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Worth L, Khreisat A, Iacobelli A. Successful Treatment of Relapsing Chronic Eosinophilic Pneumonia With Mepolizumab: A Case Report. Cureus 2024; 16:e65097. [PMID: 39040614 PMCID: PMC11262050 DOI: 10.7759/cureus.65097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 07/24/2024] Open
Abstract
We present a case of a 73-year-old male with a five-month history of progressive dyspnea on exertion, cough, and worsening hypoxemia. Initial lab work did not identify peripheral eosinophilia. Chest computed tomography identified extensive ground-glass opacities in the mid-basilar. Diagnostic bronchoscopy showed an eosinophilic-rich bronchoalveolar lavage representing 63% of the total white blood cell count, confirming the diagnosis of chronic eosinophilic pneumonia. No etiology was identified despite extensive diagnostic workup. Our patient had a prolonged course of prednisone taper treatment complicated by frequent hospitalizations, osteopenia, and insomnia. Additionally, his chronic eosinophilic pneumonia relapsed shortly after stopping steroids. In our patient, off-label treatment with mepolizumab, an interleukin-5-inhibiting monoclonal antibody, was associated with symptomatic relief, imaging findings resolution, and remission maintenance without systemic steroids.
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Affiliation(s)
- Lauren Worth
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Ali Khreisat
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Angela Iacobelli
- Allergy and Immunology, Corewell Health Beaumont Troy Hospital, Troy, USA
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2
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Vural Solak GT, Aksu K, Akkale O, Telli O, Celik Tuglu H, Dindar Celik F, Yagdiran M. The long-term outcomes of mepolizumab treatment at 100 mg dose on idiopathic chronic eosinophilic pneumonia: A real-life experience. Allergy Asthma Proc 2024; 45:e46-e53. [PMID: 38982601 DOI: 10.2500/aap.2024.45.240029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Background: The standard therapeutic regimen for idiopathic chronic eosinophilic pneumonia (ICEP) involves the administration of oral corticosteroids (OCS). However, a notable proportion of individuals experience recurrent episodes after the tapering or cessation of OCS during the course of ICEP. There has been a growing interest in exploring alternative treatment modalities for patients with ICEP at heightened risk of relapse. Objective: The aim of this study was to assess the efficacy of mepolizumab at a dose of 100 mg administered every 4 weeks in preventing relapses of ICEP and its impact on the clinical outcomes. Methods: This retrospective clinical observational study used real-world data to assess the impact of mepolizumab on patients diagnosed with ICEP accompanied by severe asthma. Demographic information and clinical characteristics were extracted from medical records. The study examined the effect of mepolizumab on the annual relapse rate, OCS dose, eosinophil count, and respiratory function parameters. Results: All patients included in the study, with a median (range) follow-up period of 19 months (4-40 months), the annual relapse rate decreased from 0.33 to 0 after the initiation mepolizumab. In addition, the maintenance OCS dose, expressed in methylprednisolone equivalents, declined from 4 mg/day to 0 mg/day. A reduction in the blood eosinophil count was observed, alongside a partial improvement in respiratory function test results among the patients. Conclusıon: A dose regimen of 100 mg of mepolizumab administered every 4 weeks emerges as a promising and well-tolerated therapeutic approach for averting relapses of ICEP.
