Rolf C. Gaillard

A genome-wide scan identifies mutations in the gene encoding phosphodiesterase 11A4 ( PDE11A ) in individuals with adrenocortical hyperplasia

Phosphodiesterases (PDEs) regulate cyclic nucleotide levels. Increased cyclic AMP (cAMP) signaling has been associated with PRKAR1A or GNAS mutations and leads to adrenocortical tumors and Cushing syndrome. We investigated the genetic source of Cushing syndrome in individuals with adrenocortical hyperplasia that was not caused by known defects. We performed genome-wide SNP genotyping, including the adrenocortical tumor DNA. The region with the highest probability to harbor a susceptibility gene by loss of heterozygosity (LOH) and other analyses was 2q31–2q35. We identified mutations disrupting the expression of the PDE11A isoform-4 gene (PDE11A) in three kindreds. Tumor tissues showed 2q31–2q35 LOH, decreased protein expression and high cyclic nucleotide levels and cAMP-responsive element binding protein (CREB) phosphorylation. PDE11A codes for a dual-specificity PDE that is expressed in adrenal cortex and is partially inhibited by tadalafil and other PDE inhibitors; its germline inactivation is associated with adrenocortical hyperplasia, suggesting another means by which dysregulation of cAMP signaling causes endocrine tumors.

Leptin inhibits directly glucocorticoid secretion by normal human and rat adrenal gland.

Different interactions have been described between glucocorticoids and the product of the ob gene leptin. Leptin can inhibit the activation of the hypothalamo-pituitary-adrenal axis by stressful stimuli, whereas adrenal glucocorticoids stimulate leptin production by the adipocyte. The present study was designed to investigate the potential direct effects of leptin to modulate glucocorticoid production by the adrenal. Human adrenal glands from kidney transplant donors were dissociated, and isolated primary cells were studied in vitro. These cells were preincubated with recombinant leptin (10–10 M) for 6 or 24 h, and basal or ACTH-stimulated cortisol secretion was subsequently measured. Basal cortisol secretion was unaffected by leptin, but a significant and dose-dependent inhibition of ACTH-stimulated cortisol secretion was observed [down by 29 6 0.1% of controls with the highest leptin dose, P , 0.01 vs. CT (unrelated positive control)]. This effect of leptin was also observed in rat primary adrenocortical cells, where leptin inhibited stimulated corticosterone secretion in a dose-dependent manner (down by 46 6 0.1% of controls with the highest leptin dose, P , 0.001 vs. CT). These effects of leptin in adrenal cells are likely mediated by the long isoform of the leptin receptor (OB-R), because its transcript was found to be expressed in the adrenal tissue and leptin had no inhibitory effect in adrenal glands obtained from db/db mice. Therefore, leptin inhibits directly stimulated cortisol secretion from human and rat adrenal glands, and this may represent an important mechanism to modulate glucocorticoid levels in various metabolic states. (Endocrinology 139: 4264– 4268, 1998) A glucocorticoid hormones are key regulators of several metabolic pathways, under normal conditions and during the response to stressful stimuli. At low concentrations, corticosterone (or cortisol) is anabolic, stimulating feeding and promoting normal fat and protein storage (1–3). In addition to their physiological effects, glucocorticoids play a critical permissive role in the pathogenesis of the experimental hypothalamic obesity syndrome (4). These deleterious effects played by corticosterone in the development of obesity have also been demonstrated in the genetically obese fatty Zucker rat, where the obese phenotype can be prevented by adrenalectomy (1). Finally, at high doses (5) or in diabetic animals in which insulin may not play its counterregulatory effects on food intake (3), glucocorticoids seem to participate in excessive fat storage, as well as in insulin resistance. The secreted product of the adipocyte leptin (6) also participates in the regulation of metabolism and food intake, at least partially, by modulating the expression of the hypothalamic orexigenic peptide neuropeptide Y (7). Several other neuroendocrine effects of leptin have been described, including a down-regulation of the fasting-induced activation of the hypothalamo-pituitary-adrenal (HPA) axis (8). Therefore, changes in the nutritional or metabolic status of the organism, as reflected by changes in circulating leptin levels, can ultimately modulate the production of cortisol, a hormone with numerous metabolic functions. These effects are mediated, in part, by the lowering of ACTH secretion induced by leptin (8). However, recent data suggest that leptin could also have direct effects on the endocrine pancreas (9–11), as well as on ovarian granulosa cells (12, 13). In the present study, we have tested the hypothesis that, in addition to its central nervous system (CNS) effects, leptin may have direct effects in the control of glucocorticoid secretion by the adrenal gland. We have demonstrated that leptin exerts a direct, dose-dependent inhibition of stimulated cortisol secretion by normal human adrenal cells in vitro and that a similar inhibition was also present in normal rat adrenocortical cells in primary culture. This effect is likely mediated by the active isoform of the leptin receptor, OB-Rb (14, 15), because its expression could be demonstrated in human adrenal tissue. Materials and Methods Human adrenal culture Normal human adrenals (n 5 3) were obtained from cadaveric kidney transplant donors. They were dissected from the kidney before its transplantation to the receiver, and adrenal cells were immediately dispersed as described previously (16). Briefly, adrenals were minced with a scalpel blade, and then subjected Received December 1, 1997. Address all correspondence and requests for reprints to: François P. Pralong, M.D., Division of Endocrinology, Diabetology and Metabolism, Department of Medicine, BH 19707, Centre Universitaire Vaudois, 1011 Lausanne, Switzerland. E-mail: francois.pralong@chuv.hospvd.ch. * This work was supported by a grant from the Swiss National Science Foundation (No. 3100–050748.97/1). † Recipient of a Research Development Carrier Award from the Prof. Dr. Max Cloëtta Foundation. ‡ Recipient of a Research Development Carrier Award from the Swiss National Science Foundation (No. 32–49673.96). 0013-7227/98/

