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Finsterer J. Primary Angiitis of the Central Nervous System: Exclusion of Differentials and Long-Term Follow-Up. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:480-481. [PMID: 38617855 PMCID: PMC11009138 DOI: 10.3348/jksr.2024.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024]
Affiliation(s)
- Josef Finsterer
- Department of Neurology, Neurology & Neurophysiology Center, Vienna, Austria
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2
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Keret S, Mazareeb J, Snir A, Shouval A, Awisat A, Kaly L, Rosner I, Rozenbaum M, Boulman N, Hardak E, Slobodin G, Rimar D. Von Willebrand factor: a possible biomarker for disease activity in vasculitis. Scand J Rheumatol 2024:1-9. [PMID: 38314784 DOI: 10.1080/03009742.2024.2302679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Inflammation markers, e.g. C- reactive protein (CRP) and sedimentation rate, can be normal despite active vasculitis. Von Willebrand factor (vWF) is secreted from endothelial cells in response to vascular damage. Some reports suggest increased vWF levels in vasculitis. This study aimed to evaluate vWF serum concentration in vasculitis patients as a possible biomarker of disease activity and to review the current literature. METHOD Adult patients with systemic vasculitis were prospectively enrolled. Disease activity was recorded using the Birmingham Vasculitis Activity Score (BVAS) version 3. Blood group-adjusted vWF antigen serum level was evaluated at diagnosis and, when available, after treatment. RESULTS Twenty-five vasculitis patients were compared to 15 healthy controls. The mean age of patients was 56 ± 17 years and 56% were women. Forty percent had anti-neutrophil cytoplasmic autoantibody-associated vasculitis, 20% giant cell arteritis, 16% polyarteritis nodosa, 8% Takayasu arteritis, and the rest had other vasculitides. The mean disease duration was 3.4 ± 4.8 years. Mean vWF was higher in patients with active vasculitis than in healthy controls (212 ± 81% vs 106 ± 26%, p < 0.001). vWF levels directly correlated with BVAS. In 13 patients with active vasculitis who reached remission or low disease activity after treatment, vWF level at follow-up decreased significantly. In three out of five patients who were treated with interleukin-6 inhibitors, vWF was elevated despite normal CRP levels, while vasculitis was clinically active. CONCLUSION vWF antigen serum level is increased in active vasculitis and could potentially serve as a biomarker for active disease.
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Affiliation(s)
- S Keret
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - J Mazareeb
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - A Snir
- Hematology Laboratory, Bnai Zion Medical Center, Haifa, Israel
| | - A Shouval
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - A Awisat
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - L Kaly
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - I Rosner
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - M Rozenbaum
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - N Boulman
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - E Hardak
- Pulmonary Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - G Slobodin
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
| | - D Rimar
- Rheumatology Unit, Bnai Zion Medical Center, Faculty of Medicine, Technion, Haifa, Israel
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3
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Hamam O, Cartmell SC, Romero JM. Imaging of Small Artery Vasculitis. Neuroimaging Clin N Am 2024; 34:67-79. [PMID: 37951706 DOI: 10.1016/j.nic.2023.07.009] [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] [Indexed: 11/14/2023]
Abstract
Small artery vasculitis of the CNS is a rare and serious condition characterized by the inflammation of blood vessels within the brain and spinal cord. There are two groups of small artery vasculitis determined by the presence or absence of immunoglobulin complex deposition in the vessel wall. The former includes anti-glomerular basement membrane disease, cryoglobulinemic vasculitis, and IgA vasculitis. Absence of immune complex deposition is associated with anti-neutrophil cytoplasmic antibody (ANCA) and includes microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and primary angiitis of the CNS. These conditions present a diagnostic challenge in which imaging plays a crucial role.
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Affiliation(s)
- Omar Hamam
- Neurovascular Laboratory R.H Ackerman, Radiology, Mass General Brigham, 55 Fruit street, Boston, MA, 02115, USA
| | - Samuel C Cartmell
- Neurovascular Laboratory R.H Ackerman, Radiology, Mass General Brigham, 55 Fruit street, Boston, MA, 02115, USA
| | - Javier M Romero
- Neurovascular Laboratory R.H Ackerman, Radiology, Mass General Brigham, 55 Fruit street, Boston, MA, 02115, USA.
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4
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Pașa V, Popa E, Poroch M, Cosmescu A, Bacusca AI, Slanina AM, Ceasovschih A, Stoica A, Petroaie A, Ungureanu M, Popa AE, Avram RI, Bologa C, Poroch V, Coman EA. The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1162. [PMID: 37374366 DOI: 10.3390/medicina59061162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.
