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Cheng L, Zhan H, Liu Y, Chen H, Zhang F, Zheng W, Li Y. Infectious agents and pathogenesis of Behçet's disease: An extensive review. Clin Immunol 2023; 251:109631. [PMID: 37127189 DOI: 10.1016/j.clim.2023.109631] [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: 02/27/2023] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Abstract
Behçet's disease (BD) is a multisystemic chronic vasculitis. Sustained and enhanced immune responses were reportedly associated with active BD. Although genetic polymorphisms increase development risk, genetic factors alone cannot account for BD development, suggesting the involvement of exogenous factors. Also, how various infectious agents promote BD in high-risk populations is not fully understood. In this review, we summarized the current findings on the associations of infectious agents with BD pathogenesis. The review also highlights the potential microbial risk factors and their pathogenic role in BD progression. Interactions between genetic and infectious risk factors was also discussed. Furthermore, evidence implied that after the eradication of infectious agents, BD symptoms and recurrence decreased, thus highlighting that combined use of antibiotics may be an effective therapy for BD. Finally, we summarized the main limitation of the current related studies, providing valuable insights and a basis for future studies on BD pathogenic factors.
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Affiliation(s)
- Linlin Cheng
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haoting Zhan
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongmei Liu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hua Chen
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Yongzhe Li
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Sciascia S, Arbrile M, Trunfio M, Calcagno A, Radin M, Roccatello D, Lembo D, Civra A. The role of bacteria and viruses in Behçet syndrome: Should we move towards new paradigms? Autoimmun Rev 2023; 22:103237. [PMID: 36414220 DOI: 10.1016/j.autrev.2022.103237] [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: 10/22/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
The etiological complexity of Behçet syndrome (BS), an immune-mediated rare form of vasculitis characterized by multi-organ involvement, is still elusive due to an incomplete understanding of the synergy between genetic susceptibility, environmental triggers, and an abnormal immune response. Long-standing theories regarding the origins of BS include the involvement of infectious organisms supporting an aberrant immunological response through different mechanisms, including molecular mimicry. Additionally, it has been demonstrated that the BS phenotypes are linked to oral and gut microbiome dysbiosis, which is a dynamic reservoir of millions of microbes containing proteins and metabolites that can mimic the autoantigens. Infections, including viral pathogens, could potentially trigger the inflammation and symptoms of BS. In this review, we aim to describe the available evidence on the cross-talk between BS and infections in order to discuss potential clinical implications and possible therapeutic targets.
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Affiliation(s)
- Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy.
| | - Marta Arbrile
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - Mattia Trunfio
- Unit of Infectious diseases, Department of medical sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious diseases, Department of medical sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Massimo Radin
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - David Lembo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Andrea Civra
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Mumcu G, Fortune F. Oral Health and Its Aetiological Role in Behçet's Disease. Front Med (Lausanne) 2021; 8:613419. [PMID: 34095159 PMCID: PMC8172597 DOI: 10.3389/fmed.2021.613419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
Behçet's disease (BD) is a chronic multi-systemic inflammatory disorder characterised by oro-genital ulcers, cutaneous manifestations, ocular, vascular, neurologic and gastrointestinal involvement. Complex interactions operating on the genetic background e.g.(HLA51), of infectious and other environmental agents, together with immune dysregulation impacts on the pathogenesis of BD. This suggests that the environmental factors triggering immune responses may activate clinical manifestations in genetically susceptible individuals. Since oral health forms the basis of all general health both dental and systemic, it is an important component of both Dentistry and Medicine. Oral ulcers are the most common clinical manifestation of oral mucosal health. Changes in the oral environment consequently acts as an infective and immune trigger. In this review, complex interactions between the oral ulcers, the oral microbiome and immune responses together with the course of oral and systemic disease manifestations in BD are discussed in the context of the aetiologic role of oral health.
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Affiliation(s)
- Gonca Mumcu
- Department of Health Management, Faculty of Health Science, Marmara University, Istanbul, Turkey
| | - Farida Fortune
- Centre for Immuno-Biology and Regenerative Medicine, Behçet's Centre of Excellence, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Iwata D, Namba K, Yamamoto T, Mizuuchi K, Saito W, Ohno S, Kitaichi N, Ishida S. Recent Clinical Features of Intraocular Inflammation in Hokkaido, Japan - Comparison with the Previous Decade. Ocul Immunol Inflamm 2021; 30:848-854. [PMID: 33571416 DOI: 10.1080/09273948.2020.1836565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to investigate the clinical features of intraocular inflammation (uveitis) in Hokkaido and to assess the etiology trends in comparison with those of our previous survey. METHODS We retrospectively reviewed the medical records of 1,616 new referral uveitis patients (1,020 females and 596 males) in Hokkaido University Hospital between 2004 and 2014. RESULTS Sarcoidosis was the most frequent etiology (17.4%), followed by Vogt-Koyanagi-Harada disease (8.1%), Behçet's disease (4.5%), and human leukocyte antigen B27 -associated uveitis (2.5%). The etiologies in 48.7% of the patients were unclassified. Compared to the previous survey between 1994 and 2003, the rate of Behçet's disease decreased and that of sarcoidosis increased. The rates of infectious uveitis and vitreoretinal lymphoma increased. CONCLUSION Although the order of the top four etiologies was the same in the two surveys, the rate of sarcoidosis increased and that of Behçet's disease decreased.
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Affiliation(s)
- Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taku Yamamoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Limtong P, Chanprapaph K, Vachiramon V, Ngamjanyaporn P. Cutaneous and Extracutaneous Manifestations of Behçet's Disease Linked to Its Disease Activity and Prognosis. Clin Cosmet Investig Dermatol 2020; 13:639-647. [PMID: 32904702 PMCID: PMC7457676 DOI: 10.2147/ccid.s265169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/26/2020] [Indexed: 11/23/2022]
Abstract
Background Behçet’s disease is a potentially fatal vasculitis disorder involving vessels in both the arterial and venous systems. Cutaneous manifestation is the most common sign in Behçet’s disease, but its relation to disease activity and prognosis is lacking. Objective Our study aims to determine the relationship between cutaneous, extracutaneous manifestations with Behçet’s disease activity, morbidity, and mortality. Materials and Methods Patients diagnosed with Behçet’s disease were identified by using the 1990 International Study Group for Behçet’s disease criteria and/or the 2014 international criteria for Behçet’s disease. Data regarding patients’ clinical manifestations, laboratory results, disease activity, and prognosis were retrieved and analyzed. Disease activity was evaluated using the 2006 Behçet’s disease current activity form (BDCAF). Results Of 119 patients, the mean age at diagnosis was 35.7 ± 10.7 years and 60% were female. Median disease duration was 96 months (IQR 48–168). Minor oral ulcer at the buccal mucosa was associated with lower median BDCAF score (p = 0.003), whereas minor oral ulcer at the tonsil was related to higher BDCAF score (p = 0.024). Male gender was associated with higher cumulative dose of corticosteroids (p = 0.003) and hospitalization (OR = 2.89 (95% CI [1.10, 7.57]), p = 0.031). Ocular manifestations were related to higher dose of corticosteroids (p = 0.002) and morbidity (OR = 4.39 (95% CI [1.57, 12.29]), p = 0.005). Conclusion Our study suggests that different locations of minor oral ulcers help predict disease activity. Male gender and the presence of ocular manifestations resulted in less favorable outcomes for Behçet’s disease.
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Affiliation(s)
- Preeyachat Limtong
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kumutnart Chanprapaph
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Vasanop Vachiramon
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pintip Ngamjanyaporn
- Division of Allergy Immunology and Rheumatology, Department of Internal Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Behçet’s disease (BD) is a multi-system inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis, and erythema nodosum. Behçet’s disease runs a chronic course, with unpredictable exacerbations and remissions whose frequency and severity may diminish with time. Behçet’s disease typically arises in young adults, although childhood-onset BD has also been reported. The disease can affect both genders and has a worldwide distribution, although it is more prevalent in countries of the ancient Silk Route. The cause of BD remains unknown, although an autoimmune reaction triggered by an infectious agent in a genetically predisposed individual has been suggested. The treatment of BD is symptomatic and empirical, but generally specific to the clinical features of each patient. The majority of affected individuals do not have life-threatening disease, although mortality can be associated with vascular-thrombotic and neurological disease.