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Murillo AD, Castrillon AI, Serrano CD, Fernandez-Trujillo L. Monoclonal antibodies in idiopathic chronic eosinophilic pneumonia: a scoping review. BMC Pulm Med 2024; 24:74. [PMID: 38331769 PMCID: PMC10851541 DOI: 10.1186/s12890-024-02868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disease characterized by pulmonary radiological alterations, peripheral eosinophilia, and demonstrated pulmonary eosinophilia. Oral steroids (OSs) are the standard management, but relapses occur in up to 50% of patients during the decrease or suspension of steroids, usually requiring reinitiation of treatment, exposing patients to secondary events derived from the management. Management with monoclonal antibodies has been proposed in these cases to control the disease and limit the secondary effects. The objective is to describe the extent and type of evidence regarding the use of monoclonal antibodies for ICEP. METHODS A panoramic review of the literature was performed. Observational and experimental studies of pediatric and adult populations that managed recurrent ICEP with monoclonal antibodies were included. Data search, selection, and extraction were performed by two independent reviewers. RESULTS 937 studies were found. After applying the inclusion and exclusion criteria, 37 titles remained for the final analysis: a retrospective, observational, real-life study, two case series publications, and 34 case reports published in academic poster sessions and letters to the editor. In general, the use of monoclonal antibodies approved for severe asthma could be useful for the control of ICEP, since most of the results show a good response for clinical and radiological outcomes. Biological drugs seem to be a safer option for controlling relapses in ICEP, allowing lowering/suspension of OSs, and sometimes replacing them in patients intolerant to them, patients with significant comorbidities, and patients who have already developed adverse events. CONCLUSION The extent of the evidence supporting management of ICEP with monoclonal antibodies against IL-5 and IgE (omalizumab) is limited, but it could be promising in patients who present frequent relapses, in cortico-dependent individuals, or in patients in whom the use of steroids is contraindicated. The extent of the evidence for management with dupilumab is more limited. Studies with better design and structure are needed to evaluate quality of life and outcomes during a clear follow-up period. To our knowledge, this is the first scoping review of the literature showing the extent of the evidence for the management of ICEP with monoclonal antibodies.
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Affiliation(s)
- Andrea Dionelly Murillo
- Department of Internal Medicine, Allergology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia
| | - Ana Isabel Castrillon
- Clinical Research Center, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
| | - Carlos Daniel Serrano
- Department of Internal Medicine, Allergology Service, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760032, Colombia
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia
| | - Liliana Fernandez-Trujillo
- Faculty of Health Sciences, Universidad Icesi, Calle 18 # 122-135, Cali, 760032, Colombia.
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology. Fundacion Valle del Lili, Av. Simón Bolívar. Carrera 98 # 18-49. Torre 6, 4th Floor, Cali, Colombia.
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Prieto-García A, Peligros MI, Pérez Tamayo I, Zubeldia JM, Álvarez-Sala L, Lavilla C. Long-term use of mepolizumab in a case of chronic eosinophilic pneumonia: extending interval dosing. J Asthma 2024; 61:69-71. [PMID: 37467753 DOI: 10.1080/02770903.2023.2239343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/01/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
INTRODUCTION Mepolizumab, a humanized anti IL-5 monoclonal antibody, has been used off-label for chronic eosinophilic pneumonia (CEP), inducing disease remission and saving systemic corticosteroids. CASE STUDY We present a case of CEP, requiring long-term corticosteroids therapy due to relapse upon withdrawal. Mepolizumab was started and maintained for 2 years and 6 months. RESULTS Corticosteroids could be withdrawn and mepolizumab dose interval was spared up to 10 wk with no disease relapse. CONCLUSION Mepolizumab is shown to be useful for chronic eosinophilic pneumonia, allowing corticosteroid withdrawal. Dose interval may be individualized under close monitoring, for a more efficient treatment, reducing medical costs while improving patients' quality of life.
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Affiliation(s)
- Alicia Prieto-García
- Allergy Service, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - María Isabel Peligros
- Pathology Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Isabel Pérez Tamayo
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - José Manuel Zubeldia
- Allergy Service, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
- Biomedical Research Network on Rare Diseases (CIBERER)-U761, Madrid, Spain
| | - Luis Álvarez-Sala
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Cristina Lavilla
- Internal Medicine Department, Gregorio Marañón University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
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Daboussi S, Essebaa S, Mhamdi S, Aichaouia C, Hela G, Ayadi A, Zied M. Case Report: Mepolizumab in the treatment of idiopathic chronic eosinophilic pneumonia. F1000Res 2023; 12:337. [PMID: 37691733 PMCID: PMC10483178 DOI: 10.12688/f1000research.130939.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/12/2023] Open
Abstract
Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare interstitial lung disease of unknown cause. It usually responds well to systemic corticosteroid therapy, but relapses are frequent. We describe two cases of 21- and 27-year-old patients, presenting with dyspnea. The diagnosis of steroid-relapsing and steroid-dependent ICEP was made respectively. Mepolizumab was prescribed to both patients. This treatment resulted in successful long-term disease management with much fewer side effects than a traditional corticosteroid therapy.
