1
|
Zheng SY, Du X, Dong JZ. Re-evaluating serum angiotensin-converting enzyme in sarcoidosis. Front Immunol 2023; 14:950095. [PMID: 37868968 PMCID: PMC10586325 DOI: 10.3389/fimmu.2023.950095] [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: 05/22/2022] [Accepted: 08/25/2023] [Indexed: 10/24/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology, which mainly affects the lungs and lymph nodes, as well as extrapulmonary organs. Its incidence, and prevalence rate, and disease course largely vary with regions and populations globally. The clinical manifestations of sarcoidosis depend on the affected organs and the degree of severity, and the diagnosis is mainly based on serum biomarkers, radiographic, magnetic resonance, or positron emission tomography imaging, and pathological biopsy. Noncaseating granulomas composing T cells, macrophages, epithelioid cells, and giant cells, were observed in a pathological biopsy, which was the characteristic pathological manifestation of sarcoidosis. Angiotensin-converting enzyme (ACE) was first found in the renin-angiotensin-aldosterone system. Its main function is to convert angiotensin I (Ang I) into Ang II, which plays an important role in regulating blood pressure. Also, an ACE insertion/deletion polymorphism exists in the human genome, which is involved in the occurrence and development of many diseases, including hypertension, heart failure, and sarcoidosis. The serum ACE level, most commonly used as a biomarker in diagnosing sarcoidosis, in patients with sarcoidosis increases. because of epithelioid cells and giant cells of sarcoid granuloma expressing ACE. Thus, it serves as the most commonly used biomarker in the diagnosis of sarcoidosis and also aids in analyzing its therapeutic effect and prognosis in patients with sarcoidosis.
Collapse
Affiliation(s)
- Shi-yue Zheng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
2
|
Abstract
Renal sarcoidosis (RS) is a rare form of sarcoidosis that results in granulomatous inflammation of renal parenchyma. We describe the epidemiology, pathogenesis, clinical features, diagnostic approach, treatment strategies and outcomes of this condition. RS occurs most commonly at the time of initial presentation of sarcoidosis but can at any time along the course of the disease. The most common presenting clinical manifestations of RS are renal insufficiency or signs of general systemic inflammation. End-stage renal disease requiring dialysis is a rare initial presentation of RS. The diagnosis of RS should be considered in patients who present with renal failure and have either a known diagnosis of sarcoidosis or have extra-renal features consistent with sarcoidosis. A renal biopsy helps to establish the diagnosis of RS, with interstitial non-caseating granulomas confined primarily to the renal cortex being the hallmark pathological finding. However, these histologic findings are not specific for sarcoidosis, and alternative causes for granulomatous inflammation of the renal parenchyma should be excluded. Corticosteroids are the drug of choice for RS. Although RS usually responds well to corticosteroids, the disease may have a chronic course and require long-term immunosuppressive therapy. The risk of progression to ESRD is rare.
Collapse
|
3
|
In vivo evaluation of TNF-alpha in the lungs of patients affected by sarcoidosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:401341. [PMID: 25866780 PMCID: PMC4383433 DOI: 10.1155/2015/401341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/09/2014] [Accepted: 08/11/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystemic granulomatous disorder characterized by multiple noncaseating granulomas involving intrathoracic lymph nodes and lung parenchyma. Recently, the use of anti-tumor necrosis factor alpha (anti-TNFα) agents has been introduced for therapy of chronic and refractory sarcoidosis with controversial results. Infliximab (Remicade) is a chimeric monoclonal antibody (mAb) that recognizes and binds TNFα, neutralizing its biological effects. In the present study, (99m)Tc labelled infliximab was used to study the expression of TNFα in sarcoid lesions and to evaluate its role as a predictive marker in response to therapy with Remicade. MATERIAL AND METHODS A total of 10 patients with newly diagnosed sarcoidosis were enrolled together with 10 control patients affected by rheumatoid arthritis. All patients were studied by planar imaging of the chest with (99m)Tc-infliximab at 6 h and 24 h and total body [(18)F]-FDG PET/CT. Regions of interest were drawn over the lungs and the right arm and target-to-background ratios were analysed for (99m)Tc-infliximab. SUV mean and SUV max were calculated over lungs for FDG. RESULTS AND DISCUSSION Image analysis showed low correlation between T/B ratios and BAL results in patients despite positivity at [(18)F]-FDG PET. CONCLUSION In conclusion, patients with newly diagnosed pulmonary sarcoidosis, with FDG-PET and BAL positivity, showed a negative (99m)Tc-infliximab scintigraphy.
