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Wang and colleagues have investigated a mechanistic basis for resistance to steroid therapy in systemic lupus erythematosus patients. Their examination reveals significant differences in macrophage migration inhibitory factor (MIF)-dependent expression of IκB, which is a critical cellular regulator of the broadly proinflammatory transcription factor NF-κB. Their studies also suggest that MIF may be a clinically useful biomarker in systemic lupus erythematosus and support the therapeutic targeting of MIF as a means to reduce clinical steroid resistance.

Approaching the immunophysiology of steroid resistance