151
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Ten Berge B, Kleinjan A, Muskens F, Hammad H, Hoogsteden HC, Hendriks RW, Lambrecht BN, Van den Blink B. Evidence for local dendritic cell activation in pulmonary sarcoidosis. Respir Res 2012; 13:33. [PMID: 22513006 PMCID: PMC3352267 DOI: 10.1186/1465-9921-13-33] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 04/18/2012] [Indexed: 02/15/2023] Open
Abstract
Background Sarcoidosis is a granulomatous disease characterized by a seemingly exaggerated immune response against a difficult to discern antigen. Dendritic cells (DCs) are pivotal antigen presenting cells thought to play an important role in the pathogenesis. Paradoxically, decreased DC immune reactivity was reported in blood samples from pulmonary sarcoidosis patients. However, functional data on lung DCs in sarcoidosis are lacking. We hypothesized that at the site of disease DCs are mature, immunocompetent and involved in granuloma formation. Methods We analyzed myeloid DCs (mDCs) and plasmacytoid DCs (pDCs) in broncho-alveolar lavage (BAL) and blood from newly diagnosed, untreated pulmonary sarcoidosis patients and healthy controls using 9-color flowcytometry. DCs, isolated from BAL using flowcytometric sorting (mDCs) or cultured from monocytes (mo-DCs), were functionally assessed in a mixed leukocyte reaction with naïve allogeneic CD4+ T cells. Using Immunohistochemistry, location and activation status of CD11c+DCs was assessed in mucosal airway biopsies. Results mDCs in BAL, but not in blood, from sarcoidosis patients were increased in number when compared with mDCs from healthy controls. mDCs purified from BAL of sarcoidosis patients induced T cell proliferation and differentiation and did not show diminished immune reactivity. Mo-DCs from patients induced increased TNFα release in co-cultures with naïve allogeneic CD4+ T cells. Finally, immunohistochemical analyses revealed increased numbers of mature CD86+ DCs in granuloma-containing airway mucosal biopsies from sarcoidosis patients. Conclusion Taken together, these finding implicate increased local DC activation in granuloma formation or maintenance in pulmonary sarcoidosis.
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Affiliation(s)
- Bregje Ten Berge
- Department of Pulmonary Medicine, Erasmus MC, Dr Molewaterplein 50, 3015 GE Rotterdam, The Netherlands
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152
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Abstract
Patients with sarcoidosis can be subgrouped according to organ engagement and clinical manifestations. One such subgroup is Löfgren's syndrome (LS), constituting a distinct group of sarcoidosis patients with typical clinical manifestations, separate genetic associations and an immune response that seems to differ from that of non-LS patients. In particular, LS patients have strong associations with HLA-DRB1 alleles, and the well-known association with HLA-DRB1*03 is particularly striking. This particular HLA-DRB1 allele is also a very strong marker within that particular group of patients for a prognostically favorable disease course. This article will mainly discuss genetic associations with LS, and the possible implications of such associations.
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Affiliation(s)
- Johan Grunewald
- Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet, Lung Research Laboratory L4:01, Karolinska University Hospital Solna, S-171 76 Stockholm, Sweden.
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153
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Abstract
Neuro-ophthalmic disease occurs in about a third of patients with neurosarcoidosis. Optic nerve involvement is the most common manifestation, but other cranial nerves and the optic chiasm can be involved. However, there are several other common diseases that cause optic neuropathy, including multiple sclerosis. The diagnosis of sarcoidosis can often be made based on the multi-organ nature of the disease and ancillary testing. Most patients with neuro-ophthalmic sarcoidosis require systemic therapy. While corticosteroids are usually the first step in therapy, cytotoxic agents such as methotrexate and azathioprine have been useful as steroid-sparing agents for chronic disease. The monoclonal antibodies directed against tumor necrosis factor have been reported as effective in refractory cases of neuro-ophthalmic disease.
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Affiliation(s)
| | | | - Karl C Golnik
- Department of Ophthalmology, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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154
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Zhang X. Genome-wide association study of skin complex diseases. J Dermatol Sci 2012; 66:89-97. [PMID: 22480995 DOI: 10.1016/j.jdermsci.2012.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 02/24/2012] [Indexed: 01/04/2023]
Abstract
Complex diseases are caused by both genetic and environmental factors. Over decades, scientists endeavored to uncover the genetic myth of complex diseases by linkage and association studies. Since 2005, the genome-wide association study (GWAS) has been proved to be the most powerful and efficient study design thus far in identifying genetic variants that are associated with complex diseases. More than 230 complex diseases and traits have been investigated by this approach. In dermatology, 10 skin complex diseases have been investigated, a wealth of common susceptibility variants conferring risk for skin complex diseases have been discovered. These findings point to genes and/or loci involved in biological systems worth further investigating by using other methodologies. Certainly, as our understanding of the genetic etiology of skin complex diseases continues to mature, important opportunities will emerge for developing more effective diagnostic and clinical management tools for these diseases.
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Affiliation(s)
- Xuejun Zhang
- Institute of Dermatology and Department of Dermatology, No. 1 Hospital, Anhui Medical University, Hefei, Anhui, China.
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155
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Sarcoidosis diagnosed after September 11, 2001, among adults exposed to the World Trade Center disaster. J Occup Environ Med 2012; 53:966-74. [PMID: 21860326 DOI: 10.1097/jom.0b013e31822a3596] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Explore relationships between World Trade Center (WTC) exposures and sarcoidosis. METHODS Sarcoidosis has been reported after exposure to the WTC disaster. We ascertained biopsy-proven post-9/11 sarcoidosis among WTC Health Registry enrollees. Cases diagnosed after Registry enrollment were included in a nested case-control study. Controls were matched to cases on age, sex, race or ethnicity, and eligibility group (eg, rescue or recovery worker). RESULTS We identified 43 cases of post-9/11 sarcoidosis. Twenty-eight incident cases and 109 controls were included in the case-control analysis. Working on the WTC debris pile was associated with sarcoidosis (odds ratio 9.1, 95% confidence interval 1.1 to 74.0), but WTC dust cloud exposure was not (odds ratio 1.0, 95% confidence interval 0.4 to 2.8). CONCLUSIONS Working on the WTC debris pile was associated with an elevated risk of post-9/11 sarcoidosis. Occupationally exposed workers may be at increased risk.
