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Potential Association of Cutibacterium acnes with Sarcoidosis as an Endogenous Hypersensitivity Infection. Microorganisms 2023; 11:microorganisms11020289. [PMID: 36838255 PMCID: PMC9964181 DOI: 10.3390/microorganisms11020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The immunohistochemical detection of Cutibacterium acnes in sarcoid granulomas suggests its potential role in granuloma formation. C. acnes is the sole microorganism ever isolated from sarcoid lesions. Histopathologic analysis of some sarcoid lymph nodes reveals latent infection and intracellular proliferation of cell-wall-deficient C. acnes followed by insoluble immune-complex formation. Activation of T helper type 1 (Th1) immune responses by C. acnes is generally higher in sarcoidosis patients than in healthy individuals. Pulmonary granulomatosis caused by an experimental adjuvant-induced allergic immune response to C. acnes is preventable by antimicrobials, suggesting that the allergic reaction targets C. acnes commensal in the lungs. C. acnes is the most common bacterium detected intracellularly in human peripheral lungs and mediastinal lymph nodes. Some sarcoidosis patients have increased amounts of C. acnes-derived circulating immune complexes, which suggests the proliferation of C. acnes in affected organs. In predisposed individuals with hypersensitive Th1 immune responses to C. acnes, granulomas may form to confine the intracellular proliferation of latent C. acnes triggered by certain host-related or drug-induced conditions. Current clinical trials in patients with cardiac sarcoidosis are evaluating combined treatment with steroids and antimicrobials during active disease with continued antimicrobial therapy while tapering off steroids after the disease subsides.
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Yamaguchi T, Costabel U, McDowell A, Guzman J, Uchida K, Ohashi K, Eishi Y. Immunohistochemical Detection of Potential Microbial Antigens in Granulomas in the Diagnosis of Sarcoidosis. J Clin Med 2021; 10:jcm10050983. [PMID: 33801218 PMCID: PMC7957865 DOI: 10.3390/jcm10050983] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
Sarcoidosis may have more than a single causative agent, including infectious and non-infectious agents. Among the potential infectious causes of sarcoidosis, Mycobacterium tuberculosis and Propionibacterium acnes are the most likely microorganisms. Potential latent infection by both microorganisms complicates the findings of molecular and immunologic studies. Immune responses to potential infectious agents of sarcoidosis should be considered together with the microorganisms detected in sarcoid granulomas, because immunologic reactivities to infectious agents reflect current and past infection, including latent infection unrelated to the cause of the granuloma formation. Histopathologic data more readily support P. acnes as a cause of sarcoidosis compared with M. tuberculosis, suggesting that normally symbiotic P. acnes leads to granuloma formation in some predisposed individuals with Th1 hypersensitivity against intracellular proliferation of latent P. acnes, which may be triggered by certain host or drug-induced conditions. Detection of bacterial nucleic acids in granulomas does not necessarily indicate co-localization of the bacterial proteins in the granulomas. In the histopathologic diagnosis of sarcoidosis, M. tuberculosis-associated and P. acnes-associated sarcoidosis will possibly be differentiated in some patients by immunohistochemistry with appropriate antibodies that specifically react with mycobacterial and propionibacterial antigens, respectively, for each etiology-based diagnosis and potential antimicrobial intervention against sarcoidosis.
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Affiliation(s)
- Tetsuo Yamaguchi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (T.Y.); (K.U.); (K.O.)
- Department of Pulmonology, Shinjuku Tsurukame Clinic, Tokyo 151-0053, Japan
| | - Ulrich Costabel
- Department of Pneumology, Ruhrlandklinik, Medical Faculty, University of Duisburg-Essen, 45239 Essen, Germany;
| | - Andrew McDowell
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine BT52 1SA, UK;
| | - Josune Guzman
- Department of General and Experimental Pathology, Ruhr University, 44801 Bochum, Germany;
| | - Keisuke Uchida
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (T.Y.); (K.U.); (K.O.)
| | - Kenichi Ohashi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (T.Y.); (K.U.); (K.O.)
| | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School and Faculty of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; (T.Y.); (K.U.); (K.O.)
