Enhancement of granulocyte chemotaxis in Behcet's disease

The neutrophil: A key resourceful agent in immune‐mediated vasculitis

The term "vasculitis" refers to a group of rare immune-mediated diseases characterized by the dysregulated immune system attacking blood vessels located in any organ of the body, including the skin, lungs, and kidneys. Vasculitides are classified according to the size of the vessel that is affected. Although this observation is not specific to small-, medium-, or large-vessel vasculitides, patients show a high circulating neutrophil-to-lymphocyte ratio, suggesting the direct or indirect involvement of neutrophils in these diseases. As first responders to infection or inflammation, neutrophils release cytotoxic mediators, including reactive oxygen species, proteases, and neutrophil extracellular traps. If not controlled, this dangerous arsenal can injure the vascular system, which acts as the main transport route for neutrophils, thereby amplifying the initial inflammatory stimulus and the recruitment of immune cells. This review highlights the ability of neutrophils to "set the tone" for immune cells and other cells in the vessel wall. Considering both their long-established and newly described roles, we extend their functions far beyond their direct host-damaging potential. We also review the roles of neutrophils in various types of primary vasculitis, including immune complex vasculitis, anti-neutrophil cytoplasmic antibody-associated vasculitis, polyarteritis nodosa, Kawasaki disease, giant cell arteritis, Takayasu arteritis, and Behçet's disease.

Incontinentia pigmenti and bipolar aphthosis: an unusual combination

Incontinentia pigmenti (IP) is an uncommon X-linked dominant multisystem disorder, lethal in the majority of affected males in utero and variably expressed in females. The cutaneous manifestations are diagnostic and classically occur in four stages: vesicular, verrucous, hyperpigmented, and atrophic. The skin lesions are typically spread along the lines of Blaschko, and they are usually present at birth. It may be variably accompanied by dental, ocular, neurologic, bones and joints, and development anomalies. The genes IP has been mapped to Xq28. Mutations in the NEMO/IKKγ gene, located at Xq28, have been found to cause expression of the disease. Behçets disease is a multisystem disorder consisting of recurrent oral aphtae, genital ulcers, pustular skin eruption, and uveitis. Occasionally there are other articular, neurological, intestinal, or vascular abnormalities. This disease is rare in children. Here, we report a case of a 16-year-old female with the rare combination of incontinentia pigmenti and an aphthosis bipolar, and we discuss the probably relationship between these two diseases.

Coexistence of familial Mediterranean fever with sacroiliitis and Behçet's disease: a rare occurrence

Familial Mediterranean fever (FMF) and Behçet's disease are relatively rare but may still coexist in the same patient. Sacroiliitis is another feature whose significance is controversial in either of the diseases. We report a case of longstanding FMF with sacroiliitis who later developed typical characteristics of Behçet's disease. Although occurrence by chance cannot be ruled out, this unusual patient may enhance the claims that FMF and Behçet's disease have common aetiopathogenetic mechanisms. It would be appropriate to include this coexistence in the list of differential diagnoses of the two diseases.

Serum of Behçet's disease enhances superoxide production of normal neutrophils

Using an MCLA-dependent chemiluminescence technique, we evaluated superoxide production by neutrophils isolated from 7 patients with Behçet's disease. After stimulation by phorbol myristate acetate, N-formyl-methionyl-leucyl-phenylalanine or opsonized zymosan, neutrophils from the patients produced significantly more superoxide than those from 20 controls. Pretreatment of control neutrophils with serum prominently enhanced superoxide production, and serum from Behçet's disease patients had a significantly greater effect than that from controls. These findings suggest that serum from patients with Behçet disease contains the priming factor(s) that can enhance enhanced superoxide production by neutrophils in response to stimulation.

Sweet's syndrome (acute febrile neutrophilic dermatosis)

Acute febrile neutrophilic dermatosis, first described in 1964 by Robert Douglas Sweet, has been termed Sweet's syndrome. Classic Sweet's syndrome occurs in middle-aged women after a nonspecific infection of the respiratory or gastrointestinal tract. Raised erythematous plaques with pseudoblistering and occasionally pustules occur on the face, neck, chest, and extremities, accompanied by fever and general malaise. Involvement of the eyes, joints, and oral mucosa as well as internal manifestations of Sweet's syndrome in the lung, liver, kidneys, and central nervous system has been described. The disease is thought to be a hypersensitivity reaction. Parainflammatory (e.g., infections, autoimmune disorders, vaccination) and paraneoplastic (e.g., hemoproliferative disorders, solid malignant tumors) occurrence is found in approximately 25% of the cases and 2% are associated with pregnancy. Sweet's syndrome responds rapidly to systemic therapy with corticosteroids but recurs in about 25% of the cases. Alternative treatment modalities (e.g., potassium iodide, colchicine, dapsone, clofazimine, cyclosporine) have also been used. This article presents data from 38 patients with Sweet's syndrome and reviews its epidemiology, clinical spectrum, histologic features, laboratory results, differential diagnosis, pathogenic mechanisms, associated diseases, and treatment.

