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Broesby-Olsen S, Farkas DK, Vestergaard H, Hermann AP, Møller MB, Mortz CG, Kristensen TK, Bindslev-Jensen C, Sørensen HT, Frederiksen H. Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis: A nationwide population-based study. Am J Hematol 2016; 91:1069-1075. [PMID: 27428296 DOI: 10.1002/ajh.24490] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 01/08/2023]
Abstract
In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997-2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer, venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9-2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4-16.3). Specifically, we found a HR of 7.5 (95% CI 4.4-13.0) for melanoma and a HR of 2.5 (95% CI 1.7-3.5) for non-melanoma skin cancers (NMSCs). For VTE we found a HR of 1.9 (95% CI 1.2-3.0), with a 10-year AR of 3.9% (95% CI 2.3-6.1); for MI a nonsignificant increased HR of 1.4 (95% CI 0.9-2.3), with a 10-year AR of 1.8% (95% CI 0.9-3.2); and for stroke a HR of 1.6 (95% CI 1.1-2.3) with a 10-year AR of 4.6% (95% CI 2.8-6.9). The HR for anaphylaxis was 7.2 (95% CI 5.3-9.9), and the 10-year AR was 3.1% (95% CI 1.9-4.9). For osteoporosis the HR was 3.6 (95% CI 2.7-4.6) with a 10-year AR of 7.2% (95% CI 5.2-9.8). For fractures the HR was 1.2 (95% CI 0.9-1.6) and the 10-year AR was 5.9% (95% CI 3.9-8.4). SM patients are at increased risk of solid cancers - especially melanoma and NMSC-and cardiovascular disease. The risk of anaphylaxis and osteoporosis is clearly increased in SM, though absolute risk was low in this population-based study. The fracture-risk was only slightly increased. Am. J. Hematol. 91:1069-1075, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
| | | | - Hanne Vestergaard
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
- Department of Haematology; Odense University Hospital; Odense Denmark
| | - Anne Pernille Hermann
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
- Department of Endocrinology; Odense University Hospital; Odense Denmark
| | - Michael Boe Møller
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
- Department of Pathology; Odense University Hospital; Odense Denmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
| | - Thomas Kielsgaard Kristensen
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
- Department of Pathology; Odense University Hospital; Odense Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
| | | | - Henrik Frederiksen
- Mastocytosis Centre, Odense University Hospital (MastOUH); Odense Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Denmark
- Department of Haematology; Odense University Hospital; Odense Denmark
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Abstract
Systemic Mastocytosis (SM) is characterized by accumulation of clonal, neoplastic proliferations of abnormal mast cells (MC) in one or more organ system other than skin. Presence of these multifocal clusters of abnormal mast cells is an essential feature of SM. Frequently associated with D816V (KIT) mutation, the presence of this mutation and elevated serum tryptase are minor criteria for diagnosis. SM manifestations depend on the degree of mast cell proliferation, activation and degranulation. SM has a variable prognosis and presentation, from indolent to "smoldering" to life-threatening disease. Bone manifestations of SM include: osteopenia with or without lytic lesions, osteoporosis with or without atraumatic fracture, osteosclerosis with increased bone density, and isolated lytic lesions. Male sex, older age, higher bone resorption markers, lower DKK1 level, lower BMD, absence of urticaria pigmentosa, and alcohol intake are all associated with increased risk of fracture. Treatment of SM is generally palliative. Most therapy is symptom-directed; and, infrequently, chemotherapy for refractory symptoms is indicated. Anti-histamines may alleviate direct bone effects of histamine. Bisphosphonates, including alendronate, clodronate, pamidronate and zoledronic acid are recommended as a first line treatment of SM and osteoporosis. Interferon α may act synergistically with bisphosphonates. As elevation of RANKL and OPG is reported in SM, denosumab could be an effective therapy for bone manifestations of SM.
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Affiliation(s)
- Loren Wissner Greene
- Department of Medicine, Division of Endocrinology, and ObGyn, NYU School of Medicine, 650 First Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Kamyar Asadipooya
- Department of Medicine, Division of Endocrinology, NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Patricia Freitas Corradi
- Department of Medicine, Division of Endocrinology, NYU School of Medicine, c/o Ira Goldberg, MD 522 First Avenue, Smilow 901, New York, NY, 10016, USA
| | - Cem Akin
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, One Jimmy Fund Way, Room 616D, Boston, MA, 02115, USA
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Rossini M, Zanotti R, Orsolini G, Tripi G, Viapiana O, Idolazzi L, Zamò A, Bonadonna P, Kunnathully V, Adami S, Gatti D. Prevalence, pathogenesis, and treatment options for mastocytosis-related osteoporosis. Osteoporos Int 2016; 27:2411-21. [PMID: 26892042 DOI: 10.1007/s00198-016-3539-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 02/11/2016] [Indexed: 12/20/2022]
Abstract
Mastocytosis is a rare condition characterized by abnormal mast cell proliferation and a broad spectrum of manifestations, including various organs and tissues. Osteoporosis is one of the most frequent manifestations of systemic mastocytosis, particularly in adults. Osteoporosis secondary to systemic mastocytosis is a cause of unexplained low bone mineral density that should be investigated when accompanied by suspicious clinical elements. Bone involvement is often complicated by a high recurrence of fragility fractures, mainly vertebral, leading to severe disability. The mechanism of bone loss is the result of different pathways, not yet fully discovered. The main actor is the osteoclast with a relative or absolute predominance of bone resorption. Among the stimuli that drive osteoclast activity, the most important one seems to be the RANK-RANKL signaling, but also histamine and other cytokines play a significant role in the process. The central role of osteoclasts made bisphosphonates, as anti-resorptive drugs, the most rational treatment for bone involvement in systemic mastocytosis. There are a few small studies supporting this approach, with large heterogeneity of drug and administration scheme. Currently, zoledronate has the best evidence in terms of gain in bone mineral density and bone turnover suppression, two surrogate markers of anti-fracture efficacy.
