This thesis investigates the biological activity of selected non-steroidal analogues of sex steroid hormones by examining two different effects of analogues on endogenous sex hormone activity. Non-steroidal analogues of sex hormones were synthesised to study their biological interactions with a sex steroid receptor and a sex steroid metabolising enzyme. Chapter One introduces the steroid hormones and their physiology, which leads to a review of the mechanisms by which steroids exert their effects. Their implication in disease is discussed, with particular emphasis on the sex steroids. As the biological activity of steroids is related to their chemical structure, the important features of steroid structure are identified, including the cyclopentanoperhydrophenanthrene nucleus, arrangement of ring substituents and ring junction conformation. The concept of non-steroidal analogues of steroids is introduced, and the harmful or beneficial effects analogues have on endogenous steroid activity are considered. Alteration of steroid activity and its consequences are focussed on two main areas; the potential adverse effects of environmental chemicals which mimic sex steroid activity, and the use of non-steroidal analogues in medicinal chemistry for treating sex steroid related disease. Chapter Two describes an investigation into the 17β-estradiol mimicking activity of non-steroidal analogues. Exogenous chemicals that mimic estradiol are of concern as they may alter endogenous estradiol activity and disrupt endocrine systems. Firstly, an introduction to the field of research concerned with environmental chemicals that mimic steroid hormones is given. The interaction of xenoestrogens with the estrogen receptor is described, as are the methods available for assessing the estrogen mimicking activity of xenoestrogens. The concern for insecticides mimicking estrogen activity is described by reviewing reported activities of insecticides, which leads into a discussion of work carried out as part of this thesis. Metabolites of the pyrethroid insecticides permethrin and cypermethrin, 2.14, 2.15, and 2.16 were synthesised while others were commercially obtained. The interaction of pyrethroid insecticide metabolites with the human estrogen receptor expressed in recombinant yeast (Saccharomyces cerevisiae) was studied, following the establishment and validation of the assay. Metabolites 2.11, 2.12, and 2.14 were found to weakly stimulate estrogen receptor-mediated estradiol responsive gene expression in the yeast assay (105 less active than 17β-estradiol). Since the activity of the metabolites using the yeast assay was greater than for the parent compounds, metabolic pathways need to be considered when assessing the impact of exposure to environmental estrogens. The low estrogenic activity suggests these compounds are not individually contributing significantly to the xenoestrogenic impact on humans, but will add to total xenoestrogen exposure. Chapter Three describes the inhibition of a sex steroid metabolising enzyme, steroid 5a-reductase, by novel non-steroidal compounds. Inhibitors of this enzyme are potentially useful therapeutic agents for regulating the activity of an androgen in prostate disorders. A review of the literature on non-steroidal inhibition of 5a-reductase identified three key structural features known to enhance inhibitor potency; ring substitution, position and nature of ring unsaturation and angular methyl group presence. These features were taken into account in the design of inhibitors synthesised in this thesis (3.55-3.57, 3.59, 3.61, 3.62, 3.110 and 3.111). Inhibitors consisting of non-steroidal 5- or 1-aryl pyridone scaffolds were synthesised to investigate SAR for 4'-substituents. The 5-aryl 1-methyl-2-pyridone/piperidone scaffold of compounds 3.55-3.57 and 3.59 was constructed by Suzuki cross coupling methodology, while the 1-aryl 2-methyl 2,3-dihydro-4-pyridone scaffold of 3.61 and 3.62 was constructed by aza Diels-Alder methodology. Long carbon chain olefin containing tethers 3.107 and 3.108 were synthesised for conjugation to inhibitor 3.57 by cross metathesis to give conjugates 3.110 and 3.111. Compounds 3.55-3.57, 3.59, 3.61, 3.62, 3.110 and 3.111 inhibited the type 1 5a-reductase isozyme expressed by HEK-I cells, with activities comparable to those of related literature compounds. The 1-aryl 2,3-dihydro-4-pyridone 3.62 inhibited both the type 1 and 2 isozymes (expressed by HEK-II cells) of 5a-reductase. The presence of bulky hydrophobic groups (benzoyl, long chain tethers) at the 4' position enhanced the potency of type 1 inhibition by 5-aryl pyridone type compounds in comparison to N,N-diisopropyl- and N-allylacetamide groups. This information provides further understanding of SAR within and across different classes of non-steroidal inhibitors of steroid 5a-reductase towards improved drug design.

Dehydroepiandrosteron wirkt hauptsächlich indirekt über nachfolgende Umwandlung in Androgene und Östrogene sowie deren Zwischenprodukte in den peripheren Zielzellen, respektive Immunzellen. In vitro Versuche erbrachten den Nachweis von gesteigerter Interleukin-2 Sekretion durch T-Lymphozyten nach Gabe von DHEA, wohingegen es zu einer Inhibierung der Interleukin-6 Sekretion kam. Dementgegen wird im Altersprozess ein Abfall von DHEA und Interleukin-2 beobachtet bei gleichzeitigem Anstieg von Interleukin-6. Diese Arbeit beschäftigt sich mit der Frage, in wieweit humane periphere mononukleäre Blutzellen (PBMCs) über Expression und funktionale Aktivität der im DHEA-Downstream-Metabolismus essentiellen Enzyme verfügen und ob es alters- bzw. geschlechtsspezifische Unterschiede gibt. Die Studie wurde an 8 gesunden jüngeren Frauen sowie 8 gesunden jüngeren und 8 gesunden älteren Männern durchgeführt. Zur Bestimmung der mRNA-Expression der im DHEA-Downstreammetabolismus notwendigen Steroidenzyme in humanen PBMCs wurden qualitative, semiquantitative und quantitative RT-PCR Analysen sowie PBMC-Enzymfunktionsassays durchgeführt. Hierbei wurden PBMCs mit radioaktiv markiertem 4-14C-Testosteron, 4-14C-Androstendion bzw. 4-14C-DHEA inkubiert, extrahiert und mittels Dünnschichtchromatographie separiert. Die anschließende quantitative Auswertung der Konversionsprodukte erfolgte durch Phosphorimager-Analyse. Zusammenfassend lässt sich aussagen, dass humane periphere mononukleäre Blutzellen (PBMCs) ausgehend von DHEA über alle notwendigen Steroidenzyme für einen effizienten Downstreammetabolismus zu aktiven Androgenen verfügen. Dies konnte sowohl durch den qualitativen und quantitativen Nachweis von mRNA der betreffenden Enzyme als auch durch die nachgewiesene Aktivität in PBMC-Enzymfunktionsassays bestätigt werden. Dabei zeigten sich signifikante alters- und geschlechtsspezifische Veränderungen im Androgenmetabolismus. Insbesondere konnte eine erhöhte 17beta-HSD5-Aktivität und -Expression in der älteren männlichen und weiblichen Probandengruppe im Vergleich zur jüngeren männlichen nachgewiesen werden, was sich in signifikant höheren Konversionsraten von DHEA zu Androstenediol und Androstenedion zu Testosteron widerspiegelte. Ebenso konnte eine signifikant erhöhte 5alpha-Reduktase-Aktivität in der älteren männlichen Probandengruppe im Vergleich zur jüngeren männlichen aufgezeigt werden. Dementgegen waren die