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Gelmez MY, Cinar S, Cetin EA, Ozcit-Gürel G, Babuna-Kobaner G, Erdugan M, Gul A, Akdag-Kose A, Deniz G. Inflammatory status might direct ILC and NK cells to IL-17 expressing ILC3 and NK subsets in Behcet's disease. Immunol Lett 2021; 235:1-8. [PMID: 33901541 DOI: 10.1016/j.imlet.2021.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 01/20/2021] [Revised: 04/07/2021] [Accepted: 04/18/2021] [Indexed: 01/06/2023]
Abstract
Innate lymphoid cells (ILCs) are lymphoid cells that have important effector and regulatory functions in innate immunity and tissue remodeling. Uncontrolled activation and proliferation of ILCs can contribute to inflammatory autoimmune diseases. Behcet's disease (BD) is a complex systemic inflammatory disorder of unknown etiology. It has been shown that natural killer (NK) cells may play an immunoregulatory role in BD, however the role of ILCs is unknown. In this study, the levels and functions of ILCs and NK cell subsets in BD patients were investigated. Cell surface and cytotoxic granules (perforin and granzyme) expression of NK cells and ILCs were evaluated and labeled according to whole blood lysing protocol in peripheral blood samples obtained from the patients and healthy subjects. Cytokine levels of NK cells were investigated in stimulated peripheral blood mononuclear cells. All data were analyzed by flow cytometry. Total ILC and ILC3+ cells were increased in active BD patients compared to inactive BD patients and healthy subjects. There was no significant difference between the patients and healthy subjects regarding NK cell surface and intracellular molecule expression. Although, an increase in IFN-γ and IL-17, and a decrease in IL-4 levels were observed in CD56dim NK cell subset of BD patients. Recent studies showed increased neutrophilic infiltration and IL-17 secreting Th17 cells in BD patients. It is known that ILC3+cells are similar to Th17 subset regarding their cytokine profile and transcription factor expression patterns. Results of current study may suggest that inflammatory microenvironment in BD patients might direct ILC cells to differentiate into ILC3+ subset, and IL-17 released by NK cells might have a role in neutrophilic infiltration.
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Affiliation(s)
- Metin Yusuf Gelmez
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Istanbul University, Istanbul, Turkey
| | - Suzan Cinar
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Istanbul University, Istanbul, Turkey
| | - Esin Aktas Cetin
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Istanbul University, Istanbul, Turkey
| | - Gulce Ozcit-Gürel
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Istanbul University, Istanbul, Turkey
| | | | - Murat Erdugan
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Afet Akdag-Kose
- Department of Dermatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Gunnur Deniz
- Department of Immunology, Aziz Sancar Institute of Experimental Medicine (Aziz Sancar DETAE), Istanbul University, Istanbul, Turkey.
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Abstract
In this both narrative and systematic review, we explore the role of TNF-α in the immunopathogenesis of Behçet's disease (BD) and the effect of treatment with TNF-α blockers. BD is an auto-inflammatory disease, characterized by recurrent painful oral ulcerations. The pathogenesis of BD is not yet elucidated; it is assumed that TNF-α may play a key role. In the narrative review, we report an increased production of TNF-α, which may be stimulated via TLR-signaling, or triggered by increased levels of IL-1β and IFN-γ. The abundance of TNF-α is found in both serum and in sites of inflammation. This increased presence of TNF-α stimulates T-cell development toward pro-inflammatory subsets, such as Th17 and Th22 cells. Treatment directed against the surplus of TNF-α is investigated in the systematic review, performed according to the PRISMA guideline. We searched the Pubmed and Cochrane database, including comparative studies only. After including 11 studies, we report a beneficial effect of treatment with TNF-α blockers on the various manifestations of BD. In conclusion, the pivotal role of TNF-α in the immunopathogenesis of BD is reflected in both the evidence of their pro-inflammatory effects in BD and in the evidence of the positive effect of treatment on the course of disease in BD.
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Affiliation(s)
| | - Jan van Laar
- Section of Clinical Immunology, Departments of Internal Medicine and Immunology, ErasmusMC, 3015 GD Rotterdam, The Netherlands;
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Abstract
Behçet's disease (BD) is presumably an autoinflammatory disease of unknown etiology for which several animal models have been described over the years. Agents and methods used for the development of these models have ranged from the herpes simplex type one virus (hsv-1) pathogen to the use of transgenic mice. Other models have also been used to investigate a possible autoimmune component. Each model possesses its own unique set of benefits and shortcomings, with no one model fully being able to recapitulate the disease phenotype. Here, we review the proposed models and provide commentary on their effectiveness and usefulness in studying the disease.
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Affiliation(s)
- Jermilia Charles
- W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Francis J. Castellino
- W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN 46556, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Victoria A. Ploplis
- W.M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN 46556, USA
- Department of Chemistry and Biochemistry, University of Notre Dame, Notre Dame, IN 46556, USA
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4
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Emmi G, Prisco D. Behçet's syndrome: focus on pathogenetic background, clinical phenotypes and specific treatments. Intern Emerg Med 2019; 14:639-643. [PMID: 31317313 DOI: 10.1007/s11739-019-02154-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy
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5
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Abstract
Environmental and other triggering factors are suggested to cause the onset and the clinical relapses of Behçet's syndrome (BS), a multi-systemic inflammatory disorder. In this review, environmental factors are discussed according to their interactions with etiopathogenesis, immune response and disease activity. Stress is a common self-triggering factor for most BS patients. Stimuli such as some foods can activate oral ulcers, and may be linked to the histamine content of the food. Oral/skin trauma and menstruation associated with hormonal factors aggravate, whereas allergy/atopy seem to alleviate the symptoms of BS. Infections are associated with BS, and microbial stimuli can activate inflammation in mucosal surfaces with increased Th1/Th17 responses. Fecal and oral microbiome patterns change in diversity and composition in BS. Better oral hygiene applications and anti-microbial interventions might be helpful to suppress oral ulcers in BS.
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Affiliation(s)
- Gonca Mumcu
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey.
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Abstract
Behcet's disease is a rare systemic vasculitis disorder of unknown etiology characterized by recurrent attacks of acute inflammation affecting multiple parts of the body.
