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Zhang N, Zhang H, Bao X, Yuan C. Transactivation DNA-binding protein-related genes were associated with salivary gland injury in primary Sjögren syndrome. Medicine (Baltimore) 2024; 103:e39827. [PMID: 39331939 PMCID: PMC11441856 DOI: 10.1097/md.0000000000039827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 09/02/2024] [Indexed: 09/29/2024] Open
Abstract
The purpose was to identify transactivation DNA-binding protein-related genes in salivary gland injury in primary Sjögren syndrome (pSS) in southwest China. We downloaded the datasets of GSE7451, GSE23117, and GSE40611. In order to screen the candidate genes, 2 kinds of machine learning algorithms were used. We collected blood from 28 patients and 20 controls to verify the expression of candidate genes using quantitative real-time polymerase chain reaction. The receiver operating characteristic curve was used to evaluate the diagnostic efficiency. Correlations between candidate genes and immune cells were examined. A total of 31 differentially expressed genes were obtained. Through different algorithms, 6 genes including IFIT1, CSF2RB, TRIM22, PPM1H, VAMP7, and C21orf2 were getted. Validation results suggested that the expression of CSF2RB, VAMP7, IFIT1, C21orf2, and TRIM22 was significantly increased in pSS. The area under the curve of CSF2RB was 0.937 and that of TRIM22 was 0.915. Immune infiltration analysis showed that the percentage of activated mast cells was lower than the controls (P = .025). Correlation analysis suggested that CSF2RB was associated with immune cell infiltration. The expression of CSF2RB was significantly upregulated, which could be related to the increase of γδ T cells. We revealed that CSF2RB could be the candidate gene of pSS. CSF2RB was involved by regulating various immune cells. The expression of CSF2RB was significantly upregulated, which was related to the increase of γδ T cells.
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Affiliation(s)
- Naidan Zhang
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
| | - Hongsheng Zhang
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
| | - Xiao Bao
- Department of Rheumatology, Peoples Hospital of Deyang City, Deyang, China
| | - Chengliang Yuan
- Department of Clinical Laboratory, Peoples Hospital of Deyang City, Deyang, China
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2
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Ono-Minagi H, Nohno T, Takabatake K, Tanaka T, Katsuyama T, Miyawaki K, Wada J, Ibaragi S, Iida S, Yoshino T, Nagatsuka H, Sakai T, Ohuchi H. Histological differences related to autophagy in the minor salivary gland between primary and secondary types of Sjögren's syndrome. BMC Oral Health 2024; 24:1099. [PMID: 39285388 PMCID: PMC11406829 DOI: 10.1186/s12903-024-04869-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/05/2024] [Indexed: 09/19/2024] Open
Abstract
Some forms of Sjögren's syndrome (SS) follow a clinical course accompanied by systemic symptoms caused by lymphocyte infiltration and proliferation in the liver, kidneys, and other organs. To better understand the clinical outcomes of SS, here we used minor salivary gland tissues from patients and examine their molecular, biological, and pathological characteristics. A retrospective study was performed, combining clinical data and formalin-fixed paraffin-embedded (FFPE) samples from female patients over 60 years of age who underwent biopsies at Okayama University Hospital. We employed direct digital RNA counting with nCounter® and multiplex immunofluorescence analysis with a PhenoCycler™ on the labial gland biopsies. We compared FFPE samples from SS patients who presented with other connective tissue diseases (secondary SS) with those from stable SS patients with symptoms restricted to the exocrine glands (primary SS). Secondary SS tissues showed enhanced epithelial damage and lymphocytic infiltration accompanied by elevated expression of autophagy marker genes in the immune cells of the labial glands. The close intercellular distance between helper T cells and B cells positive for autophagy-associated molecules suggests accelerated autophagy in these lymphocytes and potential B cell activation by helper T cells. These findings indicate that examination of FFPE samples from labial gland biopsies can be an effective tool for evaluating molecular histological differences between secondary and primary SS through multiplexed analysis of gene expression and tissue imaging.
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Affiliation(s)
- Hitomi Ono-Minagi
- Department of Cytology and Histology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan.
- Division of Hospital Dentistry, Central Clinical Department, Okayama University Hospital, Okayama, Japan.
- Research Fellow of Japan Society for the Promotion of Science, Tokyo, Japan.
- Adeno-Associated Virus Biology Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, United States of America.
| | - Tsutomu Nohno
- Department of Cytology and Histology, Okayama University Medical School, Okayama, Japan
| | - Kiyofumi Takabatake
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takayuki Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Hospital, Okayama, Japan
| | - Kohta Miyawaki
- Division of Precision Medicine, Kyushu University School of Medicine, Fukuoka, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Seiji Iida
- Department of Oral and Maxillofacial Reconstructive Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takayoshi Sakai
- Department of Rehabilitation for Orofacial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Hideyo Ohuchi
- Department of Cytology and Histology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
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Gandolfo S, Bombardieri M, Pers JO, Mariette X, Ciccia F. Precision medicine in Sjögren's disease. THE LANCET. RHEUMATOLOGY 2024; 6:e636-e647. [PMID: 38723653 DOI: 10.1016/s2665-9913(24)00039-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/16/2024] [Accepted: 02/08/2024] [Indexed: 08/23/2024]
Abstract
Sjögren's disease is a clinically and pathophysiologically heterogeneous disease to which precision medicine, on the basis of clinical and biological heterogeneity, has been not always applicable. In patients with Sjögren's disease, the relationship between dysregulated biological pathways and symptoms such as fatigue and pain or clinical manifestations is often difficult to establish. This clinical and biological dissociation also poses challenges when defining appropriate clinical endpoints for clinical trials. In the last few years, however, research efforts have been focused on gaining a better understanding of the considerable heterogeneity of Sjögren's disease by developing stratification models aimed at clustering patients with this condition into homogenous subgroups characterised by distinctive molecular signatures, biomarkers, clinical features, and outcomes. In this Review, we discuss current evidence regarding clinical, laboratory, histological, and biomolecular stratification in Sjögren's disease and examine how available stratification data can guide precision medicine and inform the design of future clinical trials.
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Affiliation(s)
- Saviana Gandolfo
- Rheumatology Section, Ospedale San Giovanni Bosco, Naples, Italy.
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Jacques-Olivier Pers
- Lymphocytes B Autoimmunité et Immunothérapies, UMR1227, INSERM, CHU de Brest, University of Brest, Brest, France
| | - Xavier Mariette
- Rheumatology Department, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France
| | - Francesco Ciccia
- Rheumatology Section, Department of Precision Medicine, University della Campania Luigi Vanvitelli, Naples, Italy
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4
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Pinnix CC, Dabaja BS, Gunther JR, Fang PQ, Wu SY, Nastoupil LJ, Strati P, Nair R, Ahmed S, Steiner R, Westin J, Neelapu S, Rodriguez MA, Lee HJ, Wang M, Flowers C, Feng L, Esmaeli B. Response-Adapted Ultralow-Dose Radiation Therapy for Orbital Indolent B-Cell Lymphoma: A Phase 2 Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:1195-1203. [PMID: 38990564 PMCID: PMC11240230 DOI: 10.1001/jamaoncol.2024.2112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 07/12/2024]
Abstract
Importance Radiation therapy to doses of 24 to 36 Gy is currently used to treat indolent B-cell lymphoma of the ocular adnexa; however, ocular adverse effects are common. Objective To determine if a response-adapted radiation therapy strategy will result in excellent disease outcomes while reducing orbital morbidity. Design, Setting, and Participants This single-institution, phase 2 prospective nonrandomized controlled trial of a response-adapted strategy involved 50 evaluable patients with stage I to IV indolent B-cell lymphoma of the ocular adnexa enrolled between July 2015 and January 2021. This treatment approach was also retrospectively evaluated with a separate 55-patient cohort treated between March 2013 and October 2021. All data were analyzed between November 2021 and December 2023. Interventions Patients were treated with ultralow-dose radiation therapy to 4 Gy in 2 fractions and assessed for response at 3-month intervals. Patients with persistent orbital lymphoma were offered an additional 20 Gy in 10 fractions to complete the response-adapted treatment. Main Outcome and Measures The primary end point was 2-year local orbital control within the irradiated field after response-adapted therapy. Secondary end points included overall survival and complete response rate. Results The 50 prospective patients were a median (range) of 63 (29-88) years old, and 31 (62%) were female. Among the 50 patients, 32 (64%) had mucosa-associated lymphoid tissue lymphoma, 12 (24%) had follicular lymphoma, and 6 (12%) had unclassifiable low-grade B-cell lymphoma. Thirty-one patients (62%) had stage I disease, and 36 (72%) were newly diagnosed. At a median follow-up of 37.4 (95% CI, 33.7-52.5) months, the 2-year local control rate was 89.4% (95% CI, 81.0%-98.7%), and the 2-year overall survival rate was 98.0% (95% CI, 94.1%-100%); 45 patients (90.0%; 95% CI, 78.2%-96.7%) experienced a complete response to response-adapted radiation, including 44 patients with a complete response to ultralow-dose radiation and 1 patient with a complete response after an additional 20 Gy. No local recurrences were observed among patients with a complete response to response-adapted therapy. No grade 3 or higher toxic effects were observed. In a planned subset analysis of 22 patients with newly diagnosed, untreated stage I mucosa-associated lymphoid tissue lymphoma, the 2-year local control rate was 90.7% (95% CI, 79.2%-100%), and the 2-year freedom from distant relapse rate was 95.2% (95% CI, 86.6%-100%). Conclusion and Relevance In this nonrandomized controlled trial, response-adapted ultralow-dose therapy for indolent orbital B-cell lymphoma resulted in reduced radiation exposure, negligible toxic effects, and excellent disease outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT02494700.
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Affiliation(s)
- Chelsea C. Pinnix
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Bouthaina S. Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jillian R. Gunther
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Penny Q. Fang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Susan Y. Wu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Loretta J. Nastoupil
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Paolo Strati
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Ranjit Nair
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Sairah Ahmed
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Raphael Steiner
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
- Now with Department of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jason Westin
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Sattva Neelapu
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Maria A. Rodriguez
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Hun Ju Lee
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael Wang
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Christopher Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston
| | - Lei Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Department of Ophthalmic Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
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Hüper S, Nagler L, Strunz PP, Froehlich M, Labinsky H, Schmalzing M, Gernert M. Lymphoma in Sjögren's syndrome: no need for repetitive screening ultrasounds of the major salivary glands and neck in asymptomatic patients. Scand J Rheumatol 2024:1-9. [PMID: 39007819 DOI: 10.1080/03009742.2024.2370109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Patients with primary Sjögren's syndrome (pSS) have an increased risk of lymphoma, especially mucosa-associated lymphoid tissue (MALT) lymphoma of the salivary glands. Risk factors for lymphoma are well known, but there are no studies on screening by imaging. Therefore, we aimed to assess the usefulness and adverse effects of ultrasound of the major salivary glands and neck as lymphoma screening. METHOD A retrospective, single-centre, analysis of imaging studies in pSS patients was conducted. Imaging studies were classified as either screening examinations (asymptomatic patients) or occasion-related (imaging due to signs of lymphoma or at least moderate systemic activity). Results were categorized as: not suspicious; requiring control; triggering tissue sampling with exclusion of lymphoma; or triggering tissue sampling with diagnosis of lymphoma. RESULTS The study included 134 patients and covered 1031 patient-years. Lymphoma was diagnosed in 15 patients (11.2%), all of whom had clinical signs of lymphoma at the time of diagnosis. During this period, 569 screening examinations and 179 occasion-related examinations were conducted. None of the screening examinations detected lymphoma, but follow-up imaging was recommended in 17.1% (95% CI 14.2-20.4%) and invasive exclusion of lymphoma was performed in 0.5% (95% CI 0.1-1.5%). In contrast, lymphoma was detected in 6.1% (95% CI 3.5-10.6%) of occasion-related examinations. CONCLUSION pSS patients with neither signs of lymphoma nor increased systemic disease activity did not benefit from screening. In contrast, patients with symptoms of lymphoma or at least moderate systemic activity can benefit from imaging of the neck and major salivary glands.
