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Abstract
The outcome of diseases accompanied or caused by mucostasis depends both on the restoration of drainage function of the airways and on the effectiveness of immune mechanisms against pathogens. N-acetylcysteine (NAC) is widely used as mucolytic and antioxidant remedy in clinical practice. In this regard, the data of the scientific literature on the direct and indirect effects of NAC on the mucosal immunity of the respiratory tract have been reviewed. NAC possesses pleiotropic immunomodulating properties, most of which contribute to the regression of clinical manifestations of acute and chronic inflammatory diseases of the respiratory tract. Biological and pharmacological effects of NAC include improvement in rheological properties of mucus, reduction of excess mucin production, restoration of mucociliary clearance and production of sIgA, suppression of excess production of IgE and IgG4, destruction of biofilms and inhibition of their formation, suppression of adhesion of pathogenic bacteria to epithelial cells, antioxidant activity, regulation of the production of pro-inflammatory and profibrotic cytokines. There was no convincing evidence that NAC is able to suppress any component of mucosal immunity. For final conclusions on this subject, further research are required.
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Affiliation(s)
- O V Kalyuzhin
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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102
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Changes in N-glycans of IgG4 and its relationship with the existence of hypocomplementemia and individual organ involvement in patients with IgG4-related disease. PLoS One 2018; 13:e0196163. [PMID: 29672582 PMCID: PMC5908088 DOI: 10.1371/journal.pone.0196163] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/06/2018] [Indexed: 12/24/2022] Open
Abstract
Background Although increased serum IgG4 level and tissue infiltration of IgG4-positive cells are key events in IgG4-related disease (IgG4RD), and nearly half of IgG4RD patients show hypocomplementemia, the role of IgG4 in the pathogenesis of IgG4RD remains unclear. Many reports show that altered IgG glycosylation, especially IgG with agalactosylated N-linked glycan (G0 N-glycan), have proinflammatory roles including complement activation, implicated in the pathogenesis of various inflammatory diseases. This study determined the concentration of N-linked glycans (N-glycan) released from serum IgG4 in IgG4RD patients and compared the difference of glycosylation changes to those in healthy controls. We also compared the concentration of each IgG4 glycoform between patients with and without hypocomplementemia and individual organ involvement (kidney, pancreas, lymph node) in IgG4RD. Methods We collected sera from 12 IgG4RD patients and 8 healthy controls. IgG4 was isolated from sera via Melon™ Gel IgG Spin Purification Kit followed by Capture Select IgG4 (Hu) Affinity Matrix. IgG4 N-glycans were analyzed by S-BIO GlycanMap® Xpress methodology. Results Significant increases of IgG4 G0 N-glycan and IgG4 fucosylated N-glycan (F1 N-glycan) concentrations were observed in IgG4RD compared with healthy controls. Although we observed decreased levels of IgG4 F0 glycan in IgG4RD with hypocomplementemia, there were no significant differences in the galactosylation and sialyation of IgG4 N-glycans. Furthermore, there were no significant differences in the glycosylation of IgG4 N-glycans between patients with and without individual organ involvement of IgG4RD. Conclusions Although IgG4 has anti-inflammatory properties, IgG4 G0 and F1 glycans were increased in patients with IgG4RD. Our results suggest that decreased galactosylation of IgG4 is not related to complement activation and the differences of individual organ involvement in IgG4RD. IgG4 fucosylation change may be related to complement activation in IgG4RD. Further investigation is needed to clarify the role of IgG4 in IgG4RD.
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103
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Takkar B, Tandon N, Venkatesh P. De novo ossification of the choroid in a case of multifocal fibrosclerosis. Can J Ophthalmol 2018; 53:e62-e65. [PMID: 29631844 DOI: 10.1016/j.jcjo.2017.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Brijesh Takkar
- Retina and Uvea Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Retina and Uvea Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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104
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Gui H, You J, Liu D, Liu S, Wang X, Liu L. IgG4 positive autoimmune pancreatitis: report of a case and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2160-2164. [PMID: 31938327 PMCID: PMC6958195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 02/25/2017] [Indexed: 06/10/2023]
Abstract
Autoimmune pancreatitis (AIP) is a rare chronic pancreatitis and the incidence is increasing recently. However, the formal report of this disease is still rare in literatures. Here, we reported a rare case of IgG4 positive autoimmune pancreatitis to make the awareness of this type of disease. The patient was a 58-year-old Chinese male who was suffered from epigastric pain accompanied by nausea and vomiting. An occupying lesion was detected in the body of the pancreas tail with the ultrasound examination. The serum IgG4 levels, white blood cells, blood amylase and the γ-globulin fraction were all increased. After operation, the following pathological detection with immunochemistry test confirmed the diagnosis of autoimmune pancreatitis.
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Affiliation(s)
- Huawei Gui
- Department of Pathology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Jian You
- Department of General Surgery, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Dongling Liu
- Department of Pathology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Song Liu
- Department of Radiology, Wuhan Puai HospitalWuhan, Hubei Province, P. R. China
| | - Xuming Wang
- Department of Histopathology, Jiangda Pathology Institute, Jianghan UniversityWuhan, Hubei Province, P. R. China
| | - Lijiang Liu
- Department of Histopathology, Jiangda Pathology Institute, Jianghan UniversityWuhan, Hubei Province, P. R. China
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105
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Della-Torre E, Campochiaro C, Cassione EB, Albano L, Gerevini S, Bianchi-Marzoli S, Bozzolo E, Passerini G, Lanzillotta M, Terreni M, Callea M, Trimarchi M, Mortini P, Tresoldi M, Acerno S, Dagna L. Intrathecal rituximab for IgG 4-related hypertrophic pachymeningitis. J Neurol Neurosurg Psychiatry 2018; 89:441-444. [PMID: 28819060 DOI: 10.1136/jnnp-2017-316519] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Corrado Campochiaro
- Università Vita-Salute San Raffaele, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Bozzalla Cassione
- Università Vita-Salute San Raffaele, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Albano
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simonetta Gerevini
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Bianchi-Marzoli
- Department of Ophthalmology, Fondazione IRCCS Istituto Auxologico Italiano, Neuro-Ophthalmology Service, Milan, Italy
| | - Enrica Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriella Passerini
- Department of Laboratory Medicine, IRCCS San Raffaele Institute, Milan, Italy
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mariarosa Terreni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcella Callea
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Trimarchi
- Department of Otorhinolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Acerno
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, Milan, Italy, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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106
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Kim AJ, Ro H, Chang JH, Jung JY, Chung WK, Park YH, Lee HH. Suspected Frequent Relapsing IgG4-related Lung Disease in Kidney Transplant Patient: A Case Report. Transplant Proc 2018; 50:2572-2574. [PMID: 30316401 DOI: 10.1016/j.transproceed.2018.02.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/19/2018] [Indexed: 12/21/2022]
Abstract
Besides the initial description of IgG4-related pancreatic disease, other sites are now commonly involved. However, occurrence of IgG4-related disease is rare in organ transplanted patients. A 57-year-old man who received a kidney transplantation presented with recurrent dyspnea on exertion. A computed tomography scan of the chest revealed bilateral interlobular septal thickening and multiple tubular and branching small nodular lesions in the right upper lobe, and mass-like consolidation of the left middle lobe. Despite no elevation of serum IgG4 level, a percutaneous core needle biopsy on consolidative mass showed interstitial fibrosis and infiltration of IgG4-positive plasma cells to be more than > 20 per high power field. After treatment with glucocorticoids and rituximab, the consolidative mass of the left middle lobe disappeared.
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Affiliation(s)
- A J Kim
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea
| | - H Ro
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea
| | - J H Chang
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea
| | - J Y Jung
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea
| | - W K Chung
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea
| | - Y H Park
- Department of Surgery, College of Medicine, Gachon University, Incheon, Korea
| | - H H Lee
- Department of Internal Medicine, College of Medicine, Gachon University, Incheon, Korea.
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107
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Bienfait L, Nagy N, El Moussaoui I, Lingier P, El Nakadi I, Demetter P, Verset L. Immunoglobulin G4-related sclerosing oesophagitis in a 9-year-old girl. Histopathology 2018; 73:173-174. [DOI: 10.1111/his.13479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Lucie Bienfait
- Department of Pathology; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Nathalie Nagy
- Department of Pathology; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Imad El Moussaoui
- Department of Digestive Surgery; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Pierre Lingier
- Department of Digestive Surgery; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Issam El Nakadi
- Department of Digestive Surgery; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Pieter Demetter
- Department of Pathology; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
| | - Laurine Verset
- Department of Pathology; Erasme University Hospital; Université Libre de Bruxelles; Brussels Belgium
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108
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Karim AF, Eurelings LEM, Bansie RD, van Hagen PM, van Laar JAM, Dik WA. Soluble Interleukin-2 Receptor: A Potential Marker for Monitoring Disease Activity in IgG4-Related Disease. Mediators Inflamm 2018; 2018:6103064. [PMID: 29686532 PMCID: PMC5854105 DOI: 10.1155/2018/6103064] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a fibroinflammatory condition. T-cells play a crucial role in the pathogenesis, and therefore, serum soluble interleukin-2 receptor (sIL-2R) may be a potential biomarker. METHOD We studied the levels of sIL-2R in 26 histologically proven IgG4-RD patients with available serum sIL-2R and compared them to those in newly diagnosed and untreated sarcoidosis patients (n = 78) and controls (n = 101) and the serum sIL-2R levels in patients after treatment of IgG4-RD (n = 15). The disease activity was measured using the IgG4-Related Disease Responder Index (IgG4-RD RI). RESULTS Median serum sIL-2R in IgG4-RD patients was 4667 pg/ml compared to 1515 pg/ml in controls (P < 0.001) and 6050 pg/ml in sarcoidosis patients (P = 0.004 compared to IgG4-RD). All IgG4-RD patients had elevated serum sIL-2R levels compared to the reference value of <2500 pg/ml in controls and 85% elevated serum IgG4; however, these did not correlate with each other. Both serum sIL-2R and IgG4 levels declined significantly after treatment (P = 0.001 and P = 0.01, resp.). Before treatment, serum sIL-2R level and IgG4-RD RI did not correlate with each other. However, the decrease in serum sIL-2R upon treatment did correlate significantly (P = 0.04) with the decrease in disease activity assessed by IgG-RD RI. CONCLUSION Serum sIL-2R is elevated in IgG4-RD reflecting the inflammatory process with enhanced T-cell activation. Furthermore, serum sIL-2R might serve as a potential marker of response to treatment in IgG4-RD.
