WWII: the dawn of the corticosteroid era
WWII: the dawn of the corticosteroid era
Kashmir time. Dated: 06/27/2021 01:25:08 AM
Corticosteroids: miracle drug with warnings
âThis discovery of cortisone by Philip Hench and Edward Kendall with Polish chemist Tadeus Riechstein, received the Nobel Prize for Medicine and Physiology in 1950. At the same time, chemists in pharmaceutical companies have manipulated cortisone like a Tinker Toy , adding, removing or substituting a part here or there to create new structures that are always more useful.
By Dr Showkat hUSSAIN Shah
World War II was a world war that lasted from 1939 to 1945. With the United States entering the war on the horizon in December 1941, rumors circulated that the Nazis were secretly importing bovine adrenal glands from Argentina. via a submarine to produce extracts for military use. It has long been known that animals with surgically removed adrenal glands (adrenalectomized animals) would succumb quickly when exposed to even minimal stress, according to the work of Addison and Brown-Sequard in the 1880s. It seemed natural to postulate that adrenal extracts could protect against stress. Fears have surfaced that Luftwaffe pilots will receive such medication to allow them to tolerate low levels of oxygen (hypoxia) and to fly at altitudes of 40,000 feet or more. While these rumors are undoubtedly false, the specter of a steroid-enhanced enemy has caught the attention of the US government, and an impending war has prompted the US government to set up a research council. In 1941, a committee of 14 chemists was assembled, including Kendall, and priorities were set. Remarkably, the number one priority was the isolation and production of Cortin (compound E) in addition to the development of antimalarials for potential tropical warfare and penicillin as antibiotics to fight infections in soldiers on the second and third priorities. . Considerable money has been invested in adrenal hormone research and the resulting partnership with industry has led to the isolation and purification of compound E (cortin).
On September 21, 1948, Mrs. G. (Patient with debilitating rheumatoid arthritis) received the first of her twice daily intramuscular injections of 50 mg of Compound E from Dr. Charles H. Slocumb, the junior rheumatologist in the hospital ward of Mayo’s Clinic. On day 3 after receiving the injections she experienced gradual improvement in her pain and stiffness and on day 4 she visited other patients to show her progress. Paralyzed by her illness, she had never felt better in her life before that. A miracle happened and we have all witnessed the magic of this compound and its analogues since then. It was the dawn of the cortisone era.
This discovery of cortisone by Philip Hench and Edward Kendall with Polish chemist Tadeus Riechstein, received the Nobel Prize for Medicine and Physiology in 1950. At the same time, chemists from pharmaceutical companies manipulated cortisone like a Tinker Toy, adding, removing or substituting a part here or there to create new and ever more useful structures. Since then, cortisone and a succession of closely related synthetic analogues have remained among the most prescribed drugs in the world.
Steroids and my medical career
The long journey from resident to physician to practicing cardiologist is Butterfly’s metamorphosis experience, and this professional change – encapsulated in medical education research by the more nuanced term “transition” – is complex. It is full of challenges, not the least of which is fully accepting the mantle of a new status. This role change involves a lot of stress and as we embark on this endless journey we come across situations where we sometimes feel helpless in the face of incurable diseases such as cancer, genetic disorders, HIV, cardiomyopathies, among others. . Not being able to cure a disease, despite being the standard bearer of medicine, while putting all of our efforts into it is one of the most difficult parts of being a doctor. And in many such situations, we use corticosteroids in one form or another as part of curative or palliative regimens. I barely remember a medical specialty / subspecialty where steroids are not used. The remarkable ability of corticosteroids to reduce inflammation has made them the treatment of choice for many serious conditions, including severe asthma, flare-ups of rheumatoid arthritis and lupus, leukemia, ulcerative colitis, dermatological practice, and some. eye diseases. Successful solid organ transplants (kidney, liver and heart) would not have been possible without corticosteroids.
