Widespread Use Of Glucocorticoids Research Articles

Rheumatology: What You May Have Missed in 2023.

Many patients with rheumatologic conditions receive care from physicians other than rheumatologists. Here we note key findings from 6 studies in rheumatology published in 2023 that offer valuable insights for internal medicine specialists and subspecialists outside of rheumatology. The first study investigated the effect of low-dose glucocorticoids on patients with rheumatoid arthritis (RA) over 2 years and challenged existing perceptions about the risks of glucocorticoids in this setting. The second study focused on the updated guideline for preventing and treating glucocorticoid-induced osteoporosis. With the chronic and widespread use of glucocorticoids, the American College of Rheumatology emphasized the importance of assessing fracture risk and initiating pharmacologic therapy when appropriate. The third study explored the potential use of methotrexate in treating inflammatory hand osteoarthritis, suggesting a novel approach to managing this challenging and common condition. The results of the fourth article we highlight suggest that sarilumab has promise as an adjunct treatment of polymyalgia rheumatica relapse during glucocorticoid dosage tapering. The fifth study evaluated sublingual cyclobenzaprine for fibromyalgia treatment, noting both potential benefits and risks. Finally, the sixth article is a systematic review and meta-analysis that assessed the therapeutic equivalence of biosimilars and reference biologics in the treatment of patients with RA. Knowledge of this recent literature will be useful to clinicians regardless of specialty who care for patients with these commonly encountered conditions.

Neuropsychiatric effects of glucocorticoids

Neuropsychiatric effects of glucocorticoids

Glucocorticoid receptor action in prostate cancer: the role of transcription factor crosstalk.

Prostate cancer is one of the most prevalent malignancies and is primarily driven by aberrant androgen receptor (AR) signaling. While AR-targeted therapies form the cornerstone of prostate cancer treatment, they often inadvertently activate compensatory pathways, leading to therapy resistance. This resistance is frequently mediated through changes in transcription factor (TF) crosstalk, reshaping gene regulatory programs and ultimately weakening treatment efficacy. Consequently, investigating TF interactions has become crucial for understanding the mechanisms driving therapy-resistant cancers. Recent evidence has highlighted the crosstalk between the glucocorticoid receptor (GR) and AR, demonstrating that GR can induce prostate cancer therapy resistance by replacing the inactivated AR, thereby becoming a driver of the disease. In addition to this oncogenic role, GR has also been shown to act as a tumor suppressor in prostate cancer. Owing to this dual role and the widespread use of glucocorticoids as adjuvant therapy, it is essential to understand GR's actions across different stages of prostate cancer development. In this review, we explore the current knowledge of GR in prostate cancer, with a specific focus on its crosstalk with other TFs. GR can directly and indirectly interact with a variety of TFs, and these interactions vary significantly depending on the type of prostate cancer cells. By highlighting these crosstalk interactions, we aim to provide insights that can guide the research and development of new GR-targeted therapies to mitigate its harmful effects in prostate cancer.

Glucocorticoid-induced osteoporosis: an overview with focus on its prevention and management.

The widespread use of glucocorticoids (GCs) contributes to the effective management of several diseases and conditions. However, it comes at a price in the case of the bones causing glucocorticoid-induced osteoporosis (GIOP), the most common cause of secondary osteoporosis and fractures. Several scientific societies have issued comprehensive guidelines on the optimal management of patients receiving GCs with the aim of providing answers to three fundamental questions, namely, whom to treat, when to treat, and how to treat. Both common ground and different approaches exist among them. General preventive measures should start along with GC initiation, and the duration of GC therapy should be limited to the minimal effective range. A pre-existing fracture, age, gender, menopausal status, dose, and duration of GC treatment are key factors in the decision to initiate antiosteoporotic medication. Oral bisphosphonates are typically regarded as the first-line treatment choice for GIOP partly due to their cost-effectiveness. Denosumab is another valid option, but an "exit strategy" should be considered before its initiation due to the risk of rebound-associated vertebral fractures upon its discontinuation. Since impaired bone formation represents the main mechanism by which GCs negatively affect skeletal health, osteoanabolic therapies appear to be pathophysiologically the more appropriate and appealing option, although cost considerations currently limit their use to selected severe cases. Regardless of the agent selected to mitigate the impact of GCs on the skeleton, what is most crucial is that the treating physician correctly stratifies the risk and intervenes at the right time.

