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Seidel H, Hertfelder HJ, Oldenburg J, Kruppenbacher JP, Afrin LB, Molderings GJ. Effects of Primary Mast Cell Disease on Hemostasis and Erythropoiesis. Int J Mol Sci 2021; 22:ijms22168960. [PMID: 34445665 PMCID: PMC8396658 DOI: 10.3390/ijms22168960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 01/21/2023] Open
Abstract
Mast cell disease is an epigenetically and genetically determined disease entity with very diverse clinical manifestations in potentially every system and tissue due to inap pro priate release of variable subsets of mast cell mediators together with accumulation of either morphologically normal or altered mast cells. Easy bruising, excessive bleeding, and aberrancies of erythropoiesis can frequently be observed in patients with mast cell disease. A thorough history, including a family history, will guide the appropriate work-up, and laboratory evaluations may provide clues to diagnosis. In recent years, our understanding of the involvement of coagulation and anticoagulant pathways, the fibrinolytic system, and erythropoiesis in the pathophysiology of mast cell disease has increased considerably. This review summarizes current knowledge of the impact of the disturbed hemostatic and erythropoietic balance in patients with mast cell disease and describes options of treatment.
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Affiliation(s)
- Holger Seidel
- Center for Bleeding Disorders and Transfusion Medicine (CBT), Am Propsthof 3, D-53121 Bonn, Germany; (H.S.); (H.-J.H.); (J.P.K.)
| | - Hans-Jörg Hertfelder
- Center for Bleeding Disorders and Transfusion Medicine (CBT), Am Propsthof 3, D-53121 Bonn, Germany; (H.S.); (H.-J.H.); (J.P.K.)
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany;
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Hospital Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany;
| | - Johannes P. Kruppenbacher
- Center for Bleeding Disorders and Transfusion Medicine (CBT), Am Propsthof 3, D-53121 Bonn, Germany; (H.S.); (H.-J.H.); (J.P.K.)
| | - Lawrence B. Afrin
- Department of Mast Cell Studies, AIM Center for Personalized Medicine, 3010 Westchester Ave Suite 404, Purchase, NY 10577, USA;
| | - Gerhard J. Molderings
- Institute of Human Genetics, University Hospital of Bonn, Venusberg-Campus 1, D-53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-51000
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kohn A, Chang C. The Relationship Between Hypermobile Ehlers-Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS). Clin Rev Allergy Immunol 2020; 58:273-297. [PMID: 31267471 DOI: 10.1007/s12016-019-08755-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In recent years, an association between hypermobile Ehlers-Danlos syndrome (hEDS), mast cell activation syndrome (MCAS), and postural orthostatic tachycardia syndrome (POTS) has garnered attention and patients are increasingly presenting with this triad. However, a real relationship between these entities is unclear due to a lack of scientific validity. We conducted an extensive review of the literature using two different search strategies. A narrower strategy included 88 searches of various combinations of terms for each of the three conditions, yielding 19 unique papers. A broader search included 136 searches of various combinations of terms but included all forms of EDS and yielded 40 unique papers. Of these, only four and nine papers from the narrower and broader search strategies were original research articles. None of these papers resulted from a combination of the search terms for the three conditions. All three clinical entities are controversial in either existence or pathogenesis. MCAS is a poorly defined clinical entity, and many studies do not adhere to the proposed criteria when establishing the diagnosis. Patients previously diagnosed with EDS hypermobility type may not meet the new, stricter criteria for hEDS but may for a less severe hypermobility spectrum disorder (HSD). The pathophysiology of POTS is still unclear. An evidence-based, common pathophysiologic mechanism between any of the two, much less all three conditions, has yet to be described. Our review of the literature shows that current evidence is lacking on the existence of MCAS or hEDS as separate or significant clinical entities. Studies proposing a relationship between the three clinical entities are either biased or based on outdated criteria. The reason behind the purported association of these entities stems from an overlapping pool of vague, subjective symptoms, which is inadequate evidence to conclude that any such relationship exists.
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Affiliation(s)
- Alison Kohn
- Florida Atlantic University, Boca Raton, FL, USA
| | - Christopher Chang
- Florida Atlantic University, Boca Raton, FL, USA.
- Joe DiMaggio Children's Hospital, 1131 North 35th Avenue, Suite 220, Hollywood, FL, 33021, USA.
- University of California, Davis, CA, USA.
- Florida International University, Miami, FL, USA.
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Rodrigues F, Edjlali M, Georgin-Lavialle S, Chandesris O, Barete S, Bouktit H, Dubreuil P, Hamidou M, Saadoun D, Gaillard R, Hermine O. Neuroinflammatory disorders and mastocytosis: A possible association? J Allergy Clin Immunol Pract 2019; 7:2878-2881.e1. [PMID: 31077881 DOI: 10.1016/j.jaip.2019.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/29/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Affiliation(s)
- François Rodrigues
- Internal Medicine Department, Tenon Hospital, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Myriam Edjlali
- Departments of Neuroradiology, Université Paris Descartes Sorbonne Paris Cité, INSERM S894, DHU Neurovasc, Sainte-Anne Hospital, Paris, France
| | - Sophie Georgin-Lavialle
- Internal Medicine Department, Tenon Hospital, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivia Chandesris
- Centre de référence des mastocytoses (CEREMAST), Université Paris Descartes, Sorbonne, Paris Cité, Necker Enfants Malades Hospital, Imagine Foundation, Paris, France
| | - Stéphane Barete
- Centre de référence des mastocytoses (CEREMAST), Université Paris Descartes, Sorbonne, Paris Cité, Necker Enfants Malades Hospital, Imagine Foundation, Paris, France; Dermatology Department, Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Hassiba Bouktit
- Centre de référence des mastocytoses (CEREMAST), Université Paris Descartes, Sorbonne, Paris Cité, Necker Enfants Malades Hospital, Imagine Foundation, Paris, France
| | - Patrice Dubreuil
- Centre de référence des mastocytoses (CEREMAST), Université Paris Descartes, Sorbonne, Paris Cité, Necker Enfants Malades Hospital, Imagine Foundation, Paris, France
| | - Mohamed Hamidou
- Internal Medicine Department, Nantes Teaching Hospital, Université de Nantes, Nantes, France
| | - David Saadoun
- Internal Medicine Department, Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Raphaël Gaillard
- "Psychiatric Diseases Pathophysiology" Laboratory, Psychiatry and Neurosciences Centre U894, INSERM, Paris, France; Psychiatry Department, Sainte-Anne Hospital, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France
| | - Olivier Hermine
- Centre de référence des mastocytoses (CEREMAST), Université Paris Descartes, Sorbonne, Paris Cité, Necker Enfants Malades Hospital, Imagine Foundation, Paris, France; INSERM U1163 and CNRS ERL 8254, Laboratory of Physiopathology and Treatment of Hematological Disorders, Paris, France; Adults Haematology Unit, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Imagine Foundation, Necker-Enfants Malades Hospital, Paris, France.