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Affiliation(s)
- M Rossini
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy.
| | - R Zanotti
- Hematology Section, Department of Medicine, University of Verona, Verona, Italy
| | - G Orsolini
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - G Tripi
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - O Viapiana
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - L Idolazzi
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - A Zamò
- Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - P Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - V Kunnathully
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - S Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
| | - D Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Policlinico Borgo Roma, Piazzale Scuro, 10, 37134, Verona, Italy
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Ble C, Tsitsopoulos PP, Anestis DM, Hadjileontiadou S, Koletsa T, Papaioannou M, Tsonidis C. Osteoporotic spinal burst fracture in a young adult as first presentation of systemic mastocytosis. J Surg Case Rep 2016; 2016:rjw063. [PMID: 27141048 PMCID: PMC4852953 DOI: 10.1093/jscr/rjw063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Osteoporotic vertebral fractures are uncommon in young adults and usually indicate an underlying disease. Systemic mastocytosis is a myeloproliferative neoplasm, which can be associated with osteoporosis. A previously healthy 30-year-old man presented with an L4 burst fracture after lifting a heavy object. He was operated with laminectomy and posterior lumbar instrumentation. During surgery, abnormally soft bone was noted. Postoperatively, osteoporosis was confirmed with measurement of bone mineral density. Further investigation revealed elevated serum tryptase levels while bone marrow biopsy findings showed systemic mastocytosis. He was also tested positive for D816V KIT mutation. Treatment with biphosphonates and interferon was initiated. No extraskeletal involvement was noted up to the last checkup, 18 months after the first presentation. Abrupt vertebral fractures in apparently healthy young individuals should raise the suspicion of an underlying pathology. Prompt identification and treatment of systemic mastocytosis is crucial in order to avoid unexpected sequelae.
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Affiliation(s)
- Christina Ble
- Department of Neurosurgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Parmenion P Tsitsopoulos
- Department of Neurosurgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios M Anestis
- Department of Neurosurgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Hadjileontiadou
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllia Koletsa
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Papaioannou
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Tsonidis
- Department of Neurosurgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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55
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Carrasco Cubero C, Chamizo Carmona E. Multiple vertebral fractures in young man as first manifestation of systemic mastocytosis. ACTA ACUST UNITED AC 2016; 13:107-109. [PMID: 26975512 DOI: 10.1016/j.reuma.2016.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 10/22/2022]
Abstract
Systemic mastocytosis (SM) is a clonal disease of mast cell progenitors from the bone marrow. The clinical picture varies from asymptomatic forms (indolent) to a highly aggressive form with a very short (mast cell leukemia) survival. Between 28-34% of patients with SM are related to bone condition at the time of diagnosis and 16% have symptomatic fractures. The presentation of SM as clinical vertebral fractures in young men is rare. Here, we describe a case of established osteoporosis as the only manifestation of SM.
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Affiliation(s)
- Carmen Carrasco Cubero
- Servicio de Reumatología, Complejo Hospitalario Universitario de Badajoz, Hospital Perpetuo Socorro, Badajoz, España.
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56
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Aasarød KM, Stunes AK, Mosti MP, Ramezanzadehkoldeh M, Viggaklev BI, Reseland JE, Skallerud BH, Fossmark R, Syversen U. Effects of the Histamine 1 Receptor Antagonist Cetirizine on the Osteoporotic Phenotype in H(+) /K(+) ATPase Beta Subunit KO Mice. J Cell Biochem 2016; 117:2089-96. [PMID: 26869358 DOI: 10.1002/jcb.25514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/09/2016] [Indexed: 12/14/2022]
Abstract
Epidemiological studies suggest increased fracture risk in patients using proton pump inhibitors (PPIs). We have previously shown that the H(+) /K(+) ATPase beta subunit knockout (KO) mouse, which is a model of PPI-use, have lower bone mineral density (BMD) and impaired bone quality compared to wild type (WT) mice. Like PPI users, these KO mice display elevated gastric pH and hypergastrinemia, which in turn stimulates gastric histamine release. Previous studies have suggested a negative effect of histamine on bone, thus, we wanted to study whether a histamine 1 receptor (H1R) antagonist could improve bone quality in KO mice. Female KO and WT mice aged 8 weeks received either an H1R antagonist (cetirizine) or polyethylene glycol (PEG) for 6 months. At the end of the study, KO mice displayed elevated plasma histamine levels compared to WT. As demonstrated previously, the KO mice also exhibited lower whole body BMD, reduced mechanical bone strength, and impaired bone quality assessed by μCT. No significant differences, however, were found between the KO groups receiving cetirizine or PEG for any of the measured bone parameters. In vitro gene expression analyses of histamine receptors revealed the presence of H1R and H2R both in osteoblasts and osteoclasts, and H3R in late stage osteoblasts. In conclusion, administration of the H1R antagonist cetirizine in a concentration of 3 mg/kg did not rescue the osteoporotic phenotype in H(+) /K(+) ATPase beta subunit KO mice. It can, however, not be ruled out that histamine may influence bone via other receptors. J. Cell. Biochem. 117: 2089-2096, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Kristin M Aasarød
