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Treccani M, Veschetti L, Patuzzo C, Malerba G, Vaglio A, Martorana D. Genetic and Non-Genetic Contributions to Eosinophilic Granulomatosis with Polyangiitis: Current Knowledge and Future Perspectives. Curr Issues Mol Biol 2024; 46:7516-7529. [PMID: 39057087 PMCID: PMC11275403 DOI: 10.3390/cimb46070446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/12/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
In this work, we present a comprehensive overview of the genetic and non-genetic complexity of eosinophilic granulomatosis with polyangiitis (EGPA). EGPA is a rare complex systemic disease that occurs in people presenting with severe asthma and high eosinophilia. After briefly introducing EGPA and its relationship with the anti-neutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitis (AAVs), we delve into the complexity of this disease. At first, the two main biological actors, ANCA and eosinophils, are presented. Biological and clinical phenotypes related to ANCA positivity or negativity are explained, as well as the role of eosinophils and their pathological subtypes, pointing out their intricate relations with EGPA. Then, the genetics of EGPA are described, providing an overview of the research effort to unravel them. Candidate gene studies have investigated biologically relevant candidate genes; the more recent genome-wide association studies and meta-analyses, able to analyze the whole genome, have confirmed previous associations and discovered novel risk loci; in the end, family-based studies have dissected the contribution of rare variants and the heritability of EGPA. Then, we briefly present the environmental contribution to EGPA, reporting seasonal events and pollutants as triggering factors. In the end, the latest omic research is discussed and the most recent epigenomic, transcriptomic and microbiome studies are presented, highlighting the current challenges, open questions and suggesting approaches to unraveling this complex disease.
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Affiliation(s)
- Mirko Treccani
- GM Lab, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, 37134 Verona, Italy;
| | - Laura Veschetti
- Infections and Cystic Fibrosis Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy;
- Vita-Salute San Raffaele University, 20132 Milano, Italy
| | - Cristina Patuzzo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Giovanni Malerba
- GM Lab, Department of Surgery, Dentistry, Gynaecology and Paediatrics, University of Verona, 37134 Verona, Italy;
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy;
- Department of Biomedical Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50121 Florence, Italy
| | - Davide Martorana
- Medical Genetics Unit, Department of Onco-Hematology, University Hospital of Parma, 43126 Parma, Italy;
- CoreLab Unit, Research Center, University Hospital of Parma, 43126 Parma, Italy
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2
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Reggiani F, Stella M, Calatroni M, Sinico RA. Treatment strategies for ANCA-associated vasculitides: from standard protocols to future horizons. Expert Rev Clin Immunol 2024; 20:765-780. [PMID: 38445642 DOI: 10.1080/1744666x.2024.2326628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/29/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION ANCA-associated vasculitides (AAV), classified into granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis represent a group of disorders characterized by necrotizing vasculitis of small vessels, endothelial injury and tissue damage. The outcomes and prognosis of AAV have undergone significant changes with the introduction of glucocorticoids (GCs) and other immunosuppressants (cyclophosphamide, azathioprine, methotrexate, and mycophenolate mofetil). The enhanced understanding of pathogenesis has subsequently led to the incorporation into clinical practice of drugs targeting specific therapeutic targets. AREAS COVERED After an extensive literature search of Pubmed, Medline, Embase of the most recent evidence, we provide an overview of available treatments, highlighting how newer drugs have integrated into standard protocols. Our review also explores potential new therapeutic targets, including B cell depletion and inhibition, T cell inhibition, complement inhibition, and IL-5 and IgE inhibition. EXPERT OPINION There is hope that the new treatment targets currently under study in AAV may enable a faster and more lasting clinical response, ensuring the reduction of possible side effects from therapies. Moreover, numerous aspects necessitate further exploration in the future, such as tailoring of GCs, integration of GCs-sparing agents, efficacy of combination therapy, optimal maintenance therapy, to reduce organ-damage and improve quality of life.
