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Background: Hyperadrenocorticism is an uncommon guinea pig disease, but it is an important rule out for bilateral symmetrical non-pruritic alopecia, polyuria, polydipsia, and other generalized signs of illness. Diagnostic testing options are limited due to lack of reference intervals. Testing is challenging due to daily fluctuations in cortisol, stress, concurrent disease, obtaining sufficient samples, and large/variable adrenal gland size in normal guinea pigs. Case description: A three-and-a-half-year-old female guinea pig (Cavia porcellus) presented for a five-week history of bilateral symmetrical alopecia, polyuria, and polydipsia. Abdominal ultrasound revealed small adrenal glands bilaterally. An ACTH stimulation test revealed markedly elevated cortisol pre- and post-stimulation. Treatment with trilostane was initiated (2-4 mg/kg PO q12h), which resolved the clinical signs after three months with no adverse effects noted. The guinea pig later became refractory to treatment and had lost significant weight, at which time an ultrasound was performed and revealed a right adrenal gland mass. Conclusions: Diagnosing hyperadrenocorticism in guinea pigs is challenging and cases can present similarly to ovarian cysts. Diagnosis can be achieved using a combination of clinical signs, abdominal ultrasound, cortisol testing, and ACTH stimulation testing. Case relevance: This report highlights the need for establishment of reference intervals for traditional screening and differentiating tests, as well as reporting effective therapeutic protocols.

Approaches to downregulate ovarian function in the sexually mature bitch by applying slow release GnRH agonist implants are hampered by the initial stimulation of folliculogenesis (flare up) and the resulting side effects. The present pilot study was designed to test to what extent these effects can be suppressed by simultaneous treatment with the 3s-hydroxysteroid-dehydrogenase (HSD3B) blocker trilostane (T). Treatment with T in 6-h intervals completely blocked adrenal cortisol production. However, in parallel and concomitant with the increase of LH, progesterone and estradiol levels increased, ending up in pro-estric steroid levels in two of the three dogs. Hormonal changes were reflected in the respective clinical symptoms. During the whole observation period the course of LH concentrations did not indicate downregulation of pituitary function as a result of treatment with the GnRH-agonist Suprelorin®, 4.7 mg. The incomplete inhibitory effect of T on the follicular production of sex steroids could be explained by an insufficient transfer of T into the follicular compartment or the existence of a HSD3B isoform in the dog ovary different from the adrenal enzyme. Concerning the lack of downregulation and when accounting for published data different pharmacodynamics/pharmacokinetic activities of GnRH-agonists should be taken into account.

While evidence indicates that sigma-1 receptors (Sig-1Rs) play an important role in the induction of peripheral neuropathic pain, there is limited understanding of the role that the neurosteroidogenic enzymes, which produce Sig-1R endogenous ligands, play during the development of neuropathic pain. We examined whether sciatic nerve injury upregulates the neurosteroidogenic enzymes, cytochrome P450c17 and 3β-hydroxysteroid dehydrogenase (3β-HSD), which modulate the expression and/or activation of Sig-1Rs leading to the development of peripheral neuropathic pain. Chronic constriction injury (CCI) of the sciatic nerve induced a significant increase in the expression of P450c17, but not 3β-HSD, in the ipsilateral lumbar spinal cord dorsal horn at postoperative day 3. Intrathecal administration of the P450c17 inhibitor, ketoconazole during the induction phase of neuropathic pain (day 0 to day 3 post-surgery) significantly reduced the development of mechanical allodynia and thermal hyperalgesia in the ipsilateral hind paw. However, administration of the 3β-HSD inhibitor, trilostane had no effect on the development of neuropathic pain. Sciatic nerve injury increased astrocyte Sig-1R expression as well as dissociation of Sig-1Rs from BiP in the spinal cord. These increases were suppressed by administration of ketoconazole, but not by administration of trilostane. Co-administration of the Sig-1R agonist, PRE084 restored the development of mechanical allodynia originally suppressed by the ketoconazole administration. However, ketoconazole-induced inhibition of thermal hyperalgesia was not affected by co-administration of PRE084. Collectively these results demonstrate that early activation of P450c17 modulates the expression and activation of astrocyte Sig-1Rs, ultimately contributing to the development of mechanical allodynia induced by peripheral nerve injury.

Paeoniflorin (PF) is one of the important active components in peony that are known to produce the neuroprotective effects. However, the involved cytoprotective factors on brain astrocytes are remain unclear. Translocator protein 18 kDa (TSPO) and its downstream neurosteroids biosynthesis play a significant role in cytoprotection. Based on these, the role of TSPO and neurosteroids biosynthesis in the cytoprotective effects of PF is evaluated. The astrocyte cells were cultured and AC-5216 (TSPO ligand) was selected as the positive control drug. The cytoprotective effects of PF and the levels of neurosteroids were quantified by water-soluble tetrazolium assay and enzyme linked immunosorbent assay, respectively. The cytoprotective activities of PF were relevant to neurosteroids (e.g. progsterone and allopregnanolone) biosynthesis, while these effects were totally blocked by PK11195, trilostane and finasteride, respectively. In summary, the cytoprotective effects of PF maybe mediated by TSPO and neurosteroids biosynthesis. The findings may provide the new insights into the cytoprotective effects of PF.

Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.

The aim of this study was to describe the incidence and permanence of hypoadrenocorticism associated with trilostane treatment and to assess potential risk factors for hypoadrenocorticism. A retrospective cohort study was conducted using case records for 156 dogs treated with trilostane after a diagnosis of hyperadrenocorticism. Occurrences of hypoadrenocorticism were categorised as either transient or permanent. After initiation of treatment with trilostane, the estimated cumulative incidence of hypoadrenocorticism was 15% by 2 years and 26% by 4.3 years, respectively. Occurrences of hypoadrenocorticism were transient in 14/19 (74%) affected study dogs. The risk of hypoadrenocorticism was not significantly associated with trilostane dose rate and other potential risk factors assessed were not significantly associated with subhazard of hypoadrenocorticism, but effect estimates for most were imprecise. In conclusion, approximately 15% of dogs being treated with trilostane developed hypoadrenocorticism within the first 2 years of treatment and about one quarter became affected by 4 years. However, first occurrences of hypoadrenocorticism were mostly transient. Over the range of dose rates studied, each 1mg/kg/day increase in trilostane dose rate resulted in, at most, only a small increase in the risk of developing hypoadrenocorticism.

Acrolein, an α, β-unsaturated aldehyde, exists in a wide range of sources. Acrolein can be not only generated from all types of smoke but also produced endogenously from the metabolism by lipid peroxidation. The cellular influence of acrolein is due to its electrophilic character via binding to and depleting cellular nucleophiles. Although the toxicity of acrolein has been extensively studied, there is relatively little information about its impact on hormone release. This study aimed at the effect of acrolein on hypothalamic-pituitary-adrenal (H-P-A) axis. In an in vivo study, male rats were administrated with acrolein for 1 or 3days. The plasma corticosterone in response to a single injection of adrenocorticotropic hormone (ACTH) increased slowly in acrolein-pretreated rats than in control rats. Further investigating the steroidogenic pathway, the protein expressions of steroidogenic acute regulatory protein (StAR) and the upper receptor-melanocortin 2 receptor (MC2R) were attenuated in acrolein-treated groups. Another experiment using trilostane showed less activity of P450scc in zona fasciculata-reticularis (ZFR) cells in acrolein-treated groups. In addition to the suppressed ability of corticosterone production in ZFR cells, acrolein even had extended influence at higher concentrations. The lower ACTH was observed in the plasma from acrolein-pretreated rats. In an in vitro study, ZFR cells were incubated with acrolein and the results showed that corticosterone concentrations in media were decreased in a dose-dependent manner. Acrolein also desensitized the response of the ZFR cells to ACTH. These results suggested that acrolein decreased the releasing ability of corticosterone via an inhibition on the response of ZFR cells to ACTH and the reduction of protein expressions of StAR and MC2R as well as the activity of P450scc in rat ZFR cells. The present evidences showed that the H-P-A axis was affected by the administration of acrolein.