Konversionsraten von DHEA zu Androstenedion via 3beta-Aktivität unter den einzelnen Probandengruppen ähnlich. Die vermehrte Konversion von DHEA zum immunmodulatorisch wirksamen Metabolit Androstendiol sowie von Androstendion zu Testosteron entspricht einer vermehrten Androgenaktivierung. Dieses Hochregulieren könnte einen kompensatorischen Mechanismus der peripheren Zielzelle darstellen, dem sinkenden DHEA-Serumspiegel während des Alterungsprozesses entgegenzuwirken und kann einen endokrinen Hinweis auf eine „Immunseneszenz“ geben. / CONTEXT: Dehydroepiandrosterone (DHEA) mainly exerts indirect action via downstream conversion toward sex steroids within peripheral target cells including immune cells. In vitro DHEA has been shown to enhance IL-2 release from T lymphocytes, whereas it inhibits IL-6 secretion. Conversely, aging is associated with a decline in both DHEA and IL-2, whereas IL-6 increases. OBJECTIVE: The objective of the study was to investigate age and sex-related differences in expression and functional activity of steroidogenic enzymes involved in downstream conversion of DHEA in peripheral blood mononuclear cells (PBMCs). DESIGN: This study was cross-sectional. PARTICIPANTS/SETTING: Healthy young men (n = 8) and women (n = 8) and healthy middle-aged men (n = 8) were studied in an academic setting. MEASURES: mRNA expression of steroidogenic enzymes in PBMCs was measured by qualitative and quantitative RT-PCR analysis and enzyme activity assays after incubation of PBMCs with radiolabeled DHEA, 4-androstene-3,17-dione (androstenedione), and testosterone. RESULTS: RT-PCR analysis showed expression of all enzymes required for DHEA conversion toward active androgens and to the immune-stimulatory metabolite androstenediol. Steroid conversion patterns indicated a particularly increased activity of 17beta-hydroxysteroid dehydrogenase type 5 (17beta-HSD5) in the older men and young women demonstrated by significantly higher conversion rates of DHEA to androstenediol and of androstenedione to testosterone (all P < 0.05). By contrast, conversion of DHEA to androstenedione via 3beta-HSD occurred at a similar rate. Quantitative RT-PCR analysis revealed increased expression of 17beta-HSD 5 mRNA in PBMCs from the older men. CONCLUSIONS: Our results provide evidence for significant changes in sex steroid metabolism by human PBMCs with aging, which may represent an endocrine link to immune senescence.

This thesis investigates the biological activity of selected non-steroidal analogues of sex steroid hormones by examining two different effects of analogues on endogenous sex hormone activity. Non-steroidal analogues of sex hormones were synthesised to study their biological interactions with a sex steroid receptor and a sex steroid metabolising enzyme. Chapter One introduces the steroid hormones and their physiology, which leads to a review of the mechanisms by which steroids exert their effects. Their implication in disease is discussed, with particular emphasis on the sex steroids. As the biological activity of steroids is related to their chemical structure, the important features of steroid structure are identified, including the cyclopentanoperhydrophenanthrene nucleus, arrangement of ring substituents and ring junction conformation. The concept of non-steroidal analogues of steroids is introduced, and the harmful or beneficial effects analogues have on endogenous steroid activity are considered. Alteration of steroid activity and its consequences are focussed on two main areas; the potential adverse effects of environmental chemicals which mimic sex steroid activity, and the use of non-steroidal analogues in medicinal chemistry for treating sex steroid related disease. Chapter Two describes an investigation into the 17β-estradiol mimicking activity of non-steroidal analogues. Exogenous chemicals that mimic estradiol are of concern as they may alter endogenous estradiol activity and disrupt endocrine systems. Firstly, an introduction to the field of research concerned with environmental chemicals that mimic steroid hormones is given. The interaction of xenoestrogens with the estrogen receptor is described, as are the methods available for assessing the estrogen mimicking activity of xenoestrogens. The concern for insecticides mimicking estrogen activity is described by reviewing reported activities of insecticides, which leads into a discussion of work carried out as part of this thesis. Metabolites of the pyrethroid insecticides permethrin and cypermethrin, 2.14, 2.15, and 2.16 were synthesised while others were commercially obtained. The interaction of pyrethroid insecticide metabolites with the human estrogen receptor expressed in recombinant yeast (Saccharomyces cerevisiae) was studied, following the establishment and validation of the assay. Metabolites 2.11, 2.12, and 2.14 were found to weakly stimulate estrogen receptor-mediated estradiol responsive gene expression in the yeast assay (105 less active than 17β-estradiol). Since the activity of the metabolites using the yeast assay was greater than for the parent compounds, metabolic pathways need to be considered when assessing the impact of exposure to environmental estrogens. The low estrogenic activity suggests these compounds are not individually contributing significantly to the xenoestrogenic impact on humans, but will add to total xenoestrogen exposure. Chapter Three describes the inhibition of a sex steroid metabolising enzyme, steroid 5a-reductase, by novel non-steroidal compounds. Inhibitors of this enzyme are potentially useful therapeutic agents for regulating the activity of an androgen in prostate disorders. A review of the literature on non-steroidal inhibition of 5a-reductase identified three key structural features known to enhance inhibitor potency; ring substitution, position and nature of ring unsaturation and angular methyl group presence. These features were taken into account in the design of inhibitors synthesised in this thesis (3.55-3.57, 3.59, 3.61, 3.62, 3.110 and 3.111). Inhibitors consisting of non-steroidal 5- or 1-aryl pyridone scaffolds were synthesised to investigate SAR for 4'-substituents. The 5-aryl 1-methyl-2-pyridone/piperidone scaffold of compounds 3.55-3.57 and 3.59 was constructed by Suzuki cross coupling methodology, while the 1-aryl 2-methyl 2,3-dihydro-4-pyridone scaffold of 3.61 and 3.62 was constructed by aza Diels-Alder methodology. Long carbon chain olefin containing tethers 3.107 and 3.108 were synthesised for conjugation to inhibitor 3.57 by cross metathesis to give conjugates 3.110 and 3.111. Compounds 3.55-3.57, 3.59, 3.61, 3.62, 3.110 and 3.111 inhibited the type 1 5a-reductase isozyme expressed by HEK-I cells, with activities comparable to those of related literature compounds. The 1-aryl 2,3-dihydro-4-pyridone 3.62 inhibited both the type 1 and 2 isozymes (expressed by HEK-II cells) of 5a-reductase. The presence of bulky hydrophobic groups (benzoyl, long chain tethers) at the 4' position enhanced the potency of type 1 inhibition by 5-aryl pyridone type compounds in comparison to N,N-diisopropyl- and N-allylacetamide groups. This information provides further understanding of SAR within and across different classes of non-steroidal inhibitors of steroid 5a-reductase towards improved drug design.