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Degboé Y, Eischen M, Apoil PA, Mailhol C, Dubreuil P, Hermine O, Paul C, Bulai Livideanu C, Laroche M. Higher prevalence of vertebral fractures in systemic mastocytosis, but not in cutaneous mastocytosis and idiopathic mast cell activation syndrome. Osteoporos Int 2019; 30:1235-1241. [PMID: 30847528 DOI: 10.1007/s00198-019-04918-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 02/26/2019] [Indexed: 01/08/2023]
Abstract
UNLABELLED Little is known about osteoporosis in mast cell disorders (MCDs) not related to systemic mastocytosis. We described osteoporosis and fractures in MCDs and showed that systemic mastocytosis was the only studied MCDs associated with osteoporotic vertebral fractures. INTRODUCTION To describe osteoporosis (OP) and fragility fractures in mast cell disorders (MCDs). METHODS We retrospectively analyzed data concerning all successive patients with systemic mastocytosis (SM), cutaneous mastocytosis (CM), and mast cell activation syndromes (MCAS) diagnosed in our mastocytosis expert center between 2004 and 2015. We collected data concerning demographic profiles, clinical signs of MCD, osteoporosis, fractures, densitometry, and biological assessment of MCD. We compared CM and MCAS patients with SM patients with regard to the characteristics of OP and fragility fractures. RESULTS We assessed 89 SM patients, 20 CM patients, and 20 MCAS patients. Osteoporosis was less frequent in CM (15.0%) and MCAS (10.0%) than in SM (44.9%). Similarly, fractures were less frequent in non-SM MCDs, respectively 5.0%, 5.0%, and 28.1%. SM patients displayed high prevalence of vertebral fractures (22.5%), mostly multiple. Conversely, in non-SM patients, vertebral fractures appeared to be uncommon (5%) and more frequently associated with risk factors for osteoporosis. CONCLUSIONS SM is associated with multiple vertebral osteoporotic fractures, whereas CM and MCAS do not appear to be associated with this phenotype.
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Affiliation(s)
- Y Degboé
- Rheumatology Centre, Pierre Paul Riquet Hospital, Toulouse University Hospital & Paul Sabatier University, 1 Place du Dr Baylac, 31059, Toulouse, France.
- Center for Pathophysiology of Toulouse Purpan, INSERM UMR 1043, CHU Purpan, Toulouse, France.
| | - M Eischen
- Rheumatology Centre, Pierre Paul Riquet Hospital, Toulouse University Hospital & Paul Sabatier University, 1 Place du Dr Baylac, 31059, Toulouse, France
| | - P A Apoil
- Department of Immunology, Rangueil Hospital, Toulouse University Hospital, Toulouse, France
| | - C Mailhol
- Department of Pneumo-allergology, Larrey Hospital, Toulouse University Hospital, Toulouse, France
| | - P Dubreuil
- Cancer Research Center of Marseille, INSERM , Institut Paoli Calmettes & CNRS, CEREMAST, Label Ligue Contre le Cancer, Aix Marseille University, Marseille, France
| | - O Hermine
- Department of Hematology, CEREMAST, Label Ligue Contre le Cancer, Université Paris Descartes & Hôpital Necker Enfants Malades & Assistance Publique Hôpitaux de Paris, Paris, France
| | - C Paul
- Department of Dermatology, Mastocytosis Expert Centre of Midi-Pyrénées, Toulouse University Hospital & Paul Sabatier University, Toulouse, France
| | - C Bulai Livideanu
- Department of Dermatology, Mastocytosis Expert Centre of Midi-Pyrénées, Toulouse University Hospital & Paul Sabatier University, Toulouse, France
| | - M Laroche
- Rheumatology Centre, Pierre Paul Riquet Hospital, Toulouse University Hospital & Paul Sabatier University, 1 Place du Dr Baylac, 31059, Toulouse, France
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Valent P, Akin C, Bonadonna P, Hartmann K, Brockow K, Niedoszytko M, Nedoszytko B, Siebenhaar F, Sperr WR, Oude Elberink JNG, Butterfield JH, Alvarez-Twose I, Sotlar K, Reiter A, Kluin-Nelemans HC, Hermine O, Gotlib J, Broesby-Olsen S, Orfao A, Horny HP, Triggiani M, Arock M, Schwartz LB, Metcalfe DD. Proposed Diagnostic Algorithm for Patients with Suspected Mast Cell Activation Syndrome. J Allergy Clin Immunol Pract 2019; 7:1125-1133.e1. [PMID: 30737190 DOI: 10.1016/j.jaip.2019.01.006] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 12/31/2018] [Accepted: 01/05/2019] [Indexed: 12/18/2022]
Abstract
Mast cell activation (MCA) accompanies diverse physiologic and pathologic processes and is one of the more frequently encountered conditions in medicine. MCA-related symptoms are usually mild and often transient. In such cases, histamine receptor blockers and other mediator-targeting drugs can usually control MCA. In severe cases, an MCA syndrome (MCAS) may be diagnosed. However, overt MCAS is an unusual condition, and many patients referred because of suspected MCAS are diagnosed with other diseases (autoimmune, neoplastic, or infectious) unrelated to MCA or suffer from MCA-related (eg, allergic) disorders and/or comorbidities without fulfilling criteria of an overt MCAS. These considerations are important as more and more patients are informed that they may have MCA or even MCAS without completing a thorough medical evaluation. In fact, in several instances, symptoms are misinterpreted as MCA/MCAS, and other clinically relevant conditions are not thoroughly pursued. The number of such referrals is increasing. To avoid such unnecessary referrals and to prevent misdiagnoses, we here propose a diagnostic algorithm through which a clinically relevant (systemic) MCA can be suspected and MCAS can subsequently be documented or excluded. In addition, the algorithm proposed should help guide the investigating care providers to consider the 2 principal diagnoses that may underlie MCAS, namely, severe allergy and systemic mastocytosis accompanied by severe MCA. Although validation is required, we anticipate that this algorithm will facilitate the management of patients with suspected MCAS.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria.
| | - Cem Akin
- Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich
| | | | - Karin Hartmann
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdansk, Gdansk, Poland
| | | | - Frank Siebenhaar
- Department of Dermatology & Allergy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang R Sperr
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
| | - Joanna N G Oude Elberink
- Department of Allergology, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Ivan Alvarez-Twose
- Instituto de Estudios de Mastocitosis de Castilla La Mancha (CLMast) and CIBERONC, Hospital Virgen del Valle, Toledo, Spain
| | - Karl Sotlar
- Institute of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Reiter
- III. Medizinische Klinik, Universitäts-Medizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Hanneke C Kluin-Nelemans
- Department of Haematology, 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
| | - Jason Gotlib
- Stanford Cancer Institute/Stanford University School of Medicine, Stanford, Calif
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Alberto Orfao
- Servicio Central de Citometria, Centro de Investigacion del Cancer (IBMCC; CSIC/USAL), IBSAL, CIBERONC and Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Hans-Peter Horny
- Institute of Pathology, Ludwig-Maximilian University, Munich, Germany
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Michel Arock
- Department of Hematological Biology, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University (UPMC), Paris, France
| | - Lawrence B Schwartz
- Department of Internal Medicine, Division of Rheumatology, Allergy & Immunology, Virginia Commonwealth University, Richmond, Va
| | - Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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VAN Gysel D, DE Maeseneer H, Oranje AP. Mastocytosis: a comprehensive insight. GIORN ITAL DERMAT V 2016; 151:385-396. [PMID: 27070304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mastocytosis refers to a heterogeneous group of clinical disorders characterized by an abnormal accumulation of mast cells (MCs) in various tissues. The skin is the organ most frequently involved, but all organs may be affected. The clinical signs and symptoms are produced by the functional effects of mast cell-derived mediators and the anatomical distribution of the mast cells. The 2008 WHO-classification defines 7 categories of mastocytosis. Skin disease, with or without systemic involvement, is by far the most common form of childhood mastocytosis. Measurement of serum tryptase is important in the diagnostic algorithm of pediatric mastocytosis. In children with tryptase <20 ng/mL, the diagnosis of cutaneous mastocytosis (CM) may be decided upon without bone marrow examination (BME), unless other signs of SM are present. If the baseline tryptase level exceeds 100 ng/mL, a BME should be considered regardless of age. If the serum tryptase is 20-100 ng/mL in children without other signs of SM, the provisional diagnosis "mastocytosis in the skin" (MIS) can be established and monitored until puberty. If MIS remains present after puberty, a BME should be performed. In adult-onset mastocytosis a complete staging and application of the systemic mastocytosis criteria should always be performed. Treatment is mainly directed at alleviation of symptoms. As c-kit mutations prove to be very important in the pathogenesis of mastocytosis, targeted therapies using kit inhibitors may evolve as important future therapeutic options.
