1
|
Chou SM, Yeh HJ, Lin TM, Chang YS, Hsu HC, Shen YC, Kuo TT, Chen JH, Chen SC, Chang CC. Association of interferon-based therapy with risk of autoimmune diseases in patients with chronic hepatitis C virus infection: A population-based Taiwanese cohort study. Front Immunol 2022; 13:992819. [PMID: 36275719 PMCID: PMC9585940 DOI: 10.3389/fimmu.2022.992819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/29/2022] Open
Abstract
Background Interferon in combination with ribavirin has been the standard of care for chronic hepatitis C virus infection (HCV) for the past few decades. However, its effect on the risk of autoimmune diseases (ADs) among patients with HCV infection remains unclear. We assessed the potential association between interferon-based therapy (IBT) and AD risk in patients with HCV infection. Methods This retrospective cohort study identified patients diagnosed with HCV infection between January 1, 2006, and December 31, 2015, from Taiwan’s National Health Insurance Research Database. In total, 16,029 patients with HCV infection who received IBT and 141,214 patients with HCV infection who did not receive IBT were included. Both cohorts were followed up to assess the development of ADs. Hazard ratios (HRs) were calculated using the Cox proportional hazards regression model, which was adjusted for potential confounders. Results The median follow-up period for IBT and non-IBT users was 4.53 and 3.34 years, respectively. No significant difference in the risk of overall ADs (adjusted HR [aHR]: 0.96, 95% confidence interval [CI]: 0.81–1.14) or systemic ADs (aHR: 0.88, 95% CI: 0.71–1.10) was noted during the study period. However, a slight increase in the risk of organ-specific ADs was noted among IBT users (incidence rate ratio: 1.33, 95% CI: 1.02–1.72). Furthermore, analysis of AD subgroups revealed a significant increase in the risks of Graves’ disease (aHR: 6.06, 95% CI: 1.27–28.8) and Hashimoto’s thyroiditis (aHR 1.49, 95% CI 1.01–2.21) among IBT users. Conclusions IBT use increases the risk of autoimmune thyroid diseases (Hashimoto’s thyroiditis and Graves’ disease) in patients with HCV infection to a greater extent than non-IBT use.
Collapse
Affiliation(s)
- Shu-Ming Chou
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsing-Jung Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Min Lin
- Division of allergy, immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of allergy, immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hui-Ching Hsu
- Division of allergy, immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Shen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Tung Kuo
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Jin-Hua Chen
- Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Shu-Chuan Chen
- Department of Mathematics and Statistics, Idaho State University, Pocatello, ID, United States
| | - Chi-Ching Chang
- Division of allergy, immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- *Correspondence: Chi-Ching Chang,
| |
Collapse
|
2
|
Katewa A, Suto E, Hui J, Heredia J, Liang J, Hackney J, Anderson K, Alcantar TM, Bacarro N, Dunlap D, Eastham J, Paler-Martinez A, Rairdan XY, Modrusan Z, Lee WP, Austin CD, Lafkas D, Ghilardi N. The peptide symporter SLC15a4 is essential for the development of systemic lupus erythematosus in murine models. PLoS One 2021; 16:e0244439. [PMID: 33444326 PMCID: PMC7808665 DOI: 10.1371/journal.pone.0244439] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/09/2020] [Indexed: 11/18/2022] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease representing a serious unmet medical need. The disease is associated with the loss of self-tolerance and exaggerated B cell activation, resulting in autoantibody production and the formation of immune complexes that accumulate in the kidney, causing glomerulonephritis. TLR7, an important mediator of the innate immune response, drives the expression of type-1 interferon (IFN), which leads to expression of type-1 IFN induced genes and aggravates lupus pathology. Because the lysosomal peptide symporter slc15a4 is critically required for type-1 interferon production by pDC, and for certain B cell functions in response to TLR7 and TLR9 signals, we considered it as a potential target for pharmacological intervention in SLE. We deleted the slc15a4 gene in C57BL/6, NZB, and NZW mice and found that pristane-challenged slc15a4-/- mice in the C57BL/6 background and lupus prone slc15a4-/- NZB/W F1 mice were both completely protected from lupus like disease. In the NZB/W F1 model, protection persisted even when disease development was accelerated with an adenovirus encoding IFNα, emphasizing a broad role of slc15a4 in disease initiation. Our results establish a non-redundant function of slc15a4 in regulating both innate and adaptive components of the immune response in SLE pathobiology and suggest that it may be an attractive drug target.
Collapse
Affiliation(s)
- Arna Katewa
- Dept. Biochemical and Cellular Pharmacology, Genentech, South San Francisco, CA, United States of America
| | - Eric Suto
- Dept. Translational Immunology, Genentech, South San Francisco, CA, United States of America
| | - Jessica Hui
- Evercore ISI, New York, NY, United States of America
| | - Jose Heredia
- Dept. Immunology, Genentech, South San Francisco, CA, United States of America
| | - Jie Liang
- Dept. Molecular Oncology, Genentech, South San Francisco, CA, United States of America
| | - Jason Hackney
- Dept. Bioinformatics, Genentech, South San Francisco, CA, United States of America
| | - Keith Anderson
- Dept. Molecular Biology, Genentech, South San Francisco, CA, United States of America
| | - Tuija M. Alcantar
- Dept. Molecular Biology, Genentech, South San Francisco, CA, United States of America
| | - Natasha Bacarro
- Dept. Molecular Biology, Genentech, South San Francisco, CA, United States of America
| | - Debra Dunlap
- Dept. Pathology, Genentech, South San Francisco, CA, United States of America
| | - Jeffrey Eastham
- Dept. Pathology, Genentech, South San Francisco, CA, United States of America
| | - Andres Paler-Martinez
- Dept. Translational Immunology, Genentech, South San Francisco, CA, United States of America
| | - Xin Y. Rairdan
- gRED Animal Resources, South San Francisco, CA, United States of America
| | - Zora Modrusan
- Dept. Microchemistry, Proteomics, & Lipidomics, Genentech, South San Francisco, CA, United States of America
| | - Wyne P. Lee
- Dept. Translational Immunology, Genentech, South San Francisco, CA, United States of America
| | - Cary D. Austin
- Dept. Pathology, Genentech, South San Francisco, CA, United States of America
| | - Daniel Lafkas
- Dept. Immunology, Genentech, South San Francisco, CA, United States of America
| | - Nico Ghilardi
- DiCE Molecules, South San Francisco, CA, United States of America
| |
Collapse
|
3
|
Krenn M, Grisold A, Wohlfarth P, Rath J, Cetin H, Koneczny I, Zimprich F. Pathomechanisms and Clinical Implications of Myasthenic Syndromes Exacerbated and Induced by Medical Treatments. Front Mol Neurosci 2020; 13:156. [PMID: 32922263 PMCID: PMC7457047 DOI: 10.3389/fnmol.2020.00156] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
Myasthenic syndromes are typically characterized by muscle weakness and increased fatigability due to an impaired transmission at the neuromuscular junction (NMJ). Most cases are caused by acquired autoimmune conditions such as myasthenia gravis (MG), typically with antibodies against the acetylcholine receptor (AChR). Different drugs are among the major factors that may complicate pre-existing autoimmune myasthenic conditions by further impairing transmission at the NMJ. Some clinical observations are substantiated by experimental data, indicating that presynaptic, postsynaptic or more complex pathomechanisms at the NMJ may be involved, depending on the individual compound. Most robust data exist for the risks associated with some antibiotics (e.g., aminoglycosides, ketolides, fluoroquinolones) and cardiovascular medications (e.g., class Ia antiarrhythmics, beta blockers). Apart from primarily autoimmune-mediated disorders of the NMJ, de novo myasthenic manifestations may also be triggered by medical treatments that induce an autoimmune reaction. Most notably, there is growing evidence that the immune checkpoint inhibitors (ICI), a modern class of drugs to treat various malignancies, represent a relevant risk factor to develop severe and progressive medication-induced myasthenia via an immune-mediated mechanism. From a clinical perspective, it is of utmost importance for the treating physicians to be aware of such adverse treatment effects and their consequences. In this article, we aim to summarize existing evidence regarding the key molecular and immunological mechanisms as well as the clinical implications of medication-aggravated and medication-induced myasthenic syndromes.
