15.5) to the alveolar stage (postnatal day (PND) 15) by in situ hybridization. Cyp21a1-mRNA was found mainly in epithelial cells from GD 15.5 to PND 5, but the precise site of expression shifted from the distal epithelium during the pseudoglandular and the canalicular stages including the distal epithelium without lumina, to the proximal epithelium and the wall of developing saccules during the perinatal period (GD 19.5 and PND 0), and to the wall of developing saccules and septa, most probably in type I pneumonocytes (PTI), on PND 5. Cyp21a1 expression changed from PTI cells to capillary endothelial cells of the same distal structures during alveolarization. The mesenchyme was generally negative. Endothelial cells forming large vessels were negative. However the tunica adventitia surrounding arteries was Cyp21a1-positive, while several veins were surrounded by a Cyp21a1-positive layer. In conclusion, Cyp21a1 remains expressed in the most distal structure of the developing lung even though these structures are changing, but its expression is not restricted to these areas. Taken together, our data show the highly dynamic modulation of Cyp21a1 expression sites, consistent with the evolving structures of the developing lung.
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Affiliation(s)
- Catherine Gilbert
- Reproduction, Mother and Youth Health, Centre de recherche du CHU de Québec, Québec, QC, Canada; Centre de Recherche en Reproduction, Développement et Santé Intergénérationnelle (CRDSI), Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Pierre R Provost
- Reproduction, Mother and Youth Health, Centre de recherche du CHU de Québec, Québec, QC, Canada; Department of Obstetrics/Gynecology & Reproduction, Faculty of Medicine, Université Laval, Québec, QC, Canada; Centre de Recherche en Reproduction, Développement et Santé Intergénérationnelle (CRDSI), Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Yves Tremblay
- Reproduction, Mother and Youth Health, Centre de recherche du CHU de Québec, Québec, QC, Canada; Department of Obstetrics/Gynecology & Reproduction, Faculty of Medicine, Université Laval, Québec, QC, Canada; Centre de Recherche en Reproduction, Développement et Santé Intergénérationnelle (CRDSI), Faculté de Médecine, Université Laval, Québec, QC, Canada.
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4
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Bouhaddioui W, Provost PR, Tremblay Y. CYP21A2 expression is localized in the developing distal epithelium of the human perinatal lung and is compatible with in situ production and intracrine actions of active glucocorticoids. J Steroid Biochem Mol Biol 2016; 163:12-9. [PMID: 27004467 DOI: 10.1016/j.jsbmb.2016.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 11/29/2022]
Abstract
Glucocorticoids play essential roles in lung development. We investigated for expression of CYP21A2 (21-hydroxylase) as well as for the presence of the corresponding protein and identification of CYP21A2-expressing cells in several human developing lungs. Expression of some related genes was also assessed. CYP21A2 and CYP17A1 (P450c17) mRNAs were found in all the 34 lung samples from 17 to 40 weeks' gestation at variable levels. No correlation was found according to sex but a correlation with age was detected for CYP17A1 only. In contrast, CYP11B1 (11β-hydroxylase)- and CYP11B2 (aldosterone synthase)-mRNAs were not detected. Significant levels of the CYP21A2 protein were detected in all the analyzed samples, while only very low signals were detected for CYP17A1 protein. In situ hybridization revealed that CYP21A2 was almost exclusively expressed in the distal epithelium. It was reported that the lung distal epithelium of human fetuses also express 11β-hydroxysteroid dehydrogenase type 2, which catalyzes cortisol inactivation into cortisone. Based on this information, intracrine glucocorticoid actions should take place from CYP21A2 products through the glucocorticoid receptor in the absence of cortisol. In contrast, mineralocorticoid receptor activation did not seem to depend on deoxycorticosterone produced from local activity of CYP21A2 because of the reported circulating amounts of aldosterone.
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Affiliation(s)
- Wafae Bouhaddioui
- Reproduction, Mother and Youth Health, Centre de recherche CHU de Québec, Québec, QC, Canada; Centre de Recherche en Biologie de la Reproduction (CRBR), Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Pierre R Provost
- Reproduction, Mother and Youth Health, Centre de recherche CHU de Québec, Québec, QC, Canada; Department of Obstetrics/Gynecology & Reproduction, Faculty of Medicine, Université Laval, Québec, QC, Canada; Centre de Recherche en Biologie de la Reproduction (CRBR), Faculté de Médecine, Université Laval, Québec, QC, Canada
| | - Yves Tremblay
- Reproduction, Mother and Youth Health, Centre de recherche CHU de Québec, Québec, QC, Canada; Department of Obstetrics/Gynecology & Reproduction, Faculty of Medicine, Université Laval, Québec, QC, Canada; Centre de Recherche en Biologie de la Reproduction (CRBR), Faculté de Médecine, Université Laval, Québec, QC, Canada.