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Affiliation(s)
- S Hüper
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
- Praxis für Rheumatologie und Osteologie, Hildesheim, Germany
| | - L Nagler
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - P P Strunz
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - M Froehlich
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - H Labinsky
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - M Schmalzing
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - M Gernert
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
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6
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Brito-Zerón P, Flores-Chávez A, González-de-Paz L, Feijoo-Massó C, de Escalante B, González-García A, Gómez-de-la-Torre R, Policarpo-Torres G, Alguacil A, García-Morillo JS, López-Dupla M, Robles Á, Bonet M, Gómez-Lozano A, Toledo N, Chamorro A, Morcillo C, Cruz-Caparrós G, de Miguel-Campo B, Akasbi M, Fonseca-Aizpuru E, Gómez-Cerezo JF, Mas-Maresma L, Vallejo-Grijalba J, Starita-Fajardo G, Sánchez-Niño R, Ramos-Casals M. Temporal relationship between sarcoidosis and malignancies in a nationwide cohort of 1942 patients. Postgrad Med J 2024:qgae045. [PMID: 38972066 DOI: 10.1093/postmj/qgae045] [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: 11/02/2023] [Revised: 01/22/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE To investigate the phenotype of sarcoidosis according to the time when a malignancy is diagnosed (preexisting to the diagnosis of sarcoidosis, concomitant, or sequential) and to identify prognostic factors associated with malignancies in a large cohort of patients with sarcoidosis. METHODS We searched for malignancies in the SARCOGEAS cohort, a multicenter nationwide database of consecutive patients diagnosed with sarcoidosis according to the ATS/ESC/WASOG criteria. Solid malignancies were classified using the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) nomenclature, and hematological malignancies using the 2016 WHO classification. We excluded patients with a biopsy-proven diagnosis of sarcoidosis based exclusively on demonstrating granulomas in tissues also involved by malignant cells. RESULTS Out of 1942 patients with sarcoidosis, 233 (12%) developed 250 malignancies, including solid (n = 173), hematological (n = 57), and both types of malignancies (n = 3). Concerning the time interval between the diagnoses of both conditions, 83 (36%) patients were diagnosed with malignancy at least 1 year before sarcoidosis diagnosis, 22 (9%) had s synchronous diagnosis of both diseases, and 118 (51%) developed malignancies at least 1 year after the diagnosis of sarcoidosis (the remaining cases developed malignancies in different time intervals). The multivariate-adjusted model showed that individuals with sarcoidosis who developed a malignancy had an hazard ratio (HR) of 2.27 [95% confidence interval (CI), 1.62-3.17] for having an asymptomatic clinical phenotype at diagnosis of sarcoidosis and that spleen (presence vs. absence: HR = 2.06; 95% CI, 1.21-3.51) and bone marrow (presence vs. absence: HR = 3.04; 95% CI, 1.77-5.24) involvements were independent predictors for the development of all-type malignancies. No predictive factors were identified when the analysis was restricted to the development of solid malignancies. The analysis limited to the development of hematological malignancies confirmed the presence of involvement in the spleen (HR = 3.73; 95% CI, 1.38-10.06) and bone marrow (presence vs. absence: HR = 8.00; 95% CI, 3.15-20.35) at the time of sarcoidosis diagnosis as predictive factors. CONCLUSION It is essential to consider the synchronous or metachronous timing of the diagnosis of malignancies in people with sarcoidosis. We found that half of the malignancies were diagnosed after a diagnosis of sarcoidosis, with spleen and bone marrow involvement associated with a four to eight times higher risk of developing hematological malignancies. Key messages What is already known on this topic Malignancies are one of the comorbidities more frequently encountered in people with sarcoidosis What this study adds Malignancies occur in 12% of patients with sarcoidosis Malignancy may precede, coincide with, or follow the diagnosis of sarcoidosis One-third were identified before sarcoidosis, and half were diagnosed after Spleen and bone marrow involvement are risk factors for developing hematological malignancies How this study might affect research, practice or policy Patients with sarcoidosis should be regularly monitored for neoplasms, informed of the increased risk, and educated on early detection. Those with spleen or bone marrow involvement must be closely followed.
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Affiliation(s)
- Pilar Brito-Zerón
- Department of Internal Medicine, Research and Innovation Group in Autoimmune Diseases, Hospital-CIMA-Sanitas, Barcelona, 08034, Spain
| | | | - Lluís González-de-Paz
- Primary Care Center Les Corts, CAPSBE, Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Carles Feijoo-Massó
- Department of Internal Medicine, Hospital Parc Tauli, Sabadell, 08208, Spain
| | | | | | - Ricardo Gómez-de-la-Torre
- Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Oviedo, 33011, Spain
| | | | - Ana Alguacil
- Department of Internal Medicine, Hospital Virgen de la Salud, Toledo, 45071, Spain
| | | | - Miguel López-Dupla
- Department of Internal Medicine, Hospital Joan XXIII, Tarragona, 43007, Spain
| | - Ángel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, 28046, Spain
| | - Mariona Bonet
- Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Manresa, 08243, Spain
| | - Albert Gómez-Lozano
- Department of Internal Medicine, Hospital Santa Caterina, Girona, 17190, Spain
| | - Neera Toledo
- Department of Internal Medicine, Hospital Gregorio Marañón, Madrid, 28007, Spain
| | - Antonio Chamorro
- Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, 37007, Spain
| | - César Morcillo
- Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, 08034, Spain
| | | | | | - Miriam Akasbi
- Department of Internal Medicine, Hospital de Cabueñes, Gijón, 33394, Spain
| | - Eva Fonseca-Aizpuru
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, 28046, Spain
| | | | - Laia Mas-Maresma
- Department of Internal Medicine, Hospital Parc Tauli, Sabadell, 08208, Spain
| | | | | | - Raúl Sánchez-Niño
- Department of Internal Medicine, Hospital Universitario Central de Asturias (HUCA), Oviedo, 33011, Spain
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, 08036, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, 08036, Spain
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7
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Lee AYS, Rischmueller M. The diagnosis and misdiagnosis of Sjögren disease. Intern Med J 2024; 54:833-835. [PMID: 38757225 DOI: 10.1111/imj.16395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/19/2024] [Indexed: 05/18/2024]
Abstract
Although one of the most common systemic autoimmune disorders, Sjögren disease (SjD) may be overlooked in patients presenting with non-specific symptoms or no complaints of sicca symptoms. SjD is not a condition to be missed as patients could present with serious extra-glandular manifestations, including lymphomas. In this article, we discuss the diagnostic pitfalls of this disorder and encourage physicians to consider carefully the 'non-textbook' presentations.
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Affiliation(s)
- Adrian Y S Lee
- Centre for Immunology & Allergy Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
- Department of Clinical Immunology & Allergy, Westmead Hospital, Sydney, New South Wales, Australia
- Department of Immunopathology, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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8
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Luo Q, Wu K, Li H, Wang H, Wang C, Xia D. Weighted Gene Co-expression Network Analysis and Machine Learning Validation for Identifying Major Genes Related to Sjogren's Syndrome. Biochem Genet 2024:10.1007/s10528-024-10750-4. [PMID: 38678487 DOI: 10.1007/s10528-024-10750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/19/2024] [Indexed: 05/01/2024]
Abstract
Sjogren's syndrome (SS) is an autoimmune disorder characterized by dry mouth and dry eyes. Its pathogenic mechanism is currently unclear. This study aims to integrate weighted gene co-expression network analysis (WGCNA) and machine learning to identify key genes associated with SS. We downloaded 3 publicly available datasets from the GEO database comprising the gene expression data of 231 SS and 78 control cases, including GSE84844, GSE48378 and GSE51092, and carried out WGCNA to elucidate differences in the abundant genes. Candidate biomarkers for SS were then identified using a LASSO regression model. Totally 6 machine-learning models were subsequently utilized for validating the biological significance of major genes according to their expression. Finally, immune cell infiltration of the SS tissue was assessed using the CIBERSORT algorithm. A weighted gene co-expression network was built to divide genes into 10 modules. Among them, blue and red modules were most closely associated with SS, and showed significant enrichment in type I interferon signaling, cellular response to type I interferon and response to virus, etc. Combined machine learning identified 5 hub genes, including OAS1, EIF2AK2, IFITM3, TOP2A and STAT1. Immune cell infiltration analysis showed that SS was associated with CD8+ T cell, CD4+ T cell, gamma delta T cell, NK cell and dendritic cell activation. WGCNA was combined with machine learning to uncover genes that may be involved in SS pathogenesis, which can be utilized for developing SS biomarkers and appropriate therapeutic targets.
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Affiliation(s)
- Qiang Luo
- Department of Cardiology, Southwest Jiaotong University Affiliated Chengdu Third People' s Hospital, Chengdu, 610036, Sichuan, China
| | - Kaiwen Wu
- Southwest Jiaotong University College of Medicine, Southwest Jiaotong University Affiliated Chengdu Third People' s Hospital, Chengdu, 610036, Sichuan, China
| | - He Li
- Department of Emergency, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
| | - Han Wang
- Department of Cardiology, Southwest Jiaotong University Affiliated Chengdu Third People' s Hospital, Chengdu, 610036, Sichuan, China
| | - Chen Wang
- Department of Burn and Plastic Surgery, Third Affiliated Hospital of Naval Medical University, Shanghai, China.
| | - Demeng Xia
- Department of Pharmacy, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200120, China.
- Department of Clinical Medicine, Hainan Health Vocational College, Hainan, 572000, China.
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9
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Luo S, Zhang X, Wang Z. Breast mucosa-associated lymphoid tissue lymphoma: A case report and literature review. Medicine (Baltimore) 2024; 103:e37895. [PMID: 38640287 PMCID: PMC11029987 DOI: 10.1097/md.0000000000037895] [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] [Received: 01/03/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Mucosa-associated lymphoid tissue (MALT) lymphoma, also known as extranodal marginal zone lymphoma, is more commonly detected in the stomach and rarely in the breast. Our study presented a clinical and pathological examination of a patient diagnosed with breast MALT lymphoma, supplemented with pertinent research, to offer guidance for the diagnosis and treatment of this condition. PEOPLE CONCERNS The occurrence of breast MALT lymphoma has risen in the past decade, but its etiology, progression and treatment response are less well-studied. DIAGNOSIS Breast MALT lymphoma was diagnosed by excisional biopsy and histopathology. INTERVENTIONS Following breast MALT lymphoma diagnosis, the patient was transferred to the hematology department for further treatment, and she made the decision to continue observing. OUTCOMES After 3 months of observation, the patient remained asymptomatic. CONCLUSION Breast MALT lymphoma is an indolent disease with an asymptomatic presentation, There are no standardized treatment guidelines for breast MALT lymphoma, treatment must be tailored to the patient willingness to treat and the severity of the disease. Hence, in order to give patients a better chance of cure, more research is needed to explore its pathogenesis and more clinical trials are needed investigate the treatment of this disease.
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Affiliation(s)
- Siyi Luo
- Department of Breast, Jiujiang NO.1 People’s Hospital, Jiujiang, People’s Republic of China
| | - Xinyue Zhang
- Department of Pathology, Jiujiang NO.1 People’s Hospital, Jiujiang, People’s Republic of China
| | - Zhichun Wang
- Department of Breast, Jiujiang NO.1 People’s Hospital, Jiujiang, People’s Republic of China
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Bandeira M, Silvério-António M, Khmelinskii N, Fonseca JE, Romão VC. Beyond sicca: high prevalence and predictors of baseline and worsening systemic involvement in patients with Sjögren's disease. Rheumatol Adv Pract 2024; 8:rkae035. [PMID: 38560642 PMCID: PMC10978570 DOI: 10.1093/rap/rkae035] [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] [Received: 07/10/2023] [Accepted: 02/22/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives Systemic extraglandular involvement in SS has been reported in one-third of patients but may be more frequent. We aimed to evaluate systemic disease prevalence at baseline and throughout follow-up and find its predictors. Methods We conducted a retrospective cohort study including SS patients followed in a tertiary centre. The cumulative EULAR SS disease activity index (ESSDAI) was calculated by adding each domain's maximum score throughout follow-up. We identified independent predictors of systemic involvement (ESSDAI ≥1 at baseline and/or follow-up) through logistic regression modelling. A survival analysis was conducted to identify predictors of new/worsening ESSDAI domains. Results A total of 216 patients were included, most of whom had systemic involvement (86%), frequently at diagnosis (76%). Biological (53%) and articular ESSDAI domains (44%) were most commonly involved, but all were affected at least once. Around half of the patients with baseline systemic disease developed an additional/worsening domain throughout follow-up. Although most patients had low disease activity at baseline, 60% eventually reached moderately active disease. Younger age at diagnosis [odds ratio (OR) 0.95 (95% CI 0.91, 0.99)], a positive minor salivary gland biopsy [OR 4.08 (95% CI 1.40, 11.86)] and RF [OR 4.67 (95% CI 1.52, 14.33)] were independent predictors of systemic involvement. Patients with baseline constitutional involvement [hazard ratio (HR) 2.23 (95% CI 1.13, 4.40)] and RF [HR 1.89 (95% CI 1.20, 3.00)] were more likely to develop new/worsening systemic disease activity. Conclusion Systemic involvement is seen in most SS patients. Younger and RF and salivary gland biopsy-positive patients are at higher risk of systemic disease. Around half of patients with systemic involvement experienced aggravated disease over time, especially those with constitutional involvement or RF.
