Browsing by Subject "Glucocorticoids"
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Item Open Access A 17-Year-Old Girl With Unilateral Headache and Double Vision.(Journal of investigative medicine high impact case reports, 2019-01) Rodriguez-Homs, Larissa G; Goerlitz-Jessen, Mark; Das, Samrat UTolosa-Hunt syndrome is characterized by a painful ophthalmoplegia secondary to a granulomatous inflammation in or adjacent to the cavernous sinus. Magnetic resonance imaging will show enhancement of the cavernous sinus and/or the orbital apex. Although this syndrome is extremely rare in children, it should be a diagnostic consideration in patients presenting with painful ophthalmoplegia with variable involvement of cranial nerves II to VI. The differential diagnosis for unilateral cavernous sinus lesion is broad, including vascular lesions (cavernous sinus thrombosis), inflammatory processes (sarcoidosis, autoimmune), neoplastic processes (schwannoma, lymphoma), as well as infectious etiologies. We describe a pediatric patient presenting with neurological symptoms from a unilateral cavernous sinus magnetic resonance imaging abnormality and the thorough diagnostic approach to arrive at the diagnosis of Tolosa-Hunt syndrome.Item Open Access Catastrophic antiphospholipid syndrome with concurrent thrombotic and hemorrhagic manifestations.(Lupus, 2013-07) Rangel, ML; Alghamdi, I; Contreras, G; Harrington, T; Thomas, DB; Barisoni, L; Andrews, D; Wolf, M; Asif, A; Nayer, AAntiphospholipid syndrome (APS) is a distinct autoimmune prothrombotic disorder due to pathogenic autoantibodies directed against proteins that bind to phospholipids. APS is characterized by arterial and venous thrombosis and their clinical sequelae. Catastrophic antiphospholipid syndrome (CAPS) is a rare and often fatal form of APS characterized by disseminated intravascular thrombosis and ischemic injury resulting in multiorgan failure. Rarely, intravascular thrombosis in CAPS is accompanied by hemorrhagic manifestations such as diffuse alveolar hemorrhage. Here, we report a 43-year-old woman who presented with anemia, acute gastroenteritis, abnormal liver function tests, bilateral pulmonary infiltrates, and a systemic inflammatory response syndrome. The patient developed respiratory failure as a result of diffuse alveolar hemorrhage followed by acute renal failure. Laboratory tests disclosed hematuria, proteinuria, and reduced platelet count. Microbiologic tests were negative. A renal biopsy demonstrated acute thrombotic microangiopathy and extensive interstitial hemorrhage. Serologic tests disclosed antinuclear antibodies and reduced serum complement C4 concentration. Coagulation studies revealed the lupus anticoagulant and autoantibodies against cardiolipin, beta 2-glycoprotein I, and prothrombin. High-dose glucocorticoids and plasma exchange resulted in rapid resolution of pulmonary, renal, and hematological manifestations. This rare case emphasizes that CAPS can present with concurrent thrombotic and hemorrhagic manifestations. Rapid diagnosis and treatment may result in complete recovery.Item Open Access Glucocorticoid-Mediated Transcriptional Regulation in the Human Genome(2021) Seo, JungkyunGlucocorticoids (GCs) are a class of steroid hormones released from adrenal gland to mediate multiple physiological processes including the immune responses, cognitive functions and development. Glucocorticoids exert their gene regulatory effects through a ligand-activated transcription factor, glucocorticoid receptor (GR). Upon GC activation, GRs are particularly recruited to promoter-distal regulatory elements enriched with other transcription factors (TFs) and co-regulators including active protein 1 (AP-1). AP-1 is a heterodimeric TF potentially composed of subunits belongs to JUN, FOS and activating protein TF family. While the genomic function of AP-1 in response to GCs is well studied, the effect of specific configurations of AP-1 subunits on GR-mediated transcription remains unknown. In chapter 1, I introduce various regulatory components for transcriptional regulation. In chapter 2, I demonstrate that AP-1 subunits may not form preferential dimers between specific subunits, but rather bind each other promiscuously. I further show that the convergence of AP-1 subunits to enhancers is a key determinant for GR-mediated transcription and, by extension, cell-type specific