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Affiliation(s)
- L M Al-Otaibi
- Oral Medicine, Division of Maxillofacial Diagnostic, Medical & Surgical Sciences, Eastman Dental Institute for Oral Health Care Sciences, UCL, University of London, 256 Gray's Inn Road, London WC1X 8LD, UK
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Kirino Y, Ideguchi H, Takeno M, Suda A, Higashitani K, Kunishita Y, Takase-Minegishi K, Tamura M, Watanabe T, Asami Y, Uehara T, Yoshimi R, Yamazaki T, Sekiguchi A, Ihata A, Ohno S, Ueda A, Igarashi T, Nagaoka S, Ishigatsubo Y, Nakajima H. Continuous evolution of clinical phenotype in 578 Japanese patients with Behçet's disease: a retrospective observational study. Arthritis Res Ther 2016; 18:217. [PMID: 27716399 PMCID: PMC5048408 DOI: 10.1186/s13075-016-1115-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/08/2016] [Indexed: 12/22/2022] Open
Abstract
Background It has been suggested that the phenotypes of Behçet’s disease (BD) in Japan are changing. To ask whether the evolution of BD holds true in recent-onset cases in Japan, we performed a retrospective study. Methods We reviewed the records of 578 patients with BD who met the 1987 revised diagnostic criteria of the Behçet’s disease research committee of Japan. The patients were divided into three groups based on the date of disease onset. We compared the demography, clinical features, and treatments among them with or without adjustment for the observation period. Patients having oral ulcers, genital ulcers, regional skin involvement, and uveitis are categorized as having complete-type BD, and the associated factors were determined by univariate and multivariate logistic regression analyses. Results Male patients had a higher propensity for uveitis and central nervous system (CNS) involvement, whereas female patients had higher rates of genital ulcers and arthritis. We found a significant trend in reduction of complete-type, genital ulcer, HLA-B51 carriers, and increment of gastrointestinal BD over time. Multiple regression analysis identified HLA-B51 positivity, earlier date of disease onset, and younger age of onset as independently associated with complete-type BD. Although treatments had been also chronologically changed, the causative relationship between therapeutic agents and phenotypical changes was not determined from the study. Conclusion The present study revealed that phenotypical evolution was characterized by decreased incidence of the complete type and increment of gastrointestinal involvement in Japanese patients with BD during the last 30 years. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1115-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan. .,Y-CURD study group, Yokohama, Japan.
| | - Haruko Ideguchi
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.,Y-CURD study group, Yokohama, Japan
| | - Akiko Suda
- Yokosuka Center for Rheumatic Diseases, Yokosuka City Hospital, Yokosuka, Japan.,Y-CURD study group, Yokohama, Japan
| | - Kana Higashitani
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
| | - Yosuke Kunishita
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Kaoru Takase-Minegishi
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Maasa Tamura
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Toshiyuki Watanabe
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Yukiko Asami
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Takeaki Uehara
- Department of Rheumatology, Chigasaki City Hospital, Chigasaki, Japan.,Y-CURD study group, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Tetsu Yamazaki
- Department of Rheumatology, Yamato City Hospital, Yamato, Japan.,Y-CURD study group, Yokohama, Japan
| | - Akiko Sekiguchi
- Department of Hematology and Rheumatology, Fujisawa City Hospital, Fujisawa, Japan.,Y-CURD study group, Yokohama, Japan
| | - Atsushi Ihata
- Department of Rheumatology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | - Atsuhisa Ueda
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan.,Y-CURD study group, Yokohama, Japan
| | - Toshihisa Igarashi
- Department of Rheumatology, Yamato City Hospital, Yamato, Japan.,Y-CURD study group, Yokohama, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, Yokohama, Japan.,Y-CURD study group, Yokohama, Japan
| | | | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan
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HnRNP A1 is Involved in Deep Vein Thrombosis Patients with Behçet's Disease. EBioMedicine 2016; 6:215-221. [PMID: 27211563 PMCID: PMC4856785 DOI: 10.1016/j.ebiom.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to verify the hypothesis originated from bioinformatics and literature reviews that hnNRP A1 may be a new immune target of Behçet's disease (BD). Methods First, bioinformatics was used to show the correlation between hnRNP A1 and A2/B1 in amino acid sequences and three dimensional structures. Second, hnRNP A1 was expressed, purified, and immunologically confirmed by systematic immunology methods including: Western blotting, immunoprecipitation and Dot-ELISA. Then, ELISA was used to screen the anti-hnRNP A1 autoantibodies in newly confirmed clinical samples and the clinical significance was compared between anti-hnRNP A1 antibody positive and negative groups. Finally, the endothelial cells antigen profile of one anti-hnRNP A1 antibody positive BD patient was detected using immunoprecipitation with liquid chromatography tandem mass spectrometry (LC–TMS). Results In total 720 subjects enrolled and tested in this study. Our results demonstrated hnRNP A1 as a new immune target of BD. The reactivity of BD serum IgG antibodies against hnRNP A1 was significantly higher than healthy controls (P < 0.0001), and deep vein thrombosis (DVT) showed a significant higher in the anti-hnRNP A1 antibodies positive group (P < 0.05). Bioinformatics was used to predict that hnRNP A1 may play a role in BD. HnRNP A1 was immunologically confirmed as an autoantigen of BD. Deep vein thrombosis has a close relationship with anti-hnRNP A1 antibody in patients' blood circulation.
Behçet's disease (BD) is a chronic systemic autoimmune disease. The pathogenesis of BD is still not clear, and the diagnosis is based on typical clinical syndromes. Autoantigen identification was considered a key to solve this problem. This study was to verify the hypothesis suggested by bioinformatics that hnRNP A1 may be a new autoantigen of BD. Among the 720 subjects enrolled and systemic tested, our results demonstrated hnRNP A1 as a new autoantigen of BD, and associated with deep vein thrombosis.
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Mucocutaneous Involvement in Behçet's Disease: How Systemic Treatment Has Changed in the Last Decades and Future Perspectives. Mediators Inflamm 2015; 2015:451675. [PMID: 26185360 PMCID: PMC4491584 DOI: 10.1155/2015/451675] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 05/19/2015] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a multisystemic disorder of unknown etiology characterized by the "triple symptom complex" consisting of recurrent oral aphthosis, genital ulcers, and chronic relapsing bilateral uveitis. Recurrent mucocutaneous lesions are generally considered the hallmark of the disease, being the most common symptoms presenting at the onset of disease. Although the improvement of knowledge about the pathogenetic mechanism added important changes in the treatment management of BD clinical manifestations, thus avoiding the appearance of serious life-threatening complications which are disease related, the mucocutaneous lesions are still the most nagging clinical manifestations to be treated. In this work we reviewed the current state of knowledge regarding the therapeutic approaches for mucocutaneous lesions of BD mainly based on controlled studies to provide a rational framework for selecting the appropriate therapy for treating these troublesome features of the disease.
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Seoudi N, Bergmeier LA, Drobniewski F, Paster B, Fortune F. The oral mucosal and salivary microbial community of Behçet's syndrome and recurrent aphthous stomatitis. J Oral Microbiol 2015; 7:27150. [PMID: 26037240 PMCID: PMC4452653 DOI: 10.3402/jom.v7.27150] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/19/2015] [Accepted: 04/20/2015] [Indexed: 01/05/2023] Open
Abstract
Background Behçet's syndrome (BS) is a multisystem immune-related disease of unknown etiology. Recurrent aphthous stomatitis (RAS) is characterized by the presence of idiopathic oral ulceration without extraoral manifestation. The interplay between the oral microbial communities and the immune response could play an important role in the etiology and pathogenesis of both BS and RAS. Objective To investigate the salivary and oral mucosal microbial communities in BS and RAS. Methods Purified microbial DNA isolated from saliva samples (54 BS, 25 healthy controls [HC], and 8 RAS) were examined by the human oral microbe identification microarray. Cultivable salivary and oral mucosal microbial communities from ulcer and non-ulcer sites were identified by matrix-assisted laser desorption/ionization time-of-flight analysis. Mycobacterium spp. were detected in saliva and in ulcer and non-ulcer oral mucosal brush biopsies following culture on Lowenstein-Jensen slopes and Mycobacterial Growth Indicator Tubes. Results There was increased colonization with Rothia denticariosa of the non-ulcer sites of BS and RAS patients (p<0.05). Ulcer sites in BS were highly colonized with Streptococcus salivarius compared to those of RAS (p<0.05), and with Streptococcus sanguinis compared to HC (p<0.0001). Oral mucosa of HC were more highly colonized with Neisseria and Veillonella compared to all studied groups (p<0.0001). Conclusions Despite the uncertainty whether the reported differences in the oral mucosal microbial community of BS and RAS are of causative or reactive nature, it is envisaged that restoring the balance of the oral microbial community of the ulcer sites may be used in the future as a new treatment modality for oral ulceration.