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Affiliation(s)
- Matilde Bandeira
- Rheumatology Department, Unidade Local de Saúde Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Manuel Silvério-António
- Rheumatology Department, Unidade Local de Saúde Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Unidade Local de Saúde Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - João E Fonseca
- Rheumatology Department, Unidade Local de Saúde Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Vasco C Romão
- Rheumatology Department, Unidade Local de Saúde Santa Maria, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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La Bella S, Vivarelli M, Di Ludovico A, Di Donato G, Chiarelli F, Breda L. Kidney manifestations of pediatric Sjögren's syndrome. Pediatr Nephrol 2024; 39:711-721. [PMID: 37638982 DOI: 10.1007/s00467-023-06135-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
Approximately 1% of all patients with Sjögren's syndrome (SS) are children. Unlike the adult form, in which sicca syndrome is the main presentation, in children, the most common clinical finding is recurrent enlargement of the salivary glands. In pediatric SS, extraglandular manifestations represent a significant feature and, among these, kidney manifestations are relevant. Kidney involvement is observed in 5-20.5% of children with SS, most frequently tubulointerstitial nephritis. This injury can lead to serious phenotypes, including distal kidney tubular acidosis with the development of severe hypokalemia, which can lead to ECG abnormalities, weakness, and hypokalemic periodic paralysis. Kidney implications in pediatric SS also include nephrolithiasis, nephrocalcinosis, and various types of glomerular damage, which often require immunosuppressive therapies. Laboratory findings are usually comparable to adults, including hyperglobulinemia and high rates of antinuclear antibodies (ANA, 63.6-96.2%), and anti-Ro/SSA (36.4-84.6%). The current classification criteria for SS are inaccurate for the pediatric population, and more specific criteria are needed to improve the diagnostic rate. Due to the rarity of the disease, strong recommendations for treatment are lacking, and several therapeutic strategies have been reported, mostly based on glucocorticoids and disease-modifying antirheumatic drugs, with different outcomes. The aim of this paper is to provide an overview of the kidney implications of pediatric SS based on the latest evidence of the medical literature.
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Affiliation(s)
- Saverio La Bella
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Marina Vivarelli
- Division of Nephrology, Laboratory of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Armando Di Ludovico
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giulia Di Donato
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Luciana Breda
- Department of Pediatrics, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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12
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Witkowski Durand Viel P, Henry K, Morel J, Jacot W, Jorgensen C, Riviere S, Maria ATJ, Rigau V, Le Quellec A, Goulabchand R, Guilpain P. Chronological interplay, clinical features, and treatments among patients with cancer and primary Sjögren's syndrome. Cancer Immunol Immunother 2023; 72:4309-4322. [PMID: 37938369 PMCID: PMC10991638 DOI: 10.1007/s00262-023-03565-6] [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: 04/26/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE While the incidence and type of blood malignancies are well documented amid primary Sjögren's syndrome patients (pSS), data focusing on solid neoplasms are more conflicting. We aimed to describe clinical, pathological, and immunological characteristics of pSS patients with cancers, along with the chronological interplay between the two conditions. METHODS Outcomes concerning both pSS and cancer were retrospectively collected from Montpellier University Hospital (tertiary center) between 2019 and 2020. pSS characteristics were compared to a control group of pSS patients without cancer. RESULTS A total of 165 patients with pSS were included: 55 patients with cancer (52 female, mean age 58.4 ± 10.4 years at pSS diagnosis; mean follow-up 10.5 ± 10.1 years, 12 patients had multiple cancers) and 110 controls without cancer. Characteristics of pSS patients with cancers were different from controls mostly for lymphoma prognosis factors. Among the 70 cancers, we recorded 55 solid neoplasms (whom 27 breast cancers and 8 lung cancers, and 82% of adenocarcinomas), with no evidence of disease at the end of follow-up in 85% of them. Among the 15 recorded blood malignancies, ten were lymphomas with an excellent prognosis. Regarding chronological interplay between cancer and pSS, most cancers (43%) were diagnosed close (± 5 years) to pSS diagnosis. Breast cancers were diagnosed before or close to pSS diagnosis (mean delay - 1.8 ± 13.0 years), at an early stage, with only two relapses (no cancer-related death), while lung cancers were diagnosed late after. CONCLUSIONS The tight chronological interplay between breast cancer and pSS and the intriguing pathological and immunological pattern of pSS in these patients suggest a hypothesis of immune control of cancer.
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Affiliation(s)
- Philine Witkowski Durand Viel
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Kim Henry
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Jacques Morel
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Department of Rheumatology, Montpellier University Hospital, IDESP, Montpellier, France
| | - William Jacot
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Medical Oncology, Montpellier Cancer Institute (ICM) Val d'Aurelle, Montpellier, France
| | - Christian Jorgensen
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Montpellier University Hospital, Montpellier, France
| | - Sophie Riviere
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
| | - Valérie Rigau
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Department of Biopathology, Biopathology Tumor Bank, Montpellier University Hospital, Montpellier, France
| | - Alain Le Quellec
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
- Faculty of Medicine, University of Montpellier, Montpellier, France
| | - Radjiv Goulabchand
- Faculty of Medicine, University of Montpellier, Montpellier, France
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France
- IDESP, Univ Montpellier, INSERM, Montpellier, Nimes University Hospital, Nimes, France
- Department of Internal Medicine, University Hospital, Nimes, France
| | - Philippe Guilpain
- Department of Internal Medicine - Multi-organ Diseases, St Eloi Hospital, Montpellier University Hospital, Univ Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
- Faculty of Medicine, University of Montpellier, Montpellier, France.
- Institute for Regenerative Medicine & Biotherapy, University of Montpellier, Montpellier, France.
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13
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Kor A, Yalçın M, Erten Ş, Maraş Y, Oğuz EF, Doğan İ, Atalar E, Başer S, Erel Ö. 14-3-3η Proteins as a Diagnostic Marker, Disease Activation Indicator, and Lymphoma Predictor in Patients with Primary Sjögren Syndrome. ARCHIVES OF IRANIAN MEDICINE 2023; 26:582-591. [PMID: 38310415 PMCID: PMC10862092 DOI: 10.34172/aim.2023.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 07/03/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Primary Sjögren syndrome (PSS) is a chronic, autoimmune, and lymphoproliferative disease of the connective tissue. In patients with PSS, the risk of developing B-cell non-Hodgkin lymphoma (NHL) increases dramatically, with a prevalence of approximately 5%. The 14-3-3 protein isoforms are phospho-serin/phospho-threonine binding proteins associated with many malignant diseases. This study aimed to evaluate the relationship between disease activity parameters and markers predicting lymphoma development in patients with PSS and 14-3-3η proteins. METHODS This study was designed as an analytical case-control study. A total of 57 PSS patients and 54 healthy volunteers were included in the study. The European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index (ESSDAI) was used to assess systemic disease activity in PSS. Receiver operating characteristic (ROC) analysis was used to test the diagnostic accuracy measures of the analytical results. Multivariable linear regression analysis was used to evaluate the effects of independent variables on the 14-3-3η protein. RESULTS The 14-3-3η protein serum levels were found to be significantly higher in PSS (2.72 [2.04-4.07]) than healthy controls (1.73 [1.41-2.43]) (P<0.0001). A significant relationship was found between 14-3-3η protein levels and ESSDAI group (β=0.385, 95%CI=0.318-1.651, P=0.005), hypocomplementemia (C3 or C4) (β=0.223, 95% CI=0.09-1.983, P=0.048) and purpura (β=0.252, 95% CI=0.335-4.903, P=0.022), which are accepted as lymphoma predictors. A significant correlation was found between PSS disease activity score ESSDAI and 14-33η protein (β=0.496, 95% CI=0.079-0.244, P=0.0002). CONCLUSION 14-3-3η proteins are potential candidates for diagnostic marker, marker of disease activity, and predictor of lymphoma in PSS patients.
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Affiliation(s)
- Ahmet Kor
- Department of Rheumatology, Aksaray Education and Research Hospital, Aksaray, Turkey
| | - Merve Yalçın
- Department of Internal Medicine, Ankara Bilkent City Hospital, Ministry of Health, Ankara, Turkey
| | - Şükran Erten
- Department of Rheumatology, Faculty of Medicine Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Yüksel Maraş
- Department of Rheumatology, Ankara Bilkent City Hospital, Health Sciences University, Ankara, Turkey
| | - Esra Fırat Oğuz
- Department of Medical Biochemistry, Ankara Bilkent City Hospital, Ministry of Health, Ankara, Turkey
| | - İsmail Doğan
- Department of Rheumatology, Faculty of Medicine Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ebru Atalar
- Department of Rheumatology, Ankara Bilkent City Hospital, Ministry of Health, Ankara, Turkey
| | - Salih Başer
- Department of Internal Medicine, Faculty of Medicine Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Özcan Erel
- Department of Medical Biochemistry, Faculty of Medicine Ankara Bilkent City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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14
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Lee AYS, Wang JJ, Gordon TP, Reed JH. Phases and Natural History of Sjögren's Disease: A New Model for an Old Disease? Arthritis Care Res (Hoboken) 2023; 75:1580-1587. [PMID: 36063396 PMCID: PMC10953327 DOI: 10.1002/acr.25011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023]
Abstract
Sjögren's disease (SjD) is an archetypal and heterogenous autoimmune disorder that is characterized by exocrine glandular dysfunction. A proportion of patients develop severe extraglandular manifestations, such as cryoglobulinemia, and have an increased risk of lymphoma, both of which can adversely affect quality of life and occasionally mortality. As with most autoimmune disorders, the pathogenesis is poorly understood and difficult to predict, and, frustratingly, there is a lack of targeted therapies to cure this disease. We review the disease manifestations of SjD and propose a staged model for understanding the evolution of pathology. In longitudinal studies, most patients remain relatively stable in terms of their laboratory and clinical parameters. However, in the setting of various risk factors, a proportion of patients develop severe symptoms and/or lymphoma. We discuss potential underlying mechanisms for disease progression and the strengths and limitations of using a staged model to correlate the pathogenesis and spectrum of manifestations in SjD. Ultimately, understanding how and why some patients remain relatively stable, whereas others progress and develop florid systemic disease and a fraction develop lymphoma, is key to developing preventative and therapeutic treatments.
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Affiliation(s)
- Adrian Y. S. Lee
- The Westmead Institute for Medical ResearchUniversity of Sydney, Westmead Hospital, NSW Health PathologyWestmeadNew South WalesAustralia
| | - Jing Jing Wang
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Tom P. Gordon
- SA Pathology and Flinders UniversityBedford ParkSouth AustraliaAustralia
| | - Joanne H. Reed
- The Westmead Institute for Medical ResearchUniversity of SydneyWestmeadNew South WalesAustralia
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15
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Mihai A, Caruntu C, Jurcut C, Blajut FC, Casian M, Opris-Belinski D, Ionescu R, Caruntu A. The Spectrum of Extraglandular Manifestations in Primary Sjögren's Syndrome. J Pers Med 2023; 13:961. [PMID: 37373950 DOI: 10.3390/jpm13060961] [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: 04/30/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Extraglandular manifestations (EGMs) in primary Sjogren's syndrome (pSS) represent the clinical expression of the systemic involvement in this disease. EGMs are characterized by a wide heterogeneity; virtually any organ or system can be affected, with various degrees of dysfunction. The existing gaps of knowledge in this complex domain of extraglandular extension in pSS need to be overcome in order to increase the diagnostic accuracy of EGMs in pSS. The timely identification of EGMs, as early as from subclinical stages, can be facilitated using highly specific biomarkers, thus preventing decompensated disease and severe complications. To date, there is no general consensus on the diagnostic criteria for the wide range of extraglandular involvement in pSS, which associates important underdiagnosing of EGMs, subsequent undertreatment and progression to severe organ dysfunction in these patients. This review article presents the most recent basic and clinical science research conducted to investigate pathogenic mechanisms leading to EGMs in pSS patients. In addition, it presents the current diagnostic and treatment recommendations and the trends for future therapeutic strategies based on personalized treatment, as well as the latest research in the field of diagnostic and prognostic biomarkers for extraglandular involvement in pSS.
