title: Inhibition of 11beta-hydroxysteroid dehydrogenase type 1 activity in vivo limits glucocorticoid exposure to human adipose tissue and decreases lipolysis.
abstract: BACKGROUND
  The pathophysiological importance of glucocorticoids (GCs) is exemplified by patients with Cushing's syndrome who develop hypertension, obesity, and insulin resistance. At a cellular level, availability of GCs to the glucocorticoid and mineralocorticoid receptors is controlled by the isoforms of 11beta-hydroxysteroid dehydrogenase (11beta-HSD). In liver and adipose tissue, 11beta-HSD1 converts endogenous, inactive cortisone to active cortisol but also catalyzes the bioactivation of the synthetic prednisone to prednisolone.
  
  
  OBJECTIVE
  The objective of the study was to compare markers of 11beta-HSD1 activity and demonstrate that inhibition of 11beta-HSD1 activity limits glucocorticoid availability to adipose tissue.
  
  
  METHODS
  This was a clinical study.
  
  
  METHODS
  Seven healthy male volunteers participated in the study.
  
  
  METHODS
  Intervention included carbenoxolone (CBX) single dose (100 mg) and 72 hr of continuous treatment (300 mg/d).
  
  
  METHODS
  Inhibition of 11beta-HSD1 was monitored using five different mechanistic biomarkers (serum cortisol and prednisolone generation, urinary corticosteroid metabolite analysis by gas chromatography/mass spectrometry, and adipose tissue microdialysis examining cortisol generation and glucocorticoid-mediated glycerol release).
  
  
  RESULTS
  Each biomarker demonstrated reduced 11beta-HSD1 activity after CBX administration. After both a single dose and 72 hr of treatment with CBX, cortisol and prednisolone generation decreased as did the urinary tetrahydrocortisol+5alpha-tetrahydrocortisol to tetrahydrocortisone ratio. Using adipose tissue microdialysis, we observed decreased interstitial fluid cortisol availability with CBX treatment. Furthermore, a functional consequence of 11beta-HSD1 inhibition was observed, namely decreased prednisone-induced glycerol release into adipose tissue interstitial fluid indicative of inhibition of GC-mediated lipolysis.
  
  
  CONCLUSIONS
  CBX is able to inhibit rapidly the generation of active GC in human adipose tissue. Importantly, limiting GC availability in vivo has functional consequences including decreased glycerol release.
authors.affiliation: M.R.C.P., Institute of Biomedical Research, Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom. j.w.tomlinson@bham.ac.uk
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Tomlinson
authors.forename: Mark
authors.initials: M
authors.lastname: Sherlock
authors.forename: Beverley
authors.initials: B
authors.lastname: Hughes
authors.forename: Susan V
authors.initials: SV
authors.lastname: Hughes
authors.forename: Fiona
authors.initials: F
authors.lastname: Kilvington
authors.forename: William
authors.initials: W
authors.lastname: Bartlett
authors.forename: Rachel
authors.initials: R
authors.lastname: Courtney
authors.forename: Paul
authors.initials: P
authors.lastname: Rejto
authors.forename: William
authors.initials: W
authors.lastname: Carley
authors.forename: Paul M
authors.initials: PM
authors.lastname: Stewart
mesh_terms: D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1 / Q000378:metabolism*; D000273:Adipose Tissue / Q000187:drug effects / Q000378:metabolism*; D000328:Adult; D002229:Carbenoxolone / Q000008:administration & dosage / Q000493:pharmacokinetics; D045604:Extracellular Fluid / Q000737:chemistry; D005938:Glucocorticoids / Q000378:metabolism* / Q000494:pharmacology; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008066:Lipolysis / Q000187:drug effects; D008297:Male; D011239:Prednisolone / Q000378:metabolism; D044967:Serum / Q000737:chemistry
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone; D043205:11-beta-Hydroxysteroid Dehydrogenase Type 1; D002229:Carbenoxolone; D006854:Hydrocortisone