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5
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The effects of drugs with immunosuppressive or immunomodulatory activities on xenobiotics-metabolizing enzymes expression in primary human hepatocytes. Toxicol In Vitro 2015; 29:1088-99. [PMID: 25929522 DOI: 10.1016/j.tiv.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/02/2015] [Accepted: 04/22/2015] [Indexed: 11/22/2022]
Abstract
In this paper we investigated the effects of several drugs used in transplant medicine, i.e. cyclosporine A, tacrolimus, rapamycin, everolimus, mycophenolate mofetil, fluvastatin and rosuvastatin, on the expression of major drug-metabolizing enzymes in human hepatocytes. Moreover, we tested the ability of these drugs to affect transcriptional activity of glucocorticoid (GR) and aryl hydrocarbon receptor (AhR). We found that most of tested compounds did not induce expression of CYP1A1/1A2/3A4/2A6/2B6/2C9 mRNAs in human hepatocytes. Slight induction was observed for CYP2A6/2C9 mRNAs and CYP2A6 protein in the rapamycin-treated hepatocytes. Decrease of CYP2A6 and CYP2B6 proteins was observed in rosuvastatin-treated cells. Mycophenolate mofetil antagonized the effects of dexamethasone on GR but it potentiated the action of dioxin on AhR. Induction of CYP1A1 mRNA in HepG2 cells by dioxin was modestly antagonized by mycophenolate mofetil, while the induction by benzo[a]pyren or S-omeprazole was significantly potentiated by this drug. In general, tested compounds can be considered safe in the terms of possible drug-drug interaction caused by induction of drug-metabolizing cytochromes P450. Nevertheless, mycophenolate mofetil is of possible concern and its combination with drugs, environmental pollutants or food constituents, which activate AhR, may represent a significant toxicological risk.
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Abstract
Substantial evidence shows that the hypophyseal–pituitary–adrenal (HPA) axis and corticosteroids are involved in the process of addiction to a variety of agents, and the adrenal cortex has a key role. In general, plasma concentrations of cortisol (or corticosterone in rats or mice) increase on drug withdrawal in a manner that suggests correlation with the behavioural and symptomatic sequelae both in man and in experimental animals. Corticosteroid levels fall back to normal values in resumption of drug intake. The possible interactions between brain corticotrophin releasing hormone (CRH) and proopiomelanocortin (POMC) products and the systemic HPA, and additionally with the local CRH–POMC system in the adrenal gland itself, are complex. Nevertheless, the evidence increasingly suggests that all may be interlinked and that CRH in the brain and brain POMC products interact with the blood-borne HPA directly or indirectly. Corticosteroids themselves are known to affect mood profoundly and may themselves be addictive. Additionally, there is a heightened susceptibility for addicted subjects to relapse in conditions that are associated with change in HPA activity, such as in stress, or at different times of the day. Recent studies give compelling evidence that a significant part of the array of addictive symptoms is directly attributable to the secretory activity of the adrenal cortex and the actions of corticosteroids. Additionally, sex differences in addiction may also be attributable to adrenocortical function: in humans, males may be protected through higher secretion of DHEA (and DHEAS), and in rats, females may be more susceptible because of higher corticosterone secretion.
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7
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Martinet W, Verheye S, De Meyer I, Timmermans JP, Schrijvers DM, Van Brussel I, Bult H, De Meyer GR. Everolimus Triggers Cytokine Release by Macrophages. Arterioscler Thromb Vasc Biol 2012; 32:1228-35. [DOI: 10.1161/atvbaha.112.245381] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective—
Stent-based delivery of the mammalian target of rapamycin (mTOR) inhibitor everolimus is a promising strategy for the treatment of coronary artery disease. We studied potential adverse effects associated with mTOR inhibition.