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156
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Wikén M, Grunewald J, Eklund A, Wahlström J. Multiparameter phenotyping of T-cell subsets in distinct subgroups of patients with pulmonary sarcoidosis. J Intern Med 2012; 271:90-103. [PMID: 21682779 DOI: 10.1111/j.1365-2796.2011.02414.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Sarcoidosis is an inflammatory disorder in which elevated numbers of activated T cells are found in the lung. HLA-DRB1*0301(pos) (DR3(pos) ) patients are characterized by good prognosis and an accumulation of lung CD4(pos) T cells expressing the T-cell receptor (TCR) gene segment AV2S3. Our aim was to phenotype lung and blood T-cell subsets in distinct patient groups to better understand the function of these subsets. DESIGN Bronchoalveolar lavage (BAL) fluid and whole blood were obtained from a total of 22 patients with sarcoidosis, of whom 11 were DR3(pos) . Using eight-colour flow cytometry, phenotyping of T cells was performed with regard to CD3, CD4, CD8, CD25, CD27, CD45RO, CD57, CD69, CD103, FOXP3 and TCR AV2S3. RESULTS DR3(pos) patients had fewer FOXP3(pos) (regulatory) CD45RO(pos) (memory) BAL T cells than DR3(neg) patients. Fewer AV2S3(pos) T cells were FOXP3(pos) , compared with AV2S3(neg) cells, thus indicating an effector function and not a regulatory role for this subset. Fewer lung and blood AV2S3(pos) T cells were CD25(pos) CD27(pos) , and more were CD25(neg) CD27(neg) and CD69(pos) , compared with AV2S3(neg) T cells, indicating a higher degree of differentiation and activation in both compartments. CONCLUSION Our main findings were a lower proportion of regulatory T cells in DR3(pos) patients, together with the accumulation of AV2S3(pos) T cells with a highly activated effector phenotype in the lungs of these patients. This may provide for efficient elimination of a harmful antigen in DR3(pos) patients and could thus help to explain the spontaneous recovery typically seen in these patients.
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Affiliation(s)
- M Wikén
- Respiratory Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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157
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Hostettler KE, Studler U, Tamm M, Brutsche MH. Long-Term Treatment with Infliximab in Patients with Sarcoidosis. Respiration 2012; 83:218-24. [PMID: 21811048 DOI: 10.1159/000328738] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022] Open
Affiliation(s)
- Katrin E Hostettler
- Clinic of Respiratory Medicine, University Hospital Basel, Basel, Switzerland.
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158
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Akçakaya P, Azeroglu B, Even I, Ates O, Turker H, Ongen G, Topal-Sarikaya A. The functional SLC11A1 gene polymorphisms are associated with sarcoidosis in Turkish population. Mol Biol Rep 2011; 39:5009-16. [DOI: 10.1007/s11033-011-1297-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
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159
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Abstract
The interstitial lung diseases (ILDs), or diffuse parenchymal lung diseases, are a heterogeneous collection of more than 100 different pulmonary disorders that affect the tissue and spaces surrounding the alveoli. Patients affected by ILD usually present with shortness of breath or cough; for many, there is evidence of pulmonary restriction, decreased diffusion capacity, and radiographic appearance of alveolar and/or reticulonodular infiltrates. This article reviews the inherited ILDs, with a focus on the diseases that may be seen by pulmonologists caring for adult patients. The authors conclude by briefly discussing the utility of genetic testing in this population.
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Affiliation(s)
- Megan Stuebner Devine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Eugene McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX 75390-8591, USA
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160
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Abstract
Sarcoidosis is a multisystem, granulomatous disease. In this article, the various clinical manifestations, approach to, and management of, pulmonary and extrapulmonary sarcoidosis are reviewed.
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Affiliation(s)
- Nabeel Hamzeh
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO 80206, USA.
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161
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Wennerström A, Pietinalho A, Vauhkonen H, Lahtela L, Palikhe A, Hedman J, Purokivi M, Varkki E, Seppänen M, Lokki ML, Selroos O. HLA-DRB1 allele frequencies and C4 copy number variation in Finnish sarcoidosis patients and associations with disease prognosis. Hum Immunol 2011; 73:93-100. [PMID: 22074998 DOI: 10.1016/j.humimm.2011.10.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 08/30/2011] [Accepted: 10/03/2011] [Indexed: 11/24/2022]
Abstract
Sarcoidosis is a multiorgan immune-mediated disease of unknown etiology with varying clinical pictures. We studied 3 genes in the major histocompatibility complex region (HLA-DRB1 and complement C4A and C4B) in patients with resolved disease after a 2-year follow-up (n = 90) and in patients whose disease was still active at that time point (n = 98) and compared them with controls (n = 150). Our primary aim was to detect genetic differences between the patient groups. We observed that the susceptibility allele for sarcoidosis was HLA-DRB1*15:01 (p = 0.011; odds ratio [OR] = 1.67) and the protective allele was HLA-DRB1*01:01 (p = 0.001; OR = 0.43). HLA-DRB1*03:01 was associated with resolving disease when compared with the persistent group (p = 0.011; OR = 2.22). The probability of having resolving disease was even greater if the patient had HLA-DRB1*03:01 and did not have extrapulmonary lesions (p = 0.001; OR = 3.39). By evaluating amino acid variants of the HLA-DRB1 gene, we determined that specific amino acids in pockets 4, 7, and 9 were associated with the prognosis of sarcoidosis. Our results support the importance of HLA-DRB1 as a predisposing gene for sarcoidosis. Particularly, HLA-DRB1*03:01 and polymorphisms of DRB1 pocket residues were associated with a favorable prognosis. Thus, accurate categorization of disease phenotype and HLA-DRB1 sequencing offer a basis for disease course estimation of sarcoidosis.
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Affiliation(s)
- Annika Wennerström
- Transplantation Laboratory, Haartman Institute, University of Helsinki, 00014 Helsinki, Finland.
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162
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Yeager H, Gopalan S, Mathew P, Lawless O, Bellanti JA. Sarcoidosis: can a murine model help define a role for silica? Med Hypotheses 2011; 78:36-8. [PMID: 22000713 DOI: 10.1016/j.mehy.2011.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 09/16/2011] [Accepted: 09/19/2011] [Indexed: 10/16/2022]
Abstract
Both genetic and environmental factors are thought to play a role in the etiology of sarcoidosis. An association of the condition with exposure to environmental microbes has been recognized for many years, and has become stronger in the last 10-15 years with the advent of newer investigative techniques. A body of literature now is accumulating suggesting that silica may be yet another trigger in genetically predisposed persons. Impressive support for an etiologic role of mycobacteria derives from earlier studies by several investigators in Japan and in Europe and more recently from the US in Baltimore and Nashville. Other investigators have produced evidence that propionibacteria and fungi can also act as environmental triggers in sarcoidosis patients. We propose that, in an animal model that has been previously sensitized to microbial antigens, the introduction of silica through the gastrointestinal route, or intravenously, may have a granuloma-worsening effect, if the strain of animals is already predisposed to develop granulomatous disease. Here the silica may add a "second hit" to the "first hit" given by the exposure to microbial antigens.