Thesis (M.S.) -- University of Texas Southwestern Medical Center at Dallas, 2005. / Embargoed. Vita. Bibliography: 33-36.

Prostate cancer is the second most commonly occurring cancer in men in the United States. Generally, an extended period of time is needed for a mutation to develop into a full scale tumor. Because of this long latency period, lifestyle and environmental factors, such as diet, may play an important role in the development and progression of the disease. Diet is one factor that has been implicated in the risk for developing prostate cancer. We previously showed that diets high in soy isoflavones and selenium (Se) decreased androgen receptor expression and expression of androgen regulated genes in healthy rat prostates. The purpose of this study was to determine whether treatment of soy isoflavones and/or supplemental Se provide chemopreventive effects in the Transgenic Adenocarcinoma of Mouse Prostate (TRAMP) model of prostate cancer, and whether the timing of the introduction of these nutrients determines protective effects. Male hemizygous C57/BL6 x FVB TRAMP mice were exposed to a diet high in isoflavones, a 4 mg/kg daily bolus of supplemental Se as methylselenocysteine (MSC), or the combination of high isoflavones and MSC starting at one of two time points: conception or 6 weeks of age, and were killed and dissected for prostate tissue, liver, and serum at either 4 weeks or 12 weeks of age (n per dietary treatment = 20: total mice = 240). Treatment with MSC resulted in decreased urogenital tract weight at 4 and 12 weeks. Treatment with MSC and isoflavones, both individually and as a combination, resulted in decreased androgen receptor expression, 5 alpha-reductase levels, and aromatase levels. The combination of MSC and a basal diet high in isoflavones resulted in decreased serum IGF-1 levels in 12 week TRAMP mice. Treatment from conception resulted in greater decreases in urogenital tract weight, 5 alpha-reductase expression, and aromatase expression than treatment from 6 weeks. This study demonstrated that in 12 week TRAMP mice, reductions in risk factors for prostate cancer by treatments of high isoflavones and supplemental Se are maximized by introduction to treatments at conception.

Doctor of Philosophy / Department of Human Nutrition / Brian L. Lindshield / The growth-inhibitory effect of saw palmetto supplements (SPS) with high long-chain fatty acids (FA)-low phytosterols (HLLP), high long-chain FA-high phytosterols (HLHP), and high medium-chain FA-low phytosterols (HMLP) was determined using androgen-sensitive LNCaP prostate cancer (PCa) cells and Syrian hamster flank organs. In vitro, all three SPS at high concentrations significantly decreased dihydrotestosterone-stimulated LNCaP cell number. HMLP and HLLP at high concentrations significantly decreased, but HLHP which significantly increased testosterone-stimulated LNCaP cell number. In Syrian hamsters, all three SPS treatments caused notable, but nonsignificant reduction in the difference between the left and right flank organ growth in the testosterone-, but not dihydrotestosterone-treated SPS groups. Results suggest SPS might be a mild 5-alpha-reductase (5-alpha-R) inhibitor. The pharmaceuticals finasteride inhibits 5-alpha-R2, and dutasteride inhibits 5-alpha-R1 and 5-alpha-R2 isoenzymes. Because finasteride inhibits only 5-alpha-R2, we hypothesized that it would not be as efficacious in preventing PCa development and/or progression in TRAMP mice as dutasteride. Six-week-old C57BL/6 TRAMP x FVB male mice were randomized to control, pre- and post- finasteride and dutasteride diet groups that began at 6 and 12 weeks of age, respectively, and terminated at 20 weeks of age. Pre and post groups received drugs before and after mice were expected to develop PCa, respectively. Post-Dutasteride treatment was significantly more effective than Pre-Dutasteride; and dutasteride treatments significantly more effective than finasteride treatments in decreasing prostatic intraepithelial neoplasia progression and PCa development. The finasteride groups and the Pre-Dutasteride group had significantly increased incidence of poorly differentiated PCa versus control. Androgen receptor and Ki-67 protein, DNA fragmentation from apoptosis, 5-alpha-R1 and 5-alpha-R2 mRNA levels were determined in mice with genitourinary weight less than 1 gram and greater than 1 gram to elucidate the discordant response in Pre-Dutasteride and finasteride groups, and Post-Dutasteride’s efficacy. Results suggest the difference in genitourinary weights is influenced more by proliferation, rather than androgen receptor and apoptosis in tumor. Mice age may not be significantly important in regulating proliferation, androgen receptor and apoptosis to promote tumor growth. In conclusion, the results with 5-alpha-reductase inhibitors may support the therapeutic use of dutasteride, but not finasteride, or saw palmetto supplements.

