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Bazewicz M, Heissigerova J, Pavesio C, Willermain F, Skrzypecki J. Ocular sarcoidosis in adults and children: update on clinical manifestation and diagnosis. J Ophthalmic Inflamm Infect 2023; 13:41. [PMID: 37721575 PMCID: PMC10507006 DOI: 10.1186/s12348-023-00364-z] [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: 05/07/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
Sarcoidosis-associated uveitis, is the predominant ocular sarcoidosis presentation, which affects both adults and children. For adults, international ocular sarcoidosis criteria (IWOS) and sarcoidosis-associated uveitis criteria (SUN) are defined. However, for children they are not yet established internationally. Due to the specificity of pediatric manifestations of sarcoidosis, this task is even more challenging. In children, sarcoidosis is subdivided into Blau syndrome and early-onset sarcoidosis (BS/EOS) affecting younger children (< 5 years) and the one affecting older children with clinical presentation resembling adults. Differential diagnosis, clinical work-up as well as diagnostic criteria should be adapted to each age group. In this article, we review the clinical manifestation of sarcoidosis-associated uveitis in adults and children and the sensitivity and specificity of various ocular sarcoidosis diagnostic modalities, including chest X-ray and CT, FDG PET-CT, gallium-67 scintigraphy, bronchoalveolar lavage fluid, genetic testing for NOD2 mutations and serum biomarkers, such as ACE, lysozyme and IL2R.
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Affiliation(s)
- Magdalena Bazewicz
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital, National Health Service Foundation Trust London, London, UK
- University College London, London, UK
| | - François Willermain
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Janusz Skrzypecki
- Department of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
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Yadav S, Kumar R, Kumar R, Sagar P. Fungal central skull-base osteomyelitis: atypical presentation and management issues. BMJ Case Rep 2021; 14:e243530. [PMID: 34531233 PMCID: PMC8449942 DOI: 10.1136/bcr-2021-243530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/03/2022] Open
Abstract
Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.
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Affiliation(s)
- Sanjeev Yadav
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajeev Kumar
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rakesh Kumar
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prem Sagar
- Otorhinolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Lahtela E, Kankainen M, Sinisalo J, Selroos O, Lokki ML. Exome Sequencing Identifies Susceptibility Loci for Sarcoidosis Prognosis. Front Immunol 2019; 10:2964. [PMID: 31921204 PMCID: PMC6937869 DOI: 10.3389/fimmu.2019.02964] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
Many sarcoidosis-associating immunological genes have been shown to be shared between other immune-mediated diseases. In Finnish sarcoidosis patients, good prognosis subjects more commonly have HLA-DRB1*03:01 and/or HLA-DRB1*04:01-DPB1*04:01 haplotype, but no marker for persistent disease have been found. The objective was to further pinpoint genetic differences between prognosis subgroups in relation to the HLA markers. Whole-exome sequencing was conducted for 72 patients selected based on disease activity (resolved disease, n = 36; persistent disease, n = 36). Both groups were further divided by the HLA markers (one/both markers, n = 18; neither of the markers, n = 18). The Finnish exome data from the Genome Aggregation Database was used as a control population in the WES sample. Statistical analyses included single-variant analysis for common variants and gene level analysis for rare variants. We attempted to replicate associated variants in 181 Finnish sarcoidosis patients and 150 controls. An association was found in chromosome 1p36.21 (AADACL3 and C1orf158), which has recently been associated with sarcoidosis in another WES study. In our study, variations in these genes were associated with resolved disease (AADACL3, p = 0.0001 and p = 0.0003; C1orf158, p = 7.03E-05). Another interesting chromosomal region also peaked, Leucocyte Receptor Complex in 19q13.42, but the association diminished in the replication sample. In conclusion, this WES study supports the previously found association in the region 1p36.21. Furthermore, a novel to sarcoidosis region was found, but additional studies are warranted to verify this association.