Collapse
Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Philipp Wohlfarth
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Inga Koneczny
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
Hassan M, Karkhur S, Bae JH, Halim MS, Ormaechea MS, Onghanseng N, Nguyen NV, Afridi R, Sepah YJ, Do DV, Nguyen QD. New therapies in development for the management of non-infectious uveitis: A review. Clin Exp Ophthalmol 2020; 47:396-417. [PMID: 30938012 DOI: 10.1111/ceo.13511] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high-dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid-sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non-infectious uveitis (NIU) consists of a step-ladder strategy with the first-line option being corticosteroids in various formulations followed by the use of first-, second- and third-line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side-effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.
Collapse
Affiliation(s)
- Muhammad Hassan
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Samendra Karkhur
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Sadguru Netra Chikitsalaya, Chitrakoot, India
| | - Jeong H Bae
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Maria S Ormaechea
- Byers Eye Institute, Stanford University, Palo Alto, California.,Department of Ophthalmology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Neil Onghanseng
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Nam V Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Rubbia Afridi
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Yasir J Sepah
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Diana V Do
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Quan D Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California
| |
Collapse
|
5
|
Iacopo G, Allinovi M, Caroti L, Cirami LC. Broad spectrum of interferon-related nephropathies—glomerulonephritis, systemic lupus erythematosus-like syndrome and thrombotic microangiopathy: A case report and review of literature. World J Nephrol 2019. [DOI: 10.5527/wjgo.v8.i7.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
6
|
Tung CH, Lai NS, Li CY, Tsai SJ, Chen YC, Chen YC. Risk of rheumatoid arthritis in patients with hepatitis C virus infection receiving interferon-based therapy: a retrospective cohort study using the Taiwanese national claims database. BMJ Open 2018; 8:e021747. [PMID: 30037875 PMCID: PMC6059328 DOI: 10.1136/bmjopen-2018-021747] [Citation(s) in RCA: 8] [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
OBJECTIVES To illuminate the association between interferon-based therapy (IBT) and the risk of rheumatoid arthritis (RA) in patients infected with hepatitis C virus (HCV). DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS This retrospective cohort study used Taiwan's Longitudinal Health Insurance Database 2005 that included 18 971 patients with HCV infection between 1 January 1997 and 31 December 2012. We identified 1966 patients with HCV infection who received IBT (treated cohort) and used 1:4 propensity score-matching to select 7864 counterpart controls who did not receive IBT (untreated cohort). OUTCOME MEASURES All study participants were followed until the end of 2012 to calculate the incidence rate and risk of incident RA. RESULTS During the study period, 305 RA events (3.1%) occurred. The incidence rate of RA was significantly lower in the treated cohort than the untreated cohort (4.0 compared with 5.5 per 1000 person-years, p<0.018), and the adjusted HR remained significant at 0.63 (95% CI 0.43 to 0.94, p=0.023) in a Cox proportional hazards regression model. Multivariate stratified analyses revealed that the attenuation in RA risk was greater in men (0.35; 0.15 to 0.81, p=0.014) and men<60 years (0.29; 0.09 to 0.93, p=0.036). CONCLUSIONS This study demonstrates that IBT may reduce the risk of RA and contributes to growing evidence that HCV infection may lead to development of RA.
Collapse
Affiliation(s)
- Chien-Hsueh Tung
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ning-Sheng Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chung-Yi Li
- Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Shiang-Jiun Tsai
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yen-Chun Chen
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yi-Chun Chen
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| |
Collapse
|
7
|
Ocular Surface Changes With Sofosbuvir in Egyptian Patients With Hepatitis C Virus Infection. Cornea 2016; 35:323-8. [PMID: 26764884 DOI: 10.1097/ico.0000000000000736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effect of oral sofosbuvir on the ocular surface of Egyptian patients with chronic hepatitis C virus infection. METHODS This prospective randomized comparative study was performed on 300 eyes undergoing sofosbuvir therapy with peginterferon and ribavirin and on 300 eyes undergoing treatment with only peginterferon and ribavirin. Patients were evaluated for dry eye subjectively (Ocular Surface Disease Index questionnaire) and objectively, Schirmer test, tear film breakup time, and conjunctival nucleus/cytoplasm ratio by impression cytology. RESULTS The Ocular Surface Disease Index score significantly changed from 3.1 ± 2.8 at baseline to 11.9 ± 4.1 and 15.2 ± 3.8 after 1 and 3 months of therapy, respectively, in the sofosbuvir group but had decreased to 7.6 ± 6.2 by 3 months after cessation of therapy. Mean Schirmer test values showed a significant change in the sofosbuvir group from 17.5 ± 2.7 mm at baseline to 10.8 ± 1.4 and 7.0 ± 2.5 mm after 1 and 3 months, respectively, and started returning to normal (11.0 ± 3.3 mm) after 1 month of treatment and mean tear film breakup time varied from 11.0 ± 5.2 seconds at baseline to 9.2 ± 2.6 and 6.1 ± 1.2 seconds at 1 and 3 months, respectively (P < 0.001). The mean nucleus/cytoplasm ratio was significantly different from 1/1.5 at baseline to 1/1.9 and 1/2.4 at 1 and 3 months, respectively, and persisted 3 months after discontinuation of therapy (nucleus/cytoplasm ratio 1/2.0). These changes were not the same in the non-sofosbuvir group. CONCLUSIONS Impairment of tear function and squamous metaplastic changes in the ocular surface occurred in patients with chronic hepatitis C treated with sofosbuvir combined with other antivirals.
Collapse
|
8
|
The Clinical Significance of Autoantibodies in Hepatitis C Patients Submitted to Interferon Treatment. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:24-27. [PMID: 28868365 PMCID: PMC5580009 DOI: 10.1016/j.jpge.2014.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/05/2014] [Indexed: 11/21/2022]
Abstract
Hepatitis C virus is associated with several immune-mediated phenomena, presented usually as extra-hepatic hepatitis C manifestations. A predisposition to autoimmunity associated with the presence of baseline autoantibodies has been demonstrated in interferon mediated autoimmune diseases. We report a male patient, 34 years old, with genotype 1, chronic hepatitis C (hepatitis C viremia 1.432.463 UI/mL) and family history of psoriasis. He had high levels of transaminases and immunology showed positive antinuclear antibodies (1/320) and anti-smooth-muscle antibodies, with elevated immunoglobulin G (1740 mg/dL). Liver biopsy revealed a F1/2 Metavir score, histologic activity index of 3 and mild piecemeal necrosis. Antiviral treatment was started with peg-interferon α2a 180 mcg plus ribavirin 1200 mg, and the patient had rapid virologic response, normalization of transaminases, negativation of antinuclear antibodies positivity and decrease of immunoglobulin levels. However, at week 22, he developed psoriatic-like eczema and arthritis with functional limitation. Due to suspicion of latent psoriatic arthritis not previously diagnosed, he was started on methotrexate 10 mg/weekly with improvement of psoriatic plaques, arthritis and functional limitation. Patient achieved sustained virologic response, with normal transaminases and no significant changes in immunology. Post-treatment median hepatic elastography was 3.6 kPa. Autoimmunity in hepatitis C infection is not limited to surrogate autoantibody seropositivity, but may embrace the full spectrum of autoimmune disorders.
