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Hamilton MJ. Mast Cell Activation Syndrome and Gut Dysfunction: Diagnosis and Management. Curr Gastroenterol Rep 2024; 26:107-114. [PMID: 38353900 DOI: 10.1007/s11894-024-00924-w] [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] [Accepted: 01/29/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Mast cell activation syndrome (MCAS) is a clinical disorder that may explain irritable bowel syndrome (IBS) type symptoms as well as other allergic symptoms experienced by an individual. The diagnosis and treatment of MCAS with specific focus on gastrointestinal (GI) manifestations is reviewed. RECENT FINDINGS Although biomarkers for MCAS remain elusive, testing for baseline serum tryptase will distinguish the type of mast cell disorder and urine tests for mast cell mediator metabolites may support the diagnosis. Endoscopy and Colonoscopy with biopsies is not used to diagnose MCAS but is important to rule out other conditions that may cause symptoms. There is increased awareness of the association between MCAS and autonomic dysfunction, small fiber neuropathy, and connective tissue disorders which all impact GI symptoms. MCAS is a disorder often of unknown etiology (idiopathic) and characterized by intermittent allergy type symptoms that affect multiple organ systems after exposure to a trigger. GI symptoms including abdominal cramping and loose stool are prominent and mimic those of IBS. Diagnostic testing is performed to assess for elevations in mast cell mediators during symptoms and to rule out other conditions. A comprehensive treatment plan includes medications that target mast cells, treatments for associated conditions including autonomic dysfunction, and management of comorbid psychiatric illness and nutritional deficits.
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Affiliation(s)
- Matthew J Hamilton
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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2
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Nicoloro-SantaBarbara J, Majd M, Burdick KE, Dixon V, Giannetti MP. Cognitive Impairment and Depression in Mastocytosis: A Synthesis of the Literature. Curr Allergy Asthma Rep 2024; 24:53-62. [PMID: 38294589 DOI: 10.1007/s11882-024-01127-z] [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] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Symptoms of depression and cognitive dysfunction are commonly reported in mastocytosis. The aims of this review paper are to summarize the current literature on cognitive dysfunction and depressive symptoms, elucidate some of the mechanistic pathways underlying depressive symptoms in mastocytosis, identify gaps in the literature, and offer guidance for future research in this area. RECENT FINDINGS The study of cognition and depression in mastocytosis is in its infancy and the methodological flaws of the current literature limit interpretability. There is preliminary evidence that some individuals with mastocytosis might experience mild deficits in memory. On average, depression symptom scores fell within the mild to moderate or sub-syndromal range. Regrettably, only one study utilized a standardized diagnostic instrument to assess major depressive disorder. The authors' tendency to inaccurately equate depressive symptoms with a diagnosis of major depressive disorder presents a notable issue. The prevalence of cognitive deficits and depression appears to be similar to other chronic illnesses. Future work needs to better characterize cognition and characterize "depression" in this population.
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Affiliation(s)
- Jennifer Nicoloro-SantaBarbara
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Marzieh Majd
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
| | - Victoria Dixon
- Department of Psychology, Northeastern University, Boston, MA, USA
| | - Matthew P Giannetti
- Harvard Medical School, Boston, MA, USA
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, MA, USA
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3
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Sagües‐Sesé E, García‐Casares N, Álvarez‐Twose I. Cognitive, neuropsychiatric and neurological alterations in mastocytosis: A systematic review. Clin Transl Allergy 2023; 13:e12319. [PMID: 38146805 PMCID: PMC10718195 DOI: 10.1002/clt2.12319] [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: 08/06/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Mastocytosis manifests with multisystemic symptoms, often involving the nervous system. Numerous cognitive, neuropsychiatric and neurological alterations have been reported in multiple observational studies. METHODS We performed a qualitative systematic literature review of reported data consulting the electronic databases Medline, Scopus, Web of Science, Cochrane, and BASE until June 2023. RESULTS We selected 24 studies in which the majority showed that a high proportion of mastocytosis patients suffer cognitive, neuropsychiatric and neurological alterations. The most common disorders and estimated ranges of frequency observed in adults were depression (68%-75%), anxiety, high stress or irritability (27%-54%), cognitive impairment (27%-39%, primarily affecting memory skills), and headaches (55%-69%). Attention challenges and learning difficulties were reported in children at a rate of 13%, while neurodevelopmental disorders occurred at rates of 8%-12%. Frequent white abnormalities in mastocytosis patients with concomitant psychocognitive symptoms have been reported although neuroimaging studies have been performed rarely in this population. CONCLUSION Further studies with more comprehensive and homogeneous evaluations and neuroimaging and histological analysis should be performed for a better understanding of these manifestations. An earlier detection and proper management of these symptoms could greatly improve the quality of life of these patients.
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Affiliation(s)
- Elena Sagües‐Sesé
- Departamento de Medicina, Facultad de MedicinaUniversidad de MálagaMálagaSpain
| | - Natalia García‐Casares
- Departamento de Medicina, Facultad de MedicinaUniversidad de MálagaMálagaSpain
- Centro de Investigaciones Médico‐Sanitarias (CIMES), Fundación General de la Universidad de Málaga, Universidad de MálagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND)MálagaSpain
| | - Ivan Álvarez‐Twose
- Instituto de Estudios de Mastocitosis de Castilla‐La Mancha (CLMast)Reference Center for Mastocytosis and CIBERONCToledoSpain
- Spanish Network on Mastocytosis (REMA)Toledo and SalamancaSpain
- Instituto de Investigación Sanitaria de Castilla‐La Mancha (IDISCAM)ToledoSpain
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Weinstock LB, Nelson RM, Blitshteyn S. Neuropsychiatric Manifestations of Mast Cell Activation Syndrome and Response to Mast-Cell-Directed Treatment: A Case Series. J Pers Med 2023; 13:1562. [PMID: 38003876 PMCID: PMC10672129 DOI: 10.3390/jpm13111562] [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: 09/10/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Mast cell activation syndrome (MCAS) is an immune disease with an estimated prevalence of 17%. Mast cell chemical mediators lead to heterogeneous multisystemic inflammatory and allergic manifestations. This syndrome is associated with various neurologic and psychiatric disorders, including headache, dysautonomia, depression, generalized anxiety disorder, and many others. Although MCAS is common, it is rarely recognized, and thus, patients can suffer for decades. The syndrome is caused by aberrant mast cell reactivity due to the mutation of the controller gene. A case series is presented herein including eight patients with significant neuropsychiatric disorders that were often refractory to standard medical therapeutics. Five patients had depression, five had generalized anxiety disorder, and four had panic disorder. Other psychiatric disorders included attention-deficit hyperactivity disorder, obsessive compulsive disorder, phobias, and bipolar disorder. All eight patients were subsequently diagnosed with mast cell activation syndrome; six had comorbid autonomic disorders, the most common being postural orthostatic tachycardia syndrome; and four had hypermobile Ehlers-Danlos syndrome. All patients experienced significant improvements regarding neuropsychiatric and multisystemic symptoms after mast-cell-directed therapy. In neuropsychiatric patients who have systemic symptoms and syndromes, it is important to consider the presence of an underlying or comorbid MCAS.
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Affiliation(s)
- Leonard B. Weinstock
- Independent Researcher, Specialists in Gastroenterology, St. Louis, MO 63141, USA
| | - Renee M. Nelson
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (R.M.N.); (S.B.)
| | - Svetlana Blitshteyn
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY 14203, USA; (R.M.N.); (S.B.)
- Dysautonomia Clinic, Williamsville, NY 14221, USA
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5
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Costanza A, Amerio A, Aguglia A, Serafini G, Amore M, Hasler R, Ambrosetti J, Bondolfi G, Sampogna G, Berardelli I, Fiorillo A, Pompili M, Nguyen KD. Hyper/neuroinflammation in COVID-19 and suicide etiopathogenesis: Hypothesis for a nefarious collision? Neurosci Biobehav Rev 2022; 136:104606. [PMID: 35289272 PMCID: PMC8916836 DOI: 10.1016/j.neubiorev.2022.104606] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
Accumulating scientific and clinical evidence highlighted pathological hyperinflammation as a cardinal feature of SARS-CoV-2 infection and acute COVID-19 disease. With the emergence of long COVID-19 syndrome, several chronic health consequences, including neuropsychiatric sequelae, have gained attention from the public and medical communities. Since inflammatory mediators have also been accredited as putative biomarkers of suicidal ideations and behaviors, hyper- and neuroinflammation might share some colliding points, overlapping and being interconnected in the context of COVID-19. This review aims to provide a summary of current knowledge on the molecular and cellular mechanisms of COVID-19-associated hyper/neuroinflammation with focus on their relevance to the inflammatory hypothesis of suicide development. Subsequently, strategies to alleviate COVID-19 hyper/neuroinflammation by immunomodulatory agents (many of which at experimental stages) as well as psychopharmacologic/psychotherapeutic approaches are also mentioned. While suicide risk in COVID-19 survivors - until now little known - needs further analysis through longitudinal studies, current observations and mechanistic postulates warrant additional attention to this possibly emerging mental health concern.
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Affiliation(s)
- A Costanza
- Departement of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.
| | - A Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - A Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - M Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - R Hasler
- Departement of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Department of Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva (HUG), Geneva, Switzerland
| | - J Ambrosetti
- Department of Psychiatry and Department of Emergency, Emergency Psychiatric Unit (UAUP), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - G Bondolfi
- Departement of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), University Hospitals (HUG), Geneva, Switzerland
| | - G Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - I Berardelli
- Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - A Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - M Pompili
- Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - K D Nguyen
- Tranquis Therapeutics, Palo Alto, CA, USA; Department of Microbiology and Immunology, Stanford University, Palo Alto, CA, USA
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SantaBarbara JN, Carroll J, Lobel M. Coping, social support, and anxiety in people with mast cell disorders. Ann Allergy Asthma Immunol 2021; 127:435-440. [PMID: 34153442 PMCID: PMC9909465 DOI: 10.1016/j.anai.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Mast cell disorders (MCDs) are rare, chronic, debilitating diseases with a varied and complex clinical trajectory that creates challenges to physical and mental health. Reliable estimates of the prevalence of anxiety in this population are largely nonexistent. Furthermore, very little is known on how sufferers' coping efforts affect their emotions and adjustment. Because a person with an MCD cannot eliminate the stressors associated with their chronic illness, it is important to understand what helps them adjust. OBJECTIVE To document the magnitude of anxiety in those with MCD, their physical symptoms, levels of social support, and ways of coping with the stress of the disease and to evaluate the extent to which symptoms, social support, and coping are associated with anxiety. METHODS Individuals with MCDs completed an anonymous Internet-based survey (N = 157). RESULTS More than half of individuals with MCDs in this study found their illness to be very stressful, and nearly a third were experiencing moderate levels of anxiety. Participants who had more frequent and severe physical symptoms reported higher levels of anxiety. Those who reported coping with their problems by using planning strategies and those who felt they had more social support available to them were less anxious; those who used more avoidant strategies to cope were more anxious. CONCLUSION Based on the current results, and intervention work in other chronic illness groups, it seems likely that coping behaviors are a fruitful target of intervention for patients with MCD to reduce their emotional distress.