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Affiliation(s)
- Selsabil Daboussi
- University of Tunis El Manar, Tunis, Tunisia
- Pneumology, Military Hospital of Tunis, Tunis, 1008, Tunisia
| | - Samia Essebaa
- Pneumology, Military Hospital of Tunis, Tunis, 1008, Tunisia
| | - Samira Mhamdi
- University of Tunis El Manar, Tunis, Tunisia
- Pneumology, Military Hospital of Tunis, Tunis, 1008, Tunisia
| | - Chiraz Aichaouia
- University of Tunis El Manar, Tunis, Tunisia
- Pneumology, Military Hospital of Tunis, Tunis, 1008, Tunisia
| | - Ghedira Hela
- University of Tunis El Manar, Tunis, Tunisia
- Hematology, Military Hospital of Tunis, Tunis, 1008, Tunisia
| | - Aida Ayadi
- University of Tunis El Manar, Tunis, Tunisia
- Pathology, Abderrahmen Mami Hospital,, Ariana, 2080, Tunisia
| | - Moetemri Zied
- University of Tunis El Manar, Tunis, Tunisia
- Pneumology, Military Hospital of Tunis, Tunis, 1008, Tunisia
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Baqir M, Peikert T, Johnson TF, Tandon YK, Yi ES, Schroeder DR, Ryu JH. Idiopathic Chronic Eosinophilic Pneumonia Evolving to Pulmonary Fibrosis: A Retrospective Analysis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2022; 39:e2022020. [PMID: 36118537 PMCID: PMC9437755 DOI: 10.36141/svdld.v39i2.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with idiopathic chronic eosinophilic pneumonia (ICEP) may have pulmonary fibrosis. OBJECTIVES To investigate the predictors of pulmonary fibrosis in ICEP, to describe the timeline of pulmonary fibrosis after ICEP diagnosis, and to detail the radiologic pattern of fibrosis. METHODS A retrospective computer-assisted search was performed to identify patients with ICEP seen at Mayo Clinic in Rochester, Minnesota, from January 1, 1997, through September 1, 2019. Patients with follow-up chest computed tomography (CT) beyond 12 months after the ICEP diagnosis were included in the study. Demographic, clinical, radiologic, and histopathologic characteristics were analyzed. Proportional hazards regression was used to assess the predictors of pulmonary fibrosis. RESULTS We identified 62 patients (mean [SD] age at ICEP diagnosis, 60 [13] years; female sex, 37 [60%]). Cough (87%) and shortness of breath (85%) were the most common presenting symptoms. Of patients, 27 (44%) had a history of smoking and 27 (44%) had a history of asthma. During follow-up, 23 patients (37%) had CT evidence of pulmonary fibrosis, of whom 16 patients (70%) had a CT pattern inconsistent with usual interstitial pneumonia. In 29% of the patients, the CT evidence of pulmonary fibrosis developed within 2 years after ICEP. Age and male sex were predictors of pulmonary fibrosis. Of note, a history of asthma decreased the likelihood of pulmonary fibrosis. CONCLUSIONS Development of pulmonary fibro-sis is not uncommon in patients with ICEP, especially older men, and is associated with increased risk of death.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
| | | | | | - Eunhee S. Yi
- Division of Anatomic Pathology, Rochester, Minnesota, USA
| | - Darrell R. Schroeder
- Division of Clinical Trial and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
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Delcros Q, Groh M, Nasser M, Kahn JE, Cottin V. Steroid alternatives for managing eosinophilic lung diseases. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.2003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Quentin Delcros
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine Hôpital Foch, Suresnes, France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine Hôpital Foch, Suresnes, France
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases (Orphalung), Louis Pradel Hospital, Hospices Civils De Lyon, and Claude Bernard University Lyon 1, IVPC, Member of OrphaLung, RespiFIL and ERN-lung, France
| | - Jean-Emmanuel Kahn
- National Reference Center for Hypereosinophilic Syndrome (Cereo)
- Department of Internal Medicine, Hôpital Ambroise Paré, Université Paris Saclay, Assistance Publique Hôpitaux De Paris, Boulogne-Billancourt, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Coordinating Reference Centre for Rare Pulmonary Diseases (Orphalung), Louis Pradel Hospital, Hospices Civils De Lyon, and Claude Bernard University Lyon 1, IVPC, Member of OrphaLung, RespiFIL and ERN-lung, France
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8
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Eldaabossi SAM, Awad A, Anshasi N. Mepolizumab and dupilumab as a replacement to systemic glucocorticoids for the treatment of Chronic Eosinophilic Pneumonia and Allergic Bronchopulmonary Aspergillosis - Case series, Almoosa specialist hospital. Respir Med Case Rep 2021; 34:101520. [PMID: 34692397 PMCID: PMC8512623 DOI: 10.1016/j.rmcr.2021.101520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/18/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
