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Artaza H, Eriksson D, Lavrichenko K, Aranda-Guillén M, Bratland E, Vaudel M, Knappskog P, Husebye ES, Bensing S, Wolff ASB, Kämpe O, Røyrvik EC, Johansson S. Rare copy number variation in autoimmune Addison's disease. Front Immunol 2024; 15:1374499. [PMID: 38562931 PMCID: PMC10982488 DOI: 10.3389/fimmu.2024.1374499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Autoimmune Addison's disease (AAD) is a rare but life-threatening endocrine disorder caused by an autoimmune destruction of the adrenal cortex. A previous genome-wide association study (GWAS) has shown that common variants near immune-related genes, which mostly encode proteins participating in the immune response, affect the risk of developing this condition. However, little is known about the contribution of copy number variations (CNVs) to AAD susceptibility. We used the genome-wide genotyping data from Norwegian and Swedish individuals (1,182 cases and 3,810 controls) to investigate the putative role of CNVs in the AAD aetiology. Although the frequency of rare CNVs was similar between cases and controls, we observed that larger deletions (>1,000 kb) were more common among patients (OR = 4.23, 95% CI 1.85-9.66, p = 0.0002). Despite this, none of the large case-deletions were conclusively pathogenic, and the clinical presentation and an AAD-polygenic risk score were similar between cases with and without the large CNVs. Among deletions exclusive to individuals with AAD, we highlight two ultra-rare deletions in the genes LRBA and BCL2L11, which we speculate might have contributed to the polygenic risk in these carriers. In conclusion, rare CNVs do not appear to be a major cause of AAD but further studies are needed to ascertain the potential contribution of rare deletions to the polygenic load of AAD susceptibility.
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Affiliation(s)
- Haydee Artaza
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K. G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Daniel Eriksson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Ksenia Lavrichenko
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Maribel Aranda-Guillén
- Center for Molecular Medicine, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Eirik Bratland
- K. G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Marc Vaudel
- Mohn Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
- Computational Biology Unit, Department of Informatics, University of Bergen, Bergen, Norway
- Department of Genetics and Bioinformatics, Health Data and Digitalization, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Knappskog
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Eystein S. Husebye
- K. G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sophie Bensing
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anette S. B. Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K. G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Olle Kämpe
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Ellen C. Røyrvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K. G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Genetics and Bioinformatics, Norwegian Institute of Public Health, Bergen, Norway
| | - Stefan Johansson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
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2
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Roberts E, Dobromylskyj MJ. Histopathological evaluation of the adrenal glands in a cat with primary hypoadrenocorticism and multiple endocrine disease. JFMS Open Rep 2022; 8:20551169221125207. [PMID: 36226303 PMCID: PMC9549196 DOI: 10.1177/20551169221125207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Case summary A 6-year-old male neutered domestic longhair cat was referred for investigation of weight loss, hyporexia, vomiting and diarrhoea. The cat was diagnosed with primary hypoadrenocorticism, exocrine pancreatic insufficiency, cobalamin deficiency and a chronic enteropathy, and started on therapeutic treatment. Diabetes mellitus developed 4.5 months later, and the cat was started on insulin therapy. The cat was euthanased 10 months following the diagnosis of hypoadrenocorticism due to the development of status epilepticus, which was not associated with glucose or electrolyte abnormalities. Histopathological assessment of the adrenal glands at post-mortem examination documented lymphoplasmacytic adrenalitis, with the lymphocytic population being predominant. Immunohistochemical staining classified the lymphocytic infiltrate as T-cell rich, supportive of the cat's hypoadrenocorticism being due to autoimmune disease. Relevance and novel information This case documents the novel use of immunohistochemical staining in combination with histopathology to further assess the adrenal glands in non-neoplastic-associated primary hypoadrenocorticism in a cat. This identified similar pathological changes to those previously described in dogs with autoimmune primary hypoadrenocorticism. Additionally, this is the first report of a cat with multiple endocrine disease that included primary hypoadrenocorticism and highlights that monitoring for the development of additional endocrine disease should be advised in these cases.
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Affiliation(s)
- Emma Roberts
- Highcroft Veterinary Referrals,
Bristol, UK
- Emma Roberts BVetMed (Hons), MVM,
DipECVIM-CA, Highcroft Veterinary Referrals, 615 Wells Road, Bristol BS14 9BE,
UK
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3
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Hellesen A, Aslaksen S, Breivik L, Røyrvik EC, Bruserud Ø, Edvardsen K, Brokstad KA, Wolff ASB, Husebye ES, Bratland E. 21-Hydroxylase-Specific CD8+ T Cells in Autoimmune Addison's Disease Are Restricted by HLA-A2 and HLA-C7 Molecules. Front Immunol 2021; 12:742848. [PMID: 34721410 PMCID: PMC8551825 DOI: 10.3389/fimmu.2021.742848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives CD8+ T cells targeting 21-hydroxylase (21OH) are presumed to play a central role in the destruction of adrenocortical cells in autoimmune Addison’s disease (AAD). Earlier reports have suggested two immunodominant CD8+ T cell epitopes within 21OH: LLNATIAEV (21OH342-350), restricted by HLA-A2, and EPLARLEL (21OH431-438), restricted by HLA-B8. We aimed to characterize polyclonal CD8+ T cell responses to the proposed epitopes in a larger patient cohort with AAD. Methods Recombinant fluorescent HLA-peptide multimer reagents were used to quantify antigen-specific CD8+ T cells by flow cytometry. Interferon-gamma (IFNγ) Elispot and biochemical assays were used to functionally investigate the 21OH-specific T cells, and to map the exactly defined epitopes of 21OH. Results We found a significantly higher frequency of HLA-A2 restricted LLNATIAEV-specific cells in patients with AAD than in controls. These cells could also be expanded in vitro in an antigen specific manner and displayed a robust antigen-specific IFNγ production. In contrast, only negligible frequencies of EPLARLEL-specific T cells were detected in both patients and controls with limited IFNγ response. However, significant IFNγ production was observed in response to a longer peptide encompassing EPLARLEL, 21OH430-447, suggesting alternative dominant epitopes. Accordingly, we discovered that the slightly offset ARLELFVVL (21OH434-442) peptide is a novel dominant epitope restricted by HLA-C7 and not by HLA-B8 as initially postulated. Conclusion We have identified two dominant 21OH epitopes targeted by CD8+ T cells in AAD, restricted by HLA-A2 and HLA-C7, respectively. To our knowledge, this is the first HLA-C7 restricted epitope described for an autoimmune disease.