Bile acids (BAs) are important signaling molecules acting via the farnesoid X nuclear receptor (FXR) and the membrane G protein-coupled bile acid receptor 1 (GPBAR1). Besides deconjugation of BAs, the oxidoreductive enzymes of colonic bacteria and hepatocytes enable the conversion of BAs into their epimers or dehydrogenated forms. Obeticholic acid (OCA) is the first-in-class BA-derived FXR agonist approved for the treatment of primary biliary cholangitis. Herein, a library of OCA derivatives, including 7-keto, 6-ethylidene derivatives and 3β-epimers, was synthetized and investigated in terms of interactions with FXR and GPBAR1 in transaction assays and evaluated for FXR target genes expression in human hepatocytes and C57BL/6 mice. The derivatives were further subjected to cell-free analysis employing in silico molecular docking and a TR-FRET assay. The conversion of the 3βhydroxy epimer and its pharmacokinetics in mice were studied using LC-MS. We found that only the 3β-hydroxy epimer of OCA (3β-isoOCA) possesses significant activity to FXR in hepatic cells and mice. However, in a cell-free assay, 3β-isoOCA had about 9-times lower affinity to FXR than did OCA. We observed that 3β-isoOCA readily epimerizes to OCA in hepatocytes and murine liver. This conversion was significantly inhibited by the hydroxy-Δ5-steroid dehydrogenase inhibitor trilostane. In addition, we found that 3,7-dehydroobeticholic acid is a potent GPBAR1 agonist. We conclude that 3β-isoOCA significantly activates FXR due to its epimerization to the more active OCA by hepatic metabolism. Other modifications as well as epimerization on the C3/C7 positions and the introduction of 6-ethylidene in the CDCA scaffold abrogate FXR agonism and alleviate GPBAR1 activation.

Trilostane, a competitive inhibitor of 3β-hydroxysteroid dehydrogenase, is often used to treat canine hyperadrenocorticism. In some species, trilostane has been shown to have additional effects on steroid biosynthesis, and it has been postulated that trilostane might have effects on 11β-hydroxysteroid dehydrogenase (11β-HSD) in dogs. To investigate the effect of trilostane on 11β-HSD in canine adrenal glands, healthy Beagle dogs were treated with trilostane for 8 weeks. Trilostane treatment resulted in a significant decrease of the cortisol/cortisone ratio in the serum. The adrenal gland mRNA and protein expression levels of 11β-HSD type 1 and 11β-HSD type 2 were significantly higher and significantly lower respectively in dogs treated with trilostane compared to those in control healthy Beagle dogs. These findings suggest that trilostane may have an effect on 11β-HSD activity in canine adrenal glands.

Cogent evidence points to the involvement of neurosteroids in the regulation of dopamine (DA) neurotransmission and signaling, yet the neurobiological bases of this link remain poorly understood. We previously showed that inhibition of 5α-reductase (5αR), a key neurosteroidogenic enzyme, attenuates the sensorimotor gating deficits induced by DA receptor activation, as measured by the prepulse inhibition (PPI) of the acoustic startle reflex. To extend these findings, the present study was aimed at the assessment of the role of other key neurosteroidogenic enzymes in PPI, such as 17α-hydroxylase/C17,20 lyase (CYP17A1), 3α- and 3β-hydroxysteroid dehydrogenase (HSD), in Sprague-Dawley rats. The PPI deficits induced by the DAergic non-selective agonist apomorphine (APO, 0.25 mg/kg, SC) were dose-dependently attenuated by the selective CYP17A1 inhibitor abiraterone (ABI, 10-50 mg/kg, IP) in a fashion akin to that of the 5αR inhibitor finasteride (FIN, 100 mg/kg, IP). These systemic effects were reproduced by intracerebroventricular injection of ABI (1 μg/1 μl), suggesting the involvement of brain CYP17A1 in PPI regulation. Conversely, the PPI disruption induced by APO was not significantly affected by the 3α- and 3β-HSD inhibitors indomethacin and trilostane. Given that CYP17A1 catalyzes androgen synthesis, we also tested the impact on PPI of the androgen receptor (AR) antagonist flutamide (10 mg/kg, IP). However, this agent failed to reverse APO-induced PPI deficits; furthermore, AR endogenous ligands testosterone and dihydrotestosterone failed to disrupt PPI. Collectively, these data highlight CYP17A1 as a novel target for antipsychotic-like action, and suggest that the DAergic regulation of PPI is modulated by androgenic neurosteroids, through AR-unrelated mechanisms.

Midazolam is a benzodiazepine derivative drug that has powerful anxiolytic, amnestic, hypnotic, and sedative properties. The cytoprotective effect of midazolam on brain astrocytes is poorly understood. This study aimed to investigate the cytoprotective effect of midazolam on astrocytes exposed to corticosterone, a stress-produced glucocorticoid. We found that midazolam stimulated pregnenolone and progesterone secretion in astrocytes in a dose-dependent manner. Midazolam protected astrocytes from corticosterone-induced damages in a dose-dependent manner. In addition, we demonstrated that progesterone reduced corticosterone-induced damages. Finally, we applied trilostane, an inhibitor of 3β-hydroxysteroid dehydrogenase, to inhibit pregnenolone metabolism and found that pretreatment with trilostane significantly inhibited the cytoprotective effect of midazolam on corticosterone-induced cytotoxicity in rat astrocytes in a dose-dependent manner. Taken together, these results demonstrate that midazolam has cytoprotective effect on astrocytes. This is, at least partially, derived from midazolam-induced steroidogenesis including progesterone and downstream products in astrocytes. Our data provide new insights into the cytoprotective effect of midazolam.

A 12-year-old female spayed domestic short-haired cat presented for lethargy, poor hair coat, alopecia, difficulty walking, and mild polyuria/polydipsia. The cat's skin tore easily in the neck area during routine restraint for blood draw. Physical examination, blood analysis, and ultrasound imaging were all consistent with pituitary-dependent hyperadrenocorticism (PDH) with secondary insulin-resistant diabetes mellitus, which was nonketotic. Insulin therapy, fluids, and diet change were initiated for the diabetes mellitus and the owner reported improvement in clinical signs although the blood glucose measurements remained elevated. Surgical repair of the torn skin was successful. Although a guarded prognosis was given to the owner because of an advanced stage of hyperadrenocorticism, and the limited treatment options currently available for feline PDH, trilostane was agreed on as an initial therapeutic option. The day trilostane was to be initiated, the cat presented with dyspnea and the owner chose to euthanize. Because of the rarity of hyperadrenocorticism disease in the cat, permission was obtained by the owner for a necropsy to confirm suspected PDH as the underlying cause for insulin resistance and skin fragility syndrome.

