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Lai C, Wu Z, Li Z, Huang X, Hu Z, Yu H, Yuan Z, Shi J, Hu J, Mulati Y, Liu C, Xu K. Single-cell analysis extracted CAFs-related genes to established online app to predict clinical outcome and radiotherapy prognosis of prostate cancer. Clin Transl Oncol 2024; 26:1240-1255. [PMID: 38070051 DOI: 10.1007/s12094-023-03348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/03/2023] [Indexed: 04/20/2024]
Abstract
BACKGROUND Cancer-associated fibroblasts (CAFs) play a significant role in regulating the clinical outcome and radiotherapy prognosis of prostate cancer (PCa). The aim of this study is to identify CAFs-related genes (CAFsRGs) using single-cell analysis and evaluate their potential for predicting the prognosis and radiotherapy prognosis in PCa. METHODS We acquire transcriptome and single-cell RNA sequencing (scRNA-seq) results of PCa and normal adjacent tissues from The GEO and TCGA databases. The "MCPcounter" and "EPIC" R packages were used to assess the infiltration level of CAFs and examine their correlation with PCa prognosis. ScRNA-seq and differential gene expression analyses were used to extract CAFsRGs. We also applied COX and LASSO analysis to further construct a risk score (CAFsRS) to assess biochemical recurrence-free survival (BRFS) and radiotherapy prognosis of PCa. The predictive efficacy of CAFsRS was evaluated by ROC curves and subgroup analysis. Finally, we integrated the CAFsRS gene signature with relevant clinical features to develop a nomogram, enhancing the predictive accuracy. RESULTS The abundance of CAFs is associated with a poor prognosis of PCa patients. ScRNA-seq and differential gene expression analysis revealed 323 CAFsRGs. After COX and LASSO analysis, we obtained seven CAFsRGs with prognostic significance (PTGS2, FKBP10, ENG, CDH11, COL5A1, COL5A2, and SRD5A2). Additionally, we established a risk score model based on the training set (n = 257). The ROC curve was used to confirm the performance of CAFsRS (The AUC values for 1, 3 and 5-year survival were determined to be 0.732, 0.773, and 0.775, respectively.). The testing set (n = 129), GSE70770 set (n = 199) and GSE116918 set (n = 248) revealed that the model exhibited exceptional predictive performance. This was also confirmed by clinical subgroup analysis. The violin plot demonstrated a statistically significant disparity in the CAFs infiltrations between the high-risk and low-risk groups of CAFsRS. Further analysis confirmed that both CAFsRS and T stage were independent prognostic factors for PCa. The nomogram was then established and its excellent predictive performance was demonstrated through calibration and ROC curves. Finally, we developed an online prognostic prediction app ( https://sysu-symh-cafsnomogram.streamlit.app/ ) to facilitate the practical application of the nomogram. CONCLUSIONS The prognostic prediction risk score model we constructed could accurately predict BRFS and radiotherapy prognosis PCa, which can provide new ideas for clinicians to develop personalized PCa treatment and follow-up programs.
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Affiliation(s)
- Cong Lai
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Zhikai Wu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Zhuohang Li
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, 510000, Guangdong, China
| | - Xin Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Zhensheng Hu
- Department of Medical Informatics, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Hao Yu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, 510000, Guangdong, China
| | - Zhihan Yuan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Juanyi Shi
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, 510000, Guangdong, China
| | - Jintao Hu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Yelisudan Mulati
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China
| | - Cheng Liu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China.
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, 510000, Guangdong, China.
| | - Kewei Xu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, Guangdong, China.
- Guangdong Provincial Clinical Research Center for Urological Diseases, Guangzhou, 510000, Guangdong, China.
- Sun Yat-Sen College of Medical Science, Sun Yat-Sen University, Shenzhen, 518000, Guangdong, China.
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Neocleous V, Fanis P, Toumba M, Skordis N, Phylactou LA. Genetic diagnosis of endocrine disorders in Cyprus through the Cyprus Institute of Neurology and Genetics: an ENDO-ERN Reference Center. Orphanet J Rare Dis 2024; 19:167. [PMID: 38637882 PMCID: PMC11027394 DOI: 10.1186/s13023-024-03171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/30/2024] [Indexed: 04/20/2024] Open
Abstract
The report covers the current and past activities of the department Molecular Genetics-Function and Therapy (MGFT) at the Cyprus Institute of Neurology and Genetics (CING), an affiliated Reference Center for the European Reference Network on Rare Endocrine Conditions (Endo-ERN).The presented data is the outcome of > 15 years long standing collaboration between MGFT and endocrine specialists from the local government hospitals and the private sector. Up-to-date > 2000 genetic tests have been performed for the diagnosis of inherited rare endocrine disorders. The major clinical entities included Congenital Adrenal Hyperplasia (CAH) due to pathogenic variants in CYP21A2 gene and Multiple Endocrine Neoplasia (MEN) type 2 due to pathogenic variants in the RET proto-oncogene. Other rare and novel pathogenic variants in ANOS1, WDR11, FGFR1, RNF216, and CHD7 genes were also found in patients with Congenital Hypogonadotropic Hypogonadism. Interestingly, a few patients with Disorders of Sexual Differentiation (DSD) shared rare pathogenic variants in the SRD5A2, HSD17B3 and HSD3B2 while patients with Glucose and Insulin Homeostasis carried theirs in GCK and HNF1A genes. Lastly, MGFT over the last few years has established an esteemed diagnostic and research program on premature puberty with emphasis on the implication of MKRN3 gene on the onset of the disease and the identification of other prognosis biomarkers.As an Endo-ERN member MGFT department belongs to this large European network and holds the same humanistic ideals which aim toward the improvements of health care for patients with rare endocrine conditions in respect to improved and faster diagnosis.