Medicine is a science with many probabilities and possibilities. The human body is not a laboratory and does not always produce the same result. Diseases vary in their cause and complication. Evidence-based medicine sometimes has to be refined by experience. As residents, we have witnessed the miracle of these drugs countless times: the timely administration of steroids in head and spinal injuries, brain inflammation, severe life-threatening allergic reactions (anaphylactic shock). ) and many other emergencies have literally saved lives. In my cardiology practice, I have found the use of steroids in limited but nonetheless difficult and important situations in the management of certain heart conditions. To mention a few of these disorders include rheumatic fever (usually affecting school children), amyloidosis, sarcoidosis, post-pericardiotomy syndrome and many more.
Steroids and the Covid Age
The Covid-19 pandemic is a classic of humanity against nature. This upstart from the animal kingdom finds a way somewhere in China to cross the barrier into a human host. From there it starts infecting people by the thousands and then by the millions. It’s an enigmatic foe, sometimes killing, other times causing no symptoms. Humans in skyscrapers, laboratories, and mansions are battling the clock for cures and even a cure – yet we still have only a shadow of understanding of the nature of the thing we are up against.
In an unexpected sign of hope amid the expanding pandemic, an inexpensive and commonly available drug has reduced deaths in patients with severe Covid-19, the disease caused by the coronavirus. And the saga of the search for a drug capable of changing the natural history of coronavirus disease 19 (COVID-19) has seen a new chapter: dexamethasone has emerged and has undoubtedly reduced mortality in hospitalized patients. However, before its emergence, other treatments like Hydroxychloroquine, Remdisivir, Azithromycin, Ivermectin and many more came with the promise of miraculous achievements but fell behind, remaining only side effects. and a lack of access to drugs for clinical conditions that would truly benefit from their use. Among all these molecules, Dexamethasone made the testament. Thanks to Kindell and the others for discovering the molecule in 1950 and saving humanity in the 2020s.
The dark side
Sir William Osler once said: “The person who takes medicine has to recover twice, once from the disease and once from the medicine”. Miracle drugs aren’t always that great. Like any strong remedy, corticosteroids have one downside – side effects that can sometimes be as serious as the ailments they are meant to treat.
Steroids are widely misused by doctors, charlatans, and alternative medicine practitioners because they produce a rapid response to treatment.
People sometimes demand a “quick fix” not only for the disease, but also for bodybuilding and athletic prowess. A readily available “magic bullet” of steroids gives the feeling of artificial well-being, the euphoria of steroids. Whenever events like the Asian Games or the Olympics happen, steroids make the news as there is widespread abuse to improve performance.
American director Nicholas Ray (1956) – portrayed a film about the discovery of cortisone and its consequences
“Bigger Than Life” in which a critically ill teacher becomes addicted to a “miracle” drug that begins to affect his mental health. Ray posed the question of whether 1950s domestic bliss was a farce full of cracks and involving steroids exposing and exacerbating a less than idyllic situation.
My homage to steroids as a “premature parent”
The maternal experience of a premature birth is configured as a period of crisis, an event often experienced as disappointing and dramatic. Faced with the birth of a premature child, the woman often becomes a fragile, disoriented and particularly vulnerable mother, dominated by the anguish of death and feelings of guilt. A great contribution to overcoming this agonizing and painful experience of woman and infant survival is the miraculous discovery of the role of betamethasone (a steroid analogue) by Liggins and Howie in 1972, twenty-five years after the start corticosteroids, for the prevention of the primary complications of preterm delivery and a leading cause of neonatal death and disability, respiratory distress syndrome. Since then, myriads of premature infant deaths have been prevented by accelerating the maturation of fetal lungs.
As a parent, I too have been through this difficult and painful time and am grateful for the opportunity in life that prenatal corticosteroids have given to my premature daughter, my little angel Ayzal (which means gift from Allah ). I thank God every day for my eagerness to hear that first cry, a gift from heaven to cherish love.
The first cryâ¦.
The embodiment of Happiness,
Offered as a blessing.
It is the Loneliness of pain,
It’s unbearable to win,
Like soothing music,
He heals hearts.
It is the fusion of the love of two entities,
Who gives their love an identity