Collapse
|
4
|
Amy de la Breteque M, Saussine A, Rybojad M, Kramkimel N, Vignon Pennamen MD, Bagot M, Guibal F. Infliximab in recalcitrant granuloma annulare. Int J Dermatol 2014; 55:220-2. [DOI: 10.1111/ijd.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 06/04/2013] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Maud Amy de la Breteque
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Anne Saussine
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Michel Rybojad
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Nora Kramkimel
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Marie-Dominique Vignon Pennamen
- Department of Pathology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Martine Bagot
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| | - Fabien Guibal
- Department of Dermatology; Hôpital Saint Louis; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Diderot Saint Louis Hospital; University of Paris Diderot; Paris France
| |
Collapse
|
5
|
Hilderson I, Van Laecke S, Wauters A, Donck J. Treatment of renal sarcoidosis: is there a guideline? Overview of the different treatment options. Nephrol Dial Transplant 2013; 29:1841-7. [DOI: 10.1093/ndt/gft442] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
6
|
|
7
|
Lee JH, Lee JJ, Park KS, Park SH, Kim HY, Kwok SK. Simultaneous Presentation of Ocular Sarcoidosis and Early Axial Spondyloarthritis in a Young Woman. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.6.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jae Ho Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Jennifer Jooha Lee
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Kyung-Su Park
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Ho-Youn Kim
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| |
Collapse
|
8
|
Stehlé T, Boffa JJ, Lang P, Desvaux D, Sahali D, Audard V. [Kidney involvement in sarcoidosis]. Rev Med Interne 2012; 34:538-44. [PMID: 23154110 DOI: 10.1016/j.revmed.2012.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 09/26/2012] [Accepted: 10/08/2012] [Indexed: 12/20/2022]
Abstract
Sarcoidosis is a chronic multisystemic inflammatory disorder of unknown etiology, characterized by the presence of non-necrotizing epithelioid and giant cell granulomas. Various renal manifestations have been reported in patients with sarcoidosis. Disorders of bone and mineral metabolism related to the overexpression of 25-hydroxyvitamin-D1α-hydroxylase by alveolar and granuloma macrophages are frequently associated with sarcoidosis. Hypercalcemia and hypercalciuria are a major cause of renal injury predisposing to pre renal azotemia, acute tubular necrosis, nephrolithiasis and nephrocalcinosis. Therapeutic management of hypercalcemia includes preventive measures (limited sunlight exposure, limited vitamin D and calcium intakes, and adequate hydration) and specific treatment in cases of severe hypercalcemia (corticosteroid therapy, chloroquine or ketoconazole). Granulomatous tubulointerstitial nephritis is the most common renal lesion associated with sarcoidosis leading to end stage renal disease in some patients. In these cases, interstitial fibrosis seems to appear early in the course of sarcoidosis and is a major prognostic factor requiring rapid corticosteroid therapy to reduce the risk of severe renal impairment. Membranous nephropathy seems to be the most frequent glomerular disease that may occur in association with sarcoidosis. Among kidney allograft recipients, the risk of recurrence of granulomatous tubulointerstitial nephritis is high and may have a negative impact on the graft survival.
Collapse
Affiliation(s)
- T Stehlé
- Inserm U955, service de néphrologie et transplantation, université Paris Est, hôpital Henri-Mondor, institut francilien de recherche en néphrologie et transplantation (IFRNT), AP-HP, 94010 Créteil, France.
| | | | | | | | | | | |
Collapse
|
9
|
|
10
|
Abstract
Anti-TNF antibodies have acquired a prominent place in the management of IBD (including Crohn's disease and ulcerative colitis), rheumatologic conditions (such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis) and psoriasis. They have a good safety profile, especially when contraindications such as demyelinating disease, active infections and/or abscesses are ruled out, and when necessary precautions to prevent reactivation of tuberculosis are taken. However, with increasing use of these agents, paradoxical adverse events have been reported. Some of these features are shared with the underlying disease for which these drugs are given, making management of these conditions challenging. For example, anti-TNF therapy is used for the treatment of psoriasis, but psoriasiform lesions are sometimes observed in patients receiving therapy. Similarly, anti-TNF therapy is used for the treatment of rheumatologic diseases, but arthralgias and arthritis are sometimes observed in patients receiving anti-TNF agents. We review the paradoxical inflammation induced by anti-TNF agents in patients with IBD, provide hypotheses for the occurrence of this paradoxical inflammation and give practical advice on how to manage these patients.
Collapse
|
11
|
Dastoori M, Fedele S, Leao JC, Porter SR. Sarcoidosis - a clinically orientated review. J Oral Pathol Med 2012; 42:281-9. [DOI: 10.1111/j.1600-0714.2012.01198.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 01/15/2023]
Affiliation(s)
- Mahmoud Dastoori
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
| | - Stefano Fedele
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
| | | | - Stephen R. Porter
- Department of Maxillofacial Medicine and Surgery; Oral Medicine unit; UCL Eastman Dental Institute; London; UK
| |
Collapse
|