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Affiliation(s)
- Vassos Neocleous
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Pavlos Fanis
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Meropi Toumba
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Department of Pediatrics, Pediatric Endocrinology Clinic, Aretaeio Hospital, Nicosia, Cyprus
| | - Nicos Skordis
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
- Division of Paediatric Endocrinology, Paedi Center for Specialized Paediatrics, Nicosia, Cyprus
- School of Medicine, University of Nicosia, Nicosia, Cyprus
| | - Leonidas A Phylactou
- Department of Molecular Genetics, Function and Therapy, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
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Gao Z, Pu C, Lin L, Ou Q, Quan H. Genome-wide association study of blood lipid levels in Southern Han Chinese adults with prediabetes. Front Endocrinol (Lausanne) 2024; 14:1334893. [PMID: 38371897 PMCID: PMC10869499 DOI: 10.3389/fendo.2023.1334893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/22/2023] [Indexed: 02/20/2024] Open
Abstract
Background Dyslipidemia is highly prevalent among individuals with prediabetes, further exacerbating their cardiovascular risk. However, the genetic determinants underlying diabetic dyslipidemia in Southern Han Chinese remain largely unexplored. Methods We performed a genome-wide association study (GWAS) of blood lipid traits in 451 Southern Han Chinese adults with prediabetes. Fasting plasma lipids, including triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were assayed. Genotyping was conducted using the Precision Medicine Diversity Array and Gene Titan platform, followed by genotype imputation using IMPUTE2 with the 1000 Genomes Project (Phase 3, Southern Han Chinese) as reference. Single nucleotide polymorphisms (SNPs) associated with lipid levels were identified using mixed linear regression, with adjustment for covariates. Results We identified 58, 215, 74 and 81 novel SNPs associated with TG, TC, HDL-C and LDL-C levels, respectively (P < 5×10-5). Several implicated loci were located in or near genes involved in lipid metabolism, including SRD5A2, PCSK7, PITPNC1, IRX3, BPI, and LBP. Pathway enrichment analysis highlighted lipid metabolism and insulin secretion. Conclusion This first GWAS of dyslipidemia in Southern Han Chinese with prediabetes identified novel genetic variants associated with lipid traits. Our findings provide new insights into genetic mechanisms underlying heightened cardiovascular risk in the prediabetic stage. Functional characterization of implicated loci is warranted.
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Affiliation(s)
- Zhenshu Gao
- Department of Endocrinology, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, China
| | - Changchun Pu
- Department of Endocrinology, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, China
| | - Leweihua Lin
- Department of Endocrinology, Hainan General Hospital, Haikou, China
| | - Qianying Ou
- Department of Endocrinology, Hainan General Hospital, Haikou, China
| | - Huibiao Quan
- Department of Endocrinology, Hainan General Hospital, Haikou, China
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Buck SAJ, Meertens M, van Ooijen FMF, Oomen-de Hoop E, de Jonge E, Coenen MJH, Bergman AM, Koolen SLW, de Wit R, Huitema ADR, van Schaik RHN, Mathijssen RHJ. A common germline variant in CYP11B1 is associated with adverse clinical outcome of treatment with abiraterone or enzalutamide. Biomed Pharmacother 2023; 169:115890. [PMID: 37988848 DOI: 10.1016/j.biopha.2023.115890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
Extragonadal androgens play a pivotal role in prostate cancer disease progression on androgen receptor signaling inhibitors (ARSi), including abiraterone and enzalutamide. We aimed to investigate if germline variants in genes involved in extragonadal androgen synthesis contribute to resistance to ARSi and may predict clinical outcomes on ARSi. We included ARSi naive metastatic prostate cancer patients treated with abiraterone or enzalutamide and determined 18 germline variants in six genes involved in extragonadal androgen synthesis. Variants were tested in univariate and multivariable analysis for the relation with overall survival (OS) and time to progression (TTP) by Cox regression, and PSA response by logistic regression. A total of 275 patients were included. From the investigated genes CYP17A1, HSD3B1, CYP11B1, AKR1C3, SRD5A1 and SRD5A2, only rs4736349 in CYP11B1 in homozygous form (TT), present in 54 patients (20%), was related with a significantly worse OS (HR = 1.71, 95% CI 1.09 - 2.68, p = 0.019) and TTP (HR = 1.50, 95% CI 1.08 - 2.09, p = 0.016), and was related with a significantly less frequent PSA response (OR = 0.48, 95% CI 0.24 - 0.96, p = 0.038) on abiraterone or enzalutamide in a multivariable analysis. The frequent germline variant rs4736349 in CYP11B1 is, as homozygote, an independent negative prognostic factor for treatment with abiraterone or enzalutamide in ARSi naive metastatic prostate cancer patients. Our findings warrant prospective investigation of this potentially important predictive biomarker.