In this case series, we present four patients who had asthma and blood eosinophilia. Two patients were diagnosed with Chronic Eosinophilic Pneumonia (CEP) and the other two with Allergic Bronchopulmonary Aspergillosis (ABPA). Laboratory findings revealed profound peripheral eosinophilia with abnormal chest radiography (alveolar shadows, segmental atelectasis, and cystic changes). Initial improvement (clinical, laboratory, and radiological) occurred with traditional asthma therapy, including systemic corticosteroids. The patients did not tolerate corticosteroid therapy because of weight gain, uncontrolled diabetes, bone fractures, and psychological adverse effects. Mepolizumab (administered to two CEP cases and one ABPA case) and Dupilumab (administered to one ABPA case) were initiated as steroid-sparing agents, resulting in successful therapy without relapse or adverse effects. Mepolizumab, and Interleukin-5 (IL-5) antagonist, targets diseases mediated by eosinophil activity and proliferation. Dupilumab blocks the Interleukin-4/Interleukin-13 pathway and suppresses Type 2 inflammation, including Immunoglobulin E (IgE). Dupilumab resulted in up to 70% drop in total IgE levels from baseline and reduced eosinophil-mediated lung inflammation, despite the presence of normal or increased blood eosinophil counts.
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Affiliation(s)
- Safwat A M Eldaabossi
- Consultant Pulmonology, Almoosa Specialist Hospital, Saudi Arabia - Associate Professor of Chest Diseases, Faculty of Medicine, Al Azhar University, Egypt
| | - Amgad Awad
- Consultant Nephrology, Almoosa Specialist Hospital, Saudi Arabia - Lecturer of Internal Medicine, Faculty of Medicine, Al Azhar University, Egypt
| | - Neda'a Anshasi
- Resident Internal Medicine, Almoosa Specialist Hospital, Saudi Arabia
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9
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Ben-David Y, Bentur L, Gur M, Ilivitzki A, Gut G, Toukan Y, Nir V, Shallufi G, Bar-Yoseph R. Reverse butterfly pattern image with eosinophilia: Effective treatment with benralizumab-A case report. Pediatr Pulmonol 2021; 56:2736-2739. [PMID: 34077999 DOI: 10.1002/ppul.25511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 11/07/2022]
Abstract
A 16-year-old adolescent presented with dry cough, fever, weight loss, night sweats, exercise intolerance, and eosinophilia. Computed tomography showed consolidations with "reverse butterfly" pattern. He responded well to corticosteroids but had frequent relapses. He became steroid dependent and developed steroid related morbidity. Benralizumab was prescribed with complete resolution of eosinophilia and lung infiltrates with no adverse effect.
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Affiliation(s)
- Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Anat Ilivitzki
- Pediatric Imaging Unit, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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10
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Ricketti PA, Ricketti AJ. Relapsing chronic eosinophilic pneumonia treated successfully with benralizumab. Ann Allergy Asthma Immunol 2021; 126:726-727. [PMID: 33636343 DOI: 10.1016/j.anai.2021.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Peter A Ricketti
- Mercer Allergy and Pulmonary Associates, LLC, Trenton, New Jersey.
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11
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Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia. Biomolecules 2020; 10:biom10040638. [PMID: 32326200 PMCID: PMC7226607 DOI: 10.3390/biom10040638] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/12/2020] [Accepted: 04/20/2020] [Indexed: 12/29/2022] Open
Abstract
Eosinophilic pneumonia (EP), including acute EP and chronic EP, is characterized by the massive pulmonary infiltration of eosinophils into the lung. However, the mechanisms underlying the selective accumulation of eosinophils in EP have not yet been fully elucidated. We reported that bronchoalveolar lavage fluid (BALF) from EP patients induced the transmigration of eosinophils across endothelial cells in vitro. The concentrations of eotaxin-2 (CCL24) and monocyte chemotactic protein (MCP)-4 (CCL13), which are CC chemokine receptor (CCR) 3 ligands, were elevated in the BALF of EP patients, and anti-CCR3 monoclonal antibody inhibited the eosinophil transmigration induced by the BALF of EP patients. The concentration of macrophage inflammatory protein 1β (CCL4), a CCR5 ligand that induces eosinophil migration, was increased in the BALF of EP patients. Furthermore, the concentration of interleukin (IL) 5 was increased in the BALF of EP patients, and it has been reported that anti-IL-5 antibody treatment resulted in remission and the reduction of glucocorticoid use in some cases of chronic EP. The concentrations of lipid mediators, such as leukotriene (LT) B4, damage-associated molecular pattern molecules (DAMPs), such as uric acid, or extracellular matrix proteins, such as periostin, were also increased in the BALF of EP patients. These findings suggest that chemokines, such as CCR3/CCR5 ligands, cytokines, such as IL-5, lipid mediators, such as LTB4, DAMPs, and extracellular matrix proteins may play roles in the accumulation or activation of eosinophils in EP.
