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Zhang Y, Jiang X, Wang Q, Wu J, Zhou J. Dexamethasone alleviates pulmonary sarcoidosis by regulating the TGF-β/Smad3 signaling to promote Th17/Treg cell rebalance. Cell Immunol 2024; 395-396:104781. [PMID: 38159414 DOI: 10.1016/j.cellimm.2023.104781] [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: 06/18/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 01/03/2024]
Abstract
Pulmonary sarcoidosis is an immune-mediated disorder closely related to Th17/Treg cell imbalance. Dexamethasone has been shown to regulate inflammation and immune responses in sarcoidosis patients. However, the underlying mechanisms of dexamethasone regulating Th17/Treg balance in sarcoidosis remain elusive. Herein, we elucidated the function role of TGF-β/Smad3 signaling in pulmonary sarcoidosis development and explored the underlying mechanism of dexamethasone in treating pulmonary sarcoidosis. We found that the TGF-β/Smad3 pathway was inactivated in pulmonary sarcoidosis patients. Propionibacterium acnes (PA) induced mouse model was generated to investigate the function of TGF-β/Smad3 signaling in vivo. Data indicated that IL17A inhibition with neutralizing antibody and activation of TGF-β/Smad3 signaling with SRI-011381 alleviated granuloma formation in the sarcoidosis mouse model. Moreover, we revealed that the Th17/Treg cell ratio was increased with PA treatment in mouse bronchoalveolar lavage fluid (BALF) and peripheral blood. The concentration of cytokines produced by Th17 cells (IL-17A, IL-23) was up-regulated in the BALF of PA-treated mice, while those produced by Tregs (IL-10, TGF-β1) presented significant reduction. The treatment of IL-17A neutralizing antibody or SRI-011381 was demonstrated to rescue the PA-induced changes in the concentration of IL-17A, IL-23, IL-10, and TGF-β1. Additionally, we demonstrated that dexamethasone treatment activated the TGF-β/Smad3 signaling in the lung tissues of pulmonary sarcoidosis mice. Dexamethasone was also revealed to promote the rebalancing of the Th17/Treg ratio and attenuated the granuloma formation in pulmonary sarcoidosis. In conclusion, dexamethasone activates the TGF-β/Smad3 signaling and induces Th17/Treg rebalance, alleviating pulmonary sarcoidosis, which suggests the potential of dexamethasone in treating pulmonary sarcoidosis.
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Affiliation(s)
- Yu Zhang
- Department of Respiratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, China; Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China
| | - Xuan Jiang
- Department of Respiratory Medicine, Wuxi Second People's Hospital, Wuxi, Jiangsu 214000, China
| | - Qing Wang
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China
| | - Jiayi Wu
- Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226000, China
| | - Juan Zhou
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Nantong University, No. 20, Xisi Road, Nantong, Jiangsu 226000, China.