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Affiliation(s)
- A. F. Karim
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L. E. M. Eurelings
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - R. D. Bansie
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - P. M. van Hagen
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
- Section Clinical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J. A. M. van Laar
- Section Clinical Immunology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
- Section Clinical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - W. A. Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
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109
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Kamata K, Watanabe T, Minaga K, Strober W, Kudo M. Autoimmune Pancreatitis Mouse Model. ACTA ACUST UNITED AC 2018; 120:15.31.1-15.31.8. [PMID: 29512140 DOI: 10.1002/cpim.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disorder of the pancreas. However, extensive clinico-pathological analyses have revealed that AIP is, in reality, a pancreatic manifestation of a newly described systemic disease known as IgG4-related disease (IgG4-RD). IgG4-RD is characterized by enhanced local and systemic IgG4 antibody (Ab) responses as well as inflammation involving multiple organs, including the pancreas, bile ducts, and salivary glands. Although mice lack the IgG4 Ab subtype, autoimmune-prone MRL/Mp mice treated with repeated injection with polyinosinic-polycytidylic acid (poly (I:C)) provide an experimental model of AIP. These mice exhibit massive destruction of pancreatic architecture associated with pancreatic immune cell infiltration and fibrosis. Moreover, this experimental AIP may be accompanied by involvement of multiple organs as well as elevation of serum levels of autoAbs, resembling humans with IgG4-RD. Thus, elucidation of the molecular mechanisms accounting for the development of experimental AIP can potentially provide new insights into the immuno-pathogenesis of human IgG4-related AIP. © 2018 by John Wiley & Sons, Inc.
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Affiliation(s)
- Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.,Mucosal Immunity Section, Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Warren Strober
- Mucosal Immunity Section, Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
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110
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Puxeddu I, Capecchi R, Pratesi F, Cianchetti S, Tavoni A, Migliorini P. Mediators of angiogenesis and fibrosis in IgG4-related disease. Clin Exp Med 2017; 18:245-249. [PMID: 29243036 DOI: 10.1007/s10238-017-0484-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/10/2017] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) is a rare fibro-inflammatory condition that can affect almost any organ, characterized by tumefactive lesions and often by eosinophilia and elevated serum IgG4 concentrations. The aim of the study is to analyze in IgG4-RD patients the serum levels of a group of cytokines and growth factors potentially involved in the regulation of fibrotic processes. In the sera of 12 patients affected by IgG4-RD and of 15 normal healthy subjects (NHS), pro-fibrogenic mediators (TGF-β1 and periostin) and pro- (VEGF and angiogenin-1) and anti- (endostatin and thrombospondin-1) angiogenic mediators were measured by sandwich enzyme immunoassay. Among mediators regulating fibrosis and angiogenesis, endostatin levels were significantly higher in IgG4-RD patients compared to NHS (p < 0.0001). No differences in the levels of TGF-β1, periostin, VEGF, angiogenin-1 and thrombospondin-1 were observed between groups. Our study suggests that among the mediators mainly involved in fibrosis and angiogenesis endostatin might play a role in the pathogenetic processes of IgG4-RD.
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Affiliation(s)
- Ilaria Puxeddu
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Riccardo Capecchi
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Federico Pratesi
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Silvana Cianchetti
- Respiratory Pathophysiology Unit, Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Antonio Tavoni
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Paola Migliorini
- Clinical Immunology and Allergy Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
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111
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Dua P, Shinder R, Laskar DB, Lazzaro DR, Rizzuti AE. A case of hypertrophic herpes simplex virus affecting the eyelid and cornea masquerading as IgG4-related disease. Am J Ophthalmol Case Rep 2017; 9:68-71. [PMID: 29468223 PMCID: PMC5786855 DOI: 10.1016/j.ajoc.2017.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose To report a case of hypertrophic herpes simplex virus (HSV) of the eyelid and cornea masquerading as IgG4-related disease. Observations A 37-year old African American female with a past medical history of human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and a recent history of treated genital herpes, presented with an ulcerative lesion of the left upper and lower eyelids, and severe ocular inflammation with symblepharon. Initially, eyelid biopsy revealed findings consistent with IgG4-related disease, and the patient was treated with high dose oral prednisone. After one week of therapy, there was no improvement in the patient's symptoms, and she subsequently developed a corneal epithelial defect which progressed to chronic ulceration. Repeat biopsy and corneal cultures revealed herpes simplex virus type 2. The patient was treated with high dose acyclovir, and the lid lesion improved. The conjunctival inflammation and corneal epithelial defect resolved but symblepharon restricting her eye movement remained. She also developed corneal vascularization and opacification causing severe vision loss. Conclusions and importance Chronic hypertrophic herpes simplex virus infection is a rare condition reported in patients with HIV. While there have been few reports of hypertrophic HSV affecting the eyelid, this is the first reported case of hypertrophic HSV affecting the eye, resulting in severe vision loss.
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Affiliation(s)
- Prachi Dua
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Derek B Laskar
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Douglas R Lazzaro
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Allison E Rizzuti
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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112
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Martínez-Valle F, Orozco-Gálvez O, Fernández-Codina A. Update in ethiopathogeny, diagnosis and treatment of the IgG4 related disease. Med Clin (Barc) 2017; 151:18-25. [PMID: 29241876 DOI: 10.1016/j.medcli.2017.10.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
IgG4 related disease (IgG4-RD) is probably an autoimmune pathology of unknown etiology. Diverse interactions participate in its pathogen between the adaptive and innate immune systems, activating lymphocytes B and T which trigger the inflammatory cascade, which culminates in fibrosis of the organs and their malfunction. It can affect a multitude of organs simultaneously. The diagnosis is based on the correlation of clinical findings with anatomopathological results (lymphoplasmocitary infiltrate, storiform fibrosis, obliterative phlebitis and IgG4+plasmatic cell count) and with the presence of elevated IgG4 in serum, depending on the criteria used. Corticoids and rituximab are among the few validated treatments available. There are multiple biomarkers and treatments in development. In this review, we aim to go over the principal pathogenic and clinical characteristics of IgG4-RD, as well as its handling, in accordance with the available scientific evidence.
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Affiliation(s)
- Fernando Martínez-Valle
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Vall Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Vall d'Hebron Institut de Recerca, Barcelona, España.
| | - Olimpia Orozco-Gálvez
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Vall Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Andreu Fernández-Codina
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Vall Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Vall d'Hebron Institut de Recerca, Barcelona, España; Rheumatology Division, Department of Medicine, University of Western Ontario, London, Ontario, Canadá
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113
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Baird T, Cooper CL, Wong R, Runnegar N, Keir G. Pulmonary schistosomiasis mimicking IgG4-related lung disease. Respirol Case Rep 2017; 6:e00276. [PMID: 29046807 PMCID: PMC5641579 DOI: 10.1002/rcr2.276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/11/2017] [Indexed: 12/20/2022] Open
Abstract
IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterized by tumefactive lesions in various organ systems, including the lungs. Clinical and radiological manifestations of IgG4-RD are relatively non-specific, and we report a case highlighting the importance of histopathological confirmation in cases of suspected IgG4-related lung disease. A 44-year-old male with significantly elevated serum IgG4 levels, patchy consolidation on thoracic CT imaging, and cough was referred with suspected IgG4-related lung disease. However, surgical lung biopsy revealed an unexpected diagnosis of pulmonary schistosomiasis, and following treatment with praziquantel, cough resolved and IgG4 levels significantly declined. This case highlights the potentially diverse array of conditions that may mimic IgG4-related lung disease and the importance of comprehensive evaluation including histopathological confirmation where possible.
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Affiliation(s)
- Timothy Baird
- Department of Respiratory and Sleep Medicine Princess Alexandra Hospital Brisbane Australia
| | - Caroline L Cooper
- Department of Anatomical Pathology, Pathology Queensland Princess Alexandra Hospital Brisbane Australia.,Southside Clinical Unit, Faculty of Medicine University of Queensland Brisbane Australia
| | - Richard Wong
- Department of Immunology, Princess Alexandra Hospital & Division of Immunology Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital Brisbane Australia
| | - Naomi Runnegar
- Southside Clinical Unit, Faculty of Medicine University of Queensland Brisbane Australia.,Department of Infectious Diseases Princess Alexandra Hospital Brisbane Australia
| | - Gregory Keir
- Department of Respiratory and Sleep Medicine Princess Alexandra Hospital Brisbane Australia.,Southside Clinical Unit, Faculty of Medicine University of Queensland Brisbane Australia
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114
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Struja T, Kutz A, Fischli S, Meier C, Mueller B, Recher M, Schuetz P. Is Graves' disease a primary immunodeficiency? New immunological perspectives on an endocrine disease. BMC Med 2017; 15:174. [PMID: 28942732 PMCID: PMC5611589 DOI: 10.1186/s12916-017-0939-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/04/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Uncertainty about factors influencing the susceptibility and triggers for Graves' disease persists, along with a wide variation in the response to anti-thyroid drugs, currently at approximately 50% of non-responders. The aim of this narrative review is to summarize immunological concepts, with a combined endocrine and immunological perspective, to highlight potential new areas of research. MAIN TEXT Relevant studies were identified through a systematic literature search using the PubMed and EMBASE databases in March 2016. No cut-offs regarding dates were imposed. We used the terms "Graves' Disease" or "Basedow" or "thyrotoxicosis" together with the terms "etiology", "pathophysiology", "immunodeficiency", "causality", and "autoimmunity". The terms "orbitopathy", "ophthalmopathy", and "amiodarone" were excluded. Articles in English, French, German, Croatian, Spanish, and Italian were eligible for inclusion. CONCLUSIONS While concepts such as the impact of iodine, smoking, human leucocyte antigen, infections, and ethnicity are established, new ideas have emerged. Pertaining evidence suggests the involvement of autoimmunity and immunodeficiency in the pathophysiology of Graves' disease. Recent studies point to specific immunological mechanisms triggering the onset of disease, which may also serve as targets for more specific therapies.
