Introduction: Glicocorticoides are pharmacos utilized in treatment of inflamatory diseases. However, they can trigger adverse reactions that can compromise the immune system and metabolism. Physical exercise can be used as a non pharmacologial way to minimize these effects. Objective: To evaluate the responses induced by resisted exercise over hematological profile of rats treated with dexametasona. Methods: 40 rats were used for the study and divided into 4 randomized: sedentary control (SC), trained control (TC), sedentary dexamethasone (SDx), and trained dexamethasone (TDx). The groups were subjected to resistance exercise for 12 weeks. three series of 10 repetitions, with intensity of 70% - 1RM), in a squatting apparatus. Dexamethasone (0.2 mg / kg) was given intraperitoneally once weekly. After 24 hours of the last training session, the animals were euthanized for sample collection. The statistical test used was ANOVA One Way, with Bonferroni post-test and data were expressed as mean ± standard error (SEM) with p <0.05. Results: The mean corpuscular hemoglobin concentration (MCHC) decreased in SDx (3.4%) and TDx (3.6%) groups compared with the TC group. The number of total leucocytes increased in the TC group compared with SC (24.3) and SDx (37.8%) groups. The number of neutrophils in the SDx group increased compared with SC (50.0%) and TC (41.9%) groups. The number of lymphocytes decreased in the SDx group compared with the SC (31.4%) and TC (26.9%) groups. The number of monocytes decreased in the SDx group compared with the SC (46.1%) and TC (47.9%) groups. Conclusion: The resistance exercise was unable to attenuate the effects of dexamethasone on the MCHC, neutrophil, lymphocyte, and monocyte levels. / Introdução: Glicocorticoides são fármacos utilizados no tratamento de doenças inflamatórias. Entretanto, podem desencadear reações adversas que comprometem o sistema imune e o metabolismo. O exercício físico pode ser utilizado como um meio não farmacológico para atenuar esses efeitos. Objetivo: avaliar as respostas induzidas pelo exercício resistido sobre o perfil hematológico de ratos Wistar tratados com dexametasona. Métodos: Foram utilizados quarenta ratos Wistar divididos randomicamente em quatro grupos: controle sedentário (CS), controle treinado (CT), dexametasona sedentário (DxS) e dexametasona treinado (DxT), e submetidos ao exercício resistido por 12 semanas (3 séries de 10 repetições, com intensidade de 70% - 1RM), em aparelho de agachamento. A dexametasona (0,2 mg/kg) foi administrada via intraperitoneal, 1 vez por semana. Após 24 horas da última sessão de treinamento, os animais foram eutanasiados para coleta das amostras. O teste estatístico utilizado foi ANOVA One Way, com pós-teste de Bonferroni e os dados foram expressos em média ± erro padrão (SEM) com p < 0,05. Resultados: A concentração de hemoglobina corpuscular média (CHCM) diminuiu nos grupos DxS (3,4%) e DxT (3,6%), em relação ao grupo CT. O número de leucócitos totais aumentou no CT quando comparado com os grupos CS (24,3%) e DxS (37,8%). O número de neutrófilos no grupo DxS aumentou quando comparado com os grupos CS (50,0%) e CT (41,9%). O número de linfócitos diminuiu no grupo DxS em relação aos grupos CS (31,4%) e CT (26,9%). O número de monócitos diminuiu no grupo DxS em relação aos grupos CS (46,1%) e CT (47,9%). Conclusão: O exercício resistido não foi capaz de atenuar os efeitos da dexametasona sobre a CHCM, neutrófilos, linfócitos e monócitos. / São Cristóvão, SE

