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-Dihydrotestosterone during Development of the Male Urogenital Tract1
Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas 75235-8857
Address all correspondence and requests for reprints to: F. W. George, Ph.D., Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75235-8857. E-mail: george02{at}utsw.swmed.edu
| Abstract |
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-dihydrotestosterone (DHT) formation in vivo is not
as effective as total androgen ablation (castration) in causing
involution of the prostate. It is likely that this is due to the fact
that testosterone is partially effective in maintaining androgen
action. To provide insight into this observation, the androgenic
metabolites of testosterone, androstenedione, and 5
-DHT, were
measured in prostate tissue and in blood of 5
-reductase inhibitor
(finasteride)-treated adult male rats. Finasteride treatment caused a
significant decrease in prostatic DHT levels and a profound increase in
prostatic testosterone and androstenedione levels. Similarly,
circulating DHT levels were decreased in finasteride-treated rats (0.02
ng/ml compared with 0.05 ng/ml seen in control rats), and circulating
androstenedione and testosterone levels were significantly elevated in
finasteride-treated animals compared with controls. The in
vitro effects of finasteride were assessed on the metabolism of
[3H]testosterone in a tissue-slice assays. In the
prostate, the inhibition of 5
-reductase activity resulted not only
in the decreased formation of 5
-reduced metabolites (primarily DHT
and 5
-androstanedione), but also an increase in the 17-oxo
metabolite androstenedione. In contrast, the tissues derived from the
embryonic wolffian duct (seminal vesicle and epididymis) formed
relatively low amounts of 17-keto steroids. Because DHT is a high
affinity ligand for the androgen receptor and androstenedione shows
very little, if any, affinity for the receptor, these studies suggest
that 5
-reduction of testosterone may be a mechanism to amplify
androgen action in urogenital tissues such as the prostate by
preventing catabolism of testosterone to the inactive androgen,
androstenedione, at the site of hormone action. | Introduction |
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-reduced metabolite of testosterone,
5
-dihydrotestosterone (DHT) (1). Different roles for testosterone
and DHT in androgen action were originally suspected based on the
results of androgen metabolism studies in urogenital tissues of
embryos. These studies demonstrated that 5
-reductase activity was
detectable in the fetal urogenital sinus before differentiation of the
prostate and in the urogenital tubercle before differentiation of the
penis and scrotum, but that DHT formation was not detectable in the
embryonic wolffian duct until after differentiation of the seminal
vesicle and epididymis is complete (2, 3). This concept that the action
of two androgens are involved in differentiation of the male urogenital
tract is substantiated by studies of patients with a rare form of male
pseudohermaphroditism caused by the inability to form DHT at its site
of action due to the absence, or inactivity, of the critical
5
-reductase enzyme (4). Patients are characterized by
undervirilization of the external genitalia and prostate; however,
virilization of the seminal vesical and epididymis occurs normally
(5, 6, 7). These results, therefore, imply that DHT formation is not
critical for virilization of the tissues derived from the fetal
wolffian duct. Although two androgens, testosterone and DHT, mediate separate androgenic effects in different target tissues, considerable evidence suggests that both bind to (8) and activate (9, 10) the same intranuclear androgen receptor protein. However, DHT has a much higher affinity for the androgen receptor than does testosterone (8, 11, 12).
There are two distinct genes that code for isoforms of steroid
5
-reductase in both the rat and the human (13). In the human,
mutations in the gene that encodes the type 2 isoform of the enzyme
cause the phenotype associated with 5
-reductase deficiency (14). In
the rat, the type 2 enzyme is expressed predominantly in tissues of the
male urogenital tract, whereas the type 1 enzyme appears to be
ubiquitously expressed (15, 16, 17), suggesting that expression of type 2
enzyme in the rat is also the critical isoform of the enzyme for
differentiation of the male urogenital tract. Indeed, treating pregnant
rats with a pharmacological dose of the 5
-reductase 2 inhibitor
finasteride during the time of embryonic sexual differentiation causes
a phenotype in male offspring that is very similar to humans with
5
-reductase 2 deficiency (18).