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Affiliation(s)
- Tristan Struja
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland.
| | - Alexander Kutz
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland
| | - Stefan Fischli
- Medical Clinic, Department for Endocrinology, Diabetes & Metabolism, Kantonsspital Luzern, Luzern, Switzerland
| | - Christian Meier
- Medical Faculty of the University of Basel, Basel, Switzerland.,Division of Endocrinology, Diabetes & Metabolism, University Hospital and University Basel, Basel, Switzerland
| | - Beat Mueller
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Mike Recher
- Medical Faculty of the University of Basel, Basel, Switzerland.,Medical Outpatient Clinic and Immunodeficiency Laboratory, Department of Biomedicine, University Hospital and University Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Clinic for Endocrinology, Diabetes & Metabolism, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
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Hassanzadeh B, DeSanto J, Kattah JC. Ipilimumab-induced Adenohypophysitis and Orbital Apex Syndrome: Importance of Early Diagnosis and Management. Neuroophthalmology 2017; 42:176-181. [PMID: 29796053 DOI: 10.1080/01658107.2017.1368090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/13/2017] [Accepted: 08/13/2017] [Indexed: 10/18/2022] Open
Abstract
Ipilimumab is a novel anti-melanoma agent known to infrequently cause multi-organ autoimmunity. We report a case of pituitary hypophysitis and orbital inflammation followed by an orbital apex syndrome. A 64-year-old woman with a history of skin melanoma, receiving ipilimumab treatment, was seen for near total loss of vision in the right eye and proptosis. Headache of 3-month duration preceded the onset of diplopia followed by severe loss of vision in the right eye. Neuro-ophthalmologic examination was consistent with an orbital apex syndrome. Extensive blood work and magnetic resonance imaging of the brain and orbit suggested an inflammatory process, rather than a metastatic lesion. Accordingly, the patient received high-dose methylprednisolone followed by tapering oral prednisone. At the 6-month follow-up visit, visual acuity on the right eye had significantly improved but diplopia remained, associated with large amplitude esotropia that improved incompletely though while on prednisone. The favourable outcome supported a final diagnosis of ipilimumab-induced inflammatory orbital apex syndrome and clinically silent pituitary adenohypophysitis. The case presented herein highlights unexpected ipilimumab-associated adverse effects and proposes the possibility of and interaction between inflammatory and immune mechanisms.
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Affiliation(s)
- Bahareh Hassanzadeh
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.,OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA
| | - Jeffrey DeSanto
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.,OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA
| | - Jorge C Kattah
- Department of Neurology, University of Illinois College of Medicine Peoria, Peoria, Illinois, USA.,OSF HealthCare Illinois Neurological Institute, Peoria, Illinois, USA
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116
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Uzunhan Y, Jeny F, Kambouchner M, Didier M, Bouvry D, Nunes H, Bernaudin JF, Valeyre D. The Lung in Dysregulated States of Humoral Immunity. Respiration 2017; 94:389-404. [PMID: 28910817 DOI: 10.1159/000480297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In common variable immunodeficiency, lung manifestations are related to different mechanisms: recurrent pneumonias due to encapsulated bacteria responsible for diffuse bronchiectasis, diffuse infiltrative pneumonia with various patterns, and lymphomas, mostly B cell extranodal non-Hodgkin type. The diagnosis relies on significant serum Ig deficiency and the exclusion of any primary or secondary cause. Histopathology may be needed. Immunoglobulin (IgG) replacement is crucial to prevent infections and bronchiectasis. IgG4-related respiratory disease, often associated with extrapulmonary localizations, presents with solitary nodules or masses, diffuse interstitial lung diseases, bronchiolitis, lymphadenopathy, and pleural or pericardial involvement. Diagnosis relies on international criteria including serum IgG4 dosage and significantly increased IgG4/IgG plasma cells ratio in pathologically suggestive biopsy. Respiratory amyloidosis presents with tracheobronchial, nodular, and cystic or diffuse interstitial lung infiltration. Usually of AL (amyloid light chain) subtype, it may be localized or systemic, primary or secondary to a lymphoproliferative process. Very rare other diseases due to nonamyloid IgG deposits are described. Among the various lung manifestations of dysregulated states of humoral immunity, this article covers only those associated with the common variable immunodeficiency, IgG4-related disease, amyloidosis, and pulmonary light-chain deposition disease. Autoimmune connective-vascular tissue diseases or lymphoproliferative disorders are addressed in other chapters of this issue.
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117
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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Abstract
INTRODUCTION IgG4-Related Disease is a newly recognized condition which is increasingly diagnosed by practitioners due to improvement in clinical awareness. Men and women have been found to be affected by this disease in various organs, more commonly with involvement of the salivary and lacrimal glands as well as pancreas and liver. Areas covered: The diagnosis and management of this condition remain challenging as biomarkers and therapies are being investigated. Hallmark features on histology are still the gold standard for confirmation of diagnosis, whereas serum IgG4 level has been shown to be neither necessary nor sufficient for the diagnosis. Glucocorticoids remain the most effective initial management for this condition while there are limited clinical trials on the effectiveness of maintenance therapy. Expert commentary: This review serves as an update on approaches for diagnosis and management of IgG4-RD. Most of the known data in this field comes from retrospective cohort studies and expert consensus guidelines but new ongoing prospective studies, clinical trials and better understanding of the pathogenesis of this condition are promising.
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Affiliation(s)
- Mary Abraham
- a Department of Medicine, Division of Rheumatology , Emory University School of Medicine , Atlanta , GA , USA
| | - Arezou Khosroshahi
- a Department of Medicine, Division of Rheumatology , Emory University School of Medicine , Atlanta , GA , USA
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Zheng K, Teng F, Li XM. Immunoglobulin G4-related kidney disease: Pathogenesis, diagnosis, and treatment. Chronic Dis Transl Med 2017; 3:138-147. [PMID: 29063068 PMCID: PMC5643773 DOI: 10.1016/j.cdtm.2017.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 12/19/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a recently recognized clinical entity that often involves multiple organs; it is characterized by high levels of serum immunoglobulin G4 (IgG4), dense infiltration of IgG4+ cells, and storiform fibrosis. Cellular immunity, particularly T cell-mediated immunity, has been implicated in the pathogenesis of IgG4-RD. The most frequent renal manifestations of IgG4-RD are IgG4-related tubulointerstitial nephritis, membranous glomerulonephropathy (MGN), and obstructive nephropathy secondary to urinary tract obstruction due to IgG4-related retroperitoneal fibrosis, prostatitis, or ureter inflammation. Kidney function impairment can be acute or chronic. In IgG4-MGN, proteinuria can be in the nephrotic range. The diagnosis of IgG4-related kidney disease should not be based solely on serum IgG4 levels or the number of tissue-infiltrating IgG4+ plasma cells. Diagnosis should be based on specific histopathological findings, confirmed by tissue immunostaining and an appropriate clinical context. Steroid treatment is the first-line therapy. For relapsing or refractory cases, immunosuppressants could be combined with steroids. In hydronephrosis patients, appropriate immunosuppressive therapy could preclude the implantation of a double J ureteral catheter.
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120
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Berti A, Della-Torre E, Gallivanone F, Canevari C, Milani R, Lanzillotta M, Campochiaro C, Ramirez GA, Bozzalla Cassione E, Bozzolo E, Pedica F, Castiglioni I, Arcidiacono PG, Balzano G, Falconi M, Gianolli L, Dagna L. Quantitative measurement of 18F-FDG PET/CT uptake reflects the expansion of circulating plasmablasts in IgG4-related disease. Rheumatology (Oxford) 2017; 56:2084-2092. [DOI: 10.1093/rheumatology/kex234] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Indexed: 12/24/2022] Open
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Murata Y, Aoe K, Mimura-Kimura Y, Murakami T, Oishi K, Matsumoto T, Ueoka H, Matsunaga K, Yano M, Mimura Y. Association of immunoglobulin G4 and free light chain with idiopathic pleural effusion. Clin Exp Immunol 2017; 190:133-142. [PMID: 28617941 DOI: 10.1111/cei.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 12/24/2022] Open
Abstract
The cause of pleural effusion remains uncertain in approximately 15% of patients despite exhaustive evaluation. As recently described immunoglobulin (Ig)G4-related disease is a fibroinflammatory disorder that can affect various organs, including the lungs, we investigate whether idiopathic pleural effusion includes IgG4-associated etiology. Between 2000 and 2012, we collected 830 pleural fluid samples and reviewed 35 patients with pleural effusions undiagnosed after pleural biopsy at Yamaguchi-Ube Medical Center. Importantly, IgG4 immunostaining revealed infiltration of IgG4-positive plasma cells in the pleura of 12 patients (34%, IgG4+ group). The median effusion IgG4 level was 41 mg/dl in the IgG4+ group and 27 mg/dl in the IgG4- group (P < 0·01). The light and heavy chains of effusion IgG4 antibodies of patients in the IgG4+ group were heterogeneous by two-dimensional electrophoresis, indicating the absence of clonality of the IgG4 antibodies. Interestingly, the κ light chains were more heterogeneous than the λ light chains. The measurement of the κ and λ free light chain (FLC) levels in the pleural fluids showed significantly different κ FLC levels (median: 28·0 versus 9·1 mg/dl, P < 0·01) and κ/λ ratios (median: 2·0 versus 1·2, P < 0·001) between the IgG4+ and IgG4- groups. Furthermore, the κ/λ ratios were correlated with the IgG4+ /IgG+ plasma cell ratios in the pleura of the IgG4+ group. Taken together, these results demonstrate the involvement of IgG4 in certain idiopathic pleural effusions and provide insights into the diagnosis, pathogenesis and therapeutic opportunities of IgG4-associated pleural effusion.