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Affiliation(s)
- Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matteo Stella
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Milan, Italy
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3
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Ma R, Sun D, Wang Y, Huang X, Ye Q. Cuproptosis-associated hub gene identification and immune cell infiltration patterns in silicosis. Toxicology 2024; 504:153762. [PMID: 38403151 DOI: 10.1016/j.tox.2024.153762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
Recent research has hinted at a potential connection between silicosis, a fibrotic lung disease caused by exposure to crystalline silica particles, and cuproptosis. The aim of the study was to explore how cuproptosis-related genes (CRGs) may influence the development of silicosis and elucidate the underlying mechanisms. An analysis of genes associated with both silicosis and cuproptosis was conducted. Key gene identification was achieved through the application of two machine learning techniques. Additionally, the correlation between these key genes and immune cell populations was explored and the critical pathways were discerned. To corroborate our findings, the expression of key genes was verified in both a publicly available silica-induced mouse model and our own silicosis mouse model. A total of 12 differentially expressed CRGs associated with silicosis were identified. Further analysis resulted in the identification of 6 CRGs, namely LOX, SPARC, MOXD1, ALB, MT-CO2, and AOC2. Elevated immune cell infiltration of CD8 T cells, regulatory T cells, M0 macrophages, and neutrophils in silicosis patients compared to healthy controls was indicated. Validation in a silica-induced pulmonary fibrosis mouse model supported SPARC and MT-CO2 as potential signature genes for the prediction of silicosis. These findings highlight a strong association between silicosis and cuproptosis. Among CRGs, LOX, SPARC, MOXD1, ALB, MT-CO2, and AOC2 emerged as pivotal players in the context of silicosis by modulating CD8 T cells, regulatory T cells, M0 macrophages, and neutrophils.
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Affiliation(s)
- Ruimin Ma
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China; Department of Respiratory Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanying Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoxi Huang
- Medical Research Center, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Peyronel F, Haroche J, Campochiaro C, Pegoraro F, Amoura Z, Tomelleri A, Mazzariol M, Papo M, Cavalli G, Benigno GD, Fenaroli P, Grigoratos C, Mengoli MC, Bonometti A, Berti E, Savino G, Cives M, Neri I, Pacinella G, Tuttolomondo A, Marano M, Muratore F, Manfredi A, Broccoli A, Zinzani PL, Didona B, Massaccesi C, Buono A, Ammirati E, Di Lernia V, Dagna L, Vaglio A, Cohen-Aubart F. Epidemiology and geographic clustering of Erdheim-Chester disease in Italy and France. Blood 2023; 142:2119-2123. [PMID: 37871575 DOI: 10.1182/blood.2023021670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/07/2023] [Accepted: 09/24/2023] [Indexed: 10/25/2023] Open
Abstract
This geoepidemiological study, performed in Italy and France, shows that Erdheim-Chester disease is increasingly diagnosed and cases cluster in specific geographic areas, namely southern Italy and central France. Disease frequency inversely correlates with the Human Development Index.
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Affiliation(s)
- Francesco Peyronel
- Nephrology and Dialysis Unit, Azienda Ospedaliera Universitaria Meyer IRCCS, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Julien Haroche
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Corrado Campochiaro
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Zahir Amoura
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | | | - Matthias Papo
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | | | - Paride Fenaroli
- Nephrology and Dialysis Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria C Mengoli
- Operative Unit of Pathology, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Reggio Emilia, Italy
| | - Arturo Bonometti
- Pathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Clinical and Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gustavo Savino
- Ocular Oncology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- Università Cattolica del Sacro Cuore, UCSC, Rome, Italy
| | - Mauro Cives
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro," Bari, Italy
| | - Iria Neri
- Dermatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gaetano Pacinella
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Massimo Marano
- Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Andreina Manfredi
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Policlinico of Modena, Modena, Italy
| | - Alessandro Broccoli
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Pier L Zinzani
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Biagio Didona
- Istituto Dermopatico dell'Immacolata-Istituto di Ricovero e Cura a Carattere Scientifico Rare Disease Center, Rome, Italy
| | | | - Andrea Buono
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milan, Italy
| | - Enrico Ammirati
- De Gasperis Cardio Center, Transplant Center, Niguarda Hospital, Milan, Italy
- Department of Health Sciences, University of Milan-Bicocca, Monza, Italy
| | - Vito Di Lernia