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - Astrid K Stunes
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - Mats P Mosti
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | | | - Bjørn I Viggaklev
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway
| | - Janne E Reseland
- Department of Biomaterials, Institute for Clinical Dentistry, University of Oslo, Oslo, Norway
| | | | - Reidar Fossmark
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Gastroenterology and Hepatology, St. Olav's Hospital, Trondheim, Norway
| | - Unni Syversen
- Department of Cancer Research and Molecular Medicine, NTNU, Trondheim, Norway.,Department of Endocrinology, St. Olav's Hospital, Trondheim, Norway
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57
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Azaña J, Torrelo A, Matito A. Update on Mastocytosis (Part 1): Pathophysiology, Clinical Features, and Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Azaña JM, Torrelo A, Matito A. Update on Mastocytosis (Part 1): Pathophysiology, Clinical Features, and Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:5-14. [PMID: 26546030 DOI: 10.1016/j.ad.2015.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/25/2015] [Accepted: 09/12/2015] [Indexed: 12/20/2022] Open
Abstract
Mastocytosis is a term used to describe a heterogeneous group of disorders characterized by clonal proliferation of mast cells in various organs. The organ most often affected is the skin. Mastocytosis is a relatively rare disorder that affects both sexes equally. It can occur at any age, although it tends to appear in the first decade of life, or later, between the second and fifth decades. Our understanding of the pathophysiology of mastocytosis has improved greatly in recent years, with the discovery that somatic c-kit mutations and aberrant immunophenotypic features have an important role. The clinical manifestations of mastocytosis are diverse, and skin lesions are the key to diagnosis in most patients.
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Affiliation(s)
- J M Azaña
- Servicio de Dermatología, Complejo Hospitalario Universitario, Albacete, España.
| | - A Torrelo
- Servicio de Dermatología, Hospital del Niño Jesús, Madrid, España
| | - A Matito
- Instituto de Estudios de Mastocitosis de Castilla La Mancha, Hospital Virgen del Valle, Toledo, España
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59
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Systemic Mastocytosis: Clinical Update and Future Directions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:728-38. [PMID: 26382091 DOI: 10.1016/j.clml.2015.07.644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 12/20/2022]
Abstract
Systemic mastocytosis (SM) is defined as the accumulation of abnormal mast cells (MC) in 1 or more extracutaneous tissues. Symptoms are due to either MC activation or organ infiltration and vary depending on disease subtype. More benign forms of SM, such as indolent SM, result in a life expectancy similar to the general population, while more aggressive subtypes, such as MC leukemia (MCL), have a median survival measured on the order of months. Treatment of indolent SM is directed at controlling the symptoms associated with MC activation. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as KIT tyrosine kinase inhibitors, cladribine, and thalidomide may be provided. Newer agents based on preclinical rationale are also being actively investigated. However, the only potentially curative therapy for aggressive SM/MCL remains hematopoietic stem cell transplantation. Given that SM is a relatively rare disease, clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous condition. Here we seek to familiarize clinicians with this orphan disease and review current and future treatment approaches.
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60
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Beck-Broichsitter BE, Werk AN, Smeets R, Gröbe A, Heiland M, Cascorbi I, Wiltfang J, Häsler R, Becker ST. Targeting gene expression during the early bone healing period in the mandible: A base for bone tissue engineering. J Craniomaxillofac Surg 2015; 43:1452-60. [PMID: 26189147 DOI: 10.1016/j.jcms.2015.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/21/2015] [Accepted: 06/16/2015] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Although bone tissue engineering techniques have become more and more sophisticated than in the past, natural bone healing mechanisms have not been sufficiently considered for further improvement of these techniques so far. We used an established animal model with transcriptome analysis to generate an unbiased picture of early bone healing to support tissue engineering concepts. MATERIAL AND METHODS In 30 Wistar rats, a 3-mm bone defect was created in the mandibular angle. Tissue was sampled at 5, 10, and 15 days, and the former defect area was excised to undergo transcriptome analysis after RNA extraction. Five differentially expressed genes were further evaluated with reverse transcription-polymerase chain reaction (rt-PCR). RESULTS Transcriptome analysis revealed 2467 significantly over- and under-expressed transcripts after 5 days and 2265 after 15 days of bone healing, respectively. Validation via rt-PCR confirmed overexpression of osteoactivin, angiopoietin-like factor-4, and metallomatrix proteinase-9 and underexpression of mastcellprotease-10 and proteoglycane-2 in comparison to values in the control group. CONCLUSION This systematic genome-wide transcriptome analysis helps to decipher the physiological mechanisms behind physiological bone healing. The exemplary depiction of 5 genes demonstrates the great complexity of metabolic processes during early bone healing. Here, BMP-2 signaling pathways and local hypoxia play decisive roles in bone formation.
