title: Glucocorticoid receptors, in vitro steroid sensitivity, and cytokine secretion in idiopathic nephrotic syndrome.
abstract: BACKGROUND
  Glucocorticoids (GC) represent the mainstay of treatment of idiopathic nephrotic syndrome (INS) and might be involved in the pathogenesis of the disease. We evaluated basal secretion of cortisol, number and affinity of glucocorticoid receptors, dexamethasone (Dex)-mediated inhibition of concanavalin-A (Con-A)-stimulated peripheral blood mononuclear cell (PBMC) proliferation, and cytokine secretion in patients with INS.
  
  
  METHODS
  Blood and saliva were obtained from 20 INS patients in relapse and 11 control patients. Cortisol concentrations were measured by radioimmunoassay. PBMC were isolated for binding and in vitro GC sensitivity assays. Cytokines were measured in supernatants of PBMC culture by enzyme-linked immunosorbent assay (ELISA).
  
  
  RESULTS
  Salivary cortisol concentrations were similar in INS patients and control patients. Density and affinity of GC receptors were similar in steroid-sensitive (SS) patients and control, whereas in steroid-resistant (SR) patients they were variable. Lymphocyte proliferation after Con-A stimulation was inhibited by Dex in a dose-dependent manner in control and SS patients. Control and all clinically SS patients were steroid-sensitive by in vitro test, but control patients significantly presented more suppression of PBMC proliferation compared with SS patients. Basal- and Con-A-stimulated interleukin (IL)-6, IL-10, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha levels were similar in control and INS patients, and all cytokines but IL-10 were significantly inhibited by Dex 10-6 mol/L. In SR patients, cytokine secretion remained elevated after treatment with high doses of Dex.
  
  
  CONCLUSIONS
  Abnormalities of number and affinity of the GC receptor and altered secretion of cytokines may be involved in tissue sensitivity to GC in INS patients.
authors.affiliation: Department of Pediatrics and Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
authors.forename: Ana Paula de Carvalho Panzeri
authors.initials: AP
authors.lastname: Carlotti
authors.forename: Paulo Benedito
authors.initials: PB
authors.lastname: Franco
authors.forename: Lucila Leico
authors.initials: LL
authors.lastname: Elias
authors.forename: Inalda
authors.initials: I
authors.lastname: Facincani
authors.forename: Elaine Lourenço Cardeal
authors.initials: EL
authors.lastname: Costa
authors.forename: Norma
authors.initials: N
authors.lastname: Foss
authors.forename: Ayrton Custódio
authors.initials: AC
authors.lastname: Moreira
authors.forename: Margaret
authors.initials: M
authors.lastname: de Castro
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003208:Concanavalin A / Q000494:pharmacology; D016207:Cytokines / Q000378:metabolism*; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D005938:Glucocorticoids / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism*; D066298:In Vitro Techniques; D007223:Infant; D007371:Interferon-gamma / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000187:drug effects / Q000378:metabolism; D008297:Male; D009404:Nephrotic Syndrome / Q000378:metabolism*; D011446:Prospective Studies; D011965:Receptors, Glucocorticoid / Q000378:metabolism*; D012463:Saliva / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D016207:Cytokines; D005938:Glucocorticoids; D015850:Interleukin-6; D011965:Receptors, Glucocorticoid; D014409:Tumor Necrosis Factor-alpha; D003208:Concanavalin A; D016753:Interleukin-10; D003907:Dexamethasone; D007371:Interferon-gamma; D006854:Hydrocortisone