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Affiliation(s)
- Alexander Hellesen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Sigrid Aslaksen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Lars Breivik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ellen Christine Røyrvik
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Øyvind Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Kine Edvardsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Karl Albert Brokstad
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Broegelmann Research Laboratory, University of Bergen, Bergen, Norway
| | - Anette Susanne Bøe Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,KG Jebsen Centre for Autoimmune Diseases, University of Bergen, Bergen, Norway.,Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
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4
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Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, Husebye ES, Quinkler M. Adrenal insufficiency. Nat Rev Dis Primers 2021; 7:19. [PMID: 33707469 DOI: 10.1038/s41572-021-00252-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/25/2022]
Abstract
Adrenal insufficiency (AI) is a condition characterized by an absolute or relative deficiency of adrenal cortisol production. Primary AI (PAI) is rare and is caused by direct adrenal failure. Secondary AI (SAI) is more frequent and is caused by diseases affecting the pituitary, whereas in tertiary AI (TAI), the hypothalamus is affected. The most prevalent form is TAI owing to exogenous glucocorticoid use. Symptoms of AI are non-specific, often overlooked or misdiagnosed, and are related to the lack of cortisol, adrenal androgen precursors and aldosterone (especially in PAI). Diagnosis is based on measurement of the adrenal corticosteroid hormones, their regulatory peptide hormones and stimulation tests. The goal of therapy is to establish a hormone replacement regimen that closely mimics the physiological diurnal cortisol secretion pattern, tailored to the patient's daily needs. This Primer provides insights into the epidemiology, mechanisms and management of AI during pregnancy as well as challenges of long-term management. In addition, the importance of identifying life-threatening adrenal emergencies (acute AI and adrenal crisis) is highlighted and strategies for prevention, which include patient education, glucocorticoid emergency cards and injection kits, are described.
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Affiliation(s)
- Stefanie Hahner
- Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Richard J Ross
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Wiebke Arlt
- Institute for Metabolism and Systems Research, University of Birmingham, Birmingham, UK.,Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Irina Bancos
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stephanie Burger-Stritt
- Department of Medicine I, Division of Endocrinology and Diabetology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - David J Torpy
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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5
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Abstract
Vitiligo is a disease of the skin characterized by the appearance of white spots. Significant progress has been made in understanding vitiligo pathogenesis over the past 30 years, but only through perseverance, collaboration, and open-minded discussion. Early hypotheses considered roles for innervation, microvascular anomalies, oxidative stress, defects in melanocyte adhesion, autoimmunity, somatic mosaicism, and genetics. Because theories about pathogenesis drive experimental design, focus, and even therapeutic approach, it is important to consider their impact on our current understanding about vitiligo. Animal models allow researchers to perform mechanistic studies, and the development of improved patient sample collection methods provides a platform for translational studies in vitiligo that can also be applied to understand other autoimmune diseases that are more difficult to study in human samples. Here we discuss the history of vitiligo translational research, recent advances, and their implications for new treatment approaches.
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Affiliation(s)
| | - John E. Harris
- Department of Medicine, Division of Dermatology, University of Massachusetts Medical School, Worcester, MA, United States
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6
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Bellan M, Andreoli L, Mele C, Sainaghi PP, Rigamonti C, Piantoni S, De Benedittis C, Aimaretti G, Pirisi M, Marzullo P. Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases. Nutrients 2020; 12:E789. [PMID: 32192175 PMCID: PMC7146294 DOI: 10.3390/nu12030789] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023] Open
Abstract
Vitamin D is a pleiotropic secosteroid yielding multiple actions in human physiology. Besides the canonical regulatory activity on bone metabolism, several non-classical actions have been described and the ability of vitamin D to partake in the regulation of the immune system is particularly interesting, though far stronger and convincing evidence has been collected in in vitro as compared to in vivo studies. Whether vitamin D is able to regulate at physiological concentrations the human immune system remains unproven to date. Consequently, it is not established if vitamin D status is a factor involved in the pathogenesis of immune-mediated diseases and if cholecalciferol supplementation acts as an adjuvant for autoimmune diseases. The development of autoimmunity is a heterogeneous process, which may involve different organs and systems with a wide range of clinical implications. In the present paper, we reviewed the current evidences regarding vitamin D role in the pathogenesis and management of different autoimmune diseases.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of Internal Medicine, “AOU Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Centre for Autoimmune and Allergic Diseases, 28100 Novara, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit and Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, 25128 Brescia, Italy; (L.A.); (S.P.)
| | - Chiara Mele
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of Internal Medicine, “AOU Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Centre for Autoimmune and Allergic Diseases, 28100 Novara, Italy
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of Internal Medicine, “AOU Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Centre for Autoimmune and Allergic Diseases, 28100 Novara, Italy
| | - Silvia Piantoni
- Rheumatology and Clinical Immunology Unit and Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, 25128 Brescia, Italy; (L.A.); (S.P.)
| | - Carla De Benedittis
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of Internal Medicine, “AOU Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Centre for Autoimmune and Allergic Diseases, 28100 Novara, Italy
| | - Gianluca Aimaretti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of Internal Medicine, “AOU Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Centre for Autoimmune and Allergic Diseases, 28100 Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (M.B.); (C.M.); (P.P.S.); (C.R.); (C.D.B.); (G.A.); (M.P.)
- Division of General Medicine, Ospedale S. Giuseppe, I.R.C.C.S. Istituto Auxologico Italiano, 28921 Verbania, Italy
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7
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Betterle C, Presotto F, Furmaniak J. Epidemiology, pathogenesis, and diagnosis of Addison's disease in adults. J Endocrinol Invest 2019; 42:1407-1433. [PMID: 31321757 DOI: 10.1007/s40618-019-01079-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Addison's disease (AD) is a rare disorder and among adult population in developed countries is most commonly caused by autoimmunity. In contrast, in children genetic causes are responsible for AD in the majority of patients. PURPOSE This review describes epidemiology, pathogenesis, genetics, natural history, clinical manifestations, immunological markers and diagnostic strategies in patients with AD. Standard care treatments including the management of patients during pregnancy and adrenal crises consistent with the recent consensus statement of the European Consortium and the Endocrine Society Clinical Practice Guideline are described. In addition, emerging therapies designed to improve the quality of life and new strategies to modify the natural history of autoimmune AD are discussed. CONCLUSIONS Progress in optimizing replacement therapy for patients with AD has allowed the patients to lead a normal life. However, continuous education of patients and health care professionals of ever-present danger of adrenal crisis is essential to save lives of patients with AD.
