Potentiation of glucocorticoid activity by 5 beta-dihydrocortisol: its role in glaucoma.

5 beta-Dihydrocortisol potentiated the threshold level (the smallest dose producing a measurable effect) of topically applied cortisol (0.02 percent) and dexamethasone (0.003 percent) in causing nuclear translocation of the cytosolic glucocorticoid receptor in rabbit iris-ciliary body tissue. 5 beta-Dihydrocortisol accumulates in cells cultured from trabecular meshwork specimens from patients with primary open-angle glaucoma, but not in similar cells derived from nonglaucomatous patients. In view of the sensitivity of patients with primary open-angle glaucoma to the effects of glucocorticoids in raising intraocular pressure, this potentiation may be responsible for the steroid sensitivity and for the ocular hypertension seen in this disorder.

Prolonged ethanol consumption increases testosterone metabolism in the liver.

Male alcoholics often suffer from features of hypogonadism related to abnormal metabolism of sex steroids. Since the activity of testosterone reductases is rate limiting for testosterone metabolism in the liver, the effect of prolonged ethanol consumption by rats and human volunteers on the activities of these microsomal and cytosolic enzymes was studied. In rats, long-term ethanol ingestion doubled microsomal 5alpha-testosterone reductase activity, a major pathway for testosterone metabolism, while in human volunteers the activity was increased two- to fivefold. These changes may play a role in the altered androgenic activity of the chronic alcoholic.

Receptors for glucocorticoids in the lens epithelium of the calf.

The calf lens epithelium contains a specific cytoplasmic receptor for glucocorticoids. This binding protein has a high affinity for dexamethasone (average dissociation constant, 8 x 10(-9) mole per liter), a low capacity (average, 550 femtomoles per milligram of protein), extreme heat sensitivity, and exhibits a pattern of competition similar to that of glucocorticoid receptors in other tissues. This provides direct biochemical evidence that these tissues may function as a target organ for glucocorticoids.

Sixteen-week dose-intense chemotherapy in the adjuvant treatment of breast cancer.

Fifty-three women with breast cancer were treated with a new 16-week dose-intense, chemotherapy regimen. Patients with operable breast cancer with 10 or more histologically positive axillary nodes were treated with this five-drug regimen that incorporated the concepts of weekly chemotherapy, sequential administration of antimetabolites, and continuous infusion of fluorouracil (5-FU). The chemotherapy regimen consisted of eight cycles (each of 2 wk duration) of 100 mg of cyclophosphamide/m2 orally on days 1-7, 40 mg of doxorubicin/m2 intravenous (IV) on day 1, 100 mg of methotrexate/m2 IV on day 1 with 10 mg of leucovorin rescue/m2 every 6 hours for six oral doses on day 2, 1 mg of vincristine IV on day 1, and 600 mg of 5-FU/m2 IV at hour 20 over 2 hours. A continuous infusion of 300 mg of 5-FU/m2 per day was given IV on days 8-9 of each 2-week cycle. The doses and schedule of drug administration were designed to minimize dosage reduction and treatment delay. At a median follow-up of 17 months, there have been eight relapses in the 53 patients. The actuarial 3-year disease-free survival is 80% (95% confidence interval, 62% to 90%). The major side effects were attributable to myelosuppression. Absolute neutrophil counts less than 250/microL were noted in 12 (23%) patients; seven patients (13%) required hospitalization for management of neutropenic fever. No treatment-related deaths occurred. Ninety-four percent of the planned doses were administered, and only 5% of the courses were delayed because of toxic reactions. The encouraging therapeutic data, manageable side effects, and our ability to deliver over 90% of the planned doses provide the rationale for a phase III comparison of this new dose-intense regimen and standard chemotherapy in patients with operable disease and positive axillary nodes.

Effect of chronic alcohol ingestion on the biosynthesis of steroids in rat testicular homogenate in vitro.