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Abstract
BACKGROUND Behçet's disease (BD) is a complex multisystemic disease with an unknown origin, which presents with aphthous and genital ulcers, cutaneous lesions, arthritis, ocular lesions, and defects in the gastrointestinal and central nervous systems. OBJECTIVES In this study, we examined the relationship between serum interleukin-20 (IL-20) levels and disease activity in BD patients. MATERIAL AND METHODS A total of 45 BD patients diagnosed according to the BD diagnosis criteria determined by the International Study Group for Behçet's Disease were included in the study. Out of 45 patients, 17 had inactive BD and 28 had active BD. The control group consisted of 25 healthy subjects. The IL-20 levels of all the groups were detected and compared with each other. Serum IL-20, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were examined. RESULTS The IL-20 levels of the active BD patient group were significantly higher than in the control group (p < 0.001) and in the inactive BD patient group (p < 0.001). No statistically significant difference was detected between the IL-20 levels of the control group and the inactive BD patient group (p = 0.2). CONCLUSIONS Higher IL-20 levels in active BD patients, when compared to inactive BD patients and healthy controls indicate that the disease is an inflammatory one and IL-20 plays a role in the disease pathogenesis. Moreover, it can be concluded that IL-20 might have a role in the complex process of the settlement and activation of the disease.
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Affiliation(s)
- Mehmet Emin Enecik
- Department of Rheumatology, Ankara Numune Training and Research Hospital, Turkey
| | - Barış Mavi
- Department of Internal Medicine, Mersin State Hospital, Turkey
| | - Çiğdem Yücel
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Turkey
| | - Göksal Keskin
- Department of Immunology and Allergy, Medical Faculty, Ankara University, Turkey
| | - Mehmet Yıldız
- Department of Internal Medicine, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Islam SMS, Sohn S. HSV-Induced Systemic Inflammation as an Animal Model for Behçet's Disease and Therapeutic Applications. Viruses 2018; 10:v10090511. [PMID: 30235840 PMCID: PMC6163530 DOI: 10.3390/v10090511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/14/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
Behçet’s disease (BD) affects multiple organs. It is mainly characterized by recurrent oral, skin, and genital aphthous ulcers, and eye involvement. Successful management of BD is increasing, although its etiology remains unclear. A number of etiologies have been proposed, including environmental, genetic, viral, and immunological factors. To understand its complex etiology and improve its management, animal models of BD have been used to enable more effective therapeutic applications with increased clinical significance. An herpes simplex virus (HSV) type 1-induced BD mouse model has shown disease characteristics similar to those seen in BD patients. An HSV-induced BD animal model has been used to test various therapeutic modalities. The applied modalities are several materials that are derived from natural products, conventional therapeutics, and possible biologics. In this review, we provided how they regulate inflammation in an HSV-induced BD model.
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Affiliation(s)
- S M Shamsul Islam
- Department of Biomedical Science, Ajou University School of Medicine, Suwon 16499, Korea.
| | - Seonghyang Sohn
- Department of Biomedical Science, Ajou University School of Medicine, Suwon 16499, Korea.
- Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Korea.
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Ozlu E, Karadag AS. Behçet Disease: New Developments in the Etiopathogenesis of an Old Silk Road Disease. Skinmed 2018; 16:176-181. [PMID: 29989537] [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: 06/08/2023]
Abstract
Behçet disease (BD) is a systemic inflammatory disorder that affects the skin, mucosa, eyes, joints, blood vessels, brain, and gastrointestinal tract. The etiopathogenesis of BD has not yet been fully elucidated, but disorganized immune responses against the stimuli of environmental triggering factors have been considered to play a major role in the pathogenesis of the disease in individuals with genetic susceptibility. Human leukocyte antigen (HLA)-B*51 is known to be the main factor involved in genetic susceptibility to BD. Among the environmental factors, infectious agents in particular are thought to be important. Immunological abnormalities could thus be the cornerstone in the development of BD. Along with cytokines that play a role in disease pathogenesis, numerous other cytokines have been recently identified or have been the focus of recent studies. This contribution sheds light on the etiopathogenesis and immunology of BD in relation to the current literature.
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Affiliation(s)
- Emin Ozlu
- Department of Dermatology, Duzce University School of Medicine, Duzce, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology, Istanbul Medeniyet University School of Medicine, Istanbul, Turkey;
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Palizgir MT, Akhtari M, Mahmoudi M, Mostafaei S, Rezaeimanesh A, Akhlaghi M, Shahram F. Macrophages from Behcet's Disease Patients Express Decreased Level of Aryl Hydrocarbon Receptor (AHR) mRNA. Iran J Allergy Asthma Immunol 2017; 16:418-424. [PMID: 29149781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 10/28/2017] [Indexed: 06/07/2023]
Abstract
Aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor, connecting environmental stimulators with the immune system. M1 macrophages are a part of immune system that contribute to the inflammatory events in the pathogenesis of Behcet's disease (BD). The effect of AHR on the macrophages in BD patients is still unclear. In this study, we investigated the mRNA expression of AHR in the monocyte-derived and M1 macrophages in active BD patients in comparison to healthy controls. Isolated monocytes from 10 healthy controls and 10 active BD patients were differentiated to macrophages by macrophage-colony stimulating factor (M-CSF) for 7 days. Cells were then polarized to M1 macrophages by lipopolysaccharide (LPS) and interferon-γ (IFNγ) for 24h. Monocyte purity and macrophage markers expression were analyzed by flow cytometry. Analysis of AHR mRNA expression was performed by SYBR Green real-time PCR. Our results showed that AHR expression is significantly down-regulated in M1 macrophages compare to monocyte-derived macrophages. It was shown that both monocyte-derived macrophages and M1 macrophages from BD patients significantly express lower level of AHR mRNA compared to healthy individuals. Our results demonstrate an anti-inflammatory role for AHR in macrophages, which suggest that decreased AHR expression is associated with pro-inflammatory M1 macrophage and BD susceptibility.
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Affiliation(s)
| | - Maryam Akhtari
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran AND Department of Cell and Molecular Biology, University of Tehran, Tehran, Iran
| | - Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sceinces, Tehran, Iran
| | - Shayan Mostafaei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Rezaeimanesh
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoomeh Akhlaghi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Liu HM, Dong C, Zhang YZ, Tian YY, Chen HX, Zhang S, Li N, Gu P. Clinical and imaging features of spinal cord type of neuro Behçet disease: A case report and systematic review. Medicine (Baltimore) 2017; 96:e7958. [PMID: 28984755 PMCID: PMC5737991 DOI: 10.1097/md.0000000000007958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 01/20/2023] Open
Abstract
RATIONAL To investigate the clinical and MRI characteristics of spinal cord nerve Behçet's disease. PATIENT CONCERNS One patient with spinal cord nerve Behçet's disease was admitted to our hospital at October 20, 2015. DIAGNOSE Spinal cord nerve Behçet's disease. INTERVENTIONS Retrospective analysis was performed on such case as well as 16 cases of spinal cord nerve Behçet's disease reported in China or abroad. OUTCOMES Seventeen cases of spinal cord type of neuro Behçet's disease include 13 men and 4 women, with an average age of onset of 34.8 years old. The mean time from Behçet's disease symptoms to spinal cord involvement were 10.8 years. The initial symptom in one case was spinal cord injury, and another 4 cases had a recurrence course. The most common performance of spinal cord injury was sensory disturbance (82.4%), following by weakness (76.5%), sphincter or sexual dysfunction (58.8%), and pain in back, backside of neck or lower chest (29.4%). The number of cells was slightly increased or the protein level was increased in cerebrospinal fluid test. And the water channel protein antibody and oligoclonal band of serum levels were all negative. The spinal cord injury involved more than 3 vertebral bodies in 10 cases, and involved more than half of spinal cord in sagittal plane in 8 cases. In acute stage, shock therapy with large dose of glucocorticoid was generally applied both in China and abroad. LESSONS The clinical features of spinal cord nerve Behçet's disease were various, making it easily misdiagnosed. Longitudinal extensive transverse myelitis performs as a characteristic manifestation.
