Professional Documents
Culture Documents
Penting
Penting
GLUCOCORTIC OIDS ar e p o te nt in h ibitors o f in flam m atory p r oces s e s and are w ide ly use d in th e tre atm en t of as th m a. Th e an ti-inflam m ato ry effe cts are m e diated eith er by dire ct bin din g of th e gluco co rticoid/gluco cortico id r ecep tor co m p lex to glucocortico id r es po ns ive e lem e nts in th e p r om oter r e gion of ge ne s , o r by an in te raction of th is com p lex w ith oth e r tran s cription factors , in p articular activatin g p ro te in -1 o r n uclear fa ctor -k B. Gluco co rticoids in h ib it m an y in flam m atio n-as s o cia te d m ole cules s uch as cyto kin es , ch em o kin es , arach idon ic acid m etabolites , and adh e s ion m o lecules . In co ntras t, an ti-inflam m ato ry m ediators ofte n are up -r e gulate d by glucocortico ids . In vivo s tudie s h ave s h o w n th at tr eatm e nt of as th m atic p atie nts w ith in h aled gluco co rticoids in h ibits th e br on ch ial in flam m ation an d s im ultan eous ly im p r oves th eir lun g function . In th is r evie w , our curr en t kn ow le dge of th e m ech an is m of action of glucocor ticoids an d th eir anti-in flam m atory p oten tial in as th m a is des cribe d. Sin ce br on ch ial ep ith e lial cells m ay be im p ortan t tar ge ts for gluco co rticoid th e rap y in as th m a, th e effects of glucocor ticoids on ep ith e lial e x p re s s ed in flam m ato ry ge n es w ill be em p h as ize d. Key w o r ds : Glucocorticoids, Asthma, Bronchial epithe lial ce lls, Inflammation
Introduction
Glucocortic oids are hormones synthe size d in the adrenal cortex and sec re te d into the blood, w here the levels of gluc oc ortic oids fluctuate in a circadian mode . In humans, the naturally occ urring gluc ocortic oid is hydroc ortisone (c ortisol), w hich is synthesized from its pre c ursor cortisone . The be ne ficial e ffec ts of glucocorticoids in as thmatic patients w ere first de scribe d in 1950.1 Sinc e then on, many studie s have foc used on the therapeutic pote ntial of glucocortic oids. Several synthetic gluc ocorticoids, much more potent than c ortisol and w ithout the unw ante d mine ralocorticoid side e ffec ts, have be en developed. Now adays, glucocorticoids are pow e rful agents in the tre atment of inflammatory diseases and are by far the most effective antiinflammatory drugs used in the treatment of asthma.
Glucocorticoid receptor
To ex ert the ir effe cts, gluc oc ortic oids ne ed to bind to a spec ific cytoplasmic glucocortic oid re ce ptor (GR). Almost all ce lls of the body ex pre ss the GR, but the number of re cep tors may vary be tw een differe nt ce ll type s.2 Cloning of the GR has re veale d that the GR cons is ts of approx imately 800 amino ac id re sidues, and that ce rtain areas of the mole cule show homology w ith othe r ste roid re ce ptors, re c eptors for thyroid hormones, and re ce ptors for re tinoic acid.3 7 All me mbers of the nuclear hormone re c eptor family share a charac te ristic thre e-domain structure , first desc ribed for the human GR. The C-te rminal domain is equal in size in all nucle ar re c eptors studied (about 250 amino ac ids) and its main function is to bind the ste roid. 8 It also c ontain s the binding site s for the heat shock prote ins (hsp) 90.9,1 0 Removal of the ste roidbinding domain re sults in a c onstitutiv ely ac tive GR molecule, indicating that this part of the mole cule acts as a re pre ssor of the transcription-activation function. The most c onserve d ce ntral domain is involved in direct binding of the re ce ptor to DNA. It contains tw o distinct loop s of prote in, each bound at their base via four cyste ine re sidue s to a single zinc ion, the so-c alled zinc fingers.1 1 These zinc cluste rs are involved in binding of the GR to the major groove of the DNA double he lix and play a role in dimeriza229
Mechanism of Action
Although gluc oc orticoids have be en know n for a long period of time , the ir pre c ise mechanism of ac tion is still not complete ly unde rstood. How e ver, re ce nt studies have inc re ased our understanding of their complex me chanisms of action.
