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Clinical Application
11-Beta Hydroxysteroid Dehydrogenase (HSD11B) is an enzyme that is involved in steroid hormone physiology. 11 beta- Hydroxysteroid Dehydrogenase enzyme exist in two isoforms, HSD11B-Type 1 and HSD11B- Type 2. The Type 1 isozyme is found in metabolic tissues targeted by glucocorticoids and converts cortisone to active cortisol. HSD11B-Type 1 acts as a reductase producing active cortisol and the amplification of glucocorticoids. This enzyme is most abundant in the liver but can be found in most tissues in the body. The increased HSD11B is a common mechanism for visceral obesity. HSD11B- Type 1 amplifies glucocorticoid concentrations in the liver and adipose tissue, glucocorticoid excess induces obesity with other features such as hypertension and diabetes mellitus. The Type 2 isozyme is expressed by aldosterone-selective tissues and protects the mineralocorticoid receptor from the activation by cortisol by converting it to cortisone using the enzyme 11-Oxoreductase.Type 2 protects tissues from continuous activation by decreasing local cortisol levels and preventing 11- Oxoreductase from activating. In tissues that do not express the mineralocorticoid receptor, such as the placenta and testis, it protects cells from the growth-inhibiting and/or pro-apoptotic effects of cortisol, particularly during embryonic development. Mutations in this gene cause the syndrome of apparent mineralocorticoid excess and hypertension.

1..“Kaitlin Lindsay: Medical & Scientific Illustration.” Kaitlin Lindsay Medical Scientific Illustration, kaitlinlindsay.com/the-11-%CE%B2-hsd-system/.

2. Ellis, Wendy L. Ellis, ND and Ronald Steriti, ND, PhD, and Ronald Steriti. “11-Beta-Hydroxysteroid Dehydrogenase.” Semantic Scholars, 2009, pdfs.semanticscholar.org/a531/d1c9310a17c9cd2743699586cb3127b7b688.pdf.

3. Katherine A Hughes, Scott P Webster & Brian R Walker (2008) 11-Beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) inhibitors in Type 2 diabetes mellitus and obesity, Expert Opinion on Investigational Drugs, 17:4, 481-496, DOI: 10.1517/13543784.17.4.481

4. “11-Beta Dehydrogenase Enzyme.” ESPL1 Gene - GeneCards | ESPL1 Protein | ESPL1 Antibody, www.genecards.org/cgi-bin/carddisp.pl?gene=HSD11B2.

Effect of Hyperlipidemia on 11β-hydroxysteroid-dehydrogenase
Hyperlipidemia has a great effect on 11β-hydroxysteroid-dehydrogenase. Glucocorticoid is dependent on Glucocorticoid plasma concentration, cellular glucocorticoid receptor expression and the pre-receptor hormone metabolism that is catalyzed by 11β-HSD. There are two types of 11β-Hydroxysteroid dehydrogenases that control cortisol concentration: 11β-HSD1 and 11β-HSD2. 11β-HSD1 is responsible for converting cortisone to cortisol by acting as an oxo-reductase because it is NADP(H) dependent, while 11β-HSD2 inactivates cortisol to cortisone via NAD. 10-d hyperlipidemia increases the 11β-HSD1 expression in visceral and subcutaneous adipose tissues. Hyperlipidemia decreases 11β-HSD2 expression in in the liver and adipose tissue. Hyperlipidemia has a great influence on 11β-HSD1 and 11β-HSD2. This demonstrates that there is likely a relationship between hyperlipidemia and cortisol metabolism.

