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Sbeih N, Bourguiba R, Hoyeau-Idrissi N, Launay JM, Callebert J, Canioni D, Sokol H, Hentgen V, Grateau G, Hermine O, Georgin-Lavialle S. Histamine elevation in familial Mediterranean fever: A study from the Juvenile Inflammatory Rheumatism cohort. Eur J Intern Med 2023; 116:89-95. [PMID: 37349205 DOI: 10.1016/j.ejim.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is the most frequent monogenic autoinflammatory disease (AID). Some patients have persistent symptoms despite colchicine intake. Mast cells (MC) are innate immune cells involved in inflammatory conditions including AID. Their activation is responsible for various symptoms such as abdominal pain, bloating and pruritus. OBJECTIVE Our objective was to evaluate features of a systemic MC activation in FMF adult patients. METHODS FMF adult patients prospectively filled a MC activation survey and usual MC mediators (tryptase and histamine in whole blood, plasma and urine) were measured. They were compared with a healthy control group (HC) and a systemic mastocytosis (SM) group. When digestive biopsies were realized during follow-up, MC infiltration in digestive mucosa was analyzed in FMF, in comparison with SM, Crohn disease (CD) and normal biopsies. RESULTS Forty-four FMF patients, 44 HC and 44 SM patients were included. Thirty-one (70%) FMF patients had symptoms of mast cell activation, versus 14 (32%) in the HC group (p = 0.0006). Thirty (68%) FMF patients had at least one elevated MC mediator: mainly whole blood histamine, in 19 (43%) and urinary histamine, in 14 (32%), which were significantly higher than in HC subjects. MC infiltration was comparable in FMF digestive biopsies, biopsies of CD and normal biopsies but was lower than in SM biopsies. CONCLUSION FMF patients show frequent symptoms of MC activation and an increase of blood or urinary histamine never described before in this disease. This suggests an implication of MC and possibly basophils in FMF pathophysiology.
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Affiliation(s)
- Nabiha Sbeih
- Department of Internal Medicine, National Reference Centre for Auto-inflammatory Diseases and inflammatory Amyloidosis (CEREMAIA), Tenon Hospital, AP-HP, Paris, France; Sorbonne Université, Inserm U938, Paris, France; Laboratory of Molecular mechanisms of Hematological disorders and therapeutic implications, INSERM U1163 and CNRS ERL 8254, Fondation Imagine, Paris, France
| | - Rim Bourguiba
- Department of Internal Medicine, National Reference Centre for Auto-inflammatory Diseases and inflammatory Amyloidosis (CEREMAIA), Tenon Hospital, AP-HP, Paris, France; Sorbonne Université, Inserm U938, Paris, France
| | | | - Jean-Marie Launay
- Service de Biochimie et Biologie Moléculaire, INSERM U942, Hôpital Lariboisière et Université Paris Cité, AP-HP, Paris, France
| | - Jacques Callebert
- Service de Biochimie et Biologie Moléculaire, INSERM U942, Hôpital Lariboisière et Université Paris Cité, AP-HP, Paris, France
| | - Danielle Canioni
- Laboratoire d'Anatomie-Pathologie, Hôpital Necker-Enfants Malades, AP-HP et Université Paris Cité, Paris, France
| | - Harry Sokol
- Service de Gastroentérologie et Nutrition, Hôpital Saint-Antoine, AP-HP, Paris, France et Sorbonne Université, Equipe AVENIR, Laboratoire INSERM U938, Paris, France; Equipe Interactions des bactéries commensales et probiotiques avec l'hôte, MICALIS, INRA, Jouy en Josas, France
| | - Véronique Hentgen
- Department of General Pediatrics, André Mignot Hospital, National Reference Centre for Auto-inflammatory Diseases and inflammatory Amyloidosis (CEREMAIA), Versailles, France
| | - Gilles Grateau
- Department of Internal Medicine, National Reference Centre for Auto-inflammatory Diseases and inflammatory Amyloidosis (CEREMAIA), Tenon Hospital, AP-HP, Paris, France
| | - Olivier Hermine
- Centre de Référence des Mastocytoses, Service d'Hématologie adulte, Université Paris Cité, Hôpital Necker-Enfants malades, AP-HP, Paris, France; Laboratory of Molecular mechanisms of Hematological disorders and therapeutic implications, INSERM U1163 and CNRS ERL 8254, Fondation Imagine, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, National Reference Centre for Auto-inflammatory Diseases and inflammatory Amyloidosis (CEREMAIA), Tenon Hospital, AP-HP, Paris, France; Sorbonne Université, Inserm U938, Paris, France.