Methods and Results—
Macrophages in culture were either treated with everolimus or starved to inhibit mTOR. Everolimus led to inhibition of protein translation, activation of p38 MAPK, and the release of proinflammatory cytokines (eg, IL-6, TNFα) and chemokines (eg, MCP1, Rantes) before induction of autophagic death. These effects were also observed with rapamycin, but not after starvation. Everolimus-induced cytokine release was similar in macrophages lacking the essential autophagy gene Atg7 but was inhibited when macrophages were cotreated with p38 MAPK inhibitor SB202190 or the glucocorticoid clobetasol. Combined stent-based delivery of clobetasol and everolimus in rabbit plaques downregulated TNFα expression as compared with everolimus-treated plaques but did not affect the ability of everolimus to induce macrophage clearance.
Conclusion—
mTOR inhibition by everolimus triggers cytokine release in macrophages through inhibition of protein translation and p38 activation. These findings provide a rationale for combined local treatment of atherosclerotic plaques with everolimus and an anti-inflammatory agent.
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Affiliation(s)
- Wim Martinet
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Stefan Verheye
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Inge De Meyer
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Jean-Pierre Timmermans
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Dorien M. Schrijvers
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Ilse Van Brussel
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Hidde Bult
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
| | - Guido R.Y. De Meyer
- From the Laboratory of Physiopharmacology, University of Antwerp, Antwerp, Belgium (W.M., I.D.M., D.M.S., I.V.B., H.B., G.R.Y.D.M.); Antwerp Cardiovascular Center, ZNA Middelheim, Antwerp, Belgium (S.V.); and the Laboratory of Cell Biology and Histology, University of Antwerp, Antwerp, Belgium (J.-P.T.)
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Dezitter X, Masselot B, Tardivel M, Mereau-Richard C, Formstecher P, Idziorek T. Macromolecular synthesis inhibitors perturb glucocorticoid receptor trafficking. J Steroid Biochem Mol Biol 2011; 126:104-12. [PMID: 21569845 DOI: 10.1016/j.jsbmb.2011.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 04/21/2011] [Accepted: 04/22/2011] [Indexed: 11/17/2022]
Abstract
The ability of inhibitors of transcription and translation to prevent glucocorticoid-induced apoptosis has been interpreted to indicate that the cell death machinery requires de novo protein synthesis. The transcriptional inhibitors actinomycin D (Act D) and DRB as well as the translational inhibitors CHX and puromycin inhibited early loss of mitochondrial membrane integrity in a dose-dependent manner. This effect was not observed with the transcriptional inhibitor α-amanitin suggesting they may have additional effects. Their role in the glucocorticoid receptor (GR) intracellular trafficking was therefore investigated. Here, we show that Act D and CHX reduced glucocorticoid binding, GR turnover and impaired GR nuclear translocation. We performed the same experiments in different thymocyte subpopulations of Balb/c mice. At the highest dose tested, actinomycin D and cycloheximide abolished glucocorticoid-induced cell death of CD4+CD8+ and CD4+CD8-. In all subsets, Act D, DRB, as well as CHX and puromycin prevented receptor nuclear translocation, indicating a general alteration of GR trafficking. Overall, our data support a direct effect of macromolecular inhibitors on GR activation and trafficking. Finally, direct alterations of the functional properties of the glucocorticoid receptor might be responsible for cell death prevention by actinomycin D, DRB, cycloheximide and puromycin.