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Affiliation(s)
- Dirk VAN Gysel
- Department of Pediatrics, Onze-Lieve-Vrouw Hospital, Aalst, Belgium -
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Stobiecki M, Sacha M, Czarnobilska E. [Anaphylaxis as part of a clinical diagnosis of mastocytosi - case demonstration]. Przegl Lek 2015; 72:783-786. [PMID: 27024961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mastocytosis is a heterogeneous group of diseases characterized by excessive proliferation and accumulation of mast cells--in one or more organs. The number of symptoms and clinical prognosis vary depending on the disease. One of the most severe potential outcome of mastocytosis is anaphylactic shock. Early diagnosis and identification of triggers enables education and avoidance them. We describe the case of a 31-year-old woman with systemic mastocytosis (SM) without skin symptoms with multiple anaphylactic reactions, including two severe. Systemic mastocytosis was confirmed in bone marrow and genetic studies. We identify allergic triggers: latex and cefuroxime and also other non-immunological triggers as non-steroidal anti-inflammatory drugs (NSAIDs). The patient never had any allergic reaction after Hymenoptera stings. Only one result of serum tryptase was elevated. There was a need to determine the safety of antibiotic use and anesthetic drugs before cesarean. The moment when the disease was diagnosed and triggers were identifie, helped avoid further severe reactions.
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Kiwamoto T, Kawasaki N, Paulson JC, Bochner BS. Siglec-8 as a drugable target to treat eosinophil and mast cell-associated conditions. Pharmacol Ther 2012; 135:327-36. [PMID: 22749793 PMCID: PMC3587973 DOI: 10.1016/j.pharmthera.2012.06.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 12/19/2022]
Abstract
Siglecs (sialic acid immunoglobulin-like lectins) are members of the immunoglobulin gene family that contain sialoside binding N-terminal domains. They are cell surface proteins found predominantly on cells of the immune system. Among them, Siglec-8 is uniquely expressed by human eosinophils and mast cells, as well as basophils. Engaging this structure with antibodies or glycan ligands results in apoptosis in human eosinophils and inhibition of release of preformed and newly generated mediators from human mast cells without affecting their survival. Pro-apoptotic effects are also seen when its closest functional paralog, Siglec-F, on mouse eosinophils is similarly engaged in vitro, and beneficial effects are observed after administration of Siglec-F antibody using models of eosinophilic pulmonary and gastrointestinal inflammation in vivo. Siglec-8 targeting may thus provide a means to specifically inhibit or deplete these cell types. Cell-directed therapies are increasingly sought after by the pharmaceutical industry for their potential to reduce side effects and increase safety. The challenge is to identify suitable targets on the cell type of interest, and selectively deliver a therapeutic agent. By targeting Siglec-8, monoclonal antibodies and glycan ligand-conjugated nanoparticles may be ideally suited for treatment of eosinophil and mast cell-related diseases, such as asthma, chronic rhinosinusitis, chronic urticaria, hypereosinophilic syndromes, mast cell and eosinophil malignancies and eosinophilic gastrointestinal disorders.
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Affiliation(s)
- Takumi Kiwamoto
- Department of Medicine, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
| | - Norihito Kawasaki
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA 92037 USA
| | - James C. Paulson
- Department of Chemical Physiology, The Scripps Research Institute, La Jolla, CA 92037 USA
| | - Bruce S. Bochner
- Department of Medicine, Division of Allergy and Clinical Immunology, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA
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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: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Moura DS, Sultan S, Georgin-Lavialle S, Pillet N, Montestruc F, Gineste P, Barete S, Damaj G, Moussy A, Lortholary O, Hermine O. Depression in patients with mastocytosis: prevalence, features and effects of masitinib therapy. PLoS One 2011; 6:e26375. [PMID: 22031830 PMCID: PMC3198767 DOI: 10.1371/journal.pone.0026375] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/26/2011] [Indexed: 12/16/2022] Open
Abstract
Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms.
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Affiliation(s)
- Daniela Silva Moura
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, 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 Paris Descartes, Sorbonne, Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA 4057, IUPDP Institut de Psychologie, Paris, France
- Université de Montréal, Centre de Recherche du CHU Sainte-Justine, Montréal, Canada
| | - Sophie Georgin-Lavialle
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
- CNRS UMR 8147, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants malades, Paris, France
| | | | | | | | - Stéphane Barete
- Département de dermatologie, Centre de référence des mastocytoses, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France
| | - Gandhi Damaj
- Service d'hématologie, CHU d'Amiens, Université Jules–Vernes Picardie, Amiens, France
| | - Alain Moussy
- AB Science, S.A., Paris, France
- Association Française pour les initiatives et la recherche sur les mastocytes et les mastocytoses (AFIRMM), Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne, Paris Cité, Service de maladies infectieuses et tropicales, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
| | - Olivier Hermine
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
- CNRS UMR 8147, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants malades, Paris, France
- AB Science, S.A., Paris, France
- Association Française pour les initiatives et la recherche sur les mastocytes et les mastocytoses (AFIRMM), Paris, France
- * E-mail:
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Maintz L, Wardelmann E, Walgenbach K, Fimmers R, Bieber T, Raap U, Novak N. Neuropeptide blood levels correlate with mast cell load in patients with mastocytosis. Allergy 2011; 66:862-9. [PMID: 21284654 DOI: 10.1111/j.1398-9995.2011.02550.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mastocytosis is characterized by abnormal growth and accumulation of mast cells (MCs) in different organs. MCs have been shown to express receptors for neuropeptides. Furthermore, neuropeptides can activate MCs inducing cytokine production and MC mediator release, which further contribute to MC chemotaxis and stimulate the release of vasoactive peptides from sensory nerves. Thus, a contribution of neuropeptides to mastocytosis seems highly conceivable, but has not been investigated sufficiently yet. This study aimed to analyse blood levels of the neuropeptides substance P (SP), somatostatin (SST), vasoactive intestinal peptide (VIP), calcitonine gene--related peptide (CGRP) and expression of the SP receptor NK-1R in the skin of patients with mastocytosis (n = 46) compared to healthy controls (n = 69). METHODS Substance P, SST, VIP and CGRP plasma levels were analysed by ELISA, serum tryptase levels with the UniCAP System and NK-1R expression in the skin by immunohistochemistry. RESULTS Plasma levels of SP (P < 0.0001), SST, (P = 0.007), VIP (P < 0.0001) and CGRP (P = 0.003) were significantly increased in patients with mastocytosis compared to controls. Tryptase serum levels correlated significantly with neuropeptide levels, implying a link between MC load and neuropeptide blood levels in mastocytosis. NK-1R was expressed on the majority of MCs, and NK-1R-positive cells were increased in lesional mastocytosis skin compared to control skin (P = 0.01). CONCLUSIONS Elevated blood levels of the neuropeptides SP, SST, VIP and CGRP correlate with MC load and together with an increased expression of NK-1R in the skin of patients with mastocytosis indicate a role of neuropeptides in the pathophysiology of mastocytosis.