- Dermatology Unit, S. Maria Nuova, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico Reggio Emilia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Azienda Ospedaliera Universitaria Meyer IRCCS, Florence, Italy
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Fleur Cohen-Aubart
- Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Internal Medicine Department 2, French National Referral Center for Rare Systemic Diseases and Histiocytoses, Centre d'immunologie et des maladies infectieuses (Cimi INSERM Unité Mixte de Recherche Scientifique-1135), Paris, France
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5
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Reggiani F, L’Imperio V, Calatroni M, Pagni F, Sinico RA. Renal involvement in eosinophilic granulomatosis with polyangiitis. Front Med (Lausanne) 2023; 10:1244651. [PMID: 37790127 PMCID: PMC10544898 DOI: 10.3389/fmed.2023.1244651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing vasculitis, which typically affects small-to medium-sized blood vessels. It is characterized by the presence of tissue infiltrates rich in eosinophils, along with the formation of granulomatous lesions. About 40% of cases have positive anti-neutrophil cytoplasm antibodies (ANCA), with predominant perinuclear staining, and anti-myeloperoxidase (anti-MPO) specificity in about 65% of cases. Typical manifestations of EGPA include the late onset of asthma, nasal and sinus-related symptoms, peripheral neuropathy, and significant eosinophilia observed in the peripheral blood. In contrast to granulomatosis with polyangiitis and microscopic polyangiitis, renal involvement in EGPA is less frequent (about 25%) and poorly studied. Necrotizing pauci-immune crescentic glomerulonephritis is the most common renal presentation in patients with ANCA-positive EGPA. Although rarely, other forms of renal involvement may also be observed, such as eosinophilic interstitial nephritis, mesangial glomerulonephritis, membranous nephropathy, or focal sclerosis. A standardized treatment for EGPA with renal involvement has not been defined, however the survival and the renal outcomes are usually better than in the other ANCA-associated vasculitides. Nonetheless, kidney disease is an adverse prognostic factor for EGPA patients. Larger studies are required to better describe the renal involvement, in particular for patterns different from crescentic glomerulonephritis, and to favor the development of a consensual therapeutic approach. In this article, in addition to personal data, we will review recent findings on patient clinical phenotypes based on ANCA, genetics and the impact of biological drugs on disease management.
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Affiliation(s)
- Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Vincenzo L’Imperio
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Nephrology and Dialysis Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano-Bicocca, IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Fondazione San Gerardo dei Tintori, Monza, Italy
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6
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Yoshida Y, Nakamoto N, Oka N, Kidoguchi G, Hosokawa Y, Araki K, Ishitoku M, Watanabe H, Sugimoto T, Mokuda S, Kida T, Yajima N, Omura S, Nakagomi D, Abe Y, Kadoya M, Takizawa N, Nomura A, Kukida Y, Kondo N, Yamano Y, Yanagida T, Endo K, Matsui K, Takeuchi T, Ichinose K, Kato M, Yanai R, Matsuo Y, Shimojima Y, Nishioka R, Okazaki R, Takata T, Ito T, Moriyama M, Takatani A, Miyawaki Y, Ito-Ihara T, Kawaguchi T, Kawahito Y, Hirata S. Seasonal Influence on Development of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: A Retrospective Cohort Study Conducted at Multiple Institutions in Japan (J-CANVAS). J Rheumatol 2023; 50:1152-1158. [PMID: 37263656 DOI: 10.3899/jrheum.2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To clarify seasonal and other environmental effects on the onset of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS We enrolled patients with new-onset eosinophilic granulomatosis with polyangiitis (EGPA), microscopic polyangiitis (MPA), and granulomatosis with polyangiitis (GPA) registered in the database of a Japanese multicenter cohort study. We investigated the relationship between environmental factors and clinical characteristics. Seasons were divided into 4 (spring, summer, autumn, and winter), and the seasonal differences in AAV onset were analyzed using Pearson chi-square test, with an expected probability of 25% for each season. RESULTS A total of 454 patients were enrolled, with a mean age of 70.9 years and a female proportion of 55.5%. Overall, 74, 291, and 89 patients were classified as having EGPA, MPA, and GPA, respectively. Positivity for myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA was observed in 355 and 46 patients, respectively. Overall, the seasonality of AAV onset significantly deviated from the expected 25% for each season (P = 0.001), and its onset was less frequently observed in autumn. In ANCA serotypes, seasonality was significant in patients with MPO-ANCA (P < 0.001), but not in those with PR3-ANCA (P = 0.97). Additionally, rural residency of patients with AAV was associated with PR3-ANCA positivity and biopsy-proven pulmonary vasculitis. CONCLUSION The onset of AAV was influenced by seasonal variations and was less frequently observed in autumn. In contrast, the occurrence of PR3-ANCA was triggered, not by season, but by rural residency.
