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Teshigawara T, Meguro A, Takeuchi M, Ishido M, Soejima Y, Hirahara L, Kirino Y, Ohno S, Mizuki N. Replication Study of the Association of GAS6 and PROS1 Polymorphisms with Behçet's Disease in a Japanese Population. Ocul Immunol Inflamm 2024; 32:447-453. [PMID: 37133403 DOI: 10.1080/09273948.2023.2173239] [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: 02/10/2022] [Accepted: 01/22/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate whether polymorphisms of GAS6 and PROS1, which each encode protein ligands for a family of tyrosine kinase receptors, are associated with Behçet's disease (BD) in a Japanese population. METHODS We recruited 734 Japanese patients with BD and 1789 Japanese healthy controls. In all participants, we genotyped two single-nucleotide polymorphisms (SNPs) reportedly associated with BD: rs9577873 in GAS6 and rs4857037 in PROS1. RESULTS We found that GAS6 rs9577873 was not significantly associated with BD. In contrast, PROS1 rs4857037, specifically the A allele, was associated with increased risk for BD. The A allele was also significantly associated with BD under additive and recessive genetic models. Expression analysis revealed that this allele was significantly associated with increased PROS1 expression. CONCLUSIONS Our findings suggest that increased PROS1 expression related to the A risk allele of rs4857037 affects tyrosine kinase receptor signaling, contributing to the development of BD.
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Affiliation(s)
- Takeshi Teshigawara
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Japan
- Department of Ophthalmology, Tsurumi Chuoh Eye Clinic, Yokohama, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mizuho Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Lisa Hirahara
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Wang X, Li C, Luo W, Zhang Y, Huang Z, Xu J, Mei H, Hu Y. IL-10 plus the EASIX score predict bleeding events after anti-CD19 CAR T-cell therapy. Ann Hematol 2023; 102:3575-3585. [PMID: 37814134 PMCID: PMC10640490 DOI: 10.1007/s00277-023-05477-y] [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: 03/29/2023] [Accepted: 09/24/2023] [Indexed: 10/11/2023]
Abstract
Chimeric antigen receptor (CAR) T-cell-associated coagulopathy can cause bleeding events. To explore risk factors for hemorrhage after CAR T-cell therapy, we retrospectively analyzed routine indicators in 56 patients with non-Hodgkin lymphoma and B-cell acute lymphoblastic leukemia who received anti-CD19 CAR T-cell therapy. Disturbance of coagulation occurred mainly within one month post infusion, especially on day 7 and 14. The cumulative incidence of bleeding events within one month was 32.8%, with the median onset of 7 (range, 0-28) days. All bleeding events were grade 1-3. Patients who experienced bleeding events within one month had longer prothrombin time, higher IL-6, higher IL-10, and lower platelets before lymphodepletion. There were also correlations among coagulation-, inflammatory-, and tumor burden-related markers. Multi-variate analysis showed IL-10 (> 7.98 pg/mL; adjusted odds ratio [OR], 13.84; 95% confidence interval [CI], 2.03-94.36; P = 0.007) and the endothelial activation and stress index (EASIX, defined as dehydrogenase [U/L] × creatinine [mg/dL] / platelets [×109 cells/L]; >7.65; adjusted OR, 7.06; 95% CI, 1.03-48.23; P = 0.046) were significant risk factors for bleeding events. IL-10 plus the EASIX defined three risk groups for bleeding events with cumulative incidence of 100% (hazard ratio [HR], 14.47; 95% CI, 2.78-75.29; P < 0.0001), 38.5% (HR, 3.68; 95% CI, 0.82-16.67; P = 0.089), and 11.8% (reference), respectively. Future studies are needed to verify the risk assessment models for bleeding events after CAR T-cell treatment in larger cohorts.
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Affiliation(s)
- Xindi Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Chenggong Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Wenjing Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Yinqiang Zhang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Zhongpei Huang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Jia Xu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan, 430022, China.
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Retinal microvasculature features in patients with Behcet's disease: a systematic review and meta-analysis. Sci Rep 2022; 12:752. [PMID: 35031636 PMCID: PMC8760269 DOI: 10.1038/s41598-021-04730-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/29/2021] [Indexed: 12/22/2022] Open
Abstract
This meta-analysis aimed to analyze retinal microvasculature features in eyes with Behçet's disease (BD) using optical coherence tomography angiography (OCTA). Electronic databases, including PubMed, Web of Science, Embase, and Cochrane Library, were comprehensively searched for published studies comparing retinal microvasculature characteristics between eyes with BD and controls. Continuous variables were calculated using the mean difference (MD) with 95% confidence interval (CI). Review Manager software (version 5.30) was used to conduct statistical analysis. A total of 13 eligible studies involving 599 eyes with BD and 622 control eyes were included in the meta-analysis. The pooled results showed that the macular whole enface superficial and deep vessel density (VD) values measured by OCTA were significantly lower in eyes with BD than in control eyes (superficial VD: MD = - 3.05, P < 0.00001; deep VD: MD = - 4.05, P = 0.0004). The foveal superficial and deep VD values were also significantly lower in the BD group than in the control group (superficial VD: MD = - 1.50, P = 0.009; deep VD: MD = - 4.25, - = 0.03). Similarly, the analysis revealed a significant reduction in the parafoveal superficial and deep VD in eyes with BD than in control eyes (superficial VD: MD = - 3.68, P < 0.00001; deep VD: MD = - 4.95, P = 0.0007). In addition, the superficial and deep foveal avascular zones (FAZs) were significantly larger in patients with BD than in controls (superficial FAZ: MD = 0.06, P = 0.02; deep FAZ: MD = 0.12, P = 0.03). The present meta-analysis found that macular whole enface VD, foveal VD, and parafoveal VD were lower in eyes with BD, and the FAZ was larger in patients with BD. The findings suggest that OCTA can assist clinicians in diagnosing and monitoring the status of patients with BD.