O estado nutricional influencia o crescimento gástrico, e enquanto a proliferação celular é estimulada pelo jejum em filhotes, ela é inibida em ratos adultos. A corticosterona também age no desenvolvimento, e seus efeitos são regulados pela corticosterone binding globulin (CBG) e receptores de glicocorticóides (GR). Para investigar se a atividade da corticosterona responde ao jejum e como possíveis mudanças poderiam controlar o ciclo celular epitelial gástrico, nós avaliamos diferentes parâmetros durante a progressão do jejum em ratos de 18 e 40 dias de vida pós-natal. A restrição alimentar induziu um aumento de corticosterona no plasma em ambas as idades, mas apenas em filhotes o binding da CBG se elevou após o jejum curto, permanecendo alto até o final do tratamento. O jejum aumentou a atividade transcricional do GR na mucosa gástrica e os níveis protéicos, porém o efeito foi mais pronunciado em adultos. Além disso, observamos que nos filhotes, o GR é principalmente citoplasmático, enquanto em animais adultos, o receptor é acumulado no núcleo durante o jejum. As proteínas HSP 70 e HSP 90 foram diferencialmente reguladas, e podem contribuir para a estabilidade do GR no citoplasma em filhotes, e para o trânsito de GR para o núcleo em animais adultos. Quanto ao ciclo celular epitelial, observamos que em filhotes, ciclina D1 e p21 aumentaram durante o jejum, enquanto em ratos adultos, a ciclina E diminuiu e a p27 aumentou muito. Assim, nós demonstramos que a atividade da corticosterona é diferencialmente regulada pelo jejum em filhotes e ratos adultos, e que as variaçõe observadas poderiam atenuar um possível efeito supressor durante o desenvolvimento pós-natal. Sugerimos que este mecanismo pode estimular a proliferação celular e possibilitar o crescimento da mucosa gástrica durante condições nutricionais adversas. / The nutritional status influences gastric growth, and interestingly, whereas cell proliferation is stimulated by fasting in suckling rats, it is inhibited in adult animals. Corticosterone takes part in the mechanisms that govern development, and its effects are regulated in particular by corticosterone binding globulin (CBG) and glucocorticoid receptor (GR). To investigate whether corticosterone activity responds to fasting and how possible changes might control gastric epithelial cell cycle, we evaluated different parameters during the progression of fasting in 18- and 40-d-old rats. Food restriction induced higher corticosterone plasma concentration at both ages, but only in pups did CBG binding increase after short and long-term treatments. Fasting also increased gastric GR at transcriptional and protein levels, but the effect was more pronounced in 40-d-old animals. Moreover, in pups, GR was observed in the cytoplasm, whereas in adults, it accumulated in the nucleus after the onset of fasting. HSP 70 and HSP 90 were differentially regulated, and might contribute to the stability of GR and to the high cytoplasmic levels in pups and elevated shuttling in adult rats. As for gastric epithelial cell cycle, whereas cyclin D1 and p21 increased during fasting in pups, in adults, cyclin E slowly decreased concomitant with higher p27. In summary, we demonstrated that corticosterone function is differentially regulated by fasting in 18- and 40-d-old rats, and such variation might attenuate any possible suppressive effects during postnatal development. We suggest that this mechanism could ultimately increase cell proliferation and allow regular gastric growth during adverse nutritional conditions.

