Review: Ageing and hormones

Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences

BACKGROUND

The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history.

AIMS

The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD).

METHOD

Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder.

RESULTS

A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017).

CONCLUSIONS

Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

Oxidative stress as a therapeutic target for the prevention and treatment of early age-related macular degeneration

Age-related macular degeneration, the leading cause of irreversible visual loss among older adults in developed countries, is a chronic, multifactorial, and progressive disease with the development of painless, central vision loss. Retinal pigment epithelial cell dysfunction is a core change in age-related macular degeneration that results from aging and the accumulated effects of genetic and environmental factors that, in part, is both caused by and leads to oxidative stress. In this review, we describe the role of oxidative stress, the cytoprotective oxidative stress pathways, and the impact of oxidative stress on critical cellular processes involved in age-related macular degeneration pathobiology. We also offer targeted therapy that may define how antioxidant therapy can either prevent or improve specific stages of age-related macular degeneration.

Diagnosis and Treatment of Growth Hormone Deficiency: A Position Statement from Korean Endocrine Society and Korean Society of Pediatric Endocrinology

Growth hormone (GH) deficiency is caused by congenital or acquired causes and occurs in childhood or adulthood. GH replacement therapy brings benefits to body composition, exercise capacity, skeletal health, cardiovascular outcomes, and quality of life. Before initiating GH replacement, GH deficiency should be confirmed through proper stimulation tests, and in cases with proven genetic causes or structural lesions, repeated GH stimulation testing is not necessary. The dosing regimen of GH replacement therapy should be individualized, with the goal of minimizing side effects and maximizing clinical improvements. The Korean Endocrine Society and the Korean Society of Pediatric Endocrinology have developed a position statement on the diagnosis and treatment of GH deficiency. This position statement is based on a systematic review of evidence and expert opinions.

Role of Endogenous Glucocorticoids in Cancer in the Elderly

Although not a disease itself, aging represents a risk factor for many aging-related illnesses, including cancer. Numerous causes underlie the increased incidence of malignancies in the elderly, for example, genomic instability and epigenetic alterations that occur at cellular level, which also involve the immune cells. The progressive decline of the immune system functions that occurs in aging defines immunosenescence, and includes both innate and adaptive immunity; the latter undergoes major alterations. Aging and chronic stress share the abnormal hypothalamic–pituitary–adrenal axis activation, where altered peripheral glucocorticoids (GC) levels and chronic stress have been associated with accelerated cellular aging, premature immunosenescence, and aging-related diseases. Consequently, changes in GC levels and sensitivity contribute to the signs of immunosenescence, namely fewer naïve T cells, poor immune response to new antigens, decreased cell-mediated immunity, and thymic involution. GC signaling alterations also involve epigenetic alterations in DNA methylation, with transcription modifications that may contribute to immunosenescence. Immune cell aging leads to decreased levels of immunosurveillance, thereby providing tumor cells one more route for immune system escape. Here, the contribution of GC secretion and signaling dysregulation to the increased incidence of tumorigenesis in the elderly is reviewed.

Combined exercise is a modality for improving insulin resistance and aging-related hormone biomarkers in elderly Korean women

BACKGROUND

The functional decline of the endocrine and immune systems with aging causes changes in the regulation of the body's metabolism and defense functions. Although it is impossible to stop aging artificially, regular exercises reportedly delay aging and have positive effects on senile diseases. The improvements in insulin resistance values and aging-related hormones in elderly women after combined exercises have not been effectively elucidated.

OBJECTIVE

In this study, we aimed to examine the impact of combined exercise on insulin resistance and aging-related hormones in elderly women.

METHODS

Twenty elderly Korean women were randomly assigned to a "non-exercise" (n = 10) or combined exercise group (n = 10). The exercise group performed both anaerobic and aerobic exercises for 12 weeks, three times per week. Exercise intensity was increased gradually, from 40% to 70% of the heart rate reserve (HRR) every 3 weeks. Insulin resistance, growth hormone, IGF-1, DHEA-S, and estrogen were measured before and after the 12-week intervention.