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Affiliation(s)
- Y Murata
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.,The Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.,Division of Cardiology, The Department of Medicine and Clinical Science, Ube, Japan
| | - K Aoe
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - Y Mimura-Kimura
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - T Murakami
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - K Oishi
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.,The Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan.,Division of Cardiology, The Department of Medicine and Clinical Science, Ube, Japan
| | - T Matsumoto
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - H Ueoka
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - K Matsunaga
- The Department of Respiratory Medicine and Infectious Disease, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - M Yano
- Division of Cardiology, The Department of Medicine and Clinical Science, Ube, Japan
| | - Y Mimura
- The Department of Clinical Research, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
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122
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Tan ES, Friesen B, Loh SF, Fox J. Immunoglobulin-G4 related mastitis: A case report. Int J Surg Case Rep 2017; 37:169-172. [PMID: 28735232 PMCID: PMC5522915 DOI: 10.1016/j.ijscr.2017.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/11/2017] [Accepted: 06/11/2017] [Indexed: 12/11/2022] Open
Abstract
IgG4-RM is exceedingly rare with only ten reported cases in the literatreu. Diagnosis of IgG4-RM is based exclusively on histological analysis. It is a benign chronic inflammatory process that can be treated sufficiently with excision or steroid. Extensive whole body imaging is generally not recommended unless the patient is symptomatic.
Introduction IgG4-related mastitis (IgG4-RM) is exceedingly rare with only ten cases reported in the literature to date. Organs that are affected with IgG4-related disease (IgG4-RD) all share the same histopathological hallmarks consisting of dense lymphocytic infiltration, storiform fibrosis and obliterative phlebitis. Presentation of case This case report highlights a case of IgG4-RM found incidentally in a 52-year-old woman during a routine breast screen and it explores the current literature about IgG4-RM and IgG4-RD. Discussion IgG4-RM and IgG4-RD, in general, is a new entity in the field of medicine and its aetiology is not well understood. In the literature, IgG4-RM often presents as a painless palpable breast lump in isolation or with other systemic manifestations. IgG4-RM is considered benign and has excellent prognosis post-conservative treatment with steroid or surgical excision. Conclusion IgG4-RM is diagnosed exclusively on histological analysis. It is hard to distinguish IgG4-RD from malignant breast lesions purely on clinical examination and imaging studies. Increasing awareness of this condition among clinicians will assist them in managing patients better. Extensive whole body imaging is not recommended unless symptomatic.
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Affiliation(s)
- Ee Syn Tan
- Department of General Surgery (Monash Health), 135-145 David Street, Dandenong, VIC 3175, Australia.
| | - Brendon Friesen
- Lake Imaging, St John of God Hospital, Geelong, VIC, Australia
| | - Seow Foong Loh
- Department of Breast Surgery (Monash Health), Moorabbin Hospital, 823-865 Centre Rd, Bentleigh East, VIC 3165, Australia
| | - Jane Fox
- Department of Breast Surgery (Monash Health), Moorabbin Hospital, 823-865 Centre Rd, Bentleigh East, VIC 3165, Australia
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Peretti M, Radu DM, Pfeuty K, Dujon A, Riquet M, Martinod E. Surgical resection of pulmonary inflammatory pseudotumors: long-term outcome. Asian Cardiovasc Thorac Ann 2017; 25:440-445. [PMID: 28605954 DOI: 10.1177/0218492317716587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pulmonary inflammatory pseudotumors are rare lesions that remain problematic in several aspects, especially regarding the therapeutic strategy. The goal of this study was to evaluate long-term survival in a multicenter series of patients who required surgery for pulmonary inflammatory pseudotumors. Methods Thirty-six cases of pulmonary inflammatory pseudotumors, operated on in 3 French thoracic surgery departments between 1989 and 2015, were studied retrospectively. We recorded pre-, peri- and postoperative data for each patient, and long-term survival was analyzed. Results There were 22 men and 14 women. Mean age was 53.5 years (range 14-81 years). Three pneumonectomies, 1 bilobectomy, 19 lobectomies, 2 segmentectomies, 10 wedge resections, and 1 biopsy were performed. Complete resection was carried out in 32 (88.8%) patients. Median follow-up was 76 months. Five-year and 10-year survival rates were respectively 86.8% and 81.7% (96% and 90% for patients with R0 resection). Conclusions Long-term survival was excellent for patients with pulmonary inflammatory pseudotumors who benefited from surgery, especially when surgical resection was complete. These results confirm that surgical resection must be proposed as the first-line treatment for patients with pulmonary inflammatory pseudotumors.
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Affiliation(s)
- Marine Peretti
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Dana M Radu
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
| | - Karel Pfeuty
- 2 Department of Thoracic and Vascular Surgery, Saint-Brieuc Hospital, France
| | - Antoine Dujon
- 3 Department of Thoracic and Vascular Surgery, Cedar Surgical Center, Bois Guillaume, France
| | - Marc Riquet
- 4 Department of Thoracic Surgery, Assistance Publique Hôpitaux de Paris, Georges Pompidou European Hospital, Paris Descartes University, COMUE Sorbonne Paris Cité, Paris, France
| | - Emmanuel Martinod
- 1 Department of Thoracic and Vascular Surgery, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, SMBH Faculty of Medicine, Paris 13 University, COMUE Sorbonne Paris Cité, Bobigny, France
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Wang Y, Li K, Gao D, Luo G, Zhao Y, Wang X, Zhang J, Jin J, Zhao Z, Yang C, Zhu J, Zhang J, Huang F. Combination therapy of leflunomide and glucocorticoids for the maintenance of remission in patients with IgG4-related disease: a retrospective study and literature review. Intern Med J 2017; 47:680-689. [PMID: 28321964 DOI: 10.1111/imj.13430] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/07/2017] [Accepted: 03/08/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Yiwen Wang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Kunpeng Li
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Dai Gao
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Gui Luo
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Yurong Zhao
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Xiuru Wang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Jie Zhang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Jingyu Jin
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Zheng Zhao
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Chunhua Yang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Jian Zhu
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Jianglin Zhang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
| | - Feng Huang
- Department of Rheumatology; Chinese PLA General Hospital; Beijing China
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Iwata N, Iwama S, Sugimura Y, Yasuda Y, Nakashima K, Takeuchi S, Hagiwara D, Ito Y, Suga H, Goto M, Banno R, Caturegli P, Koike T, Oshida Y, Arima H. Anti-pituitary antibodies against corticotrophs in IgG4-related hypophysitis. Pituitary 2017; 20:301-310. [PMID: 27896569 DOI: 10.1007/s11102-016-0780-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE IgG4-related disease is a systemic inflammatory disease characterized by infiltration of IgG4-positive plasma cells into multiple organs, including the pituitary gland. Autoimmunity is thought to be involved in the pathogenesis of IgG4-related disease. The diagnosis of IgG4-related hypophysitis (IgG4-RH) is difficult because its clinical features, such as pituitary swelling and hypopituitarism, are similar to those of other pituitary diseases, including lymphocytic hypophysitis and sellar/suprasellar tumors. The presence and significance of anti-pituitary antibodies (APA) in IgG4-RH is unclear. METHODS In this case-control study, we used single indirect immunofluorescence on human pituitary substrates to assess the prevalence of serum APA in 17 patients with IgG4-RH, 8 control patients with other pituitary diseases (lymphocytic infundibulo-neurohypophysitis, 3; craniopharyngioma, 2; germinoma, 3), and 9 healthy subjects. We further analyzed the endocrine cells targeted by the antibodies using double indirect immunofluorescence. RESULTS APA were found in 5 of 17 patients with IgG4-RH (29%), and in none of the pituitary controls or healthy subjects. The endocrine cells targeted by the antibodies in the 5 IgG4-RH cases were exclusively corticotrophs. Antibodies were of the IgG1 subclass, rather than IgG4, in all 5 cases, suggesting that IgG4 is not directly involved in the pathogenesis. Finally, antibodies recognized pro-opiomelanocortin in 2 of the cases. CONCLUSIONS Our study suggests that autoimmunity is involved in the pathogenesis of IgG4-RH and that corticotrophs are the main antigenic target, highlighting a possible new diagnostic marker for this condition.
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Affiliation(s)
- Naoko Iwata
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Shintaro Iwama
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan.