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Affiliation(s)
- C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale Civile 105, 35128, Padua, Italy
| | - F Presotto
- Endocrine Unit, Department of Medicine (DIMED), University of Padova, Via Ospedale Civile 105, 35128, Padua, Italy.
- Unit of Internal Medicine, Ospedale dell'Angelo, via Paccagnella 11, 30174, Mestre-Venice, Italy.
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8
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Aslaksen S, Methlie P, Vigeland MD, Jøssang DE, Wolff AB, Sheng Y, Oftedal BE, Skinningsrud B, Undlien DE, Selmer KK, Husebye ES, Bratland E. Coexistence of Congenital Adrenal Hyperplasia and Autoimmune Addison's Disease. Front Endocrinol (Lausanne) 2019; 10:648. [PMID: 31611844 PMCID: PMC6776599 DOI: 10.3389/fendo.2019.00648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/06/2019] [Indexed: 11/21/2022] Open
Abstract
Background: Underlying causes of adrenal insufficiency include congenital adrenal hyperplasia (CAH) and autoimmune adrenocortical destruction leading to autoimmune Addison's disease (AAD). Here, we report a patient with a homozygous stop-gain mutation in 3β-hydroxysteroid dehydrogenase type 2 (3βHSD2), in addition to impaired steroidogenesis due to AAD. Case Report: Whole exome sequencing revealed an extremely rare homozygous nonsense mutation in exon 2 of the HSD3B2 gene, leading to a premature stop codon (NM_000198.3: c.15C>A, p.Cys5Ter) in a patient with AAD and premature ovarian insufficiency. Scrutiny of old medical records revealed that the patient was initially diagnosed with CAH with hyperandrogenism and severe salt-wasting shortly after birth. However, the current steroid profile show complete adrenal insufficiency including low production of pregnenolone, dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEA-S), without signs of overtreatment with steroids. Conclusion: To the best of our knowledge, this is the first description of autoimmune adrenalitis in a patient with 3βHSD2 deficiency and suggests a possible association between AAD and inborn errors of the steroidogenesis.
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Affiliation(s)
- Sigrid Aslaksen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Paal Methlie
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Magnus D. Vigeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Dag E. Jøssang
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Anette B. Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | - Ying Sheng
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Bergithe E. Oftedal
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
| | | | - Dag E. Undlien
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Kaja K. Selmer
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, University of Oslo, Oslo, Norway
- National Centre for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Eystein S. Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- K.G. Jebsen Center for Autoimmune Diseases, University of Bergen, Bergen, Norway
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9
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Aslaksen S, Wolff AB, Vigeland MD, Breivik L, Sheng Y, Oftedal BE, Artaza H, Skinningsrud B, Undlien DE, Selmer KK, Husebye ES, Bratland E. Identification and characterization of rare toll-like receptor 3 variants in patients with autoimmune Addison's disease. J Transl Autoimmun 2019; 1:100005. [PMID: 32743495 PMCID: PMC7388336 DOI: 10.1016/j.jtauto.2019.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
Autoimmune Addison's disease (AAD) is a classic organ-specific autoimmune disease characterized by an immune-mediated attack on the adrenal cortex. As most autoimmune diseases, AAD is believed to be caused by a combination of genetic and environmental factors, and probably interactions between the two. Persistent viral infections have been suggested to play a triggering role, by invoking inflammation and autoimmune destruction. The inability of clearing infections can be due to aberrations in innate immunity, including mutations in genes involved in the recognition of conserved microbial patterns. In a whole exome sequencing study of anonymized AAD patients, we discovered several rare variants predicted to be damaging in the gene encoding Toll-like receptor 3 (TLR3). TLR3 recognizes double stranded RNAs, and is therefore a major factor in antiviral defense. We here report the occurrence and functional characterization of five rare missense variants in TLR3 of patients with AAD. Most of these variants occurred together with a common TLR3 variant that has been associated with a wide range of immunopathologies. The biological implications of these variants on TLR3 function were evaluated in a cell-based assay, revealing a partial loss-of-function effect of three of the rare variants. In addition, rare mutations in other members of the TLR3-interferon (IFN) signaling pathway were detected in the AAD patients. Together, these findings indicate a potential role for TLR3 and downstream signaling proteins in the pathogenesis in a subset of AAD patients.
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Affiliation(s)
- Sigrid Aslaksen
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway
| | - Anette B Wolff
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway
| | - Magnus D Vigeland
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Medical Genetics, Oslo University Hospital, Norway
| | - Lars Breivik
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Norway
| | - Ying Sheng
- Department of Medical Genetics, Oslo University Hospital, Norway
| | - Bergithe E Oftedal
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway
| | - Haydee Artaza
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway
| | | | - Dag E Undlien
- Institute of Clinical Medicine, University of Oslo, Norway.,Department of Medical Genetics, Oslo University Hospital, Norway
| | - Kaja K Selmer
- Department of Research and Development, Division of Neuroscience, Oslo University Hospital and the University of Oslo, Norway.,National Centre for Epilepsy, Oslo University Hospital, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Norway
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Norway.,KG Jebsen Center for Autoimmune Diseases, University of Bergen, Norway
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10
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Treeful AE, Rendahl AK, Friedenberg SG. DLA class II haplotypes show sex-specific associations with primary hypoadrenocorticism in Standard Poodle dogs. Immunogenetics 2019; 71:373-382. [PMID: 30968193 DOI: 10.1007/s00251-019-01113-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/27/2019] [Indexed: 12/19/2022]
Abstract
Addison's disease (AD) is a life-threatening endocrine disorder that occurs spontaneously in both humans and dogs. Associations between MHC class II genes and AD have been shown in several human studies. Our goal was to identify MHC class II associations with AD in a large population of Standard Poodles, a breed highly predisposed to AD. We sequenced exon 2 of the class II genes DLA-DRB1, DLA-DQA1, and DLA-DQB1 in 110 affected and 101 unaffected Standard Poodles and tested for association with AD. After correcting for population structure, two haplotypes were found to confer risk of developing AD in a sex-specific manner: DLA-DRB1*015:01-DQA1*006:01-DQB1*023:01 in males (x2p = 0.03, OR 2.1) and DLA-DRB1*009:01-DQA1*001:01-DQB1*008:01:1 in females (x2p = 0.02, OR 8.43). Sex-specific associations have been previously described in human populations, but this is the first report of this kind in dogs. Consistent with findings in other studies, we found the DLA-DQA1*006:01 allele (x2p = 0.04) to be associated with AD in males independent of haplotype. In females, the haplotype DLA-DRB1*009:01-DQA1*001:01-DQB1*008:01:1 confers a very high risk for developing AD, although its frequency was rare (9 of 124 females) in our study population. Further studies are warranted to validate the findings of this exploratory dataset and to assess the usefulness of this haplotype as a risk marker for AD in female Standard Poodles. Our results highlight the importance of evaluating MHC class II disease associations in large populations, and accounting for both biological sex and population structure.