RESULTS

The main effect was found in the glucose level for a time, which significantly decreased in the exercise group. The insulin level and HOMA-IR showed significant interaction effects and increased significantly in the control group. The GH level showed significant interaction effects and increased significantly in the exercise group. The IGF-1 level showed significant interaction effects, but not significantly within and between groups. The DHEA-S level revealed interaction effects and the main effect for a time and significantly increased in the exercise group. The estrogen level exhibited an interaction effect and increased significantly in the exercise group. After the 12-week combined exercise intervention, no significant difference was observed between groups.

DISCUSSION

This study has shown that 12-week combined exercise is useful for improving insulin resistance and GH, IGF-1, and DHEA-S levels in elderly women. Thus, this study provides evidence that combined exercise is a useful therapeutic method to decrease insulin resistance and stimulate the secretion of aging-related hormones in elderly women.

Human aging and disease: Lessons from age-related macular degeneration

Aging is the most significant risk factor associated with chronic disease in humans. The accumulation of genetic damage throughout life leads to a variety of biological aberrations, including disrupted protein homeostasis, metabolic dysfunction, and altered cellular signaling. Such changes ultimately result in cellular senescence, death, or transformation to uncontrolled proliferation, thereby compromising human health. Events contributing to age-dependent physiological decline also occur in the context of hormonal and metabolic changes, affecting interconnected cellular networks. This complexity often confounds the development of effective treatments for aging and age-related diseases. In contrast to monotherapy and polypharmacology, an innovative systems pharmacology approach can identify synergistic combinations of drugs that modulate distinct mechanistic nodes within a network, minimizing off-target side effects and enabling better therapeutic outcomes. G protein-coupled receptors (GPCRs) are particularly good targets for the application of systems pharmacology, because they activate different signal transduction pathways that can culminate in a common response. Here, we describe a systems pharmacology strategy for the treatment of age-related macular degeneration (AMD), a multifactorial chronic disease of the eye. By considering the retina as part of a large, interconnected network, systems pharmacology will enable the identification of combination therapies targeting GPCRs to help restore genomic, proteomic, and endocrine homeostasis. Such an approach can be advantageous in providing drug regimens for the treatment of AMD, while also having broader ramifications for ameliorating adverse effects of chronic, age-related disease in humans.

Development of an in vitro model of menopause using primary human dermal fibroblasts

OBJECTIVE

To overcome the current lack of in vitro models to specifically reproduce hormonal skin ageing in women, and in search of active ingredients with innovative efficacy claim for cosmetic skin care, we developed a cell culture-based model by simulating menopause's hormonal decline and assessed several parameters of collagen metabolism.

METHODS

Human dermal fibroblasts were incubated with media containing 17β-oestradiol, progesterone, dehydroepiandrosterone, growth hormone and insulin-like growth factor-1 at concentrations corresponding to those of non-menopausal women's sera and then of menopausal women's sera. We measured cell proliferation [by 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT)], matrix metalloproteinase-1 and metalloproteinase-3 (MMPs) release (by enzyme-linked immunosorbent assay - ELISA), total collagen deposition (by Sirius red staining), types I and III collagen deposition (by ELISA), and types I and III procollagen gene expression (by real-time q-RT-PCR).

RESULTS

Our results showed a significant decrease over time in cell proliferation, collagen deposition and type III/type I collagen ratio, together with an increase in MMP release, when cells were incubated in media containing sex hormones at menopausal levels. This is consistent with in vivo data from menopausal women available in the literature. Surprisingly, procollagen gene expression was only reduced within the first hours and increased afterwards when compared with non-menopausal culture conditions.

CONCLUSION

Our results demonstrated that the increased procollagen synthesis with menopausal conditions was not sufficient to compensate for the MMPs' catabolic effects and/or the impaired procollagen protein maturation, resulting in a decrease in extracellular collagen content. These findings add to the overall understanding of hormone-dependent skin behaviour and highlight the suitability of this in vitro model for cosmetic actives testing aiming to underpin claims of anti-ageing efficacy, specifically for menopausal women, regarding collagen metabolism and balance of types, for maintenance of dermal mechanical properties.