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Pei M, Zhao C, Gao F, Qu Y, Liang A, Xiao J, Zhang M. Analysis of Parafoveal Microvascular Abnormalities in Behcet's Uveitis Using Projection-Resolved Optical Coherence Tomographic Angiography. Ocul Immunol Inflamm 2019; 29:524-529. [PMID: 31743043 DOI: 10.1080/09273948.2019.1685108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: To assess the characteristics of parafoveal microvascular abnormalities in Behcet's uveitis (BDU) using projection-resolved optical coherence tomographic angiography (PR-OCTA).Methods: A retrospective study of BDU patients who underwent PR-OCTA examination between April 1, 2017 and October 31, 2018.Results: Sixty consecutive BDU patients (102 eyes) were included. Sixty-two (124 eyes) healthy subjects served as normal controls (NCs). As compared with NCs, the vessel densities (VDs) of superficial and deep retinal capillary plexuses were decreased, and the fovea avascular zone area, perimeter and acircularity index were increased in BDU eyes (all p < .001). Macular edema (p < .001) and long uveitis course (p = .033) were identified as risk factors for capillary disruptions. Consistent VD reductions were observed in the quiescent fellow eyes of BDU patients during unilateral uveitis relapse.Conclusions: BDU patients had significant OCTA changes. Macular circulatory disturbances may exist in the quiescent fellow eyes during unilateral BDU attack.
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Affiliation(s)
- Minghang Pei
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junyan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim JH, Lee KA, Jung MY, Kim AR, Yoon JM, Shim HJ, Lee SH, Kim HY, Kim HR. Pulmonary thromboembolism in patient with coexistence of Behçet's disease and antiphospholipid syndrome. Int J Rheum Dis 2018; 21:2188-2192. [DOI: 10.1111/1756-185x.12923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jun-Hyun Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Kyung-Ann Lee
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Min-Young Jung
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Ah-Ran Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Jeong-Min Yoon
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Hyoung-Joon Shim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Sang-Heon Lee
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
- Division of Rheumatology; Department of Internal Medicine; Konkuk University School of Medicine; Seoul Korea
| | - Ho-Youn Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
| | - Hae-Rim Kim
- Division of Rheumatology; Department of Internal Medicine; Konkuk University Medical Center; Seoul Korea
- Division of Rheumatology; Department of Internal Medicine; Konkuk University School of Medicine; Seoul Korea
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Yalçindağ F, YalçIndağ A, Çağlayan O, Özdemir Ö. Serum Haptoglobin Levels in Ocular Behçet Disease and Acute Phase Proteins in the Course of Behçet Disease. Eur J Ophthalmol 2018; 18:787-91. [DOI: 10.1177/112067210801800520] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Changes in concentrations of acute phase proteins in the serum of patients might be significant in the pathogenesis of Behçet disease. This report investigates the association between ocular disease activity and serum haptoglobin levels in patients with Behçet disease, and summarizes the current understanding of the correlation between acute phase proteins and Behçet disease based on both personal studies and data from the literature. Methods Thirty patients with Behçet disease with ocular involvement and 15 healthy subjects were included in the study. Of the 30 patients, 14 had acute uveitis and 16 had inactive ocular involvement at the time of enrollment. Results There was a significant difference in haptoglobin levels between the patients with active ocular disease and controls (p=0.0005). There was also a significant difference in haptoglobin levels between the patients with inactive ocular disease and control subjects (p<0.0001). However, no significant difference was observed among patients with active versus inactive uveitis with regard to serum haptoglobin levels. Conclusions Higher serum haptoglobin levels in patients with Behçet disease compared to control subjects were obtained. However, elevated serum haptoglobin levels do not seem to be a risk factor for uveitis activity. Behçet disease is generally diagnosed by physical examinations and no laboratory marker has been widely accepted for follow-up of disease activity.