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Affiliation(s)
- Noha Seoudi
- Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Lesley A Bergmeier
- Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Francis Drobniewski
- Centre for Immunology and Infectious Diseases, Blizard Institute of Cell and Molecular Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Department of Infectious Diseases, Imperial College, London, UK
| | - Bruce Paster
- Department of Microbiology, The Forsyth Institute, Boston, MA, USA.,Department of Microbiology, Harvard School of Dental Medicine, Boston, MA, USA
| | - Farida Fortune
- Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK;
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Annexin A2 as a target endothelial cell membrane autoantigen in Behçet's disease. Sci Rep 2015; 5:8162. [PMID: 25641213 PMCID: PMC4313095 DOI: 10.1038/srep08162] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/06/2015] [Indexed: 12/27/2022] Open
Abstract
Cell membrane proteins are believed to play a critical role in the pathogenesis of autoimmune diseases. However, few membrane autoantigens have been linked with Behçet's disease. Here, a cell-chip was performed to identify autoantibody target cells, and the suspected autoantigens were detected using immunoblotting. The amino acid sequences of the detected proteins were determined using LC-MALDI-TOF/TOF. Putative proteins were recombinantly expressed and purified, and a corresponding ELISA was developed and clinically validated using real clinical samples. It was found that a 36-kDa membrane protein--annexin A2--was detected in approximately one-third of the patients' blood circulation. The immunohistochemistry results showed that annexin A2 was highly expressed in vascular endothelial cells. Moreover, vascular involvement was significantly higher in the anti-annexin A2 antibody-positive group versus the anti-annexin A2 antibody-negative group among all the clinical samples analyzed, indicating that annexin A2 is a novel endothelial cell membrane antigen involved in Behçet's disease.
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Uzkeser H, Karatay S, Yildirim K, Karakuzu A, Uyanik MH. Antistreptolysin O Levels in Patients with Behcet's Disease. Eurasian J Med 2015; 43:169-72. [PMID: 25610186 DOI: 10.5152/eajm.2011.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 08/14/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Behcet's disease is a multisystem inflammatory disorder, and its etiology has not been defined clearly yet. In this study, we aimed to investigate the antistreptolysin O (ASO) levels of patients with Behcet's disease. MATERIALS AND METHODS Thirty patients with Behcet's disease and 30 healthy controls were enrolled in this study. We measured erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), and ASO levels in both groups. RESULTS There was no statistically significant difference between the two groups with respect to demographic data (p>0.05). The ASO levels of the patients and the controls were 288.4±145.7 and 170.6±142.4 ng/ml, respectively. In the patients with Behcet's disease, ASO (p<0.01) and ESR (p<0.05) values were significantly higher than in the healthy controls. There was no other significant difference in serum CRP levels between the patients and the controls. We could not find any correlation among ASO, CRP, and ESR values. CONCLUSION Our results suggest that serum ASO levels may increase in patients with Behcet's disease. Further studies are needed in order to define the relationship between ASO levels and inflammation status in Behcet's disease.
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Affiliation(s)
- Hulya Uzkeser
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Saliha Karatay
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Kadir Yildirim
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ali Karakuzu
- Department of Dermatology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Muhammed Hamidullah Uyanik
- Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Mazzoccoli G, Matarangolo A, Rubino R, Inglese M, De Cata A. Behçet syndrome: from pathogenesis to novel therapies. Clin Exp Med 2014; 16:1-12. [PMID: 25447032 DOI: 10.1007/s10238-014-0328-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/22/2014] [Indexed: 12/11/2022]
Abstract
Behçet syndrome is a chronic disease hallmarked by inflammation of the blood vessels that is related to an autoimmune reaction caused by inherited susceptibility due to specific genes and environmental factors, probably components of infectious microorganisms, which turn on or get going the disease in genetically susceptible subjects. The more common clinical expression of the disease is represented by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis, sometimes associated with inflammatory arthritis, phlebitis, iritis, as well as inflammation of the digestive tract, brain, and spinal cord. The treatment strategies used to manage the manifestations of Behçet syndrome have gradually progressed, and a number of new therapeutic resources have been implemented in recent years, allowing better control of pathogenic mechanisms, reducing symptoms and suffering, and ameliorating patient's outcome.
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Affiliation(s)
- Gianluigi Mazzoccoli
- Division of Internal Medicine and Chronobiology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy.
| | - Angela Matarangolo
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Rosa Rubino
- Division of Internal Medicine and Chronobiology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Michele Inglese
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy
| | - Angelo De Cata
- Division of Internal Medicine and Rheumatology Unit, Department of Medical Sciences, IRCCS Scientific Institute and Regional General Hospital "Casa Sollievo della Sofferenza", San Giovanni Rotondo, FG, Italy.
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Kaneko F, Togashi A, Nomura E, Nakamura K. A New Diagnostic Way for Behcet's Disease: Skin Prick with Self-Saliva. GENETICS RESEARCH INTERNATIONAL 2014; 2014:581468. [PMID: 24587910 PMCID: PMC3920895 DOI: 10.1155/2014/581468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/18/2013] [Indexed: 12/26/2022]
Abstract
Behcet's disease (BD) is a mysterious multisystemic disorder characterized by recurrent involvement of mucocutaneous (including recurrent aphthous stomatitis; RAS), ocular, intestinal, vascular, and/or nervous system organs. Previously, the positivity of "pathergy test", which is one of the diagnostic examinations, was reported to be related to the possession of HLA-B51 gene in BD patients, even though the positivity is low and different from the countries. Here, instead of the ordinal pathergy test, we would like to propose the prick with self-saliva as a new diagnostic way for patients with RAS of BD based on the genetic intrinsic factors including HLA-B51 and extrinsic triggering factors. BD patients are considered to acquire the hypersensitivity against oral streptococci through the innate immune mechanism in the oral cavity. Bes-1 gene and 65 kD of heat shock protein (HSP-65) derived from oral S. sanguinis are supposed to play important roles as extrinsic factors in BD pathogenesis. Although the prick positivity was not related to the possession of HLA-B51 gene, the method is suggested to be a significant way for BD diagnosis. The results also suggest that BD symptoms are due to the vascular immune responses by monocytes expressed oral streptococcal agents of the patients.
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Affiliation(s)
- Fumio Kaneko
- Institute of Dermato-Immunology and -Allergy, Southern TOHOKU Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Ari Togashi
- Institute of Dermato-Immunology and -Allergy, Southern TOHOKU Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Erika Nomura
- Institute of Dermato-Immunology and -Allergy, Southern TOHOKU Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama, Fukushima 963-8563, Japan
| | - Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, 38 Hongo, Moroyama Iruma-gun, Saitama 350-0495, Japan
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Hamzaoui K, Hamzaoui A. Immunological responses in patients with Behçet’s disease: advances in understanding. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.30] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Cicek D, Dağlı A, Aydin S, Baskaya Dogan F, Dertlioğlu S, Uçak H, Demir B. Does hepcidin play a role in the pathogenesis of aphthae in Behçet's disease and recurrent aphthous stomatitis? J Eur Acad Dermatol Venereol 2013; 28:1500-6. [DOI: 10.1111/jdv.12326] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/31/2013] [Indexed: 12/14/2022]
Affiliation(s)
- D. Cicek
- Department of Dermatology; Firat University; Elazig Turkey
| | - A.F. Dağlı
- Department of Pathology; Inonu University; Malatya Turkey
| | - S. Aydin
- Department of Medical Biochemistry and Clinical Biochemistry (Firat Hormones Research Group); Firat University; Elazig Turkey
| | - F. Baskaya Dogan
- Department of Dermatology; Education and Research Hospital; Sanliurfa Turkey
| | | | - H. Uçak
- Department of Dermatology; Dicle University; Diyarbakir Turkey
| | - B. Demir
- Department of Dermatology; Education and Research Hospital; Elazig Turkey
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Neves FS, Spiller F. Possible mechanisms of neutrophil activation in Behçet's disease. Int Immunopharmacol 2013; 17:1206-10. [DOI: 10.1016/j.intimp.2013.07.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/15/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
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Kitai Y, Murakami K, Yoshifuji H, Yukawa N, Kawabata D, Ohmura K, Fujii T, Mimori T. A case of Behçet’s disease developing after poststreptococcal acute glomerulonephritis. Mod Rheumatol 2013. [DOI: 10.3109/s10165-012-0736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Neves FS, Spiller F. WITHDRAWN: Neutrophil activation in Behçet's Disease. Int Immunopharmacol 2013:S1567-5769(13)00291-9. [PMID: 23941768 DOI: 10.1016/j.intimp.2013.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/05/2013] [Indexed: 11/17/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.intimp.2013.07.017. The duplicate article has therefore been withdrawn.