Hormonal therapy of intrinsic aging

Intrinsic skin aging represents the biological clock of the skin cells per se and reflects the reduction processes that are common in internal organs. The reduced secretion of the pituitary, adrenal glands, and the gonads contributes to characteristic aging-associated body and skin phenotypes as well as behavior patterns. Our knowledge of whether there is a direct or indirect connection between hormonal deficiency and skin aging still remains limited. In females, serum levels of 17β-estradiol, dehydroepiandrosterone, progesterone, growth hormone (GH), and its downstream hormone insulin-like growth factor I (IGF-I) are significantly decreased with increasing age. In males, serum levels of GH and IGF-I decrease significantly, whereas it can decrease in late age in a part of the population. Hormones have been shown to influence skin morphology and functions, skin permeability, wound healing, sebaceous lipogenesis, and the metabolism of skin cells. Prevention of skin aging by estrogen/progesterone replacement therapy is effective if administered early after menopause and influences intrinsically aged skin only. Vitamin D substitution and antioxidant treatment may also be beneficial. Replacement therapy with androgens, GH, IGF-I, progesterone, melatonin, cortisol, and thyroid hormones still remains controversial.

[Dermatoendocrinology. Skin aging]

Hormones and their imbalances have significant effects on the morphology and physiology of the skin and influence various skin functions, especially wound healing and lipogenesis. With increasing age, the concentrations of important circulating hormones, including growth hormone and sex-related steroids, decrease continuously. As a result, physiologic processes are negatively influenced and various age-associated disorders may develop. As the population aged 80 and over is expected to rise in the next decades, the understanding of the molecular mechanisms accompanying skin aging and disease prevention will become even more important and play a role in preventing disease.

Antiepileptic action of exogenous dehydroepiandrosterone in iron-induced epilepsy in rat brain

In the study described here, the antiepileptic effect of dehydroepiandrosterone (DHEA) treatment on iron-induced focal epileptiform activity in the rat brain was investigated. DHEA is a neuroactive corticosteroid hormone synthesized both in the adrenal cortex and in the brain. Its antioxidant properties are well known. As oxidative stress seems to play a major role in epileptogenesis in the iron-induced model of posttraumatic epilepsy, it was of interest to examine whether DHEA would exert antiepileptic activity. DHEA at a dose of 30 mg/kg/day administered intraperitoneally for 7, 14, and 21 days to iron-induced epileptic rats prevented epileptiform electrophysiological activity. Morris water maze and open-field tests on iron-induced epileptic rats revealed that DHEA also prevented behavioral alterations related to epileptiform activity. Thus, DHEA attenuated the cognitive defects produced by epileptic activity. Moreover, alterations in epileptogenesis-related biochemical parameters-lipid peroxidation, protein oxidation and Na(+), K(+)-ATPase (sodium pump) activity--were also countered by DHEA.

[Skin aging]

Like the entire human organism, the skin is subject to an intrinsic unpreventable aging process. But exogenous factors also influence skin aging. Ultraviolet radiation in particular results in premature skin aging, also referred to as extrinsic skin aging or photo aging, causing in large part aging-associated changes in sun-exposed areas. Intrinsic and extrinsic aging share several molecular similarities despite morphological and pathophysiological differences. The formation of reactive oxygen species and the induction of metalloproteinases reflect central aspects of skin aging. Accumulation of fragmented collagen fibrils prevents neocollagenesis and accounts for further degradation of extracellular matrix by means of positive feedback regulation. The importance of extrinsic factors in skin aging and the detection of its mechanisms has given rise to development of various therapeutic and preventive strategies.

