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Goulabchand R, Hafidi A, Millet I, Morel J, Lukas C, Humbert S, Rivière S, Gény C, Jorgensen C, Le Quellec A, Perrochia H, Guilpain P. Mastitis associated with Sjögren's syndrome: a series of nine cases. Immunol Res 2018; 65:218-229. [PMID: 27561784 DOI: 10.1007/s12026-016-8830-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Sjögren's syndrome is well known to target exocrine glands, especially lacrimal and salivary glands, which share with mammary glands anatomical, histological, and immunological features. Herein, we investigated the mammary involvement in patients with Sjögren's syndrome and compared the histological findings with minor salivary gland involvement. We reviewed the charts of patients with Sjögren's syndrome (followed in Montpellier University Hospital, between January 2000 and January 2015), in whom minor salivary gland and mammary tissues were available. Two expert pathologists analysed retrospectively these tissues in order to identify inflammatory patterns. Immunohistochemical stainings were performed to precise leucocyte distribution. Sixteen Sjögren's syndrome patients with available salivary and breast tissue samples were included. All were women, with a median age of 60.1 ± 11.3 years at Sjögren's syndrome diagnosis. Mammary biopsy was conducted because of breast symptoms in 6 patients and following imaging screening strategies for breast cancer in 10 patients. Nine patients exhibited an inflammatory breast pattern (lymphocytic infiltrates or duct ectasia), close to minor salivary gland histological findings. Immunohistochemical stainings (n = 5) revealed B and T cell infiltrates within breast tissue, with a higher proportion of T CD4+ cells, but no IgG4-secreting plasma cells were found. This is the first series to describe breast inflammatory patterns in Sjögren's syndrome. Mastitis is in line with the classical involvement of exocrine glands in this disease. These findings are consistent with the literature data considering Sjögren's syndrome as an "autoimmune epithelitis".
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Affiliation(s)
- Radjiv Goulabchand
- Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence "maladies systémiques et auto-immunes rares", St Eloi Hospital, CHRU de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
| | - Assia Hafidi
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Pathology Department, Gui de Chauliac Hospital, Montpellier University, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Ingrid Millet
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Medical Imaging Department, Lapeyronie Hospital, Montpellier University, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Jacques Morel
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Cédric Lukas
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Rheumatology Department, Lapeyronie Hospital, Montpellier University, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Sébastien Humbert
- Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence "maladies systémiques et auto-immunes rares", St Eloi Hospital, CHRU de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Internal Medicine Department, Jean Minjoz Hospital, Besançon University, 3 Boulevard Fleming, 25030, Besançon, France
| | - Sophie Rivière
- Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence "maladies systémiques et auto-immunes rares", St Eloi Hospital, CHRU de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
| | - Christian Gény
- Neurology Department, Gui de Chauliac Hospital, Montpellier University, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Christian Jorgensen
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Lapeyronie Hospital, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, France
- Inserm U1183, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Alain Le Quellec
- Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence "maladies systémiques et auto-immunes rares", St Eloi Hospital, CHRU de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
| | - Hélène Perrochia
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France
- Pathology Department, Gui de Chauliac Hospital, Montpellier University, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine, Maladies Multi-Organiques, Centre de compétence "maladies systémiques et auto-immunes rares", St Eloi Hospital, CHRU de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.
- UFR Médecine (Medical School), Montpellier University, 34295, Montpellier, France.
- Inserm U1183, St Eloi Hospital, 80 Avenue Augustin Fliche, 34295, Montpellier, France.
