{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:42:58Z","timestamp":1790700178714,"version":"4.1.0"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T00:00:00Z","timestamp":1696896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"NINDS","doi-asserted-by":"crossref","award":["U54 NS115054"],"award-info":[{"award-number":["U54 NS115054"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000065","name":"ninds","doi-asserted-by":"crossref","award":["NS042685"],"award-info":[{"award-number":["NS042685"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>High-dose prednisone use, lasting several months or longer, is the primary initial therapy for myasthenia gravis (MG). Upwards of a third of patients do not respond to treatment. Currently no biomarkers can predict clinical responsiveness to corticosteroid treatment. We conducted a discovery-based study to identify treatment responsive biomarkers in MG using sera obtained at study entry to the thymectomy clinical trial (MGTX), an NIH-sponsored randomized, controlled study of thymectomy plus prednisone versus prednisone alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We applied ultra-performance liquid chromatography coupled with electro-spray quadrupole time of flight mass spectrometry to obtain comparative serum metabolomic and lipidomic profiles at study entry to correlate with treatment response at 6 months. Treatment response was assessed using validated outcome measures of minimal manifestation status (MMS), MG-Activities of Daily Living (MG-ADL), Quantitative MG (QMG) score, or a strictly defined composite measure of response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Increased serum levels of phospholipids were associated with treatment response as assessed by QMG, MMS, and the Responders classification, but all measures showed limited overlap in metabolomic profiles, in particular the MG-ADL. A panel including histidine, free fatty acid (13:0), \u03b3-cholestenol and guanosine was highly predictive of the strictly defined treatment response measure. The AUC in Responders\u2019 prediction for these markers was 0.90 irrespective of gender, age, thymectomy or baseline prednisone use. Pathway analysis suggests that xenobiotic metabolism could play a major role in treatment resistance. There was no association with outcome and gender, age, thymectomy or baseline prednisone use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>We have defined a metabolomic and lipidomic profile that can now undergo validation as a treatment predictive marker for MG patients undergoing corticosteroid therapy. Metabolomic profiles of outcome measures had limited overlap consistent with their assessing distinct aspects of treatment response and supporting unique biological underpinning for each outcome measure. Interindividual variation in prednisone metabolism may be a determinate of how well patients respond to treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0287654","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T13:25:17Z","timestamp":1696944317000},"page":"e0287654","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Serum metabolomics of treatment response in myasthenia gravis"],"prefix":"10.1371","volume":"18","author":[{"given":"Patricia","family":"Sikorski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9200-1016","authenticated-orcid":true,"given":"Yaoxiang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehar","family":"Cheema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gil I.","family":"Wolfe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5530-2140","authenticated-orcid":true,"given":"Linda L.","family":"Kusner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada","family":"Aban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8195-0141","authenticated-orcid":true,"given":"Henry J.","family":"Kaminski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"pone.0287654.ref001","doi-asserted-by":"crossref","first-page":"886625","DOI":"10.3389\/fneur.2022.886625","article-title":"Corticosteroid Treatment-Resistance in Myasthenia Gravis","volume":"13","author":"HJ Kaminski","year":"2022","journal-title":"Front Neurol"},{"issue":"6","key":"pone.0287654.ref002","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1002\/mus.23330","article-title":"Recommendations for myasthenia gravis clinical trials","volume":"45","author":"M Benatar","year":"2012","journal-title":"Muscle