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Affiliation(s)
- Henry Yeager
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Georgetown University Medical Center, Washington, DC 20007, USA.
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163
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Milman N, Svendsen CB, Nielsen FC, van Overeem Hansen T. The BTNL2 A allele variant is frequent in Danish patients with sarcoidosis. CLINICAL RESPIRATORY JOURNAL 2011; 5:105-11. [PMID: 21410903 DOI: 10.1111/j.1752-699x.2010.00206.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The butyrophilin-like 2 (BTNL2) gene is located on chromosome 6p21.3 close to the HLA-class II genes. An association has been reported between sarcoidosis and a single nucleotide polymorphism in BTNL2, rs2076530, also termed the A allele. OBJECTIVES To evaluate whether patients with sarcoidosis carry the A allele more frequently than healthy subjects. METHODS The series comprised 87 ethnic Danes with sarcoidosis and 113 healthy control subjects. Analysis of rs2076530 was performed by Taqman assay, polymerase chain reaction and sequencing of genomic DNA. RESULTS Sarcoidosis patients had a higher frequency of the A allele than controls (73.9% vs 55.8%) (P < 0.025). The frequency of GG, GA and AA genotype was 5.7%, 40.2% and 54.0% in patients vs 16.0%, 56.6% and 27.4% in controls (P < 0.001). The AA genotype was associated with increased risk of sarcoidosis in both a dominant [odds ratio (OR) 3.1; 95% confidence interval (CI) 1.1-8.7; P < 0.03] and a recessive model (OR 3.1; 95% CI 1.72-5.61; P < 0.001). Population attributable fraction for disease was 50% in a dominant model and 25% in a recessive model. CONCLUSIONS The BTNL2 A allele variant occurs with a high frequency in Danish patients with sarcoidosis and the AA genotype is associated with a ∼threefold higher risk of sarcoidosis than the GG genotype. Our results should encourage future studies on the interrelationship between the BTNL2 protein and granuloma formation in sarcoidosis.
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Affiliation(s)
- Nils Milman
- Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Denmark.
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164
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Abstract
The first-line treatment for the neuro-ophthalmologic manifestations of sarcoidosis is corticosteroid therapy. Prednisone, 0.5 to 1 mg/kg/day, is initially prescribed for 2 to 4 weeks, before a slow taper is begun as the patient's symptoms and examination are monitored. Patients frequently require adjunct therapy, which can be in the form of immunomodulatory drugs such as pentoxyfillin, hydroxychloroquine, or thalidomide, or immunosuppressive drugs such as mycophenolate mofetil, azathioprine, methotrexate, and cyclophosphamide. Individuals with profound visual compromise or progressive disease may benefit from high-dose intravenous methylprednisolone or tumor necrosis factor-alpha antagonists such as infliximab. Attention to the overall medical status of the patient is essential to ensure that an optimal clinical status is achieved.
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Affiliation(s)
- Barney J Stern
- Barney J. Stern, MD Department of Neurology, University of Maryland, 22 South Greene Street-N4W46, Baltimore, MD 21201, USA.
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165
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Abstract
Sarcoidosis is an uncommon systemic inflammatory disorder characterized by noncaseating granulomatous inflammation that most commonly affects the lungs, intrathoracic lymph nodes, eyes and skin. One-third or more of patients with sarcoidosis have chronic, unremitting inflammation with progressive organ impairment. Findings of family and genetic studies indicate a genetic susceptibility to sarcoidosis, with genes in the MHC region having a dominant role. Immunologic hallmarks of the disease include highly polarized expression of cytokines produced by type 1 T helper cells and tumor necrosis factor (TNF) at sites of inflammation. Increasing evidence obtained within the past decade suggests the etiology of sarcoidosis predominantly involves microbial triggers, with the most convincing data implicating mycobacterial or propionibacterial organisms. Innate immune mechanisms, possibly involving misfolding and aggregation of serum amyloid A, might have a critical role in the pathobiology of sarcoidosis. Despite these advances, there are no clinically useful biomarkers that can assist the clinician in diagnosis, prognosis or assessment of treatment effects. Corticosteroids remain the cornerstone of therapy when organ function is threatened or progressively impaired. The role of immunosuppressive drugs and anti-TNF agents in the treatment of sarcoidosis remains uncertain, and there are no FDA-approved therapies. Meaningful progress in developing clinically useful tools and new therapies will depend on further advances in understanding the pathogenesis of sarcoidosis and its disease-specific pathways.
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Affiliation(s)
- Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University, 5501 Hopkins Bayview Circle, Room 4B63, Baltimore, MD 21224, USA
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166
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The puzzling clinical spectrum and course of juvenile sarcoidosis. World J Pediatr 2011; 7:103-10. [PMID: 21574025 DOI: 10.1007/s12519-011-0261-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 12/18/2010] [Indexed: 12/15/2022]
Abstract
BACKGROUND Juvenile sarcoidosis is a rare, chronic, multisystem, granulomatous disease of obscure etiology which is seen in childhood and adulthood. The disease in childhood has a course different from that in adulthood. DATA SOURCES PubMed database was searched using terms sarcoidosis, children or childhood sarcoidosis or juvenile sarcoidosis in combination with one of the following terms: epidemiology, clinical manifestations, genetics, diagnosis, treatment, and prognosis. We also retrieved the terms such as early onset sarcoidosis and Blau syndrome. Furthermore, e-medicine and European Respiratory Society monographs for sarcoidosis were reviewed. RESULTS Sarcoidosis in childhood presents with two age dependent, distinct forms. In younger children it is clinically evident before the age of four years and characterized by the triad of rash, arthritis and uveitis. In their older counterparts, the juvenile late onset sarcoidosis involves several organs and its clinical appearance resembles the adult type of the disease, with the respiratory system being most frequently affected (hilar lymphadenopathy, pulmonary infiltrations). Steroid is the main agent of treatment whereas methotrexate is also used for beneficial steroid sparing effects. New, novel therapies may change the outcome of the disease especially in difficult morbid cases. CONCLUSIONS Sarcoidosis in childhood is recognized as a systemic disease affecting various organs and having diverse clinical course depending on the age of onset.
