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Rai MK, Yadav S, Jain A, Singh K, Kumar A, Raj R, Dubey D, Singh H, Guleria A, Chaturvedi S, Khan AR, Nath A, Misra DP, Agarwal V, Kumar D. Clinical metabolomics by NMR revealed serum metabolic signatures for differentiating sarcoidosis from tuberculosis. Metabolomics 2023; 19:92. [PMID: 37940751 DOI: 10.1007/s11306-023-02052-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Pulmonary sarcoidosis (SAR) and tuberculosis (TB) are two granulomatous lung-diseases and often pose a diagnostic challenge to a treating physicians. OBJECTIVE The present study aims to explore the diagnostic potential of NMR based serum metabolomics approach to differentiate SAR from TB. MATERIALS AND METHOD The blood samples were obtained from three study groups: SAR (N = 35), TB (N = 28) and healthy normal subjects (NC, N = 56) and their serum metabolic profiles were measured using 1D 1H CPMG (Carr-Purcell-Meiboom-Gill) NMR spectra recorded at 800 MHz NMR spectrometer. The quantitative metabolic profiles were compared employing a combination of univariate and multivariate statistical analysis methods and evaluated for their diagnostic potential using receiver operating characteristic (ROC) curve analysis. RESULTS Compared to SAR, the sera of TB patients were characterized by (a) elevated levels of lactate, acetate, 3-hydroxybutyrate (3HB), glutamate and succinate (b) decreased levels of glucose, citrate, pyruvate, glutamine, and several lipid and membrane metabolites (such as very-low/low density lipoproteins (VLDL/LDL), polyunsaturated fatty acids, etc.). CONCLUSION The metabolic disturbances not only found to be well in concordance with various previous reports, these further demonstrated very high sensitivity and specificity to distinguish SAR from TB patients suggesting serum metabolomics analysis can serve as surrogate method in the diagnosis and clinical management of SAR.
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Affiliation(s)
- Mohit Kumar Rai
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
| | - Sachin Yadav
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
- Department of Chemistry, Integral University, Lucknow, UP, 226026, India
| | - Avinash Jain
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India.
- Department of Clinical Immunology and Rheumatology, SMS Medical College, Jaipur, India.
| | - Kritika Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
| | - Amit Kumar
- Centre of Biomedical Research (CBMR), Lucknow, UP, 226014, India
| | - Ritu Raj
- Centre of Biomedical Research (CBMR), Lucknow, UP, 226014, India
| | - Durgesh Dubey
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
- Centre of Biomedical Research (CBMR), Lucknow, UP, 226014, India
| | - Harshit Singh
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
- Immuno Biology Lab, Translational Health Science and Technology Institute, Faridabad, HR, 121001, India
| | - Anupam Guleria
- Centre of Biomedical Research (CBMR), Lucknow, UP, 226014, India
| | - Saurabh Chaturvedi
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
- Department of Medical Laboratory Technology, School of Allied Health Sciences, Delhi Pharmaceutical Sciences and Research University, Sector III, Pushp Vihar, M.B. Road, New Delhi, 110017, India
| | - Abdul Rahman Khan
- Department of Chemistry, Integral University, Lucknow, UP, 226026, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, UP, 226014, India.
| | - Dinesh Kumar
- Centre of Biomedical Research (CBMR), Lucknow, UP, 226014, India.
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Kato S, Sakai Y, Okabe A, Kawashima Y, Kuwahara K, Shiogama K, Abe M, Ito H, Morimoto S. Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis. J Clin Med 2022; 11:jcm11010251. [PMID: 35011991 PMCID: PMC8746035 DOI: 10.3390/jcm11010251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy is invasive and has limited sensitivity for identifying granulomas, it is the only modality that yields a definitive diagnosis of cardiac sarcoidosis. It is imperative to develop novel pathological approaches for the precise diagnosis of cardiac sarcoidosis. Here, we aimed to discuss commonly used diagnostic criteria for cardiac sarcoidosis and to summarize useful and novel histopathologic criteria of cardiac sarcoidosis. While classical histologic observations including noncaseating granulomas and multinucleated giant cells (typically Langhans type) are the most important findings, others such as microgranulomas, CD68+ CD163- pro-inflammatory (M1) macrophage accumulation, CD4/CD8 T-cell ratio, Cutibacterium acnes components, lymphangiogenesis, confluent fibrosis, and fatty infiltration may help to improve the sensitivity of endomyocardial biopsy for detecting cardiac sarcoidosis. These novel histologic findings are based on the pathology of cardiac sarcoidosis. We also discussed the principal histologic differential diagnoses of cardiac sarcoidosis, such as tuberculosis myocarditis, fungal myocarditis, giant cell myocarditis, and dilated cardiomyopathy.
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Affiliation(s)
- Shu Kato
- Postgraduate Clinical Training Center, Fujita Health University Hospital, Aichi 470-1192, Japan;
| | - Yasuhiro Sakai
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
- Correspondence: ; Tel.: +81-562-93-9934
| | - Asako Okabe
- Department of Diagnostic Pathology, Kansai Medical University Hospital, Osaka 573-1191, Japan;
| | - Yoshiaki Kawashima
- Department of Pathology, Fujita Health University Bantane Hospital, Aichi 454-8509, Japan;
| | - Kazuhiko Kuwahara
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
| | - Kazuya Shiogama
- Department of Morphology and Pathological Diagnosis, Fujita Health University School of Medical Sciences, Aichi 470-1192, Japan; (K.S.); (M.A.)
| | - Masato Abe
- Department of Morphology and Pathological Diagnosis, Fujita Health University School of Medical Sciences, Aichi 470-1192, Japan; (K.S.); (M.A.)
| | - Hiroyasu Ito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
| | - Shin’ichiro Morimoto
- Department of Cardiology, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
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3
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Alba AC, Gupta S, Kugathasan L, Ha A, Ochoa A, Balter M, Sosa Liprandi A, Sosa Liprandi MI. Cardiac Sarcoidosis: A Clinical Overview. Curr Probl Cardiol 2021; 46:100936. [PMID: 34400001 DOI: 10.1016/j.cpcardiol.2021.100936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/26/2022]
Abstract
Cardiac sarcoidosis (CS) with clinical manifestation occurs in about 5-8% of patients with sarcoidosis. CS may be clinically suspected by the presence of ventricular arrhythmia, conduction abnormalities, and heart failure (HF). However, 20%-25% of patients may present with silent CS, having asymptomatic cardiac involvement. The diagnosis of CS is based on findings from nuclear studies, cardiac magnetic resonance, and extra-cardiac tissue biopsy. Due to the inflammatory nature of the disease, immunosuppressive medications are a cornerstone of therapy. The treatment also includes recommended HF medical therapies. Since CS patients are at risk of sudden cardiac death resulting from progression of cardiac dysfunction or the presence of scar originating from fatal arrhythmias, implantable cardioverter-defibrillators should be considered, with special indication beyond accepted recommendations in HF. In CS, the extent of left ventricular dysfunction is the most important mortality predictor. Heart transplant or mechanical circulatory support may represent life saving strategies in selective CS patients.