Neutrophilic vascular reactions

Dermatologic diseases are classified most commonly by morphology, by pathogenesis, or by etiology. Nontraditional classifications may be useful in terms of providing a reassessment of traditional views about disease interrelationships. This review of dermatoses characterized by neutrophilic infiltrates and dermal vessel changes reveals evidence suggesting that these dermatoses result from immune complex-mediated, neutrophil-induced dermal vessel damage. Therapeutic approaches to these heretofore unlinked dermatoses are remarkably similar.

Complex aphthosis: a forme fruste of Behçet's syndrome?

The evaluation of the rare patient who presents with oral and genital aphthae or almost constant, multiple (greater than 3) oral aphthae, but no systemic signs or symptoms (i.e., complex aphthosis), is difficult because no laboratory test is available to exclude Behçet's syndrome. Six patients with complex aphthosis were evaluated. In addition, patients with simple aphthosis, those with seronegative arthritis, and normal controls were assessed for circulating immune complexes (CIC) by in vitro and in vivo assays and for neutrophil migration by subagarose methods, since these tests have given significant results in patients with Behçet's syndrome. Patient 1, with complex aphthosis, had Raji cell evidence for CIC (51.2 mg aggregated human gamma globulin Eq/ml), C1q, and C3 in dermal blood vessels 4 hours post intradermal histamine injection and had a Sweet's syndrome-like vasculitis 24 hours post histamine injection. In addition, her serum enhanced the migration of patient neutrophils (3.6 +/- 0.6 to 4.6 +/- 0.5; N = 6, p less than or equal to 0.01). All other test and control patients had negative or normal CIC and neutrophil migration determinations. Sixteen-month clinical follow-up has confirmed that Patient 1, but not Patients 2 to 6, has developed overt manifestations of Behçet's syndrome.

Mouth and genital ulcers with inflamed cartilage: MAGIC syndrome. Five patients with features of relapsing polychondritis and Behçet's disease

Five patients with features of coexistent relapsing polychondritis and Behçet's disease are described. Review of the literature supports the overlap of the clinical manifestations of these two conditions. A common immunologic abnormality is likely, and elastin is cited as a possible target antigen. The "mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome" is the proposed name for this entity.

Behçet's syndrome: immune regulation, circulating immune complexes, neutrophil migration, and colchicine therapy

Immune regulatory dysfunction, circulating immune complexes (CIC), and polymorphonuclear (PMN) cell migration were investigated in patients with Behçet's syndrome. Six patients meeting rigorous clinical criteria were evaluated. Only one patient showed evidence of immune regulatory dysfunction (increased T4/T8 ratio). Although C1q binding and Raji cell assays for CIC yielded positive results in only one of five patients, all five patients had in vivo "histamine trap test" evidence of CIC (all controls had normal results). Sera from all Behçet's syndrome patients increased migration of neutrophils to zymosan-activated serum. Colchicine therapy abolished the enhancing effect of the patient's sera on movement of PMN cells from patients and controls. An immune complex-mediated injury that is followed by an excessive accumulation of PMN cells may lead to the cutaneous lesions and other lesions in Behçet's syndrome. Further evaluation of colchicine therapy is warranted on the basis of these studies.

Abnormal polymorphonuclear leukocyte motility in dermatologic diseases

A variety of skin diseases have been reported to have associated abnormalities in PMN chemotactic motility; however, the relationship of abnormal leukocyte motility to the pathogenesis of these diseases is poorly understood. A common feature in skin diseases associated with depressed chemotaxis has been the frequency of recurrent pyogenic infections. Since the chemotaxins and methodologies for evaluating leukocyte chemotaxis differ among laboratories, little is known about the specificity of these chemotactic defects. Further information regarding PMN motility defects may be obtained from detailed studies of migration to various doses of chemotaxins. The commercial availability of potent, structurally defined chemotaxins, such a N-formylated peptides, provides laboratories the opportunity to evaluate migration to "common" chemotaxins. In addition, the development of the multiple microwell chemotaxis chamber has made possible the opportunity to collect substantial leukocyte motility data from relatively small blood samples. Further investigations of leukocyte motility in various dermatologic diseases are clearly needed. A more systematic approach, i.e. (1) use of several different chemotaxins at various doses in chemotaxis assays and (2) use of standard, structurally defined chemotaxins, would facilitate comparative analyses of clinical studies among laboratories. It is likely that this approach would provide more specific information about the relevance of leukocyte motility defects in these diseases.

Lytic effect of cytotoxic lymphocytes on oral epithelial cells in Behçet's disease

The effect of blood lymphocytes on syngeneic oral epithelial cells was studied in twelve patients with Behçet's disease (BD) and twenty-one patients with recurrent aphthous ulcers (RAU). The control group consisted of twenty-five patients with non-aphthous skin disease and eight healthy individuals. Primary cell lines obtained from oral mucosa by suction blistering and subsequent enzymatic dissociation were used as target cells. Using a modified 51chromium release macro-assay, a significant lytic effect due to antibody-independent lymphocytotoxicity could be demonstrated in patients with BD, but no significant lysis of target cells was found in the RAU patients compared with the control group. These results provide further evidence that antibody-independent lymphocytotoxicity may play an important role in oral ulceration in BD.