Chronic Glucocorticoid Use and Risk for Advanced Prostate Cancer at Presentation: A SEER-Medicare Cohort Study

BackgroundExamine the relationship between exposure to systemic glucocorticoids (steroids) and advanced prostate cancer (PCa) at presentation. Prior work suggested that steroid use may be associated with increased PCa risk. Materials and MethodsWe queried the linked SEER-Medicare database (2004-2015) to identify PSA screened patients diagnosed with PCa. Criteria for screening included a PSA lab test or DRE exam in both the 12 month and 13 to 36 month periods prior to diagnosis of PCa. Steroid exposure was determined using Medicare Part D and groups were divided based on duration of use in the 3 years prior to diagnosis: controls with no exposure, <30 days, 30 days – 1 year, 1 to 2 years, and >2+ years. Advanced PCa was defined as systemic metastases or regional lymph node metastasis at presentation. Risk estimates for advanced PCa at presentation for steroid exposure groups vs. controls were assessed with univariable and multivariable logistic regression models. ResultsWe identified 22,920 PSA screened patients diagnosed with PCa of which 29% used glucocorticoids in the exposure period. The mean (SD) duration for glucocorticoid use (in days) among all steroid users was 76.7 days (192.1). On univariable and multivariable analyses, > 2 years of steroid exposure was associated with significantly increased risk for advanced PCa (OR 2.06, 95% CI 1.35-3.14 and OR 1.74, 95% CI 1.12-2.69, respectively). ConclusionIn this population-based PSA-screened cohort, prolonged steroid use was associated with increased risk of advanced PCa at diagnosis. With the widespread use of glucocorticoids, it is important to consider the role steroids may play in PCa pathogenesis.

The Biologist's Guide to the Glucocorticoid Receptor's Structure.

The glucocorticoid receptor α (GRα) is a member of the nuclear receptor superfamily and functions as a glucocorticoid (GC)-responsive transcription factor. GR can halt inflammation and kill off cancer cells, thus explaining the widespread use of glucocorticoids in the clinic. However, side effects and therapy resistance limit GR's therapeutic potential, emphasizing the importance of resolving all of GR's context-specific action mechanisms. Fortunately, the understanding of GR structure, conformation, and stoichiometry in the different GR-controlled biological pathways is now gradually increasing. This information will be crucial to close knowledge gaps on GR function. In this review, we focus on the various domains and mechanisms of action of GR, all from a structural perspective.

Meta-analysis reveals between-population differences affect the link between glucocorticoids and population health.

Glucocorticoids are a popular tool for monitoring health of animal populations because they can increase with environmental stressors and can indicate chronic stress. However, individual responses to stressors create variation in the glucocorticoid-fitness relationship within populations. The inconsistency in this relationship calls into question the widespread use of glucocorticoids in conservation. We investigated the sources of variation in the glucocorticoid-fitness relationship by conducting a meta-analysis across a diverse set of species exposed to conservation-relevant stressors. We first quantified the extent to which studies inferred population health from glucocorticoids without first validating the glucocorticoid-fitness relationship in their own populations. We also tested whether population-level information like life history stage, sex and species longevity influenced the relationship between glucocorticoids and fitness. Finally, we tested for a universally consistent relationship between glucocorticoids and fitness across studies. We found more than half of peer-reviewed studies published between 2008 and 2022 inferred population health solely based on glucocorticoid levels. While life history stage explained some variation in the relationship between glucocorticoids and fitness, we found no consistent relationship between them. Much of the variation in the relationship could be the result of idiosyncratic characteristics of declining populations, such as unstable demographic structure, that coincided with large amounts of variation in glucocorticoid production. We suggest that conservation biologists capitalize on this variation in glucocorticoid production by declining populations by using the variance in glucocorticoid production as an early warning for declines in population health.

Early Lupus Project: one-year follow-up of an Italian cohort of patients with systemic lupus erythematosus of recent onset.

