title: Therapeutic and adverse effects of a non-steroidal glucocorticoid receptor ligand in a mouse model of multiple sclerosis.
abstract: BACKGROUND
  Dissociating glucocorticoid receptor (GR) ligands hold great promise for treating inflammatory disorders since it is assumed that they exert beneficial activities mediated by transrepression but avoid adverse effects of GR action requiring transactivation. Here we challenged this paradigm by investigating 2-(4-acetoxyphenyl)-2-chloro-N-methyl-ethylammonium chloride (CpdA), a dissociating non-steroidal GR ligand, in the context of experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS).
  
  
  RESULTS
  CpdA inhibited pro-inflammatory mediators in myelin-specific T cells and fibroblasts in a GR-dependent manner while gene activation was abolished. However, it also induced massive apoptosis in various cell types even in the absence of the GR by engaging a Bcl-2- and caspase-dependent pathway. (1)H NMR spectroscopy corroborated these findings by revealing that CpdA dissolved in buffered solutions rapidly decomposes into aziridine intermediates known to act as alkylating pro-apoptotic agents. Importantly, the dichotomy of CpdA action also became evident in vivo. Administration of high-dose CpdA to mice was lethal while treatment of EAE with low to intermediate amounts of CpdA dissolved in water significantly ameliorated the disease. The beneficial effect of CpdA required expression of the GR in T cells and was achieved by down regulating LFA-1 and CD44 on peripheral Th cells and by repressing IL-17 production.
  
  
  CONCLUSIONS
  CpdA has significant therapeutic potential although adverse effects severely compromise its application in vivo. Hence, non-steroidal GR ligands require careful analysis prior to their translation into new therapeutic concepts.
authors.affiliation: Institute for Multiple Sclerosis Research, University of Göttingen and Gemeinnützige Hertie-Stiftung, Göttingen, Germany.
authors.forename: Simone
authors.initials: S
authors.lastname: Wüst
authors.forename: Denise
authors.initials: D
authors.lastname: Tischner
authors.forename: Michael
authors.initials: M
authors.lastname: John
authors.forename: Jan P
authors.initials: JP
authors.lastname: Tuckermann
authors.forename: Christiane
authors.initials: C
authors.lastname: Menzfeld
authors.forename: Uwe-Karsten
authors.initials: UK
authors.lastname: Hanisch
authors.forename: Jens
authors.initials: J
authors.lastname: van den Brandt
authors.forename: Fred
authors.initials: F
authors.lastname: Lühder
authors.forename: Holger M
authors.initials: HM
authors.lastname: Reichardt
mesh_terms: D000085:Acetates; D000818:Animals; D017209:Apoptosis / Q000187:drug effects; D001388:Aziridines / Q000494:pharmacology; D015815:Cell Adhesion Molecules / Q000378:metabolism; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D004622:Embryo, Mammalian / Q000166:cytology; D004681:Encephalomyelitis, Autoimmune, Experimental / Q000188:drug therapy; D005347:Fibroblasts / Q000187:drug effects / Q000378:metabolism; D006168:Guinea Pigs; D020381:Interleukin-17 / Q000096:biosynthesis; D008024:Ligands; D051379:Mice; D008810:Mice, Inbred C57BL; D008928:Mitochondria / Q000187:drug effects / Q000378:metabolism; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000473:pathology; D009186:Myelin Sheath / Q000187:drug effects / Q000378:metabolism; D009928:Organ Specificity / Q000187:drug effects; D000644:Quaternary Ammonium Compounds / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use*; D011965:Receptors, Glucocorticoid / Q000378:metabolism*; D012997:Solvents; D013578:Synephrine / Q000494:pharmacology; D013601:T-Lymphocytes / Q000187:drug effects / Q000378:metabolism; D015533:Transcriptional Activation / Q000187:drug effects; D014439:Tyramine / Q000031:analogs & derivatives
chemical_list: C104564:2-(4-acetoxyphenyl)-2-chloro-N-methylethylamine; D000085:Acetates; D001388:Aziridines; D015815:Cell Adhesion Molecules; D020381:Interleukin-17; D008024:Ligands; D000644:Quaternary Ammonium Compounds; D011965:Receptors, Glucocorticoid; D012997:Solvents; D013578:Synephrine; D014439:Tyramine