Nerve"},{"issue":"26","key":"pone.0287654.ref003","doi-asserted-by":"crossref","first-page":"2570","DOI":"10.1056\/NEJMra1602678","article-title":"Myasthenia Gravis","volume":"375","author":"NE Gilhus","year":"2016","journal-title":"N Engl J Med"},{"issue":"3","key":"pone.0287654.ref004","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update","volume":"96","author":"P Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"pone.0287654.ref005","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1002\/ana.410150316","article-title":"Long-term corticosteroid treatment of myasthenia gravis: Report of 116 patients","volume":"15","author":"RM Pascuzzi","year":"1984","journal-title":"Ann Neurol"},{"issue":"1","key":"pone.0287654.ref006","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1600-0404.1991.tb04899.x","article-title":"Effectiveness of steroid treatment in myasthenia gravis: a retrospective study","volume":"84","author":"V Cosi","year":"1991","journal-title":"Acta Neurol Scand"},{"issue":"1","key":"pone.0287654.ref007","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000116785","article-title":"Long-term results of corticosteroid therapy in patients with myasthenia gravis","volume":"32","author":"A Evoli","year":"1992","journal-title":"Eur Neurol"},{"issue":"6","key":"pone.0287654.ref008","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1056\/NEJMoa1602489","article-title":"Randomized Trial of Thymectomy in Myasthenia Gravis","volume":"375","author":"GI Wolfe","year":"2016","journal-title":"N Engl J Med"},{"issue":"1","key":"pone.0287654.ref009","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/mas.20108","article-title":"Mass spectrometry-based metabolomics","volume":"26","author":"K Dettmer","year":"2007","journal-title":"Mass Spectrom Rev"},{"key":"pone.0287654.ref010","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1146\/annurev.pharmtox.48.113006.094715","article-title":"Metabolomics: a global biochemical approach to drug response and disease","volume":"48","author":"R Kaddurah-Daouk","year":"2008","journal-title":"Annu Rev Pharmacol Toxicol"},{"key":"pone.0287654.ref011","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.radonc.2020.04.018","article-title":"Plasma metabolite biomarkers predictive of radiation induced cardiotoxicity","volume":"152","author":"K Unger","year":"2020","journal-title":"Radiother Oncol"},{"issue":"33","key":"pone.0287654.ref012","doi-asserted-by":"crossref","first-page":"23078","DOI":"10.18632\/oncotarget.25212","article-title":"Metabolomics based predictive classifier for early detection of pancreatic ductal adenocarcinoma","volume":"9","author":"K Unger","year":"2018","journal-title":"Oncotarget"},{"issue":"1","key":"pone.0287654.ref013","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1007\/s11306-019-1625-z","article-title":"Metabolomic profile overlap in prototypical autoimmune humoral disease: a comparison of myasthenia gravis and rheumatoid arthritis","volume":"16","author":"D Blackmore","year":"2020","journal-title":"Metabolomics: Official journal of the Metabolomic Society"},{"issue":"8","key":"pone.0287654.ref014","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s11306-019-1571-9","article-title":"Beyond the antibodies: serum metabolomic profiling of myasthenia gravis","volume":"15","author":"D Blackmore","year":"2019","journal-title":"Metabolomics: Official journal of the Metabolomic Society"},{"key":"pone.0287654.ref015","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1007\/s11306-011-0364-6","article-title":"Serum metabolomics for the diagnosis and classification of myasthenia gravis","volume":"8","author":"Y Lu","year":"2012","journal-title":"Metabolomics: Official journal of the Metabolomic Society"},{"issue":"2","key":"pone.0287654.ref016","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/mus.26910","article-title":"Correlation of Quantitative Myasthenia Gravis and Myasthenia Gravis Activities of Daily Living scales in the MGTX study","volume":"62","author":"T McPherson","year":"2020","journal-title":"Muscle Nerve"},{"issue":"2","key":"pone.0287654.ref017","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ncl.2018.01.006","article-title":"Measuring Clinical Treatment Response in Myasthenia Gravis","volume":"36","author":"C Barnett","year":"2018","journal-title":"Neurol Clin"},{"key":"pone.0287654.ref018","article-title":"MicroRNA and mRNA expression associated with ectopic germinal centers in thymus of myasthenia gravis","author":"M Sengupta","year":"2018","journal-title":"PLoS