C11
Chemistry 151
Whitesell
The Provisional Progress of Prednisone
“This is my family, minus one. I know, I know… ‘Mitch is still with us.’ But he
is not. Not the way he used to be and not the way I want him to be. And for those
who grieve, absence is all that matters. Absence is why we grieve.”
As Mitchell’s mother glanced over a family portrait, tears rolled down her
cheek, her heart aching over the loss of her youngest son. In due time, she did not
sulk anymore as slowly but surely, she turned her grief into determination. She
made it a personal goal to share her story to the world: the tearful retellings
reiterated her family’s hardships, strife and ultimate loss. Why? As an effort to
educate the public about a horrid disease that took her son’s life in 2013: Duchenne
Muscular Dystrophy. Diagnosed in 2005, the prognosis of Mitchell’s disease was to
be wheelchair-bound for the next four to five years. However, Duchenne Muscular
Dystrophy (abbreviated DMD) is known to be the irreversible deterioration of one’s
muscles. The disease is progressive over time and ultimately terminal. Although
Mitchell passed away last year at the age of ten, his family still continues to make a
valiant effort in order to raise awareness for this rare disease, hoping other families
will be blessed with a cure.
There is no known cure for Duchenne Muscular Dystrophy, yet one drug has
been proven to be very effective with minimal side effects. Prednisone is a
corticosteroid better known as its brand names Deltasone® or PredniSONE
Intensol®. It is the most commonly prescribed oral corticosteroid, known for its
variety of medical uses against a wide range of diseases and health conditions which
include asthma, rheumatic disorders, allergy reactions, Crohn’s disease, laryngitis,
multiple sclerosis, lupus, and much more. Corticosteroids represent a class of
chemicals including a steroid hormone that may be naturally produced in the body.
They have similar chemical mechanisms in the human body and mimic the effects of
hormones the human body produces naturally in the adrenal glands. When
prescribed in doses that exceed one’s body's typical levels, Prednisone has the
ability to suppress one’s own immune system, resulting in a patient being less prone
to infections. This aids in the control of conditions in which an immune system
mistakenly attacks its own tissues, thinking it to be a threat. This universal drug is
particularly effective as an immunosuppressant and its effects vary based upon the
dosage amount given to the patient (ranging from lower doses to treat mild allergic
reactions to higher doses to treat certain types of cancer).
Deltasone 20mg Tablet and PredniSONE Intensol Oral Solution
Two-Dimensional and Three-Dimensional Structures of Prednisone
In 1950, Arthur Nobile completed the very first isolation and structure
identification of prednisone and prednisolone. However, it was not until five years
later that the laboratories of Schering Corporation began to commercially produce
Prednisone, by Nobile himself along with his team of chemists. After discovering the
oxidative use of the bacterium Corynebacterium simplex, Nobile and his team were
able to synthesis prednisone from cortisone, which is the exact same process used
to synthesize prednisolone (active form of prednisone) from hydrocortisone. In
1955, Schering Corporation first introduced prednisone under its brand name DeltaCortef, serving as a replacement to cortisone. In 1948 when cortisone was first
discovered to regenerate muscle movement in crippled patients, the “miracle drug”
had harmful side effects when taken in large doses. Therefore, prednisone was
utilized as a corticosteroid in high doses at a short period of time, in order to
decrease the risks of dangerous side effects.
The FDA first approved prednisone in 1955. It is prescribed to Duchenne
Muscular Dystrophy patients in its pill or tablet form to be taken orally multiple
times a day for a few weeks. This high dose is intended to reduce inflammation in
the body. Prednisone has minimal side effects, dependent on how high or low the
dosage prescribed to the patient. Common side effects are excess stomach acid
secretion, trouble sleeping, increased hunger, and anxiety. Infrequent side effects of
this drug include small red skin lesions, irregular periods, dry skin, puffy face (from
water retention) and high blood sugar. Additional infrequent side effects may cause
severe conditions such as osteoporosis, diabetes, and Cushing’s Syndrome. Although
severe, these conditions are very rare and unlikely to occur.
Relative to hydrocortisone, prednisone is about four times as potent as a
glucocorticoid, which control cortisol levels in the body. Prednisone is an
intermediate between hydrocortisone and dexamethasone in duration of action.
Although the exact chemical mechanism of how prednisone works in one’s body, it
is known that prednisone is rapidly absorbed across the gastrointestinal membrane
following oral administration. Peak effects can be observed after one to two hours.
The circulating drug binds extensively to the plasma proteins: albumin and
transcortin, with only the unbound portion of a dose active. Systemic prednisone is
quickly distributed into the kidneys, intestines, skin, liver and muscle. The drug is
metabolized in the liver to its active form, prednisolone.
Two-Dimensional and Three-Dimensional Structures of Prednisolone
The active metabolite, prednisolone, is then further metabolized to inactive
compounds. These inactive metabolites, as well as a small portion of unchanged
drug, are excreted in the urine. The plasma elimination half-life is one hour whereas
the biological half-life of prednisone is eighteen to thirty-six hours. Blood muscle
enzymes tend to return to normal about four to six weeks after treatment starts.
Patients aim to regain muscle strength in two to three months.
Despite the fact that there is still no cure for Duchenne Muscular Dystrophy,
Prednisone has a lot of potential to improve the lives of many. It is unfortunate for
his family that Mitchell could not be saved. Yet may his young soul and his
everlasting story still live on. If prednisone was discovered from basis of cortisone,
there is high hope that another molecular discovery, branching from prednisone,
may serve as a better medicine with lesser side effects. Prednisone is only the start
of a new medicinal era where diseases such as Duchenne Muscular Dystrophy do
not stand a chance.
Works Cited:
"All about Prednisone." Prednisone by Schein. NoAirToGo, 3 Aug. 2007. Web. 22 Feb.
2014.
Fusco, Robert D. "All About Prednisone." GI Health. GI Health, n.d. Web. 23 Feb.
2014.
"Mitchell's Journey." Facebook. N.p., n.d. Web. 23 Feb. 2014.
"Myopathy Treatment." Myopathies. Remedy Health Media, 14 Sept. 2010. Web. 22
Feb. 2014.
"Prednisone and Other Corticosteroids." Mayo Clinic. Mayo Foundation for Medical
Education and Research, 1 Dec. 2012. Web. 22 Feb. 2014.
"Prednisone." PubChem Compound. U.S. National Library of Medicine, n.d. Web. 23
Feb. 2014.
The Role of Corticosteroids in Muscular Dystrophy." Action Duchenne. Action
Duchenne 2014, n.d. Web. 22 Feb. 2014.