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Affiliation(s)
- Benedicta E Beck-Broichsitter
- University Medical Center Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Martinistraße 52, Campus Forschung Gebäude N27, 20246 Hamburg, Germany.
| | - Anneke N Werk
- Schleswig-Holstein University Hospital, Institute of Clinical and Experimental Pharmacology, Arnold-Heller-Straße 3, Haus 30, 24105 Kiel, Germany
| | - Ralf Smeets
- University Medical Center Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Martinistraße 52, Campus Forschung Gebäude N27, 20246 Hamburg, Germany
| | - Alexander Gröbe
- University Medical Center Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Martinistraße 52, Campus Forschung Gebäude N27, 20246 Hamburg, Germany
| | - Max Heiland
- University Medical Center Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Martinistraße 52, Campus Forschung Gebäude N27, 20246 Hamburg, Germany
| | - Ingolf Cascorbi
- Schleswig-Holstein University Hospital, Institute of Clinical and Experimental Pharmacology, Arnold-Heller-Straße 3, Haus 30, 24105 Kiel, Germany
| | - Jörg Wiltfang
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery (Head: J. Wiltfang, MD, DMD, PhD), Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
| | - Robert Häsler
- Institute of Clinical Molecular Biology, Center for Molecular Biosciences, Christian Albrechts University of Kiel, Am Botanischen Garten 11, 24118 Kiel, Germany
| | - Stephan T Becker
- Schleswig-Holstein University Hospital, Department of Oral and Maxillofacial Surgery (Head: J. Wiltfang, MD, DMD, PhD), Arnold-Heller-Straße 3, Haus 26, 24105 Kiel, Germany
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Farmer S, Ocias LF, Vestergaard H, Broesby-Olsen S, Hermann AP, Frederiksen H. Bone morbidity in chronic myeloproliferative neoplasms. Expert Rev Hematol 2015; 8:447-56. [DOI: 10.1586/17474086.2015.1053456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Zechner C, Gruntmanis U. Systemic Mastocytosis With Decreased Bone Density and Fractures. Mayo Clin Proc 2015; 90:843-4. [PMID: 26046417 PMCID: PMC5526622 DOI: 10.1016/j.mayocp.2014.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 10/14/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Christoph Zechner
- Department of Internal Medicine, Division of Endocrinology, University of Texas, Southwestern Medical Center, Dallas; Department of Pharmacology, University of Texas, Southwestern Medical Center, Dallas
| | - Ugis Gruntmanis
- Department of Internal Medicine, Division of Endocrinology, University of Texas, Southwestern Medical Center, Dallas.
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63
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Farmer S, Vestergaard H, Hansen S, Shanbhogue VV, Shanbhoque VV, Stahlberg CI, Hermann AP, Frederiksen H. Bone geometry, bone mineral density, and micro-architecture in patients with myelofibrosis: a cross-sectional study using DXA, HR-pQCT, and bone turnover markers. Int J Hematol 2015; 102:67-75. [PMID: 25939704 DOI: 10.1007/s12185-015-1803-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 12/20/2022]
Abstract
Primary myelofibrosis (MF) is a severe chronic myeloproliferative neoplasm, progressing towards a terminal stage with insufficient haematopoiesis and osteosclerotic manifestations. Whilst densitometry studies have showed MF patients to have elevated bone mineral density, data on bone geometry and micro-structure assessed with non-invasive methods are lacking. We measured areal bone mineral density (aBMD) using dual-energy X-ray absorptiometry (DXA). Bone geometry, volumetric BMD, and micro-architecture were measured using high-resolution peripheral quantitative computed tomography (HR-pQCT). We compared the structural parameters of bones by comparing 18 patients with MF and healthy controls matched for age, sex, and height. Blood was analysed for biochemical markers of bone turnover in patients with MF. There were no significant differences in measurements of bone geometry, volumetric bone mineral density, and micro-structure between MF patients and matched controls. Estimated bone stiffness and bone strength were similar between MF patients and controls. The level of pro-collagen type 1 N-terminal pro-peptide (P1NP) was significantly increased in MF, which may indicate extensive collagen synthesis, one of the major diagnostic criteria in MF. We conclude that bone mineral density, geometry, and micro-architecture in this cohort of MF patients are comparable with those in healthy individuals.
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Affiliation(s)
- Sarah Farmer
- Department of Haematology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark,
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64
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Castells MC, Hornick JL, Akin C. Anaphylaxis After Hymenoptera Sting: Is It Venom Allergy, a Clonal Disorder, or Both? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:350-5. [DOI: 10.1016/j.jaip.2015.03.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/28/2015] [Accepted: 03/30/2015] [Indexed: 11/28/2022]
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65
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Chehab M, Copelan A, Al-faham Z, Bahoura L, Wong CYO. Systemic mastocytosis: a rare cause of single vertebral body uptake on bone scan. J Radiol Case Rep 2015; 9:31-41. [PMID: 25926926 DOI: 10.3941/jrcr.v9i2.2264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Systemic Mastocytosis is a rare condition characterized by the abnormal proliferation of Mast Cells. Presentation as a solitary vertebral body lesion is extremely uncommon and may be confused with more ominous conditions such as metastasis. Familiarity with the condition can heighten clinical suspicion, direct tissue diagnosis, guide management and indicate appropriate follow up. We present a case of a 64-year-old woman undergoing staging for recently diagnosed breast cancer who was found to have Systemic Mastocytosis of a single vertebral body.
