Testosterone and estradiol circulate in the bloodstream, loosely bound mostly to serum albumin (~54%), and to a lesser extent bound tightly to SHBG (~44%). Only a very small fraction of about 1 to 2% is unbound, or "free," and thus biologically active and able to enter a cell and activate its receptor. SHBG inhibits the function of these hormones. Thus, the local bioavailability of sex hormones is influenced by the level of SHBG. Because SHBG binds to testosterone (T) and dihydrotestosterone (DHT), these hormones are made less lipophilic and become concentrated within the luminal fluid of the seminiferous tubules. The higher levels of these hormones enable spermatogenesis in the seminiferous tubules and sperm maturation in the epididymis. SHBG’s production is regulated under the influence of FSH[6] on Sertoli cells, enhanced by insulin, retinol, and testosterone.
SHBG levels are usually about twice as high in women as in men.[9] In women, SHBG serves to limit exposure to both androgens and estrogens.[9] Low SHBG levels in women have been associated with hyperandrogenism and endometrial cancer due to heightened exposure to androgens and estrogens, respectively.[9] During pregnancy, due to activation of SHBG production in the liver by high estrogen levels, SHBG levels increase by five-fold to ten-fold.[9] The high SHBG levels during pregnancy may serve to protect the mother from exposure to fetal androgens that escape metabolism by the placenta.[9] A case report of severe hyperandrogenism in a pregnant woman due to a rare instance of genetic SHBG deficiency illustrates this.[9][13]
Biochemistry
Biosynthesis
SHBG is produced mostly by the liver and is released into the bloodstream. Other sites that produce SHBG include the brain, uterus, testes, and placenta.[14] Testes-produced SHBG is called androgen-binding protein.
Gene
The gene for SHBG is called Shbg, located on chromosome 17[14] on the short arm between the bands 17p12→p13.[15] Overlapping on the complementary DNA strand is the gene for spermidine/spermine N1-acetyltransferase family member 2 (SAT2). Nearby are the genes for p53 and ATP1B2, and fragile X mental retardation, autosomal homolog 2 (FXR2) on the complementary strand.[16] There are eight exons, of which exon 1 has three variations called 1L, 1T and 1N which are triggered by three promoters: PL, PT and PN respectively. SHBG comes with the 1L, 2, 3, 4, 5, 6, 7, and 8 exons connected together. A variation includes SHBG-T which is missing exon 7 but with exon 1T promoted by promoter PT on the opposite strand, which shared with that for SAT2.[17]
Polymorphisms
There are variations in the genetic material for this protein that have different effects.
In humans common polymorphisms include the following:
Rs6259, also called Asp327Asn location 7633209 on chromosome 17, results in there being an extra N-glycosylation site, and so an extra sugar can be attached. This results in a longer circulation half-life for the protein, and raised levels. Health effects include a lowered risk of endometrial cancer and an increased risk of systemic lupus erythematosus.[18]
Rs6258 also called Ser156Pro is at position 7631360 on chromosome 17.
Rs727428 position 7634474 is in several percent of humans.[19]
(TAAAA)(n) is five base pairs that repeats a variable number of times on the opposite DNA strand.[20]
Promoter activation
The mechanism of activating the promoter for SHBG in the liver involves hepatocyte nuclear factor 4 alpha (HNF4A) binding to a DR1-like cis-element which then stimulates production. Competing with HNF4A at a third site on the promoter is PPARG-2 which reduces copying the gene to RNA. If the HNF4A level is low, then COUP-TF binds to the first site and turns off production of SHBG.[7]
Protein
Sex hormone-binding globulin is homodimeric, meaning it has two identical peptide chains making up its structure. The amino acid sequence is the same as for androgen-binding protein produced in testes, but with different oligosaccharides attached.[14]
SHBG has two laminin G-like domains which form pockets that bind hydrophobic molecules. The steroids are bound by the LG domain at the amino end of the protein.[7] Inside the pocket of the domain is a serine residue that attracts the two different types of steroids at different points, thus changing their orientation. Androgens bind at the C3 functional groups on the A ring, and estrogens bind via a hydroxyl attached to C17 on the D ring. The two different orientations change a loop over the entrance to the pocket and the position of trp84 (in humans). Thus the whole protein signals what hormone it carries on its own surface.[7] The steroid binding LG domain is coded by exons 2 to 5.[7] A linker region joins the two LG domains together.[7]
When first produced, the SHBG precursor has a leading signal peptide attached with 29 amino acids. The remaining peptide has 373 amino acids.[21] There are two sulfur bridges.