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Affiliation(s)
- Ana Carolina Alba
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Shyla Gupta
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lakshmi Kugathasan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alejandro Ochoa
- Echocardiography, Cardioestudio, Clinica Las Vegas, Medellin, Colombia
| | - Meyer Balter
- Division of Respiratory Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Alvaro Sosa Liprandi
- Department of Cardiology and Heart Failure, Sanatorio Güemes, Buenos Aires, Argentina
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Abstract
After the initial description of extrarenal synthesis of 1,25-dihydroxyvitamin D (1,25-(OH)2D) three decades ago, extensive progress has been made in unraveling the immunomodulatory roles of vitamin D in the pathogenesis of granulomatous disorders, including sarcoidosis. It has been shown that 1,25-(OH)2D has dual effects on the immune system, including upregulating innate immunity as well as downregulating the autoimmune response. The latter mechanism plays an important role in the pathogenesis and treatment of sarcoidosis. Vitamin D supplementation in patients with sarcoidosis has been hampered owing to concerns about the development of hypercalcemia and hypercalciuria given that extrarenal 1-α hydroxylase is substrate dependent. Recently, a few studies have cast doubt over the mechanisms underlying the development of hypercalcemia in this population. These studies demonstrated an inverse relationship between the level of vitamin D and severity of sarcoidosis. Consequently, clinical interest has been piqued in the use of vitamin D to attenuate the autoimmune response in this disorder. However, the development of hypercalcemia and the attendant detrimental effects are real possibilities. Although the average serum calcium concentration did not change following vitamin D supplementation, in two recent studies, hypercalciuria occurred in one out of 13 and two out of 16 patients. This review is a concise summary of the literature, outlining past work and newer developments in the use of vitamin D in sarcoidosis. We feel that larger-scale placebo-controlled randomized studies are needed in this population. Since the current first-line treatment of sarcoidosis is glucocorticoids, which confer many systemic adverse effects, and steroid-sparing immunosuppressant treatment options carry additional risks of adverse effects, adjunct management with vitamin D in combination with potent anti-osteoporotic medications could minimize the risk of glucocorticoid-induced osteoporosis and modulate the immune system to attenuate disease activity in sarcoidosis.
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Affiliation(s)
- Fabiola Gianella
- Pulmonary and Critical Care Medicine Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Connie CW Hsia
- Pulmonary and Critical Care Medicine Division, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Khashayar Sakhaee
- Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Kinoshita Y, Ishii H, Eishi Y, Uchida K, Yoshimura M, Iwasaki A, Fujita M, Nabeshima K, Watanabe K. Histological differences between sarcoidosis and lung cancer-related sarcoid reaction. Respir Investig 2020; 58:421-424. [PMID: 32482594 DOI: 10.1016/j.resinv.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/17/2020] [Accepted: 04/13/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Yoshiaki Kinoshita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan; Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University, Graduate School and Faculty of Medicine, Tokyo, Japan
| | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University, Graduate School and Faculty of Medicine, Tokyo, Japan
| | - Masayo Yoshimura
- Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Akinori Iwasaki
- Thoracic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Masaki Fujita
- Department of Respiratory Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kazuki Nabeshima
- Department of Pathology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kentaro Watanabe
- Department of Respiratory Medicine, Nishi Fukuoka Hospital, Fukuoka, Japan.
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Catalase expression of Propionibacterium acnes may contribute to intracellular persistence of the bacterium in sinus macrophages of lymph nodes affected by sarcoidosis. Immunol Res 2020; 67:182-193. [PMID: 31187451 DOI: 10.1007/s12026-019-09077-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bacterial catalase is important for intracellular survival of the bacteria. This protein of Propionibacterium acnes, one of possible causes of sarcoidosis, induces hypersensitive Th1 immune responses in sarcoidosis patients. We examined catalase expression in cultured P. acnes isolated from 19 sarcoid and 18 control lymph nodes and immunohistochemical localization of the protein in lymph nodes from 43 sarcoidosis and 102 control patients using a novel P. acnes-specific antibody (PAC) that reacts with the catalase protein, together with the previously reported P. acnes-specific PAB and TIG antibodies. High catalase expression of P. acnes cells was found during stationary phase in more isolates from sarcoid than from non-sarcoid lymph nodes and was associated with bacterial survival under H2O2-induced oxidative stress. In many sarcoid and some control lymph nodes, catalase expression was detected at the outer margins of PAB-reactive Hamazaki-Wesenberg (HW) bodies in sinus macrophages, the same location as catalase expression on the surface of cultured P. acnes and the same distribution as bacterial cell membrane-bound lipoteichoic acid in HW bodies. Some or no catalase expression was detected in sarcoid granulomas with PAB reactivity or in clustered paracortical macrophages packed with many PAB-reactive small-round bodies. HW bodies expressing catalase may be persistent P. acnes in sinus macrophages whereas PAB-reactive small-round bodies with undetectable catalase may be activated P. acnes proliferating in paracortical macrophages. Intracellular proliferation of P. acnes in paracortical macrophages may lead to granuloma formation by this commensal bacterium in sarcoidosis patients with Th1 hypersensitivity to certain P. acnes antigens, including catalase.
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7
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Inaoka PT, Shono M, Kamada M, Espinoza JL. Host-microbe interactions in the pathogenesis and clinical course of sarcoidosis. J Biomed Sci 2019; 26:45. [PMID: 31182092 PMCID: PMC6558716 DOI: 10.1186/s12929-019-0537-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/22/2019] [Indexed: 12/27/2022] Open
Abstract
Sarcoidosis is a rare inflammatory disease characterized by the development of granulomas in various organs, especially in the lungs and lymph nodes. Clinics of the disease largely depends on the organ involved and may range from mild symptoms to life threatening manifestations. Over the last two decades, significant advances in the diagnosis, clinical assessment and treatment of sarcoidosis have been achieved, however, the precise etiology of this disease remains unknown. Current evidence suggests that, in genetically predisposed individuals, an excessive immune response to unknown antigen/s is crucial for the development of sarcoidosis. Epidemiological and microbiological studies suggest that, at least in a fraction of patients, microbes or their products may trigger the immune response leading to sarcoid granuloma formation. In this article, we discuss the scientific evidence on the interaction of microbes with immune cells that may be implicated in the immunopathogenesis of sarcoidosis, and highlight recent studies exploring potential implications of human microbiota in the pathogenesis and the clinical course of sarcoidosis.
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Affiliation(s)
- Pleiades T Inaoka
- Department of Physical Therapy, School of Health Sciences, Kanazawa University, Kodatsuno, Kanazawa, 577-8502, Japan
| | - Masato Shono
- Faculty of Medicine, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 577-8502, Japan
| | - Mishio Kamada
- Faculty of Medicine, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 577-8502, Japan
| | - J Luis Espinoza
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 577-8502, Japan.
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8
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Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias. HeartRhythm Case Rep 2018; 4:584-588. [PMID: 30581738 PMCID: PMC6301890 DOI: 10.1016/j.hrcr.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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9
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Arkema EV, Cozier YC. Epidemiology of sarcoidosis: current findings and future directions. Ther Adv Chronic Dis 2018; 9:227-240. [PMID: 30364496 PMCID: PMC6196636 DOI: 10.1177/2040622318790197] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease with unknown etiology. Epidemiological studies have contributed greatly to our knowledge about sarcoidosis, providing critical information on the determinants and distribution of the disease. In this review, we summarize recently published findings from epidemiological studies on sarcoidosis. We review the epidemiological tools used, the incidence and prevalence of disease, mortality and cancer risk after sarcoidosis and nongenetic risk factors for sarcoidosis. Genetics studies have not been included as they deserve a separate review. Leveraging existing epidemiological data to conduct etiological studies aimed towards understanding and preventing disease is critical for future sarcoidosis research.
