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Pozzato M, Dilena R, Rogani G, Beretta G, Torreggiani S, Lanni S, Tozzo A, Andreetta F, Cavalcante P, Triulzi F, Martinelli Boneschi F, Minoia F, Filocamo G. Can early-onset acquired demyelinating syndrome (ADS) hide pediatric Behcet's disease? A case report. Front Pediatr 2023; 11:1175584. [PMID: 37425262 PMCID: PMC10327559 DOI: 10.3389/fped.2023.1175584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Behcet's disease (BD) is a rare vasculitis characterized by multisystemic inflammation. Central nervous system (CNS) involvement is rare and heterogeneous, particularly in the pediatric population. A diagnosis of neuro-Behcet could be highly challenging, especially if neurological manifestations precede other systemic features; however, its timely definition is crucial to prevent long-term sequelae. In this study, we describe the case of a girl who, at 13 months of age, presented with a first episode of encephalopathy compatible with acute disseminated encephalomyelitis, followed, after 6 months, by a neurological relapse characterized by ophthalmoparesis and gait ataxia, in association with new inflammatory lesions in the brain and spinal cord, suggesting a neuromyelitis optica spectrum disorder. The neurological manifestations were successfully treated with high-dose steroids and intravenous immunoglobulins. In the following months, the patient developed a multisystemic involvement suggestive of Behcet's disease, characterized by polyarthritis and uveitis, associated with HLA-B51 positivity. The challenge presented by this unique case required a multidisciplinary approach involving pediatric neurologists, neuro-radiologists, and pediatric rheumatologists, with all of these specialists creating awareness about early-onset acquired demyelinating syndromes (ADSs). Given the rarity of this presentation, we performed a review of the literature focusing on neurological manifestations in BD and differential diagnosis of patients with early-onset ADS.
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Affiliation(s)
- Mattia Pozzato
- Neurology Unit & MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Robertino Dilena
- Neuropathophysiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Greta Rogani
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
| | - Gisella Beretta
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
| | - Sofia Torreggiani
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Lanni
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Tozzo
- Infantile Neuropsychiatry Unit, Pediatric Neuroscience Department, IRCCS Fondazione Istituto Neurologico “C. Besta”, Milan, Italy
| | - Francesca Andreetta
- Neurology 4 - Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Paola Cavalcante
- Neurology 4 - Neuroimmunology and Neuromuscular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Filippo Martinelli Boneschi
- Clinical Neurology, Department of Health Science CRC “Aldo Ravelli” for Experimental Brain Therapeutics, Hospital San Paolo ASST Santi Paolo e Carlo Milan and University of Milan, Milan, Italy
| | - Francesca Minoia
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda ospedale Maggiore Policlinico, Milan, Italy
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Chu F, Shi M, Lang Y, Chao Z, Jin T, Cui L, Zhu J. Adoptive transfer of immunomodulatory M2 macrophages suppresses experimental autoimmune encephalomyelitis in C57BL/6 mice via blockading NF-κB pathway. Clin Exp Immunol 2021; 204:199-211. [PMID: 33426702 DOI: 10.1111/cei.13572] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 12/16/2022] Open
Abstract
Macrophages play important roles in multiple sclerosis (MS) and experimental autoimmune encephalomyelitis (EAE), and M2 macrophage may have anti-inflammatory effects. In this study, we elucidated the roles of M1 and M2 macrophages in the pathogenesis of EAE and the effects of treatment with M2 macrophages that target certain proinflammatory cytokines and with immunomodulatory preparations that beneficially influence the disease course. We found macrophages increased at the onset of clinical signs in the EAE group, consistent with an increased proportion of M1 macrophages and low numbers of M2 macrophages. As the disease progressed and the symptoms worsened, M1 macrophages decreased and M2 macrophages gradually increased until the peak. In the recovery stage, M2 macrophages gradually decreased. Treatment with M2 macrophages inhibited the nuclear factor kappa B (NF-κB) pathway, alleviated the symptoms of EAE, reduced inflammatory cell infiltration and demyelination in the central nervous system and decreased the numbers of macrophages in the spleens. BAY-11-7082, an NF-κB blocking agent, could reduce the total number of macrophages both in vivo and in vitro, effectively prevented EAE development and significantly inhibited EAE symptoms in mice. Our study demonstrates that macrophages may play a crucial role in the pathogenesis of EAE, while M2 macrophages have anti-inflammatory effects. Transfer of M2 macrophages to EAE mice can block the NF-κB pathway successfully and relieve EAE symptoms. Application of NF-κB blockers is useful in the prevention and treatment of EAE.
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Affiliation(s)
- F Chu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China.,Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - M Shi
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China.,Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Y Lang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Z Chao
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - T Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - L Cui
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - J Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, Jilin Province, China.,Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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