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Murata O, Suzuki K, Takeuchi T. Thymus variants on imaging of patients with primary Sjögren's syndrome and polymyositis/dermatomyositis: clinical and immunological significance. Immunol Med 2023; 46:25-31. [PMID: 36200743 DOI: 10.1080/25785826.2022.2129371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the presence of radiographic thymus variants using a scoring system and examined their association with clinical and immunological features in primary Sjögren's syndrome (pSS) and polymyositis/dermatomyositis (PM/DM) patients. Cases of 72 patients with pSS and 47 with PM/DM were randomly selected from all visitors to our department who received chest CT scanning, excluding those with thymoma or thymic cyst, or age <30 years. We quantitatively interpreted and assessed thymus size and attenuation score in axial CT images. Thymic enlargement was identified in 16 (22.2%) pSS and 14 (29.8%) PM/DM patients. A thymus attenuation score ≥ 2 was seen in 11 (15.3%) pSS and 9 (19.1%) PM/DM patients. Thymic enlargement showed a significant association with the titre of rheumatoid factor in PM/DM patients. Thymic enlargement and score showed a significant association with body weight in pSS patients. Radiographic thymus variants are often observed in pSS and PM/DM patients, particularly in cases of PM/DM, and may suggest the role of an abnormal immune response in their pathogenesis.
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Affiliation(s)
- Okinori Murata
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan.,Department of Internal Medicine, Division of Allergy and Rheumatology, Iwate Medical University School of Medicine, Morioka, Japan
| | - Katsuya Suzuki
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Department of Internal Medicine, Division of Rheumatology, Keio University School of Medicine, Tokyo, Japan
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Alexakou Z, Liatsos G, Vasileiou N, Vamvakaris I, Mani I, Alexopoulou A. Thymic Carcinoma With Multiple Paraneoplastic Disorders. Am J Med Sci 2021; 362:324-330. [PMID: 33961845 DOI: 10.1016/j.amjms.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/20/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Thymic neoplasms are rare and may run an indolent course. Among them, thymic epithelial carcinoma is exceptional as it may be presented with extensive local invasion and distant metastases. There is a wide spectrum of autoimmune/paraneoplastic syndromes associated with thymic tumors including autoimmune diseases, some of which may precede the diagnosis of thymoma. This article describes a 37-year-old woman with metastatic malignant thymoma and a combination of manifestations from different organs. Vitiligo, Raynaud's phenomenon and anti-centromere antibodies were preceded while eosinophilia, interstitial lung disease, rash, thickening of the skin and asymptomatic cryoglobulinemia were diagnosed concomitantly with the neoplasm. We have reviewed the literature and found only twenty case reports with a cluster of three or more autoimmune/paraneoplastic syndromes in the same patient but none with this unique constellation of disorders. The diversity of thymoma's clinical presentation and laboratory/histological features may cause diagnostic dilemmas and therapeutic challenges.
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Affiliation(s)
- Zoe Alexakou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - George Liatsos
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Nick Vasileiou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | | | - Iliana Mani
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
| | - Alexandra Alexopoulou
- 2(nd) Department of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece.
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Murata O, Suzuki K, Sugiura H, Kondo Y, Takeshita M, Koga K, Takiguchi M, Kurisu R, Kassai Y, Yasuoka H, Yamaoka K, Morita R, Yoshimura A, Takeuchi T. Thymus variants on imaging in patients with rheumatoid arthritis-Clinical and immunological significance. Rheumatology (Oxford) 2021; 60:5595-5600. [PMID: 33590850 DOI: 10.1093/rheumatology/keab164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We sought to clarify the presence of radiographic thymus variants using a scoring system, and their association with clinical and immunological features in RA patients. METHODS 387 RA patients randomly selected from all patients visiting our department who underwent chest CT scanning, with exclusion of patients with thymoma or thymic cyst, or age < 30 y. Thymus size and attenuation score in axial CT images were quantitatively interpreted and assessed. Associations between immunophenotype data and clinical and serological features were analysed in a subset of patients. RESULTS Thymic enlargement was found in 76 (19.6%) patients, and a thymus attenuation score ≥ 2 was found in 50 (12.9%) patients. The score was significantly associated with antibodies to citrullinated peptide antigens (ACPA) positivity. Thymic enlargement was significantly associated with the proportions of CD4+ effector memory T cells. CONCLUSION Radiographic thymus variants were frequently observed in RA patients, and may reflect an abnormal immune response involved in the pathogenesis of RA.