Adrenal necrosis has been reported as a complication of trilostane application in dogs with hyperadrenocorticism. One suspicion was that necrosis results from the increase of adrenocorticotropic hormone (ACTH) during trilostane therapy. The aim of the current study was to assess the effects of ACTH and trilostane on adrenal glands of rats. For experiment 1, 36 rats were divided into 6 groups. Groups 1.1 to 1.4 received ACTH in different doses (60, 40, 20, and 10 μg/d) infused subcutaneously with osmotic minipumps for 16 wk. Group 1.5 received saline, and group 1.6 received no therapy. For experiment 2, 24 rats were divided into 3 groups. Group 2.1 and 2.2 received 5 and 50 mg/kg trilostane/d orally mixed into chocolate pudding for 16 wk. Eight control rats received pudding alone. At the end of the experiments, adrenal glands were assessed for necrosis by histology and immunohistochemistry; levels of endogenous ACTH and nucleosomes were assessed in the blood. Rats treated with 60 μg ACTH/d showed more hemorrhage and vacuolization and increased numbers of apoptotic cells in the adrenal glands than rats treated with 20 or 10 μg ACTH/d, trilostane, or control rats. Rats treated with 60 μg ACTH/d had a higher amount of nucleosomes in the blood compared with rats treated with 10 μg ACTH/d, trilostane, or saline. We conclude that in healthy rats ACTH, but not trilostane, causes adrenal degeneration in a dose-dependent manner. Results of this study support the hypothesis that adrenal gland lesions seen in trilostane-treated dogs are caused by ACTH and not by trilostane.

Interference with the pregnancy-maintaining influence of progesterone is the basis of most methods for termination of unwanted pregnancy in dogs. The currently available methods are based on induction of luteolysis or blocking of the progesterone receptor. Inhibition of progesterone synthesis using a competitive inhibitor of 3 -hydroxysteroid dehydrogenase (3 -HSD) could be another strategy to terminate unwanted pregnancies. In this study we investigated the effects of the 3 -HSD inhibitor trilostane on corpus luteum function in non-pregnant bitches. Trilostane was administered orally for seven consecutive days in either the pituitary-independent part of the luteal phase (PIP, start of treatment on D11 after ovulation, n 6) or the pituitary-dependent part (PDP, start of treatment on D31 after ovulation, n 6), in an oral dose of about 4.5 mg/kg bw, twice daily. Results were compared with those obtained in control bitches (n 6). ACTH stimulation tests were performed to assess adrenocortical reserve capacity. Trilostane caused no apparent side effects and ACTH stimulation tests revealed good suppression of cortisol secretion. Trilostane also caused a significant decrease in plasma progesterone concentration. When it was stopped during PIP, progesterone secretion was completely restored and there was no difference in the length of the luteal phase between those dogs and control dogs (99 days, range 70–138 d and 99 d, range 60–112 d, respectively). When trilostane was stopped during PDP there was no post-treatment recovery of progesterone secretion and although the luteal phase tended to be shorter (66 d, range 41–101 d) the difference was not significant (P 0.09). Plasma prolactin concentration did not increase after the trilostane-induced decrease in plasma progesterone. The interoestrous interval in dogs treated during PIP (234 d, range 175–269 d) or PDP (198 d, range 120–287 d) was not significantly shorter than the control interval (247 d, range 176–313 d). In conclusion, trilostane treatment was effective in decreasing plasma progesterone concentration in bitches during the luteal phase, but the dose regimen used in this study produced less clear-cut inhibition of ovarian steroidogenesis than have other strategies to decrease plasma progesterone concentration. Further studies are warranted to determine whether trilostane can be used to terminate unwanted pregnancy in the bitch without inducing adrenocortical insufficiency. © 2011 Elsevier Inc. All rights reserved.

The intracellular androgen metabolism and cell activity in prostate cancer cells with mutated (LNCaP-FGC) or wild-type (VCaP) androgen receptors in the presence of trilostane, an inhibitor of 3β-hydroxysteroid dehydrogenase, were examined. Trilostane suppressed the intracellular production of androstenedione, testosterone, and dihydrotestosterone from dehydroepiandrosterone in LNCaP-FGC cells. In both LNCaP-FGC and VCaP cell types, the prostate-specific antigen (PSA) levels in media were increased by trilostane alone in a concentration-dependent manner. Both cells pretreated with trilostane showed a dose-dependent decrease in PSA production with bicalutamide (P < 0.001). Trilostane should be used with particular concern when treating prostate cancer.

In postmenopausal women, human 3beta-hydroxysteroid dehydrogenase type 1 (3beta-HSD1) is a critical enzyme in the conversion of DHEA to estradiol in breast tumors, while 3beta-HSD2 participates in the production of cortisol and aldosterone in the human adrenal gland. The goals of this project are to determine if Arg195 in 3beta-HSD1 vs. Pro195 in 3beta-HSD2 in the substrate/inhibitor binding site is a critical structural difference responsible for the higher affinity of 3beta-HSD1 for inhibitor and substrate steroids compared to 3beta-HSD2 and whether Asp61, Glu192 and Thr8 are fingerprint residues for cofactor and substrate binding using site-directed mutagenesis. The R195P-1 mutant of 3beta-HSD1 and the P195R-2 mutant of 3beta-HSD2 have been created, expressed, purified and characterized kinetically. Dixon analyses of the inhibition of the R195P-1 mutant, P195R-2 mutant, wild-type 3beta-HSD1 and wild-type 3beta-HSD2 by trilostane has produced kinetic profiles that show inhibition of 3beta-HSD1 by trilostane (K(i)=0.10microM, competitive) with a 16-fold lower K(i) and different mode than measured for 3beta-HSD2 (K(i)=1.60microM, noncompetitive). The R195P-1 mutation shifts the high-affinity, competitive inhibition profile of 3beta-HSD1 to a low-affinity (trilostane K(i)=2.56microM), noncompetitive inhibition profile similar to that of 3beta-HSD2 containing Pro195. The P195R-2 mutation shifts the low-affinity, noncompetitive inhibition profile of 3beta-HSD2 to a high-affinity (trilostane K(i)=0.19microM), competitive inhibition profile similar to that of 3beta-HSD1 containing Arg195. Michaelis-Menten kinetics for DHEA, 16beta-hydroxy-DHEA and 16alpha-hydroxy-DHEA substrate utilization by the R195P-1 and P195R-2 enzymes provide further validation for higher affinity binding due to Arg195 in 3beta-HSD1. Comparisons of the Michaelis-Menten values of cofactor and substrate for the targeted mutants of 3beta-HSD1 (D61N, D61V, E192A, T8A) clarify the functions of these residues as well.

Over the last 10 years, trilostane, a competitive inhibitor of steroid synthesis, is being widely used for the treatment of canine hyperadrenocorticism. Trilostane causes a significant but reversible decrease in cortisol production and a concomitant improvement in clinical signs in most dogs with this common condition. Side effects, though infrequent, can be serious: dogs treated with this drug require regular monitoring. This review summarizes current knowledge of the use of this drug with particular emphasis on its efficacy, safety, adverse reactions, and effects on endocrine parameters. Brief mention is made of its other uses in dogs and other species.