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan.
| | - Yoshihisa Sugimura
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yoshinori Yasuda
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Kohtaro Nakashima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Seiji Takeuchi
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Daisuke Hagiwara
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Yoshihiro Ito
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Hidetaka Suga
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Motomitsu Goto
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Ryoichi Banno
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
| | - Patrizio Caturegli
- Department of Pathology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Teruhiko Koike
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan
| | - Yoshiharu Oshida
- Research Center of Health, Physical Fitness and Sports, Nagoya University, Furo-cho, Chikusa-ku, Nagoya, 464-8601, Japan
| | - Hiroshi Arima
- Department of Endocrinology and Diabetes, Nagoya University Graduate School of Medicine, Nagoya, 466-8550, Japan
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Thompson A, Whyte A. Imaging of IgG4-related disease of the head and neck. Clin Radiol 2017; 73:106-120. [PMID: 28501095 DOI: 10.1016/j.crad.2017.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 12/15/2022]
Abstract
IgG4-related disease is a systemic, inflammatory disorder typically involving multiple organ systems. Several eponymous conditions described previously in the clinical and radiology literature are now recognised to be part of the IgG4-related disease spectrum. This includes multiple manifestations in the head and neck region, which are the subject of this review. Imaging can occasionally suggest the specific diagnosis of IgG4 disease. More commonly, it will be included in a limited differential diagnosis that requires clarification with the aid of image-guided biopsy. There are strict histopathological criteria for the diagnosis of IgG4-related disease.
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Affiliation(s)
- A Thompson
- Neurological Intervention and Imaging Service Western Australia, Level 1, G Block, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; Neurological Intervention and Imaging Service Western Australia, Royal Perth Hospital, 197 Wellington Street, Perth, WA 6000, Australia; Princess Margaret Hospital for Children, Roberts Road, Subiaco, WA 6008, Australia.
| | - A Whyte
- Perth Radiological Clinic, 127 Hamersley Road, Subiaco, WA 6008, Australia; School of Surgery, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; Department of Medicine and Radiology, University of Melbourne, Parkville, VIC 3010, Australia
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127
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Ardila-Suarez O, Abril A, Gómez-Puerta JA. Enfermedad relacionada con IgG4: revisión concisa de la literatura. ACTA ACUST UNITED AC 2017; 13:160-166. [DOI: 10.1016/j.reuma.2016.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 12/24/2022]
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128
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Diny NL, Rose NR, Čiháková D. Eosinophils in Autoimmune Diseases. Front Immunol 2017; 8:484. [PMID: 28496445 PMCID: PMC5406413 DOI: 10.3389/fimmu.2017.00484] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/07/2017] [Indexed: 12/15/2022] Open
Abstract
Eosinophils are multifunctional granulocytes that contribute to initiation and modulation of inflammation. Their role in asthma and parasitic infections has long been recognized. Growing evidence now reveals a role for eosinophils in autoimmune diseases. In this review, we summarize the function of eosinophils in inflammatory bowel diseases, neuromyelitis optica, bullous pemphigoid, autoimmune myocarditis, primary biliary cirrhosis, eosinophilic granulomatosis with polyangiitis, and other autoimmune diseases. Clinical studies, eosinophil-targeted therapies, and experimental models have contributed to our understanding of the regulation and function of eosinophils in these diseases. By examining the role of eosinophils in autoimmune diseases of different organs, we can identify common pathogenic mechanisms. These include degranulation of cytotoxic granule proteins, induction of antibody-dependent cell-mediated cytotoxicity, release of proteases degrading extracellular matrix, immune modulation through cytokines, antigen presentation, and prothrombotic functions. The association of eosinophilic diseases with autoimmune diseases is also examined, showing a possible increase in autoimmune diseases in patients with eosinophilic esophagitis, hypereosinophilic syndrome, and non-allergic asthma. Finally, we summarize key future research needs.
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Affiliation(s)
- Nicola L Diny
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Noel R Rose
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniela Čiháková
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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129
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Baptista B, Casian A, Gunawardena H, D'Cruz D, Rice CM. Neurological Manifestations of IgG4-Related Disease. Curr Treat Options Neurol 2017; 19:14. [PMID: 28374231 PMCID: PMC5378735 DOI: 10.1007/s11940-017-0450-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OPINION STATEMENT IgG4-related disease (IgG4-RD) is a multisystem inflammatory disorder. Early recognition of IgG4-RD is important to avoid permanent organ dysfunction and disability. Neurological involvement by IgG4-RD is relatively uncommon, but well recognised-hypertrophic pachymeningitis and hypophysitis are the most frequent manifestations. Although the nervous system may be involved in isolation, this more frequently occurs in conjunction with involvement of other systems. Elevated circulating levels of IgG4 are suggestive of the condition, but these are not pathognomonic and exclusion of other inflammatory disorders including vasculitis is required. Wherever possible, a tissue diagnosis should be established. The characteristic histopathological changes include a lymphoplasmacytoid infiltrate, storiform fibrosis and obliterative phlebitis. IgG4-RD typically responds well to treatment with glucocorticoids, although relapse is relatively common and treatment with a steroid-sparing agent or rituximab may be required. Improved understanding of the pathogenesis of IgG4-RD is likely to lead to the development of more specific disease treatments in the future.
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Affiliation(s)
| | - Alina Casian
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
| | - Harsha Gunawardena
- Department of Rheumatology, Brunel Building, Southmead Hospital, Bristol, UK
- Musculoskeletal Research Unit, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - David D'Cruz
- Louise Coote Unit, Guy's and St Thomas NHS Foundation Trust, London, UK
- Division of Immunology, Infection and Inflammatory Diseases, King's College London, New Hunt's House, Guy's Campus, Great Maze Pond, London, SE1 1UL, UK
| | - Claire M Rice
- School of Clinical Sciences, Level 1, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Department of Neurology, Brunel Building, Southmead Hospital, Bristol, UK.
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130
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Higuchi T, Haruta I, Shibata N, Yanagisawa N, Yagi J. Flagellar filament structural protein induces Sjögren's syndrome-like sialadenitis in mice. Oral Dis 2017; 23:636-643. [PMID: 28142222 DOI: 10.1111/odi.12649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/31/2016] [Accepted: 01/23/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Sjögren's syndrome (SS) is a systemic autoimmune disease that primarily affects lacrimal and salivary glands. We previously reported that FliC derived from Escherichia coli could induce autoimmune pancreatitis-like lesions. From these results, we speculated that FliC could also induce SS-like exocrinopathy. In this study, we investigated the effects of chronic exposure to FliC on lacrimal and salivary glands and the possibility that it might lead to an autoimmune response. METHODS C57BL/6 mice were repeatedly injected with FliC and histological changes, serum levels of cytokine/chemokines and autoantibodies were evaluated at different time points after the final injection. The presence of sialadenitis was diagnosed by histological methods. RESULTS In FliC-treated groups, 57% of subjects developed inflammatory cell infiltrates around ducts in mandibular salivary glands, but not lacrimal glands. In addition, serum levels of total IgG, IgG1, and IgG2a were significantly higher in FliC-treated groups. Intriguingly, serum anti-SSA/Ro levels were also significantly higher in FliC-treated groups. Cytokine analysis revealed that serum levels of IL-1β, IL-12p70, IL-13, IFN-γ, IL-15, and IL-23 seemed to be higher in FliC-treated mice. CONCLUSIONS Our data suggest that FliC-treated mice develop an SS-like phenotype. Our model may elucidate the relationship between commensal bacteria and SS.
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Affiliation(s)
- T Higuchi
- Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - I Haruta
- Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - N Shibata
- Department of Pathology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - N Yanagisawa
- Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - J Yagi
- Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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131
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Chen Y, Zhao JZ, Feng RE, Shi JH, Li XM, Fei YY, Shi Y, Zhang W, Zhang FC. Types of Organ Involvement in Patients with Immunoglobulin G4-related Disease. Chin Med J (Engl) 2017; 129:1525-32. [PMID: 27364787 PMCID: PMC4931257 DOI: 10.4103/0366-6999.184459] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic disease that can involve multiple organs and various clinical phenotypes. The purpose of this study was to analyze different types of organ involvement in IgG4-RD patients in China. Methods: We conducted a prospective cohort study on IgG4-RD patients to analyze the clinical manifestations and rare features of IgG4-RD. Patients were grouped into different types according to organ involvement regarding organ number and organ site. The constituent ratio in different types was also analyzed. Results: A total of 200 IgG4-RD patients, with a male:female ratio of 2.08:1, were grouped into different types. Cases having involvement of two or three organs were the most common whereas the fewest number of patients had multi-organ (≥4) involvement. Serum IgG4 and IgE levels, IgG4/IgG ratio, and percentage of eosinophils increased as the number of involved organs increased. In addition, constituent ratio analysis revealed that patients with salivary gland/lacrimal gland swelling, who also constituted the largest number of IgG4-RD patients, had higher serum IgG4 concentrations and IgG4/IgG values, had higher percentage of Eos, and were more likely to have had a history of allergies relative to patients with internal organ involvement. Conclusions: The characteristic feature of IgG4-RD is multiple organ involvement with various clinical manifestations and different types. Although serum IgG4 levels increased with the number of involved organs, serum IgG4 levels were higher for those patients with salivary gland/lacrimal gland swelling compared with those with internal organ involvement. Thus, valuable clues to the differential diagnosis of IgG4-RD could be obtained by examining the clinical patterns of organ involvement.
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Affiliation(s)
- Yu Chen
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Ji-Zhi Zhao
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Rui-E Feng
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ju-Hong Shi
- Department of Respiratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xue-Mei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yun-Yun Fei
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Yang Shi
- Department of Rheumatology, Traditional Chinese Medicine Hospital, Capital Medical University, Beijing 100010, China
| | - Wen Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
| | - Feng-Chun Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100032, China
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Abstract
IgG4-related disease was only recently discovered, so its description, management, and new discoveries related to its etiology are rapidly evolving. Because IgG4 itself is a unique antibody which is intimately related to the diagnosis of the disease, the role of plasmablasts in the pathophysiology remains an active area of discussion. Recent studies have uncovered a possible role for CD4-positive cytotoxic T lymphocytes, T follicular helper cells, and M2 macrophages. The clinical presentation is variable and can be vague, as this disease affects many organs and new presentations are continuing to be described. The diagnosis depends on clinical and histopathological assessment. The mainstay of treatment is with glucocorticoids, but rituximab has recently shown promise. Monitoring disease activity using imaging modalities (including positron emission tomography) and serum markers is imperative, as relapses are common. IgG4-related disease spans many medical disciplines but is a treatable condition with which all clinicians should be familiar.