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Matsuda T, Takimoto-Ito R, Lipsker D, Kambe N. Similarities and differences in autoinflammatory diseases with urticarial rash, cryopyrin-associated periodic syndrome and Schnitzler syndrome. Allergol Int 2023:S1323-8930(23)00009-6. [PMID: 36906447 DOI: 10.1016/j.alit.2023.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 03/12/2023] Open
Abstract
Cryopyrin-associated periodic syndromes (CAPS) and Schnitzler syndrome (SchS) are autoinflammatory diseases that present with urticaria-like rashes. CAPS is characterized by periodic or persistent systemic inflammation caused by the dysfunction of the NLRP3 gene. With the advent of IL-1-targeted therapies, the prognosis of CAPS has improved remarkably. SchS is considered an acquired form of autoinflammatory syndrome. Patients with SchS are adults of relatively older age. The pathogenesis of SchS remains unknown and is not associated with the NLRP3 gene. Previously, the p.L265P mutation in the MYD88 gene, which is frequently detected in Waldenström macroglobulinemia (WM) with IgM gammopathy, was identified in several cases of SchS. However, because persistent fever and fatigue are symptoms of WM that require therapeutic intervention, it is a challenge to determine whether these patients truly had SchS or whether advanced WM was misidentified as SchS. There are no established treatments for SchS. The treatment algorithm proposed with the diagnostic criteria is to use colchicine as first-line treatment, and systemic administration of steroids is not recommended due to concerns about side effects. In difficult-to-treat cases, treatment targeting IL-1 is recommended. If targeted IL-1 treatment does not improve symptoms, the diagnosis should be reconsidered. We hope that the efficacy of IL-1 therapy in clinical practice will serve as a stepping stone to elucidate the pathogenesis of SchS, focusing on its similarities and differences from CAPS.
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Affiliation(s)
- Tomoko Matsuda
- Department of Dermatology, Kansai Medical University, Hirakata, Japan
| | - Riko Takimoto-Ito
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Dan Lipsker
- Dermatology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Naotomo Kambe
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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3
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Sylvester M, Son A, Schwartz DM. The Interactions Between Autoinflammation and Type 2 Immunity: From Mechanistic Studies to Epidemiologic Associations. Front Immunol 2022; 13:818039. [PMID: 35281022 PMCID: PMC8907424 DOI: 10.3389/fimmu.2022.818039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/02/2022] [Indexed: 12/30/2022] Open
Abstract
Autoinflammatory diseases are a group of clinical syndromes characterized by constitutive overactivation of innate immune pathways. This results in increased production of or responses to monocyte- and neutrophil-derived cytokines such as interleukin-1β (IL-1β), Tumor Necrosis Factor-α (TNF-α), and Type 1 interferon (IFN). By contrast, clinical allergy is caused by dysregulated type 2 immunity, which is characterized by expansion of T helper 2 (Th2) cells and eosinophils, as well as overproduction of the associated cytokines IL-4, IL-5, IL-9, and IL-13. Traditionally, type 2 immune cells and autoinflammatory effectors were thought to counter-regulate each other. However, an expanding body of evidence suggests that, in some contexts, autoinflammatory pathways and cytokines may potentiate type 2 immune responses. Conversely, type 2 immune cells and cytokines can regulate autoinflammatory responses in complex and context-dependent manners. Here, we introduce the concepts of autoinflammation and type 2 immunity. We proceed to review the mechanisms by which autoinflammatory and type 2 immune responses can modulate each other. Finally, we discuss the epidemiology of type 2 immunity and clinical allergy in several monogenic and complex autoinflammatory diseases. In the future, these interactions between type 2 immunity and autoinflammation may help to expand the spectrum of autoinflammation and to guide the management of patients with various autoinflammatory and allergic diseases.
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Affiliation(s)
- McKella Sylvester
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Aran Son
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
| | - Daniella M Schwartz
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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4
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Abstract
Schnitzler syndrome is a rare disease of adult-onset with main features including chronic urticarial rash, recurrent fever, arthralgia or arthritis, monoclonal gammopathy of undetermined significance (MGUS), and marked systemic inflammation. Schnitzler syndrome is often underdiagnosed. Patients with Schnitzler syndrome may present to dermatologists and allergists for urticaria, hematologists for MGUS, or rheumatologists for arthritis. It is important to recognize Schnitzler syndrome for its remarkable response to interleukin (IL)-1 blockade. Besides, many cases of Schnitzler-like syndromes do not meet the diagnostic criteria of classical Schnitzler syndrome but display excellent response to IL-1 inhibitors. The overly produced IL-1 is the result of a somatic mosaic gain of function mutation of NLRP3 (nucleotide-binding oligomerization domain [NOD]-like receptor [NLR] family pyrin domain containing 3) gene in some patients with Schnitzler-like syndromes. Inflammasome activation is evident in patients with classical Schnitzler syndrome although no NLRP3 gene mutation is identified. Collectively, Schnitzler syndrome and Schnitzler-like syndromes represent a spectrum of IL-1 mediated adult-onset autoinflammatory diseases.
