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Inhibition of 11ß-Hydroxysteroid Dehydrogenase Type 1 Activity in Vivo Limits Glucocorticoid Exposure to Human Adipose Tissue and Decreases Lipolysis

Division of Medical Sciences (J.W.T., M.S., B.H., S.V.H., P.M.S.), Institute of Biomedical Research, University of Birmingham, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TT, United Kingdom; Department of Clinical Chemistry and Immunology (F.K., W.B.), Heart of England National Health Service Foundation Trust, Birmingham B9 5SS, United Kingdom; and Pfizer Global Research and Development (R.C., P.R., W.C.), La Jolla Laboratories, San Diego, California 92121

Address all correspondence and requests for reprints to: Dr. Jeremy W. Tomlinson, Ph.D., M.R.C.P., Institute of Biomedical Research, Division of Medical Sciences, University of Birmingham, Queen Elizabeth Hospital, Birmingham B15 2TT, United Kingdom. E-mail: j.w.tomlinson{at}bham.ac.uk.

Context: 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 11ß-hydroxysteroid dehydrogenase (11ß-HSD). In liver and adipose tissue, 11ß-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 11ß-HSD1 activity and demonstrate that inhibition of 11ß-HSD1 activity limits glucocorticoid availability to adipose tissue.

Design and Setting: This was a clinical study.

Patients: Seven healthy male volunteers participated in the study.

Intervention: Intervention included carbenoxolone (CBX) single dose (100 mg) and 72 hr of continuous treatment (300 mg/d).

Main Outcome Measures: Inhibition of 11ß-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 11ß-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+5-tetrahydrocortisol to tetrahydrocortisone ratio. Using adipose tissue microdialysis, we observed decreased interstitial fluid cortisol availability with CBX treatment. Furthermore, a functional consequence of 11ß-HSD1 inhibition was observed, namely decreased prednisone-induced glycerol release into adipose tissue interstitial fluid indicative of inhibition of GC-mediated lipolysis.

Conclusion: 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.

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