One"},{"issue":"6","key":"pone.0287654.ref019","doi-asserted-by":"crossref","first-page":"e0197435","DOI":"10.1371\/journal.pone.0197435","article-title":"Histopathology of thymectomy specimens from the MGTX-trial: Entropy analysis as strategy to quantify spatial heterogeneity of lymphoid follicle and fat distribution","volume":"13","author":"CA Weis","year":"2018","journal-title":"PLoS One"},{"issue":"3","key":"pone.0287654.ref020","doi-asserted-by":"crossref","first-page":"e450","DOI":"10.1212\/NXI.0000000000000450","article-title":"Thymectomy lowers the myasthenia gravis biomarker miR-150-5p","volume":"5","author":"CJ Molin","year":"2018","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"issue":"48","key":"pone.0287654.ref021","doi-asserted-by":"crossref","first-page":"30649","DOI":"10.1073\/pnas.2007206117","article-title":"Thymus-derived B cell clones persist in the circulation after thymectomy in myasthenia gravis","volume":"117","author":"R Jiang","year":"2020","journal-title":"Proc Natl Acad Sci U S A"},{"key":"pone.0287654.ref022","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1111\/j.1749-6632.1998.tb11015.x","article-title":"Reliability testing of the quantitative myasthenia gravis score","volume":"841","author":"RJ Barohn","year":"1998","journal-title":"Ann N Y Acad Sci"},{"issue":"1","key":"pone.0287654.ref023","article-title":"Serum galectins as potential biomarkers of inflammatory bowel diseases","volume":"15","author":"TB Yu","year":"2020","journal-title":"PLoS ONE"},{"issue":"1","key":"pone.0287654.ref024","doi-asserted-by":"crossref","first-page":"e0227069","DOI":"10.1371\/journal.pone.0227069","article-title":"Galectin-9 as a biomarker for disease activity in systemic lupus erythematosus","volume":"15","author":"N Matsuoka","year":"2020","journal-title":"PLoS One"},{"issue":"7","key":"pone.0287654.ref025","doi-asserted-by":"crossref","first-page":"e1003123","DOI":"10.1371\/journal.pcbi.1003123","article-title":"Predicting network activity from high throughput metabolomics","volume":"9","author":"S Li","year":"2013","journal-title":"PLoS Comput Biol"},{"key":"pone.0287654.ref026","doi-asserted-by":"crossref","first-page":"678753","DOI":"10.3389\/fmolb.2021.678753","article-title":"Serum Metabolite Biomarkers Predictive of Response to PD-1 Blockade Therapy in Non-Small Cell Lung Cancer","volume":"8","author":"X Nie","year":"2021","journal-title":"Front Mol Biosci"},{"issue":"7","key":"pone.0287654.ref027","doi-asserted-by":"crossref","first-page":"e102231","DOI":"10.1371\/journal.pone.0102231","article-title":"Survivin as a potential mediator to support autoreactive cell survival in myasthenia gravis: a human and animal model study","volume":"9","author":"LL Kusner","year":"2014","journal-title":"PLoS One"},{"issue":"3","key":"pone.0287654.ref028","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1089\/10966200360716634","article-title":"Cholestanol metabolism, molecular pathology, and nutritional implications","volume":"6","author":"Y. Seyama","year":"2003","journal-title":"J Med Food"},{"issue":"3","key":"pone.0287654.ref029","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s11302-016-9509-4","article-title":"Guanosine and its role in neuropathologies","volume":"12","author":"LE Bettio","year":"2016","journal-title":"Purinergic Signal"},{"issue":"5","key":"pone.0287654.ref030","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1002\/mus.21142","article-title":"Comparison of outcome measures from a trial of mycophenolate mofetil in myasthenia gravis","volume":"38","author":"Muscle Study G","year":"2008","journal-title":"Muscle Nerve"},{"key":"pone.0287654.ref031","doi-asserted-by":"crossref","first-page":"596382","DOI":"10.3389\/fneur.2020.596382","article-title":"Outcome Measures in Clinical Trials of Patients With Myasthenia Gravis","volume":"11","author":"JLS Thomsen","year":"2020","journal-title":"Front Neurol"},{"key":"pone.0287654.ref032","volume-title":"Cancer Medicine","author":"LI M","year":"2003","edition":"6"},{"issue":"11","key":"pone.0287654.ref033","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/gm395","article-title":"Assessing the metabolic effects of prednisolone in healthy volunteers using urine metabolic profiling","volume":"4","author":"S Ellero-Simatos","year":"2012","journal-title":"Genome Med"},{"issue":"1","key":"pone.0287654.ref034","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ecl.2013.10.005","article-title":"Mechanisms of