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Park YS, Gauna AE, Cha S. Mouse Models of Primary Sjogren's Syndrome. Curr Pharm Des 2016; 21:2350-64. [PMID: 25777752 DOI: 10.2174/1381612821666150316120024] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/13/2015] [Indexed: 01/03/2023]
Abstract
Sjogren's syndrome (SjS) is a chronic autoimmune disorder characterized by immune cell infiltration and progressive injury to the salivary and lacrimal glands. As a consequence, patients with SjS develop xerostomia (dry mouth) and keratoconjunctivitis sicca (dry eyes). SjS is the third most common rheumatic autoimmune disorder, affecting 4 million Americans with over 90% of patients being female. Current diagnostic criteria for SjS frequently utilize histological examinations of minor salivary glands for immune cell foci, serology for autoantibodies, and dry eye evaluation by corneal or conjunctival staining. SjS can be classified as primary or secondary SjS, depending on whether it occurs alone or in association with other systemic rheumatic conditions, respectively. Clinical manifestations typically become apparent when the disease is relatively advanced in SjS patients, which poses a challenge for early diagnosis and treatment of SjS. Therefore, SjS mouse models, because of their close resemblance to the human SjS, have been extremely valuable to identify early disease markers and to investigate underlying biological and immunological dysregulations. However, it is important to bear in mind that no single mouse model has duplicated all aspects of SjS pathogenesis and clinical features, mainly due to the multifactorial etiology of SjS that includes numerous susceptibility genes and environmental factors. As such, various mouse models have been developed in the field to try to recapitulate SjS. In this review, we focus on recent mouse models of primary SjS xerostomia and describe them under three categories of spontaneous, genetically engineered, and experimentally induced models. In addition, we discuss future perspectives highlighting pros and cons of utilizing mouse models and current demands for improved models.
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Affiliation(s)
| | | | - Seunghee Cha
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL32610, USA.
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Karlsen TH, Vesterhus M, Boberg KM. Review article: controversies in the management of primary biliary cirrhosis and primary sclerosing cholangitis. Aliment Pharmacol Ther 2014; 39:282-301. [PMID: 24372568 DOI: 10.1111/apt.12581] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/09/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite considerable advances over the last two decades in the molecular understanding of cholestasis and cholestatic liver disease, little improvement has been made in diagnostic tools and therapeutic strategies. AIMS To critically review controversial aspects of the scientific basis for common clinical practice in primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) and to discuss key ongoing challenges to improve patient management. METHODS We performed a literature search using PubMed and by examining the reference lists of relevant review articles related to the clinical management of PBC and PSC. Articles were considered on the background of the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD) practice guidelines and clinical experience of the authors. RESULTS Ongoing challenges in PBC mainly pertain to the improvement of medical therapy, particularly for patients with a suboptimal response to ursodeoxycholic acid. In PSC, development of medical therapies and sensitive screening protocols for cholangiocarcinoma represent areas of intense research. To rationally improve patient management, a better understanding of pathogenesis, including complications like pruritis and fatigue, is needed and there is a need to identify biomarker end-points for treatment effect and prognosis. Timing of liver transplantation and determining optimal regimens of immunosuppression post-liver transplantation will also benefit from better appreciation of pre-transplant disease mechanisms. CONCLUSION Controversies in the management of PBC and PSC relate to topics where evidence for current practice is weak and further research is needed.
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Affiliation(s)
- T H Karlsen
- Norwegian PSC Research Center, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
An increasing body of evidence suggests that immune-mediated processes affect female reproductive success at multiple levels. Crosstalk between endocrine and immune systems regulates a large number of biological processes that affect target tissues, and this crosstalk involves gene expression, cytokine and/or lymphokine release and hormone action. In addition, endocrine-immune interactions have a major role in the implantation process of the fetal (paternally derived) semi-allograft, which requires a reprogramming process of the maternal immune system from rejection to temporary tolerance for the length of gestation. Usually, the female immune system is supportive of all of these processes and, therefore, facilitates reproductive success. Abnormalities of the female immune system, including autoimmunity, potentially interfere at multiple levels. The relevance of the immune system to female infertility is increasingly recognized by investigators, but clinically is often not adequately considered and is, therefore, underestimated. This Review summarizes the effect of individual autoimmune endocrine diseases on female fertility, and points towards selected developments expected in the near future.
