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Zaninelli TH, Martelossi-Cebinelli G, Saraiva-Santos T, Borghi SM, Fattori V, Casagrande R, Verri WA. New drug targets for the treatment of gout arthritis: what's new? Expert Opin Ther Targets 2023; 27:679-703. [PMID: 37651647 DOI: 10.1080/14728222.2023.2247559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/14/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Gout arthritis (GA) is an intermittent inflammatory disease affecting approximately 10% of the worldwide population. Symptomatic phases (acute flares) are timely spaced by asymptomatic periods. During an acute attack, redness, joint swelling, limited movement, and excruciating pain are common symptoms. However, the current available therapies are not fully effective in reducing symptoms and offer numerous side effects. Therefore, unveiling new drug targets and effector molecules are required in developing novel GA therapeutics. AREAS COVERED This review discusses the pathophysiological mechanisms of GA and explores potential pharmacological targets to ameliorate disease outcome. In addition, we listed promising pre-clinical studies demonstrating effector molecules with therapeutical potential. Among those, we emphasized the importance of natural products, including traditional Chinese medicine formulas and their multitarget mechanisms of action. EXPERT OPINION In our search, we observed that there is a massive gap between pre-clinical and clinical knowledge. Only a minority (4.4%) of clinical trials aimed to intervene by applying natural products or current hot targets described herein. In this sense, we envisage four possibilities for GA therapeutics, which include the repurposing of existing therapies, ALX/FPR2 agonism for improvement in disease outcome, the use of multitarget drugs (e.g. natural products), and targeting the neuroinflammatory component of GA.
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Affiliation(s)
- Tiago H Zaninelli
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Geovana Martelossi-Cebinelli
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Telma Saraiva-Santos
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
| | - Sergio M Borghi
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
- Center for Research in Health Sciences, University of Northern Londrina, Londrina, Brazil
| | - Victor Fattori
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
- Vascular Biology Program, Department of Surgery, Boston Children's Hospital-Harvard Medical School, Karp Research Building, Boston, MA, USA
| | - Rubia Casagrande
- Laboratory of Antioxidants and Inflammation, Department of Pharmaceutical Sciences, Centre of Health Sciences, Londrina State University, Londrina, Brazil
| | - Waldiceu A Verri
- Laboratory of Pain, Inflammation, Neuropathy, and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina, Paraná, Brazil
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Yokose C, McCormick N, Lu N, Tanikella S, Lin K, Joshi AD, Raffield LM, Warner E, Merriman T, Hsu J, Saag K, Zhang Y, Choi HK. Trends in Prevalence of Gout Among US Asian Adults, 2011-2018. JAMA Netw Open 2023; 6:e239501. [PMID: 37083663 PMCID: PMC10122173 DOI: 10.1001/jamanetworkopen.2023.9501] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Importance Gout disparities among Black individuals in the US have recently been explained by socioclinical factors; however, no information is available among Asian individuals living in Western countries, despite their disproportionately worsening metabolic health. Objective To determine the prevalence of gout and serum urate concentrations according to race and ethnicity and to explore the association of social determinants of health and clinical factors. Design, Setting, and Participants This is a population-based, cross-sectional analysis. Data from a nationally representative sample of US adults were obtained from the National Health and Nutrition Examination Survey (NHANES) (2011-2018) in which Asian race data were collected (primary). Data from the UK Biobank (2006-2021) were used for replication of the Asian vs White differences. Data analysis was performed from December 2021 to September 2022. Main Outcomes and Measures Race-specific gout prevalence and serum urate levels. Results A total of 22 621 participants from NHANES (2011-2018) were included in the analysis (mean [SD] age, 49.8 [17.8] years; 10 948 male participants [48.4%]). In 2017 to 2018, gout affected 12.1 million US individuals, with its crude prevalence increasing from 3.6% (95% CI, 2.8%-4.5%) in 2011 to 2012 to 5.1% (95% CI, 4.2%-5.9%) in 2017 to 2018 (P for trend = .03); this trend was no longer significant after age adjustment (P for trend = .06) or excluding Asian individuals (P for trend = .11). During the same period, age- and sex-adjusted prevalence among Asian Americans doubled from 3.3% (95% CI, 2.1%-4.5%) to 6.6% (95% CI, 4.4%-8.8%) (P for trend = .007) to numerically exceed all other racial and ethnic groups in 2017 to 2018, with age- and sex-adjusted odds ratio (ORs) of 1.61 (95% CI, 1.03-2.51) and a socioclinical factor-adjusted multivariable OR of 2.62 (95% CI, 1.59-4.33) for Asian vs White individuals. The latest age- and sex-adjusted gout prevalence among US individuals aged 65 years and older was 10.0% among White individuals and 14.8% among Asian individuals (including 23.6% of Asian men). Serum urate concentrations also increased between 2011 and 2018 among US Asian individuals (P for trend = .009). The Asian vs White disparity was also present in the UK Biobank. Conclusions and Relevance The findings of this study suggest that the prevalence of gout among Asian individuals numerically surpassed that for all other racial and ethnic groups in 2017 to 2018. This Asian vs White disparity did not appear to be associated with socioclinical factors.
