16a-Bromoepiandrosterone as a new candidate for diabetes-tuberculosis
comorbidity treatment
Abstract
Being the leading cause of mortality by a single infectious agent,
tuberculosis (TB) continues as one of the most relevant issues of public
health. Another pandemic disease is type 2 diabetes mellitus (T2D) is
usually associated with immunodeficiency. Thus, an increased prevalence
of TB-T2D comorbidity represents one of the most significant challenges
for health providers. During the chronic phase of both diseases, several
immunoendocrine abnormalities are occurring, but extra-adrenal
production of active glucocorticoids (GCs) is a possible deleterious
factor in both entities. Active GCs have been related to insulin
resistance and suppression of Th1 responses, contributing to T2D and TB
pathogenesis. 11-β-hydroxysteroid dehydrogenase type 1 (11-βHSD1)
catalyzes the conversion of inactive GGs in their active form (cortisol
or corticosterone in rodents) in the lungs and liver and could be
responsible for this immunoendocrine disfunction. Dehydroepiandrosterone
(DHEA) is an anabolic adrenal hormone with antagonist effects against
GCs on immune cells and glucose metabolism. A synthetic analog of DHEA,
the 16a-bromoepindrosterone (BEA), lacks an anabolic effect while
keeping his immune and metabolic effect. The therapeutic efficiency of
BEA was studied in a murine model of T2D-TB comorbidity. TB-T2D mice
underwent more severe lung disease than in TB-infected but non-diabetic
animals. BEA decreased the active form of GCs and 11-βHSD1 expression,
while increasing 11-βHSD2 expression, which reduced hyperglycemia and
liver steatosis, lung bacillary loads, and pneumonia. Thus, it seems
that BEA is an efficient therapy to control metabolic and immune
abnormalities caused by high active GCs production.