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Affiliation(s)
- Monzer Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Alexander Copelan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Zaid Al-faham
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Lawrence Bahoura
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
| | - Ching Yee Oliver Wong
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Michigan, USA
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Baum T, Karampinos DC, Brockow K, Seifert-Klauss V, Jungmann PM, Biedermann T, Rummeny EJ, Bauer JS, Müller D. MR-based trabecular bone microstructure is not altered in subjects with indolent systemic mastocytosis. Clin Imaging 2014; 39:886-9. [PMID: 25542754 DOI: 10.1016/j.clinimag.2014.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 11/30/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022]
Abstract
Subjects with indolent systemic mastocytosis (ISM) have an increased risk for osteoporosis. It has been demonstrated that trabecular bone microstructure analysis improves the prediction of bone strength beyond dual-energy X-ray absorptiometry-based bone mineral density. The purpose of this study was to obtain Magnetic Resonance (MR)-based trabecular bone microstructure parameters as advanced imaging biomarkers in subjects with ISM (n=18) and compare them with those of normal controls (n=18). Trabecular bone microstructure parameters were not significantly (P>.05) different between subjects with ISM and controls. These findings revealed important pathophysiological information about ISM-associated osteoporosis and may limit the use of trabecular bone microstructure analysis in this clinical setting.
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Affiliation(s)
- Thomas Baum
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
| | - Dimitrios C Karampinos
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Knut Brockow
- Klinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802 München, Germany
| | - Vanadin Seifert-Klauss
- Frauenklinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Pia M Jungmann
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Tilo Biedermann
- Klinik für Dermatologie und Allergologie am Biederstein, Technische Universität München, Biedersteiner Str. 29, 80802 München, Germany
| | - Ernst J Rummeny
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Jan S Bauer
- Abteilung für Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany
| | - Dirk Müller
- Institut für Radiologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany; Institut und Poliklinik für Diagnostische Radiologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937 Köln, Germany
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67
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van der Veer E, Arends S, van der Hoek S, Versluijs JB, de Monchy JG, Oude Elberink JN, van Doormaal JJ. Predictors of new fragility fractures after diagnosis of indolent systemic mastocytosis. J Allergy Clin Immunol 2014; 134:1413-1421. [DOI: 10.1016/j.jaci.2014.05.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 04/03/2014] [Accepted: 05/08/2014] [Indexed: 12/14/2022]
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Zoledronic acid in osteoporosis secondary to mastocytosis. Am J Med 2014; 127:1127.e1-1127.e4. [PMID: 24954632 DOI: 10.1016/j.amjmed.2014.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 05/26/2014] [Accepted: 06/09/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Osteoporosis is the prevalent manifestation of bone involvement in patients with systemic mastocytosis. Mastocytosis-related osteoporosis is characterized by both absolute and relative prevalence of osteoclastic activity, consistent with the positive results reported in small series of patients with antiresorptive drugs, such as bisphosphonates. The aim of this study is to investigate the efficacy of zoledronic acid in patients with mastocytosis-related osteoporosis. METHODS Twenty-five patients with osteoporosis secondary to indolent systemic mastocytosis were given a single intravenous infusion of 5 mg zoledronic acid dissolved in 100 mL of 0.9% saline over 60 minutes. RESULTS After 1 year, the mean increase in bone mineral density was 6.0% ± 4.4% at the spine and 2.4% ± 3.2% at the total hip. Serum levels of bone turnover markers decreased versus baseline: bone alkaline phosphatase -34% and -35%, and C-terminal telopeptide -68% and -56% at 6 and 12 months, respectively. None of the patients reported new fractures during the year of follow-up. In all the first 20 treated patients, a transitory acute phase response was observed, but this was prevented in 4 of 5 subsequent patients in whom acetaminophen was given systematically during the 3 days post-infusion. CONCLUSIONS A single 5 mg zoledronic acid intravenous infusion in patients with osteoporosis secondary to indolent systemic mastocytosis is associated with significant increases in spine and hip bone mineral density and decreases of bone turnover markers over at least 1 year. Yearly zoledronic acid might represent a therapeutic option for indolent systemic mastocytosis-associated osteoporosis.
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69
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Valent P, Escribano L, Broesby-Olsen S, Hartmann K, Grattan C, Brockow K, Niedoszytko M, Nedoszytko B, Oude Elberink JNG, Kristensen T, Butterfield JH, Triggiani M, Alvarez-Twose I, Reiter A, Sperr WR, Sotlar K, Yavuz S, Kluin-Nelemans HC, Hermine O, Radia D, van Doormaal JJ, Gotlib J, Orfao A, Siebenhaar F, Schwartz LB, Castells M, Maurer M, Horny HP, Akin C, Metcalfe DD, Arock M. Proposed diagnostic algorithm for patients with suspected mastocytosis: a proposal of the European Competence Network on Mastocytosis. Allergy 2014; 69:1267-74. [PMID: 24836395 DOI: 10.1111/all.12436] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2014] [Indexed: 01/08/2023]
Abstract
Mastocytosis is an emerging differential diagnosis in patients with more or less specific mediator-related symptoms. In some of these patients, typical skin lesions are found and the diagnosis of mastocytosis can be established. In other cases, however, skin lesions are absent, which represents a diagnostic challenge. In the light of this unmet need, we developed a diagnostic algorithm for patients with suspected mastocytosis. In adult patients with typical lesions of mastocytosis in the skin, a bone marrow (BM) biopsy should be considered, regardless of the basal serum tryptase concentration. In adults without skin lesions who suffer from mediator-related or other typical symptoms, the basal tryptase level is an important parameter. In those with a slightly increased tryptase level, additional investigations, including a sensitive KIT mutation analysis of blood leucocytes or measurement of urinary histamine metabolites, may be helpful. In adult patients in whom (i) KIT D816V is detected and/or (ii) the basal serum tryptase level is clearly increased (>25-30 ng/ml) and/or (iii) other clinical or laboratory features suggest the presence of 'occult' mastocytosis or another haematologic neoplasm, a BM investigation is recommended. In the absence of KIT D816V and other signs or symptoms of mastocytosis or another haematopoietic disease, no BM investigation is required, but the clinical course and tryptase levels are monitored in the follow-up. In paediatric patients, a BM investigation is usually not required, even if the tryptase level is increased. Although validation is required, it can be expected that the algorithm proposed herein will facilitate the management of patients with suspected mastocytosis and help avoid unnecessary referrals and investigations.
