Δ-9,11 modification of glucocorticoids dissociates nuclear factor-κB inhibitory efficacy from glucocorticoid response element-associated side effects.

Glucocorticoids are standard of care for many inflammatory conditions, but chronic use is associated with a broad array of side effects. This has led to a search for dissociative glucocorticoids-drugs able to retain or improve efficacy associated with transrepression [nuclear factor-kappa B (NF-kappa B) inhibition] but with the loss of side effects associated with transactivation (receptor-mediated transcriptional activation through glucocorticoid response element gene promoter elements). We investigated a glucocorticoid derivative with a Delta-9,11 modification as a dissociative steroid. The Delta-9,11 analog showed potent inhibition of tumor necrosis factor-alpha-induced NF-kappa B signaling in cell reporter assays, and this transrepression activity was blocked by 17 beta-hydroxy-11 beta-[4-dimethylamino phenyl]-17 alpha-[1-propynyl]estra-4,9-dien-3-one (RU-486), showing the requirement for the glucocorticoid receptor (GR). The Delta-9,11 analog induced the nuclear translocation of GR but showed the loss of transactivation as assayed by GR-luciferase constructs as well as mRNA profiles of treated cells. The Delta-9,11 analog was tested for efficacy and side effects in two mouse models of muscular dystrophy: mdx (dystrophin deficiency), and SJL (dysferlin deficiency). Daily oral delivery of the Delta-9,11 analog showed a reduction of muscle inflammation and improvements in multiple muscle function assays yet no reductions in body weight or spleen size, suggesting the loss of key side effects. Our data demonstrate that a Delta-9,11 analog dissociates the GR-mediated transcriptional activities from anti-inflammatory activities. Accordingly, Delta-9,11 analogs may hold promise as a source of safer therapeutic agents for chronic inflammatory disorders.