Background/Aims: A 33-year-old man was referred for the first time to the Division of Neurology because of the presence and progression of neurological symptoms. Dysphagia, weakness, reduced tear production, and nasal speech were present. In order to point the attention of late-onset triple A syndrome we describe this case and review the literature. Methods: Hormonal and biochemical evaluation, Schirmer test, tilt test and genetic testing for AAAS gene mutations. Results: Late-onset triple A syndrome caused by a novel homozygous missense mutation in the AAAS gene (A167V in exon 6) was diagnosed at least 17 years after symptom onset. Conclusions: The association between typical signs and symptoms of triple A syndrome should suggest the diagnosis even if they manifest in adulthood. The diagnosis should be confirmed by Schirmer test, endocrine testing (both basal and dynamic), genetic analysis, and detailed gastroenterological and neurological evaluations. Awareness of the possible late onset of the disease and of diagnosis in adulthood is still poor among clinicians, the acquaintance with the disease is more common among pediatricians. The importance of an adequate multidisciplinary clinical approach, dynamic testing for early diagnosis of adrenal insufficiency and periodical reassessment of adrenal function are emphasized. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Les glucocorticoïdes (GC), généralement sécrétés par le cortex surrénalien, exercent de très nombreuses fonctions dans l’organisme, via leur liaison au récepteur des glucocorticoïdes (GR). Les rares mutations inactivatrices du GR déjà décrites, sont responsables d’un syndrome de résistance aux GC et peuvent conduire à une hypertension artérielle (HTA), une hyperplasie surrénalienne (HBS), un hirsutisme et une obésité. Dans ce travail, nous avons caractérisé fonctionnellement 13 variants hétérozygotes du GR (expression, transactivation, localisation subcellulaire,...). Six variants du GR, découverts par séquençage à haut débit (NGS) ne sont pas pathogènes alors que 7 mutations hétérozygotes originales délétères ont été identifiées dans le cadre du protocole hospitalier de recherche clinique (Muta-GR). Ce PHRC a permis de préciser une prévalence à 5% de mutations inactivatrices du GR dans une cohorte de 100 patients avec HBS associée à une HTA et/ou un hypercortisolisme biologique sans signe clinique de Cushing.Une haploinsuffisance du GR, démontrée par la diminution d’induction par la déxamethasone du gène cible FKBP5, a été mise en évidence dans les fibroblastes cutanés de certains patients porteurs de mutations inactivatrices du GR. Ces patients présentent souvent un hypercorticisme avec hypokaliémie, aldostérone et rénine basse, signant un pseudohyperaldostéronisme. Nous avons démontré que le gène HSD11B2 codant pour l’enzyme 11β-HSD2, assurant l’inactivation des GC, est une cible directe du GR comme démontré par transfection transitoire de gène-rapporteur, RT-qPCR, LC/MSMS et ChIP. L’établissement des modèles de knock-in de mutations GR par stratégie Crispr/cas9 dans des lignées cellulaires préadipocytaires ou corticosurrénaliennes humaines s’est soldé par un échec. Ce travail devrait faciliter la sélection des patients chez qui la recherche de mutation inactivatrice du GR doit être faite et invite à un suivi régulier de ces patients. / Glucocorticoids (GC) regulate many essential biological functions by activating the glucocorticoid receptor (GR). GR loss-of function mutations are responsible for GC resistance syndrome, often associated with high blood pressure, hirsutism, bilateral adrenal hyperplasia (BAH) and obesity. Herein, functional characterization of 13 GR variants is presented (expression and binding studies, transactivation assays, subcellular localization) 6 variants were discovered with next-generating sequencing and had no functional impact on GR signaling while 7 GR loss-of-function mutations were mainly discovered during the National Clinical Hospital Research Program, Muta-GR. This PHRC discloses a 5% prevalence of GR loss-of-function mutations in a cohort of 100 patients with BAH, biological hypercortisolism and/or hypertension without Cushing signs. A GR haploinsuffisiency was demonstrated by a reduced dexamethasone-induced FKBP5 expression in skin fibroblasts of some patients harbouring GR loss-of-function mutations. These patients often presented with hypercorticism, hypokalemia, low renin and aldosterone levels, consistent with a pseudohypermineralocorticism. We showed that HSD11B2 encoding the 11β-HSD2 enzyme inactivating GC, is a direct GR target gene by transient transfection of reporter gene, RT-qPCR, LC/MSMS and ChIP. We failed to introduce GR loss-of-function mutations in human preadipocytes and adrenocortical cells by Crispr/Cas 9 technology. This work should facilitate selection of patients in whom GR mutation may be search, enabling an appropriate follow-up.