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Affiliation(s)
- Yusuke Yoshida
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima;
| | - Naoki Nakamoto
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Naoya Oka
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Genki Kidoguchi
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Yohei Hosokawa
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Kei Araki
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Michinori Ishitoku
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Hirofumi Watanabe
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Tomohiro Sugimoto
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Sho Mokuda
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
| | - Takashi Kida
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Nobuyuki Yajima
- N. Yajima, MD, PhD, MPH, R. Yanai, MD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | - Satoshi Omura
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Daiki Nakagomi
- D. Nakagomi, MD, PhD, Department of Rheumatology, University of Yamanashi Hospital, Chuo
| | - Yoshiyuki Abe
- Y. Abe, MD, PhD, Department of Internal Medicine and Rheumatology, Juntendo University, Tokyo
| | - Masatoshi Kadoya
- M. Kadoya, MD, PhD, Center for Rheumatic Disease, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto
| | - Naoho Takizawa
- N. Takizawa, MD, Department of Rheumatology, Chubu Rosai Hospital, Nagoya
| | - Atsushi Nomura
- A. Nomura, MD, PhD, Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo
| | - Yuji Kukida
- Y. Kukida, MD, PhD, Department of Rheumatology, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto
| | - Naoya Kondo
- N. Kondo, PhD, Department of Nephrology, Kyoto Katsura Hospital, Kyoto
| | - Yasuhiko Yamano
- Y. Yamano, PhD, Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto
| | - Takuya Yanagida
- T. Yanagida, MD, Department of Hematology and Rheumatology, Kagoshima University Hospital, Kagoshima
| | - Koji Endo
- K. Endo, MD, Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, and Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto
| | - Kiyoshi Matsui
- K. Matsui, MD, PhD, Department of Diabetes, Endocrinology and Clinical Immunology, School of Medicine, Hyogo Medical University, Nishinomiya
| | - Tohru Takeuchi
- T. Takeuchi, MD, PhD, Department of Internal Medicine (IV), Osaka Medical and Pharmaceutical University, Osaka
| | - Kunihiro Ichinose
- K. Ichinose, MD, PhD, Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, and Department of Rheumatology, Shimane University Faculty of Medicine, Izumo
| | - Masaru Kato
- M. Kato, MD, PhD, Department of Rheumatology, Endocrinology and Nephrology, Graduate School of Medicine, Hokkaido University, Sapporo
| | - Ryo Yanai
- N. Yajima, MD, PhD, MPH, R. Yanai, MD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo
| | - Yusuke Matsuo
- Y. Matsuo, MD, PhD, Department of Rheumatology, Tokyo Kyosai Hospital, and Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo
| | - Yasuhiro Shimojima
- Y. Shimojima, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto
| | - Ryo Nishioka
- R. Nishioka, MD, Department of Rheumatology, Graduate School of Medical Science, Kanazawa University, Kanazawa
| | - Ryota Okazaki
- R. Okazaki, MD, PhD, Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago
| | - Tomoaki Takata
- T. Takata, MD, PhD, Division of Gastroenterology and Nephrology, Tottori University, Yonago
| | - Takafumi Ito
- T. Ito, MD, PhD, Division of Nephrology, Shimane University Hospital, Izumo
| | - Mayuko Moriyama
- M. Moriyama, MD, Department of Rheumatology, Shimane University Faculty of Medicine, Izumo
| | - Ayuko Takatani
- A. Takatani, MD, PhD, Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo
| | - Yoshia Miyawaki
- Y. Miyawaki, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama
| | - Toshiko Ito-Ihara
- T. Ito-Ihara, MD, PhD, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto
| | - Takashi Kawaguchi
- T. Kawaguchi, PhD, Department of Practical Pharmacy, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Yutaka Kawahito
- T. Kida, MD, PhD, MPH, S. Omura, MD, Y. Kawahito, MD, PhD, Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto
| | - Shintaro Hirata
- Y. Yoshida, MD, PhD, N. Nakamoto, MD, N. Oka, MD, G. Kidoguchi, MD, Y. Hosokawa, MD, K. Araki, MD, M. Ishitoku, MD, H. Watanabe, MD, T. Sugimoto, MD, PhD, S. Mokuda, MD, PhD, S. Hirata, MD, PhD, Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima
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7
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Emmi G, Bettiol A, Gelain E, Bajema IM, Berti A, Burns S, Cid MC, Cohen Tervaert JW, Cottin V, Durante E, Holle JU, Mahr AD, Del Pero MM, Marvisi C, Mills J, Moiseev S, Moosig F, Mukhtyar C, Neumann T, Olivotto I, Salvarani C, Seeliger B, Sinico RA, Taillé C, Terrier B, Venhoff N, Bertsias G, Guillevin L, Jayne DRW, Vaglio A. Evidence-Based Guideline for the diagnosis and management of eosinophilic granulomatosis with polyangiitis. Nat Rev Rheumatol 2023; 19:378-393. [PMID: 37161084 DOI: 10.1038/s41584-023-00958-w] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/11/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, characterized by asthma, eosinophilia and granulomatous or vasculitic involvement of several organs. The diagnosis and management of EGPA are often challenging and require an integrated, multidisciplinary approach. Current practice relies on recommendations and guidelines