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5
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Magrone T, Magrone M, Jirillo E. Mast Cells as a Double Edged Sword in Immunity: Disorders of Mast Cell Activation and Therapeutic Management. Second of Two Parts. Endocr Metab Immune Disord Drug Targets 2021; 20:670-686. [PMID: 31789136 DOI: 10.2174/1871530319666191202121644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/20/2022]
Abstract
Mast cells (MCs) bear many receptors that allow them to respond to a variety of exogenous and endogenous stimuli. However, MC function is dual since they can initiate pathological events or protect the host against infectious challenges. The role of MCs in disease will be analyzed in a broad sense, describing cellular and molecular mechanisms related to their involvement in auto-inflammatory diseases, asthma, autoimmune diseases and cancer. On the other hand, their protective role in the course of bacterial, fungal and parasitic infections will also be illustrated. As far as treatment of MC-derived diseases is concerned, allergen immunotherapy as well as other attempts to reduce MC-activation will be outlined according to the recent data. Finally, in agreement with current literature and our own data polyphenols have been demonstrated to attenuate type I allergic reactions and contact dermatitis in response to nickel. The use of polyphenols in these diseases will be discussed also in view of MC involvement.
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Affiliation(s)
- Thea Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Manrico Magrone
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
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6
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Gusdorf L, Lipsker D. Schnitzler Syndrome: the paradigm of an acquired adult-onset auto-inflammatory disease. GIORN ITAL DERMAT V 2020; 155:567-573. [PMID: 33295738 DOI: 10.23736/s0392-0488.20.06692-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Schnitzler Syndrome is a rare acquired auto-inflammatory syndrome defined by an urticarial eruption and a monoclonal gammopathy, mainly of the IgM kappa isotype. It shares many clinical and biological features with other autoinflammatory disorders such as NLRP3-auto-inflammatory disorders (NLRP3-AID, formerly cryopyrin associated periodic syndromes or CAPS) or adult-onset Still disease (AOSD). Hence, recurrent fever, urticarial rash with a neutrophilic infiltrate on skin biopsy (i.e. neutrophilic urticarial dermatosis or NUD) and a significant elevation of blood inflammation markers are commonly found in Schnitzler Syndrome as well as in NLRP3-AID or AOSD. IL-1ß plays a crucial role in the pathogenesis and explains the clinical symptoms of Schnitzler Syndrome. This is emphasized by the spectacular effectiveness of IL-1 blocking therapies, especially anakinra. IL-1 blocking therapies are efficient on the inflammation-linked symptoms but not on the monoclonal component. The evolution is chronic and about 15-20% of patients may develop lymphoproliferative disease, in particular Waldenström disease, a proportion similar to patients with IgM monoclonal gammopathy of undetermined significance, and more rarely AA-amyloidosis.
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Affiliation(s)
- Laurence Gusdorf
- Department of Dermatology and Venereology, CHU de Reims, Reims, France -
| | - Dan Lipsker
- Department of Dermatology, University Hospital of Strasbourg, Strasbourg, France
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7
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Darrieutort-Laffite C, Ansquer C, Aubert H, Kraeber-Bodéré F, Masseau A, Agard C, Hamidou M, Bernier C, Berthelot JM, Le Goff B, Barbarot S, Néel A. Rheumatic involvement and bone scan features in Schnitzler syndrome: initial and follow-up data from a single-center cohort of 25 patients. Arthritis Res Ther 2020; 22:272. [PMID: 33208192 PMCID: PMC7677784 DOI: 10.1186/s13075-020-02318-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/11/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To report on the characteristics and long-term course of rheumatic manifestations in Schnitzler syndrome (SchS). Methods A retrospective cohort study of patients with SchS followed between 2000 and 2020. Inclusion criteria included a diagnosis of SchS (Strasbourg criteria). All available bone scans were reviewed and scored according to the intensity and number of pathological sites. The scintigraphic score was compared with the clinical activity score, CRP level, and treatments. Results Twenty-five patients were included. Median age at diagnosis was 68 years. Eighty patients (72%) had SchS-related rheumatic pain. Most patients had a long-standing isolated rash before constitutional and/or rheumatic symptoms appeared. The monoclonal component level was usually very low (IgMκ in 22/25). Rheumatic pain predominated around the knees. Bone scans revealed abnormal tracer uptake in 15/18 (85%). The scintigraphic score correlated with clinical activity (r = 0.4, p < 0.02) and CRP level (r = 0.47, p < 0.01). The scintigraphic score was lower in patients receiving corticosteroids or IL1Ra (interleukin 1 receptor antagonist) than in untreated patients (median scores:2, 0, and 13, respectively; p < 0.05). Two patients developed Waldenström macroglobulinemia. Of the 22 surviving patients, median age at follow-up was 76 years. IL1Ra was used in 13 patients, with dramatic efficacy on both symptoms and bone scan features. Conclusions Rheumatic manifestations are very prevalent in SchS. However, bone pain can be misleading and contribute to misdiagnosis. Bone scan abnormalities are very prevalent and correlate with disease activity and treatments. IL1-Ra has a dramatic and durable efficacy but may not be required in every patient early on.
