5a-Reductase 1 (5aR1) metabolises steroids such as glucocorticoids and androgens and is highly expressed in the livers of mice. Genetic disruption of 5aR1 leads to adverse metabolic consequences in mice and pharmacological inhibition in humans induces peripheral insulin resistance. I hypothesised that these effects are due to increased hepatic glucocorticoid action and firstly set up an experimental paradigm using A-348441, a liver-selective glucocorticoid receptor antagonist, to assess the contribution of hepatic glucocorticoid action. A-348441 was then utilised to assess whether changes in hepatic glucocorticoid signalling underpinned metabolic changes in: 1) a genetic model where the gene for 5aR1 has been disrupted, and 2) a pharmacological model using dutasteride, a dual 5aR1, R2 inhibitor. Previous work with A-348441 has demonstrated it can lower blood glucose levels in ob/ob mice. However, monogenic models of obesity are not fully representative of idiopathic obesity, which is commonly related to diet. Therefore, I utilised a mouse model of high fat dietary challenge to determine the effects of A-348441 in a more relevant model. High fat diet worsened metabolic indices such as body weight and weight gain, adipose tissue depot mass, fasting insulin and insulin response to a glucose challenge. A-348441 improved metabolic health of mice on high fat diet, preventing high fat-induced body weight gain, total white adipose depot weight gain and attenuating high fat-induced elevations in fasting plasma insulin, fasting glucose and insulin response to a glucose tolerance test. Importantly, hepatic glucocorticoid receptor antagonism did not change plasma corticosterone concentrations, indicating that glucocorticoid receptor antagonism was limited to the liver and thus demonstrating that hepatic glucocorticoid action plays a major role in high fat dietinduced metabolic phenotype. Using A-348441, I then went on to test the contribution of hepatic glucocorticoid action to the adverse metabolic phenotype in wild-type and 5aR1 knockout mice also under a high fat dietary challenge; two timescales were explored – 10 weeks with A- 348441 administered from the start and 6 months with A-348441 introduced after 5 months of high fat diet. 5aR1 knockout mice were overall more insulin resistant and had fattier livers than the wild-type mice at 10 weeks regardless of diet consumed. High fat diet overall worsened metabolic indices - increasing body weight, weight gain, adipose tissue depot mass, fasting insulin and insulin response to a glucose challenge in both genotypes and at both time points. Hepatic glucocorticoid receptor antagonism in 5aR1 knockout mice prevented high fat diet-induced metabolic consequences as expected in the 10-week high fat diet model, but not in the 6-month experiment; hyperinsulinaemia and weight gain were attenuated in the 10-week high fat diet model but not the 6-month high fat diet model, suggesting hepatic glucocorticoid receptor antagonism can prevent, but not reverse, high fat diet-induced metabolic consequences. However, A-348441 did not have a bigger effect on ameliorating the worsened metabolic state of the 5αR1 knockout mice. This suggests that increased hepatic glucocorticoid action does not underpin the adverse phenotype reported in the 5aR1 knockout mice. Dutasteride is a dual 5aR inhibitor prescribed to men for benign prostate hyperplasia or prostate cancer. I then recapitulated the human experiment where 5aR was pharmacologically inhibited and investigated the effects of dutasteride in mice. Inhibition of 5aRs in mice impaired insulin sensitivity, with increased insulin response to glucose tolerance test and also increased liver triglyceride levels; body weight, total adipose depot weight, fasting insulin, fasting glucose or glucose response to a glucose tolerance test were not changed by dutasteride. A-348441 reduced this hyperinsulinaemia but, as in other models, did not reduce the increased liver triglyceride levels. This suggests hepatic glucocorticoid action plays a substantial role in the development of insulin resistance caused by 5aR inhibition, but not in the development of hepatic steatosis. Therefore, adverse metabolic changes as a result of 5aR1 inhibition with dutasteride may be driven by altered hepatic glucocorticoid metabolism. Furthermore, metabolic changes caused by lifelong 5aR1 disruption are not responsive to short-term hepatic glucocorticoid receptor antagonism and altered androgen signalling may play a greater role. In conclusion, targeting the hepatic glucocorticoid receptor may be beneficial in restoring metabolic homeostasis in diet-induced obesity.

