How Do Steroids Cause Immunosuppression?

Glucocorticoids (GCs, “steroids”) are routinely used to induce immunosuppression in patients who have received transplants or have autoimmune diseases. However, we often see an increase in the measured white blood cell (WBC) count after steroid administration. Let’s explore this further.

Genes within the DNA genome are transcribed into messenger (mRNA), which is subsequently translated into proteins by ribosomes. Thus, steroids promote the transcription of anti-inflammatory genes while inhibiting inflammatory interleukins such as IL-1. Furthermore, mRNA that happens to be transcribed for GM-CSF, TNF, and inflammatory interleukins is rendered more unstable in the presence of steroids.

White blood cells (WBCs) normally roll along endothelial adhesion proteins (i.e., selectins) looking for infection or tissue damage signals. Upon activation, they transmigrate through the endothelium into the region of interest. Steroids degrade these adhesion proteins causing more WBCs to demarginate off the endothelial walls into free-flowing circulation. WBC trafficking from the endothelium into the tissues is therefore altered. This demargination effect, coupled with the release of immature WBCs from the bone marrow by steroids, explains why we see an apparent increase in WBC. Remember, to a large extent, the true “WBC count” hasn’t increased. They have just shifted compartments from extravascular tissues back into the plasma, where we measure their concentrations and morphologies (i.e., on a CBC).

Less trafficking of WBCs into inflamed/infected tissues + decreased proinflammatory interleukin/cytokine production + increased anti-inflammatory gene transcription = immunosuppression.

Drop me a comment with questions! 🙂

Related Articles


  1. If cortisterioid decrease inflammation, decrease immune response, then how would body heal or repair cell damage , how would fight of inflammatory agents that entered the body.

  2. I ate buff meat. It caused me severe inflammation.
    Since then no inflammation in my body heals. Even I took fish oil no effect but when I quit after a week, my inflammation raised high now my eyes have started paning. Even I eat apple after few days inflammation surge most likely rebound inflammation.
    My tongue is swollen.
    When I eat banana, I get rashes on my face and body.

    Doctor prescribed me cortisterioid.

    After stopping cortisterioid is it possible for inflammation come back.

    I read red meat contains neu5gc inflammatory molecules. Shouldn’t this be destroyed for inflammation to heal.

    If it supresses immune system, how is it gonna destroy that.

  3. I am taking steroids for disseminated eczema. It has tremendous effect +. But I fail to understand how it makes the skin shining apart from just immunosuppression. Pl explain as to a layman

  4. Can the white blood cells fight off infection just as if they are produced naturally and not through prednisone administration?

  5. And why we measure it on cytopenias, what information a WBC count can provide while taking steroids?

    Thanks for this info.


Please enter your comment!
Please enter your name here

Try EchoTools - my free, iOS ultrasonography reference application!

Latest Articles