Orientador: Sebastião Roberto Taboga / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-10T18:00:13Z (GMT). No. of bitstreams: 1 Corradi_LaraSilvia_D.pdf: 6064748 bytes, checksum: 6595f8861a86f33fa6761af9a8f6b0a8 (MD5) Previous issue date: 2008 / Resumo: Os andrógenos têm papel central na biologia da próstata, mas os estrógenos também podem afetar o crescimento e a diferenciação desta glândula. Em tecidos específicos do corpo, a proporção entre andrógenos e estrógenos pode diferir significativamente daquela encontrada no plasma sanguíneo. As concentrações intracelulares desses esteróides nos tecidos alvos são reguladas pelo metabolismo local de hormônios, altamente dependente de enzimas específicas metabolizadoras de esteróides, como a 5a-redutase (5a-r) e a Aromatase (aro). Na próstata, a ação androgênica é acentuada devido à conversão de testosterona em dihidrotestosterona por ação da enzima 5a-r, enquanto que a aro é responsável pela aromatização da testosterona em estrógenos. Assim, a síntese local destes esteróides assume grande importância em doenças que acometem tecidos glandulares, como o câncer de próstata, onde níveis anormais de hormônios promovem o desenvolvimento e o aumento de ocorrência de malignidades. Desse modo, os papéis dos andrógenos e estrógenos ativados podem ainda ser melhor compreendidos na manutenção das interações homeostáticas epitélio-estromais prostáticas. Estudos com inibidores específicos destas enzimas vêm sendo desenvolvidos a fim de se tentar esclarecer os reais papéis enzimáticos na manutenção da fisiologia prostática, assim como no surgimento e desenvolvimento de doenças. De modo geral, após 30 dias consecutivos de inibição, simultânea ou não, das enzimas 5a-r e aro, respectivamente por ação da Finasterida e do Letrozol, a próstata de gerbilos jovens, adultos e velhos mostrou-se com o compartimento epitelial e o estromal alterados e reorganizados na tentativa de adaptar-se à nova condição hormonal induzida. Imediatamente após o término de administração das drogas, na fase inicial do período de pós-tratamentos, as concentrações de testosterona e estrógenos modificaram-se, as células epiteliais tiveram o padrão de atividade secretora alterada e, no estroma, a matriz extracelular ficou totalmente remodelada, além das células musculares lisas e dos fibroblastos fenotipicamente alterados. Na fase final do período de pós-tratamento, ficou evidente a tentativa da próstata em se normalizar morfologica e fisiologicamente, porém, em nenhuma das idades isso aconteceu de modo efetivo. O bloqueio da metabolização de hormônios esteróides na próstata pode ser uma ferramenta importante para o estudo da interação epitélio-estroma tanto na fisiologia normal, quanto nas doenças da próstata. Sugere-se portanto, que o desbalanço entre as concentrações de andrógenos e estrógenos provocados pela Finasterida e de Letrozol, juntos ou separados, alterou significativamente a interação epitélio-estroma. Todos os resultados obtidos parecem ser indicativos de importantes sinais do novo cenário hormonal intraprostático. A recuperação do equilíbrio entre as concentrações hormonais da próstata fica comprometida após o bloqueio enzimático, dando, portanto, às enzimas em estudo, status de crucial importância para o desenvolvimento e manutenção da próstata. O estabelecimento de modelos experimentais para o estudo das relações entre epitélio e estroma e o conhecimento dos componentes celulares e macromoleculares da próstata tornam-se instrumentos muito importantes para o entendimento do desenvolvimento, da estrutura e da fisiologia desta glândula / Abstract: Androgens have substantial role in the biology of the prostate, but estrogens also can affect the growth and differentiation of this gland. In specific tissues of the body, the ratio between androgens and estrogens can differ significantly from that found into plasma. The intracellular concentrations of these steroids in target tissues are mediated by a local hormone metabolism, by specifcs steroid-metabolizing enzymes, as the 5a-redutase (5a -r) and the aromatase (aro). In the prostate, the androgenic action is accented due to the conversion of testosterone in dihydrotestosterone by the activity of the 5a -r, while aro enzyme is an alternative pathway for the aromatization of testosterone into estrogens. These locally syntheses of steroids hormones assume thus, a great importance to the prostate cancer, where abnormal hormone levels can promote development and proliferation of malignancy to this gland. The activated functions of androgens and estrogens may be better understood focusing the maintenance of homeostatic prostatic epithelial-stromal interactions. Studies conducted with inhibitors of these specific enzymes have been carried out in an effort to clarify the real role of steroid-metabolizing enzymes in the maintenance of prostatic physiology, as well as into malignant progression prostatic cancer. After 30 consecutive days of inhibition, simultaneous or not, of the enzymes 5a -r and aro, respectively by Finasterida and Letrozol, the prostate of young, adult and old gerbils revealed that epithelial and estromal compartments were totally modified and reorganized in the attempt to adapt it to the new induced hormonal condition. Immediately after the end of drugs administration, in the early phase of the post-treatments period, the concentrations of testosterone and estrogens had been altered, the epithelial cells had their secretore activity pattern modified and, in the stromal compartment, the extracellular matrix was totally remodeled. The smooth muscle cells and fibroblasts became fenotipically modified. In the late phase of the post-treatments period, it was evident the attempt of the prostate gland in became morphologically and physiologically as a normal gland, however, this was not achieved in any analyzed gerbil. These steroids hormone metabolization blockade seems to be a good tool for the study of the epithelium-stroma interaction both in normal and abnormal prostate gland. Based on this data, it is suggested that the unbalance between androgens and estrogens intraprostatic concentrations provoked by Finasteride and Letrozol, together or not, interfered into the prostatic compartments interactions significantly. The results seem to be indicative of important signals of the new locally hormonal scene within the prostate gland. The recovery of balance hormonal concentrations of the prostate is damaged after the enzymatic blockade what gives, therefore, to this to 5a -r and aro enzymes, a status of crucial key for the normal and abnormal prostate gland. The establishment of experimental models for this kind of study and the knowledge of the cellular and macromolecular components of the prostate are also fundamental for the agreement of development, structure and physiology of prostate / Doutorado / Biologia Celular / Doutor em Biologia Celular e Estrutural

