Glucocorticoid receptor alpha and beta isoforms are not mutated in bipolar affective disorder

SRD5A2 is associated with increased cortisol metabolism in schizophrenia spectrum disorders

OBJECTIVE

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar disorder and schizophrenia, but the mechanism is unclear; recently, increased activity of cortisol metabolizing enzymes was indicated in these disorders. We investigated whether five genes involved in cortisol metabolism were associated with altered activity of cortisol metabolizing enzymes in bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ).

METHODS

A case-control sample of subjects with BD (N=213), SCZ (N=274) and healthy controls (N=370) from Oslo, Norway, were included and genotyped from 2003 to 2008. A sub-sample (healthy controls: N=151; SCZ: N=40; BD: N=39) had estimated enzyme activities based on measurements of urinary free cortisol, urinary free cortisone and metabolites. A total of 102 single nucleotide polymorphisms (SNPs) in the SRD5A1, SRD5A2, AKR1D1, HSD11B1 and HSD11B2 genes were genotyped, and significant SNPs analyzed in the sub-sample.

RESULTS

There was a significant association of rs6732223 in SRD5A2 (5α-reductase) with SCZ (p=0.0043, Bonferroni corrected p=0.030, T risk allele). There was a significantly increased 5α-reductase activity associated with rs6732223 (T allele) within the SCZ group (p=0.011).

CONCLUSIONS

The present data suggest an interaction between SCZ and SRD5A2 variants coding for the enzyme 5α-reductase, giving rise to increased 5α-reductase activity in SCZ. The findings may have implications for cortisol metabolizing enzymes as possible drug targets.

Phosphorylation status of glucocorticoid receptor, heat shock protein 70, cytochrome c and Bax in lymphocytes of euthymic, depressed and manic bipolar patients

Bipolar disorder (BD), a severe mental illness, has been correlated with alterations in glucocorticoid receptor (GR) signaling. Since it is phosphorylated GR that contributes to receptor function and determines its transcriptional activity, the Ser211 being a biomarker for activated GR in vivo, it is pertinent that we seek to determine the putative role of the total phosphorylation status of GR and site-specific phosphorylation at serine 211 (S211) in BD and their possible association with parameters of apoptosis. In lymphocytes from 48 BD patients under multiple psychotropic therapy and 20 healthy subjects, we measured whole cell GR, total GR phosphorylation, and phosphorylation of GR at serine 211 in nucleus, using immunoprecipitation, phosphospecific antibody and Western-blot analysis. Cytosolic cytochrome c and Bax and whole cell HSP70 were determined by immunoblot analysis. One-way ANOVA statistical analysis was carried out. Total phosphorylated GR was lower (P<0.001) while the GR S211 was higher (P<0.001) in all BD patients as compared to healthy subjects. HSP70 was reduced in euthymic (P<0.05), depressed (P<0.001) and manic (P<0.001) as compared to healthy subjects. Cytochrome c was higher in all-patient groups as compared to healthy subjects, however without reaching statistical significance (P>0.05). Bax levels were lower in the cytosolic fraction of all three BD groups. We provide the first evidence of altered GR phosphorylation joined with signs of apoptosis in lymphocytes of BD patients and suggest that the phosphorylation status of GR may play a role in the pathophysiology of bipolar disorder.

A relative resistance of T cells to dexamethasone in bipolar disorder

OBJECTIVE

A relative resistance of immune cells to steroids has been established in patients with major depression (MD). In this study, we investigated the in vitro responsiveness of T cells to dexamethasone (DEX) of patients with bipolar disorder (BD).

METHODS

T cells of outpatients with DSM-IV BD (n = 54) and of healthy control subjects (HC; n = 29) were isolated, cultured and stimulated with phytohemagglutinin (PHA) for 72 h. The suppressive effect of graded concentrations of DEX (5 x 10(-9)-10(-5) M) on PHA-induced CD25 (IL-2R) expression was measured by fluorescence-activated cell sorting (FACS) analysis. Data were correlated to the T-cell activation status in the peripheral blood of the same patients and to their diagnosis, current mood state, ultradian cycling pattern and current use of medication, including lithium.