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Affiliation(s)
- Okinori Murata
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsuya Suzuki
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroaki Sugiura
- Department of Radiology, National Defense Medical College, Saitama, Japan
| | - Yasushi Kondo
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Takeshita
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiko Koga
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Maiko Takiguchi
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Rina Kurisu
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Yoshiaki Kassai
- Inflammation Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company Limited, Kanagawa, Japan
| | - Hidekata Yasuoka
- Fujita Health University School of Medicine, Division of Rheumatology, Department of Internal Medicine, Aichi, Japan
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Rimpei Morita
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Akihiko Yoshimura
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Mencel J, Gargett T, Karanth N, Pokorny A, Brown MP, Charakidis M. Thymic hyperplasia following double immune checkpoint inhibitor therapy in two patients with stage IV melanoma. Asia Pac J Clin Oncol 2019; 15:383-386. [PMID: 31373116 DOI: 10.1111/ajco.13233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/12/2019] [Indexed: 11/27/2022]
Abstract
Hyperplasia of the thymus is commonly seen in myasthenia gravis and other autoimmune disorders. Thymic size also varies with age, corticosteroid use, infections, and inflammatory disease. Although thymic hyperplasia has been described following chemotherapy, there is no known association of true thymic hyperplasia with immune checkpoint inhibitor therapy. We present two cases of suspected true thymic hyperplasia in patients with stage IV melanoma who were treated with the combination of nivolumab and ipilimumab, which was complicated by immune-related toxicity requiring corticosteroid therapy, and then subsequently also by secondary hypoadrenalism requiring replacement hydrocortisone. In one patient, histological and flurocytometric analyses of an incisional biopsy of the thymus revealed findings consistent with true thymic hyperplasia. In the other case, the stable fluorodeoxyglucose positron emission tomography/Computed tomography (FDG-PET/CT) findings were consistent also with true thymic hyperplasia. These are the first described cases of true thymic hyperplasia following combination immune checkpoint inhibitor therapy for metastatic melanoma. We hypothesize that the true thymic hyperplasia in these cases results from initial lymphocyte depletion caused by intense corticosteroid therapy followed by rebound thymic hyperplasia during the period of relative hypocortisolism, which may have been aggravated by the onset of secondary hypoadrenalism.
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Affiliation(s)
- Justin Mencel
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Tessa Gargett
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
| | - Narayan Karanth
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Adrian Pokorny
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Michael P Brown
- Cancer Clinical Trials Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, South Australia, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Michail Charakidis
- Department of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Weis CA, Schalke B, Ströbel P, Marx A. Challenging the current model of early-onset myasthenia gravis pathogenesis in the light of the MGTX trial and histological heterogeneity of thymectomy specimens. Ann N Y Acad Sci 2018; 1413:82-91. [DOI: 10.1111/nyas.13563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/23/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Berthold Schalke
- Department of Neurology, University Hospital Regensburg; University of Regensburg; Regensburg Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen; University of Göttingen; Göttingen Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
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Weis CA, Märkl B, Schuster T, Vollert K, Ströbel P, Marx A. [True thymic hyperplasia : Differential diagnosis of thymic mass lesions in neonates and children]. DER PATHOLOGE 2017; 38:286-293. [PMID: 28429039 DOI: 10.1007/s00292-017-0283-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Reactive and neoplastic thymic pathologies are the main considerations in the case of masses in the anterior and middle part of the mediastinum, while neurogenic tumors are predominant in the posterior mediastinum (which are not dealt with here). In neonates and infants, the commonest pathologies in the anterior mediastinum comprise germ cell tumors (mainly teratomas), congenital thymic cysts and true thymic hyperplasia (TTH). In toddlers, teratomas, yolk sac tumors and cysts predominate. In children over 5 years of age, lymphomas are the commonest mass lesions whereas thymomas and thymic carcinomas are rare. In addition, inflammation-linked hyperplasia in myasthenia gravis and rebound thymic hyperplasia after chemotherapy must be considered. Although rare at all ages, sarcomas must be considered in the differential diagnosis from birth onwards and throughout adolescence. Based on the report of a rare case of recurrent TTH, the differential diagnosis of this benign but potentially life-threatening condition is discussed.