Inflammation plays a key role in the underlying pathogenesis of obesity and its associated health risks, with increased markers of inflammation evident in both liver and adipose tissue. In parallel, there is dysregulation of glucocorticoid metabolism in obesity, with increased adipose levels of the glucocorticoid-regenerating enzyme 11β-hydroxysteroid dehydrogenase type 1 (11βHSD1) and increased hepatic levels of 5α-reductase type 1 (5αR1), which catalyses the reduction of glucocorticoids. Both the mechanisms and consequences of this glucocorticoid metabolism dysregulation remain unclear, however, there is evidence that it may be related to inflammation. In vitro studies have demonstrated that pro-inflammatory markers upregulate 11βHSD1 expression in adipocytes, potentially explaining increased expression of this enzyme in obesity. Previous work has also demonstrated that the glucocorticoid metabolites produced by 5αR1 lack the metabolic effects of the parent glucocorticoid, but retain its anti-inflammatory properties, indicating that increased expression of hepatic 5αR1 may serve to dampen down inflammation in the liver. The hypotheses addressed in this thesis are that in obesity, inflammation regulates adipose glucocorticoid metabolism through 11βHSD1, and that hepatic glucocorticoid metabolism regulates the inflammatory state of the liver through 5αR1. The role of inflammation in the regulation of 11βHSD1 was assessed in vivo in mice treated with the anti-inflammatory compound sodium salicylate (salicylate). In diet-induced obese mice, salicylate downregulated 11βHSD1 expression and activity selectively in visceral adipose tissue, alongside improved glucose tolerance, reduced plasma non-esterified fatty acids, and changes in adipose lipid metabolism. 11βHSD1-deficient mice fed a high-fat diet were resistant to the insulin sensitising effects of salicylate treatment. These results indicate a novel role for 11βHSD1 down-regulation in mediating the insulin sensitising effect of anti-inflammatory treatment. The mechanisms underpinning the anti-inflammatory properties of 5α-reduced glucocorticoids were explored in vitro and in vivo. In lipopolysaccharide-stimulated murine macrophages, both 5α-reduced glucocorticoid metabolites tested, namely 5α-dihydrocorticosterone (5αDHB) and 5α-tetrahydrocorticosterone (5αTHB), suppressed tumor necrosis factor-α (TNFα) and interleukin-6 (IL-6) release, although to a lesser extent than corticosterone (B). Similar to B, both 5αDHB and 5α THB suppressed phosphorylation of intra-cellular inflammatory signalling mitogen-activated protein kinases (MAPK) proteins c-Jun N-terminal kinase (JNK) and p38, as well as increasing protein expression of MAPK phosphatase-1 (MKP-1). Treatment of phorbol ester-stimulated HEK293 kidney cells with these 5α-metabolites revealed that 5αDHB suppressed nuclear factor κB (NFκB) and activator protein-1 (AP-1) activation to a similar extent to that of B, whilst 5αTHB increased activation of these pro-inflammatory transcription factors, indicating cell-specific effects of 5αTHB. In conclusion, reduced intra-adipose glucocorticoid regeneration by 11βHSD1 mediates the insulin sensitising effects of salicylate, suggesting that altered glucocorticoid metabolism may reflect altered intra-adipose inflammation in obesity. Furthermore, these data support the concept that this enzyme provides a therapeutic target in obesity-related metabolic disorders. 5α-reduced metabolites of glucocorticoids have similar anti-inflammatory properties to the parent glucocorticoid, indicating that the elevated hepatic levels of 5α-reductase in obesity may be a protective mechanism to limit the adverse metabolic effects of glucocorticoids upon the liver, but maintain the beneficial anti-inflammatory properties. These 5α-reduced glucocorticoid metabolites may provide a potential therapeutic treatment as selective glucocorticoid receptor modulators for inflammatory conditions.

Glucocorticoid excess is associated with adverse effects on a number of physiological parameters, leading to obesity, dysfunction of the hypothalamic-pituitary- adrenal (HPA) axis and behavioural changes such as anxiety and impaired learning and memory. Circulating and local tissue glucocorticoid levels are tightly controlled by the HPA axis but an additional level of control exists in tissues such as brain, liver and adipose tissue. In these structures, enzymes including 5α-reductase 1 (5αR1), catalyse the conversion of corticosterone to A-ring reduced metabolites, which have a different spectrum of activities. This thesis investigates the role of 5αR1 in regulating central glucocorticoid actions which control HPA axis function and behaviour in a mouse model with genetic disruption of 5αR1 (5αR1-KO). Preliminary data showed 5αR1-KO mice were susceptible to developing insulin resistance and obesity and had reduced HPA axis responses to acute stress. Additionally, male 5αR1-KO mice were more prone to obesity than wild-type (WT) when fed a high-fat diet whilst female 5αR1-KO mice gained more weight than WT even on a normal chow diet. Intriguingly, female 5αR1-KO mice subjected to social isolation stress lost this extra weight and became comparable to WT controls. This study tested the hypothesis that 5αR1-KO mice are less able to inactivate glucocorticoids in the periphery and within tissues, resulting in a predisposition to metabolic disturbances and behavioural alterations. These were hypothesised to include