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Affiliation(s)
- Aritro Sen
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021, USA
| | - Vitaly A Kushnir
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021, USA
| | - David H Barad
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021, USA
| | - Norbert Gleicher
- The Center for Human Reproduction (CHR), 21 East 69th Street, New York, NY 10021, USA
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Kongkam P, Ang TL, Vu CKF, Dy FT, Yasuda K, Rerknimitr R, Varadarajulu S, Dhir V, Chong VH, Zhen DJ, Wong JYY, Ho KY. Current status on the diagnosis and evaluation of pancreatic tumor in Asia with particular emphasis on the role of endoscopic ultrasound. J Gastroenterol Hepatol 2013; 28:924-30. [PMID: 23488477 DOI: 10.1111/jgh.12198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/16/2022]
Abstract
In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear that the future for pancreatic cancer lies in early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging, such as computerized tomography and magnetic resonance imaging, smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended for the evaluation of portal vein confluence, portal vein, celiac axis, and superior mesentric artery origin, and exclusion of resectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine-needle aspiration of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast-enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.
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Affiliation(s)
- Pradermchai Kongkam
- Endoscopic Ultrasound Research Unit, Chulalongkorn University, Bangkok, Thailand
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Current concepts: mouse models of Sjögren's syndrome. J Biomed Biotechnol 2010; 2011:549107. [PMID: 21253584 PMCID: PMC3018660 DOI: 10.1155/2011/549107] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/10/2010] [Indexed: 11/18/2022] Open
Abstract
Sjögren's syndrome (SjS) is a complex chronic autoimmune disease of unknown etiology which primarily targets the exocrine glands, resulting in eventual loss of secretory function. The disease can present as either primary SjS or secondary SjS, the latter of which occurs concomitantly with another autoimmune disease such as rheumatoid arthritis, systemic lupus erythematosus, scleroderma, or primary biliary cirrhosis. Current advancements in therapeutic prevention and treatment for SjS are impeded by lack of understanding in the pathophysiological and clinical progression of the disease. Development of appropriate mouse models for both primary and secondary SjS is needed in order to advance knowledge of this disease. This paper details important features, advantages, and pitfalls of current animal models of SjS, including spontaneous, transgenic, knockout, immunization, and transplantation chimera mouse models, and emphasizes the need for a better model in representing the human SjS phenotype.
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Chiorini J, Cihakova D, Ouellette C, Caturegli P. Sjögren syndrome: advances in the pathogenesis from animal models. J Autoimmun 2009; 33:190-6. [PMID: 19800762 PMCID: PMC3439154 DOI: 10.1016/j.jaut.2009.09.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sjögren syndrome is an autoimmune disease characterized by hyposecretion of the lacrimal and salivary glands, resulting in dryness of the eyes and mouth. Individuals may experience primary Sjögren syndrome or a secondary form accompanying another rheumatic autoimmune disease, such as rheumatoid arthritis or systemic lupus erythematosus. The pathogenic mechanisms of Sjögren syndrome remain largely unknown, in part a consequence of the heterogeneity of the disease. Animal models have shed light on the connections between specific pathways and symptoms, but an ideal system is wanting. Improved disease models will enable a better understanding of Sjögren syndrome, including how immune tolerance is lost and potential therapeutic interventions. Most importantly, an optimal model will enable detection of disease biomarkers, since injury to the salivary glands may precede lymphocytic infiltration. This review aims to characterize available mice models of Sjögren syndrome, including advantages and disadvantages, from the researcher's perspective.
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Affiliation(s)
- J.A. Chiorini
- Molecular Physiology and Therapeutics Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, DHHS, Bethesda, MD, USA
| | - D. Cihakova
- Department of Pathology, The Johns Hopkins School of Medicine – Ross 632, 720 Rutland Avenue, Baltimore, MD 21205, USA
| | - C.E. Ouellette
- Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - P. Caturegli
- Department of Pathology, The Johns Hopkins School of Medicine – Ross 632, 720 Rutland Avenue, Baltimore, MD 21205, USA
- Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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