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Affiliation(s)
- P. Valent
- Division of Haematology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - L. Escribano
- Servicio Central de Citometria; Centro de Investigacion del Cancer (IBMCC; CSIC/USAL); IBSAL and Department of Medicine; University of Salamanca; Salamanca Spain
| | - S. Broesby-Olsen
- Department of Dermatology and Allergy Centre; Odense University Hospital; Odense Denmark
| | - K. Hartmann
- Department of Dermatology; University of Cologne; Cologne Germany
| | - C. Grattan
- Norfolk and Norwich University Hospital; Norwich UK
| | - K. Brockow
- Department of Dermatology and Allergy Biederstein; Technical University of Munich; Munich Germany
| | - M. Niedoszytko
- Department of Allergology; Medical University of Gdansk; Gdansk Poland
| | - B. Nedoszytko
- Department of Dermatology; Medical University of Gdansk; Gdansk Poland
| | - J. N. G. Oude Elberink
- Department of Allergology; University Medical Center of Groningen; University of Groningen; Groningen the Netherlands
| | - T. Kristensen
- Department of Pathology; Odense University Hospital; Odense Denmark
| | | | - M. Triggiani
- Division of Allergy and Clinical Immunology; University of Salerno; Salerno Italy
| | - I. Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast); Hospital Virgen del Valle; Toledo Spain
| | - A. Reiter
- III. Medizinische Klinik; Universitäts-Medizin Mannheim; Universität Heidelberg; Mannheim Germany
| | - W. R. Sperr
- Division of Haematology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - K. Sotlar
- Institute of Pathology; Ludwig-Maximilians-University; Munich Germany
| | - S. Yavuz
- Division of Haematology; Department of Internal Medicine; University of Istanbul; Istanbul Turkey
| | - H. C. Kluin-Nelemans
- Department of Haematology; University Medical Center Groningen; University of Groningen; Groningen the Netherlands
| | - O. Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité; Centre national de référence des mastocytoses; Paris France
| | - D. Radia
- Department of Haematology; Guys and St Thomas' NHS Foundation Trust; Guys Hospital; London UK
| | - J. J. van Doormaal
- Department of Allergology; University Medical Center of Groningen; University of Groningen; Groningen the Netherlands
| | - J. Gotlib
- Stanford Cancer Institute; Stanford University School of Medicine; Stanford CA USA
| | - A. Orfao
- Servicio Central de Citometria; Centro de Investigacion del Cancer (IBMCC; CSIC/USAL); IBSAL and Department of Medicine; University of Salamanca; Salamanca Spain
| | - F. Siebenhaar
- Department of Dermatology & Allergy; Charité Universitätsmedizin Berlin; Berlin Germany
| | - L. B. Schwartz
- Division of Rheumatology, Allergy & Immunology; Department of Internal Medicine; Virginia Common-wealth University; Richmond VA USA
| | - M. Castells
- Division of Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. Maurer
- Department of Dermatology & Allergy; Charité Universitätsmedizin Berlin; Berlin Germany
| | - H.-P. Horny
- Institute of Pathology; Ludwig-Maximilians-University; Munich Germany
| | - C. Akin
- Division of Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - D. D. Metcalfe
- Laboratory of Allergic Diseases; NIAID; NIH; Bethesda MD USA
| | - M. Arock
- LBPA CNRS UMR8113; Ecole Normale Supérieure de Cachan; Cachan France
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Rossini M, Zanotti R, Viapiana O, Tripi G, Orsolini G, Idolazzi L, Bonadonna P, Schena D, Escribano L, Adami S, Gatti D. Bone Involvement and Osteoporosis in Mastocytosis. Immunol Allergy Clin North Am 2014; 34:383-96. [DOI: 10.1016/j.iac.2014.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Akin C, Valent P. Diagnostic Criteria and Classification of Mastocytosis in 2014. Immunol Allergy Clin North Am 2014; 34:207-18. [DOI: 10.1016/j.iac.2014.02.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Siebenhaar F, Akin C, Bindslev-Jensen C, Maurer M, Broesby-Olsen S. Treatment strategies in mastocytosis. Immunol Allergy Clin North Am 2014; 34:433-47. [PMID: 24745685 DOI: 10.1016/j.iac.2014.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment recommendations for mastocytosis are based mostly on expert opinion rather than evidence obtained from controlled clinical trials. In this article, treatment options for mastocytosis are presented, with a focus on the control of mediator-related symptoms in patients with indolent disease.