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9
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Arya V, Issar M, Wang Y, Talton JD, Hochhaus G. Brain permeability of inhaled corticosteroids. J Pharm Pharmacol 2010; 57:1159-67. [PMID: 16105236 DOI: 10.1211/jpp.57.9.0010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
The aim of this study was to evaluate if the permeability of inhaled corticosteroids entering the brain is reduced and if P-glycoprotein (P-gp) transporters are involved. Currently employed inhaled corticosteroids were given intravenously and intratracheally to rats at a dose of 100 μg kg−1. An ex-vivo receptor binding assay was used to monitor over 12 h the glucocorticoid receptor occupancy in the brain and a systemic reference organ (kidney). The involvement of P-gp in the brain permeability of triamcinolone acetonide was assessed in wild-type mice and mdr1a(-/-) knockout mice (mice lacking the gene for expressing P-gp). After both forms of administration, the average brain receptor occupancies were 20–56% of those of the reference organ, with the more lipophilic drugs showing a more pronounced receptor occupation. While the receptor occupancies in the liver of wild-type and mdr1a(-/-) mice were similar after administration of triamcinolone acetonide, brain receptor occupancies in mdr1a(-/-) mice were significantly greater (mdr1a(-/-): 47.6%, 40.2–55.0%, n = 2; wild-type: 11.5±33.0%, n = 3). Penetration into the brain for inhaled corticosteroids (especially those of lower lipophilicity) is reduced. Experiments in mdr1a(-/-) mice confirmed the involvement of P-gp transporters. Further studies are needed to assess whether potential drug interactions at the transporter level are of pharmacological significance.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- Administration, Inhalation
- Adrenal Cortex Hormones/administration & dosage
- Adrenal Cortex Hormones/metabolism
- Adrenal Cortex Hormones/pharmacokinetics
- Androstadienes/pharmacology
- Animals
- Beclomethasone/chemistry
- Beclomethasone/pharmacology
- Brain/drug effects
- Brain/metabolism
- Budesonide/pharmacology
- Dose-Response Relationship, Drug
- Drug Evaluation, Preclinical
- Fluticasone
- Injections, Intravenous
- Intubation, Intratracheal
- Kidney/drug effects
- Liver/drug effects
- Mice
- Mice, Knockout
- Particle Size
- Permeability/drug effects
- Powders
- Prodrugs/pharmacology
- Rats
- Rats, Inbred F344
- Receptors, Steroid/drug effects
- Species Specificity
- Time Factors
- Triamcinolone Acetonide/pharmacology
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Affiliation(s)
- Vikram Arya
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
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10
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Pariante CM. The role of multi-drug resistance p-glycoprotein in glucocorticoid function: studies in animals and relevance in humans. Eur J Pharmacol 2008; 583:263-71. [PMID: 18275949 DOI: 10.1016/j.ejphar.2007.11.067] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Revised: 10/01/2007] [Accepted: 11/07/2007] [Indexed: 01/16/2023]
Abstract
Entry of glucocorticoid hormones into cells is tightly regulated by membrane transporters. One of these transporters, the multi-drug resistance p-glycoprotein, has been extensively described to confer treatment resistance to tumour cells as well as to regulate the intracellular levels of glucocorticoid hormones. Moreover, multi-drug resistance p-glycoprotein is also present on the endothelial cells of the blood-brain-barrier, and in neurones, where it limits the access of glucocorticoids to the brain. Finally, this transporter also has the ability to limit the entry of some antidepressants to the brain, with potential consequences for the clinical therapeutic effects of these drugs. This review will focus on the studies that have used multi-drug resistance p-glycoprotein knockout animals in such context, and will discuss the potential clinical relevance of these transporters for psychiatric disorders. In particular, we will discuss the reciprocal interactions between this transporter and antidepressants, both as its inhibitors and as its substrates. We believe that the interaction between antidepressants and multi-drug resistance p-glycoprotein is one of the most potentially exciting developments in psychopharmacological research.
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Affiliation(s)
- Carmine M Pariante
- Section and Laboratory of Stress, Psychiatry and Immunology (SPI-Lab), Institute of Psychiatry, Kings College London, United Kingdom.
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11
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Webster JI, Moayeri M, Sternberg EM. Novel repression of the glucocorticoid receptor by anthrax lethal toxin. Ann N Y Acad Sci 2004; 1024:9-23. [PMID: 15265771 DOI: 10.1196/annals.1321.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Death from anthrax has been reported to occur from systemic shock. The lethal toxin (LeTx) is the major effector of anthrax mortality. Although the mechanism of entry of this toxin into cells is well understood, its actions once inside the cell are not as well understood. LeTx is known to cleave and inactivate MAPKKs. We have recently shown that LeTx represses the glucocorticoid receptor (GR) both in vitro and in vivo. This repression is partial and specific, repressing the glucocorticoid, progesterone, and estrogen receptor alpha, but not the mineralocorticoid or estrogen receptor beta. This toxin does not affect GR ligand or DNA binding, and we have suggested that it may function by removing/inactivating one or more of the many cofactors involved in nuclear hormone receptor signaling. Although the precise involvement of this nuclear hormone receptor repression in LeTx toxicity is unknown, examples of blunted HPA axis and glucocorticoid signaling in numerous autoimmune/inflammatory diseases suggest that such repression of critically important receptors could have deleterious effects on health.