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2
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Akhavanrezayat A, Matsumiya W, Ongpalakorn P, Ghoraba HH, Or C, Khojasteh Jafari H, Kirimli GU, Yasar C, Than NTT, Karaca I, Zaidi M, Mobasserian A, Yavari N, Bazojoo V, Shin YU, Bromeo AJ, Nguyen QD. Neurosarcoidosis, Coccidioidomycosis, or Both! Int Med Case Rep J 2023; 16:887-895. [PMID: 38164515 PMCID: PMC10758176 DOI: 10.2147/imcrj.s434632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose To report a case of neurosarcoidosis (NS) who was initially diagnosed as Coccidioidomycosis immitis (CI) infection. Observations A 57-year-old diabetic man presented with sudden painless diminution of vision, metamorphopsia, and color vision deficits in the left eye (OS) for one month. His vision was 20/20 in the right eye (OD) and 20/40 OS. Ophthalmic examination revealed left relative afferent pupillary defect, blurred optic nerve margin, creamy chorioretinal infiltration around the optic disc, and mild macular edema. OD examination was non-revealing. Chest CT scan with contrast showed calcified mediastinal lymph nodes, but biopsy of the lymph nodes was normal. Brain and orbit MRI demonstrated soft tissue abnormality with enhancement in left orbital apex with involvement of the extraocular muscles. CSF culture was negative, but complement fixation had positive titer of 1:2 for CI. The patient was diagnosed with CI meningitis, and antifungal therapy was initiated. Slight visual and symptomatic improvement was observed, which was not completely satisfactory. Biopsy of extraocular orbital muscle five months later revealed non-caseating granulomatous inflammation, leading to initiation of prednisone trial therapy. Nine months later, the patient was referred to a tertiary center owing to persistence of optic disc edema OS. PET CT was consistent with a diagnosis of sarcoidosis. Antifungal treatment was discontinued, and oral prednisone with methotrexate was initiated. Subsequently, methotrexate was replaced by infliximab to further manage ocular inflammation and neurologic symptoms which was effective. Vision was 20/20 OD and 20/30 OS at the most recent visit. Conclusion and Importance Signs and symptoms of neurosarcoidosis and coccidioidomycosis can be similar and deceiving. The index case underscores importance of considering appropriate differential diagnoses in patients with similar symptoms and signs who may respond to preliminary designated treatment but not to the optimal extent. Considering such possibility could assist clinicians in managing the patients timely and efficiently.
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Affiliation(s)
- Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Wataru Matsumiya
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Prapatsorn Ongpalakorn
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hashem H Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Chris Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Hassan Khojasteh Jafari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Moosa Zaidi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Yong Un Shin
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Albert John Bromeo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
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3
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Moore CE, Marshall L. Diagnosing Extrapulmonary Sarcoidosis and the Implications of Diagnosis on Military Service. Cureus 2023; 15:e47115. [PMID: 38021643 PMCID: PMC10647944 DOI: 10.7759/cureus.47115] [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: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease that can cause granulomatous infiltration of almost all organs and tissues which allows for a wide variety of presentations that may overlap with other disease processes. Renal sarcoidosis is a much rarer site of extrapulmonary involvement and may present as hypercalcemia, tubular or glomerular dysfunction, and/or granulomatous interstitial nephritis. Prompt diagnosis of sarcoidosis is crucial for initiating appropriate treatment and avoiding organ dysfunction. Herein, we describe a case of an armed forces service member who developed extrapulmonary sarcoidosis and renal sarcoidosis with acute complications refractory to glucocorticoids requiring adalimumab. The case highlights and emphasizes a rare manifestation of extrapulmonary sarcoidosis, the importance of avoiding premature closure of the differential diagnosis to avoid diagnostic delay and treatment imitation, and the unique clinical reasoning that occurs in active-duty personnel where diagnoses and subsequent treatments can have career implications and affect the ability of the service member to maintain the ability to deploy worldwide.