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Affiliation(s)
- Frank Siebenhaar
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Cem Akin
- Division of Rheumatology, Allergy, Immunology, Mastocytosis Center, Harvard Medical School, Brigham and Women's Hospital, 1 Jimmy Fund Way, Room 626B, Boston, MA 02115, USA
| | - Carsten Bindslev-Jensen
- Department of Dermatology, Allergy Centre, Mastocytosis Centre Odense University Hospital, MastOUH, Odense University Hospital, Sdr. Boulevard 29, Entrance 142, 5000 Odense C, Denmark
| | - Marcus Maurer
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Sigurd Broesby-Olsen
- Department of Dermatology, Allergy Centre, Mastocytosis Centre Odense University Hospital, MastOUH, Odense University Hospital, Sdr. Boulevard 29, Entrance 142, 5000 Odense C, Denmark
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74
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Adult-onset mastocytosis in the skin is highly suggestive of systemic mastocytosis. Mod Pathol 2014; 27:19-29. [PMID: 23807778 DOI: 10.1038/modpathol.2013.117] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 11/08/2022]
Abstract
Adult-onset urticaria pigmentosa/mastocytosis in the skin almost always persists throughout life. The prevalence of systemic mastocytosis in such patients is not precisely known. Bone marrow biopsies from 59 patients with mastocytosis in the skin and all available skin biopsies (n=27) were subjected to a meticulous cytological, histological, immunohistochemical, and molecular analysis for the presence of WHO-defined diagnostic criteria for systemic mastocytosis: compact mast cell infiltrates (major criterion); atypical mast cell morphology, KIT D816V, abnormal expression of CD25 by mast cells, and serum tryptase levels >20 ng/ml (minor criteria). Systemic mastocytosis is diagnosed when the major diagnostic criterion plus one minor criterion or at least three minor criteria are fulfilled. Systemic mastocytosis was confirmed in 57 patients (97%) by the diagnosis of compact mast cell infiltrates plus at least one minor diagnostic criterion (n=42, 71%) or at least three minor diagnostic criteria (n=15, 25%). In two patients, only two minor diagnostic criteria were detectable, insufficient for the diagnosis of systemic mastocytosis. By the use of highly sensitive molecular methods, including the analysis of microdissected mast cells, KIT D816V was found in all 58 bone marrow biopsies investigated for it but only in 74% (20/27) of the skin biopsies. It is important to state that even in cases with insufficient diagnostic criteria for systemic mastocytosis, KIT D816V-positive mast cells were detected in the bone marrow. This study demonstrates, for the first time, that almost all patients with adult-onset mastocytosis in the skin, in fact, have systemic mastocytosis with cutaneous involvement.
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75
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Rabenhorst A, Christopeit B, Leja S, Gerbaulet A, Kleiner S, Förster A, Raap U, Wickenhauser C, Hartmann K. Serum levels of bone cytokines are increased in indolent systemic mastocytosis associated with osteopenia or osteoporosis. J Allergy Clin Immunol 2013; 132:1234-1237.e7. [DOI: 10.1016/j.jaci.2013.06.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 06/04/2013] [Accepted: 06/19/2013] [Indexed: 11/26/2022]
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Farmer S, Horváth-Puhó E, Vestergaard H, Hermann AP, Frederiksen H. Chronic myeloproliferative neoplasms and risk of osteoporotic fractures; a nationwide population-based cohort study. Br J Haematol 2013; 163:603-10. [DOI: 10.1111/bjh.12581] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/16/2013] [Accepted: 08/21/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Sarah Farmer
- Department of Haematology; Odense University Hospital; Odense Denmark
| | | | - Hanne Vestergaard
- Department of Haematology; Odense University Hospital; Odense Denmark
| | | | - Henrik Frederiksen
- Department of Haematology; Odense University Hospital; Odense Denmark
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
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Broesby-Olsen S, Kristensen T, Vestergaard H, Brixen K, Møller MB, Bindslev-Jensen C. KIT D816V mutation burden does not correlate to clinical manifestations of indolent systemic mastocytosis. J Allergy Clin Immunol 2013; 132:723-728. [DOI: 10.1016/j.jaci.2013.02.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/14/2013] [Accepted: 02/19/2013] [Indexed: 02/06/2023]
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Seitz S, Barvencik F, Koehne T, Priemel M, Pogoda P, Semler J, Minne H, Pfeiffer M, Zustin J, Püschel K, Eulenburg C, Schinke T, Amling M. Increased osteoblast and osteoclast indices in individuals with systemic mastocytosis. Osteoporos Int 2013; 24:2325-34. [PMID: 23436077 DOI: 10.1007/s00198-013-2305-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/04/2013] [Indexed: 01/08/2023]
Abstract
UNLABELLED Indolent systemic mastocytosis (ISM) can trigger bone loss. However, the clinical relevance of different mast cell infiltration patterns for bone remains to be clarified. Here, we report increased bone turnover in individuals with ISM, and its extent is rather related to the type of mast cell distribution within the bone marrow than to the presence or absence of cutaneous manifestations. INTRODUCTION It is well established that ISM can trigger osteopenia or osteoporosis. However, neither the clinical relevance of the infiltration pattern of mast cells within the bone marrow nor the impact of the presence or absence of cutaneous mast cell infiltration has been elucidated. METHODS We retrospectively analysed 300 cases with histologically proven ISM of the bone marrow and performed quantitative histomorphometry for a subgroup of 159 patients that did not receive any treatment before the biopsies were taken. Most importantly, since 66 % of the patients displayed ISM without the characteristic skin lesions, we were able to compare ISM with or without cutaneous manifestation. RESULTS We found that both forms of ISM were not only characterized by a decreased trabecular bone mass but also by an increased number of osteoclasts and osteoblasts. Interestingly, when we analysed these data in relation to mast cell distribution, we found that the bone cell numbers in cases with mast cell granulomas were significantly increased compared to cases with diffuse mast cell distribution. Moreover, evidence of increased bone turnover was also found in 16 patients displaying osteosclerosis. CONCLUSION Based on the largest cohort of bone biopsies from patients with ISM analysed so far, we could demonstrate high bone turnover, more specifically increased osteoblast and osteoclast numbers and surface indices, as a cause of the skeletal changes. Moreover, the severity of the bone disease is presumably rather dependent on the amount of mast cells and their distribution within the bone marrow irrespective of the presence or absence of cutaneous involvement.