The sugars are attached at two different N-glycosylation points on asparagine (351 and 367) and one O-glycosylation point (7) on threonine.[21]
Metals
A calcium ion is needed to link the two elements of the dimer together. Also a zinc ion is used to orient an otherwise disorganised part of the peptide chain.[7]
In an effort to explain obesity-related reductions in SHBG, recent evidence suggests sugar or monosaccharide-induced hepatic lipogenesis, hepatic lipids in general, and cytokines like TNF-alpha and interleukins reduce SHBG, whereas insulin does not. For example, anti-psoriatic drugs that inhibit TNF-alpha cause an increase in SHBG. The common downstream mechanism for all of these, including the effect of thyroid hormones,[22] was downregulation of hepatocyte nuclear factor 4 (HNF4).[23][24][25][26]
In utero, the human fetus has a low level of SHBG, allowing increased activity of sex hormones. After birth, the SHBG level rises and remains at a high level throughout childhood. At puberty the SHBG level halves in girls and goes down to a quarter in boys.[7] The change at puberty is triggered by growth hormone, and its pulsatility differs in boys and girls.[clarification needed] In the third trimester of pregnancy, the SHBG level of the parent escalates to five to ten times the usual level for a woman.[7][9] A hypothesis is that this protects against the effect of hormone produced by the fetus.[7]
Obese girls are more likely to have an early menarche due to lower levels of SHBG.[7] Anorexia or a lean physique in women leads to higher SHBG levels, which in turn can lead to amenorrhea.[7]
Type 2 diabetes
Reduced levels of SHBG and also certain polymorphisms of the SHBG gene are implicated in the development of insulin resistance and type 2 diabetes.[36] Such effects apparently involve direct action at the cellular level where it became apparent that cell membranes of certain tissues contain specific high-affinity SHBG receptors.[37]
Oral contraceptives containing ethinylestradiol can increase SHBG levels 2- to 4-fold and decrease free testosterone concentrations by 40 to 80% in women.[41] They can be used to treat symptoms of hyperandrogenism like acne and hirsutism.[41][9] Some oral contraceptives, namely those containing high doses of ethinylestradiol (which have been discontinued and are no longer marketed), can increase SHBG levels as much as 5- to 10-fold.[9]
The reference ligands (100%) for the RBATooltip relative binding affinity (%) values were testosterone for SHBG and cortisol for CBGTooltip corticosteroid-binding globulin.
Affinities of 21 progestins for SHBG and CBG[44][47]
Values are RBAsTooltip relative binding affinities (%). The reference ligand (100%) for SHBG was dihydrotestosterone and for CBGTooltip corticosteroid-binding globulin was cortisol.
Values are RBAsTooltip relative binding affinities (%). The reference ligand (100%) for SHBG was dihydrotestosterone and for CBGTooltip corticosteroid-binding globulin was cortisol.
The reference ligand (100%) for the SHBG RBATooltip relative binding affinity (%) values was testosterone.
Endogenous steroids
Measurement
When checking serum estradiol or testosterone, a total level that includes free and bound fractions can be assayed, or the free portion may be measured alone. Sex hormone-binding globulin can be measured separately from the total fraction of testosterone.
A free androgen index expresses the ratio of testosterone to SHBG and can be used to summarize the activity of free testosterone.
Affinity and binding
Affinities of endogenous steroids for SHBG and plasma protein binding[51]
Steroid
SHBG affinity
Plasma protein binding in men
Plasma protein binding in women (follicular phase)
In men, the concentrations of SHBG, CBG, and albumin were 28 nM, 0.7 μM, and 0.56 mM, respectively. In women, the concentrations of SHBG, CBG, and albumin were 37 nM, 0.7 μM, and 0.56 mM, respectively.