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Affiliation(s)
- Elizabeth V. Arkema
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm 17176, Sweden
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10
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Cozier YC. Assessing the worldwide epidemiology of sarcoidosis: challenges and future directions. Eur Respir J 2018; 48:1545-1548. [PMID: 27903684 DOI: 10.1183/13993003.01819-2016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/15/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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11
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Westreich RW, Lawson W. Midline Necrotizing Nasal Lesions: Analysis of 18 Cases Emphasizing Radiological and Serological Findings with Algorithms for Diagnosis and Management. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240401800405] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The aim of this study was to assess the principal signs and symptoms for severe necrotizing midline nasal lesions and give diagnostic and management algorithms. Methods Literature review and retrospective chart review were performed. Three patients with Wegener's granulomatosis (WG), six patients with sarcoid, eight patients with cocaine abuse, and one lymphoma patient were analyzed with respect to symptom complexes, laboratory results, and radiographic findings. Based on computed tomography findings, a nasal destruction score was tabulated for each patient. Results All diseases essentially had similar signs and symptoms within the head and neck but several extranasal sites were suggestive of specific etiologies. Serological laboratory testing was diagnostic in only two of the six sarcoid patients and two of the three WG patients. There were no specific tests associated with lymphoma or cocaine abuse, although erythrocyte sedimentation rate was consistently and significantly elevated in the latter group. Biopsy confirmed disease was found in one of the three sarcoid patients, in one of the three WG patients, and in one out of one of the lymphoma patients. Nasal destruction scores were highest in WG and lymphoma patients, intermediate in cocaine abuse patients, and lowest in patients with sarcoidosis. Two of the three WG patients had extensive neo-osteogenesis. One out of one lymphoma and five of the eight cocaine abuse patients had oronasal or oroantral fistulas. Conclusion Laboratory tests and biopsies were consistently unreliable in all diseases. Repeat studies should be performed in all cases of negative results if clinical suspicion is high. Neo-osteogenesis and mastoid disease were associated with WG when compared with patients with similar levels of nasal destruction due to other etiologies. Laryngeal and dermatologic changes without significant nasal bony abnormalities raised suspicion for sarcoidosis. Hard and soft palate defects were associated with cocaine abuse and extranodal nasal lymphoma.
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Affiliation(s)
| | - William Lawson
- Department of Otolaryngology, Mount Sinai Hospital, New York, New York
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12
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Yang G, Eishi Y, Raza A, Rojas H, Achiriloaie A, De Los Reyes K, Raghavan R. Propionibacterium acnes
-associated neurosarcoidosis: A case report with review of the literature. Neuropathology 2017; 38:159-164. [DOI: 10.1111/neup.12411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Guang Yang
- Department of Pathology and Laboratory Medicine; Loma Linda University Medical Center; Loma Linda California USA
| | - Yoshinobu Eishi
- Department of Human Pathology; Tokyo Medical and Dental University Graduate School; Tokyo Japan
| | - Anwar Raza
- Department of Pathology and Laboratory Medicine; Loma Linda University Medical Center; Loma Linda California USA
| | - Heather Rojas
- Department of Pathology and Laboratory Medicine; Loma Linda University Medical Center; Loma Linda California USA
| | - Adina Achiriloaie
- Department of Radiology; Loma Linda University Medical Center; Loma Linda California USA
| | - Kenneth De Los Reyes
- Department of Neurosurgery; Loma Linda University Medical Center; Loma Linda California USA
| | - Ravi Raghavan
- Department of Pathology and Laboratory Medicine; Loma Linda University Medical Center; Loma Linda California USA
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13
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Bowers L, Brennan M. Oral Complications of Multiorgan Disorders. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:187-195. [PMID: 28778307 DOI: 10.1016/j.cxom.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Leah Bowers
- Oral and Maxillofacial Surgery, UCSF School of Dentistry, 533 Parnassus Avenue, PO Box 0404, UB-10, San Francisco, CA 94143, USA.
| | - Michael Brennan
- Department of Oral Medicine, Carolinas Medical Center, Carolinas HealthCare System, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
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Werner JL, Escolero SG, Hewlett JT, Mak TN, Williams BP, Eishi Y, Núñez G. Induction of Pulmonary Granuloma Formation by Propionibacterium acnes Is Regulated by MyD88 and Nox2. Am J Respir Cell Mol Biol 2017; 56:121-130. [PMID: 27607191 DOI: 10.1165/rcmb.2016-0035oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Sarcoidosis is characterized by noncaseating granulomas with an unknown cause that present primarily in the lung. Propionibacterium acnes, an immunogenic commensal skin bacterium involved in acne vulgaris, has been implicated as a possible causative agent of sarcoidosis. Here, we demonstrate that a viable strain of P. acnes isolated from a patient with sarcoidosis and instilled intratracheally into wild-type mice can generate pulmonary granulomas similar to those observed in patients with sarcoidosis. The formation of these granulomas is dependent on the administration of viable P. acnes. We also found that mice deficient in the innate immunity adapter protein MyD88 had a greater number and a larger area of granuloma lesions compared with wild-type mice administered P. acnes. Early after P. acnes administration, wild-type mice produced proinflammatory mediators and recruited neutrophils into the lung, a response that is dependent on MyD88. In addition, there was an increase in granuloma number and size after instillation with P. acnes in mice deficient in CybB, a critical component of nicotinamide adenine dinucleotide phosphate oxidase required for the production of reactive oxygen species in the phagosome. Myd88-/- or Cybb-/- mice both had increased persistence of P. acnes in the lung, together with enhanced granuloma formation. In conclusion, we have generated a mouse model of early granuloma formation induced by a clinically relevant strain of P. acnes isolated from a patient with sarcoidosis, and, using this model, we have shown that a deficiency in MyD88 or CybB is associated with impaired bacterial clearance and increased granuloma formation in the lung.
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Affiliation(s)
- Jessica L Werner
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Sylvia G Escolero
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Jeff T Hewlett
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Tim N Mak
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Brian P Williams
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
| | - Yoshinobu Eishi
- 2 Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gabriel Núñez
- 1 Department of Pathology and Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan; and
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15
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Goto H, Usui Y, Umazume A, Uchida K, Eishi Y. Propionibacterium acnesas a possible pathogen of granuloma in patients with ocular sarcoidosis. Br J Ophthalmol 2017; 101:1510-1513. [DOI: 10.1136/bjophthalmol-2016-309248] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 02/06/2017] [Accepted: 02/18/2017] [Indexed: 11/03/2022]
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16
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TREM-2 Receptor Expression Increases with 25(OH)D Vitamin Serum Levels in Patients with Pulmonary Sarcoidosis. Mediators Inflamm 2015; 2015:181986. [PMID: 26166951 PMCID: PMC4488005 DOI: 10.1155/2015/181986] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 05/08/2015] [Accepted: 05/18/2015] [Indexed: 11/17/2022] Open
Abstract
TREM-1 and TREM-2 molecules are members of the TREM transmembrane glycoproteins. In our previous study we identified increased expressions of TREM-1 and TREM-2 receptors in pulmonary sarcoidosis (PS). Only a few studies concerning the association between vitamin D and TREM receptor expression can be found. The aim of our current study was to determine the association between the levels of an inactive form of 25(OH)D vitamin and TREM-1 and TREM-2 receptor expressions. We have detected low levels of 25(OH)D vitamin in 79% of PS patients. Only 21% of patients had normal serum level of 25(OH)D vitamin with values clustered within the low-normal range. The most striking findings were the increased TREM-2 expressions on myeloid cells surfaces in BALF of PS patients with normal 25(OH)D vitamin serum levels compared with those with its decreased levels. The total number of TREM-2 positive cells was 5.7 times higher and the percentage of TREM-2 positive cells was also significantly increased in BALF of PS patients with normal compared to PS patients with low 25(OH)D vitamin serum levels. A significant correlation between total TREM-2 expression and vitamin D levels has been detected too. However, we have not detected similar differences in TREM-1expression and 25(OH)D vitamin serum levels.