Cushing's disease caused by pituitary corticotroph adenoma in dogs is usually treated by medical treatment, and the efficacy of this treatment has been reported. However, controversy remains as to whether reduced negative feedback through the inhibition of cortisol secretion, similar to Nelson's syndrome, may appear as an adverse effect. The purpose of this study was to investigate the effect of reduced negative feedback through the inhibition of cortisol secretion by daily trilostane administration on the pituitary-adrenal axis in clinically normal dogs. Dogs were administered 5mg/kg trilostane twice a day every day for 8 weeks (n=8) or 16 weeks (n=3). After the initiation of trilostane administration, plasma adrenocorticotropic hormone (ACTH) concentrations were increased remarkably. As assessed by magnetic resonance imaging (MRI) during administration, the pituitary became enlarged. After trilostane administration, the cytoplasmic areas of the pituitary corticotrophs were increased and the ratio of pituitary corticotrophs to all cells in the anterior lobe was greater in the trilostane-treated dogs than that in untreated animals. In addition, histological examinations revealed bilateral adrenal cortical hyperplasia. Using real-time PCR quantification, the expression of proopiomelanocortin (POMC) mRNA in the pituitary and ACTH receptor (ACTH-R) mRNA in the adrenal gland was greater in the dogs treated with trilostane than in untreated dogs. These results indicate that reduced negative feedback induced hyperfunction of the pituitary corticotrophs and pituitary enlargement in healthy dogs. These changes suggest that the inhibition of cortisol secretion by trilostane may increase the risk for accelerating the growth of corticotroph adenomas in dogs with Cushing's disease.

Pituitary-dependent hyperadrenocorticism is a common endocrine disorder in dogs in the United States. Once a diagnosis is established, a decision must be made whether or not to pursue treatment, and if so, which medication to use. Historically, mitotane (Lysodren, o,p'-DDD, Bristol-Myers Squibb, New York) has been the most commonly used treatment for medical management. Its use is complicated and comes with many potential side effects, making many practitioners wary of its use. Recently, trilostane has been proven to be an effective treatment of pituitary-dependent hyperadrenocorticism and is approved for use in other countries. Treatment with trilostane is somewhat simpler and the incidence of side effects seems to be less when compared with mitotane therapy. Either treatment can be a safe and effective method of treatment for pituitary-dependent hyperadrenocorticism when the practitioner and client are well educated regarding their use and an appropriate monitoring protocol is used.

4-Hydroxy tamoxifen (OHT) and trilostane interact differently with the oestrogen receptor (ER). OHT is a competitive inhibitor whereas trilostane has direct, but non-competitive effects on ER. This study compared the effects of OHT and trilostane, in the presence of 17beta-oestradiol (E2) on gene expression in MCF-7 breast cancer cells using microarrays each representing nearly 20,000 human genes. Striking differences between the sets of genes affected by these two drugs were observed. Both OHT and trilostane affected transcription of genes involved in cell cycle regulation, cell adhesion and matrix formation, however, only 12.5% of trilostane down-regulated genes and 9.2% of up-regulated genes were similarly regulated by OHT. A selective up-regulation of ERbeta by trilostane, but not OHT, was observed and confirmed by qRT-PCR. Similar up-regulation of this gene by trilostane was observed in the uterus of trilostane-treated (4 mg/kg for 7 days) rats, in which ERbeta mRNA (3-fold) and ERbeta protein expression (10-fold) were both increased. These data show that OHT and trilostane regulate the expression of different sets of genes, reflecting their different modes of interaction with ER. Trilostane-specific up-regulation of ERbeta could explain its positive benefit rates in acquired tamoxifen resistance.

In vitro germinal vesicle breakdown (GVBD) in Cyprinus carpio oocytes was induced by recombinant human insulin-like growth factor-I and -II (IGF-I and IGF-II) and bovine insulin (b-insulin). Treatment of postvitellogenic ovarian follicles with IGF-I and b-insulin increased concentration of maturation-inducing hormone (MIH), 17alpha,20beta-dihydroxy-4-pregnane-3-one (DHP) in the medium. IGF-I and IGF-II both and b-insulin induced GVBD in denuded oocytes. IGF-I analogue R3 IGF-I was more potent than IGF-I in inducing GVBD of postvitellogenic follicles suggesting that ovarian IGF binding proteins may inhibit IGF-I action. Vitellogenic follicles, which were immature for oocytes to complete GVBD in response to DHP or HCG, underwent GVBD by IGF-I, not by b-insulin. IGF-I was also able to stimulate DHP production in such follicles. Addition of DHP and HCG to the culture of vitellogenic follicles containing IGF-I or b-insulin did neither potentiate the stimulation of GVBD induced by IGF-I nor initiate the same in response to b-insulin. Incubation of postvitellogenic follicles with trilostane (3beta-HSD inhibitor) had no inhibitory effects on IGF-I- and b-insulin-induced GVBD but attenuated the same under HCG stimulation. Trilostane, however, strongly inhibited DHP production induced by all these effectors. Induction of GVBD by IGF-I and b-insulin was not altered in the presence of actinomycin D. However, it significantly blocked the HCG-induced GVBD. Cycloheximide was shown to inhibit the induction of GVBD and DHP production by IGF-I, b-insulin and HCG. Both actinomycin D and cycloheximide were found to inhibit DHP production stimulated by all the three effectors. Collectively, these observations indicate that IGF-I and b-insulin can induce GVBD via MIH- and transcription-independent pathway. Incubation of the follicles with gap junction uncouplers, 1-heptanol or 1-octanol, had no effect on IGF-I- and b-insulin-induced GVBD, but attenuated the same induced by HCG. These uncouplers, however, inhibited DHP production induced by IGF-I, b-insulin and HCG. This result suggests that both IGF-I and b-insulin can induce oocyte maturation without coupled gap junction between oocytes and granulosa cells, while homologous gap junctions are required for DHP production. Inhibitors of phosphatidylinositol-3 kinase (PI-3 kinase), wortmannin and LY294002 inhibited GVBD by IGF-I and b-insulin. These two inhibitors also attenuated HCG-induced GVBD. These data suggest that PI-3 kinase activity is required for IGF-I, b-insulin and HCG induction of GVBD in C. carpio.