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Affiliation(s)
- Stefan A J Buck
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
| | - Marinda Meertens
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | | | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Evert de Jonge
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marieke J H Coenen
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Andries M Bergman
- Department of Medical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands; Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Alwin D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
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Xiao T, Li B, Lai R, Liu Z, Xiong S, Li X, Zeng Y, Jiao S, Tang Y, Lu Y, Xu Y. Active pharmaceutical ingredient-ionic liquids assisted follicular co-delivery of ferulic acid and finasteride for enhancing targeted anti-alopecia. Int J Pharm 2023; 648:123624. [PMID: 37984619 DOI: 10.1016/j.ijpharm.2023.123624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
Androgenetic alopecia (AGA) is the primary hair loss with impairing patients' quality of life. Finasteride (FIN) is an SRD5A2 inhibitor for AGA treatment, but oral FIN causes systemic adverse effects. Topical FIN delivery is anticipated to overcome this problem. Ferulic acid (FA) is a natural phenolic acid with vascular remodeling and anti-inflammatory effects. Herein, an active pharmaceutical ingredient ionic liquid (API IL) based on choline and FA (CF-IL) is for the first time constructed to load FIN for fabricating FIN CF-IL. CF-IL aims to act as carriers and cargos and enhance hair follicle (HF) co-delivery of FA and FIN for synergistic anti-alopecia. Thermal and spectroscopic analysis combined with quantum chemistry calculations and molecular dynamics confirm the formation of CF-IL. The CF-IL simultaneously increases the solubility of FA (∼648-fold) and FIN (∼686-fold), enhances the permeation and retention of FIN and FA through the follicular pathway, and promotes cellular uptake. FIN CFIL regulates the abnormal mRNA expressions in dihydrotestosterone-irritated hDPCs, and promotes hair regrowth in AGA mice in a combined manner with FIN and FA. These findings suggest that FA-based API IL is a promising approach for percutaneously co-delivering FA and FIN to HF, providing an enhanced targeting treatment for AGA.
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Affiliation(s)
- Ting Xiao
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Bin Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Rongrong Lai
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Ziyi Liu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Sha Xiong
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Xiaojuan Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yao Zeng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Siwen Jiao
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yujia Tang
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yi Lu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Yuehong Xu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China.
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Chen J, Zhang Z, Shi W, Yan Q, Bi X, Zhu P, Zhang D, Wu X. Preimplantation genetic testing and prenatal diagnosis in a family with pseudovaginal perineoscrotal hypospadias: A case report. Medicine (Baltimore) 2023; 102:e36171. [PMID: 37986304 PMCID: PMC10659598 DOI: 10.1097/md.0000000000036171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Pseudovaginal perineoscrotal hypospadias (PPSH) is a rare autosomal recessive disorder of sex development caused by biallelic mutations in SRD5A2. PPSH is characterized by a vaginal-like blind ending perineal opening, penoscrotal hypospadias, and impaired masculinization. PATIENT CONCERNS We reported preimplantation genetic testing and prenatal diagnosis in a family with PPSH. DIAGNOSIS Whole-exome sequencing of the family identified 2 SRD5A2 pathogenic variants (c.578A>G and c.607G>A). Haplotype analysis showed that the variants were inherited from the previous generation of this family. INTERVENTIONS During subsequent in vitro fertilization, preimplantation genetic testing was performed on 9 embryos. One unaffected embryo was transferred, resulting in a singleton pregnancy. OUTCOMES The prenatal diagnosis at 20 weeks' gestation confirmed the fetus was unaffected. A healthy female infant weighing 3100 g and measuring 50 cm was delivered vaginally at 39+5 weeks of gestation. LESSONS SUBSECTIONS This case highlights the use of preimplantation genetic testing and prenatal diagnosis to prevent the transmission of PPSH in families at risk. Our approach provides an effective strategy for identification and management of families with autosomal recessive disorders like PPSH.
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Affiliation(s)
- Jiayao Chen
- Shanxi Medicine University, Taiyuan, Shanxi, China
- Children’s Hospital of Shanxi Medicine University, Taiyuan, Shanxi, China
| | - Zhiping Zhang
- Center of Reproductive Medicine, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, China
| | - Wenjing Shi
- Shanxi Medicine University, Taiyuan, Shanxi, China
| | - Qin Yan
- Shanxi Medicine University, Taiyuan, Shanxi, China
| | - Xingyu Bi
- Center of Reproductive Medicine, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, China
| | - Pengfei Zhu
- Center of Reproductive Medicine, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, China
| | - Dongdong Zhang
- Center of Reproductive Medicine, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, China
| | - Xueqing Wu
- Center of Reproductive Medicine, Children’s Hospital of Shanxi and Women Health Center of Shanxi, Taiyuan, Shanxi, China
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Levy B, Teplitsky S, Kalaitzoglou E, Kahler S, Matheny JP, Saltzman AF. "Exogenous" 5 Alpha Reductase Deficiency: A Case Report. Urology 2023; 178:147-150. [PMID: 37178876 DOI: 10.1016/j.urology.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Testosterone and dihydrotestosterone are significant drivers of male external genital development, and therefore teratogens that alter these hormone profiles have been hypothesized to cause aberrations in development. Here, we present the first case report of genitalia anomalies after prenatal exposure to spironolactone and dutasteride through 8-weeks of gestation. The patient was born with abnormal male external genitalia which was surgically managed. Long-term outcomes such as gender identity, sexual function, hormonal maturation through puberty, and fertility remain unknown. These numerous considerations necessitate multi-disciplinary management with close follow-up to address sexual, psychological, and anatomic concerns.
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Affiliation(s)
- Brittany Levy
- Department of Surgery, University of Kentucky, Lexington, KY
| | - Seth Teplitsky
- Department of Urology & Pediatrics, Division of Pediatric Urology, University of Kentucky, Lexington, KY
| | - Evangelia Kalaitzoglou
- Department of Pediatrics, Division of Endocrinology and Barnstable Brown Diabetes Center, University of Kentucky, Lexington, KY
| | - Stephen Kahler
- Department of Pediatrics, Division of Genetics, University of Kentucky, Lexington, KY
| | - Juliann Paige Matheny
- Department of Pediatrics, Division of Genetics, University of Kentucky, Lexington, KY
| | - Amanda F Saltzman
- Department of Urology & Pediatrics, Division of Pediatric Urology, University of Kentucky, Lexington, KY.