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167
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Abstract
Sarcoidosis, a systemic granulomatous disease of undetermined etiology, is characterized by a variable clinical presentation and course. During the past decade, advances have been made in the study of sarcoidosis. The multicenter ACCESS (A Case Control Etiologic Study of Sarcoidosis) trial recruited > 700 subjects with newly diagnosed sarcoidosis and matched control subjects. Investigators were unable to identify a single cause of sarcoidosis, but ACCESS paved the way for subsequent etiologic studies. The Mycobacterium tuberculosis catalase-peroxidase protein has been identified as a potential sarcoidosis antigen. Genetic aspects of the disease have been elucidated further. Genome-wide scans have identified candidate genes. Gene expression analyses have defined cytokine dysregulation in sarcoidosis more clearly. Although the criteria for diagnosis have not changed, sarcoidosis remains a diagnosis of exclusion best supported by a tissue biopsy specimen that demonstrates noncaseating granulomas in a patient with compatible clinical and radiologic features of the disease. Endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes has facilitated diagnosis, often eliminating the need for more invasive procedures, such as mediastinoscopy. PET scanning has proven valuable in locating occult sites of active disease. Currently, no reliable prognostic biomarkers have been identified. The tumor necrosis factor inhibitors, a relatively new class of agents, have been used in patients with refractory disease. It is unclear whether phosphodiesterase-5 inhibitors, prostaglandin analogs, or endothelin antagonists should be used for the treatment of sarcoidosis-associated pulmonary hypertension.
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Affiliation(s)
- Adam S Morgenthau
- Department of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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168
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Kobayashi D, Rouster-Stevens K, Harper A. La crosse virus encephalitis preceding neurosarcoidosis diagnosed by brain biopsy. Pediatrics 2011; 127:e1091-6. [PMID: 21402636 DOI: 10.1542/peds.2010-0615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Childhood neurosarcoidosis is rare, and its etiology is unknown. La Crosse virus is one of the most common causes of encephalitis in North America. We report the case of a 12-year-old boy who had La Crosse virus encephalitis and subsequently developed imaging and pathologic findings suggestive of neurosarcoidosis. He presented with acute onset of transient aphasia 4 months after an episode of encephalitis; serology results at the time of aphasia were positive for La Crosse virus. Brain MRI revealed diffuse subcortical nodular lesions. His serum angiotensin-converting enzyme level was elevated, and brain biopsy revealed noncaseating granuloma. It is interesting to note that he has had no recurrence of aphasia; repeat MRI showed significant improvement of nodular lesions without therapy. To our knowledge, this is the first case of La Crosse virus encephalitis associated with neurosarcoid findings.
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Affiliation(s)
- Daisuke Kobayashi
- Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI 48201-2119, USA.
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Criado E, Sánchez M, Ramírez J, Arguis P, de Caralt TM, Perea RJ, Xaubet A. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2011; 30:1567-86. [PMID: 21071376 DOI: 10.1148/rg.306105512] [Citation(s) in RCA: 242] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Sarcoidosis is a multisystem disorder that is characterized by noncaseous epithelioid cell granulomas, which may affect almost any organ. Thoracic involvement is common and accounts for most of the morbidity and mortality associated with the disease. Thoracic radiologic abnormalities are seen at some stage in approximately 90% of patients with sarcoidosis, and an estimated 20% develop chronic lung disease leading to pulmonary fibrosis. Although chest radiography is often the first diagnostic imaging study in patients with pulmonary involvement, computed tomography (CT) is more sensitive for the detection of adenopathy and subtle parenchymal disease. Pulmonary sarcoidosis may manifest with various radiologic patterns: Bilateral hilar lymph node enlargement is the most common finding, followed by interstitial lung disease. At high-resolution CT, the most typical findings of pulmonary involvement are micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities. Atypical manifestations, such as masslike or alveolar opacities, honeycomb-like cysts, miliary opacities, mosaic attenuation, tracheobronchial involvement, and pleural disease, and complications such as aspergillomas, also may be seen. To achieve a timely diagnosis and help reduce associated morbidity and mortality, it is essential to recognize both the typical and the atypical radiologic manifestations of the disease, take note of features that may be suggestive of diseases other than sarcoidosis, and correlate imaging features with pathologic findings to help narrow the differential diagnosis.
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Affiliation(s)
- Eva Criado
- Department of Radiology, Hospital Clínic de Barcelona, Barcelona, Spain.
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170
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Abstract
Familial features of sarcoidosis and observations in monozygotic twins affected by the condition suggest the presence of a genetic predisposition. Various genetic associations have been described with genes coding for proteins involved in immune regulation in particular at the level of interaction between T-lymphocyte and antigen presenting cell. We review the various genetic targets described with techniques ranging from classic human lymphocyte antigen genotype to genome wide linkage scans. The 6p21 region has been highlighted, which includes relevant genes such as MHC class II, BTNL2 and TNFα. These studies show that the genetics of sarcoidosis are complex, that patient sub-groups exist, which may explain some of the heterogeneity in the results of genetic studies and that the interactions between genetic and environmental factors remains to be elucidated.
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Affiliation(s)
- Y Pacheco
- Service de pneumologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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171
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de Boer S, Wilsher M. Review series: Aspects of interstitial lung disease. Sarcoidosis. Chron Respir Dis 2011; 7:247-58. [PMID: 21084549 DOI: 10.1177/1479972310388352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sally de Boer
- Green Lane Respiratory Services, Auckland District Health Board, Auckland, New Zealand
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172
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Pacheco Y. Éthiopathogénie de la sarcoïdose. Rev Med Interne 2011; 32:73-9. [DOI: 10.1016/j.revmed.2010.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 01/13/2023]
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173
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174
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Mesa Álvarez A, González GA, Sánchez PRDÁ. Sarcoidosis with lung and systemic involvement in a 5 year old girl. Arch Bronconeumol 2010; 47:52-3. [PMID: 21190765 DOI: 10.1016/j.arbres.2010.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 10/03/2010] [Accepted: 10/06/2010] [Indexed: 11/26/2022]
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Rybicki BA, Levin AM, McKeigue P, Datta I, Gray-McGuire C, Colombo M, Reich D, Burke RR, Iannuzzi MC. A genome-wide admixture scan for ancestry-linked genes predisposing to sarcoidosis in African-Americans. Genes Immun 2010; 12:67-77. [PMID: 21179114 PMCID: PMC3058725 DOI: 10.1038/gene.2010.56] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Genome-wide linkage and association studies have uncovered variants associated with sarcoidosis, a multi-organ granulomatous inflammatory disease. African ancestry may influence disease pathogenesis since African Americans are more commonly affected by sarcoidosis. Therefore, we conducted the first sarcoidosis genome-wide ancestry scan using a map of 1,384 highly ancestry informative single nucleotide polymorphisms genotyped on 1,357 sarcoidosis cases and 703 unaffected controls self-identified as African American. The most significant ancestry association was at marker rs11966463 on chromosome 6p22.3 (ancestry association risk ratio (aRR)= 1.90; p=0.0002). When we restricted the analysis to biopsy-confirmed cases, the aRR for this marker increased to 2.01; p=0.00007. Among the eight other markers that demonstrated suggestive ancestry associations with sarcoidosis were rs1462906 on chromosome 8p12 which had the most significant association with European ancestry (aRR=0.65; p=0.002), and markers on chromosomes 5p13 (aRR=1.46; p=0.005) and 5q31 (aRR=0.67; p=0.005), which correspond to regions we previously identified through sib pair linkage analyses. Overall, the most significant ancestry association for Scadding stage IV cases was to marker rs7919137 on chromosome 10p11.22 (aRR=0.27; p=2×10−5), a region not associated with disease susceptibility. In summary, through admixture mapping of sarcoidosis we have confirmed previous genetic linkages and identified several novel putative candidate loci for sarcoidosis.