<p>  </p> <p>Glucocorticoids (GC) play a critical role in regulating the physiological response to stress. Disruptions to baseline levels due to stress can have negative implications on a variety of factors including growth and development, physical body conditions, metabolism, immune functions, and expression of normal behaviors, although this list is not exhaustive. When birds are unable to adapt to the stressor and return to homeostasis, the energy expenditure associated with the failed attempt at coping can lead to significant declines in the overall health, welfare, production, and performance of the bird. This can go on to impact producers and consumers as well, indicating the extensive repercussions of stress. Recently, scientists have been investigating thorough and efficient methods of quantifying stress in birds, such as measuring heterophil-to-lymphocyte ratio (HLR) or detecting glucocorticoid levels through enzyme-linked immunoassays (ELISA). However, the precise mechanism behind HLR increase during stress is unknown and ELISAs may not provide accurate results depending on when the blood is being measured. </p> <p><br></p> <p>GC are differentially released and exert their effects in a manner that is dependent on sex, age, and time. However, before investigating this, it was critical to validate the GC kits to ensure that they were measuring cortisol and corticosterone separately along with zero cross reactions with other precursors. Chapter 2 had 4 experiments carried out. The objective of experiment 1 was to validate ELISAs to ensure that they were measuring the GC accurately and separately since both cortisol and corticosterone were being measured. To do this, duck serum was pooled and charcoal-stripped to remove the presence of steroids. 3 standard curves were run to confirm that there was no cross reactivity. The objective of experiment 2 was to further validate the ELISA kits with mass spectrometry by checking for both glucocorticoids in the pooled samples. Once the validation process was complete, experiment 3 was carried out to look at the effect of ACTH stimulation on GC release. 16-week-old drakes and hens were given either intramuscular (IM) injections of cosyntropin (0.06 mg/kg) or saline as control. The cosyntropin dose was chosen according to previous studies reporting relatively high physiological responses, therefore, we wanted to replicate this. N was 10/sex/treatment. Blood was then collected at 0, 1, and 2 hours after injections and serum was analyzed by ELISAs. Lastly for experiment 4, 14-week-old developer drakes and hens at Maple Leaf Farms were assessed for a transportation stress experiment. Blood from 10 ducks/sex/time/barn were collected at 24 hours before transport to the breeder barn, immediately after a 1-hour transport, 24 hours after, and 1 week after transport. The results from experiment 1 yielded that both cortisol and corticosterone can be measured without the presence of unwanted contaminants or other products. Experiment 2 identified the greater sensitivity of mass spectrometry when reading GC levels, although the differences were linear. Experiment 3 showed that serum corticosterone levels were significantly increased at 1 hour after ACTH injections in both drakes and hens, with levels continuing to increase for the drakes. Serum cortisol levels were significantly increased at 1 hour after ACTH injections in both sexes, however, the hens had greater levels compared to the drakes. Serum cortisol levels returned to levels similar to that of saline-injected ducks at the 2-hour mark. Lastly, the transportation stress portion showed that cortisol was released at about 1/3 of corticosterone levels in both sexes. Hens showed increased levels of serum corticosterone compared to drakes at all time points except for 1 week after transport, and also had significantly increased serum cortisol levels at all time points. In conclusion, the ELISA kits were verified for future use when measuring GC as well as mass spectrometry. GC were detected in the ACTH and transportation stress experiments with hens displaying a greater sensitivity to GC release due to increased circulating levels compared to drakes. Although it was nonsignificant, there was a trend for GC to increase in response to transport. </p> <p><br></p> <p>There are sex differences in GC release and HLR for Pekin ducks and various challenges from the studies support this. With hens showing increased sensitivity to stress and drakes with more transient and gradual levels, we have consistently seen that both GC have differential roles in the stress response and not only is it critical to study both hormones, the timing of when measurements are taken are important as well to get a clear understanding of when the stress response is initiated. </p> <p><br></p> <p>Chapter 3 went further to understand the response