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Jin R, Forbes C, Miller NL, Strand D, Case T, Cates JM, Kim HYH, Wages P, Porter NA, Mantione KM, Burke S, Mohler JL, Matusik RJ. Glucocorticoids are induced while dihydrotestosterone levels are suppressed in 5-alpha reductase inhibitor treated human benign prostate hyperplasia patients. Prostate 2022; 82:1378-1388. [PMID: 35821619 PMCID: PMC9427722 DOI: 10.1002/pros.24410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/10/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND The development of benign prostatic hyperplasia (BPH) and medication-refractory lower urinary tract symptoms (LUTS) remain poorly understood. This study attempted to characterize the pathways associated with failure of medical therapy for BPH/LUTS. METHODS Transitional zone tissue levels of cholesterol and steroids were measured in patients who failed medical therapy for BPH/LUTS and controls. Prostatic gene expression was measured using qPCR and BPH cells were used in organoid culture to study prostatic branching. RESULTS BPH patients on 5-α-reductase inhibitor (5ARI) showed low levels of tissue dihydrotestosterone (DHT), increased levels of steroid 5-α-reductase type II (SRD5A2), and diminished levels of androgen receptor (AR) target genes, prostate-specific antigen (PSA), and transmembrane serine protease 2 (TMPRSS2). 5ARI raised prostatic tissue levels of glucocorticoids (GC), whereas alpha-adrenergic receptor antagonists (α-blockers) did not. Nuclear localization of GR in prostatic epithelium and stroma appeared in all patient samples. Treatment of four BPH organoid cell lines with dexamethasone, a synthetic GC, resulted in budding and branching. CONCLUSIONS After failure of medical therapy for BPH/LUTS, 5ARI therapy continued to inhibit androgenesis but a 5ARI-induced pathway increased tissue levels of GC not seen in patients on α-blockers. GC stimulation of organoids indicated that the GC receptors are a trigger for controlling growth of prostate glands. A 5ARI-induced pathway revealed GC activation can serve as a master regulator of prostatic branching and growth.
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Affiliation(s)
- Renjie Jin
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Connor Forbes
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nicole L. Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas Strand
- Department of Urology, University of Texas, Southwestern, Dallas, Texas, USA
| | - Thomas Case
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin M. Cates
- Department of Pathology Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hye-Young H. Kim
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Phillip Wages
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Ned A. Porter
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Krystin M. Mantione
- Bioanalytics, Metabolomics, and Pharmacokinetics Shared Resource, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sarah Burke
- Bioanalytics, Metabolomics, and Pharmacokinetics Shared Resource, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - James L. Mohler
- Bioanalytics, Metabolomics, and Pharmacokinetics Shared Resource, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
- Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Robert J. Matusik
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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9
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Ma L, Shen H, Fang C, Chen T, Wang J. Camellia Seed Cake Extract Supports Hair Growth by Abrogating the Effect of Dihydrotestosterone in Cultured Human Dermal Papilla Cells. Molecules 2022; 27:molecules27196443. [PMID: 36234980 PMCID: PMC9572183 DOI: 10.3390/molecules27196443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Autocrine and paracrine factors play key roles in the process of Androgenetic alopecia (AGA), which are secreted by balding dermal papilla cells (DPCs) after dihydrotestosterone (DHT) induction. Camellia seed cake is an oriental oil extraction byproduct, and its extract has been traditionally used to wash hair in China. This study elucidated the hair growth-promoting effects of Camellia seed cake extract (CSCE) in DHT-treated cultured DPCs and its underlying mechanisms. The effect of CSCE on cell viability and release of inflammatory factors IL-6 and IL-1α was performed on human dermal papilla cells (DPCs) incubated with DHT. Relative expression of bax, bcl-2, p53, androgen receptor (AR) and 5α- reductase type II (SRD5A2) was determined by PCR. Senescence-associated was examined by β-galactosidase (SA-β-Gal) assays. CSCE restored DHT-induced cell damage in a dose-dependent manner, and effectively reduced the production of IL-6 and IL-1α in DHT-treated DPCs. CSCE exhibited an anti-apoptotic effect, which increased the expression of bcl-2, and decreased the expressions of bax and p53 in DHT-incubated DPCs. CSCE also showed an anti-androgenic effect reversing the increase in AR and SRD5A2 expressions in DPCs driven by DHT incubation. In addition, CSCE inhibited the β-galactosidase enzyme activity and slowed down the cell senescence of DPCs which is crucial for AGA progression. In this study, we found that CSCE may have the potential to prevent and alleviate AGA by abrogating the effect of DHT in cultured DPCs.
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Affiliation(s)
- Ling Ma
- Adolph Innovation Laboratory, Guangzhou Degu Personal Care Products Co., Ltd., Guangzhou 510000, China
- Correspondence: (L.M.); (J.W.)
| | - Huchi Shen
- Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi 214122, China
| | - Chengge Fang
- Key Laboratory of Synthetic and Biological Colloids, Ministry of Education, School of Chemical and Material Engineering, Jiangnan University, Wuxi 214122, China
| | - Timson Chen
- Adolph Innovation Laboratory, Guangzhou Degu Personal Care Products Co., Ltd., Guangzhou 510000, China
| | - Jing Wang
- Adolph Innovation Laboratory, Guangzhou Degu Personal Care Products Co., Ltd., Guangzhou 510000, China
- Correspondence: (L.M.); (J.W.)