0962-9351/98/040229-09 $9.00 1998 Carfax Publishing Ltd
V. H. J. va n de r Ve lde n
tion of tw o GR molec ule s.1 2,1 3 In addition, the central DNA-binding domain has a transcription-activation func tion. 4 ,14 The ste roid-bindin g and DNA-binding domains are separate d by the hinge-re gion, w hich contains se que nce s that are important for nucle ar translocation and dimerization. 9,10 The N-te rminal domain is ex treme ly variable in size (24600 amino acids). Its pre cis e role is still unc ertain, but it is re quired in transc riptional activation. 15 Tw o differe nt forms of the human GR have be en desc ribe d.3 ,1 6 The se tw o highly homologous is oforms, te rmed GRa and GRb , are gene rate d by alternativ e splic ing of the human GR pre -mRNA. The GRb isoform diffe rs from the GRa isoform only in its C-te rminal domain, in w hich the last 50 amino acids of the latte r are re plac ed by a unique 15 amino ac id se que nce . How ever, this re plac eme nt has dramatic functional cons eque nce s, sinc e the GRb isoform is unable to bind gluc oc ortic oids and to transduc e ligand-depende nt transac tivation. How e ve r, the physiological signific anc e of the GRb isoform re mains questionable, since some re c ent studies indic ate that this form is not conse rved among spec ie s and no dominant ne gative inhibition of GRa activity c ould be found. 17 ,1 8 Ne vertheless, abundant ex p re ssion of GRb prote in c an be found in the epithe lial cells lining the te rminal bronchioli of the lung.19 The ex pre ssion of the GR may be re gulated by numerous fac tors either at the transc riptional, translational or p ost-translational le ve l.2 0,21 Glucoc ortic oids have be en show n to dow n-re gulate the ex pre ssion of the GR, both in v itro and in vivo .22 ,23 In contrast, inflammatory me diators like interle ukin (IL)-1b , IL-4, tumour ne crosis fac tor (TNF)-a , lipopolysac charide (LPS) and interferon (IFN)-g have be e n show n to inc re as e gluc oc ortic oid binding in vitro .24 28 How e ve r, the inc re ase in GR numbe rs may be ac companied by a re duc ed affinity for glucocortic oids.24 ,2 8 Analysis of GR localization in normal and asthmatic lung has not re vealed differe nc es in the le vel or sites of GR ex p re ssion. 2 9
FIG. 1. Schematic representation of the cellular events after administration of glucocorticoids (adapted from Ref. 39).
Furthe rmore , in the nucle us ligande d GR form homodime rs (Fig. 1). Within the nucleus, the GR homodimers may re gulate ge ne transc ription in se ve ral w ays: (1) via binding of the gluc oc ortic oid-GR c omplex to spec ific DNA se quenc es, the re by directly ac tivating or re pre ssing gene s; (2) via inte raction w ith other transcription factors; and (3) via modulating the stability of specific mRNA molec ule s.3 5 3 9 Bin ding to DNA s e qu e n c e s Se ve ral ste roid-re sponsive ge ne s contain glucocortic oid re sponsive ele ments (GRE) in their promoter re gion. 3 5,4 0 Binding of GR homodime rs to GRE may either re sult in transcriptional activation of the ge ne (via a p o s itive GRE) or re pre ssion of the gene (via a n e g a tive GRE) (Fig. 1). The cons ensus sequenc e for (positive) GRE is the palindromic 15-base-pair se que nce GGTACAnnnTGTTCT, w here as the ne gative GRE has a more variable sequenc e.36 The rate of transc riptional re gulation of ste roid-re sponsive gene s is de pendent on both the numbe rs of GRE, the affinity of the glucocortic oid-GR complex to the GRE, and the position of the GRE re lative to the transcriptional start site. Binding of the complex to GRE may re sult in conformationa l change s in the DNA and ex posure of pre viously maske d areas, re sulting in incre ase d binding of othe r transcription factors.4 1 44 In te ra c tio n w ith o th e r tra n s c riptio n fa c to rs Many ste roid-re sp onsive gene s do not have GRE in their promoter re gion. How ever, binding site s for othe r transcription factors, including nuclear factor (NF)-k B, ac tivating prote in (AP)-1, and cAMP-re sponsive eleme nt binding protein (CREB), often c an be found. 45
AP-1, w hich is a dimer of tw o proto-oncogene s (membe rs of the c-jun and c-fos family),46 ,47 is involved in the re gulation of se veral ge ne s, including adhesion molecules and cytokines (re view ed in Ref. 47). Dire ct protein prote in inte raction be tw ee n AP-1 and the glucocortic oid-GR c omplex re sults in re c iprocal re pre ssion of one anothers transc riptional activation by pre ve nting binding of the AP-1 and gluc ocortic oid-GR c omplex to AP-1 sites and GRE, re spective ly (Fig. 1).3 7,4 8,4 9 Comparable to AP-1, NF-k B (a hete rodimer of p50 and p65 subunits 5 0,51 ) re gulate s the transcription of se veral gene s involve d in inflammatory re actions.5 0,52,5 3 In unstimulated ce lls, NF-k B is re tained in the c ytoplasm of the cells through the interaction w ith the inhibitor s Ik Ba and Ik Bb .5 4 56 Upon c ell stimulation, for ex ample by IL-1 b or TNF-a , Ik B are rap idly phosp horylated, ubiquitinated, and consequently prote olysed.53 ,57 The liberated NF-k B dimers translocate to the nucleus w he re the y can ac tivate target gene s. Glucocortic oids may inhibit NF-k B-stimulated gene s by a direct interaction be tw e en the glucoc ortic oid-GR complex and the p65 subunit of NF-k B, re sulting in transre pre ssion (Fig. 1).5 1,5 5,5 8,5 9 Furthe rmore , glucocortic oids may indirec tly antagonize NF-k B