RESULTS

T cells of patients with BD were less sensitive to DEX-induced suppressive effects as compared with T cells of HC. These data were particularly evident at 10(-7) M DEX (mean % suppression +/- SEM BD: 18.9% +/- 3.5 versus HC: 35.8% +/- 4.7, p = 0.001). We found no correlations of this relative in vitro DEX resistance of T cells neither with the previously mentioned clinical characteristics nor with the actual activation status of the T cells in the BD patients.

CONCLUSION

A relative T-cell resistance to steroids, as has been observed in MD previously, may be a trait phenomenon of BD, independent of mood state.

Altered glucocorticoid receptor signaling cascade in lymphocytes of bipolar disorder patients

Bipolar disorder (BD) is characterized by hypothalamic pituitary adrenal (HPA) axis hyperactivity, glucocorticoid insensitivity and alterations in serotonin and inflammatory mediators. The glucocorticoid receptor (GR), activator protein-1 (AP-1), nuclear factor-kappa B (NF-kappaB) and c-jun N-terminal kinase (JNK) regulate the above mentioned processes; we therefore assessed their role in BD. Fifteen bipolar depressed patients under multiple anti-depressant therapy, 15 bipolar euthymics under lithium monotherapy and 25 matched controls were studied. Whole cell and nuclear extracts from lymphocytes were immunoblotted for GR, c-fos, JNK and NF-kappaB and nuclear aliquots were submitted to electrophoretic mobility shift assay for GR, AP-1 and NF-kappaB. Associations with the anti-depressant therapy and the state of the disease were also sought. Results, expressed as percentage of pooled protein standard sample intergraded optical density (IOD) (mean +/- SD), revealed: (a) depressed patients had significantly higher GR levels than controls in whole cell (82.63 +/- 6.18 versus 76.27 +/- 4.21%, P < 0.01) and nuclear extracts (86.66 +/- 3.81 versus 81.72 +/- 2.71%, P < 0.001) but lower GR-DNA binding (68.75 +/- 7.91 versus 81.84 +/- 4.25%, P < 0.05). Euthymics had normalized whole cell GR content (73.64 +/- 5.95%) and GR-DNA binding activity (76.82 +/- 7.29%) but higher nuclear GR content (86.89+/-3.96%, P<0.01) than controls; (b) nuclear c-fos content and AP-1-DNA-binding were significantly lower in depressed patients than controls (80.49 +/- 2.03 versus 84.82 +/- 3.48%, P < 0.05 and 78.46 +/- 4.17 versus 84.80 +/- 5.79%, P < 0.05, respectively). Euthymics however, showed similar nuclear c-fos and AP-1-DNA-binding to controls (85.48 +/- 2.71 and 87.78 +/- 3.54%, respectively) but lower whole cell c-fos than in controls (81.18 +/- 3.87 versus 87.01 +/- 4.22%, P < 0.001); (c) depressed patients had significantly lower whole cell and nuclear JNK than controls (67.01 +/- 4.29 versus 72.00 +/- 3.68%, P < 0.05 and 80.10 +/- 2.53 versus 86.96 +/- 2.49%, P < 0.001) whereas euthymics showed lower nuclear JNK (83.27 +/- 1.93%, P < 0.01); (d) whole cell NF-kB was higher in the depressed patients than in controls (67.30 +/- 5.00 versus 63.63 +/- 3.3%, P < 0.05). Concluding, intracellular signaling of GR, AP-1 and JNK are altered in BD and may underly disease aetiopathogenesis and/or reflect the effect of the anti-depressants.