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Affiliation(s)
- Chio Yokose
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Natalie McCormick
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Na Lu
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sruthi Tanikella
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Kehuan Lin
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Amit D Joshi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Regeneron Pharmaceuticals, Tarrytown, New York
| | - Laura M Raffield
- Department of Genetics, University of North Carolina, Chapel Hill
| | - Erica Warner
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Boston, Massachusetts
| | - Tony Merriman
- Division of Clinical Immunology and Rheumatology, the University of Alabama, Birmingham
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - John Hsu
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kenneth Saag
- Division of Clinical Immunology and Rheumatology, the University of Alabama, Birmingham
| | - Yuqing Zhang
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
| | - Hyon K Choi
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston
- The Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston
- Arthritis Research Canada, Vancouver, British Columbia, Canada
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3
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Nian YL, You CG. Susceptibility genes of hyperuricemia and gout. Hereditas 2022; 159:30. [PMID: 35922835 PMCID: PMC9351246 DOI: 10.1186/s41065-022-00243-y] [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: 04/10/2022] [Accepted: 07/03/2022] [Indexed: 11/10/2022] Open
Abstract
Gout is a chronic metabolic disease that seriously affects human health. It is also a major challenge facing the world, which has brought a heavy burden to patients and society. Hyperuricemia (HUA) is the most important risk factor for gout. In recent years, with the improvement of living standards and the change of dietary habits, the incidence of gout in the world has increased dramatically, and gradually tends to be younger. An increasing number of studies have shown that gene mutations may play an important role in the development of HUA and gout. Therefore, we reviewed the existing literature and summarized the susceptibility genes and research status of HUA and gout, in order to provide reference for the early diagnosis, individualized treatment and the development of new targeted drugs of HUA and gout.
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Affiliation(s)
- Yue-Li Nian
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Chong-Ge You
- Laboratory Medicine Center, Lanzhou University Second Hospital, Lanzhou, 730030, China.
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Ye J, Zeng Z, Chen Y, Wu Z, Yang Q, Sun T. Examining an Association of Single Nucleotide Polymorphisms with Hyperuricemia in Chinese Flight Attendants. Pharmgenomics Pers Med 2022; 15:589-602. [PMID: 35702613 PMCID: PMC9188807 DOI: 10.2147/pgpm.s364206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Both genetic and environmental factors strongly affect serum uric acid (SUA) concentrations. The incidence of hyperuricemia tends to be younger in the Chinese population. In particular, we have found a high prevalence of hyperuricemia among Chinese flight attendants, aged from 20 to 40, in our survey. This study aims to evaluate whether there is an association between gene polymorphisms and hyperuricemia among Chinese flight attendants. Methods A total of 532 flight attendants with high and normal serum uric acid levels were recruited. Allele-specific polymerase chain reaction (AS-PCR) was performed using blood samples of enrolled subjects. Results Previous studies have reported single nucleotide polymorphisms (SNPs) that are tightly associated with uric acid levels. Among them, six SNPs that are strongly associated with SUA or gout in Asians, for instance ABCG2 (rs2231142, rs72552713 and rs2231137), GCKR (rs780094), SLC2A9 (rs1014290) and SLC17A1 (rs1183201), were selected for AS-PCR analyses. We found that SNPs such as ABCG2 rs2231142, GCKR rs780094 and SLC2A9 rs1014290 are strongly associated with hyperuricemia in male flight attendants, and SLC2A9 rs1014290 among female flight attendants. Conclusion Our study provides evidences of an association between SNPs and hyperuricemia in the Chinese flight attendants, and highlights the significance of improving diagnostics and prevention of disease development in uric acid metabolism disorders and gout using these SNPs.