addressing the management of ANCA-associated vasculitis and not specifically developed for EGPA. Here, we present evidence-based, cross-discipline guidelines for the diagnosis and management of EGPA that reflect the substantial advances that have been made in the past few years in understanding the pathogenesis, clinical subphenotypes and differential diagnosis of the disease, as well as the availability of new treatment options. Developed by a panel of European experts on the basis of literature reviews and, where appropriate, expert opinion, the 16 statements and five overarching principles cover the diagnosis and staging, treatment, outcome and follow-up of EGPA. These recommendations are primarily intended to be used by healthcare professionals, pharmaceutical industries and drug regulatory authorities, to guide clinical practice and decision-making in EGPA. These guidelines are not intended to limit access to medications by healthcare agencies, nor to impose a fixed order on medication use.
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC, Australia
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Ingeborg M Bajema
- Department of Pathology, Groningen University Medical Center, Groningen, the Netherlands
| | - Alvise Berti
- Rheumatology, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, Trento, Italy
| | - Stella Burns
- Vasculitis and Lupus Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maria C Cid
- Department of Autoimmune Diseases, Hospital Clinic de Barcelona, Barcelona, Spain
- University of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Jan W Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, IVPC, INRAE, ERN-LUNG, Lyon, France
| | - Eugenia Durante
- APACS, Associazione Pazienti con Sindrome di Churg Strauss, Arosio, Italy
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster/Kiel, Germany
| | - Alfred D Mahr
- Department of Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marcos Martinez Del Pero
- Vasculitis and Lupus Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- ENT Department, West Suffolk Hospital, Bury St Edmunds, UK
| | - Chiara Marvisi
- Rheumatology Unit, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Sergey Moiseev
- Tareev Clinic of Internal Disease, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster/Kiel, Germany
| | - Chetan Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Thomas Neumann
- Department of Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Iacopo Olivotto
- Meyer Children Hospital and Careggi University Hospital, University of Florence, Florence, Italy
| | - Carlo Salvarani
- Unit of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
| | - Benjamin Seeliger
- Department of Respiratory Medicine and German Centre of Lung Research, Hannover Medical School, Hannover, Germany
| | - Renato A Sinico
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Renal Unit, ASST-Monza, Monza, Italy
| | - Camille Taillé
- Reference center for rare respiratory diseases, Bichat Hospital, AP-HP-Nord, University Paris Cité, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Nils Venhoff
- Clinic for Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Iraklio, Crete, Greece
- Laboratory of Autoimmunity-Inflammation, Institute of Molecular Biology and Biotechnology, Heraklion, Crete, Greece
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Internal Medicine, Cochin Hospital, AP-HP, University of Paris, Paris, France
| | - David R W Jayne
- University of Cambridge, Box 118, Addenbrooke's Hospital, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
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8
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Wechsler ME, Hellmich B, Cid MC, Jayne D, Tian X, Baylis L, Roufosse F. Unmet needs and evidence gaps in hypereosinophilic syndrome and eosinophilic granulomatosis with polyangiitis. J Allergy Clin Immunol 2023:S0091-6749(23)00334-2. [PMID: 37086239 DOI: 10.1016/j.jaci.2023.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/17/2023] [Accepted: 03/16/2023] [Indexed: 04/23/2023]
Abstract
Hypereosinophilic syndrome (HES) and eosinophilic granulomatosis with polyangiitis (EGPA) are rare systemic inflammatory disorders with overlapping symptoms, elevated eosinophil counts, and heterogenous clinical presentations. Although progress has been made in recent years, there are substantial gaps in our understanding of the pathologic mechanisms involved in these diseases, as well as numerous unmet needs relating to both diagnosis and patient management. For example, in most cases of HES, the underlying cause of hypereosinophilia is unknown, while in EGPA, although a polygenic genetic susceptibility has been found, understanding of the pathogenic mechanisms remains largely elusive. Delineating differences between certain disease variants may be challenging, and there are no reliable predictive markers of disease course. In addition, the current diagnostic criteria for HES and classification criteria for EGPA are not easy to implement in a nonspecialist setting, and specialist referral pathways need to be signposted more clearly. Furthermore, disease-specific activity scores need to be developed to aid the assessment of treatment effects, and improved biomarkers are needed to aid with treatment stratification. In this review, we outline the limitations of our current understanding of HES and EGPA and highlight areas for future work, which ultimately should help improve patient management and outcomes.