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Affiliation(s)
- B A Rybicki
- Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI 48310, USA.
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176
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Abstract
PURPOSE OF REVIEW Almost 100 years after its original description, sarcoidosis remains an enigmatic disease with unclear etiology and capricious symptomology, as well as a diagnostic challenge. This review coalesces current literature on the neuro-ophthalmic manifestations of sarcoidosis and discusses the epidemiology, etiology, clinical presentation, diagnosis, and management of this disease. RECENT FINDINGS Recent investigations strongly identify a genetic component as well as a host of candidate antigenic triggers. Certain human leukocyte antigen polymorphisms may influence not only the susceptibility of individuals to sarcoidosis but also the course of the disease. Diagnostic advances include the finding of two additional potential biomarkers of sarcoidosis as well as the use of positron emission tomography technology in localization of disease sites for biopsy. In addition to the concomitant and alternative use of immunosuppressive agents to steroid therapy, disease remission in refractory neuro-ophthalmic sarcoidosis with tumor necrosis factor alpha inhibitors has also been reported. SUMMARY Sarcoidosis can affect any part of the visual system; the most common neuro-ophthalmic presentation is optic neuropathy. Diagnosing the disease is problematic as the clinical presentation is nonspecific which may be associated with many other pathologies and no diagnostic finding is pathognomonic. In recent years, progress has been made in identifying new biomarkers and developing imaging techniques. Although corticosteroids remain the mainstay of therapy, many new pharmacological agents have been added to the treatment arsenal.
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Affiliation(s)
- Yanny L Phillips
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing, Michigan, USA
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177
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Hattori T, Konno S, Takahashi A, Isada A, Shimizu K, Shimizu K, Taniguchi N, Gao P, Yamaguchi E, Hizawa N, Huang SK, Nishimura M. Genetic variants in mannose receptor gene (MRC1) confer susceptibility to increased risk of sarcoidosis. BMC MEDICAL GENETICS 2010; 11:151. [PMID: 21029423 PMCID: PMC2987761 DOI: 10.1186/1471-2350-11-151] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 10/28/2010] [Indexed: 01/24/2023]
Abstract
BACKGROUND Mannose receptor (MR) is a member of the C-type lectin receptor family involved in pathogen molecular-pattern recognition and thought to be critical in shaping host immune response. The aim of this study was to investigate potential associations of genetic variants in the MRC1 gene with sarcoidosis. METHODS Nine single nucleotide polymorphisms (SNPs), encompassing the MRC1 gene, were genotyped in a total of 605 Japanese consisting of 181 sarcoidosis patients and 424 healthy controls. RESULTS Suggestive evidence of association between rs691005 SNP and risk of sarcoidosis was observed independent of sex and age in a recessive model (P = 0.001). CONCLUSIONS These results suggest that MRC1 is an important candidate gene for sarcoidosis. This is the first study to imply that genetic variants in MRC1, a major member of the C-type lectin, contribute to the development of sarcoidosis.
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Affiliation(s)
- Takeshi Hattori
- First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Hokkaido, Japan
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178
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Lagana SM, Parwani AV, Nichols LC. Cardiac sarcoidosis: a pathology-focused review. Arch Pathol Lab Med 2010; 134:1039-46. [PMID: 20586635 DOI: 10.5858/2009-0274-ra.1] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Sarcoidosis is a granulomatous disease of unclear etiology. It is not commonly fatal, but when sarcoidosis is fatal, it is most often from cardiac involvement and when sarcoidosis involves the heart, it frequently causes death. The disease presents diagnostic challenges both clinically and histologically. OBJECTIVES To review the histology of cardiac sarcoidosis and the histologic differential diagnosis of cardiac granulomatous disease and to review the epidemiology and gross pathology of cardiac sarcoid as well as discuss current controversies, clinical diagnostic criteria, and proposed mechanisms of pathogenesis. DATA SOURCES We reviewed the literature searchable on PubMed as well as selected older studies revealed by our review of the recent literature. Photographs were taken from cases on file at the University of Pittsburgh Medical Center (Pittsburgh, Pennsylvania) and Columbia University Medical Center (New York, New York). CONCLUSIONS Sarcoidosis is a focal or disseminated granulomatous disease that likely represents the final common pathway of various pathogenic insults in a genetically susceptible host. The type of insult may influence the specific sarcoid phenotype. Controversy still abounds, but many areas of investigation around sarcoidosis are yielding exciting discoveries and bringing us closer to a richer understanding of this puzzling disease.
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Affiliation(s)
- Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
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179
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Cozier YC, Berman JS, Palmer JR, Boggs DA, Serlin DM, Rosenberg L. Sarcoidosis in black women in the United States: data from the Black Women's Health Study. Chest 2010; 139:144-50. [PMID: 20595459 DOI: 10.1378/chest.10-0413] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disorder of unknown cause that occurs among men and women of all races. In the United States, black women are most frequently and most severely affected. There have been few epidemiologic studies of sarcoidosis focusing on black women. METHODS In this article, we present data on incidence, prevalence, and clinical characteristics of sarcoidosis among participants in the Black Women's Health Study, a cohort study of 59,000 black women from across the United States. Data on incident disease and potential risk factors are obtained through biennial questionnaires. Follow-up has been > 80% through six completed cycles. RESULTS There were 685 prevalent cases of sarcoidosis at baseline in 1995 and 435 incident cases reported during 611,585 person-years of follow-up through 2007, for an average annual incidence rate of 71/100,000 and a current prevalence of 2.0%. The sarcoid diagnosis was confirmed in 96% of self-reported cases for whom medical records or physician checklists were obtained. The most frequently affected site was the lung. Most patients also had extrapulmonary involvement, with the most common sites being lymph nodes, skin, and eyes. Prednisone had the highest prevalence of use, followed by inhaled corticosteroids. CONCLUSIONS This study confirms previous reports of high incidence and prevalence of sarcoidosis among black women, as well as the extent of extrapulmonary disease, frequent need for steroid therapy, and comorbid conditions in this population. The prospective identification of sarcoidosis cases from a defined population will enable a valid assessment of risk factors for incident disease as follow-up continues.