me diate d transc ription by up-re gulating the synthesis of the inhibitory protein Ik Ba , w hich trap s NF-k B in inac tive cytoplasmic complex e s.39 ,54 ,5 5 A large numbe r of immunore gulatory ge ne s, w hose ex p re ssion is induc ed by a variety of pro-inflammatory me diators, contain NF-k B sites in their promote rs/re gulatory re gions. The re fore , it is no w onde r that gluc oc ortic oids have be en found to pre ve nt the ex p re ssion of the se gene s, including those coding for IL-1 b , IL-2, IL-6, IL-8, monocyte chemoattrac tant prote in (MCP)-1, RANTES (Regulated up on Activation, Normal T ce ll Ex pre sse d, and pre sumably Sec re te d), granulocyte mac rop hage colony-stimulating factor (GM-CSF), the IL-2 re c eptor, inte rcellular adhe sion molec ule (ICAM)-1, and E-se le ctin (re view ed in Ref. 45). Probably, interactions be tw e en glucocortic oids and NF-k B or AP-1 w ill ex plain most of the anti-inflammatory and immunosuppre ssive activities of glucocortic oids. An inte rac tion be tw ee n CREB and the glucocortic oid-GR c omplex has also be e n sugge ste d.6 0,6 1 b -agonists, w hich are used as bronchodilators in the tre atment of asthma, inc re ase c AMP formation and subse que ntly ac tivate CREB. The re fore , simultaneous tre atment of as thmatic patients w ith gluc oc ortic oids and b -agonists may re sult in re duced re sponsivene ss of the airw ays for ste roids.6 1 63 Mo du la tio n o f m RNA s ta bility. A third me chanism by w hich glucocortic oids may re gulate the synthesis of p rote ins is via enhance d transc ription of spec ific ribonuclease s w hich are able to degrade mRNA c ontainin g constitutiv e AU-rich se que nce s in the untranslated 3 9 -re gion. 64 Such gluco-
Table 1. Influence of glucocorticoids on the synthesis of proteins with inflammatory effects by bronchial epithelial cells Protein Cytokines IL-1b , IL-6, IL-11, TNF-a , GM-CSF IL-10, LIF G-CSF Glucocorticoid effect
? =
Chemokines MCP-1, eotaxin, IL-8, RANTES, MIP-1a Receptors NK, GR IL-1R II, IL-6R, b 2-adrenergic receptor Enzymes iNOS, COX-2, cPLA2 NEP Adhesion molecules ICAM-1 Inhibitory proteins Lc-1 IL-1RA type I, SPLI
=/
cortic oid-mediated modulation of post-translational e ve nts (resulting in de cre ased mRNA stability and re duced half-life time) has be en observe d for IL-1 b , IL6 and GM-CSF .6 5,6 6
V. H. J. va n de r Ve lde n
Bronchial e pithelial cells are c apable of producing a varie ty of c ytokine s and che mokine s that may contrib ute to the initiation and pe rpetuation of airw ay inflammation. Several studies have show n that cytokine-induced ex pre ssion of eotax in, IL-6, IL-8, GMCSF , and RANTES can be diminishe d by glucocortic oids in v itro .68 76 In contrast, glucoc ortic oids did not modulate the sec re tion of G-CSF by human bronchial epithelial cells.7 6 In v ivo studie s have show n that treatme nt w ith inhaled ste roids decre ase s both the ex pre ssion of GM-CSF,77 IL-1 b ,78 IL-8, 79 and RANTES80 by the bronchial ep ithe lium, toge the r w ith the number of ac tivated eosinophils in the epithe lium.
Receptors
Glucocortic oids may modulate the ex pre ssion of se veral re ce ptors. The ex pre ssion of the ne urokinin (NK) 1 re cep tor, w hich me diate s many effects of substanc e P (SP) in the airw ays and is be lieved to be up-re gulate d in asthma,8 1 is dow n-re gulated by glucocortic oids.8 2 Sinc e the NK 1 re ce ptor gene promoter re gion has no GRE but has an AP-1 re sponse eleme nt, this e ffec t probably w ill be me diated via an inte raction of the gluc oc orticoid-GR c omplex w ith AP-1. In c ontrast to NK1 re ce ptors, ex pre ssion of the b 2 -adrene rgic re c eptor is incre ase d by glucocortic oids.8 3 Sinc e the human b 2 -adrene rgic re c eptor gene c ontains thre e potential GRE, this effect of gluc ocorticoids probably is a dire ct one .83 Up-re gulation of b 2 -adrene rgic re ce ptors by gluc oc ortic oids may be re le vant in as thma as it may pre vent dow nre gulation in re sponse to p rolonged tre atment w ith b 2 -agonists .84 The IL-1 re c eptor typ e II, w hich func tions as a decoy re ce ptor,8 5 may also be up-re gulated by gluc ocortic oids, there by re ducing the functional ac tivity of IL-1 agonists.8 6,8 7 Soluble TNF-re ce ptor type I (p 55) re lease by human bronchial epithelial c ells, both cons titutiv e as w ell as IL-1 b -induce d, has be e n show n to be re duce d by gluc oc orticoids.8 8 In contrast, gluc ocorticoids up-re gulate the ex pre ssion of IL-6 re c eptors in rat hep atoma and human epithelial ce lls.89 ,90 Thus far little is know n about this proce ss in human bronchial e pithe lial ce lls, w hich cons titutiv ely ex pre ss these re ce ptors.91 Gluc oc orticoids also modulate the ex pre ssion of their ow n re c eptor. In a re cent study it w as show n that ex pre ssion of the a -form (but not the b -form) of the GR in human bronchial ep ithe lial ce lls w as dow nre gulated in he althy subjects after 4 w e eks of budesonide inhalation .2 3