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Affiliation(s)
- Elisa Lahtela
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Matti Kankainen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland.,Medical and Clinical Genetics, Helsinki University Hospital, University of Hesinki, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Marja-Liisa Lokki
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
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Prediction of Disordered Regions and Their Roles in the Anti-Pathogenic and Immunomodulatory Functions of Butyrophilins. Molecules 2018; 23:molecules23020328. [PMID: 29401697 PMCID: PMC6017450 DOI: 10.3390/molecules23020328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 12/13/2022] Open
Abstract
Butyrophilins (BTNs) are a group of the moonlighting proteins, some members of which are secreted in milk. They constitute a large family of structurally similar type 1 transmembrane proteins from the immunoglobulin superfamily. Although the founding member of this family is related to lactation, participating in the secretion, formation and stabilization of milk fat globules, it may also have a cell surface receptor function. Generally, the BTN family members are known to modulate co-stimulatory responses, T cell selection, differentiation, and cell fate determination. Polymorphism of these genes was shown to be associated with the pathology of several human diseases. Despite their biological significance, structural information on human butyrophilins is rather limited. Based on their remarkable multifunctionality, butyrophilins seem to belong to the category of moonlighting proteins, which are known to contain intrinsically disordered protein regions (IDPRs). However, the disorder status of human BTNs was not systematically investigated as of yet. The goal of this study is to fill this gap and to evaluate peculiarities of intrinsic disorder predisposition of the members of human BTN family, and to find if they have IDPRs that can be attributed to the multifunctionality of these important proteins.
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Lahtela E, Wolin A, Pietinalho A, Lokki ML, Selroos O. Disease marker combination enhances patient characterization in the Finnish sarcoidosis patients. Respir Med 2017; 132:92-94. [PMID: 29229112 DOI: 10.1016/j.rmed.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 11/26/2022]
Abstract
Sarcoidosis is an inflammatory disease of unknown etiology and multiple clinical phenotypes. Clinical manifestations range from asymptomatic disease to severe loss-of-function leading to the hypothesis that sarcoidosis might not be just one disease, but consists of several distinct disease entities each with potentially distinct genetic associations. We have previously demonstrated that in our series HLADRB1* 03:01 and haplotype HLA-DRB1*04:01-DPB1*04:01 are associated with good prognosis sarcoidosis. In our recent work, we found a novel SNP (rs9905945) in the 5'upstream region of the ACE gene to be associated with favorable disease prognosis as well. The main objective of this study was to expand the previous results and analyse combined influence of the found ACE SNP rs9905945 with the protective HLA markers HLADRB1* 03:01 and HLA-DRB1*04:01-DPB1*04:01 in 188 Finnish sarcoidosis patients (resolved disease, n = 90; persistent disease, n = 98). When combining the frequencies of the rs9905945 and of the HLA markers, the strongest association was found for a combination of either/or both HLA markers and rs9905945 for good disease prognosis (37.1% in resolved vs. 11.3% in persistent, p < 0.001, OR = 4.61, (95%CI 2.15-9.86)). In conclusion, we discovered that a combination of the ACE SNP rs9905945 and HLA markers enhance the accuracy for predicting disease course in Finnish sarcoidosis patients further characterizing genetic differences between Finnish sarcoidosis patients with different prognosis.
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Affiliation(s)
- E Lahtela
- Transplantation Laboratory, Medicum, University of Helsinki, Finland.
| | - A Wolin
- Transplantation Laboratory, Medicum, University of Helsinki, Finland
| | - A Pietinalho
- Raasepori Health Care Centre, Raasepori, Finland
| | - M-L Lokki
- Transplantation Laboratory, Medicum, University of Helsinki, Finland
| | - O Selroos
- University of Helsinki, Helsinki, Finland
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Vona B, Nanda I, Shehata-Dieler W, Haaf T. Genetics of Tinnitus: Still in its Infancy. Front Neurosci 2017; 11:236. [PMID: 28533738 PMCID: PMC5421307 DOI: 10.3389/fnins.2017.00236] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/10/2017] [Indexed: 12/20/2022] Open
Abstract
Tinnitus is the perception of a phantom sound that affects between 10 and 15% of the general population. Despite this considerable prevalence, treatments for tinnitus are presently lacking. Tinnitus exhibits a diverse array of recognized risk factors and extreme clinical heterogeneity. Furthermore, it can involve an unknown number of auditory and non-auditory networks and molecular pathways. This complex combination has hampered advancements in the field. The identification of specific genetic factors has been at the forefront of several research investigations in the past decade. Nine studies have examined genes in a case-control association approach. Recently, a genome-wide association study has highlighted several potentially significant pathways that are implicated in tinnitus. Two twin studies have calculated a moderate heritability for tinnitus and disclosed a greater concordance rate in monozygotic twins compared to dizygotic twins. Despite the more recent data alluding to genetic factors in tinnitus, a strong association with any specific genetic locus is lacking and a genetic study with sufficient statistical power has yet to be designed. Future research endeavors must overcome the many inherent limitations in previous study designs. This review summarizes the previously embarked upon tinnitus genetic investigations and summarizes the hurdles that have been encountered. The identification of candidate genes responsible for tinnitus may afford gene based diagnostic approaches, effective therapy development, and personalized therapeutic intervention.