Finasteride is primarily an inhibitor of the steroid 5
-reductase 2
enzyme (19) and is being promoted as a treatment for benign prostatic
hyperplasia (20). The primary effect of finasteride on inhibition of
the 5
-reductase activity has been well studied and characterized in
detail, and there is no question that finasteride (or other
5
-reductase inhibitors) is effective in disrupting androgen action
in the intact male rat (21, 22, 23, 24). However, the metabolic fate of
androgenic steroids in peripheral target tissues when DHT formation is
blocked is largely unreported. Herein are reported in vivo
and in vitro studies of the effect of the 5
-reductase 2
inhibitor finasteride on testosterone metabolism in the urogenital
tract of the male rat. The findings have important implications for
understanding the physiology of androgen action and suggest a testable
hypothesis to explain why two androgens (testosterone and DHT) are
involved in virilization of the male urogenital tract at the time of
embryonic sexual differentiation.
| Materials and Methods |
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-reductase 2 inhibitor finasteride.
Enzyme assays
5
-Reductase and 17ß-hydroxysteroid dehydrogenase
(17ß-HSD) activities were measured in the same assay. Briefly,
[1,2,6,7-3H]testosterone (New England Nuclear Corp.; 90
Ci/mmol) was dried under nitrogen and reconstituted in Eagles MEM
(GIBCO-BRL, Gaithersburg, MD), pH 7.4, so that the working
concentration was 0.25 µM. After gassing the incubation
tubes with 95% oxygen/5% CO2, the tissues (25 mg) were
incubated, with shaking, at 37 C, for 1 h. At the end of the
incubation period, the tubes were transferred to an ice bath and
extracted with 5 vol (1 ml) of chloroform. A TLC assay (25) was used to
determine 5
-reductase and 17ß-HSD activities. When appropriate,
finasteride was added to the incubation medium in a small (<1/20)
volume of ethanol at 1 µM and diluted appropriately in
medium.
Other assays and statistical analyses
Androstenedione, DHT, and testosterone levels were measured in
the blood and prostate tissue by RIAs as described (26, 27, 28). The
androstenedione antibodies are highly specific showing <0.001%
cross-reactivity with either testosterone or DHT. The DHT and
testosterone antibodies, however, are not specific. Therefore,
specificity was acheived by separating the steroids in each sample on
celite mini-columns (26, 27, 28). The intraassay coefficients of variation
for the three assays were between 3.4 and 5.5%; the interassay
coefficients of variation were between 9.6 and 14.7%. Protein was
measured in prostatic tissue slices by the method of Lowry et
al. (29). The data were analyzed by Welchs approximation to a
one-way ANOVA.
| Results |
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-reduction of
testosterone may not only activate the hormone in the rat prostate but
also prevent its conversion to the inactive androgen, androstenedione.
Once again, castration resulted in almost a total disappearance of
androgen from the circulation.
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-reductase activity and
DHT formation in this assay. However, increasing the concentration of
finasteride in the incubation by 100-fold to 1 nM blocked
5
-reductase activity and the formation of DHT by about 50%; a
further 100-fold increase in concentration to 100 nM
blocked 5
-reductase activity by >95%. As illustrated in Fig. 3B
-androstanedione is inhibited by
increasing concentrations of finasteride in the incubation medium, the
formation of androstenedione is increased in a reciprocal manner. Thus,
finasteride does not inhibit overall 17ß-HSD activity. Furthermore,
as shown in Fig. 3C
-reductase activity results
in an inhibition of DHT formation and an almost equimolar increase in
the formation of androstenedione. Extensive washing of the tissue
fragment after such incubations has demonstrated that androstenedione
rapidly diffuses from the tissue, whereas DHT is retained by the tissue
(results not shown).
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-reductase activity and 17ß-HSD activity in urogenital tissues
derived from the fetal wolffian duct which virilize in response to
testosterone rather than DHT (1). Figure 4
-androstanedione from DHT). This observation is
reinforced by the fact that the presence of finasteride in the
incubation medium did not uncover any apparent 17ß-HSD activity in
the two wolffian duct-derived tissues (seminal vesicle and epididymis)
as it did in the prostate which is derived from the urogenital sinus
(1).