sis of asthma through an inhibitory effect on enzyme induc tion. The synthe sis of inducible nitric ox ide synthase (iNOS) by human airw ay e pithelial cells is inhibited by glucocortic oids, both in vitro and in v ivo .92 9 4 This effe ct seems to be mediated via inactivation of NF-k B.9 5,9 6 Since nitric ox ide (NO) may contribute to skew ing of Th lymphocytes tow ards a Th2 p henotype , there by promoting IgE production and eosinophil re c ruitment, inhibition of iNOS may be of importanc e in anti-inflammatory therapy in as thma.9 7 Gluc oc orticoids also inhibit the gene transcription of a cytosolic form of phospholipase A2 induc e d by cytokine s 98 and inhibit the gene ex p re ssion of cycloox ygenase-2, re sulting in re duc ed formation of prostaglandins and thrombox anes.99 In contrast to the enzymes me ntione d above, gluc ocorticoids have be en show n to incre ase the ex pre ssion of ne utral e ndope ptidase (NEP),10 0 10 2 there by pote ntially limiting ne urogenic inflammatory re spons es.1 03 In ac cordanc e w ith the se re sults, it w as found that the ex pre ssion of NEP on bronchial epithe lial c ells w as higher in as thmatic s treate d w ith ste roids c ompared w ith nonste roid-treate d asthmatics.1 04
Endothelins
Endothelins are a family of highly homologous 21-amino acid pe ptide s, charac te rized by tw o intrachain disulphide chains, a hairpin loop cons isting of polar amino acids, and a hydrophobic C-te rminal chain. 10 5 Human bronchial epithelial c ells have be en show n to produce ET-1, 1 06 1 08 w hich promotes the prolife ration of smooth muscle ce lls, is a pote nt cons trictor of both vasc ular and non-vascular smooth muscle ce lls, inc re ases the se cre tion of mucus, and may ac tivate inflammatory ce lls.1 05 ,1 07 ,1 0 9 ET-1 also stimulates c ollagen ge ne ex pre ssion and through its inhibitory ac tions on collage nase w ill promote airw ay w all c ollagen deposition, there by contributin g to airw ay w all thickening w hich unde rlies bronchial hyperresp onsive ne ss.11 0 11 2 Inc re as ed le vels of ET1-immunore ac tivity w e re dete cte d in airw ay epithelium and vasc ular e ndothelium of bronchial biopsy spe cime ns from nonste roid-tre ate d asthmatic s compared w ith healthy subje cts .10 6,1 13 ,1 1 4 In c ontrast, no inc re as ed ET-1 ex pre ssion w as found in the bronchial epithe lium of asthmatic patients treate d w ith gluc ocorticoids.11 5
Adhesion molecules
Adhesion mole cules play an imp ortant role in the re c ruitment of inflammatory ce lls to the inflammatory loc us. Ex pre ssion of adhesion mole cule s on endothelial, epithelial or inflammatory ce lls is often
Enzymes
Glucocortic oids inhibit the synthe sis of se veral inflammatory me diators implicate d in the pathoge ne 232 Mediators of Inflammation Vol 7 1998
induc ed by cytokine s, w here as gluc oc ortic oids re duce surfac e ex pre ssion of adhe sion mole cules. This effect may be due either to inhibition of cytokine synthesis or to a direc t effect of gluc oc orticoids on adhesion mole cule gene transcription. It has be en show n that the ex pre ssion of ICAM-1, e ndothelial leukoc yte adhesion molec ule (ELAM)-1, and E-selec tin is dow n-re gulated by ste roids.11 6 Basal and cytokinestimulated ICAM-1 ex pre ssion on human bronchial epithe lial c ell lines is inhibited by glucocortic oids.1 17 ,11 8 How e ve r, inhale d gluc oc orticoids did not modulate ICAM-1 ex p re ssion by bronchial epithelial ce lls from asthmatic s in vivo .11 9 Eosinophil adhe sion to cytokine-stimulated bronchial ep ithe lial c ells w as show n to be inhibited by the synthetic gluc oc orticoid dex ame thasone .120 Although cytokine-activate d epithelial c ells show ed incre ase d ex pre ssion of ICAM-1, this mole cule did not seem to be involved in the dec re ased adhe sion of e osinophils observe d in the pre senc e of dex ame thasone .12 0
Inhibitory proteins
The anti-inflammatory e ffec ts of glucocorticoids may be mediated by incre asing the produc tion of inhibitory prote ins, such as lipocortins. Lip oc ortins are me mbers of a supe rfamily of proteins characte rize d by the ir ability to bind calcium and anionic phospholipids, now know n as the annex ins.12 1,12 2 In se veral ce ll type s, but not all, gluc ocorticoids are induc ers of lipoc ortins, w hich have an inhibitory effec t on the activity of phospholipase A2 .123 ,1 24 As a re sult, the synthesis of lipid me diators, including p rostaglandins and e icosanoids, w ill be re duce d. How ever, in human bronchial e pithelial c ells gluc oc orticoids do not se em to up-re gulate the ex p re ssion of lip oc ortins.12 5 Furthermore , no significant differe nc e w as found be tw e en lipoc ortin-1 c onc entration in BAL fluid from asthmatic patients re ce iving inhale d gluc ocorticoid therapy and those w ho w e re not treate d w ith gluc ocorticoids.12 6 Re ce ntly, glucocorticoids have also be en show n to inc re as e the ex pre ssion of intra cellular IL-1 re c eptor antagonist type I by human bronchial epithelial c ells in vitro .1 27 Incre ase d production of this me diator may inhibit the effe cts of IL-1 agonists , the re by re ducing inflammation. How e ve r, gluc oc orticoid tre atment of asthmatic patients did not affe ct the ex pre ssion of IL-1 re c eptor antagonist by the bronchial e pithe lium.78 To provide prote ction against potentially injurious agents, airw ay e pithe lial cells se cre te a numbe r of me diators, including antiprote ase s. Se cre tory leukocyte prote ase inhibitor (SLPI) is the p re dominant antiprote ase in the airw ays. Its ex pre ssion has be en show n to be inc re ased in airw ay epithelial ce lls after stimulation w ith glucocorticoids.12 8
V. H. J. va n de r Ve lde n