Labor induction abortion in the second trimester is a difficult problem in developing countries because antiprogestins are either not available or unaffordable. When prostaglandins are used alone for labor induction abortion without antiprogestin pretreatment, the induction to delivery interval and the treatment failure rate increase. Trilostane, an inhibitor of 3beta-hydroxysteroid dehydrogenase enzyme system, was given to 93 women between 13 and 19 weeks gestation. The trilostane dosage used was 120 mg twice daily for the first 24 h, and then 240 mg twice daily for the next 24 h. The women returned after 48 h for hospital admission. The women were randomized to three different misoprostol regimens: low-dose vaginal group (200 microg every 4 h), high-dose vaginal group (initial dose of 400 microg followed by 200 microg every 4 h) and vaginal-oral group (400 microg vaginally followed by 200 microg orally every 4 h). The median induction to abortion times were 17, 8.3 and 9.4 h, respectively. The latter two groups had significantly shorter induction to delivery times (p

The mechanism of action of dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S), two interconvertable neurosteroids, has not been fully characterized in the central nervous system (CNS). Previous studies demonstrated that DHEA was intrinsically androgenic, suggesting that it may act through a genomic pathway. However, it is not known whether DHEA-S also produces androgenic effects, an important question given that the concentration of DHEA-S in brain is some 7-12 times that of DHEA. The current study compared the potential androgenic effects of DHEA-S with DHEA by examining their capacity to induce two characteristic effects of an androgenic compound. These included the ability to (1) up-regulate neural androgen receptor (AR) protein level in mouse brain and immortalized GT1-7 hypothalamic cells and (2) assess their effect on reporter gene expression through AR in CV-1 cells cotransfected with pSG5-AR and pMMTV-ARE-CAT reporter. Semi-quantitative Western blot analysis showed that DHEA treatment significantly augmented AR in mouse brain and GT1-7 cells in a dose-dependent manner and that these effects were not blocked by trilostane (TRIL), a known 3beta-hydroxysteroid dehydrogenase inhibitor. DHEA also promoted AR-mediated reporter gene expression as a function of dose and the effect was comparable with or without the addition of TRIL. In contrast, DHEA-S treatment failed to increase AR level in the mouse brain or GT1-7 cells and modestly induced AR-mediated reporter gene expression only at substantially elevated concentrations compared to DHEA. The findings demonstrate that DHEA is capable of exerting androgenic effects through AR while the androgenicity of DHEA-S is negligible. The implications of the results for models of the mechanism of action of DHEA and its sulfate ester, DHEA-S, in the brain are considered.

The cerebellar Purkinje cell (PC) is a typical site for neurosteroid formation. We have demonstrated that this neuron possesses intranuclear receptor for progesterone and actively synthesizes progesterone de novo from cholesterol only during rat neonatal life, when the formation of the cerebellar cortex occurs dramatically. In this study, we therefore analyzed the effect of progesterone on dendritic spine formation of the PC. In vitro studies using cerebellar slice cultures from newborn rats showed that progesterone increases the density of PC dendritic spines in a dose-dependent manner. This effect was blocked by the progesterone receptor antagonist, RU486. Furthermore, trilostane, a specific inhibitor of progesterone synthesis, inhibited the increase of spine density. These results suggest that progesterone can promote dendritic spine formation, and endogenous progesterone synthesized de novo in the developing PC may induce such an effect.

Ninety-day pregnant sheep were ovariectomized and received vehicle or trilostane every 12 h through 132 h, starting at 72 h postovariectomy. All trilostane-treated ewes aborted (Por = 0.05) between 36 and 50 h after initiation of treatment. Profiles of progesterone in jugular venous blood differed (Por = 0.05) and was lower (Por = 0.05) in trilostane-treated ewes. Profiles of estradiol-17beta in jugular venous plasma of trilostane-treated ewes differed (Por = 0.05) from controls. Estradiol-17beta increased after the first two treatments, followed by a return 2 h later to pretreatment levels (Por = 0.05), which was followed by a sustained increase (Por = 0.05) in estradiol-17beta. Profiles of PGF2alpha in inferior vena cava plasma of trilostane-treated ewes differed and were greater (Por = 0.05) and occurred with the sustained increase in estradiol-17beta and the onset of most of the abortions. Profiles of PGE in inferior vena cava plasma between control and trilostane-treated 90-day pregnant ewes did not differ (Por = 0.05). It is concluded that abortions occur at midpregnancy in sheep when the estradiol-17beta : progesterone ratio changes sufficiently to cause a sustained increase in estradiol-17beta and PGF2alpha but without changing placental secretion of PGE.

Ewes were lutectomized and treatments were started 72 h later. Pregnant ewes were treated with vehicle; prostaglandin F2alpha (PGF2alpha); cortisol (C); trilostane (TR), a 3beta-hydroxy-steroid dehydrogenase inhibitor; PGF2alpha + C; TR + PGF2alpha; TR + C, or TR + PGF2 + C. TR, TR + PGF2alpha, TR + C, and TR + PGF2alpha + C aborted (Por = 0.05) all ewes receiving TR. One ewe treated with PGF2alpha aborted (Por = 0.05). The average time to abortion of TR-treated ewes was 50.8 h (Por = 0.05) after initiation of treatments. All aborted ewes had retained placentas (Por = 0.05) except one ewe in the TR + PGF2alpha, treatment group. TR was given every 12 h starting at 72 h postlutectomy until 96 h postlutectomy. TR reduced (Por = 0.05) progesterone. Estradiol-17beta was increased (Por = 0.05) 2 h after the first two TR treatments and declined 2 h later and was followed by a sustained increase (Por = 0.05) in estradiol-17beta, which was coincident with the onset of abortions. Estradiol-17beta was increased (Por = 0.05) by PGF2alpha but did not decrease (Por = 0.05) placental secretion of progesterone. It is concluded that TR but not PGF2alpha is an abortifacient in 90-day-pregnant lutectomized ewes and that abortion occurs only when there is a decrease in circulating progesterone and an increase in circulating estradiol-17beta.

The structure of the corpus luteum and the steroidogenic activity of the corpus luteum and placenta in the viviparous reptile Chalcides chalcides have been investigated. The corpus luteum has a compact structure, almost without internal vascularized connective septa. It begins to degenerate after the middle of pregnancy, when plasma progesterone (P) remains high. The sections of the corpora lutea taken during early pregnancy showed an intense 3β-HSDH reaction, whereas the sections taken in late pregnancy gave weak reactions localized exclusively in the peripheral luteal cells. In contrast, sections of placentae taken at the beginning and in the middle of pregnancy always gave negative 3β-HSDH reactions, whereas those of late pregnancy were always strongly positive, localized in the maternal component of the placenta. In vitro, the corpora lutea from early pregnancy secreted significant amounts of P, whereas appreciable amounts of P were not detected in incubates of early pregnancy placentae. Near the time of delivery, P levels decreased in the culture medium of the corpora lutea, but increased in that of the placentae. The addition of pregnenolone (a precursor of P biosynthesis) to the culture medium caused an increase in the luteal and placental P levels, whereas the addition of trilostane (an inhibitor of 3β-HSDH) reduced them. The placenta of C. chalcides is suggested to have an endocrine function and to replace the corpus luteum in the production of P when the gland degenerates in late pregnancy.

Inhibition of the aggressive behavior of castrated male mice toward lactating female intruders by dehydroepiandrosterone (DHEA) is correlated with a decrease of pregnenolone sulfate (PREG S) concentrations in brain. We attempted to establish a cause to effect relationship by preventing the decrease of PREG S with trilostane (TRIL), a competitive inhibitor of delta 5-3 beta-hydroxysteroid dehydrogenase delta 5 --4 isomerase enzyme. Indeed, TRIL elicited a large increase of PREG levels in brain. Those of PREG S were, however, unchanged, and TRIL unexpectedly decreased the aggressive behavior of control castrated males and did not counteract the inhibition elicited by DHEA. The neurosedative progesterone (PROG) metabolite, 3 alpha-hydroxy-5 alpha-pregnan-20-one (TH PROG), undetectable in the brain of control mice, reached nanomolar concentration range in TRIL-treated ones. However, injection of appropriate amounts of PROG, producing an even larger increase of brain TH PROG, had no antiaggressive effect. Finally, the latter was attributed to the large (up to 80 nM) TRIL-induced increase of brain 3 alpha,21-dihydroxy-5 alpha-pregnan-20-one, which like TH PROG potentiates inhibitory gamma-aminobutyric acid (GABA)ergic neurotransmission.