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Affiliation(s)
- Fabricio Souza Neves
- Immunobiology Laboratory (LiDI), Federal University of Santa Catarina (UFSC), Florianopolis, 88040-900 Brazil.
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Mumcu G, İnanç N, Özdemir FT, Tulunay A, Ekşioğlu-Demiralp E, Ergun T, Direskeneli H. Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in Behçet's disease. Int J Dermatol 2013; 52:1561-6. [DOI: 10.1111/ijd.12144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Gonca Mumcu
- Department of Health Informatics and Technologies; Faculty of Health Sciences; Marmara University; Istanbul Turkey
| | - Nevsun İnanç
- Department of Rheumatology; Faculty of Medicine; Marmara University; Istanbul Turkey
| | | | - Aysın Tulunay
- Department of Immunology; Faculty of Medicine; Istanbul Turkey
| | | | - Tülin Ergun
- Department of Dermatology; Faculty of Medicine; Marmara University; Istanbul Turkey
| | - Haner Direskeneli
- Department of Rheumatology; Faculty of Medicine; Marmara University; Istanbul Turkey
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Erdem V, Yıldız M, Erdem T. The Evaluation of Saliva Flow Rate, pH, Buffer Capacity, Microbiological Content and Indice of Decayed, Missing and Filled Teeth in Behçet's Patients. Balkan Med J 2013; 30:211-4. [PMID: 25207102 DOI: 10.5152/balkanmedj.2013.7932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/29/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several lines of evidence indicate that oral microbial flora play a critical role in the pathogenesis of Behçet disease. Saliva flow rate, buffer capacity and microorganism content are very important in the maintenance of oral health. AIMS We aimed to evaluate saliva flow rate, pH, buffer capacity and Streptococcus mutans and Lactobacilli content along with the decayed, missing, and filled tooth index in Behçet's patients. STUDY DESIGN Case-control study. METHODS Forty patients with active Behçet disease [female:male (F/M) 21/19, mean age 31.05±11.08 years] and forty healthy persons (F/M 21/19, mean age 31.03±9.14 years) were included in the study. The oral region was first examined, and the decayed, missing, and filled tooth index was calculated for each person. Stimulated saliva was collected and divided into two separate millimetric tubes to calculate the buffer capacity of the saliva, determine Streptococcus mutans and Lactobacilli levels and measure the pH of the saliva. A Caries Risk Test buffer strip was used to calculate the buffer capacity. Caries Risk Test bacterial kit was used to determine Streptococcus mutans and lactobacilli levels. A pH meter was used to measure the pH of the saliva. RESULTS The mean saliva pH of the patients was higher than the controls (7.76±0.51, 7.18±0.46, respectively) (p<0.001). The mean level of Streptococcus mutans and Lactobacilli in patients was higher than controls (p<0.05). The mean decayed, missing, and filled tooth index of patients was 9.82±6.59 (range 1-28), while the mean decayed, missing, and filled tooth index of the controls was 6.05±3.35 (range 1-16) (p<0.01). There were no significant differences between the patients and the controls with respect to saliva flow rate and saliva buffer capacity (p>0.05). CONCLUSION We think that the maintenance of oral health by effective, regular tooth brushing, regular dental check-ups and dental treatment for Behçet patients is very important for the prevention and therapy of Behçet disease.
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Affiliation(s)
- Vildan Erdem
- Department of Dentistry, Atatürk University Dental Faculty, Erzurum, Turkey
| | - Mehmet Yıldız
- Department of Dentistry, Atatürk University Dental Faculty, Erzurum, Turkey
| | - Teoman Erdem
- Department of Dermatology, Sakarya University Faculty of Medicine, Sakarya, Turkey
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Tsuchida M, Mineshita S, Okonogi H, Sugimori K, Hoshi K, Horiuchi T, Wang LM, Fujimoto EK. The role of an uncommon type of oral streptococcus sanguis in the etiology of behcet's disease. Environ Health Prev Med 2012; 2:59-63. [PMID: 21432453 DOI: 10.1007/bf02931965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/1996] [Accepted: 04/07/1997] [Indexed: 10/21/2022] Open
Abstract
The relationships of Behcet's disease (BD) with oral diseases and the prevalence of an uncommon type of oralStreptococcus sanguis (Str. sanguis) in the oral cavity were investigated in a case-control study. BD patients were compared to patient controls (collagen disease) and healthy controls.An interview questionnaire survey of BD and oral diseases showed that during the pre-onset, onset, and post-onset periods, the incidences of tonsillitis and dental caries, or the history of dental treatment, were greater in BD cases. Typological analysis showed a higher prevalence of an uncommon type ofStr. sanguis, differing from the common type, among BD cases compared to control groups. These results, showing a higher incidence of tonsillitis and dental caries during the presymptomatic period, a greater frequency of dental treatments during the symptomatic period, and the presence of an uncommon type ofStr. sanguis, indicate thatStr. sanguis of an uncommon type is related to increased risk of BD, and the possibility of a causal role is suggested.
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Affiliation(s)
- M Tsuchida
- Major in Health Science, Faculty of Human Sciences, Aichi Mizuho College, 86-1, Haiwa, Hiratobashi-cho, 470-03, Toyota, Japan
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A case of Behçet’s disease developing after poststreptococcal acute glomerulonephritis. Mod Rheumatol 2012; 23:1221-5. [DOI: 10.1007/s10165-012-0736-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
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Cho SB, Ahn KJ, Kim DH, Zheng Z, Cho S, Kang SW, Lee JH, Park YB, Lee KH, Bang D. Identification of HnRNP-A2/B1 as a Target Antigen of Anti-Endothelial Cell IgA Antibody in Behçet's Disease. J Invest Dermatol 2012; 132:601-8. [DOI: 10.1038/jid.2011.397] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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25
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Insights in Behçet's disease: has a target antigen been identified? J Invest Dermatol 2012; 132:505. [PMID: 22327260 DOI: 10.1038/jid.2012.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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García-Palenzuela R, Graña Gil J, Varela Arias M, Tovar Bobo M. Actualización de la enfermedad de Behçet. A propósito de 2 casos en atención primaria. Semergen 2012. [DOI: 10.1016/j.semerg.2011.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Pineton de Chambrun M, Wechsler B, Geri G, Cacoub P, Saadoun D. New insights into the pathogenesis of Behçet's disease. Autoimmun Rev 2011; 11:687-98. [PMID: 22197900 DOI: 10.1016/j.autrev.2011.11.026] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/27/2011] [Indexed: 01/01/2023]
Abstract
Behçet's disease (BD) is a recurrent systemic inflammatory disorder of unknown origin characterized by oral and genital mucous ulcer, uveitis, and skin lesions. Involvement of large vessels, central nervous system (CNS), gastrointestinal tract and thrombotic events are less frequent but can be life threatening. The aim of this review is to provide new insights into the pathogenesis of BD. Over the past year substantial advances have been done in the understanding of the genetic [1,2] and immunology [3] of BD. BD is at the crossroad between autoimmune and autoinflammatory syndromes. In common with autoimmune diseases BD shares class I MHC association. However, in contrast to autoimmune disorders, BD has clinical features that seem to be mostly autoinflammatory. The pathogenesis of BD is still unknown, but major determinants of the genetic and immune system abnormalities have been reported recently. Triggering infectious factors are supposed to participate in the outbreak of BD in genetically predisposed patients. Two recent large genome-wide association study (GWAS) conducted in Turkey and Japan reported association between single nucleotide polymorphism (SNP) of interleukin (IL)-10 and IL-23R/IL-12RB2 genes and BD. New insights into the perturbations of T cell homeostasis of BD recently emerged. We have recently demonstrated the promotion of Th17 responses and the suppression of regulatory T cells (Tregs) that were driven by interleukin (IL)-21 production and that correlates with BD activity. Inflammatory cells within BD inflammatory lesions included mostly neutrophils, Th1 and Th17 cells, and cytotoxic CD8+ and γδ T cells. Altogether, the recent progresses in the knowledge of BD pathogenesis pave the way for innovative therapy.