environmental responses. GR binds DNA both directly and indirectly. While genome wide binding activity of GR can be effectively characterized by ChIP-seq, the binding mode (i.e. direct vs. indirect) at a specific site can’t be directly inferred. In chapter 3, I describe a machine learning approach to predict direct and indirect GR-DNA interactions using Protein Binding Microarray data. I demonstrate that motif-directed GR binding remains to be persistent after stimulus whereas indirect GR binding is likely transient. I further illustrate that robust transcriptional activation requires persistent GR binding and direct GR binding have the higher regulatory potential than indirect GR binding. GR activation represses certain genes. Along with the regulatory actions of GR cofactors, histone deacetylation is thought to regulate gene expression, especially gene repression. Therefore, I hypothesize that limiting histone deacetylases (HDAC) activity promotes robust gene activation. To test this hypothesis, in chapter 4, I delve into the GC-mediated transcriptional change after inhibiting the activity of histone deacetylases by HDACi to determine HDAC effect on GC-meditated transcriptional outputs. I demonstrate that the inhibition of HDAC activity reduces the magnitude of GC-mediated repression as well as activation in transcription. I also show that HDACi x GR-mediated intronic changes quantified from RNA-seq are minimally confounded by mRNA half-life linked to exonic changes, thereby accurately capturing transcriptional activity. Throughout the dissertation, I investigate GR-mediated transcriptional regulation by integrative analyses for numerous functional genomic datasets and by a predictive modeling for differential GR-DNA binding modes. In particular, the dissertation demonstrates that TF cooperativity, especially from subunits of AP-1 TF family, is a key determinant that drives the control of transcriptional output in cell-type specific manner. The dissertation further shows the potential for the generality of this regulatory mechanism beyond glucocorticoid stimulus and human cell types, suggesting that the TF convergence to a site, especially from the same TF family, may determine their functional specificity in a given cellular context.
Item Open Access Identification of select glucocorticoids as Smoothened agonists: potential utility for regenerative medicine.(Proc Natl Acad Sci U S A, 2010-05-18) Wang, Jiangbo; Lu, Jiuyi; Bond, Michael C; Chen, Minyong; Ren, Xiu-Rong; Lyerly, H Kim; Barak, Larry S; Chen, WeiRegenerative medicine holds the promise of replacing damaged tissues largely by stem cell activation. Hedgehog signaling through the plasma membrane receptor Smoothened (Smo) is an important process for regulating stem cell proliferation. The development of Hedgehog-related therapies has been impeded by a lack of US Food and Drug Administration (FDA)-approved Smo agonists. Using a high-content screen with cells expressing Smo receptors and a beta-arrestin2-GFP reporter, we identified four FDA-approved drugs, halcinonide, fluticasone, clobetasol, and fluocinonide, as Smo agonists that activate Hedgehog signaling. These drugs demonstrated an ability to bind Smo, promote Smo internalization, activate Gli, and stimulate the proliferation of primary neuronal precursor cells alone and synergistically in the presence of Sonic Hedgehog protein. Halcinonide, fluticasone, clobetasol, and fluocinonide provide an unprecedented opportunity to develop unique clinical strategies to treat Hedgehog-dependent illnesses.Item Open Access Patient Characteristics and Indicators of Treatment Initiation with Repository Corticotropin Injection in Patients with Rheumatoid Arthritis: A Claims Database Analysis.