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Affiliation(s)
| | | | - Hélène Aubert
- Department of Dermatology, CHU Nantes, Nantes, France
| | | | - Agathe Masseau
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | - Christian Agard
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | - Mohamed Hamidou
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
| | | | - Jean-Marie Berthelot
- Department of Rheumatology, CHU Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - Benoit Le Goff
- Department of Rheumatology, CHU Nantes, 1 place Alexis Ricordeau, 44000, Nantes, France
| | | | - Antoine Néel
- Department of Internal Medicine Interne, CHU Nantes, Nantes, France
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8
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Frizinsky S, Haj-Yahia S, Machnes Maayan D, Lifshitz Y, Maoz-Segal R, Offengenden I, Kidon M, Agmon-Levin N. The innate immune perspective of autoimmune and autoinflammatory conditions. Rheumatology (Oxford) 2020; 58:vi1-vi8. [PMID: 31769855 PMCID: PMC6878844 DOI: 10.1093/rheumatology/kez387] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022] Open
Abstract
Innate immunity is one of two immune defence system arms. It is present at birth and does not require ‘learning’ through exposure to foreign organisms. It activates various mechanisms collectively to eliminate pathogens and hold an infection until the adaptive response are mounted. The innate immune system consists of four elements: the epithelial barrier, cells (e.g. macrophages, NK cells), plasma proteins (e.g. complement) and cytokines. These components act in concert to induce complex processes, as well as recruitment, activation and differentiation of adaptive responses. The innate response is more than just the ‘first line of defence’, as it essentially withholds the vast majority of any intruder, has a complex interplay with the adaptive arm and is crucial for survival of the host. Finally, yet importantly, a myriad of diseases has been linked with innate immune dysregulation. In this mini-review we will shed some light on these conditions, particularly regarding autoinflammatory ones.
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Affiliation(s)
- Shirly Frizinsky
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Soad Haj-Yahia
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Diti Machnes Maayan
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Lifshitz
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ramit Maoz-Segal
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irean Offengenden
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Mona Kidon
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Chen YD, Krause K, Tu P, Zhao ZT, Maurer M. Response of omalizumab in normocomplementemic urticarial vasculitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2114-2117.e2. [PMID: 32145404 DOI: 10.1016/j.jaip.2020.02.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Yu-Di Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Karoline Krause
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - Zuo-Tao Zhao
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China; National Clinical Research Center for Skin and Immune Diseases, Beijing, China.
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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10
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Alix L, Néel A, Cador B, Smail A, Serratrice J, Closs-Prophette F, Jego P, Devillers A, Decaux O. Diagnostic value of 18-F fluorodeoxyglucose PET/CT and bone scan in Schnitzler syndrome. Autoimmunity 2019; 52:264-271. [PMID: 31646899 DOI: 10.1080/08916934.2019.1680649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Schnitzler syndrome is an auto-inflammatory disease defined by chronic urticarial eruption and monoclonal gammopathy. 18F fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is often performed, but its utility in Schnitzler syndrome has not been specifically investigated. The aim of this study was to determine whether PET/CT is informative in the diagnosis and follow-up of Schnitzler syndrome relative to other imaging techniques, including bone scans.Patients and methods: Patients of this study were selected from the French cohort established by Néel et al. All patients with a diagnosis of Schnitzler syndrome (according to Strasbourg's and Lipsker's criteria) who had at least one PET/CT were included. Data were collected from medical records. PET/CT scans were all reviewed by a nuclear physician blinded to the clinical and imaging data.Results: Ten patients underwent at least one PET/CT scan and all had at least one 99mTechnetium bone scan during their follow-up. The most frequent PET/CT abnormalities were diffuse bone-marrow and/or increased femoral fluorodeoxyglucose uptake, but they did not correlate with disease activity. Conversely, bone-scan abnormalities, including mainly increased radiotracer uptake in long bones, appeared to strongly correlate with Schnitzler syndrome activity.Discussion: PET/CT does not appear to be useful for the diagnosis and follow-up of Schnitzler syndrome. However, bone scans appear to be more sensitive for diagnosis and may correlate with clinical activity. Bone scans may be well positioned to distinguish Schnitzler syndrome relapse from other aetiologies of bone, joint, or muscle pain.Conclusion: Bone scans may be favoured over PET/CT in Schnitzler syndrome.
