Glucocorticosteroid therapy in inflammatory bowel diseases: From clinical practice to molecular biology

Table 1 Glucocorticoids of first and second generation and his medical uses

Glucocorticoids	Component	Indications	Ref.
1st generation	Prednisone	Moderate to Severe cases	[3,25,27]
	Methyl-Prednisolone	of IBDs	[26]
	Hydrocortisone	Short duration of treatment	[29]
2nd generation	Budesonide	Moderate CD cases	[32-34]
	Budesonide MMX	Mild to moderate UC cases	[36,37]
	Beclomethasone dipropionate	Topical administration	[40,41]
	Erythrocyte - Mediated Delivery of Dexamethasone	In research for long term treatments	[42]

IBDs: Inflammatory bowel diseases; CD: Crohn's disease; UC: Ulcerative colitis.

Table 2 Molecular highlights on responses to steroidal treatment

Gene/protein	Function	Molecular alteration or genetic variant	Effect on GC response	Ref.
NR3C1	GC receptor	Increased expression of the isoform	Block signaling of the isoform/GC resistance	[58]
		rs6189	Altered transactivation of GC receptor/GC resistance	[54,63]
		rs6190
		rs6195	Enhanced sensitivity to GC	[65]
		rs41423247	Alternative splicing of receptor/GC resistance	[54,63]
MDR1	Export of drugs from the cell	rs1045642	Decreased MDR1 levels/GC resistance in Brazilian CD patients	[68]
		rs1128503	Possible misfolding/GC dependence in Chinese CD patients	[75-77]
		rs1045642
IL-10	Anti-inflammatory cytokine	rs1800896	Lowered production of IL-10/GC dependence in UC and CD patients	[45]
EBF3	Transcription factor	Decreased levels of EBF3	More severely inflamed phenotype/GC dependence	[72]
PAR2	G protein coupled receptor	Methylation of gene promoter	GC resistance/dependence in UC patients.	[82]

UC: Ulcerative colitis; CD: Crohn's disease; GCs: Glucocorticoids.