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Sawahata M, Sugiyama Y, Nakamura Y, Nakayama M, Mato N, Yamasawa H, Bando M. Age-related and historical changes in the clinical characteristics of sarcoidosis in Japan. Respir Med 2015; 109:272-8. [PMID: 25613109 DOI: 10.1016/j.rmed.2014.12.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 08/09/2014] [Accepted: 12/26/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND National surveys conducted in Japan between 1960 and 2004 suggest a gradually increasing incidence of sarcoidosis in women >50 years old with increased involvement of the eye, skin, and heart. However, whether this involvement is due to the increased age at diagnosis is still unclear. We aimed here to identify the age-related differences in organ involvement in sarcoidosis in Japan, as well as the historical changes in clinical characteristics and the age-specific distribution of cases at diagnosis. METHODS We reviewed 588 consecutive Japanese patients newly diagnosed with sarcoidosis between 1974 and 2012 at Jichi Medical University Hospital. We compared organ involvement between subgroups differentiated by sex and age (<45 years; n = 275; ≥45 years; n = 313) at diagnosis and identified historical changes in the age-specific distribution in 10-year intervals. RESULTS Younger patients had more common involvement of extrathoracic lymph nodes, parotid/salivary gland, and liver, while older patients had more common involvement of non-lymphatic extrathoracic organs such as the eye, heart, muscle, and kidney. The age at diagnosis has consistently increased over the past four decades. The monophasic distribution in men has tended to become biphasic, and the biphasic distribution in women monophasic. Increasing trends were apparent for hypercalcemia and involvement of the gastrointestinal tract, skin, nervous system, muscle, and kidney. CONCLUSIONS Elderly patients at diagnosis had various extrathoracic involvement including eye, skin, and cardiac lesions. Moreover, the age at diagnosis of sarcoidosis has continued to increase in both sexes, influencing the recent trends in clinical characteristics.
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Affiliation(s)
- Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Masayuki Nakayama
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Hideaki Yamasawa
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
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Mortaz E, Adcock IM, Barnes PJ. Sarcoidosis: Role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis. Int J Mycobacteriol 2014; 3:225-9. [PMID: 26786620 DOI: 10.1016/j.ijmyco.2014.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/18/2014] [Indexed: 11/29/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease that is induced by unknown antigen(s) in a genetically susceptible host. Although the direct link between Mycobacterium tuberculosis (MTB) infection and sarcoidosis can be excluded on the basis of current knowledge, non-infectious mechanisms may explain the causative role of mycobacterial antigens. Ever since sarcoidosis was first described, its relationship with tuberculosis (TB) has been under-investigated. Whereas some researchers consider sarcoidosis and TB as two examples of the same disease process, others have rejected mycobacteria as playing any causative role in sarcoidosis. Whether they are linked causally or not, clinical evidence makes a differential diagnosis between the two conditions very challenging, particularly in countries with high burden of TB. The present study analyzes the relationship between sarcoidosis and TB and its implications in clinical practice. The coincidence of TB and sarcoidosis and the higher incidence of mycobacterial DNA in biological samples of sarcoid patients have been reported by many authors. In addition, new evidence of a similarity in MTB phenotype in sarcoidosis is provided. Overall, these observations suggest that TB and sarcoidosis may not only share the same etiology, but may even be different aspects of one disease.
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Affiliation(s)
- Esmaeil Mortaz
- Division of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Sciences, Utrecht University, Utrecht, The Netherlands; Clinical Tuberculosis and Epidemiology Research Center, National Research and Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, UK
| | - Ian M Adcock
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, UK.
| | - Peter J Barnes
- Cell and Molecular Biology Group, Airways Disease Section, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London, UK
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Takemori N, Nakamura M, Kojima M, Eishi Y. Successful treatment in a case of Propionibacterium acnes-associated sarcoidosis with clarithromycin administration: a case report. J Med Case Rep 2014; 8:15. [PMID: 24428939 PMCID: PMC3916803 DOI: 10.1186/1752-1947-8-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/12/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction Sarcoidosis is recognized as a multiorgan disorder characterized by the presence of non-caseating granulomas in the involved tissues. It has been suggested that sarcoidosis might be due to the exposure to infectious or non-infectious agents in genetically susceptible individuals. In particular, Propionibacterium acnes and Mycobacterium tuberculosis have been considered causative microorganisms. We report a case of P. acnes-associated sarcoidosis in which a drastic improvement was achieved with clarithromycin administration. A possible mechanism of clarithromycin action is discussed. Case presentation A 78-year-old Japanese-Mongoloid woman with P. acnes-associated sarcoidosis presented with a persisting fever, joint pains and generalized lymph node swelling. The diagnosis of sarcoidosis was confirmed by pathological and immunohistochemical studies of a biopsied lymph node. In this case, an oral administration of clarithromycin was applied. Soon after the initiation of this treatment her symptoms as well as lymph node swelling disappeared. The clarithromycin treatment was discontinued 3.5 months after its initiation. She is currently in good condition. The pathological analysis of her lymph node, which was obtained during the clarithromycin treatment, suggested an apoptosis-inducing effect of clarithromycin on the sarcoid granulomas. Conclusions Clarithromycin was found to be effective for treating sarcoidosis and seems to have important pharmacological effects such as immunosuppression, immunomodulation and induction of apoptosis in addition to its antimicrobial role. In this case, apoptosis in the sarcoid granulomas induced by clarithromycin administration might have resulted in satisfactory improvement.
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Affiliation(s)
- Nobuo Takemori
- Division of Hematology, Department of Internal Medicine, Imai Hospital, Tanaka-cho 100, Ashikaga, Tochigi 326-0822, Japan.
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Robinson LA, Smith P, SenGupta DJ, Prentice JL, Sandin RL. Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case-control study with clinical correlates. BMJ Open 2013; 3:e004065. [PMID: 24366580 PMCID: PMC3884606 DOI: 10.1136/bmjopen-2013-004065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sarcoidosis is an incurable, chronic granulomatous disease primarily involving the lungs and lymph nodes of unknown aetiology, treated with non-specific anti-inflammatory/immunosuppressive drugs. Persistently symptomatic patients worsen with a disabling, potentially fatal clinical course. To determine a possible infectious cause, we correlated in a case-control study the clinical information with the presence of bacterial DNA in sarcoidosis mediastinal lymph nodes compared with control lymph nodes resected during cancer surgery. METHODS We retrospectively studied formalin-fixed, paraffin-embedded, mediastinal lymph nodes from 30 patients with sarcoidosis and 30 control patients with lung cancer. Nucleic acids were extracted from nodes, evaluated by ribosomal RNA PCR for bacterial 16S ribosomal DNA and the results were sequenced and compared with a bacterial sequence library. Clinical information was correlated. RESULTS 11/30 (36.7%) of lymph nodes from patients with sarcoidosis had detectable bacterial DNA, significantly more than control patient lymph nodes (2/30, 6.7%), p=0.00516. At presentation, 19/30 (63.3%) patients with sarcoidosis were symptomatic including all patients with detectable bacterial DNA. Radiographically, there were 18 stage I and 12 stage II patients. All stage II patients were symptomatic and 75% had PCR-detectable bacteria. After a mean follow-up of 52.8±32.8 months, all patients with PCR-detectable bacteria in this series were persistently symptomatic requiring treatment. DISCUSSION 36.6% of patients with sarcoidosis had detectable bacterial DNA on presentation, all of these patients were quite symptomatic and most were radiographically advanced stage II. These findings suggest that bacterial DNA-positive, symptomatic patients have more aggressive sarcoidosis that persists long term and might benefit from antimicrobial treatment directed against this presumed chronic granulomatous infection.
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Affiliation(s)
- Lary A Robinson
- Division of Thoracic Oncology, Center for Infection Research in Cancer, Moffitt Cancer Center, Tampa, Florida, USA
| | - Prudence Smith
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Dhruba J SenGupta
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Jennifer L Prentice
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, USA
| | - Ramon L Sandin
- Department of Pathology, Moffitt Cancer Center, Tampa, Florida, USA
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Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology. Cardiac involvement may occur, leading to an adverse outcome. Although early treatment to improve morbidity and mortality is desirable, sensitive and accurate detection of cardiac sarcoidosis remains a challenge. Accordingly, interest in the use of advanced imaging such as cardiac MR and PET with (18)F-FDG is increasing in order to refine the clinical workup. Although the field is still facing challenges and uncertainties, this article presents a summary of clinical background and the current state of diagnostic modalities and treatment of cardiac sarcoidosis.
