The increasing complexity of glucocorticoid receptor signaling and regulation

Glucocorticoids, although being one of the eldest drugs in the clinic and despite their widespread usage for the treatment of inflammatory and immune disorders and cancer, have not yet come of age when it comes to a full understanding of how they work. The majority of the biological actions of glucocorticoid hormones are explained by a wide diversity in the cellular action mechanism of the hormone-activated Glucocorticoid Receptor (GR). All molecular mechanisms described in the current overview are not only complex, exhibiting an astonishing degree of gene- and tissue-specificity, but on top of this they are also non-exclusive. This layering of mechanisms makes it extremely difficult for researchers to extract the crucial pieces of information that would assist in a rational design of drugs with an improved therapeutic profile, i.e. a satisfying and maintained therapeutic response in the absence of the many incapacitating glucocorticoid-associated side effects, such as diabetes, osteoporosis, muscle wasting, depression etc. In direct correlation with increased glucocorticoid usage as observed in the clinic, the impetus and desire to reveal all of these mechanisms -and most importantly, to try to integrate them in a sensible manner for the sake of finding better alternatives- has never been stronger.