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Affiliation(s)
- Jeanette I Webster
- Section on Neuroendocrine Immunology and Behavior, National Institute of Mental Health, NIH, Bethesda, MD 20892-4020, USA
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12
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Pariante CM, Thomas SA, Lovestone S, Makoff A, Kerwin RW. Do antidepressants regulate how cortisol affects the brain? Psychoneuroendocrinology 2004; 29:423-47. [PMID: 14749091 DOI: 10.1016/j.psyneuen.2003.10.009] [Citation(s) in RCA: 153] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the effects of antidepressants on glucocorticoid hormones and their receptors are relevant for the therapeutic action of these drugs, the molecular mechanisms underlying these effects are unclear. Studies in depressed patients, animals and cellular models have demonstrated that antidepressants increase glucocorticoid receptor (GR) and mineralocorticoid receptor (MR) expression and function; this, in turn, is associated with enhanced negative feedback by endogenous glucocorticoids, and thus with reduced resting and stimulated hypothalamic-pituitary-adrenal (HPA) axis activity. In a series of studies conducted over the last few years, we have shown that antidepressants modulate GR function in vitro by inhibiting membrane steroid transporters that regulate the intracellular concentration of glucocorticoids. In this paper, we will review the effects of membrane steroid transporters and antidepressants on corticosteroid receptors. We will then present our unpublished data on GR live microscopy in vitro, showing that ligand-induced translocation of the GR starts within 30 seconds and is completed within minutes. Furthermore, we will present our new data using an in situ brain perfusion model in anaesthetised guinea-pigs, showing that entry of cortisol to the brain of these animals is limited at the blood-brain barrier (BBB). Finally, we will present a comprehensive discussion of our published findings on the effects of chemically unrelated antidepressants on membrane steroid transporters, in mouse fibroblasts and rat cortical neurones. We propose that antidepressants in humans could inhibit steroid transporters localised on the BBB and in neurones, like the multidrug resistance p-glycoprotein, and thus increase the access of cortisol to the brain and the glucocorticoid-mediated negative feedback on the HPA axis. Enhanced cortisol action in the brain might prove to be a successful approach to maximise therapeutic antidepressant effects.
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Affiliation(s)
- Carmine M Pariante
- Institute of Psychiatry, King's College London, 1 Windsor Walk, Denmark Hill, London SE5 8AF, UK.
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Juruena MF, Cleare AJ, Bauer ME, Pariante CM. Molecular mechanisms of glucocorticoid receptor sensitivity and relevance to affective disorders. Acta Neuropsychiatr 2003; 15:354-67. [PMID: 26983771 DOI: 10.1046/j.1601-5215.2003.00051.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Changes in the hypothalamic-pituitary-adrenocortical (HPA) system are characteristic of depression, and in the majority of these patients these result in HPA axis hyperactivity. This is further supported by the reduced sensitivity to the inhibitory effects of the glucocorticoid, dexamethasone (DEX), on the production of adrenocorticotropic hormone (ACTH) and cortisol, during the DEX suppression test and the DEX-corticotropin-releasing hormone (DEX/CRH) test. Because the effects of glucocorticoids are mediated by intracellular receptors including, most notably, the glucocorticoid receptor (GR), several studies have examined the number and/or function of GRs in depressed patients. These studies have consistently demonstrated that GR function is impaired in major depression, resulting in reduced GR-mediated negative feedback on the HPA axis and increased production and secretion of CRH in various brain regions postulated to be involved in the causality of depression. This article summarizes the literature on GR in depression and on the impact of antidepressants on the GR in clinical and preclinical studies, and supports the concept that impaired GR signaling is a key mechanism in the pathogenesis of depression, in the absence of clear evidence of decreased GR expression. The data also indicate that antidepressants have direct effects on the GR, leading to enhanced GR function and increased GR expression. Hypotheses regarding the mechanism of these receptor changes involve non-steroid compounds that regulate GR function via second messenger pathways, such as cytokines and neurotransmitters. Moreover, we present recent evidence suggesting that membrane steroid transporters such as the multidrug resistance (MDR) p-glycoprotein, which regulate access of glucocorticoids to the brain, could be a fundamental target of antidepressant treatment. Research in this field will lead to new insights into the pathophysiology and treatment of affective disorders.