Glucocorticoid receptor gene-based SNP analysis in patients with recurrent major depression

Dysregulation of the hypothalamic-pituitary-adrenal axis, one of the stress-response systems, is one of the key neurobiological features of major depression (MDD). Data supporting the notion that glucocorticoid-mediated feedback inhibition is impaired in MDD come from a multitude of studies demonstrating nonsuppression of cortisol secretion following administration of the synthetic glucocorticoid dexamethasone. We examined whether genetic variations in the glucocorticoid receptor gene (Nuclear Receptor Subfamily 3, Group C, Member 1; NR3C1) could be associated with increased susceptibility for MDD using a whole gene-based association analysis of single nucleotide polymorphisms (SNPs). Four SNPs were identified in NR3C1 and genotyped in two well-diagnosed samples of patients with MDD ascertained in Belgium and northern Sweden, and matched control samples. In total, 314 MDD patients and 354 control individuals were included in the study. In the Belgian sample, we observed significant allele (p=0.02) and genotype (p=0.02) association with an SNP in the promoter region (NR3C1-1); in the Swedish sample, we observed significant allele (p=0.02) and genotype (p=0.02) association with the R23K SNP. The haplotype association studies showed modest evidence for an involvement of the 5' region of the NR3C1 gene in the genetic vulnerability for MDD. This study suggests that polymorphisms in the 5' region of the NR3C1 gene may play a role in the genetic vulnerability for MDD.

Gene analysis of the glucocorticoid receptor alpha in Alzheimer's disease

BACKGROUND

In Alzheimer's disease (AD), the hypothalamic-pituitary-adrenal (HPA) axis is hyperactive and the sensitivity to dexamethasone is decreased, suggesting a possible involvement of glucocorticoid receptor alpha (GRalpha) defects in the aetiopathology of the disease.

METHODS

We, therefore, searched for the presence of mutations in the human GRalpha (hGRalpha) gene, focusing on the hormone-binding domain due to its importance in mediating glucocorticoids' effects. RNA isolated from peripheral blood mononuclear cells (PBMCs) of 15 patients with Alzheimer's disease and 20 healthy individuals was subjected to reverse transcription-polymerase chain reaction amplification (RT-PCR) analysis followed by denaturing gradient gel electrophoresis (DGGE).

RESULTS

No mutations could be detected in the region of the hGRalpha gene examined.

CONCLUSIONS

We conclude that the hormone-binding domain of GRalpha is not altered in Alzheimer's disease and molecular defects in other gene regions of the GRalpha or in its isoform GRbeta warrant further investigation in Alzheimer's disease.

Hypothalamic-pituitary-adrenocortical system and mood disorders: highlights from mutant mice

In recent years, refined molecular technologies and the generation of genetically engineered mice have allowed to specifically target individual genes involved in the regulation of the hypothalamic-pituitary-adrenocortical (HPA) system. Given the fundamental role of the corticotropin-releasing hormone (CRH) system in anxiety, stress-associated pathologies, and mood disorders, we describe genetic modifications of the genes that encode proteins integral to the CRH/CRH receptor system with particular emphasis on conditional gene-targeting strategies. The profile of results, consistent with current knowledge of CRH function from more traditional assays, indicates that enhancement of the CRH function is associated with an activation of the HPA system, an anxious phenotype, alterations in cognitive performance, reductions in food intake, and disturbances of autonomic functions. In general, blockade of CRH activity produces the opposite effects, namely an anxiety-reduced phenotype. Molecular genetic strategies for conditional inactivation or overexpression of the glucocorticoid receptor contribute to our understanding of the genetics of endocrine activity and behavior, the most complex form of biological organization. In addition, we introduce mice with a genetic manipulation in the function of the blood-brain barrier as an animal model for the study of neuroendocrine regulation and, in particular, of HPA system activity. By use of mice deficient for abcb1- (also called multidrug resistance gene 1, mdr1-) type P glycoproteins, it was shown most recently that abcb1-type P glycoproteins control the access of endogenous glucocorticoids into the central nervous system. Thus, the ABCB1-type P glycoprotein function exerts a profound influence on activity and regulation of the HPA system under both basal conditions and during stress. Taken together, these genetically engineered mice are valuable tools for increasing our understanding of HPA system dysregulation in anxiety and stress-related pathologies, including human affective disorders. The identification and detailed characterization of these molecular pathways will ultimately lead to the development of novel neuropharmacological intervention strategies.