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Affiliation(s)
- Jianpin Ye
- Outpatient Department Laboratory, Xiamen Aviation, Xiamen, Fujian, People’s Republic of China
| | - Zhiwei Zeng
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, Fujian, People’s Republic of China
| | - Yuxian Chen
- Taokang Institute of Neuro Medicine, Xiamen, Fujian, People’s Republic of China
| | - Zhenkun Wu
- Taokang Institute of Neuro Medicine, Xiamen, Fujian, People’s Republic of China
| | - Qingwei Yang
- Department of Neurology, Zhongshan Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, People’s Republic of China
| | - Tao Sun
- Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, Fujian, People’s Republic of China
- Correspondence: Tao Sun, Center for Precision Medicine, School of Medicine and School of Biomedical Sciences, Huaqiao University, Xiamen, Fujian, People’s Republic of China, Email
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Zheng Q, Keliang W, Hongtao Q, Xiaosheng L. Genetic Association Between SLC22A12 Variants and Susceptibility to Hyperuricemia: A Meta-Analysis. Genet Test Mol Biomarkers 2022; 26:81-95. [PMID: 35225677 DOI: 10.1089/gtmb.2021.0175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Aims: Gout is a form of inflammatory arthritis characterized by the deposition of monosodium urate crystals. An important risk factor for gout is hyperuricemia. The relationship between SLC22A12 gene variants and the susceptibility to hyperuricemia has been reported, but these findings have been inconsistent. Thus, we aimed to assess the relationship between SLC22A12 gene variants and hyperuricemia susceptibility through a meta-analysis. Methods: The meta-analysis was performed by searching PubMed, Embase, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) databases. The relationship between hyperuricemia risk and the SLC22A12 rs11602903, rs524023, rs3825018, rs3825016, rs11231825, rs7932775, rs893006, and rs475688 variants was assessed by odds ratios and 95% confidence intervals. Results: In total, 20 eligible publications with 4817 cases and 6819 controls were included in the meta-analysis. Hyperuricemia risk was significantly associated with the SLC22A12 alleles rs3825018, rs7932775, and rs475688 under both the dominant and recessive models and with rs3825016 under the allelic and dominant models. Conclusions: Under the allelic model SLC22A12 rs3825018 and rs3825016 were risk factors for hyperuricemia and gout as was rs7932775 under dominant and recessive models, while the SLC22A12 rs475688 was protective against hyperuricemia under both dominant and recessive models.
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Affiliation(s)
- Qu Zheng
- Department of Orthopedics, Guangzhou University of Chinese Medicine, Guangzhou, China.,Orthopedics First Ward, Shenzhen Bao'an Traditional Chinese Medicine Hospital Group, Shenzhen, China
| | - Wu Keliang
- Department of Orthopedics, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qiu Hongtao
- Orthopedics First Ward, Shenzhen Bao'an Traditional Chinese Medicine Hospital Group, Shenzhen, China
| | - Lin Xiaosheng
- Orthopedics Ward, Shenzhen Integrative Medicine Hospital, Shenzhen, China
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Chung S, Kim GH. Urate Transporters in the Kidney: What Clinicians Need to Know. Electrolyte Blood Press 2021; 19:1-9. [PMID: 34290818 PMCID: PMC8267069 DOI: 10.5049/ebp.2021.19.1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022] Open
Abstract
Urate is produced in the liver by the degradation of purines from the diet and nucleotide turnover and excreted by the kidney and gut. The kidney is the major route of urate removal and has a pivotal role in the regulation of urate homeostasis. Approximately 10% of the glomerular filtered urate is excreted in the urine, and the remainder is reabsorbed by the proximal tubule. However, the transport of urate in the proximal tubule is bidirectional: reabsorption and secretion. Thus, an increase in reabsorption or a decrease in secretion may induce hyperuricemia. In contrast, a decrease in reabsorption or an increase in secretion may result in hyperuricosuria. In the proximal tubule, urate reabsorption is mainly mediated by apical URAT1 (SLC22A12) and basolateral GLUT9 (SLC2A9) transporter. OAT4 (SLC22A11) also acts in urate reabsorption in the apical membrane, and