A deficiência da 21-hidroxilase é uma freqüente doença autossômica recessiva caracterizada por manifestações hiperandrogênicas, que se iniciam na infância, puberdade ou vida adulta. Observa-se existência de forte correlação do comprometimento da atividade enzimática conferido pelo genótipo com a forma clínica e com as concentrações basais e pós-estímulo da 17OH-progesterona. Entretanto, não se observa a mesma correlação com a intensidade, idade de início das manifestações e com as concentrações séricas de testosterona. Sugere-se que variações individuais na sensibilidade periférica aos andrógenos ou no metabolismo da testosterona poderiam estar implicadas na variabilidade fenotípica desta doença. Porém, os possíveis mecanismos nunca foram estudados na literatura. Os andrógenos têm sua ação mediada pelo receptor de andrógenos (AR), cujo gene apresenta um trato polimórfico de repetições CAG, o qual modula sua atividade de transativação. Em tecidos periféricos a ação androgênica pode ser ainda potencializada pela enzima 5 alfa-redutase, que transforma testosterona em dihidrotestosterona. O seu gene codificador (SRD5A2) possui vários polimorfismos que alteraram esta atividade de biotransformação nos tecidos periféricos. No clearance da testosterona, os citocromos hepáticos P4503a4, P4503a5 p4503a7 e P4502c19 são os principais envolvidos. Além disso, outro citocromo, o P450c17 representa uma enzima chave na via de produção de andrógenos. Para os citocromos P450 tipo 2, tanto da via de clearance como de síntese dos andrógenos, é necessário ainda a interação com o P450 óxido-redutase para realizar suas reações de hidroxilação. São descritos polimorfismos em todos os genes acima referidos, que alteram sua expressão ou a eficiência catalítica e, consequentemente, tem sido envolvidos na etiologia de doenças andrógeno-dependentes. Consideramos que alterações nos genes codificadores das proteínas relacionadas ao metabolismo e/ou ação periférica dos andrógenos possam atuar na modulação do fenótipo da forma não clássica. Objetivos: Correlacionar o nCAG do gene AR e os polimorfismos nos genes CYP3A5, CYP3A7, CYP3A4, CYP2C19 e CYP17A1, POR e SRD5A2 com a idade de aparecimento dos sintomas, score de Ferriman do hirsutismo ao diagnóstico, presença de virilização, com as concentrações séricas basais de testosterona, bem como com a ausência ou presença de sintomas. Casuística: Selecionamos 122 pacientes com diagnóstico de forma não clássica confirmado por 17OH-progesterona basal ou pós-estímulo com ACTH 10 ng/mL. Todos os pacientes tiveram o diagnóstico molecular, ou seja, mutações identificadas nos dois alelos do gene CYP21A2. As pacientes foram divididas de acordo com o comprometimento da atividade da 21-OH predito pelo genótipo em grupos A/C (grave) e C/C (moderado). As pacientes também foram divididas em grupos pediátrico e adulto, início das manifestações antes e após os 12 anos, respectivamente. Metodologia: O DNA foi extraído de leucócitos periféricos. As regiões de repetições CAG foram amplificadas por PCR e os produtos submetidos à eletroforese capilar e análise pelo software GeneScan. Amostras de DNA das pacientes heterozigotas para o número de repetições CAG foram digeridas com a enzima Hpa II e os produtos submetidos à amplificação da região CAG para se determinar o padrão de inativação do cromossomo X. Os genes CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR e SRD5A2 foram amplificados por PCR e submetidos à reação de seqüenciamento ou à reação de digestão enzimática para rastreamento das variantes alélicas. Os resultados foram comparados com as respectivas seqüências selvagens depositadas no GeneBank. Na análise estatística foram empregados os testes t de Student, ANOVA, Wilcoxon rank-sun, Kruskall Wallis rank e regressão linear. Resultados: Observamos uma frequência significativamente menor de alelos longos (> 26 repetições) do trato CAG do AR no grupo pediátrico em relação ao de adultos com genótipo 21-OH do grupo C/C (p=0,01). Adicionalmente, a média ponderada do trato CAG foi significativamente menor nas pacientes com clitoromegalia (19,1 ± 2,7) em comparação com a de pacientes sem virilização (21,6 ± 2,5), correlação que independeu do genótipo da 21-OH. A mediana das concentrações séricas de testosterona foi significativamente maior nas carreadoras da variante CYP17A1*A2 (145,7 ng/dL, 126-153) em relação às carreadoras da variante selvagem (57 ng/dL, 36-87) com genótipo 21-OH do grupo A/C. As demais variantes não se correlacionaram com os fenótipos clínico e hormonal. Conclusão: Observamos que o trato CAG apresentou efeito na modulação do fenótipo de virilização de mulheres com forma não clássica. Além disso, o trato CAG pode ter contribuído no período de início das manifestações, uma vez que o grupo pediátrico com genótipo C/C teve freqüência menor de alelos longos em relação às adultas. Dentre as variantes alélicas pesquisadas, que alteram a síntese e/ou metabolismo dos andrógenos, identificamos associação do alelo CYP17A1*A2 com concentrações maiores de testosterona. Embora tenhamos avaliado uma casuística expressiva para esta patologia, para as demais correlações com resultados negativos, não podemos afastar um efeito do tamanho da amostra. / Introduction: The 21-hydroxylase deficiency is a common autosomal recessive disease characterized by clinical hyperandrogenism, which could begin at childhood, puberty or adulthood. There is a strong correlation among impairment of enzymatic activity conferred by genotypes, clinical forms, basal and post-stimulation 17OH-progesterone (17-OHP) levels. However, we did not observe the same correlation with the intensity, age at onset of manifestations and basal testosterone levels. It is suggested that individual variations in the androgen peripheral sensitivity and/or metabolism could be implicated in the phenotypic variability of this disease. However, potential mechanisms have never been studied before. The androgen action is mediated by the androgen receptor (AR), whose gene has a polymorphic CAG repeat that modulates its transactivation activity. In the peripheral tissues, the androgen action is modified by the 5 alpha-reductase type 2 activity, which converts testosterone into a potent androgen, dihydrotestosterone. Its coding gene (SRD5A2) carries several polymorphisms altering its catalytic activity in