The activity and kinetics of delta 5-3 beta-dehydrogenase and 17 alpha-hydroxylase, using labeled pregnenolone as substrate, were measured in gonadal homogenates from rats fed alcohol or isocalorically substituted carbohydrate for 40 days. There was no difference in the rate or reaction kinetics for either enzyme noted between control and alcohol-treated animals when the assays were carried out in the presence of saturating amounts of exogenous pyridine nucleotide cofactors. However, when exogenous cofactors were omitted from the reaction mixture, there was decreased activity of the delta 5-3 beta-dehydrogenase system and increased activity of the 17 alpha-hydroxylase reaction. Furthermore, a cofactor-specific inhibiting effect on delta 5-3 beta-dehydrogenase activity by NADH and NADPH was found. Incubation of gonadal homogenates from the alcohol-treated animals with pyruvate on lactate (in the absence of exogenous cofactors) resulted in an increase and a decrease, respectively, in enzyme activity. These studies indicate that chronic alcohol use decreases gonadal delta 5-3 beta-dehydrogenase activity and that this is most likely due to an effect of the agent on the concentration and/or availability of pyridine nucleotide cofactors rather than to a direct effect on the enzyme. This phenomenon may account for the mechanism by which alcohol decreases testosterone secretion in these animals.

Specific 5 alpha-dihydrotestosterone receptors in human gingiva.

The cytoplasm of normal human male and female gingiva contains a receptor capable of specifically binding 5 alpha-dihydrotestosterone (DHT). This binding has a high affinity for DHT (Kd, approximately 2.2 x 10-9 M) and a low capacity (approximately 190 fmol/mg protein). The binding is extremely heat sensitive and exhibits a pattern of competition similar to that obtained with DHT receptors from other target tissues. The demonstration of a specific DHT receptor in human gingiva provides the first direct biochemical evidence that this tissue may function as a target organ for androgens. There was no correlation between the Kd in normal tissue and gingival hyperplasia or between the Kd or number of binding sites and the age or sex of the patient. However, there sites and the age or sex of the patient. However, there was a significant difference (P less than 0.0005) between the amount of DHT-binding sites per mg protein in normal tissue as compared to gingival hyperplasia (drugs or pregnancy).

Conversion of androgens to estrogens in cirrhosis of the liver.

The contribution, by peripheral conversion, of androstenedione and testosterone to the circulating estrogens was determined in men with cirrhosis of the liver. The conversion ratio of androstenedione to estrone, estradiol and testosterone and the conversion ratio of testosterone to estrone (but not estradiol) and androstenedione were significantly increased. The plasma concentrations of androstenedione and testosterone were increased and decreased respectively; the mean plasma concentration of androstenedione being similar to that found in normal women. The metabolic clearance rate of androstenedione was not altered in cirrhosis although the metabolic clearance rate of testosterone was decreased. The production rate of androstenedione was elevated while that of testosterone was reduced. The instantaneous contribution of plasma androstenedione to estrone and estradiol was increased in cirrhosis as was the contribution of testosterone to estrone (but not to estradiol). Thus the increased estradiol levels in cirrhosis result, in large part, from increased peripheral conversion from the androgens. The percent contribution of plasma testosterone to plasma androstenedione was decreased although the absolute amount derived by conversion was normal. The percent contribution of plasma androstenedione to plasma testosterone was increased sevenfold in cirrhosis. The fraction of the daily androstenedione production derived from the plasma testosterone pool was not significantly altered. However, a significant fraction of the daily production rate of testosterone was derived from androstenedione. Thus, 15% of the circulating testosterone is not secreted but is derived by peripheral conversion from androstenedione. Normal levels of gonadotropins were found in cirrhosis.

Vitamin A treatment of sexual dysfunction in male alcoholics.

Thirty abstinent male alcoholics with sexual dysfunction were randomized to treatment with 3 mg RE (10,000 IU) vitamin A or placebo daily for 4 mo. Age, drinking history, period of abstinence before enrollment, and base-line laboratory indices were comparable in both groups at entry. Of the 15 subjects given placebo, 13 had a partial or full recovery of sexual functioning. By contrast, of those given vitamin A, 10 had a partial response. There were no complete responders. Six subjects (1 placebo, 5 vitamin A) who developed liver abnormalities during treatment underwent liver biopsies; five had fibrosis or cirrhosis. A significant decrease in luteinizing hormone was noted in the group given vitamin A compared with the placebo-treated group. Thus vitamin A therapy did not improve sexual functioning in male alcoholics and may have been associated with toxicity.

Defects in cortisol-metabolizing enzymes in primary open-angle glaucoma.