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Affiliation(s)
- S Seitz
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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79
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How I treat patients with indolent and smoldering mastocytosis (rare conditions but difficult to manage). Blood 2013; 121:3085-94. [DOI: 10.1182/blood-2013-01-453183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Indolent systemic mastocytosis (SM) patients have a varied clinical presentation, ranging from predominantly cutaneous symptoms to recurrent systemic symptoms (eg, flushing, palpitations, dyspepsia, diarrhea, bone pain) that can be severe and potentially life threatening (anaphylaxis). Mastocytosis patients without skin involvement pose a diagnostic challenge; a high index of suspicion is needed in those with mast cell–degranulation symptoms, including anaphylaxis following Hymenoptera stings or other triggers. Modern-era molecular and flow-cytometric diagnostic methods are very sensitive and can detect minimal involvement of bone marrow with atypical/clonal mast cells; in some cases, full diagnostic criteria for SM are not fulfilled. An important aspect of treatment is avoidance of known symptom triggers; other treatment principles include a stepwise escalation of antimediator therapies and consideration of cytoreductive therapies for those with treatment-refractory symptoms. The perioperative management of mastocytosis patients is nontrivial; a multidisciplinary preoperative assessment, adequate premedications, and close intra- and postoperative monitoring are critical. Smoldering mastocytosis is a variant with high systemic mast cell burden. While its clinical course can be variable, there is greater potential need for cytoreductive therapies (eg, interferon-alpha, cladribine) in this setting. A systematic approach to the diagnosis and treatment of indolent SM using a case-based approach of representative clinical scenarios is presented here.
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80
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Gil-Diaz A, Delgado-Martinez JR, Suarez-Ortega S, Rivero-Vera JC, Lorenzo-Rivero JA, Betancor-Leon P. Systemic mastocytosis associated with severe osteoporosis in a male patient. Intern Med J 2013; 43:461-2. [DOI: 10.1111/imj.12095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 01/15/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Gil-Diaz
- Hospital Universitario de Gran Canaria Dr. Negrín; Las Palmas de Gran Canaria; Spain
| | | | - S. Suarez-Ortega
- Hospital Universitario de Gran Canaria Dr. Negrín; Las Palmas de Gran Canaria; Spain
| | - J. C. Rivero-Vera
- Hospital Universitario de Gran Canaria Dr. Negrín; Las Palmas de Gran Canaria; Spain
| | - J. A. Lorenzo-Rivero
- Hospital Universitario de Gran Canaria Dr. Negrín; Las Palmas de Gran Canaria; Spain
| | - P. Betancor-Leon
- Hospital Universitario de Gran Canaria Dr. Negrín; Las Palmas de Gran Canaria; Spain
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81
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Iwaniec UT, Turner RT. Failure to generate bone marrow adipocytes does not protect mice from ovariectomy-induced osteopenia. Bone 2013; 53:145-53. [PMID: 23246792 PMCID: PMC3564669 DOI: 10.1016/j.bone.2012.11.034] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 11/18/2012] [Accepted: 11/20/2012] [Indexed: 01/04/2023]
Abstract
A reciprocal association between bone marrow fat and bone mass has been reported in ovariectomized rodents, suggesting that bone marrow adipogenesis has a negative effect on bone growth and turnover balance. Mice with loss of function mutations in kit receptor (kit(W/W-v)) have no bone marrow adipocytes in tibia or lumbar vertebra. We therefore tested the hypothesis that marrow fat contributes to the development of osteopenia by comparing the skeletal response to ovariectomy (ovx) in growing wild type (WT) and bone marrow adipocyte-deficient kit(W/W-v) mice. Mice were ovx at 4 weeks of age and sacrificed 4 or 10 weeks post-surgery. Body composition was measured at necropsy by dual-energy X-ray absorptiometry. Cortical (tibia) and cancellous (tibia and lumbar vertebra) bone architecture were evaluated by microcomputed tomography. Bone marrow adipocyte size and density, osteoblast- and osteoclast-lined bone perimeters, and bone formation were determined by histomorphometry. Ovx resulted in an increase in total body fat mass at 10 weeks post-ovx in both genotypes, but the response was attenuated in the in kit(W/W-v) mice. Adipocytes were present in bone marrow of tibia and lumbar vertebra in WT mice and bone marrow adiposity increased following ovx. In contrast, marrow adipocytes were not detected in either intact or ovx kit(W/W-v) mice. However, ovx in WT and kit(W/W-v) mice resulted in statistically indistinguishable changes in cortical and cancellous bone mass, cortical and cancellous bone formation rate, and cancellous osteoblast and osteoclast-lined bone perimeters. In conclusion, our findings do not support a causal role for increased bone marrow fat as a mediator of ovx-induced osteopenia in mice.
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Affiliation(s)
- Urszula T Iwaniec
- Skeletal Biology Laboratory, School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR 97331, USA.
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82
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Fuller SJ. New Insights into the Pathogenesis, Diagnosis, and Management of Mastocytosis. Hematol Oncol Clin North Am 2012; 26:1143-68. [DOI: 10.1016/j.hoc.2012.08.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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