STEROID RESISTANCE AND ANNEXIN A1 LEVEL IN PATIENTS WITH ACANTHOLYTIC PEMPHIGUS
Authors: Abdalla Aliya E-S. E-S. 
Published: November 2022

Systemic glucocorticosteroids due to their powerful anti-inflammatory and immunosuppressive properties are widely used in the treatment of severe chronic autoimmune diseases. Systemic glucocorticosteroids are the basic therapy for acantholytic pemphigus that must be taken continually. Therapy regimens of systemic glucocorticosteroids in acantholytic pemphigus depend on the sensitivity of patients to hormonal drugs. Recently, there have been observed an increasing number of patients with acantholytic pemphigus who have reduced sensitivity to systemic glucocorticosteroids. The scientific literature describes theories of the development of steroid resistance; they are diverse and still insufficiently studied. Therefore, further investigation of new pathogenetic links of steroid resistance, including the presence of annexin A1 (annexin A1, ANXA1, lipocortin-1) in patients with acantholytic pemphigus receiving long-term therapy with systemic glucocorticosteroids, in relation to the dose of hormonal drugs and the course of the disease, is extremely relevant and timely. The aim: to determine the level of annexin A1 in patients with acantholytic pemphigus during treatment depending on the dose of systemic glucocorticosteroids and steroid sensitivity. Materials and methods: 33 patients with acantholytic pemphigus were under observation at the Department of Dermatology, Institute of Dermatology and Venereology of the National Academy of Medical Sciences of Ukraine, Kharkiv. The level of ANXA1 in blood serum was studied by enzyme-linked immunosorbent assay (ELISA). The study was conducted in patients with acantholytic pemphigus before treatment, at the beginning of treatment and over the course of maintenance therapy, taking into account the daily dose of systemic glucocorticosteroids. Evaluation of sensitivity to systemic glucocorticosteroids in patients with acantholytic pemphigus was assessed by a specially developed 12-point scale of the index of resistance to systemic glucocorticosteroids. Discussion. According to the results of the study, a significant increase in the level of ANXA1 was observed in patients with acantholytic pemphigus at the beginning of therapy and under the maintenance therapy with systemic glucocorticosteroids. In untreated patients, ANXA1 levels were equal to those in the control group. This is confirmed by the theory of glucocorticosteroid sensitivity of this mediator. An increase in ANXA1 level at the beginning of therapy with systemic glucocorticosteroids was determined: in steroid-sensitive group at an average daily dose of 45.63±5.49 mg, the level of ANXA1 was on average 0.82±0.09 ng/mL; in steroid-resistant group, with an average daily dose of systemic glucocorticosteroids of 59.57±7.94 mg/d, ANXA1 was 1.18±0.13 ng/mL. With a decrease in the daily dose of systemic glucocorticosteroids to 17.25±4.14 mg/d, the ANXA1 level in patients of steroid-sensitive group had the values of the control group 0.46±0.11 ng/mL and 0.48±0.05 ng/mL, respectively, while in patients of steroid-resistant group the ANXA1 level was 0.68±011 ng/mL at an average daily dose of corticosteroids of 27.23±2.94 mg/d. Conclusion. ANXA1 level depends on the dose of systemic glucocorticosteroids. All patients who did not receive systemic glucocorticosteroids had the level of ANXA1 equal to the control group. All patients with acantholytic pemphigus at the beginning of therapy had a significant increase in ANXA1 levels and their decrease when a maintenance dose was reached. The average daily maintenance dose of systemic glucocorticosteroids is 1.57 times higher in the group of steroid-resistant patients.