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Affiliation(s)
- Amy E Treeful
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - Aaron K Rendahl
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA.
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11
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Hellesen A, Bratland E. The potential role for infections in the pathogenesis of autoimmune Addison's disease. Clin Exp Immunol 2018; 195:52-63. [PMID: 30144040 DOI: 10.1111/cei.13207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/02/2018] [Accepted: 08/10/2018] [Indexed: 12/21/2022] Open
Abstract
Autoimmune Addison's disease (AAD), or primary adrenocortical insufficiency, is a classical organ-specific autoimmune disease with 160 years of history. AAD is remarkably homogeneous with one major dominant self-antigen, the cytochrome P450 21-hydroxylase enzyme, which is targeted by both autoantibodies and autoreactive T cells. Like most autoimmune diseases, AAD is thought to be caused by an unfortunate combination of genetic and environmental factors. While the number of genetic associations with AAD is increasing, almost nothing is known about environmental factors. A major environmental factor commonly proposed for autoimmune diseases, based partly on experimental and clinical data and partly on shared pathways between anti-viral immunity and autoimmunity, is viral infections. However, there are few reports associating viral infections to AAD, and it has proved difficult to establish which immunological processes that could link any viral infection with the initiation or progression of AAD. In this review, we will summarize the current knowledge on the underlying mechanisms of AAD and take a closer look on the potential involvement of viruses.
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Affiliation(s)
- A Hellesen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
| | - E Bratland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,K.G. Jebsen Senter for Autoimmune Sykdommer, University of Bergen, Bergen, Norway
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12
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Anand G, Beuschlein F. MANAGEMENT OF ENDOCRINE DISEASE: Fertility, pregnancy and lactation in women with adrenal insufficiency. Eur J Endocrinol 2018; 178:R45-R53. [PMID: 29191934 DOI: 10.1530/eje-17-0975] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 11/30/2017] [Accepted: 11/30/2017] [Indexed: 12/21/2022]
Abstract
With the introduction of hormonal substitution therapy in the 1950s, adrenal insufficiency (AI) has been turned into a manageable disease in pregnant women. In fact, in the light of glucocorticoid replacement therapy and improved obstetric care, it is realistic to expect good maternal and fetal outcomes in patients with AI. However, there are still a number of challenges such as establishing the diagnosis of AI in pregnant women and optimizing the treatment of AI and related comorbidities prior to as well as during pregnancy. Clinical and biochemical diagnoses of a new-onset AI may be challenging because of overlapping symptoms of normal pregnancy as well as pregnancy-induced changes in cortisol values. Physiological changes occurring during pregnancy should be taken into account while adjusting the substitution therapy. The high proportion of reported adrenal crisis in pregnant women with AI highlights persistent problems in this particular clinical situation. Due to the rarity of the disease, there is no prospective data-guiding management of pregnancy in patients with known AI. The aim of this review is to summarize the maternal and fetal outcomes based on recently published case reports in patients with AI and to suggest a practical approach to diagnose and manage AI in pregnancy.
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Affiliation(s)
- Gurpreet Anand
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Felix Beuschlein
- Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, UniversitätsSpital Zürich, Zürich, Switzerland
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
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13
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Penna-Martinez M, Filmann N, Bogdanou D, Shoghi F, Huenecke S, Schubert R, Herrmann E, Koehl U, Husebye ES, Badenhoop K. High-dose vitamin D in Addison's disease regulates T-cells and monocytes: A pilot trial. Nutrition 2017. [PMID: 29522979 DOI: 10.1016/j.nut.2017.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES On the basis of the immunomodulatory actions of vitamin D (VD), we investigated the effects of high-dose VD therapy over a 3 mo period on the immune response in patients with Addison's disease (AD). METHODS This randomized, controlled, crossover trial included 13 patients with AD who received either cholecalciferol (4000 IU/d) for 3 mo followed by 3 mo placebo oil or the sequential alternative placebo followed by verum. Glucocorticoid replacement doses remained stable. The primary outcome measures were changes in 25-hydroxyvitamin D3 (25(OH)D3) levels and immune cells including T helper cells (Th; CD3+CD4+), late-activated Th cells (CD3+CD4+HLA-DR+), regulatory T cells (CD3+CD4+CD25brightCD127dim/neg), cytotoxic T cells (Tc; CD3+CD8+), late-activated Tc cells (CD3+CD8+HLA-DR+), and monocytes. The explorative analysis included the correlation of changes with VD-related gene polymorphisms and 21-hydroxylase antibody titers. RESULTS Ten of 13 patients (77%) were VD deficient. Median 25(OH)D3 concentrations increased significantly to 41.5 ng/ml (median changes: 19.95 ng/ml; P = 0.0005) after 3 mo of cholecalciferol treatment. Within the T-cells, only the late-activated Th (median changes: 1.6%; P = 0.02) and late-activated Tc cells (median changes: 4.05%; P = 0.03) decreased, whereas monocytes (median changes: 1.05%; P = 0.008) increased after VD therapy. T-cell changes were associated with two polymorphisms (CYP27B1-rs108770012 and VDR-rs10735810), but no changes in the 21-hydroxylase antibody titers were observed. CONCLUSIONS Three months of treatment with cholecalciferol achieved sufficient 25(OH)D3 levels and can regulate late-activated T-cells and monocytes in patients with AD. Explorative analysis revealed potential genetic contributions. This pilot trial provides novel insights about immunomodulation in AD.
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Affiliation(s)
- Marissa Penna-Martinez
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Goethe University, Frankfurt am Main, Germany.