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Affiliation(s)
- F.N. Yalçindağ
- Department of Ophthalmology, Ankara University, Faculty of Medicine, Ankara
| | - A. YalçIndağ
- Department of Clinical Biochemistry, Kirikkale University, Faculty of Medicine, Kirikkale - Turkey
| | - O. Çağlayan
- Department of Clinical Biochemistry, Kirikkale University, Faculty of Medicine, Kirikkale - Turkey
| | - Ö. Özdemir
- Department of Ophthalmology, Ankara University, Faculty of Medicine, Ankara
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Przeździecka-Dołyk J, Węgrzyn A, Turno-Kręcicka A, Misiuk-Hojło M. Immunopathogenic Background of Pars Planitis. Arch Immunol Ther Exp (Warsz) 2015; 64:127-37. [PMID: 26438050 PMCID: PMC4805694 DOI: 10.1007/s00005-015-0361-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/29/2015] [Indexed: 12/14/2022]
Abstract
Pars planitis is defined as an intermediate uveitis of unknown background of systemic disease with characteristic formations such as vitreous snowballs, snowbanks and changes in peripheral retina. The incidence of pars planitis varies 2.4–15.4 % of the uveitis patients. The pathogenesis of the disease is to be determined in future. Clinical and histopathological findings suggest an autoimmune etiology, most likely as a reaction to endogenous antigen of unknown source, with T cells predominant in both vitreous and pars plana infiltrations. T cells subsets play an important role as a memory-effector peripheral cell. Snowbanks are formed as an effect of post inflammatory glial proliferation of fibrous astrocytes. There is also a genetic predisposition for pars planitis by human leukocyte antigen and several other genes. A coexistence of multiple sclerosis and optic neuritis has been described in numerous studies. Epiretinal membrane, cataract, cystoid macular edema, retinal detachment, retinal vasculitis, neovascularization, vitreous peripheral traction, peripheral hole formation, vitreous hemorrhage, disc edema are common complications observed in pars planitis. There is a need to expand the knowledge of the pathogenic and immunologic background of the pars planitis to create an accurate pharmacological treatment.
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Affiliation(s)
- Joanna Przeździecka-Dołyk
- Department and Clinic of Ophthalmology, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland.
| | - Agnieszka Węgrzyn
- Department of Internal Medicine, Jagiellonian University, Kraków, Poland
| | - Anna Turno-Kręcicka
- Department and Clinic of Ophthalmology, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Marta Misiuk-Hojło
- Department and Clinic of Ophthalmology, Wroclaw Medical University, Borowska 213, 50-556, Wrocław, Poland
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Alkaabi JK, Gravell D, Al-Haddabi H, Pathare A. Haemostatic Parameters in Patients with Behçet's Disease. Sultan Qaboos Univ Med J 2014; 14:e190-e196. [PMID: 24790741 PMCID: PMC3997535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/11/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the cause of thrombosis in Behçet's disease (BD) patients, since abnormalities in coagulation and fibrinolytic parameters have shown contradictory results. METHODS Haemostatic parameters were retrospectively evaluated in BD patients treated between January 2007 and January 2011 at Sultan Qaboos University Hospital, Oman. The blood samples of 35 Omani BD patients and 30 healthy controls were analysed for factor VIII:C levels, activated protein C resistance (APCR), von Willebrand factor (vWF) antigens (Ag), collagen binding and ristocetin co-factor activity (RiCoF), antithrombin (AT), protein C (chromogenic and clotting), protein S, homocysteine, tissue plasminogen activator, plasminogen activator inhibitor, plasminogen, alpha 2-antiplasmin, lupus anticoagulant and anticardiolipin and beta2-glycoprotein-1 antibodies. RESULTS The mean values of factor VIII:C, vWF Ag, AT and protein S were significantly higher in the patient group (P = 0.01, 0.006, 0.04 and 0.01, respectively). There was no deficiency in protein C. Screening for APCR, anticardiolipin antibodies, anti-beta2-glycoprotein-1 antibodies and lupus anticoagulant was negative and there were no differences in homocysteine levels, nor were there differences between patients with and without thrombosis. Six patients had elevated factor VIII:C levels (>150 IU/dL, P <0.02) which normalised on repeat measurements after three months. CONCLUSION The elevation of factors VIII:C, vWF Ag and AT most likely represent an acute phase phenomenon. In this study, thrombophilic factors did not seem to explain thrombotic tendency. Therefore, further mechanistic studies in a larger group of patients are needed to elucidate the basis for thrombosis in BD. We hypothesise that active BD causes vasculitic endothelial perturbation with dysfunction, leading to the observed increased propensity for thrombosis.