glucocorticoid-induced insulin resistance: focus on adipose tissue function and lipid metabolism","volume":"43","author":"EB Geer","year":"2014","journal-title":"Endocrinol Metab Clin North Am"},{"issue":"8","key":"pone.0287654.ref035","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1007\/s00125-011-2174-9","article-title":"Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial","volume":"54","author":"DH van Raalte","year":"2011","journal-title":"Diabetologia"},{"issue":"7","key":"pone.0287654.ref036","doi-asserted-by":"crossref","first-page":"e102635","DOI":"10.1371\/journal.pone.0102635","article-title":"Serum metabolomic response of myasthenia gravis patients to chronic prednisone treatment","volume":"9","author":"Muscle Study G","year":"2014","journal-title":"PLoS One"},{"key":"pone.0287654.ref037","doi-asserted-by":"crossref","first-page":"90","DOI":"10.3389\/fimmu.2019.00090","article-title":"The Role of Glycosphingolipids in Immune Cell Functions","volume":"10","author":"T Zhang","year":"2019","journal-title":"Front Immunol"},{"key":"pone.0287654.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jnutbio.2015.11.002","article-title":"Role of lipids in the metabolism and activation of immune cells","volume":"34","author":"MJ Hubler","year":"2016","journal-title":"J Nutr Biochem"},{"key":"pone.0287654.ref039","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.coph.2016.06.005","article-title":"Bioactive lipids as modulators of immunity, inflammation and emotions","volume":"29","author":"V Chiurchiu","year":"2016","journal-title":"Curr Opin Pharmacol"},{"issue":"2","key":"pone.0287654.ref040","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1172\/JCI69571","article-title":"Normalizing glycosphingolipids restores function in CD4+ T cells from lupus patients","volume":"124","author":"G McDonald","year":"2014","journal-title":"J Clin Invest"},{"issue":"1","key":"pone.0287654.ref041","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1172\/JCI114694","article-title":"Human growth hormone prevents the protein catabolic side effects of prednisone in humans","volume":"86","author":"FF Horber","year":"1990","journal-title":"J Clin Invest"},{"issue":"1","key":"pone.0287654.ref042","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1186\/s13075-020-02264-2","article-title":"Caution in studying and interpreting the lupus metabolome","volume":"22","author":"T Zhang","year":"2020","journal-title":"Arthritis research & therapy"},{"issue":"10","key":"pone.0287654.ref043","doi-asserted-by":"crossref","first-page":"3923","DOI":"10.1210\/jc.2007-0951","article-title":"Impact of acute and chronic low-dose glucocorticoids on protein metabolism","volume":"92","author":"MG Burt","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0287654.ref044","first-page":"1","article-title":"Metabolites and metabolic pathways associated with glucocorticoid resistance in pregnant African-American women","author":"E Corwin","year":"2020","journal-title":"Compr Psychoneuroendocrinol"},{"issue":"4","key":"pone.0287654.ref045","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.ajhg.2013.08.005","article-title":"Genetic mapping with multiple levels of phenotypic information reveals determinants of lymphocyte glucocorticoid sensitivity","volume":"93","author":"JC Maranville","year":"2013","journal-title":"Am J Hum Genet"},{"issue":"3","key":"pone.0287654.ref046","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1136\/gut.45.3.382","article-title":"Predicting therapeutic outcome in severe ulcerative colitis by measuring in vitro steroid sensitivity of proliferating peripheral blood lymphocytes","volume":"45","author":"SD Hearing","year":"1999","journal-title":"Gut"},{"issue":"6","key":"pone.0287654.ref047","first-page":"821","article-title":"Response to glucocorticoid treatment in rheumatoid arthritis: in vitro cell mediated immune assay predicts in vivo responses","volume":"18","author":"BW Kirkham","year":"1991","journal-title":"J Rheumatol"},{"issue":"1","key":"pone.0287654.ref048","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1172\/JCI116963","article-title":"Steroid-resistant asthma. Cellular mechanisms contributing to inadequate response to glucocorticoid therapy","volume":"93","author":"ER Sher","year":"1994","journal-title":"J Clin Invest"},{"issue":"8","key":"pone.0287654.ref049","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1111\/ene.13040","article-title":"GR gene polymorphism is associated with inter-subject