of GC and HLR. The objective was to  investigate the release of cortisol and corticosterone in response to an ACTH dose response challenge. In Chapter 2, only one dose of cosyntropin was used and sample collection times only went to 2 hours after injections. In this study, 2 additional doses and an extra hour of sample collection were added to obtain more information. Pekin ducks were either given IM cosyntropin injections or saline for control, with an N of 10/sex/treatment. There were 3 treatment doses: High (0.06 mg/kg), medium (0.03 mg/kg), and low (0.015 mg/kg). All injections were given promptly at 0730 hours. Blood was collected at 0, 1, 2 and 3 hours after injections from the tibia veins to obtain serum for ELISAs. Blood smears were done to analyze HLR and sent to an independent lab to obtain values. The results indicated that both GC had significant sex x dose x time interactions. The low dose injection had no effect on corticosterone in hens with a slight increase for drakes at the first hour. The high dose for hens led to a spike in corticosterone levels at the first hour with a gradual decrease, and drakes had an increase that lasted for 2 hours until they returned to baseline at the last hour. The high dose in drakes stimulated cortisol release during the first 2 hours after injection with a similar effect in hens. However, hens had elevated levels compared to drakes. Finally, there was no dose response effect for HLR, although interestingly, the low dose injection elevated HLR even though there was no effect in GC. There were sex differences in the HLR response where the drakes given the high dose had levels that plateaued by the third hour, while the hens still had elevated levels. In conclusion, the ACTH dose-response test identified that ACTH has a dose-dependent effect in both GC and sex differences in their release. HLR also showed sex differences that did not depend on the dose given.</p> <p><br></p> <p>Chapter 4 observed acute exposure of GC in ducks. Pekin ducks were assigned 10/sex/treatment to receive either IM control, cortisol, or corticosterone injections. In addition, a low-dose cortisol treatment was given to represent the endogenous levels of cortisol compared to corticosterone. The control injections contained safflower oil, which was chosen as vehicle due to the low levels of genistein present. This is important as genistein is a plant estrogen and this could interact with the GC and alter the results. Blood was collected at 0, 1, 2, and 3 hours after injections for serum analysis with ELISAs, and blood smears were collected for complete blood count (CBC) differentials. Significant sex x treatment x time interactions were notable in both GC. Hens had significant increases at the first hour after injections in all treatments compared to controls, and drakes had increases at 2 hours after injections in all treatments except the low-dose cortisol. </p> <p><br></p> <p>After observing the effect of acute stress in ducks, the next step was to investigate the effects of chronic stress in chapter 5. Adult breeder Pekin ducks were randomly distributed into 3 groups: corticosterone, cortisol, or control treatments. The GC were in crystalline steroid form distributed through 2 capsules that were subcutaneously implanted on the backs of the neck. The ducks in the control group were given empty capsules. Blood smears, blood draws for serum, egg collection, body weights, and organ samples were collected over a period of 2 weeks. For the results, the corticosterone implants elevated corticosterone levels in both sexes. Interestingly, cortisol levels were elevated in both GC treatments in both sexes. Cortisol elevated HLR in drakes 1 day after implants with no effect from corticosterone. Hens had elevated HLR from both GC at all timepoints throughout the experiment. There were no significant differences in morphometrics in either sex. Corticosterone was not present in eggs, but cortisol was elevated in the albumen on day 7 and 14 of the experiment. Overall, there were sex differences in HLR where hens had greater levels in both GC treatments.</p>

La maladie de Cushing est caractérisée par une sécrétion excessive de l’hormone adrénocorticotrope (ACTH) à partir des tumeur corticotropes de l'hypophyse. Un excès d'ACTH entraîne un hypercortisolisme et provoque des symptômes tels que diabète, hypertension, obésité et les maladies cardiovasculaires entraînant un risque accru de mortalité si la maladie n’est pas traitée. Les tumeurs corticotropes sont caractérisées par la perte du rétro-contrôle négatif exercé par les glucocorticoïdes (GCs) sur la proopiomélanocortine (POMC) qui est le précurseur de l’ACTH : c'est la caractéristique majeure de la maladie de Cushing. Les causes de la résistance aux GC dans les adénomes corticotropes sont encore mal connues. Des études récentes ont montré