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Affiliation(s)
- Victoria Pașa
- 2nd Rheumatology Department, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Elena Popa
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Mihaela Poroch
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Adriana Cosmescu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Agnes Iacinta Bacusca
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Ana Maria Slanina
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Alexandr Ceasovschih
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Antoneta Petroaie
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Monica Ungureanu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
| | - Andrei Emilian Popa
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
| | - Raluca Ioana Avram
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Vladimir Poroch
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
| | - Elena Adorata Coman
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iasi, Romania
- Department of Family Medicine, Preventive Medicine and Interdisciplinary, "Grigore T. Popa" University of Medicine and Pharmacy, Universitatii Str. 16, 700115 Iasi, Romania
- 2nd Internal Medicine Department, Sf. Spiridon Clinical Emergency Hospital, 700111 Iasi, Romania
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Vascular and Vasogenic Manifestations of Systemic ANCA-Associated Vasculitis with Renal Involvement in Non-Contrast Brain MRI in Patients with Acute Disease Onset. J Clin Med 2022; 11:jcm11164863. [PMID: 36013102 PMCID: PMC9409864 DOI: 10.3390/jcm11164863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background. Data concerning central nervous system (CNS) alterations in ANCA-associated vasculitis with renal involvement (AAVR) are sparse. The study aimed to assess vascular and vasogenic brain alterations in patients with acute onset of AAVR and the applicability of non-contrast magnetic resonance imaging (MRI) techniques in this diagnosis. Methods. Thirty-eight patients with acute onset of AAVR were included in the study. BVAS/WG, c-ANCA, p-ANCA, renal function and perfusion, neurological assessment, and brain MRI were performed. Results. Cerebral vascular alternating narrowing and dilatation (VAND) was detected in 42.1% of patients, and the black-blood was significantly more diagnostic than the TOF technique (p < 0.001). VAND occurrence was independently associated with the concentration of p-ANCA. The vasogenic white matter lesions (VWML) were found in 94.4% of patients, and in their detection, SWAN was significantly better than the FLAIR technique (p = 0.002). The number of VWML correlated with age and cranial nerve damage. Hemosiderin deposits were found in 21.6% of patients and were associated with a gait impairment and paresthesia. Conclusions. Vascular and vasogenic alterations in the CNS are frequent in patients with acute onset of systemic ANCA-associated vasculitis with renal involvement. Non-contrast MRI is useful in the diagnosis of brain vasculitis.
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Ahmad SJ, Zampolin RL, Brook AL, Kobets AJ, Altschul DJ. A case of hydrocephalus confounded by suprasellar arachnoid cyst and concomitant reversible cerebral vasoconstriction syndrome. Surg Neurol Int 2022; 13:331. [PMID: 36128109 PMCID: PMC9479517 DOI: 10.25259/sni_313_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 07/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Obstructive hydrocephalus is a neurologic condition that has varied clinical and imaging presentations, as well as a multitude of congenital etiologies including aqueductal stenosis and less commonly arachnoid cysts. Aqueductal stenosis is a physical limitation to cerebrospinal fluid flow along the course of the aqueduct, which results in enlargement of the third and lateral ventricles. Arachnoid cysts are thin walled and fluid filled central nervous system lesions that can result in mass effect on adjacent structures. While arachnoid cysts are mostly asymptomatic, they may present with neurological symptoms that vary depending on the location of the lesion. Suprasellar cysts in particular may cause obstructive hydrocephalus as well as endocrine dysfunction. Reversible cerebral vasoconstriction syndrome (RCVS) is an unusual condition caused by cerebral arterial vasoconstriction that often presents initially with a thunderclap headache. Frequently, there is some environmental trigger associated with this condition. RCVS more commonly affects women and can induce stroke. Case Description: A 57-year-old female presented to the emergency department with progressive headache and visual changes. Initial workup suggested the patient’s symptoms where related to RCVS but subsequent surgical management of what was presumed to be long standing, compensated hydrocephalus resulted in resolution of the patient’s symptoms. Conclusion: We report, to the best of our knowledge, the first case of aquedutal stenosis and suprasellar arachnoid cyst with concomitant RCVS. The presence of multiple pathologies found on radiologic imaging illustrates the challenges presented by incidental findings and subsequent anchoring bias in medical diagnosis.