the peripheral tissues. Regarding the testosterone clearance, hepatic cytochromes P4503a4, P4503a5 p4503a7 P4502c19 are the most important. In addition, another cytochrome, P450c17, is a key enzyme in the androgen production pathway. For the cytochrome P450 type 2 activities, involved in the androgen clearance and/or synthesis, an interaction with the P450 oxidoreductase is still necessary. Polymorphisms are described in all the aforementioned genes, which change their expression and/or catalytic efficiencies; consequently, they have been implicated in the etiology of androgen-dependent diseases. We supposed that changes in the coding genes for the aforesaid proteins could act in modulating the nonclassical phenotype. Objectives: To compare the nCAG of AR gene and polymorphisms of CYP3A5, CYP3A7, CYP3A4, CYP2C19, and CYP17A1, SRD5A2 and POR genes with the age of onset of symptoms, Ferriman score of hirsutism at diagnosis, presence of virilization, basal testosterone levels, as well as with the absence or the presence of symptoms. Patients: We selected 122 patients with basal or post-ACTH 17-OHP 10 ng/mL. All patients had confirmed nonclassical molecular diagnoses. Patients were divided according to the impairment of 21-OH activity predicted by genotype groups into A/C (severe) and C/C (moderate). Patients were also classified according to the onset of manifestations into pediatric and adult groups, younger than or older than 12 years, respectively. Methods: DNA was extracted from peripheral leukocytes. CAG repeat regions were PCR amplified, products submitted to capillary electrophoresis and analyzed by GeneScan software. DNA samples from CAG heterozygous patients were digested with the Hpa II enzyme and also submitted to PCR, in order to determine X-chromosome inactivation pattern. The CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR and SRD5A2 genes were PCR amplified and submitted to sequencing or enzymatic assays to screen the allelic variants. The results were compared with their wild sequences in the GenBank. Statistical comparisons employed Student\'s t tests, ANOVA, Wilcoxon rank-sun, Kruskal Wallis rank and linear regression. Results: We observed a significantly lower frequency of longer CAG alleles (> 26 repeats) of AR in the pediatric group compared to the adults carrying the 21-OH genotype from group C/C (p = 0.01). Additionally, the weighted biallelic mean of the CAG tract was considerably lower in patients with clitoromegaly (19.1 ± 2.7) in comparison to patients without it (21.6 ± 2.5), a correlation that was independent of the 21-OH genotype severity. The median of testosterone levels was significantly higher in the CYP17A1*A2 carriers (145.7 ng/dL, 126-153) compared to the ones carrying the wild allele (57 ng/dL, 36-87), from the group A/C of 21-OH genotype. The other variants did not show a correlation with clinical and hormonal phenotypes. Conclusions: We observed that the CAG tract was effective in modulating the phenotype of virilization in nonclassical women as well as influenced the period of onset of manifestations of patients carrying moderate CYP21A2 genotype. Considering the remaining allelic variants, which alter the androgen synthesis or metabolism, we identified the association of CYP17A1*A2 alleles with higher testosterone levels. Although we evaluated a significant number of patients with 21-OHD, we cannot rule out a sample size effect.

A indicação de biópsia para o diagnóstico precoce do câncer prostático baseia-se na dosagem sérica do PSA e nos achados do toque retal. O PSA é uma kalecreina estando seus genes reguladores ligados aos andrógenos. Drogas que afetam o metabolismo dos andrógenos podem afetar a produção de PSA. A finasterida é uma droga sintética que inibe a conversão de testosterona em DHT pela enzima 5 AR. O uso da finasterida na dose de 5mg/dia para o tratamento da HPB causa redução do volume prostático de 20 a 30% e diminuição dos valores dos PSA em aproximadamente 50% do seu valor inicial após 6 meses. O uso da finasterida na dose de 1mg/dia para o tratamento da AAM foi aprovado pelo FDA em 1997. Um estudo realizado em 2007 avaliou a alteração do nível do PSA em homens com mais de 40 anos fazendo uso de finasterida 1mg/dia para tratamento da AAM. Os resultados revelaram redução dos valores do PSA semelhante à verificada nos pacientes portadores de HPB. Não existem estudos prospectivos sobre o tema incluindo pacientes mais jovens. O objetivo do nosso trabalho foi verificar as alterações da dosagem do PSA, da testosterona sérica total e do volume prostático em indivíduos com menos de 40 anos de idade com em uso de finasterida 1mg/dia. Selecionamos 52 pacientes que após avaliação inicial preenchiam os critérios de inclusão. Foram dosados os níveis séricos do PSA e da testosterona, e mensurado o volume prostático através da ultrassonografia transabdominal, no início do estudo (T0) e um ano após o uso da finasterida (T2). No intervalo, 6 meses após o início da droga, foi solicitada apenas nova dosagem de PSA (T1). O valor médio na avaliação inicial (T0) da dosagem do PSA, da testosterona total plasmática e do volume prostático mensurado pela ultrassonografia transabdominal foi de 0,398 ng/ml (0,14- 0,78); 735,77 ng/dl (548-927) e 21,35 ml (15-31ml) respectivamente. Foi observada uma redução do valor médio do PSA de 9,21% após 6 meses do uso da droga (p=0,001). Após 12 meses do uso da finasterida verificamos uma redução de 10,51% do valor do PSA em relação à dosagem inicial (p<0,001) e uma diminuição do valor médio do volume prostático 21,37 ml para 20,03 ml (p<0,001). Não foi detectada alterações nos níveis de testosterona. Diferentemente de estudos anteriores em que, em homens fazendo uso de finasterida 1mg/dia, houve redução de 40% e 50% dos valores do PSA nas faixas etárias de 40 a 49 anos e 50 a 59 anos, nosso trabalho revelou reduções inferiores. Nosso estudo traz importantes questionamentos em relação a como deve ser feita a correção dos valores do PSA nos pacientes que começaram a utilizar finansterida 1mg antes dos 40 anos de idade e que se apresentam para avaliação prostática. Outro ponto de interesse é se a hiperplasia do componente epitelial observada durante envelhecimento masculino poderia ser inibida pelo uso da finasterida desde a juventude, pois sabemos que indivíduos portadores de deficiência congênita de 5AR não apresentam alopecia e nem tão pouco desenvolvem HPB. / The indication of biopsy for early diagnosis of prostate cancer is based on serum PSA levels and digital rectal examination findings. PSA is a kalecreine and its regulatory genes are modulating by androgens. Drugs