Collapse
|
9
|
Jeon EK, Hong J, Hong SH, Kang JY, Park G, Ahn MI, Lee JY, Kang J. First reported case of interferon-alpha-induced sarcoidosis in an Asian patient with malignant melanoma. Asia Pac J Clin Oncol 2014; 12:e347-e349. [PMID: 24935527 DOI: 10.1111/ajco.12204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 11/28/2022]
Abstract
Anticancer agents can induce sarcoidosis. Interferon-alpha, which is used for the treatment of malignant melanoma and renal cell cancer, is one causative agent of sarcoidosis. However, there are few reports of interferon-alpha-induced sarcoidosis in patients with malignant melanoma. Clinically, it is important to consider the possibility of sarcoidosis in such patients because it could be easily regarded as a metastatic lesion due to underlying malignancy and given unnecessary treatment. Here, we report on the first case of interferon-alpha-induced sarcoidosis in an Asian melanoma patient.
Collapse
Affiliation(s)
- Eun Kyoung Jeon
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihyoung Hong
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Hee Hong
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Young Kang
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Gyeongsin Park
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myeong Im Ahn
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jinhyoung Kang
- Division of Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
10
|
Lazzari E, Jefferies CA. IRF5-mediated signaling and implications for SLE. Clin Immunol 2014; 153:343-52. [PMID: 24928322 DOI: 10.1016/j.clim.2014.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 05/12/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
Transcription of the type I IFN genes is regulated by members of the Interferon Regulatory Factor (IRF) family of transcription factors, composed in humans of 9 distinct proteins. In addition to IRF3 and IRF7, the transcription factor IRF5 has been shown to be involved in type I IFN production and interestingly, polymorphisms of the IRF5 gene in humans can result in risk or protective haplotypes with regard to SLE susceptibility. In addition to regulation of type I IFN expression, IRF5 is involved in other signaling pathways, including IgG switching in B cells, macrophage polarization and apoptosis, and its role in SLE pathogenesis may therefore not be limited to dysregulated control of IFN expression. In this review we will comprehensively discuss the role of IRF5 in immune-mediated responses and its potential multifaceted role in conferring SLE susceptibility.
Collapse
Affiliation(s)
- Elisa Lazzari
- Molecular and Cellular Therapeutics, Research Institute, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Caroline A Jefferies
- Molecular and Cellular Therapeutics, Research Institute, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| |
Collapse
|
11
|
Headaches and vasculitis. Neurol Clin 2014; 32:321-62. [PMID: 24703534 DOI: 10.1016/j.ncl.2013.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Vasculitis is a spectrum of clinicopathologic disorders defined by inflammation of arteries of veins of varying caliber with variable tissue injury. Headache may be an important clue to vasculitic involvement of central nervous system (CNS) vessels. CNS vasculitis may be primary, in which only intracranial vessels are involved in the inflammatory process, or secondary to another known disorder with overlapping systemic involvement. A suspicion of vasculitis based on the history, clinical examination, or laboratory studies warrants prompt evaluation and treatment to forestall progression and avert cerebral ischemia or infarction.
Collapse
|
12
|
Zierhut M, Abu El-Asrar AM, Bodaghi B, Tugal-Tutkun I. Therapy of Ocular Behçet Disease. Ocul Immunol Inflamm 2013; 22:64-76. [DOI: 10.3109/09273948.2013.866257] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
13
|
Abstract
Interferon-induced cutaneous sarcoidosis in the adjuvant treatment of melanoma is a rare side effect. We present the case of a patient who developed two histologically confirmed subcutaneous sarcoid nodules 15 months after starting adjuvant therapy with interferon for lymph node metastatic melanoma in which the primary tumor was not known. The extension study, coinciding with occurrence of the nodules, showed no systemic sarcoidosis. This therefore represents the second reported case of interferon-induced cutaneous sarcoidosis in melanoma therapy. As computed axial tomography-PET or other imaging techniques are unable to differentiate between the radiological signs of melanoma metastasis and sarcoidosis, histological evaluation of the granulomatous lesions is essential with a view to avoiding unnecessary treatments.
Collapse
|
14
|
Yoshikawa M, Fukui H, Tsujii T. Immunological Adverse Effects of Interferon Treatment. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03259299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Paul-Clark MJ, George PM, Gatheral T, Parzych K, Wright WR, Crawford D, Bailey LK, Reed DM, Mitchell JA. Pharmacology and therapeutic potential of pattern recognition receptors. Pharmacol Ther 2012; 135:200-15. [PMID: 22627269 DOI: 10.1016/j.pharmthera.2012.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 04/20/2012] [Indexed: 12/30/2022]
Abstract
Pharmacologists have used pathogen-associated molecular patterns (PAMPs), such as lipopolysaccharide (LPS) for decades as a stimulus for studying mediators involved in inflammation and for the screening of anti-inflammatory compounds. However, in the view of immunologists, LPS was too non-specific for studying the mechanisms of immune signalling in infection and inflammation, as no receptors had been identified. This changed in the late 1990s with the discovery of the Toll-like receptors. These 'pattern recognition receptors' (PRRs) were able to recognise highly conserved sequences, the so called pathogen associated molecular patterns (PAMPs) present in or on pathogens. This specificity of particular PAMPs and their newly defined receptors provided a common ground between pharmacologists and immunologists for the study of inflammation. PRRs also recognise endogenous agonists, the so called danger-associated molecular patterns (DAMPs), which can result in sterile inflammation. The signalling pathways and ligands of many PRRs have now been characterised and there is no doubt that this rich vein of research will aid the discovery of new therapeutics for infectious conditions and chronic inflammatory disease.
Collapse
Affiliation(s)
- M J Paul-Clark
- Department of Cardiothoracic Pharmacology, Pharmacology and Toxicology, National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Dovehouse Street, London SW3 6LY, United Kingdom.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Lenalidomide is a potent immunomodulatory agent being used increasingly for treatment of hematologic malignancies including multiple myeloma and myelodysplasia. The common toxicities of lenalidomide, including dose-limiting myelosuppression, are well described. However, the immunomodulatory properties of lenalidomide may give rise to unexpected autoimmune complications. Herein, we describe a case of immune thrombocytopenic purpura (ITP) associated with use of lenalidomide.
Collapse
|
17
|
Stübiger N, Winterhalter S, Pleyer U, Doycheva D, Zierhut M, Deuter C. [Janus-faced?: Effects and side-effects of interferon therapy in ophthalmology]. Ophthalmologe 2011; 108:204-12. [PMID: 21350868 DOI: 10.1007/s00347-010-2261-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interferon alpha (IFN-α) and interferon beta (IFN-β) are naturally occurring cytokines, which belong to the type I interferons and share the same receptor leading to very similar therapeutic effects. The immunomodulatory effect of type I interferons includes modulation of antibody production, inhibition of lymphocyte proliferation, inhibition of delayed-type hypersensitivity and enhancement of T-cell and NK-cell cytotoxicity. An increasing number of open clinical studies and case reports have demonstrated the efficacy of IFN-α for severe ocular inflammation in patients with Behçet's disease and of interferon-β, which has been used mainly for the treatment of multiple sclerosis.