The role of stress factors during aging of the immune system

This manuscript reviews current evidence suggesting that aging of the immune system (immunosenescence) may be closely related to chronic stress and stress factors. Healthy aging has been associated with emotional distress in parallel to increased cortisol to dehydroepiandrosterone (DHEA) ratio. The impaired DHEA secretion together with the increase of cortisol results in an enhanced exposure of lymphoid cells to deleterious glucocorticoid actions. The lack of appropriated growth hormone signaling during immunosenescence is also discussed. It follows that altered neuroendocrine functions could be underlying several immunosenescence features. Indeed, changes in both innate and adaptive immune responses during aging are also similarly reported during chronic glucocorticoid exposure. In addition, chronically stressed elderly subjects may be particularly at risk of stress-related pathology because of further alterations in both neuroendocrine and immune systems. The accelerated senescent features induced by chronic stress include higher oxidative stress, reduced telomere length, chronic glucocorticoid exposure, thymic involution, changes in cellular trafficking, reduced cell-mediated immunity, steroid resistance, and chronic low-grade inflammation. These senescent features are related to increased morbidity and mortality among chronically stressed elderly people. Overall, these data suggest that chronic stress leads to premature aging of key allostatic systems involved in the adaptation of the organisms to environmental changes. Stress management and psychosocial support may thus promote a better quality of life for elderly people and at the same time reduce hospitalization costs.

William J. Cunliffe Scientific Awards. Characteristics and pathomechanisms of endogenously aged skin

The skin, being in direct contact with several environmental factors (e.g. UV irradiation), does not only undergo endogenous aging, which has to do with the 'biological clock' of the skin cells per se, but also exogenous aging. While exogenous skin aging has been extensively studied, the pathomechanisms of endogenous skin aging remain far less clear. Endogenous skin aging reflects reduction processes, which are common in internal organs. These processes include cellular senescence and decreased proliferative capacity, decrease in cellular DNA repair capacity and chromosomal abnormalities, loss of telomeres, point mutations of extranuclear mtDNA, oxidative stress and gene mutations. As a consequence, aged skin in nonexposed areas shows typical characteristics including fine wrinkles, dryness, sallowness and loss of elasticity. Recent data have illustrated that lack of hormones occurring with age may also contribute to the aging phenotype. Improvement of epidermal skin moisture, elasticity and skin thickness, enhanced production of surface lipids, reduction of wrinkle depth, restoration of collagen fibers and increase of the collagen III/I ratio have been reported after hormone replacement therapy or local estrogen treatment in postmenopausal women. Furthermore, an in vitro model of endogenous skin aging consisting of human SZ95 sebocytes which were incubated under a hormone-substituted environment illustrated that hormones at age- and sex-specific levels were able to alter the development of cells by regulating their transcriptome. In conclusion, among other factors the hormone environment plays a distinct role in the generation of aged skin.

Age-specific hormonal decline is accompanied by transcriptional changes in human sebocytes in vitro

The importance of hormones in endogenous aging has been displayed by recent studies performed on animal models and humans. To decipher the molecular mechanisms involved in aging we maintained human sebocytes at defined hormone-substituted conditions that corresponded to average serum levels of females from 20 (f20) to 60 (f60) years of age. The corresponding hormone receptor expression was demonstrated by reverse transcription-polymerase chain reaction (RT-PCR), Western blotting and immunocytochemistry. Cells at f60 produced significantly lower lipids than at f20. Increased mRNA and protein levels of c-Myc and increased protein levels of FN1, which have been associated with aging, were detected in SZ95 sebocytes at f60 compared to those detected at f20 after 5 days of treatment. Expression profiling employing a cDNA microarray composed of 15 529 cDNAs identified 899 genes with altered expression levels at f20 vs. f60. Confirmation of gene regulation was performed by real-time RT-PCR. The functional annotation of these genes according to the Gene Ontology identified pathways related to mitochondrial function, oxidative stress, ubiquitin-mediated proteolysis, cell cycle, immune responses, steroid biosynthesis and phospholipid degradation - all hallmarks of aging. Twenty-five genes in common with those identified in aging kidneys and several genes involved in neurodegenerative diseases were also detected. This is the first report describing the transcriptome of human sebocytes and its modification by a cocktail of hormones administered in age-specific levels and provides an in vitro model system, which approximates some of the hormone-dependent changes in gene transcription that occur during aging in humans.

Healthy aging is associated with unaltered production of immunoreactive growth hormone but impaired neuroimmunomodulation

BACKGROUND

Both endocrine and immune systems are continuously remodeled during aging.

OBJECTIVE

Here, we investigated to what extent adrenal and somatosenescence are associated reciprocal changes in the immune system during strictly healthy aging.