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Affiliation(s)
- L Maintz
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
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14
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Shah M. Smouldering systemic mastocytosis: a rare disorder with a difficult diagnosis. J PAK MED ASSOC 2011; 61:111. [PMID: 22368922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Abstract
It is known that patients with mastocytosis have an increased risk of anaphylaxis. This also appears to be the case with patients with evidence of a clonal mast cell disorder resulting in the monoclonal mast cell activation syndrome (MMAS) who do not express the full mastocytosis phenotype. Most patients with mastocytosis are recognized by their characteristic skin lesions. An increased level of baseline serum mast cell tryptase is also an indicator for a possible clonal mast cell disorder including mastocytosis. Other markers for mast cell clonality and for mastocytosis include abnormal immunostaining of mast cells with CD25 and CD2, clustering of mast cells in tissues, abnormal mast cell morphology, and the presence of a mutation in the proto-oncogene c-kit encoding for the mast cell growth receptor KIT. As recognition depends on an understanding of mastocytosis, and this disease should be considered in patients with recurrent anaphylaxis, we describe the features of mast cell clonality, MMAS and mastocytosis, and review recent findings.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - Dean D. Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Abstract
Mastocytosis is a general term for a heterogeneous group of rare disorders. Many agents used in anaesthesia can trigger mast cell degranulation with release of histamine, prostaglandin, tryptase and heparin. Therefore, patients with mastocytosis are high-risk patients when undergoing anaesthesia. The management of these patients in anaesthesia will be discussed on the basis of the literature and illustrated with the discussion of three case reports. A premedication with antihistamines and a glucocorticoid is recommended. For induction of general anaesthesia propofol, etomidate, ketamine, a fentanyl-type opioid, cis-atracurium or pancuronium are recommended. Anaesthesia can be maintained either by a total intravenous technique or with a volatile anaesthetic such as sevoflurane.
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Affiliation(s)
- F M Konrad
- Klinik für Anaesthesiologie und Intensivmedizin, Universitätsklinikum Tübingen
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Lähdeaho ML, Tuomi ML, Vornanen M, Ruuska T. [Mastocytosis as the cause of childrens' abdominal discomforts]. Duodecim 2010; 126:492-498. [PMID: 20597301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In mastocytosis the number of mast cells is increased, and the most common manifestation is urticaria pigmentosa. We describe four children, of which two developed ulceration of the upper gastrointestinal tract. Main symptoms in the other children were vomiting, heartburn and abdominal pains, which were manifested as intense crying spells. The symptoms are caused by mediators such as histamine being released from the mast cells, and blockers of the histamine receptor thus play a central role in their treatment. The childrens' condition was significantly alleviated by adequate medication: the ulceration healed, symptoms were relieved and growth was normalized.
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Affiliation(s)
- Marja-Leena Lähdeaho
- Tampereen yliopisto, lääketieteen laitos ja TAYS:n lastenklinikka, PL 2000, 33521 Tampere
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Hermine O, Lortholary O, Leventhal PS, Catteau A, Soppelsa F, Baude C, Cohen-Akenine A, Palmérini F, Hanssens K, Yang Y, Sobol H, Fraytag S, Ghez D, Suarez F, Barete S, Casassus P, Sans B, Arock M, Kinet JP, Dubreuil P, Moussy A. Case-control cohort study of patients' perceptions of disability in mastocytosis. PLoS One 2008; 3:e2266. [PMID: 18509466 PMCID: PMC2386235 DOI: 10.1371/journal.pone.0002266] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 03/24/2008] [Indexed: 01/08/2023] Open
Abstract
Background Indolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis. Methodology/Principal Findings In 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score) and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score). Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient's measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (≥20 ng/mL) serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level. Conclusions On the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under-diagnosed, and that the symptoms of the indolent forms of mastocytosis might be due more to systemic release of mediators than mast cell burden.
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Affiliation(s)
- Olivier Hermine
- Service de Dermatologie, Centre de référence sur la mastocytose, Hôpital Necker, Paris, France.
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Abstract
BACKGROUND Excessive mast cell mediator release may lead to anaphylaxis in patients with mastocytosis. However, the incidence, clinical features and trigger factors have not yet been analyzed. METHODS To identify risk factors for anaphylaxis in mastocytosis, we determined cumulative incidence, severity, clinical characteristics, and trigger factors for anaphylaxis in 120 consecutive patients (53 male; 67 female, median age and range 24 years, 1 month to 73 years), and correlated these with disease severity of mastocytosis, skin involvement, basal total serum tryptase, and diaminooxidase concentrations. RESULTS The cumulative incidence of anaphylaxis in patients with mastocytosis was higher in adults (49%; P < 0.01) compared with that in children (9%). Only children with extensive skin involvement had experienced anaphylaxis. In adults, anaphylaxis was correlated to the absence of urticaria pigmentosa lesions (P < 0.03). Reactions occurred more frequently in adults with systemic (56%) when compared with cutaneous mastocytosis (13%; P < 0.02). In adults, 48% of reactions were severe, and 38% resulted in unconsciousness. Major perceived trigger factors for adults were hymenoptera stings (19%), foods (16%), and medication (9%); however, in 26% of reactions, only a combination of different triggers preceded anaphylaxis. Trigger factors remained unidentified in 67% of reactions in children compared with 13% in adults. Patients with anaphylaxis had higher basal tryptase values (60.2 +/- 55 ng/ml, P < 0.0001) in comparison with those without (21.2 +/- 33 ng/ml), but not diaminooxidase levels. CONCLUSION Adult patients and children with extensive skin disease with mastocytosis have an increased risk to develop severe anaphylaxis; thus, an emergency set of medication including epinephrine is recommended.
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Affiliation(s)
- K Brockow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
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21
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Abstract
PURPOSE OF REVIEW To illustrate features of allergy in mastocytosis. RECENT FINDINGS The rates of atopy in patients with mastocytosis have generally been found to be similar to those of the normal population, although the incidence of anaphylaxis is much higher in mastocytosis. Introduction of objective pathologic criteria by the WHO for the diagnosis of mastocytosis has greatly facilitated the workup of patients with suspected mastocytosis, and has led to identification of mast cell disease in a subset of patients with anaphylaxis. There is increasing evidence that an activating c-kit mutation (D816V) exists in a subset of patients with recurrent mast cell activation symptoms who have normal-appearing bone marrow biopsies in routine evaluations without skin lesions. The genetic deficiency of alpha tryptase has not been found to influence serum tryptase levels in patients with mastocytosis. SUMMARY Pathologic mast cell activation is a key finding in both allergic diseases and mastocytosis, albeit caused by entirely different mechanisms. Mastocytosis should be suspected in patients with recurrent anaphylaxis, who present with syncopal or near-syncopal episodes without associated hives or angioedema.