Collapse
Affiliation(s)
- N Stübiger
- Augenklinik, Charite Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | | | | | | | | | | |
Collapse
|
18
|
Hamadah I, Binamer Y, Sanai FM, Abdo AA, Alajlan A. Interferon-induced vitiligo in hepatitis C patients: a case series. Int J Dermatol 2010; 49:829-33. [DOI: 10.1111/j.1365-4632.2009.04443.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Dhillon S, Kaker A, Dosanjh A, Japra D, Vanthiel DH. Irreversible pulmonary hypertension associated with the use of interferon alpha for chronic hepatitis C. Dig Dis Sci 2010; 55:1785-90. [PMID: 20411421 PMCID: PMC2882564 DOI: 10.1007/s10620-010-1220-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 03/23/2010] [Indexed: 02/06/2023]
Abstract
The interferons are a complex group of virally induced proteins produced by activated macrophages and lymphocytes, which have become the mainstay of therapy for hepatitis C infection. Sustained viral response (SVR) rates in noncirrhotic patients vary from 40-80% with interferon-based therapy. This, along with transplantation, has drastically changed the course of hepatitis C virus (HCV) infection over the last two decades. Numerous side effects associated with interferon therapy have been reported. These range from transient flu-like symptoms to serious effects such as cardiac arrhythmias, cardiomyopathy, renal and liver failure, polyneuropathy, and myelosuppression. Pulmonary side effects including pneumonitis, pulmonary fibrosis, and reversible pulmonary hypertension have been reported. Herein, we present four cases in which irreversible pulmonary hypertension was diagnosed after prolonged treatment with interferon alpha. In each case, other causes of pulmonary hypertension were systematically eliminated. Pulmonary artery hypertension, which may be irreversible, should be considered in patients being treated with interferon alpha who present with exertional dyspnea and do not have a readily identifiable inflammatory or thromboembolic cause.
Collapse
Affiliation(s)
- Sonu Dhillon
- Department of Medicine, Rush University Medical Center, Ste. 158 Professional Building, Chicago, IL 60612, USA.
| | | | | | | | | |
Collapse
|
20
|
Abstract
IFN-alpha and skin-infiltrating activated T lymphocytes have important roles in the pathogenesis of psoriasis. T cells from psoriatic patients display an increased sensitivity to IFN-alpha, but the pathological mechanisms behind the hyperresponsiveness to IFN-alpha remained unknown. In this study, we show that psoriatic T cells display deficient expression of the suppressor of cytokine signaling (SOCS)3 in response to IFN-alpha and a low baseline expression of the SH2-domain-containing protein-tyrosine phosphatase (SHP)-1 when compared with skin T cells from nonpsoriatic donors. Moreover, IFN-alpha-stimulated psoriatic T cells show enhanced activation of JAKs (JAK1 and TYK2) and signal transducers and activators of transcription. Increased expression of SOCS3 proteins resulting from proteasomal blockade partially inhibits IFN-alpha response. Similarly, forced expression of SOCS3 and SHP-1 inhibits IFN-alpha signaling in psoriatic T cells. In conclusion, our data suggest that loss of regulatory control is involved in the aberrant hypersensitivity of psoriatic T cells to IFN-alpha.
Collapse
|
21
|
Chang C, Gershwin ME. Drugs and autoimmunity--a contemporary review and mechanistic approach. J Autoimmun 2009; 34:J266-75. [PMID: 20015613 DOI: 10.1016/j.jaut.2009.11.012] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Drug-induced autoimmunity is an idiosyncratic, non-IgE immune related drug reaction. Interestingly, although many drugs have been reported to induce autoantibodies, only a few have a definitive association with drug-induced autoimmune disease. The prototype disease is drug-induced lupus and the typical drug for drug-induced lupus is minocycline. The production of autoantibodies and the induction of symptoms in drug-induced lupus results from a variety of mechanisms, which can include suppression of central or peripheral tolerance, alteration of gene transcription in T and B cells, abnormal cytokine and/or cytokine receptor balance and function, chromatin structure modification and antigen modification. Multiple mechanisms may apply for different drugs, and understanding the pharmacological actions of these agents helps us decipher the etiology. For example, DNA hypomethylation may occur with hydralazine, which leads to increased transcription, increased LFA-1, the generation of autoreactive T cells and a breakdown in peripheral tolerance. Frequently, more than one pathway may be involved. Interestingly, most patients with newly formed autoantibodies resulting from drugs do not develop clinical disease. Nonetheless, the explosion in the use of biological modifiers has been associated with production of autoantibodies, an observation that illustrates the complex nature of these interactions, in that these agents are frequently used to treat autoimmunity, yet may produce autoimmune diseases themselves.
Collapse
Affiliation(s)
- Christopher Chang
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA 95616, USA.
| | | |
Collapse
|
22
|
Benmousa A, Helmy A, Sanai FM, Ghandour ZM. Autoimmune Hepatitis Induced by Interferon Beta Therapy in a Patient with Multiple Sclerosis: A Case Report. J Pharm Technol 2009. [DOI: 10.1177/875512250902500605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To report a case of a woman who had multiple sclerosis and developed autoimmune hepatitis (AIH) induced by interferon beta therapy. Case Summary: A 35–year-old woman with multiple sclerosis was being treated with interferon beta when she presented with fatigue and jaundice. Liver biochemistry testing revealed acute hepatitis (alanine and aspartate aminotransferase values >10 times the upper limit of normal) that was histologically consistent with AIH. Our patient had a score of 9 on the Roussel Uclaf Causality Assessment Method scale, indicating a high probability that hepatotoxicity in this case was related to interferon beta therapy. The patient had spontaneous clinical and biochemical improvement after stoppage of treatment. However, when she resumed interferon beta therapy, derangement of liver function reappeared, which again responded well to discontinuation of interferon. Discussion: Interferons can induce many autoimmune diseases due to their immunomodulatory effects. Autoimmune thyroid diseases and, to a lesser extent, skin and pulmonary involvement, are frequently reported during interferon alfa treatment for chronic hepatitis C. Several different forms of hepatotoxicity have also been described with interferon alfa and beta therapy, but few cases of AIH induced by interferon are reported in the literature. AIH has been described in association with interferon alfa therapy; however, this association with interferon beta therapy is extremely rare, and only a handful of cases have been described. Moreover, reports of previous cases were not rechallenged with the same medication, thereby failing to demonstrate firm evidence of causality. This is the first report of the disease reappearing upon drug rechallenge. In addition, we have shown that interferon-induced AIH can be suitably treated by drug withdrawal rather than by institution of steroid therapy. Conclusions: Practitioners need to be aware of the potential complication of AIH induced by interferon beta; this condition occurs independently of the typically benign enzyme elevations frequently reported with this drug.