METHODS

Forty-six elderly subjects and 33 young adults were recruited according to the health criteria of the SENIEUR protocol. Peripheral blood mononuclear cells were isolated and stimulated in vitro with lipopolysaccharide or phytohemagglutinin to assess the production of immunoreactive growth hormone (GH). Peripheral sensitivity to steroids was assessed in vitro by dexamethasone-, cortisol- or dehydroepiandrosterone (DHEA)-induced inhibition of T-cell proliferation. DHEA and GH levels were measured by radioimmunoassays.

RESULTS

Healthy elderly had lower salivary DHEA and serum GH levels (somatosenescence). They presented reduced T-cell sensitivity to dexamethasone but similar cellular sensitivities to cortisol and DHEA. Their cells produced similar levels of immunoreactive GH compared to the cells of young adults.

CONCLUSIONS

These data indicate that healthy aging is associated with adrenal and somatosenescence as well as impaired neuroendocrine immunoregulation at the level of the lymphocyte. In addition, somatosenescence may not be associated with a reciprocal decline in immunoreactive GH.

Food intake and ageing—the role of the gut

Healthy ageing is associated with decreased appetite and energy intake and this is generally associated with weight loss after about 70 years of age. The mechanisms responsible for this 'physiological' anorexia are not well understood, but it may predispose to the development of protein-energy malnutrition in older people, which is associated with increased morbidity and mortality. Many sensory and social factors, including olfactory changes and economic status, contribute to under-nutrition in older people; however, normal ageing is associated with a number of significant changes in gastrointestinal function. The control of appetite is complex but it is clear that gastrointestinal signals are important in the regulation of appetite and food intake. This review examines the role of small intestinal hormones and gastrointestinal motor function in the observed changes to appetite and food intake in older people.

The effect of age on prepro-orexin gene expression and contents of orexin A and B in the rat brain

Orexin A and B (hypocretin 1 and 2) are hypothalamic peptides, which are synthesized in the lateral hypothalamus. Orexins participate in the regulation energy balance, food intake, vigilance and several endocrine and autonomic functions. The widespread projections of the orexin neurons suggest that they may have a role in coordination of different brain activities. The effects of ageing on the orexin system have not been studied previously. Prepro-orexin gene expression in the lateral hypothalamus, and the contents of orexin A and B peptides in the lateral hypothalamus and hypothalamus were measured in young, middle-aged and old (3, 12 and 24 months) rats. In the course of ageing, the expression of the prepro-orexin gene and the levels of orexin A and B decreased; the main decrease occurred by 12 months. Sleep deprivation for 6h increased slightly the expression of prepro-orexin gene in young rats. Deterioration of the orexin system may play a role in the phenomenon associated with aging, e.g. decreased consolidation of vigilance states, endocrine changes and dysfunctions of autonomic nervous system.

Mitotic and neurogenic effects of dehydroepiandrosterone (DHEA) on human neural stem cell cultures derived from the fetal cortex

Dehydroepiandrosterone (DHEA) is a neurosteroid with potential effects on neurogenesis and neuronal survival in humans. However, most studies on DHEA have been performed in rodents, and there is little direct evidence for biological effects on the human nervous system. Furthermore, the mechanism of its action is unknown. Here, we show that DHEA significantly increased the growth rates of human neural stem cells derived from the fetal cortex and grown with both epidermal growth factor (EGF) and leukemia inhibitory factor (LIF). However, it had no effect on cultures grown in either factor alone, suggesting a specific action on the EGF/LIF-responsive cell. Precursors of DHEA such as pregnenolone or six of its major metabolites, had no significant effect on proliferation rates. DHEA did not alter the small number (<3%) of newly formed neuroblasts or the large number (>95%) of nestin-positive precursors. However, the number of glial fibrillary acidic protein-positive cells, its mRNA, and protein were significantly increased by DHEA. We found both N-methyl-d-aspartate and sigma 1 antagonists, but not GABA antagonists, could completely eliminate the effects of DHEA on stem cell proliferation. Finally we asked whether the EGF/LIF/DHEA-responsive stem cells had an increased potential for neurogenesis and found a 29% increase in neuronal production when compared to cultures grown in EGF/LIF alone. Together these data suggest that DHEA is involved in the maintenance and division of human neural stem cells. Given the wide availability of this neurosteroid, this finding has important implications for future use.