Chemical neuroimmunology: health in a nutshell bidirectional communication between immune and stress (limbic-hypothalamic-pituitary-adrenal) systems

Stress is a ubiquitous and pervasive part of modern life that is frequently blamed for causing a plethora of diseases and other discomforting medical conditions. All higher organisms, including humans, experience stress in the form of a wide variety of stressors that range from environmental pollutants and drugs to traumatic events or self-induced trauma. Stressors registered by the central nervous system (CNS) generate physiological stress responses in the body (periphery) by means of the limbic-hypothalamic-pituitary-adrenal (LHPA) axis. This LHPA axis operates through the use of chemical messengers such as the stress hormones corticotropin-releasing hormone (CRH) and glucocorticoids (GCs). Under conditions of frequent exposure to acute stress and/or chronic, long-term exposure to stress, the LHPA axis becomes dysfunctional and in the process frequently overproduces both CRH and GCs, which results in many mild to severely toxic side effects. Bidirectional communication between the LHPA axis and immune/inflammatory systems can dramatically potentiate these side effects and create environments in the CNS and periphery ripe for the triggering and/or promotion of tissue degeneration and disease. This review aims to present as far as possible a molecular view of the processes involved so as to provide a bridge from the diffuse range of studies on molecular structure and receptor interactions to the burgeoning biological and medical literature that describes the empirical interplay between stress and disease. We hope that our review of this fast-growing field, which we christen chemical neuroimmunology, will give a clear indication of the striking range and depth of current molecular, cellular and medical evidence linking stress hormones to degeneration and disease. In so doing, we hope to provide encouragement for others to become interested in this critical and far-reaching field of research, which is very much at the heart of many important disease processes and very much a critical part of the crucial interface between chemistry and biology.

Application of denaturing gradient gel electrophoresis (DGGE) to screen for mutations of the human glucocorticoid receptor alpha gene (hGRalpha)

OBJECTIVES

In a previous publication, we had presented a sensitive method to detect mutations of the segment of the human glucocorticoid receptor alpha (hGRalpha) gene encoding the ligand binding domain (LBD) and part of the DNA binding domain (DBD) of hGRalpha, as several types of glucocorticoid resistance syndromes have been correlated with mutations in the respective nucleotide sequences. However, mutations affecting various regions covering the whole length of hGRalpha are increasingly reported in a variety of disease states. We now present an expanded screening methodology to detect mutations covering the whole length of hGRalpha.

DESIGN AND METHODS

We developed a sensitive, simple screening PCR-DGGE method to detect mutations in the aminoterminal domain and DNA-binding domain of the hGRalpha. Wild type hGRalpha cDNA and mutant samples were included in the analysis to ensure the accuracy and sensitivity of the method.

RESULTS

The PCR-DGGE method identified the mutant samples and discriminated them from wild type hGRalpha.

CONCLUSIONS

The method described is accurate, sensitive, simple, cheap and fulfills the critera for a screening method which will be useful in delineating possible involvement of hGRalpha mutations in the aetiopathology of diseases correlated to derangements of glucocorticoid action.