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Affiliation(s)
- Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA 02215, USA.
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180
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Fridlender ZG, Schwartz A, Kohan M, Amir G, Glazer M, Berkman N. Association between CD14 gene polymorphisms and disease phenotype in sarcoidosis. Respir Med 2010; 104:1336-43. [PMID: 20430603 DOI: 10.1016/j.rmed.2010.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 03/01/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
Although the etiology of sarcoidosis is unknown, genetic susceptibility has been demonstrated. Granuloma formation is a key feature in the pathophysiology of sarcoidosis and Crohn's Disease, raising the possibility that these diseases share common pathogenetic pathways. An association between sarcoidosis and the protein "CD14", a molecule that is part of the lipopolysaccharide (LPS) cell surface receptor complex, has been suggested. In the current study we evaluated the CD14 gene promoter 159 C-->T polymorphic site and soluble CD14 levels in a cohort of 74 sarcoidosis patients compared to 85 healthy controls. We further sought to identify correlations between clinical phenotype, specific genotypes and soluble CD14 levels. We found the TT genotype to be more prevalent in the sarcoidosis patient group than in controls (p=0.03). Serum levels of soluble CD14 were higher in the sarcoidosis patients (p=0.001). Within the patient cohort, CC homozygous patients presented at an older age with milder disease as assessed with the SAC score, longer time to diagnosis, and less impairment of pulmonary function tests. Our study suggests a role of CD14 in the pathogenesis of sarcoidosis, and a clinical phenotype-genotype association. Further mechanistic and epidemiologic studies are needed in order to establish the specific role of CD14 in the etiology, pathogenesis and clinical phenotype of sarcoidosis.
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Affiliation(s)
- Zvi G Fridlender
- Institute of Pulmonology, Hadassah-Hebrew University, Jerusalem 91120, Israel.
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181
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182
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Abstract
Neurosarcoidosis is a diagnostic consideration in diverse clinical settings. Efforts should be made to secure pathologic confirmation of systemic sarcoidosis; only rarely is central nervous system (CNS) pathologic confirmation available. CNS infection and malignancy should be reasonably excluded before making a diagnosis of CNS sarcoidosis. Corticosteroid therapy alone may not be sufficient to treat neurosarcoidosis; adjunct immunosuppressive agents are increasingly used to achieve an optimal clinical outcome.
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Cha YS, Kim HJ, Lee JC, Yoo J, Hwang SS, Cho HM. Left Adrenal Sarcoidosis. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.4.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yu Sun Cha
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Hyung Jin Kim
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jae Cheong Lee
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Jinyoung Yoo
- Department of Pathology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seong Su Hwang
- Department of Radiology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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184
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Valeyre D, Freynet O, Dion G, Bouvry D, Annesi-Maesano I, Nunes H. [Epidemiology of interstitial lung diseases]. Presse Med 2009; 39:53-9. [PMID: 19962852 DOI: 10.1016/j.lpm.2009.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 09/21/2009] [Indexed: 11/17/2022] Open
Abstract
Diffuse interstitial lung diseases (DILD) cover more than 200 conditions classified in 4 groups: secondary DILD; sarcoidosis; particular DILDs and idiopathic interstitial pneumonias. Overall, these diseases have a prevalence of 60-80/100,000 and an incidence around 30/100,000. Sarcoidosis and idiopathic pulmonary fibrosis are the 2 most frequent diseases, accounting together for more than 50% of all cases, followed by DILD related to connective tissue disease and to immunologic lung diseases. The incidence of different causes of DILD depends on epidemiologic factors: age, sex, race, smoking habits, and history. Mortality is very elevated in idiopathic pulmonary fibrosis, linked in more than 80% of cases to the fibrosis itself, with a median survival between 24 and 36 months. The epidemiologic studies on DILD have substantial limitations, and new studies must be conducted, in particular in France where we lack epidemiologic data beyond one old study of sarcoidosis and one more recent study focused on farmer's lung in the Doubs.
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186
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Musellim B, Kumbasar O, Ongen G, Cetinkaya E, Turker H, Uzaslan E, Yenturk E, Uzun O, Saglam L, Celik G, Okumus G, Annakkaya A, Altiay G, Tabak L, Sakar A, Kiter G, Erturan S, Turktas H, Yalniz E, Akkoclu A, Ogus C, Dogan O, Ozkan M, Aktogu S, Uzel I. Epidemiological features of Turkish patients with sarcoidosis. Respir Med 2009; 103:907-12. [DOI: 10.1016/j.rmed.2008.12.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 11/02/2008] [Accepted: 12/08/2008] [Indexed: 10/21/2022]
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187
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Ji J, Shu X, Li X, Sundquist K, Sundquist J, Hemminki K. Cancer risk in hospitalized sarcoidosis patients: a follow-up study in Sweden. Ann Oncol 2009; 20:1121-6. [DOI: 10.1093/annonc/mdn767] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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188
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McDougal KE, Fallin MD, Moller DR, Song Z, Cutler DJ, Steiner LL, Cutting GR. Variation in the lymphotoxin-alpha/tumor necrosis factor locus modifies risk of erythema nodosum in sarcoidosis. J Invest Dermatol 2009; 129:1921-6. [PMID: 19225544 DOI: 10.1038/jid.2008.456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sarcoidosis is a multi-system inflammatory disease with organ involvement that varies by race and sex. Family studies indicate that genes play a role in the etiology and extent of organ involvement in sarcoidosis. In this study, we evaluated whether 25 variants distributed in 19 genes with a known role in inflammation were associated with erythema nodosum status in 659 sarcoidosis patients and 658 controls from A Case-Control Etiologic Study of Sarcoidosis (ACCESS). We found no association with affectation status; however, a variant in the promoter of tumor necrosis factor (TNF) at position -308 was found to be associated with erythema nodosum in Caucasian sarcoidosis patients (study-wide P=0.027). When separated by sex, a variant in intron 1 of lymphotoxin-alpha (LTA), a gene adjacent to TNF, was associated with erythema nodosum in female Caucasian sarcoidosis patients (study-wide P=0.027). These DNA variants frequently occur together in Caucasians, and each variant has individually been associated with erythema nodosum in sarcoidosis patients. These results confirm that variation in the LTA/TNF gene cluster modifies a major skin manifestation of sarcoidosis and may explain the higher rate of erythema nodosum in females with sarcoidosis.