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Affiliation(s)
| | - Judith Carroll
- Cousins Center for Psychoneuroimmunology, Department of Psychiatry and Biobehavioral Science, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Di Mauro P, Anzivino R, Distefano M, Borzì DD. Systemic mastocytosis: The roles of histamine and its receptors in the central nervous system disorders. J Neurol Sci 2021; 427:117541. [PMID: 34139449 DOI: 10.1016/j.jns.2021.117541] [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: 04/26/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
Mastocytosis is a rare disease of clonal hematological disorders characterized by a pathological accumulation of Mast Cells (MCs) in different tissues, with variable symptomatology and prognosis. Signs and symptoms of Systemic Mastocytosis (SM) are due to pathological infiltration of MCs and to the release of chemical mediators, mainly histamine. Patients with SM may also present with neurological symptoms or complications. The pathophysiology of these neurological disorders remains uncertain to this day, but it can be associated with the infiltration of tissue mastocytes, release of mastocytes' mediators or both. Moreover, there is a lot to understand about the role of neurological symptoms in SM and knowing, for example, what is the real frequency of neurological disorders in SM and if is present a relation between other SM subtypes, because it has been noted that the alteration of the histamine expression may be an initiating factor for susceptibility, gravity and progression of the epigenetic disease. In this review we explain the possible pathophysiological mechanism about neurological symptomatology found in some patients affected by SM, describing the role of histamine and its receptors in the nervous system and, in light of the results, what the future prospects may be for a more specific course of treatment.
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Affiliation(s)
- Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia" A.O.U. "Policlinico - Vittorio Emanuele", University of Catania, Catania, Italy.
| | | | | | - Davide Domenico Borzì
- University of Catania, Italy and Italian Federation of Sports Medicine (FMSI), Rome, Italy
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8
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Nicoloro SantaBarbara J, Lobel M. Depression, psychosocial correlates, and psychosocial resources in individuals with mast cell activation syndrome. J Health Psychol 2021; 27:2013-2026. [PMID: 34000855 PMCID: PMC10103633 DOI: 10.1177/13591053211014583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Individuals with Mast Cell Activation Syndrome (MCAS), a rare chronic disease, experience unpredictable physical symptoms and diagnostic challenges resulting in poor emotional states. The prevalence and correlates of depressive symptoms were examined among 125 participants who completed the CES-D and relevant instruments. The majority reported a clinically-significant level of depression which was especially common among younger participants and those who reported greater loneliness or more disease-specific stressors. Greater magnitude of depressive symptoms was associated with greater illness intrusiveness, less social support, and lower optimism. Results highlight the value of interventions targeting loneliness and stressors unique to this population.
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9
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Jendoubi F, Severino-Freire M, Negretto M, Arbus C, Paul C, Bulai Livideanu C. Neuropsychiatric, cognitive and sexual impairment in mastocytosis patients. Orphanet J Rare Dis 2021; 16:118. [PMID: 33673856 PMCID: PMC7934538 DOI: 10.1186/s13023-021-01747-y] [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: 10/19/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background Mastocytosis is a rare disease characterised by the accumulation and/or proliferation of abnormal mast cells (MCs) in one or several organs. It may present with a number of different symptoms that involve various organ systems. The current study aims to assess the prevalence of MC mediator-related symptoms in a cohort of mastocytosis patients with a specific focus on neurological, psychiatric, cognitive and sexual symptoms. We also assessed the impact of the disease on patients’ professional lives. Patients were administered a validated multidimensional questionnaire to collect information on patients’ perception of the severity of their symptoms. From the questionnaires we extracted the neurological, cognitive, psychiatric and sexual symptoms and the impact of the disease on patients’ professional lives as well as their grading. The affective status was assessed using the 17-item version of the Hamilton Depression Rating Scale. Results We included 139 patients. Mastocytosis was classified as systemic in 113 patients and cutaneous in 26 patients. The prevalence of MC mediator-related systemic symptoms was as follows: cutaneous (71%), gastro-intestinal (48%), cardio-vascular (36%), musculoskeletal (26.6%), fatigue (24%), urinary (14.4%) and respiratory (10%). Headaches and vertigo were noted in respectively 55% and 32% of patients. Irritability, episodes of memory loss and difficulty concentrating were reported in 54%, 52% and 40% of cases, respectively. Sexual impairment was noted in 24% of patients. No associations were found between neuropsychiatric/cognitive impairment and age, gender, diagnostic delay, disease form, the presence of cutaneous lesions, the level of serum and bone marrow tryptase and the presence of KIT mutation in bone marrow and/or skin. Depression was noted in 49% of patients. One in four patients reported a negative impact of the disease on their professional lives. Conclusion This current study provides some insights regarding symptoms related to mastocytosis and their impact on patients’ professional lives.
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Affiliation(s)
- Fatma Jendoubi
- Mastocytosis National Expert Centre (CEREMAST), Department of Dermatology, Toulouse University Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - Maella Severino-Freire
- Mastocytosis National Expert Centre (CEREMAST), Department of Dermatology, Toulouse University Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - Mathilde Negretto
- Mastocytosis National Expert Centre (CEREMAST), Department of Dermatology, Toulouse University Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - Christophe Arbus
- Department of Psychiatry, Toulouse University Hospital, Tonic Inserm 1214, Toulouse, France
| | - Carle Paul
- Mastocytosis National Expert Centre (CEREMAST), Department of Dermatology, Toulouse University Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France
| | - Cristina Bulai Livideanu
- Mastocytosis National Expert Centre (CEREMAST), Department of Dermatology, Toulouse University Hospital, 24 Chemin de Pouvourville, 31059, Toulouse, France.
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Komarow HD, Brenchley JM, Eisch AR, Young ML, Scott LM, Kulinski JM, Heller T, Bai Y, Metcalfe DD. A study of microbial translocation markers in mastocytosis. Clin Exp Allergy 2021; 51:369-372. [PMID: 33259149 PMCID: PMC8932442 DOI: 10.1111/cea.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hirsh D. Komarow
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jason M. Brenchley
- Barrier Immunity Section, Laboratory of Viral Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Robin Eisch
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Michael L. Young
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, MD, USA
| | - Linda M. Scott
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joseph M. Kulinski
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Theo Heller
- Translational Hepatology Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yun Bai
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dean D. Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Fuchs D, Kilbertus A, Kofler K, von Bubnoff N, Shoumariyeh K, Zanotti R, Bonadonna P, Scaffidi L, Doubek M, Elberink HO, Span LFR, Hermine O, Elena C, Benvenuti P, Yavuz AS, Brockow K, Zink A, Aberer E, Gorska A, Romantowski J, Hadzijusufovic E, Fortina AB, Caroppo F, Perkins C, Illerhaus A, Panse J, Vucinic V, Jawhar M, Sabato V, Triggiani M, Parente R, Bergström A, Breynaert C, Gotlib J, Reiter A, Hartmann K, Niedoszytko M, Arock M, Kluin-Nelemans HC, Sperr WR, Greul R, Valent P. Scoring the Risk of Having Systemic Mastocytosis in Adult Patients with Mastocytosis in the Skin. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1705-1712.e4. [PMID: 33346151 DOI: 10.1016/j.jaip.2020.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mastocytosis in adults often presents with skin lesions. A bone marrow biopsy is necessary to confirm or exclude the presence of systemic mastocytosis (SM) in these cases. When a bone marrow biopsy is not performed, the provisional diagnosis is mastocytosis in the skin (MIS). No generally accepted scoring system has been established to estimate the risk of SM in these patients. OBJECTIVE To develop a risk score to predict SM in adults with MIS. METHODS We examined 1145 patients with MIS from the European Competence Network on Mastocytosis Registry who underwent a bone marrow biopsy. A total of 944 patients had SM and 201 patients had cutaneous mastocytosis; 63.7% were female, and 36.3% were male. Median age was 44 ± 13.3 years. The median serum tryptase level amounted to 29.3 ± 81.9 ng/mL. We established a multivariate regression model using the whole population of patients as a training and validation set (bootstrapping). A risk score was developed and validated with receiver-operating curves. RESULTS In the multivariate model, the tryptase level (P < .001), constitutional/cardiovascular symptoms (P = .014), and bone symptoms/osteoporosis (P < .001) were independent predictors of SM (P < .001; sensitivity, 90.7%; specificity, 69.1%). A 6-point risk score was established (risk, 10.7%-98.0%) and validated. CONCLUSIONS Using a large data set of the European Competence Network on Mastocytosis Registry, we created a risk score to predict the presence of SM in patients with MIS. Although the score will need further validation in independent cohorts, our score seems to discriminate safely between patients with SM and with pure cutaneous mastocytosis.