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Affiliation(s)
- Barbara Vona
- Institute of Human Genetics, Julius Maximilians University WürzburgWürzburg, Germany
| | - Indrajit Nanda
- Institute of Human Genetics, Julius Maximilians University WürzburgWürzburg, Germany
| | - Wafaa Shehata-Dieler
- Plastic, Aesthetic and Reconstructive Surgery, Department of Otorhinolaryngology, Comprehensive Hearing Center, University Hospital WürzburgWürzburg, Germany
| | - Thomas Haaf
- Institute of Human Genetics, Julius Maximilians University WürzburgWürzburg, Germany
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Abstract
Sarcoidosis is a systemic inflammatory disorder characterised by tissue infiltration by mononuclear phagocytes and lymphocytes with associated non-caseating granuloma formation. Originally described as a disorder of the skin, sarcoidosis can involve any organ with wide-ranging clinical manifestations and disease course. Recent studies have provided new insights into the mechanisms involved in disease pathobiology, and we now know that sarcoidosis has a clear genetic basis largely involving human leukocyte antigen (HLA) genes. In contrast to Mendelian-monogenic disorders--which are generally due to specific and relatively rare mutations often leading to a single amino acid change in an encoded protein--sarcoidosis results from genetic variations relatively common in the general population and involving multiple genes, each contributing an effect of varying magnitude. However, an individual may have the necessary genetic profile and yet the disease will not develop unless an environmental or infectious factor is encountered. Genetics appears also to contribute to the huge variability in clinical phenotype and disease behaviour. Moreover, it has been established that sarcoidosis granulomatous inflammation is a highly polarized T helper 1 immune response that starts with an antigenic stimulus followed by T cell activation via a classic HLA class II-mediated pathway. A complex network of lymphocytes, macrophages, and cytokines is pivotal in the orchestration and evolution of the granulomatous process. Despite these advances, the aetiology of sarcoidosis remains elusive and its pathogenesis incompletely understood. As such, there is an urgent need for a better understanding of disease pathogenesis, which hopefully will translate into the development of truly effective therapies.
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Abstract
Sarcoidosis is a chronic systemic disease of unknown origin and uncertain prognosis that most commonly affects young adults, and frequently presents with bilateral hilar lymphadenopathy, pulmonary infiltrates and ocular and skin lesions. The diagnosis is established when characteristic clinical-radiological features are supported by compatible histopathology of epithelioid cell granulomas, following exclusion of known causes of granulomatous inflammation. Indeed, sarcoidosis belongs to a large family of disorders that share granuloma formation as common denominator. Since its first description by Jonathan Hutchinson in 1869, sarcoidosis has generated enormous interest and considerable controversy. In Hutchinson's day, it was considered a dermatological condition, which gradually evolved into a multisystem disorder associated in the majority of cases with respiratory abnormalities. With time, it has also become clear that sarcoidosis occurs throughout the world, affecting individuals of both genders and all races, although its prevalence varies widely across ethnic and racial groups. In recent years, advances in different disciplines, particularly biochemistry, genetics, immunology and molecular biology, have improved dramatically our understanding of the disease. Yet, the critical questions regarding who gets sarcoidosis and whether it has an infectious origin remain unanswered. Sarcoidosis has a distinguished medical history that covers the last 150 years. Right from the time of seminal contributions by Hutchinson, Besnier and Boeck medical discussion on sarcoidosis has always been animated and to a certain extent emotional. Such discussions will inevitable continue until the true cause of the disease has been found, hopefully in the near future.