Objective To describe the clinical and serological features of a prospectively followed cohort of early diagnosed systemic lupus erythematosus (SLE) patients during a one-year follow-up period. Methods SLE patients with disease duration less than 12 months were consecutively enrolled in a multicentre, prospective study. At study entry and then every 6 months, a large panel of data was recorded. Results Of 260 patients enrolled, 185 had at least 12 months of follow-up; of these, 84.3% were female, 92.4% were Caucasians. Mean diagnostic delay was about 20 months; higher values of European Consensus Lupus Activity Measurement (ECLAM) and of organs/systems involved were both associated with shorter diagnostic delay. Clinical and serological parameters improved after study entry. However, patients' quality of life deteriorated and cardiovascular risk factors significantly increased. About one-third of patients with active disease at study entry went into remission (ECLAM = 0). Negative predictors for remission were: oral ulcers, arthritis, low C4, anti-SSB (Ro) antibodies and therapy with mycophenolate. There was a widespread use of glucocorticoids both at baseline and during follow-up. Conclusion Clinical symptoms and serological parameters improve during the first period after diagnosis. However, patients' quality of life deteriorates. The widespread use of glucocorticoids is probably the reason for the early significant increase of some cardiovascular risk factors.

Cryptic glucocorticoid receptor-binding sites pervade genomic NF-\u03baB response elements

Glucocorticoids (GCs) are potent repressors of NF-κB activity, making them a preferred choice for treatment of inflammation-driven conditions. Despite the widespread use of GCs in the clinic, current models are inadequate to explain the role of the glucocorticoid receptor (GR) within this critical signaling pathway. GR binding directly to NF-κB itself—tethering in a DNA binding-independent manner—represents the standing model of how GCs inhibit NF-κB-driven transcription. We demonstrate that direct binding of GR to genomic NF-κB response elements (κBREs) mediates GR-driven repression of inflammatory gene expression. We report five crystal structures and solution NMR data of GR DBD-κBRE complexes, which reveal that GR recognizes a cryptic response element between the binding footprints of NF-κB subunits within κBREs. These cryptic sequences exhibit high sequence and functional conservation, suggesting that GR binding to κBREs is an evolutionarily conserved mechanism of controlling the inflammatory response.

Anti-Inflammatory Chromatinscape Suggests Alternative Mechanisms of Glucocorticoid Receptor Action

Despite the widespread use of glucocorticoids (GCs), their anti-inflammatory effects are not understood mechanistically. Numerous investigations have examined the effects of glucocorticoid receptor (GR) activation prior to inflammatory challenges. However, clinical situations are emulated by a GC intervention initiated in the midst of rampant inflammatory responses. To characterize the effects of a late GC treatment, we profiled macrophage transcriptional and chromatinscapes with Dexamethasone (Dex) treatment before or after stimulation by lipopolysaccharide (LPS). The late activation of GR had a similar gene-expression profile as from GR pre-activation, while ameliorating the disruption of metabolic genes. Chromatin occupancy of GR was not predictive of Dex-regulated gene expression, contradicting the "trans-repression by tethering" model. Rather, GR activation resulted in genome-wide blockade of NF-κB interaction with chromatin and directly induced inhibitors of NF-κB and AP-1. Our investigation using GC treatments with clinically relevant timing highlights mechanisms underlying GR actions for modulating the "inflamed epigenome."

Eosinophils in the lung - modulating apoptosis and efferocytosis in airway inflammation.

Due to the key role of the lung in efficient transfer of oxygen in exchange for carbon dioxide, a controlled inflammatory response is essential for restoration of tissue homeostasis following airway exposure to bacterial pathogens or environmental toxins. Unregulated or prolonged inflammatory responses in the lungs can lead to tissue damage, disrupting normal tissue architecture, and consequently compromising efficient gaseous exchange. Failure to resolve inflammation underlies the development and/or progression of a number of inflammatory lung diseases including asthma. Eosinophils, granulocytic cells of the innate immune system, are primarily involved in defense against parasitic infections. However, the propagation of the allergic inflammatory response in chronic asthma is thought to involve excessive recruitment and impaired apoptosis of eosinophils together with defective phagocytic clearance of apoptotic cells (efferocytosis). In terms of therapeutic approaches for the treatment of asthma, the widespread use of glucocorticoids is associated with a number of adverse health consequences after long-term use, while some patients suffer from steroid-resistant disease. A new approach for therapeutic intervention would be to promote the resolution of inflammation via modulation of eosinophil apoptosis and the phagocytic clearance of apoptotic cells. This review focuses on the mechanisms underpinning eosinophil-mediated lung damage, currently available treatments and therapeutic targets that might in future be harnessed to facilitate inflammation resolution by the manipulation of cell survival and clearance pathways.