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Affiliation(s)
- Imke Schatka
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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22
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Abstract
With new insights into the pathogenesis of specific granulomatous diseases, and with the advent of high-throughput genetic screening and availability of next-generation biological therapies, clinicians have several options at their disposal to help ensure accurate diagnosis and effective treatment. This article highlights some of the current knowledge about the more common granulomatous systemic diseases that may be encountered in clinical practice.
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Affiliation(s)
- Faizan Alawi
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, 240 South 40th Street, Room 328B, Philadelphia, PA 19104-6002, USA.
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Etiologic aspect of sarcoidosis as an allergic endogenous infection caused by Propionibacterium acnes. BIOMED RESEARCH INTERNATIONAL 2013; 2013:935289. [PMID: 23844371 PMCID: PMC3697284 DOI: 10.1155/2013/935289] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 05/07/2013] [Indexed: 11/17/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology. Propionibacterium acnes is the only microorganism that has been isolated from sarcoid lesions. Many P. acnes have been detected in sarcoid lymph nodes using quantitative PCR and in sarcoid granulomas by in situ hybridization. P. acnes trigger factor protein causes a cellular immune response only in sarcoid patients and induces pulmonary granulomas in mice sensitized with the protein and adjuvant, but only those with latent P. acnes infection in their lungs. Eradication of P. acnes by antibiotics prevents the development of granulomas in this experimental model. Although P. acnes is the most common commensal bacterium in the lungs and lymph nodes, P. acnes-specific antibody detected the bacterium within sarcoid granulomas of these organs. P. acnes can cause latent infection in the lung and lymph node and persist in a cell-wall-deficient form. The dormant form is activated endogenously under certain conditions and proliferates at the site of latent infection. In patients with P. acnes hypersensitivity, granulomatous inflammation is triggered by intracellular proliferation of the bacterium. Proliferating bacteria may escape granulomatous isolation, spreading to other organs. Latent P. acnes infection in systemic organs can be reactivated by another triggering event, leading to systemic sarcoidosis.
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Daniil Z, Mollaki V, Malli F, Koutsokera A, Antoniou KM, Rodopoulou P, Gourgoulianis K, Zintzaras E, Vassilopoulos G. Polymorphisms and haplotypes in MyD88 are associated with the development of sarcoidosis: a candidate-gene association study. Mol Biol Rep 2013; 40:4281-6. [PMID: 23666053 DOI: 10.1007/s11033-013-2513-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 04/27/2013] [Indexed: 12/21/2022]
Abstract
Sarcoidosis is considered as a disorder of protracted immune response to an as yet unidentified causative agent that leads to granuloma formation. Material from M. tuberculosis and P. acne has been repeatedly detected in the sarcoidosis lesions, implying the involvement of the Toll-like receptor2 (TLR2) gene that responds to these intracellular pathogens. Since TLR2 association studies have produced controversial results, we sought to investigate whether the downstream signalling molecule MyD88 could be linked to disease susceptibility. We analyzed a total of 93 cases with sarcoidosis and of 89 controls for the most common MyD88 SNPs: -938C>A (rs4988453) and 1944C>G (rs4988457). There is evidence that the genotype distributions of both variants are associated with the development of sarcoidosis (p = 0.038 for -938C>A and p = 0.026 for 1944C>G). In particular, -938A and 1944G carriers were associated with risk of sarcoidosis [OR = 2.48 (1.23-5.02) and OR = 0.33 (0.14-0.76)], respectively, indicating dominance of the mutant alleles; however, the adjustment of the effect size for age and sex diminished the significance. The haplotype analysis showed association for the -938A/1944G haplotype (p < 0.001). Since genetic association studies have linked MyD88 to Hodgkin's lymphoma it is tempting to speculate that MyD88 may contribute to the granuloma formation that characterizes sarcoidosis.
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Affiliation(s)
- Z Daniil
- Department of Respiratory Medicine, University of Thessaly School of Medicine, Larissa, Greece
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25
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Eishi Y. Etiologic link between sarcoidosis and Propionibacterium acnes. Respir Investig 2013; 51:56-68. [PMID: 23790733 DOI: 10.1016/j.resinv.2013.01.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/12/2013] [Accepted: 01/18/2013] [Indexed: 11/19/2022]
Abstract
Propionibacterium acnes is the only microorganism isolated from sarcoid lesions by bacterial culture. Numerous P. acnes genomes are found in lymph node samples from Japanese and European patients with sarcoidosis, whereas a few genomes are found in some non-sarcoid samples. The high frequency and specificity of detecting P. acnes within sarcoid granulomas suggests that this indigenous bacterium causes granuloma formation in many patients with sarcoidosis. P. acnes is the most common commensal bacterium in the lungs and lymph nodes. Occasional detection of P. acnes in non-granulomatous areas of these organs from non-sarcoid patients suggests that host factors are more critical than agent factors in the etiology of sarcoidosis. A particular protein, i.e., trigger factor, from P. acnes causes a cellular immune response only in sarcoid patients. The P. acnes trigger-factor protein induces pulmonary granulomas in mice sensitized with the protein and adjuvant, but only in those with latent P. acnes infection in their lungs. Eradication of P. acnes by antibiotics prevents the development of granulomas in this experimental model. P. acnes can cause latent infection in the lung and lymph nodes and persists in a cell wall-deficient form. The dormant form is endogenously activated under certain conditions and proliferates at the site of latent infection. In patients with P. acnes hypersensitivity, granulomatous inflammation is triggered by intracellular proliferation of the bacterium. Proliferating bacteria may escape granulomatous isolation, spreading to other organs. Latent P. acnes infection in systemic organs can be reactivated by another triggering event, leading to systemic sarcoidosis.
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Affiliation(s)
- Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
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Chen HI, Lang SS, Coyne TM, Malhotra NR, Schuster JM. Intramedullary spinal sarcoidosis masquerading as cervical stenosis. World Neurosurg 2012; 80:e375-80. [PMID: 23041066 DOI: 10.1016/j.wneu.2012.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/13/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Intramedullary spinal sarcoidosis is a difficult diagnosis to make because of its nonspecific clinical and imaging features and its imitation of other common spine disorders. We present a patient with intramedullary spinal sarcoidosis that mimicked spinal cord injury from a cervical disk herniation. METHODS Relevant information was extracted from the patient's medical and imaging records. A thorough literature review subsequently was performed. RESULTS A 59-year-old woman presented to our institution with several months of intermittent parathesias, pain, and subjective weakness in her right upper and lower extremities. Magnetic resonance imaging of the cervical spine demonstrated a large osteophyte-disk complex at C4-5 adjacent to a small area of intramedullary spinal cord enhancement. The patient underwent C4-5 anterior cervical diskectomy and fusion for the osteophyte-disk complex. She initially improved postoperatively but subsequently worsened after a few months. Because of more prominent spinal cord enhancement, a posterior laminectomy and biopsy of the enhancing lesion was performed. Intramedullary spinal sarcoidosis was diagnosed, and she was treated medically with steroids and immunosuppressive agents. CONCLUSION Spinal sarcoidosis can mimic more common disease processes, such as cervical spondylosis. It is an important consideration in the diagnosis of intramedullary or intradural lesions of the spinal cord because early medical treatment may improve the course of the disease process. Surgery should be limited to biopsy for diagnostic purposes.
