UK-based hormone specialist Miguel Debono. Photo: Matthew Mirabelli

Steroids have been used to treat inflammatory diseases like asthma and arthritis but research by a Maltese doctor may yet deliver drugs without nasty side effects.

Miguel Debono, a UK-based hormone specialist, says prolonged steroid use or the administration of high doses may result in side effects including bone disease with an increased risk of fractures, heart disease and diabetes.

Some patients are also at an increased risk of developing infections as steroids used in excessive amounts suppress the body’s immune system.

While doctors have been using steroids for six decades to help improve patients’ quality of life, it is the concerns linked to the side effects that prompted Dr Debono’s research.

Having just completed his PhD at the University of Sheffield, Dr Debono’s research focused on steroids and the management of steroid-related diseases.

He wanted to identify new strategies to restore steroid levels in a way that mirror natural steroid production in the body.

Steroids are produced by the adrenal glands – the scientific jargon for them is glucocorticoids or corticosteroids – and are unlike the performance-enhancing anabolic steroids used by some athletes.

Naturally occurring steroids are essential to help the body overcome stressful situations but they also regulate metabolism, suppress inflammation and maintain blood pressure.

Some patients suffer from steroid deficiency that causes fatigue, depression and an inability to work. It can also be fatal if left untreated by steroid replacement therapy.

“There is an unmet need to try to improve the management of patients who lack cortisol production or produce cortisol in excess and also to develop new formulations of steroids to treat multiple inflammatory conditions effectively but with lesser side effects,” Dr Debono argues.

It is estimated that steroids are prescribed in around one per cent of the population.

He explains that if given at the right time, and at the smallest effective dose, steroid medication may potentially have fewer side effects.

It is all about trying to find drugs that mimic the body’s natural hormone rhythms controlled by the central clock in the brain, Dr Debono adds.

The research is being tested on patients in the UK and US and the process is expected to last approximately two or three years. The drugs may be available commercially in the next four years and initial results are very encouraging.

“These treatments could offer a better life to patients with abnormal levels of cortisol,” he says, adding that the many patients in Malta who are on steroids could potentially benefit from progress in this area.

It is estimated that steroids are prescribed in around one per cent of the population

But Dr Debono is also researching rare medical disorders such as Addison’s disease, caused by a deficiency of steroids, and Cushing’s syndrome, a result of excess steroid production.

By studying these conditions he has come up with new treatments that may help the millions of patients who take steroids for any condition thus improving their quality of life and reducing mortality.

Dr Debono’s research has led to his appointment as a clinical lecturer at the University of Sheffield where he will collaborate with other universities to continue expanding steroid related research programmes.

The doctor travelled to the UK seven years ago after completing his training at St Luke’s Hospital. He successively obtained a National Institute of Health Research (NIHR) Academic Clinical Fellowship in endocrinology and diabetes.

The post is reserved for individuals who show outstanding potential for a career in academic medicine and integrates specialist clinical training with research education.

It was the start of a career path that saw Dr Debono establishing himself in endocrinology presenting his work on steroids in national and international conferences and working alongside world experts, including Professor Richard Ross and Dr John Newell-Price.

Reflecting on the research programme that helped him develop his career, Dr Debono says the UK health service benefitted a lot when the NIHR was set up in 2006.

The health service shifted its strategy to develop and support research that benefited patients, he says. “It was a cost-effective solution for the State as the programme created a number of fellowship posts that combined clinical work with academic research.” It is a story Dr Debono would like to see repeated in Malta. He believes the University of Malta could benefit much more through collaborations with foreign universities to enhance research that will benefit patients.

“The Maltese medical profession enjoys a strong reputation among foreign counterparts but compared to other EU states, research in Malta is at its roots. The time has come to focus our strengths on this aspect of academia which is so stimulating, exciting and rewarding and can have a huge positive impact on the economy of the island,” he says.

ksansone@timesofmalta.com