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Affiliation(s)
- Paolo Spagnolo
- Medical University Clinic, Canton Hospital Baselland and University of Basel, Rheinstrasse 26, 4410, Liestal, Switzerland,
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Abstract
Sarcoidosis is a multisystem inflammatory disease, the aetiology of which has still to be resolved. The proposed mechanism is that a susceptible genotype is exposed to one or more potential antigens. A sustained inflammatory response follows, which ultimately results in pathognomonic granuloma formation. Various clinical phenotypes exist with specific genetic associations influencing disease susceptibility, protection, and clinical progression. Occupational and environmental factors, including microbial elements, may then effect the development of this disease. Sarcoidosis is a heterogeneous disease, showing geographic and racial variation in clinical presentation. It demonstrates a familial tendency and clear genotype associations. Additionally, it appears to cluster within closely associated populations (eg, work colleagues) and appears to be related to selected occupations and environmental exposures. Frequently occult, but occasionally fatal, this disease has a very variable prognosis. It is also unusual in having no specific biomarker. The epidemiology and multiple factors that appear to influence the aetiology of sarcoidosis illustrate why this disease state is frequently described as a clinical enigma.
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Affiliation(s)
- Simon Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK
| | - Shreena Shah
- The Medical Admissions Unit, Queens Hospital, Romford, Essex, UK
| | - Timothy Hardman
- Niche Science & Technology Ltd., Unit 26, Richmond-Upon-Thames, London, UK
| | - Rakesh Sharma
- Department of Cardiology, The Royal Brompton Hospital, London, UK
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Dubrey SW, Sharma R, Underwood R, Mittal T. Cardiac sarcoidosis: diagnosis and management. Postgrad Med J 2015; 91:384-94. [PMID: 26130811 DOI: 10.1136/postgradmedj-2014-133219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 06/12/2015] [Indexed: 12/19/2022]
Abstract
Cardiac sarcoidosis is one of the most serious and unpredictable aspects of this disease state. Heart involvement frequently presents with arrhythmias or conduction disease, although myocardial infiltration resulting in congestive heart failure may also occur. The prognosis in cardiac sarcoidosis is highly variable, which relates to the heterogeneous nature of heart involvement and marked differences between racial groups. Electrocardiography and echocardiography often provide the first clue to the diagnosis, but advanced imaging studies using positron emission tomography and MRI, in combination with nuclear isotope perfusion scanning are now essential to the diagnosis and management of this condition. The identification of clinically occult cardiac sarcoidosis and the management of isolated and/or asymptomatic heart involvement remain both challenging and contentious. Corticosteroids remain the first treatment choice with the later substitution of immunosuppressive and steroid-sparing therapies. Heart transplantation is an unusual outcome, but when performed, the results are comparable or better than heart transplantation for other disease states. We review the epidemiology, developments in diagnostic techniques and the management of cardiac sarcoidosis.
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Affiliation(s)
- S W Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, UK
| | - R Sharma
- Department of Cardiology, The Royal Brompton Hospital, London, UK
| | - R Underwood
- Department of Radiology, Harefield Hospital, Harefield, UK
| | - T Mittal
- Department of Radiology, Harefield Hospital, Harefield, UK
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Bonifazi M, Bravi F, Gasparini S, La Vecchia C, Gabrielli A, Wells AU, Renzoni EA. Sarcoidosis and cancer risk: systematic review and meta-analysis of observational studies. Chest 2015; 147:778-791. [PMID: 25340385 DOI: 10.1378/chest.14-1475] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An increased cancer risk in patients with sarcoidosis has been suggested, although results are conflicting in a number of case-control and cohort studies. We conducted a systematic review of all available data and performed a meta-analysis to better define and quantify the association between sarcoidosis and cancer. METHODS We searched Medline and Embase for all original articles on cancer and sarcoidosis published up to January 2013. Two independent authors reviewed all titles/abstracts to identify studies according to predefined selection criteria. We derived summary estimates using a random-effects model and reported them as relative risk (RR). Publication bias was evaluated using a funnel plot and was quantified by the Egger test. RESULTS Sixteen original studies, involving > 25,000 patients, were included in the present review. The summary RR to develop all invasive cancers was 1.19 (95% CI, 1.07-1.32). The results for selected cancer sites indicated a significantly increased risk of skin (RR, 2.00; 95% CI, 1.69-2.36), hematopoietic (RR, 1.92; 95% CI, 1.41-2.62), upper digestive tract (RR, 1.73; 95% CI, 1.07-2.79), kidney (RR, 1.55; 95% CI, 1.21-1.99), liver (RR, 1.79; 95% CI, 1.03-3.11), and colorectal cancers (RR, 1.33; 95% CI, 1.07-1.67). There was no evidence of publication bias for all cancers (P = .9), nor for any specific cancer site. CONCLUSIONS The present meta-analysis suggests a significant, though moderate, association between sarcoidosis and malignancy.