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Affiliation(s)
- David Fuchs
- Department for Hematology and Internal Oncology, Kepler University Hospital, Linz, Austria; Johannes Kepler University, Linz, Austria.
| | - Alex Kilbertus
- Department of Dermatology and Venerology, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Karin Kofler
- Department for Hematology and Internal Oncology, Kepler University Hospital, Linz, Austria
| | - Nikolas von Bubnoff
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Hematology and Oncology, Medical Center, University of Schleswig Holstein, Campus Lübeck, Lübeck, Germany
| | - Khalid Shoumariyeh
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner site Freiburg, Freiburg, Germany
| | - Roberta Zanotti
- Section of Hematology, Department of Medicine, Verona University Hospital, Verona, Italy
| | | | - Luigi Scaffidi
- Section of Hematology, Department of Medicine, Verona University Hospital, Verona, Italy
| | | | - Hanneke Oude Elberink
- Department of Internal Medicine, Section of Allergy, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lambert F R Span
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Olivier Hermine
- Imagine Institute Université Paris Descartes, Sorbonne, Paris Cité, Centre national de référence des mastocytoses, Paris, France
| | - Chiara Elena
- Department of Hematology Oncology, IRCCS Policlinico San Matteo Foundation Pavia, Pavia, Italy
| | - Pietro Benvenuti
- Department of Hematology Oncology, School of Hematology, University of Pavia and IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Akif Selim Yavuz
- Division of Hematology, Department of Internal Medicine, University of Istanbul, Istanbul, Turkey
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Elisabeth Aberer
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Aleksandra Gorska
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Jan Romantowski
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Emir Hadzijusufovic
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria; Department/Hospital for Companion Animals and Horses, University Clinic for Small Animals, Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Cecelia Perkins
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, Calif
| | - Anja Illerhaus
- Department of Dermatology, University of Cologne, Cologne, Germany
| | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | | | - Mohamad Jawhar
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology-Allergology-Rheumatology, University of Antwerp and Antwerp University Hospital, Antwerpen, Belgium
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Salerno, Italy
| | - Anna Bergström
- Department of Dermatology and Venereology, Akademiska University Hospital, Uppsala, and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Christine Breynaert
- Department of General Internal Medicine - Allergy and Clinical Immunology (MASTEL), University Hospitals Leuven and KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, Calif
| | - Andreas Reiter
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Karin Hartmann
- Department of Dermatology, University of Cologne, Cologne, Germany; Division of Allergy, Department of Dermatology, University of Basel, Basel, Switzerland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Paris Sorbonne University, Paris, France
| | - Hanneke C Kluin-Nelemans
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
| | - Rosemarie Greul
- Department for Hematology and Internal Oncology, Kepler University Hospital, Linz, Austria
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Vienna, Austria
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12
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Vermeiren MR, Kranenburg LW, van Daele PLA, Gerth van Wijk R, Hermans MAW. Psychological functioning and quality of life in patients with mastocytosis: A cross-sectional study. Ann Allergy Asthma Immunol 2020; 124:373-378.e2. [PMID: 31923542 DOI: 10.1016/j.anai.2019.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/17/2019] [Accepted: 12/27/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psychological symptoms appear to be frequent among patients with mastocytosis and can significantly affect patient quality of life. However, it remains unclear whether and to which extent this may be the case. OBJECTIVE To investigate he presence and type of psychological symptoms and quality of life in patients with mastocytosis. METHODS In this cross-sectional cohort study of adult patients with mastocytosis, all patients completed the 36-item Short Form Health Survey (SF-36) and the 90-item Symptom Checklist (SCL-90). Results were compared with those of a healthy groups of patients with other diseases (chronic pain and cancer) and healthy populations. RESULTS Fifty patients were included in the study. Seventy percent had indolent systemic mastocytosis. Patients with mastocytosis scored significantly worse than a healthy norm group on the total SCL-90 and more specifically on the dimensions of depression, somatization, sleeping problems, and inadequacy of acting and thinking. Strikingly, patients with mastocytosis scored similarly to patients with cancer on the SF-36 subdomains of general health perception and vitality. However, no significant difference in the mental health subdomain of the SF-36 was found when compared with a healthy group. CONCLUSION In addition to the presence of psychological symptoms, the physical symptoms that are associated with mastocytosis also have a significant impact on the quality of life of patients with this disease. Therefore, correct treatment through symptom control and psychological counseling is necessary. TRIAL REGISTRATION EudraCT Identifier 2015-004604-37.
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Affiliation(s)
- Marie R Vermeiren
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Erasmus Medical Center Rotterdam, Academic Center of Excellence for Allergic Diseases, Rotterdam, the Netherlands
| | - Leonieke W Kranenburg
- Department of Psychiatry, Section of Medical Psychology & Psychotherapy, Erasmus Medical Center Rotterdam, the Netherland
| | - Paul L A van Daele
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Erasmus Medical Center Rotterdam, Academic Center of Excellence for Allergic Diseases, Rotterdam, the Netherlands; Department of Immunology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Roy Gerth van Wijk
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Erasmus Medical Center Rotterdam, Academic Center of Excellence for Allergic Diseases, Rotterdam, the Netherlands
| | - Maud A W Hermans
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Erasmus Medical Center Rotterdam, Academic Center of Excellence for Allergic Diseases, Rotterdam, the Netherlands.
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13
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Traina G. Mast Cells in Gut and Brain and Their Potential Role as an Emerging Therapeutic Target for Neural Diseases. Front Cell Neurosci 2019; 13:345. [PMID: 31417365 PMCID: PMC6682652 DOI: 10.3389/fncel.2019.00345] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
The mast cells (MCs) are the leader cells of inflammation. They are well known for their involvement on allergic reactions through degranulation and release of vasoactive, inflammatory, and nociceptive mediators. Upon encountering potential danger signal, MCs are true sensors of the environment, the first to respond in rapid and selective manner. The MC activates the algic response and modulates the evolution of nociceptive pain, typical of acute inflammation, to neuropathic pain, typical not only of chronic inflammation but also of the dysregulation of the pain system. Yet, MC may contribute to modulate intensity of the associated depressive and anxiogenic component on the neuronal and microglial biological front. Chronic inflammation is a common mediator of these co-morbidities. In parallel to the removal of the etiological factors of tissue damage, the modulation of MC hyperactivity and the reduction of the release of inflammatory factors may constitute a new frontier of pharmacological intervention aimed at preventing the chronicity of inflammation, the evolution of pain, and also the worsening of the depression and anxiogenic state associated with it. So, identifying specific molecules able to modify MC activity may be an important therapeutic tool. Various preclinical evidences suggest that the intestinal microbiota contributes substantially to mood and behavioral disorders. In humans, conditions of the microbiota have been linked to stress, anxiety, depression, and pain. MC is likely the crucial neuroimmune connecting between these components. In this review, the involvement of MCs in pain, stress, and depression is reviewed. We focus on the MC as target that may be mediating stress and mood disorders via microbiota-gut-brain axis.
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Affiliation(s)
- Giovanna Traina
- Department of Pharmaceutical Sciences, University of Perugia, Perugia, Italy
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14
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Relevant updates in systemic mastocytosis. Leuk Res 2019; 81:10-18. [PMID: 30978435 DOI: 10.1016/j.leukres.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 12/29/2022]
Abstract
Systemic Mastocytosis (SM) is a rare myeloproliferative neoplasm (MPN) that is characterized by a clonal proliferation of mast cells (MCs). The symptoms and clinical presentation of SM are the result of both MC proliferation as well as activation and degranulation, causing hyperactive and over-exaggerated hypersensitivity responses, as well as organ infiltration by pathogenic MCs. The clinical presentation and course of SM is varied and organ involvement can lead to significant morbidity and mortality in some cases. The subtypes of SM include indolent SM (ISM), smoldering SM (SSM), aggressive SM (ASM), SM with associated hematologic neoplasm (SM-AHN) and mast cell leukemia (MCL) and survival can range from normal in the case of ISM to months in MCL. The treatment of indolent forms of SM is largely focused on addressing symptom burden (B findings), while cytoreductive agents and more recently molecularly targeted agents are employed to reduce MC burden and reverse associated organ dysfunction (C findings). Although the pathogenesis of SM is multi-factorial, the acquisition of KIT D816 V is a relatively frequent mutational event and serves as the target of novel agents. The recent approval of midostaurin for the treatment of advanced SM has brought awareness to this disease and energized further drug development efforts. Expanding our understanding of the underlying molecular mechanisms of SM will continue to inform future therapeutic approaches.
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15
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Le Foll B, French L. Transcriptomic Characterization of the Human Habenula Highlights Drug Metabolism and the Neuroimmune System. Front Neurosci 2018; 12:742. [PMID: 30429765 PMCID: PMC6220030 DOI: 10.3389/fnins.2018.00742] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
Due to size and accessibility, most information about the habenula is derived from rodent studies. To better understand the molecular signature of the habenula we characterized the genes that have high expression in the habenula. We compared anatomical expression profiles of three normal adult human brains and four fetal brains. We used gene set enrichment analyses to determine if genes annotated to specific molecular functions, cellular components, and biological processes are enriched in the habenula. We also tested gene sets related to depression and addiction to determine if they uniquely involve the habenula. As expected, we observed high habenular expression of GPR151, nicotinic cholinergic receptors, and cilia-associated genes (medial division). Genes identified in genetic studies of smoking and associated with nicotine response were enriched in the habenula. Genes associated with major depressive disorder did not have enriched expression in the habenula but genes negatively correlated with hedonic well-being were, providing a link to anhedonia. We observed enrichment of genes associated with diseases that are comorbid with addictions (hematopoiesis, thrombosis, liver cirrhosis, pneumonia, and pulmonary fibrosis) and depression (rheumatoid arthritis, multiple sclerosis, and kidney disease). These inflammatory diseases mark a neuroimmune signature that is supported by genes associated with mast cells, acute inflammatory response, and leukocyte migration. We also found enrichment of cytochrome p450 genes suggesting the habenula is uniquely sensitive to endogenous and xenobiotic compounds. Our results suggest the habenula receives negative reward signals from immune and drug processing molecules. This is consistent with the habenular role in the "anti-reward" system and suggests it may be a key bridge between autoimmune disorders, drug use, and psychiatric diseases.
