Therapeutically targeting lymphocyte energy metabolism by high-dose glucocorticoids

Lymphocytes use a considerable amount of energy, mainly in the form of ATP, especially when they become stimulated following activation by antibodies or mitogens. Cellular respiration is the major energy source, and in quiescent cells the ATP produced is used to drive protein synthesis and sodium transport. In stimulated cells there is significantly higher ATP production to balance the higher ATP demand of specific processes resulting from activation. The major ATP-consuming processes under these conditions are protein synthesis and Na(+),K(+)-ATPase (about 20% each), while Ca(2+)-ATPase and RNA/DNA syntheses contribute about 10% each. There is a wealth of available information about glucocorticoid effects on lymphocytes, but here we focus on the extent to which this lymphocyte bioenergetic machinery is targeted by glucocorticoids when they are used therapeutically at high doses. High-dose glucocorticoids have been shown recently to interfere with processes that are essential for the activation and maintenance of lymphocytes, such as sodium and potassium transport. Therefore, in this article we describe the bioenergetics of lymphocytes in resting, activated, and glucocorticoid-treated states and present a concept for discussion to describe the relationship among these states in fundamental and clinical terms.