During studies on the regulation of rat ovarian steroidogenic enzymes by interleukin-1 beta (IL-1 beta), we observed substantial metabolism of 25-hydroxycholesterol to two unusual polar products. This unexpected effect was observed both in isolated granulosa cells and in whole ovarian dispersates and was also induced by tumor necrosis factor alpha, but not by insulin-like growth factor I or follicle-stimulating hormone. The effect was dependent on time and the dose of IL-1 beta and was blocked by and IL-1 receptor antagonist. The formation of the polar metabolites was inhibited by ketoconazole and trilostane, but not by aminoglutethimide. Subsequent purification of these novel metabolites and analysis by gas chromatography/ mass spectrometry, NMR, and high performance liquid chromatography revealed them to be related 7 alpha-hydroxylated hydroxycholesterols (cholest-4-ene-7 alpha,25-diol-3-one and cholest-5-ene-3 beta,7 alpha,25-triol). IL-1 beta-stimulated ovarian 7 alpha-hydroxylase activity (3-10 pmol/min/mg of cellular protein) was nearly 4-fold that of control levels using 25-hydroxycholesterol as substrate. Activities at or below control levels were observed when IL-1 beta-treated cell sonicates were boiled or assayed in the presence of NADH (rather than NADPH), indicating that involvement of a nonenzymatic process was unlikely. IL-1 beta-stimulated 7 alpha-hydroxylase activity was inhibited to basal levels by a 10-fold excess of unlabeled 25- or 27-hydroxycholesterol, but not by cholesterol, pregnenolone, progesterone, testosterone, or dehydroepiandrosterone, suggesting that ovarian 7 alpha-hydroxylase is specific for hydroxycholesterols. Furthermore, when IL-1 beta-treated ovarian cultures were incubated with radiolabeled cholesterol or testosterone, no 7 alpha-hydroxylated products were observed. We were also unable to detect any mRNA transcripts for liver cholesterol 7 alpha-hydroxylase in IL-1 beta-stimulated ovarian cultures. This study describes an ovarian hydroxycholesterol 7 alpha-hydroxylase that differs from liver cholesterol 7 alpha-hydroxylase and from other nonhepatic progestin/ androgen 7 alpha-hydroxylases. The novel finding of the regulation of a 7 alpha-hydroxylase by IL-1 beta (and tumor necrosis factor alpha) suggests a unique role for cytokines in the regulation of cholesterol metabolism in the ovary and possibly other tissues.

An in vitro culture system was developed to investigate hormonal control of final oocyte maturation (FOM) in striped bass (Morone saxatilis). Isolated ovarian fragments exposed to human chorionic gonadotropin (hCG), dibutyryl cAMP, or forskolin produced significant amounts of 17 alpha,20 beta-dihydroxy-4-pregnen-3-one (DHP) and the oocytes underwent germinal vesicle breakdown (GVBD). Slight increases in 17 alpha,20 beta,21-trihydroxy-4-pregnen-3-one (20 beta-S) production were also observed. Production of testosterone and estradiol-17 beta was relatively high at the beginning of in vitro treatment with hCG but decreased as production of DHP increased and GVBD was initiated. Inhibitors of protein transcription (actinomycin-D), translation (cycloheximide), and steroidogenesis (trilostane) completely blocked hCG-induced DHP and 20 beta-S production and the associated GVBD. FOM, assessed from the progress of GVBD, proceeded in trilostane-treated but not in cycloheximide-treated follicle-enclosed oocytes when DHP or 20 beta-S was added to the cultures. Structure-activity experiments revealed that DHP and 20 beta-S were more potent at inducing GVBD than 14 other structurally similar C21 steroids that were tested. These results demonstrate that FOM in striped bass is induced by gonadotropin-mediated production of a delta 4 steroid through an adenylate-cyclase pathway which requires protein synthesis. DHP and 20 beta-S are implicated as final oocyte maturation-inducing steroid hormones in striped bass.

Objective To test the hypothesis that steroids locally modulate and may be required for normal follicular function and gametogenesis in primates, the effects of steroid reduction during gonadotropin-stimulated folliculogenesis was studied in rhesus monkeys. Design Animals received human FSH (hFSH; days 1 to 6) and hFSH+human LH (hLH; day 7) to promote multiple follicular growth, and then received hCG (day 8) for ovulatory maturation. Four animals received trilostane (3 β -hydroxysteroid dehydrogenase inhibitor) on days 1 to 8 or no inhibitor (controls; n=4). Follicles were aspirated 34hours after hCG. Main Outcome Measures Follicular growth, serum E 2 , P, and pregnenolone, oocyte nuclear maturity, and IVF. Results Trilostane markedly reduced E 2 to levels as low as 7% of controls throughout the follicular phase. Pregnenolone was 66-fold greater during trilostane treatment relative to controls. In both groups, P was at baseline during follicular stimulation but was reduced for 72hours after hCG in trilostane-treated animals. Despite E 2 suppression, follicular growth and oocyte nuclear maturity were unaltered by trilostane. Trilostane hindered the fertilizability of metaphase II oocytes (15%) in three of four animals compared with controls (65%). Metaphase I oocytes that required >8hours to complete meiosis in vitro failed to fertilize in the same three of four receiving trilostane relative to controls (31%). Conclusions Follicular growth and oocyte meiosis did not require high or increasing E 2 levels. Levels of follicular products other than E 2 may be of value in determining the progress of ovarian stimulation protocols. However, the acquisition of oocyte competence for fertilization may require steroids.

The progesterone production by rat ovaries from 18-day-old fetuses to 6-day-old neonates was measured in vitro in the presence of dibutyryl cAMP (dcAMP, 1 mM). A pronounced decline was observed at the end of fetal life. The 5 alpha-reductase activity did not seem sufficient to explain this decrease. Preculture of the ovaries for 48 h in the basal medium enhanced responsiveness to the nucleotide. Addition of spironolactone, an inhibitor of 17 alpha-hydroxylase to dcAMP did not modify this evolution. 3 beta-hydroxysteroid dehydrogenase activity, detectable in fetal ovaries in the absence of dcAMP was also increased after preculture. In the presence of spironolactone and trilostane, the pregnenolone production showed the same evolution as progesterone and was also enhanced after culture. These results suggest the existence of inhibitory factor(s) present in vivo at the end of fetal life.

A simple high-performance liquid chromatographic (HPLC) method for assaying trilostane, a synthetic steroid, and one of its metabolites, ketotrilostane, in small volumes of rat plasma has been developed. A single liquid-liquid extraction was used to isolate the two compounds from acidified plasma prior to the quantitative analysis. The HPLC conditions involved the use of a Spherisorb ODS column (250 mm x 4.6 mm I.D.) and a mobile phase of 1,4-dioxan-Sorenson's buffer at pH 5.0 (52:48, v/v). Ethisterone was used as an internal standard. Trilostane and ketotrilostane were detected by their ultraviolet absorbance at 255 nm. Recoveries greater than 80% and detection limits of 50 ng/ml were obtained for both compounds. Inter-day coefficients of variation were less than 10%.