(Rheumatology and therapy, 2021-03) Hayes, Kyle; Panaccio, Mary P; Goel, Niti; Fahim, MohammedRepository corticotropin injection (RCI) is indicated as adjunctive, short-term therapy in selected patients with RA. To characterize RCI users and identify predictors of RCI initiation in RA, we compared preindex characteristics, treatment patterns, comorbidities, healthcare resource utilization (HCRU), and costs for patients who had initiated RCI treatment (RCI cohort) versus patients with no RCI claims and ≥ 1 targeted synthetic or biologic disease-modifying antirheumatic drugs (ts/bDMARD) claim (non-RCI ts/bDMARD cohort). We analyzed pharmacy and medical claims data from a large commercial and Medicare supplemental administrative database. Inclusion criteria were age ≥ 18 years, ≥ 1 inpatient or ≥ 2 outpatient claims with RA diagnosis (January 1, 2007-December 31, 2018), and 12-month continuous medical and pharmacy coverage preindex. Results from baseline cohort comparisons informed multiple logistic regression analysis. Compared with the non-RCI ts/bDMARD cohort (n = 162,065), the RCI cohort (n = 350) had a greater proportion of patients with higher Charlson comorbidity index (CCI) scores; higher mean claims-based index of RA severity and CCI scores; greater frequency of almost all comorbidities; higher use of nontraditional DMARDs, glucocorticoids, and opioids; higher all-cause HCRU; and higher medical and total costs. By multivariable analysis, the most significant predictors of RCI initiation were intermittent glucocorticoid use at any dose (odds ratio [OR] 1.67), extended-use glucocorticoids at medium (OR 2.03) and high doses (OR 2.99), nontraditional DMARD use (OR 2.09), anemia (OR 1.39), and renal disease (OR 2.45). Before RCI initiation, patients had more severe RA, higher comorbidity burden, greater use of glucocorticoids and opioids, and higher HCRU compared with non-RCI initiators. The most significant predictors for starting RCI in patients with RA were intermittent use of glucocorticoids at any dose, extended-use high-dose glucocorticoids, use of nontraditional DMARDs, and comorbid anemia and renal disease.Item Open Access Steroid Hormone Variation and Stress Responses in Short-finned Pilot Whales(2023) Wisse, JillianAs humans continue to introduce stressors into the marine environment, we are obligated to understand how our behaviors impact wildlife. For many cetacean populations, anthropogenic noise poses a significant conservation threat, but the ability to monitor these animals is constrained by their often-remote habitats and limited time at the surface. Researchers have developed innovative solutions to overcome these challenges, including the development of techniques that enable physiological sampling with minimal disturbance. As frontiers, these methods require careful development and validation before they can be used reliably in experimental studies. In this dissertation, I employ one of these innovative techniques, measuring steroid hormones in remote blubber biopsy samples, in short-finned pilot whales (Globicephala macrorhynchus). As modulators of reproduction and stress, steroid hormones provide information that is advantageous for wildlife monitoring. Because a validated method for measuring these compounds in short-finned pilot whale blubber did not yet exist, I adapted a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method to simultaneously quantify 11 steroid hormones of interest. Before proceeding with its application, I tested its analytical and biological validity with blubber from three stranded short-finned pilot whales. Next, I applied the validated LC-MS/MS method to an archive of blubber biopsies, collected from free-ranging short-finned pilot whales in the Western North Atlantic. Leveraging the comprehensive nature of LC-MS/MS profiling, I investigated relationships between hormones and characterized steroid hormone profiles across demographic groups and seasons. In the fourth chapter, I conducted an acoustic response study, using the previously established methods to collect and quantify steroid hormones after exposure to simulated mid-frequency active sonar (MFAS). I modeled the responses of cortisol and cortisone over time to gain insight into steroid perfusion rates in cetacean blubber and asked whether demography contributed to these responses. Together, my results demonstrate the reliability of blubber for measuring steroid hormones and reflecting relevant physiological states, like stress and pregnancy. While LC-MS/MS enables extensive steroid measurement, it struggled to detect some steroids of interest in this matrix. This dissertation shows the relevance of multi-steroid profiling and offers reference points for baseline steroid concentrations in analytes relevant to behavior, reproduction, and stress. The observation of post-exposure stress responses confirms a relationship between noise and physiology in short-finned pilot whales and illustrates the ability of blubber sampling to be applied in this context.