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Affiliation(s)
- Hui-Miao Liu
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ci Dong
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Yong-Zhi Zhang
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ya-Yun Tian
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Hong-Xu Chen
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Sai Zhang
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Na Li
- Department of Neurology, the First Hospital of Hebei Medical University
| | - Ping Gu
- Department of Neurology, the First Hospital of Hebei Medical University
- Brain Ageing and Cognitive Neuroscience Laboratory of Hebei, Shijiazhuang, Hebei, China
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12
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Hosseini A, Shanehbandi D, Estiar MA, Gholizadeh S, Khabbazi A, Khodadadi H, Sakhinia E, Babaloo Z. A Single Nucleotide Polymorphism in the FOXP3 Gene Associated with Behçet's Disease in an Iranian Population. Clin Lab 2016; 61:1897-903. [PMID: 26882813 DOI: 10.7754/clin.lab.2015.150433] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
UNLABELLED Background: Behçet's Disease (BD) is a rare autoimmune disease that involves the dysfunction of regulatory T cells. FOXP3 is a key transcription factor in the development and function of T(reg) cells. Recent studies have shown SNPs in the FOXP3 contribute to the susceptibility to some autoimmune disorders. METHODS To clarify the association between the FOXP3 gene and the risk of BD, 50 patients diagnosed with BD and 50 healthy controls from north-western Iran were genotyped by PCR-RFLP (Mun I and Pst I) for two SNPs including rs3761547 (-3499T/C) and rs3761548 (-3279 C/A) in the promoter region of the FOXP3 gene. In addition, a 506 bp nucleotide sequence of FOXP3 promoter was analyzed. RESULTS The allele -3279 C/A was significantly associated with BD [p = 0.002; odds ratio (OR) = 3.841; 95% confidence interval (CI) 1.610 - 9.161]; whereas, there was no contribution of the FOXP3 polymorphism -3499T/C to BD [(p = 0.084); (OR = 0.348, 95% CI = 0.101 - 1.195)]. Meanwhile, sequence analysis showed 100% similarity in both controls and BD patient groups. CONCLUSIONS Therefore, the SNP rs3761548 in the FOXP3 gene appears to contribute to the risk of Behçet's disease among the north-western Iranian population.
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Zhang L, Xu Y, Peng Y, Yan B, Liu Y. Behçet's disease-like syndrome secondary to microbial infection: a case report and review of the literature. Int J Clin Exp Pathol 2015; 8:13619-13624. [PMID: 26722585 PMCID: PMC4680530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/23/2015] [Indexed: 06/05/2023]
Abstract
Behçet's disease (BD)-like syndrome is an extremely rare situation occurred after Mycobacterium tuberculosis infection and virus infection. We reported a 45-year-old woman who visited our hospital complaining of swollen left ankle, painful genital ulcer, redness in the left eye and skin rash on lower limbs. The patient had a history of pleural tuberculosis and had received anti-tuberculous therapy for one year. Her left cervical lymph node sample demonstrated tubercle bacilli DNA fragmentation. The diagnosis of tuberculous lymphadenitis and Behçet's disease (BD)-like syndrome were made. This patient's symptoms remitted following treatment with anti-tuberculous therapy. This case indicates that some microbial infection can trigger the onset of BD-like syndrome in genetically susceptible subjects. However, treatment strategy of BD-like syndrome secondary to infection is totally different from primary BD. The aim of this case report is to present our experience of the different clinical signs and treatment of BD-like syndrome to expedite its early diagnosis in future. Combination of clinical, radiological, immunophenotypic, pathological, and genetic data contribute to improving the rate of diagnosis.
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Affiliation(s)
- Lingshu Zhang
- Department of Rheumatology and Immunology, West China Hospital, Sichuan UniversityChengdu, China
| | - Yuan Xu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Sichuan Medical UniversityLuzhou, China
| | - Yun Peng
- Department of Rheumatology and Immunology, West China Hospital, Sichuan UniversityChengdu, China
| | - Bing Yan
- Department of Rheumatology and Immunology, West China Hospital, Sichuan UniversityChengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, West China Hospital, Sichuan UniversityChengdu, China
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Hisanaga K. [Neuro-Sweet disease]. Nihon Rinsho 2015; 73 Suppl 7:680-684. [PMID: 26480777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Azizi G, Simhag A, El Rouby NMM, Mirshafiey A. Th22 Cells Contribution in Immunopathogenesis of Rheumatic Diseases. Iran J Allergy Asthma Immunol 2015; 14:246-54. [PMID: 26546892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 06/05/2023]
Abstract
Newly identified T helper cell 22 (Th22) is a subset of CD4+T cells with specific properties apart from other known CD4+ T cell subsets with distinguished gene expression and function. Th22 cells are characterized by production of a distinct profile of effector cytokines, including interleukin (IL)-22, IL-13, and tumor necrosis factor-α (TNF-α). The levels of Th22 and related cytokine IL-22 are increased in various autoimmune diseases and positively associated with some rheumatic diseases such as rheumatoid arthritis, systemic lupus erythematosus, behcet's disease, ankylosing spondylitis and psoriatic arthritis. In summary, IL-22 and Th22 cells play a significant and complicated role in inflammatory and autoimmune rheumatic diseases, therefore, targeting IL-22 or Th22 have unique and attractive advantages due to the fact that Th22 subset is recently identified and its associated research is extremely limited. This review discusses the role of Th22 and its cytokine IL-22 in the immunopathogenesis of rheumatic disease.