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Affiliation(s)
- Ancuta Mihai
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Rheumatology, Faculty of General Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Dermatology, Prof. N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
| | - Florin Cristian Blajut
- Department of General Surgery, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Medical-Surgical Specialties, "Titu Maiorescu" University of Bucharest, 040441 Bucharest, Romania
| | - Mihnea Casian
- Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, 022328 Bucharest, Romania
- Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Daniela Opris-Belinski
- Internal Medicine and Rheumatology Department, Sfanta Maria Clinical Hospital, 011172 Bucharest, Romania
- Internal Medicine and Rheumatology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ruxandra Ionescu
- Internal Medicine and Rheumatology Department, Sfanta Maria Clinical Hospital, 011172 Bucharest, Romania
| | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, Carol Davila Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Titu Maiorescu University, 031593 Bucharest, Romania
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16
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Yang L, Pu J, Cai F, Zhang Y, Gao R, Zhuang S, Liang Y, Wu Z, Pan S, Song J, Han F, Tang J, Wang X. Chronic Epstein-Barr virus infection: A potential junction between primary Sjögren's syndrome and lymphoma. Cytokine 2023; 168:156227. [PMID: 37244248 DOI: 10.1016/j.cyto.2023.156227] [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: 11/30/2022] [Revised: 04/24/2023] [Accepted: 05/04/2023] [Indexed: 05/29/2023]
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease that targets exocrine glands, leading to exocrine dysfunction. Due to its propensity to infect epithelial and B cells, Epstein-Barr virus (EBV) is hypothesized to be related with pSS. Through molecular mimicry, the synthesis of specific antigens, and the release of inflammatory cytokines, EBV contributes to the development of pSS. Lymphoma is the most lethal outcome of EBV infection and the development of pSS. As a population-wide virus, EBV has had a significant role in the development of lymphoma in people with pSS. In the review, we will discuss the possible causes of the disease.
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Affiliation(s)
- Lufei Yang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Jincheng Pu
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Feiyang Cai
- Department of Experimental Medicine, Faculty of Medicine, McGill University, Montréal, Québec, Canada; Gerald Bronfman Department of Oncology, Segal Cancer Centre, Lady Davis Institute and Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Youwei Zhang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Ronglin Gao
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shuqi Zhuang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yuanyuan Liang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Zhenzhen Wu
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Shengnan Pan
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Jiamin Song
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Fang Han
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Jianping Tang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.
| | - Xuan Wang
- Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China.
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Aleksiejūnaitė M, Talijūnas A, Zaleckas L, Rastenienė R. Mucosa-Associated Lymphoid Tissue Lymphoma of the Sublingual Salivary Gland: A Case Report. Cureus 2023; 15:e38179. [PMID: 37252593 PMCID: PMC10220322 DOI: 10.7759/cureus.38179] [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: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is a type of B-cell lineage lymphoma that can affect the head and neck region. This report presents a rare case of an extra-nodal marginal zone B-cell MALT lymphoma of a sublingual gland, diagnosed in an 18-year-old male patient. The patient had a history of ranula surgical removal on the right side of the mouth. One year after surgery, the patient presented with complaints of swelling of the left parotid gland, with no significant changes found during the examination and a self-resolving outcome. Subsequently, two years later, the patient began to complain of a fast-growing cyst under the tongue. A surgical excision of the left sublingual gland and the ranula was performed, and a final diagnosis of MALT lymphoma was rendered. The patient was referred to the department of hematology for further treatment planning and follow-up.
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Affiliation(s)
- Monika Aleksiejūnaitė
- Centre of Oral and Maxillofacial Surgery, Faculty of Medicine, Vilnius University Hospital Žalgiris Clinic, Vilnius, LTU
| | - Andrius Talijūnas
- Centre of Oral and Maxillofacial Surgery, Faculty of Medicine, Vilnius University Hospital Žalgiris Clinic, Vilnius, LTU
| | - Linas Zaleckas
- Centre of Oral and Maxillofacial Surgery, Faculty of Medicine, Vilnius University Hospital Žalgiris Clinic, Vilnius, LTU
| | - Rūta Rastenienė
- Centre of Oral and Maxillofacial Surgery, Faculty of Medicine, Vilnius University Hospital Žalgiris Clinic, Vilnius, LTU
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Badarinza M, Serban O, Maghear L, Pelea MA, Rosca RI, Fodor D, Stancu B. Diagnostic role of CXCL13 biomarker in primary Sjogren's syndrome patients with parotid non-Hodgkin's lymphoma complication. Med Clin (Barc) 2023:S0025-7753(23)00094-5. [PMID: 37005121 DOI: 10.1016/j.medcli.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Serum biomarkers are important predictive factors for development of parotid non-Hodgkin's lymphoma (NHL) complication in primary Sjogren's syndrome (pSS) patients. The aim was to evaluate the diagnostic accuracy of serum CXCL13 chemokine in pSS patients with parotid NHL complication. MATERIAL AND METHODS Serum CXCL13 chemokine was assessed in 33 patients with pSS [7 with parotid NHL complication (pSS+NHL subgroup) and 26 without NHL (pSS-NHL subgroup)] and 30 healthy subjects. RESULTS The serum CXCL13 levels in pSS+NHL subgroup [175.2 (107.9-220.4) pg/ml] were significantly higher comparing to the healthy subjects group (p=0.018) and the pSS-NHL subgroup (p=0.048). A cut-off value of 123.45pg/ml (Se=71.4%, Sp=80.8%, AUROC=0.747) was established for parotid lymphoma diagnosis. CONCLUSION The serum CXCL13 biomarker could be considered a valuable tool for the diagnosis of parotid NHL complication in pSS patients.
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Brito-Zerón P, Retamozo S, Ramos-Casals M. [Sjögren syndrome]. Med Clin (Barc) 2023; 160:163-171. [PMID: 36528400 DOI: 10.1016/j.medcli.2022.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 12/23/2022]
Abstract
In 1933, the Swedish ophthalmologist Hendrik Sjögren was the first to suggest that behind the dryness that several of his patients presented, there could be a systemic disease related to an abnormal immune response. Since then, the term Sjögren's syndrome (SjS) has been used and it has been considered a minor and infrequent disorder compared to other systemic autoimmune diseases (SAD) and, consequently, with little progress both in clinical and therapeutic research. The emergence of new technologies at the end of the 20th century rapidly promoted the development of international projects of great impact and diffusion, which have completely changed this scenario, and in the last 20 years significant progress has been made in understanding the main epidemiological determinants and pathogenic mechanisms to increase the diagnostic accuracy and to design specific and individualized therapeutic strategies. Currently, SjS should be considered one of the most frequent SADs with an undoubtedly systemic phenotype beyond dryness, in which the identification of prognostic factors can allow personalized follow-up and, therefore, early therapeutic interventions that avoid severe, irreversible outcomes.
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Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, España; Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España
| | - Soledad Retamozo
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Reumatología, Hospital Quirón Salud, Barcelona, España
| | - Manuel Ramos-Casals
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España; Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, España.
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20
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Oral immune-mediated disorders with malignant potential/association: An overview. Dis Mon 2023; 69:101349. [PMID: 35337657 DOI: 10.1016/j.disamonth.2022.101349] [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: 01/11/2023]
Abstract
A group of oral disorders or conditions, which may result from, or could be triggered by an abnormality in the normal immune response of an individual are known as oral immune-mediated disorders. Some of these disorders have malignant potential, while others are associated with malignancy. In this overview, we will discuss a few of the oral diseases (such as oral lichen planus, primary Sjogren's syndrome, systemic lupus erythematosus, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis, to name a few), which are caused due to irregularity in the immune system and are either associated with malignancy or capable of undergoing malignant transforming, thereby increasing the morbidity and mortality rate.
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21
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Kolijn PM, Huijser E, Wahadat MJ, van Helden-Meeuwsen CG, van Daele PLA, Brkic Z, Rijntjes J, Hebeda KM, Groenen PJTA, Versnel MA, Thurlings RM, Langerak AW. Extranodal marginal zone lymphoma clonotypes are detectable prior to eMZL diagnosis in tissue biopsies and peripheral blood of Sjögren's syndrome patients through immunogenetics. Front Oncol 2023; 13:1130686. [PMID: 37035202 PMCID: PMC10076775 DOI: 10.3389/fonc.2023.1130686] [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] [Received: 12/23/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Activated B cells play a key role in the pathogenesis of primary Sjögren's syndrome (pSS) through the production of autoantibodies and the development of ectopic germinal centers in the salivary glands and other affected sites. Around 5-10% of pSS patients develop B-cell lymphoma, usually extranodal marginal zone lymphomas (eMZL) of the mucosa-associated lymphoid tissue (MALT). The aim of the current study is to investigate if the eMZL clonotype is detectable in prediagnostic blood and tissue biopsies of pSS patients. Methods/Results We studied prediagnostic tissue biopsies of three pSS patients diagnosed with eMZL and four pSS controls through immunoglobulin (IG) gene repertoire sequencing. In all three cases, we observed the eMZL clonotype in prediagnostic tissue biopsies. Among controls, we observed transient elevation of clonotypes in two pSS patients. To evaluate if eMZL clonotypes may also be detected in the circulation, we sequenced a peripheral blood mononuclear cell (PBMC) sample drawn at eMZL diagnosis and two years prior to eMZL relapse in two pSS patients. The eMZL clonotype was detected in the peripheral blood prior to diagnosis in both cases. Next, we selected three pSS patients who developed eMZL lymphoma and five additional pSS patients who remained lymphoma-free. We sequenced the IG heavy chain (IGH) gene repertoire in PBMC samples taken a median of three years before eMZL diagnosis. In two out of three eMZL patients, the dominant clonotype in the prediagnostic PBMC samples matched the eMZL clonotype in the diagnostic biopsy. The eMZL clonotypes observed consisted of stereotypic IGHV gene combinations (IGHV1-69/IGHJ4 and IGHV4-59/IGHJ5) associated with rheumatoid factor activity, a previously reported feature of eMZL in pSS. Discussion In conclusion, our results indicate that eMZL clonotypes in pSS patients are detectable prior to overt eMZL diagnosis in both tissue biopsies and peripheral blood through immunogenetic sequencing, paving the way for the development of improved methods of early detection of eMZL.
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Affiliation(s)
- P. Martijn Kolijn
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Erika Huijser
- Department of Immunology, Erasmus MC, Rotterdam, Netherlands
| | - M. Javad Wahadat
- Department of Immunology, Erasmus MC, Rotterdam, Netherlands
- Department of Paediatric Rheumatology, Sophia Children’s Hospital, Erasmus MC, Rotterdam, Netherlands
| | | | - Paul L. A. van Daele
- Department of Immunology, Erasmus MC, Rotterdam, Netherlands
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Zana Brkic
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, Rotterdam, Netherlands
| | - Jos Rijntjes
- Department of Pathology, Radboudumc, Nijmegen, Netherlands
| | | | | | | | | | - Anton W. Langerak
- Department of Immunology, Laboratory Medical Immunology, Erasmus MC, Rotterdam, Netherlands
- *Correspondence: Anton W. Langerak,
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22
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Hernández-Molina G, Kostov B, Brito-Zerón P, Vissink A, Mandl T, Hinrichs AC, Quartuccio L, Baldini C, Seror R, Szántó A, Isenberg D, Gerli R, Nordmark G, Rasmussen A, Solans-Laque R, Hofauer B, Sène D, Pasoto SG, Rischmueller M, Praprotnik S, Gheita TA, Danda D, Armağan B, Suzuki Y, Valim V, Devauchelle-Pensec V, Retamozo S, Kvarnstrom M, Sebastian A, Atzeni F, Giacomelli R, Carsons SE, Kwok SK, Nakamura H, Fernandes Moça Trevisani V, Flores-Chávez A, Mariette X, Ramos-Casals M. Characterization and outcomes of 414 patients with primary SS who developed haematological malignancies. Rheumatology (Oxford) 2022; 62:243-255. [PMID: 35385104 DOI: 10.1093/rheumatology/keac205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To characterize 414 patients with primary SS who developed haematological malignancies and to analyse how the main SS- and lymphoma-related features can modify the presentation patterns and outcomes. METHODS By January 2021, the Big Data Sjögren Project Consortium database included 11 966 patients fulfilling the 2002/2016 classification criteria. Haematological malignancies diagnosed according to the World Health Organization (WHO) classification were retrospectively identified. RESULTS There were 414 patients (355 women, mean age 57 years) with haematological malignancies (in 43, malignancy preceded at least one year the SS diagnosis). A total of 376 (91%) patients had mature B-cell malignancy, nearly half had extranodal marginal zone lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT lymphoma) (n = 197), followed by diffuse large B-cell lymphoma (DLBCL) (n = 67), nodal MZL lymphoma (n = 29), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (n = 19) and follicular lymphoma (FL) (n = 17). Rates of complete response, relapses and death were 80%, 34% and 13%, respectively, with a 5-year survival rate of 86.5% after a mean follow-up of 8 years. There were significant differences in age at diagnosis (younger in MALT, older in CLL/SLL), predominant clinical presentation (glandular enlargement in MALT lymphoma, peripheral lymphadenopathy in nodal MZL and FL, constitutional symptoms in DLBCL, incidental diagnosis in CLL/SLL), therapeutic response (higher in MALT lymphoma, lower in DLBCL) and survival (better in MALT, nodal MZL and FL, worse in DLBCL). CONCLUSION In the largest reported study of haematological malignancies complicating primary SS, we confirm the overwhelming predominance of B-cell lymphomas, especially MALT, with the salivary glands being the primary site of involvement. This highly-specific histopathological scenario is linked with the overall good prognosis with a 5-year survival rate of nearly 90%.