hyperphagia, weight gain, impaired stress responses, anxiety (exacerbated by environmental stress) and cognitive deficits. It was also thought that many of these features would be more pronounced in female vs. male mice. The main aims of this study were to determine if 5αR1-KO induced weight gain and if this was correlated to altered gene expression of key hypothalamic neuropeptides which regulate appetite, to determine the central mechanisms which underpin attenuated HPA axis responses to acute stress and to determine whether behaviours such as anxiety and learning and memory ability are affected by global 5αR1 loss. It was hypothesised that female 5αR1-KO mice have increased appetite and reduced locomotor activity compared with WT and male 5αR1-KOs. However, male 5αR1- KO mice (on a mixed genetic background, C57Bl/6j/SvEv/129) were hyperphagic on a normal chow diet but did not gain extra weight, while female 5αR1-KO mice gained more weight vs. WT despite hypophagia. Free ambulatory activity was unaffected by genotype in either sex. Male 5αR1-KO mice appeared less anxious but responses of female 5αR1-KO mice in tests of anxiety did not differ from WT controls. Mice lacking 5αR1 generally had a poorer metabolic profile with impaired glucose tolerance and hyperinsulinaemia; with hepatic steatosis evident in female mice. There was evidence of compensatory changes in hypothalamic orexigenic and anorexigenic peptides. Phenotypes were sexually dimorphic such that male mice had a poorer metabolic profile vs. females, which was particularly marked in male 5αR1- KO animals. 5αR1-KO mice were previously shown to have attenuated HPA axis responses to acute stress and it was hypothesised that disruption of 5αR1 would result in altered expression of genes related HPA axis regulation with a view to increased negative feedback. Here, male and female 5αR1-KO mice demonstrated altered corticosteroid receptor expression within the hippocampus and the pituitary, two key structures in the HPA cascade. In situ hybridisation showed reduced mRNA for MR in the hippocampus and for Crh in the hypothalamus of 5αR1-KO mice. These modifications along with decreased Crhr-1 mRNA (CRH‘s main receptor) may be due to a lack of corticosterone metabolism within the brain resulting in enhanced negative feedback and reduced HPA axial drive. In order to study behaviour in detail and also to test whether potential central glucocorticoid excess may predispose to cognitive decline with ageing, a separate cohort of female 5αR1-KO backcrossed onto a uniform C57Bl/6j background was studied both when young (6 months) and when aged (14-15 months). Additionally, mice were housed in either groups or singly (social isolation) to investigate the potentially additive effects of environmental stress. It was hypothesised that local glucocorticoid increases in the brains of 5αR1-KO mice would be associated with anxiety and cognitive deficiencies and that these phenotypes would be exaggerated by the stress of social isolation as well as ageing. Behavioural differences were not observed at 6 months of age. However aged, 5αR1-KO mice housed singly showed increased anxiety and had higher plasma corticosterone levels than group-housed mice. Moreover, aged mice lacking 5αR1 performed less well than WT in tests of memory and had a marginally greater cognitive decline when learning ability at 14- 15 months old was compared to that of the same animals tested at 6 months old. Overall, mice with global 5αR1 loss appeared susceptible to anxiety as well as some degree of age-associated cognitive impairment, but only when subjected to social isolation stress which is a known chronic stressor. The final set of experiments aimed to determine the effect of mouse strain on 5αR1- KO phenotypes. It was hypothesised that glucocorticoid clearance would be attenuated to a lesser degree in 5αR1-KO mice bred onto a congenic C57Bl/6j strain compared to those of the mixed strain and that this would manifest as less disruption of metabolism and less suppression of HPA axis stress responses. Although social isolation again induced weight-loss in female mice and more so in 5αR1-KO animals, mice on the C57Bl/6j background strain did not show dampened HPA axis responses to acute stress as seen previously. It was subsequently shown in adrenalectomised mice that animals bred on the C57Bl/6j strain cleared active corticosterone from plasma and liver faster than mixed strain mice. This may have rendered mixed strain 5αR1-KO mice more susceptible to excessive corticosterone levels producing a more exaggerated phenotype in this group. In conclusion, these data suggest a role for the enzyme 5αR1 in modifying glucocorticoid concentrations in the brain and liver, influencing not only metabolic and peripheral effects such as weight gain and insulin resistance, but also in modifying cognition, appetite stimulation and affective behaviours. It has been highlighted that outside factors such as housing and age can modify these phenotypes and are important considerations for future studies. This study has also highlighted the importance of choosing an appropriate genetic background for genetically modified animals since phenotypes can be enhanced or attenuated depending on strain. Finally, 5αR inhibitors are used to treat disorders such as benign prostatic hyperplasia in men, and it is important to consider that these drugs may have a wide array of associated side effects both systemically and in the central nervous system.