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Papadopoulos KI, Papadopoulou A, Sutheesophon W, Aw TC. Anti-SARS-CoV-2 Action of 5α-Reductase Inhibitors May Be Mediated by Dehydroepiandrosterone. Letter. J Urol 2022; 207:1163-1164. [PMID: 35119308 DOI: 10.1097/ju.0000000000002469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | - Tar-Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
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Brossaud J, Corcuff JB, Vautier V, Bergeron A, Valade A, Lienhardt A, Moisan MP, Barat P. Altered Cortisol Metabolism Increases Nocturnal Cortisol Bioavailability in Prepubertal Children With Type 1 Diabetes Mellitus. Front Endocrinol (Lausanne) 2021; 12:742669. [PMID: 34970219 PMCID: PMC8712331 DOI: 10.3389/fendo.2021.742669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Disturbances in the activity of the hypothalamus-pituitary-adrenal axis could lead to functional alterations in the brain of diabetes patients. In a later perspective of investigating the link between the activity of the hypothalamus-pituitary-adrenal axis and the developing brain in children with diabetes, we assessed here nocturnal cortisol metabolism in prepubertal children with type 1 diabetes mellitus (T1DM). METHODS Prepubertal patients (aged 6-12 years) diagnosed with T1DM at least 1 year previously were recruited, along with matched controls. Nocturnal urine samples were collected, with saliva samples taken at awakening and 30 minutes after awakening. All samples were collected at home over 5 consecutive days with no detectable nocturnal hypoglycaemia. The State-Trait Anxiety Inventory (trait scale only) and Child Depression Inventory were also completed. Glucocorticoid metabolites in the urine, salivary cortisol (sF) and cortisone (sE) were measured by liquid chromatography-tandem mass spectrometry. Metabolic data were analysed by logistic regression, adjusting for sex, age, BMI and trait anxiety score. RESULTS Urine glucocorticoid metabolites were significantly lower in T1DM patients compared to controls. 11β-hydroxysteroid dehydrogenase type 1 activity was significantly higher, while 11β-hydroxysteroid dehydrogenase type 2, 5(α+β)-reductase and 5α-reductase levels were all lower, in T1DM patients compared to controls. There was a significant group difference in delta sE level but not in delta sF level between the time of awakening and 30 minutes thereafter. CONCLUSIONS Our findings suggest that altered nocturnal cortisol metabolism and morning HPA axis hyperactivity in children with T1DM leads to greater cortisol bioavailability and lower cortisol production as a compensatory effect. This altered nocturnal glucocorticoid metabolism when cortisol production is physiologically reduced and this HPA axis hyperactivity question their impact on brain functioning.
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Affiliation(s)
- Julie Brossaud
- Nuclear Medicine, Hospital of Bordeaux, Pessac, France
- Université de Bordeaux, INRAE, Bordeaux INP, NutriNeuro, Bordeaux, France
| | - Jean-Benoît Corcuff
- Nuclear Medicine, Hospital of Bordeaux, Pessac, France
- Université de Bordeaux, INRAE, Bordeaux INP, NutriNeuro, Bordeaux, France
| | - Vanessa Vautier
- Pediatric Endocrinology and DiaBEA Unit, Hôpital des Enfants, Hospital of Bordeaux, Bordeaux, France
| | - Aude Bergeron
- Pediatric Endocrinology and DiaBEA Unit, Hôpital des Enfants, Hospital of Bordeaux, Bordeaux, France
| | | | | | | | - Pascal Barat
- Université de Bordeaux, INRAE, Bordeaux INP, NutriNeuro, Bordeaux, France
- Pediatric Endocrinology and DiaBEA Unit, Hôpital des Enfants, Hospital of Bordeaux, Bordeaux, France
- *Correspondence: Pascal Barat,
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Hazlehurst JM, Tomlinson JW. Response to the Letter: "Dual-5α-Reductase Inhibition Promotes Hepatic Lipid Accumulation in Man". J Clin Endocrinol Metab 2016; 101:L48-9. [PMID: 27032327 DOI: 10.1210/jc.2016-1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jonathan M Hazlehurst
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, National Institute for Health Research, Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom
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13
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Mauvais-Jarvis F. Letter to the Editor: "Dual-5α-Reductase Inhibition Promotes Hepatic Lipid Accumulation in Man" by Hazlehurst J.M., Oprescu A.I., Nikolaou N., et al. J Clin Endocrinol Metab 2016; 101:L46-7. [PMID: 27032326 DOI: 10.1210/jc.2016-1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Affiliation(s)
- Franck Mauvais-Jarvis
- Section of Endocrinology Tulane University Health Sciences Center, New Orleans, Louisiana 70112
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Hazlehurst JM, Oprescu AI, Nikolaou N, Di Guida R, Grinbergs AEK, Davies NP, Flintham RB, Armstrong MJ, Taylor AE, Hughes BA, Yu J, Hodson L, Dunn WB, Tomlinson JW. Dual-5α-Reductase Inhibition Promotes Hepatic Lipid Accumulation in Man. J Clin Endocrinol Metab 2016; 101:103-13. [PMID: 26574953 PMCID: PMC4701851 DOI: 10.1210/jc.2015-2928] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
CONTEXT 5α-Reductase 1 and 2 (SRD5A1, SRD5A2) inactivate cortisol to 5α-dihydrocortisol in addition to their role in the generation of DHT. Dutasteride (dual SRD5A1 and SRD5A2 inhibitor) and finasteride (selective SRD5A2 inhibitor) are commonly prescribed, but their potential metabolic effects have only recently been identified. OBJECTIVE Our objective was to provide a detailed assessment of the metabolic effects of SRD5A inhibition and in particular the impact on hepatic lipid metabolism. DESIGN We conducted a randomized study in 12 healthy male volunteers with detailed metabolic phenotyping performed before and after a 3-week treatment with finasteride (5 mg od) or dutasteride (0.5 mg od). Hepatic magnetic resonance spectroscopy (MRS) and two-step hyperinsulinemic euglycemic clamps incorporating stable isotopes with concomitant adipose tissue microdialysis were used to evaluate carbohydrate and lipid flux. Analysis of the serum metabolome was performed using ultra-HPLC-mass spectrometry. SETTING The study was performed in the Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital, Birmingham, United Kingdom. MAIN OUTCOME MEASURE Incorporation of hepatic lipid was measured with MRS. RESULTS Dutasteride, not finasteride, increased hepatic insulin resistance. Intrahepatic lipid increased on MRS after dutasteride treatment and was associated with increased rates of de novo lipogenesis. Adipose tissue lipid mobilization was decreased by dutasteride. Analysis of the serum metabolome demonstrated that in the fasted state, dutasteride had a significant effect on lipid metabolism. CONCLUSIONS Dual-SRD5A inhibition with dutasteride is associated with increased intrahepatic lipid accumulation.
