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Local Regulation of Glucocorticoid Activity in Sites of Inflammation: Insights from the Study of Tuberculosis
Author(s) -
ROOK G.,
BAKER R.,
WALKER B.,
HONOUR J.,
JESSOP D.,
HERNANDEZPANDO R.,
ARRIAGA K.,
SHAW R.,
ZUMLA A.,
LIGHTMAN S.
Publication year - 2000
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.2000.tb05457.x
Subject(s) - cortisone , proinflammatory cytokine , inflammation , glucocorticoid , glucocorticoid receptor , cytokine , immune system , immunology , endocrinology , medicine , biology
A bstract : In sites of inflammation there is a change in the equilibrium between the enzymes that inactivate cortisol by conversion to cortisone and those that reactivate cortisone by conversion to cortisol. Current evidence suggests that during an immune response with a Type 1 cytokine profile such as tuberculosis, there is locally enhanced reductase activity with locally increased cortisol concentrations due to recruitment of cortisone. This results in enhanced cortisol mediated feedback on the inflammatory process, and deviation of the response towards Type 2. Preliminary data suggest that eventually, in the presence of Type 2 cytokine polarization, the enzyme equilibrium may reverse again and cortisol is then locally inactivated to cortisone. Together with changes in glucocorticoid receptor expression and function this may result in local cortisol resistance and susceptibility to tissue damage mediated by proinflammatory cytokines. These observations help to explain the sequence of events in several infectious, inflammatory and autoimmune diseases.