Steroids may worsen Crohn's disease

[Waverunner]

MDR1 expression is found for about 5 to 10% of Th17 cells. In Crohn's disease this expression increases to about 60%. MDR1 Th17 cells are resistant to steroids and are implicated in autoimmune disease. If a patient with these cells is treated with steroids, they will give Th17 MDR1 cells the possibility to thrive, while other cells are influenced by the treatment. Steroids could make Crohn's disease worse, not only by promoting resistance to treatment but also by increasing the numbers of inflammatory cells.

http://www.emaxhealth.com/1020/could-steroids-make-crohns-disease-worse

For the first time The Scripps Research Instiitute (TSRI) scientists have identified a way some people with Crohn's disease may become resistant to steroids. According to their findings, steroids may even make things worse in some instances.

The study

The scientists focused on immune cells known as Th17 that are a type of white blood cell for their study. They found out that some Th17 cells express a protein called MDR1 and that these cells are linked to inflammation in Crohn's patients. MDR1 is also associated with drug resistance that develops with cancer.

Biologist Mark Sundrud, a TSRI assistant professor who led the study said in a press release: "We were able to sort these cells directly out of damaged tissue resected from Crohn's patients and found that these pro-inflammatory cells are over-expressing genes that contribute to disease."

Just 5 to 10 percent of specialized immune cells produce MDR1-expressing TH17 cells in healthy individuals the study authors explain. The investigation found actively inflamed tissue taken from Crohn's disease patients contained almost 60 percent MDR1+ TH17 cells that are resistant to both natural and synthetic steroids.

The overexpression of MDR1 is thought to be a protective mechanism.

"If a T cell expresses MDR1, it is likely to have an unfair growth advantage over surrounding T cells," Sundrud explains. "When exposed to steroids, it's this subset of cells that will survive and thrive."

The researchers are continuing to investigate whether the pro-inflammatory cells continue to accumulate over time, The finding helps explain how Crohn's disease develops, but more specifically why the disease can become resistant to steroid treatment that can ultimately lead to the need for surgery.

 

[maryb]

@Waverunner
I know that for youngsters eg 14yr olds, steroids and diet are the treatment initially in the UK when first diagnosed with Crohns.

 

[Ema]

I don't think most patients go on steroids thinking that they will be any great cure. They are usually just desperate enough for some symptom relief to suffer the enormous side effects caused by high doses of steroids. It's another good kick to the already sore gut to determine that this bad idea is an even worse idea.

It's also important to differentiate between the high dose steroids that Crohn's patients are typically given and the low physiological doses typical given to those with HPA axis dysregulation. I would be very surprised if the ill effects weren't dose dependent and didn't occur at physiological doses at all.

 

[Waverunner]

First of all, I don't want to criticize steroids. In many cases they offer relief. The damage from the disease, if left untreated, can be far worse, than the side effects of steroids. What makes me really mad however, is the fact, that medicine bases lots of treatment regimens on drugs, that were developed around World War 2. It's 2014 now and all the medical field does, is hook patients on crappy drugs, that never treat the cause, often are not effective in certain patients and have to be taken forever. If you look at Crohn's disease, you have a few drugs, which suppress the immune system but 2/3 of Crohn's patients come down with surgery sometime in their life. Are you kidding me? What has the medical field been doing during the last 60 years? Has it been sleeping?

 

[Ema]

First of all, I don't want to criticize steroids. In many cases they offer relief. The damage from the disease, if left untreated, can be far worse, than the side effects of steroids. What makes me really mad however, is the fact, that medicine bases lots of treatment regimens on drugs, that were developed around World War 2. It's 2014 now and all the medical field does, is hook patients on crappy drugs, that never treat the cause, often are not effective in certain patients and have to be taken forever. If you look at Crohn's disease, you have a few drugs, which suppress the immune system but 2/3 of Crohn's patients come down with surgery sometime in their life. Are you kidding me? What has the medical field been doing during the last 60 years? Has it been sleeping?

It makes me mad too.

 

[PDXhausted]

This is really interesting. Both of my sisters developed Crohn's disease in their teens (in the mid 90's) and were put on prednisone. Within a year of the prednisone, they both had ruptured abscesses requiring major emergency surgery. They both had felt that the steroids made them worse, and everyone just wrote it off as their disease and not the drugs. Of course, its impossible to know what would have happened otherwise.

Whereas for my husband, who also has Crohn's but a different type than my sisters, steroids put him into remission. There is clearly more research that needs to be done-- good to see studies like this happening.

 

[Waverunner]

This is really interesting. Both of my sisters developed Crohn's disease in their teens (in the mid 90's) and were put on prednisone. Within a year of the prednisone, they both had ruptured abscesses requiring major emergency surgery. They both had felt that the steroids made them worse, and everyone just wrote it off as their disease and not the drugs. Of course, its impossible to know what would have happened otherwise.

Whereas for my husband, who also has Crohn's but a different type than my sisters, steroids put him into remission. There is clearly more research that needs to be done-- good to see studies like this happening.

I fully agree. The most important thing would be, that medicine takes patient and illness heterogeneity into account. There is not only one tumor type and there is not only one type of IBD. As long as medicine treats everybody the same we will continue to stay in the miserable situation we find us in today.