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - Dimitra Bogdanou
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Firouzeh Shoghi
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Sabine Huenecke
- Laboratory for Stem Cell Transplantation and Immunotherapy, Clinic for Pediatric and Adolescent Medicine, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Ralf Schubert
- Department for Children and Adolescents, Division for Allergology, Pneumology and Cystic Fibrosis, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Koehl
- Institute of Cellular Therapeutics, Hannover Medical School, Hanover, Germany
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen and Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Klaus Badenhoop
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Metabolism, University Hospital, Goethe University, Frankfurt am Main, Germany
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14
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Altieri B, Muscogiuri G, Barrea L, Mathieu C, Vallone CV, Mascitelli L, Bizzaro G, Altieri VM, Tirabassi G, Balercia G, Savastano S, Bizzaro N, Ronchi CL, Colao A, Pontecorvi A, Della Casa S. Does vitamin D play a role in autoimmune endocrine disorders? A proof of concept. Rev Endocr Metab Disord 2017; 18:335-346. [PMID: 28070798 DOI: 10.1007/s11154-016-9405-9] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the last few years, more attention has been given to the "non-calcemic" effect of vitamin D. Several observational studies and meta-analyses demonstrated an association between circulating levels of vitamin D and outcome of many common diseases, including endocrine diseases, chronic diseases, cancer progression, and autoimmune diseases. In particular, cells of the immune system (B cells, T cells, and antigen presenting cells), due to the expression of 1α-hydroxylase (CYP27B1), are able to synthesize the active metabolite of vitamin D, which shows immunomodulatory properties. Moreover, the expression of the vitamin D receptor (VDR) in these cells suggests a local action of vitamin D in the immune response. These findings are supported by the correlation between the polymorphisms of the VDR or the CYP27B1 gene and the pathogenesis of several autoimmune diseases. Currently, the optimal plasma 25-hydroxyvitamin D concentration that is necessary to prevent or treat autoimmune diseases is still under debate. However, experimental studies in humans have suggested beneficial effects of vitamin D supplementation in reducing the severity of disease activity. In this review, we summarize the evidence regarding the role of vitamin D in the pathogenesis of autoimmune endocrine diseases, including type 1 diabetes mellitus, Addison's disease, Hashimoto's thyroiditis, Graves' disease and autoimmune polyendocrine syndromes. Furthermore, we discuss the supplementation with vitamin D to prevent or treat autoimmune diseases.
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Affiliation(s)
- Barbara Altieri
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giovanna Muscogiuri
- Ios and Coleman Medicina Futura Medical Center, University Federico II, Naples, Italy
| | - Luigi Barrea
- Ios and Coleman Medicina Futura Medical Center, University Federico II, Naples, Italy
| | - Chantal Mathieu
- Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Carla V Vallone
- Emergency Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Luca Mascitelli
- Comando Brigata Alpina Julia/Multinational Land Force, Medical Service, Udine, Italy
| | | | | | - Giacomo Tirabassi
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Umberto I Hospital, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Savastano
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy
| | - Cristina L Ronchi
- Division of Endocrinology and Diabetes, Department of Internal Medicine I, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, University "Federico II", Naples, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Della Casa
- Division of Endocrinology and Metabolic Diseases, Institute of Medical Pathology, Catholic University of the Sacred Heart, Rome, Italy
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15
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Fishman D, Kisand K, Hertel C, Rothe M, Remm A, Pihlap M, Adler P, Vilo J, Peet A, Meloni A, Podkrajsek KT, Battelino T, Bruserud Ø, Wolff ASB, Husebye ES, Kluger N, Krohn K, Ranki A, Peterson H, Hayday A, Peterson P. Autoantibody Repertoire in APECED Patients Targets Two Distinct Subgroups of Proteins. Front Immunol 2017; 8:976. [PMID: 28861084 PMCID: PMC5561390 DOI: 10.3389/fimmu.2017.00976] [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: 06/21/2017] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
High titer autoantibodies produced by B lymphocytes are clinically important features of many common autoimmune diseases. APECED patients with deficient autoimmune regulator (AIRE) gene collectively display a broad repertoire of high titer autoantibodies, including some which are pathognomonic for major autoimmune diseases. AIRE deficiency severely reduces thymic expression of gene-products ordinarily restricted to discrete peripheral tissues, and developing T cells reactive to those gene-products are not inactivated during their development. However, the extent of the autoantibody repertoire in APECED and its relation to thymic expression of self-antigens are unclear. We here undertook a broad protein array approach to assess autoantibody repertoire in APECED patients. Our results show that in addition to shared autoantigen reactivities, APECED patients display high inter-individual variation in their autoantigen profiles, which collectively are enriched in evolutionarily conserved, cytosolic and nuclear phosphoproteins. The APECED autoantigens have two major origins; proteins expressed in thymic medullary epithelial cells and proteins expressed in lymphoid cells. These findings support the hypothesis that specific protein properties strongly contribute to the etiology of B cell autoimmunity.
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Affiliation(s)
- Dmytro Fishman
- Institute of Computer Science, University of Tartu, Tartu, Estonia.,Quretec Ltd., Tartu, Estonia
| | - Kai Kisand
- Institute of Biomedical and Translational Medicine, University of Tartu, Tartu, Estonia
| | | | | | - Anu Remm
- Institute of Biomedical and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Maire Pihlap
- Institute of Biomedical and Translational Medicine, University of Tartu, Tartu, Estonia
| | - Priit Adler
- Institute of Computer Science, University of Tartu, Tartu, Estonia.,Quretec Ltd., Tartu, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu, Estonia.,Quretec Ltd., Tartu, Estonia
| | - Aleksandr Peet
- Children's Clinic of Tartu University Hospital, Tartu, Estonia
| | - Antonella Meloni
- Pediatric Clinic II, Ospedale Microcitemico, Cagliari, Italy.,Department of Biomedical and Biotechnological Science, University of Cagliari, Cagliari, Italy
| | - Katarina Trebusak Podkrajsek
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Øyvind Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anette S B Wolff
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Kai Krohn
- Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Annamari Ranki
- Department of Dermatology, Allergology and Venereology, Institute of Clinical Medicine, University of Helsinki, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Hedi Peterson
- Institute of Computer Science, University of Tartu, Tartu, Estonia.,Quretec Ltd., Tartu, Estonia
| | - Adrian Hayday
- Peter Gorer Department of Immunobiology, King's College, Guy's Hospital, London, United Kingdom
| | - Pärt Peterson
- Institute of Biomedical and Translational Medicine, University of Tartu, Tartu, Estonia
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16
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Friedenberg SG, Brown DL, Meurs KM, Law JM. Lymphocyte Subsets in the Adrenal Glands of Dogs With Primary Hypoadrenocorticism. Vet Pathol 2016; 55:177-181. [PMID: 28005496 DOI: 10.1177/0300985816684914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Primary hypoadrenocorticism, or Addison's disease, is an autoimmune condition common in certain dog breeds that leads to the destruction of the adrenal cortex and a clinical syndrome involving anorexia, gastrointestinal upset, and electrolyte imbalances. Previous studies have demonstrated that this destruction is strongly associated with lymphocytic-plasmacytic inflammation and that the lymphocytes are primarily T cells. In this study, we used both immunohistochemistry and in situ hybridization to characterize the T-cell subtypes involved. We collected postmortem specimens of 5 dogs with primary hypoadrenocorticism and 2 control dogs and, using the aforementioned techniques, showed that the lymphocytes are primarily CD4+ rather than CD8+. These findings have important implications for improving our understanding of the pathogenesis and in searching for the underlying causative genetic polymorphisms.