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Affiliation(s)
- Gholamreza Azizi
- Imam Hassan Mojtaba Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Anita Simhag
- Karolinska Institutet Science Park AB, Huddinge, Sweden
| | | | - Abbas Mirshafiey
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Keskin D, Keskin G, Inal A, Ozışık L. Serum angiostatin levels in patients with Behçet's disease: does angiogenesis play a role in the pathogenesis of Behçet's disease? Acta Clin Belg 2014; 69:246-50. [PMID: 25012748 DOI: 10.1179/2295333714y.0000000030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Angiogenesis plays an important role in the pathogenesis of inflammatory diseases, but the possible role of angiogenesis in Behçet's disease (BD) has not yet been studied. The aim of this study was to determine angiostatin levels in patients with BD and the role of angiogenesis in the pathogenesis of the disease. Thirty-seven patients with BD (mean age: 28·6±5·4 years, mean disease duration: 9·3±3·7 years) and 18 healthy controls were enrolled to the study. Twenty-four patients were in active and 13 patients were in inactive stage of the disease. The mean serum angiostatin level of patients with BD was 113·9±53·2 and 60·7±20·1 ng/ml in healthy controls. The mean serum angiostatin level was 142·7±43·1 ng/ml in active and 86·9±15·5 ng/ml in inactive patients with BD. Serum angiostatin levels were significantly high in patients with BD compared with healthy controls (P<0·001) and it was significantly high in active patients compared with inactive patients with BD (P<0·001). In inactive patients with BD, serum angiostatin concentrations were found to be higher compared with healthy controls (P<0·01). In active BD patients, the mean serum angiostatin level was correlated with the deep vein thrombosis (r = 0·482, P = 0·05), uveitis (r = 0·582, P = 0·01), and arthritis (r = 0·492, P = 0·05). According to these results; elevated serum angiostatin levels in patients with BD suggest the possible role of angiogenesis in the pathogenesis of the disease and its high levels in inactive Behçet's patients is related with the continuous activation of the disease even in the subclinical period.
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Dervis E, Geyik N. Sensitivity and Specificity of Different Diagnostic Criteria for Behçet's Disease in a Group of Turkish Patients. J Dermatol 2014; 32:266-72. [PMID: 15863848 DOI: 10.1111/j.1346-8138.2005.tb00760.x] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 07/10/2004] [Accepted: 11/30/2004] [Indexed: 11/29/2022]
Abstract
Because there are no diagnostic laboratory tests or histopathologic findings, the diagnosis of Behçet's disease (BD) is based on clinical criteria. Various diagnostic criteria have been proposed. In this study, we assessed the sensitivity, specificity and the relative value of the Mason & Barnes, Japanese, Hamza, O'Duffy, Cheng & Zhang, Dilşen and International Study Group (ISG) criteria. Two hundred twenty-eight patients with Behçet's disease diagnosed according to either O'Duffy's or ISG criteria and 89 control patients with a variety of connective tissue diseases, including sarcoidosis, uveitis, erythema nodosum, and granulomatous intestinal disease, were evaluated. ISG and Hamza criteria showed the highest specificity (100%) in discriminating control subjects from the entire cohort. The highest sensitivity value (100%) was found in the Cheng & Zang criteria, which were found to be the most sensitive but the least specific (74.2%). The Hamza criteria had the highest relative value (sensitivity plus specificity) (198.2). Dilşen (196.9) and ISG (196.5) criteria also had high relative values. In this study, Hamza, Dilşen, and ISG criteria performed quite well in diagnosing BD in our country compared to the other criteria sets.
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Affiliation(s)
- Emine Dervis
- Department of Dermatology, Haseki General Hospital, Istanbul, Turkey
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18
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Emmi G, Silvestri E, Squatrito D, D'Elios MM, Ciucciarelli L, Prisco D, Emmi L. Behçet's syndrome pathophysiology and potential therapeutic targets. Intern Emerg Med 2014; 9:257-65. [PMID: 24415351 DOI: 10.1007/s11739-013-1036-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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] [Received: 09/15/2013] [Accepted: 12/13/2013] [Indexed: 12/14/2022]
Abstract
Behçet syndrome is a systemic inflammatory disorder characterized by multiorgan involvement such as oral and genital ulcers, uveitis, skin lesions as well as by less frequent, but often more severe, central nervous system and vascular manifestations. The pathogenetic mechanisms are still incompletely known; however the interaction between a specific genetic background and environmental or infectious factors certainly contributes to the immune dysregulation that characterizes this disease. The discovery of new immunological pathways in Behçet syndrome pathogenesis may help us to set up new treatments. In this review, we will focus our attention on the possible mechanisms underlying Behçet syndrome pathogenesis and their potential role as novel therapeutic targets.
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Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, L.go G. Brambilla 3, 50134, Florence, Italy,
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Abstract
A 48-year-old man visited our hospital complaining of a tender mass in the left side of the neck. He was diagnosed with tuberculous lymphadenitis based on the results of a biopsy. Shortly after the diagnosis, oral aphthae, erythema nodosum-like lesions on the lower legs and genital ulcers developed. A diagnosis of cutaneous tuberculosis was ruled out according to a negative mycobacterial culture of tissues obtained from stained smears and lesional biopsy specimens. The patient's symptoms remitted following the introduction of antituberculous therapy. We assume that tuberculous lymphadenitis was strongly associated with the appearance of Behçet's disease-like symptoms in this case.
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Affiliation(s)
- Shoichi Fukui
- Department of Connective Tissue Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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Vural B, Sehitoğlu E, Cavuş F, Yalçınkaya N, Haytural H, Küçükerden M, Ulusoy C, Uğurel E, Turan S, Bulut L, Türkoğlu R, Shugaiv E, Kürtüncü M, Atakan S, Güre AO, Gül A, Eraksoy M, Akman-Demir G, Tüzün E. Mitochondrial carrier homolog 1 (Mtch1) antibodies in neuro-Behçet's disease. J Neuroimmunol 2013; 263:139-44. [PMID: 24035008 DOI: 10.1016/j.jneuroim.2013.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Received: 03/20/2013] [Revised: 08/03/2013] [Accepted: 08/14/2013] [Indexed: 11/18/2022]
Abstract
Efforts for the identification of diagnostic autoantibodies for neuro-Behcet's disease (NBD) have failed. Screening of NBD patients' sera with protein macroarray identified mitochondrial carrier homolog 1 (Mtch1), an apoptosis-related protein, as a potential autoantigen. ELISA studies showed serum Mtch1 antibodies in 68 of 144 BD patients with or without neurological involvement and in 4 of 168 controls corresponding to a sensitivity of 47.2% and specificity of 97.6%. Mtch1 antibody positive NBD patients had more attacks, increased disability and lower serum nucleosome levels. Mtch1 antibody might be involved in pathogenic mechanisms of NBD rather than being a coincidental byproduct of autoinflammation.