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Affiliation(s)
- Matthew Greenhawt
- Division of Allergy and Immunology, Department of Internal Medicine, University of Michigan, School of Medicine, Ann Arbor, Michigan 48109, USA
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Sant GR, Kempuraj D, Marchand JE, Theoharides TC. The Mast Cell in Interstitial Cystitis: Role in Pathophysiology and Pathogenesis. Urology 2007; 69:34-40. [PMID: 17462477 DOI: 10.1016/j.urology.2006.08.1109] [Citation(s) in RCA: 210] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 06/29/2006] [Accepted: 08/24/2006] [Indexed: 12/21/2022]
Abstract
Current evidence from clinical and laboratory studies confirms that mast cells play a central role in the pathogenesis and pathophysiology of interstitial cystitis (IC). In this article, we focus on the role of the mast cell in IC and examine the ways in which mast cells and other pathophysiologic mechanisms are interrelated in this disease. Identifying the patients with IC who have mast cell proliferation and activation will enable us to address this aspect of disease pathophysiology in these individuals with targeted pharmacotherapy to inhibit mast cell activation and mediator release.
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Affiliation(s)
- Grannum R Sant
- Department of Urology, Tufts University School of Medicine, Boston, Massachusetts, USA.
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Abstract
Systemic mastocytosis (SM) is characterized by the abnormal growth and accumulation of mast cells (MC) in one or more organs. The interaction between the cytokine stem cell factor (SCF) and its cognate receptor, the c-kit receptor tyrosine kinase (KIT), plays a central role in regulating MC growth and differentiation. Whereas germline and somatically acquired activating mutations of KIT have been identified in SM, the issue as to whether individual KIT mutation(s) are necessary and sufficient to cause MC transformation remains unclear based on currently available data. Activating mutations of platelet-derived growth factor receptor-alpha (FIP1 L1-PDGFRA) are identified in a significant number of SM cases that have associated eosinophilia. To date, as with gastrointestinal stromal tumors, activating mutations of KIT and PDGFRA appear to be alternative and mutually exclusive genetic events in SM. The World Health Organization has specified criteria for classification of SM into six major subtypes: cutaneous mastocytosis, indolent systemic mastocytosis (ISM), systemic mastocytosis with an associated clonal hematological non-mast-cell disorder (SM-AHNMD), aggressive systemic mastocytosis (ASM), mast cell leukemia, and mast cell sarcoma. The ability to molecularly classify individual SM cases based on the presence or absence of specific mutations allows for molecularly targeted therapy in a growing number of cases. Imatinib mesylate therapy might result in complete remission of SM cases with wild-type KIT, certain KIT mutations, such as F522C, or the FIP1L1-PDGFRA fusion gene, but not of D816V-KIT-bearing SM. For the latter, interferon-alpha and 2-CdA are potential first- and second-line therapeutic options. Other drugs under investigation include novel tyrosine kinase inhibitors, as well as NF-kappaB inhibitors, which might display greater selectivity towards D816V-KIT as compared to wild type KIT. The pathogenesis of mastocytosis, its major clinical subtypes, and recent treatment advances are discussed in this chapter.
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Affiliation(s)
- A Pardanani
- Division of Hematology, Mayo Clinic, Mayo Building W10A, 200 First Street SW, Rochester, MN 55905, USA.
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24
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Metcalfe DD. Mastocytosis. Novartis Found Symp 2005; 271:232-42; discussion 242-9. [PMID: 16605139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Systemic mast cell disorders in most instances appear to be clonal disorders of the mast cell and its progenitor. Symptoms result from a pathological release of mast cell mediators and a destructive mast cell infiltration. Cutaneous mastocytosis is most frequently seen in children and may regress. Systemic mastocytosis (SM) is a persistent disease. A somatic c-kit mutation at codon 816 is often detectable in haematopoietic cells. The clinical course of mastocytosis is variable, ranging from indolent to aggressive. Five categories of disease are recognized: Indolent SM, aggressive SM, SM with associated clonal haematological non-mast cell-lineage disease (AHNMD) and mast cell leukaemia (MCL). In SM-AHNMD, additional genetic abnormalities have been reported. Patients with cutaneous or indolent systemic disease are treated symptomatically. Patients with aggressive disease are candidates for cytoreductive therapy. The use of 'Kit-targeting' tyrosine kinase inhibitors are best selected following a mutational analysis of c-kit. For instance, the D816V mutation appears to be associated with relative resistance against imatinib. However, imatinib has been used with success in patients with SM-hypereosinophilic syndrome (HES) and the FIPL1/PDGFRA fusion gene and in a patient with mastocytosis with a mutation outside of codon 816. The value of bone marrow transplantation remains under investigation.
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Affiliation(s)
- Dean D Metcalfe
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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Abstract
C-kit encodes a transmembrane protein with intrinsic tyrosine kinase activity, which functions as the receptor for stem cell factor. It is expressed on a variety of cell types, including mast cells, hematopoietic progenitor cells, melanocytes, germ cells, and gastrointestinal pacemaker cells. Mutations resulting in alteration of Kit function are associated with diseases involving each of these cells. Recent development of tyrosine kinase inhibitors led to their evaluation as novel therapies for diseases associated with Kit activation. This review will discuss the pathobiology of Kit in human disease, with a particular emphasis on implications for potential targeted treatment strategies in mast cell disease.
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Affiliation(s)
- Cem Akin
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA.
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Arock M. [Mastocytosis: advances in molecular diagnosis and therapeutics]. Ann Pharm Fr 2004; 62:233-43. [PMID: 15243341 DOI: 10.1016/s0003-4509(04)94307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Systemic mastocytosis is a rare myeloproliferative-like disease, characterized by an abnormal proliferation of mast cells in various organs. Two types of clinical manifestations can be distinguished: those related to release of mast cell mediators release and those related to tumor proliferation involving different organs, these later defining systemic mastocytosis. Until recently, treatment was mainly symptomatic, without anti tumor effect. These last years, advances have been made in the understanding of the disease with the discovery of the presence, in a number of patients, of mutations of the c-kit oncogene, coding for the receptor of the major growth factor for mast cells. These mutations induce autophosphorylation of the c-kit receptor in the absence of its ligand, the Stem Cell Factor. Based on experiences acquired in the treatment of myeloproliferative disorders, evaluation of new therapeutics, such as cladribine or interferon-alpha, is in progress. Finally, it would be possible to design, in the very next future, new tyrosine kinase inhibitors targeting specifically the mutant forms of c-Kit found in patients suffering from systemic mastocytosis.
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Affiliation(s)
- M Arock
- Laboratoire d'hématologie cellulaire et moléculaire, Unité CNRS UMR 8147, Faculté de Pharmacie 4, avenue de l'Observatoire, F75270 Paris Cedex.