Collapse
Affiliation(s)
- Ali Benmousa
- ALI BENMOUSA ABIM SBG, Clinical Fellow, Division of Gastroenterology & Hepatology, Department of Medicine, Riyadh Military Hospital, Riyadh, Saudi Arabia
| | - Ahmed Helmy
- AHMED HELMY MB ChB MSc MD PhD, Associate Consultant, Section of Gastroenterology Department of Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh
| | - Faisal M Sanai
- FAISAL M SANAI ABIM SBG, Consultant, Division of Gastroenterology & Hepatology, Department of Medicine, Riyadh Military Hospital
| | - Zuhal M Ghandour
- ZUHAL M GHANDOUR MRCP, Consultant, Division of Gastroenterology & Hepatology, Department of Medicine, Riyadh Military Hospital
| |
Collapse
|
23
|
Yao Y, Richman L, Higgs BW, Morehouse CA, de los Reyes M, Brohawn P, Zhang J, White B, Coyle AJ, Kiener PA, Jallal B. Neutralization of interferon-alpha/beta-inducible genes and downstream effect in a phase I trial of an anti-interferon-alpha monoclonal antibody in systemic lupus erythematosus. ACTA ACUST UNITED AC 2009; 60:1785-96. [PMID: 19479852 DOI: 10.1002/art.24557] [Citation(s) in RCA: 235] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Type I interferons (IFNs) play an important role in the pathogenesis of systemic lupus erythematosus (SLE). This phase Ia trial was undertaken to evaluate the safety, pharmacokinetics, and immunogenicity of anti-IFNalpha monoclonal antibody (mAb) therapy in SLE. During the trial, we also examined whether overexpression of an IFNalpha/beta-inducible gene signature in whole blood could serve as a pharmacodynamic biomarker to evaluate IFNalpha neutralization and investigated downstream effects of neutralizing IFNalpha on BAFF and other key signaling pathways, i.e., granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-10 (IL-10), tumor necrosis factor alpha (TNFalpha), and IL-1beta, in SLE. METHODS Affymetrix Human Genome U133 Plus 2.0 microarrays were used to profile whole blood and lesional skin of patients receiving standard therapy for mild to moderate SLE. Selected IFNalpha/beta-inducible proteins were analyzed by immunohistochemistry. RESULTS With the study treatment, we observed anti-IFNalpha mAb-specific and dose-dependent inhibition of overexpression of IFNalpha/beta-inducible genes in whole blood and skin lesions from SLE patients, at both the transcript and the protein levels. In SLE patients with overexpression of messenger RNA for BAFF, TNFalpha, IL-10, IL-1beta, GM-CSF, and their respective inducible gene signatures in whole blood and/or skin lesions, we observed a general trend toward suppression of the expression of these genes and/or gene signatures upon treatment with anti-IFNalpha mAb. CONCLUSION IFNalpha/beta-inducible gene signatures in whole blood are effective pharmacodynamic biomarkers to evaluate anti-IFNalpha mAb therapy in SLE. Anti-IFNalpha mAb can neutralize overexpression of IFNalpha/beta-inducible genes in whole blood and lesional skin from SLE patients and has profound effects on signaling pathways that may be downstream of IFNalpha in SLE.
Collapse
Affiliation(s)
- Yihong Yao
- MedImmune, Gaithersburg, Maryland 20878, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
|
25
|
Raimbourg J, Cormier G, Stéphane Varin, Tanguy G, Bleher Y, Maisonneuve H. Hairy-cell leukemia with inaugural joint manifestations. Joint Bone Spine 2009; 76:416-20. [DOI: 10.1016/j.jbspin.2008.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2008] [Indexed: 10/20/2022]
|
26
|
Kim YK, Kim Y, Shim SS. Thoracic Complications of Liver Cirrhosis: Radiologic Findings. Radiographics 2009; 29:825-37. [DOI: 10.1148/rg.293085093] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
27
|
Interferon-alpha-associated presumed ocular sarcoidosis. Graefes Arch Clin Exp Ophthalmol 2008; 247:675-80. [PMID: 19034483 DOI: 10.1007/s00417-008-1002-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 11/01/2008] [Accepted: 11/05/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Interferon alpha, used in the treatment of different viral, autoimmune and malignant diseases, is known to induce a variety of side effects. Recently, induction of sarcoidosis during interferon therapy has been reported. We analyzed patients for uveitis, possibly induced by interferon alpha. METHODS We report on three patients who had developed typical signs of ocular sarcoidosis under treatment with interferon alpha for chronic hepatitis C virus infection. In two patients, conventional interferon alpha was used and in another one, pegylated interferon alpha-2b. All patients additionally received ribavirin. RESULTS In all three cases, panuveitis was diagnosed. The mean duration of interferon treatment before development of uveitis was 10 months. Clinically, all patients demonstrated granulomatous panuveitis with choroidal granulomas of various sizes. In one case, the uveitis developed together with renal failure, fever and malaise. In this patient, an elevated ACE level was detected. In another patient, the diagnosis of sarcoid induced uveitis was confirmed by positive chest CT scan. The intraocular inflammation was managed with a reduction of the interferon dosage. The therapy with ribavirin was not changed. All patients received topical steroids. Systemic steroids were applied only in the case with systemic disease manifestations. CONCLUSIONS Uveitis can be a sign of sarcoidosis induced by interferon alpha. Further studies are required to support the observation that with early diagnosis the prognosis of uveitis seems to be good.
Collapse
|
28
|
Gheorghe L, Cotruta B, Trifu V, Cotruta C, Becheanu G, Gheorghe C. Drug-induced Sweet's syndrome secondary to hepatitis C antiviral therapy. Int J Dermatol 2008; 47:957-9. [DOI: 10.1111/j.1365-4632.2008.03724.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
29
|
BACHMEYER C, FARGE D, GLUCKMAN E, MICLEA J, ARACTINGI S. Raynaud's phenomenon and digital necrosis induced by interferon-alpha. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-1028.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
30
|
|
31
|
Franchini M, Targher G, Manzato F, Lippi G. Acquired factor VIII inhibitors in oncohematology: A systematic review. Crit Rev Oncol Hematol 2008; 66:194-9. [DOI: 10.1016/j.critrevonc.2007.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 12/06/2007] [Accepted: 12/07/2007] [Indexed: 10/22/2022] Open
|
32
|
Mongey AB, Hess EV. Drug insight: autoimmune effects of medications-what's new? ACTA ACUST UNITED AC 2008; 4:136-44. [PMID: 18200008 DOI: 10.1038/ncprheum0708] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 11/19/2007] [Indexed: 12/30/2022]
Abstract
Autoantibodies and lupus-like syndromes can develop following the use of certain medications; however, although many patients develop autoantibodies, only a minority develop clinical features. Although these autoantibodies primarily consist of antinuclear and antihistone antibodies, additional types of antibody, such as antineutrophil cytoplasmic antibodies and anti-double-stranded DNA antibodies, have been reported in association with minocycline and tumor necrosis factor inhibitor therapy. Clinical features of drug-related lupus usually consist of constitutional symptoms, arthralgias, arthritis, myalgias and serositis, although cutaneous manifestations have been reported in association with the use of tumor necrosis factor inhibitors. Typically, clinical features resolve with discontinuation of the medication, although antibodies can persist for months or years. Arthralgias and inflammatory arthritis have also been reported in association with the use of aromatase inhibitors and other biologic agents such as interleukins and interferons.