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Affiliation(s)
- Samuel Jack Ahmad
- Department of Neurosurgery, Albert Einstein College of Medicine, New York, United States
| | - Richard L. Zampolin
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Allan L. Brook
- Department of Radiology, Montefiore Medical Center, Bronx, New York, United States
| | - Andrew J. Kobets
- Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, United States
| | - David J. Altschul
- Department of Neurosurgery, Montefiore Medical Center, Bronx, New York, United States
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Mansueto G, Lanza G, Fisicaro F, Alaouieh D, Hong E, Girolami S, Montella M, Feola A, Di Napoli M. Central and Peripheral Nervous System Complications of Vasculitis Syndromes From Pathology to Bedside: Part 1-Central Nervous System. Curr Neurol Neurosci Rep 2022; 22:47-69. [PMID: 35138587 PMCID: PMC9056593 DOI: 10.1007/s11910-022-01172-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide a comprehensive update on the clinical assessment, diagnosis, complications, and treatment of primary central nervous system vasculitis (PCNSV). RECENT FINDINGS The developments in neuroimaging, molecular testing, and cerebral biopsy have enhanced clinical assessment and decision making, providing novel insights to prevent misdiagnosis increasing diagnostic certainty. Advances in imaging techniques visualizing the wall of intracranial vessels have improved the possibility to distinguish inflammatory from non-inflammatory vascular lesions. Large recent studies have revealed a more varied histopathological pictures and disclosed an association with amyloid angiopathy. Unfortunately, therapy remains largely empiric. PCNSV is a heterogeneous group of disorders encompassing different clinical subsets that may differ in terms of prognosis and therapy. Recent evidence has described a more benign course, with good response to therapy. New diagnostic techniques will play soon a pivotal role in the appropriate diagnosis and prompt management of PCNSV.
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Affiliation(s)
- Gelsomina Mansueto
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania “Luigi Vanvitelli”, Piazza L. Miraglia 2, 80138 Naples, Italy
- grid.9841.40000 0001 2200 8888Clinical Department of Laboratory Services and Public Health—Legal Medicine Unit, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy
- grid.4691.a0000 0001 0790 385XPathology-Unit of Federico II University, via S. Pansini 3, 80131 Naples, Italy
| | - Giuseppe Lanza
- grid.8158.40000 0004 1757 1969Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- grid.419843.30000 0001 1250 7659Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
| | - Francesco Fisicaro
- grid.8158.40000 0004 1757 1969Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123 Catania, Italy
| | - Danielle Alaouieh
- grid.266832.b0000 0001 2188 8502School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Emily Hong
- grid.266832.b0000 0001 2188 8502School of Medicine, University of New Mexico, Albuquerque, NM USA
| | - Sara Girolami
- grid.413811.eNeurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039 Sulmona, L’Aquila, Italy
| | - Marco Montella
- grid.9841.40000 0001 2200 8888Mental and Physical Health and Preventive Medicine Department, University of Campania “Luigi Vanvitelli”, via Luciano Armanni 5, 80138 Naples, Italy
| | - Alessandro Feola
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy
| | - Mario Di Napoli
- grid.413811.eNeurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039 Sulmona, L’Aquila, Italy
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Abstract
PURPOSE OF REVIEW The main purpose of this review is to present advances in diagnostics of central nervous system vasculitis (CNS-V). RECENT FINDINGS Progress in molecular technologies and neuroimaging have added formidably to our knowledge of CNS-V. Next-generation sequencing has the promise to enhance our ability to diagnose, interrogate, and track infectious diseases, making this test attractive and capable of avoiding brain biopsy in cases where CNS infections are suspected. Further the continuum of neuroimaging progress has advanced our ability to diagnose CNS-V. Our capability to visualize the vessel wall have added a great value in differentiating inflammatory from noninflammatory vasculopathies. New genetic variations are being exposed with exome and genome sequences which will aid future diagnosis. SUMMARY We have witnessed tremendous advances in CNS-V mainly by our ability to rule out mimics. Progress in molecular technologies, neuroimaging and genetic studies will continue to enhance the field further.
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Stegmayr B, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Ptak J, Blaha M, Lanska M, Gasova Z, Bhuiyan-Ludvikova Z, Hrdlickova R, Ramlow W, Prophet H, Kielstein JT, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout-Sestrienkova E, Aandahl A, Sikole A, Tomaz J, Lalic K, Bojanic I, Strineholm V, Brink B, Berlin G, Dykes J, Nilsson T, Eich T, Hadimeri H, Welander G, Ortega Sanchez S, Ilhan O, Poole C. Using the World Apheresis Association Registry Helps to Improve the Treatment Quality of Therapeutic Apheresis. Transfus Med Hemother 2021; 48:234-239. [PMID: 34539317 DOI: 10.1159/000513123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
Therapeutic apheresis (TA) is prescribed to patients that suffer from a severe progressive disease that is not sufficiently treated by conventional medications. A way to gain more knowledge about this treatment is usually by the local analysis of data. However, the use of large quality assessment registries enables analyses of even rare findings. Here, we report some of the recent data from the World Apheresis Association (WAA) registry. Data from >104,000 procedures were documented, and TA was performed on >15,000 patients. The main indication for TA was the collection of autologous stem cells (45% of patients) as part of therapy for therapy. Collection of stem cells from donors for allogeneic transplantation was performed in 11% of patients. Patients with indications such as neurological diseases underwent plasma exchange (28%). Extracorporeal photochemotherapy, lipid apheresis, and antibody removal were other indications. Side effects recorded in the registry have decreased significantly over the years, with approximately only 10/10,000 procedures being interrupted for medical reasons. Conclusion Collection of data from TA procedures within a multinational and multicenter concept facilitates the improvement of treatment by enabling the analysis of and feedback on indications, procedures, effects, and side effects.
