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Martirosyan A, Aminov R, Manukyan G. Environmental Triggers of Autoreactive Responses: Induction of Antiphospholipid Antibody Formation. Front Immunol 2019; 10:1609. [PMID: 31354742 PMCID: PMC6635959 DOI: 10.3389/fimmu.2019.01609] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022] Open
Abstract
Antiphospholipid antibodies (aPLs) comprise a diverse family of autoantibodies targeted against proteins with the affinity toward negatively charged phospholipids or protein-phospholipid complexes. Their clinical significance, including prothrombotic potential of anti-cardiolipin antibodies (aCLs), anti-β2-glycoprotein I antibodies (aβ2-GPIs), and lupus anti-coagulant (LA), is well-established. However, the ontogeny of these pathogenic aPLs remains less clear. While transient appearance of aPLs could be induced by various environmental factors, in genetically predisposed individuals these factors may eventually lead to the development of the antiphospholipid syndrome (APS). Since the first description of APS, it has been found that a wide variety of microbial and viral agents influence aPLs production and contribute to clinical manifestations of APS. Many theories attempted to explain the pathogenic potential of different environmental factors as well as a phenomenon termed molecular mimicry between β2-GPI molecule and infection-relevant structures. In this review, we summarize and critically assess the pathogenic and non-pathogenic formation of aPLs and its contribution to the development of APS.
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Affiliation(s)
- Anush Martirosyan
- Laboratory of Molecular and Cellular Immunology, Institute of Molecular Biology, Yerevan, Armenia.,Russian-Armenian (Slavonic) University, Yerevan, Armenia
| | - Rustam Aminov
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Gayane Manukyan
- Laboratory of Molecular and Cellular Immunology, Institute of Molecular Biology, Yerevan, Armenia.,Russian-Armenian (Slavonic) University, Yerevan, Armenia
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2
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Kang MK, Gupta RK, Srinivasan J. Peripheral Vasculitic Neuropathy Associated With Minocycline Use. J Clin Neuromuscul Dis 2018; 19:138-141. [PMID: 29465615 DOI: 10.1097/cnd.0000000000000197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We describe 2 patients presenting with multiplex mononeuritis, associated with skin manifestation, secondary to minocycline-induced vasculitis. One of the cases is associated neither with lupus nor polyarteritis nodosa. An extensive laboratory workup ruled out any possible underlying immunologic disorder. Electrodiagnostic studies were conducted to show axonal neuropathy in patchy and multifocal distribution consistent with multiplex mononeuritis. This diagnosis was confirmed with nerve biopsy. Withdrawing from the offending medication, minocycline, improved the patients' clinical condition and the quantitative serological measures.
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Affiliation(s)
- Min K Kang
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA
- Department of Neurology, Tufts Medical Center, Boston, MA
| | - Rajesh K Gupta
- Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA
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Risse J, Vieira M, Beuret F, Petitpain N, Zuily S, Wahl D. Reversible drug-induced antiphospholipid syndrome. Lupus 2017; 27:333-335. [PMID: 28592198 DOI: 10.1177/0961203317712463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report an original case of reversible antiphospholipid syndrome (APS) due to minocycline in a young male patient who experienced recurrent strokes while taking minocycline. He started minocycline therapy (50 mg twice daily) at 15 years old for acne. After three years of treatment, the patient experienced a lateral medullary syndrome. He was treated with aspirin while minocycline was continued. Eighteen months later, the patient complained about horizontal binocular diplopia. MRI revealed an infarct of the oculomotor nerve nucleus. Laboratory investigations revealed high titers of anti-beta 2 glycoprotein 1 (antiβ2GP1) antibodies of 470 U/ml (normal range <15 U/ml) and antiphosphatidylethanolamine antibodies of 137.4 U/ml (normal range <18 U/ml). Other laboratory tests were normal. Six weeks after discontinuation of minocycline, anti-β2GP1 antibodies decreased to 335 U/ml and to 36 U/ml at six months and then remained negative for six years. Many drugs have been considered as possibly causing APS but only in a limited number of patients. To our knowledge this is the first case of drug-induced APS with complete disappearance of high titers of anti-β2GP1 antibodies after minocycline withdrawal. This case also illustrates the need to monitor the levels of antiphospholipid antibodies, even though initial values are high and confirmed after 12 weeks.
