Krieger Stephen, Sorrells Shawn F, Nickerson Molly, Pace Thaddeus W W
Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Neurosurgery, The Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, California, USA.
Clin Neurol Neurosurg. 2014 Apr;119:6-16. doi: 10.1016/j.clineuro.2013.12.021. Epub 2014 Jan 10.
Relapse management is a crucial component of multiple sclerosis (MS) care. High-dose corticosteroids (CSs) are used to dampen inflammation, which is thought to hasten the recovery of MS relapse. A diversity of mechanisms drive the heterogeneous clinical response to exogenous CSs in patients with MS. Preclinical research is beginning to provide important insights into how CSs work, both in terms of intended and unintended effects. In this article we discuss cellular, systemic, and clinical characteristics that might contribute to intended and unintended CS effects when utilizing supraphysiological doses in clinical practice. The goal of this article is to consider recent insights about CS mechanisms of action in the context of MS.
We reviewed relevant preclinical and clinical studies on the desirable and undesirable effects of high-dose corticosteroids used in MS care.
Preclinical studies reviewed suggest that corticosteroids may act in unpredictable ways in the context of autoimmune conditions. The precise timing, dosage, duration, cellular exposure, and background CS milieu likely contribute to their clinical heterogeneity.
It is difficult to predict when patients will respond favorably to CSs, both in terms of therapeutic response and tolerability profile. There are specific cellular, systemic, and clinical characteristics that might merit further consideration when utilizing CSs in clinical practice, and these should be explored in a translational setting.
复发管理是多发性硬化症（MS）护理的关键组成部分。大剂量皮质类固醇（CSs）用于减轻炎症，人们认为这有助于MS复发的恢复。多种机制导致MS患者对外源性CSs产生异质性临床反应。临床前研究开始为CSs的作用方式提供重要见解，包括预期和非预期效果。在本文中，我们讨论了在临床实践中使用超生理剂量时，可能导致CS预期和非预期效果的细胞、全身和临床特征。本文的目的是在MS背景下考虑关于CS作用机制的最新见解。
我们回顾了有关MS护理中使用大剂量皮质类固醇的预期和非预期效果的相关临床前和临床研究。
所回顾的临床前研究表明，皮质类固醇在自身免疫性疾病背景下可能以不可预测的方式起作用。精确的时间、剂量、持续时间、细胞暴露情况和背景CS环境可能导致其临床异质性。
无论是在治疗反应还是耐受性方面，都很难预测患者何时会对CSs产生良好反应。在临床实践中使用CSs时，有一些特定的细胞、全身和临床特征可能值得进一步考虑，这些应在转化研究环境中进行探索。