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Affiliation(s)
- Juma K. Alkaabi
- Rheumatology Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - David Gravell
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamood Al-Haddabi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
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Benhamou Y, Bellien J, Armengol G, Gomez E, Richard V, Lévesque H, Joannidès R. [Assessment of endothelial function in autoimmune diseases]. Rev Med Interne 2014; 35:512-23. [PMID: 24412013 DOI: 10.1016/j.revmed.2013.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 11/07/2013] [Accepted: 12/02/2013] [Indexed: 11/15/2022]
Abstract
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to an increase in cardiovascular disease incidence. In addition to traditional cardiovascular risk factors, endothelial dysfunction is an important early event in the pathogenesis of atherosclerosis, contributing to plaque initiation and progression. Endothelial dysfunction is characterized by a shift of the actions of the endothelium toward reduced vasodilation, a proinflammatory and a proadhesive state, and prothrombic properties. Therefore, assessment of endothelial dysfunction targets this vascular phenotype using several biological markers as indicators of endothelial dysfunction. Measurements of soluble adhesion molecules (ICAM-1, VCAM-1, E-selectin), pro-thrombotic factors (thrombomodulin, von Willebrand factor, plasminogen activator inhibitor-1) and inflammatory cytokines are most often performed. Regarding the functional assessment of the endothelium, the flow-mediated dilatation of conduit arteries is a non-invasive method widely used in pathophysiological and interventional studies. In this review, we will briefly review the most relevant information upon endothelial dysfunction mechanisms and explorations. We will summarize the similarities and differences in the biological and functional assessments of the endothelium in different autoimmune diseases.
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Affiliation(s)
- Y Benhamou
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France.
| | - J Bellien
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - G Armengol
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - E Gomez
- Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - V Richard
- Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - H Lévesque
- Département de médecine interne, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
| | - R Joannidès
- Service de pharmacologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France; Inserm U 1096, faculté de médecine de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France
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Barić Rafaj R, Kuleš J, Selanec J, Vrkić N, Zovko V, Zupančič M, Trampuš Bakija A, Matijatko V, Crnogaj M, Mrljak V. Markers of coagulation activation, endothelial stimulation, and inflammation in dogs with babesiosis. J Vet Intern Med 2013; 27:1172-8. [PMID: 23875771 DOI: 10.1111/jvim.12146] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 04/30/2013] [Accepted: 06/06/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Babesia infections in dogs can result in a wide range of clinical and laboratory presentations, including coagulopathy. Expression of intercellular adhesion molecule-1 (ICAM-1) and von Willebrand factor (vWF) in dogs with babesiosis is unknown. OBJECTIVES Whether inflammation in babesiosis triggers activation of ICAM-1 and the coagulation system. ANIMALS Twelve and 10 dogs with naturally occurring babesiosis before and after antiparasitic treatment, respectively, were compared with 10 healthy dogs. METHODS In this prospective study, diagnosis was made by blood smear examination and confirmed by PCR. C-reactive protein (CRP), soluble intercellular adhesion molecule 1 (sICAM-1), and von Willebrand factor (vWF) levels were measured by a canine ELISA kit, fibrinogen (FIB) and factor VIII activity levels were measured by coagulometric methods, and blood cell counts (WBC, RBC, PLT) were determined with an automatic analyzer. RESULTS Compared to healthy dogs, the CRP, sICAM-1, and FIB concentrations were significantly increased before therapy and remained high for 3 days after therapy in dogs with babesiosis. vWF activity was significantly decreased in dogs with babesiosis before treatment. FVIII activity did not differ between dogs with babesiosis and healthy dogs. WBC; RBC and PLT were significantly lower before treatment and normalized by 3 days after treatment. CONCLUSION AND CLINICAL IMPORTANCE A proinflammatory condition in babesiosis appears to influence endothelial dysfunction and hemostatic activity. Although clearly beneficial for the parasite, sequestered blood cells can obstruct blood flow in small vessels, promote an inflammatory state, and could increase the severity of babesiosis.
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Affiliation(s)
- R Barić Rafaj
- Department of Chemistry and Biochemistry, Faculty of Veterinary Medicine, Zagreb, Croatia
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Fernández-Bello I, López-Longo FJ, Arias-Salgado EG, Jiménez-Yuste V, Butta NV. Behçet's disease: new insight into the relationship between procoagulant state, endothelial activation/damage and disease activity. Orphanet J Rare Dis 2013; 8:81. [PMID: 23711081 PMCID: PMC3669042 DOI: 10.1186/1750-1172-8-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/21/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Behçet disease (BD) is associated with a prothrombotic state of unknown origin that may lead to life-threatening events. Calibrated Automated Thrombogram (CAT) and Rotational Thromboelastometry (ROTEM) are two global haemostasis assays that may reveal new insights into the physiopathological mechanisms of the disease and its procoagulant condition. METHODS 23 BD patients who had no signs or symptoms of current thrombosis and 33 age- and sex-matched controls were included in the study. We performed ROTEM and CAT tests and assessed erythrocyte count, platelet count, platelet contribution to clot formation and plasma levels of tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), fibrinogen, C-reactive protein (CRP), thrombin-antithrombin III complex (TAT), D-dimer and E-selectin (ES). RESULTS Both ROTEM and CAT tests showed a hypercoagulable state in the BD patients. Plasma levels of PAI-1, fibrinogen, TAT, CRP and ES were significantly increased in this group compared to controls. The disease activity (DA) was significantly correlated with levels of ES and the maximum clot firmness, and this last one, in turn, correlated with rising levels of ES, PAI-1, CRP and fibrinogen. CAT parameters did not correlate with DA or ES. CONCLUSIONS Both ROTEM and CAT tests reveal that patients with BD have a procoagulant state even in the absence of thrombosis. ROTEM test indicates that increased levels of fibrinogen and PAI-1 may be involved in the prothrombotic state of this pathology, while platelets do not significantly contribute. Moreover, CAT assay demonstrate that plasma from BD patients is able to generate more thrombin than controls in response to the same stimulus and that this effect is independent of the DA and the endothelial impairment suggesting the involvement of another factor in the hypercoagulable state observed in BD patients. This study also shows that endothelium activation/damage may be a contributing factor in both the procoagulant and clinical conditions of BD, as shown by the direct correlation between ES levels, ROTEM parameters and DA.