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Affiliation(s)
- S G Friedenberg
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.,2 Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, MN, USA
| | - D L Brown
- 3 WIL Research (a Charles River Company), Hillsborough, NC, USA
| | - K M Meurs
- 1 Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - J McHugh Law
- 4 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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17
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Buron F, Vouillarmet J, Thaunat O, Thivolet C, Badet L, Morelon E. Autoimmune Recurrence as a Cause of Adrenal Gland Graft Loss? Am J Transplant 2016; 16:2235-6. [PMID: 26813879 DOI: 10.1111/ajt.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- F Buron
- Department of Transplantation and Clinical Immunology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Vouillarmet
- Department of Endocrinology, Diabetes and Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - O Thaunat
- Department of Transplantation and Clinical Immunology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - C Thivolet
- Department of Endocrinology, Diabetes and Nutrition, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - L Badet
- Department of Transplantation Surgery, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - E Morelon
- Department of Transplantation and Clinical Immunology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
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18
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Edvardsen K, Hellesen A, Husebye ES, Bratland E. Analysis of cellular and humoral immune responses against cytomegalovirus in patients with autoimmune Addison's disease. J Transl Med 2016; 14:68. [PMID: 26956521 PMCID: PMC4784442 DOI: 10.1186/s12967-016-0822-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/25/2016] [Indexed: 01/01/2023] Open
Abstract
Background Autoimmune Addison’s disease (AAD) is caused by multiple genetic and environmental factors. Variants of genes encoding immunologically important proteins such as the HLA molecules are strongly associated with AAD, but any environmental risk factors have yet to be defined. We hypothesized that primary or reactivating infections with cytomegalovirus (CMV) could represent an environmental risk factor in AAD, and that CMV specific CD8+ T cell responses may be dysregulated, possibly leading to a suboptimal control of CMV. In particular, the objective was to assess the HLA-B8 restricted CD8+ T cell response to CMV since this HLA class I variant is a genetic risk factor for AAD. Methods To examine the CD8+ T cell response in detail, we analyzed the HLA-A2 and HLA-B8 restricted responses in AAD patients and healthy controls seropositive for CMV antibodies using HLA multimer technology, IFN-γ ELISpot and a CD107a based degranulation assay. Results No differences between patients and controls were found in functions or frequencies of CMV-specific T cells, regardless if the analyses were performed ex vivo or after in vitro stimulation and expansion. However, individual patients showed signs of reactivating CMV infection correlating with poor CD8+ T cell responses to the virus, and a concomitant upregulation of interferon regulated genes in peripheral blood cells. Several recently diagnosed AAD patients also showed serological signs of ongoing primary CMV infection. Conclusions CMV infection does not appear to be a major environmental risk factor in AAD, but may represent a precipitating factor in individual patients. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0822-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kine Edvardsen
- Department of Clinical Science, University of Bergen, Laboratory Building, 8th floor, 5021, Bergen, Norway.
| | - Alexander Hellesen
- Department of Clinical Science, University of Bergen, Laboratory Building, 8th floor, 5021, Bergen, Norway. .,Department of Medicine, Haukeland University Hospital, 5020, Bergen, Norway.
| | - Eystein S Husebye
- Department of Clinical Science, University of Bergen, Laboratory Building, 8th floor, 5021, Bergen, Norway. .,Department of Medicine, Haukeland University Hospital, 5020, Bergen, Norway.
| | - Eirik Bratland
- Department of Clinical Science, University of Bergen, Laboratory Building, 8th floor, 5021, Bergen, Norway.
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19
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Mastrandrea LD. An Overview of Organ-Specific Autoimmune Diseases Including Immunotherapy. Immunol Invest 2015; 44:803-16. [DOI: 10.3109/08820139.2015.1099409] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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20
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Kisand K, Peterson P. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy. J Clin Immunol 2015; 35:463-78. [PMID: 26141571 DOI: 10.1007/s10875-015-0176-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/22/2015] [Indexed: 12/29/2022]
Abstract
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is an autosomal recessive disease caused by mutations in the autoimmune regulator (AIRE) gene. This review focuses on the clinical and immunological features of APECED, summarizes the current knowledge on the function of AIRE and discusses the importance of autoantibodies in disease diagnosis and prognosis. Additionally, we review the outcome of recent immunomodulatory treatments in APECED patients.
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Affiliation(s)
- Kai Kisand
- Institute of Biomedicine and Translational Medicine, University of Tartu, 19 Ravila Str., Tartu, EE50411, Estonia,
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21
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Edvardsen K, Bjånesøy T, Hellesen A, Breivik L, Bakke M, Husebye ES, Bratland E. Peripheral Blood Cells from Patients with Autoimmune Addison's Disease Poorly Respond to Interferons In Vitro, Despite Elevated Serum Levels of Interferon-Inducible Chemokines. J Interferon Cytokine Res 2015; 35:759-70. [PMID: 25978633 PMCID: PMC4589105 DOI: 10.1089/jir.2014.0171] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Autoimmune Addison's disease (AAD) is a disorder caused by an immunological attack on the adrenal cortex. The interferon (IFN)-inducible chemokine CXCL10 is elevated in serum of AAD patients, suggesting a peripheral IFN signature. However, CXCL10 can also be induced in adrenocortical cells stimulated with IFNs, cytokines, or microbial components. We therefore investigated whether peripheral blood mononuclear cells (PBMCs) from AAD patients display an enhanced propensity to produce CXCL10 and the related chemokine CXCL9, after stimulation with type I or II IFNs or the IFN inducer poly (I:C). Although serum levels of CXCL10 and CXCL9 were significantly elevated in patients compared with controls, IFN stimulated patient PBMC produced significantly less CXCL10/CXCL9 than control PBMC. Low CXCL10 production was not significantly associated with medication, disease duration, or comorbidities, but the low production of poly (I:C)-induced CXCL10 among patients was associated with an AAD risk allele in the phosphatase nonreceptor type 22 (PTPN22) gene. PBMC levels of total STAT1 and -2, and IFN-induced phosphorylated STAT1 and -2, were not significantly different between patients and controls. We conclude that PBMC from patients with AAD are deficient in their response to IFNs, and that the adrenal cortex itself may be responsible for the increased serum levels of CXCL10.