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Affiliation(s)
- Jonathan M Hazlehurst
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Andrei I Oprescu
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Nikolaos Nikolaou
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Riccardo Di Guida
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Annabel E K Grinbergs
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Nigel P Davies
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Robert B Flintham
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Matthew J Armstrong
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Angela E Taylor
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Beverly A Hughes
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Jinglei Yu
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Leanne Hodson
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Warwick B Dunn
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology, and Metabolism (J.M.H., N.N., L.H., J.W.T.), National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, United Kingdom; Centre for Diabetes, Endocrinology, and Metabolism (A.I.O., A.E.T., B.A.H.), Institute of Biomedical Research, School of Clinical and Experimental Medicine, School of Biosciences and Regional Phenome Centre (R.D.G., W.B.D.), Centre for Liver Research and National Institute for Health Research Liver Biomedical Research Unit (M.J.A.), and School of Sports and Exercise Sciences (J.Y.), University of Birmingham, Birmingham B15 2TH, United Kingdom; National Institute for Health Research/Wellcome Trust Clinical Research Facility (A.E.K.G.), Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom; and Department of Medical Physics (N.P.D., R.B.F.), Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
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Mitterberger M, Pinggera G, Horninger W, Strasser H, Halpern E, Pallwein L, Gradl J, Bartsch G, Frauscher F. Dutasteride Prior to Contrast-Enhanced Colour Doppler Ultrasound Prostate Biopsy Increases Prostate Cancer Detection. Eur Urol 2008; 53:112-7. [PMID: 17321668 DOI: 10.1016/j.eururo.2007.02.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 02/09/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study assessed the effect of premedication with dutasteride, a dual 5alpha-reductase inhibitor, on prostatic blood flow prior to prostate biopsy and its impact on prostate cancer detection. METHODS Thirty-six patients, aged 52-74 yr, with elevated prostate-specific antigen (PSA) levels (>or=1.25 ng/ml and free-to-total ratio of <18%) were treated with dutasteride 14 d prior to prostate biopsy. Contrast-enhanced colour Doppler (CECD) ultrasound was performed before and 7 and 14 d after dutasteride treatment. Contrast-enhanced targeted biopsies (<or=5) were performed into hypervascular areas of the peripheral zone only. Subsequently, a second investigator performed 10 systematic biopsies of the prostate in a standard spatial distribution guided by conventional grey-scale ultrasonography on a Combison 530MT unit. RESULTS Dutasteride reduced prostatic blood flow in benign prostatic tissue, whereas in prostate cancer areas blood flow was still observed after a 14-d course of dutasteride intake. A reduction of blood flow was observed even after 7 d. Maximum flow reduction was observed after 14 d. Twelve patients (33%) of our cohort were found to have suspicious blood flow and prostate cancer and six cancers (17%) were detected solely by targeted contrast-enhanced biopsy. CONCLUSION Premedication with dutasteride seems promising to improve prostate cancer detection by using CECD ultrasound.
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Shao TC, Li H, Ittmann M, Cunningham GR. Effects of dutasteride on prostate growth in the large probasin-large T antigen mouse model of prostate cancer. J Urol 2007; 178:1521-7. [PMID: 17707058 DOI: 10.1016/j.juro.2007.05.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE We evaluated the effects of dutasteride for preventing or delaying prostate growth and neoplastic changes in a transgenic model of prostate cancer. MATERIALS AND METHODS Large probasin-large T antigen mice were treated for 4 or 8 weeks with dutasteride. The prostate and seminal vesicles were compared with those from intact and castrated large probasin-large T antigen mice and WT mice. RESULTS Dutasteride greatly decreased the transgene induced increase in prostate weight but castration caused greater reduction. Dutasteride inhibited type 1 and 2, 5alpha-reductase activities, decreased DNA and protein, and increased apoptotic bodies and TUNEL staining in the dorsolateral prostate. No evidence of poorly differentiated cancer was seen. Dutasteride did not decrease the weight of the androgen dependent levator ani or bulbocavernosus muscle. CONCLUSIONS Dutasteride inhibited type 1 and 2, 5alpha-reductase activities, and decreased DNA and protein content of the dorsolateral prostate without affecting androgen responsive muscle weight in large probasin-large T antigen mice. These studies provide support for the hypothesis that a 5alpha-reductase inhibitor inhibits the initiation and/or progression of clinical prostate cancers.