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Affiliation(s)
- Burçak Vural
- Department of Genetics, Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
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Choi J, Lee ES, Choi B, Sohn S. Therapeutic potency of Poly I:C in HSV-induced inflammation through up-regulation of IL-15 receptor alpha. Immunobiology 2013; 218:1119-30. [PMID: 23618691 DOI: 10.1016/j.imbio.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Received: 02/13/2013] [Accepted: 03/20/2013] [Indexed: 11/19/2022]
Abstract
Interleukin-15 receptor alpha (IL-15Rα) forms stable complex with IL-15 on the cell surface of activated monocytes and mediates the proliferation of memory CD8+ T cells. Recent studies informed that polyinosinic:polycytidylic acid (Poly I:C) is an immunostimulant which boosts the generation of memory T cells through induction of IL-15Rα. The aim of this study is to evaluate the relevance of IL-15Rα in Herpes simplex virus (HSV)-induced Behçet's disease (BD) mouse model and BD patients. The frequencies of IL-15Rα expression in PBMCs of BD patients and BD-like symptomatic mice were analyzed by flow cytometry. In addition, Poly I:C supplementation could reduce inflammation through the up-regulation of memory T cells and IL-15Rα+ cells accompany with down-regulation of pro-inflammatory cytokine, IL-17A in BD mice. In BD patients, the frequencies of IL-15Rα expression in PBMCs were also significantly different between the inactive and active disease states. These results suggest that IL-15Rα is a relevant factor in BD.
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Affiliation(s)
- Juyoung Choi
- Laboratory of Cell Biology, Institute for Medical Sciences, Ajou University, Suwon, Republic of Korea
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Uva L, Miguel D, Pinheiro C, Filipe P, Freitas JP. Mucocutaneous manifestations of Behçet's disease. Acta Reumatol Port 2013; 38:77-90. [PMID: 24141344] [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: 06/02/2023]
Abstract
Behçet's disease is a relapsing multisystem polysymptomatic disease with exacerbations and remissions defined by the presence of the major symptom, recurrent oral aphthous ulcers, plus two of the following: recurrent genital ulceration, eye lesions, skin lesions or a positive pathergy test. Mucocutaneous manifestations like oral and genital ulcers, and cutaneous lesions (papulopustular lesions, erythema nodosum-like lesions, cutaneous ulcers, superficial thrombophlebitis), are considered the \"fingerprint\" of the disease, being the most common and often the first signs to appear. Although the exact etiopathogenesis is still not known, genetic predispose and environmental factors may influence and contribute to the development of this disease. Diagnosis is based in the International Study Group criteria. During the last years, this disease has been largely studied and new immunological data and treatment strategies have been postulated. Despite that, further studies and attention to new data are needed.
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Togashi A, Saito S, Kaneko F, Nakamura K, Oyama N. Skin prick test with self-saliva in patients with oral aphthoses: a diagnostic pathergy for Behcet's disease and recurrent aphthosis. Inflamm Allergy Drug Targets 2011; 10:164-70. [PMID: 21428910 PMCID: PMC3228232 DOI: 10.2174/187152811795564109] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 11/22/2010] [Accepted: 12/03/2010] [Indexed: 11/22/2022]
Abstract
There may be some difficulties to differentiate Behcet's disease (BD), recurrent aphthosis (RA), and herpetic aphthous ulceration, from other mimicking oral disorders. Despite of unexpected sensitivity and responsiveness, the skin pathergy test regarding a non specific hypersensitivity has long been thought as one of auxiliary diagnostic benefits for BD. To determine the potential usefulness and disease specificity of the prick reaction with saliva, a skin prick test with neat and filter-sterilized saliva was performed on the forearm skin of 26 individuals; 10 patients with BD (8 incomplete type without uveitis, 1 complete type, and 1 neurological type), 5 with RA, 3 with herpetic oral aphthosis, 2 with erythema nodosum alone, and 6 healthy controls. We assessed the skin reaction at 48 hours after pricking, and the pricked skin lesions were biopsied and analyzed immunohistologically. Nine of 10 BD patients (90 %) exhibited an indurative erythema at the skin site pricked with self-saliva, whereas 3 of 5 RA patients (60%) were relatively weak reaction. Pricking with filter-sterilized saliva failed to recapitulate any of positive skin reactions, albeit a faint erythematous dot appeared in a few BD patients, implicating the involvement of causative microorganism(s) in oral bacterial flora. Culture of saliva from 3 randomly chosen BD patients revealed numerous streptococcal colonies on Mitis-Salivarius agar. Histology of the pricked skin sites showed perivascular inflammatory infiltrates, composed of CD4+ T cells and CD68+ monocyte/macrophage lineage, a feature consistent with a delayed type hypersensitive reaction. Our results suggested that skin prick test using self-saliva (a new diagnostic pathergy) can be a simple and valuable in vivo diagnostic approach for differentiating BD and RA from other mimicking mucocutaneous diseases. The positive skin prick may be triggered by resident intra-oral microflora, particularly streptococci, and may in part address the underlying immunopathology in BD.
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Affiliation(s)
- Ari Togashi
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Sanae Saito
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Fumio Kaneko
- Institute of Dermato-Immunology and Allergy, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Fukushima 963-8563, Japan
| | - Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Noritaka Oyama
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima, Japan
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Direskeneli H, Mumcu G. A possible decline in the incidence and severity of Behçet's disease: implications for an infectious etiology and oral health. Clin Exp Rheumatol 2010; 28:S86-S90. [PMID: 20868578] [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] [Received: 01/24/2010] [Accepted: 03/26/2010] [Indexed: 05/29/2023]
Abstract
Behçet's disease (BD) is a systemic and inflammatory disorder mainly present along the ancient Silk Road, from the Mediterranean to East Asia. A wide range of prevalence figures (0.1-420/100.000) are reported for BD, also among populations of similar ethnicity living in different countries. Recently, a decline of the incidence of BD and a change of the disease spectrum to less severe mucocutaneous manifestations is reported from Japan, a genetically homogenous, affluent population with limited immigration. Among environmental factors, a change in atopy/allergic disorders and a decline in infections are two possible mechanisms for this epidemiological change. A shift in Th1/Th2 immune balance towards Th2-associated immune responses are possible, however 'hygiene hypothesis' associated with this approach does not explain the recent trend of the increase in Th1-associated disorders such as inflammatory bowel disease and multiple sclerosis in Western Countries. We hypothesise that a decline in oral infections, associated with the improvement in oral health in Japan, could be behind this decline. Better epidemiological studies in other populations will show whether this decline is a worldwide trend and may provide a better understanding of the environmental factors associated with the onset or relapses of BD, leading a way to new therapeutic approaches.