effects of the rap y on airw ay muc osal inflammation. Thus far, most studie s have focuse d on the pre senc e of eosinophils and e osinophil-re late d mediators. In accordanc e w ith the findings in BAL fluid and bronchial biopsie s, gluc oc ortic oid treatment w as associated w ith a re duction in sputum eosinophil numbers , eosinophil cationic protein (ECP), and eosinophil pe rox idase (EPO).156 Gluc oc orticoids also re duc e the numbe r of activated T lymphocyte s in bronchial biopsie s and BAL fluid. 1 29 ,1 3 3,1 34 ,1 55,1 5 7 In addition, inhaled cortic oste roids re duc ed the number of ce lls ex pre ssing mRNA for IL-4 or IL-5, and incre ase d the numbe r of cells ex pre ssing mRNA for IFN-g ,1 31 ,13 2 the re by favouring the development of Th1 c ells.15 8 In addition to the e ffec ts of glucocorticoids on epithe lial ce lls described above, inhale d glucocortic oid therapy has be en show n to re duce the she dding of e pithe lial cells.1 55 ,1 5 9,1 6 0 No consiste nt e ffec t of cortic oste roids on the thickness of the baseme nt me mbrane has be en obse rved.79 ,16 0,161 Be sides the sup pre ssive e ffec ts on inflammatory ce lls, inhale d gluc oc ortic oids have also show n to inhibit mucus secre tion and mic rovascular leakage (as dete rmined by the dow n-re gulation of plasma p rote ins in BAL fluid).1 60 ,1 6 2 16 6 At pre sent it is not clear w hether this is me diated via a dire ct effe ct of gluc ocorticoids on endothe lial or mucous c ells, or via a re duction of inflammatory mediators that inc re as e mucus se cre tion and vasc ular leakage.
effects are mediated either by direc t binding of the gluc ocorticoid/GR c omplex to GRE in the promoter re gion of re spons ive gene s, or by an inte raction of this complex w ith transcription fac tors such as AP-1 and NF-k B. Glucocortic oids inhibit the ex pre ssion of a large number of inflammation-assoc iated mole cules, including cytokines, che mokines, arachidonic ac id me tabolite s, and adhesion mole cules. These e ffec ts pre dominantly are me diate d via inhibition of NF-k B activity. In contrast, anti-inflammatory me diators, such as NEP and IL-1 re c eptor antagon ist, often are up-re gulate d by glucocorticoids. The be ne fic ial e ffec ts of glucocorticoid the rap y in asthma is demonstrate d by in vivo studie s show ing that treatme nt of as thmatic patients w ith inhale d glucocorticoids inhibits the inflammation of the airw ays and simultane ously improve s the ir lung func tion. The se effe cts may be me diated in part by modulation of epithelial ce ll functions, sinc e many studies, both in v itro and in v ivo , have show n that glucocortic oids are able to modulate the inflammatory func tions of bronchial epithe lial ce lls. Further studies on the mechanism of action of gluc oc ortic oids w ill e ventually le ad to the development of drugs w hich spec ifically inhibit the transc ription of inflammatory ge ne s w ithout having ne gative side e ffec ts, and w ill contribute to a more effic ie nt tre atment of asthmatic p atie nts.
References
1. Carrye r HM, Koe lsc he GA, Prickman LE, Maytum CK, Lake CF, Williams HL. Effe c ts of cortisone on bronc hial asthma and hay fe ve r oc c uring in subje c ts s e ns itive to ragw e e d polle n. Pro c Sta ff Me e t, Ma yo Clin 1950; 25 : 482 486. 2. Barne s PJ, Pede rse n S. Effic acy and s afe ty of inhale d c ortic os te roids in asthma. Am Re v Re s pir Dis 1993; 148 : S1 S26. 3. Holle nbe rg SM, We inbe rge r C, Ong ES, e t a l. Primary s truc ture and ex pre ss ion of a func tional human gluc oc or tic oid rec e ptor c DNA. Na tu re 1985; 318 : 635 641. 4. Holle nbe rg SM, Gigue re V, Se gui P, Evans RM. Coloc alization of DNAbinding and transc rip tional activation func tions in th e human gluc ocortic oid rec e ptor. Ce ll 1987; 49 : 39 46. 5. Kumar V , Gre e n S, Staub A, Chambon P. Localis ation of th e oe s tradiolbinding and p utative DNA-binding domains of th e human oe stroge n re ce p tor. EMBO J 1986; 5 : 22312236. 6. Rusc oni S, Yamamoto KR. Func tional diss e c tion of the hor mone and DNA binding activ itie s of th e gluc oc ortic oid re c e p tor. EMBO J 1987; 6 : 1309 1315. 7. Evans RM. The ste roid and thyroid hormon e re ce p tor sup e rfamily. Scie n c e 1988; 240 : 889 895. 8. Evans RM, Holle nbe rg SM. Coop e rative and p ositiona l inde p e nde nt trans-ac tivation domains of the human gluc oc ortic oid rece p tor. Co ld Sprin g Ha rb Sy m p Qu a n t Bio l 1988; 53 : 813 818. 9. Pic ard D, Yamamoto KR. Tw o signals me diate hormone -de p e nde nt nuc le ar loc alization of th e glucoc ortic oid rec e p tor. EMBO J 1987; 6 : 3333 3340. 10. Kumar V , Chambon P. The e stroge n rec e p tor binds tightly to its re sponsive e le me nt as a ligand-induc e d homodime r. Ce ll 1988; 55 : 145 156. 11. Fre e dman LP, Luisi BF, Korszun ZR, Bas avapp a R, Sigle r PB, Yamamoto KR. The func tion and struc ture of the me tal coordination site s w ithin th e gluc oc ortic oid rec e p tor DNA binding domain. Na tu re 1988; 334 : 543 546. 12. Fre e dman LP. Anatomy of the ste roid rec e ptor zinc finge r re gion. En do c r R e v 1992; 13 : 129 145. 13. Luis i BF, Xu WX, Otw inow ski Z, Fre e dman LP, Yamamoto KR, Sigle r PB. Crys tallographic analysis of th e inte rac tion of th e gluc oc ortic oid re ce p tor w ith DNA. Na tu re 1991; 352 : 497505. 14. Sc hena M, Fre e dman LP, Yamamoto KR. Mutations in the gluc oc ortic oid re ce p tor zinc finge r re gion that distinguish inte rdigitate d DNA binding and transc rip tional e nhanc e me nt activitie s. Ge n e s De v 1989; 3 : 1590 1601.