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Affiliation(s)
- Caroline E Moore
- Internal Medicine, Naval Medical Center San Diego, San Diego, USA
| | - Landry Marshall
- Internal Medicine, Naval Medical Center Camp Lejeune, Camp Lejeune, USA
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4
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Suzuki A, Kamio K, Takeno M, Terasaki Y, Taniuchi N, Sato J, Nishijima N, Saito Y, Seike M, Gemma A, Azuma A. Pulmonary sarcoidosis complicated by rheumatoid arthritis in a patient presenting with progressive fibrosing interstitial lung disease and treated with nintedanib: a case report and literature review. Ther Adv Respir Dis 2023; 17:17534666231158279. [PMID: 36872912 PMCID: PMC9989416 DOI: 10.1177/17534666231158279] [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: 03/07/2023] Open
Abstract
Sarcoidosis is a multisystem disease with an unknown etiology and is characterized by the formation of noncaseating granulomas in the affected organs. We present the case of a 69-year-old male Japanese patient with bilateral hilar lymphadenopathy on chest radiographs for more than 10 years, left without further investigation. The patient reported no clinical symptoms. Chest computed tomography revealed ground-glass opacities and reticular shadows in both lungs, along with bilateral hilar and mediastinal lymphadenopathy. Lymphocytosis was observed in bronchoalveolar lavage fluid. Pathological examination of transbronchial lung biopsy revealed noncaseating, epithelioid granulomas congruous with sarcoidosis, together with other findings. There were no abnormalities on electrocardiogram, echocardiogram, and ophthalmic examination.For progressive dyspnea on exertion, systemic corticosteroid therapy with oral prednisolone (25 mg/day) was initiated in 2017 and gradually tapered. Despite this intervention, the decline in forced vital capacity (FVC) was accelerated. Three years later, the patient noticed swelling in his right wrist. Further investigation revealed elevated anti-cyclic citrullinated peptide antibodies and absence of noncaseating epithelioid granuloma on surgical biopsy, leading to the diagnosis of rheumatoid arthritis (RA). Thereafter, the anti-fibrotic agent nintedanib was initiated, because interstitial lung disease (ILD) was considered to have converted into a progressive fibrosing phenotype (PF-ILD) with overlapping RA-associated lung involvement. With treatment, the progression of decline in FVC was slowed, although home oxygen therapy was introduced.
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Affiliation(s)
- Ayana Suzuki
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
| | - Koichiro Kamio
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugi-machi, Nakahara-ku, Kawasaki-shi 211-8533, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Namiko Taniuchi
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
| | - Junpei Sato
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
| | - Nobuhiko Nishijima
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki-shi, Japan
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5
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Basida B, Haider MB, Bapatla A, Zalavadiya N, Iqbal S. Subhepatic Abscess Unmasking the Silent Gastric and Pulmonary Sarcoidosis. Cureus 2021; 13:e16957. [PMID: 34527450 PMCID: PMC8418939 DOI: 10.7759/cureus.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 11/05/2022] Open
Abstract
Sarcoidosis is a non-necrotizing granulomatous disease of unknown etiology presenting with variable systemic manifestations. Lung involvement is the most common initial presentation of sarcoidosis. Rarely, patients can present with initial non-pulmonary symptoms. Asymptomatic gastric sarcoidosis is a difficult diagnosis as it is not only rare but also under-recognized in the majority of cases. Its treatment is exclusively recommended for symptomatic cases only. However, it is of extreme significance to have the asymptomatic patients follow up outpatient regularly to prevent any major complications. Here, we present an interesting case of a 54-year-old African American female patient with only abdominal pain symptoms attributed to a hepatic abscess. A diagnosis of gastric sarcoidosis was solely based on the presence of non-necrotizing granulomas on biopsy following esophagogastroduodenoscopy (EGD). Incidentally, she was also found to have pulmonary sarcoidosis based on imaging. Her abdominal symptoms improved with abscess drainage and so, she was never started on steroids. She was followed up outpatient for pulmonary function tests. The patient continues to do well without any specific treatment for sarcoidosis. This case demonstrates the variability of sarcoidosis and the significance of biopsy in gastric sarcoidosis.