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Valent P, Sperr WR, Schwartz LB, Horny HP. Diagnosis and classification of mast cell proliferative disorders: delineation from immunologic diseases and non–mast cell hematopoietic neoplasms. J Allergy Clin Immunol 2004; 114:3-11; quiz 12. [PMID: 15241337 DOI: 10.1016/j.jaci.2004.02.045] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In mast cell (MC) disorders (mastocytosis), clinical symptoms are caused by the release of chemical mediators from MCs, the pathologic infiltration of neoplastic MCs in tissues, or both. Cutaneous mastocytosis is a benign disease in which MC infiltration is confined to the skin. In pediatric cases cutaneous mastocytosis might regress spontaneously. Systemic mastocytosis (SM) is more frequently diagnosed in adults and is a persistent (clonal) disease of bone marrow-derived myelomastocytic progenitors. The somatic c-kit mutation D816V is found in the majority of such patients. The natural clinical course in SM is variable. Whereas most patients remain at the indolent stage for many years, some have aggressive SM (ASM) at diagnosis. Other patients have an associated clonal hematologic non-MC lineage disease (AHNMD). MC leukemia (MCL) is a rare disease variant characterized by circulating MCs and fatal disease progression. The diagnoses of ASM, SM-AHNMD, and MCL might be confused with a variety of endocrinologic, vascular, or immunologic disorders. It is therefore of particular importance to be aware of the possibility of an underlying (malignant) MC disease in patients with unexplained vascular instability, unexplained (anaphylactoid) shock, idiopathic flushing, diarrhea, headache, and other symptoms that might be mediator related. An important diagnostic clue in such cases is an increased serum tryptase level. The current review provides an overview of mastocytosis and its subvariants and a practical guide that might help to delineate mastocytosis from unrelated systemic disorders.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology, Medical University of Vienna, Austria.
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Abstract
Abstract
In Section I, Dr. Stephen O’Brien reviews the latest data on the clinical use of imatinib (STI571, Gleevec, Glivec) in CML. His review focuses on the use of imatinib in newly diagnosed chronic phase patients and summarizes cytogenetic and molecular response data, as well as use of the agent at high doses and in combination with other drugs. A brief summary of the prospective international Phase III studies that are currently ongoing is also provided, and the issues of resistance and definition of suboptimal therapeutic response are also covered. Finally, therapeutic decision-making and treatment strategy are considered.
In Section II, Dr. Ayalew Tefferi considers the latest developments in the biology and therapy of myeloid metaplasia/myelofibrosis. Dr. Tefferi covers what is currently understood of the biology of the disease and reviews established therapies for the condition as well as novel agents that are being used in clinical trials. The development of optimal management strategies for the disease is considered.
In Section III, Dr. Peter Valent reviews the classification of mast cell proliferative disorders and covers the clinical and pathological presentation of this group of neoplasms. He reviews the state-of-the-art regarding the molecular biology of mastocytosis along with diagnostic criteria and novel treatment concepts.
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Affiliation(s)
- Stephen O'Brien
- Univeristy of Newcastle, Royal Victoria Infirmary, Department of Hematology, Newcastle Upon Tyne, UK
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Brockow K, Scott LM, Worobec AS, Kirshenbaum A, Akin C, Huber MM, Metcalfe DD. Regression of urticaria pigmentosa in adult patients with systemic mastocytosis: correlation with clinical patterns of disease. Arch Dermatol 2002; 138:785-90. [PMID: 12056960 DOI: 10.1001/archderm.138.6.785] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine clinical correlates of urticaria pigmentosa (UP) regression in adult patients with systemic mastocytosis (SM). DESIGN Cohort study of the natural history of mastocytosis. SETTING National Institutes of Health Clinical Center. PATIENTS In a study of adult patients referred to the National Institutes of Health after 1980 and observed for a minimum of 10 years, 12 of 106 adult patients experienced clearance or fading of UP. MAIN OUTCOME MEASURES Data from each patient's history and results of physical examination, laboratory evaluation, and organ biopsy at presentation to the National Institutes of Health were compared with findings at the patient's most recent visit. RESULTS In the patients in whom clearance of (n = 5) or a decrease in skin lesions (n = 7) was noted, UP had persisted from 4 to 34 years (median, 17 years). Older age was a prognostic feature for regression of UP. Despite improvement of UP, the 2 patients with SM with an associated hematologic disorder experienced a deterioration in clinical condition. In the 10 patients with indolent SM, severity and frequency of symptoms decreased as the UP regressed. However, bone marrow changes consistent with SM remained. CONCLUSIONS Urticaria pigmentosa regresses in approximately 10% of the older patients who have SM. In patients with an associated hematologic disorder such as myelodysplasia, this regression may be accompanied by disease progression. In contrast, regression of UP in patients with indolent SM parallels a decrease in disease intensity, although bone marrow findings of indolent SM remain.
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Affiliation(s)
- Knut Brockow
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892-1881, USA
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Roupe G. [Mastocytosis--two diseases with different physiopathology]. Lakartidningen 2002; 99:2400-4. [PMID: 12090168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Mastocytosis means proliferation and accumulation of mast cells in skin and internal organs. Bone marrow cytogenetic abnormalities are similar to those found in myeloproliferative diseases. Recent findings indicate different pathogenetic forms of mastocytosis. Thus, adult patients with associated hematological diseases express mutation of the gene for the thyrosine kinase receptor, while childhood cases lack this mutation. In adults the skin and bone marrow are the most commonly affected organs but involvement of the skeleton and gastrointestinal tract also occur. Hematological malignancy is a rare but well-recognized complication. Childhood onset mastocytosis in the skin regresses spontaneously, whereas virtually all of the adult-onset cases persist.
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Affiliation(s)
- Gösta Roupe
- Hudkliniken, Sahlgrenska Universitetssjukhuset, Göteborg.
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Abstract
Mast cells may participate in tumor angiogenesis through the release of angiogenic cytokines from their secretory granules. To gain additional insight into the role of mast cells in bone marrow angiogenesis, we performed a semiquantitative measurement of bone marrow microvessel density in 52 consecutive adult patients with systemic mast cell disease (SMCD). The results were examined for potential correlations with mast cell expression of angiogenic cytokines and with other histologic features of the bone marrow. Standard immunohistochemical methods were used to visualize bone marrow microvessels (CD34 staining) and mast cell expression of transforming growth factor-beta, basic fibroblast growth factor, and their respective receptors. An increase in microvessel density was demonstrated in 32 of the 52 patients (62%) with SMCD, and the degree of bone marrow angiogenesis did not correlate with either the mast cell expression pattern of the study cytokines or the presence (23 patients) or absence (29 patients) of an associated hematologic disorder. In the 29 patients without an associated hematologic disorder, microvessel density was correlated significantly with the presence of an abnormal pattern of hematopoiesis but not with the degree of bone marrow involvement by mast cells. Furthermore, areas occupied by mast cell lesions were often devoid of neovascularization. We conclude that bone marrow angiogenesis characterizes a percentage of patients with SMCD and that the pathogenesis may not necessarily be linked to the mast cells themselves.
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Affiliation(s)
- Jin-Young Baek
- Divisions of Hematopathology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Valent P, Akin C, Sperr WR, Horny HP, Metcalfe DD. Smouldering mastocytosis: a novel subtype of systemic mastocytosis with slow progression. Int Arch Allergy Immunol 2002; 127:137-9. [PMID: 11919424 DOI: 10.1159/000048185] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Systemic mastocytosis (SM) is a clonal disease that shows an either indolent or an aggressive clinical course. Utilizing established criteria, indolent SM can readily be discriminated from the rare aggressive subvariants of SM in most cases. In a small group of patients, however, clinical and laboratory parameters are indicative of slow progression without signs of aggressive disease or an associated hemopoietic neoplasm. These SM patients exhibit a high burden of mast cells, hypercellular marrow and organomegaly. Because of the 'intermediate' course and uncertain prognosis, these cases have been referred to as smouldering SM. In the present article, we discuss clinical and laboratory findings in smouldering SM and review the current literature. In addition, the pathophysiology of this novel subtype of SM is discussed.
