Chapter 20 Hormonal Modulation of Autoimmune Diseases: Glucocorticoids

Publisher Summary This chapter discusses the hormonal modulation of autoimmune diseases, glucocorticoids (GCs). GCs are the most effective and most used immune modulators in systemic auto-immune diseases. GCs mediate fascinating anti-inflammatory and immunomodulatory effects when used therapeutically. There are many specific effects of the commonly used GC drugs, which include prednisone, prednisolone, methylprednisolone, or dexamethasone. GCs at high concentrations are able to intercalate into cellular membranes, such as plasma and mitochondrial membrane, and change their properties. This is the basis for non-specific non-genomic effects, possibly mediated by changes in the cation transport through the plasma membrane and in the proton leak of the mitochondria. These physicochemical interactions with biological membranes are very likely to be the key to the very rapid immunosuppressive and anti-inflammatory effects of high-dose GCs. These high GC concentrations are achieved by intra-articular GC injections or intravenous GC pulse therapy. Several risk factors are involved in the pathogenesis of chronic inflammatory diseases, including genetics, chronic infections, sex hormones, and stress.