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Affiliation(s)
- Marc Pineton de Chambrun
- Department of Internal Medicine and Laboratory I3 Immunology, Immunopathology, Immunotherapy, UMR CNRS 7211, INSERM U959, Groupe Hospitalier La Pitié-Salpetrière, Université Pierre et Marie Curie, Paris 6, Paris, France
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Salivary levels of antimicrobial peptides Hnp 1-3, Ll-37 and S100 in Behcet's disease. Arch Oral Biol 2011; 57:642-6. [PMID: 22153317 DOI: 10.1016/j.archoralbio.2011.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 09/11/2011] [Accepted: 11/04/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oral ulcer is the cardinal clinical sign and increased neutrophilic activity is a part of the pathogenesis in Behcet's disease (BD). Saliva, as a part of the innate immune response, contains antimicrobial peptides (AMPs) that are derived from both oral epithelial cells and neutrophils. The aim of this study was to investigate the associations between salivary levels of AMPs HNP 1-3, LL-37 and S100 and disease course in patients with Behcet's disease (BD). METHODS Fifty-three patients with BD and 44 healthy controls (HC) were included in the study. Disease severity score reflecting organ involvement was calculated. Salivary HNP 1-3, LL-37 and S100 levels were measured in unstimulated saliva samples by ELISA. RESULTS Salivary HNP 1-3 and S100 levels in BD patients (2715.2 ± 1333.4 μg/ml and 430.6 ± 203.9 ng/ml) were significantly higher compared to HC (1780.6 ± 933.2 μg/ml and 365.3 ± 84.7 ng/ml) (p = 0.000 and p = 0.004, respectively). Although LL-37 levels were also higher in BD than HC (190.9 ± 189.1 vs 143.1 ± 128.9 ng/ml), no significant difference was observed (p = 0.53). Salivary HNP 1-3 and LL-37 levels were associated with the severity of BD (mild disease: 1975.1 ± 1174.2 μg/ml and 115.9 ± 109.4 ng/ml vs severe disease: 2955.7 ± 1305.6 μg/ml and 215.3 ± 203.8 ng/ml, p=0.020 and p=0.031, respectively). Salivary LL-37 levels also correlated with the number of monthly oral ulcers (r = 0.5 p = 0.000). CONCLUSION An increase in salivary HNP 1-3 and S100 levels might be associated with enhanced local and systemic innate responses in BD.
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Durrani O, Banahan K, Sheedy FJ, McBride L, Ben-Chetrit E, Greiner K, Vaughan RW, Kondeatis E, Hamburger J, Fortune F, Stanford MR, Murray PI, O'Neill LA, Wallace GR. TIRAP Ser180Leu polymorphism is associated with Behcet's disease. Rheumatology (Oxford) 2011; 50:1760-5. [PMID: 21705416 DOI: 10.1093/rheumatology/ker200] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES The initiating cause of Behçet's disease (BD) is unknown, but an aberrant response to infection has been suggested. In this study, single nucleotide polymorphisms in Toll-like receptors (TLRs) and associated molecules that have a sentinel function at mucosal surfaces were analysed in patients with BD. METHODS TLR expression was determined by immunohistochemistry in buccal mucosal tissue from patients with BD, in tissue from patients with lichen planus (LP) or pyogenic granuloma (PG) as disease controls, or from healthy individuals. Using SSP-PCR we analysed SNP in CD14, TLR2, TLR4 and TIRAP (TIR domain-containing adaptor protein) in patients with BD from different geographical regions. RESULTS TLR expression was increased in buccal lesions from patients with BD compared with healthy controls; however, a similar increase was seen in lesion tissue from patients with LP or PG, suggesting that this was a generalized inflammatory response as opposed to a BD-specific response. SNP analysis showed no association between CD14, TLR2 or TLR4 polymorphisms. However, TIRAP 180Leu was significantly associated with BD in UK, but not Middle Eastern, patients. CONCLUSION TLR expression showed no difference in tissue from patients with BD compared with either disease or healthy controls. Likewise, SNPs in TLR genes were no different from healthy controls. The association with the increased function variant of TIRAP suggests that encounter with a pathogen at mucosal sites will lead to increased cytokine production and tissue damage with persistence of mucosal lesions.
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Affiliation(s)
- Omar Durrani
- Academic Unit of Ophthalmology, School of Immunity and Infection, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK
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Togashi A, Saito S, Kaneko F, Nakamura K, Oyama N. Skin prick test with self-saliva in patients with oral aphthoses: a diagnostic pathergy for Behcet's disease and recurrent aphthosis. INFLAMMATION & ALLERGY DRUG TARGETS 2011; 10:164-70. [PMID: 21428910 PMCID: PMC3228232 DOI: 10.2174/187152811795564109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/22/2010] [Accepted: 12/03/2010] [Indexed: 11/22/2022]
Abstract
There may be some difficulties to differentiate Behcet's disease (BD), recurrent aphthosis (RA), and herpetic aphthous ulceration, from other mimicking oral disorders. Despite of unexpected sensitivity and responsiveness, the skin pathergy test regarding a non specific hypersensitivity has long been thought as one of auxiliary diagnostic benefits for BD. To determine the potential usefulness and disease specificity of the prick reaction with saliva, a skin prick test with neat and filter-sterilized saliva was performed on the forearm skin of 26 individuals; 10 patients with BD (8 incomplete type without uveitis, 1 complete type, and 1 neurological type), 5 with RA, 3 with herpetic oral aphthosis, 2 with erythema nodosum alone, and 6 healthy controls. We assessed the skin reaction at 48 hours after pricking, and the pricked skin lesions were biopsied and analyzed immunohistologically. Nine of 10 BD patients (90 %) exhibited an indurative erythema at the skin site pricked with self-saliva, whereas 3 of 5 RA patients (60%) were relatively weak reaction. Pricking with filter-sterilized saliva failed to recapitulate any of positive skin reactions, albeit a faint erythematous dot appeared in a few BD patients, implicating the involvement of causative microorganism(s) in oral bacterial flora. Culture of saliva from 3 randomly chosen BD patients revealed numerous streptococcal colonies on Mitis-Salivarius agar. Histology of the pricked skin sites showed perivascular inflammatory infiltrates, composed of CD4+ T cells and CD68+ monocyte/macrophage lineage, a feature consistent with a delayed type hypersensitive reaction. Our results suggested that skin prick test using self-saliva (a new diagnostic pathergy) can be a simple and valuable in vivo diagnostic approach for differentiating BD and RA from other mimicking mucocutaneous diseases. The positive skin prick may be triggered by resident intra-oral microflora, particularly streptococci, and may in part address the underlying immunopathology in BD.
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Affiliation(s)
- Ari Togashi
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Sanae Saito
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Fumio Kaneko
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Noritaka Oyama
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Hatemi G, Yazici H. Behçet’s syndrome and micro-organisms. Best Pract Res Clin Rheumatol 2011; 25:389-406. [DOI: 10.1016/j.berh.2011.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 05/23/2011] [Indexed: 11/17/2022]
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Behçet's disease (Adamantiades-Behçet's disease). Clin Dev Immunol 2010; 2011:681956. [PMID: 21052488 PMCID: PMC2967828 DOI: 10.1155/2011/681956] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 09/07/2010] [Indexed: 12/13/2022]
Abstract
Adamantiades-Behçet's disease (ABD) is characterized by starting with oral aphthous ulceration and developing of the systemic involvements. The pathogenesis of ABD is closely correlated with the genetic factors and the triggering factors which acquire delayed-type hypersensitivity reaction against oral streptococci mediated by IL-12 cytokine family. HLA-B51 is associated in more than 60% of the patients and its restricted CD8+ T cell response is clearly correlated with the target tissues. Bes-1 gene encoded partial S. sanguinis genome which is highly homologous with retinal protein, and 65 kD heat shock protein (Hsp-65) released from streptococci is playing an important role with human Hsp-60 in the pathogenesis of ABD. Although Hsp-65/60 has homologies with the respective T cell epitope, it stimulates peripheral blood mononuclear cells (PBMCs) from ABD patients. On the other hand, some peptides of Hsp-65 were found to reduce IL-8 and IL-12 production from PBMCs of ABD patients in active stage.