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Affiliation(s)
- Anna R Wolfson
- Massachusetts General Hospital, Allergy and Immunology Division, Cox 201, 55 Fruit Street, Boston, Massachusetts, 02114, USA
| | - Daniel L Hamilos
- Massachusetts General Hospital, Allergy and Immunology Division, Cox 201, 55 Fruit Street, Boston, Massachusetts, 02114, USA
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Katabathina VS, Khalil S, Shin S, Lath N, Menias CO, Prasad SR. Immunoglobulin G4-Related Disease: Recent Advances in Pathogenesis and Imaging Findings. Radiol Clin North Am 2017; 54:535-51. [PMID: 27153787 DOI: 10.1016/j.rcl.2015.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Immunoglobulin G4-related disease (IgG4-RD) is a novel, immune-mediated, multisystem disease characterized by the development of tumefactive lesions in multiple organs. IgG4-RD encompasses many fibroinflammatory diseases that had been thought to be confined to single organs. Delayed diagnosis or misdiagnosis as malignancies leading to aggressive treatment may be averted by identification of the multisystem nature of IgG4-RD. Most cases show exquisite response to steroid therapy; steroid-resistant cases are being treated by novel therapeutic agents, including B-cell depleting agents such as rituximab. Cross-sectional imaging studies play a pivotal role in the initial diagnosis, assessing response to therapy and long-term surveillance.
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Affiliation(s)
- Venkata S Katabathina
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | - Suhare Khalil
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Sooyoung Shin
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Narayan Lath
- Department of Radiology, Singapore General Hospital, Outram road, Singapore 169608, Singapore
| | | | - Srinivasa R Prasad
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sasaki Yatabe M, Watanabe K, Hayashi Y, Yatabe J, Morimoto S, Ichihara A, Nakayama M, Watanabe T. Overlap of Post-obstructive Diuresis and Unmasked Diabetes Insipidus in a Case of IgG4-related Retroperitoneal Fibrosis and Tuberoinfundibular Hypophysitis: A Case Report and Review of the Literature. Intern Med 2017; 56:47-53. [PMID: 28049999 PMCID: PMC5313424 DOI: 10.2169/internalmedicine.56.6648] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The clinical picture of IgG4-related disease (IgG4-RD) is diverse because various organs can be affected. We describe the case of a 56-year-old man with acute renal failure and tuberoinfundibular hypophysitis due to IgG4-RD. Steroid therapy lowered the serum IgG4 level and ameliorated renal dysfunction, bilateral hydronephrosis and retroperitoneal fibrosis. However, polyuria from post-obstructive diuresis and unmasked central diabetes insipidus ensued. The patient's polyuria continued despite the administration of a therapeutic dose of glucocorticoid; the patient's pituitary swelling and anterior pituitary dysfunction were partially ameliorated. The pituitary swelling recurred seven months later. In patients with IgG4-RD, the manifestation of polyuria after steroid therapy should prompt suspicion of post-obstructive diuresis and the unmasking of central diabetes insipidus.
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Affiliation(s)
- Midori Sasaki Yatabe
- Department of Nephrology, Hypertension, Diabetology, Crinology and Metabolism, Fukushima Medical University School of Medicine, Japan
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Della-Torre E, Conti A, Berti A, Yacoub MR, Alessio M. Rituximab hypersensitivity in IgG4-related disease: successful desensitization in a patient with IgG4 rheumatoid factor. Int J Rheum Dis 2016; 20:276-279. [PMID: 28036157 DOI: 10.1111/1756-185x.13021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Medicine and Clinical immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Conti
- Proteome Biochemistry, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alvise Berti
- Università Vita-Salute San Raffaele, School of Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Unit of Medicine and Clinical immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mona Rita Yacoub
- Unit of Medicine and Clinical immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Alessio
- Proteome Biochemistry, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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136
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Della-Torre E, Stone JH. “How I manage” IgG4-Related Disease. J Clin Immunol 2016; 36:754-763. [DOI: 10.1007/s10875-016-0331-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022]
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137
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Lanzillotta M, Campochiaro C, Trimarchi M, Arrigoni G, Gerevini S, Milani R, Bozzolo E, Biafora M, Venturini E, Cicalese MP, Stone JH, Sabbadini MG, Della-Torre E. Deconstructing IgG4-related disease involvement of midline structures: Comparison to common mimickers. Mod Rheumatol 2016; 27:638-645. [PMID: 27622319 DOI: 10.1080/14397595.2016.1227026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A series of destructive and tumefactive lesions of the midline structures have been recently added to the spectrum of IgG4-related disease (IgG4-RD). We examined the clinical, serological, endoscopic, radiological, and histological features that might be of utility in distinguishing IgG4-RD from other forms of inflammatory conditions with the potential to involve the sinonasal area and the oral cavity. METHODS We studied 11 consecutive patients with erosive and/or tumefactive lesions of the midline structures referred to our tertiary care center. All patients underwent serum IgG4 measurement, flow cytometry for circulating plasmablast counts, nasal endoscopy, radiological studies, and histological evaluation of tissue specimens. The histological studies included immunostaining studies to assess the number of IgG4 + plasma cells/HPF for calculation of the IgG4+/IgG + plasma cell ratio. RESULTS Five patients with granulomatosis with polyangiitis (GPA), three with cocaine-induced midline destructive lesions (CIMDL), and three with IgG4-RD were studied. We found no clinical, endoscopic, or radiological findings specific for IgG4-RD. Increased serum IgG4 and plasmablasts levels were not specific for IgG4-RD. Rather, all 11 patients had elevated blood plasmablast concentrations, and several patients with GPA and CIMDL had elevated serum IgG4 levels. Storiform fibrosis and an IgG4+/IgG + plasma cell ratio >20% on histological examination, however, were observed only in patients with IgG4-RD. CONCLUSIONS Histological examination of bioptic samples from the sinonasal area and oral cavity represents the mainstay for the diagnosis of IgG4-RD involvement of the midline structures.
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Affiliation(s)
- Marco Lanzillotta
- a Unit of Medicine and Clinical Immunology, Ospedale San Raffaele , Milan , Italy.,b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy
| | - Corrado Campochiaro
- a Unit of Medicine and Clinical Immunology, Ospedale San Raffaele , Milan , Italy.,b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy
| | - Matteo Trimarchi
- b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy.,c Department of Otorhinolaryngology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Gianluigi Arrigoni
- d Pathology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Simonetta Gerevini
- e Neuroradiology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Raffaella Milani
- f Immunohematology and Transfusion Medicine Unit , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Enrica Bozzolo
- a Unit of Medicine and Clinical Immunology, Ospedale San Raffaele , Milan , Italy
| | - Matteo Biafora
- b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy.,c Department of Otorhinolaryngology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Elena Venturini
- b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy.,e Neuroradiology Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - Maria Pia Cicalese
- g San Raffaele Telethon Institute for Gene Therapy (TIGET) , Milan , Italy.,h Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute , Milan , Italy , and
| | - John H Stone
- i Division of Rheumatology, Allergy, and Immunology , Massachusetts General Hospital, Harvard Medical School , Boston , MA , USA
| | - Maria Grazia Sabbadini
- a Unit of Medicine and Clinical Immunology, Ospedale San Raffaele , Milan , Italy.,b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy
| | - Emanuel Della-Torre
- a Unit of Medicine and Clinical Immunology, Ospedale San Raffaele , Milan , Italy.,b Unit of Medicine and Clinical Immunology, Università Vita-Salute San Raffaele , Milan , Italy
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Association between IgG4 Autoantibody and Complement Abnormalities in Systemic Lupus Erythematosus. Mediators Inflamm 2016; 2016:2196986. [PMID: 27597802 PMCID: PMC4997081 DOI: 10.1155/2016/2196986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 07/13/2016] [Indexed: 12/24/2022] Open
Abstract
In order to investigate the association between IgG4 autoantibody and complement abnormalities in systemic lupus erythematosus (SLE), 72 newly diagnosed SLE patients, 67 rheumatoid arthritis (RA) patients, and 41 healthy normals were employed. Serum levels of antinuclear IgG4 and IgG4-specific IgM-rheumatoid factor (RF) were measured, and the correlations between serum levels of antinuclear IgG4 and several clinical parameters were analyzed. Also, the levels of IgG subclasses, C1q, and C3 deposition in lupus nephritis (LN) were detected. The results showed that serum levels of antinuclear IgG4 were higher in SLE patients relative to healthy normals (P < 0.01). Serum levels of antinuclear IgG4 in SLE patients were positively correlated with serum levels of total IgG4, albumin, and C3 (r = 0.61, P < 0.05; r = 0.40, P < 0.05; and r = 0.54, P < 0.05, resp.) and negatively correlated with 24-hour urinary protein (r = 0.49, P < 0.05). Serum levels of IgG4-specific IgM-RF were higher in RA patients than in SLE patients (P < 0.001). Also, the ratio of the deposition score for IgG4/(IgG1 + IgG2 + IgG3 + IgG4) was negatively correlated with the score for C1q and C3 deposition in LN (r = 0.34, P < 0.05; r = 0.51, P < 0.01, resp.). In summary, the IgG4 autoantibody may dampen the inflammatory response in SLE, thus maybe providing a novel therapeutic target for SLE.