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Affiliation(s)
- J Risse
- 1 CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France.,2 Inserm, UMR S 1116, Lorraine University, Nancy, France
| | - M Vieira
- 3 Hospital Universitario Clementino Fraga Filho, Department of Internal Medicine, Rio de Janeiro, Brazil
| | - F Beuret
- 4 CHRU de Nancy, Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France
| | - N Petitpain
- 5 CHRU de Nancy, Regional Center of Pharmacovigilance, Department of Clinical Pharmacology and Toxicology, Nancy, France
| | - S Zuily
- 1 CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France.,2 Inserm, UMR S 1116, Lorraine University, Nancy, France
| | - D Wahl
- 1 CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France.,2 Inserm, UMR S 1116, Lorraine University, Nancy, France
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McMillan HJ, Jansen GH, Koujok K, Milman N, Duffy CM, Watanabe Duffy K. Mononeuritis multiplex associated with minocycline in an adolescent. Muscle Nerve 2017; 56:E33-E35. [PMID: 28561927 DOI: 10.1002/mus.25718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Gerard H Jansen
- The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Khaldoun Koujok
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Nataliya Milman
- The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
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Baratta JM, Dyck PJB, Brand P, Thaisetthawatkul P, Dyck PJ, Engelstad JK, Goodman B, Karam C. Vasculitic neuropathy following exposure to minocycline. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 3:e180. [PMID: 26601119 PMCID: PMC4645168 DOI: 10.1212/nxi.0000000000000180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/06/2015] [Indexed: 11/15/2022]
Abstract
Objective: To report 3 patients with minocycline-induced autoimmunity resulting in peripheral nerve vasculitis. Methods: We report 3 patients who, during minocycline treatment for acne vulgaris, developed subacute onset of pain and weakness caused by vasculitis in single and multiple mononeuropathy patterns. Results: Each patient underwent either a nerve or muscle biopsy that confirmed vasculitis. One patient additionally developed systemic symptoms (including fever, fatigue, and night sweats) and another had a posterior circulation stroke. Symptoms developed with either early or prolonged use of minocycline. Despite withdrawal of minocycline, patients needed long-term immunotherapy to gain neurologic improvement. Conclusions: Our findings suggest that the typical neuropathy associated with minocycline use is painful single or multiple mononeuropathy due to peripheral nerve vasculitis, which may also be accompanied by presumed CNS vasculitis (presenting as stroke).
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Affiliation(s)
- John M Baratta
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - P James B Dyck
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - Patricio Brand
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - Pariwat Thaisetthawatkul
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - Peter J Dyck
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - JaNean K Engelstad
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - Brent Goodman
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
| | - Chafic Karam
- Departments of Physical Medicine & Rehabilitation (J.M.B.) and Neurology (C.K.), The University of North Carolina, Chapel Hill; the Department of Neurology (P.J.B.D., P.B., P.J.D., J.K.E.), Mayo Clinic, Rochester, MN; the Department of Neurological Sciences (P.T.), University of Nebraska Medical Center, Omaha; and the Department of Neurology (B.G.), Mayo Clinic, Scottsdale, AZ
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Ogawa N, Kawai H, Yamakawa I, Sanada M, Sugimoto T, Maeda K. [Case of minocycline-induced vasculitic neuropathy]. Rinsho Shinkeigaku 2010; 50:301-305. [PMID: 20535977 DOI: 10.5692/clinicalneurol.50.301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A 70-year-old woman was admitted to our hospital because of fever, numbness in her extremities and right drop foot. Because her hip prosthesis had loosened as a result of infection, she had been taking 100 mg of minocycline orally for eight months. Three months before admission, she had had melena several times and body weight loss and pyrexia developed. A month before admission, asymmetrical paresthesia and numbness appeared in her extremities and finally right drop foot developed. Laboratory tests showed elevated C-reactive protein and positive anti-nuclear antibody. Abnormalities found in nerve conduction study were compatible with mononeuritis multiplex. Sural nerve biopsy revealed an occluded medium-size artery in the epineurium and axonal degeneration in the nerve fascicles, confirming the diagnosis of vasculitic neuropathy. These manifestations met the American Congress Rheumatology criteria for polyarteritis nodosa. However, her clinical conditions markedly improved after discontinuing minocycline and therefore she was diagnosed as having minocycline-induced vasculitic neuropathy. Although minocycline-induced vasculitis is a well known adverse effect of the drug, peripheral neuropathy with biopsy findings has rarely been reported. Drug induced-vasculitis is important as a differential diagnosis for mononeuritis multiplex because the symptoms can be improved by the discontinuation of an offending drug.
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Affiliation(s)
- Nobuhiro Ogawa
- Division of Neurology, Department of Internal Medicine, Shiga University of Medical Science
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Abstract
Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder that can affect any organ system. Predominant manifestations include arthralgia, rash, photosensitivity, pleuritis, renal and central nervous system involvement. Fortunately, pleuritis in systemic lupus erythematosus is not usually as life threatening as may be the renal or central nervous system complications. Nevertheless, pleuritis does occur in systemic lupus erythematosus and may be a significant cause of morbidity. In addition to primary pleuritis attributed to systemic lupus erythematosus, secondary pleural complications, especially infections, may occur as a consequence of systemic lupus erythematosus. Pleuritis in patients with systemic lupus erythematosus may therefore frequently challenge the diagnostic and therapeutic acumen of physicians.
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Affiliation(s)
- Der-Yuan Wang
- Department of Internal Medicine, Lin Shin Hospital, Taichung, Taiwan.
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