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Affiliation(s)
- L Alix
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Néel
- Internal Medicine Department, Nantes University Hospital, Nantes, France
| | - B Cador
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Smail
- Internal Medicine Department, Amiens University Hospital, Amiens, France
| | - J Serratrice
- Internal Medicine Department, Geneva University Hospital, Geneva, Switzerland
| | | | - P Jego
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Devillers
- Nuclear Medicine Department, Regional Center for the Fight against Cancer, Rennes, France
| | - O Decaux
- Internal Medicine Department, Rennes University Hospital, Rennes, France
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11
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Abstract
Schnitzler syndrome is a very rare acquired systemic disease with many similarities to hereditary autoinflammatory syndromes. The main characteristics are generalized exanthema and IgM monoclonal gammopathy. Other clinical features include fever, muscle, bone, and/or joint pain, and lymphadenopathy. About 15-20% of patients with Schnitzler syndrome develop lymphoproliferative diseases and, in rare cases, amyloid A (AA) amyloidosis can occur if the disease is not treated. Activation of the innate immune system, especially interleukin (IL)-1β, is central to the pathogenesis of disease. Consequently, complete control of disease symptoms can be achieved in 80% of patients by treatment with the IL-1 receptor antagonist anakinra.
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Affiliation(s)
- F F Gellrich
- Department of Dermatology, University Hospital Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - C Günther
- Department of Dermatology, University Hospital Dresden, Fetscherstr. 74, 01307, Dresden, Germany
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12
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Kambe N, Nguyen CTH. CCL
2 serves as a downstream effector of interleukin‐1β and tumour necrosis factor‐α signalling in Schnitzler syndrome. Br J Dermatol 2019; 180:706-707. [DOI: 10.1111/bjd.17503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Kambe
- Department of Dermatology Kansai Medical University Hirakata Osaka Japan
- Allergy Center Kansai Medical University Hirakata Osaka Japan
| | - C. T. H. Nguyen
- Department of Dermatology and Venereology University of Medicine and Pharmacy at Ho Chi Minh City Ho Chi Minh Vietnam
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13
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Bonnekoh H, Scheffel J, Wu J, Hoffmann S, Maurer M, Krause K. Skin and Systemic Inflammation in Schnitzler's Syndrome Are Associated With Neutrophil Extracellular Trap Formation. Front Immunol 2019; 10:546. [PMID: 30967871 PMCID: PMC6438918 DOI: 10.3389/fimmu.2019.00546] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/28/2019] [Indexed: 01/28/2023] Open
Abstract
Schnitzler's syndrome is a rare autoinflammatory disorder characterized by interleukin-1ß-mediated and neutrophil-dominated inflammation. Neutrophil extracellular traps (NETs) are web-like structures of decondensed chromatin, histones, and antimicrobial peptides released by neutrophils. NETs were initially described in the context of pathogen defense but are also involved in autoimmune-mediated skin diseases. Here, we assessed the role of neutrophil extracellular trap formation (NETosis) in Schnitzler's syndrome. Immunofluorescence co-staining of myeloperoxidase and subnucleosomal complex was performed on lesional skin samples from patients with Schnitzler's syndrome, other neutrophilic dermatoses (cryopyrin-associated periodic syndrome, Sweet syndrome, and pyoderma gangrenosum), urticarial vasculitis and chronic spontaneous urticaria as well as healthy control skin. Blood neutrophils from patients with Schnitzler's syndrome and controls were isolated, and NETosis was induced by phorbol 12-myristate 13-acetate (PMA). Also, NETosis of control neutrophils induced by symptomatic Schnitzler's syndrome sera, cytokines and sub-threshold PMA doses was studied. Immunofluorescence co-staining revealed widespread and substantial NET formation in lesional skin of Schnitzler's syndrome patients but absence of NETs in chronic spontaneous urticaria and control skin. Neutrophils undergoing NETosis were observed in the skin of other neutrophilic diseases too. Correspondingly, blood neutrophils from Schnitzler's syndrome patients showed significantly elevated NETosis rates compared to control neutrophils following stimulation with PMA. Increased NETosis correlated well with high levels of C-reactive protein (CRP). SchS patients with the lowest NETosis rates had persistent joint and bone pain despite IL-1 blockade. Stimulation of control neutrophils and sub-threshold PMA with sera of symptomatic Schnitzler's syndrome patients disclosed enhanced NETosis as compared to control sera. Our results suggest that the induction of NET formation by neutrophils contributes to skin and systemic inflammation and may support the resolution of local inflammation in Schnitzler's syndrome.