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Affiliation(s)
- Kathryn E McDougal
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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189
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Abstract
Pulmonary pathology includes a large spectrum of both neoplastic and non-neoplastic diseases that affect the lung. Many of these are a result of the unusual relationship of the lung with the outside world. Every breath that a human takes brings the outside world into the body in the form of infectious agents, organic and inorganic particles, and noxious agents of all types. Although the lung has many defense mechanisms to protect itself from these insults, these are not infallible; therefore, lung pathology arises. Damage to the lung is particularly important given the role of the lung in the survival of the organism. Any impairment of lung function has widespread effects throughout the body, since all organs depend on the lungs for the oxygen they need. Pulmonary pathology catalogs the changes in the lung tissues and the mechanisms through which these occur. This chapter presents a review of lung pathology and the current state of knowledge about the pathogenesis of each disease. It suggests that a clear understanding of both morphology and mechanism is required for the development of new therapies and preventive measures.
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190
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Grunewald J, Eklund A. Löfgren's syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 2008; 179:307-12. [PMID: 18996998 DOI: 10.1164/rccm.200807-1082oc] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sarcoidosis may consist of a number of distinct disease entities, one of which could be Löfgren's syndrome. Patients with Löfgren's syndrome have an acute onset of erythema nodosum (EN) and/or periarticular inflammation or arthritis of the ankles, with bilateral hilar lymphadenopathy (and in some cases parenchymal infiltrates) and usually fever. There is a known association between HLA-DRB1*03 and Löfgren's syndrome. OBJECTIVES To investigate whether human leukocyte antigen type influences clinical manifestations, including the disease course in Löfgren's syndrome. METHODS We clinically characterized and HLA-DRB1 typed 301 patients with Löfgren's syndrome. A total of 275 of the patients were followed for more than 2 years and classified as having a nonresolving or a resolving disease. MEASUREMENTS AND MAIN RESULTS Almost every DRB1*03-positive patient had a resolving disease within 2 years, and 49% of the DRB1*03-negative patients developed a nonresolving disease. Mucosal granulomas were identified significantly more often in DRB1*03-negative patients. Among DRB1*03-negative patients who were treated with oral steroids at disease onset, 80% developed a nonresolving disease. CONCLUSIONS Patients with Löfgren's syndrome have a different disease course depending on whether they are DRB1*03 positive or not. This observation has clinical implications, and by comparing DRB1*03-positive and DRB1*03-negative patients with Löfgren's syndrome, we can search for additional markers of importance for developing a resolving or a nonresolving disease, respectively.
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Affiliation(s)
- Johan Grunewald
- Department of Medicine, Division of Respiratory Medicine, Lung Research Laboratory L4:01, Karolinska Hospital, S-171 76 Stockholm, Sweden.
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191
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Morais A, Alves H, Lima B, Delgado L, Gonçalves R, Tafulo S. Estudo de polimorfismos genéticos do HLA (classes I e II) e do TNF-α em doentes com sarcoidose. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008. [DOI: 10.1016/s0873-2159(15)30284-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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192
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Abstract
PURPOSE OF REVIEW Increased familial occurrences as well as different disease modes in different ethnic groups suggest a genetic influence in sarcoidosis. Also, genetic analyses have revealed a number of chromosomal regions and specific genes associated with sarcoidosis. This review brings up some recent discoveries on the genetic contribution to sarcoidosis. RECENT FINDINGS As a more detailed clinical classification of patients is performed, stronger genetic associations between distinct clinical phenotypes and specific gene variants have been revealed. The strong association between human leucocyte antigen DRB10301/DQB10201 and good prognosis in patients with Löfgren's syndrome is one such recent example. Linkage studies have revealed certain chromosomal regions of interest and furthermore pointed out specific genes of interest, for example, a variant of the butyrophilin-like 2 gene. SUMMARY Sarcoidosis is a complex disease which is influenced by a multitude of genes and environmental factors. The strongest genetic associations are found within the human leucocyte antigen region, in which several specific human leucocyte antigen alleles clearly associate with disease risk and phenotype, but additional genes in the same region may turn out to be important as well. Future studies on large, clinically well defined patient cohorts will help to elucidate the genetic impact on sarcoidosis.
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193
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Shetty AK, Gedalia A. Childhood sarcoidosis: A rare but fascinating disorder. Pediatr Rheumatol Online J 2008; 6:16. [PMID: 18811966 PMCID: PMC2559831 DOI: 10.1186/1546-0096-6-16] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 09/23/2008] [Indexed: 12/22/2022] Open
Abstract
Childhood sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. In the pediatric series reported from the southeastern United States, sarcoidosis had a higher incidence among African Americans. Most reported childhood cases have occurred in patients aged 13-15 years. Macrophages bearing an increased expression of major histocompatibility class (MHC) II molecules most likely initiate the inflammatory response of sarcoidosis by presenting an unidentified antigen to CD4+ Th (helper-inducer) lymphocytes. A persistent, poorly degradable antigen driven cell-mediated immune response leads to a cytokine cascade, to granuloma formation, and eventually to fibrosis. Frequently observed immunologic features include depression of cutaneous delayed-type hypersensitivity and a heightened helper T cell type 1 (Th1) immune response at sites of disease. Circulating immune complexes, along with signs of B cell hyperactivity, may also be found. The clinical presentation can vary greatly depending upon the organs involved and age of the patient. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestations, with frequent hilar lymphadenopathy and pulmonary infiltrations. Early-onset sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in children presenting before four years of age. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. Other granulmatous diseases should be reasonably excluded. The current therapy of choice for sarcoidosis in children with multisystem involvement is oral corticosteroids. Methotrexate given orally in low doses has been effective, safe and steroid sparing in some patients. Alternative immunosuppressive agents, such as azathioprine, cyclophosphamide, chlorambucil, and cyclosporine, have been tried in adult cases of sarcoidosis with questionable efficacy. The high toxicity profile of these agents, including an increased risk of lymphoproliferative disorders and carcinomas, has limited their use to patients with severe disease refractory to other agents. Successful steroid sparing treatment with mycophenolate mofetil was described in an adolescent with renal-limited sarcoidosis complicated by renal failure. Novel treatment strategies for sarcoidosis have been developed including the use of TNF-alpha inhibitors, such as infliximab. The long-term course and prognosis is not well established in childhood sarcoidosis, but it appears to be poorer in early-onset disease.
