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Hill M, Pařízek A, Šimják P, Koucký M, Anderlová K, Krejčí H, Vejražková D, Ondřejíková L, Černý A, Kancheva R. Steroids, steroid associated substances and gestational diabetes mellitus. Physiol Res 2021; 70:S617-S634. [DOI: 10.33549/physiolres.934794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As gestational diabetes mellitus (GDM) is both a frequent and serious complication, steroid levels in pregnancy are extremely elevated and their role in pregnancy is crucial, this review focuses on the role of steroids and related substances in the GDM pathophysiology. Low SHBG levels are associated with insulin resistance and hyperinsulinemia, while also predicting a predisposition to GDM. Other relevant agents are placental hormones such as kisspeptin and CRH, playing also an important role beyond pregnancy, but which are synthesized here in smaller amounts in the hypothalamus. These hormones affect both the course of pregnancy as well as the synthesis of pregnancy steroids and may also be involved in the GDM pathophysiology. Steroids, whose biosynthesis is mainly provided by the fetal adrenal glands, placenta, maternal adrenal glands, and both maternal and fetal livers, are also synthesized in limited amounts directly in the pancreas and may influence the development of GDM. These substances involve the sulfated Δ5 steroids primarily acting via modulating different ion channels and influencing the development of GDM in different directions, mostly diabetogenic progesterone and predominantly anti-diabetic estradiol acting both in genomic and non-genomic way, androgens associated with IR and hyperinsulinemia, neuroactive steroids affecting the pituitary functioning, and cortisol whose production is stimulated by CRH but which suppresses its pro-inflammatory effects. Due to the complex actions of steroids, studies assessing their predominant effect and studies assessing their predictive values for estimating predisposition to GDM are needed.
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Hill M, Pařízek A, Šimják P, Koucký M, Anderlová K, Krejčí H, Vejražková D, Ondřejíková L, Černý A, Kancheva R. Steroids, steroid associated substances and gestational diabetes mellitus. Physiol Res 2021. [DOI: 10.33549//physiolres.934794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
As gestational diabetes mellitus (GDM) is both a frequent and serious complication, steroid levels in pregnancy are extremely elevated and their role in pregnancy is crucial, this review focuses on the role of steroids and related substances in the GDM pathophysiology. Low SHBG levels are associated with insulin resistance and hyperinsulinemia, while also predicting a predisposition to GDM. Other relevant agents are placental hormones such as kisspeptin and CRH, playing also an important role beyond pregnancy, but which are synthesized here in smaller amounts in the hypothalamus. These hormones affect both the course of pregnancy as well as the synthesis of pregnancy steroids and may also be involved in the GDM pathophysiology. Steroids, whose biosynthesis is mainly provided by the fetal adrenal glands, placenta, maternal adrenal glands, and both maternal and fetal livers, are also synthesized in limited amounts directly in the pancreas and may influence the development of GDM. These substances involve the sulfated Δ5 steroids primarily acting via modulating different ion channels and influencing the development of GDM in different directions, mostly diabetogenic progesterone and predominantly anti-diabetic estradiol acting both in genomic and non-genomic way, androgens associated with IR and hyperinsulinemia, neuroactive steroids affecting the pituitary functioning, and cortisol whose production is stimulated by CRH but which suppresses its pro-inflammatory effects. Due to the complex actions of steroids, studies assessing their predominant effect and studies assessing their predictive values for estimating predisposition to GDM are needed.
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Affiliation(s)
- M Hill
- Institute of Endocrinology, Prague, Czech Republic.
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Ondřejíková L, Pařízek A, Šimják P, Vejražková D, Velíková M, Anderlová K, Vosátková M, Krejčí H, Koucký M, Kancheva R, Dušková M, Vaňková M, Bulant J, Hill M. Altered Steroidome in Women with Gestational Diabetes Mellitus: Focus on Neuroactive and Immunomodulatory Steroids from the 24th Week of Pregnancy to Labor. Biomolecules 2021; 11:biom11121746. [PMID: 34944390 PMCID: PMC8698588 DOI: 10.3390/biom11121746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/12/2021] [Accepted: 11/20/2021] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a complication in pregnancy, but studies focused on the steroidome in patients with GDM are not available in the public domain. This article evaluates the steroidome in GDM+ and GDM- women and its changes from 24 weeks (± of gestation) to labor. The study included GDM+ (n = 44) and GDM- women (n = 33), in weeks 24-28, 30-36 of gestation and at labor and mixed umbilical blood after delivery. Steroidomic data (101 steroids quantified by GC-MS/MS) support the concept that the increasing diabetogenic effects with the approaching term are associated with mounting progesterone levels. The GDM+ group showed lower levels of testosterone (due to reduced AKR1C3 activity), estradiol (due to a shift from the HSD17B1 towards HSD17B2 activity), 7-oxygenated androgens (competing with cortisone for HSD11B1 and shifting the balance from diabetogenic cortisol towards the inactive cortisone), reduced activities of SRD5As, and CYP17A1 in the hydroxylase but higher CYP17A1 activity in the lyase step. With the approaching term, the authors found rising activities of CYP3A7, AKR1C1, CYP17A1 in its hydroxylase step, but a decline in its lyase step, rising conjugation of neuroinhibitory and pregnancy-stabilizing steroids and weakening AKR1D1 activity.
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Affiliation(s)
- Leona Ondřejíková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Antonín Pařízek
- Department of Gynecology and Obstetrics, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (A.P.); (P.Š.); (K.A.); (H.K.); (M.K.)
| | - Patrik Šimják
- Department of Gynecology and Obstetrics, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (A.P.); (P.Š.); (K.A.); (H.K.); (M.K.)
| | - Daniela Vejražková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Marta Velíková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Kateřina Anderlová
- Department of Gynecology and Obstetrics, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (A.P.); (P.Š.); (K.A.); (H.K.); (M.K.)
| | - Michala Vosátková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Hana Krejčí
- Department of Gynecology and Obstetrics, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (A.P.); (P.Š.); (K.A.); (H.K.); (M.K.)
| | - Michal Koucký
- Department of Gynecology and Obstetrics, First Faculty of Medicine, General University Hospital in Prague, Charles University in Prague, 128 08 Prague, Czech Republic; (A.P.); (P.Š.); (K.A.); (H.K.); (M.K.)
| | - Radmila Kancheva
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Michaela Dušková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Markéta Vaňková
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Josef Bulant
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
| | - Martin Hill
- Institute of Endocrinology, 116 94 Prague, Czech Republic; (L.O.); (D.V.); (M.V.); (M.V.); (R.K.); (M.D.); (M.V.); (J.B.)
- Correspondence: ; Tel.: +420-224-905-246
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Abstract
Ageing is accompanied by deterioration in physical condition and a number of physiological processes and thus a higher risk of a range of diseases and disorders. In particular, we focused on the changes associated with aging, especially the role of small molecules, their role in physiological and pathophysiological processes and potential treatment options. Our previously published results and data from other authors lead to the conclusion that these unwanted changes are mainly linked to the hypothalamic-pituitary-adrenal axis can be slowed down, stopped, or in some cases even reversed by an appropriate treatment, but especially by a life-management adjustment.
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Affiliation(s)
- M Hill
- Department of Steroids and Proteohormones, Institute of Endocrinology, Prague, Czech Republic.
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