Energy requirements in the eighth decade of life

BACKGROUND

Knowledge of energy requirements among relatively healthy elderly is limited.

OBJECTIVES

The objectives of the study were to measure total energy expenditure (TEE)-derived energy requirements in a biracial population of older adults without limitations to daily life and to test these empirical measures against national and international recommendations.

DESIGN

TEE (measured by the doubly labeled water method), resting metabolic rate (RMR), activity-related energy expenditure (AEE), and body composition were measured in 288 persons aged 70-79 y selected from the Health, Aging, and Body Composition Study.

RESULTS

TEE was lower in women (approximately 530 kcal/d; P < 0.0001) than in men because of the women's lower RMR and AEE. Fat-free mass explained the sex difference in RMR, but body weight failed to account for the women's lower AEE (approximately 1 kcal x kg(-1) x d(-1); P = 0.007). Blacks had lower TEE than did whites (approximately 100 kcal/d, P = 0.03), and that was explained by blacks' lower RMR. Physical activity level (TEE/RMR) did not differ significantly between sexes and races (1.70 +/- 0.23). The World Health Organization (WHO) recommendations overestimated TEE by 10 +/- 15% (P < 0.0001) in women but not in men, and the dietary reference intakes (DRIs) were accurate to 0 +/- 14% (P = 0.1). Both WHO and DRI recommendations are based on an underestimated physical activity level, and WHO recommendations are based on overestimated RMR.

CONCLUSIONS

This study of well-functioning older adults confirms the racial difference in energy metabolism and supports the use of the 2002 DRIs. Because the DRIs and WHO recommendations underestimated PAL, new predictive equations of energy requirements are proposed.

Does dietary sugar and fat influence longevity?

Simultaneous consideration of the influence of the different types of carbohydrates and fats in human diets on mortality rates (especially the diseases of aging), and the probable retardation of such diseases by caloric restriction (CR) leads to the hypothesis that restriction of foods with a high glycemic index and saturated or hydrogenated fats would avoid or delay many diseases of aging and might result in life extension. Many of the health benefits of CR might thereby be available to humans without the side effects or unacceptability of semi-starvation diets.

Hypothalamic-pituitary-adrenocortical axis function in patients with polymyalgia rheumatica and giant cell arteritis

BACKGROUND

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are 2 closely related syndromes affecting elderly people. One of the most striking features of these conditions is the development of the disease in an almost exclusive manner in people older than 50 years. Despite this close association with age, the pathogenic mechanisms that could explain this age-related predisposition are unknown. Aging is accompanied by a number of quantitative and qualitative changes in the endocrine system that may predispose to several pathologic conditions that occur in the elderly.

OBJECTIVE

To explore the hypothalamic-pituitary-adrenal axis in PMR and GCA.

METHODS

Basal levels of adrenal hormones as well as the response to low-dose adrenocorticotropin hormone (ACTH) were investigated in 20 patients with active untreated disease and compared with levels in 16 healthy age-matched controls.

RESULTS

Male patients with active disease had low basal levels of androstenedione compared to the controls. After low-dose ACTH challenge, cortisol and dehydroepiandrosterone reached higher levels in patients than in healthy subjects, indicating that the adrenal gland function was not suppressed. Furthermore, the authors did not find a clear relationship between the levels of acute phase reactants and adrenal hormones in the patient population.

CONCLUSIONS

The authors' findings are probably more compatible with the hypothesis that the abnormalities found in the patient group are the consequences of chronic illness rather than a crucial factor contributing to the pathogenesis of the disease.