- Correspondence: ; Tel.: +81-90-3332-0948
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Okazaki F, Wakiguchi H, Korenaga Y, Nakamura T, Yasudo H, Uchi S, Yanai R, Asano N, Hoshii Y, Tanabe T, Izawa K, Honda Y, Nishikomori R, Uchida K, Eishi Y, Ohga S, Hasegawa S. A novel mutation in early-onset sarcoidosis/Blau syndrome: an association with Propionibacterium acnes. Pediatr Rheumatol Online J 2021; 19:18. [PMID: 33602264 PMCID: PMC7890802 DOI: 10.1186/s12969-021-00505-5] [Citation(s) in RCA: 7] [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] [Received: 07/21/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early-onset sarcoidosis (EOS) and Blau syndrome (BS) are systemic inflammatory granulomatous diseases without visible pulmonary involvement, and are distinguishable from their sporadic and familial forms. The diseases are characterized by a triad of skin rashes, symmetrical polyarthritis, and recurrent uveitis. The most common morbidity is ocular involvement, which is usually refractory to conventional treatment. A gain-of-function mutation in the nucleotide-binding oligomerization domain-containing protein 2 (NOD2) gene has been demonstrated in this disease; however, little is known about the relationship between the activation of NOD2 and the pathophysiology of EOS/BS. Here we describe EOS/BS with a novel mutation in the NOD2 gene, as well as detection of Propionibacterium acnes (P. acnes) in the granulomatous inflammation. CASE PRESENTATION An 8-year-old Japanese girl presented with refractory bilateral granulomatous panuveitis. Although no joint involvement was evident, she exhibited skin lesions on her legs; a skin biopsy revealed granulomatous dermatitis, and P. acnes was detected within the sarcoid granulomas by immunohistochemistry with P. acnes-specific monoclonal (PAB) antibody. Genetic analyses revealed that the patient had a NOD2 heterozygous D512V mutation that was novel and not present in either of her parents. The mutant NOD2 showed a similar activation pattern to EOS/BS, thus confirming her diagnosis. After starting oral prednisolone treatment, she experienced an anterior vitreous opacity relapse despite gradual prednisolone tapering; oral methotrexate was subsequently administered, and the patient responded positively. CONCLUSIONS We presented a case of EOS/BS with a novel D512V mutation in the NOD2 gene. In refractory granulomatous panuveitis cases without any joint involvement, EOS/BS should be considered as a differential diagnosis; genetic analyses would lead to a definite diagnosis. Moreover, this is the first report of P. acnes demonstrated in granulomas of EOS/BS. Since intracellular P. acnes activates nuclear factor-kappa B in a NOD2-dependent manner, we hypothesized that the mechanism of granuloma formation in EOS/BS may be the result of NOD2 activity in the presence of the ligand muramyl dipeptide, which is a component of P. acnes. These results indicate that recognition of P. acnes through mutant NOD2 is the etiology in this patient with EOS/BS.
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Affiliation(s)
- Fumiko Okazaki
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505, Ube, Yamaguchi, Japan.
| | - Yuno Korenaga
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Tamaki Nakamura
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Hiroki Yasudo
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
| | - Shohei Uchi
- grid.268397.10000 0001 0660 7960Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Ryoji Yanai
- grid.268397.10000 0001 0660 7960Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Nobuyuki Asano
- grid.268397.10000 0001 0660 7960Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yoshinobu Hoshii
- grid.268397.10000 0001 0660 7960Department of Diagnostic Pathology, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tsuyoshi Tanabe
- grid.268397.10000 0001 0660 7960Department of Public Health and Preventive Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazushi Izawa
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Honda
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuta Nishikomori
- grid.258799.80000 0004 0372 2033Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan ,grid.410781.b0000 0001 0706 0776Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Japan
| | - Keisuke Uchida
- grid.265073.50000 0001 1014 9130Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yoshinobu Eishi
- grid.265073.50000 0001 1014 9130Department of Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Shouichi Ohga
- grid.177174.30000 0001 2242 4849Department of Pediatrics, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Shunji Hasegawa
- grid.268397.10000 0001 0660 7960Department of Pediatrics, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, 755-8505 Ube, Yamaguchi Japan
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