Abstract
11β-hydroxysteroid dehydrogenase type 1 as a predictive biomarker for glucocorticoid treatment response in inflammatory myopathies
Department of Clinical Physiology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
Department of Clinical Physiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Pathology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
Department of Clinical Biochemistry, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Basic Medical Sciences, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
Department of Pathology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
Department of Internal Medicine, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
Lahore Medical Research Center, Lahore, Pakistan
Department of Neurology, King Abdulaziz Medical City, Jeddah, Saudi Arabia
Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Department of Medicine, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
Department of Pathology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
Department of Neurogenetics, Istituto Neurologico Nazionale a Carattere Scientifico, IRCCS, Pavia, Italy
Department of Data Science, INTI International University, Malaysia
Department of Quality Enhancement Cell, Fatima Jinnah Medical University, Lahore, Pakistan
Folia Neuropathol 2026; 64 (2): 142-149
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.
Keywords
treatment response, inflammatory myopathies, 11-hydroxysteroid dehydrogenase type 1, glucocorticoid therapy
Integrated with
