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Overview Of The Steroidogenic Acute Regulatory Protein And Its Role in Steroid Hormone Synthesis

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This essay will determine the exact role of StAR, its structure, regulation, and problems associated with mutations, and thereby review recent research that has been carried out in relation to the role of StAR in steroid hormone synthesis.


The synthesis of steriod hormones is essential for many functions of the body. The adrenal glandsynthesises glucocorticoids and mineralocorticoids which regulate metabolism and water balance, and alsosmall amounts of sex hormones such as androgens. The main site of androgen synthesis is theLeydig cells in the testes, that of oestradiol in the ovary. The testes and ovaries are collectively calledgonads and gonadal steroids are essential for reproductive function. Steroids also have animportant role in the brain, and steriods found here are called neurosteroids. Progesterone is involved inmyelination and dehydroepiandrosterone in plasticity. All these hormones require strictregulation to ensure normal bodily function.

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An Introduction to StAR

The steroidogenic acute regulatory protein (StAR) was first identified by Orme-Johnson et al. in themid 1980’s. They discovered that this protein with molecular weight 28, 000 was expressed in rat corpusluteum and adrenal cortex cells, both steroidogenic tissues, and that its synthesis was stimulated by humanchorionic gonadotrophin and cyclic AMP. It was later described by Clark etal. (1994). They were the first to clone StAR and therefore identify it as a novel protein. Their study used MA-10 cells in mouse Leydig tumour cells, and they found StAR to be synthesized in response tostimulation by luteinizing hormone. StAR is important in transferring cholesterol, the precursor for all steroid hormones, from the outerto inner mitochondrial membrane where P450scc is located.

The Structure of StAR

The structure of StAR has been very recently revised in relation to mutations. StAR acts exclusively on the outer mitochondrial membrane to bind cholesterol, and is inactivated whenimported into the mitochondria. This process is important in the regulation of steroidogenesis.

The Regulation of StAR

Many signalling pathways have been identified to be involved in regulating the transcription ofStAR. cAMP is the main regulator, promoting both expression and phosphorylation. Phosphorylation of serine 195 increases activity.

One recent insight has been into the role of adiponectin, an adipokine, in the expression of StAR andconsequently levels of steroid hormone, specifically cortisol. The studydemonstrated that adiponectin increases StAR expression in H295R cells, which are adrenal cells thatexpress all the key enzymes involved in steroidogenesis.

The study also showed that adiponectin activated AMPK, AKT and ERK1/2 MAPK signalling pathways. This study is significant for obese people as an increased level of adiponectin would result in increasedlevels of cortisol.

A similar study by Ramanjaneya et al. (2008) looked into the effects of two neuropeptide orexins, Aand B, on the expression of StAR. They found that these molecules work through G-protein signallingpathways to upregulate StAR in the adrenal H295R cells in a dose dependent manner.

Cdk5 is another protein that has been found to be involved in regulating StAR levels in mouseLeydig cells. The researchers found that levels of StAR were directly correlated with theamount and activity of Cdk5, and therefore the amount of androgen produced. However, even though p35 isusually a coregulator of Cdk5 in its neuronal function, there was no correlation of p35 levels. The researchers suggest that this is because p35 and StAR comptete for a binding domain on Cdk5, but stress that further research is required to confirm this.

As stated in a review by Sierra (2004), StAR is widely distributed in the brain. Meethal et al. (2009) has found that it is part of regulatory feedback loop. They found that StAR is processed differentlydepending on the amount of peripheral hormones present, such as GnRH or sex steriods. Therefore theamount of steroids produced in the brain is regulated by gonadal steroidogenesis.

Mutations, Congenital Lipoid Hyperplasia, and Other Diseases

A recent study by Sahakitrungruang et al. (2010) has identified the effects of a mutation in StARwhich results in the partial loss of its function. They found that nonclassic congenital lipoid adrenalhyperplasia, where steroid hormone synthesis is impaired, can result from different mutations in the StARgene, many of which are located in the C-terminal helix where cholesterol binds. This type of mutation was first identified by Baker et al. (2006). Congenital lipoid hyperplasia affects the production of oestrogen, asteroid essential for pregnancy. The first successful pregnancy in a StAR deficient woman was reported byKhoury et al. (2009).

Another successful case has been reported by Sertedaki et al. (2009). This particularpatient had a mutation in StAR and could not conceive, but when oestrogens were administered she was ableto become pregnant. Oestrogens were administered until the placenta could fully function, as other researchhas shown that steroidogenesis in the placenta is independent of StAR. However, theseresults should not be generalized as only a small number of cases have been reported.

The effects of StAR mutations are very different between males and females. Females withmutations still experience menstrual bleeding and develop normal secondary sexual characteristics. This isbecause enough oestrogens can be produced using StAR independent mechanisms of transportingcholesterol across the mitochondrial membrane, and also because the ovaries are not stimulated early indevelopment. Males are affected much more because the gonads produce androgensfrom foetal life, and if this is impaired then male external genitalia fail to develop and there is also a build upof lipid droplets in the Leydig cells. This is due to accumulation of cholesterol and can cause mechanical damage.

This two stage model of lipoid CAH was first described by Bose et al. (1996). A perhaps less obvious place where StAR is essential for steroidogenesis is in the skin. Hannen et al. (2011) have recently researched into steroid hormone synthesis in keratinocytes. They concluded that in thecondition of eczema, StAR was not found in the basal layer of the skin as it would be normally, and was alsoabnormally expressed in skin conditions such as psoriasis which are treated with cortisol. However, theabsence of StAR could be secondary to these skin conditions as patients with StAR mutations have not beenreported to have eczema or psoriasis.

The role of StAR in the brain remains unclear as neurological symptoms are not common to patientswith severe mutations, although some cases of neurological damage in patients with lipoid CAH have beenreported. However, this damage could be secondary and more research is requiredinto this area.


The steroidogenic acute regulatory protein mediates the rate-limiting step in steroidogenesis: thetransfer of cholesterol across the mitochondrial membrane to the side chain cleavage enzyme. Cholesterolbinds to the molecule on the outer mitochondrial membranes for transfer. StAR is regulated by manydifferent signalling pathways, and new regulatory signals are being discovered. Its importance insteroidogenic tissues can be demonstrated by looking at diseases associated with mutations. Congenitallipoid hyperplasia is the biggest health issue linked to mutations in the StAR protein due to the inability tosynthesize essential steriods from cholesterol, and results in the build up of lipid droplets in cells. Males andfemales are affected differently by mutations due to sex steroids being needed for foetal development ofsexual characteristics in males.


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