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Affiliation(s)
- Hanna Bonnekoh
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Autoinflammation Reference Center Charité (ARC2), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jörg Scheffel
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Autoinflammation Reference Center Charité (ARC2), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jim Wu
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sheila Hoffmann
- German Center for Neurodegenerative Diseases, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Autoinflammation Reference Center Charité (ARC2), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Karoline Krause
- Department of Dermatology and Allergy, Allergie-Centrum-Charité, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Autoinflammation Reference Center Charité (ARC2), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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14
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Abstract
Schnitzler syndrome is a very rare acquired systemic disease with many similarities to hereditary autoinflammatory syndromes. The main characteristics are generalized exanthema and a monoclonal gammopathy with IgM. Other clinical features include fever, muscle, bone and/or joint pain, and lymphadenopathy. About 15-20% of patients with Schnitzler syndrome develop lymphoproliferative diseases and, in rare cases, amyloid A (AA) amyloidosis can occur if the disease is not treated. Activation of the innate immune system, especially interleukin(IL)-1β, is central in the pathogenesis of the disease. Consequently, complete control of disease symptoms can be achieved in 80% of patients by treatment with the IL-1 receptor antagonist anakinra.
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Affiliation(s)
- F F Gellrich
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Anstalt des öffentlichen Rechts des Freistaates Sachsen, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Anstalt des öffentlichen Rechts des Freistaates Sachsen, Fetscherstr. 74, 01307, Dresden, Deutschland
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15
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Krause K, Sabat R, Witte-Händel E, Schulze A, Puhl V, Maurer M, Wolk K. Association of CCL2 with systemic inflammation in Schnitzler syndrome. Br J Dermatol 2018; 180:859-868. [PMID: 30339714 DOI: 10.1111/bjd.17334] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Schnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticarial exanthema, bone and joint alterations, fever and monoclonal gammopathy, which manifest mostly in the second half of life. It involves overactivation of the interleukin (IL)-1 system, but the exact pathophysiological pathways remain largely unknown. OBJECTIVES To identify and characterize the pathogenetic players in SchS. METHODS Blood parameters were quantified in patients with SchS compared with healthy controls and patients with psoriasis and hidradenitis suppurativa using enzyme-linked immunosorbent assay (ELISA). CCL2 expression in cultured primary cells was analysed by quantitative reverse-transcriptase polymerase chain reaction and ELISA. RESULTS CCL2, a chemoattractant for monocytic and further mononuclear immune cells, was found to be significantly elevated in patients with SchS. CCL2 levels showed a positive association with global disease activity, especially with bone pain, but not disease duration, gammopathy, neutrophilia or skin disease. In vitro stimulation assays demonstrated a strong CCL2 production capacity of mononuclear immune cells and fibroblasts, but not epithelial or endothelial cells. Among a range of inflammatory mediators, only IL-1β (immune cells, fibroblasts) and tumour necrosis factor (TNF)-α (fibroblasts) were important CCL2 inducers. TNF-α, but not IL-17, strengthened the CCL2-inducing effect of IL-1β in fibroblasts. Accordingly, CCL2 levels positively correlated with both TNF-α and IL-1β serum levels in patients with SchS. Therapeutic IL-1β blockade decreased CCL2 blood levels in these patients as early as 1 week after the initiation of treatment. CONCLUSIONS CCL2 may be an important component of the pathogenetic cascade leading to bone alterations, and a suitable marker of disease activity in patients with SchS.
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Affiliation(s)
- K Krause
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Autoinflammation Reference Centre Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - R Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology and, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - E Witte-Händel
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology and, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A Schulze
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology and, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - V Puhl
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Autoinflammation Reference Centre Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - M Maurer
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Autoinflammation Reference Centre Charité, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - K Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology and, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Berlin-Brandenburg Centre for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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16
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[Schnitzler syndrome]. Hautarzt 2018; 69:761-772. [PMID: 30167710 DOI: 10.1007/s00105-018-4250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Schnitzler syndrome is a very rare acquired systemic disease with many similarities to hereditary autoinflammatory syndromes. The main characteristics are generalized exanthema and a monoclonal gammopathy with IgM. Other clinical features include fever, muscle, bone and/or joint pain, and lymphadenopathy. About 15-20% of patients with Schnitzler syndrome develop lymphoproliferative diseases and, in rare cases, amyloid A (AA) amyloidosis can occur if the disease is not treated. Activation of the innate immune system, especially interleukin(IL)-1β, is central in the pathogenesis of the disease. Consequently, complete control of disease symptoms can be achieved in 80% of patients by treatment with the IL-1 receptor antagonist anakinra.
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17
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Abstract
PURPOSE OF REVIEW We focus on recent advances in diagnosis and therapeutic strategies, as well as on pathogenesis of Schnitzler syndrome. RECENT FINDINGS New diagnostic criteria were established, and their external validity was assessed in a retrospective cohort study. The cytokine interleukin-1 (IL-1) plays a crucial role in the pathogenesis of the Schnitzler syndrome, and this explains the spectacular efficiency of IL-1 blocking therapies. The Schnitzler syndrome is now considered as a late-onset acquired autoinflammatory syndrome in which the cytokine IL-1 plays a crucial role. IL-1 blocking therapies are efficient on the inflammation-linked symptoms but not on the monoclonal component. Therefore, they probably don't reduce the risk of the development of lymphoproliferative disorders that remains the main prognostic issue. The link between autoinflammation and the monoclonal component needs to be further elucidated.