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Affiliation(s)
- Mario F Juruena
- 1Affective Disorders Unit, Federal University of Porto Alegre (FFFCMPA), Department of Psychiatry, Porto Alegre/RS, Brazil
| | - Anthony J Cleare
- 2Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, London, UK
| | - Moisés E Bauer
- 4FABIO and Institute for Biomedical Research, PUCRS, Porto Alegre/RS, Brazil
| | - Carmine M Pariante
- 2Section of Neurobiology of Mood Disorders, Division of Psychological Medicine, Institute of Psychiatry, London, UK
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Pariante CM, Hye A, Williamson R, Makoff A, Lovestone S, Kerwin RW. The antidepressant clomipramine regulates cortisol intracellular concentrations and glucocorticoid receptor expression in fibroblasts and rat primary neurones. Neuropsychopharmacology 2003; 28:1553-61. [PMID: 12784111 DOI: 10.1038/sj.npp.1300195] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Incubation of LMCAT fibroblasts cells with antidepressants potentiates glucocorticoid receptor (GR)-mediated gene transcription in the presence of cortisol, but not of corticosterone. We have suggested that antidepressants do so by inhibiting the LMCAT cells membrane steroid transporter and thus by increasing cortisol intracellular concentrations. We now confirm and extend this model to primary neuronal cultures. Clomipramine, a tricyclic antidepressant, increased the intracellular accumulation of 3H-cortisol, but not 3H-corticosterone, in LMCAT cells (+80%) and primary rat neurones (+20%). The latter finding is the first demonstration that a membrane steroid transporter is present in neurones. Moreover, verapamil, a membrane steroid transporter inhibitor, reduced the effects of clomipramine on the intracellular accumulation of 3H-cortisol in LMCAT cells. Finally, clomipramine also decreased GR expression (whole-cell Western blot) in LMCAT cells (50% reduction) and primary rat neurones (80% reduction). This GR downregulation can explain the reduced GR-mediated gene transcription previously described under experimental conditions that do not elicit the effects on the LMCAT cells steroid transporter. This work further supports the hypothesis that membrane steroid transporters regulating the access of glucocorticoids to the brain in vivo are a fundamental target for antidepressant action.
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Affiliation(s)
- Carmine M Pariante
- Section of Clinical Neuropharmacology, Institute of Psychiatry, King's College London, London, UK.
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Pariante CM, Kim RB, Makoff A, Kerwin RW. Antidepressant fluoxetine enhances glucocorticoid receptor function in vitro by modulating membrane steroid transporters. Br J Pharmacol 2003; 139:1111-8. [PMID: 12871829 PMCID: PMC1573949 DOI: 10.1038/sj.bjp.0705357] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
1. Incubation of LMCAT fibroblast cells with antidepressants potentiates glucocorticoid receptor (GR)-mediated gene transcription in the presence of dexamethasone and cortisol, but not of corticosterone. We have shown that antidepressants do so by inhibiting the LMCAT cell membrane steroid transporter (which is virtually identical to the multidrug resistance P-glycoprotein) and thus by increasing dexamethasone or cortisol intracellular concentrations. However, previous experiments with the antidepressant fluoxetine in the presence of dexamethasone have produced negative results (Pariante et al. (2001). Br. J. Pharmacol., 134, 1335-1343). 2. We have since re-examined the effects of fluoxetine on GR-mediated gene transcription in the presence of dexamethasone. Moreover, we have examined the effects of fluoxetine on GR-mediated gene transcription in the presence of cortisol and corticosterone, and on the intracellular accumulation of radioactive cortisol and corticosterone. Finally, we have examined the effects of fluoxetine on inhibition of P-glycoprotein activity in Caco-2 cells. 3. We now find that fluoxetine (1-10 micro M) enhances GR-mediated gene transcription in the presence of dexamethasone and cortisol (+140-170%), but not of corticosterone, and increases the intracellular accumulation of (3)H-cortisol (+5-15%), but not of (3)H-corticosterone. Moreover, fluoxetine (10 micro M) induces approximately 30% inhibition of PGP activity in Caco-2 cells. 4. Our results show that fluoxetine, like other antidepressants, inhibits membrane steroid transporters.