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Affiliation(s)
- Kine Edvardsen
- 1 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Trine Bjånesøy
- 2 Department of Biomedicine, University of Bergen , Bergen, Norway
| | - Alexander Hellesen
- 1 Department of Clinical Science, University of Bergen , Bergen, Norway .,3 Department of Medicine, Haukeland University Hospital , Bergen, Norway
| | - Lars Breivik
- 1 Department of Clinical Science, University of Bergen , Bergen, Norway
| | - Marit Bakke
- 2 Department of Biomedicine, University of Bergen , Bergen, Norway
| | - Eystein S Husebye
- 1 Department of Clinical Science, University of Bergen , Bergen, Norway .,3 Department of Medicine, Haukeland University Hospital , Bergen, Norway
| | - Eirik Bratland
- 1 Department of Clinical Science, University of Bergen , Bergen, Norway
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Muscogiuri G, Mitri J, Mathieu C, Badenhoop K, Tamer G, Orio F, Mezza T, Vieth R, Colao A, Pittas A. Mechanisms in endocrinology: vitamin D as a potential contributor in endocrine health and disease. Eur J Endocrinol 2014; 171:R101-10. [PMID: 24872497 DOI: 10.1530/eje-14-0158] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE It has been suggested that vitamin D may play a role in the pathogenesis of several endocrine diseases, such as hyperparathyroidism, type 1 diabetes (T1DM), type 2 diabetes (T2DM), autoimmune thyroid diseases, Addison's disease and polycystic ovary syndrome (PCOS). In this review, we debate the role of vitamin D in the pathogenesis of endocrine diseases. METHODS Narrative overview of the literature synthesizing the current evidence retrieved from searches of computerized databases, hand searches and authoritative texts. RESULTS Evidence from basic science supports a role for vitamin D in many endocrine conditions. In humans, inverse relationships have been reported not only between blood 25-hydroxyvitamin D and parathyroid hormone concentrations but also with risk of T1DM, T2DM, and PCOS. There is less evidence for an association with Addison's disease or autoimmune thyroid disease. Vitamin D supplementation may have a role for prevention of T2DM, but the available evidence is not consistent. CONCLUSIONS Although observational studies support a potential role of vitamin D in endocrine disease, high quality evidence from clinical trials does not exist to establish a place for vitamin D supplementation in optimizing endocrine health. Ongoing randomized controlled trials are expected to provide insights into the efficacy and safety of vitamin D in the management of endocrine disease.
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Affiliation(s)
- Giovanna Muscogiuri
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Joanna Mitri
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Chantal Mathieu
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Klaus Badenhoop
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Gonca Tamer
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Francesco Orio
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, CanadaDepartment of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Teresa Mezza
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Reinhold Vieth
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, CanadaDepartment of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Annamaria Colao
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
| | - Anastassios Pittas
- Department of Clinical Medicine and SurgeryUniversity 'Federico II' Naples, Via Sergio Pansini, 5-80131 Napoli, ItalyDivision of EndocrinologyDiabetes and Metabolism, Tufts Medical Center, Boston, Massachusetts, USADepartment of EndocrinologyUZ Gasthuisberg, 3000 Leuven, BelgiumDivision Endocrinology and DiabetologyDepartment of Medicine 1, University Hospital of the Goethe-University Frankfurt, Frankfurt am Main, GermanyDivision of Endocrinology and MetabolismDepartment of Internal Medicine, Goztepe Training and Research Hospital, Medeniyet University, Istanbul, TurkeyEndocrinologyUniversity 'Parthenope' Naples, Naples, ItalyEndocrinology of Fertile AgeUniversity Hospital 'S. Giovanni di Dio e Ruggi d'Aragona' Salerno, ItalyEndocrinology and Metabolic DiseasesUniversità Cattolica del Sacro Cuore, Rome, ItalyDepartments of Nutritional SciencesLaboratory Medicine and PathobiologyUniversity of Toronto, Toronto, Ontario, Canada
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Abstract
Adrenal insufficiency is the clinical manifestation of deficient production or action of glucocorticoids, with or without deficiency also in mineralocorticoids and adrenal androgens. It is a life-threatening disorder that can result from primary adrenal failure or secondary adrenal disease due to impairment of the hypothalamic-pituitary axis. Prompt diagnosis and management are essential. The clinical manifestations of primary adrenal insufficiency result from deficiency of all adrenocortical hormones, but they can also include signs of other concurrent autoimmune conditions. In secondary or tertiary adrenal insufficiency, the clinical picture results from glucocorticoid deficiency only, but manifestations of the primary pathological disorder can also be present. The diagnostic investigation, although well established, can be challenging, especially in patients with secondary or tertiary adrenal insufficiency. We summarise knowledge at this time on the epidemiology, causal mechanisms, pathophysiology, clinical manifestations, diagnosis, and management of this disorder.
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Affiliation(s)
- Evangelia Charmandari
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece; Division of Endocrinology and Metabolism, Clinical Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece.
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece; Division of Endocrinology and Metabolism, Clinical Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - George P Chrousos
- Division of Endocrinology, Metabolism, and Diabetes, First Department of Pediatrics, University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece; Division of Endocrinology and Metabolism, Clinical Research Center, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Hellesen A, Edvardsen K, Breivik L, Husebye ES, Bratland E. The effect of types I and III interferons on adrenocortical cells and its possible implications for autoimmune Addison's disease. Clin Exp Immunol 2014; 176:351-62. [PMID: 24666275 DOI: 10.1111/cei.12291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2014] [Indexed: 02/06/2023] Open
Abstract
Autoimmune Addison's disease (AAD) is caused by selective destruction of the hormone-producing cells of the adrenal cortex. As yet, little is known about the potential role played by environmental factors in this process. Type I and/or type III interferons (IFNs) are signature responses to virus infections, and have also been implicated in the pathogenesis of autoimmune endocrine disorders such as type 1 diabetes and autoimmune thyroiditis. Transient development of AAD and exacerbation of established or subclinical disease, as well as the induction of autoantibodies associated with AAD, have been reported following therapeutic administration of type I IFNs. We therefore hypothesize that exposure to such IFNs could render the adrenal cortex susceptible to autoimmune attack in genetically predisposed individuals. In this study, we investigated possible immunopathological effects of type I and type III IFNs on adrenocortical cells in relation to AAD. Both types I and III IFNs exerted significant cytotoxicity on NCI-H295R adrenocortical carcinoma cells and potentiated IFN-γ- and polyinosine-polycytidylic acid [poly (I : C)]-induced chemokine secretion. Furthermore, we observed increased expression of human leucocyte antigen (HLA) class I molecules and up-regulation of 21-hydroxylase, the primary antigenic target in AAD. We propose that these combined effects could serve to initiate or aggravate an ongoing autoimmune response against the adrenal cortex in AAD.