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Affiliation(s)
| | - Bernhard Hellmich
- Department of Medicine, Medius Kliniken, Academic Teaching Hospital, University of Tübingen, Kirchheim-Teck, Germany
| | - Maria C Cid
- Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Xinping Tian
- Peking Union Medical College Hospital, Beijing, China
| | | | - Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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9
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Xu W, Ma R, Wang J, Sun D, Yu S, Ye Q. Pneumoconiosis combined with connective tissue disease in China: a cross-sectional study. BMJ Open 2023; 13:e068628. [PMID: 37012009 PMCID: PMC10083820 DOI: 10.1136/bmjopen-2022-068628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To describe the prevalence, clinical features and potential risk factors of pneumoconiosis in combination with connective tissue disease (CTD) or positive autoantibodies. DESIGN Cross-sectional study. SETTING A retrospective study of adults recruited in China between December 2016 and November 2021. PARTICIPANTS A total of 931 patients with pneumoconiosis at Beijing Chao-Yang Hospital were enrolled in this study; of these, 580 patients were included in the final analysis. MAIN OUTCOME MEASURES Pneumoconiosis combined with CTD or positive autoantibodies was a major adverse outcome. RESULTS In total, 13.8% (80/580) of the patients had combined pneumoconiosis with CTD, among whom the prevalence of CTD was 18.3% (46/251) in asbestosis and 11.4% (34/298) in silicosis/coal mine workers' pneumoconiosis. In comparison to the general Chinese adult population, the relative risk of various CTD in pneumoconiosis, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, primary Sjögren's syndrome, idiopathic inflammatory myopathy and antineutrophil cytoplasmic antibodies-associated vasculitis, were 11.85, 12.12, 127.40, 4.23, 9.94 and 644.66, respectively. Multivariate analysis revealed that female sex (OR 2.55, 95% CI 1.56 to 4.17) and a later stage of pneumoconiosis (OR 2.04, 95% CI 1.24 to 3.34) were the independent risk factors for CTD in patients with pneumoconiosis (all p<0.050). CONCLUSION CTD is highly prevalent in patients with pneumoconiosis, especially in patients of asbestosis, and silicosis/coal mine workers' pneumoconiosis. Female sex and later stages of pneumoconiosis are associated with an increased risk of combined with CTD.
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Affiliation(s)
- Wenjing Xu
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Pulmonary and Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Ruimin Ma
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingwei Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shiwen Yu
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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10
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Caminati M, Maule M, Bello F, Emmi G. Biologics for eosinophilic granulomatosis with polyangiitis. Curr Opin Allergy Clin Immunol 2023; 23:36-43. [PMID: 36413432 DOI: 10.1097/aci.0000000000000875] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW The link between severe asthma and eosinophilic granulomatosis with polyangiitis (EGPA) in terms of pathophysiological background, clinical manifestations and disease evolution has leaded to investigate the relevance of anti T2 monoclonal antibodies licensed for severe asthma patients as a treatment option for EGPA. The present review aimed to provide un update on EGPA pathophysiology and to critically summarize the most robust evidence coming from trials and real-life setting on the use of anti T2 biologics in EGPA patients. RECENT FINDINGS Mepolizumab, an anti-interleukin-5 monoclonal antibody, is the only biologic drug targeting eosinophilic inflammation currently approved for EGPA treatment at the dose of 300 mg/4 weeks. Its use is restricted by the American College of Rheumatology guidelines to specific diseases phases and severity grades. However the most appropriate mepolizumab positioning and dose is still under investigation in the real life practice, which is providing an increasing amount of evidence confirming its efficacy, alone or in combination with other options in different disease stages. The relevance of other monoclonal antibodies interfering with T2 inflammation, including omalizumab and benralizumab, is under investigation but the evidence is still scarce. SUMMARY Taking into account the suboptimal medium-long term safety profile of conventional EGPA treatments, the opportunity of selectively targeting eosinophilic inflammation certainly represents a revolutionary approach. However, further real-word evidence is required to effectively position the new treatments in the light of the disease complexity, including different immunological drivers, and individual variability.