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Affiliation(s)
- Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elizabeth Newman
- Bone Marrow Transplant and Apheresis, Concord, New South Wales, Australia
| | - Volker Witt
- St. Anna, Pediatric Department, Vienna, Austria
| | | | - Gerda Leitner
- Apheresis Unit, Haematological, AKH, Vienna, Austria
| | - Sunny Eloot
- Department of Nephrology, University Hospital, Ghent, Belgium
| | | | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Jan Ptak
- Transfusion Medicine, Frydek-Mistek, Czechia
| | - Milan Blaha
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Mirka Lanska
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Zdenka Gasova
- Institute of Hematology and Blood Transfusion, Prague, Czechia
| | | | | | | | | | - Jan T Kielstein
- Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital, Braunschweig, Germany
| | | | | | | | | | | | | | - Astrid Aandahl
- Center for Immunology and Transfusion, Akers University Hospital, Loerenskog, Norway
| | - Aleksandar Sikole
- Department of Nephrology, University Hospital, Skopje, North Macedonia
| | - Jorge Tomaz
- Apheresis Unit, Coimbra University Hospital, Coimbra, Portugal
| | - Katarina Lalic
- Institute for Endocrinology, University Hospital, Belgrade, Serbia
| | - Ines Bojanic
- Transfusion Medicine and Transplantation Biology, University, Zagreb, Croatia
| | | | - Bo Brink
- Department of Nephrology, University Hospital, Huddinge, Sweden
| | - Gösta Berlin
- Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden
| | | | - Thomas Nilsson
- Department of Nephrology, University Hospital, Uppsala, Sweden
| | - Torsten Eich
- Blood Center, University, Uppsala, Sweden, Uppsala, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | | | | | - Osman Ilhan
- Department Haematology, University Hospital, Ankara, Turkey
| | - Colwyn Poole
- South African National Blood Service, Johannesburg, South Africa
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Petrey AC, Qeadan F, Middleton EA, Pinchuk IV, Campbell RA, Beswick EJ. Cytokine release syndrome in COVID-19: Innate immune, vascular, and platelet pathogenic factors differ in severity of disease and sex. J Leukoc Biol 2020; 109:55-66. [PMID: 32930456 DOI: 10.1002/jlb.3cova0820-410rrr] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 rapidly emerged as a crippling public health crisis in the last few months, which has presented a series health risk. Understanding of the immune response and biomarker analysis is needed to progress toward understanding disease pathology and developing improved treatment options. The goal of this study is to identify pathogenic factors that are linked to disease severity and patient characteristics. Patients with COVID-19 who were hospitalized from March 17 to June 5, 2020 were analyzed for clinical features of disease and soluble plasma cytokines in association with disease severity and sex. Data from COVID-19 patients with acute illness were examined along with an age- and gender-matched control cohort. We identified a group of 16 soluble factors that were found to be increased in COVID-19 patients compared to controls, whereas 2 factors were decreased. In addition to inflammatory cytokines, we found significant increases in factors known to mediate vasculitis and vascular remodeling (PDGF-AA, PDGF-AB-BB, soluble CD40L (sCD40L), FGF, and IP10). Four factors such as platelet-derived growth factors, fibroblast growth factor-2, and IFN-γ-inducible protein 10 were strongly associated with severe disease and ICU admission. Th2-related factors (IL-4 and IL-13) were increased with IL-4 and sCD40L present at increased levels in males compared with females. Our analysis revealed networking clusters of cytokines and growth factors, including previously unknown roles of vascular and stromal remodeling, activation of the innate immunity, as well activation of type 2 immune responses in the immunopathogenesis of COVID-19. These data highlight biomarker associations with disease severity and sex in COVID-19 patients.
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Affiliation(s)
- Aaron C Petrey
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA.,Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Fares Qeadan
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Elizabeth A Middleton
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA.,Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Irina V Pinchuk
- Division of Gastroenterology, Department of Medicine, Pennsylvania State Health, Hershey, Pennsylvania, USA
| | - Robert A Campbell
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, USA.,Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Ellen J Beswick
- Division of Microbiology and Immunology, Department of Pathology, University of Utah, Salt Lake City, Utah, USA.,Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
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11
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Elavarasi A, Mahadevan A, Vijayan Sobha V. CNS and PNS vasculitis: Looking beyond the obvious-A teaching exercise. Clin Neurol Neurosurg 2020; 195:105907. [PMID: 32442807 DOI: 10.1016/j.clineuro.2020.105907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
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