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Affiliation(s)
- Martina Bonifazi
- Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri-Istituto di Ricovero e Cura a carattere Scientifico, Milan, Italy.
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Gasparini
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università Degli Studi di Milano, Milan, Italy
| | - Armando Gabrielli
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England
| | - Elisabetta A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England
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NERY PABLOB, BEANLANDS ROBS, NAIR GIRISHM, GREEN MARTIN, YANG JIM, MCARDLE BRIANA, DAVIS DARRYL, OHIRA HIROSHI, GOLLOB MICHAELH, LEUNG EUGENE, HEALEY JEFFS, BIRNIE DAVIDH. Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle-Aged Adults. J Cardiovasc Electrophysiol 2014; 25:875-881. [DOI: 10.1111/jce.12401] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 02/16/2014] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- PABLO B. NERY
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - ROB S. BEANLANDS
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - GIRISH M. NAIR
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - MARTIN GREEN
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - JIM YANG
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - BRIAN A. MCARDLE
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - DARRYL DAVIS
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - HIROSHI OHIRA
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - MICHAEL H. GOLLOB
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - EUGENE LEUNG
- Division of Nuclear Medicine; Department of Medicine; University of Ottawa and The Ottawa Hospital; Ottawa Canada
| | - JEFF S. HEALEY
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - DAVID H. BIRNIE
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
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Spagnolo P, Luppi F, Cerri S, Richeldi L. Genetic testing in diffuse parenchymal lung disease. Orphanet J Rare Dis 2012; 7:79. [PMID: 23075428 PMCID: PMC3489730 DOI: 10.1186/1750-1172-7-79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 10/14/2012] [Indexed: 02/06/2023] Open
Abstract
Diffuse parenchymal lung diseases (DPLD) represent a diverse group of disorders affecting the distal lung parenchyma, specifically the tissue and spaces surrounding the alveoli, which may be filled with inflammatory cells, proliferating fibroblasts or established fibrosis, often leading to architectural distortion and impaired gas exchange. While the underlying pathogenetic mechanisms are known or inferred for some DPLD (such as sarcoidosis, silicosis, drug reactions and collagen vascular diseases), the pathogenesis of the majority of these entities - particularly those characterized by progressive fibrosis - is poorly understood. Several lines of evidence indicate that the development of pulmonary fibrosis is genetically determined. They include: 1. familial clustering; 2. the occurrence of pulmonary fibrosis in the context of rare inherited disorders; 3. substantial variability in the development of pulmonary fibrosis amongst individuals exposed to organic or inorganic dusts; 4. difference in susceptibility to fibrogenic stimuli amongst inbred strains of mice. This review focuses on idiopathic pulmonary fibrosis (IPF) and sarcoidosis, the two most common DPLD and the two entities for which there is stronger evidence of a genetic predisposition, although how aberrant genes interact with each other and with environmental factors, such as smoking in IPF and infectious agents in sarcoidosis, in determining disease susceptibility and clinical phenotypes is largely unknown. Finally, we discuss practical issues and implications for both patients and physicians of recent advances in the genetics of sarcoidosis and IPF.
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Affiliation(s)
- Paolo Spagnolo
- Department of Oncology, Center for Rare Lung Disease, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy.
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Tchernev G, Ananiev J, Cardoso JC, Wollina U, Verma SB, Patterson JW, Dourmishev LA, Tronnier M, Okamoto H, Mizuno K, Kanazawa N, Gulubova M, Manolova I, Salaro C. Sarcoidosis and molecular mimicry--important etiopathogenetic aspects: current state and future directions. Wien Klin Wochenschr 2012; 124:227-38. [PMID: 22527817 DOI: 10.1007/s00508-012-0154-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Accepted: 01/21/2012] [Indexed: 01/19/2023]
Abstract
Sarcoidosis is a disease of uncertainty in terms of its cause, presentation, and clinical course. The disease has a worldwide distribution and affects all ages, races, and both sex. Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. The factors that influence clinical picture and severity of the disease are probably linked to the etiopathogenesis of sarcoidosis, which continues to be shrouded in mystery. The current state of the art on the pathogenesis of sarcoidosis is that it is an immunological response in a genetically susceptible individual to an as-yet undefined antigenic stimulus. How exposure occurs in genetically predisposed patients is not completely clear, but the most likely explanation is that these agents or antigens are either inhaled into the lungs or enter through contact with the skin, as these are the common target organs that are constantly in contact with the environment. An autoimmune etiology of sarcoidosis could possibly occur through a process of molecular mimicry of infectious or other environmental antigens to host antigens. This could lead to a cross-mediated immune response and induction of autoimmune disease. This molecular mimicry may probably be responsible for the heterogeneous clinical presentations of the disease. Several investigations and studies have provided valuable evidence on the etiopathogenesis of sarcoidosis, which may lead to the future development of targeted and innovative treatment strategies. Nevertheless, we are still a long way from unravelling the underlying cause of this mysterious disease.