Human Recombinant Interleukin-1Beta and -Alpha, but Not Recombinant Tumor Necrosis Factor Alpha Stimulate ACTH Release from Rat Anterior Pituitary Cells in vitro in a Prostaglandin E2 and cAMP Independent Manner

03.00/0 Vol. 139, No. 10 Endocrinology Printed in U.S.A. Copyright

Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women.

The pituitary-adrenal axis is known to be stimulated during the acute-phase response. As cytokines play a central role in mediating the constellation of host response occurring during the acute-phase response it was of interest to assess the ability of cytokines to stimulate ACTH secretion from normal pituitary cells in culture. We used human recombinant interleukin-1 beta and -alpha (hrIL1 beta, hrIL1 alpha) and human recombinant tumor necrosis factor alpha (hrTNF alpha) to analyze the ability of these cytokines to induce ACTH secretion from normal rat anterior pituitary cells in culture. We also investigated the possible roles of prostaglandin E2 (PGE2) and cAMP in the cellular transduction mechanism. After 3 days of incubation primary cultures of rat anterior pituitary cells were stimulated for 24 h with either hrIL1 beta, hrIL1 alpha or hrTNF alpha alone or with the addition of dexamethasone or indomethacin. The culture media were analyzed for ACTH, PGE2 and cAMP content. At doses ranging from 0.03 to 30 nM, hrIL1 beta stimulated the release of ACTH and PGE2 in a dose-dependent manner. In contrast, at doses ranging from 3 to 60 nM, hrTNF alpha was unable to stimulate ACTH secretion although it stimulated PGE2 synthesis. Time-course experiments demonstrated that hrIL1 beta (3 nM) stimulates ACTH production over a period of 8, 16 and 24 h, but not after a period of 4 h. In these experiments, hrIL1 beta failed to cause any change in the secretions of growth hormone and luteinizing hormone.(ABSTRACT TRUNCATED AT 250 WORDS)

Integrative molecular bioinformatics study of human adrenocortical tumors: microRNA, tissue-specific target prediction, and pathway analysis

OBJECTIVE: To evaluate, during the first postoperative year in obese pre-menopausal women, the effects of laparoscopic gastric banding on calcium and vitamin D metabolism, the potential modifications of bone mineral content and bone mineral density, and the risk of development of secondary hyperparathyroidism.SUBJECTS: Thirty-one obese pre-menopausal women aged between 25 and 52 y with a mean body mass index (BMI) of 43.6 kg/m2, scheduled for gastric banding were included. Patients with renal, hepatic, metabolic and bone disease were excluded.METHODS: Body composition and bone mineral density (BMD) were measured at baseline, 6 and 12 months after gastric banding using dual-energy X-ray absorptiometry. Serum calcium, phosphate, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, bilirubin, urea, creatinine, uric acid, proteins, parathormone, vitamin D3, IGF-1, IGF-BP3 and telopeptide, as well as urinary telopeptide, were measured at baseline and 1, 3, 6, 9 and 12 months after surgery.RESULTS: After 1 y vitamin D3 remained stable and PTH decreased by 12%, but the difference was not significant. Serum telopeptide C increased significantly by 100% (P<0.001). There was an initial drop of the IGF-BP3 during the first 6 months (P<0.05), but the reduction was no longer significant after 1 y. The BMD of cortical bone (femoral neck) decreased significantly and showed a trend of a positive correlation with the increase of telopeptides (P<0.06). The BMD of trabecular bone, at the lumbar spine, increased proportionally to the reduction of hip circumference and of body fat.CONCLUSION: There is no evidence of secondary hyperparathyroidism 1 y after gastric banding. Nevertheless biochemical bone markers show a negative remodelling balance, characterized by an increase of bone resorption. The serum telopeptide seems to be a reliable parameter, not affected by weight loss, to follow up bone turnover after gastroplasty.