Concluding Remarks
Glucocortic oids are w idely use d in the tre atment of asthma and have anti-inflammatory e ffec ts. The se
234 Mediators of Inflammation Vol 7 1998
235
V. H. J. va n de r Ve lde n
72. Kw on OJ, Au BT, Collins PD, e t a l. Inhibition of inte rle ukin-8 e x p res sion by dex ame thas one in human c ulture d airw ay e p ithe lial c e lls. Im m u n o lo g y 1994; 81 : 389 394. 73. Lilly CM, Nakamura H, Ke s se lman H, e t a l. Ex p ress ion of e otax in b y human lung e p ithe lial c e lls: induc tion b y c ytokine s and inhibition by glucoc ortic oids. J Clin In ve s t 1997; 99 : 17671773. 74. Be dard M, Mc Clure CD, Sc hille r NL, Franc oe ur C, Cantin A, De nis M. Re le ase of inte rle ukin-8, inte rle ukin-6, and c olony-stimu lating fac tors by upp e r airw ay e p ithe lial ce lls: imp lications for c ystic fibrosis. Am J Re s pir Ce ll Mo l Bio l 1993; 9 : 455 462. 75. Kw on OJ, Jos e PJ, Robbins RA, Sc hall TJ, Williams TJ, Barne s PJ. Glucoc ortic oid inhibition of RANTES ex p re ssion in human lung e p ithe lial ce lls. Am J Re s pir Ce ll Mo l Bio l 1995; 12 : 488 496. 76. Levine SJ, Larive e P, Logun C, Angus CW, She lhame r JH. Corticos te roids diffe re ntially re gulate se c retion of IL-6, IL-8, and G-CSF by a human bronchial e p ithe lial ce ll line . Am J Phy s io l 1993; 265 : L360L368. 77. Sous a AR, Poston RN, Lane SJ, Nakhoste e n JA, Lee TH. De te c tion of GMCSF in asthmatic bronc hial e pithe lium and dec rease by inhale d corticos te roids. Am R e v Re s p ir Dis 1993; 147 : 15571561. 78. Sous a AR, Trigg CJ, Lane SJ, e t a l. Effe ct of inhale d gluc oc ortic oids on IL1 b e ta and IL-1 rec e p tor antagonist (IL-1 ra) e x p res sion in asthmatic bronchial e p ithe lium. Th o ra x 1997; 52 : 407410. 79. Trigg CJ, Manolits as ND, Wang J, e t a l. Plac e bo-controlle d immunop ath olo gic s tudy of four months of inhale d c ortic os te roids in asthma. Am J Re s pir Crit Ca re Me d 1994; 150 : 1722. 80. Wang JH, De valia JL, Xia C, Sap s ford RJ, Davie s RJ. Ex pre s sion of RANTES b y human bronchial e pithe lial c e lls in vitro and in vivo and th e e ffe c t of c orticoste roids . Am J Re s p ir Ce ll Mo l Bio l 1996; 14 : 2735. 81. Bai TR, Zhou D, We ir T, e t a l. Subs tanc e P (NK1)- and ne urokinin A (NK2)-rece p tor gene ex p re ssion in inflammatory airw ay dise ase s . Am J Phy s io l 1995; 269 : L309 L317. 82. Adcoc k IM, Pete rs M, Ge lde r C, Shiras aki H, Brow n CR, Barne s PJ. Inc rease d tachykinin re ce p tor gene e x p res sion in asthmatic lung and its modulation by ste roids . J Mo l En d o c rin o l 1993; 11 : 17. 83. Mak JC, Nis hikaw a M, Shiras aki H, Miyayasu K, Barne s PJ. Prote c tive e ffe cts of a glucoc ortic oid on dow nre gulation of p ulmonary be ta 2-adre ne rgic rec e p tors in vivo. J Clin In ve s t 1995; 96 : 99 106. 84. Tan S, Hall IP, De w ar J, Dow E, Lip w orth B. Assoc iation be tw e e n be ta 2-adre noce p tor p olymorp hism and susc e p tibility to bronc hodilator dese nsitisation in mode rate ly se ve re stable asth matic s. La n c e t 1997; 350 : 995 999. 85. Colotta F , Re F, Muzio M, e t a l. Inte rle ukin-1 typ e II rec e p tor: a dec oy targe t for IL-1 that is re gulate d by IL-4. Scie n c e 1993; 261 : 472 475. 86. Dow e r SK, Fanslow W, Jacobs C, Waugh S, Sims JE, Widme r MB. Inte rle ukin-I antagonists. Th e r Im m u n o l 1994; 1 : 113 122. 87. Re F , Muzio M, De Rossi M, e t a l. The type II rec e ptor as a dec oy targe t for inte rle ukin 1 in p olymorp honucle ar le ukoc yte s: charac te rization of induction by dex ame thas one and ligand binding p rop e rtie s of the re le ase d de coy rece p tor. J Ex p Me d 1994; 179 : 739 743. 88. Levine SJ, Logun C, Chop ra DP, Rhim JS, She lhame r JH. Prote in kinase C, inte rle ukin-1 be ta, and corticoste roids regulate she dding of the typ e I, 55 kDa TNF re ce p tor from human airw ay e p ithe lial ce lls. Am J Re s p ir Ce ll Mo l Bio l 1996; 14 : 254 261. 