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Association of allelic variants of factor V Leiden, prothrombin and methylenetetrahydrofolate reductase with thrombosis or ocular involvement in Behçet's disease: a systematic review and meta-analysis. Autoimmun Rev 2012. [PMID: 23207285 DOI: 10.1016/j.autrev.2012.11.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Thrombosis is frequent in patients with Behçet's disease (BD), although the exact cause remains uncertain. Some single nucleotide polymorphism (SNP) (G1691A in factor V gene, also called factor V Leiden [FVL], G20210A in prothrombin gene and C677T in methyltetrahydrofolate reductase [MTHFR] gene) have been associated with thrombosis and ocular involvement in BD with controversial results. AIM To assess the effects of FVL, prothrombin and MTHFR SNP variants in patients with BD and thrombosis and ocular involvement by means of a systematic review and meta-analysis. METHODS We retrieved studies analyzing the genotype of the above-mentioned polymorphism among patients with BD. A meta-analysis was conducted in a random effects model and calculations of odds ratio (OR) and confidence intervals (CI) were done. Sensitivity analysis and tests for heterogeneity of the results were performed. RESULTS 27 previous studies analyzed the association of BD and thrombosis with the FVL, prothrombin and MTHFR polymorphisms. A significant association was found between the possession of the AA or GA genotypes of FVL polymorphism among patients with BD and the presence of any thrombosis (OR=2.51; 95% CI: 1.68, 3.74; P<0.00001). In addition, a significant association was found between the possession of the GA or AA genotypes and the presence of BD (OR=2.67; 95% CI: 1.93. 3.72; P<0.00001) when cases with BD and healthy controls were compared. This association was not found when studies from Turkey were excluded. No association was found between prothrombin and MTHFR SNPs and thrombosis in BD, and no association between any SNP and ocular involvement was shown either. CONCLUSIONS Factor V Leiden could be responsible for some thrombotic events in at least Turkish patients. However, this relationship has to be demonstrated from a pathogenic point of view.
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Serum vitronectin levels in patients with Behçet’s disease. Inflamm Res 2012; 61:1241-6. [DOI: 10.1007/s00011-012-0521-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 06/06/2012] [Accepted: 06/22/2012] [Indexed: 11/26/2022] Open
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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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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behçet's Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010; 4:71-7. [PMID: 20360979 PMCID: PMC2847254 DOI: 10.2174/1874192401004020071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/23/2009] [Accepted: 12/12/2009] [Indexed: 01/11/2023] Open
Abstract
Behçet's disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow's triad of venous thrombosis. Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Periodic Fevers Research Centre, Catholic University, Rome, Italy
| | | | | | - Domenico Prisco
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Regina ML, Gasparyan AY, Orlandini F, Prisco D. Behçet’s Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010. [DOI: 10.2174/1874192401004010071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%.
In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow’s triad of venous thrombosis.
Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Nowatzky J, Chajek-Shaul T. Biomarkers in Behçet’s disease: diagnosis and disease activity. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Sezer I, Melikoglu MA, Çay HF, Kocabaş H, Bütün B. Superior vena cava syndrome associated with Behcet’s disease and 18 months’ follow up: a case report. Rheumatol Int 2008; 28:807-9. [DOI: 10.1007/s00296-008-0517-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 12/16/2007] [Indexed: 10/22/2022]
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Souza RC, Lage L, Goldesntein-Schainberg C, Macedo AR, Carrasco S, Gonçalves CR. Anti-endothelial cell antibodies and central nervous system involvement in Behçet's disease. Clinics (Sao Paulo) 2007; 62:685-90. [PMID: 18209908 DOI: 10.1590/s1807-59322007000600005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 08/08/2007] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Previous studies have detected the presence of anti-endothelial cell antibodies (AECA) in patients with Behçet's disease (BD). However, no real evidence exists whether these antibodies exert any influence on clinical presentation and/or activity of this disease. OBJECTIVES To determine the frequency of AECA in patients with BD and analyze possible clinical associations. METHODS 50 patients with BD who fulfilled diagnostic criteria were selected. Thirty-seven patients were females, and 13 were males; the mean age was 44 +/- 9 years with a mean follow-up time of 10 +/- 7.5 years. AECA were assayed by ELISA using ECV-304 cells as the antigenic substrate. The prevalence of AECA was determined, and their possible relationships with present and past clinical features were investigated. RESULTS AECA were detected in the sera of 38% of the patients (IgG in 13, IgM in four, and IgG plus IgM in two). An association was observed between AECA and a previous history of central nervous system involvement (OR= 5.4, p= 0.03). This association was more evident for IgG-AECA (OR= 6.0, p= 0.02). A trend of an increased risk of aneurysms was also observed in patients with IgG-AECA (OR= 2.58, p= 0.77). None of the other clinical characteristics showed a relevant association with these antibodies. CONCLUSION Our data suggest that IgG-AECA may be a marker of more severe lesions in patients with BD based on the higher frequency of previous central nervous system manifestations in patients who presently display circulating AECA.