variability in response to glucocorticoids in patients with myasthenia gravis","volume":"23","author":"Y Xie","year":"2016","journal-title":"Eur J Neurol"},{"issue":"1","key":"pone.0287654.ref050","doi-asserted-by":"crossref","first-page":"17092","DOI":"10.1038\/s41598-017-17220-5","article-title":"Plasma metabolomic profile varies with glucocorticoid dose in patients with congenital adrenal hyperplasia","volume":"7","author":"MA Alwashih","year":"2017","journal-title":"Sci Rep"},{"key":"pone.0287654.ref051","doi-asserted-by":"crossref","DOI":"10.7554\/eLife.62236","article-title":"Identification of human glucocorticoid response markers using integrated multi-omic analysis from a randomized crossover trial","volume":"10","author":"D Chantzichristos","year":"2021","journal-title":"Elife"},{"issue":"1","key":"pone.0287654.ref052","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.ekir.2019.09.010","article-title":"Predicting and Defining Steroid Resistance in Pediatric Nephrotic Syndrome Using Plasma Metabolomics","volume":"5","author":"JR Gooding","year":"2020","journal-title":"Kidney Int Rep"},{"issue":"3","key":"pone.0287654.ref053","doi-asserted-by":"crossref","first-page":"1870","DOI":"10.4049\/jimmunol.1002275","article-title":"IL-1beta is overexpressed and aberrantly regulated in corticosteroid nonresponders with autoimmune inner ear disease","volume":"186","author":"S Pathak","year":"2011","journal-title":"J Immunol"},{"issue":"3","key":"pone.0287654.ref054","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1517\/17425255.2014.878703","article-title":"Cytochrome P450 enzyme regulation by glucocorticoids and consequences in terms of drug interaction","volume":"10","author":"P Matoulkova","year":"2014","journal-title":"Expert Opin Drug Metab Toxicol"},{"issue":"8","key":"pone.0287654.ref055","doi-asserted-by":"crossref","first-page":"2280","DOI":"10.1172\/JCI26283","article-title":"Mutual repression between steroid and xenobiotic receptor and NF-kappaB signaling pathways links xenobiotic metabolism and inflammation","volume":"116","author":"C Zhou","year":"2006","journal-title":"J Clin Invest"},{"issue":"2","key":"pone.0287654.ref056","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1038\/tpj.2011.55","article-title":"Inter-ethnic differences in lymphocyte sensitivity to glucocorticoids reflect variation in transcriptional response","volume":"13","author":"JC Maranville","year":"2013","journal-title":"Pharmacogenomics J"},{"issue":"8","key":"pone.0287654.ref057","doi-asserted-by":"crossref","DOI":"10.3390\/metabo9080164","article-title":"Metabolomics-Based Studies Assessing Exercise-Induced Alterations of the Human Metabolome: A Systematic Review","volume":"9","author":"CA Sakaguchi","year":"2019","journal-title":"Metabolites"},{"issue":"4","key":"pone.0287654.ref058","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1080\/14789450.2020.1772059","article-title":"The potential for metabolomics in the study and treatment of major depressive disorder and related conditions","volume":"17","author":"J Duan","year":"2020","journal-title":"Expert Rev Proteomics"},{"issue":"10","key":"pone.0287654.ref059","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/ncprheum0898","article-title":"Genomic and nongenomic effects of glucocorticoids","volume":"4","author":"C Stahn","year":"2008","journal-title":"Nat Clin Pract Rheumatol"},{"key":"pone.0287654.ref060","doi-asserted-by":"crossref","first-page":"31727","DOI":"10.1038\/srep31727","article-title":"Serum pharmacodynamic biomarkers for chronic corticosteroid treatment of children","volume":"6","author":"Y Hathout","year":"2016","journal-title":"Sci Rep"},{"key":"pone.0287654.ref061","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.steroids.2018.10.008","article-title":"Serum biomarkers of glucocorticoid response and safety in anti-neutrophil cytoplasmic antibody-associated vasculitis and juvenile dermatomyositis","volume":"140","author":"LS Conklin","year":"2018","journal-title":"Steroids"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0287654","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T13:25:55Z","timestamp":1696944355000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0287654"}},"subtitle":[],"editor":[{"given":"Anil","family":"Bhatia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,10,10]]},"references-count":61,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0287654","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,10]]}}}