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Affiliation(s)
- Georgi Tchernev
- Policlinic for Dermatology and Venereology, University Hospital Lozenetz, Academic Educational Hospital of The Saint Kliment Ohridski University, Koziak street 1, 1407, Sofia, Bulgaria.
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Spagnolo P, Luppi F, Roversi P, Cerri S, Fabbri LM, Richeldi L. Sarcoidosis: challenging diagnostic aspects of an old disease. Am J Med 2012; 125:118-25. [PMID: 22269612 DOI: 10.1016/j.amjmed.2011.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 11/16/2022]
Abstract
Over the past few years, there have been substantial advances in our understanding of sarcoidosis immunopathogenesis. Conversely, the etiology of the disease remains obscure for a number of reasons, including heterogeneity of clinical manifestations, often overlapping with other disorders, and insensitive and nonspecific diagnostic tests. While no cause has been definitely confirmed, there is increasing evidence that one or more infectious agents may cause the disease, although the organism may no longer be viable. Here we present 2 cases, in which sarcoidosis preceded tuberculosis and non-Hodgkin lymphoma. Development of new lesions in a patient with chronic/remitting sarcoidosis should be looked at with suspicion and promptly investigated in order to rule out an alternative/concomitant diagnosis. In such cases, tissue confirmation from the most accessible site, and bone marrow biopsy-if lymphoma is in the differential diagnosis-should be performed. In conclusion, we strongly advise that physicians be ready to reconsider the diagnosis of sarcoidosis in the presence of atypical manifestations or persistent/progressive disease despite conventional therapy.
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Affiliation(s)
- Paolo Spagnolo
- Section of Respiratory Diseases, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy.
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Akçakaya P, Azeroglu B, Even I, Ates O, Turker H, Ongen G, Topal-Sarikaya A. The functional SLC11A1 gene polymorphisms are associated with sarcoidosis in Turkish population. Mol Biol Rep 2011; 39:5009-16. [DOI: 10.1007/s11033-011-1297-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
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de Boer S, Wilsher M. Review series: Aspects of interstitial lung disease. Sarcoidosis. Chron Respir Dis 2011; 7:247-58. [PMID: 21084549 DOI: 10.1177/1479972310388352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sally de Boer
- Green Lane Respiratory Services, Auckland District Health Board, Auckland, New Zealand
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Grunewald J, Idali F, Kockum I, Seddighzadeh M, Nisell M, Eklund A, Padyukov L. Major histocompatibility complex class II transactivator gene polymorphism: associations with Löfgren's syndrome. ACTA ACUST UNITED AC 2010; 76:96-101. [PMID: 20230522 DOI: 10.1111/j.1399-0039.2010.01476.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The major histocompatibility complex (MHC) class II transactivator (MHC2TA) is known as a master regulator for expression of MHC class II molecules. In the present study, we investigated the influence on the risk for sarcoidosis of two variants of the MHC2TA gene, selected from previous association studies of inflammatory diseases. Seven hundred and twenty-eight sarcoidosis patients and 873 controls matched by ethnicity were included in the study. Patients were classified as with Löfgren's syndrome (or not) as subphenotypes. Individuals were genotyped for two single nucleotide polymorphisms (SNPs) of the MHC2TA gene, rs3087456 A/G and rs11074932 C/T, and were human leukocyte antigen (HLA)-DRB1-typed. After correction for multiple testing, our data showed a significant association with Löfgren's syndrome in allelic model for the rs3087456 SNP, which was not detected in non-Löfgren's patients. A similar trend was noted for the rs11074932 SNP. These risk factors were independent of HLA-DRB1*03, which is known to be associated with Löfgren's syndrome. The finding of a new genetic association between Löfgren's syndrome and MHC2TA gene polymorphisms, which seems independent of HLA-DRB1*03 and relates to the expression of MHC class II molecules, strongly supports the idea that Löfgren's syndrome is a separate disease entity.
