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11β-HSD1 increases local cortisol production in metabolically active tissue types such as adipose and liver.
Inhibition of local cortisol regeneration from circulating cortisone by blocking 11β-hydroxysteroid dehydrogenase 1 (11β-has1) has been shown to ameliorate the risk factors associated with the metabolic syndrome.
Furthermore local steroid metabolism in the synovial cells may play a role in increasing local cortisol and prednisolone concentration, as shown by Hardy and co-workers [ 44].
Recently, in vitro, in vivo, and clinical data have collectively demonstrated the importance of local cortisol generation via 11β-HSD1 in hepatic and adipose tissue in mediating aspects of the metabolic syndrome (3, 6).
Thus, at the site of inflammation, the tight crosstalk between immune cells and cortisol allows local cortisol levels to increase in the early phase of the inflammatory process, thus counteracting the effects of proinflammatory mediators.
The results from this study indicate, for the first time, that decreasing local cortisol exposure through 11βHSD1 inhibition improves hyperglycemia over 12 weeks in patients with type 2 diabetes.
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Thus, a tightly controlled ratio of H6PDH to 11β-HSD1 is crucial since the local regeneration of cortisol and corticosterone in tissues such as liver, skeletal muscle and adipose tissue determines the magnitude of glucocorticoid receptor (GR) activation and subsequent regulation of genes involved in carbohydrate and lipid metabolism.
If the former is true, even small local increase of cortisol levels may cause persistent disturbances.
Local regulation of cortisol production in mammary gland due to the activity of 11ß-hydroxysteroid dehydrogenase can be another factor interfering on the concentration of hormone in milk.
This indicates possibility of local synthesis of cortisol during exposures to external stimuli in the absence of marked increase of its plasma levels.
The local increase of cortisol is believed to play a role in providing an anti-inflammatory environment to counteract inflammation caused at ovulation (Andersen and Hornnes, 1994; Escher et al, 1997; Hillier and Tetsuka, 1998; Yong et al, 2002; Rae et al, 2004).
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