affecting the androgens metabolism can affect the production of PSA. Finasteride is a synthetic drug, which inhibits the conversion of testosterone to DHT by the enzyme 5 AR. There are two subtypes of 5AR enzymes, Type 1 that predominates in non-prostatic tissues such as liver and skin, and Type 2, which predominates in the prostate and scalp but is also expressed in other tissues. The use of Finasteride 5mg / day for the treatment of BPH is well known. After six months we observe a decrease in prostate volume by 20 to 30% and also a decrease in total serum PSA concentration of approximately 50%. The use of Finasteride at 1mg / day for the treatment of MAA has been approved by the FDA in 1997. In 2007 a study evaluated the change in total serum PSA concentration in men over 40 years taking Finasteride 1 mg / day to treat MAA. The results showed a reduction in PSA values similar to that observed in patients treated of BPH. There are no prospective studies including younger patients. The aim of our study was to assess the changes in total serum PSA concentration, total serum testosterone concentration and prostate volume in patients younger than 40 years of age in use of Finasteride 1mg / day for MAA. We prospectively selected 52 patients with MAA and indication for treatment with Finasteride who met the inclusion criteria. Serum levels of total PSA and total testosterone and prostate volume, measured by transabdominal ultrasound, were obtained at baseline (T0) and one year after started the drug (T2). In the interval, 6 months after started drug, only serum total PSA concentration was measured (T1). The median value at baseline (T0), for total PSA, total testosterone and prostate volume was 0.398 ng / ml (0.14 to 0.78); 735.77 ng / dl (548-927) and 21.35 ml (15-31ml) respectively. A reduction of 9.21% on total PSA concentration was detected 6 months after started the drug (p = 0.001). After 12 months we observed a 10.51% decrease in total serum PSA concentration, when compared with the baseline value, (p <0.001). A reduction in the median value of prostate volume from 21.37 ml to 20.03 ml (p < 0.001) was also detected at the same period. There were no detectable changes in testosterone levels. They reported a decrease of 40% and 50% in total PSA concentration for groups between 40-49 and 50-59 of age respectively. In our study we observed lower reductions. Our finding may be explained by the fact that the epithelial component of the prostate gland has not yet started the hyperplasia process, so the conversion of testosterone into DHT by blocking 5AR by Finasteride would cause less impact. The fact that the values of plasma testosterone not have changed is not surprising since Finasteride is not considered an anti androgenic drug, it means that the synthesis of the testosterone is not affected by its use. Our study highlights important questions about how the adjustment of PSA values should be done in patients who began taking Finasteride 1mg / day before 40 years of age and present for prostate evaluation. Another point of interest is whether the hyperplasia of the epithelial component, observed during the aging process, could be inhibited by the use of Finasteride. This hypothesis can be corroborate by the fact that individuals with congenital deficiency of 5AR do not present alopecia or develop BPH. In conclusion the use of Finasteride 1mg /day reduces the total serum PSA value by 10,51% after one year. Prostate volume is also reduced by 6,3% in the same period.

A deficiência da 21-hidroxilase é uma freqüente doença autossômica recessiva caracterizada por manifestações hiperandrogênicas, que se iniciam na infância, puberdade ou vida adulta. Observa-se existência de forte correlação do comprometimento da atividade enzimática conferido pelo genótipo com a forma clínica e com as concentrações basais e pós-estímulo da 17OH-progesterona. Entretanto, não se observa a mesma correlação com a intensidade, idade de início das manifestações e com as concentrações séricas de testosterona. Sugere-se que variações individuais na sensibilidade periférica aos andrógenos ou no metabolismo da testosterona poderiam estar implicadas na variabilidade fenotípica desta doença. Porém, os possíveis mecanismos nunca foram estudados na literatura. Os andrógenos têm sua ação mediada pelo receptor de andrógenos (AR), cujo gene apresenta um trato polimórfico de repetições CAG, o qual modula sua atividade de transativação. Em tecidos periféricos a ação androgênica pode ser ainda potencializada pela enzima 5 alfa-redutase, que transforma testosterona em dihidrotestosterona. O seu gene codificador (SRD5A2) possui vários polimorfismos que alteraram esta atividade de biotransformação nos tecidos periféricos. No clearance da testosterona, os citocromos hepáticos P4503a4, P4503a5 p4503a7 e P4502c19 são os principais envolvidos. Além disso, outro citocromo, o P450c17 representa uma enzima chave na via de produção de andrógenos. Para os citocromos P450 tipo 2, tanto da via de clearance como de síntese dos andrógenos, é necessário ainda a interação com o P450 óxido-redutase para realizar suas reações de hidroxilação. São descritos polimorfismos em todos os genes acima referidos, que alteram sua expressão ou a eficiência catalítica e, consequentemente, tem sido envolvidos na etiologia de doenças andrógeno-dependentes. Consideramos que alterações nos genes codificadores das proteínas relacionadas ao metabolismo e/ou ação periférica dos andrógenos possam atuar na modulação do fenótipo da forma não clássica. Objetivos: Correlacionar o nCAG do gene AR e os polimorfismos nos genes CYP3A5, CYP3A7, CYP3A4, CYP2C19 e CYP17A1, POR e SRD5A2 com a idade de aparecimento dos sintomas, score de Ferriman do hirsutismo ao diagnóstico, presença de virilização, com as concentrações séricas basais de testosterona, bem como com a ausência ou presença de sintomas. Casuística: Selecionamos 122 pacientes com diagnóstico de forma não clássica confirmado por 17OH-progesterona basal ou pós-estímulo com ACTH 10 ng/mL. Todos os pacientes tiveram o diagnóstico molecular, ou seja, mutações identificadas nos dois alelos do gene CYP21A2. As pacientes foram divididas de acordo com o comprometimento da atividade da 21-OH predito pelo genótipo em grupos A/C (grave) e C/C (moderado). As pacientes também foram divididas em grupos pediátrico e adulto, início das manifestações antes e após os 12 anos, respectivamente. Metodologia: O DNA foi extraído de leucócitos periféricos. As regiões de repetições CAG foram amplificadas por PCR e os produtos submetidos à eletroforese capilar e análise pelo software GeneScan. Amostras