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Affiliation(s)
- Bernard Le Foll
- Addictions Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Leon French
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, ON, Canada
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16
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17
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Germundson DL, Smith NA, Vendsel LP, Kelsch AV, Combs CK, Nagamoto-Combs K. Oral sensitization to whey proteins induces age- and sex-dependent behavioral abnormality and neuroinflammatory responses in a mouse model of food allergy: a potential role of mast cells. J Neuroinflammation 2018; 15:120. [PMID: 29685134 PMCID: PMC5913881 DOI: 10.1186/s12974-018-1146-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/03/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Growing evidence has strengthened the association of food allergy with neuropsychiatric symptoms such as depression, anxiety, and autism. However, underlying mechanisms by which peripheral allergic responses lead to behavioral dysfunction are yet to be determined. Allergen-activated mast cells may serve as mediators by releasing histamine and other inflammatory factors that could adversely affect brain function. We hypothesized that eliciting food allergy in experimental animals would result in behavioral changes accompanied by mast cell accumulation in the brain. Our hypothesis was tested in a mouse model of milk allergy using bovine milk whey proteins (WP) as the allergen. METHODS Male and female C57BL/6 mice at 4 weeks (young) and 10 months (old) of age underwent 5-week WP sensitization with weekly intragastric administration of 20 mg WP and 10 μg cholera toxin as an adjuvant. Age-matched sham animals were given the vehicle containing only the adjuvant. All animals were orally challenged with 50 mg WP in week 6 and their intrinsic digging behavior was assessed the next day. Animals were sacrificed 3 days after the challenge, and WP-specific serum IgE, intestinal and brain mast cells, glial activation, and epigenetic DNA modification in the brain were examined. RESULTS WP-sensitized males showed significantly less digging activity than the sham males in both age groups while no apparent difference was observed in females. Mast cells and their activities were evident in the intestines in an age- and sex-dependent manner. Brain mast cells were predominantly located in the region between the lateral midbrain and medial hippocampus, and their number increased in the WP-sensitized young, but not old, male brains. Noticeable differences in for 5-hydroxymethylcytosine immunoreactivity were observed in WP mice of both age groups in the amygdala, suggesting epigenetic regulation. Increased microglial Iba1 immunoreactivity and perivascular astrocytes hypertrophy were also observed in the WP-sensitized old male mice. CONCLUSIONS Our results demonstrated that food allergy induced behavioral abnormality, increases in the number of mast cells, epigenetic DNA modification in the brain, microgliosis, and astrocyte hypertrophy in a sex- and age-dependent manner, providing a potential mechanism by which peripheral allergic responses evoke behavioral dysfunction.
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Affiliation(s)
- Danielle L Germundson
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Nicholas A Smith
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Lane P Vendsel
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Andrea V Kelsch
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Colin K Combs
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA
| | - Kumi Nagamoto-Combs
- Department of Pathology, University of North Dakota School of Medicine and Health Sciences, 1301 North Columbia Road, Stop 9037, Grand Forks, ND, 58202-9037, USA.
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18
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Jamison NK, Holmes EG. A Case of Mast Cell Leukemia: A Review of the Pathophysiology of Systemic Mastocytosis and Associated Psychiatric Symptoms. PSYCHOSOMATICS 2018; 59:517-521. [PMID: 29571984 DOI: 10.1016/j.psym.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 10/18/2022]
Affiliation(s)
| | - Emily G Holmes
- Department of Psychiatry, Indiana University, Indianapolis, IN; Indiana University Health University Hospital, Indianapolis, IN.
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19
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Skaper SD, Facci L, Zusso M, Giusti P. An Inflammation-Centric View of Neurological Disease: Beyond the Neuron. Front Cell Neurosci 2018; 12:72. [PMID: 29618972 PMCID: PMC5871676 DOI: 10.3389/fncel.2018.00072] [Citation(s) in RCA: 292] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022] Open
Abstract
Inflammation is a complex biological response fundamental to how the body deals with injury and infection to eliminate the initial cause of cell injury and effect repair. Unlike a normally beneficial acute inflammatory response, chronic inflammation can lead to tissue damage and ultimately its destruction, and often results from an inappropriate immune response. Inflammation in the nervous system (“neuroinflammation”), especially when prolonged, can be particularly injurious. While inflammation per se may not cause disease, it contributes importantly to disease pathogenesis across both the peripheral (neuropathic pain, fibromyalgia) and central [e.g., Alzheimer disease, Parkinson disease, multiple sclerosis, motor neuron disease, ischemia and traumatic brain injury, depression, and autism spectrum disorder] nervous systems. The existence of extensive lines of communication between the nervous system and immune system represents a fundamental principle underlying neuroinflammation. Immune cell-derived inflammatory molecules are critical for regulation of host responses to inflammation. Although these mediators can originate from various non-neuronal cells, important sources in the above neuropathologies appear to be microglia and mast cells, together with astrocytes and possibly also oligodendrocytes. Understanding neuroinflammation also requires an appreciation that non-neuronal cell—cell interactions, between both glia and mast cells and glia themselves, are an integral part of the inflammation process. Within this context the mast cell occupies a key niche in orchestrating the inflammatory process, from initiation to prolongation. This review will describe the current state of knowledge concerning the biology of neuroinflammation, emphasizing mast cell-glia and glia-glia interactions, then conclude with a consideration of how a cell's endogenous mechanisms might be leveraged to provide a therapeutic strategy to target neuroinflammation.
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Affiliation(s)
- Stephen D Skaper
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Laura Facci
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Morena Zusso
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
| | - Pietro Giusti
- Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy
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20
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Decrease of cocaine, but not heroin, self-administration and relapse by the tyrosine kinase inhibitor masitinib in male Sprague Dawley rats. Psychopharmacology (Berl) 2018; 235. [PMID: 29520592 PMCID: PMC5920000 DOI: 10.1007/s00213-018-4865-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
RATIONALE Accumulating evidence shows that cocaine, and also heroin, influence several tyrosine kinases, expressed in neurons and in non-neuronal populations such as microglia, astrocytes and mast-cells. Drug-induced activation of mast cells both triggers inflammatory processes in the brain mediated by the glial cells they activate, and facilitates histamine release which may directly influence the dopamine system. Thus, by triggering the activation and degranulation of mast cells dependent on the tyrosine kinase c-kit and Fyn, the latter being also involved in NMDA-dependent synaptic plasticity, cocaine and heroin may indirectly influence the neural mechanisms that mediate their reinforcing properties. Masitinib, a novel tyrosine kinase inhibitor with high selectivity for c-Kit, Fyn and Lyn, may alter the aberrant consequences of the activation of these tyrosine kinases by cocaine and heroin. OBJECTIVE We investigated in rats the effect of a chronic oral treatment with masitinib (20 mg/kg) on the reinforcing and motivational properties of self-administered cocaine (250 μg/infusion) and heroin (40 μg/infusion). METHODS Three different cohorts of rats were trained instrumentally to respond for cocaine, heroin or food under continuous reinforcement. In each group, we assessed the influence of chronic daily treatment with masitinib on the maintenance of instrumental responding and intake and the motivation for the reinforcer. Thus, masitinib and vehicle-treated rats were challenged to adapt to high behavioural demand, to respond under a progressive ratio schedule of reinforcement and to reinstate instrumental responding after extinction and/or abstinence. RESULTS Masitinib selectively decreased cocaine intake, the motivation for cocaine and the subsequent propensity to respond for cocaine under extinction, while having no effect on instrumental responding for heroin or food. CONCLUSION The present findings suggest masitinib, a drug with proven efficacy in CNS disorders, could represent a novel treatment for cocaine addiction provided its influence on the reinforcing and incentive properties of the drug is confirmed.
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21
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Mucke HA. Drug Repurposing Patent Applications April–June 2017. Assay Drug Dev Technol 2017; 15:372-377. [DOI: 10.1089/adt.2017.29068.pq2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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22
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Gotlib J. Tyrosine Kinase Inhibitors in the Treatment of Eosinophilic Neoplasms and Systemic Mastocytosis. Hematol Oncol Clin North Am 2017; 31:643-661. [PMID: 28673393 DOI: 10.1016/j.hoc.2017.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The World Health Organization's semimolecular classification of eosinophilias emphasizes neoplasms driven by fusion tyrosine kinases. More than 80% of patients with systemic mastocytosis carry the KIT D816V mutation, the primary driver of disease pathogenesis. Genetic annotation of these diseases is critical and affords opportunities for targeted therapy. This article discusses our understanding of the mutated tyrosine kinome of eosinophilic neoplasms and systemic mast cell disease, and the successes and limitations of available therapies. Use of tyrosine kinase inhibitors as a bridge to hematopoietic stem cell transplantation, and development of more selective and potent tyrosine kinase inhibitors is also highlighted.
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Affiliation(s)
- Jason Gotlib
- Division of Hematology, Stanford Cancer Institute/Stanford University School of Medicine, 875 Blake Wilbur Drive, Room 2324, Stanford, CA 94305-5821, USA.
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23
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Boddaert N, Salvador A, Chandesris MO, Lemaître H, Grévent D, Gauthier C, Naggara O, Georgin-Lavialle S, Moura DS, Munsch F, Jaafari N, Zilbovicius M, Lortholary O, Gaillard R, Hermine O. Neuroimaging evidence of brain abnormalities in mastocytosis. Transl Psychiatry 2017; 7:e1197. [PMID: 28786975 PMCID: PMC5611717 DOI: 10.1038/tp.2017.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/06/2017] [Accepted: 04/20/2017] [Indexed: 01/08/2023] Open
Abstract
Mastocytosis is a rare disease in which chronic symptoms are related to mast cell accumulation and activation. Patients can display depression-anxiety-like symptoms and cognitive impairment. The pathophysiology of these symptoms may be associated with tissular mast cell infiltration, mast cell mediator release or both. The objective of this study is to perform morphological or functional brain analyses in mastocytosis to identify brain changes associated with this mast cell disorder. We performed a prospective and monocentric comparative study to evaluate the link between subjective psycho-cognitive complaints, psychiatric evaluation and objective medical data using magnetic resonance imaging with morphological and perfusion sequences (arterial spin-labeled perfusion) in 39 patients with mastocytosis compared with 33 healthy controls. In the test cohort of 39 mastocytosis patients with psycho-cognitive complaints, we found that 49% of them had morphological brain abnormalities, mainly abnormal punctuated white matter abnormalities (WMA). WMA were equally frequent in cutaneous mastocytosis patients and indolent forms of systemic mastocytosis patients (42% and 41% of patients with WMA, respectively). Patients with WMA showed increased perfusion in the putamen compared with patients without WMA and with healthy controls. Putamen perfusion was also negatively correlated with depression subscores. This study demonstrates, for we believe the first time, a high prevalence of morphological and functional abnormalities in the brains of mastocytosis patients with neuropsychiatric complaints. Further studies are required to determine the mechanism underpinning this association and to ascertain its specificity.