5. Sieber-Ruckstuhl, N., Zini, E., Osto, M., Franchini, M., Boretti, F., Meli, M.,. . . Reusch, C. (Nov 2010). Effect of hyperlipidemia on 11β-hydroxysteroid-dehydrogenase, glucocorticoid receptor, and leptin expression in insulin-sensitive tissues of cats. Domestic Animal Endocrinology, 39(4), 222-30. doi:10.1016/j.domaniend.2010.06.003

Activity of 11β-HSD in organs
11β-hydroxysteroid dehydrogenase is active in organs and in the adrenal gland. The isoforms of the enzyme take on various duties. During an active state, the first isoform promotes the increase in glucocorticoids in the hepatocytes and also enhances gluconeogenesis. The second isoform converts active glucocorticoid hormones to inactive metabolites in target tissues such as kidney, salivary glands, intestines, etc. The activation of the two isoforms of 11β-HSD in the kidneys and liver triggers the extra-adrenal formation in alloxan diabetes, which affiliates with the reduction in the synthesis of glucocorticoid hormones in the adrenal glands. The extra-adrenal formation leads to the increased local formation of corticosterone in the liver and has a high activity of reactions with gluconeogenesis. These gluconeogenesis reactions add to the continued metabolic disorders similar to that of diabetes. The first isoform of 11β-HSD can serve as a potential treatment agents for diabetes, obesity, and metabolic syndrome due to increasing local corticosterone.

6. Cherkasova, O., Selyatitskaya, V., Pal'chikova, N., & Kuznetsova, N. (2014). Activity of 11β-hydroxysteroid dehydrogenase in the adrenal glands, liver, and kidneys of rats with experimental diabetes. Bulletin of Experimental Biology and Medicine, 158(2), 185-7. doi:10.1007/s10517-014-2718-3

Involvement in the brain
11β-hydroxysteroid dehydrogenase is expressed in the central nervous system of aged individuals. It is essential in Hypothalamo-Pituitary-Adrenal Axis function. 11β-hydroxysteroid dehydrogenase also partakes involvement in the decline of conscious intellectual activity due to ageing. The enzyme also contributes to central effects are also during the development stages. For instance, the 11β-hydroxysteroid dehydrogenase type 2 shows frequently in fetal tissues such as a newborn’s brain and placenta. If there is an absence or decline in 11β-HSD2 in the fetus tissues, there are negative developmental consequences such as anxiety.

11β-hydroxysteroid dehydrogenase are partly responsible for  intracellular metabolism that determine the operation of glucocorticoids within cells. Glucocorticoids impact the brain development and ultimately the function of the central nervous system. So much so, that if there is a surplus or scant amounts of it, the consequences are deformities throughout one’s entire life. 11β-HSD1 is responsible for activating glucocorticoids while 11β-HSD2 is responsible for deactivating them. The consequences for 11β-HSD1 activating glucocorticoids is that there is a decline in cognition especially as one ages. Contrarily, the effects of 11β-HSD2 occur during development. Some consequences of a high expression 11β-HSD2 are anxiety and cardiometabolic disorders, both of which are part of the early age glucocorticoid programming.

7. Wyrwoll, C. S., Holmes, M. C., & Seckl, J. R. (August 2011). 11β-hydroxysteroid dehydrogenases and the brain: from zero to hero, a decade of progress. Frontiers in neuroendocrinology, 32(3), 265-86.

Involvement in Preterm Births
Infants born underweight are susceptible to having metabolic disease throughout their lives. The presence of glucocorticoids has contributed to the relatively low infant birth weight. Glucocorticoid regulation is determined by 11β-hydroxysteroid dehydrogenase since they convert cortisone and cortisol and vice versa depending on the isoform (type 1 or type 2). A decrease in 11β-HSD2 in the placenta can lead to infant restriction in growth, specifically during the first 12 months of an infant’s life. The reason for this is because the 11β-HSD2 is meant to be expressed in high quantities in the placenta, This is so because the enzymes secure the fetus from exposure to increased levels of glucocorticoids, which are linked to underweight newborns.

8. Samantha L. Rogers, Beverly A. Hughes, Christopher A. Jones, Lauren Freedman, Katherine Smart, Norman Taylor, Paul M. Stewart, Cedric H. L. Shackleton, Nils P. Krone, Jacqueline Blissett, Jeremy W. Tomlinson; Diminished 11β-Hydroxysteroid Dehydrogenase Type 2 Activity Is Associated With Decreased Weight and Weight Gain Across the First Year of Life, The Journal of Clinical Endocrinology & Metabolism, Volume 99, Issue 5, 1 May 2014, Pages E821–E831, https://doi.org/10.1210/jc.2013-3254