Assays of cortisol-metabolizing enzymes in homogenates of human trabecular meshwork cells under optimal conditions revealed two defects in primary open-angle glaucoma (POAG): one is a marked increase in delta 4-reductase and the other is a decrease in 3-oxidoreductase. Experiments indicated that the differences in enzyme activities seen between POAG and nonPOAG trabecular meshwork derived cell homogenates were due to altered amounts of enzymes rather than to alterations in cofactor availability, pH, or endogenous activators or inhibitors. This clearly demonstrates an enzymatic defect(s) in POAG which may be the basis for the ocular hypertension and sensitivity to exogenous glucocorticoids seen in this disorder.

Intraocular hypotensive effect of a topically applied cortisol metabolite: 3 alpha, 5 beta-tetrahydrocortisol.

3 alpha, 5 beta-tetrahydrocortisol, previously considered an inactive metabolite of cortisol, was found to lower significantly the intraocular pressure (IOP) of rabbits made ocular hypertensive with dexamethasone alone or with threshold levels of dexamethasone plus 5 beta-dihydrocortisol. The ocular hypotensive effect appeared within 3-7 days after the metabolite was started and persisted through the duration of the experiments. The metabolite did not lower the IOP of ocular normotensive untreated animals. Thus, 3 alpha,5 beta-tetrahydrocortisol is a naturally occurring steroid antagonist, which may be of use in the treatment of primary open-angle glaucoma.

Potentiation of collagen synthesis in explants of the rabbit eye by 5 beta-dihydrocortisol.

The biologic effect of 5 beta-dihydrocortisol on collagen synthesis was evaluated. The metabolite was found to potentiate subthreshold levels of dexamethasone in increasing 3H-proline incorporation in cells of the outflow region of the rabbit. Digestion of the tissue with highly purified collagenase indicated that the 3H-proline was incorporated into collagen type protein. This study demonstrates another biologic activity of 5 beta-dihydrocortisol, a metabolite found to accumulate in cells cultured from trabeculectomy specimens from patients with primary open angle glaucoma.

Nuclear translocation of the cytoplasmic glucocorticoid receptor in the iris--ciliary body of the rabbit.

The cytoplasmic glucocorticoid receptor of the iris--ciliary body of the rabbit has been shown to translocate to the cell nucleus within 30 min of an injection of cortisol. Over the next 2 1/2 hr the amount of receptor returns to the control value. The threshold of the loss of receptor from the cytosol was found at 0.04 mg of cortisol per kilogram body weight, with a maximal loss being reached at a cortisol dose of 0.5 mg/kg B.W. The inactive glucocorticoid tetrahydrocortisol and the major sex steroids, dihydrotestosterone, estradiol, and progesterone, had little or no effect on this translocation, indicating the specificity of the cortisol effect. Thus this receptor appears to migrate to the cell nucleus in a manner similar to that found in other steroid-sensitive tissues and is consistent with the accepted mechanism whereby these hormones regulate differential gene expression in the nucleus.

Human trabecular meshwork cells in culture: morphology and extracellular matrix components.

This study demonstrates the presence of laminin and collagen type IV in the extracellular space of human trabecular meshwork (HTM) cells in culture and its absence in cultures of fibroblasts from sclera adjacent to the outflow pathway. These basement membrane components can be detected by standard immunohistochemical techniques. Positive staining for these macromolecules is found only after the HTM cells have reached confluence. The presence of laminin and human collagen type IV in the early passages can serve as additional criteria for identification of HTM cells in culture. These cells provide a useful experimental system for studying the effects of drugs and other factors on the synthesis of components of the extracellular matrix.

Specific glucocorticoid receptor in the iris--ciliary body of the rabbit.

The cytoplasm of the iris--ciliary body of the rabbit contains a receptor capable of specifically binding dexamethasone. This binding protein has a high affinity for dexamethasone (average KD = 2.0 X 10(-8) M), a low capacity (average 4.8 X 10(-13) mol of steroid bound per milligram of protein), and extreme heat sensitivity; it exhibits a pattern of competition virtually identical to that obtained with glucocorticoid receptors from other tissues and shows characteristic physicochemical behavior in various salt concentrations. The demonstration of a specific dexamethasone receptor in the iris--ciliary body provides the first direct biochemical evidence that these tissues may function as a target organ for glucocorticoids.

The effect of dexamethasone on the synthesis of collagen in normal human trabecular meshwork explants.