de DNA das pacientes heterozigotas para o número de repetições CAG foram digeridas com a enzima Hpa II e os produtos submetidos à amplificação da região CAG para se determinar o padrão de inativação do cromossomo X. Os genes CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR e SRD5A2 foram amplificados por PCR e submetidos à reação de seqüenciamento ou à reação de digestão enzimática para rastreamento das variantes alélicas. Os resultados foram comparados com as respectivas seqüências selvagens depositadas no GeneBank. Na análise estatística foram empregados os testes t de Student, ANOVA, Wilcoxon rank-sun, Kruskall Wallis rank e regressão linear. Resultados: Observamos uma frequência significativamente menor de alelos longos (> 26 repetições) do trato CAG do AR no grupo pediátrico em relação ao de adultos com genótipo 21-OH do grupo C/C (p=0,01). Adicionalmente, a média ponderada do trato CAG foi significativamente menor nas pacientes com clitoromegalia (19,1 ± 2,7) em comparação com a de pacientes sem virilização (21,6 ± 2,5), correlação que independeu do genótipo da 21-OH. A mediana das concentrações séricas de testosterona foi significativamente maior nas carreadoras da variante CYP17A1*A2 (145,7 ng/dL, 126-153) em relação às carreadoras da variante selvagem (57 ng/dL, 36-87) com genótipo 21-OH do grupo A/C. As demais variantes não se correlacionaram com os fenótipos clínico e hormonal. Conclusão: Observamos que o trato CAG apresentou efeito na modulação do fenótipo de virilização de mulheres com forma não clássica. Além disso, o trato CAG pode ter contribuído no período de início das manifestações, uma vez que o grupo pediátrico com genótipo C/C teve freqüência menor de alelos longos em relação às adultas. Dentre as variantes alélicas pesquisadas, que alteram a síntese e/ou metabolismo dos andrógenos, identificamos associação do alelo CYP17A1*A2 com concentrações maiores de testosterona. Embora tenhamos avaliado uma casuística expressiva para esta patologia, para as demais correlações com resultados negativos, não podemos afastar um efeito do tamanho da amostra. / Introduction: The 21-hydroxylase deficiency is a common autosomal recessive disease characterized by clinical hyperandrogenism, which could begin at childhood, puberty or adulthood. There is a strong correlation among impairment of enzymatic activity conferred by genotypes, clinical forms, basal and post-stimulation 17OH-progesterone (17-OHP) levels. However, we did not observe the same correlation with the intensity, age at onset of manifestations and basal testosterone levels. It is suggested that individual variations in the androgen peripheral sensitivity and/or metabolism could be implicated in the phenotypic variability of this disease. However, potential mechanisms have never been studied before. The androgen action is mediated by the androgen receptor (AR), whose gene has a polymorphic CAG repeat that modulates its transactivation activity. In the peripheral tissues, the androgen action is modified by the 5 alpha-reductase type 2 activity, which converts testosterone into a potent androgen, dihydrotestosterone. Its coding gene (SRD5A2) carries several polymorphisms altering its catalytic activity in the peripheral tissues. Regarding the testosterone clearance, hepatic cytochromes P4503a4, P4503a5 p4503a7 P4502c19 are the most important. In addition, another cytochrome, P450c17, is a key enzyme in the androgen production pathway. For the cytochrome P450 type 2 activities, involved in the androgen clearance and/or synthesis, an interaction with the P450 oxidoreductase is still necessary. Polymorphisms are described in all the aforementioned genes, which change their expression and/or catalytic efficiencies; consequently, they have been implicated in the etiology of androgen-dependent diseases. We supposed that changes in the coding genes for the aforesaid proteins could act in modulating the nonclassical phenotype. Objectives: To compare the nCAG of AR gene and polymorphisms of CYP3A5, CYP3A7, CYP3A4, CYP2C19, and CYP17A1, SRD5A2 and POR genes with the age of onset of symptoms, Ferriman score of hirsutism at diagnosis, presence of virilization, basal testosterone levels, as well as with the absence or the presence of symptoms. Patients: We selected 122 patients with basal or post-ACTH 17-OHP 10 ng/mL. All patients had confirmed nonclassical molecular diagnoses. Patients were divided according to the impairment of 21-OH activity predicted by genotype groups into A/C (severe) and C/C (moderate). Patients were also classified according to the onset of manifestations into pediatric and adult groups, younger than or older than 12 years, respectively. Methods: DNA was extracted from peripheral leukocytes. CAG repeat regions were PCR amplified, products submitted to capillary electrophoresis and analyzed by GeneScan software. DNA samples from CAG heterozygous patients were digested with the Hpa II enzyme and also submitted to PCR, in order to determine X-chromosome inactivation pattern. The CYP3A5, CYP3A4, CYP3A7, CYP17A1, CYP2C19, POR and SRD5A2 genes were PCR amplified and submitted to sequencing or enzymatic assays to screen the allelic variants. The results were compared with their wild sequences in the GenBank. Statistical comparisons employed Student\'s t tests, ANOVA, Wilcoxon rank-sun, Kruskal Wallis rank and linear regression. Results: We observed a significantly lower frequency of longer CAG alleles (> 26 repeats) of AR in the pediatric group compared to the adults carrying the 21-OH genotype from group C/C (p = 0.01). Additionally, the weighted biallelic mean of the CAG tract was considerably lower in patients with clitoromegaly (19.1 ± 2.7) in comparison to patients without it (21.6 ± 2.5), a correlation that was independent of the 21-OH genotype severity. The median of testosterone levels was significantly higher in the CYP17A1*A2 carriers (145.7 ng/dL, 126-153) compared to the ones carrying the wild allele (57 ng/dL, 36-87), from the group A/C of 21-OH genotype. The other variants did not show a correlation with clinical and hormonal phenotypes. Conclusions: We observed that the CAG tract was effective in modulating the phenotype of virilization in nonclassical women as well as influenced the period of onset of manifestations of patients carrying moderate CYP21A2 genotype. Considering the remaining allelic variants, which alter the androgen synthesis or metabolism, we identified the association of CYP17A1*A2 alleles with higher testosterone levels. Although we evaluated a significant number of patients with 21-OHD, we cannot rule out a sample size effect.