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Senel K, Pasa O, Baykal T, Ugur M, Levent A, Melikoglu M, Melikoglu MA. Behçet's disease associated with subarachnoid hemorrhage due to intracranial aneurysm. Acta Reumatol Port 2010; 35:391-392. [PMID: 20975647] [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: 05/30/2023]
Affiliation(s)
- Kazim Senel
- Department of Rheumatology, Ataturk University Medical Faculty, Erzurum, Turkey.
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Sánchez Sobrino P, Páramo Fernández C, Lamas Ferreiro JL, Mantiñán Gil B, Palmeiro Carballeira R, García-Mayor RV. [Behçet disease with isolated ACTH deficiency]. ACTA ACUST UNITED AC 2010; 56:463-6. [PMID: 20096211 DOI: 10.1016/s1575-0922(09)72968-7] [Citation(s) in RCA: 2] [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] [Received: 08/13/2009] [Accepted: 10/19/2009] [Indexed: 11/18/2022]
Abstract
We report a case of a patient with longstanding Behçet disease, with neurological symptoms predominantly, who became hospitalized for adrenal insufficiency, caused by isolated deficiency of corticotropin (DAACTH). DAACTH is a typical characteristic of hypophysitis, reported in association with many autoimmune diseases. Nevertheless, hypothalamic-pituitary injury in Behçet disease is exceptional. We review the literature and possible mechanisms of this association until now not reported.
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Affiliation(s)
- Paula Sánchez Sobrino
- Servicio de Endocrinología y Nutrición, Hospital Xeral, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España.
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Abstract
We report a patient with neuro Behçet's disease (BD) initially presenting with meningitis and severe hearing loss. A 51-year-old man with no noteworthy past history was hospitalized for evaluation of non-pulsating headache and high fever. Lumbar puncture on admission only showed slight pleocytosis (6 /microL, monomorphonuclear cells predominantly) but no evidence of meningitis. However, after admission, he continued to have a fever of over 38 degrees, and he developed painful oral aphthous ulcer and pseudofolliculitis on the upper limbs and trunk. Prior to admission he had often experienced oral ulceration and had bought commercially available mouthwash for prophylaxis. Subsequently, genital ulceration appeared. A small ulcer was observed at the blood collection site, leading to the diagnosis of BD. On the seventh hospital day, the patient developed sudden hearing loss, which was diagnosed as severe sensorineural hearing loss. Lumbar puncture was performed again. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis (60 /microL, predominantly monomorphonuclear cells), with high CSF IL-6 levels. Neither edematous change nor atrophy of the brainstem was noted and there were no other abnormal findings on the brain MRI/MRA. Auditory brainstem response was normal, suggesting that the patient had developed hearing loss due to peripheral neuropathy. We speculate that the hearing loss was likely due to vasculitis associated with BD. This case is considered to be a rare case of Behçet's disease caused by severe hearing loss and meningitis.
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Affiliation(s)
- Tomomi Kikuchi
- Division of Rheumatology, Itabashi Chuo Medical Center, Tokyo
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Abstract
Pathergy is the term used to describe hyper-reactivity of the skin that occurs in response to minimal trauma. A positive skin pathergy test (SPT), characterised by erythematous induration at the site of the needle stick with a small pustule containing sterile pus at its centre, is among the criteria required for a diagnosis of Behçet's disease (BD) and in certain population has been shown to be highly specific for this condition. Problems with standardising the induction manoeuvre for the SPT as well as the method of assessment of the response have limited the usefulness of the SPT in the clinical setting. Extensive investigation into histopathological and immunological aspects of pathergy has led to a number of hypotheses relating to the aetiology of the skin pathergy reaction and the disease itself, but the cause is considered to be unknown. Pathergy lesions, the development of new skin lesions or the aggravation of existing ones following trivial trauma, are also reported in pyoderma gangrenosum and has been noted in other neutrophilic dermatoses such as Sweet's syndrome. The response of such patient groups to the systematic application of the SPT has not been described. We propose that a new way of considering the pathergy reaction is to see it as an aberration of the skin's innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Our understanding of BD and other similar conditions would profit by more detailed mechanistic knowledge of skin homeostasis to minimal trauma in both health and disease through a more structured and systematic use of the SPT.
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Affiliation(s)
- Alexandra Varol
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
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Gönül M, Gül U, Kilinç C, Cakmak SK, Soylu S, Kiliç A. Homocysteine levels in patients with Behçet's disease and patients with recurrent aphthous stomatitis. Clin Rheumatol 2009; 28:1153-6. [PMID: 19575262 DOI: 10.1007/s10067-009-1214-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/25/2009] [Accepted: 06/03/2009] [Indexed: 11/26/2022]
Abstract
The mechanism for vascular involvement of Behçet disease (BD) includes arterial and venous thrombosis. Although the exact etiology of systemic vasculitis and thrombosis is still unknown, many hypotheses have been suggested. One of these hypotheses is that hyperhomocysteinemia causes vascular disease and thrombosis. The aim of this study was to compare the levels of homocysteine, vitamin B(12), and folic acid of BD patients with those of recurrent aphthous stomatitis (RAS) patients and healthy controls. Forty-five BD patients, 47 RAS patients, and 69 healty control subjects were included in this study. Vitamin B(12), folic acid, and homocysteine levels of the patients and controls were measured, and statistical differences among the groups were determined. BD patients had mostly cutaneous symptoms. Arthritis and ocular and vascular involvement were seen in 24.4%, 22%, and 11% of BD patients, respectively. No significant difference was detected among the groups in the levels of vitamin B(12), folic acid, and homocysteine. There was no significant difference in any parameters according to sex and age of the patients and activity of BD and if the patients with BD were treated or not. Homocysteine level inversely correlated with vitamin B(12) and folic acid levels in the BD group. We could not find any differences in homocysteine, vitamin B(12), and folic acid levels between BD and RAS patients and controls. This may be due to the fact that our patients mostly had cutaneous symptoms rather than vascular involvement.
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Affiliation(s)
- Müzeyyen Gönül
- 2nd Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Cakmak SK, Gül U, Kiliç A, Gönül M, Soylu S, Demirel O. Behçet's disease associated with chronic myelogenous leukemia and chronic graft-vs-host disease. Leuk Lymphoma 2009; 47:2674-5. [PMID: 17169820 DOI: 10.1080/10428190600925426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Six male patients out of seven with Behçet's disease were found to have a very similar and close contact with pigs and pork. These six cases are reported and we ask the question whether the contacts with pigs are just coincidental findings or whether an external agent, e.g. a virus, could be forwarded to man from pigs and pork. Immune complex associated vasculitis is described e.g. in patients with hepatitis B and the same mechanisms might be operating in patients with Behçet's disease.
