Folia neuropathologica · 2026
11β-hydroxysteroid dehydrogenase type 1 as a predictive biomarker for glucocorticoid treatment response in inflammatory myopathies.
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Kabli Ali, Bamaga Ahmed, Gasemaltayeb Raed, Karami Mohammed, Alkhotani Alaa, Almansouri Majid, Noorwali Hussain, Fadul Motaz, Badahdah Adnan, Mehboob Riffat, Alqarni Abdulaziz, Khashoggi Khalid, Alkhotani Amal, Fathaddin Amany, Hassan Amber, Waseem Humaira, Kurdi Maher
Аннотация
INTRODUCTION: Glucocorticoid therapy is commonly used in inflammatory myopathies (IMs); however, patients' responses are variable, and predictive biomarkers remain unavailable. 11 -hydroxysteroid dehydrogenase type 1 (11 -HSD1), a key enzyme regulating intracellular glucocorticoid activation, may influence treatment response. This study evaluated the relationship between muscle 11 -HSD1 expression and clinical response to glucocorticoid therapy.
MATERIAL AND METHODS: This study included 32 patients with biopsy-confirmed IMs, of whom 25 received post-biopsy prednisolone (0.5-1 mg/kg/day) for approximately 8 months without glucocorticoid-sparing agents. Clinical response was evaluated based on muscle strength, symptom improvement, and creatinine kinase (CK) reduction. Muscle 11 -HSD1 expression was assessed and categorized as low-medium or high. Associations between enzyme expression and response to glucocorticoid were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of 11 -HSD1 expression.
RESULTS: Among the 25 treated patients with glucocorticoid therapy, 21 (84.0%) demonstrated clinical improvement, while 4 (16.0%) showed no clinical response. Baseline diagnostic subtypes and MHC class I expression were not significantly associated with treatment outcome (p = 0.37 and p = 0.59, respectively). In contrast, high 11 -HSD1 expression was significantly associated with clinical improvement (66.7% vs. 0% in non-responders; p = 0.026). High 11 -HSD1 expression was associated with increased odds of response (OR = 17.4, 95% CI: 0.77-392). ROC analysis demonstrated good predictive performance (AUC = 0.83).
CONCLUSIONS: Elevated muscle 11 -HSD1 expression before glucocorticoid therapy was associated with an improved clinical response after therapy in IMs. These findings support the potential role of 11 -HSD1 as a predictive biomarker.
MATERIAL AND METHODS: This study included 32 patients with biopsy-confirmed IMs, of whom 25 received post-biopsy prednisolone (0.5-1 mg/kg/day) for approximately 8 months without glucocorticoid-sparing agents. Clinical response was evaluated based on muscle strength, symptom improvement, and creatinine kinase (CK) reduction. Muscle 11 -HSD1 expression was assessed and categorized as low-medium or high. Associations between enzyme expression and response to glucocorticoid were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the predictive performance of 11 -HSD1 expression.
RESULTS: Among the 25 treated patients with glucocorticoid therapy, 21 (84.0%) demonstrated clinical improvement, while 4 (16.0%) showed no clinical response. Baseline diagnostic subtypes and MHC class I expression were not significantly associated with treatment outcome (p = 0.37 and p = 0.59, respectively). In contrast, high 11 -HSD1 expression was significantly associated with clinical improvement (66.7% vs. 0% in non-responders; p = 0.026). High 11 -HSD1 expression was associated with increased odds of response (OR = 17.4, 95% CI: 0.77-392). ROC analysis demonstrated good predictive performance (AUC = 0.83).
CONCLUSIONS: Elevated muscle 11 -HSD1 expression before glucocorticoid therapy was associated with an improved clinical response after therapy in IMs. These findings support the potential role of 11 -HSD1 as a predictive biomarker.