Cytokines Stimulate the CRH but Not the Vasopressin Neuronal System: Evidence for a Median Eminence Site of Interleukin-6 Action

MicroRNAs (miRs) are involved in the pathogenesis of several neoplasms; however, there are no data on their expression patterns and possible roles in adrenocortical tumors. Our objective was to study adrenocortical tumors by an integrative bioinformatics analysis involving miR and transcriptomics profiling, pathway analysis, and a novel, tissue-specific miR target prediction approach. Thirty-six tissue samples including normal adrenocortical tissues, benign adenomas, and adrenocortical carcinomas (ACC) were studied by simultaneous miR and mRNA profiling. A novel data-processing software was used to identify all predicted miR-mRNA interactions retrieved from PicTar, TargetScan, and miRBase. Tissue-specific target prediction was achieved by filtering out mRNAs with undetectable expression and searching for mRNA targets with inverse expression alterations as their regulatory miRs. Target sets and significant microarray data were subjected to Ingenuity Pathway Analysis. Six miRs with significantly different expression were found. miR-184 and miR-503 showed significantly higher, whereas miR-511 and miR-214 showed significantly lower expression in ACCs than in other groups. Expression of miR-210 was significantly lower in cortisol-secreting adenomas than in ACCs. By calculating the difference between dCT(miR-511) and dCT(miR-503) (delta cycle threshold), ACCs could be distinguished from benign adenomas with high sensitivity and specificity. Pathway analysis revealed the possible involvement of G2/M checkpoint damage in ACC pathogenesis. To our knowledge, this is the first report describing miR expression patterns and pathway analysis in sporadic adrenocortical tumors. miR biomarkers may be helpful for the diagnosis of adrenocortical malignancy. This tissue-specific target prediction approach may be used in other tumors too.

The neuropeptide Y Y1 receptor regulates leptin-mediated control of energy homeostasis and reproductive functions

Antigen-activated immune cells acutely release cytokines which, besides their effects on the immune system, increase hypothalamopituitary-adrenocortical (HPA) function to counteract the inflammatory process. The present study was designed to test, using in vitro paradigms, whether there exists a hypothalamic and/or a median eminence site of action, whereby different substances derived from the immune system could stimulate the CRH and/or the arginine-vasopressin (AVP) neuronal pathway. For this purpose, whole medial basal hypothalamus (containing the median eminence) were dissected from female rats and incubated in vitro with several concentrations of interleukin-1 (IL-1)beta, interleukin-6 (IL-6), tumor necrosis factor (TNF)-alpha, thymosin fraction 5 (TF5) or bacterial lipopolysaccharide (LPS). After a 40-min incubation period, the amounts of CRH and AVP released into the incubation medium were measured by specific radioimmunoassays (RIAs). Additional experiments were carried out by superfusing isolated rat median eminence fragments with the different test substances; CRH and AVP released into the medium were also measured by RIAs. The results indicated that IL-1 beta (10(-11) to 10(-7) M), IL-6 (0.06 x 10(-10) to 0.4 x 10(-10) M), TNF-alpha (6 x 10(-9) to 6 x 10(-7) M) and TF5 (5-500 micrograms/ml) but not LPS (1-100 ng/ml) significantly enhanced hypothalamic CRH secretion above baseline in a concentration-related fashion. Additionally, superfusion experiments demonstrated that, among all test substances, only IL-6 possesses a direct and dose-dependent CRH-releasing activity at the median eminence level. Conversely, no preparation enhanced basal AVP release in either in vitro design.(ABSTRACT TRUNCATED AT 250 WORDS)

A Physiological Role for Neuropeptide Y in Regulating the Estrogen/Progesterone Induced Luteinizing Hormone Surge in Ovariectomized Rats