Cell-specific regulation of apoptosis by glucocorticoids: implication to their anti-inflammatory action

Glucocorticoids play a major role in attenuation of the inflammatory response. These steroid hormones are able to induce apoptosis in cells of the hematopoietic system such as monocytes, macrophages, and T lymphocytes that are involved in the inflammation reaction. In contrast, it was discovered recently that in glandular cells such as the mammary gland epithelia, hepatocytes, ovarian follicular cells, and in fibroblasts glucocorticoids protect against apoptotic signals evoked by cytokines, cAMP, tumor suppressors, and death genes. The anti-apoptotic effect of glucocorticoids is exerted by modulation of several survival genes such as Bcl-2, Bcl-x(L), and NFkB, in a cell-specific manner. Moreover, upregulation or downregulation of the same gene product can occur in a cell-dependent manner following stimulation by glucocorticoids. This phenomenon is probably due to composite regulatory cross-talk among multiple nuclear coactivators or corepressors, which mediate the transcription regulation of the genes, by their interaction with the glucocorticoid receptor. These observations suggest that the anti-inflammatory action of glucocorticoids is exerted by two complementary mechanisms: on one hand, they induce death of the cells that provoke the inflammation, and on the other hand they protect the resident cells of the inflamed tissue by arresting apoptotic signals. Moreover, the complementary action of glucocorticoids provides a new insight to the therapeutic potential of these hormones.

Glucocorticoid receptor variants: clinical implications

Following exposure to stress, cortisol is secreted from the adrenal cortex under the control of the hypothalamic-pituitary-adrenal axis (HPA-axis). Central in the regulation of the HPA-axis is a two tied corticosteroid-receptor system, comprised of high and low affinity receptors, the mineralocorticoid receptor (MR) and the glucocorticoid receptor (GR), respectively. In addition, these corticosteroid receptors mediate the effects of cortisol during stress on both central and peripheral targets. Cortisol modulates gene-expression of corticosteroid-responsive genes, with the effect lasting from hours to days. Mutations in the GR-gene are being associated with corticosteroid resistance and haematological malignancies, although these mutations are relatively rare and probably not a common cause of these diseases. However, several GR-gene variants and single nucleotide polymorphisms (SNP) in the GR-gene have been identified which are relatively common in the human population. The GRbeta-variant, for example, has been proposed to influence corticosteroid-sensitivity and most evidence has been derived from the immune system and in particular asthma. With respect to polymorphisms, a BclI restriction fragment polymorphism and a Asp363Ser have been described, which not only influence the regulation of the HPA-axis, but are also associated with changes in metabolism and cardiovascular control. These associations of a GR-gene polymorphism with metabolism and cardivascular control, and also with the regulation of the HPA-axis, indicates an important underlying role of cortisol in the etiology of these complex disorders. Therefore, we propose that a common underlying defect in these complex disorders is a disregulation of the HPA-axis, especially during stress. The clinical implication is that the regulation of the HPA-axis should be envisioned as a primary target of new drugs for the treatment of stress-related disorders.

Mutation detection of the human glucocorticoid receptor alpha gene area coding for the hormone-binding domain by denaturing gradient gel electrophoresis

Mutations in the hormone-binding domain of the human glucocorticoid receptor alpha (hGRalpha) gene have been detected in a variety of glucocorticoid resistance syndromes. Using the denaturing gradient gel electrophoresis technique, we developed a sensitive method for the detection of alterations in the gene area coding for the whole hormone-binding domain and part of the DNA-binding domain of the hGRalpha. This method can be applied for screening of glucocorticoid receptor gene alterations in glucocorticoid-dependent diseases.

Genetic modification of corticosteroid receptor signalling: novel insights into pathophysiology and treatment strategies of human affective disorders

