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Methylprednisolone and Me, a Love/Hate Relationship (#1)

Posted by Frederick Wasti
May 28 2012

Yes, I did spell this entry's title correctly - "Methylprednis-OL-one", and not "Methylprednisone". Technically, these two names belong to two molecules very slightly different from each other, and it is Methylprednisolone that I'm being given at my Dana-Farber trial, even though, up to now, I've tended to use the slightly easier to say and slightly faster to type "Methylprednisone" in this blog. (In fact, I just Googled "methylprednisone site:leukos.us" and "methylprednisolone site:leukos.us", to learn that I've used the shorter name perhaps a dozen times, and the longer name just once, and the latter was just as part of a quotation.)

(And, speaking of the title, "Methylprednisolone and Me, a Love/Hate Relationship", yes, I do know that, grammatically, it should really be "Methylprednisolone and ~I~", but "Methylprednisolone and Me" is so much more alliterative - <grin>.) (And, yes, "Methylprednisone and Me" is easier to say than is "Methylprednisolone and Me", but I'm going to use the correct name from now on.)

Interestingly, one can use Google to prove that there is some popular confusion over whether Methylprednisone and Methylprednisolone are the same chemical or not. If you were to Google "Methylprednisone Methylprednisolone", you would get some search hits that state that "methylprednisone is a common misspelling of methylprednisolone" (and the Google results page would even ask you, "Did you mean: Methylprednisolone Methylprednisolone" (see the image above), as if you had spelled Methylprednisolone incorrectly, and as if you had ~really~ meant to type the exact same word ~twice~ in a row - <grin>).

However, your Google search would also produce hits that lead to scientific papers about "analysis of methylprednisolone and methylprednisone", and "bioavailability and nonlinear disposition of methylprednisolone and methylprednisone", and "interconversion of methylprednisolone and methylprednisone", all of which would suggest that the two words are not merely names for the same molecule, but are names for two different molecules (even if they are closely related, as the phrase "interconversion of methylprednisolone and methylprednisone" might suggest).

Also interestingly, even the clinical trial I am participating in, "Ofatumumab With High Dose Methylprednisone Followed by Ofatumumab and Alemtuzumab in 17p CLL", uses "Methylprednisone" once, in the trial's title, but then uses "Methylprednisolone" within the trial's description about a dozen times.

However, they ~are~ indeed different molecules - Methylprednisone has a molecular formula of C22 H28 O5 while, for Methylprednisolone, it is C22 H30 O5.

But I digress...

Today I am going to use the proper name of "Methylprednisolone", and I will note that this should, at least partly, be out of respect, because that is the name of one of the drugs that is helping to save my life (or at least helping to extend it a bit).

Let me try to explain what Methylprednisolone is, and then why it should be helping me:

First, I would like to point out that, yes, Methylprednisolone is a steroid, but it is not one of "those" steroids. That is to say, the steroids I will be discussing here are known as glucocorticoids and mineralocorticoids, and have nothing to do with the anabolic steroids as used by some athletes.

The terms "glucocorticoid" and "mineralocorticoid" are used for several different steroid hormones naturally produced by the cortex (i.e., the outer layer) of the adrenal glands. In the picture below you can see where the adrenals are located (and also ~why~ they are so named - "adrenal" comes from the Latin words "ad", meaning "near", and "ren" meaning "kidney"):

There are two layers of glandular tissue in each adrenal gland - there is an inner medulla area and an outer cortex area. The medulla secretes Adrenaline (a.k.a. Epinephrine) and Noradrenaline (a.k.a. Norepinephrine). The cortex secretes a number of hormones, of which Aldosterone and Hydrocortisone (a.k.a. Cortisol) are a couple of examples.

[Please note that I am going to use a few images of structural formulas below. Please try to avoid getting bogged down in their details, but instead just please notice that their structures show an interesting similarity, but that they also show differences that are related to how they each differ in function.] [An apology (sort of): Having been a science person and science educator for most of my adult life, and, most specifically, having taught Human Anatomy and Physiology at both the high school and college levels for a couple of decades late last century, it is difficult for me to spend many hours now each week being pumped full of chemicals without me also thinking a lot about those chemicals.] [<grin>]

Aldosterone (above) is the principal mineralocorticoid hormone - it controls water and mineral balance in the body. (The term "mineralocorticoid" denotes that Aldosterone is a sterOID produced by the adrenal CORTex that affects MINERALs.)

Hydrocortisone (above) is one of several glucocorticoids secreted by the adrenal cortex, and is a hormone that has a variety of important functions throughout the body:

Metabolic functions of Hydrocortisone, which do affect ~every~ single individual cell in the body, include the buildup and breakdown of food molecules, including fats, sugars, and amino acids. Among other things, Hydrocortisone tends to counteract insulin - while insulin decreases the level of glucose in the blood and increases glucose within body cells, Hydrocortisone does the opposite. (The term "glucocorticoid" is used for hormones such as Hydrocortisone, which are sterOIDs produced by the adrenal CORTex that affect GLUCOse utilization.)

Important immunological functions of Hydrocortisone include regulating the number and functioning of certain white blood cells and the control of inflammation throughout the body. There are many (perhaps dozens of) other functions for Hydrocortisone, too many to mention here (and I'm betting that you're probably glad of that - <grin>).

And that brings me back to Methylprednisolone:

Methylprednisolone is a synthetic glucocorticoid that acts just like Hydrocortisone, except that it is more powerful and more long-lasting in its effects: Compared to Hydrocortisone, Methylprednisone is 5 to 7.5 times more potent, gram per gram. And then, while the half-life of Hydrocortisone (the length of time that one-half of the original dose is still active in the body) is 8 hours, the half-life of Methylprednisolone is between 18 and 40 hours.

So, in my clinical trial, I am being given HDMP (high-dose Methylprednisolone), or, as can be seen above, high doses of what might be called "Super-hydrocortisone". (And I also receive small doses of Methylprednisolone before receiving Ofatumumab.) Not surprisingly, Methylprednisolone has had (and is having) significant effects on my body, some of them good (of course - else why would I be taking it? - <grin>), and some not so good. I'll discuss these effects (both the intended benefits and the "collateral damage" side effects) soon...

[By the way, if you're at all curious about the structural relationships between the various cortical steroid molecules, there's an excellent graphic of this on Wikipedia at This Link.]

Categories: Leukemia