Anti‐Inflammatory Glucocorticoids

Abstract

Glucocorticoids are the first line medication used in the treatment of afflictions ranging from the moderate skin rash to severe acute inflammatory disorders. They exert their activity through binding to the glucocorticoid receptor, a ligand‐dependent transcription factor, and result in either activation or repression of a large set of glucocorticoid responsive genes. The glucocorticoid receptor ( GR ) is a cytoplasmic protein of complex structure that is associated with various heat shock proteins (e.g., hsp 90). The desired immunosuppressive effect is apparently due largely to the downregulation of a variety of proinflammatory factors, whereas adverse reactions such as corticoid‐induced diabetes and osteoporosis could be connected to the inappropriate activation of genes involved in the control of metabolic processes. The discovery of selective receptor modulators, which maintain beneficial therapeutic activity together with a diminished risk of side effects, focuses on ligands that lead to repression rather than activation of genes targeted by the glucocorticoid receptor. Current drug‐screening programs have yielded a number of molecules including steroidal as well as nonsteroidal compounds, which preferentially induce receptor‐mediated repression.