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Affiliation(s)
- Marco Caminati
- Allergy, Asthma, Clinical Immunology, Department of Medicine, University of Verona, Verona
| | - Matteo Maule
- Allergy, Asthma, Clinical Immunology, Department of Medicine, University of Verona, Verona
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Giacomo Emmi
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
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11
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Katz G, Wallace ZS. Environmental Triggers for Vasculitis. Rheum Dis Clin North Am 2022; 48:875-890. [PMID: 36333001 DOI: 10.1016/j.rdc.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides are autoimmune diseases characterized by vascular inflammation. Most types of vasculitis are thought to result from antigen exposure in genetically susceptible individuals, suggesting a likely role for environmental triggers in these conditions. Seasonal and geographic variations in incidence provide insight into the potential role of environmental exposures in these diseases. Many data support infectious triggers in some vasculitides, whereas other studies have identified noninfectious triggers, such as airborne pollutants, silica, smoking, and heavy metals. We review the known and suspected environmental triggers in giant cell arteritis, Takayasu arteritis, polyarteritis nodosa, Kawasaki disease, and antineutrophil cytoplasmic antibody-associated vasculitis.
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Affiliation(s)
- Guy Katz
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Bulfinch 165, 55 Fruit Street, Boston, MA 02114, USA
| | - Zachary S Wallace
- Clinical Epidemiology Program, Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, 100 Cambridge Street, Boston, MA 02114, USA.
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12
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Trivioli G, Marquez A, Martorana D, Tesi M, Kronbichler A, Lyons PA, Vaglio A. Genetics of ANCA-associated vasculitis: role in pathogenesis, classification and management. Nat Rev Rheumatol 2022; 18:559-574. [PMID: 36109667 DOI: 10.1038/s41584-022-00819-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 12/15/2022]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), that share features of pauci-immune small-vessel vasculitis and the positivity of ANCA targeting proteinase-3 (PR3-ANCA) or myeloperoxidase (MPO-ANCA). AAV syndromes are rare, complex diseases and their aetio-pathogenesis is mainly driven by the interaction between environmental and genetic factors. In patients with GPA and MPA, the genetic associations are stronger with ANCA specificity (PR3- versus MPO-ANCA) than with the clinical diagnosis, which, in keeping with the known clinical and prognostic differences between PR3-ANCA-positive and MPO-ANCA-positive patients, supports an ANCA-based re-classification of these disorders. EGPA is also made up of genetically distinct subsets, which can be stratified on ANCA-status (MPO ANCA-positive versus ANCA-negative); these subsets differ in clinical phenotype and possibly in their response to treatment. Interestingly, MPO-ANCA-positive patients with either MPA or EGPA have overlapping genetic determinants, thus strengthening the concept that this EGPA subset is closely related to the other AAV syndromes. The genetics of AAV provides us with essential information to understand its varied phenotype. This Review discusses the main findings of genetic association studies in AAV, their pathogenic implications and their potential effect on classification, management and prognosis.
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Affiliation(s)
- Giorgio Trivioli
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Ana Marquez
- Institute of Parasitology and Biomedicine "López-Neyra", CSIC, Granada, Spain
| | - Davide Martorana
- Medical Genetics Unit, Department of Diagnostics, University Hospital of Parma, Parma, Italy
- CoreLab Unit, Research Center, University Hospital of Parma, Parma, Italy
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Andreas Kronbichler
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Vasculitis and Lupus Service, Department of Renal Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paul A Lyons
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge, UK
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Jeffrey Cheah Biomedical Centre, University of Cambridge, Cambridge, UK
| | - Augusto Vaglio
- Department of Biomedical Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy.
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.