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Affiliation(s)
- Carmine M Pariante
- Section of Clinical Neuropharmacology, PO 51, Institute of Psychiatry, King's College London, 1 Windsor Walk, Denmark Hill, London, SE5 8AF
- Author for correspondence:
| | - Richard B Kim
- Division of Clinical Pharmacology, Vanderbilt University, Nashville, TN, U.S.A
| | - Andrew Makoff
- Section of Clinical Neuropharmacology, PO 51, Institute of Psychiatry, King's College London, 1 Windsor Walk, Denmark Hill, London, SE5 8AF
| | - Robert W Kerwin
- Section of Clinical Neuropharmacology, PO 51, Institute of Psychiatry, King's College London, 1 Windsor Walk, Denmark Hill, London, SE5 8AF
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Shimada T, Terada A, Yokogawa K, Kaneko H, Nomura M, Kaji K, Kaneko S, Kobayashi KI, Miyamoto KI. Lowered blood concentration of tacrolimus and its recovery with changes in expression of CYP3A and P-glycoprotein after high-dose steroid therapy. Transplantation 2002; 74:1419-24. [PMID: 12451243 DOI: 10.1097/00007890-200211270-00014] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In a living-donor liver transplant patient continuously receiving tacrolimus (FK506), pulse steroid therapy for 3 days caused the blood concentration of FK506 to decrease, followed by a gradual recovery to presteroid levels within 2 weeks. We conducted a study in rats to clarify the mechanism of the changes in the blood concentration of FK506 during and after steroid therapy. METHODS Rats were intraperitoneally treated with a low dose (1 mg/kg per day) or a high dose (75 mg/kg per day) of dexamethasone (DEX) for 4 days and, at 1.5 hours after the last dose, were given FK506 (2 mg/kg) intravenously (IV) or orally (PO). Blood concentrations of FK506 and changes in the expression levels of P-glycoprotein and CYP3A2 in the liver and intestine were monitored. RESULTS In the low-dose DEX group, the blood concentrations of FK506 after PO administration of FK506 were significantly lowered compared with those in the untreated group, while there was no such difference after IV administration. In the high-dose DEX group, the blood concentrations of FK506 after either IV or PO administration were significantly lowered. Consequently, the bioavailability of FK506 was decreased by DEX treatment, and the total clearance was significantly increased by high-dose DEX treatment. The pharmacokinetic parameters gradually recovered within 2 weeks after high-dose DEX treatment. In the high-dose DEX group, the protein levels of P-glycoprotein and CYP3A2 in the liver and intestine increased just after the treatment then decreased to normal levels within 2 weeks. CONCLUSION Our results indicate that the decrease in the blood FK506 concentration caused by high-dose steroid therapy is a consequence of the induction of P-glycoprotein and CYP3A in the liver and intestine, and these changes were reversed within 2 weeks after cessation of steroid therapy.
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Affiliation(s)
- Tsutomu Shimada
- Department of Hospital Pharmacy, School of Medicine, Kanazawa University, Kanazawa, Japan
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Webster JI, Carlstedt-Duke J. Involvement of multidrug resistance proteins (MDR) in the modulation of glucocorticoid response. J Steroid Biochem Mol Biol 2002; 82:277-88. [PMID: 12589934 DOI: 10.1016/s0960-0760(02)00227-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Glucocorticoid resistance is a problem in the treatment of many diseases. One possible factor involved in the modulation of a glucocorticoid response is the export of glucocorticoids out of the cell. It has been shown that multidrug resistance protein 1 (MDR1, ABCB1), a member of the ABC family, is capable of transporting some glucocorticoids. This paper uses a mouse cell line, LMCAT in which the glucocorticoid response can be modulated by inhibitors of multidrug resistance proteins. Glucocorticoids fall into three categories. Firstly, those that are transported by an Abcb1a/Abcb1b transporter and whose transport can be inhibited by inhibitors of ABCB1 activity. Functional Abcb1a/Abcb1b was detected by inhibition of rhodamine efflux by these drugs and mRNA for Abcb1a and Abcb1b were detected in these cells. Secondly, those that are not transported. Finally, those that are transported by an Abcc1a transporter. Calcein transport out of these cells was blocked by treatment with probenecid indicating a functional Abcc1a transporter. Abcc1a mRNA was also detected in these cells. Thus, this paper provides insight into the mechanisms of glucocorticoid transport in cells and demonstrates a diversity of two independent mechanisms of transport of glucocorticoids by Abcb1a/Abcb1b and Abcc1a with individual patterns of steroid specificity.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- ATP Binding Cassette Transporter, Subfamily B, Member 1/genetics
- ATP Binding Cassette Transporter, Subfamily B, Member 1/metabolism
- ATP-Binding Cassette Transporters/genetics
- ATP-Binding Cassette Transporters/metabolism
- Animals
- Biological Transport
- Cells, Cultured/drug effects
- Cells, Cultured/metabolism
- Chloramphenicol O-Acetyltransferase/metabolism
- DNA Primers/chemistry
- Dexamethasone/pharmacology
- Drug Resistance, Multiple
- Fluoresceins/metabolism
- Glucocorticoids/pharmacology
- Mice
- Multidrug Resistance-Associated Proteins/genetics
- Multidrug Resistance-Associated Proteins/metabolism
- Probenecid/pharmacology
- Promoter Regions, Genetic
- Reverse Transcriptase Polymerase Chain Reaction
- Rhodamines/metabolism
- Transcriptional Activation/drug effects
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Affiliation(s)
- Jeanette I Webster
- Department of Medical Nutrition, Karolinska Institute, Novum, Huddinge Hospital, Sweden.