Changes in peripheral blood lymphocyte subsets in elderly subjects are associated with an impaired function of the hypothalamic-pituitary-adrenal axis

A growing body of evidence indicates that ageing brings a progressive disruption in the immune and endocrine systems. However, very few reports have correlated the changes in the immune system with the endocrine function in the elderly. The aim of the present study was to investigate the changes occurring in the peripheral blood lymphocyte subpopulations with age and correlate them with the hypothalamic-pituitary-adrenal (HPA) function. We determined the peripheral blood lymphocyte phenotype and the T cell receptor usage by flow cytometry analysis. The HPA function was evaluated by the basal serum levels of adrenal steroids and the response to stimulation with a low-dose ACTH. In the elderly, we observed a decrease of major T subsets together with an increase of NK cells and activated T cells. With regard to the HPA function, the most significant decline was found in dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulphate (DHEAS). A close correlation between immune changes with ageing and DHEA response to ACTH stimulation was found. The present study showed an inverse correlation of lymphocyte changes with the plasma levels of steroids, especially DHEA and its metabolite, DHEAS. This association was not found for other steroids and points for the possibility of using DHEA to correct the immunological decline associated with ageing.

Hormone receptors and proliferation in breast carcinomas of equivalent histologic grades in pre- and postmenopausal women

Breast cancers in younger, premenopausal women are more likely to exhibit an adverse prognostic profile (including negative steroid hormone receptors and a high rate of cellular proliferation) and poor outcome than breast cancers in postmenopausal women. It has been hypothesized that this adverse prognostic profile is a result of the higher histologic grade of breast cancers in pre- compared with post-menopausal women. To assess the association of expression of steroid hormone receptors and indicators of proliferation while controlling for histologic grade, we identified 100 infiltrating ductal carcinomas from premenopausal women 45 years of age or younger and 100 from postmenopausal women 65 years of age or older. The carcinomas were selected so that the histologic grades (low versus high) were distributed equally between the 2 groups. Estrogen receptors (ER), progesterone receptors (PR), p27(Kip1) and Ki-67 (to measure rate of proliferation) were assessed by immunohistochemistry and compared between groups. Clinical information and survival data were also analyzed. ER content was lower and proliferation was higher in carcinomas in premenopausal women (p = 0.048 and p = 0.005, respectively). By univariate analysis, p27(Kip1) and PR were not different between the groups; however, in multivariate analysis, p27(Kip1) was higher in postmenopausal women, but only in a subgroup with highly proliferative carcinomas. Overall survival was similar in the pre- and postmenopausal women. Furthermore, low p27(Kip1) and African-American ethnicity predicted a poorer overall survival in the premenopausal, but not in the postmenopausal, women in our study. After controlling for histologic grade, a lower expression of ER and a higher proliferative index were detected in breast carcinomas in premenopausal women. Therefore, some prognostic indicators, such as ER and proliferative rate, may be more closely associated with menopausal status than histologic grade. Our data also suggest that some prognostic factors are not equally effective as predictors of survival in pre- and postmenopausal women.

Dehydroepiandrosterone (DHEA) and its sulfated derivative (DHEAS) regulate apoptosis during neurogenesis by triggering the Akt signaling pathway in opposing ways

Dehydroepiandrosterone (DHEA) can function to protect neural precursors and their progeny targeted with toxic insults; however, the molecular mechanisms underlying the neuroprotective effects of DHEA are not understood. We cultured neural precursors from the embryonic forebrain of rats and examined the effects of DHEA and its sulfated derivative (DHEAS) on the activation of the serine-threonine protein kinase Akt, which is widely implicated in cell survival signaling. We found that DHEA activated Akt in neural precursor culture, in association with a decrease in apoptosis. In contrast, DHEAS decreased activated Akt levels and increased apoptosis. The effects of DHEA on neural cell survival and activation of Akt were not blocked by the steroid hormone antagonists flutamide and tamoxifen, but both were blocked by a PI3-K inhibitor, LY294002. These findings suggest that during neurogenesis in the developing cortex, DHEA and DHEAS regulate the survival of neural precursors and progeny through the Akt signaling pathway.

Hormonal effects on skin aging

With aging, there is a decrease in the level of hormones, such as estrogen, testosterone, dehydroepiandrosterone sulfate, and growth hormone. The effect of this decrease on the skin has been poorly documented, although more data are available for estrogen than for other hormones. This article reviews the effect of decreasing hormone levels on the skin and the possible cutaneous benefits of hormone replacement therapy.