Molecular Biomarkers for Predicting Patient Response to Steroid Therapy

Steroids are commonly prescribed medications in the US and around the world. Topical steroids are used extensively to treat a wide range of skin disorders such as psoriasis, eczema and dermatitis, while local steroid injections are a mainline therapy for benign fibrotic skin tumors know as keloids. Additionally, oral steroids are to treat systemic autoimmune conditions, while inhaled steroids serve as the mainline therapy for long-term control of asthma and nasal allergies. However, there is a wide variation in the response of patients to steroid therapy. For example, only about 34% of keloid patients benefit from steroid therapy, while 49% do not respond to it and the remaining 17% of patients actually see a worsening of their symptoms upon steroid therapy. This variability in patients' responses to steroids is likely due to individual differences in the patients’ genetic or epigenetic makeup, although the genes or epigenetic pathways involved have not yet been identified. The highly variable patient responses to steroid therapy highlight the dire need for a screening test to determine patients’ response to steroids prior to initiating therapy.

Since all our cells reflect our genetic/epigenetic makeup, they are also potentially capable of accurately reporting our response to steroids. Hence, as long as we can obtain a biopsy sample from patients, we can test them for sensitivity to steroids.  We have identified six genes whose expression patters correlate well with response to steroids and have developed a simple method for screening patients to determine the effects of steroids. This qRT-PCR based molecular test can provide results in a few hours. In the future it may be possible to use an antibody based lateral flow rapid test that can provide results in minutes.