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Affiliation(s)
- C-A Weis
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - B Märkl
- Institut für Pathologie, Klinikum Augsburg, Augsburg, Deutschland
| | - T Schuster
- Kinderchirurgische Klinik, Klinikum Augsburg, Augsburg, Deutschland
| | - K Vollert
- Klinik für Diagnostische Radiologie und Neuroradiologie, Klinikum Augsburg, Augsburg, Deutschland
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - A Marx
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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The True Association of Systemic Sclerosis with Myasthenia Gravis and the Myth of D-Penicillamine-Induced Myasthenia. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2017. [DOI: 10.5301/jsrd.5000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It has been long considered that d-penicillamine may induce various autoimmune conditions, including myasthenia gravis (MG), whereas early observations suggested that about 1.5% of patients with systemic sclerosis (SSc) develop MG. Along this line it has been thought that the association of SSc and MG was due to d-penicillamine, which was the standard therapy for SSc in the past. We report a 66-year-old woman with SSc who developed MG in the absence of d-penicillamine exposure. We found seven other similar cases in the literature, as well as seven additional cases in whom SSc followed MG. Since it has been clear now that different autoimmune diseases frequently cluster within families, we suggest a true association of these two autoimmune diseases which could be under-reported.
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Donzelli G, Carnesecchi G, Amador C, di Tommaso M, Filippi L, Caporali R, Codullo V, Riccieri V, Valesini G, Gabrielli A, Bagnati R, McGreevy KS, De Masi S, Matucci Cerinic M. Fetal programming and systemic sclerosis. Am J Obstet Gynecol 2015; 213:839.e1-8. [PMID: 26232509 DOI: 10.1016/j.ajog.2015.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 06/16/2015] [Accepted: 07/21/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study investigated whether birthweight is linked to an increased risk of the development of systemic sclerosis. STUDY DESIGN This was a multicenter case-control study with perinatal data that were obtained from 332 cases with systemic sclerosis and 243 control subjects. Birthweight was treated as a dichotomous variable (<2500 g vs ≥2500 g); low birthweight was defined as a weight <2500 g; small for gestational age was defined as birthweight <10th percentile for gestational age adjusted for sex. The relationship between systemic sclerosis and both low birthweight and small for gestational age was expressed with the crude (univariate analysis) and adjusted (multivariate analysis) odds ratio (OR). RESULTS Significantly increased ORs were observed in the univariate analysis for low birthweight (OR, 2.59; 95% confidence interval [CI], 1.39-5.05) and small for gestational age (OR, 2.60; 95% CI, 1.34-5.32) subjects. Similarly increased risks were confirmed for both conditions in the multivariate analysis (OR, 3.93; 95% CI, 1.92-8.07; and OR, 2.58; 95% CI, 1.28-5.19), respectively. CONCLUSION Low birthweight and small for gestational age at birth are risk factors for the adult onset of systemic sclerosis.
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Affiliation(s)
- Gianpaolo Donzelli
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy.