Protecting the auditory system with glucocorticoids

Glucocorticoids are hormones released following stress-related events and function to maintain homeostasis. Glucocorticoid receptors localize, among others, to hair cells, spiral ligament and spiral ganglion neurons. Glucocorticoid receptor-induced protection against acoustic trauma is found by i) pretreatment with glucocorticoid agonists; ii) acute restraint stress; and iii) sound conditioning. In contrast, glucocorticoid receptor antagonists exacerbate hearing loss. These findings have important clinical significance since synthetic glucocorticoids are commonly used to treat hearing loss. However, this treatment has limited success since hearing improvement is often not maintained once the treatment has ended, a fact that reduces the overall appeal for this treatment. It must be realized that despite the widespread use of glucocorticoids to treat hearing disorders, the molecular mechanisms underlying this treatment are not well characterized. This review will give insight into some physiological and biochemical mechanisms underlying glucocorticoid treatment for preventing hearing loss.

Targeting inflammation using selective glucocorticoid receptor modulators

Glucocorticoids have been used since several decades in a variety of diseases in view of their potent anti-inflammatory properties. Nevertheless, the widespread use of glucocorticoids is hampered by the risk of side effects. Because the effects of glucocorticoids are mediated at large through interaction with the glucocorticoid receptor, which results in anti-inflammatory effects as well as side effects, much attention has been given to understanding the molecular regulation. Over the past decade, remarkable progress has been made in the mechanisms mediating glucocorticoid receptor dependent gene regulation. In this review we provide an overview of recent progress in understanding the mode of action of glucocorticoids and novel strategies to dissociate anti-inflammatory from metabolic side effects.

Estrogen Receptor, Progesterone Receptor, and Glucocorticoid Receptor Expression in Normal Breast Tissue, Breast In Situ Carcinoma, and Invasive Breast Cancer

Glucocorticoids (GCs) are used in cancer treatment to induce programmed cell death in transformed cells of the hematopoietic system and to lessen side effects. Moreover, GCs have been described not only as inhibitors of some chemotherapy or radiation-induced apoptosis, but also as inhibitors of cancer progression by down-regulation or up-regulation of different gene expressions. Recently, it has been suggested that GCs can attenuate estrogen responses through induction of expression and activity of the sulfotransferase. The presence or absence of glucocorticoid receptor (GR) in normal and abnormal breast tissue is thus interesting, and the aim of this study was to analyze the expression of GR during the progression of breast tissue. We tested by immunohistochemistry the expression status of estrogen receptor (ER), progesterone receptor (PR), and GR in normal breast parenchyma (n=49), ductal intraepithelial neoplasia (DIN) 1a (n=9), DIN 1b-1c (n=15), DIN 2-3 (n=21), and invasive breast carcinoma (n=39). The evaluation of GR expression was made by using the Allred score. All the normal parenchyma, DIN 1a, DIN 1b, and DIN 1c were ER-positive (ER+) and PR-positive (PR+). Seventeen of 21 DIN 2-3 and 30 of 39 invasive carcinomas were ER+/PR+. The other samples were ER-negative (ER-) and PR-negative (PR-). Moreover, all the ER-/PR- samples were GR-negative. Interestingly, we found a significant correlation between the histologic grade and the GR-negative tumors, and a percentage of positive patients presented with nuclear immunoreaction to GR, which decreases significantly with tumor histologic grade. Understanding the role of GCs in breast carcinoma is thus essential before continuing the widespread use of GCs combined with antineoplastic drugs or agents in the clinical management of women with breast cancer.

Selective inhibition of cyclooxygenase-2 attenuates expression of inflammation-related genes in CNS injury.