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Affiliation(s)
- Peter Valent
- Department of Internal Medicine I, Division of Hematology, University of Vienna, Austria.
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Abstract
The abnormality in mastocytosis is the excessive accumulation of mast cells in the affected tissue. The growth and differentiation of human mast cells are quite dependent on stem cell factor (SCF), the ligand for the protein products of c-kit. Recent studies have demonstrated that all adult patients examined so far carry c-kit point mutations, leading to SCF-independent autophosphorylation of the receptor and autonomous cell growth. On the other hand, typical pediatric patients have been found to bear no activating Asp816Val mutation in c-kit. Although most mastocytosis patients are children, the mechanism by which mast cells proliferate in these pediatric patients remains unclear. Recently, were reported that human mast cells obtained from adult skin could dramatically proliferate when cultured with SCF. From these experimental results, it is speculated that local excessive production of SCF results in the mast cell proliferation in pediatric patients.
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Affiliation(s)
- Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, Japan
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Abstract
Mastocytosis is defined by a pathological increase in mast cell numbers in tissues. Recent clinical observations on rare manifestations highlight the diversity of this disease. The diagnosis is now aided by new surrogate markers. At the molecular level, recent studies have reinforced the role of activating mutations in KIT in the etiology of mastocytosis. These findings provide a conceptual basis for the development for new therapeutic strategies.
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Affiliation(s)
- K Brockow
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1881, USA.
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Abstract
Mastocytosis represents a heterogeneous group of clinical disorders resulting from the infiltration of mast cells in the skin and other organs. Although mastocytosis was first described over 130 years ago, the pathophysiologic mechanisms responsible for this disease have been identified only recently. This article discusses the salient clinical features of the disease, the mechanisms responsible for its development, and provides treatment approaches that have proven useful for managing patients with this disorder.
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Affiliation(s)
- M D Tharp
- Department of Dermatology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA
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37
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Takegami T, Hayashi K. [Granulocytic disorder(except malignant tumor)]. Ryoikibetsu Shokogun Shirizu 2001:191-5. [PMID: 11031928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- T Takegami
- Department of Neurology, Tajimi Municipal Hospital
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Abstract
In the 1990s, major improvements occurred in the therapeutic index of H1 antihistamines. The third-generation compounds promise to be more effective and nontoxic. The future major advances are likely to result from development and exploitation of non-H1 receptor-mediated antiallergic actions of these drugs.
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Affiliation(s)
- M W Greaves
- St. John's Institute of Dermatology, St. Thomas' Hospital, London, United Kingdom
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Abstract
Mastocytosis is a disease characterized by an abnormal increase in mast cells. Rare in occurrence, protean in its manifestations, it is a disease which is very seldom thought of and hence, possibly even overlooked. The last few decades have witnessed an upsurge in the understanding of the physiology and pathobiology of mast cells. Better means for diagnosis and follow-up have become available. Once a diagnosis is established histamine antagonists remain the mainstay of treatment. Most patients live and die with the disease rather than of it. The objective of this review is to discuss this entity with a special focus on diagnosis and treatment.
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Affiliation(s)
- U Karnam
- Department of Gastroenterology, University of Miami, Fla., USA
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Sade K, Dotan I, Levo Y. [Systemic mastocytosis]. Harefuah 2000; 139:202-6, 245. [PMID: 11062953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Mastocytosis has a highly variable clinical expression, and systemic mastocytosis is occasionally associated with a myeloproliferative or a myelodysplastic disorder. These patients often present without skin involvement and have a very poor prognosis. We report a 72-year-old man with this condition who had spells of flushing and dyspnea, myelofibrosis, and high serum and urine histamine levels.
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Affiliation(s)
- K Sade
- Dept. of Pulmonary Diseases, Tel Aviv-Sourasky Medical Center
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Albitar M, Freireich EJ. Molecular defects in chronic myeloproliferative disorders. Mol Med 2000; 6:555-67. [PMID: 10997337 PMCID: PMC1949970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
MESH Headings
- Chromosomes, Human, Pair 8/genetics
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Hypereosinophilic Syndrome/genetics
- Hypereosinophilic Syndrome/physiopathology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Mastocytosis/genetics
- Mastocytosis/physiopathology
- Mutation
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/physiopathology
- Signal Transduction
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Affiliation(s)
- M Albitar
- Department of Leukemia, The University of Texas M.D. Anderson Cancer Center, Houston 77030-4095, USA.
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Gay J, Fioramonti J, Garcia-Villar R, Buéno L. Alterations of intestinal motor responses to various stimuli after Nippostrongylus brasiliensis infection in rats: role of mast cells. Neurogastroenterol Motil 2000; 12:207-14. [PMID: 10867617 DOI: 10.1046/j.1365-2982.2000.00201.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Nippostrongylus brasiliensis infection induces jejunal mastocytosis associated with enteric nerve remodelling in rats. The aim of this study was to evaluate the intestinal motility responses to meals and to neurotransmitters involved in the control of gut motility (acetylcholine (carbachol), substance P and neurokinin A) in both control and N. brasiliensis-infected rats 30 days post-infection. All rats were equipped with NiCr electrodes in the jejunum to record myoelectrical activity. The duration of disruption of the jejunal migrating myoelectrical complexes (MMC) induced by the different stimuli was determined. Meal ingestion and substance P administration disrupted the MMC pattern for similar durations in the two groups. Carbachol and neurokinin A induced a significantly longer MMC disruption in post-infected rats than in controls (125 +/- 8.3 vs. 70 +/- 6 min for carbachol 100 microg kg-1 and 51 +/- 4 vs. 40 +/- 2 for neurokinin A 50 microg kg-1). The enhanced motor response in postinfected rats was reduced by previous mast cell stabilization with ketotifen or mast cell degranulation with compound BrX 537 A. In conclusion, the increased intestinal motor reactivity to carbachol and neurokinin A in post-N. brasiliensis-infected rats depends upon intestinal mast cell hyperplasia and degranulation.
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Affiliation(s)
- J Gay
- Neuro-Gastroenterology and Nutrition Unit, Institut National de la Recherche Agronomique, Toulouse, France
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Duché A. [Systemic mastocytosis]. Presse Med 1999; 28:1955-8. [PMID: 10598159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
UNLABELLED HEMATOPOIESIS DISORDER: Systemic mastocytosis is a primary proliferation of mast cells in several noncutaneous tissues. It remains an uncommon disease, difficult to diagnosis and often missed. The spectrum of clinical signs is wide and the course and prognosis are quite variable. CLINICAL ASPECTS Sudden release of mediators by mast cell degranulation lead manifestations of paroxysmal congestion. Pigmentary urticaria is the most frequent cutaneous form. Among visceral localizations, bone involvement is encountered in 90% of the cases, digestive tract and hematological involvement are less frequent. Respiratory and cardiovascular involvement is exceptional. DIAGNOSIS Osteomedullary biopsy is required for diagnosis. Urinary histamine metabolites may be suggestive. PROGNOSIS Prognosis depends on the presence of an associated hematological disorder, found in 30% of the cases. TREATMENT Symptomatic treatment is the rule, aimed at blocking histamine release by mast cell degranulation and avoid the subsequent paroxysmal manifestations.