its polymorphism is associated with the risk of hyperuricemia. Renal hypouricemia is caused by SLC22A12 or SLC2A9 loss-of-function mutations, and it may be complicated by exercise-induced acute kidney injury. URAT1 and GLUT9 are also drug targets for uricosuric agents. Sodium-glucose cotransporter inhibitors may induce hyperuricosuria by inhibiting GLUT9b located in the apical plasma membrane. Urate secretion is mediated by basolateral OAT1 (SLC22A6) and OAT3 (SLC22A8) and apical ATP-binding cassette super-family G member 2 (ABCG2), NPT1 (SLC17A1), and NPT4 (SLC17A3) transporter in the proximal tubule. NPT1 and NPT4 may be key players in renal urate secretion in humans, and deletion of SLC22A6 and SLC22A8 in mice leads to decreased urate excretion. Dysfunctional variants of ABCG2 inhibit urate secretion from the gut and kidney and may cause gout. In summary, the net result of urate transport in the proximal tubule is determined by the dominance of transporters between reabsorption (URAT1, OAT4, and GLUT9) and secretion (ABCG2, NPT1, NPT4, OAT1, and OAT3).
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Affiliation(s)
- Sungjin Chung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Zhu C, Sun B, Zhang B, Zhou Z. An update of genetics, co-morbidities and management of hyperuricaemia. Clin Exp Pharmacol Physiol 2021; 48:1305-1316. [PMID: 34133780 DOI: 10.1111/1440-1681.13539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Abstract
Hyperuricaemia (HU) caused by disorders of purine metabolism is a metabolic disease. A number of epidemiological reports have confirmed that HU is correlated with multiple disorders, such as chronic kidney diseases, cardiovascular disease and gout. Recent studies showed that the expression and functional changes of uric acid transporters, including URAT1, GLUT9 and ABCG2, were associated with HU. Moreover, a large number of genome-wide association studies have shown that these transporters' dysfunction leads to HU. In this review, we describe the recent progress of aetiology and related transporters of HU, and we also summarise the common co-morbidities possible mechanisms, as well as the potential pharmacological and non-pharmacological treatment methods for HU, aiming to provide new ideas for the treatment of HU.
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Affiliation(s)
- Chunsheng Zhu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bao Sun
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China.,Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Bing Zhang
- School of Chinese Pharmacy, Beijing University of Chinese Medicine, Beijing, China
| | - Zheng Zhou
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Pavelcova K, Bohata J, Pavlikova M, Bubenikova E, Pavelka K, Stiburkova B. Evaluation of the Influence of Genetic Variants of SLC2A9 (GLUT9) and SLC22A12 (URAT1) on the Development of Hyperuricemia and Gout. J Clin Med 2020; 9:jcm9082510. [PMID: 32759716 PMCID: PMC7465009 DOI: 10.3390/jcm9082510] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 02/07/2023] Open
Abstract
Urate transporters, which are located in the kidneys, significantly affect the level of uric acid in the body. We looked at genetic variants of genes encoding the major reabsorption proteins GLUT9 (SLC2A9) and URAT1 (SLC22A12) and their association with hyperuricemia and gout. In a cohort of 250 individuals with primary hyperuricemia and gout, we used direct sequencing to examine the SLC22A12 and SLC2A9 genes. Identified variants were evaluated in relation to clinical data, biochemical parameters, metabolic syndrome criteria, and our previous analysis of the major secretory urate transporter ABCG2. We detected seven nonsynonymous variants of SLC2A9. There were no nonsynonymous variants of SLC22A12. Eleven variants of SLC2A9 and two variants of SLC22A12 were significantly more common in our cohort than in the European population (p = 0), while variants p.V282I and c.1002+78A>G had a low frequency in our cohort (p = 0). Since the association between variants and the level of uric acid was not demonstrated, the influence of variants on the development of hyperuricemia and gout should be evaluated with caution. However, consistent with the findings of other studies, our data suggest that p.V282I and c.1002+78A>G (SLC2A9) reduce the risk of gout, while p.N82N (SLC22A12) increases the risk.