Synonyms
SHBG has been known under a variety of different names including:[52][53][54]
^"Human PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
^"Mouse PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
^Bardin CW, Musto N, Gunsalus G, Kotite N, Cheng SL, Larrea F, Becker R (1981). "Extracellular androgen binding proteins". Annual Review of Physiology. 43: 189–98. doi:10.1146/annurev.ph.43.030181.001201. PMID7011179.
^ abHansson V, Weddington SC, French FS, McLean W, Smith A, Nayfeh SN, Ritzén EM, Hagenäs L (September 1976). "Secretion and role of androgen-binding proteins in the testis and epididymis". Journal of Reproduction and Fertility. Supplement (24 suppl): 17–33. PMID1069850.
^ abcdefghijHammond GL (25 April 2017). "Sex Hormone-Binding Globulin and the Metabolic Syndrome". In Winters SJ, Huhtaniemi IT (eds.). Male Hypogonadism: Basic, Clinical and Therapeutic Principles. Humana Press. pp. 305–324. doi:10.1007/978-3-319-53298-1_15. ISBN978-3-319-53298-1.
^* Bérubé D, Séralini GE, Gagné R, Hammond GL (1991). "Localization of the human sex hormone-binding globulin gene (SHBG) to the short arm of chromosome 17 (17p12----p13)". Cytogenetics and Cell Genetics. 54 (1–2): 65–7. doi:10.1159/000132958. PMID2249477.
^Joseph DR (January 1998). "The rat androgen-binding protein (ABP/SHBG) gene contains triplet repeats similar to unstable triplets: evidence that the ABP/SHBG and the fragile X-related 2 genes overlap". Steroids. 63 (1): 2–4. doi:10.1016/S0039-128X(97)00087-1. PMID9437788. S2CID12825993.
^ abHammond GL, Underhill DA, Smith CL, Goping IS, Harley MJ, Musto NA, Cheng CY, Bardin CW (May 1987). "The cDNA-deduced primary structure of human sex hormone-binding globulin and location of its steroid-binding domain". FEBS Letters. 215 (1): 100–4. Bibcode:1987FEBSL.215..100H. doi:10.1016/0014-5793(87)80121-7. PMID3569533. S2CID23058156.
^Mean F, Pellaton M, Magrini G (October 1977). "Study on the binding of dihydrotestosterone, testosterone and oestradiol with sex hormone binding globulin". Clin. Chim. Acta. 80 (1): 171–80. doi:10.1016/0009-8981(77)90276-5. PMID561671.
^Ruokonen A, Alén M, Bolton N, Vihko R (July 1985). "Response of serum testosterone and its precursor steroids, SHBG and CBG to anabolic steroid and testosterone self-administration in man". Journal of Steroid Biochemistry. 23 (1): 33–8. doi:10.1016/0022-4731(85)90257-2. PMID3160892.
^Rosner W, Hryb DJ, Kahn SM, Nakhla AM, Romas NA (March 2010). "Interactions of sex hormone-binding globulin with target cells". Molecular and Cellular Endocrinology. 316 (1): 79–85. doi:10.1016/j.mce.2009.08.009. PMID19698759. S2CID27912941.
^Odlind V, Milsom I, Persson I, Victor A (June 2002). "Can changes in sex hormone binding globulin predict the risk of venous thromboembolism with combined oral contraceptive pills?". Acta Obstet Gynecol Scand. 81 (6): 482–90. PMID12047300.
^ abcPugeat MM, Dunn JF, Nisula BC (July 1981). "Transport of steroid hormones: interaction of 70 drugs with testosterone-binding globulin and corticosteroid-binding globulin in human plasma". J. Clin. Endocrinol. Metab. 53 (1): 69–75. doi:10.1210/jcem-53-1-69. PMID7195405.
^ abSaartok T, Dahlberg E, Gustafsson JA (1984). "Relative binding affinity of anabolic-androgenic steroids: comparison of the binding to the androgen receptors in skeletal muscle and in prostate, as well as to sex hormone-binding globulin". Endocrinology. 114 (6): 2100–6. doi:10.1210/endo-114-6-2100. PMID6539197.
^Pugeat MM, Dunn JF, Rodbard D, Nisula BC (December 1981). "The significance of drug interactions with human TeBG and CBG under physiological conditions: a new approach". J. Steroid Biochem. 15: 487–90. doi:10.1016/0022-4731(81)90319-8. PMID7200170.