Injury to the brain, whether arising from trauma, stroke, or infection, elicits a tissue response characterized by glial cell activation and production of inflammation-related gene products. A similar response occurs in Alzheimer’s disease, where deposits of amyloid-beta are associated with activated glia and a wide variety of inflammatory products have been detected (Neuroinflammation Working Group, 2000). The widespread use of glucocorticoids in spinal cord injury and epidemiological evidence that nonsteroidal anti-inflammatory drugs may be beneficial in Alzheimer’s disease indicate that therapies targeting inflammatory processes may be useful in treatment of central nervous system (CNS) injury and disease. Cyclooxygenase-2 (COX-2) plays a major role in peripheral inflammatory processes (Dubois et al., 1998). Tissue culture studies show that astrocytes and microglia have the capacity to express COX-2 in response to proinflammatory cytokines (O’Banion et al., 1996; O’Banion, 1999). However, little is known about the contribution of COX-2 to inflammatory processes in the CNS.KeywordsTraumatic Brain InjuryCentral Nervous System InjuryGlial ActivationTissue Culture StudyGlial Cell ActivationThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Selective inhibition of cyclooxygenase-2 attenuates expression of inflammation-related genes in CNS injury models

Injury to the brain, whether arising from trauma, stroke, or infection, elicits a tissue response characterized by glial cell activation and production of inflammation-related gene products. A similar response occurs in Alzheimer’s disease, where deposits of amyloid-beta are associated with activated glia and a wide variety of inflammatory products have been detected (Neuroinflammation Working Group, 2000). The widespread use of glucocorticoids in spinal cord injury and epidemiological evidence that nonsteroidal anti-inflammatory drugs may be beneficial in Alzheimer’s disease indicate that therapies targeting inflammatory processes may be useful in treatment of central nervous system (CNS) injury and disease. Cyclooxygenase-2 (COX-2) plays a major role in peripheral inflammatory processes (Dubois et al., 1998). Tissue culture studies show that astrocytes and microglia have the capacity to express COX-2 in response to proinflammatory cytokines (O’Banion et al., 1996; O’Banion, 1999). However, little is known about the contribution of COX-2 to inflammatory processes in the CNS.

Immunoregulatory genes and immunosuppression by glucocorticoids.

Glucocorticoids (GCs) are physiological inhibitors of inflammatory responses and are widely used as immunosuppressive and anti-inflammatory agents. GCs induce (i) lymphocyte apoptosis (Cohen, 1989, Galili, 1983) and (ii) inhibit synthesis of lymphokines (Arya et al., 1984, Culpepper and Lee, 1985, Knudsen et al., 1987, Wang et al., 1993, Zanker et al., 1990) and cell surface molecules (Von Knebel et al., 1990) required for immune function. In spite of the widespread use of GCs, the molecular mechanisms that underlie their therapeutic effects are poorly understood.

Immunoregulatory genes and immunosuppression by glucocorticoids

Glucocorticoids (GCs) are physiological inhibitors of inflammatory responses and are widely used as immunosuppressive and anti-inflammatory agents. GCs induce (i) lymphocyte apoptosis (Cohen, 1989, Galili, 1983) and (ii) inhibit synthesis of lymphokines (Arya et al., 1984, Culpepper and Lee, 1985, Knudsen et al., 1987, Wang et al., 1993, Zanker et al., 1990) and cell surface molecules (Von Knebel et al., 1990) required for immune function. In spite of the widespread use of GCs, the molecular mechanisms that underlie their therapeutic effects are poorly understood.

Glucocorticosteroid inhibition of cytokine production: Relevance to antiallergic actions

We believe that there are the following four classes of glucocorticoid-sensitive cytokines that are involved in cell recruitment: (1) those that activate endothelium nonspecifically; (2) those that activate endothelium specifically; (3) those that activate, prime, and prolong the survival of eosinophils; and (4) those that stimulate movement of cells up into the epithelium. Glucocorticoids inhibit the generation of these cytokines and thereby prevent several different aspects of inflammation, including the activation and recruitment of inflammatory cells (eosinophils, basophils, and lymphocytes) and the release of inflammatory mediators. We believe such pleiotropic actions account for the efficacy and widespread use of glucocorticoids in the treatment of asthma.