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Della-Torre E, Lanzillotta M, Campochiaro C, Bozzalla E, Bozzolo E, Bandiera A, Bazzigaluppi E, Canevari C, Modorati G, Stone JH, Manfredi A, Doglioni C. Antineutrophil cytoplasmic antibody positivity in IgG4-related disease: A case report and review of the literature. Medicine (Baltimore) 2016; 95:e4633. [PMID: 27559962 PMCID: PMC5400329 DOI: 10.1097/md.0000000000004633] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a fibroinflammatory condition characterized by serum IgG4 elevation and tissue infiltration of IgG4-positive plasma cells. Substantial overlap between IgG4-RD and antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) exists in terms of organ involvement and histopathological features. A positive ANCA assay is regarded as a highly specific finding in favor of an AAV, and generally influences away from a diagnosis of IgG4-RD. Recent reports, however, have raised the possibility that some patients with IgG4-RD are ANCA positive, thus suggesting reconsideration of the role of ANCA in the diagnostic workup. In the present work, we describe the first case of concomitant biopsy-proven IgG4-RD and granulomatosis with polyangiitis (GPA), demonstrating antiproteinase 3 (PR3) ANCA of the IgG4 subclass in the patient's serum. We also review the literature in order to provide clinicians with tools for interpreting ANCA positivity in IgG4-RD patients. CASE SUMMARY A 51-year-old woman was referred for left exopthalmos due to lacrimal gland enlargement and increased serum IgG4 concentration. IgG4-RD was suspected and further imaging studies disclosed multiple pulmonary masses in the right lung. Histological analysis of the left lacrimal gland was diagnostic for IgG4-RD, but lung biopsy showed typical features of GPA. ANCA assay was positive for anti-PR3 antibodies. Further immunofluorescence studies demonstrated anti-PR3 antibodies of IgG1 and IgG4 subclass. Treatment with rituximab induced swift remission of both IgG4-RD and GPA manifestations. We identified 9 other reports of patients with IgG4-RD and positive ANCA in the English literature, 5 cases with biopsy-proven IgG4-RD and 4 cases in whom IgG4-RD was diagnosed presumptively. Four patients had also histological evidence of concomitant AAV. CONCLUSION The present work demonstrates that ANCA positivity in patients with biopsy-proven IgG4-RD should prompt the exclusion of a concomitant vasculitic process; a positive ANCA does not exclude the diagnosis of IgG4-RD; confirmation through immunoenzymatic assays of the ANCA specificity, clinical-pathological correlation, and histopathological evaluation remain crucial steps for the differential diagnosis between AAV and IgG4-RD.
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Affiliation(s)
- Emanuel Della-Torre
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
- Correspondence: Emanuel Della-Torre, Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy (e-mail: )
| | - Marco Lanzillotta
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
| | - Corrado Campochiaro
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | - Emanuele Bozzalla
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
| | - Enrica Bozzolo
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | | | | | - Carla Canevari
- Division of Nuclear Medicine, IRCCS-San Raffaele Scientific Institute
| | - Giulio Modorati
- Department of Ophthalmology, IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - John H. Stone
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Angelo Manfredi
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS-San Raffaele Scientific Institute
- Unit of Medicine and Clinical Immunology, IRCCS-San Raffaele Scientific Institute
| | - Claudio Doglioni
- Università Vita-Salute San Raffaele, IRCCS-San Raffaele Scientific Institute
- Pathology Unit, IRCCS-San Raffaele Scientific Institute, Milan, Italy
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140
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IgG4-assoziierte Erkrankungen. Z Rheumatol 2016; 75:575-9. [DOI: 10.1007/s00393-016-0112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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141
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Mann S, Seidman MA, Barbour SJ, Levin A, Carruthers M, Chen LYC. Recognizing IgG4-related tubulointerstitial nephritis. Can J Kidney Health Dis 2016; 3:34. [PMID: 27429760 PMCID: PMC4947514 DOI: 10.1186/s40697-016-0126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/02/2016] [Indexed: 12/24/2022] Open
Abstract
PURPOSE OF THE REVIEW Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disorder affecting nearly all organs, including the kidney. Tubulointerstitial nephritis (IgG4-TIN) is the most common form of IgG4-related kidney disease (IgG4-RKD) and is the focus of this concise review. OBJECTIVE The study aims to describe when IgG4-TIN should be suspected and to summarize the diagnosis, treatment, and natural history of the disease. SOURCES OF INFORMATION Ovid MEDLINE, Google Scholar, and PubMed were searched for full-text English language articles up to January 2016. References included in the manuscript were chosen at the authors' discretion based on their relevance to the subject of the review. FINDINGS IgG4-TIN should be considered in patients presenting with abnormal urinalysis, abnormal kidney function, renal lesions on imaging, and elevated IgG, IgE, or hypocomplementemia. Diagnosis of IgG4-TIN requires a combination of histologic features (plasma cell-enriched TIN with >10 IgG4+ plasma cells/hpf, +/- TBM immune complex deposits in many cases) and at least one of the following:Characteristic radiologic findings (small peripheral low-attenuation cortical nodules, round or wedge-shaped lesions, or diffuse patchy involvement)Elevated serum IgG4 levelCharacteristic findings of IgG4-RD in other organs Other conditions such as lupus, vasculitis, diabetic nephropathy, and lymphoma must be excluded, as these can also present with IgG4+ plasma cells in the renal parenchyma. IgG4-TIN is generally responsive to steroids and B cell depletion with rituximab, but relapses are common and patients require close long-term follow-up. LIMITATIONS Available data on IgG4-TIN are from retrospective observational studies. IMPLICATIONS IgG4-TIN is a distinct and emerging subtype of interstitial nephritis. Nephrologists must be aware of this entity and how to definitively diagnose and treat it. Prospective studies and ideally multi-center clinical trials are needed to study the epidemiology, treatment, and natural history of this disease.
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Affiliation(s)
- Shawna Mann
- />Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver,, BC V5Z 1M9 Canada
| | - Michael A. Seidman
- />Department of Pathology and Laboratory Medicine, Providence Health Care, 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Sean J. Barbour
- />Division of Nephrology, University of British Columbia, 2775 Laurel Street, 5th Floor, Vancouver, BC BC V5T 3A5 Canada
| | - Adeera Levin
- />Division of Nephrology, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Mollie Carruthers
- />Division of Rheumatology, University of British Columbia, 839 West Broadway, Vancouver, BC V5Z 1J9 Canada
| | - Luke Y. C. Chen
- />Division of Hematology, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC V5Z 1M9 Canada
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142
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Fragoulis GE, Zampeli E, Moutsopoulos HM. IgG4-related sialadenitis and Sjögren's syndrome. Oral Dis 2016; 23:152-156. [PMID: 27318181 DOI: 10.1111/odi.12526] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 12/24/2022]
Abstract
IgG4-related disease (IgG4-RD) has emerged as a new entity in the last decade. It comprises numerous conditions previously thought to be unrelated. Macroscopically, these diseases cause diffuse organ swelling and formation of pseudotumorous masses. Histopathologically, they are characterized by a lymphoplasmacytic infiltrate with increased IgG4+ plasma cells and storiform fibrosis. Despite rapid progress within the last years, our knowledge on these conditions is still fragmented. To date, more than forty organs have been reported to be included in IgG4-RD, and salivary gland involvement is amongst the most common organs affected [IgG4-related sialadenitis (IgG4-RS)]. Interestingly, IgG4-RS shares commonalities with Sjögren's syndrome (SS), like glandular enlargement, sicca symptoms, arthralgias, hypergammaglobulinemia, hypocomplementemia, and circulating antinuclear antibodies. Nonetheless, they differ in that the incidence of anti-Ro and anti-La reactivity is not frequently found in patients with IgG4-RS, their salivary glands are infiltrated by a large number of IgG4+ plasma cells and IgG4-RS symptoms respond promptly to steroids. The aim of this review was to describe the clinical, serological, histopathological and pathophysiological aspects of IgG4-RS in the context of IgG4-RD and highlight the differences between IgG4-RS and SS.
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Affiliation(s)
- G E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,Pathophysiology Department, School of Medicine, University of Athens, Athens, Greece
| | - E Zampeli
- Pathophysiology Department, School of Medicine, University of Athens, Athens, Greece
| | - H M Moutsopoulos
- Pathophysiology Department, School of Medicine, University of Athens, Athens, Greece
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143
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Szczawinska-Poplonyk A, Wojsyk-Banaszak I, Jonczyk-Potoczna K, Breborowicz A. Pulmonary manifestation of immunoglobulin G4-related disease in a 7-year-old immunodeficient boy with Epstein-Barr virus infection: a case report. Ital J Pediatr 2016; 42:58. [PMID: 27277432 PMCID: PMC4898369 DOI: 10.1186/s13052-016-0269-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/02/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a multiorgan fibroinflammatory condition with lymphoplasmacytic infiltrates containing abundant IgG4-positive plasma cells. The immunopathogenesis of the disease and the potential role of triggering autoantigens or infectious factors have not been clearly defined. Immunoglobulin G4-related lung disease is a new and emerging condition in pediatric patients and to date, there have been only two reports regarding pulmonary manifestation of IgG4-RD in children recently published. This is the first report of IgG4-related lung disease in an immunodeficient child with Epstein-Barr virus infection. CASE PRESENTATION We report on the case of a 7-year old atopic boy who was hospitalized with an initial clinical and radiological diagnosis of pneumonia, positive Epstein-Barr virus (EBV)-DNA in the blood and defective adaptive immunity. The lung CT showed a consolidated mass lesion adjacent to the posterior wall of the chest and the diaphragm. The child underwent surgical resection of the tumor, and the histologic examination of the lung specimens revealed lymphoplasmacytic infiltrates with fibrosis and vasculitis correlating with IgG4-related lung disease. Subsequent monitoring of the patient with lung CT, pulmonary function tests and IgG4 levels did not show signs of active disease. CONCLUSIONS The diagnosis of IgG4-related lung disease in children is challenging because of its rarity, nonspecific symptomatology and heterogeneous morphological manifestations. Further studies are required in children with pulmonary presentation of IgG4-RD to better understand pathogenesis of this condition, possible immunological or infectious triggering factors, and finally, to determine pediatric patient-targeted therapeutic interventions.