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Abstract
A reciprocal regulation exists between the central nervous and immune systems through which the CNS signals the immune system via hormonal and neuronal pathways and the immune system signals the CNS through cytokines. The primary hormonal pathway by which the CNS regulates the immune system is the hypothalamic-pituitary-adrenal axis, through the hormones of the neuroendocrine stress response. The sympathetic nervous system regulates the function of the immune system primarily via adrenergic neurotransmitters released through neuronal routes. Neuroendocrine regulation of immune function is essential for survival during stress or infection and to modulate immune responses in inflammatory disease. Glucocorticoids are the main effector end point of this neuroendocrine system and, through the glucocorticoid receptor, have multiple effects on immune cells and molecules. This review focuses on the regulation of the immune response via the neuroendocrine system. Particular details are presented on the effects of interruptions of this regulatory loop at multiple levels in predisposition and expression of immune diseases and on mechanisms of glucocorticoid effects on immune cells and molecules.
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Affiliation(s)
- Jeanette I Webster
- Section on Neuroimmune Immunology and Behavior, National Institute of Mental Health, Bldg 36, Room 1A 23 (MSC 4020), 36 Convent Drive, Bethesda, Maryland 20892-4020, USA.
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Pariante CM, Makoff A, Lovestone S, Feroli S, Heyden A, Miller AH, Kerwin RW. Antidepressants enhance glucocorticoid receptor function in vitro by modulating the membrane steroid transporters. Br J Pharmacol 2001; 134:1335-43. [PMID: 11704655 PMCID: PMC1573058 DOI: 10.1038/sj.bjp.0704368] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
1. Previous data demonstrate that the tricyclic antidepressant, desipramine, induces glucocorticoid receptor (GR) translocation from the cytoplasm to the nucleus in L929 cells and increases dexamethasone-induced GR-mediated gene transcription in L929 cells stably transfected with the mouse mammary tumour virus-chloramphenicol acetyltransferase (MMTV-CAT) reporter gene (LMCAT cells) (Pariante et al., 1997). 2. To extend these findings, the present study has investigated the effects of 24 h coincubation of LMCAT cells with dexamethasone and amitriptyline, clomipramine, paroxetine, citalopram or fluoxetine. 3. All antidepressants, except fluoxetine, enhanced GR-mediated gene transcription, with clomipramine having the greatest effect (10 fold increase). Twenty-four hours coincubation of cells with desipramine, clomipramine or paroxetine, also enhanced GR function in the presence of cortisol, but not of corticosterone. 4. It is proposed that these effects are due to the antidepressants inhibiting the L929 membrane steroid transporter, which actively extrudes dexamethasone and cortisol from the cell, but not corticosterone. This is further confirmed by the fact that clomipramine failed to enhance GR-mediated gene transcription in the presence of dexamethasone when the membrane steroid transporter was blocked by verapamil. 5. The membrane steroid transporters that regulate access of glucocorticoids to the brain in vivo, like the multiple drug resistance p-glycoprotein, could be a fundamental target for antidepressant action.
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Affiliation(s)
- C M Pariante
- Section of Clinical Neuropharmacology, Institute of Psychiatry, King's College London, London SE5 8AF.
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Abstract
There is a clear role for mechanisms that modulate glucocorticoid receptor (GR) function. The non-steroid-binding GRbeta isoform has been proposed to play a role in this modulation but the published data are contradictory. The relative levels of this isoform appear to be low. Alternative mechanisms for the modulation of glucocorticoid action are described and contrasted with the proposed role for GRbeta.
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