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Affiliation(s)
- Romy Christmann Souza
- Department of Internal Medicine, Rheumatology Clinic, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Ahn JK, Lee YS, Jeon CH, Koh EM, Cha HS. Treatment of venous thrombosis associated with Behcet’s disease: immunosuppressive therapy alone versus immunosuppressive therapy plus anticoagulation. Clin Rheumatol 2007; 27:201-5. [PMID: 17636362 DOI: 10.1007/s10067-007-0685-z] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 05/30/2007] [Accepted: 06/19/2007] [Indexed: 11/25/2022]
Abstract
The aim of this study was to compare the efficacy of immunosuppressive therapy alone with that of combination therapy involving immunosuppressants and anticoagulation for the treatment of venous thrombosis in Behcet's disease (BD). A retrospective analysis was made of 37 patients with venous thrombosis in BD. BD patients with venous thrombosis were divided into three groups: one group (N = 16) received immunosuppressive therapy alone, another group (N = 17) received immunosuppressant and anticoagulation combination therapy, and the third group (N = 4) received anticoagulation therapy only. Clinical and laboratory parameters and the recurrence of venous thrombosis were assessed. Venous thrombosis in BD appeared to have a more diffuse pattern than idiopathic type and a predilection for lower limbs. The most commonly involved sites were the superficial and common femoral veins. Recurrence of venous thrombosis occurred in two cases in the immunosuppressant group (12.5%), one case in the combination therapy group (5.9%), and three cases in the anticoagulant group (75%). No significant difference was found between recurrence in the immunosuppressant and combination therapy groups. Acute phase reactants were elevated in all six patients at the time of venous thrombosis recurrence. Our study suggests that immunosuppressive therapy is essential and that anticoagulation therapy might not be required for the treatment of deep venous thrombosis associated with BD.
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Affiliation(s)
- Joong Kyong Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, South Korea
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Abstract
PURPOSE OF REVIEW To summarize general concepts of Behçet's disease, as well as present recent scientific developments in delineating the pathogenesis and treatment of this disorder. RECENT FINDINGS Large, long-term follow-up studies on patients with Behçet's disease have shown improved visual outcomes in recent years when compared with decades ago, presumably due to the more aggressive use of immunosuppressive agents. Increased T-helper cell type 1 activity and increased hypercoagulability continue to be a focus of research into the pathogenesis of the disease. Advanced oxidation protein products and a Behçet's disease activity index may be useful tools for following disease activity. Finally, studies of new treatment modalities, particularly infliximab, interferon-alpha and granulocytapheresis, have reported encouraging results. SUMMARY Historically a scourge among uveitic disorders, there is new hope for improved long-term visual outcomes in patients with Behçet's disease based on recent scientific advances.
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Affiliation(s)
- Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
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25
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Abstract
Behçet's disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and ocular inflammation. The disease may also involve the joints, skin, central nervous system, the lungs, and gastrointestinal tract. Ocular manifestations include anterior uveitis, posterior uveitis, macular edema, retinal vasculitis, conjunctival ulcers, optic neuropathy, papilledema, secondary glaucoma, cataract, and neovascularization of iris or retina. The cause of Behçet's disease is unknown, but autoimmune and genetic factors are considered important in its pathogenesis. Promising new imaging techniques and treatments are available to provide better management for patients. This review focuses on recent data on visual aspects, pathogenesis, and the treatment of Behçet's disease.
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Affiliation(s)
- Tulay Kansu
- Department of Neurology-Neuro-Ophthalmology Unit, Hacettepe University, School of Medicine, Ankara 06100, Turkey.