Every disturbance of the body, either real or imagined, evokes a stress response. Essential to this stress response is the activation of the hypothalamic-pituitary-adrenocortical (HPA) system, finally resulting in the release of glucocorticoid hormones from the adrenal cortex. Glucocorticoid hormones, in turn, feed back to this system by central activation of two types of corticosteroid receptors: the glucocorticoid receptor (GR) and the mineralocorticoid receptor (MR) which markedly differ in their neuroanatomical distribution and ligand affinity. Whereas a brief period of controllable stress, experienced with general arousal and excitement, can be a challenge and might thus be beneficial, chronically elevated levels of circulating corticosteroids are believed to enhance vulnerability to a variety of diseases, including affective disorders. Corticosteroids are known to influence emotions and cognitive processes, such as learning and memory. In addition, corticosteroids play extremely important roles in modulating fear and anxiety-related behaviour. The mechanisms by which corticosteroids exert their effects on behaviour are often indirect, by modulating particular sets of neurons or neurotransmitter systems. In addition, the timing of corticosteroid increase (before, during or after exposure to a stressor) determines whether and how behaviour is affected. The cumulative evidence makes a strong case implicating corticosteroid receptor dysfunction in the pathogenesis of affective disorders. Although definitive controlled trials remain to be conducted, there is evidence indicating that cortisol-lowering or corticosteroid receptor antagonist treatments may be of clinical benefit in selected individuals with major depression. A more detailed knowledge of the GR signalling pathways therefore opens up the possibility to specifically target GR function. In recent years, refined molecular technologies and the generation of genetically engineered mice (e.g. "conventional" and "conditional" knock-outs) have allowed to specifically target individual genes involved in corticosteroid receptor signalling and stress hormone regulation. Given the fundamental role of corticosteroid receptors in hippocampal integrity and mental performance during aging and psychiatric disorders, the identification and detailed characterization of these molecular pathways will ultimately lead to the development of novel neuropharmacological intervention strategies.

The anti-inflammatory action of glucocorticoids is mediated by cell type specific regulation of apoptosis

Glucocorticoids play a major role in attenuation of the inflammatory response. These steroid hormones are able to induce apoptosis in cells of the hematopoietic system such as monocytes, macrophages and T-lymphocytes that are involved in the inflammation reaction. In contrast, it was discovered recently that in glandular cells such as the mammary gland epithelia, hepatocytes, ovarian follicular cells and in fibroblasts glucocorticoids protect against apoptotic signals evoked by cytokines, cAMP, tumor suppressors and death genes. The anti-apoptotic effect of glucocorticoids is exerted by modulation of several survival genes such as Bcl-2, Bcl-x(L) and NFkappaB, in a cell type-specific manner. Moreover, up regulation or down regulation of the same gene product can occur in a cell type-dependent manner following stimulation by glucocorticoids. This phenomenon is probably due to composite regulatory cross-talk among multiple nuclear coactivators or corepressors, which mediate the transcriptional regulation of the genes, by their interaction with the glucocorticoid receptor (GR). These observations suggest that the anti-inflammatory action of glucocorticoids is exerted by two complementary mechanisms: on the one hand, they induce death of the cells that provoke the inflammation, and on the other hand, they protect the resident cells of the inflamed tissue by arresting apoptotic signals.

Genetically engineered mice for studies of stress-related clinical conditions

Genetically engineered mice with a specific deletion of targeted genes provide a novel and useful tool to study the endogenous mechanisms underlying aberrant behaviour. In this review we take the stress hormone (hypothalamic-pituitary-adrenocortical) system as an example to demonstrate how refined molecular technologies have allowed to target individual genes involved in stress hormone regulation. We describe different gene targeting methods: the generation of "conventional" knock-out mice enables us to delete a gene of interest in every cell of the body. Equally important for the studies of gene function in the mouse is the use of tissue-specific regulatory systems that allow gene inactivation to be restricted to specific tissues and, in some cases, to specific time points during development, such as the "conditional" knock-out, or the application of antisense techniques. Importantly, deletion of individual genes is not providing animal models for certain psychiatric disorders as these are caused by a manifold of minor changes in a series of so-called susceptibility genes. However, these gene targeting methods have become valuable tools to dissect the functions of individual components of complex biological systems in behavioural neuroscience: genetically engineered animals help to unravel the complex interactions and correlations between individual genes, hormonal regulation and behaviour, the most complex form of biological organization.