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Affiliation(s)
- N Boddaert
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM U1000 and UMR 1163, Institut Imagine, Paris, France,Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM U1000 and UMR 1163, Institut Imagine, 149 rue de Sèvres, 75015 Paris, France. E-mail:
| | - A Salvador
- Laboratoire de “Physiopathologie des Maladies Psychiatriques”, Centre de Psychiatrie et Neurosciences U894, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France,Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
| | - M O Chandesris
- Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,Service d'Hématologie Adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France
| | - H Lemaître
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM U1000 and UMR 1163, Institut Imagine, Paris, France
| | - D Grévent
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM U1000 and UMR 1163, Institut Imagine, Paris, France
| | - C Gauthier
- Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
| | - O Naggara
- Department of Neuroradiology, Service Hospitalo-Universitaire, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, INSERM UMR894, Paris, France
| | - S Georgin-Lavialle
- Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants Malades, Paris, France,Service de Médecine Interne, Hôpital Tenon, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D S Moura
- Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants Malades, Paris, France,Laboratoire de Psychopathologie et Processus de Santé, EA 4057, IUPDP, Institut de Psychologie, Université Paris Descartes, Paris, France
| | - F Munsch
- MRI France GE Healthcare, Vélizy Villacoublay, France and Université de Bordeaux, Bordeaux, France,Inserm U1215 - Neurocentre Magendie, Bordeaux, France
| | - N Jaafari
- Unité de Recherche Clinique Intersectorielle en Psychiatrie à Vocation Régionale Pierre Deniker du Centre Hospitalier Henri Laborit, INSERM CIC-P 1402, INSERM U 1084 Laboratoire Expérimental et Clinique en Neurosciences, Univ Poitiers, CHU Poitiers, Groupement De Recherche CNRS 3557, Poitiers, France
| | - M Zilbovicius
- Department of Pediatric Radiology, Hôpital Necker-Enfants Malades, AP-HP, University René Descartes, PRES Sorbonne Paris Cité, INSERM U1000 and UMR 1163, Institut Imagine, Paris, France
| | - O Lortholary
- Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,Infectious Diseases Unit, Necker-Enfants Malades Hospital, AP-HP Paris, Paris, France,Paris Descartes University, Imagine Institute, Paris, France
| | - R Gaillard
- Laboratoire de “Physiopathologie des Maladies Psychiatriques”, Centre de Psychiatrie et Neurosciences U894, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France,Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France,Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - O Hermine
- Centre de Référence des Mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants Malades, Fondation Imagine, Paris, France,Service d'Hématologie Adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants Malades, Paris, France,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants Malades, Paris, France
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Hendriksen E, van Bergeijk D, Oosting RS, Redegeld FA. Mast cells in neuroinflammation and brain disorders. Neurosci Biobehav Rev 2017; 79:119-133. [DOI: 10.1016/j.neubiorev.2017.05.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 12/13/2022]
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Lortholary O, Chandesris MO, Bulai Livideanu C, Paul C, Guillet G, Jassem E, Niedoszytko M, Barete S, Verstovsek S, Grattan C, Damaj G, Canioni D, Fraitag S, Lhermitte L, Georgin Lavialle S, Frenzel L, Afrin LB, Hanssens K, Agopian J, Gaillard R, Kinet JP, Auclair C, Mansfield C, Moussy A, Dubreuil P, Hermine O. Masitinib for treatment of severely symptomatic indolent systemic mastocytosis: a randomised, placebo-controlled, phase 3 study. Lancet 2017; 389:612-620. [PMID: 28069279 PMCID: PMC5985971 DOI: 10.1016/s0140-6736(16)31403-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indolent systemic mastocytosis, including the subvariant of smouldering systemic mastocytosis, is a lifelong condition associated with reduced quality of life. Masitinib inhibits KIT and LYN kinases that are involved in indolent systemic mastocytosis pathogenesis. We aimed to assess safety and efficacy of masitinib versus placebo in severely symptomatic patients who were unresponsive to optimal symptomatic treatments. METHODS In this randomised, double-blind, placebo-controlled, phase 3 study, we enrolled adults (aged 18-75 years) with indolent or smouldering systemic mastocytosis, according to WHO classification or documented mastocytosis based on histological criteria, at 50 centres in 15 countries. We excluded patients with cutaneous or non-severe systemic mastocytosis after a protocol amendment. Patients were centrally randomised (1:1) to receive either oral masitinib (6 mg/kg per day over 24 weeks with possible extension) or matched placebo with minimisation according to severe symptoms. The primary endpoint was cumulative response (≥75% improvement from baseline within weeks 8-24) in at least one severe baseline symptom from the following: pruritus score of 9 or more, eight or more flushes per week, Hamilton Rating Scale for Depression of 19 or more, or Fatigue Impact Scale of 75 or more. We assessed treatment effect using repeated measures methodology for rare diseases via the generalised estimating equation model in a modified intention-to-treat population, including all participants assigned to treatment minus those who withdrew due to a non-treatment-related cause. We assessed safety in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, number NCT00814073. FINDINGS Between Feb 19, 2009, and July 15, 2015, 135 patients were randomly assigned to masitinib (n=71) or placebo (n=64). By 24 weeks, masitinib was associated with a cumulative response of 18·7% in the primary endpoint (122·6 responses of 656·5 possible responses [weighted generalised estimating equation]) compared with 7·4% for placebo (48·9 of 656·5; difference 11·3%; odds ratio 3·6; 95% CI 1·2-10·8; p=0·0076). Frequent severe adverse events (>4% difference from placebo) were diarrhoea (eight [11%] of 70 in the masitinib group vs one [2%] of 63 in the placebo group), rash (four [6%] vs none), and asthenia (four [6%] vs one [2%]). The most frequent serious adverse events were diarrhoea (three patients [4%] vs one [2%]) and urticaria (two [3%] vs none), and no life-threatening toxicities occurred. One patient in the placebo group died (unrelated to study treatment). INTERPRETATION These study findings indicate that masitinib is an effective and well tolerated agent for the treatment of severely symptomatic indolent or smouldering systemic mastocytosis. FUNDING AB Science (Paris, France).
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Affiliation(s)
- Olivier Lortholary
- Department of Infectious Diseases and Tropical Medicine and Centre d'Infectiologie Necker-Pasteur, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; Centre de Référence des Mastocytoses, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Descartes, Paris, France
| | - Marie Olivia Chandesris
- Department of Hematology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cristina Bulai Livideanu
- Department of Dermatology, Mastocytosis Competence Center, Paul Sabatier University, Hôpital Larrey, Toulouse, France
| | - Carle Paul
- Department of Dermatology, Mastocytosis Competence Center, Paul Sabatier University, Hôpital Larrey, Toulouse, France
| | - Gérard Guillet
- Department of Dermatology, CHU Poitiers, University Hospital, Poitiers, France
| | - Ewa Jassem
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Stéphane Barete
- Department of Dermatology and Allergology, Centre de Référence des Mastocytoses, Université Pierre et Marie Curie, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Srdan Verstovsek
- Hanns A Pielenz Clinical Research Center for Myeloproliferative Neoplasms, Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - Clive Grattan
- Department of Dermatology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Gandhi Damaj
- Department of Haematology, University Hospital of Caen, Institut d'Hématologie de Basse Normandie, School of Medicine, University of Lower Normandy, Caen, France
| | - Danielle Canioni
- Department of Pathology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sylvie Fraitag
- Department of Pathology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ludovic Lhermitte
- INSERM U1151 and Laboratory of Onco-Hematology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sophie Georgin Lavialle
- Department of Internal Medicine, DHU I2B, Université Pierre et Marie Curie, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Laurent Frenzel
- Department of Hematology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; Institut Imagine INSERM U1163 and CNRS ERL8654, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Lawrence B Afrin
- Division of Hematology, Oncology & Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Katia Hanssens
- Centre de Référence des Mastocytoses, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; AB Science, Paris, France
| | - Julie Agopian
- Centre de Référence des Mastocytoses, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; AB Science, Paris, France
| | - Raphael Gaillard
- Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur; Université Paris Descartes; Centre Hospitalier Sainte-Anne, Paris, France
| | - Jean-Pierre Kinet
- Department of Pathology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christian Auclair
- Laboratoire de Biologie et Pharmacologie appliqué, CNRS UMR 8113, Ecole Normale Supérieure de Cachan, Université Paris Saclay, Paris, France; AB Science, Paris, France
| | | | | | - Patrice Dubreuil
- Centre de Référence des Mastocytoses, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; INSERM U1068, CRCM (Signaling, Hematopoiesis and Mechanism of Oncogenesis), Institut Paoli-Calmettes, Aix-Marseille Université, CNRS, UMR7258, Marseille, France; AB Science, Paris, France; INSERM, La Ligue Nationale Contre le Cancer (équipe labelliseé), Paris, France
| | - Olivier Hermine
- Department of Hematology, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; Institut Imagine INSERM U1163 and CNRS ERL8654, Université Paris Descartes, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France; AB Science, Paris, France.
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Pardanani A. Systemic mastocytosis in adults: 2017 update on diagnosis, risk stratification and management. Am J Hematol 2016; 91:1146-1159. [PMID: 27762455 DOI: 10.1002/ajh.24553] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 12/17/2022]
Abstract
Disease overview:Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extra-cutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. Risk stratification: The 2008 World Health Organization (WHO) classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD) and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting; there is a role for allogeneic stem cell transplantation in select cases. Investigational drugs: Recent data confirms midostaurin's significant anti-MC activity in patients with advanced SM. Am. J. Hematol. 91:1147-1159, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology Department of Medicine; Mayo Clinic; Rochester Minnesota
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Georgin-Lavialle S, Moura DS, Salvador A, Chauvet-Gelinier JC, Launay JM, Damaj G, Côté F, Soucié E, Chandesris MO, Barète S, Grandpeix-Guyodo C, Bachmeyer C, Alyanakian MA, Aouba A, Lortholary O, Dubreuil P, Teyssier JR, Trojak B, Haffen E, Vandel P, Bonin B, Hermine O, Gaillard R. Mast cells' involvement in inflammation pathways linked to depression: evidence in mastocytosis. Mol Psychiatry 2016; 21:1511-1516. [PMID: 26809839 DOI: 10.1038/mp.2015.216] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/24/2015] [Accepted: 11/24/2015] [Indexed: 12/17/2022]
Abstract
Converging sources of evidence point to a role for inflammation in the development of depression, fatigue and cognitive dysfunction. More precisely, the tryptophan (TRP) catabolism is thought to play a major role in inflammation-induced depression. Mastocytosis is a rare disease in which chronic symptoms, including depression, are related to mast cell accumulation and activation. Our objectives were to study the correlations between neuropsychiatric features and the TRP catabolism pathway in mastocytosis in order to demonstrate mast cells' potential involvement in inflammation-induced depression. Fifty-four patients with mastocytosis and a mean age of 50.1 years were enrolled in the study and compared healthy age-matched controls. Depression and stress were evaluated with the Beck Depression Inventory revised and the Perceived Stress Scale. All patients had measurements of TRP, serotonin (5-HT), kynurenine (KYN), indoleamine 2,3-dioxygenase 1 (IDO1) activity (ratio KYN/TRP), kynurenic acid (KA) and quinolinic acid (QA). Patients displayed significantly lower levels of TRP and 5-HT without hypoalbuminemia or malabsorption, higher IDO1 activity, and higher levels of KA and QA, with an imbalance towards the latter. High perceived stress and high depression scores were associated with low TRP and high IDO1 activity. In conclusion, TRP metabolism is altered in mastocytosis and correlates with perceived stress and depression, demonstrating mast cells' involvement in inflammation pathways linked to depression.
