tetano
Editor, Senior Moderator
Crit Care Med
. 2021 May 25.
doi: 10.1097/CCM.0000000000005097. Online ahead of print.
Increased Glucocorticoid Receptor Alpha Expression and Signaling in Critically Ill Coronavirus Disease 2019 Patients
Alice G Vassiliou[SUP] 1 [/SUP], Nikolaos Athanasiou, Chrysi Keskinidou, Edison Jahaj, Stamatios Tsipilis, Alexandros Zacharis, Efthimia Botoula, Aristidis Diamantopoulos, Ioannis Ilias, Dimitra A Vassiliadi, Stylianos Tsagarakis, Anastasia Kotanidou, Ioanna Dimopoulou
Affiliations
Abstract
Objectives: Critical illness is characterized by increased serum cortisol concentrations and bioavailability resulting from the activation of the hypothalamic-pituitary-adrenal axis, which constitutes an essential part of the stress response. The actions of glucocorticoids are mediated by a ubiquitous intracellular receptor protein, the glucocorticoid receptor. So far, data on coronavirus disease 2019 and glucocorticoid receptor alpha expression are lacking.
Design: Prospective observational study.
Setting: One academic multidisciplinary ICU.
Subjects: Twenty-six adult coronavirus disease 2019 patients; 33 adult noncoronavirus disease 2019 patients, matched for age, sex, and disease severity, constituted the control group. All patients were steroid-free.
Interventions: None.
Measurements and main results: Glucocorticoid receptor alpha, glucocorticoid-inducible leucine zipper expression, and serum cortisol were measured on ICU admission. In coronavirus disease 2019 patients, glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper messenger RNA expression were upregulated (4.7-fold, p < 0.01 and 14-fold, p < 0.0001, respectively), and cortisol was higher (20.3 vs 14.3 μg/dL, p < 0.01) compared with the control group.
Conclusions: ICU coronavirus disease 2019 patients showed upregulated glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper expression, along with cortisol levels, compared with ICU noncoronavirus disease 2019 patients. Thus, on ICU admission, critical coronavirus disease 2019 appears to be associated with hypercortisolemia, and increased synthesis of glucocorticoid receptor alpha and induced proteins.
. 2021 May 25.
doi: 10.1097/CCM.0000000000005097. Online ahead of print.
Increased Glucocorticoid Receptor Alpha Expression and Signaling in Critically Ill Coronavirus Disease 2019 Patients
Alice G Vassiliou[SUP] 1 [/SUP], Nikolaos Athanasiou, Chrysi Keskinidou, Edison Jahaj, Stamatios Tsipilis, Alexandros Zacharis, Efthimia Botoula, Aristidis Diamantopoulos, Ioannis Ilias, Dimitra A Vassiliadi, Stylianos Tsagarakis, Anastasia Kotanidou, Ioanna Dimopoulou
Affiliations
- PMID: 34034298
- DOI: 10.1097/CCM.0000000000005097
Abstract
Objectives: Critical illness is characterized by increased serum cortisol concentrations and bioavailability resulting from the activation of the hypothalamic-pituitary-adrenal axis, which constitutes an essential part of the stress response. The actions of glucocorticoids are mediated by a ubiquitous intracellular receptor protein, the glucocorticoid receptor. So far, data on coronavirus disease 2019 and glucocorticoid receptor alpha expression are lacking.
Design: Prospective observational study.
Setting: One academic multidisciplinary ICU.
Subjects: Twenty-six adult coronavirus disease 2019 patients; 33 adult noncoronavirus disease 2019 patients, matched for age, sex, and disease severity, constituted the control group. All patients were steroid-free.
Interventions: None.
Measurements and main results: Glucocorticoid receptor alpha, glucocorticoid-inducible leucine zipper expression, and serum cortisol were measured on ICU admission. In coronavirus disease 2019 patients, glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper messenger RNA expression were upregulated (4.7-fold, p < 0.01 and 14-fold, p < 0.0001, respectively), and cortisol was higher (20.3 vs 14.3 μg/dL, p < 0.01) compared with the control group.
Conclusions: ICU coronavirus disease 2019 patients showed upregulated glucocorticoid receptor alpha and glucocorticoid-inducible leucine zipper expression, along with cortisol levels, compared with ICU noncoronavirus disease 2019 patients. Thus, on ICU admission, critical coronavirus disease 2019 appears to be associated with hypercortisolemia, and increased synthesis of glucocorticoid receptor alpha and induced proteins.