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| Discussion |
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-reductase 2
inhibitor finasteride effectively blocks the formation of DHT thus
depriving the androgen receptor of its preferred ligand (8, 11, 12).
Although finasteride treatment clearly interferes with androgen action,
it is not as effective as the total androgen deprivation that occurs
following castration (21, 23, 24). This suggests that other
non-5
-reduced androgens (most likely testosterone) act to partially
maintain the androgenic status of finasteride-treated animals. We
cannot, however, rule out the remote possibility that the dose of
finasteride used in these experiments did not totally inhibit
5
-reductase activity at the site of action within the prostatic
cell, although the amount of finasteride used in these studies was
clearly in the pharmacological range. This study also confirms that
finasteride treatment depresses circulating DHT levels, even though DHT
represents a minor portion of the circulating androgens (22, 24, 30, 31).
The unique finding in these studies, however, is the fact that the
prostatic content and circulating levels of androstenedione were
elevated in finasteride-treated animals. Because the rat prostate
expresses 17ß-HSD activity, the action of this enzyme also results in
an increased metabolism of testosterone to androstenedione (a nonactive
androgen) that apparently diffuses from the cell and away from the site
of action. It is likely that the increased androstenedione levels in
the prostate and circulation are meaningful at the molecular level
given the almost one to one relationship of the metabolites between the
inhibition of 5
-reductase activity and the increase in
androstenedione formation, under in vitro conditions where
substrate (testosterone) is saturating. The net effect is to keep the
concentration of androgen at the site of action extremely low
regardless of other steroid levels within the tissue. The data,
therefore, support the idea that 5
-reduction of testosterone to DHT
in the prostate is a mechanism by which cells of the prostate
concentrate androgen at the site of action.
Although previous studies have documented the presence of 17ß-hydroxysteroid oxidoreductase activity in the rat and human prostate (32, 33, 34, 35), the significance of the presence of this enzymatic potential is not clear given that the studies were done under conditions that were not physiological. In this study, hormonal measurements of circulating and prostatic androgens in control and finasteride-treated rats were combined with in vitro androgen metabolism data obtained in tissue slice assays to infer the significance of prostate 17ß-HSD activity.
It seems unlikely that the presence of oxidative 17ß-HSD
activity in the rat prostate serves any physiological, other than
catabolic, purpose, because under normal circumstances the only 17-keto
steroid formed is 5
-androstanedione that has not been shown to have
androgenic activity. In addition, the oxidative nature of the 17ß-HSD
in the rat prostate would not only favor the inactivation of
testosterone to androstenedione but would inactivate any estrogen
formed. Even in the finasteride-treated rat where prostatic
androstenedione levels are elevated, it is difficult to conceive of
androstenedione serving as a precursor for estradiol given the
oxidative nature of the 17ß-HSD in the rat prostate.
Three isozymes of human 17ß-HSD have been identified and cloned. Each
is encoded by a gene on a separate chromosome, and each has unique
specificitys for substrate and co-factor (36). The form of the enzyme
uncovered in the ventral prostate of the finasteride-treated rat in
this study appears to have characteristics similar to the human type 2
17ß-hydroxysteroid dehydrogenase in that it is primarily oxidative in
nature (36). Indeed, the isozyme type of 17ß-HSD associated with the
rat prostate cells appears to be the type 2 form of the enzyme (37).
However, it is of no practical significance to precisely know the
identity of the isoform of the enzyme in the rat ventral prostate, only
to recognize that it is oxidative and probably acts to inactivate
testosterone (and estradiol) in prostate cells. Thus, 5
-reduction
within cells of the prostate probably acts by transforming a relatively
weak androgen (testosterone) to a more potent androgen (DHT). In the
absence of 5
-reductase activity, testosterone would be metabolized
to an even weaker (and probably totally ineffective) androgen
(androstenedione) by the 17ß-HSD enzyme present in the tissue. In
this regard, it is significant that the androstenedione levels in the
circulation of finasteride-treated rats were elevated over that of
controls, suggesting that a substantial portion of the androstenedione
formed in the prostates of these animals leaks into the blood stream. A
similar finding was reported for the effect of finasteride on the serum
androgens of male volunteers (30).