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Affiliation(s)
- Katerina Pavelcova
- Department of Molecular Biology and Immunogenetics, Institute of Rheumatology, 128 50 Prague, Czech Republic; (K.P.); (J.B.); (E.B.); (K.P.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 128 50 Prague, Czech Republic
| | - Jana Bohata
- Department of Molecular Biology and Immunogenetics, Institute of Rheumatology, 128 50 Prague, Czech Republic; (K.P.); (J.B.); (E.B.); (K.P.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 128 50 Prague, Czech Republic
| | - Marketa Pavlikova
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University, 186 75 Prague, Czech Republic;
| | - Eliska Bubenikova
- Department of Molecular Biology and Immunogenetics, Institute of Rheumatology, 128 50 Prague, Czech Republic; (K.P.); (J.B.); (E.B.); (K.P.)
- Department of Rheumatology, First Faculty of Medicine, Charles University, 128 50 Prague, Czech Republic
| | - Karel Pavelka
- Department of Molecular Biology and Immunogenetics, Institute of Rheumatology, 128 50 Prague, Czech Republic; (K.P.); (J.B.); (E.B.); (K.P.)
| | - Blanka Stiburkova
- Department of Molecular Biology and Immunogenetics, Institute of Rheumatology, 128 50 Prague, Czech Republic; (K.P.); (J.B.); (E.B.); (K.P.)
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, 120 00 Prague, Czech Republic
- Correspondence: ; Tel.: +420-234-075-319
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Wang X, Yu U, Li X, Wang C, Zhang Q, Yang C, Zhang X, Zhang Y, Wang Y, Zheng Y, Deng J, Yang W, Liu G, Deng G, Liu S, Wen F. Identification and Treatment of Tuberculosis in Pediatric Recipients of Allogeneic Hematopoietic Stem Cell Transplantation: Case Series and Review of the Literature. Infect Drug Resist 2020; 13:2641-2648. [PMID: 32801802 PMCID: PMC7406069 DOI: 10.2147/idr.s256298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Tuberculosis is a rare but life-threatening complication in patients who received hematopoietic stem cell transplantation. Early identification and intervention are essential to prevent severe complications. CASE PRESENTATION We report two pediatric patients who developed tuberculosis after receiving hematopoietic stem cell transplantation for thalassemia major among 330 recipients between January 2012 and August 2019. Patient A presented with pulmonary tuberculosis and patient B presented with lymph node tuberculosis mimicking post-transplantation lymphoproliferative disorder associated with Epstein-Barr virus reactivation. Patient B's condition was deteriorated, and shortly after the initiation of anti-tuberculosis therapy, the patient was found to have disseminated pulmonary tuberculosis. Patient B was also found to have tuberculous granulomas, an uncommon manifestation of tuberculosis causing severe airway obstruction. Both patients developed critical respiratory failure and required mechanical ventilation; however, they recovered with almost full resolution of pulmonary lesions after multiple treatment adjustments. CONCLUSION Tuberculosis must be carefully evaluated in all pediatric patients that receive hematopoietic stem cell transplantation, regardless of the identification of other pathogens. Prophylactic tuberculosis therapy should be considered for high-risk pediatric hematopoietic stem cell transplantation recipients from tuberculosis-endemic regions.
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Affiliation(s)
- Xiaodong Wang
- Department of Pediatrics, First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Uet Yu
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Xiaonan Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Chunjing Wang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Qian Zhang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Chunlan Yang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Xiaoling Zhang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Yu Zhang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Ying Wang
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Jikui Deng
- Department of Infectious Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Weiguo Yang
- Pediatric Intensive Care Unit, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Guosheng Liu
- Department of Pediatrics, First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Guofang Deng
- Guangdong Key Laboratory for Emerging Infectious Diseases & Shenzhen Key Laboratory of Infection and Immunity, Shenzhen Third People’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Sixi Liu
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Feiqiu Wen
- Department of Pediatrics, First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
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