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Affiliation(s)
- J Grunewald
- Department of Medicine, Division of Respiratory Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Iliadi A, Makrythanasis P, Tzetis M, Tsipi M, Traeger-Synodinos J, Ioannou PC, Rapti A, Kanavakis E, Christopoulos TK. Association of TLR4 Single-Nucleotide Polymorphisms and Sarcoidosis in Greek Patients. Genet Test Mol Biomarkers 2009; 13:849-53. [DOI: 10.1089/gtmb.2009.0117] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Alexandra Iliadi
- Laboratory of Analytical Chemistry, Department of Chemistry, Athens University, Athens, Greece
| | - Periklis Makrythanasis
- Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children's Hospital, Athens, Greece
- Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Maria Tzetis
- Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children's Hospital, Athens, Greece
| | - Maria Tsipi
- Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children's Hospital, Athens, Greece
| | - Jan Traeger-Synodinos
- Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children's Hospital, Athens, Greece
| | - Penelope C. Ioannou
- Laboratory of Analytical Chemistry, Department of Chemistry, Athens University, Athens, Greece
| | - Aggeliki Rapti
- 6th Department of Respiratory Medicine, Sotiria Chest Disease Hospital, Athens, Greece
| | - Emmanuel Kanavakis
- Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children's Hospital, Athens, Greece
| | - Theodore K. Christopoulos
- Department of Chemistry, University of Patras, Patras, Greece
- Foundation for Research and Technology Hellas, Institute of Chemical Engineering and High Temperature Chemical Processes (FORTH/ICE-HT), Patras, Greece
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Rosenbaum JT, Pasadhika S, Crouser ED, Choi D, Harrington CA, Lewis JA, Austin CR, Diebel TN, Vance EE, Braziel RM, Smith JR, Planck SR. Hypothesis: sarcoidosis is a STAT1-mediated disease. Clin Immunol 2009; 132:174-83. [PMID: 19464956 DOI: 10.1016/j.clim.2009.04.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/20/2009] [Accepted: 04/25/2009] [Indexed: 11/26/2022]
Abstract
Immunologic pathways involved in sarcoidosis pathogenesis are largely unknown. We hypothesized that patients with sarcoidosis have characteristic mRNA profiles. Microarray analysis of gene expression was done on peripheral blood (12 patients, 12 controls), lung (6 patients, 6 controls) and lymph node (8 patients, 5 controls). Comparing peripheral blood from patients with sarcoidosis to controls, 872 transcripts were upregulated and 1039 were downregulated at >1.5-fold change and a significant q value. Several transcripts associated with interferon and STAT1 were upregulated. Lung and lymph node analyses also showed dramatic increases in STAT1 and STAT1-regulated chemokines. Granulomas in lymph nodes of patients with sarcoidosis expressed abundant STAT1 and phosphorylated STAT1. STAT1 might play an important role in sarcoidosis. This novel hypothesis unites seemingly disparate observations with regard to sarcoidosis including implication of a casual role for interferons, a suspected infectious trigger, T(H)1 predominating lymphocytes in bronchoalveolar lavage, and the association with hypercalcemia.
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Affiliation(s)
- James T Rosenbaum
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA.
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Grunewald J, Eklund A. Löfgren's syndrome: human leukocyte antigen strongly influences the disease course. Am J Respir Crit Care Med 2008; 179:307-12. [PMID: 18996998 DOI: 10.1164/rccm.200807-1082oc] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Sarcoidosis may consist of a number of distinct disease entities, one of which could be Löfgren's syndrome. Patients with Löfgren's syndrome have an acute onset of erythema nodosum (EN) and/or periarticular inflammation or arthritis of the ankles, with bilateral hilar lymphadenopathy (and in some cases parenchymal infiltrates) and usually fever. There is a known association between HLA-DRB1*03 and Löfgren's syndrome. OBJECTIVES To investigate whether human leukocyte antigen type influences clinical manifestations, including the disease course in Löfgren's syndrome. METHODS We clinically characterized and HLA-DRB1 typed 301 patients with Löfgren's syndrome. A total of 275 of the patients were followed for more than 2 years and classified as having a nonresolving or a resolving disease. MEASUREMENTS AND MAIN RESULTS Almost every DRB1*03-positive patient had a resolving disease within 2 years, and 49% of the DRB1*03-negative patients developed a nonresolving disease. Mucosal granulomas were identified significantly more often in DRB1*03-negative patients. Among DRB1*03-negative patients who were treated with oral steroids at disease onset, 80% developed a nonresolving disease. CONCLUSIONS Patients with Löfgren's syndrome have a different disease course depending on whether they are DRB1*03 positive or not. This observation has clinical implications, and by comparing DRB1*03-positive and DRB1*03-negative patients with Löfgren's syndrome, we can search for additional markers of importance for developing a resolving or a nonresolving disease, respectively.