It is important to emphasize that 17ß-HSD activity, as measured in this assay, was relatively low in tissue slices of rat seminal vesicle and epididymis. Although in apparent contradiction to previous findings in the monkey epididymis (38) and in cultured human epididymal cells (39), significant differences in assay procedure and distribution of activity preclude any direct comparisons.
Taken together, these observations provide insight into one of the most
puzzling aspects of androgen action, i.e. why two androgens
account for the totality of androgen action. It is known that certain
aspects of virilization of the male urogenital tract, such as formation
of the prostate and male differentiation of the external genitalia, are
dependent upon DHT formation, whereas virilization of the wolffian duct
into the seminal vesicle and epididymis does not require DHT formation
(1). A study of the tissue-specific expression of the two
5
-reductase isozymes in the fetal rat urogenital tract indicates
that expression of the type 2 isozyme is expressed in mesenchymal cells
of both the male and female urogenital tract throughout the period of
sexual differentiation (17). The lack of similar developmental studies
of the expression of 17ß-HSD isozymes preclude insight into the role
17-oxidation in the fetal urogenital tract at the time of sexual
differentiation.
A model for androgen action in the differentiation of the male
urogenital tract is presented in Fig. 5
. Testosterone is
the principal androgen secreted by the embryonic and adult testis of
all known vertebrates, although very limited information suggests that
5
-reduced androgens may account for a substantial portion of the
total androgens formed in the fetal testis (40). It is postulated that
testosterone reaches cells of the indifferent wolffian duct and
urogenital sinus by different routes and in different concentration.
Testosterone reaches and enters cells of the developing urogenital
sinus via the circulation and is rapidly converted by the
5
-reductase enzyme to DHT, which shows a dramatically higher
affinity for the androgen receptor than does testosterone (8). On
the other hand, it is conceivable that cells of the undifferentiated
wolffian duct, which apparently dont have the capacity to form DHT,
are dependent on much higher concentrations of testosterone delivered
directly by lumenal transport. It is important to note that, although
both DHT and testosterone apparently bind to the same androgen receptor
protein within target cells (4, 41, 42), DHT binds to the receptor with
much higher affinity (8) and stabilizes it (43). The relatively weak
interaction of testosterone with the androgen receptor probably results
in a significant amount of the hormone dissociating from the receptor
(and the cell) before the androgenic signal is transmitted. Therefore,
a higher local concentration of testosterone within cells of the
differentiating wolffian duct is probably required to maintain an
activated receptor that is capable of interacting with DNA and
eliciting an androgenic response. Furthermore, the conversion of
testosterone to DHT is probably essential in the prostate because the
increased affinity of DHT for the androgen receptor (compared with
testosterone) protects this activated androgen from oxidative
catabolism by 17ß-HSD (43).
|
-reductase inhibitor precisely matches
the rate at which androstenedione is formed by the same tissue in
incubations with finasteride suggests that the molecular
transformations are closely linked. Metabolism of testosterone to
androstenedione, rather than DHT, at the site of action might
profoundly affect androgen action in the derivatives of the urogenital
sinus, such as the prostate, which are exposed to relatively low
concentrations of testosterone. However, cells of the undifferentiated
wolffian duct that apparently see a relatively high concentration of
testosterone directly from the testis and do not inactivate the hormone
via oxidation apparently do not require the ability to form DHT for
androgen action. Two key assumptions must be met if this model has
explanatory meaning for the dual androgenic action in differentiation
of the male urogenital tract: 1) testosterone must be delivered to
cells of the differentiating wolffian duct in substantially higher
concentration (possibly via lumenal transport from the fetal testis)
than it is to cells of the urogenital sinus; 2) cells of the wolffian
duct should not have the capacity to metabolize testosterone to
androstenedione (i.e. lack oxidative 17ß-HSD activity),
and therefore fail to inactivate testosterone. Veysierre et
al. (44) have provided support for the first assumption, and
support for the second assumption is provided herein. Ultimately,
similar patterns of androgen metabolism must be established in the
fetal urogenital tracts of other species if this model is to be
generally applicable.
| Acknowledgments |
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| Footnotes |
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Received July 22, 1996.
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