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Kim JH, Cheon JH, Kim WH. [The frequency and the course of the adverse effects of azathioprine/6-mercaptopurine treatment in patients with inflammatory bowel disease]. Korean J Gastroenterol 2008; 51:291-297. [PMID: 18516013] [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: 05/26/2023]
Abstract
BACKGROUND/AIMS This study was to evaluate the frequency and the course of the adverse effects of AZA/6-MP in Korean patients with inflammatory bowel disease (IBD). METHODS Medical records of the patients with IBD treated with AZA/6-MP at Severance hospital from June 1996 to September 2006 were retrospectively analyzed. RESULTS A total of 133 patients were studied. Male to female ratio was 1.3:1. The mean age was 31.7+/-10.9 year. Adverse effects included leukopenia occurred in 75 cases (56.4%), nausea/vomiting in 32 cases (24.1%), arthralgia in 6 cases (4.5%), hepatitis in 6 cases (4.5%), skin rash in 4 cases (3.0%), herpes zoster in 3 cases (2.3%), and headache in 1 case (0.8%). Most of leucopenia (58.7%) developed within 3 months after maximal tolerated dose of AZA/6-MP and nausea/vomiting frequently occurred within 3 months after start of AZA/6-MP treatment. Thirty-eight patients (28.6%) required the discontinuation of medication due to adverse effects. CONCLUSIONS Leukopenia was the most common adverse effect of AZA/6-MP treatment. Leukopenia and nausea/vomiting developed frequently in the early period of treatment of AZA/6-MP in patients with IBD. AZA/6-MP should be used cautiously to scrutinize bone marrow suppression.
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Affiliation(s)
- Jae Hak Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
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Filik L. Behçet's disease and celiac disease: is there a controversial link? Acta Gastroenterol Belg 2008; 71:280. [PMID: 18720944] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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35
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Tinazzi I, Caramaschi P, Patuzzo G, Bambara LM, Biasi D. [Homocysteine and rheumatic disease]. Recenti Prog Med 2007; 98:646-652. [PMID: 18369042] [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: 05/26/2023]
Abstract
In the last decade hyperhomocysteinemia has become an element of great interest as a recognized factor of independent risk for atherotrombosis. Moreover a role has been suggested in some different diseases, like rheumatic ones. Hyperhomocysteinemia could represent a mechanism of amplification of vascular damage in rheumatic disease, therefore it could interact with treatements. Moreover it could contribute to explain the high incidence of cardiovascular events, than they do not find support in traditional risk factors.
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Affiliation(s)
- Ilaria Tinazzi
- Dipartimento di Medicina Clinica e Sperimentale, Università, Verona
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36
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37
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Lee CK, Kim HJ. [Pathogenesis and treatment of intestinal Behçet's disease]. Korean J Gastroenterol 2007; 50:3-8. [PMID: 18172353] [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: 05/25/2023]
Abstract
Intestinal Behçet's disease (BD) refers to colonic ulcerative lesions documented by objective measures in patients with BD. Although the causes of intestinal BD are unknown, genetic, environmental, and immunological factors have been suggested. Intestinal BD is common in BD patients from Far East, while it is uncommon in those from the Middle East. The reasons for such peculiar geographic distribution in intestinal BD are unknown, but may provide clues for the elucidation of putative etiological agents or genetic factors that might be associated with intestinal BD. Although the treatment of Crohn's disease has improved significantly during past decade, the treatment of intestinal BD is still problematic. Corticosteroids, sulfasalazine, immunomodulators, and colchicines have been used to treat intestinal BD with varying degree of success. Thalidomide and its analogues also appear to be applicable. Monoclonal antibodies to TNF-alpha have recently been focused as a novel therapeutic option for patients with intestinal BD.
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Affiliation(s)
- Chang-Kyun Lee
- Department of Internal Medicine, Kyunghee University School of Medicine, Seoul, Korea
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40
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Abstract
Behçet's disease (Adamantiades-Behçet's disease, ABD) is a multisystemic inflammatory disease, the pathogenesis of which is still a mystery. Many questions are still to be answered and the available diverse data need to be brought together to be compared and analysed. There is at least consensus on the effect of possible, but currently unknown, environmental triggering factor(s) against a background of genetic susceptibility. The possible aetiological factors form a broad spectrum, with infectious agents being the most probable ones. Whatever the stimulus is, the target tissue seems to be the small blood vessels, with various consequences of either vasculitis and/or thrombosis in many organ systems. The endothelium seems to be the primary target in this disease; however, it may just be the subject of the bizarre behaviour of the immune system. The diverse existing data could be interpreted in favour of either explanation. A similar confusion exists about the thrombotic tendency in Adamantiades-Behçet's disease, in terms of whether a primary hypercoagulability is present or whether it is secondary to inflammation. Recent interesting immunological data promise a way out of the existing dilemma. These findings will be outlined within the context of possible hypotheses and attention will be paid to further investigations that are needed.
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Affiliation(s)
- A Kalayciyan
- Department of Dermatology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Affiliation(s)
- H Direskeneli
- Division of Rheumatology, Marmara University Hospital, Tophanelioglu Cad 13/15, Altunizade, Istanbul, Turkey.
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42
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Affiliation(s)
- J M S Pearce
- Department of Neurology, Hull Royal Infirmary and Hull York Medical School, East Yorks, UK.
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Suzuki N, Nara K, Suzuki T. Skewed Th1 responses caused by excessive expression of Txk, a member of the Tec family of tyrosine kinases, in patients with Behcet's disease. Clin Med Res 2006; 4:147-51. [PMID: 16809408 PMCID: PMC1483892 DOI: 10.3121/cmr.4.2.147] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [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] [Indexed: 11/18/2022]
Abstract
Behcet's disease (BD) is characterized by recurrent attacks of uveitis, oral aphtha, genital ulcers and skin lesions. The etiology and pathogenesis of BD are largely unknown. It has been reported that excessive Th1 cell function is involved in the pathogenesis of BD. Previously, we found that Txk, a member of the Tec family of tyrosine kinases, acts as a Th1 cell-specific transcription factor that is involved in the effector function of Th1 cells. Thus, we studied Th1 cytokine production and Txk expression of T-lymphocytes in patients with BD. Peripheral blood lymphocytes produced excessive Th1-associated cytokines including interferon-gamma (IFN-gamma) and interleukin (IL)-12 in patients with BD. Circulating CD3+ and purified CD4+ T cells expressed excessive Txk protein. The extent of IFN-gamma production by the lymphocytes correlated with the expression of Txk protein in the immunoblotting analysis. The majority of cells infiltrating into the skin lesions of patients with BD expressed IFN-gamma. IL-12 and IL-18 were found in the mononuclear cell aggregates in the skin and intestinal lesions of those with BD. Lymphocytes accumulating in the skin and intestinal lesions expressed higher levels of Txk as compared with other Th2-associated diseases. IFN-gamma, IL-18 and IL-12 detected in skin lesions may induce preferential development of Th1 cells in patients with BD. Collectively, Th1 cells expressing Txk and Th1-associated cytokines may play a critical role in the development of skin and intestinal lesions in patients with BD. This review may serve as a reminder of the importance of excessive Th1 cell function in the pathogenesis of BD and may contribute to the discovery of new molecular targets for the development of a specific therapeutic strategy for BD.