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Affiliation(s)
- Brinda Basida
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Maryam B Haider
- Internal Medicine, Detroit Medical Center/Wayne State University Sinai-Grace Hospital, Detroit, USA
| | - Anusha Bapatla
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Nirav Zalavadiya
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
| | - Sana Iqbal
- Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, USA
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Flores RJ, Flaherty KR, Jin Z, Bokhari S. The prognostic value of quantitating and localizing F-18 FDG uptake in cardiac sarcoidosis. J Nucl Cardiol 2020; 27:2003-2010. [PMID: 30421379 DOI: 10.1007/s12350-018-01504-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no identified level of FDG uptake in cardiac sarcoidosis (CS) associated with increased risk of arrhythmias, conduction disease, heart failure, or death. We aim to utilize standardized uptake value (SUV) quantitation and localization to identify patients at increased risk of cardiac events. METHODS AND RESULTS F18-FDG PET/CT with MPI was used in CS diagnosis (N = 67). Mean and max SUV were measured and grouped as basal, mid, and apical disease. Post-scan ventricular tachycardia, AICD placement, complete heart block, pacemaker placement, atrial fibrillation, heart failure, and cardiac-related hospital admissions were recorded (mean follow up 2.98 ± 2 years). Poisson regression analysis revealed that max SUV, mean SUV, as well as mean basal SUV, and LVEF were significantly associated with total cardiac events. Max SUV odds ratio (OR) = 1.068 (95% CI 1.024-1.114, P = 0.002), mean SUV OR = 1.059 (95% CI 1.008-1.113, P = 0.023), mean SUV OR = 1.061 (95% CI 1.012-1.112, P = 0.014), scan LVEF OR = 0.731 (95% CI 0.664-0.805, P < 0.001). CONCLUSIONS SUV at time of CS diagnosis has significant associations with future cardiac events. Patients with higher SUV, particularly in basal segments, are at increased risk of events. Further studies are needed to identify treatment methods utilizing risk stratification of CS.
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Affiliation(s)
- R J Flores
- Internal Medicine, Columbia University Medical Center, New York, NY, USA.
| | - K R Flaherty
- Internal Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Z Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - S Bokhari
- Internal Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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7
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d'Alessandro M, Bergantini L, Perrone A, Cameli P, Cameli M, Prasse A, Plataroti D, Sestini P, Bargagli E. Serial investigation of Angiotensin-Converting Enzyme in sarcoidosis patients treated with Angiotensin-Converting Enzyme Inhibitor. Eur J Intern Med 2020; 78:58-62. [PMID: 32307232 DOI: 10.1016/j.ejim.2020.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Angiotensin-converting enzyme (ACE) is an acid glycoprotein that converts angiotensin I into angiotensin II. It is produced mainly by activated alveolar macrophages and it resulted elevated in sarcoidosis patients. ACE is the only biomarker mentioned in WASOG international guidelines for the diagnosis and follow-up of sarcoidosis patients but its sensitivity and specificity are low. This study aimed to analyze serial measurements of ACE levels in sarcoidosis patients stratified according to concomitant ACE-inhibitor therapies (ACEIs). SUBJECTS AND METHODS 136 serum samples from sarcoidosis patients were retrospectively enrolled in the study. Serial ACE concentrations were measured once year for each patient. Population were divided according to radiogical stages and ACEIs. RESULTS ACE concentrations resulted higher in non-ACEIs than ACEIs group (p<E-04). This result was confirmed also stratifying population according to radiological stages particularly in stage 3 (p=2E-03) or stage 2 of the disease (p<1E-04). Considering ACEIs, serum ACE levels proved to be higher in sarcoidosis patients treated with zofenopril than in those treated with perindopril (p=2E-02), enalapril (p=2E-03) or ramipril (p=2E-04). Patients treated with ACEIs showed a progressive reduction in ACE levels to five years of follow-up (p=1.3E-02) and the zofenopril group recorded the highest ACE levels (p<1E-04). CONCLUSIONS This retrospective study investigated changes in ACE levels in patients with sarcoidosis treated or not treated with ACEIs. Considering the overall low sensitivity and specificity of this biomarker, we suggest systematically investigating medical drugs prescribed for patients with sarcoidosis, in order to optimize the interpretation of ACE in clinical management.