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Isogap E, Isogai H, Fujii N, Yokota K, Yamaguchi M, Oguma K, Yoshikawa K, Sasamoto Y, Ohnot S. Adhesive Properties ofStreptococcus sanguisIsolated from Patients with Behçet's Disease. MICROBIAL ECOLOGY IN HEALTH AND DISEASE 2009. [DOI: 10.3109/08910609009140254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E. Isogap
- Department of Preventive Dentistry, School of Dentistry, Higashi Nippon Gakuen University, Ishikari-Tobetsu 1757, Hokkaido, 061-02, Japan
| | - H. Isogai
- Departments of Laboratory Animal Science, Sapporo Medical College, Sapporo, 060, Japan
| | - N. Fujii
- Departments of Laboratory Animal Microbiology, Sapporo Medical College, Sapporo, 060, Japan
| | - K. Yokota
- Departments of Laboratory Animal Microbiology, Sapporo Medical College, Sapporo, 060, Japan
| | - M. Yamaguchi
- Departments of Laboratory Animal Microbiology, Sapporo Medical College, Sapporo, 060, Japan
| | - K. Oguma
- Departments of Laboratory Animal Microbiology, Sapporo Medical College, Sapporo, 060, Japan
| | - K. Yoshikawa
- Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo, 060, Japan
| | - Y. Sasamoto
- Department of Ophthalmology, Hokkaido University School of Medicine, Sapporo, 060, Japan
| | - S. Ohnot
- Department of Ophthalmology, Yokohama City University School of Medicine, Minami-Ku, Yokohama, 232, Japan
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Kohno H, Sakai T, Tsuneoka H, Imanishi K, Saito S. Staphylococcal enterotoxin B is involved in aggravation and recurrence of murine experimental autoimmune uveoretinitis via Vbeta8+CD4+ T cells. Exp Eye Res 2009; 89:486-93. [PMID: 19523946 DOI: 10.1016/j.exer.2009.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 04/25/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
Endogenous uveitis is a common cause of visual disability and blindness. The etiology of uveitis remains largely unknown but reasonable etiologic factors include infections. Superantigens are regarded as one of the leading causes of infectious etiology in autoimmune disease. However, the role of superantigens in uveitis remains unclear. In the present study, we investigated the effect of Staphylococcal enterotoxin B (SEB), a member of the superantigens, using an experimental model of autoimmune uveoretinitis (EAU). C57BL/6 mice were immunized with human interphotoreceptor retinoid binding protein (IRBP) peptide, and the severity of EAU disease was scored. Vehicle (PBS) alone or SEB dissolved in PBS was administered by intravenous injection on post-immunization day 10 or on post-immunization day 24. In addition, a systemic immune response study was performed to address the effects of SEB on systemic immunity. EAU was aggravated significantly by the injection of SEB at post-immunization day 10. Furthermore, relapse was induced by the injection of SEB at day 24. On the other hand, SEB injection without IRBP peptide immunization elicited no inflammatory changes in the uvea or retina. Furthermore, SEB enhanced not only the IRBP-specific T-cell proliferative responses but also IFN-gamma and IL-17 production. Moreover, the intraocular expression levels of these cytokines was also enhanced by SEB injection. Both anti-CD4 and -Vbeta8 Ab administration suppressed disease aggravation and the enhancement of IRBP-specific T-cell responses caused by SEB. These results suggest that SEB is involved significantly in the aggravation or recurrence of endogenous uveitis through activation of autoreactive uveitogenic T cells.
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Affiliation(s)
- Hideo Kohno
- Department of Ophthalmology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
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Karacayli U, Mumcu G, Simsek I, Pay S, Kose O, Erdem H, Direskeneli H, Gunaydin Y, Dinc A. The close association between dental and periodontal treatments and oral ulcer course in behcet’s disease: a prospective clinical study. J Oral Pathol Med 2009; 38:410-5. [DOI: 10.1111/j.1600-0714.2009.00765.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Evereklioglu C. Regarding neutrophil and lymphocyte responses to oralStreptococcusin AdamantiadesâBehçet's disease. ACTA ACUST UNITED AC 2006; 47:311-4. [PMID: 16872367 DOI: 10.1111/j.1574-695x.2006.00135.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Yanagihori H, Oyama N, Nakamura K, Mizuki N, Oguma K, Kaneko F. Role of IL-12B promoter polymorphism in Adamantiades-Behcet's disease susceptibility: An involvement of Th1 immunoreactivity against Streptococcus Sanguinis antigen. J Invest Dermatol 2006; 126:1534-40. [PMID: 16514412 DOI: 10.1038/sj.jid.5700203] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Adamantiades-Behcet's disease (ABD) is a chronic inflammatory multisystem disorder. Although the precise etiology is unclear, high prevalence of human leukocyte antigen (HLA)-B51 predisposition and predominantly involved T-helper type 1 cells (Th1)-type proinflammatory cytokines and extrinsic Streptococcal infection suggest a substantial association with an immunogenetic basis and strengthens the hypothesis that IL-12, a potent inducer of Th-1 immune reaction, is a putative candidate in its pathogenesis. These clinicopathological findings led us to examine interleukin 12 p40 (IL-12B) promoter polymorphism, for which the 4-base pair (bp) heterozygous insertion has been shown to affect the gene transcription and subsequent protein production. We analyzed IL-12B promoter genotypes in 194 Japanese subjects (92 with ABD and 102 normal controls) by PCR-based restriction enzyme digestion. The frequency of the insertion heterozygosity was significantly higher in patients than in controls (49/92, 53.3% vs 39/102, 38.2%, respectively). Comparing these with HLA haplotype data, this trend was more significant in HLA-B51-negative patients (29/42, 69.0% vs 20/50, 40.0%; P = 0.005). As assessed by semiquantitative reverse transcription-PCR and ELISA, stimulation with Streptococcal antigens specifically increased expression of IL-12 p40 mRNA and protein, in conjunction with IL-12 p70 induction, in peripheral blood mononuclear cells from heterozygous patients. Our results provide evidence for anti-bacterial host response toward Th1-immunity mediated by IL-12 in patients with ABD, and the possible insight into the genetic susceptibility that is independent of HLA background.
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Affiliation(s)
- Hirokatsu Yanagihori
- Department of Dermatology, Fukushima Medical University Graduate School of Medicine, Fukushima, Japan.
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38
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Soto-Vega E, García-Muñoz R, Richaud-Patin Y, Zúñiga-Ramos J, Crispín JC, Díaz-Jouanen E, Flores-Suárez LF, Llorente L, Granados J. Class I and class II MHC polymorphisms in Mexican patients with Behçet’s disease. Immunol Lett 2004; 93:211-5. [PMID: 15158619 DOI: 10.1016/j.imlet.2004.03.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Revised: 03/25/2004] [Accepted: 03/27/2004] [Indexed: 10/26/2022]
Abstract
Behçet's disease is a multi-system inflammatory disorder of unknown etiology. The disease is more prevalent in Eastern Mediterranean countries and Japan where there is a linkage to HLA-B51. Mexican Mestizos are suitable subjects for studying the role of ethnicity in the susceptibility to Behçet's disease. High-resolution HLA class I and class II typing was performed by polymerase chain reaction sequence-specific oligonucleotide (PCR-SSO) reverse dot blot and PCR-single-strand polymorphism in 32 patients with Behçet's disease and 99 healthy ethnically-matched controls. A significant increased frequency of HLA-B(*)44 (P = 0.02; OR = 2.78; CI 95% = 1.1-7.7), HLA-B(*)52 (P = 0.02; OR = 5.33; CI 95% = 1.07-29.1), and HLA-B(*)56 (P = 0.003; OR = 4.19; CI 95% = 3.37-5.21) as well as HLA-DRB1(*)01 and HLA-DRB1(*)13 (p = 0.007; OR = 3.36; CI 95% = 1.22-9.27) was found in Mexican patients with Behçet's disease when compared to controls. The low frequency of native markers in Mexican Mestizo patients with Behçet's disease suggests that genetic admixture between Eastern Mediterraneans and Orientals with Amerindians is a recent event that increased the risk of developing Behçet's disease in the Mexican population.