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Affiliation(s)
- H Isaac Chen
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Negi M, Takemura T, Guzman J, Uchida K, Furukawa A, Suzuki Y, Iida T, Ishige I, Minami J, Yamada T, Kawachi H, Costabel U, Eishi Y. Localization of propionibacterium acnes in granulomas supports a possible etiologic link between sarcoidosis and the bacterium. Mod Pathol 2012; 25:1284-97. [PMID: 22596102 PMCID: PMC3434354 DOI: 10.1038/modpathol.2012.80] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sarcoidosis likely results from the exposure of a genetically susceptible subject to an environmental agent, possibly an infectious one. Mycobacterial and propionibacterial organisms are the most commonly implicated potential etiologic agents. Propionibacterium acnes is the only microorganism, however, found in sarcoid lesions by bacterial culture. To evaluate the pathogenic role of this indigenous bacterium, we screened for the bacterium in sarcoid and non-sarcoid tissues using immunohistochemical methods with novel P. acnes-specific monoclonal antibodies that react with cell-membrane-bound lipoteichoic acid (PAB antibody) and ribosome-bound trigger-factor protein (TIG antibody). We examined formalin-fixed and paraffin-embedded samples of lungs and lymph nodes from 196 patients with sarcoidosis, and corresponding control samples from 275 patients with non-sarcoidosis diseases. The samples were mostly from Japanese patients, with 64 lymph node samples from German patients. Immunohistochemistry with PAB antibody revealed small round bodies within sarcoid granulomas in 20/27 (74%) video-assisted thoracic surgery lung samples, 24/50 (48%) transbronchial lung biopsy samples, 71/81 (88%) Japanese lymph node samples, and 34/38 (89%) German lymph node samples. PAB antibody did not react with non-sarcoid granulomas in any of the 45 tuberculosis samples or the 34 samples with sarcoid reaction. In nongranulomatous areas, small round bodies detected by PAB antibody were found in alveolar macrophages of lungs and paracortical macrophages of lymph nodes from many sarcoid and some non-sarcoid patients. Large-spheroidal acid-fast bodies, Hamazaki-Wesenberg bodies, which were found in 50% of sarcoid and 15% of non-sarcoid lymph node samples, reacted with both PAB and TIG antibodies. Electron microscopy revealed that these Hamazaki-Wesenberg bodies had a single bacterial structure and lacked a cell wall with occasional protrusions from the body. The high frequency and specificity of P. acnes, detected by PAB antibody within sarcoid granulomas, indicates that this indigenous bacterium might be the cause of granuloma formation in many sarcoid patients.
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Affiliation(s)
- Mariko Negi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Tamiko Takemura
- Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Josune Guzman
- Department of General and Experimental Pathology, Ruhr University, Bochum, Germany
| | - Keisuke Uchida
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Asuka Furukawa
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoshimi Suzuki
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Tadatsune Iida
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Ikuo Ishige
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Junko Minami
- Department of Clinical Engineering, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan
| | - Tetsuo Yamada
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hiroshi Kawachi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Ulrich Costabel
- Department of Pneumology and Allergology, Ruhrlandklinik, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Yoshinobu Eishi
- Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan,Department of Human Pathology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. E-mail:
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Gutiérrez S, Respaldiza N, Campano E, Martínez-Risquez MT, Calderón EJ, De La Horra C. Pneumocystis jirovecii colonization in chronic pulmonary disease. Parasite 2011; 18:121-6. [PMID: 21678787 PMCID: PMC3671413 DOI: 10.1051/parasite/2011182121] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pneumocystis jirovecii causes pneumonia in immunosuppressed individuals. However, it has been reported the detection of low levels of Pneumocystis DNA in patients without signs and symptoms of pneumonia, which likely represents colonization. Several studies performed in animals models and in humans have demonstrated that Pneumocystis induces a local and a systemic response in the host. Since P. jirovecii colonization has been found in patients with chronic pulmonary diseases it has been suggested that P. jirovecii may play a role in the physiopathology and progression of those diseases. In this report we revise P. jirovecii colonization in different chronic pulmonary diseases such us, chronic obstructive pulmonary disease, interstitial lung diseases, cystic fibrosis and lung cancer.
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Affiliation(s)
- S Gutiérrez
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain.
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29
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Sekhri V, Sanal S, DeLorenzo LJ, Aronow WS, Maguire GP. Cardiac sarcoidosis: a comprehensive review. Arch Med Sci 2011; 7:546-54. [PMID: 22291785 PMCID: PMC3258766 DOI: 10.5114/aoms.2011.24118] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/15/2011] [Accepted: 01/31/2011] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by noncaseating granulomas in involved organs. Organs involved with sarcoidosis include lymph nodes, skin, lung, central nervous system, and eye. Only 40-50% of patients with cardiac sarcoidosis diagnosed at autopsy have the diagnosis made during their lifetime. Cardiac sarcoidosis can manifest itself as complete heart block, ventricular arrhythmias, congestive heart failure, pericardial effusion, pulmonary hypertension, and ventricular aneurysms. Diagnostic tests such as the electrocardiogram, two-dimensional echocardiography, cardiac magnetic resonance imaging, positron emission tomography scan, radionuclide scan, and endomyocardial biopsy can be helpful in the early detection of cardiac sarcoidosis. Considering the increased risk of sudden death, cardiac sarcoidosis is an indication for early treatment with corticosteroids or other immunosuppressive agents. Other treatments include placement of a pacemaker or implantable defibrillator to prevent sudden death. In refractory cases, cardiac transplantation should be considered.
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Affiliation(s)
- Vishal Sekhri
- Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla, NY, USA
| | - Shireen Sanal
- Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla, NY, USA
| | - Lawrence J. DeLorenzo
- Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla, NY, USA
| | - Wilbert S. Aronow
- Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla, NY, USA
- Division of Cardiology, New York Medical College, Valhalla, NY, USA
| | - George P. Maguire
- Division of Pulmonary, Critical Care and Sleep Medicine, New York Medical College, Valhalla, NY, USA
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Hurtado García R, Torres Murillo B, Miquel Morera R, Espinosa Garriga G. [Sarcoidosis, tuberculosis or both?]. Rev Clin Esp 2011; 211:e22-4. [PMID: 21420673 DOI: 10.1016/j.rce.2010.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/04/2010] [Accepted: 07/18/2010] [Indexed: 10/18/2022]
Affiliation(s)
- R Hurtado García
- Servicio de Enfermedades Autoinmunes Sistémicas, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
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31
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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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32
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Pacheco Y. Éthiopathogénie de la sarcoïdose. Rev Med Interne 2011; 32:73-9. [DOI: 10.1016/j.revmed.2010.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 09/15/2010] [Accepted: 09/22/2010] [Indexed: 01/13/2023]
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Terčelj M, Salobir B, Harlander M, Rylander R. Fungal exposure in homes of patients with sarcoidosis - an environmental exposure study. Environ Health 2011; 10:8. [PMID: 21251285 PMCID: PMC3036600 DOI: 10.1186/1476-069x-10-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 01/20/2011] [Indexed: 05/07/2023]
Abstract
BACKGROUND There is increasing evidence that exposure to moulds (fungi) may influence the development of sarcoidosis. To assess the influence of the environmental exposure, a study was undertaken to determine the exposure to fungi in homes of subjects with sarcoidosis. METHODS Subjects were patients with clinically established sarcoidosis recruited during the period September 2007 till June 2010. Of these 55 were newly diagnosed and currently under treatment for less than one year, 25 had been treated and had no recurrence and 27 had been treated but had recurrence of the disease. Controls were healthy subjects without any respiratory symptoms (n = 30). Samples of air (about 2.5 m3) were taken in the bedroom of the subjects using a portable pump and cellulose ester filters. The filters were analysed for the content of the enzyme N-acetylhexosaminidase (NAHA) as a marker of fungal cell biomass, using a specific substrate and a fluorescent technique and expressed as NAHA units (U)/m3. RESULTS Compared to controls, subjects undergoing treatment of the disease (newly diagnosed or with recurrence) had significantly higher activities of NAHA in their homes than controls (33.6 and 39.9 vs 10.0 U/m3, p < 0.001 and <0.001). Among controls only 5 out of 30 subjects had levels of NAHA above the second quartile value (14 U/m3). In homes of subjects with newly diagnosed disease with treatment less than one year, values above 14 NAHA U/m3 were found among 35 out of 55 and among those with recurrent disease among 18 out of 27. CONCLUSIONS The higher activities of NAHA enzyme found in homes of subjects with active and recurrent sarcoidosis suggest that exposure to fungi is related to the risk of sarcoidosis. Further environmental studies to assess the importance of this exposure for subjects with sarcoidosis are warranted. The results suggest that remedial actions in homes with high levels of fungi may be justified.