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Affiliation(s)
- T C Shao
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas 77030, USA
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Hussein SA, Hashim AN, Barakat HH, Jose J, Lindequist U, Nawwar MA. Phenolics from extracts of Brahea armata with inhibitory effect against 5alpha-reductase type-II. Pharmazie 2006; 61:1034-7. [PMID: 17283663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Fractions of the aqueous alcohol extracts of the rind and kernel of Brahea aramata fruits have been investigated for their activity against 5alpha-reductase type II, which is expressed predominantly in the prostate. This isozyme represents a major target for drugs against benign prostate hyperplasia (BPH) and prostate cancer. Also, a structural analysis of the phytophenolics, present in both aqueous alcohol extracts as the major constituents, has led to the isolation of five phenolics, including the new natural product, 4',6'-dimethoxy beta,4,2'-trihydroxy chalcone from the rind extract and three phenolics, including the new natural product, 1-p-hydroxybenzoyl glycerol from the kernel extract. All structures were confirmed by ESI-MS and NMR analysis.
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Affiliation(s)
- S A Hussein
- Department of Phytochemistry, Division of Pharmaceutical Industries, National Research Centre, Dokki, Cairo, Egypt
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Salem OIA, Frotscher M, Scherer C, Neugebauer A, Biemel K, Streiber M, Maas R, Hartmann RW. Novel 5α-Reductase Inhibitors: Synthesis, Structure−Activity Studies, and Pharmacokinetic Profile of Phenoxybenzoylphenyl Acetic Acids. J Med Chem 2005; 49:748-59. [PMID: 16420060 DOI: 10.1021/jm050728w] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Novel substituted benzoyl benzoic acids and phenylacetic acids 1-14 have been synthesized and evaluated for inhibition of rat and human steroid 5alpha-reductase isozymes 1 and 2. The compounds turned out to be potent and selective human type 2 enzyme inhibitors, exhibiting IC(50) values in the nanomolar range. The phenylacetic acid derivatives were more potent than the analogous benzoic acids. Bromination in the 4-position of the phenoxy moiety led to the strongest inhibitor in this class (12; IC(50) = 5 nM), which was equipotent to finasteride. Since oral absorption is essential for a potential drug, 12 was further examined. In the parallel artificial membrane permeation assay (PAMPA) it turned out to be a good permeator, whereas it was a medium permeator in Caco2 cells. After oral administration (40 mg/kg) to rats a high bioavailability and a biological half-life of 5.5 h were observed, making it a promising candidate for clinical evaluation.
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Affiliation(s)
- Ola I A Salem
- Pharmaceutical and Medicinal Chemistry, Saarland University, D-66041 Saarbrücken, Germany
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Peters MAJ, Mol JA, van Wolferen ME, Oosterlaken-Dijksterhuis MA, Teerds KJ, van Sluijs FJ. Expression of the insulin-like growth factor (IGF) system and steroidogenic enzymes in canine testis tumors. Reprod Biol Endocrinol 2003; 1:22. [PMID: 12646054 PMCID: PMC151794 DOI: 10.1186/1477-7827-1-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Accepted: 02/14/2003] [Indexed: 01/14/2023] Open
Abstract
Testis tumors occur frequently in dogs. The main types of tumors are Sertoli cell tumors, seminomas, and Leydig cell tumors. Mixed tumors and bilateral occurrence of tumors may be encountered frequently. To elucidate the possible relationship between the insulin-like growth factor (IGF) system and the development of different types of testis tumors in dogs, the expression of insulin-like growth factor-I and II (IGF-I and IGF-II), their type I receptor (IGF-IR), and their binding proteins (IGFBPs) was examined. In addition the expression of the steroidogenic enzymes p450-aromatase and 5alpha-reductase type I and type II, and the androgen receptor (AR) was investigated by a semiquantitative reverse-transcriptase PCR (RT-PCR). Both normal testes and testes with tumors were studied. In normal testes a clear expression of IGF-I, IGF-II, IGF-IR, IGFBP2, IGFBP4 and IGFBP5 was found. Expression of IGFBP1 and IGFBP3 was weak. There was also clear expression of the steroidogenic enzymes 5alpha-reductase, aromatase, and the AR. Quantification of RT-PCR products revealed significantly less expression of IGFBP1, IGF-I, and 5alpha-reductase type I in Sertoli cell tumors and seminomas. Leydig cell tumors and mixed tumors had a significantly higher expression of IGFBP4 and IGF-IR than normal testes. The expression of aromatase was lower in seminomas and in mixed tumors. The expression of AR, IGF-II and IGFBP2, IGFBP3, IGFBP5, and 5alpha-reductase type II did not differ among the different types of tumors. It was concluded that Sertoli cell tumors and seminomas have a comparable expression of the IGF system while Leydig cell tumors have a different pattern, suggesting difference in pathobiology among these types of tumors.
