Patients with IgA nephropathy have altered levels of immunomodulatory C19 steroids. Glucocorticoid therapy with addition of adrenal androgens may be the choice

摘要

Glucocorticoid (GC) therapy is one of the methods of choices fortreatment of autoimmune diseases (ADs). In addition, adrenalandrogens are known as immunoprotective GC-antagonists.Adrenal steroids preferentially influence the Th1-componentsover the Th2 ones. We investigated steroid metabolome (usinggas chromatography-mass spectrometry) in healthy controls (H),GC-untreated patients with ADs different from IgA nephropathy(U), GC-treated patients with ADs different from IgA nephropathy(T) and in patients with IgA nephropathy (IgAN), which weremonitored on the beginning (N0), after one week (N1) andafter one month (N2) of prednisolone therapy (60 mg ofprednisolone/day/m2 of body surface). Between-groupdifferences were assessed by one-way ANOVA, while the changesduring the therapy were evaluated by repeated measuresANOVA. The ANOVA testing was followed by Duncan’s multiplecomparisons. IgAN patients and patients with other ADsexhibited lack of adrenal androgens due to attenuated activity ofadrenal zona reticularis (ZR). Androgen levels including their 7α-,7β-, and 16α-hydroxy-metabolites were further restrained byGC-therapy. Based on these results and data from the literature,we addressed the question, whether a combination of GCs withΔ5-steroids or their more stable synthetic derivatives may beoptimal for the treatment of antibodies-mediated ADs.