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Affiliation(s)
- Elena Soto-Vega
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan 14000, México, D.F., Mexico
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39
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Tojo M, Yanagihori H, Zheng X, Oyama N, Isogai E, Nakamura K, Kaneko F. Detection of microbial DNA in skin lesions from patients with Behçet's disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:185-90. [PMID: 12918687 DOI: 10.1007/0-306-48382-3_36] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
MESH Headings
- Adult
- Aged
- Amino Acid Sequence
- Antigens, Bacterial/chemistry
- Antigens, Bacterial/isolation & purification
- Behcet Syndrome/microbiology
- Behcet Syndrome/virology
- DNA, Bacterial/genetics
- DNA, Bacterial/isolation & purification
- DNA, Viral/genetics
- DNA, Viral/isolation & purification
- Female
- Herpesvirus 1, Human/genetics
- Herpesvirus 1, Human/isolation & purification
- Herpesvirus 2, Human/genetics
- Herpesvirus 2, Human/isolation & purification
- Humans
- Male
- Middle Aged
- Molecular Sequence Data
- Mouth Diseases/microbiology
- Skin Diseases/etiology
- Skin Diseases/microbiology
- Skin Diseases/virology
- Streptococcus sanguis
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Affiliation(s)
- Michiko Tojo
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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40
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Isogai E, Hirata M, Isogai H, Matuo K, Kimura K, Yokota K, Oguma K, Tojo M, Kaneko F, Kotake S, Ohno S. Antimicrobial activity of synthetic human CAP18 peptides to Streptococcus sanguis isolated from patients with Behçet's disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:195-200. [PMID: 12918689 DOI: 10.1007/0-306-48382-3_38] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- E Isogai
- Health Sciences University of Hokkaido, Japan
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41
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Abstract
Behcet's disease (BD) is a multisystem, chronic, relapsing vasculitis of unknown origin that affects nearly all organs and systems. While recurrent oral ulcerations are a "sine qua non" of BD, the frequency of extra-oral parts of the gastrointestinal involvement varies widely in different countries. The most frequent extra-oral sites of gastrointestinal involvement are the ileocecal region and the colon. The liver (except with Budd-Chiari syndrome), pancreas, and spleen are rarely involved. The symptoms associated with these extra-oral manifestations of BD are abdominal pain, nausea, vomiting, diarrhea with or without blood, and constipation. The lesions typically are resistant to medical treatment and frequently recur with surgical treatment. We review the literature regarding the gastrointestinal and hepatobiliary systems in BD. Also, we present a patient who had BD complicated with radiologically-proven hepatic veins involvement (Budd-Chiari syndrome) and complete occlusion of hepatic portion of inferior vena cava and who had a good response to colchicine and penicillin treatment.
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Affiliation(s)
- Y Bayraktar
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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42
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Celenligil-Nazliel H, Kansu E, Ebersole JL. Periodontal Findings and Systemic Antibody Responses to Oral Microorganisms in Behçet's Disease. J Periodontol 1999; 70:1449-56. [PMID: 10632520 DOI: 10.1902/jop.1999.70.12.1449] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Behçet's disease is a multisystem disorder of unknown etiology, affecting predominantly the oral mucosa, skin, and eyes. Recurrent and painful episodes of oral ulcerations interfere with regular oral hygiene leading to rapid bacterial plaque accumulation. The aims of this study were to evaluate the periodontal status of patients with Behçet's disease and determine serum antibody responses to selected oral microorganisms, including major periodontopathogens in these patients. METHODS Thirty-three patients with Behçet's disease and 15 healthy subjects were included in the study. Plaque, sulcular bleeding, periodontal index scores, probing depths, and total number of teeth were recorded. Serum IgG antibody levels to a panel of 13 oral microorganisms were determined. RESULTS Significantly higher values for each of the clinical measures were observed in patients with Behçet's disease compared to healthy subjects (P <0.0001). Antibody levels to selected members of plaque, including Actinomyces viscosus, Streptococcus mutans, Streptococcus sanguis, Streptococcus oralis, Eikenella corrodens, Campylobacter rectus, and Prevotella intermedia were significantly lower in patients with Behçet's disease than in controls (P <0.001-0.05). In contrast, these patients exhibited significantly elevated antibody levels to Actinobacillus actinomycetemcomitans Y4 compared to controls (P <0.01). CONCLUSIONS Our data indicate that the patients with Behçet's disease generally exhibit clinical findings of established periodontal disease. Decreased antibody responses to early colonizers of both supra- and subgingival plaque were observed along with the elevation in antibody levels to A. actinomycetemcomitans. These results suggest that the bacterial plaque ecology and/or immune responses to these microorganisms may be affected in Behçet's disease which could lead to changes in the expression of periodontal disease.
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Affiliation(s)
- H Celenligil-Nazliel
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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Yoshikawa K, Kotake S, Kubota T, Kimura K, Isogai E, Fujii N. Cloning and sequencing of BeS-1 gene encoding the immunogenic antigen of Streptococcus sanguis KTH-1 isolated from the patients with Behçet's disease. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1998; 287:449-60. [PMID: 9638874 DOI: 10.1016/s0934-8840(98)80184-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In order to analyze the immunopathologic mechanisms of Behçet's disease, the gene (bes-1) encoding a streptococcal antigen correlated with the disease was cloned and sequenced, and protein produced by this clone was identified by Western immunoblotting using serum antibody from the patient. Cellular DNA of Streptococcus (S.) sanguis serotype KTH-1 (uncommon serotype 1, strain 113-20) from the patient was extracted and digested with EcoRI. The digested fragments were cloned into the cloning vector lambda gt11, and then the resulting DNA library was immunoscreened using the patient's serum antibody to serotype KTH-1. The immunopositive clone of the 1.5 kbp fragment was subcloned into pUC 118 plasmid (pU8BeS1-1) and sequenced. The sequence showed that the 3'-terminal half side region of this insert contained 962bp of open-reading frame (ORF) discontinued at the EcoRI restriction site, and the stop codon was not found. The nucleotide sequence of the remaining additional 3'-terminal region of this gene encoding whole BES-1 was determined by genome walking. The whole ORF of bes-1 consisted of 849 amino acid residues with a calculated molecular mass of 95 kDa. The residues in a portion of the amino acid sequence showed a 60% correspondence to those of the human intraocular peptide Brn-3b.
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Affiliation(s)
- K Yoshikawa
- Department of Ophthalmology, Hokkaido University School of Medicine, Japan
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44
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Moore MA, Gregory RL, Switalski LM, Hakki ZW, Gfell LE, Kowolik MJ. Differential activation of human neutrophils by Streptococcus mutans isolates from root surface lesions and caries-free and caries-active subjects. ORAL MICROBIOLOGY AND IMMUNOLOGY 1998; 13:41-6. [PMID: 9573821 DOI: 10.1111/j.1399-302x.1998.tb00749.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Phagocytosis of bacterial pathogens is an important defense mechanism and may contribute to regulating Streptococcus mutans-induced dental caries, particularly at root surfaces. This study was undertaken to examine and compare differences in polymorphonuclear leukocyte or neutrophil activation by clinical isolates of S. mutans collected from the saliva of caries-free or caries-active individuals with S. mutans isolates from root surface lesions. S. mutans clinical isolates (5 caries-free, 5 caries-active, 5 root caries isolates and a laboratory strain) were incubated with neutrophils in the presence of normal human serum and the luminol dependent chemiluminescence was measured for 1 h at 37 degrees C. Results indicated that the caries active and laboratory strains activated neutrophils equally. The mean integration stimulated by caries-free strains, however, displayed a 25-30% enhanced neutrophil activation over the caries-active and laboratory strains. In contrast, neutrophil activation by root caries strains of S. mutans was 45-50% lower than all other S. mutans strains, possibly suggesting a natural selection for S. mutans strains that can evade neutrophil recognition and subsequent phagocytosis. Stimulation of neutrophils with the cell wall and membrane surface component preparations indicated that extracts from all four groups activated neutrophils significantly. Again, caries-free preparations activated neutrophils significantly more than caries active, laboratory strain and root caries isolates. This selection may become more important on root surfaces due to increased exposure to crevicular fluid and neutrophils. The data provide evidence for the presence or onset of mechanisms or biological alterations in S. mutans developed to circumvent neutrophil recognition and/or phagocytosis, thus increasing S. mutans survival and colonization on tooth surfaces, resulting in an enhanced risk of dental caries, particularly at root surfaces.