| | - Giulia Carnesecchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carolina Amador
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Luca Filippi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Roberto Caporali
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Veronica Codullo
- Department of Rheumatology, University and IRCCS Foundation, Policlinico San Matteo, Pavia, Italy
| | - Valeria Riccieri
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Guido Valesini
- Department of Internal Medicine and Clinical Specialties, Rheumatology Unit, "La Sapienza" University, Rome, Italy
| | - Armando Gabrielli
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Roberta Bagnati
- Institute of General Clinical Medicine, Hematology, and Clinical Immunology, University of Ancona, Ancona, Italy
| | - Kathleen S McGreevy
- Research, Innovation, and International Relations Office, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Salvatore De Masi
- Department of Fetal-Neonatal Medicine, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Marco Matucci Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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9
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Thymic epithelial cell development and its dysfunction in human diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:206929. [PMID: 24672784 PMCID: PMC3929497 DOI: 10.1155/2014/206929] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 11/28/2013] [Indexed: 12/01/2022]
Abstract
Thymic epithelial cells (TECs) are the key components in thymic microenvironment for T cells development. TECs, composed of cortical and medullary TECs, are derived from a common bipotent progenitor and undergo a stepwise development controlled by multiple levels of signals to be functionally mature for supporting thymocyte development. Tumor necrosis factor receptor (TNFR) family members including the receptor activator for NFκB (RANK), CD40, and lymphotoxin β receptor (LTβR) cooperatively control the thymic medullary microenvironment and self-tolerance establishment. In addition, fibroblast growth factors (FGFs), Wnt, and Notch signals are essential for establishment of functional thymic microenvironment. Transcription factors Foxn1 and autoimmune regulator (Aire) are powerful modulators of TEC development, differentiation, and self-tolerance. Dysfunction in thymic microenvironment including defects of TEC and thymocyte development would cause physiological disorders such as tumor, infectious diseases, and autoimmune diseases. In the present review, we will summarize our current understanding on TEC development and the underlying molecular signals pathways and the involvement of thymus dysfunction in human diseases.
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Colaci M, Giuggioli D, Manfredi A, Vacchi C, Della Casa G, Ferri C. Radiological thymus alterations in systemic sclerosis: our experience and a review of the literature. Rheumatology (Oxford) 2013; 53:732-6. [PMID: 24369415 DOI: 10.1093/rheumatology/ket419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Thymus alterations have been related to several autoimmune disorders. In particular, previous studies identified a significant frequency of gland abnormalities by chest high-resolution CT (HRCT) in SSc patients. In this study we aimed to investigate the prevalence of radiological thymic alterations and their correlation with clinical and serological features in a large SSc series. METHODS We retrospectively evaluated thymic shape on CT scans of 200 consecutive, unselected SSc patients aged over 30 years The presence of radiological abnormalities, i.e. enlarged gland >13 mm or nodular lesions >7 mm, was correlated with SSc clinico-serological features. Moreover, the patients were also classified using a second thickness cut-off of 7 mm in order to identify incomplete thymic involution. RESULTS Twenty-four of 200 (12%) SSc patients presented an abnormal thymus at HRCT, including hyperplasic (19/24) and nodular (5/24) glands. Otherwise, using the cut-off of 7 mm for gland thickness and excluding subjects with nodular thymus, 50/195 (25.6%) patients presented an incomplete thymic involution. Thymic radiological alterations are significantly correlated with younger age and diffuse cutaneous SSc. Moreover, an abnormally enlarged thymus tended to be more common in patients with shorter disease duration. CONCLUSION The present report on a large series of SSc patients further reinforces previous data present in the literature that includes other cohort studies and a number of anecdotal observations. Even though the actual role of thymus radiological abnormalities remains unclear, possible involvement of the gland in the early phase of immune-mediated SSc pathogenesis might be supposed.
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Affiliation(s)
- Michele Colaci
- Rheumatology Unit, University of Modena & Reggio Emilia, Policlinico di Modena, Via del Pozzo, 71, 41100 Modena, Italy.
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11
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Marx A, Pfister F, Schalke B, Nix W, Ströbel P. Thymus pathology observed in the MGTX trial. Ann N Y Acad Sci 2013; 1275:92-100. [PMID: 23278583 DOI: 10.1111/j.1749-6632.2012.06799.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The MGTX trial is the first prospective, randomized clinical trial that aims to evaluate the impact of extended transsternal thymectomy on myasthenic symptoms, prednisone requirements, and quality of life in patients with nonthymomatous, anti-acetylcholine receptor autoantibody-positive myasthenia gravis (MG). Here, we give an overview of the rationale of thymectomy and the standardized macroscopic and histopathological work-up of thymectomy specimens as fixed in MGTX standard operating procedures, including the grading of thymic lymphofollicular hyperplasia and the morphometric strategy to assess thymic involution.