The orexigenic neurotransmitter neuropeptide Y (NPY) plays a central role in the hypothalamic control of food intake and energy balance. NPY also exerts an inhibition of the gonadotrope axis that could be important in the response to poor metabolic conditions. In contrast, leptin provides an anorexigenic signal to centrally control the body needs in energy. Moreover, leptin contributes to preserve adequate reproductive functions by stimulating the activity of the gonadotrope axis. It is of interest that hypothalamic NPY represents a primary target of leptin actions. To evaluate the importance of the NPY Y1 and Y5 receptors in the downstream pathways modulated by leptin and controlling energy metabolism as well as the activity of the gonadotrope axis, we studied the effects of leptin administration on food intake and reproductive functions in mice deficient for the expression of either the Y1 or the Y5 receptor. Furthermore, the role of the Y1 receptor in leptin resistance was determined in leptin‐deficient ob/ob mice bearing a null mutation in the NPY Y1 locus. Results point to a crucial role for the NPY Y1 receptor in mediating the NPY pathways situated downstream of leptin actions and controlling food intake, the onset of puberty, and the maintenance of reproductive functions.

Gastric banding induces negative bone remodelling in the absence of secondary hyperparathyroidism: potential role of serum C telopeptides for follow-up

To test the hypothesis that neuropeptide Y (NPY) is involved in the regulation of the estrogen/progesterone-induced luteinizing hormone (LH) surge in ovariectomized rats, we passively immunized animals against NPY by administering purified immunoglobulins raised against the peptide directly into the central nervous system. Ovariectomized rats were prepared with an intracerebroventricular (i.c.v.) guide cannula and an intravenous catheter prior to experimentation. On day 1 of the experiment the animals received a 5-microliters i.c.v. injection of a highly specific immunoglobulin against NPY (NPY-ab) and a 50-micrograms injection of estradiol benzoate. The antibody injection was repeated on days 2 and 3 of the experiment. On day 3, animals received a 2.5-mg injection of progesterone. Control animals were treated in exactly the same fashion except that a nonspecific control immunoglobulin was injected i.c.v. rather than the NPY-ab. As expected, the steroid-primed animals treated with the control antibodies exhibited large surges in LH secretion approximately 4 h following the progesterone injection. Concentrations rose from 4.2 +/- 1.0 to 27.9 +/- 9.9 ng/ml. In marked contrast, the NPY-ab-treated animals demonstrated no increase in LH concentrations. Baseline values were 3.1 +/- 0.3 ng/ml and remained unchanged (maximum concentrations were 3.8 +/- 1.9 ng/ml) following the progesterone injection. These results demonstrate that hypothalamic NPY plays a role in mediating the estradiol/progesterone-induced gonadotropin surge and suggests that this neuropeptide plays a physiological role in normal ovulatory surges of LH and FSH.

Dexamethasone treatment increases neuropeptide Y levels in rat hypothalamic neurones

OBJECTIVE:Data about the consequences of laparoscopic adjustable gastric banding (LAGB) on phospho-calcic and bone metabolism remain scarce.SUBJECTS:We studied a group of 37 obese premenopausal women (age: 24–52 y; mean BMI=43.7 kg/m2) who underwent LAGB.METHODS:Serum calcium, phosphate, alkaline phosphatase, parathormone (PTH), vitamin D3, serum C-telopeptides, IGFBP-3 and IGF-1 were measured at baseline, 6, 12, 18 and 24 months after surgery. Body composition, bone mineral content (BMC) and density (BMD) were measured using dual-X-ray absorptiometry (DXA) at baseline, 6, 12 and 24 months after surgery.RESULTS:There was no clinically significant decrease of calcemia; PTH remained stable. Serum telopeptides increased by 100% (P<0.001) and serum IGFBP-3 decreased by 16% (P<0.001) during the first 6 months, and then stabilized, whereas IGF-1 remained stable over the 2 y. BMC and BMD decreased, especially at the femoral neck; this decrease was significantly correlated with the decrease of waist and hip circumference.CONCLUSIONS:We concluded that there was no evidence of secondary hyperparathyroidism 24 months after LAGB. The observed bone resorption could be linked to the decrease of IGFBP-3, although this decrease could be attributable to other confounding factors. Serum telopeptides seem to be a reliable marker of bone metabolism after gastric banding. DXA must be interpreted cautiously during major weight loss, because of the artefacts caused by the important variation of fat tissue after LAGB.