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18
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Zhou J, An X, Dong J, Wang Y, Zhong H, Duan L, Ling J, Ping F, Shang J. IL-17 induces cellular stress microenvironment of melanocytes to promote autophagic cell apoptosis in vitiligo. FASEB J 2018; 32:4899-4916. [PMID: 29613836 DOI: 10.1096/fj.201701242rr] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vitiligo is a depigmentary disorder that develops as a result of the progressive disappearance of epidermal melanocytes. Stress can precipitate or exacerbate a skin disease through psychosomatic mechanisms. Stress exposure induces vitiligo-like symptoms in mice, as cellular damage to melanocytes causes synthetic pigment loss. Stress also increases IL-17, IL-1β, and antimelanocyte IgG in model mouse serum. Up-regulation of the IL-1β transcript in patients suggests its possible role in autoimmune pathogenesis of vitiligo. We demonstrate that IL-17 promoted IL-1β secretion from keratinocytes. Mitochondrial dysfunction, which can induce the excessive production of reactive oxygen species (ROS), is emerging as a mechanism that underlies various inflammatory and autoimmune diseases. In this study, we demonstrate that IL-17 inhibits melanogenesis of zebrafish, normal human epidermal melanocytes, and B16F10 cells. IL-17 increased mitochondrial dysfunction and ROS accumulation, which was related to autophagy induction. Autophagy is needed for autophagic apoptosis of B16F10 cells induced by IL-17. To inhibit ROS generation, B16F10 cells were pretreated with N-acetyl-l-cysteine (NAC), which inhibited autophagy. 3-Methyladenine (3-MA) also had an inhibiting effect on autophagy. NAC or 3-MA pretreatments inhibited IL-17-mediated cell apoptosis. In summary, IL-17 induces the cellular stress microenvironment in melanocytes to promote autophagic cell apoptosis in vitiligo.-Zhou, J., An, X., Dong, J., Wang, Y., Zhong, H., Duan, L., Ling, J., Ping, F., Shang, J. IL-17 induces cellular stress microenvironment of melanocytes to promote autophagic cell apoptosis in vitiligo.
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Affiliation(s)
- Jia Zhou
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Xiaohong An
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Jinjin Dong
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Yichuan Wang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Hui Zhong
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Lanlan Duan
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Jingjing Ling
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
| | - Fengfeng Ping
- Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Jing Shang
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China.,Jiangsu Key Laboratory of Traditional Chinese Medicine (TCM) Evaluation and Translational Research, China Pharmaceutical University, Nanjing, China
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19
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Bonnekoh H, Scheffel J, Kambe N, Krause K. The role of mast cells in autoinflammation. Immunol Rev 2018; 282:265-275. [DOI: 10.1111/imr.12633] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Hanna Bonnekoh
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Jörg Scheffel
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - Naotomo Kambe
- Department of Dermatology; Kansai Medical University; Hirakata Japan
- Allergy Center; Kansai Medical University; Hirakata Japan
| | - Karoline Krause
- Department of Dermatology and Allergy; Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC2); Charité - Universitätsmedizin Berlin; Berlin Germany
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20
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Mast Cells as Drivers of Disease and Therapeutic Targets. Trends Immunol 2018; 39:151-162. [DOI: 10.1016/j.it.2017.10.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 02/07/2023]
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21
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Dyring-Andersen B, Honoré TV, Madelung A, Bzorek M, Simonsen S, Clemmensen SN, Clark RA, Borregaard N, Skov L. Interleukin (IL)-17A and IL-22-producing neutrophils in psoriatic skin. Br J Dermatol 2017; 177:e321-e322. [PMID: 28369663 PMCID: PMC5921865 DOI: 10.1111/bjd.15533] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Beatrice Dyring-Andersen
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
- Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, US
| | - Trine Velte Honoré
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Ann Madelung
- Department of Pathology, Rigshospitalet, Denmark
| | - Michael Bzorek
- Department of Surgical Pathology, Zealand University Hospital, Denmark
| | - Stine Simonsen
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | | | - Rachael A. Clark
- Department of Dermatology, Brigham and Women’s Hospital and Harvard Medical School, Boston, US
| | - Niels Borregaard
- The Granulocyte Research Laboratory, Department of Hematology, Rigshospitalet, Denmark
| | - Lone Skov
- Department of Dermato-Allergology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
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22
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Bonnekoh H, Scheffel J, Maurer M, Krause K. Use of skin biomarker profiles to distinguish Schnitzler syndrome from chronic spontaneous urticaria: results of a pilot study. Br J Dermatol 2017; 178:561-562. [DOI: 10.1111/bjd.15705] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- H. Bonnekoh
- Department of Dermatology and Allergy, Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC ); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Scheffel