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Affiliation(s)
- Alexander Marx
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
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12
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Meunier M, Bazeli R, Feydy A, Drape JL, Kahan A, Allanore Y. Incomplete thymic involution in systemic sclerosis and rheumatoid arthritis. Joint Bone Spine 2013; 80:48-51. [DOI: 10.1016/j.jbspin.2012.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/30/2012] [Indexed: 11/16/2022]
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Shegokar R, Singh KK. Surface modified nevirapine nanosuspensions for viral reservoir targeting: In vitro and in vivo evaluation. Int J Pharm 2011; 421:341-52. [PMID: 21986114 DOI: 10.1016/j.ijpharm.2011.09.041] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 08/31/2011] [Accepted: 09/27/2011] [Indexed: 11/18/2022]
Abstract
Most of the time HIV virus escape immunological burden exerted by antiretroviral drugs and develops resistance against therapy. For complete eradication of virus from body one has to use long term chemotherapies, which results in drug toxicity, drug resistance and eventually poor patient compliance. Nevirapine (NNRTI, non nucleoside reverse transcriptase inhibitor) nanosuspensions were developed and surface modified with serum albumin, polysaccharide and polyethylene glycol to enhance its targeting potential. The biodistribution studies revealed improved antiretroviral drug accumulation in various organs of rat for nanosuspensions as compared to the plain drug solution when administered intravenously. Nanosuspension after surface modification showed further enhancement in accumulation. Higher MRT values of surface coated nanosuspension in brain, liver and spleen as compared to pure drug solution ensured enhanced bioavailability and prolonged residence of the drug at the target site.
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Affiliation(s)
- Ranjita Shegokar
- C.U. Shah College of Pharmacy, S.N.D.T. Women's University, Santacruz (W), Mumbai 400049, India
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14
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Kanzaki S, Yamaguchi A, Yamaguchi K, Kojima Y, Suzuki K, Koumitsu N, Nagashima Y, Nagahama K, Ehara M, Hirayasu Y, Ryo A, Aoki I, Yamanaka S. Thymic alterations in GM2 gangliosidoses model mice. PLoS One 2010; 5. [PMID: 20856892 PMCID: PMC2938369 DOI: 10.1371/journal.pone.0012105] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 07/13/2010] [Indexed: 11/18/2022] Open
Abstract
Background Sandhoff disease is a lysosomal storage disorder characterized by the absence of β-hexosaminidase and storage of GM2 ganglioside and related glycolipids. We have previously found that the progressive neurologic disease induced in Hexb−/− mice, an animal model for Sandhoff disease, is associated with the production of pathogenic anti-glycolipid autoantibodies. Methodology/Principal Findings In our current study, we report on the alterations in the thymus during the development of mild to severe progressive neurologic disease. The thymus from Hexb−/− mice of greater than 15 weeks of age showed a marked decrease in the percentage of immature CD4+/CD8+ T cells and a significantly increased number of CD4+/CD8− T cells. During involution, the levels of both apoptotic thymic cells and IgG deposits to T cells were found to have increased, whilst swollen macrophages were prominently observed, particularly in the cortex. We employed cDNA microarray analysis to monitor gene expression during the involution process and found that genes associated with the immune responses were upregulated, particularly those expressed in macrophages. CXCL13 was one of these upregulated genes and is expressed specifically in the thymus. B1 cells were also found to have increased in the thy mus. It is significant that these alterations in the thymus were reduced in FcRγ additionally disrupted Hexb−/− mice. Conclusions/Significance These results suggest that the FcRγ chain may render the usually poorly immunogenic thymus into an organ prone to autoimmune responses, including the chemotaxis of B1 cells toward CXCL13.
