Document Detail

Glucocorticoid excess and the developmental origins of disease: two decades of testing the hypothesis--2012 Curt Richter Award Winner.
MedLine Citation:
PMID:  22998948     Owner:  NLM     Status:  MEDLINE    
Low birthweight, a marker of an adverse in utero environment, is associated with cardiometabolic disease and brain disorders in adulthood. The adaptive changes made by the fetus in response to the intra-uterine environment result in permanent changes in physiology, structure and metabolism, a phenomenon termed early life programming. One of the key hypotheses to explain programming, namely over exposure of the developing fetus to glucocorticoids, was proposed nearly two decades ago, following the observation that the fetus was protected from high glucocorticoid levels in the mother by the actions of the placental barrier enzyme, 11β-hydroxysteroid dehydrogenase, which converts active glucocorticoids into inactive products. Numerous mechanistic studies in animal models have been carried out to test this hypothesis using manipulations to increase maternal glucocorticoids. Overall, these have resulted in offspring of lower birthweight, with an activated hypothalamic-pituitary-adrenal (HPA) axis and an adverse metabolic profile and behavioural phenotype in adulthood. Altered glucocorticoid activity or action is a good candidate mechanism in humans to link low birthweight with cardiometabolic and brain disorders. We have carried out detailed studies in men and women showing that high levels of endogenous glucocorticoids, or treatment with exogenous glucocorticoids, is associated with an adverse metabolic profile, increased cardiovascular disease and altered mood and cognitive decline. Our laboratory carried out the first translational studies in humans to test the glucocorticoid hypothesis, firstly demonstrating in studies of adult men and women, that low birthweight was associated with high fasting cortisol levels. We went on to dissect the mechanisms underlying the high fasting cortisol, demonstrating activation of the HPA axis, with increased cortisol responses to stimulation with exogenous adrenocorticotrophin hormone, lack of habituation to the stress of venepuncture, and increased cortisol responses to psychosocial stress. We have developed new dynamic tests to dissect the mechanisms regulating HPA axis central negative feedback sensitivity in humans, and demonstrated that this may be altered in obesity, one component of the metabolic syndrome. There are now studies in humans demonstrating that high circulating levels of maternal cortisol during pregnancy correlate negatively with birthweight, suggesting that excess glucocorticoids can by-pass the placental barrier. Deficiencies in the barrier enzyme, potentially increasing fetal glucocorticoid exposure, can also arise in association with maternal stress, malnutrition and disease, and can be inhibited by consumption of liquorice, which contains glycyrrhizin, an HSD inhibitor. Importantly, studies in humans have now demonstrated that high maternal cortisol in pregnancy and/or inhibition of HSD2 are associated with programmed outcomes in childhood including higher blood pressure, behavioural disorders as well as altered brain structure. We are investigating this further, using novel magnetic resonance imaging techniques to study the developing fetal brain in utero. The translational studies in support of the glucocorticoid hypothesis, and demonstrating that glucocorticoids are both mediators and targets of programming, are exciting and raise the question of whether this information can be used to identify those individuals most at risk of later life disease. In a recent study we showed that alterations in DNA methylation at genes important in regulating cortisol levels, tissue glucocorticoid action, blood pressure and fetal growth, are present in adulthood in association with both early life parameters and cardiometabolic risk factors. These preliminary data add to the limited literature in humans indicating a persisting epigenetic link between early life events and subsequent disease risk. Such findings open novel avenues for further exploration of the contribution of glucocorticoids to later life disease.
Rebecca M Reynolds
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2012-09-19
Journal Detail:
Title:  Psychoneuroendocrinology     Volume:  38     ISSN:  1873-3360     ISO Abbreviation:  Psychoneuroendocrinology     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-03     Completed Date:  2013-05-20     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  7612148     Medline TA:  Psychoneuroendocrinology     Country:  England    
Other Details:
Languages:  eng     Pagination:  1-11     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
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MeSH Terms
11-beta-Hydroxysteroid Dehydrogenase Type 2 / antagonists & inhibitors,  physiology
Adaptation, Physiological
Awards and Prizes
Brain Diseases, Metabolic / embryology,  etiology,  physiopathology
Cardiovascular Diseases / embryology,  etiology,  physiopathology
Cognition Disorders / etiology,  physiopathology
Cushing Syndrome / embryology,  physiopathology*,  psychology
Developmental Disabilities / etiology,  physiopathology
Feedback, Physiological
Fetus / physiology
Glucocorticoids / adverse effects,  physiology*
Hypothalamo-Hypophyseal System / physiopathology*
Infant, Low Birth Weight*
Infant, Newborn
Infant, Small for Gestational Age*
Maternal-Fetal Exchange
Metabolic Syndrome X / embryology,  etiology,  physiopathology
Models, Biological*
Pituitary-Adrenal System / physiopathology*
Placenta / enzymology
Pregnancy Complications / physiopathology*,  psychology
Prenatal Exposure Delayed Effects*
Stress, Physiological / physiology*
Stress, Psychological / physiopathology*
Grant Support
CZB/4/582//Chief Scientist Office; CZG/2/478//Chief Scientist Office; //Wellcome Trust
Reg. No./Substance:
0/Glucocorticoids; EC Dehydrogenase Type 2

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