The aim of this study was to examine the first step in steroidogenesis in male and female gonads of fetal rats. Pregnenolone production was measured by radioimmunoassay in organ culture, conversion of [ 3 H]cholesterol to [ 3 H]pregnenolone was evaluated in isolated mitochondria and cytochrome P -450 scc was revealed by immunoblotting and immunocytochemical techniques. Our results clearly showed that in fetal testes (1) pregnenolone was produced in media where testes were cultured in the presence of trilostane and spironolactone, indicating an important metabolism of pregnenolone, (2) [ 3 H]cholesterol was converted into [ 3 H]pregnenolone in mitochondria, (3) cytochrome P -450 scc was revealed in immunoblots with a molecular weight of 50,000, (4) cytochrome P -450 scc was localized in Leydig cells from 15.5-day-old fetal testes onwards. With respect to fetal ovaries, we were unable to detect any scc activity, except after treatment with dibutyryl cyclic AMP. A lag period of 18 h was necessary to induce pregnenolone synthesis. However, the immunoperoxidase staining did not localize ovarian positive cells. Cytochrome P -450 scc could be revealed in postnatal ovaries by immunoblotting and some interstitial positive cells were observed with immunostaining; the reaction was enhanced in luteinizing hormone-pretreated ovaries. These data indicate that (a) the cholesterol scc activity is present in fetal testes, (b) the conversion of cholesterol to pregnenolone is a limiting step for steroidogenesis in fetal ovaries. The inductive effect of the nucleotide on the enzyme suggests that the absence of gonadotrophic receptors in fetal female gonads could explain the lack of steroidogenesis before birth.

It has been demonstrated that administration of 100 mg of trilostane (an inhibitor of 3 beta-hydroxysteroid dehydrogenase) to late pregnant sheep will rapidly lower circulating levels of progesterone and that delivery ensues. Our intention was to reduce the dose of trilostane in order to separate the latter two sequelae and thereby obtain insight into the relationship between progesterone and prostaglandin biosynthesis. At the dose chosen (10 mg) the treatment did not induce parturition in 4 chronically catheterized sheep during late pregnancy. Circulating progesterone concentrations declined precipitously in all ewes but recovered to near basal values by 24 h after administration of trilostane. Circulating concentrations of 13,14-dihydro-15-keto-prostaglandin F2 alpha rose slightly but significantly at 4-5 h after administration of trilostane but never reached values normally associated with labor. Plasma estradiol levels were unchanged by treatment. These results are consistent with the view that progesterone withdrawal must be of a critical magnitude and duration for prostaglandin biosynthesis to be sufficiently stimulated to induce labor in sheep during late gestation.

We have established an in vitro tissue explant incubation system to study endocrine functions of human amnion, chorion, and decidua. By means of this technique, tissues remain histologically similar for at least 72 hours, actively use glucose for at least 48 hours, and demonstrate no evidence of release of lactate dehydrogenase into the medium by 24 hours. All three tissues produced progesterone, measured by specific radioimmunoassay, in a dose-dependent fashion from added pregnenolone. However, chorion was many times more active in this respect than were the other tissues. These results were corroborated by demonstrating conversion of 3H-pregnenolone to radiochemically pure 3H-progesterone. This activity was inhibited by a 3 beta-hydroxysteroid dehydrogenase (3 beta HSD) enzyme inhibitor, trilostane. Histochemical staining identified the site of 3 beta HSD activity as being located predominantly in the trophoblast layer of the chorion. We conclude that: (1) this in vitro system is a simple and reliable method by means of which to study endocrine function of amnion, chorion, and decidua; and (2) human fetal membranes, particularly the trophoblast layer of the chorion, can produce progesterone, and hence may be an important regulator of local progesterone levels, which subsequently may affect myometrial contractility.

The inhibitory effect in vitro of four synthetic steroids on enzyme systems of placental progesterone synthesis at term was analyzed. Cholesterol side chain cleavage enzyme (CSCC) was not influenced by azastene, trilostane, and WIN 32,729. A 50% inhibition of CSCC was found by 10 microM cyanoketone. The 3 beta-hydroxysteroid dehydrogenase was dose-dependently inhibited by azastene (I50 = 1 microM, trilostane (I50 = 4 nM), cyanoketone (I50 = 3 nM), and WIN 32,729 (I50 = 5 nM). A competitive inhibition of the 20 alpha-hydroxysteroid dehydrogenase (20 alpha-HSDH) by azastene (I50 = 0.6 microM), trilostane (I50 = 4.1 microM), cyanoketone (I50 = 0.6 microM), and WIN 32,729 (I50 = 1.5 microM) was observed. No difference in the effect of steroids on the 20 alpha-HSDH of early gestational and term placenta was found. The four steroidogenic inhibitors did not affect the activity of placental aromatase in vitro. Our results allow a comparison of inhibitory potencies of four steroidogenic inhibitors on different steroidogenic enzymes in vitro.

Female gonads of fetal and neonatal rats were cultured for 24 h in medium 199 supplemented with dibutyryl cyclic AMP (dcAMP), cycloheximide, spironolactone (an inhibitor of 17 alpha-hydroxylase) or hydroxylated cholesterol derivatives. Radioimmunoassays of pregnenolone (P5) and progesterone (P4) were performed in the media. In control medium, progesterone production developed during the second week of life whereas ovaries treated with dcAMP (1 mM) produced progesterone as early as day 14.5 of gestation. The effect of the nucleotide was reversible and the lag period of responsiveness was 12 h. Cycloheximide (1 microgram/ml) added with dcAMP completely inhibited the production of progesterone. Addition of spironolactone to the basal medium was without effect but significantly increased P5 and P4 productions in the presence of dcAMP. The inhibitory effects of spironolactone and trilostane on steroidogenesis were tested in fetal testis. Lastly, the dcAMP effect could not be mimicked with hydroxylated cholesterol derivatives (20 microM). However, an additive effect of 22-hydroxycholesterol was observed in the presence of the nucleotide. These results indicate that the in vitro production of P5 and P4 by fetal ovaries in the presence of dcAMP suggests that dcAMP induces enzymes involved in C21 steroid synthesis. Levels of action of the nucleotide are discussed.

Trilostane (4- α -5-epoxy-17 β - hydroxy -3-oxo-5- α -androstan-2-carbonitrile) is a modified steroidal molecule. In vitro and in vivo studies in rats have shown that it inhibits adrenal, ovarian and placental steroid synthesis. It seems to act by exerting a selective blockade on 3 β -hydroxysteroid dehydrogenase. In this study, we investigated whether this molecule interacts with hormone receptors for estrogen, androgen or progesterone. We also tried to demonstrate the effect which Trilostane may have on cellular cultures of human mammary carcinoma (MCF-7 Evsa-T). We also studied hormonal modifications in a series of 12 patients treated with different doses of Trilostane, since this drug is supposed to inhibit the production by the adrenal glands of mineralocorticoids, of glucocorticoids and of the precursors of estrogens. Our results indicate that Trilostane does not react with any of the main hormonal sex steroid receptors, nor does it interfere with cultures of human mammary cancer cells either containing estrogen receptors and therefore allegedly hormone-dependent (MCF-7 line), or estrogen receptor-negative cells, presumably independent of hormonal manipulations (Evsa-T cell line). Finally, endocrine studies on postmenopausal women with advanced breast cancer show that Trilostane significantly reduces the plasma levels of estrone and of its major androgen precursor (androstenedione). However, the latter inhibition is no different from that exerted by hydrocortisone acetate administered alone at a dose of 40 mg/day . The results of clinical trials comparing hydrocortisone alone with hyrocortisone plus Trilostane are awaited.