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13
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Zhao WM, Wang ZJ, Shi R, Zhu YY, Zhang S, Wang RF, Wang DG. Environmental factors influencing the risk of ANCA-associated vasculitis. Front Immunol 2022; 13:991256. [PMID: 36119110 PMCID: PMC9479327 DOI: 10.3389/fimmu.2022.991256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of diseases characterized by inflammation and destruction of small and medium-sized blood vessels. Clinical disease phenotypes include microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), and eosinophilic granulomatosis with polyangiitis (EGPA). The incidence of AAV has been on the rise in recent years with advances in ANCA testing. The etiology and pathogenesis of AAV are multifactorial and influenced by both genetic and environmental factors, as well as innate and adaptive immune system responses. Multiple case reports have shown that sustained exposure to silica in an occupational environment resulted in a significantly increased risk of ANCA positivity. A meta-analysis involving six case-control studies showed that silica exposure was positively associated with AAV incidence. Additionally, exposure to air pollutants, such as carbon monoxide (CO), is a risk factor for AAV. AAV has seasonal trends. Studies have shown that various environmental factors stimulate the body to activate neutrophils and expose their own antigens, resulting in the release of proteases and neutrophil extracellular traps, which damage vascular endothelial cells. Additionally, the activation of complement replacement pathways may exacerbate vascular inflammation. However, the role of environmental factors in the etiology of AAV remains unclear and has received little attention. In this review, we summarized the recent literature on the study of environmental factors, such as seasons, air pollution, latitude, silica, and microbial infection, in AAV with the aim of exploring the relationship between environmental factors and AAV and possible mechanisms of action to provide a scientific basis for the prevention and treatment of AAV.
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14
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Niccolai E, Bettiol A, Baldi S, Silvestri E, Di Gloria L, Bello F, Nannini G, Ricci F, Nicastro M, Ramazzotti M, Vaglio A, Bartolucci G, Emmi G, Amedei A, Prisco D. Gut Microbiota and Associated Mucosal Immune Response in Eosinophilic Granulomatosis with Polyangiitis (EGPA). Biomedicines 2022; 10:biomedicines10061227. [PMID: 35740247 PMCID: PMC9219964 DOI: 10.3390/biomedicines10061227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is an anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. A genome-wide association study showed a correlation between ANCA-negative EGPA and variants of genes encoding proteins with intestinal barrier functions, suggesting that modifications of the mucosal layer and consequent gut dysbiosis might be involved in EGPA pathogenesis. Here, we characterized the gut microbiota (GM) composition and the intestinal immune response in a cohort of EGPA patients. Faeces from 29 patients and 9 unrelated healthy cohabitants were collected, and GM and derived metabolites’ composition were compared. Seven intestinal biopsies from EGPA patients with gastrointestinal manifestations were analysed to assess the T-cell distribution and its correlation with GM and EGPA clinical and laboratory features. No significant differences in GM composition, nor in the total amount of faecal metabolites, emerged between patients and controls. Nevertheless, differences in bacterial taxa abundances and compositional GM-derived metabolites profile were observed. Notably, an enrichment of potential pathobionts (Enterobacteriacee and Streptococcaceae) was found in EGPA, particularly in patients with active disease, while lower levels were found in patients on immunosuppression, compared with non-immunosuppressed ones. Significantly lower amounts of hexanoic acid were found in patients, compared to controls. The analysis of the immune response in the gut mucosa revealed a high frequency of IFN-γ/IL-17-producing T lymphocytes, and a positive correlation between EGPA disease activity and intestinal T-cell levels. Our data suggest that an enrichment in potential intestinal pathobionts might drive an imbalanced inflammatory response in EGPA.
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Affiliation(s)
- Elena Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Simone Baldi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Leandro Di Gloria
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Giulia Nannini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
| | - Federica Ricci
- Core Research Laboratory, Institute for Cancer Research and Prevention (ISPRO), 50139 Florence, Italy;
| | - Maria Nicastro
- Department of Medicine and Surgery, University of Parma and Unit of Occupational Medicine and Industrial Toxicology, University Hospital of Parma, 43121 Parma, Italy;
| | - Matteo Ramazzotti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio” University of Florence, 50134 Florence, Italy; (L.D.G.); (M.R.); (A.V.)
- Nephrology Unit, Meyer Children’s Hospital, 50139 Florence, Italy
| | - Gianluca Bartolucci
- Department of Neurosciences, Psychology, Drug Research and Child Health Section of Pharmaceutical and Nutraceutical Sciences, University of Florence, 50139 Florence, Italy;
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: (G.E.); (A.A.); Tel.: +39-05-5275-8020 (G.E.); +39-05-5275-8330 (A.A.)
| | - Amedeo Amedei
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
- Correspondence: (G.E.); (A.A.); Tel.: +39-05-5275-8020 (G.E.); +39-05-5275-8330 (A.A.)
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (E.N.); (A.B.); (S.B.); (E.S.); (F.B.); (G.N.); (D.P.)
- Internal Interdisciplinary Medicine Unit, Careggi University Hospital, 50134 Florence, Italy
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