89. Ge iste rfe r M, Richards C, Baumann M, Fe y G, Gyw nne D, Gauldie J. Re gulation of IL-6 and the hep atic IL-6 rec e p tor in acute inflammation in vivo. Cy to k in e 1993; 5 : 17. 90. Snye rs L, De Wit L, Conte nt J. Gluc oc ortic oid up-re gulation of highaffinity inte rle ukin 6 rece p tors on human e p ithe lial c e lls. Pro c Na tl Ac a d Sci USA 1990; 87 : 2838 2842. 91. Takizaw a H, Ohtoshi T, Yamashita N, Oka T, Ito K. Inte rle ukin 6-re c e p tor ex pre ss ion on human bronchial e p ithe lial c e lls: regulation by IL-1 and IL-6. Am J Phy s io l 1996; 270 : L346 L352. 92. Guo FH, De Rae ve HR, Rice TW, Stue hr DJ, Thunnis se n FB, Erzurum SC. Continuous nitric ox ide synthe s is by induc ible nitric ox ide s ynthas e in normal human airw ay e p ithe lium in v ivo. Pro c Na tl Ac a d Sci USA 1995; 92 : 7809 7813. 93. Robbins RA, Barne s PJ, Sp ringall DR, e t a l. Ex p ress ion of induc ible nitric ox ide in human lung e pithe lial c e lls. Bio ch e m Bio p hy s Re s Co m m u n 1994; 203 : 209 218. 94. Be rkman N, Robichaud A, Robbins RA, e t a l. Inhibition of induc ible nitric ox ide s ynthase ex p re ssion b y inte rle ukin-4 and inte rle ukin-13 in human lung e p ithe lial ce lls. Im m u n o lo g y 1996; 89 : 363 367. 95. Adcoc k IM, Brow n CR, Kw on O, Barne s PJ. Ox idative stre s s induc e s NF kap p a B DNA binding and induc ible NOS mRNA in human e p ithe lial ce lls. Bio ch e m Bio ph y s Re s Co m m u n 1994; 199 : 1518 1524. 96. Xie QW, Kashiw abara Y, Nathan C. Role of trans crip tion fac tor NF-kap p a B/Re l in induc tion of nitric o x ide s ynthase . J Bio l Ch e m 1994; 269 : 4705 4708. 97. Barne s PJ. Nitric ox ide and asthma. Re s Im m u n o l 1995; 146 : 698 702. 98. Sc halkw ijk C, Ve rvoorde ldonk M, Pfe ils c hifte r J, Marki F , van den Bosch H. Cytokine - and fors kolin-induce d synthe s is of group II p hosp holip ase A2 and p ros taglandin E2 in rat me sangial c e lls is p re ve nte d b y dex ame th asone . Bio c he m Bio ph y s Re s Co m m u n 1991; 180 : 46 52. 99. Mitc hell JA, Be lvisi MG, Akarase ree nont P, e t a l. Induc tion of c ycloox yge nase -2 by cytokine s in human pulmonary e p ithe lial c e lls : re gulation b y dex ame thas one . Br J Pha rm a co l 1994; 113 : 1008 1014. 100. van der Ve lde n VHJ, Nabe r BAE, Van de r Sp oe l P, Hoogste de n HC, Ve rsne l MA. Cytokine s and gluc oc ortic oids modulate human bronc hial e p ithe lial c e ll p e ptidas e s. Cy to k in e 1998; 10 : 55 65. 101. Lang Z, Murlas CG. Dex ame thasone inc rease s airw ay e p ithe lial ce ll ne utral e ndop e p tidase by e nhanc ing transcrip tion and ne w p rote in synthe s is. Lu n g 1993; 171 : 161172. 102. Bors on DB, Grue ne rt DC. Gluc oc ortic oids induc e ne utral e ndop e p tidase in transforme d human trache al e p ithe lial ce lls . Am J Ph y s io l 1991; 260 : L83L89. 103. Nade l JA, Borson DB. Modulation of ne uroge nic inf lammation b y ne utral e ndop e p tidase . Am Re v Re s pir Dis 1991; 143 : S33 S36. 104. Sont JK, van Krie ken JH, van Klink HC, e t a l. Enhanc e d ex p ress ion of ne utral e ndop e p tidase (NEP) in airw ay e p ithe lium in biop s ie s from ste roid- ve rsus nonste roid-tre ate d p atie nts w ith atop ic asthma. Am J Re s pir Ce ll Mo l Bio l 1997; 16 : 549 556. 105. Gandhi CR, Be rkow itz DE, Watkins WD. Endothe lins. Biochemistry and p athop hysiolog ic actions. An e s th e s io lo g y 1994; 80 : 892 905. 106. Vittori E, Marini M, Fasoli A, De Franc his R, Mattoli S. Inc rease d ex pre ss ion of e ndothe lin in bronc hial e p ithe lial c e lls of asthmatic p atie nts and e ffe c t of c ortic oste roids . Am Re v Re s pir Dis 1992; 146 : 1320 1325. 107. Hay DW, Hubbard WC, Unde m BJ. Endothe lin-induc e d c ontrac tion and me diator re le ase in human bronchus. Br J Pha rm a c o l 1993; 110 : 392 398. 