Uncovering the corticosteroid-responsive biomarkers for steroid-dependent patients
I am very grateful to the ADSHG for the £5,000 research grant which has allowed me to carry out the preliminary work to uncover the corticosteroid-responsive biomarkers for steroid-dependent patients.
Patients affected by autoimmune Addison’s disease require steroid replacement for life. An optimal steroid regimen is required to avoid the complications associated with over or under-replacement with corticosteroids. At present, endocrinologists use subjective assessment, based on history and examination, as well as measurements of renin and electrolytes to assess if an individual can have their’s replaced with corticosteroids optimally.
However, renin levels are subject to inaccuracies from concomitant medication use. While a 24-hour serum cortisol profile could be performed on some patients, serial measurement of cortisol level lacks practicality for frequent monitoring purposes. This has resulted in a wide variation in clinical practice in defining the optimal corticosteroid dose for each individual. Hence, a robust biomarker that could inform clinical outcomes objectively, as well as from fast and accurate read-outs, will be highly desirable.
For this purpose, I have carried out a pilot study to uncover the glucocorticoid-responsive biomarkers that could be retrieved from a one-off blood sample. I collaborated with the Newcastle University Protein and Proteome Analysis Unit, using advanced proteomic techniques (mass spectrometry) to identify protein patterns that would distinguish patients who are adequately supplemented with steroids from those who are not. Advances in proteomic technology have allowed broad-based assessment of protein concentrations using only small amounts of blood. The work is still in progress, but the preliminary results are encouraging. We will complete this pilot study by the end of the year and will follow up with another report. In the longer term, we hope that this will help us to develop a simple, fast and accurate read-out to allow rapid and objective assessments of the efficacy and safety of steroid therapy on an individual basis.
Dr Earn Gan
Dr Earn Gan is an NIHR academic clinical lecturer from Newcastle University who completed a PhD in 2015 under the supervision of Professor Simon Pearce. She investigated the novel therapeutic approaches and pathophysiology in autoimmune Addison’s disease. She continues to develop her research experience in the field of AAD and has had 10 publications relating to AAD in various peer-reviewed journals.
More information about the Award can be found on the ADSHG website here or you can email enquiries to the Trustees. Recipients are asked to provide regular reports, for publication in the ADSHG newsletter.
Two further recipients of ADSHG grants have also provided reports on their work.
This article was first published in the September 2018 edition of the ADSHG newsletter.