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Affiliation(s)
- Aleksandra Szczawinska-Poplonyk
- Department of Pediatric Pneumonology, Allergology and Clinical Immunology, Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland.
| | - Irena Wojsyk-Banaszak
- Department of Pediatric Pneumonology, Allergology and Clinical Immunology, Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland
| | | | - Anna Breborowicz
- Department of Pediatric Pneumonology, Allergology and Clinical Immunology, Karol Marcinkowski University of Medical Sciences, Szpitalna Street 27/33, 60-572, Poznan, Poland
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144
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Takamura S, Suyama T, Teraki Y. Immunoglobulin G4-related disease presenting with prurigo: Circulating T-helper 2 cells may be involved in the pathogenesis. J Dermatol 2016; 43:1067-70. [PMID: 27027509 DOI: 10.1111/1346-8138.13372] [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: 01/19/2016] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
We report a case of immunoglobulin G4-related disease (IgG4-RD) which presented with prurigo on the trunk and extremities. A 66-year-old man had a 2-month history of itchy erythematous papules on his trunk and extremities. Bilateral eyelid swelling and enlargement of the submandibular and parotid glands were also observed. Computed tomography revealed pleural thickening and diffuse pancreatic enlargement. Serum levels of IgG4 were markedly increased. A biopsy specimen obtained from an erythematous papule showed a perivascular inflammatory infiltrate of lymphocytes with eosinophils in the dermis, whereas a parotid gland biopsy revealed an infiltrate of abundant IgG4-positive plasma cells. Treatment with prednisolone resulted in improvement of the skin and other lesions along with a decrease in IgG4 serum levels. A flow cytometric assay revealed that percentages of interleukin (IL)-4- and IL-13-producing CD4(+) T cells were markedly higher in the circulation of the IgG4-RD patient than in that of healthy subjects. Moreover, those populations dramatically decreased after treatment. Thus, prurigo may be a skin manifestation of IgG4-RD and T-helper 2 cells may contribute to the pathogenesis.
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Affiliation(s)
- Saori Takamura
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Takayuki Suyama
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Yuichi Teraki
- Department of Dermatology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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145
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Carballo I, Alvela L, Pérez LF, Gude F, Vidal C, Alonso M, Sopeña B, Gonzalez-Quintela A. Serum Concentrations of IgG4 in the Spanish Adult Population: Relationship with Age, Gender, and Atopy. PLoS One 2016; 11:e0149330. [PMID: 26910567 PMCID: PMC4766298 DOI: 10.1371/journal.pone.0149330] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/29/2016] [Indexed: 12/24/2022] Open
Abstract
Background and Aim Serum IgG4 concentrations are commonly measured in clinical practice. The aim of this study was to investigate serum IgG4 concentrations in adults and their potential relationship with demographic, lifestyle, metabolic, and allergy-related factors. Methods Serum IgG4 concentrations were measured with a commercial assay in 413 individuals (median age 55 years, 45% males) who were randomly selected from a general adult population. Results Median IgG4 concentration was 26.8 mg/dL. Five out of the 413 individuals (1.2%) exhibited IgG4 concentrations >135 mg/dL, and 17 out of 411 (4.1%) exhibited an IgG4/total IgG ratio >8%. Serum IgG4 concentrations were significantly higher in males than in females and decreased with age. After adjusting for age and sex, serum IgG4 concentrations were not significantly influenced by alcohol consumption, smoking or common metabolic abnormalities (obesity and the related metabolic syndrome). Serum IgG4 concentrations were not significantly correlated with serum concentrations of proinflammatory cytokines and inflammation markers. Serum IgG4 concentrations were significantly correlated with IgE concentrations. Serum IgG4 concentrations tended to be higher in atopics (individuals with IgE-mediated sensitization to aeroallergens) than in non-atopics, particularly among atopics without respiratory symptoms. Serum IgG4 concentrations were not significantly correlated with total eosinophil blood count. Cases of IgG4-related disease were neither present at baseline nor detected after a median of 11 years of follow-up. Conclusions Studies aimed at defining reference IgG4 values should consider partitioning by age and sex. Further studies are needed to confirm the potential influence of atopy status on serum IgG4 concentrations.
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Affiliation(s)
- Iago Carballo
- Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Lucía Alvela
- Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Luis-Fernando Pérez
- Department of Clinical Biochemistry, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Francisco Gude
- Department of Clinical Epidemiology, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Carmen Vidal
- Department of Allergy, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Manuela Alonso
- Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
- Department of Clinical Epidemiology, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Bernardo Sopeña
- Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | - Arturo Gonzalez-Quintela
- Department of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain
- * E-mail:
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146
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Lang D, Zwerina J, Pieringer H. IgG4-related disease: current challenges and future prospects. Ther Clin Risk Manag 2016; 12:189-99. [PMID: 26929632 PMCID: PMC4760655 DOI: 10.2147/tcrm.s99985] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Immunoglobulin G4-related disease (IgG4-RD) represents an immune-mediated fibroinflammatory condition with a characteristic histopathological appearance that can affect various organs. Although numerous single-organ manifestations have been described more than a century ago, its systemic nature and unique features were only discovered in the last 2 decades, when IgG4-RD emerged as a new entity of disease. IgG4-RD is usually considered a rare disease, but its true epidemiology has not yet been fully clarified. Also, despite recent advances in the identification of the underlying immunological processes, its pathophysiology is only incompletely understood till now. The diagnostic workup of IgG4-RD is complex and usually requires a combination of clinical examination, imaging, histological, and serological analyses. However, no finding alone is specific for IgG4-RD. Therefore, its diagnosis requires careful interpretation of examination results in context with the patient’s clinical appearance as well as the exclusion of a broad variety of differential diagnoses. The past years brought rapid advances concerning this novel disease entity: diagnostic criteria, further insights into the underlying immunological processes, new biomarkers, and novel therapeutic approaches were proposed and widened the knowledge in the field of IgG4-RD. Still, a greater number of questions remain unanswered, and many recent developments require further discussion and proof from clinical trials. This review should give an overview on current knowledge and future perspectives in epidemiology, pathophysiology, diagnosis, and therapy of IgG4-RD.
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Affiliation(s)
- David Lang
- Second Department of Internal Medicine, Kepler University Clinic, Linz, Austria
| | - Jochen Zwerina
- First Department of Internal Medicine, Ludwig Boltzmann-Institute of Osteology, Hanusch Hospital, Vienna, Austria
| | - Herwig Pieringer
- Second Department of Internal Medicine, Kepler University Clinic, Linz, Austria; Paracelsus Private Medical University, Salzburg, Austria
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147
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Watanabe T, Yamashita K, Kudo M. IgG4-Related Disease and Innate Immunity. Curr Top Microbiol Immunol 2016; 401:115-128. [PMID: 27744509 DOI: 10.1007/82_2016_42] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An increased number of clinicopathological studies on autoimmune pancreatitis, cholangitis, and sialoadenitis have led to the recognition of immunoglobulin G4-related disease (IgG4-RD) as a novel disorder, characterized by elevated levels of serum IgG4 and infiltration of IgG4-expressing plasma cells in the affected organs. Although the immunological background associated with the development of IgG4-RD remains poorly understood, recent studies have suggested involvement of the innate immune response in its pathogenesis. Peripheral blood innate immune cells, such as plasmacytoid dendritic cells and monocytes isolated from patients with IgG4-RD, promote IgG4 production by B cells. Activation of the innate immune response by microbe- and/or damage-associated molecular patterns stimulates production of type I interferon and B cell-activating factor by innate immune cells and results in IgG4 production by B cells. Elucidation of the innate immune response associated with IgG4-RD may help identify a new therapeutic target for this immune disorder.
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Affiliation(s)
- Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, 606-8507, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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148
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Guptill JT, Soni M, Meriggioli MN. Current Treatment, Emerging Translational Therapies, and New Therapeutic Targets for Autoimmune Myasthenia Gravis. Neurotherapeutics 2016; 13:118-31. [PMID: 26510558 PMCID: PMC4720661 DOI: 10.1007/s13311-015-0398-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease associated with the production of autoantibodies against 1) the skeletal muscle acetylcholine receptor; 2) muscle-specific kinase, a receptor tyrosine kinase critical for the maintenance of neuromuscular synapses; 3) low-density lipoprotein receptor-related protein 4, an important molecular binding partner for muscle-specific kinase; and 4) other muscle endplate proteins. In addition to the profile of autoantibodies, MG may be classified according the location of the affected muscles (ocular vs generalized), the age of symptom onset, and the nature of thymic pathology. Immunopathologic events leading to the production of autoantibodies differ in the various disease subtypes. Advances in our knowledge of the immunopathogenesis of the subtypes of MG will allow for directed utilization of the ever-growing repertoire of therapeutic agents that target distinct nodes in the immune pathway relevant to the initiation and maintenance of autoimmune disease. In this review, we examine the pathogenesis of MG subtypes, current treatment options, and emerging new treatments and therapeutic targets.
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Affiliation(s)
- Jeffrey T Guptill
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC, USA
| | - Madhu Soni
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Matthew N Meriggioli
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA.
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149
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Affiliation(s)
- Su-Jin Moon
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ki Min
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul, Korea
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