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Affiliation(s)
- M A Moore
- Department of Oral Biology, Indiana University School of Medicine, Indianapolis 46202-5186, USA
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45
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Abstract
Two patients diagnosed as Behçet's disease (BD) were found to be neutropenic. Chronic benign neutropenia commonly presents with symptoms that mimic BD. Here, it is important to decide whether neutropenia is a complication of BD or if the symptoms should be attributed to neutropenia. In our patients, symptoms improved after the treatment of neutropenia with granulocyte colony stimulating factor. Both patients had high antistreptolysin O titers denoting a recent streptococcal infection.
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Affiliation(s)
- H Demiroğlu
- Department of Haematology, Hacettepe University Medical School, Ankara, Turkey
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46
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Yokota K, Hayashi S, Araki Y, Isogai E, Kotake S, Yoshikawa K, Fujii N, Hirai Y, Oguma K. Characterization of Streptococcus sanguis isolated from patients with Behçet's disease. Microbiol Immunol 1995; 39:729-32. [PMID: 8577288 DOI: 10.1111/j.1348-0421.1995.tb03249.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The DNA homology and cell wall sugar constituents of eight Streptococcus sanguis(-like) strains, three isolated from the patients with Behçet's disease (BD114-23, BD113-20, BD118-1), two from patients with Kawasaki disease (MCLS-1, MCLS-2), and three type and reference strains of ATCC (ATCC10556T: S. sanguis, ATCC10557: S. oralis, and ATCC10558T: S. gordonii) were analyzed. Strains BD114-23 and BD118-1 showed high DNA homology to ATCC10556T, and their cell wall constituents were identical. Conversely, BD113-20, MCLS-1, MCLS-2, and ATCC10557 showed little DNA homology to ATCC10556T and ATCC10558T, but showed approximately 50 to 60% homology to each other. The cell wall constituents of BD113-20, MCLS-1, MCLS-2, and ATCC10557, however, were somewhat different, indicating that some of the clinical isolates have different characters from those of the three ATCC strains.
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Affiliation(s)
- K Yokota
- Department of Bacteriology, Okayama University Medical School, Japan
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47
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Narikawa S, Suzuki Y, Takahashi M, Furukawa A, Sakane T, Mizushima Y. Streptococcus oralis previously identified as uncommon 'Streptococcus sanguis' in Behçet's disease. Arch Oral Biol 1995; 40:685-90. [PMID: 7487566 DOI: 10.1016/0003-9969(95)00042-n] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The relation between the biochemical and serological properties of 'Streptococcus sanguis' was studied to characterize the strains isolated from dental plaque of patients with Behçet's disease and controls. Seven reference and 100 clinical strains preserved by the Behçet's Disease Research Committee of Japan were identified using established criteria and differentiated with antisera against Strep. oralis ATCC 10557, Strep. sanguis ATCC 10556 and 'Strep. sanguis' ST7, compatible with the criteria. Uncommon serovars (serotypes) KTH-1 (= ATCC 49298), KTH-2 (= ATCC 49296), KTH-3 (= ATCC KTH-4 (= ATCC 49297) and B220 (serovar KTH-1) with both IgA1 protease and neuraminidase (sialidase) were identified as Strep. oralis, whereas common serovars ST3 with IgA1 protease alone and ST7 without both enzymes were identified as Strep. sanguis and Strep. gordonii, respectively. Isolates previously ranked as uncommon serovars were identified as Strep. oralis, whereas the rest ranked as common serovars were identified as the same species as those of the grouping strains. A soft-agar technique was available for species identification except for Strep. oralis serovar KTH-1 reacting with the antiserum against Strep. gordonii ST7. The frequency of isolation of Strep. oralis was higher in Behçet's disease (52%) than in controls (38%), but no difference was observed between the properties of the two groups of isolates. Strep. oralis virulence factors may be involved in breach the mucosal barrier in patients with specific reactivity to these antigens and inducing Behçet's disease.
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Affiliation(s)
- S Narikawa
- Institute of Medical Science, St Marianna University School of Medicine, Kanagawa, Japan
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48
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Abstract
Behçet's disease (BD) is characterized by recurrent oral aphthae, skin lesions, eye lesions, and genital ulceration. To determine the pathogenesis of BD, we performed histological and immunohistochemical studies of these mucocutaneous lesions, an assay of neutrophil activity, and HLA typing. Dense dermal or subcutaneous infiltrations of polymorphonuclear cells (PMN) without leukocytoclastic vasculitis were found in 28 of 57 lesions. Immunohistochemically, deposits of C3 on the vessels were found in 12 of 31 lesions. Deposits of immunoglobulin were not found except for one of IgM. C3 deposits and PMN infiltrations were significantly related (p < 0.05). PMN activity by polarization was enhanced; however, the results did not show a significant relationship with the PMN infiltrations or the C3 deposits. The incidence of HLA-B51 was significantly high in BD, but no significant relationship was found between HLA-B51 and the results of other examinations. These results suggest that the pathogenesis of BD lesions differs from that of collagen diseases and that C3 deposits on the vessels may play an important role in the development of mucocutaneous lesions where PMN have mainly infiltrated.
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Affiliation(s)
- C Inoue
- Department of Dermatology, St. Marianna Univeristy School of Medicine, Kawasaki, Japan
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49
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Ueta E, Osaki T, Yoneda K, Yamamoto T, Kato I. A clinical trial of Azelastine in recurrent aphthous ulceration, with an analysis of its actions on leukocytes. J Oral Pathol Med 1994; 23:123-9. [PMID: 8021845 DOI: 10.1111/j.1600-0714.1994.tb01099.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Azelastine (azelastine hydrochloride) was orally administered to 43 patients with recurrent aphthous ulcers (RAU), and its clinical effects and in vitro influence on leukocytes were examined. During at least 6 months after drug treatment, no oral ulcers occurred in 7 patients, and an improvement of the oral condition was exhibited in all except 4 of the remaining patients. The frequency of occurrence of RAU was significantly reduced, from 1.7 +/- 0.9 to 0.9 +/- 0.5 times/month, and ulcer duration and oral irritation were also significantly reduced from 12.5 +/- 2.5 and 7.5 +/- 2.4 days to 9.8 +/- 2.6 and 5.3 +/- 2.4 days, respectively. Neutrophils from patients treated with Azelastine generated a suppressed volume of superoxide (O2-). Suppression of O2- generation and chemiluminescence by in vitro Azelastine was also confirmed to occur in a dose-dependent manner. Furthermore, the production of TNF-alpha and GM-CSF in lymphocytes was suppressed in the presence of Azelastine, and the drug protected sheep red blood cells and epithelial tumor cell lines against hydrogen peroxide impairment and hypotonic shock. These clinical and experimental results lead to the conclusion that improvement of RAU by Azelastine depends on the protection of cell membranes and the suppression of leukocyte-function, including reactive oxygen generation.
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Affiliation(s)
- E Ueta
- Department of Oral Surgery, Kochi Medical School, Japan
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50
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Ishii N, Isogai E, Yamakawa Y, Nakajima H, Ohno S, Isogai H, Hayashi S, Yokota K, Oguma K. Demonstration of antigen-specific immune response against Streptococcus sanguis. J Dermatol Sci 1993; 5:182-9. [PMID: 7694648 DOI: 10.1016/0923-1811(93)90765-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The genetic control of Streptococcus sanguis antigen response was studied. Mice sensitized with inactivated S. sanguis organisms antigen-injected at the base of the tail developed footpad swelling. Those with an I-Ak,q,r region of H-2 showed a strong footpad response, whereas those with an I-Ab,d,s region showed a weak response to S. sanguis cell wall antigen. Footpad response was mediated by CD4+,8- T cells by using in vitro monoclonal antibody treatment. Similar evidence of genetic control was obtained with an in vitro T cell proliferation assay. However, quantitation of antibodies against S. sanguis showed that antibody production was not controlled by H-2. These results indicated that both in vivo footpad swelling and in vitro T cell proliferation responses were functions of helper (CD3+,4+,8-) T cells and controlled by the I-A region of H-2.
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Affiliation(s)
- N Ishii
- Department of Dermatology, Yokohama City University School of Medicine, Japan
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