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Affiliation(s)
- Marjeta Terčelj
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Barbara Salobir
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Matevz Harlander
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
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Abstract
PURPOSE OF REVIEW To review the role of microorganisms in interstitial lung disease (ILD) and to emphasize their importance in initiation and course of ILD. RECENT FINDINGS ILD can be idiopathic but often causality such as drugs or connective tissue disease can be found. Multiple microorganisms have been associated with ILD. On the one hand, pulmonary infection can cause extensive pulmonary damage with patterns of an ILD. On the other hand, microorganisms can trigger the immune system and provoke an abnormal response- not directed against the causative pathogen- that may result in ILD. Moreover, patients with ILD often are susceptible to infection, and infections can importantly influence the course of ILD. Furthermore, not only an infection but also its treatment can result in a drug-induced pneumonitis, eventually resulting in long-term lung damage. SUMMARY Microorganisms can initiate and/or influence the course of ILD. Early recognition, adequate diagnostic evaluation and therapy are essential to prevent permanent damage. Prevention of infection in patients with established ILD is strongly recommended.
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Hörster R, Kirsten D, Gaede KI, Jafari C, Strassburg A, Greinert U, Kalsdorf B, Ernst M, Lange C. Antimycobacterial immune responses in patients with pulmonary sarcoidosis. CLINICAL RESPIRATORY JOURNAL 2010; 3:229-38. [PMID: 20298409 DOI: 10.1111/j.1752-699x.2009.00136.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Sarcoidosis is a multisystem granulomatous disease of unknown origin. Pathogenetic involvement of Mycobacterium tuberculosis has frequently been discussed in the aetiology of sarcoidosis; however, studies still remain contradictory. OBJECTIVE We addressed the question of mycobacterial involvement in the pathogenesis of sarcoidosis by analysing cellular immune responses to mycobacterial antigens. METHODS We examined the interferon (IFN)-gamma production by enzyme-linked immunospot in response to purified protein derivate (PPD) mycobacterial-specific antigen early secretory antigenic target (ESAT)-6 and culture filtrate protein (CFP)-10 by peripheral blood mononuclear cells (PBMCs) and bronchoalveolar-lavage mononuclear cells (BALMCs) of patients with pulmonary sarcoidosis, smear-negative tuberculosis and controls. RESULTS Release of IFN-gamma in response to ex vivo contact with PPD, ESAT-6 or CFP-10 by BALMC and PBMC were comparable among patients with sarcoidosis and controls (PBMC P = 0.2326; BALMC P = 0.1767) and were less frequently observed in both groups compared to patients with tuberculosis (BALMC P < 0.05; PBMC P < 0.0001). Within PBMC, the immunophenotype of sarcoidosis patients differed from that of patients with tuberculosis, as well as from that of controls, while within BALMC it resembled that of patients with tuberculosis. CONCLUSION In contrast to patients with tuberculosis, the frequency of mycobacteria-specific local and systemic immune responses is not elevated in patients with sarcoidosis when compared to controls. The immunophenotype represents the local resemblance of the granulomatous reaction underlying tuberculosis and sarcoidosis while showing systemical difference. These observations do not support a role of an infection with M. tuberculosis in the pathogenesis of sarcoidosis.
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Affiliation(s)
- Robert Hörster
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany
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36
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Watanabe D, Kuhara T, Ishida N, Tamada Y, Matsumoto Y. Sarcoid tissue reaction on herpes zoster scars in a myelodysplastic syndrome patient: Wolf's isotopic response. J Eur Acad Dermatol Venereol 2009; 23:475-7. [DOI: 10.1111/j.1468-3083.2008.02924.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Young Whan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Korea.
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38
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Poate TWJ, Sharma R, Moutasim KA, Escudier MP, Warnakulasuriya S. Orofacial presentations of sarcoidosis – a case series and review of the literature. Br Dent J 2008; 205:437-42. [DOI: 10.1038/sj.bdj.2008.892] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2008] [Indexed: 11/10/2022]
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Pérez Marín J, Martín Sánchez A, Muñoz de Unamuno J, Acosta de Bilbao F, Apolinario Hidalgo R, Santos Moyano Z, Peña Quintana P, Gómez Díaz J. Varón con hipertensión arterial, lesión cutánea y nódulos esplénicos. Rev Clin Esp 2008; 208:477-9. [DOI: 10.1157/13127616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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40
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Prasse A, Katic C, Germann M, Buchwald A, Zissel G, Müller-Quernheim J. Phenotyping Sarcoidosis from a Pulmonary Perspective. Am J Respir Crit Care Med 2008; 177:330-6. [DOI: 10.1164/rccm.200705-742oc] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Grunewald J. Clinical aspects and immune reactions in sarcoidosis. CLINICAL RESPIRATORY JOURNAL 2007; 1:64-73. [DOI: 10.1111/j.1752-699x.2007.2007.00019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A sarcoidose é doença granulomatosa não infecciosa de etiologia desconhecida, de cuja patogênese parecem participar os fatores genéticos, imunológicos, ambientais e infecciosos. Vários órgãos podem ser afetados, causando amplo espectro de manifestações clínicas. A pele é acometida em cerca de 20 a 35% dos casos, proporcionando ao dermatologista importante papel no diagnóstico da doença. Epidemiologia, imunologia e tratamento também são discutidos para prover melhor entendimento dessa enfermidade.
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Abstract
The etiology of sarcoidosis remains uncertain. The hallmark of sarcoidosis is the epithelioid granuloma, which serves as a necessary starting point for considering disease etiology. Any etiologic agent of sarcoidosis must also explain the typical clinical behaviors and characteristic immunopathologic features of the disease. One clinical observation that serves as a bridge to the etiology of sarcoidosis is the Kveim reaction. In this reaction, local epithelioid granulomas develop several weeks after the intradermal injection of homogenates of sarcoidosis tissue. Our group capitalized on the known properties of the Kveim reagent to search for candidate pathogenic tissue antigens in sarcoidosis without other a priori hypotheses regarding possible microbial or autoimmune etiologies. Using a limited proteomics approach based on the physicochemical properties of Kveim reagent, we detected a limited number of poorly soluble antigenic proteins in sarcoidosis tissues by protein immunoblotting, using sarcoidosis sera. Matrix-associated laser desorption/ionization-time of flight mass spectrometry identified one of these antigens to be the Mycobacterium tuberculosis catalase-peroxidase protein (mKatG). We found IgG responses to recombinant mKatG in more than 50% of patients with sarcoidosis but rarely in purified protein derivative (PPD)-negative control subjects. These findings support the conclusion that mKatG is a tissue antigen and target of the adaptive immune response in sarcoidosis, providing further evidence of a mycobacterial etiology in a subset of sarcoidosis. More generally, the approach used in these studies might be employed to discover and validate other candidate pathogenic antigens in sarcoidosis or other granulomatous disorders.
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Affiliation(s)
- David R Moller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224, USA.