une surexpression du récepteur du facteur de croissance épidermique (EGFR) dans les adénomes corticotropes provoquant une augmentation de l'activité du gène POMC et de la sécrétion d'ACTH. Les principaux objectifs de ce travail étaient de comprendre la relation entre la signalisation dérégulée de EGF et la résistance aux GCs. Dans le présent travail, nous avons identifié la voie JAK/STAT3 comme la principale voie de signalisation EGFR qui active la transcription du gène POMC. De plus, nous montrons que l'activation de la signalisation EGFR entraîne une résistance du promoteur POMC aux GCs et que l’activation de STAT3 est responsable de cette résistance. STAT3 affecte le mécanisme de transrepression de GR sans affecter le recrutement de GR au promoteur POMC. L’utilisation d’un inhibiteur de STAT3 restaure la répression de la transcription du promoteur POMC par les GCs. Nous avons aussi trouvé que 50% des adénomes corticotropes humains montrent une surexpression de la forme active de STAT3. Nous avons aussi étudié les mécanismes sous le contrôle des GCs qui régulent la prolifération cellulaire et qui pourraient être dérégulés dans la maladie de Cushing. CABLES1 est un régulateur négatif du cycle cellulaire et son expression est sous le contrôle des GCs. L’expression de CABLES1 est perdue dans 55 % des adénomes hypophysaires corticotropes, mais la cause de cette perte est encore mal comprise. Dans ce travail, nous avons identifié quatre variants faux-sens dans le gène CABLES1, deux chez de jeunes adultes (c.532G > A, c.718C > T) et deux chez des enfants (c.935G > A, et c.1388A > G) atteints de la maladie de Cushing. Les quatre variants touchent une région de la protéine CABLES1 qui est proche du motif de liaison de la kinase-3 dépendante des cyclines (CDK3). Ces variants ont perdu la capacité d’inhiber la croissance de cellules corticotropes tumorales (AtT20). Les quatre variantes sont donc des mutations de perte de fonction. En résumé, nos travaux révèlent le rôle important de STAT3 dans la résistance aux GC et ainsi, le blocage de l'action de STAT3 peut être une nouvelle stratégie pour le traitement de la maladie de Cushing. Nous avons aussi supporté un rôle de CABLES1 en tant que nouveau gène prédisposant aux tumeurs hypophysaires. / Cushing’s disease (CD) is characterized by excess secretion of adrenocorticotropic hormone (ACTH) from corticotroph tumors of the pituitary gland. Excessive ACTH leads to hypercortisolism that causes disabling symptoms such as diabetes, hypertension, obesity and cardiovascular disease resulting in an increased risk of mortality if it is not treated. Corticotroph tumors are characterized by the loss of glucocorticoid (GC) feedback repression of the proopiomelanocortin (POMC) that encodes the precursor of ACTH: this is the hallmark of CD. The causes of GC resistance in corticotroph adenomas of CD patients remain unknown. Recent findings showed overexpression of epidermal growth factor receptor (EGFR) in corticotroph adenomas causing increased POMC activity and ACTH secretion. The main objectives of this work were to understand the relationship between deregulated EGF signaling and GC resistance in the tumorigenesis of CD. In the present work, we identified the JAK/STAT3 pathway as the main EGFR pathway activating transcription of the POMC gene. We found that sustained activation of EGFR signaling or overactivation of STAT3 causes unresponsiveness of the POMC promoter to GCs and that activated STAT3 is responsible for GC resistance. STAT3 affects the transrepression mechanism of GR without affecting GR recruitment to the POMC promoter. The use of STAT3 inhibitor restores the repressive effect of GC on POMC transcription. Importantly, 50% of human corticotroph adenomas showed overexpression of activated STAT3. We also studied the mechanisms under the control of GCs that regulate cell proliferation and that could be deregulated in CD. CABLES1 is a negative cell cycle regulator, its expression is under the control of GC. CABLES1 expression is lost in 55 % of corticotroph adenomas and the underlying reasons remain unclear. In this work, we identified the presence of four missense variants in CABLES1 gene, two in young adults (c.532G > A, c.718C > T) and two in children (c.935G > A, and c.1388A > G) with CD. The four variants are close to the predicted cyclin-dependent kinase-3 (CDK3)-binding region of the CABLES1 protein. The variants have lost the ability to inhibit growth of corticotropinoma cells (AtT20). The four variants are thus loss of function mutations. In summary, our work revealed the important role of STAT3 in GC resistance and further indicates that inhibition of STAT3 action may be a novel strategy for CD treatment. We also provided evidence for a role of CABLES1 as a novel pituitary tumor-predisposing gene.

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