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Affiliation(s)
- Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, IDIBAPS.,Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC)
| | - Pilar Brito-Zerón
- Department of Medicine, Autoimmune Diseases Unit, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Division of Rheumatology, Lund University, Malmö, Sweden
| | - Anneline C Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine (DAME), University of Udine, ASU FC, Udine
| | | | - Raphaele Seror
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud - Hôpital Bicêtre, Paris-Saclay University, INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Antonia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roser Solans-Laque
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Benedikt Hofauer
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich,Germany
| | - Damien Sène
- Université de Paris, Departement of Internal Medicine, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Tamer A Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Berkan Armağan
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Soledad Retamozo
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.,Instituto Modelo de Cardiología Privado SRL, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Marika Kvarnstrom
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital.,Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Messina
| | - Roberto Giacomelli
- Department of Clinical Immunology and Rheumatology, School of Medicine, University of Rome 'Campus Biomedico', Rome, Italy
| | - Steven E Carsons
- Division of Rheumatology, Allergy and Immunology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | - Xavier Mariette
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud - Hôpital Bicêtre, Paris-Saclay University, INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Diseases, ICMiD.,Department of Medicine, University of Barcelona, Hospital Clinic, Barcelona, Spain
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23
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Muacevic A, Adler JR, Verma N. An Unusual Presentation of Cryoglobulinemia in a Patient With Undiagnosed Sjögren's Syndrome and Treated Marginal Zone Lymphoma. Cureus 2022; 14:e32730. [PMID: 36686139 PMCID: PMC9851851 DOI: 10.7759/cureus.32730] [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: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Our case details a 47-year-old female who presented to our cancer hospital with a petechial rash of the lower extremities as well as a headache and blurred vision for the prior two days. She was found to have systolic pressures in the 200s in the emergency department and was admitted for a hypertensive emergency. Notable medical history includes marginal zone lymphoma (MZL) status post-submandibular resection at an outside institution in 11/2017 (thought to be in remission). With her history in mind, she also reported subjective submandibular swelling on admission and an unintentional 25-pound weight loss over the eight weeks prior to admission. A PET scan was completed, which showed diffusely increased reticuloendothelial activity, and a follow-up bone marrow biopsy was without residual lymphoma activity. Creatinine was markedly elevated with significant proteinuria, and a renal biopsy revealed thrombotic microangiopathy, acute tubular injury, and moderate interstitial fibrosis. Remarkable laboratory tests included positive quantitative cryoglobulins ("cryocrit") and low complement 4 (C4). Qualitative cryoglobulins were never obtained, unfortunately. She was started on prednisone and transferred to a nearby academic hospital for formal rheumatologic evaluation. Importantly, testing at this facility showed elevated Sjögren's syndrome-related antigen A (SSA/Ro) antibodies. Also elicited at the academic hospital was that she had been experiencing symptoms of chronic dry eyes and mouth years even before her diagnosis of MZL. She was diagnosed with primary Sjögren's syndrome, which was thought to be the cause of her likely mixed cryoglobulinemia and the precipitant of her acute renal failure with hypertensive emergency, her skin changes, her anemia, and her hypocomplementemia. Of note, prior to discharge from the academic hospital, the patient's cryoglobulin testing was negative after prolonged steroid treatment, and she was placed on rituximab for maintenance. Our case is important as it helps illustrate one of the myriad precipitants of mixed cryoglobulinemia, in this case possibly untreated Sjögren's syndrome.
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24
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The Predictive Role of Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocytes-to-Lymphocyte Ratio (MLR) and Gammaglobulins for the Development of Cutaneous Vasculitis Lesions in Primary Sjögren's Syndrome. J Clin Med 2022; 11:jcm11195525. [PMID: 36233393 PMCID: PMC9572220 DOI: 10.3390/jcm11195525] [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] [Received: 08/19/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background: In primary Sjögren’s Syndrome (pSS), cutaneous vasculitis lesions (CVL) are extraglandular manifestations with an important clinical and prognostic impact and their early detection might contribute to the improvement of disease control and even patients’ survival. The aim of this study was to evaluate the predictive potential of hematological elements in the development of CVL in pSS patients. Methods: In this single center, retrospective study, a total of 245 participants were included (124 pSS patients and 121 healthy controls). Complete blood count, inflammatory and immunological parameters were determined at the initial visit. pSS patients underwent a periodical follow-up program, when disease progression and response to therapy was monitored, including the emergence of CVL. Results: In pSS, leucocytes, lymphocyte, neutrophil, monocyte, erythrocyte and platelet counts are significantly decreased compared to healthy subjects (p < 0.001), whereas cellular ratios: NLR, PLR, MLR, and immunological and inflammatory parameters are significantly increased (p < 0.001). A total of 34 patients with pSS (27.41%) developed CVL during the follow-up period. The occurrence of CVL was positively correlated with neutrophil and platelet counts (p < 0.001), while for lymphocytes the correlation was negative (p < 0.001). Cellular ratios: NLR, PLR and MLR, and gammaglobulins also revealed significant positive correlations with the emergence of CVL in pSS (p < 0.001). The multivariate analysis confirmed the independent predictive character for CVL emergence in pSS for NLR (CI95% 0.053−0.2, p < 0.002), PLR (CI95% 0.001−0.003, p < 0.003), MLR (CI95% 0.086−0.935, p < 0.019), and gammaglobulins (CI95% 0.423−0.688, p < 0.001). Conclusions: Standard hematological parameters, widely used in the assessment of pSS patients, such as NLR, PLR, MLR and gammaglobulins could become valid elements that might be used for the early detection of patients at risk for the development of CVL.
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25
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André F, Böckle BC. Sjögren-Syndrom. J Dtsch Dermatol Ges 2022; 20:980-1003. [PMID: 35881105 DOI: 10.1111/ddg.14823_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Fiona André
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Barbara C Böckle
- Universitätsklinik für Dermatologie, Venerologie und Allergologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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26
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André F, Böckle BC. Sjögren's syndrome. J Dtsch Dermatol Ges 2022; 20:980-1002. [PMID: 35775593 PMCID: PMC9539881 DOI: 10.1111/ddg.14823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
Sjögren’s syndrome (SjS) is an autoimmune disease characterized by the triad of sicca symptoms, fatigue and pain. This diagnosis is usually made in women at the average age of 60 years. Diagnosis is made when sicca symptoms persist for more than three months, after the exclusion of possible differential diagnoses, and using the ACR/EULAR 2016 classification criteria for SjS. Many organs can be affected in the course of this disease. Xerosis cutis and pruritus are the most common skin manifestations, followed by leukocytoclastic vasculitis and subacute cutaneous lupus erythematosus. In addition, SjS patients often have myoarthralgia and neuropsychiatric symptoms. In the long term, attention must be paid to the increased risk of cardiovascular disease and lymphoma. Due to the multiorgan involvement in SjS patients, interdisciplinary care is required.
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Affiliation(s)
- Fiona André
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara C Böckle
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
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27
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Kaddu-Mulindwa D, Thurner L, Christofyllakis K, Bewarder M, Kos IA. Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives. Cancers (Basel) 2022; 14:cancers14123019. [PMID: 35740684 PMCID: PMC9220961 DOI: 10.3390/cancers14123019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Extranodal marginal zone lymphoma distinguishes itself from other indolent lymphomas due to its unique pathophysiology and natural history. This is reflected in its management, where next to traditional treatment strategies such as observation, radiotherapy or chemotherapy, eradication of the causal agent and even surgery represent important aspects of therapy. This review focuses on the particular aspects of this indolent lymphoma that affect management and summarizes the current evidence and different guidelines. Abstract Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy.
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28
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Li Z, Mu Y, Guo C, You X, Liu X, Li Q, Sun W. Analysis of the saliva metabolic signature in patients with primary Sjögren’s syndrome. PLoS One 2022; 17:e0269275. [PMID: 35653354 PMCID: PMC9162338 DOI: 10.1371/journal.pone.0269275] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The saliva metabolome has been applied to explore disease biomarkers. In this study we characterized the metabolic profile of primary Sjögren’s syndrome (pSS) patients and explored metabolomic biomarkers.
Methods
This work presents a liquid chromatography-mass spectrometry-based metabolomic study of the saliva of 32 patients with pSS and 38 age- and sex-matched healthy adults. Potential pSS saliva metabolite biomarkers were explored using test group saliva samples (20 patients with pSS vs. 25 healthy adults) and were then verified by a cross-validation group (12 patients with pSS vs. 13 healthy adults).
Results
Metabolic pathways, including tryptophan metabolism, tyrosine metabolism, carbon fixation, and aspartate and asparagine metabolism, were found to be significantly regulated and related to inflammatory injury, neurological cognitive impairment and the immune response. Phenylalanyl-alanine was discovered to have good predictive ability for pSS, with an area under the curve (AUC) of 0.87 in the testing group (validation group: AUC = 0.75).
Conclusion
Our study shows that salivary metabolomics is a useful strategy for differential analysis and biomarker discovery in pSS.
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Affiliation(s)
- Zhen Li
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Mu
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunlan Guo
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin You
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoyan Liu
- Core Facility of Instrument, Chinese Academy of Medical Sciences, School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Li
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (QL); (WS)
| | - Wei Sun
- Core Facility of Instrument, Chinese Academy of Medical Sciences, School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail: (QL); (WS)
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29
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Zandonella Callegher S, Giovannini I, Zenz S, Manfrè V, Stradner MH, Hocevar A, Gutierrez M, Quartuccio L, De Vita S, Zabotti A. Sjögren syndrome: looking forward to the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100295. [PMID: 35634352 PMCID: PMC9131387 DOI: 10.1177/1759720x221100295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.
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Affiliation(s)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
- Rheumatology Center of Excellence, Mexico City, Mexico
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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30
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Zhou Z, Liu H, Yang Y, Zhou J, Zhao L, Chen H, Fei Y, Zhang W, Li M, Zhao Y, Zeng X, Zhang F, Yang H, Zhang X. The five major autoimmune diseases increase the risk of cancer: epidemiological data from a large-scale cohort study in China. Cancer Commun (Lond) 2022; 42:435-446. [PMID: 35357093 PMCID: PMC9118055 DOI: 10.1002/cac2.12283] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/25/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer incidence and mortality have received critical attention during the long-term management of morbidities in patients with autoimmune diseases (AIDs). This study aimed to investigate and compare the risk of cancer associated with five major AIDs in a large-scale Chinese cohort. METHODS A total of 8,120 AID patients consecutively admitted to a national tertiary referral center in China were included and followed-up for 38,726.55 patient-years, including those with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren's syndrome (SS), systemic scleroderma (SSc), and idiopathic inflammatory myositis (IIM). Demographic data, cancer incidence, predilecting sites and cancer onset time were recorded and compared among the five AIDs. RESULTS Four hundred and thirty (5.3%) patients developed cancer. Their median age was 57.5 years and AID duration was 79.8 months. The estimated total standardized incidence ratio (SIR) of cancer in AIDs patients was 3.37, with the highest SIR observed in IIM (4.31), followed by RA (3.99), SSc (3.77), SS (2.88) and SLE (2.58). The increased SIR of cancers in AID patients showed a female predominance (female vs. male: 3.59 vs. 2.77) and younger patient involvement (age <50 vs. ≥50 years: 4.88 vs. 3.04). Patients with SLE had increased SIRs for developing hematologic malignancies and solid tumors located in the urinary bladder, corpus uteri and cervix uteri. Patients with SS had a significantly high SIR for developing non-Hodgkin's lymphoma. Within 3 years of IIM diagnosis, 74.6% of the patients developed cancer and they had a high risk of ovarian cancer. RA was associated with a wide distribution of scancers, including non-Hodgkin's lymphoma, gynecologic, urinary tract, thyroid gland and lung cancers. SSc patients had increased SIRs for developing cervical uterine, lung, and breast cancers. CONCLUSION Patients with five major AIDs in China had an increased risk of developing cancer, with a predominance in women and younger patients, although cancer incidence, predilection sites and cancer onset time may vary greatly in each AID entity.