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26
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Ozkul Y, Evereklioglu C, Borlu M, Taheri S, Calis M, Dündar M, Ilhan O. 5,10-Methylenetetrahydrofolate reductase C677T gene polymorphism in Behcet's patients with or without ocular involvement. Br J Ophthalmol 2005; 89:1634-7. [PMID: 16299146 PMCID: PMC1772966 DOI: 10.1136/bjo.2005.076836] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increased serum levels of homocysteine (Hcy) have been reported in patients with Behçet's disease (BD) with an established risk factor for vascular involvement. Recently, the authors demonstrated that elevated Hcy levels are associated with ocular involvement in such patients. On the other hand, elevated levels of Hcy can result from genetic errors. Indeed, a mutation in the 5,10-methylenetetrahydrofolate reductase (MTHFR C677T) gene influences Hcy metabolism and, therefore, MTHFR C677T polymorphism provokes hyperhomocysteinaemia. AIM To investigate the possible genetic factor for the elevation of plasma Hcy level in patients with BD by examining gene interaction with the MTHFR C677T polymorphism, a crucial factor of the Hcy metabolism. In addition, the authors aimed to evaluate if there is an association between the C677T polymorphism and the presence of ocular involvement in such patients. METHOD A total of 59 patients with BD (25 men, 34 women) with a mean age of 34.9 years and 42 age and sex matched healthy control subjects (19 men, 23 women; mean age 32.2) were included in this investigation. MTHFR gene polymorphism was investigated by the polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) of a genomic DNA fragment at nucleotide 677 in all subjects in both groups. The genetic equilibrium is assumed for the gene frequencies of the MTHFR polymorphism in both samples. RESULTS The genotype of the MTHFR gene differed between the Behçet's patients and control subjects (TT: 11.9 v 2.4%; CT: 55.9 v 61.9%; CC: 32.2 v 35.7 %). TT homozygous genotype was more frequently in BD patients than the controls, though the difference was not significant (p = 0.063). In BD patients with ocular involvement, however, the frequencies of MTHFR TT homogenetic type (27.8%) were significantly and statistically higher than those in BD patients without ocular involvement (4.9%, p = 0.022, odds ratio = 7.5), or the controls (2.4%, p = 0.003, odds ratio = 20.0). TT homozygous genotype was associated with an increased risk for ocular involvement. CONCLUSION Elevated serum levels of Hcy seem to be a result of C677T polymorphism of the MTHFR gene, with increased TT individuals over CC and CT genotype BD patients. Although no association was shown between the MTHFR reductase C677T polymorphism and the increased risk of oral aphtahe or genital ulcers, a mutation in this gene was associated with an increased risk of ocular involvement, suggesting genetic instability with a potential initiation of Hcy lowering therapy in this patient group.
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Affiliation(s)
- Y Ozkul
- Sivas Cad Cebeci Apt A-Blok, 175/15, TR-38020, Kayseri, Turkey
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27
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Abstract
Behçet's disease is a systemic vasculitis characterized by recurrent oral and genital ulcers and ocular inflammation. The disease may also involve the joints, skin, central nervous system, the lungs, and gastrointestinal tract. Ocular manifestations include anterior uveitis, posterior uveitis, macular edema, retinal vasculitis, conjunctival ulcers, optic neuropathy, papilledema, secondary glaucoma, cataract, and neovascularization of iris or retina. The cause of Behçet's disease is unknown but autoimmune and genetic factors are considered important in its pathogenesis. Promising new imaging techniques and treatments are available to provide better management for patients. This review focuses on recent data on visual aspects, pathogenesis, and the treatment of Behçet's disease.
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Affiliation(s)
- Tulay Kansu
- Department of Neurology-Neuro-ophthalmology Unit, Hacettepe University, School of Medicine, Ankara 06100, Turkey.
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28
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Darie C, Knezinsky M, Demolombe-Rague S, Pinède L, Périnetti M, Ninet JF, Ninet J. Pseudotumeur cardiaque révélant une maladie de Behçet. Rev Med Interne 2005; 26:420-4. [PMID: 15893034 DOI: 10.1016/j.revmed.2004.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2004] [Accepted: 12/30/2004] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac thrombosis is a rare complication of Behçet's disease (BD), which may present as a cardiac tumor. Its discovery precedes, in half of the cases, the diagnosis of BD. The high mortality may be associated to postsurgical complications and/or an associated involvement of pulmonary arteries. CASE REPORT We present the case of a 31 years old Caucasian French woman, with a history of venous thromboembolic disease, who had surgery after the discovery of a right ventricle tumor. That was an organised thrombus with endomyocardial fibrosis and a diagnosis of Behçet's disease was made after the surgery. The outcome was favourable under medical treatment associating corticosteroids, colchicine and antivitamin K (AVK), without relapse four years later. CONCLUSION The discovery of an intracardiac mass in a young patient must evoke the diagnosis of cardiac thrombus and Behçet's disease, even in the absence of predisposing ethnic or geographic factor.
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Affiliation(s)
- C Darie
- Service de médecine interne, hôpital Edouard-Herriot, 5, place Arsonval, 69003 Lyon, France.