Collapse
Affiliation(s)
- Anne-Barbara Mongey
- Division of Immunology at University of Cincinnati, Cincinnati, OH 45267-0563, USA.
| | | |
Collapse
|
33
|
Mangini AJ, Lafyatis R, Van Seventer JM. Type I interferons inhibition of inflammatory T helper cell responses in systemic lupus erythematosus. Ann N Y Acad Sci 2007; 1108:11-23. [PMID: 17893966 DOI: 10.1196/annals.1422.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
T helper (Th) cells play a central role in systemic lupus erythematosus (SLE). Activated autoreactive Th cells provide the help required for autoreactive B cells to differentiate and produce pathogenic autoAbs. Both autoAb-containing immune complexes and direct effects of inflammatory Th cells promote tissue injury and organ damage. In SLE, triggering of plasmacytoid dendritic cell (pDC) Toll-like receptors by autoimmune complexes containing nucleic acid autoantigens stimulates pDC secretion of high levels of type I interferons (IFN-alpha/beta). Study of SLE patients and murine disease models implicate these type I IFNs as key disease effectors. However, the role of pDC-derived type I IFNs in regulating the inflammatory function of Th cells in SLE is unknown. Although, type I IFNs are classically considered to promote Th1-mediated inflammation, they can also act as potent inhibitors of both Th1 and Th17 inflammatory cell responses. Work of ourselves and others leads us to hypothesize that if initiated during stages of SLE when Th cell-mediated tissue inflammation is absent or minimal, such as early in the disease or during periods of remission, type I IFN neutralization will disrupt the cycle of systemic autoimmune induction and disease. However, if initiated during advanced stages of disease when there is substantial ongoing Th1 (and possibly Th17) cell-mediated inflammation, targeting type I IFNs will exacerbate the Th cell-mediated inflammatory disease and thus potentiate end-organ damage and destruction. This has important implications for the application of the numerous anti-type I IFN therapies currently under development for SLE treatment.
Collapse
Affiliation(s)
- Alyson J Mangini
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA
| | | | | |
Collapse
|
34
|
DeMartelaere SL, Green MK, Shore JW. Exacerbation of Graves Ophthalmopathy With Interferon-α Therapy. Ophthalmic Plast Reconstr Surg 2007; 23:319-321. [PMID: 17667110 DOI: 10.1097/iop.0b013e3180a72711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thyroid dysfunction, particularly hypothyroidism, following interferon-alpha therapy is not uncommon. To our knowledge, this is the first case report of exacerbation of Graves ophthalmopathy during treatment with interferon-alpha for chronic hepatitis C virus.
Collapse
|
35
|
Imafuku S, Tashiro A, Furue M. Ciclosporin treatment of psoriasis in a patient with chronic hepatitis C. Br J Dermatol 2007; 156:1367-9. [PMID: 17441954 DOI: 10.1111/j.1365-2133.2007.07873.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
36
|
Alanoglu G, Kilbas S, Arslan C, Senol A, Kutluhan S. Autoimmune hemolytic anemia during interferon-beta-I b treatment for multiple sclerosis. Mult Scler 2007; 13:683-5. [PMID: 17548453 DOI: 10.1177/1352458506071333] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 31-year-old patient with multiple sclerosis (MS), treated with interferon beta-1b (IFNB-1b) for two years, presented with fatigue and dizziness. Coombs' positive autoimmune hemolytic anemia (AIHA) was found. Other potential etiologies of AIHA were ruled out. An association with IFNB-1b was highly suspected. Interferon therapy was discontinued and prednisone therapy instituted. There was resolution of the hemolytic anemia, and prednisone therapy was tapered gradually. To the best of our knowledge, there is no reported case of the development of AIHA associated with IFNB-1b use in MS patients. We conclude that if an unexplained drop in hematocrit occurs with a MS patient receiving IFNB-1b, autoimmune mediated hemolysis should also be considered.
Collapse
Affiliation(s)
- G Alanoglu
- Department of Internal Medicine, Division of Hematology, School of Medicine, Suleyman Demirel University, 32100 Isparta, Turkey.
| | | | | | | | | |
Collapse
|
37
|
Sallie R. Replicative homeostasis III: implications for antiviral therapy and mechanisms of response and non-response. Virol J 2007; 4:29. [PMID: 17355620 PMCID: PMC1847443 DOI: 10.1186/1743-422x-4-29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 03/13/2007] [Indexed: 12/27/2022] Open
Abstract
While improved drug regimens have greatly enhanced outcomes for patients with chronic viral infection, antiviral therapy is still not ideal due to drug toxicities, treatment costs, primary drug failure and emergent resistance. New antiviral agents, alternative treatment strategies and a better understanding of viral pathobiology, host responses and drug action are desperately needed. Interferon (IFN) and ribavirin, are effective drugs used to treat hepatitis C (HCV), but the mechanism(s) of their action are uncertain. Error catastrophe (EC), or precipitous loss of replicative fitness caused by genomic mutation, is postulated to mediate ribavirin action, but is a deeply flawed hypothesis lacking empirical confirmation. Paradoxically ribavirin, a proven RNA mutagen, has no impact on HCV viraemia long term, suggesting real viruses, replicating in-vitro, as opposed to mathematical models, replicating in-silico, are likely to resist EC by highly selective replication of fit (~consensus sequence) genomes mediated, in part, by replicative homeostasis (RH), an epicyclic mechanism that dynamically links RNApol fidelity and processivity and other viral protein functions. Replicative homeostasis provides a rational explanation for the various responses seen during treatment of HCV, including genotype-specific and viral load-dependent differential response rates, as well as otherwise unexplained phenomena like the transient inhibition and rebound of HCV viraemia seen during ribavirin monotherapy. Replicative homeostasis also suggests a primarily non-immunological mechanism that mediates increased immune responsiveness during treatment with ribavirin (and other nucleos(t)ide analogues), explicating the enhanced second-phase clearance of HCV ribavirin promotes and, thus, the apparent immunomodulatory action of ribavirin. More importantly, RH suggests specific new antiviral therapeutic strategies.
Collapse
|
38
|
Habermann TM. Splenectomy, Interferon, and Treatments of Historical Interest in Hairy Cell Leukemia. Hematol Oncol Clin North Am 2006; 20:1075-86. [PMID: 16990108 DOI: 10.1016/j.hoc.2006.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The evolution and "lessons learned" for therapeutic options and approaches in HCL, which subsequently evolved into the adenosine deaminase inhibitors as the treatment of choice, has been intriguing. The contributions to patient care and individual patient lives have been remarkable. Observation, splenectomy, and recombinant interferon are potential therapeutic are alternatives in select patients as initial therapy, and as therapeutic alternatives in the 10% of patients who have progressive disease after the purine nucleoside analogs.
Collapse
Affiliation(s)
- Thomas M Habermann
- Department of Hematology, Mayo Clinic College of Medicine, 200 First Street, SW Rochester, MN 55905, USA.
| |
Collapse
|
39
|
Ballanger F, Allix ML, Rimbert M, Audrain M, Muller JY, Dreno B. [Autoimmunity induced by low doses of interferon in melanoma stage I]. Ann Dermatol Venereol 2006; 133:543-8. [PMID: 16885841 DOI: 10.1016/s0151-9638(06)70959-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The principal aim of this work was to determine the prevalence of antinuclear antibodies and antinucleosomes antibodies during a treatment by interferon alpha with low dose for 18 months among patients with a melanoma stage I. The secondary objective consisted to seek the existence or not of a correlation with the clinical relapse, to determine the prevalence of appearance of clinical signs of autoimmune diseases and dysthyroidie. PATIENT AND METHODS It was an exploratory study. The patients included in the study had a melanoma stage I (French classification), whose excision was realized for 6 weeks maximum, with a Breslow index equal or higher than 1,5 mm. The statistical model of logistic regression was used. RESULTS Eighty-forth patients were included (38 women and 46 men) old from 21 to 75 years. The prevalence of antinuclear antibodies was 39%. None of the following variables: age, sex, phototype, localisation of melanoma in exposed photo zone, index of Breslow or Clark, were significantly associated with the presence of antinuclear antibodies. As the percentage of patients with anti-nucleosomes was low (5%), no statistical study was carried out. The prevalence of clinical and/or biological dysthyroidie was 37%. 60% of the patients presented at a moment in the evolution antinuclear antibodies or a dysthyroidie. The prevalence of relapses and death different was not correlated significantly with antinuclear antibodies and/or a dysthyroidie. DISCUSSION Many studies report the appearance of antinuclear antibodies, generally without clinical lesions during the treatment by interferon alpha for cancers (tumours carcinoids, hemopathies) and viral chronic hepatitis. Our study is, to our knowledge, the first evaluating the induction of an autoimmunity during the adjuvant treatment by interferon alpha of melanoma stage I. The induction of autoantibody during the treatment by interferon alpha could constitute a marker of effectiveness of the treatment with improvement of the survival of these patients. In our study, however auto immunity markers do not appear as factors of severity of evolution of the melanoma or predictive factors.