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Affiliation(s)
- S Georgin-Lavialle
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants malades, Paris, France.,Service de médecine Interne, Hôpital Tenon, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D S Moura
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants malades, Paris, France.,Laboratoire de Psychopathologie et Processus de Santé, EA 4057, IUPDP, Institut de Psychologie, Université Paris Descartes, Paris, France
| | - A Salvador
- Laboratoire de "Physiopathologie des maladies Psychiatriques", Centre de Psychiatrie et Neurosciences U894, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
| | - J-C Chauvet-Gelinier
- Service de Psychiatrie, Département de Neurosciences, Dijon, France.,Laboratoire de Psychologie et Psychopathologie Médicale (IFR 100), Université de Bourgogne, Dijon, France
| | - J-M Launay
- Laboratoire de biochimie et biologie moléculaire, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Damaj
- Service des Maladies du Sang, Centre Hospitalier Universitaire, Hôpital Sud, Amiens, France
| | - F Côté
- INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants malades, Paris, France
| | - E Soucié
- INSERM UMR 891, Centre de Recherche en Cancérologie de Marseille, Laboratoire d'Hématopoïèse Moléculaire et Fonctionnelle, Marseille, France
| | - M-O Chandesris
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France
| | - S Barète
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants malades, Paris, France
| | - C Grandpeix-Guyodo
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France
| | - C Bachmeyer
- Service de médecine Interne, Hôpital Tenon, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M-A Alyanakian
- Laboratoire d'immunologie, Hôpital Necker, Paris, France
| | - A Aouba
- Service d'Hématologie Adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - O Lortholary
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,Service des infectieuses et tropicales, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants malades, Paris, France
| | - P Dubreuil
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,INSERM UMR 891, Centre de Recherche en Cancérologie de Marseille, Laboratoire d'Hématopoïèse Moléculaire et Fonctionnelle, Marseille, France
| | - J-R Teyssier
- Laboratoire de génétique, CHU, PTB, 2 rue Angélique Ducoudray, Dijon, France
| | - B Trojak
- Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France.,Service de Psychiatrie, Département de Neurosciences, Dijon, France
| | - E Haffen
- Laboratoire de génétique, CHU, PTB, 2 rue Angélique Ducoudray, Dijon, France.,Service de Psychiatrie, CHU de Besançon, Besançon, France.,Laboratoire de Neurosciences EA 481, IFR 133, Université of Franche-Comté, Besançon, France
| | - P Vandel
- Laboratoire de Neurosciences EA 481, IFR 133, Université of Franche-Comté, Besançon, France.,Centre d'Investigation Clinique CIC-IT 808 INSERM, CHU de Besaçon, Besançon, France
| | - B Bonin
- Service de Psychiatrie, Département de Neurosciences, Dijon, France.,Laboratoire de Psychologie et Psychopathologie Médicale (IFR 100), Université de Bourgogne, Dijon, France
| | | | - O Hermine
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders, Hôpital Necker-Enfants malades, Paris, France.,Service d'Hématologie Adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants malades, Paris, France
| | - R Gaillard
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Fondation Imagine, Paris, France.,Laboratoire de "Physiopathologie des maladies Psychiatriques", Centre de Psychiatrie et Neurosciences U894, INSERM, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France.,Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
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Abstract
Urticaria pigmentosa is a rare disorder characterized by an abnormal systemic proliferation of mast cells. In this condition, various triggers can induce either cutaneous histamine release, resulting in rash, or generalized histamine release, resulting in symptomatic hypotension, syncope, or in its severest form, an anaphylactoid reaction resistant to most resuscitative measures. Many anesthetic agents and adjuncts are known potential triggers, and patients who require surgery or procedures under anesthesia must be managed carefully. In this review, we describe the safe use of general anesthesia for electroconvulsive therapy in a patient with urticaria pigmentosa and discuss the association between psychiatric disorders and mastocytoses.
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Georgin-Lavialle S, Gaillard R, Moura D, Hermine O. Mastocytosis in adulthood and neuropsychiatric disorders. Transl Res 2016; 174:77-85.e1. [PMID: 27063957 DOI: 10.1016/j.trsl.2016.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 12/18/2022]
Abstract
Patients with mastocytosis can display various disabling general and neuropsychological symptoms among one third of them, including general signs such as fatigue and musculoskeletal pain, which can have a major impact on quality of life. Neurological symptoms are less frequent and mainly consist of acute or chronic headache (35%), rarely syncopes (5%), acute onset back pain (4%), and in a few cases, clinical and radiological symptoms resembling or allowing the diagnosis of multiple sclerosis (1.3%). Headaches are associated with symptoms related to mast cell activation syndrome (flushes, prurit, and so forth) and more frequently present as migraine (37.5%), with often aura (66%). Depression-anxiety like symptoms can occur in 40% to 60% of the patients and cognitive impairment is not rare (38.6%). The pathophysiology of these symptoms could be linked to tissular mast cell infiltration or to mast cell mediators release or both. The tryptophan metabolism could be involved in mast cell-induced neuroinflammation through indoleamine-2,3-dioxygenase activation. Treatments targeting mast cell may be useful to target neuropsychological features associated with mastocytosis, including tyrosine kinase inhibitors.
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Affiliation(s)
- Sophie Georgin-Lavialle
- Service de médecine Interne, Hôpital Tenon, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphaël Gaillard
- Laboratoire de "Physiopathologie des maladies Psychiatriques", Centre de Psychiatrie et Neurosciences U894, INSERM; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France; Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - Daniela Moura
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France
| | - Olivier Hermine
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France; INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders Hôpital Necker-Enfants malades, Institut Imagine, Paris, France; Service d'hématologie adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants malades, Paris, France.
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Hermans MAW, Rietveld MJA, van Laar JAM, Dalm VASH, Verburg M, Pasmans SGMA, Gerth van Wijk R, van Hagen PM, van Daele PLA. Systemic mastocytosis: A cohort study on clinical characteristics of 136 patients in a large tertiary centre. Eur J Intern Med 2016; 30:25-30. [PMID: 26809706 DOI: 10.1016/j.ejim.2016.01.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 11/28/2015] [Accepted: 01/04/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Systemic mastocytosis (SM) is a rare heterogeneous disease which is characterized by the aberrant proliferation of mast cells. It can be divided into various subtypes with different phenotypes and prognoses. Here, we report on the clinical characteristics of 136 SM patients. METHODS A retrospective cohort study was conducted from January 2009 to September 2014 in a large tertiary centre in The Netherlands. We included all patients who fulfilled WHO criteria for SM. Data were collected from electronic patient files. RESULTS A total of 124 patients had indolent SM (ISM) (91.2%), 7 had aggressive SM (ASM) (5.1%) and 5 had SM with associated hematological non-mast cell lineage disease (SM-AHNMD) (3.7%). There was no progression from ISM to advanced SM subtypes, but 1 patient with ASM developed chronic myelocytic leukemia 2years after diagnosis. The average time to diagnosis for the whole population was 8.1years (range, 0-49years). The most frequent triggers for work-up-skin involvement, anaphylaxis and osteoporosis-were characterized by an interval to diagnosis of 10.9, 2.9 and 7.5years, respectively. A total of 32 patients (23.5%) had a serum tryptase levels below the cutoff value of 20ng/mL at the time of diagnosis, but these patients did not have significant differences in clinical phenotype. CONCLUSIONS SM comprises a wide spectrum of signs and symptoms and its often atypical presentation can delay the establishment of the diagnosis substantially. Skin involvement, anaphylaxis and unexplained osteoporosis should trigger analysis for mastocytosis. A normal serum tryptase does not exclude the diagnosis of SM.
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Affiliation(s)
- Maud A W Hermans
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Mark J A Rietveld
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jan A M van Laar
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Virgil A S H Dalm
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Maurice Verburg
- Section of Paediatric Dermatology, Dermatology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Section of Paediatric Dermatology, Dermatology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Roy Gerth van Wijk
- Section of Allergology, Internal Medicine, Erasmus MC University Medical, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - P Martin van Hagen
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Paul L A van Daele
- Section of Clinical Immunology, Internal Medicine, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Nicoloro-SantaBarbara J, Lobel M, Wolfe D. Psychosocial impact of mast cell disorders: Pilot investigation of a rare and understudied disease. J Health Psychol 2016; 22:1277-1288. [DOI: 10.1177/1359105315626784] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Mast cell disorders are rare, chronic diseases involving unpredictable physical symptoms ranging in severity, duration, and frequency. Almost two-thirds of participants with these disorders ( n = 180) experienced clinically meaningful depressive symptoms. Depressed mood was associated with somatic symptomatology, poorer quality of life, lower resilience, and indirectly with ways of coping. Newly developed measures for this population performed psychometrically well. There was no gender difference in depression but women reported greater use of several ways of coping, greater disease-related distress, poorer quality of life, and more symptoms. Results underscore the need for further research and development of effective psychosocial interventions for this population.