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Affiliation(s)
- Ziyue Zhou
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Huazhen Liu
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Yiying Yang
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Jingya Zhou
- Department of Medical RecordsPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Lidan Zhao
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Hua Chen
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Yunyun Fei
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Wen Zhang
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Mengtao Li
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Yan Zhao
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Fengchun Zhang
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Huaxia Yang
- Department of Rheumatology and Clinical ImmunologyNational Clinical Research Center for Dermatologic and Immunologic Diseasesthe Ministry of Education Key LaboratoryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- Clinical Immunology CenterChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
- State Key Laboratory of Difficult, Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
| | - Xuan Zhang
- Department of RheumatologyNational Center of GerontologyInstitute of Geriatric MedicineBeijing HospitalPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100730P. R. China
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31
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Reed JH. Transforming mutations in the development of pathogenic B cell clones and autoantibodies. Immunol Rev 2022; 307:101-115. [PMID: 35001403 DOI: 10.1111/imr.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/31/2021] [Accepted: 01/01/2022] [Indexed: 12/16/2022]
Abstract
Autoimmune diseases are characterized by serum autoantibodies, some of which are pathogenic, causing severe manifestations and organ injury. However, autoantibodies of the same antigenic reactivity are also present in the serum of asymptomatic people years before they develop any clinical signs of autoimmunity. Autoantibodies can arise during multiple stages of B cell development, and various genetic and environmental factors drive their production. However, what drives the development of pathogenic autoantibodies is poorly understood. Advances in single-cell technology have enabled the deep analysis of rare B cell clones producing pathogenic autoantibodies responsible for vasculitis in patients with primary Sjögren's syndrome complicated by mixed cryoglobulinaemia. These findings demonstrated a cascade of genetic events involving stereotypic immunoglobulin V(D)J recombination and transforming somatic mutations in lymphoma genes and V(D)J regions that disrupted antibody quality control mechanisms and decreased autoantibody solubility. Most studies consider V(D)J mutations that enhance autoantibody affinity to drive pathology; however, V(D)J mutations that increase autoantibody propensity to form insoluble complexes could be a major contributor to autoantibody pathogenicity. Defining the molecular characteristics of pathogenic autoantibodies and failed tolerance checkpoints driving their formation will improve prognostication, enabling early treatment to prevent escalating organ damage and B cell malignancy.
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Affiliation(s)
- Joanne H Reed
- Westmead Institute for Medical Research, Centre for Immunology and Allergy Research, Westmead, NSW, Australia.,Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
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Pezoulas VC, Goules A, Kalatzis F, Chatzis L, Kourou KD, Venetsanopoulou A, Exarchos TP, Gandolfo S, Votis K, Zampeli E, Burmeister J, May T, Marcelino Pérez M, Lishchuk I, Chondrogiannis T, Andronikou V, Varvarigou T, Filipovic N, Tsiknakis M, Baldini C, Bombardieri M, Bootsma H, Bowman SJ, Soyfoo MS, Parisis D, Delporte C, Devauchelle-Pensec V, Pers JO, Dörner T, Bartoloni E, Gerli R, Giacomelli R, Jonsson R, Ng WF, Priori R, Ramos-Casals M, Sivils K, Skopouli F, Torsten W, A. G. van Roon J, Xavier M, De Vita S, Tzioufas AG, Fotiadis DI. Addressing the clinical unmet needs in primary Sjögren's Syndrome through the sharing, harmonization and federated analysis of 21 European cohorts. Comput Struct Biotechnol J 2022; 20:471-484. [PMID: 35070169 PMCID: PMC8760551 DOI: 10.1016/j.csbj.2022.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/26/2022] Open
Abstract
For many decades, the clinical unmet needs of primary Sjögren's Syndrome (pSS) have been left unresolved due to the rareness of the disease and the complexity of the underlying pathogenic mechanisms, including the pSS-associated lymphomagenesis process. Here, we present the HarmonicSS cloud-computing exemplar which offers beyond the state-of-the-art data analytics services to address the pSS clinical unmet needs, including the development of lymphoma classification models and the identification of biomarkers for lymphomagenesis. The users of the platform have been able to successfully interlink, curate, and harmonize 21 regional, national, and international European cohorts of 7,551 pSS patients with respect to the ethical and legal issues for data sharing. Federated AI algorithms were trained across the harmonized databases, with reduced execution time complexity, yielding robust lymphoma classification models with 85% accuracy, 81.25% sensitivity, 85.4% specificity along with 5 biomarkers for lymphoma development. To our knowledge, this is the first GDPR compliant platform that provides federated AI services to address the pSS clinical unmet needs.
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Affiliation(s)
- Vasileios C. Pezoulas
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Andreas Goules
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Fanis Kalatzis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Luke Chatzis
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
| | - Konstantina D. Kourou
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Aliki Venetsanopoulou
- Dept. of Pathophysiology, School of Medicine, University of Athens, Athens, Greece
- University Hospital of Ioannina, Ioannina, Greece
| | - Themis P. Exarchos
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Dept. of Informatics, Ionian University, Corfu, Greece
| | - Saviana Gandolfo
- Clinic of Rheumatology, Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | - Evi Zampeli
- Institute for Systemic Autoimmune and Neurological Diseases, Athens, Greece
| | - Jan Burmeister
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | - Thorsten May
- Fraunhofer Institute for Computer Graphics Research IGD, Darmstadt, Germany
| | | | - Iryna Lishchuk
- Institute of Legal Informatics, Leibniz Universität Hannover, Hannover, Germany
| | - Thymios Chondrogiannis
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Vassiliki Andronikou
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Theodora Varvarigou
- Institute of Communication and Computer Systems, School of Electrical and Computer Engineering, National and Technical University of Athens, Athens, Greece
| | - Nenad Filipovic
- Bioengineering Research and Development Center, Faculty of Engineering, University of Kragujevac, Kragujevac, Serbia
| | - Manolis Tsiknakis
- Biomedical Informatics and eHealth Laboratory, Dept. of Electrical and Computer Engineering, Hellenic Mediterranean University, Heraklion, Greece
| | - Chiara Baldini
- Dept. of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Queen Mary University of London and Barts’ Health NHS Trust, London, United Kingdom
| | - Hendrika Bootsma
- Dept. of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Simon J. Bowman
- Rheumatology Dept., University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Dorian Parisis
- Laboratory of Pathophysiological Biochemistry and Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Delporte
- Laboratory of Pathophysiological Biochemistry and Nutrition, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jacques-Olivier Pers
- Univ Brest, Inserm, CHU de Brest, UMR1227, Lymphocytes B et Autoimmunité, Brest, France
| | - Thomas Dörner
- Dept. of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Bartoloni
- Rheumatology Unit, Dept. of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Dept. of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Roberto Giacomelli
- Division of Rheumatology, Dept. of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Roland Jonsson
- Dept. of Clinical Science, University of Bergen, Bergen, Norway
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Roberta Priori
- Dept. of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | | | - Fotini Skopouli
- Institute for Systemic Autoimmune and Neurological Diseases, Athens, Greece
- Dept. of Internal Medicine and Clinical Immunology, Euroclinic Hospital, Athens, Greece
| | - Witte Torsten
- Dept. of Rheumatology and Immunology, Hanover Medical School, Hanover, Germany
| | - Joel A. G. van Roon
- Dept. of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Mariette Xavier
- Dept. of Rheumatology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Salvatore De Vita
- Clinic of Rheumatology, Dept. of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | - Dimitrios I. Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
- Dept. of Biomedical Research, FORTH-IMBB, Ioannina, Greece
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33
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Pezoulas VC, Kalatzis F, Exarchos TP, Chatzis L, Gandolfo S, Goules A, De Vita S, Tzioufas AG, Fotiadis DI. A federated AI strategy for the classification of patients with Mucosa Associated Lymphoma Tissue (MALT) lymphoma across multiple harmonized cohorts. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1666-1669. [PMID: 34891605 DOI: 10.1109/embc46164.2021.9630014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mucosa Associated Lymphoma Tissue (MALT) type is an extremely rare type of lymphoma which occurs in less than 3% of patients with primary Sjögren's Syndrome (pSS). No reported studies so far have been able to investigate risk factors for MALT development across multiple cohort databases with sufficient statistical power. Here, we present a generalized, federated AI (artificial intelligence) strategy which enables the training of AI algorithms across multiple harmonized databases. A case study is conducted towards the development of MALT classification models across 17 databases on pSS. Advanced AI algorithms were developed, including federated Multinomial Naïve Bayes (FMNB), federated gradient boosting trees (FGBT), FGBT with dropouts (FDART), and the federated Multilayer Perceptron (FMLP). The FDART with dropout rate 0.3 achieved the best performance with sensitivity 0.812, and specificity 0.829, yielding 8 biomarkers as prominent for MALT development.
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Abstract
The association between malignancy and rheumatic diseases has been demonstrated in a multitude of studies. Little is understood regarding the pathogenesis of rheumatic and musculoskeletal diseases in association with malignancy. There is strong evidence regarding the association between Sjögren syndrome and lymphoma as well as risk factors for development of lymphoma in these patients. This article discusses the accumulating data on various malignancies described in primary Sjögren syndrome, highlighting non-Hodgkin lymphoma and thyroid, multiple myeloma, and skin cancers. These reported associations may have clinical implications in daily practice and contribute to understanding of both autoimmunity and cancer.
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Affiliation(s)
- Ann Igoe
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Medicine, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Sali Merjanah
- The Metrohealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; US Department of Veterans Affairs, Oklahoma City, OK, USA.
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35
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Dunphy K, O’Mahoney K, Dowling P, O’Gorman P, Bazou D. Clinical Proteomics of Biofluids in Haematological Malignancies. Int J Mol Sci 2021; 22:ijms22158021. [PMID: 34360786 PMCID: PMC8348619 DOI: 10.3390/ijms22158021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/25/2022] Open
Abstract
Since the emergence of high-throughput proteomic techniques and advances in clinical technologies, there has been a steady rise in the number of cancer-associated diagnostic, prognostic, and predictive biomarkers being identified and translated into clinical use. The characterisation of biofluids has become a core objective for many proteomic researchers in order to detect disease-associated protein biomarkers in a minimally invasive manner. The proteomes of biofluids, including serum, saliva, cerebrospinal fluid, and urine, are highly dynamic with protein abundance fluctuating depending on the physiological and/or pathophysiological context. Improvements in mass-spectrometric technologies have facilitated the in-depth characterisation of biofluid proteomes which are now considered hosts of a wide array of clinically relevant biomarkers. Promising efforts are being made in the field of biomarker diagnostics for haematologic malignancies. Several serum and urine-based biomarkers such as free light chains, β-microglobulin, and lactate dehydrogenase are quantified as part of the clinical assessment of haematological malignancies. However, novel, minimally invasive proteomic markers are required to aid diagnosis and prognosis and to monitor therapeutic response and minimal residual disease. This review focuses on biofluids as a promising source of proteomic biomarkers in haematologic malignancies and a key component of future diagnostic, prognostic, and disease-monitoring applications.
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Affiliation(s)
- Katie Dunphy
- Department of Biology, National University of Ireland, W23 F2K8 Maynooth, Ireland; (K.D.); (P.D.)
| | - Kelly O’Mahoney
- Department of Haematology, Mater Misericordiae University Hospital, D07 WKW8 Dublin, Ireland; (K.O.); (P.O.)
| | - Paul Dowling
- Department of Biology, National University of Ireland, W23 F2K8 Maynooth, Ireland; (K.D.); (P.D.)
| | - Peter O’Gorman
- Department of Haematology, Mater Misericordiae University Hospital, D07 WKW8 Dublin, Ireland; (K.O.); (P.O.)
| | - Despina Bazou
- Department of Haematology, Mater Misericordiae University Hospital, D07 WKW8 Dublin, Ireland; (K.O.); (P.O.)
- Correspondence:
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36
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Quartuccio L, De Marchi G, Longhino S, Manfrè V, Rizzo MT, Gandolfo S, Tommasini A, De Vita S, Fox R. Shared Pathogenetic Features Between Common Variable Immunodeficiency and Sjögren's Syndrome: Clues for a Personalized Medicine. Front Immunol 2021; 12:703780. [PMID: 34322134 PMCID: PMC8311857 DOI: 10.3389/fimmu.2021.703780] [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] [Received: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Common variable immunodeficiency disorders (CVID) are a group of rare diseases of the immune system and the most common symptomatic primary antibody deficiency in adults. The “variable” aspect of CVID refers to the approximately half of the patients who develop non-infective complications, mainly autoimmune features, in particular organ specific autoimmune diseases including thyroiditis, and cytopenias. Among these associated conditions, the incidence of lymphoma, including mucosal associated lymphoid tissue (MALT) type, is increased. Although these associated autoimmune disorders in CVID are generally attributed to Systemic Lupus Erythematosus (SLE), we propose that Sjogren’s syndrome (SS) is perhaps a better candidate for the associated disease. SS is an autoimmune disorder characterized by the lymphocytic infiltrates of lacrimal and salivary glands, leading to dryness of the eyes and mouth. Thus, it is a lymphocyte aggressive disorder, in contrast to SLE where pathology is generally attributed to auto-antibody and complement activation. Although systemic lupus erythematosus (SLE) shares these features with SS, a much higher frequency of MALT lymphoma distinguishes SS from SLE. Also, the higher frequency of germ line encoded paraproteins such as the monoclonal rheumatoid factor found in SS patients would be more consistent with the failure of B-cell VDJ switching found in CVID; and in contrast to the hypermutation that characterizes SLE autoantibodies. Thus, we suggest that SS may fit as a better “autoimmune” association with CVID. Examining the common underlying biologic mechanisms that promote lymphoid infiltration by dysregulated lymphocytes and lymphoma in CVID may provide new avenues for treatment in both the diseases. Since the diagnosis of SLE or rheumatoid arthritis is usually based on specific autoantibodies, the associated autoimmune features of CVID patients may not be recognized in the absence of autoantibodies.