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Affiliation(s)
- Johan Grunewald
- Department of Medicine, Division of Respiratory Medicine, Lung Research Laboratory L4:01, Karolinska Hospital, S-171 76 Stockholm, Sweden.
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Morais A, Alves H, Lima B, Delgado L, Gonçalves R, Tafulo S. Estudo de polimorfismos genéticos do HLA (classes I e II) e do TNF-α em doentes com sarcoidose. REVISTA PORTUGUESA DE PNEUMOLOGIA 2008. [DOI: 10.1016/s0873-2159(15)30284-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
PURPOSE OF REVIEW Increased familial occurrences as well as different disease modes in different ethnic groups suggest a genetic influence in sarcoidosis. Also, genetic analyses have revealed a number of chromosomal regions and specific genes associated with sarcoidosis. This review brings up some recent discoveries on the genetic contribution to sarcoidosis. RECENT FINDINGS As a more detailed clinical classification of patients is performed, stronger genetic associations between distinct clinical phenotypes and specific gene variants have been revealed. The strong association between human leucocyte antigen DRB10301/DQB10201 and good prognosis in patients with Löfgren's syndrome is one such recent example. Linkage studies have revealed certain chromosomal regions of interest and furthermore pointed out specific genes of interest, for example, a variant of the butyrophilin-like 2 gene. SUMMARY Sarcoidosis is a complex disease which is influenced by a multitude of genes and environmental factors. The strongest genetic associations are found within the human leucocyte antigen region, in which several specific human leucocyte antigen alleles clearly associate with disease risk and phenotype, but additional genes in the same region may turn out to be important as well. Future studies on large, clinically well defined patient cohorts will help to elucidate the genetic impact on sarcoidosis.
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Abstract
Sarcoidosis continues to be a disease of research interest because of its complicated immune mechanisms and elusive etiology. So far, it has been established that granulomatous inflammation in sarcoidosis is predominantly a T-helper 1 immune response mediated by a complex network of lymphocytes, macrophages, and cytokines. The cause of progression to a chronic and potentially fibrotic form is unclear but may involve loss of apoptotic mechanisms, loss of regulatory response, or a persistent antigen that cannot be cleared. Recent genomic and proteomic technology has emphasized the importance of host susceptibility and gene-environment interaction in the expression of the disease.
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Affiliation(s)
- Alicia K Gerke
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Abstract
Susceptibility to most human diseases is polygenic, with complex interactions between functional polymorphisms of single genes governing disease incidence, phenotype, or both. In this context, the contribution of any discrete gene is generally modest for a single individual, but may confer substantial attributable risk on a population level. Environmental exposure can modify the effects of a polymorphism, either by providing a necessary substrate for development of human disease or because the effects of a given exposure modulate the effects of the gene. In several diseases, genetic polymorphisms have been shown to be context dependent, ie, the effects of a genetic variant are realized only in the setting of a relevant exposure. Because sarcoidosis susceptibility is dependent on both genetic and environmental modifiers, the study of gene-environment interactions may yield important pathogenetic information and will likely be crucial for uncovering the range of genetic susceptibility loci. The complexity of these relationships implies, however, that investigations of gene-environment interactions will require the study of large cohorts with carefully defined exposures and similar clinical phenotypes. A general principle is that the study of gene-environment interactions requires a sample size at least severalfold greater than for either factor alone. To date, the presence of environmental modifiers has been demonstrated for one sarcoidosis susceptibility locus, HLA-DQB1, in African-American families. This article reviews general considerations obtaining for the study of gene-environment interactions in sarcoidosis. It also describes the limited current understanding of the role of environmental influences on sarcoidosis susceptibility genes.
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