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44
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Abstract
La sarcoidosis es una enfermedad multisistémica que afecta frecuentemente al pulmón. Su incidencia y prevalencia han sido ampliamente estudiadas, pero la falta de estandarización del diagnóstico, los diferentes métodos de detección de casos y la escasa sensibilidad y especificidad de las pruebas diagnósticas explican los datos discordantes. El pronóstico es generalmente favorable. Gran parte de las personas afectadas no manifestarán nunca síntomas y muchas tienen remisión espontánea. El curso es crónico en el 10-30% de los casos, con un deterioro permanente de la función pulmonar. La enfermedad es el resultado de la acción de un agente externo que desencadena la respuesta inmunitaria característica en individuos genéticamente susceptibles. Se han implicado factores ambientales, ocupacionales y genéticos, pero las investigaciones están todavía en los inicios. Estudios de casos y controles, así como los avances en biología molecular, ayudarán a definir los factores de susceptibilidad genética y a entender los distintos fenotipos de la sarcoidosis.
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45
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Pavic M, Le Pape E, Debourdeau P, Rabar D, Crevon L, Colle B, Rousset H. [Non-tuberculous systemic granulomatosis mimicking sarcoidosis but related to a specific etiology. Study of 67 cases]. Rev Med Interne 2007; 29:5-14. [PMID: 17602803 DOI: 10.1016/j.revmed.2007.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Accepted: 05/21/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE Systemic granulomatosis (SG) are frequently encountered in internal medicine. Despite a large list of aetiologies, the investigations remain often negative leading to the diagnosis of atypical sarcoidosis. The spectrum of the causes, as well as evolution of these SG is not clearly delineated in the literature. METHOD We analyzed the case reports of all but tuberculous GS submitted at the National Meetings of the National French Society of Internal Medicine from 1990 to 2006. RESULTS Sixty-seven cases were included in the study. The average age at the beginning of the symptoms was 47.8 years and 28.4% of the patients were female. The median diagnostic delay was one year. General symptoms were present in 73.1% of the cases. The involved organs were the liver (46.3%), lungs (25.4%), lymph nodes (22.4%), digestive tract (16.4%), skin (16.4%), spleen (14.9%). The granuloma were detected mainly in the liver (38.8%), lymph nodes (17.9%), bone marrow (16.4%) and lungs (11.9%). Elevated erythrocyte sedimentation rate or increased C reactive protein serum levels were noted in 65.6% of the patients. Before diagnosis, 19.4% of the patients received a corticotherapy. The most common diagnoses were infections (65.6%) followed by drugs (19.5%), "toxic substances" or various foreign bodies (5.9%), neoplasias (5.9%) and immune deficiencies (3%). The evolution was favourable in 80% of the cases but 8.3% of the patients died. The disease course of the patients having received a corticotherapy prior to the diagnosis was more unfavourable with a death rate of 45%. CONCLUSION In atypical sarcoidosis (fever, advanced age, increased acute phase reactants...) a specific aetiology and especially an infectious disease should be ruled out before considering the diagnosis of sarcoidosis. Corticotherapy is a factor of poor prognosis.
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Affiliation(s)
- M Pavic
- Service de médecine interne-oncologie, hôpital d'instruction des armées Desgenettes, 108 boulevard Pinel, Lyon, France.
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Martin LK, Lawrence R, Kossard S, Murrell DF. Cutaneous Mycobacterium neoaurum infection causing scarring alopecia in an immunocompetent host. Br J Dermatol 2007; 157:204-6. [PMID: 17501949 DOI: 10.1111/j.1365-2133.2007.07953.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
I am an experienced pathologist (4 decades), and I can now confidently perceive the cause of sarcoidosis. I can see clearly now because of 2 things: (1) modern evidence indicating a genetic-based immune dysregulation as an essential predisposing causal cofactor and (2) a century of accumulated pathology observations relevant to the point. The first factor helps explain numerous environmental, clinical, and research uncertainties, contradictions, and puzzles. The second factor, not readily available to clinicians, allows me to perceive the answer. The argument: (1) although most pathologists are vague in their conception of a "granuloma," the discerning pathologist realizes that a "true," well-formed epithelioid granuloma has only a very limited number of possible causes; (2) these causes do not include autoimmune diseases nor "self-perpetuating" granulomas to a "cleared" infectious agent; (3) the only feasible 2 causes are an infection or a reaction to a foreign particulate; (4) the only possible infections are ones where the infectious agent can be seen under the microscope; (5) experienced infectious disease pathologists do not see a microorganism (after a century of looking); (6) foreign particulates are therefore the cause (the only feasible cause remaining). This is not a new speculation; what I contribute that is new are pathology perceptions that confirm it beyond speculation. The reason the particles are not seen microscopically is that they are nanoparticles (less than a micrometer in largest dimension); larger particles are cleared from the lung efficiently by mucociliary transport. Direct evidence for this nanoparticulate theory is abundant. A recent case I studied has some compelling details. The nanoparticle theory should be accepted and acted upon, guiding further research, and there are risk-free measures that probably could benefit patients now.
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Affiliation(s)
- Dennis K Heffner
- Department of Endocrine and Otolaryngic/Head and Neck Pathology, Armed Forces Institute of Pathology, Washington, DC 20307-6000, USA.
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48
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Abstract
Granulomatous lung diseases, such as sarcoidosis, hypersensitivity pneumonitis, Wegener's granulomatosis, and chronic beryllium disease, along with granulomatous diseases of known infectious etiologies, such as tuberculosis, are major causes of morbidity and mortality throughout the world. Clinical manifestations of these diseases are highly heterogeneous, and the determinants of disease susceptibility and clinical course (e.g., resolution vs. chronic, progressive fibrosis) are largely unknown. The underlying pathogenic mechanisms of these diseases also remain poorly understood. Within this context, these diseases have been approached using genomic and proteomic technologies to allow us to identify patterns of gene/protein expression that track with clinical disease or to identify new pathways involved in disease pathogenesis. The results from these initial studies highlight the potential for these "-omics" approaches to reveal novel insights into the pathogenesis of granulomatous lung disease and provide new tools to improve diagnosis, clinical classification, course prediction, and response to therapy. Realizing this potential will require collaboration among multidisciplinary groups with expertise in the respective technologies, bioinformatics, and clinical medicine for these complex diseases.
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Affiliation(s)
- Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Johns Hopkins University, Baltimore, Maryland, USA
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49
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Fabrellas EF. Epidemiology of Sarcoidosis. ARCHIVOS DE BRONCONEUMOLOGÍA ((ENGLISH EDITION)) 2007. [PMCID: PMC7128149 DOI: 10.1016/s1579-2129(07)60030-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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50
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Dubaniewicz A, Dubaniewicz-Wybieralska M, Sternau A, Zwolska Z, Izycka-Swieszewska E, Augustynowicz-Kopec E, Skokowski J, Singh M, Zimnoch L. Mycobacterium tuberculosis complex and mycobacterial heat shock proteins in lymph node tissue from patients with pulmonary sarcoidosis. J Clin Microbiol 2006; 44:3448-51. [PMID: 16954298 PMCID: PMC1594733 DOI: 10.1128/jcm.01433-06] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We demonstrated that not whole Mycobacterium tuberculosis but its particular antigens, hsp70(Mtb), hsp65(Mtb), and hsp16(Mtb), are present in lymph node tissues of patients with sarcoidosis (SA). hsp16(Mtb) occurs in the early stage of SA, whereas hsp70(Mtb) occurs in stage II of SA. hsp65(Mtb) is highly expressed in the capillary vessels in lymph node tissues in patients with SA.
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Affiliation(s)
- Anna Dubaniewicz
- Department of Pathophysiology, Medical University of Gdansk, Debinki 7 str., 80-211 Gdansk, Poland.
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