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Affiliation(s)
- Miriana d'Alessandro
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy.
| | - Laura Bergantini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
| | - Anna Perrone
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Italy
| | - Antje Prasse
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Dario Plataroti
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
| | - Piersante Sestini
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
| | - Elena Bargagli
- Respiratory Diseases and Lung Transplantation, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Viale Bracci 1, Siena, 53100, Italy
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Abstract
A sarcoidosis patient may be refractory to corticosteroid therapy. This may be because corticosteroids are ineffective in relieving the sarcoidosis patient's symptoms/dysfunction or because the clinician has determined that the risks of corticosteroids outweigh their benefits. Interestingly, when corticosteroids truly fail to improve a sarcoidosis patient's condition, it is very rarely because of failure of the drug as an anti-granulomatous agent; rather, it is usually because the patient's symptoms were unrelated to active sarcoid granulomas. In this manuscript, we review the causes of corticosteroid refractory sarcoidosis. The clinician should consider these causes when confronted with a sarcoidosis patient who is either not responding to corticosteroids, developing corticosteroid side-effects, or is at significant risk of developing such side-effects. We believe that determining the cause of corticosteroid refractory sarcoidosis may aid the clinicians in optimizing the care of sarcoidosis patients and clinical researchers in appropriately stratifying patients for clinical trials.
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9
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Talreja J, Bauerfeld C, Sendler E, Pique-Regi R, Luca F, Samavati L. Derangement of Metabolic and Lysosomal Gene Profiles in Response to Dexamethasone Treatment in Sarcoidosis. Front Immunol 2020; 11:779. [PMID: 32477331 PMCID: PMC7235403 DOI: 10.3389/fimmu.2020.00779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022] Open
Abstract
Glucocorticoids (GCs) play a central role in modulation of inflammation in various diseases, including respiratory diseases such as sarcoidosis. Surprisingly, the specific anti-inflammatory effects of GCs on different myeloid cells especially in macrophages remain poorly understood. Sarcoidosis is a systemic granulomatous disease of unknown etiology that occurs worldwide and is characterized by granuloma formation in different organs. Alveolar macrophages play a role in sarcoidosis granuloma formation and progressive lung disease. The goal of the present study is to identify the effect of GCs on transcriptomic profiles and the cellular pathways in sarcoidosis alveolar macrophages and their corresponding blood myeloid cells. We determined and compared the whole transcriptional signatures of alveolar macrophages from sarcoidosis patients and blood CD14+ monocytes of the same subjects in response to in vitro treatment with dexamethasone (DEX) via RNA-sequencing. In response to DEX, we identified 2,834 genes that were differentially expressed in AM. Predominant pathways affected were as following: metabolic pathway (FDR = 4.1 × 10−10), lysosome (FDR = 6.3 × 10−9), phagosome (FDR = 3.9 × 10−5). The DEX effect on AMs is associated with metabolic derangements involving glycolysis, oxidative phosphorylation and lipid metabolisms. In contrast, the top impacted pathways in response to DEX treatment in blood CD14+ monocytes were as following; cytokine-cytokine receptor interaction (FDR = 6 × 10−6) and transcriptional misregulation in cancer (FDR = 1 × 10−4). Pathways similarly affected in both cell types were genes involved in lysosomes, cytoskeleton and transcriptional misregulation in cancer. These data suggest that the different effects of DEX on AMs and peripheral blood monocytes are partly dictated by lineage specific transcriptional programs and their physiological functions.
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Affiliation(s)
- Jaya Talreja
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States
| | - Christian Bauerfeld
- Division of Critical Care, Department of Pediatrics, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States
| | - Edward Sendler
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Roger Pique-Regi
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States.,Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Francesca Luca
- Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States.,Department of Obstetrics and Gynecology, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Lobelia Samavati
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine and Detroit Medical Center, Wayne State University, Detroit, MI, United States.,Center for Molecular Medicine and Genetics, School of Medicine, Wayne State University, Detroit, MI, United States
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10
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Lee HJ, Seo H, Cha SI, Park TI, Kim CH, Lee J. Sarcoidosis presenting pulmonary subsolid nodules that mimic lung adenocarcinoma in a patient with history of uveitis and arrhythmia: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:496. [PMID: 31700932 DOI: 10.21037/atm.2019.08.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sarcoidosis is an idiopathic systemic granulomatous disorder that can involve any organ, although the lung is the most commonly affected site; moreover, it may affect multiple organs simultaneously or serially over a long time span. Diagnosing sarcoidosis can be a challenge in cases presenting an isolated extra-thoracic lesion at the early stage of disease. Pulmonary nodular lesion, a rare radiologic finding, may also lead to delayed diagnosis of sarcoidosis. We reported a case of atypical pulmonary nodular sarcoidosis that was suspected as lung adenocarcinoma, which was diagnosed about 20 years after initial isolated extra-thoracic manifestation occurred.