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Affiliation(s)
- Noboru Suzuki
- Departments of Immunology, St. Marianna University School of Medicine, Kawasaki, Kanagawa 216-8511, Japan.
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Abstract
INTRODUCTION Behçet's disease and Takayasu's arteritis are both forms of large vessel vasculitis involving autoreactive T cells active against HSP 60. STATE OF THE ART Behçet's disease is more common than Takayasu's arteritis. Pulmonary aneurysms represent the major complication of pulmonary Behçet's disease and have a poor prognosis, being associated with massive haemoptysis. In situ pulmonary artery thrombus can lead to pulmonary infarction. Superior vena cava thrombosis progresses slowly, allowing the development of a prominent collateral circulation. Vascular inflammation can spread to the mediastinum, the pleura and the lungs with diffuse pulmonary haemorrhages, bronchiolitis and organising pneumonia. Electron beam tomodensitometry and MRI are the best diagnostic techniques for assessing pulmonary vascular lesions. In Takayasu's arteritis the pulmonary arteries are less frequently involved than the aorta. Pulmonary hypertension (PHT) and lung infarcts can complicate pulmonary arterial involvement and the association of malaise, fever and weight loss with PHT is characteristic of the disease. The diagnosis is confirmed by imaging means, particularly MRI, demonstrating parietal vascular inflammation. CONCLUSION Treatment of both conditions is based upon steroids and immunosuppression. Endovascular treatment may be used in a complementary way for aneurysms, arterial occlusion, and vena cava obstruction. However, patients often respond poorly to treatment and clinical trials using TNFalpha blockade, interferon alpha and vasodilators are in progress.
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Affiliation(s)
- A Hamzaoui
- Hôpital Abderrahmen Mami, Ariana, et Faculté de Médecine, Tunis, Tunisie.
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Altenburg A, Papoutsis N, Orawa H, Martus P, Krause L, Zouboulis CC. [Epidemiology and clinical manifestations of Adamantiades-Behçet disease in Germany -- current pathogenetic concepts and therapeutic possibilities]. J Dtsch Dermatol Ges 2006; 4:49-64; quiz 65-6. [PMID: 16503932 DOI: 10.1111/j.1610-0387.2006.05841.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas Altenburg
- Clinic for Dermatology, Venerology and Allergology, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin.
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Abadi U, Hadary R, Shilo L, Shabun A, Greenberg G, Kovatz S. Myositis in Behcet's disease after tonsillectomy. Isr Med Assoc J 2006; 8:294-5. [PMID: 16671372] [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: 05/09/2023]
Affiliation(s)
- Uri Abadi
- Department of Medicine C , Meir Medical Center, Kfar Saba, Israel.
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Senel S, Kaya E, Aydogdu I, Erkurt MA, Kuku I. Rheumatic diseases and chronic myelogenous leukemia, presentation of four cases and review of the literature. Rheumatol Int 2006; 26:857-61. [PMID: 16404564 DOI: 10.1007/s00296-005-0100-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Accepted: 12/18/2005] [Indexed: 10/25/2022]
Abstract
We report four patients with rheumatic disease (RD) and chronic myelogenous leukemia (CML). In two patients with Behcet's disease (BD) and rheumatoid arthritis (RA), CML developed after RD, in two patients with diffuse cutaneous systemic sclerosis and spondyloarthropathy, RD was diagnosed after CML. A variety of interactions have been described between hematological malignancies and RD. Nevertheless, few cases of RD have been documented associated with CML. It is unclear whether the development of CML in patients with RD and RD development after CML occurs by chance alone, is due to the underlying disease, or is facilitated by drugs. Whatever the cause is, it should be kept in mind that CML may develop in the course of RD and RD may be seen in CML patients.
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Affiliation(s)
- Soner Senel
- Department of Internal Medicine Turgut Ozal Medical Center, Inonu University Faculty of Medicine, 44069 Malatya, Turkey.
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Ozcan F, Ozçakar L, Ozcan HN, Bakirci S, Ozlü MF. Thoracic outlet syndrome masquerading as a diagnostic pitfall in Behçet's disease. Rheumatol Int 2005; 26:865-6. [PMID: 16341698 DOI: 10.1007/s00296-005-0089-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2005] [Accepted: 11/06/2005] [Indexed: 12/01/2022]
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Uzunoğlu S, Acar H, Okudan N, Gökbel H, Mevlitoğlu I, Sari F. Evaluation of the association between null genotypes of glutathione-S-transferases and Behcet’s disease. Arch Dermatol Res 2005; 297:289-93. [PMID: 16283344 DOI: 10.1007/s00403-005-0617-1] [Citation(s) in RCA: 5] [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] [Received: 06/13/2005] [Revised: 09/03/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
Glutathione S-transferases (GST) play an important role in oxidative stress related syndromes. An imbalance of the oxidant and antioxidant systems is important in the pathogenesis of Behcet's disease (BD). The objective of this study was to evaluate the association of null genotypes of GST-M1 and GST-T1 with BD since some preliminary molecular genetic data were recently published. Ninety-four Turkish BD patients (42 male, 52 female, 37.1+/-10.4 years) and 140 healthy volunteers (70 male, 70 female, 36.8+/-11.7 years) matched for age and gender with the patients as the control group were included in the study. Distributions of GST-M1 and GST-T1 genotypes were determined by multiplexed PCR using three sets of primers for GST-M1, GST-T1, and beta-globulin genes. There was no association between BD and the frequencies of GST-M1 and GST-T1 null genotypes when compared to controls by separate analysis. However, by cross and pooled combination analysis there was a significant association between the frequencies of pooled GSTs with one or both null genotypes in BD and controls. This is the first evidence that the association between the frequencies of GST-M1 and GST-T1 null genotypes and BD might be dependent on the interaction of multiple null allele polymorphisms rather than a single null allele of GST-M1 and GST-T1.
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Affiliation(s)
- S Uzunoğlu
- Department of Molecular Biology, Faculty of Science and Arts, Manisa Celal Bayar University, Manisa, Turkey.
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