This study demonstrates that the trabecular meshwork cells of the human eye incorporate 3H-Proline into collagen during in vitro incubation. Addition of dexamethasone to the incubation mixture produced a marked decrease in this incorporation. Dexamethasone was active at 10(-8) M and higher concentrations. The specificity of the hormone effect was demonstrated by its inability to alter 3H-leucine incorporation in these cells. These results indicate that dexamethasone decreases the synthesis of collagen, a major component of the extracellular matrix, in the trabecular meshwork.

Altered cortisol metabolism in cells cultured from trabecular meshwork specimens obtained from patients with primary open-angle glaucoma.

Cells cultured from trabecular meshwork specimens obtained from patients with primary open angle glaucoma (TMPOAG cells) exhibited two major differences in cortisol-metabolizing enzymes when compared with similar cells from nonglaucomatous patients. One is a marked increase (greater than 100-fold) in delta 4-reductase activity and the other is a decrease (4-fold) in 3-oxidoreductase activity. Peripheral lymphocytes from one of these patients as well as from five additional patients with POAG, did not show these abnormalities, indicating that the defects are not found in all cortisol-metabolizing cells. The abnormal metabolism of cortisol by TMPOAG cells may be of significance in the pathogenesis of POAG.

Glucocorticoid localization by radioautography in the rabbit eye following systemic administration of 3H-dexamethasone.

Dexamethasone was localized radioautographically in the nuclei of target cells of the rabbit eye following intravenous administration of the labeled steroid. Specifically bound steroid was found in the nuclei of stromal and endothelial cells of the outflow pathway region. This suggests that the glucocorticoid-induced alteration in outflow facility may be mediated by specific effects in these target cells. Nuclear localization was also found in conjunctiva, iridial smooth muscle, choroidal stroma, retina, and sclera, suggesting a physiologic role for glucocorticoids in these tissues as well.

Corneal-conjunctival uptake of topical 3H-dexamethasone in the rabbit eye.

Topically administered 3H-dexamethasone was localized radioautographically to the nuclei of several cell types in the cornea and conjunctiva. In the cornea, label was found in the epithelium and keratocytes. In the conjunctiva, label was found in the epithelium and in the connective tissue cells and blood vessel endothelial cells of the stroma. Prior administration of a 350-fold excess of nonlabeled hormone completely suppressed this localization, indicating that these cells are specific glucocorticoid target cells. There was no localization found in the corneal endothelium. Accumulation of silver grains between corneal stroma and Descemet's membrane suggests that this membrane acts as a partial barrier to diffusion of the steroid.

Characterization of a glucocorticoid receptor and the direct effect of dexamethasone on herpes simplex virus infection of rabbit corneal cells in culture.

Homogenates prepared from a previously established cell line derived from rabbit cornea contain a macromolecule with many properties of a glucocorticoid receptor, namely high affinity (KD = 6 x 10(-9)M) and saturable capacity (135 femtomoles/mg protein) for dexamethasone, extreme heat lability, and a pattern of competition similar to that found in other glucocorticoid target cells. Intact cells specifically bind dexamethasone with an affinity similar to that found in homogenates, and the amount of steroid bound at saturation is approximately 60,000 molecules of dexamethasone per cell. Specific dexamethasone binding was found to be localized to the cell nucleus. The corneal cells were susceptible to infection with herpes simplex virus (HSV). Dexamethasone increased cell susceptibility to the virus and facilitated the spread of the infection throughout the corneal cell culture. This effect was observed at concentrations of dexamethasone as low as 10(-9) M. Tetrahydrocortisol, an inactive glucocorticoid metabolite that does not compete with dexamethasone binding to the receptor, did not enhance HSV infection at a high concentration (10(-5) M). This study demonstrates a direct effect of dexamethasone on corneal cell-HSV interaction in the absence of exogenous immunologic factors. This effect of dexamethasone may be mediated by the glucocorticoid receptor.

Glucocorticoid receptor binding in bovine lens.

The present study demonstrates glucocorticoid receptor localization in the nuclei of cells of the anterior epithelium and bow region and its absence in all other regions of the lens. Both autoradiographic and biochemical studies show that triamcinolone acetonide is inactive whereas tetrahydrocortisol (previously considered to be an inactive metabolite of cortisol) is an active competitor of dexamethasone binding to the glucocorticoid receptor in the bovine lens. The consistency of these findings by both techniques supports the validity of this observation. In addition, it indicates that autoradiography can be used for studying glucocorticoid agonist/antagonist relationships in the human lens, where only small amounts of tissue are available.