Glucocorticoid Action: Basic and Clinical Implications (Annals of the New York Academy of Sciences)

Glucocorticoids regulate multiple metabolic and developmental processes and play a vital role in the maintenance of basal and stress-related homeostasis. For the last 50 years, pharmacologic doses of glucocorticoids have been used in the treatment of inflammatory, autoimmune, and lymphoproliferative diseases and in the prevention of allograft rejection, while substitution doses have been employed in the management of adrenocortical insufficiency. aspects of glucocorticoid action, in particular, (i) the impact of maternal and early life stress on stress-related gene regulation in the offspring; (ii) the importance of glucocorticoids and their receptors; (iii) further understanding of the mechanisms of GR action, including its effect on chromatin modulation, its interaction with coactivators and corepressors, and the genetic dissection of GR function in mice; (iv) The interaction of hGR with other transcription factors, such as NF-kappa-B, p53, transforming growth factor beta (TGF-beta) and the chicken ovalbumin upstream promoter transcription factor II (COUP-TFII); recycling, ubiquitination and degradation of the receptor, actions of the GR-beta isoform, a novel synthetic nonsteroidal target gene-specific agonist, the importance of target tissue activity of 11-beta-hydroxysteroid dehydrogenase type 1 in glucocorticoid action in health and disease, the interaction of the receptor with the nutrient carnitine, the anthrax products protective antigen (PA) and lethal factor (LF), and the human immunodeficiency virus type-1 (HIV-1)-encoded molecules Vpr and Tat; (vi) an update on the effects of glucocorticoids on the immune system; and (vii) the clinical implications of glucocorticoid action, including glucocorticoid resistance/hypersensitivity, familial and sporadic glucocorticoid resistance, and the effects of stress and depression.