^Machek SB, Cardaci TD, Wilburn DT, Willoughby DS (December 2020). "Considerations, possible contraindications, and potential mechanisms for deleterious effect in recreational and athletic use of selective androgen receptor modulators (SARMs) in lieu of anabolic androgenic steroids: A narrative review". Steroids. 164: 108753. doi:10.1016/j.steroids.2020.108753. PMID33148520. S2CID225049089.
^Bergink EW, Loonen PB, Kloosterboer HJ (August 1985). "Receptor binding of allylestrenol, a progestagen of the 19-nortestosterone series without androgenic properties". Journal of Steroid Biochemistry. 23 (2): 165–8. doi:10.1016/0022-4731(85)90232-8. PMID3928974.
^Cunningham GR, Tindall DJ, Lobl TJ, Campbell JA, Means AR (September 1981). "Steroid structural requirements for high affinity binding to human sex steroid binding protein (SBP)". Steroids. 38 (3): 243–62. doi:10.1016/0039-128X(81)90061-1. PMID7197818. S2CID2702353.
^Dunn JF, Nisula BC, Rodbard D (July 1981). "Transport of steroid hormones: binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma". J. Clin. Endocrinol. Metab. 53 (1): 58–68. doi:10.1210/jcem-53-1-58. PMID7195404.
Rosner W, Hryb DJ, Khan MS, Nakhla AM, Romas NA (1999). "Sex hormone-binding globulin mediates steroid hormone signal transduction at the plasma membrane". The Journal of Steroid Biochemistry and Molecular Biology. 69 (1–6): 481–5. doi:10.1016/S0960-0760(99)00070-9. PMID10419028. S2CID6499033.
Power SG, Bocchinfuso WP, Pallesen M, Warmels-Rodenhiser S, Van Baelen H, Hammond GL (October 1992). "Molecular analyses of a human sex hormone-binding globulin variant: evidence for an additional carbohydrate chain". The Journal of Clinical Endocrinology and Metabolism. 75 (4): 1066–70. doi:10.1210/jcem.75.4.1400872. PMID1400872.
Walsh KA, Titani K, Takio K, Kumar S, Hayes R, Petra PH (November 1986). "Amino acid sequence of the sex steroid binding protein of human blood plasma". Biochemistry. 25 (23): 7584–90. doi:10.1021/bi00371a048. PMID3542030.
Hammond GL, Robinson PA, Sugino H, Ward DN, Finne J (April 1986). "Physicochemical characteristics of human sex hormone binding globulin: evidence for two identical subunits". Journal of Steroid Biochemistry. 24 (4): 815–24. doi:10.1016/0022-4731(86)90442-5. PMID3702459.
Hardy DO, Cariño C, Catterall JF, Larrea F (April 1995). "Molecular characterization of a genetic variant of the steroid hormone-binding globulin gene in heterozygous subjects". The Journal of Clinical Endocrinology and Metabolism. 80 (4): 1253–6. doi:10.1210/jcem.80.4.7714097. PMID7714097.
Cargill M, Altshuler D, Ireland J, Sklar P, Ardlie K, Patil N, Shaw N, Lane CR, Lim EP, Kalyanaraman N, Nemesh J, Ziaugra L, Friedland L, Rolfe A, Warrington J, Lipshutz R, Daley GQ, Lander ES (July 1999). "Characterization of single-nucleotide polymorphisms in coding regions of human genes". Nature Genetics. 22 (3): 231–8. doi:10.1038/10290. PMID10391209. S2CID195213008.
Raineri M, Catalano MG, Hammond GL, Avvakumov GV, Frairia R, Fortunati N (March 2002). "O-Glycosylation of human sex hormone-binding globulin is essential for inhibition of estradiol-induced MCF-7 breast cancer cell proliferation". Molecular and Cellular Endocrinology. 189 (1–2): 135–43. doi:10.1016/S0303-7207(01)00725-0. PMID12039072. S2CID24123789.
Grishkovskaya I, Avvakumov GV, Hammond GL, Muller YA (May 2002). "Resolution of a disordered region at the entrance of the human sex hormone-binding globulin steroid-binding site". Journal of Molecular Biology. 318 (3): 621–6. doi:10.1016/S0022-2836(02)00169-9. PMID12054810.
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