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Affiliation(s)
- Hye Jin Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae In Park
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chang Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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11
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Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019; 3:358-375. [PMID: 31485575 PMCID: PMC6713839 DOI: 10.1016/j.mayocpiqo.2019.04.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.
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Key Words
- ATS, American Thoracic Society
- AV, atrioventricular
- CMRI, cardiovascular magnetic resonance imaging
- DLCO, diffusing capacity of the lung for carbon monoxide
- DMARD, disease-modifying antirheumatic drugs
- ECG, electrocardiographic
- ERS, European Respiratory Society
- FDG-PET, 18F-fluorodeoxyglucose–positron emission tomography
- FVC, forced vital capacity
- GI, gastrointestinal tract
- LVEF, left ventricular ejection fraction
- NSAID, nonsteroidal anti-inflammatory drug
- PFT, pulmonary function test
- TBB, transbronchial lung biopsy
- TNF-α, tumor necrosis factor α
- WASOG, World Association of Sarcoidosis and other Granulomatous Disorders
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Affiliation(s)
- Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Address to Patompong Ungprasert, MD, MS, Clinical Epidemiology Unit, 3rd Floor, SIMR Bldg, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Eric L. Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Department of Health Sciences Research (E.L.M.), Mayo Clinic, Rochester, MN
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Prognostic Biomarkers of Sarcoidosis: A Comparative Study of Serum Chitotriosidase, ACE, Lysozyme, and KL-6. DISEASE MARKERS 2019; 2019:8565423. [PMID: 30944672 PMCID: PMC6421736 DOI: 10.1155/2019/8565423] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/19/2019] [Accepted: 01/31/2019] [Indexed: 12/16/2022]
Abstract
Purpose Sarcoidosis is a systemic granulomatous disease with unknown etiology. Many clinical presentations have been reported, and acute disease needs to be distinguished from subacute and chronic disease. The unpredictable clinical course of the disease prompted us to evaluate the clinical utility of biomarker serum detection in sarcoidosis follow-up. Methods Serum concentrations of chitotriosidase, ACE, KL-6, and lysozyme were analyzed by different methods in a population of 74 sarcoidosis patients (46 on steroid therapy at sampling) regularly monitored at Siena Sarcoidosis Regional Referral Centre and in a group of controls with the aim of comparing their contribution to clinical management of sarcoidosis patients. Results KL-6 concentrations were significantly elevated in sarcoidosis patients with lung fibrosis and were significantly correlated with DLco and CPI score, while chitotriosidase was significantly higher in patients with extrapulmonary localizations. With a cut-off value of 303.5 IU/ml, KL-6 showed the best sensitivity (78%), while chitotriosidase reported the best specificity (85%) among the biomarkers. Conclusions KL-6 is a reliable biomarker of fibrotic lung involvement in sarcoidosis patients. Among biomarkers, KL-6 showed the best sensitivity and serum chitotriosidase the best specificity, even in patients on chronic steroid therapy, and seemed to correlate with extrapulmonary localizations.