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Systemic Mastocytosis: Clinical Update and Future Directions. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015; 15:728-38. [PMID: 26382091 DOI: 10.1016/j.clml.2015.07.644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/13/2015] [Accepted: 07/28/2015] [Indexed: 12/20/2022]
Abstract
Systemic mastocytosis (SM) is defined as the accumulation of abnormal mast cells (MC) in 1 or more extracutaneous tissues. Symptoms are due to either MC activation or organ infiltration and vary depending on disease subtype. More benign forms of SM, such as indolent SM, result in a life expectancy similar to the general population, while more aggressive subtypes, such as MC leukemia (MCL), have a median survival measured on the order of months. Treatment of indolent SM is directed at controlling the symptoms associated with MC activation. In advanced forms, such as aggressive SM and MCL, agents targeting MC proliferation such as KIT tyrosine kinase inhibitors, cladribine, and thalidomide may be provided. Newer agents based on preclinical rationale are also being actively investigated. However, the only potentially curative therapy for aggressive SM/MCL remains hematopoietic stem cell transplantation. Given that SM is a relatively rare disease, clinicians are often underprepared to evaluate, diagnose, and effectively treat this clinically heterogeneous condition. Here we seek to familiarize clinicians with this orphan disease and review current and future treatment approaches.
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Abate KH. Gender disparity in prevalence of depression among patient population: a systematic review. Ethiop J Health Sci 2015; 23:283-8. [PMID: 24307828 PMCID: PMC3847538 DOI: 10.4314/ejhs.v23i3.11] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Many people are unable to withstand the set point for usual vicissitudes of life and are overwhelmed by depression, especially when there is a potential stressor like a disease. Gender is very important in defining susceptibility and exposure to a number of mental health risks. The objective of this review is to systematically identify, appraise and synthesize the best available evidence on gender disparity in prevalence of depression among patient populations. METHODS Observational analytical studies done on patients of 18 years old were included. The JBI-MAStARI tool for extraction was used to pool quantitative data. Review Manager Software was used for meta-analysis and Odds ratios and their 95% confidence intervals were calculated. RESULT On Meta-analysis, a total of 19639 patients were involved, with male to female ratio of 1.14:1. The finding of the Meta analysis showed that male sex is 63% less likely to develop depression than female sex (Odds ratio=0.63, 95% Confidence Interval= 0.59, 0.68). The studies included were homogenous; Heterogeneity test: Chi(2) = 309.23, df = 30, (P < 0.00001). CONCLUSION Depression is more common among females than male patients.
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Pardanani A. Systemic mastocytosis in adults: 2015 update on diagnosis, risk stratification, and management. Am J Hematol 2015; 90:250-62. [PMID: 25688753 DOI: 10.1002/ajh.23931] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extracutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. RISK STRATIFICATION The 2008 World Health Organization classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent SM (ISM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD), and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (+/-corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting; there is a role for allogeneic stem cell transplantation in select cases. Investigational Drugs: Recent data confirms midostaurin's significant anti-MC activity in patients with advanced SM.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology; Mayo Clinic; Rochester Minnesota
- Department of Medicine; Mayo Clinic; Rochester Minnesota
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Bañuelos-Cabrera I, Valle-Dorado MG, Aldana BI, Orozco-Suárez SA, Rocha L. Role of Histaminergic System in Blood–Brain Barrier Dysfunction Associated with Neurological Disorders. Arch Med Res 2014; 45:677-86. [DOI: 10.1016/j.arcmed.2014.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/14/2014] [Indexed: 12/23/2022]
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Barete S. Les mastocytoses. Ann Dermatol Venereol 2014; 141:698-714; quiz 697, 715. [DOI: 10.1016/j.annder.2014.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/21/2014] [Accepted: 08/29/2014] [Indexed: 01/05/2023]
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Lafont E, Sokol H, Sarre-Annweiler ME, Lecornet-Sokol E, Barete S, Hermine O, Pouchot J, Georgin-Lavialle S. Étiologies et orientation diagnostique devant un flush. Rev Med Interne 2014; 35:303-9. [DOI: 10.1016/j.revmed.2013.08.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 06/21/2013] [Accepted: 08/21/2013] [Indexed: 12/15/2022]
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Siebenhaar F, Akin C, Bindslev-Jensen C, Maurer M, Broesby-Olsen S. Treatment strategies in mastocytosis. Immunol Allergy Clin North Am 2014; 34:433-47. [PMID: 24745685 DOI: 10.1016/j.iac.2014.01.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment recommendations for mastocytosis are based mostly on expert opinion rather than evidence obtained from controlled clinical trials. In this article, treatment options for mastocytosis are presented, with a focus on the control of mediator-related symptoms in patients with indolent disease.
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Affiliation(s)
- Frank Siebenhaar
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany.
| | - Cem Akin
- Division of Rheumatology, Allergy, Immunology, Mastocytosis Center, Harvard Medical School, Brigham and Women's Hospital, 1 Jimmy Fund Way, Room 626B, Boston, MA 02115, USA
| | - Carsten Bindslev-Jensen
- Department of Dermatology, Allergy Centre, Mastocytosis Centre Odense University Hospital, MastOUH, Odense University Hospital, Sdr. Boulevard 29, Entrance 142, 5000 Odense C, Denmark
| | - Marcus Maurer
- Department of Dermatology and Allergy, Interdisciplinary Mastocytosis Center Charité, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Sigurd Broesby-Olsen
- Department of Dermatology, Allergy Centre, Mastocytosis Centre Odense University Hospital, MastOUH, Odense University Hospital, Sdr. Boulevard 29, Entrance 142, 5000 Odense C, Denmark
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Georgin-Lavialle S, Moura DS, Bruneau J, Chauvet-Gélinier JC, Damaj G, Soucie E, Barete S, Gacon AL, Grandpeix-Guyodo C, Suarez F, Launay JM, Durieu I, Esparcieux A, Guichard I, Sparsa A, Nicolini F, Gennes CD, Trojak B, Haffen E, Vandel P, Lortholary O, Dubreuil P, Bonin B, Sultan S, Teyssier JR, Hermine O. Leukocyte telomere length in mastocytosis: correlations with depression and perceived stress. Brain Behav Immun 2014; 35:51-7. [PMID: 23917070 DOI: 10.1016/j.bbi.2013.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/04/2013] [Accepted: 07/15/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Mastocytosisis a rare disease associated with chronic symptoms related to mast cell mediator release. Patients with mastocytosis display high level of negative emotionality such as depression and stress sensibility. Brain mast cells are mainly localized in the diencephalon, which is linked to emotion regulatory systems. Negative emotionality has been shown to be associated with telomere shortening. Taken together these observations led us to hypothesize that mast cells activity could be involved in both negative emotionality and telomere shortening in mastocytosis. OBJECTIVE To demonstrate a possible relationship between negative emotionality in mastocytosis and leukocytes telomere length. METHODS Leukocyte telomere length and telomerase activity were measured among mastocytosis patients and were correlated with perceived stress and depression assessed by the Beck Depression Inventory revised and the Perceived Stress Scale. RESULTS Mild-severe depression scores were frequent (78.9%) as well as high perceived stress (42.11%). Telomere length was correlated to perceived stress (r=0.77; p=0.0001) but not to depression in our population. Patients displaying Wild-type KIT significantly presented higher perceived stress levels. Patients with the D816VC KIT mutation who had high perceived stress scores displayed significantly shorter telomere but not if they had high depression scores. CONCLUSION These findings suggest that high perceived stress in mastocytosis could accelerate the rate of leukocytes telomere shortening. Since mastocytosis is, by definition, a mast cell mediated disease; these cells could be involved in this phenomenon. Mechanistic causal relationships between these parameters need to be investigated.
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Affiliation(s)
- Sophie Georgin-Lavialle
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France; Institut Imagine Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France; CNRS UMR 8147, Hôpital Necker-Enfants malades, 149 rue des Sèvres, 75743 Paris Cedex 15, France.
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Marech I, Patruno R, Zizzo N, Gadaleta C, Introna M, Zito AF, Gadaleta CD, Ranieri G. Masitinib (AB1010), from canine tumor model to human clinical development: where we are? Crit Rev Oncol Hematol 2013; 91:98-111. [PMID: 24405856 DOI: 10.1016/j.critrevonc.2013.12.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/11/2013] [Accepted: 12/09/2013] [Indexed: 01/11/2023] Open
Abstract
Masitinib mesylate (AB1010) is a novel potent and selective tyrosine kinase inhibitor, targeting mainly wild-type and mutated c-Kit receptor (c-KitR), Platelet Derived Growth Factor Receptor-alfa/beta (PDGFRa/ß), Lymphocyte-specific kinase (Lck), Lck/Yes-related protein (LYn), Fibroblast Growth Factor Receptor 3 (FGFR3) and Focal Adhesion Kinase (FAK). It is the first anticancer therapy approved in veterinary medicine for the treatment of unresectable canine mast cell tumors (CMCTs), harboring activating c-KitR mutations, at dose of 12.5mg/kg once daily. Considering its anti-proliferative action, principally given by inhibiting the MCs c-KitR anti-angiogenic pathway that leads cancer progression, and its role as chemosensitizer, masitinib is under clinical investigation in several human malignancies (Gastro-Intestinal Stromal Tumors, acute myeloid leukemia, systemic mastocytosis, pancreatic cancer, multiple myeloma, non-small cell lung cancer, melanoma, ovarian and prostate cancer), which are characterized by similar canine c-KIT proto-oncogene mutations. Here, we analyze masitinib structure activity, its pharmacokinetics compared to imatinib, the c-KitR pathway referring to the most frequent c-KIT mutations sensitive or resistant to this novel drug compared to imatinib, and masitinib safety profile. We, also, explore preclinical and clinical (completed and ongoing) trials with the aim to emphasize as this recent anti-angiogenic therapy, at first approved in CMCTs and, currently in development for the treatment of several human neoplasms, could be represent a milestone in translational oncology, in which the murine experimental model of cancer research could be integrated by canine spontaneous tumor model.
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Affiliation(s)
- Ilaria Marech
- Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Rosa Patruno
- Department of Prevention and Animal Health, ASL BAT, Barletta, Bari, Italy
| | - Nicola Zizzo
- Chair of Pathology, Veterinary Medical School, University of Bari, Valenzano, Bari, Italy
| | - Claudia Gadaleta
- Chair of Pathology, Veterinary Medical School, University of Bari, Valenzano, Bari, Italy
| | - Marcello Introna
- Chair of Pathology, Veterinary Medical School, University of Bari, Valenzano, Bari, Italy
| | | | - Cosmo Damiano Gadaleta
- Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Girolamo Ranieri
- Interventional Radiology Unit with Integrated Section of Translational Medical Oncology, National Cancer Research Centre "Giovanni Paolo II", Bari, Italy.