108. Mattoli S, Me zz e tti M, Riva G, Alle gra L, Fasoli A. Sp e c ific binding of e ndothe lin on human bronc hial s mooth musc le ce lls in c ulture and se c re tion of e ndothe lin-like mate rial from bronc hial e p ithe lial c e lls . Am J Re s pir Ce ll Mo l Bio l 1990; 3 : 145 151. 109. Barne s PJ. Endothe lins and pulmonary dis e ase s . J App l Phy s io l 1994; 77 : 10511059. 110. Mansoor AM, Honda M, Saida K, e t a l. Endothe lin induc e d c ollage n re mode ling in ex p e rime ntal p ulmonary hyp e rte nsion. Bio ch e m Bio p hy s Re s Co m m u n 1995; 215 : 981986. 111. Rizvi MA, Katw a L, Sp adone DP, Mye rs PR. The e ffe c ts of e ndothe lin-1 on collage n typ e I and typ e III synthe sis in c ulture d p orc ine c oronary arte ry vasc ular s mooth muscle c e lls . J Mo l Ce ll Bio l 1996; 28 : 243 252. 112. Daw e s KE, Cambre y AD, Camp a JS, e t a l. Change s in c ollage n me ta bolism in res ponse to e ndothe lin-1: e v ide nc e for fibroblast he te roge ne ity. In t J Bio c he m Ce ll Bio l 1996; 28 : 229 238. 113. Springall DR, How arth PH, Counihan H, Djukanovic R, Holgate ST, Polak JM. Endothe lin immunore activity of airw ay e p ithe lium in asthmatic p atie nts . La n c e t 1991; 337 : 697701. 114. Re dington AE, Sp ringall DR, Me ng QH, e t a l. Immunore active e ndothe lin in bronchial biop sy spe c ime ns : inc rease d ex pre ss ion in asthma and modulation by c or tic oste roid th e rap y. J Alle rg y Clin Im m u n o l 1997; 100 : 544 552. 115. Re dington AE, Sp ringall DR, Me ng QH, e t a l. Immunore active e ndothe lin in bronchial biop sy spe c ime ns : inc rease d ex pre ss ion in asthma and modulation by c or tic oste roid th e rap y. J Alle rg y Clin Im m u n o l 1997; 100 : 544 552. 116. Cronste in BN, Kimme l SC, Levin RI, Martiniuk F , We issmann G. A me chanis m for th e antiinflammatory e ffe c ts of c ortic oste roids: the glucoc ortic oid rece ptor regulate s le ukoc yte adhe s ion to e ndothe lial ce lls and e x p res sion of e ndothe lial-le ukoc yte adhe s ion mole c ule 1 and inte rce llular adhe sion mole c ule 1. Pro c Na tl Ac a d Sci USA 1992; 89 : 9991 9995. 117. van de Stolp e A, Calde nhove n E, Raaijmake rs JA, van der Saag PT, Koe nde rman L. Gluc oc ortic oid-me diate d rep re ss ion of inte rce llular adhe s ion mole c ule -1 ex p ress ion in human mono c ytic and bronc hial e p ithe lial c e ll line s . Am J R e s p ir Ce ll Mo l Bio l 1993; 8 : 340 347. 118. Paolie ri F , Battifora M, Ric c io AM, e t a l. Inhibition of adhe sion mole c ule s by bude s onide on a human e pithe lial c e ll line (lung c arc inoma). Alle rg y 1997; 52 : 935 943. 119. Monte fort S, He rbe rt CA, Rob ins on C, Holgate ST. The bronc hial e p ithe lium as a targe t for inflammatory attac k in asthma. [Re vie w ]. Clin Ex p Alle rg y 1992; 22 : 511520. 120. Sato M, Takizaw a H, Kohyama T, e t a l. Eosinop hil adhe sion to human bronchial e p ithe lial c e lls : re gulation b y c ytokine s. In t Arc h Alle rg y Im m u n o l 1997; 113 : 203 205. 121. Goulding NJ, Guyre PM. Re gulation of inf lammation b y lip oc ortin 1. Im m u n o l To da y 1992; 13 : 295 297. 122. Ge isow MJ, Walke r JH, Bouste ad C, Taylor W. Annex ins ne w family of Ca2+ -re gulate d-p hos p holip id binding p rote in. Bio s ci Re p 1987; 7 : 289 298. 123. Flow e r RJ. Ele ve nth Gaddum me morial le c ture . Lip oc ortin and the me chanis m of ac tion of the gluc oc ortic oids . Br J Ph a r m a co l 1988; 94 : 9871015. 124. Wallne r BP, Mattaliano RJ, He s sion C, e t a l. Cloning and ex p re ssion of human lip oc ortin, a p hosp holip ase A2 inhibitor w ith p ote ntial antiinflammatory activ ity. Na tu re 1986; 320 : 7781. 125. Ve rhe ggen MM, De Bont HI, Adriaans e n-Soe ting PWC, e t a l. Ex p ress ion of lip oc ortins in human bronc hial e p ithe lial c e lls: e ffe c ts of IL-1B, TNFa, LPS and dex ame thas one . Me d In fla m 1996; 5 : 210 217.
236