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Affiliation(s)
- A Duché
- Service de Médecine Interne, CHU Nord, Amiens
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Kurosawa M, Inamura H, Amano H, Kanbe N, Nagata H, Nagai H, Furukawa S, Miyachi Y. Nerve growth factor release with mast-cell-derived mediators in a patient with systemic mastocytosis after middle-wave ultraviolet irradiation. Allergy 1999; 54:994-8. [PMID: 10505465 DOI: 10.1034/j.1398-9995.1999.00204.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The symptoms of a 56-year-old man with systemic mastocytosis became worse with exposure to sunlight. We evaluated mast-cell-derived mediators and cytokines before and after exposure to ultraviolet light in the patient. METHODS The patient was irradiated with middle-wave ultraviolet light, so-called ultraviolet light B, and the levels of mediators and cytokines were measured serially. The point mutation Asp816Val in c-kit was investigated by analyzing polymerase chain reaction products from the complementary DNA of peripheral blood mononuclear cells. RESULTS Before irradiation, the levels of mast-cell-derived mediators and metabolites were elevated. Among various cytokines measured, including soluble c-kit and stem cell factor, only the level of nerve growth factor was elevated. After irradiation, the nerve growth factor level was further increased along with the levels of mast-cell-derived mediators and metabolites. The point mutation Asp816Val in c-kit was not detected in peripheral blood mononuclear cells. CONCLUSIONS Middle-wave ultraviolet light may activate mast cells to release nerve growth factor and mediators in systemic mastocytosis.
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Affiliation(s)
- M Kurosawa
- Department of Geriatric Medicine, Hirosaki University School of Medicine, Japan
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45
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Alto WA, Clarcq L. Cutaneous and systemic manifestations of mastocytosis. Am Fam Physician 1999; 59:3047-54, 3059-60. [PMID: 10392589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Mastocytosis is characterized by an excessive number of apparently normal mast cells in the skin and, occasionally, in other organs. Characteristic skin lesions, called urticaria pigmentosa, are present in most patients, but clinical presentation can vary from a pruritic rash to unexplained collapse and sudden death. These lesions are typically tan to red-brown macules that appear on the trunk and spread symmetrically. Patients with mastocytosis often have a long history of chronic and acute symptoms that were unrecognized as mastocytosis. Skin lesions may or may not accompany systemic mastocytosis. Systemic disease may involve the gastrointestinal tract, the bone marrow or other organs. Even when the disease is considered as a possibility by the physician, the diagnosis can be difficult because of special technical requirements necessary for biopsy and because of the problems with biochemical testing. Drug therapy is initiated to stabilize mast cell membranes, to reduce the severity of the attacks and to block the action of inflammatory mediators. The mainstay of therapy is histamine H1 and H2 blockers and the avoidance of triggering factors.
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Affiliation(s)
- W A Alto
- Maine-Dartmouth Family Practice Residency, Fairfield, Maine 04937, USA
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46
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Terada H. [Systemic mastocytosis]. Ryoikibetsu Shokogun Shirizu 1998:152-5. [PMID: 9833458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- H Terada
- Department of Internal Medicine, St. Luke's International Hospital
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Hagen W, Schwarzmeier J, Walchshofer S, Zojer N, Chott A, Sillaber C, Ackermann J, Simonitsch I, Bühring HJ, Drach J, Lechner K, Horny HP, Valent P. A case of bone marrow mastocytosis associated with multiple myeloma. Ann Hematol 1998; 76:167-74. [PMID: 9619735 DOI: 10.1007/s002770050382] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Mastocytosis is a term used for a spectrum of disorders characterized by abnormal growth and accumulation of mast cells. The cutaneous variants of the disease have to be distinguished from systemic mastocytosis (SM), in which at least one extracutaneous organ is involved. In contrast to cutaneous mastocytosis, SM is often associated with another hematologic neoplasm. In most cases clonal myeloid malignancies such as a myeloproliferative or myelodysplastic syndrome occur. In a few cases of SM, however, clonal lymphoid disorders have been described. We here report on a case of SM associated with multiple myeloma. At first presentation, the 48-year old female patient showed monoclonal IgGlambda gammopathy and bone marrow (BM) mastocytosis, but no BM plasma cell infiltrates. Eight years later, the patient presented with BM mastocytosis and overt multiple myeloma. The co-existence of myeloma and mastocytosis was demonstrable by staining serial BM sections with antibodies against mast cell tryptase, CD68R, and the plasma cell marker VS38c. Interphase FISH analysis of BM sections revealed a numeric gain of chromosome 5 and chromosome 7 in the plasma cells but not in the mast cell infiltrates, thereby confirming the presence of two different neoplastic cell populations. To our knowledge, this is the first report describing the co-existence of multiple myeloma and mastocytosis.
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Affiliation(s)
- W Hagen
- Department of Internal Medicine I, University of Vienna, Austria
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Christofidou-Solomidou M, Longley BJ, Whitaker-Menezes D, Albelda SM, Murphy GF. Human skin/SCID mouse chimeras as an in vivo model for human cutaneous mast cell hyperplasia. J Invest Dermatol 1997; 109:102-7. [PMID: 9204963 DOI: 10.1111/1523-1747.ep12276733] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human skin xenografted to mice with severe combined immunodeficiency syndrome (SCID) was evaluated to determine the integrity and fate of human dermal mast cells. There was an approximately 3-fold increase in number of dermal mast cells by 3 mo after engraftment (p < 0.05). These cells were responsive to conventional mast cell secretagogues and were confirmed to be of human origin by ultrastructural characterization of granule substructure and by reactivity for the human mast cell proteinase, chymase. CD1a+ Langerhans cells, also bone marrow-derived cells, failed to show evidence of concomitant hyperplasia, and increased mast cell number was not associated with alterations in number of dermal vascular profiles identified immunohistochemically for human CD31. RT-PCR analysis demonstrated human but not murine stem cell factor (SCF; also termed mast cell growth factor, c-kit ligand) mRNA in xenografts. Epidermal reactivity for stem cell factor protein shifted from a cytoplasmic pattern to an intercellular pattern by 3 mo after engraftment, suggesting a secretory phenotype, as previously documented for human cutaneous mastocytosis. The majority (>90%) of mast cells demonstrated membrane reactivity for human SCF at the time points of peak hyperplasia. These data establish SCID mouse recipients of human skin xenografts as a potential in vivo model for cutaneous mast cell hyperplasia.
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Li L, Krilis SA. Conditioned media obtained from a human mastocytosis cell strain induce mast cells expressing chymase but not tryptase from human progenitors. Int Arch Allergy Immunol 1997; 113:289-90. [PMID: 9130552 DOI: 10.1159/000237576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Human mast cells (MC) were derived from umbilical cord blood and bone marrow progenitors cultured in the presence of a conditioned medium from a human mastocytosis cell strain and recombinant human kit ligand (rhKL). KL induced MC of predominantly two immunophenotypes, MC(T) and MC(TC). In contrast, the conditioned medium induced MC subtypes MC(TC) and a third subtype, MC(C), positive for chymase but negative for tryptase. This study clearly demonstrates that a third type of MC, MC(C), can be induced in vitro from normal human progenitors.
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Affiliation(s)
- L Li
- School of Medicine, University of New South Wales and Department of Immunology, Allergy and Infectious Disease, St. George Hospital, Kogarah, Australia
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