Collapse
|
40
|
Akay BN, Ekmekci P, Sanli H, Celik G, Bozdayi M. Cutaneous, pulmonary and hepatic sarcoidosis associated with autoimmune complications during interferon-alpha treatment for hepatitis C virus infection. J Eur Acad Dermatol Venereol 2006; 20:442-5. [PMID: 16643145 DOI: 10.1111/j.1468-3083.2006.01450.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A patient with hepatitis C virus (HCV) infection was diagnosed with cutaneous, pulmonary and hepatic sarcoidosis following interferon alpha therapy. There are only a few cases of sarcoidosis associated with this treatment. This is the first case who not only developed sarcoidosis, but also autoimmune hypothyroidism and thrombocytopenia during interferon alpha therapy due to the immunomodulatory effects of the drug.
Collapse
Affiliation(s)
- B N Akay
- Department of Dermatology, Ankara University School of Medicine, Ankara, Turkey
| | | | | | | | | |
Collapse
|
41
|
Marey-López J, Sousa CP. Trigeminal sensory neuropathy related to interferon-alpha treatment. Muscle Nerve 2006; 33:581-2. [PMID: 16372324 DOI: 10.1002/mus.20487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
42
|
Okada AA. Immunomodulatory therapy for ocular inflammatory disease: a basic manual and review of the literature. Ocul Immunol Inflamm 2006; 13:335-51. [PMID: 16419419 DOI: 10.1080/09273940590951034] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Corticosteroids are used as first-line treatment for many ocular inflammatory conditions. The risk of adverse effects, however, necessitates conversion to steroid-sparing immunomodulatory therapy (IMT) for disease that is recurrent, chronic, or poorly responsive to treatment. Combination drug treatments with multiple agent 'recipes' are also considered. Immunomodulatory agents include the broad categories of antimetabolites (azathioprine, methotrexate, mycophenolate mofetil), alkylating agents (cyclophosphamide, chlorambucil), T-cell inhibitors (cyclosporine, tacrolimus), and cytokines (interferon alfa). This article reviews and summarizes the evidence for IMT agent use in the treatment of various forms of ocular inflammation.
Collapse
Affiliation(s)
- Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka, Tokyo 181-8611, Japan.
| |
Collapse
|
43
|
Celik G, Sen E, Ulger AF, Kumbasar OO, Bozkaya H, Alper D, Karayalcin S. Sarcoidosis caused by interferon therapy. Respirology 2006; 10:535-40. [PMID: 16135181 DOI: 10.1111/j.1440-1843.2005.00746.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Interferon alpha (IFN-alpha) is an immunomodulator that is used as an antiviral agent in active chronic viral hepatitis C. IFN therapy can cause an induction or exacerbation of sarcoidosis. Although several reports in the gastroenterology literature have suggested an association between IFN therapy and sarcoidosis, this association has rarely been described elsewhere. A 47-year-old woman developed sarcoidosis after cessation of treatment with IFN and ribavirin for chronic hepatitis C. Her sarcoidosis showed liver, pulmonary and skin involvement. She continues to be monitored regularly in the Department of Pulmonary Diseases without steroid therapy. Her sarcoidosis improved spontaneously. We conclude that patients should be monitored for sarcoidosis during and after IFN therapy.
Collapse
Affiliation(s)
- Göhkan Celik
- Department of Pulmonary Diseases, Ankara University School of Medicine, Ankara, Turkey.
| | | | | | | | | | | | | |
Collapse
|
44
|
Ubiña-Aznar E, Fernández-Moreno N, Rivera-Irigoín R, Navarro-Jarabo JM, García-Fernández G, Pérez-Aisa A, Vera-Rivero F, Fernández-Pérez F, Moreno-Mejías P, Méndez-Sánchez I, de Sola-Earle C, Sánchez-Cantos A. [Pulmonary sarcoidosis associated with pegylated interferon in the treatment of chronic hepatitis C]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:450-2. [PMID: 16185580 DOI: 10.1157/13079006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment with pegylated interferon is usually used in active chronic hepatitis C in association with ribavirin. The adverse effects of interferon include influenza-like syndrome and mild respiratory manifestations, which are highly frequent. Among the immunomodulatory effects is the possibility of inducing or exacerbating autoimmune phenomena such as cutaneous or systemic sarcoidosis. We present a new case of pulmonary sarcoidosis induced by pegylated interferon in a 35 year-old woman with chronic hepatitis C who developed respiratory symptoms 4 months after starting therapy with pegylated interferon associated with ribavirin. Radiological images showed a micronodular pattern in both pulmonary fields together with hilar and mediastinal adenopathies. Transbronchial biopsy confirmed the presence of sarcoidal granulomas. After the diagnosis of pulmonary sarcoidosis, antiviral therapy was suspended with subsequent resolution of the clinical symptoms.
Collapse
Affiliation(s)
- E Ubiña-Aznar
- Servicio de Aparato Digestivo, Hospital Costa del Sol, Marbella, Málaga, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Schreiber ZA, Bräu N. Acquired factor VIII inhibitor in patients with hepatitis C virus infection and the role of interferon-alpha: a case report. Am J Hematol 2005; 80:295-8. [PMID: 16315253 DOI: 10.1002/ajh.20405] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A patient with HIV and hepatitis C virus (HCV) co-infection developed an autoantibody to factor VIII after 8.7 months of treatment with pegylated interferon-alpha and ribavirin. Three previous cases of the development of factor VIII autoantibody in patients infected with the hepatitis C virus have been reported. Only one of these patients was treated with interferon-alpha, and this patient had hemophilia A, a condition prone to development of factor VIII autoantibody, even without interferon treatment. It is possible that chronic HCV infection itself, which has been associated with immunological disorders, is responsible for this phenomenon, but the immunomodulatory properties of interferon-alpha may also contribute to this rare occurrence. No previous case of factor VIII inhibitor in a patient infected with HIV has been reported.
Collapse
|
46
|
Eriksen KW, Lovato P, Skov L, Krejsgaard T, Kaltoft K, Geisler C, Ødum N. Increased Sensitivity to Interferon-α in Psoriatic T Cells. J Invest Dermatol 2005; 125:936-44. [PMID: 16297193 DOI: 10.1111/j.0022-202x.2005.23864.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease characterized by abnormal epidermal proliferation. Several studies have shown that skin-infiltrating activated T cells and cytokines play a pivotal role during the initiation and maintenance of the disease. Interferon (IFN)-alpha plays an important role in host defense against infections, but recent data have also implicated IFN-alpha in psoriasis. Thus, IFN-alpha induces or aggravates psoriasis in some patients, and mice lacking a transcriptional attenuator of IFN-alpha/beta signaling spontaneously develop a psoriasis-like inflammatory skin disease characterized by CD8(+)-infiltrating T cells. In this study, we therefore investigate IFN-alpha signaling in T cells isolated from involved skin of psoriatic patients. We show that psoriatic T cells have increased and prolonged responses to IFN-alpha, on the level of signal transducers and activators of transcription (STAT) activation, compared with infiltrating T cells from skin of non-psoriatic donors. Functionally, the increased IFN-alpha signaling leads to an increased binding of STAT4 to the IFN-gamma promotor, IFN-gamma production, and inhibition of T cell growth. In contrast, to STAT responses to other cytokines were not changed in psoriasis. In conclusion, we provide evidence that psoriatic T cells have an increased sensitivity to IFN-alpha. Thus, our data suggest that increased IFN-alpha signaling is involved in the pathogenesis of psoriasis.
