This question came about as my wife has just started a course of steroids to treat her Crohn’s Disease. They work amazingly well, amazingly quickly… But they are only a temporary solution as they have a range of significant side effects such as thinning of the bones, insomnia, etc…
Steroids are “old” in medical terms – why haven’t we managed to remove the side effects yet?
In: Chemistry
Dermatologist here, but we use steroids a lot in our practice of medicine. Not ELI5, but for your particular example, we often repurpose already existing compounds or chemicals. And thus though we may use them to obtain a particular effect, it’s inevitable that they will also do other things. Our bodies are complex contraptions that we don’t fully understand and are learning bits about how they work all the time.
For example, the “steroids” your wife got for her Crohn’s are in a group of steroids we call glucocorticoids. These are synthetic steroid hormones that we have created to mimic the body’s naturally produced glucocorticoids. We use them because normally glucocorticoids are used in the normal feedback of the immune system to essentially turn down inflammation, though they also are used in tons of other bodily processes, including bone metabolism (hence osteoporosis), metabolism (they play an integral role in moving sugars, fats, and proteins into different compartments of the body), and the brain (they act in multiple ways as part of the stress response “flight or flight” signalers, to help enhance memory formation, etc.) In order to shut down your wife’s abnormal inflammatory response in her colon, we flood her system with glucocorticoids in hopes to prevent her Crohn’s from destroying her GI tract.
It’s kind of like commandeering the water pipes in a grocery store. They help supply the water that mists vegetables in the produce department, make the ice to keep the fish cold, supply water fountains for drinking, etc. They’re a natural part of the building and have an important role to play, but when there’s a fire, we open up all the taps and let the building flood to prevent the building from burning down. Yes, the floor will be ruined, and the vegetables probably spoiled, but it’s better than a 100% loss.
There are more and more targeted therapies coming out that have less side effects, like in dermatology we have biologics like IL-17, IL-22, IL-23, IL-4 inhibitors, to help treat other autoimmune diseases like eczema and psoriasis. These act further downstream in the immune pathways to hopefully cause more targeted immunosuppression. This would be like only opening up the pipes that supply the sprinklers to only the part of the building that is on fire, instead of all the sprinklers in the entire building. For Crohn’s, gastroenterologists use many of the same medications.
Latest Answers