Interactions between glucocorticoids and mineralocorticoids in the regulation of renal electrolyte transport.

The enzyme 11 beta-hydroxy steroid dehydrogenase (11 beta-OHSD) was described and its location in various organs noted more than 30 years ago (Mahesh and Ulrich, 1960; Jenkins, 1966). 11 beta-OHSD inactivates circulating glucocorticoids by transforming the hydroxyl group at the 11-carbon to a keto group. This chemical reaction has taken on a greater degree of physiologic and clinical significance in recent years. It has been suggested that 11 beta-OHSD, present in mineralocorticoid target tissues, can act as a 'guardian' over the mineralocorticoid receptor by transforming circulating endogenous glucocorticoids to their respective 'biologically inert' 11-dehydro derivatives (Edwards et al., 1988; Funder et al., 1988). These derivatives do not bind to mineralocorticoid receptors (MR) while both their parent compounds and mineralocorticoids bind to cloned MR with equal affinity (Arriza et al., 1987). 11 beta-OHSD has generated a growing sense of scientific excitement since this enzyme may represent one of a family of metabolic pathways or mechanisms which can regulate steroid induced renal reabsorption of sodium. Such 'protective' enzymatic pathways, present in the kidney and elsewhere, may not only control the access of glucocorticoids to MR, but control the access of glucocorticoids to glucocorticoid receptors (GR) (Teelucksingh et al., 1990; Monder, 1990) as well as access of mineralocorticoids to their own receptors. This review will focus on this concept of a family of protective enzymatic pathways and the possible physiological implications.