The present study was designed to examine the effect of angiotensin on both the early and the late phases of aldosterone biosynthesis. In order to isolate the early phase (the formation of pregnelone). it was necessary to identify an agent that would inhibit the 3β-hydroxysteroid dehydrogenase, 4–5 eneisomerase enzyme system which facilitates the conversion of pregnenolone to progesterone. Such an agent was found in trilostane. Treatment of zona glomerulosa cells with trilostane resulted in accumulation of pregnenolone, and the addition of angiotensin increased the accumulation of pregnenolone still further. This observation demonstrates that angiotensin stimulates aldosterone biosynthesis at a point prior to pregnenolone formation. The late phase of aldosterone biosynthesis was isolated by using aminoglutethimide to inhibit the formation of pregnenolone by cells of the zona glomerulosa. Aldosterone was formed when aldosterone precursors occurring in the biosynthetic pathway from pregnenolone onward were added. When angiotensin was added along with deoxycorticosterone, the conversion of deoxycorticosterone to aldosterone was enhanced (P

Trilostane is known as an inhibitor of 3 beta-hydroxysteroid dehydrogenase. Conflicting data published on this drug led us to look for the effects of 0.02 to 0.5 mM of trilostane on the in vitro steroid synthesis in sheep adrenals and human adrenals (Cushing's or Conn's syndrome) in the presence of an NADPH-generating system. The synthesis of 4-androstenedione, 11 beta-hydroxyandrostenedione and 11-ketoandrostenedione were studied either from dehydroepiandrosterone or 4-androstenedione or 11 beta-hydroxyandrostenedione. The synthesis of 11-deoxycortisol, cortisol, cortisone, 4-androstenedione, 11 beta-hydroxyandrostenedione and 11-ketoandrostenedione were studied either from 17-hydroxyprogesterone or 11-deoxycortisol or cortisol. This study showed that trilostane inhibited 3 beta-hydroxysteroid dehydrogenase whereas it had no effect on 21-, 11- and 17-hydroxylase. Trilostane was responsible for an increased 11 beta-hydroxysteroid dehydrogenase activity in vitro, resulting in low yields of cortisol and 11 beta-hydroxyandrostenedione, and high yields of cortisone and 11-ketoandrostenedione. This unexpected effect of trilostane allowed us to show that erroneous conclusions (in this case: pseudo inhibition of 11 beta-hydroxylase) can be drawn if all the metabolic pathways from a determined precursor are not exhaustively documented when studying the effects of drugs on steroid synthesis in vitro. The decrease of cortisol synthesis by trilostane may thus be related to the effects of the drug on both 3 beta-hydroxysteroid-dehydrogenase (inhibitory effect) and 11 beta-hydroxysteroid-dehydrogenase (stimulatory effect). This latter effect was found to be species-dependent.

The practicability and tolerability of trilostane, a competitive inhibitor of 3β-hydroxysteroid-Δ 5 -dehydrogenase, for the therapy of primary aldosteronism was assessed in 1 patient with aldosterone-producing adenoma (APA) and 3 subjects with idiopathic adrenal hyperplasia (IHA). Trilostane afforded reduction of plasma levels of aldosterone, progesterone, deoxycorticosterone, 17-OH progesterone, cortisol, Δ 4 - androstenedione , and urinary excretion of 17-hydroxycorticosteroid. Conversely, circulating levels of dehydroepiandrosterone, dehydroepiandrosterone sulfate, and urinary excretion of 17-ketosteroids were increased following this drug therapy. Suppression of mineralo- or glucocorticoid biosynthesis was accompanied by an increase in plasma renin activity. One patient with APA or 3 subjects with IHA showed slight or remarkable improvement of hypertension and hypokalemia. Based on these findings, efficacy and tolerability of trilostane appear to aid in the treatment of IHA.

Newborn rat glial cells were established in primary culture for greater than or equal to 3 weeks under conditions previously reported to permit differentiation of cholesterol side-chain cleavage activity. The cells were incubated for 48h with 3-H-Mevalonolactone in presence of Mevinolin (avoiding isotopic dilution of endogenous origin) and aminoglutethimide, a blocker of cholesterol side-chain cleavage. Radioactive steroid synthesis was then allowed to proceed in absence of aminoglutethimide, for 16h in presence of Trilostane, an inhibitor of 3 beta-hydroxysteroid dehydrogenase precluding formation of delta 4-3-ketosteroids. 3H-cholesterol accounted for approximately 10 percent of the radioactivity in cell extracts. 3H-delta 5-pregnene-3 beta, 20 alpha-diol (20-OH P) was the major steroid produced and was released in the culture medium. Dexamethasone (10 nM) increased 20-OH P formation by 30 percent, whereas cellular 3H-cholesterol decreased more than expected from the augmented formation of 20-OH P.

In order to understand better the mechanism of gonadotropin action on steroidogenesis in prematurational follicles of Fundulus heteroclitus , follicle synthesis of 17α-hydroxy, 20β-dihydroprogesterone (17α-OH,20β-DHP), testosterone (T), and 17β-estradiol (E 2 ) from a variety of precursors and the maturational response of oocytes were simultaneously followed in vitro . The addition of 25-hydroxycholesterol, pregnenolone, or progesterone to unstimulated follicles increased media 17α-OH,20β-DHP, T, and E 2 , as well as oocyte germinal vesicle breakdown (GVBD) in a dose-dependent manner. Inhibition of cholesterol side-chain cleavage by aminoglutethimide blocked 25-hydroxycholesterol-promoted steroid accumulation and GVBD, indicating that 25-hydroxycholesterol does not directly induce GVBD, but rather is metabolized in the follicle to an active steroid (presumably 17α-OH,20β-DHP). Likewise, trilostane, and inhibitor of Δ 5 -3β-hydroxysteroid dehydrogenase, blocked pregnenolone action. Both inhibitors also completely abolished steroid accumulation and GVBD promoted by a F. heteroclitus pituitary extract (FPE), but not GVBD induced by exogenous 17α-OH,20β-DHP. FPE also significantly depressed T but enhanced E 2 production from exogenous precursors. We have concluded from these observations that (1) cholesterol side-chain cleavage and pregnenolone conversion to progesterone are essential for gonadotropin-promoted follicle steroid production and the resulting reinitiation of meiosis by the oocyte, (2) the enzymes necessary for the conversion of cholesterol to 17α-OH,20β-DHP, T, and E 2 are present in the unstimulated, prematurational follicle, and (3) gonadotropin initiates steroidogenesis by acting at a step prior to the conversion of cholesterol to pregnenolone; it also appears to enhance aromatase activity.