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Affiliation(s)
- Avinash K Shetty
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA.
| | - Abraham Gedalia
- Division of Pediatric Rheumatology, Louisiana State University Medical Center and Children's Hospital of New Orleans, LA, USA
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194
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Abstract
The diagnosis of sarcoidosis can never be assured: sarcoidosis is a diagnosis of exclusion and this cannot be accomplished with complete confidence. The diagnosis requires clinicoradiographic findings compatible with the diagnosis, histologic confirmation of granulomatous inflammation, exclusion of known causes of granulomatous disease, and evidence of disease in at least two organs. The end result of this diagnostic evaluation for sarcoidosis is neither a definitive diagnosis nor an exclusion of the diagnosis, but rather a statistical likelihood of the disease.
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195
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Abstract
Sarcoidosis continues to be a disease of research interest because of its complicated immune mechanisms and elusive etiology. So far, it has been established that granulomatous inflammation in sarcoidosis is predominantly a T-helper 1 immune response mediated by a complex network of lymphocytes, macrophages, and cytokines. The cause of progression to a chronic and potentially fibrotic form is unclear but may involve loss of apoptotic mechanisms, loss of regulatory response, or a persistent antigen that cannot be cleared. Recent genomic and proteomic technology has emphasized the importance of host susceptibility and gene-environment interaction in the expression of the disease.
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Affiliation(s)
- Alicia K Gerke
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Lubitz SA, Goldbarg SH, Mehta D. Sudden cardiac death in infiltrative cardiomyopathies: sarcoidosis, scleroderma, amyloidosis, hemachromatosis. Prog Cardiovasc Dis 2008; 51:58-73. [PMID: 18634918 DOI: 10.1016/j.pcad.2007.10.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sarcoidosis, scleroderma, amyloidosis, and hemachromatosis are systemic infiltrative disorders that commonly affect the heart. Owing to their potential for diffuse organ involvement, these diseases may present with myriad clinical manifestations. Conduction system abnormalities are common, and each of these disorders has been associated with sudden cardiac death. In this review, we summarize the epidemiology, clinical features, diagnosis, and treatment of each of these entities. We place special emphasis on existing literature as it pertains to risk stratification and therapy aimed at the prevention of sudden cardiac death in these infiltrative cardiomyopathies.
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Affiliation(s)
- Steven A Lubitz
- Zena and Michael Wiener Cardiovascular Institute, Mount Sinai School of Medicine, NY, USA
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198
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Wasfi YS, Silveira LJ, Jonth A, Hokanson JE, Fingerlin T, Sato H, Parsons CE, Lympany P, Welsh K, du Bois RM, Newman LS, Maier LA. Fas promoter polymorphisms: genetic predisposition to sarcoidosis in African-Americans. TISSUE ANTIGENS 2008; 72:39-48. [PMID: 18588573 PMCID: PMC3061555 DOI: 10.1111/j.1399-0039.2008.01060.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Apoptosis may perpetuate some forms of inflammation. Of the apoptotic pathway proteins, Fas is particularly overexpressed in sarcoidosis. We hypothesized that Fas promoter single nucleotide polymorphisms (SNPs) contribute to the development and severity of sarcoidosis. Associations of known Fas promoter SNPs (-670, -690 and -1377) and deduced haplotypes with sarcoidosis and sarcoidosis severity were evaluated using matched case-control (n = 656 pairs) and case-comparison (n = 656) studies, respectively, using conditional logistic regression. Hardy-Weinberg equilibrium was confirmed for all three polymorphisms in African-Americans (AA), and for the -670 and -1377 in whites. Genotype and allele frequencies were significantly different between whites and AA. Race-stratified analysis revealed that a common haplotype, -1377G/-690T/-670G, was associated with sarcoidosis [odds ratio (OR) = 1.78, P = 0.05] only in AA. The haplotype -1377G/-690C/-670A was negatively associated with sarcoidosis (OR = 0.39, P = 0.03) only in AA. In conclusion, the consistency of these findings suggests that Fas promoter genetic variants may be related to sarcoidosis disease risk in AA.
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Affiliation(s)
- Y S Wasfi
- Merck Research Laboratories, Upper Gwynedd, PA, USA
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Steele MP, Brown KK. Genetic predisposition to respiratory diseases: infiltrative lung diseases. Respiration 2008; 74:601-8. [PMID: 18037811 DOI: 10.1159/000110204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The availability of high-throughput genotyping and large collaborative clinical networks creating well-characterized patient populations with DNA repositories has facilitated genome-wide scans and candidate gene studies to identify susceptibility alleles for the development of interstitial lung disease. The association of pulmonary fibrosis with rare inherited disorders, and the variable susceptibility of inbred mouse strains to this disease indicate that pulmonary fibrosis is determined by genetic factors. Sarcoidosis represents a complex disease with racial and ethnic differences in disease prevalence, and evidence of familial clustering. Familial aggregation of sarcoidosis from 'A Case-Control Etiologic Study of Sarcoidosis' (ACCESS) reveals a familial odds ratio (OR) of sarcoidosis of 5.8 (95% CI 2.1-15.9) for sibs and 3.8 (95% CI 1.2-11.3) for parents. Several HLA class II alleles have been associated with either increased or decreased risk of sarcoidosis, and results vary depending on study populations of different ethnicity. Genome-wide screening has conclusively identified linkage to chromosome 5q11and the development of sarcoidosis, and HLA genes and BTNL2 are susceptibility genes located in this region. Familial aggregation of idiopathic interstitial pneumonia (IIP) has been established by several groups, and a large US-based study suggests autosomal dominant inheritance with reduced penetrance; furthermore, cigarette smoking was associated with affection status among siblings (OR = 3.6, 95% CI 1.3-9.8, p = 0.01). Families demonstrate more than one type of IIP, suggesting various subtypes of IIP may share a common pathogenesis. Genome-wide linkage scans in familial interstitial pneumonia demonstrate linkage to chromosomes 4, 5 and 11. Candidate gene studies indicate that surfactant protein C and telomerase are susceptibility genes for the development of pulmonary fibrosis. Future challenges include determining how multiple susceptibility alleles interact with each other and environmental factors resulting in disease risk and multiple phenotypes, and determining the mechanism of action and cellular pathways involving susceptibility alleles. Further insight into these areas may lead to new therapeutic interventions.
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Affiliation(s)
- Mark P Steele
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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