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Affiliation(s)
- A Hellesen
- Section for Endocrinology, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
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25
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Bjanesoy TE, Andreassen BK, Bratland E, Reiner A, Islam S, Husebye ES, Bakke M. Altered DNA methylation profile in Norwegian patients with Autoimmune Addison's Disease. Mol Immunol 2014; 59:208-16. [DOI: 10.1016/j.molimm.2014.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/21/2014] [Accepted: 02/25/2014] [Indexed: 12/13/2022]
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26
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Frank CB, Valentin SY, Scott-Moncrieff JCR, Miller MA. Correlation of inflammation with adrenocortical atrophy in canine adrenalitis. J Comp Pathol 2013; 149:268-79. [PMID: 23348017 DOI: 10.1016/j.jcpa.2012.11.242] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/17/2012] [Accepted: 11/29/2012] [Indexed: 11/19/2022]
Abstract
Hypoadrenocorticism or Addison's disease (AD) is a functional disorder in which insufficient mineralocorticoid and glucocorticoid hormones are produced by the adrenal cortex. Human AD is usually attributed to lymphoplasmacytic adrenalitis with autoimmune destruction of the adrenal cortex. Lymphoplasmacytic adrenalitis is also reported in some descriptions of canine AD; however, the histological aspects of adrenalitis or adrenocortical atrophy have not been well characterized because microscopical examination is not required for diagnosis of AD. In this study, sections of adrenal glands from 33 dogs with adrenalitis were compared with those of 37 dogs without adrenal lesions. The affected dogs were classified clinically as having AD (n = 3), being suspected of having AD (n = 17), not having AD (n = 11) or were unclassified (n = 2). The adrenal inflammation was lymphoplasmacytic in 17 dogs, lymphocytic in four, lymphohistiocytic in one, granulomatous in three and neutrophilic in eight cases. Adrenal glands from control dogs lacked leucocyte infiltration and had a cortical to medullary area ratio of 1.1-7.2. All three dogs with AD, 8/17 dogs with suspected AD and 1/11 dogs without AD had a cortical to medullary area ratio <1.1. Because the area ratio was correlated (r = 0.94) with a linear cortical to medullary thickness ratio, a thickness ratio <1.1 could also indicate severe adrenocortical atrophy. Severe adrenocortical atrophy was associated typically with lymphoplasmacytic infiltration and nearly complete loss of cortical cells; however, the zona glomerulosa was partially spared in three dogs with lymphoplasmacytic adrenalitis and severe cortical atrophy. In contrast, non-lymphoid inflammation was generally part of systemic disease, multifocal and was unaccompanied by severe adrenocortical atrophy.
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Affiliation(s)
- C B Frank
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA
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Bratland E, Hellesen A, Husebye ES. Induction of CXCL10 chemokine in adrenocortical cells by stimulation through toll-like receptor 3. Mol Cell Endocrinol 2013; 365:75-83. [PMID: 22989785 DOI: 10.1016/j.mce.2012.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 09/07/2012] [Accepted: 09/08/2012] [Indexed: 12/01/2022]
Abstract
Addison's disease is a prototypic organ-specific autoimmune disease affecting the adrenal cortex. The CXC chemokine ligand 10 (CXCL10) is expressed early in viral infections, and is produced by primary adrenocortical cells stimulated by certain cytokines. CXCL10 is also elevated in the serum of Addison's disease patients. We therefore investigated if the viral RNA substitute polyinosine-polycytidylic acid (poly (I:C)) could influence the cytokine induced production of CXCL10 by adrenocortical cells. We found that poly (I:C) could induce CXCL10 in NCI-H295R adrenocortical carcinoma cells, either alone or synergistically along with cytokines interferon-γ and tumor necrosis factor-α. This effect was found to be mediated by toll-like receptor 3 and both nuclear factor κB (NFκB) and signal transducer and activator of transcription-1 (STAT1), but not type I interferons, seemed to be involved. We propose that the combination of environmental and endogenous factors presented here, could contribute to the multifactorial pathogenesis of autoimmune Addison's disease.
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Affiliation(s)
- Eirik Bratland
- Section for Endocrinology, Institute of Medicine, University of Bergen, N-5020 Bergen, Norway.
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[Subclinical adrenal diseases: silent pheochromocytoma and subclinical Addison's disease]. ANNALES D'ENDOCRINOLOGIE 2012; 73 Suppl 1:S45-54. [PMID: 23089381 DOI: 10.1016/s0003-4266(12)70014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The silent pheochromocytoma, a hidden form of pheochromocytoma, exposes the patient to an increased risk of mortality if the diagnosis is not established on time. Biological diagnosis of pheochromocytoma can be difficult. Catecholamine secretion is dependent on tumor size and a large number of physiological, pharmacological, lifestyle modifications and sampling conditions influence the measurement of urinary and plasma metanephrines. The prevalence of pheochromocytoma is 2% among adrenal incidentaloma smaller than 3 cm (2/3 of tumors). Recent studies suggest the almost zero risk of pheochromocytoma among these tumors if they are hypodense (<10 housefield units) on adrenal tomography. Addison's disease is a pathology affecting about 1 in 8000. Immunopathology is still unknown, but some elements advocated the hypothesis of a predominant cell-mediated immunity in particular Interferon-gamma production by CD4 T lymphocytes in the presence of an epitope from the 21-hydroxylase, as well as IgG1 subtype produced by activated B lymphocytes, autoantibodies do appear to be a simple marker of the disease. Subclinical Addison's disease is defined by the presence of anti-21-hydroxylase autoantibodies, without clinical symptoms. It evolves faster to the clinical phase in young subjects, male, having high levels of autoantibodies and with an initially impaired adrenal function. Dosage of ACTH, plasma renin active, and basal cortisol and after Synacthen allow to discriminate the subjects with low or high risk of evolution and establish an appropriate monitoring.
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Kisand K, Peterson P. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy: known and novel aspects of the syndrome. Ann N Y Acad Sci 2012; 1246:77-91. [DOI: 10.1111/j.1749-6632.2011.06308.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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