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Bacon PA. Endothelial cell dysfunction in systemic vasculitis: new developments and therapeutic prospects. Curr Opin Rheumatol 2005; 17:49-55. [PMID: 15604904 DOI: 10.1097/01.bor.0000149084.16639.b0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The role of the endothelium as an active player rather than a passive victim of inflammation has received considerable interest in atherosclerosis, but less so in systemic vasculitis (SV). However, the accumulating multi-organ damage seen in SV probably includes the endothelium. Assessment of endothelial function is now a standard clinical research tool in cardio-vascular departments. The exciting insights provided by their application to SV, in both primary disease and connective tissue diseases (CTD), is reviewed here. RECENT FINDINGS Diffuse endothelial cell dysfunction (ECD) documented by several techniques occurs commonly in adult and childhood SV. Similar ECD is also seen in CTD. The mechanisms probably relate to inflammatory cytokines such as TNF. The particular role of vasculitic, as opposed to synovial or internal organ inflammation, may be release of secondary mediators directly into the blood stream- whence they can reach distant endothelial beds to induce this diffuse ECD. SUMMARY Endothelial injury is the first step in atherosclerosis, where peripheral abnormalities correlate with coronary artery responses. The diffuse ECD in CTD suggests that vascular inflammation may initiate the accelerated CVS disease there. The new findings of similar ECD in primary SV predicts enhanced atherosclerosis here too. In Kawasaki syndrome, persistent late ECD correlates with abnormal coronary responses. In adult SV, initial data also suggests increased subclinical atherosclerosis. The role of endothelial function in the clinical outcome of SV deserves more attention. Research to pinpoint the mechanisms of ECD should lead to more specific therapies that may ameliorate the continuing late morbidity and mortality of SV.
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Affiliation(s)
- P A Bacon
- Department of Rheumatology, Division of Immunity and Infection, Medical School, University of Birmingham, Edgbaston, UK.
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Abstract
PURPOSE OF REVIEW The ophthalmologist has direct visual access to inflamed vessels when examining the retina, and "vasculitis" in ophthalmology has so far mainly referred to retinal vasculitis. In the past few years the means to explore vasculitis in the ocular sphere have improved. Indocyanine green angiography now enables the analysis of choroidal inflammatory vasculopathy as well as vasculitis of the sclera (scleritis) and episclera (episcleritis) in addition to retinal vasculitis. Because vasculitis detected by the ophthalmologist can be the presenting sign of a systemic disease and has to be approached in a multidisciplinary fashion, the emerging term "ocular vasculitis," instead of retinal vasculitis, should be used in the future. The term covers vasculitis affecting all structures of the eye and the periocular tissues as detailed in this article. The ocular findings have to be integrated within the established and accepted classification of systemic vasculitis, which is divided into primary vasculitides, where the vessel itself is the target of the inflammatory reaction, and secondary vasculitides, caused by other inflammatory processes. This review will deal with recently published articles on ocular vasculitis, including its clinical aspects, its link with systemic diseases, and its investigation and management. The discussion will be conducted within the framework of the new classification put forward here. RECENT FINDINGS Novel imaging techniques such as indocyanine green angiography have made it possible to explore inflammation of choroidal vessels and of scleral vasculitis in addition to retinal vasculitis, contributing to the global concept of ocular vasculitis. It has been shown, in particular, that the choriocapillaris, a vascular structure adjacent to the retina, can be the site of a primary inflammatory vasculopathy unrecognized so far. Most of the recent articles cited, however, deal not so much with new findings but with the integration of ocular pathologic changes into the systemic diseases they are part of. New knowledge about disease mechanisms and novel therapeutic modalities with biologic agents cited in this review are coming from other fields but have contributed to progress in the management of ocular vasculitis. SUMMARY New investigational techniques of vasculitis in ocular structures other than the retina have contributed to the development of the global concept of ocular vasculitis. This review shows the importance of promoting a comprehensive and global classification of ocular vasculitis compatible with the concepts accepted for systemic vasculitis to contribute to its multidisciplinary approach.
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Affiliation(s)
- Carl P Herbort
- Inflammatory Eye Diseases, La Source Eye Centre, and University of Lausanne, Lausanne, Switzerland.
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Abstract
PURPOSE OF REVIEW Large vessel vasculitis occurs in a subgroup of patients with Behçet disease at high risk for disease-related morbidity and mortality. Recognition of patients at risk, early detection of vasculitis, and the need for aggressive treatment are essential for optimal care of these patients. The authors review the clinical spectrum and management of large vessel problems in Behçet disease, highlighting contributions over the past year. RECENT FINDINGS Vasculo-Behçet patients are at risk for multiple vessel-related complications including thromboses, stenoses, occlusions, and aneurysms. A number of factors may contribute to thrombosis in individual cases, but the primary reason for clot seems to reside in the inflammatory process in the arterial wall, still incompletely understood. An appreciation for the challenges in the perioperative period requires the joint efforts of physicians and surgeons, and fuels the study of alternate, less invasive procedures for Behçet patients. SUMMARY Because of earlier recognition, aggressive medical treatment, and novel surgical procedures, the morbidity and mortality of large vessel vasculitis in Behçet disease are beginning to change. In the absence of controlled treatment studies, reports of clinical experience remain an important source of information for clinicians. Identification of patients at risk for vascular complications remains a priority.
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