Collapse
Affiliation(s)
- Karsten Wessel Eriksen
- Institute of Molecular Biology and Physiology, Department of Immunology, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | |
Collapse
|
47
|
Huang FC, Shih MH, Tseng SH, Lin SC, Chang TT. Tear Function Changes During Interferon and Ribavirin Treatment in Patients With Chronic Hepatitis C. Cornea 2005; 24:561-6. [PMID: 15968161 DOI: 10.1097/01.ico.0000151560.40236.70] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate symptoms and changes in tear function and the ocular surface with interferon and ribavirin therapy for chronic hepatitis C. METHODS Nineteen patients with chronic hepatitis C undergoing a course of interferon alfa-2b/ribavirin therapy and 19 age- and sex-matched controls participated in this prospective study. Patients were evaluated for dry eye subjectively (15-symptom assessment questionnaire) and objectively, including ophthalmologic examination, Schirmer test, tear clearance rate (TCR), tear function index (TFI), and nucleus/cytoplasm (N/C) ratio of conjunctival epithelial cell by impression cytology. All tests were performed before antiviral therapy (baseline); at 1, 3, and 6 months after initiation of therapy; and at 3 and 6 months after completing the 6-month course of treatment. All the tear functional tests and impression cytology results in controls were compared with pretreatment baseline of study group, using the Student t test. A paired t test was used to compare mean patient follow-up values with mean patient baseline values. RESULTS Patients' mean score on the dry eye symptom assessment questionnaire was significantly (P < 0.05) higher than baseline after 1 and 3 months of therapy, peaked after 6 months of therapy, remained significantly elevated at 3 months after completion of therapy, but had decreased to almost baseline by 6 months after cessation of therapy. Compared with baseline, mean Schirmer test values showed a significant change only at 1 month after the start of treatment. In contrast, mean TCR, mean TFI, and mean N/C ratio were significantly different from baseline at every examination, including 6 months after discontinuation of therapy. After 6 months of therapy, 4 patients (21%) had advanced squamous metaplasia (stage 3 or 4), but 2 patients still had mild squamous metaplasia (stage 2) even 6 months after the completion of therapy. CONCLUSIONS Impairment of tear dynamics and squamous metaplastic changes in the ocular surface occurred in patients with chronic hepatitis C treated with interferon alfa-2b and ribavirin. Symptoms of dry eye were mild and reversible; however, abnormalities in tear dynamics and the ocular surface persisted even 6 months after discontinuation of treatment.
Collapse
Affiliation(s)
- Fu-Chin Huang
- Department of Ophthalmology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | | | | | | | | |
Collapse
|
48
|
Thorpe R, Swanson SJ. Current methods for detecting antibodies against erythropoietin and other recombinant proteins. CLINICAL AND DIAGNOSTIC LABORATORY IMMUNOLOGY 2005; 12:28-39. [PMID: 15642981 PMCID: PMC540193 DOI: 10.1128/cdli.12.1.28-39.2005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Robin Thorpe
- Division of Immunobiology, The National Institute for Biological Standards and Control, Blanche Lane, South Mimms, Potters Bar, Hertfordshire EN6 3QG, United Kingdom.
| | | |
Collapse
|
49
|
Doi F, Kakizaki S, Takagi H, Murakami M, Sohara N, Otsuka T, Abe T, Mori M. Long-term outcome of interferon-alpha-induced autoimmune thyroid disorders in chronic hepatitis C. Liver Int 2005; 25:242-6. [PMID: 15780045 DOI: 10.1111/j.1478-3231.2005.01089.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Autoimmune thyroid disorders are among the well-known adverse effects of interferon-alpha (IFN-alpha) therapy in patients with chronic hepatitis C. However, there are few reports regarding the long-term outcome of this complication. We aimed to evaluate the natural history of IFN-alpha-induced autoimmune thyroid disorders with long-term follow-up. METHODS Four hundred and thirty-nine patients with chronic hepatitis C were treated with IFN-alpha for 24 weeks between March 1993 and April 1998. Seventeen of 439 (3.9%) patients developed symptomatic autoimmune thyroid disorders including nine cases of hyperthyroidism and eight cases of hypothyroidism. The patients with hypothyroidism were all women. These 17 patients were followed up for 71.1 +/- 17.8 months (48-120 months) and were evaluated for long-term outcome. RESULTS Eight patients could discontinue the thyroid medication (2-36 months, median 10 months). Nine patients needed the thyroid medication at the follow-up period. The patients with hyperthyroidism who needed long-term thyroid medication had a significantly high titer of TSH receptor antibody on onset compared with the patients who could discontinue the thyroid medication. There were no significant differences in age, type of IFN, duration from IFN administration to onset, cessation of IFN, genotype of hepatitis C virus and thyroid hormone levels on onset between the patients who needed long-term thyroid medication and the patients who could discontinue the thyroid medication. CONCLUSION All patients with IFN-alpha-induced thyroid disorders could be controlled with medication. However, the IFN-alpha-induced thyroid disorders are not always reversible. One must be careful about not only the development of autoimmune thyroid disorders during IFN-alpha therapy but also the outcome of the thyroid disease.
Collapse
Affiliation(s)
- Fumina Doi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Palucka AK, Blanck JP, Bennett L, Pascual V, Banchereau J. Cross-regulation of TNF and IFN-alpha in autoimmune diseases. Proc Natl Acad Sci U S A 2005; 102:3372-7. [PMID: 15728381 PMCID: PMC552921 DOI: 10.1073/pnas.0408506102] [Citation(s) in RCA: 395] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cytokines, most particularly TNF and type I IFN (IFN-alphabeta), have been long considered essential elements in the development of autoimmunity. Identification of TNF in the pathogenesis of rheumatoid arthritis and TNF antagonist therapy represent successes of immunology. IFN-alphabeta plays a major role in systemic lupus erythematosus (SLE), a prototype autoimmune disease characterized by a break of tolerance to nuclear components. Here, we show that TNF regulates IFN-alpha production in vitro at two levels. First, it inhibits the generation of plasmacytoid dendritic cells (pDCs), a major producer of IFN-alphabeta, from CD34+ hematopoietic progenitors. Second, it inhibits IFN-alpha release by immature pDCs exposed to influenza virus. Neutralization of endogenous TNF sustains IFN-alpha secretion by pDCs. These findings are clinically relevant, as five of five patients with systemic juvenile arthritis treated with TNF antagonists display overexpression of IFN-alpha-regulated genes in their blood leukocytes. These results, therefore, might provide a mechanistic explanation for the development of anti-dsDNA antibodies and lupus-like syndrome in patients undergoing anti-TNF therapy.
Collapse
Affiliation(s)
- A Karolina Palucka
- Baylor Institute for Immunology Research, 3434 Live Oak Street, Dallas, TX 75214, USA
| | | | | | | | | |
Collapse
|