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Affiliation(s)
- Luca Quartuccio
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | - Simone Longhino
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Valeria Manfrè
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Maria Teresa Rizzo
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | | | - Alberto Tommasini
- Pediatric Immunology, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, ASU FC, Udine, Italy.,Department of Medicine, University of Udine, Udine, Italy
| | - Robert Fox
- Rheumatology Clinic, Scripps Memorial Hospital and Research Foundation, La Jolla, CA, United States
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37
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Kim JY, Park JK. Chronic Painless Parotid Swelling. JOURNAL OF RHEUMATIC DISEASES 2021; 28:171-172. [PMID: 37475995 PMCID: PMC10324898 DOI: 10.4078/jrd.2021.28.3.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 07/22/2023]
Affiliation(s)
- Ju Yeon Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Kyun Park
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Zabotti A, Zandonella Callegher S, Lorenzon M, Pegolo E, Scott CA, Tel A, Giovannini I, Robiony M, Di Loreto C, Zuiani C, De Vita S. Ultrasound-guided core needle biopsy compared with open biopsy: a new diagnostic approach to salivary gland enlargement in Sjögren's syndrome? Rheumatology (Oxford) 2021; 60:1282-1290. [PMID: 32940706 DOI: 10.1093/rheumatology/keaa441] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/24/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Persistent (≥2 months) major salivary gland enlargement in primary SS (pSS) patients is a well-known sign of possible involvement by B cell lymphoma. The study aimed to evaluate the diagnostic accuracy and safety of US-guided core needle biopsy (CNB) of major salivary glands compared with open surgical biopsy. METHODS Prospective pSS patients (cases) with clinically persistent salivary gland enlargement underwent US-guided CNB and were compared with retrospective pSS patients (controls) submitted to open surgical biopsy. The features analysed were pre-biopsy clinical and laboratory findings, adequacy of the material for histology and diagnostic-rendered and biopsy-related complications (reported by the patient with a questionnaire and clinically verified). RESULTS Thirteen cases underwent US-guided CNB: in nine, biopsy was performed on the parotid gland and in four it was performed on the submandibular gland. Sufficient material was obtained for pathological diagnosis in all samples. The final diagnoses were 5 (38.5%) B cell lymphoma, 1 (7.7%) lymphoepithelial sialadenitis, 4 (30.7%) other sialadenitis (granulomatous consistent with sarcoidosis, IgG4-related disease, chronic sclerosing, diffuse chronic) and 3/13 (23.1%) miscellaneous lesions. Thirteen controls underwent open surgical biopsy of the parotid. In one, inadequate material was obtained, while in 12 (92.3%) the pathologic diagnoses were 4 (33.3%) B cell lymphoma, 2 (16.7%) lymphoepithelial sialadenitis, 4 (33.3%) uncertain lymphoproliferative lesions and 2 (16.7%) miscellaneous lesions. Six cases (46.1%) reported six transient complications and 12/13 (92.3%) controls had 2 persistent and 14 transient complications. CONCLUSION US-guided CNB represents a novel, clinically relevant and safe approach for the management of pSS patients with parotid or submandibular persistent enlargement.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Michele Lorenzon
- Institute of Radiology, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Enrico Pegolo
- Institute of Anatomic Pathology, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Cathryn A Scott
- Institute of Anatomic Pathology, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alessandro Tel
- Maxillofacial Surgery, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Massimo Robiony
- Maxillofacial Surgery, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Carla Di Loreto
- Institute of Anatomic Pathology, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Chiara Zuiani
- Institute of Radiology, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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39
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Mæland E, Miyamoto ST, Hammenfors D, Valim V, Jonsson MV. Understanding Fatigue in Sjögren's Syndrome: Outcome Measures, Biomarkers and Possible Interventions. Front Immunol 2021; 12:703079. [PMID: 34249008 PMCID: PMC8267792 DOI: 10.3389/fimmu.2021.703079] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 11/23/2022] Open
Abstract
Sjögren’s syndrome (SS) is an autoimmune disease affecting the salivary and lacrimal glands. Symptoms range from dryness to severe extra-glandular disease involving manifestations in the skin, lungs, nervous system, and kidney. Fatigue occurs in 70% of patients, characterizing primary SS (pSS) and significantly impacting the patient’s quality of life. There are some generic and specific instruments used to measure fatigue in SS. The mechanisms involved with fatigue in SS are still poorly understood, but it appears fatigue signaling pathways are more associated with cell protection and defense than with pro-inflammatory pathways. There are no established pharmacological treatment options for fatigue in pSS. So far, exercise and neuromodulation techniques have shown positive effects on fatigue in pSS. This study briefly reviews fatigue in pSS, with special attention to outcome measures, biomarkers, and possible treatment options.
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Affiliation(s)
- Elisabeth Mæland
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Samira T Miyamoto
- Department of Integrated Education in Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Daniel Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Valeria Valim
- Department of Rheumatology, University Hospital of Federal University of Espírito Santo (HUCAM-UFES/EBSERH), Vitoria, Brazil
| | - Malin V Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Clinical Dentistry, Section for Oral and Maxillofacial Radiology, University of Bergen, Bergen, Norway.,Research Department, Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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40
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Chang YJ, Tseng JC, Leong PY, Wang YH, Wei JCC. Increased Risk of Sjögren's Syndrome in Patients with Obsessive-Compulsive Disorder: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115936. [PMID: 34205846 PMCID: PMC8199316 DOI: 10.3390/ijerph18115936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) includes a wide range of symptoms and is often associated with comorbidities. Although psychiatric involvement may be an early manifestation of Sjögren’s syndrome (SS), only a few studies have demonstrated the relationship between OCD and SS. This is a nationwide cohort study identifying the risk of SS in OCD patients. We studied a longitudinal health insurance database for the period from 1999 to 2013. The study group was OCD patients with at least three outpatient visits or one hospitalization. The comparison cohort was matched by age and sex, as well as comorbidities. We calculated the risk of Sjögren’s syndrome using Cox proportional hazard regression models. We performed a propensity score match for confounders and effect modifiers between the two groups. The propensity score probability was estimated through logistic regression. Primary outcome was the incidental SS. A total of 1678 patients with OCD (49% women, mean age: 35.6 years) and 3356 controls were followed up, resulting in 13,077 and 25,856 person-years, respectively. The hazard ratio for developing SS was 3.31 (95% C.I.: 1.74–6.28) in patients with OCD, compared to those without OCD after adjusting for age, sex, and comorbidities. Furthermore, the risk of SS significantly increased over the 2-year follow-up period after OCD diagnosis. We concluded that risk of SS is significantly increased in patients with OCD compared to those without OCD. Clinically, Sjögren’s symptoms in OCD patients should be regularly assessed.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan; or
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404333, Taiwan
- Correspondence:
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41
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Kim JS, Kim IH, Byun JM, Chang JH. Population-based study on the association between autoimmune disease and lymphoma: National Health Insurance Service-National Sample Cohort 2002-2015 in Korea. J Autoimmun 2021; 121:102647. [PMID: 33991884 DOI: 10.1016/j.jaut.2021.102647] [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: 02/18/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to evaluate the association between autoimmune disease (AID) and lymphoma incidence in the Korean population. We also aimed to compare the overall survival (OS) in patients with AID-associated lymphoma (AAL) with that in patients with lymphoma without AID. MATERIAL AND METHODS We used National Sample Cohort 2002-2015 provided by National Health Insurance Service. Among 1,011,638 patients, 994,496 were recruited for the final cohort: 130,987 patients (13.2%) in the AID group and 863,509 (86.8%) in control. Lymphoma was diagnosed in 1162 patients and 322 patients with accompanying AID, irrespective of the time point of diagnosis, were defined as AAL. Of those, patients who experienced lymphoma development at least one year after AID diagnosis were defined as post-AID lymphoma (N = 155). RESULTS The median follow-up duration was 13.7 years. AAL accounted for 0.03% of total and 27.7% of lymphoma cases. AID patients experienced more Epstein-Barr virus (0.02 vs. 0.01%, P = 0.027) or Helicobacter pylori infection (63.9 vs. 41.4%, P < 0.001) than the control group did. AID was associated with a 1.45-fold increased risk of lymphoma. The median time interval from AID to AAL was 10.9 months. The risk of lymphoma increased in the order of: psoriasis (adjusted odds ratio [AOR] 1.61), systemic lupus erythematosus (AOR 3.99), multiple sclerosis (AOR 4.52), and sarcoidosis (AOR 26.37). Sjogren syndrome was not related to lymphoma in this cohort. The 5-year OS in AAL was not different from that in lymphoma patients without AID (60.9 vs. 61.5%, P = 0.970). CONCLUSIONS The association patterns in AAL in Korean population were different from those of Western countries. Further studies on lymphomatogenesis from distinct baseline characteristics (e.g. chronic infection status) would elucidate the difference based on race and ethnicity.
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Affiliation(s)
- Jae Sik Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, South Korea.
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42
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Ruiz-Ordoñez I, Piedrahita JM, Arévalo JA, Agualimpia A, Tobón GJ. Lymphomagenesis predictors and related pathogenesis. J Transl Autoimmun 2021; 4:100098. [PMID: 33889831 PMCID: PMC8050773 DOI: 10.1016/j.jtauto.2021.100098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/23/2022] Open
Abstract
Sjögren's syndrome (SS) is a systemic autoimmune disease characterised by a wide range of clinical manifestations and complications, including B-cell lymphoma. This study aims to describe the predictors associated with lymphomagenesis in patients with Sjögren's syndrome, emphasising the pathophysiological bases that support this association. We performed a review of the literature published through a comprehensive search strategy in PubMed/MEDLINE, Scopus, and Web of science. Forty publications describing a total of 45,208 patients with SS were retrieved. The predictors were grouped according to their pathophysiological role in the lymphoproliferation process. Also, some new biomarkers such as MicroRNAs, P2X7 receptor-NLRP3 inflammasome, Thymic stromal lymphopoietin, and Three-prime repair exonuclease 1 (TREX1) were identified. The knowledge of the pathophysiology allows the discrimination of markers that participate in the initial stages. Considering that the lymphoproliferation process includes the progression of lymphoma towards more aggressive subtypes, it is essential to recognise biomarkers associated with a worse prognosis.
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Affiliation(s)
- Ingrid Ruiz-Ordoñez
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98 No. 18-49, Cali, 760032, Colombia
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
| | - Juan-Manuel Piedrahita
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Javier-Andrés Arévalo
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Andrés Agualimpia
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cra 98 No. 18-49, Cali. 760032, Colombia
| | - Gabriel J Tobón
- Universidad Icesi, Centro de Investigación en Reumatología, Autoinmunidad y Medicina Traslacional, Cali, Colombia
- Fundación Valle del Lili, Unidad de Reumatología, Cra 98 No. 18-49, Cali. 760032, Colombia
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43
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Manfrè V, Giovannini I, Zandonella Callegher S, Lorenzon M, Pegolo E, Tel A, Gandolfo S, Quartuccio L, De Vita S, Zabotti A. Ultrasound and Bioptic Investigation of Patients with Primary Sjögren's Syndrome. J Clin Med 2021; 10:1171. [PMID: 33799655 PMCID: PMC8001290 DOI: 10.3390/jcm10061171] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/22/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a chronic and heterogeneous disorder characterized by a wide spectrum of glandular and extra-glandular features. The hallmark of pSS is considered to be the immune-mediated involvement of the exocrine glands and B-cell hyperactivation. This leads pSS patients to an increased risk of developing lymphoproliferative diseases, and persistent (>2 months) major salivary gland enlargement is a well-known clinical sign of possible involvement by B cell lymphoma. Better stratification of the patients may improve understanding of the mechanism underlying the risk of lymphoproliferative disorder. Here, we summarize the role of different imaging techniques and a bioptic approach in pSS patients, focusing mainly on the role of salivary gland ultrasonography (SGUS) and a US-guided core needle biopsy (Us-guided CNB) as diagnostic and prognostic tools in pSS patients with persistent parotid swelling.
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Affiliation(s)
- Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | | | - Enrico Pegolo
- Institute of Anatomic Pathology, ASUFC Udine, 33100 Udine, Italy;
| | - Alessandro Tel
- Maxillofacial Surgery, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy;
| | - Saviana Gandolfo
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy; (V.M.); (I.G.); (S.Z.C.); (S.G.); (L.Q.); (A.Z.)
