de Bruin C, Hanson J M, Meij B P, Kooistra H S, Waaijers A M, Uitterlinden P, Lamberts S W J, Hofland L J
Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Endocrinology. 2008 Sep;149(9):4357-66. doi: 10.1210/en.2008-0244. Epub 2008 May 15.
Cushing's disease (CD) is a severe disorder characterized by chronic hypercortisolism due to an ACTH-secreting pituitary adenoma. Transsphenoidal adenomectomy is the treatment of choice in humans with CD, but recurrences occur frequently. Finding an effective and safe medical treatment for CD may improve long-term clinical outcome. The recent demonstration of expression of somatostatin receptor subtypes (mainly sst5) and dopamine receptor subtype 2 (D2) in human corticotroph adenomas offers the possibility for medical treatment of CD with novel somatostatin analogs and dopamine agonists. Investigation of the effects of these drugs is hampered by the low incidence of CD in humans. Interestingly, CD is a frequent disorder in dogs with striking clinical similarities with CD in humans. Therefore, we investigated the expression and functional role of D2 and somatostatin receptors in corticotroph adenoma cells from 13 dogs with active CD that underwent therapeutic hypophysectomy and normal anterior pituitary cells from five dogs. Quantitative RT-PCR and immunohistochemistry revealed that both in CD and normal anterior pituitary, sst2 was the predominant receptor subtype expressed, whereas D2 was modestly expressed and sst5 was expressed only at very low levels. In primary cultures of canine adenomas (n = 7), the sst2-preferring agonist octreotide also showed the strongest ACTH-suppressive effects. In conclusion, canine corticotroph adenomas provide an interesting model to study CD, but differences in somatostatin and dopamine receptor expression between humans and dogs should be taken into account when using dogs with CD as a model to evaluate efficacy of novel somatostatin analogs and dopamine agonists for human CD.
库欣病(CD)是一种严重的疾病,其特征是由于分泌促肾上腺皮质激素(ACTH)的垂体腺瘤导致慢性皮质醇增多症。经蝶窦腺瘤切除术是人类CD的首选治疗方法,但复发频繁。找到一种有效且安全的CD药物治疗方法可能会改善长期临床结果。最近在人类促肾上腺皮质激素腺瘤中发现生长抑素受体亚型(主要是sst5)和多巴胺受体亚型2(D2)的表达,为用新型生长抑素类似物和多巴胺激动剂对CD进行药物治疗提供了可能性。这些药物作用的研究因人类CD发病率低而受到阻碍。有趣的是,CD在犬类中是一种常见疾病,与人类CD有显著的临床相似性。因此,我们研究了13只患有活动性CD并接受治疗性垂体切除术的犬的促肾上腺皮质激素腺瘤细胞以及5只犬的正常垂体前叶细胞中D2和生长抑素受体的表达及功能作用。定量逆转录聚合酶链反应(RT-PCR)和免疫组织化学显示,在CD和正常垂体前叶中,sst2都是表达的主要受体亚型,而D2表达适度,sst5仅以极低水平表达。在犬腺瘤原代培养物(n = 7)中,优先作用于sst2的激动剂奥曲肽也显示出最强的促肾上腺皮质激素抑制作用。总之,犬促肾上腺皮质激素腺瘤为研究CD提供了一个有趣的模型,但在将患有CD的犬作为模型来评估新型生长抑素类似物和多巴胺激动剂对人类CD的疗效时,应考虑到人类和犬类之间生长抑素和多巴胺受体表达的差异。