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Silver R, Curley JP. Mast cells on the mind: new insights and opportunities. Trends Neurosci 2013; 36:513-21. [PMID: 23845731 DOI: 10.1016/j.tins.2013.06.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/13/2013] [Accepted: 06/06/2013] [Indexed: 12/16/2022]
Abstract
Mast cells (MCs) are both sensors and effectors in communication among nervous, vascular, and immune systems. In the brain, they reside on the brain side of the blood-brain barrier (BBB), and interact with neurons, glia, blood vessels, and other hematopoietic cells via their neuroactive prestored and newly synthesized chemicals. They are first responders, acting as catalysts and recruiters to initiate, amplify, and prolong other immune and nervous responses upon activation. MCs both promote deleterious outcomes in brain function and contribute to normative behavioral functioning, particularly cognition and emotionality. New experimental tools enabling isolation of brain MCs, manipulation of MCs or their products, and measurement of MC products in very small brain volumes present unprecedented opportunities for examining these enigmatic cells.
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Affiliation(s)
- Rae Silver
- Department of Psychology, Barnard College, 3009 Broadway, New York, NY 10027, USA; Department of Psychology, Columbia University, 1190 Amsterdam Avenue, New York, NY 10027, USA; Department of Pathology and Cell Biology, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
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Pardanani A. Systemic mastocytosis in adults: 2013 update on diagnosis, risk stratification, and management. Am J Hematol 2013; 88:612-24. [PMID: 23720340 DOI: 10.1002/ajh.23459] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extracutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. RISK STRATIFICATION The 2008 World Health Organization (WHO) classification of SM has been shown to be prognostically relevant. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD) and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting. INVESTIGATIONAL DRUGS Dasatinib's in vitro anti- KITD816V activity has not translated into significant therapeutic activity in most SM patients. In contrast, recently updated data confirms Midostaurin's significant anti-MC activity in patients with advanced SM.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology, Department of Medicine; Mayo Clinic; Rochester Minnesota
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46
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How I treat patients with indolent and smoldering mastocytosis (rare conditions but difficult to manage). Blood 2013; 121:3085-94. [DOI: 10.1182/blood-2013-01-453183] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Indolent systemic mastocytosis (SM) patients have a varied clinical presentation, ranging from predominantly cutaneous symptoms to recurrent systemic symptoms (eg, flushing, palpitations, dyspepsia, diarrhea, bone pain) that can be severe and potentially life threatening (anaphylaxis). Mastocytosis patients without skin involvement pose a diagnostic challenge; a high index of suspicion is needed in those with mast cell–degranulation symptoms, including anaphylaxis following Hymenoptera stings or other triggers. Modern-era molecular and flow-cytometric diagnostic methods are very sensitive and can detect minimal involvement of bone marrow with atypical/clonal mast cells; in some cases, full diagnostic criteria for SM are not fulfilled. An important aspect of treatment is avoidance of known symptom triggers; other treatment principles include a stepwise escalation of antimediator therapies and consideration of cytoreductive therapies for those with treatment-refractory symptoms. The perioperative management of mastocytosis patients is nontrivial; a multidisciplinary preoperative assessment, adequate premedications, and close intra- and postoperative monitoring are critical. Smoldering mastocytosis is a variant with high systemic mast cell burden. While its clinical course can be variable, there is greater potential need for cytoreductive therapies (eg, interferon-alpha, cladribine) in this setting. A systematic approach to the diagnosis and treatment of indolent SM using a case-based approach of representative clinical scenarios is presented here.
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Abstract
Mast cells are increasingly being recognized as effector cells in many cardiovascular conditions. Many mast-cell-derived products such as tryptase and chymase can, through their enzymic action, have detrimental effects on blood vessel structure while mast cell-derived mediators such as cytokines and chemokines can perpetuate vascular inflammation. Mice lacking mast cells have been developed and these are providing an insight into how mast cells are involved in cardiovascular diseases and, as knowledge increase, mast cells may become a viable therapeutic target to slow progression of cardiovascular disease.
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Abstract
The prominent role for mast cells in the inflammatory response has been increasingly well documented in recent years. Mast cells not only contribute to maintain homeostasis via degranulation and to generate IgE-mediated allergic reactions, but also sit at a major crossroads for both innate and adaptive immune responses. The part played by mast cells in chronic inflammatory diseases such as rheumatoid arthritis and multiple sclerosis identifies mast cells as a valuable treatment target in these diseases. Tyrosine-kinase inhibitors targeting the c-Kit mast cell receptor have been found effective in treating rheumatoid arthritis, asthma, and multiple sclerosis. When used in combination with other available drugs, tyrosine-kinase inhibitors may improve the therapeutic management of these diseases.
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Affiliation(s)
- Laurent Frenzel
- Service d'Hématologie Adulte, Centre de référence des mastocytoses, CNRS UMR 8147, Institut Imagine, Hôpital Necker-Enfants-Malades, 75015 Paris, France.
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Moura DS, Sultan S, Georgin-Lavialle S, Barete S, Lortholary O, Gaillard R, Hermine O. Evidence for cognitive impairment in mastocytosis: prevalence, features and correlations to depression. PLoS One 2012; 7:e39468. [PMID: 22745762 PMCID: PMC3379977 DOI: 10.1371/journal.pone.0039468] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/21/2012] [Indexed: 12/28/2022] Open
Abstract
Mastocytosis is a heterogeneous disease characterized by mast cells accumulation in one or more organs. We have reported that depression is frequent in mastocytosis, but although it was already described, little is known about the prevalence and features of cognitive impairment. Our objective was to describe the prevalence and features of cognitive impairment in a large cohort of patients with this rare disease (n = 57; mean age = 45) and to explore the relations between memory impairment and depression. Objective memory impairment was evaluated using the 3(rd) edition of the Clinical Memory scale of Wechsler. Depression symptoms were evaluated using the Hamilton Depression Rating Scale. Age and education levels were controlled for all patients. Patients with mastocytosis presented high levels of cognitive impairment (memory and/or attention) (n = 22; 38.6%). Cognitive impairment was moderate in 59% of the cases, concerned immediate auditory (41%) and working memory (73%) and was not associated to depression (p≥0.717). In conclusion, immediate auditory memory and attention impairment in mastocytosis are frequent, even in young individuals, and are not consecutive to depression. In mastocytosis, cognitive complaints call for complex neuropsychological assessment. Mild-moderate cognitive impairment and depression constitute two specific but somewhat independent syndromes in mastocytosis. These results suggest differential effects of mast-cell activity in the brain, on systems involved in emotionality and in cognition.
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Affiliation(s)
- Daniela Silva Moura
- Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Fondation Imagine Paris, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne, Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA 4057, IUPDP Institut de Psychologie, Paris, France
| | - Serge Sultan
- Université de Montréal, Québec, Canada
- Centre de Recherche du CHU Sainte-Justine, Montréal, Québec, Canada
| | - Sophie Georgin-Lavialle
- Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Fondation Imagine Paris, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- CNRS UMR 8147, Hôpital Necker Enfants malades, Paris, France
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
| | - Stéphane Barete
- Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Fondation Imagine Paris, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- CNRS UMR 8147, Hôpital Necker Enfants malades, Paris, France
- Département de dermatologie, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France
| | - Olivier Lortholary
- Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Fondation Imagine Paris, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- Université Paris Descartes, Sorbonne, Paris Cité, Service de maladies infectieuses et tropicales, Hôpital Necker Enfants malades, Paris, France
| | - Raphael Gaillard
- INSERM; Université Paris Descartes, Sorbonne Paris Cité, Laboratoire de Physiopathologie des maladies Psychiatriques, Centre de Psychiatrie et Neurosciences U894, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Service Hospitalo Universitaire, Centre Hospitalier Sainte-Anne, Paris, France
| | - Olivier Hermine
- Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Fondation Imagine Paris, Université Paris Descartes, Sorbonne, Paris Cité, Paris, France
- CNRS UMR 8147, Hôpital Necker Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne, Paris Cité, Service d’hématologie adulte, Hôpital Necker-Enfants malades, Paris, France
- Fondation Imagine, IHU Hôpital Necker-Enfants malades, Paris, France
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50
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Pardanani A. Systemic mastocytosis in adults: 2012 Update on diagnosis, risk stratification, and management. Am J Hematol 2012; 87:401-11. [PMID: 22410759 DOI: 10.1002/ajh.23134] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
DISEASE OVERVIEW Systemic mastocytosis (SM) results from a clonal proliferation of abnormal mast cells (MC) in one or more extra-cutaneous organs. DIAGNOSIS The major criterion is presence of multifocal clusters of morphologically abnormal MC in the bone marrow. Minor diagnostic criteria include elevated serum tryptase level, abnormal MC expression of CD25 and/or CD2, and presence of KITD816V. RISK STRATIFICATION The prognostic relevance of the 2008 World Health Organization (WHO) classification of SM has recently been confirmed. Classification of SM patients into indolent (SM), aggressive SM (ASM), SM associated with a clonal non-MC lineage disease (SM-AHNMD) and mast cell leukemia (MCL) subgroups is a useful first step in establishing prognosis. MANAGEMENT SM treatment is generally palliative. ISM patients have a normal life expectancy and receive symptom-directed therapy; infrequently, cytoreductive therapy may be indicated for refractory symptoms. ASM patients have disease-related organ dysfunction; interferon-α (±corticosteroids) can control dermatological, hematological, gastrointestinal, skeletal, and mediator-release symptoms, but is hampered by poor tolerability. Similarly, cladribine has broad therapeutic activity, with particular utility when rapid MC debulking is indicated; the main toxicity is myelosuppression. Imatinib has a therapeutic role in the presence of an imatinib-sensitive KIT mutation or in KITD816-unmutated patients. Treatment of SM-AHNMD is governed primarily by the non-MC neoplasm; hydroxyurea has modest utility in this setting. INVESTIGATIONAL DRUGS Dasatinib's in vitro anti-KITD816V activity has not translated into significant therapeutic activity in most SM patients. In contrast, preliminary data suggest that Midostaurin may produce significant decreases in MC burden in some patients.
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Affiliation(s)
- Animesh Pardanani
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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