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Affiliation(s)
- Seiichi Kanzaki
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akira Yamaguchi
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
- * E-mail:
| | - Kayoko Yamaguchi
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshitsugu Kojima
- Department of Microbiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kyoko Suzuki
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Noriko Koumitsu
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoji Nagashima
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kiyotaka Nagahama
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Michiko Ehara
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yoshio Hirayasu
- Department of Psychiatry, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akihide Ryo
- Department of Microbiology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ichiro Aoki
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shoji Yamanaka
- Department of Pathology, Yokohama City University School of Medicine, Yokohama, Japan
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Reiff A, Krogstad P, Moore S, Shaham B, Parkman R, Kitchen C, Weinberg K. Study of thymic size and function in children and adolescents with treatment refractory systemic sclerosis eligible for immunoablative therapy. Clin Immunol 2009; 133:295-302. [PMID: 19793681 DOI: 10.1016/j.clim.2009.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 08/06/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
Abstract
Following hematopoietic stem cell transplantation (HSCT), thymic reconstitution of peripheral T lymphocytes is essential to avoid a chronically immunodeficient state and disease recurrence. The purpose of this study was to determine if children and adolescents with treatment refractory SSc, awaiting HSCT, have sufficient thymic function to reconstitute T lymphocyte function after transplantation. Thirteen children with systemic scleroderma were enrolled and assessed by physical exam, chest MRI, measurement of autoantibodies, B and T cell immuno-phenotyping, and quantization of T cell receptor rearrangement excision circles (TREC) as a marker of thymopoiesis. MRI detected thymic tissue in 9/13 children. TREC levels were detectable in all but one child but were significantly reduced (p<0.001) when compared to a control population. SSc patients also had a reduced percentage of naïve (CD45RA+CD31+) CD4+ T lymphocytes, further indicating diminished thymopoiesis. Our data suggest that thymic function in children with SSc might be insufficient for an adequate immunoreconstitution following transplantation in some patients. A thorough evaluation of immune and thymic functions to identify those patients prior to HSCT is recommended.
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Affiliation(s)
- A Reiff
- Divisions of Rheumatology, Radiology and Bone Marrow Transplantation, Department of Pediatrics, University of Southern California, Keck School of Medicine, Children's Hospital Los Angeles, CA 90027, USA.
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Oksel F, Tarhan F, Bayraktaroglu S, Savas R, Yargucu F, Keser G. Radiological incomplete thymus involution in systemic sclerosis. Rheumatology (Oxford) 2009; 48:800-3. [DOI: 10.1093/rheumatology/kep055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Madani G, Katz R, Haddock J, Denton C, Bell J. The role of radiology in the management of systemic sclerosis. Clin Radiol 2008; 63:959-67. [DOI: 10.1016/j.crad.2008.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 05/08/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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Zivković SA, Medsger TA. Myasthenia gravis and scleroderma: Two cases and a review of the literature. Clin Neurol Neurosurg 2007; 109:388-91. [PMID: 17280777 DOI: 10.1016/j.clineuro.2007.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 01/02/2007] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
Myasthenia gravis is uncommon in patients with scleroderma, and when diagnosed is usually associated with previous use of d-penicillamine. Clinically, both myasthenia and scleroderma may present with fatigue, weakness and bulbar symptoms, so one of diagnoses may be delayed. We report two new cases and review clinical features of 12 other reported cases of co-existing scleroderma and myasthenia gravis, unrelated to previous d-penicillamine therapy. Co-occurrence of myasthenia and scleroderma was reported almost exclusively (13/14) in women with a mean latency of 7.03 years. Most patients (10/11) had seropositive generalized myasthenia, and there were no cases with exclusively ocular symptoms. Three patients with pre-existing myasthenia were safely treated with d-penicillamine. Myasthenia and scleroderma occur in the context of an underlying autoimmune diathesis, but their co-occurrence could be underreported as the recognition of either disorder may be delayed by overlapping clinical symptoms. Our findings also suggest that d-penicillamine may be cautiously used in selected patients with pre-existing scleroderma and myasthenia, when potential benefits outweigh the risk of possible myasthenia exacerbation.
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Affiliation(s)
- Sasa A Zivković
- VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, United States.
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