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Richeldi L, Varone F, Bergna M, de Andrade J, Falk J, Hallowell R, Jouneau S, Kondoh Y, Morrow L, Randerath W, Strek M, Tabaj G. Pharmacological management of progressive-fibrosing interstitial lung diseases: a review of the current evidence. Eur Respir Rev 2018; 27:27/150/180074. [PMID: 30578333 PMCID: PMC9488647 DOI: 10.1183/16000617.0074-2018] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022] Open
Abstract
A proportion of patients with interstitial lung diseases (ILDs) are at risk of developing a progressive-fibrosing phenotype, which is associated with a deterioration in lung function and early mortality. In addition to idiopathic pulmonary fibrosis (IPF), fibrosing ILDs that may present a progressive phenotype include idiopathic nonspecific interstitial pneumonia, connective tissue disease-associated ILDs, hypersensitivity pneumonitis, unclassifiable idiopathic interstitial pneumonia, ILDs related to other occupational exposures and sarcoidosis. Corticosteroids and/or immunosuppressive therapies are sometimes prescribed to patients with these diseases. However, this treatment regimen may not be effective, adequate on its own or well tolerated, suggesting that there is a pressing need for efficacious and better tolerated therapies. Currently, the only approved treatments to slow disease progression in patients with IPF are nintedanib and pirfenidone. Similarities in pathobiological mechanisms leading to fibrosis between IPF and other ILDs that may present a progressive-fibrosing phenotype provide a rationale to suggest that nintedanib and pirfenidone may be therapeutic options for patients with the latter diseases. This review provides an overview of the therapeutic options currently available for patients with fibrosing ILDs, including fibrosing ILDs that may present a progressive phenotype, and explores the status of the randomised controlled trials that are underway to determine the efficacy and safety of nintedanib and pirfenidone. Aside from IPF, there are no proven therapies for other ILDs with a progressive-fibrosing phenotype that are effective and have tolerable adverse effects. Clinical studies evaluating the benefits of antifibrotic therapy in these populations are underway.http://ow.ly/40yL30mOs0q
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Affiliation(s)
- Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Varone
- Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario A. Gemelli IRCSS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Miguel Bergna
- Centro Médico de Enfermedades, Respiratorias, Florida, Vicente López, Buenos Aires, Argentina
| | | | - Jeremy Falk
- Cedars-Sinai Medical Center, Division of Pulmonary and Critical Care Medicine, Los Angeles, CA, USA
| | - Robert Hallowell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stéphane Jouneau
- Respiratory Diseases Dept, Hôpital Pontchaillou, IRSET, Université de Rennes 1, Rennes, France
| | - Yasuhiro Kondoh
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Lee Morrow
- Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Winfried Randerath
- Institute of Pneumology, University of Cologne, Bethanien Hospital, Solingen, Germany
| | - Mary Strek
- Dept of Radiology, University of Chicago, Chicago, IL, USA
| | - Gabriela Tabaj
- Pulmonary Medicine, Cetrángolo Hospital, Buenos Aires, Argentina
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Gherasim A, Dao A, Bernstein JA. Confounders of severe asthma: diagnoses to consider when asthma symptoms persist despite optimal therapy. World Allergy Organ J 2018; 11:29. [PMID: 30459928 PMCID: PMC6234696 DOI: 10.1186/s40413-018-0207-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/18/2018] [Indexed: 12/30/2022] Open
Abstract
Asthma can often be challenging to diagnose especially when patients present with atypical symptoms. Therefore, it is important to have a broad differential diagnosis for asthma to ensure that other conditions are not missed. Clinicians must maintain a high index of suspicion for asthma mimickers, especially when patients fail to respond to conventional therapy. The purpose of this review is to briefly review some of the more common causes of asthma mimickers that clinicians should consider when the diagnosis of asthma is unclear.
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Affiliation(s)
- Alina Gherasim
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ahn Dao
- University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Jonathan A Bernstein
- University of Cincinnati College of Medicine, Cincinnati, OH USA
- Department of Internal Medicine, Division of Immunology Rheumatology and Allergy, University of Cincinnati, 231 Albert Sabin Way ML#563, Cincinnati, OH 45267-0563 USA
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Pulmonary Sarcoidosis Considerations in Primary Care. J Nurse Pract 2018. [DOI: 10.1016/j.nurpra.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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