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Ingravallo G, Maiorano E, Moschetta M, Limongelli L, Mastropasqua MG, Agazzino GF, De Ruvo V, Tarantino P, Favia G, Capodiferro S. Primary Breast Extranodal Marginal Zone Lymphoma in Primary Sjögren Syndrome: Case Presentation and Relevant Literature. J Clin Med 2020; 9:jcm9123997. [PMID: 33321727 PMCID: PMC7764276 DOI: 10.3390/jcm9123997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
The association between autoimmune diseases, mostly rheumatoid arthritis, systemic lupus erythematosus, celiac disease and Sjögren syndrome, and lymphoma, has been widely demonstrated by several epidemiologic studies. By a mechanism which has not yet been entirely elucidated, chronic activation/stimulation of the immune system, along with the administration of specific treatments, may lead to the onset of different types of lymphoma in such patients. Specifically, patients affected by Sjögren syndrome may develop lymphomas many years after the original diagnosis. Several epidemiologic, hematologic, and histological features may anticipate the progression from Sjögren syndrome into lymphoma but, to the best of our knowledge, a definite pathogenetic mechanism for such progression is still missing. In fact, while the association between Sjögren syndrome and non-Hodgkin lymphoma, mostly extranodal marginal zone lymphomas and, less often, diffuse large B-cell, is well established, many other variables, such as time of onset, gender predilection, sites of occurrence, subtype of lymphoma, and predictive factors, still remain unclear. We report on a rare case of primary breast lymphoma occurring three years after the diagnosis of Sjögren syndrome in a 57-year-old patient. The diagnostic work-up, including radiograms, core needle biopsy, and histological examination, is discussed, along with emerging data from the recent literature, thus highlighting the usefulness of breast surveillance in Sjögren syndrome patients.
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Affiliation(s)
- Giuseppe Ingravallo
- Department of Emergency and Organ Transplantation—Section of Pathology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (E.M.); (M.G.M.); (G.F.A.); (P.T.)
- Correspondence:
| | - Eugenio Maiorano
- Department of Emergency and Organ Transplantation—Section of Pathology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (E.M.); (M.G.M.); (G.F.A.); (P.T.)
| | - Marco Moschetta
- Department of Emergency and Organ Transplantation—Breast Unit, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (M.M.); (V.D.R.)
| | - Luisa Limongelli
- Department of Interdisciplinary Medicine—Section of Odontostomatology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (L.L.); (G.F.); (S.C.)
| | - Mauro Giuseppe Mastropasqua
- Department of Emergency and Organ Transplantation—Section of Pathology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (E.M.); (M.G.M.); (G.F.A.); (P.T.)
| | - Gisella Franca Agazzino
- Department of Emergency and Organ Transplantation—Section of Pathology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (E.M.); (M.G.M.); (G.F.A.); (P.T.)
| | - Vincenzo De Ruvo
- Department of Emergency and Organ Transplantation—Breast Unit, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (M.M.); (V.D.R.)
| | - Paola Tarantino
- Department of Emergency and Organ Transplantation—Section of Pathology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (E.M.); (M.G.M.); (G.F.A.); (P.T.)
| | - Gianfranco Favia
- Department of Interdisciplinary Medicine—Section of Odontostomatology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (L.L.); (G.F.); (S.C.)
| | - Saverio Capodiferro
- Department of Interdisciplinary Medicine—Section of Odontostomatology, University of Bari Aldo Moro, Piazza G. Cesare, 11, 70124 Bari, Italy; (L.L.); (G.F.); (S.C.)
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45
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Zandonella Callegher S, Zabotti A, Giovannini I, Treppo E, Quartuccio L, De Vita S. Normal-Appearing Salivary Gland Ultrasonography Identifies a Milder Phenotype of Primary Sjögren's Syndrome. Front Med (Lausanne) 2020; 7:602354. [PMID: 33363187 PMCID: PMC7756091 DOI: 10.3389/fmed.2020.602354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Objective: Salivary gland ultrasound (SGUS) is emerging as a valid tool in the management of primary Sjögren's syndrome (pSS). This study aimed to investigate whether pSS patients with normal-appearing or pathological SGUS findings showed different clinical, laboratory, and pathologic pSS-related features, and to compare the results by using two different SGUS scores. Methods: Consecutive pSS patients, according to the ACR-EULAR classification criteria, were evaluated. Salivary glands were scored using the early 1992 score by De Vita et al. and the latest 2019 OMERACT score, both being semiquantitative 0-3 scoring systems focused on ultrasonographic parenchymal inhomogeneity (grades 0 and 1, normal-appearing; grades 2 and 3, pathological). The patients were then divided into two groups: "SGUS normal-appearing" if all the salivary glands had normal-appearing parenchyma (grade 0 or 1), or "SGUS pathological" if the grade was 2 or 3 in at least one salivary gland. The associations between SGUS and pSS-related clinical, laboratory, and pathological features were then investigated in the two groups. Results: One hundred pSS patients were evaluated, the mean age (±SD) was 60.9 ± 12.0 years, and mean disease duration was 11.7 ± 7.2 years. Twenty-nine out of 100 (29%) patients were in the "SGUS normal-appearing" group and 71/100 (71%) were in the "SGUS pathological" group. A normal-appearing SGUS was significantly associated with the absence of anti-La/SSB antibodies (p < 0.001) and normal unstimulated salivary flow rate (p = 0.02) by both univariate and multivariate analyses. By univariate analysis, a normal-appearing SGUS was significantly associated also with the absence of rheumatoid factor (p = 0.002) and of serum monoclonal component (p = 0.003), ESSDAI < 5 (p = 0.03), and with a negative lip biopsy (p = 0.029). No associations were found with other items, including anti-Ro/SSA (p = 0.145), Schirmer's test (p = 0.793), ESSPRI (p = 0.47), and demographic data. No differences in these results were observed by using the two SGUS scoring systems. Conclusion: The SGUS allowed the identification of different phenotypes of pSS, and different SGUS scores focused on salivary gland inhomogeneity may be effective to this end.
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Affiliation(s)
- Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Elena Treppo
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
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Iversen L, Eriksen PRG, Andreasen S, Clasen-Linde E, Homøe P, Wessel I, von Buchwald C, Heegaard S. Lymphoma of the Sublingual Gland: Clinical, Morphological, Histopathological, and Genetic Characterization. Front Surg 2020; 7:581105. [PMID: 33240925 PMCID: PMC7677352 DOI: 10.3389/fsurg.2020.581105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Lymphoma of the sublingual gland is rare, representing 1% of all salivary gland lymphomas. In this case report, we present three new cases and compare them to previously published cases, with the aim of characterizing the clinical, morphological, histopathological, and genetic features of this type of malignancy. Materials and Methods: We provide a clinical description of three cases along with a characterization of the microscopic features, including morphology, and immunohistochemistry. In addition, we analysed possible cytogenetic rearrangements with the use of fluorescence in situ hybridization (FISH). Results: Case 1: A 61-year-old male presenting with a painless swelling of the floor of the mouth diagnosed as extranodal marginal zone lymphoma (EMZL) of the left sublingual gland. The patient is alive with no evidence of disease after his fourth treatment regimen following several relapses. Case 2: A 68-year-old female with a prior history of mantle cell lymphoma (MCL) presenting with a tender swelling of the left sublingual gland as well as the right submandibular gland. The lesions were diagnosed as relapsing MCL. The patient died of unrelated causes after 18 months of treatment. Case 3: A 75-year-old female presenting with a swelling of the floor of the mouth diagnosed as follicular lymphoma (FL) of the left sublingual gland. The patient received chemotherapy along with radiotherapy and was still alive 10 years after the diagnosis. Conclusion: The three cases of sublingual gland lymphomas presented in this case report resemble lymphomas of other major salivary glands. The clinician should be aware of this type of malignancy and that the clinical presentation may not differ from benign lesions or other more common malignancies in this location.
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Affiliation(s)
- Lars Iversen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Simon Andreasen
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | | | - Preben Homøe
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet-Glostrup, Glostrup, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen, Denmark
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47
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Casal Moura M, Navin PJ, Johnson GB, Hartman TE, Baqir M, Yi ES, Ryu JH. Pulmonary nodules in patients with primary Sjögren's syndrome: Causes, clinico-radiologic features, and outcomes. Respir Med 2020; 174:106200. [PMID: 33147563 DOI: 10.1016/j.rmed.2020.106200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Primary Sjögren's Syndrome (pSS) is characterized by an immune-mediated lymphoplasmacytic infiltration of the salivary and lacrimal glands. Pulmonary nodules are not uncommonly encountered in these patients. METHODS We conducted a retrospective computer-assisted search for patients with pSS who were encountered at our institution between 1999 and 2018 and had histologically characterized pulmonary nodule(s)/mass (es) (PNs). RESULTS Of 41 patients with pSS and PNs, median age was 67 years (IQR, 56-74), 94% were women, and 39% had a smoking history. The PNs proved to be non-Hodgkin lymphoma (NHL) in 16 patients (39%), lung carcinoma in 11 patients (27%), other malignancies in 2 patients (5%), and benign diseases in remaining 12 patients (29%), including 7 with amyloidomas. Patients with NHL were younger (p = 0.006) while smoking exposure was more prevalent in patients with lung carcinoma (p = 0.022). Patients with NHL had a higher number of PNs and more often manifested random distribution, cysts, ground-glass changes and consolidations. Upper and/or mid-lung location, spiculated borders, solitary nodule, increasing size, and higher SUVmean on FDG-PET scan were associated with lung carcinoma. At the end of follow-up (median 5.9 years), 8 patients (20%) had died and included 5 patients with lung carcinoma; no deaths were observed in the NHL group. CONCLUSIONS The majority of biopsied PNs in patients with pSS were malignant, most commonly lymphomas. Smoking exposure, solitary nodule, and high FDG avidity were more frequently associated with lung carcinoma. The clinical context, CT and 18FDG-PET are complementary in the evaluation and management of PNs in patients with pSS.
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Affiliation(s)
- M Casal Moura
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick J Navin
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, and Department of Immunology Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Thomas E Hartman
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eunhee S Yi
- Dvision of Anatomic Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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48
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Saito S, Takeuchi T. Immune response in LPD during methotrexate administration (MTX-LPD) in rheumatoid arthritis patients. J Clin Exp Hematop 2020; 59:145-155. [PMID: 31866617 PMCID: PMC6954173 DOI: 10.3960/jslrt.19028] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Methotrexate (MTX) is known as a first-line synthetic disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis (RA). Although the risk of LPD development increases by RA inflammation itself, observation of spontaneous regression of LPD after MTX discontinuation lead to the theory of lymphomagenic role of MTX. In this review, we focused on the several immune response involved in LPD that developed under MTX administration in RA patients.
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Abstract
People living with rheumatic diseases frequently encounter cancer, either as a potential harm of antirheumatic therapies or as a comorbidity that alters the conversation about management. This article provides a general overview of the issues related to cancer and rheumatic disease and serves as a springboard for the remaining chapters in this issue. Several topics are reviewed, including epidemiology, bidirectional causal pathways, and issues related to medications. Although uncertainties remain, the issue of cancer is of great importance to patients with rheumatic diseases, and an individualized, person-centered approach to assessment and management is necessary.
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Affiliation(s)
- John Manley Davis
- Division of Rheumatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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50
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Travaglino A, Giordano C, Pace M, Varricchio S, Picardi M, Pane F, Staibano S, Mascolo M. Sjögren Syndrome in Primary Salivary Gland Lymphoma. Am J Clin Pathol 2020; 153:719-724. [PMID: 32076706 DOI: 10.1093/ajcp/aqaa005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Sjögren syndrome (SS) is considered as a major etiologic factor for primary salivary gland lymphoma (SGL). However, the percentage of SGL that is caused by SS (and thus the real impact of SS on SGL epidemiology) is unclear. We aimed to assess the prevalence of SS in patients with SGL through a systematic review and meta-analysis. METHODS Electronic databases were searched for studies assessing the presence of SS in patients with SGL. Pooled prevalence of SS in SGL was calculated, with a subgroup analysis based on histotype (mucosa-associated lymphoid tissue [MALT] vs non-MALT). RESULTS Sixteen studies with 665 SGLs were included. Pooled prevalence of SS in SGL was 18.2%, with high heterogeneity among studies. In MALT SGL, the prevalence of SS was 29.5%, with moderate heterogeneity. In non-MALT SGL, the prevalence of SS was 0%, with null heterogeneity. CONCLUSIONS SS seems to be responsible for a significant but minor portion of SGLs. SS appears involved in MALT-type SGL but not in other histotypes.
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Affiliation(s)
- Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Claudia Giordano
- Department of Clinical Medicine and Surgery, Hematology Section, Federico II University of Naples, Naples, Italy
| | - Mirella Pace
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, Federico II University of Naples, Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, Federico II University of Naples, Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, Federico II University of Naples, Naples, Italy
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