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12
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Inamo J, Kaneko Y, Ota Y, Takeuchi T. Subtypes in eosinophilic granulomatosis with polyangiitis classified according to rheumatoid factor. Clin Rheumatol 2019; 38:3493-3499. [PMID: 31317422 DOI: 10.1007/s10067-019-04680-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/21/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
To investigate the relevance of RF in patients with EGPA, we reviewed consecutive patients who were newly diagnosed with EGPA from August 1998 to February 2019 in Keio University Hospital with RF titer at diagnosis available. We divided the patients according to the median level of RF titer of 75 IU/mL and compared clinical features between the two groups. Among 16 patients identified, 8 patients were in the RF high group and the other 8 patients were in the RF low group. All patients in the high RF group were negative for MPO-ANCA, whereas all in the low RF group was positive for MPO-ANCA with a mean titer of 103 IU/mL. The eosinophil count at diagnosis was significantly higher in the RF high group than the RF low group (20001/μL vs 5144/μL, p < 0.01). Gastrointestinal lesion was significantly more frequent in the RF high group, and parenchymal organ lesions, such as heart and renal organ involvement, were frequent in the RF low group. With principal component analysis, RF high and low groups were clearly divided by the combination of eosinophil count, MPO-ANCA titer, gastrointestinal lesions, musculoskeletal symptoms, and disease activity score. Those results suggest EGPA can be divided into two groups in association with RF.Key Points• Our study showed that patients with EGPA can be separated into two groups according to RF titer.• The two subtypes reflect different underlying pathogenesis in EGPA, and the optimal treatment for them may be different.
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Affiliation(s)
- Jun Inamo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Yuichiro Ota
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Crowe M, Robinson D, Sagar M, Chen L, Ghamande S. Chronic eosinophilic pneumonia: clinical perspectives. Ther Clin Risk Manag 2019; 15:397-403. [PMID: 30936702 PMCID: PMC6420789 DOI: 10.2147/tcrm.s157882] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Chronic eosinophilic pneumonia (CEP) is an eosinophilic lung disease that is typically diagnosed by a triad of clinical symptoms including pulmonary symptoms, eosinophilia and characteristic radiographic abnormalities. It requires a high index of suspicion given its overlap with other eosinophilic conditions and lack of a specific diagnostic test. The diagnosis is made after careful consideration of other secondary causes of eosinophilia, such as infectious, drugs, or toxic etiologies. CEP generally responds rapidly to treatment, which primarily consists of corticosteroid therapy, but relapses are common. Novel therapies are being explored as more information is being discovered about the pathophysiology of eosinophilic disease processes. Close follow-up is important given the difficulty in weaning patients from glucocorticoids with many patients developing sequelae of chronic glucocorticoid therapy. Therefore, exploring alternative treatments is of upmost importance.
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Affiliation(s)
- Matthew Crowe
- Department of Medicine, Division of Pulmonary and Critical Care, Baylor Scott and White Medical Center, Temple, TX, USA,
| | - Drew Robinson
- Department of Medicine, Baylor Scott and White Medical Center, Temple, TX, USA
| | - Malvika Sagar
- Department of Pediatrics, Baylor Scott and White McLane Children's Specialty Clinic Temple, Temple, TX, USA
| | - Li Chen
- Department of Pathology, Baylor Scott and White Medical Center Temple, Temple, TX, USA
| | - Shekhar Ghamande
- Department of Medicine, Division of Pulmonary and Critical Care, Baylor Scott and White Medical Center, Temple, TX, USA,
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