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Affiliation(s)
- Monique AJ Peters
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Universiteit Utrecht, The Netherlands
- Centre for the Quality of Care, University of Nijmegen, The Netherlands
| | - Jan A Mol
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Universiteit Utrecht, The Netherlands
| | - Monique E van Wolferen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Universiteit Utrecht, The Netherlands
| | | | - Katja J Teerds
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine, Universiteit Utrecht, The Netherlands
- Department of Animal Sciences, Human and Animal Physiology Group, Wageningen University, The Netherlands
| | - Frederik J van Sluijs
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Universiteit Utrecht, The Netherlands
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Brown CT, Das G. Assessment, diagnosis and management of lower urinary tract symptoms in men. Int J Clin Pract 2002; 56:591-603. [PMID: 12425369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Lower urinary tract symptoms are very common and the approach to assessment and management has changed dramatically over the past few years. Previously referred to as prostatism, benign prostatic hyperplasia and bladder outflow obstruction, it is now recognised that in most men symptoms are due to a combination of benign prostatic enlargement and age-related bladder dysfunction. Most men require only simple tests for a diagnosis, with the more complex investigations reserved for when the diagnosis is not clear. Symptom bothersomeness and effect on quality of life are the critical factors when deciding how to treat a man. A cascade of treatments exists, including conservative management, medical therapy and surgery. A man moves up the cascade when the present management strategy fails to control symptoms. Traditional surgical techniques such as transurethral resection of the prostate are still appropriate for some men, although with improved medical treatments available the number of men undergoing surgery is declining.
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Affiliation(s)
- C T Brown
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
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Picard F, Hartmann RW. N-substituted 4-(4-carboxyphenoxy)benzamides. Synthesis and evaluation as inhibitors of steroid-5alpha-reductase type 1 and 2. J Enzyme Inhib Med Chem 2002; 17:187-96. [PMID: 12443045 DOI: 10.1080/1475636021000003156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
In search of non-steroidal inhibitors of human prostatic 5alpha-reductase, we recently described N-substituted 4'-biphenyl-4-carboxylic acids. Here, we report the optimisation of this series of compounds by increasing the conformational flexibility using an ether linker between the steroidal A-C ring mimetics. Ten new compounds were synthesised and tested against human and rat isozymes 1 and 2. The substances showed a broad range of activity from 36% inhibition at a concentration of 10 microM to an IC50 value of 60 nM for compounds 22 and 29 respectively. The most potent compound 26 showed an IC50 value improved by a factor of 5 from 1.9 microM to 0.38 microM in comparison with the parent biphenyl compound 15.
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Affiliation(s)
- Franck Picard
- 8.5 Pharmaceutical and Medicinal Chemistry, Saarland University, Saarbrücken, Germany
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22
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Abstract
In recent years, many new therapeutic regimens for hirsutism have been introduced. This has considerably enlarged the different choices of the physician but at the same time has produced considerable confusion and uncertainty as to what is the best possible therapy for the single patient or for the different pathologies of this condition. This review presents data on the characteristics, adverse effects and effective dosage for the more commonly used drugs for hirsutism. In most patients, low doses of antiandrogens (cyproterone acetate, flutamide or spironolactone) are used with few adverse effects and good results in terms of improvement of the hirsutism. Patients with severe hyperandrogenic hirsutism may require larger doses of antiandrogens. In only a few patients, therapy with agents that primarily reduce androgen secretion (mostly a gonadotropin releasing hormone agonist) is needed. In responsive patients, dexamethasone may be used at low doses (associated with an antiandrogen) to prolong the length of the remission. Finally, agents that inhibit 5alpha-reductase activity (finasteride) may be used as alternative to low dose antiandrogen therapy but the results are often less satisfactory.
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Affiliation(s)
- E Carmina
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons of Columbia University, New York 10032, USA.
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Abstract
Hirsutism, the presence of terminal (coarse) hairs in females in a male-like pattern, affects between 5% and 10% of women. Of the sex steroids, androgens are the most important in determining the type and distribution of hairs over the human body. Under the influence of androgens hair follicles that are producing vellus-type hairs can be stimulated to begin producing terminal hairs (i.e., terminalized). The activity of local 5alpha-reductase (5alpha-RA) determines to a great extent the production of dihydrotestosterone (DHT), and consequently the effect of androgens on hair follicles. While there are two distinct 5alpha-RA isoenzymes, type 1 and type 2, the activity of these in the facial or abdominal skin of hirsute women remains to be determined. Although the definition of idiopathic hirsutism (IH) has been an evolving process, the diagnosis of IH should be applied only to hirsute patients with normal ovulatory function and circulating androgen levels. A history of regular menses is not sufficient to exclude ovulatory dysfunction, since up to 40% of eumenorrheic hirsute women are anovulatory. The diagnosis of IH, when strictly defined, will include less than 20% of all hirsute women. The pathophysiology of IH is presumed to be a primary increase in skin 5alpha-RA activity, probably of both isoenzyme types, and possibly an alteration in androgen receptor function. Therapeutically, these patients respond to antiandrogen or 5alpha-RA inhibitor therapy. Pharmacological suppression of ovarian or adrenal androgen secretion may be of additional, albeit limited, benefit. New therapeutic strategies such as laser epilation or the use of new biological response modifiers may play an important role in offering a more effective means of treatment to remove unwanted hair. Further investigations into the genetic, molecular, and metabolic aspects of this disorder, including only well defined patients, are needed.
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Affiliation(s)
- R Azziz
- Department of Obstetrics and Gynecology, The University of Alabama at Birmingham, 35233-7333, USA.
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Graef V, Golf SW, Rempeters G. Solubilization of NADH: 4-ene-3-oxosteroid-5alpha-reductase from rat liver microsomes. J Steroid Biochem 1978; 9:369-71. [PMID: 661317 DOI: 10.1016/0022-4731(78)90633-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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