- Department of Dermatology and Allergy, Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC ); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy, Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC ); Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. Krause
- Department of Dermatology and Allergy, Allergie-Centrum-Charité; Charité - Universitätsmedizin Berlin; Berlin Germany
- Autoinflammation Reference Center Charité (ARC ); Charité - Universitätsmedizin Berlin; Berlin Germany
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23
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Giménez‐Arnau A, Curto‐Barredo L, Nonell L, Puigdecanet E, Yelamos J, Gimeno R, Rüberg S, Santamaria‐Babi L, Pujol R. Transcriptome analysis of severely active chronic spontaneous urticaria shows an overall immunological skin involvement. Allergy 2017; 72:1778-1790. [PMID: 28407332 DOI: 10.1111/all.13183] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The knowledge about chronic spontaneous urticaria (CSU) phenotypes is based on its clinical characteristics, associated comorbidities, course of the disease, and its response to the available effective drugs. Genotype expression and its further correlation with CSU phenotypes are still unknown. We describe the cutaneous transcriptome of patients suffering a severely active CSU refractory to antihistamine treatment. METHODS Through the bioinformatic analysis of the whole Human Genome with Oligo Microarrays and quantitative real-time polymerase chain reaction (qPCR), relevant genes expressed in nonlesional (NLS-CSU) and lesional skin (LS-CSU) and peripheral blood were identified in 20 patients suffering from severely active CSU and 10 healthy controls (HCs). RESULTS From 39 genes differentially expressed in NLS-CSU when compared with HCs, 31 (79.48%) were confirmed by qPCR corresponding to genes involved in epidermal homeostasis and dermal repair. From the analysis comparing LS-CSU with NLS-CSU, a selection of 142 genes was studied with qPCR, and 103 (72.53%) were confirmed. Differentially expressed genes in the phenomenon of wheal development are involved in a variety of biological functions as, epidermal differentiation, intracellular signal function, transcriptional factors cell cycle differentiation, inflammation, or coagulation. Differentially expressed genes that uniformly increase or decrease along the skin worsening until the wheal appearance is shown. CONCLUSION The skin of CSU patients with a severely active disease shows an overall immunological skin involvement showing a peculiar gene profile.
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Affiliation(s)
- A. Giménez‐Arnau
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
| | - L. Curto‐Barredo
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
| | - L. Nonell
- Microarray Analysis Service Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - E. Puigdecanet
- Microarray Analysis Service Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - J. Yelamos
- Immunology Department Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - R. Gimeno
- Immunology Department Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
| | - S. Rüberg
- Microarray Analysis Service Milteny Biotec GmbH Teterow Germany
| | - L. Santamaria‐Babi
- Translational Immunology, Department of Physiology and Immunology Universitat de Barcelona Barcelona Spain
| | - R.M. Pujol
- Department of Dermatology Hospital del Mar IMIM Universitat Autònoma de Barcelona Barcelona Spain
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24
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25
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Dreyfus DH. Differential Diagnosis of Chronic Urticaria and Angioedema Based on Molecular Biology, Pharmacology, and Proteomics. Immunol Allergy Clin North Am 2016; 37:201-215. [PMID: 27886907 DOI: 10.1016/j.iac.2016.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Differential diagnosis of urticaria and angioedema has been based on the phenotype as either acute or chronic depending on the duration of more than 6 to 8 weeks, respectively. Additional subdivisions include poorly defined terms such as idiopathic, spontaneous, or autoimmune. In this article, the author suggests that an increased understanding of the acquired and innate immune system and data from novel proteomic technology have blurred the lines between these categories of diagnosis. Specific molecular pathways and response to specific medications should be incorporated in classification and diagnosis schemes.
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Affiliation(s)
- David H Dreyfus
- Yale School of Medicine, Gesher LLC, Allergy, Asthma and Clinical Immunology, 4 Clifton Avenue, Waterbury CT 06710, USA.
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26
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Krause K, Tsianakas A, Wagner N, Fischer J, Weller K, Metz M, Church MK, Maurer M. Efficacy and safety of canakinumab in Schnitzler syndrome: A multicenter randomized placebo-controlled study. J Allergy Clin Immunol 2016; 139:1311-1320. [PMID: 27658762 DOI: 10.1016/j.jaci.2016.07.041] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/13/2016] [Accepted: 07/21/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Schnitzler syndrome is an adult-onset autoinflammatory disease characterized by urticarial exanthema and monoclonal gammopathy accompanied by systemic symptoms such as fever, bone, and muscle pain. Up to now, approved treatment options are not available. OBJECTIVE We assessed effects of the anti-IL-1β mAb canakinumab on the clinical signs and symptoms of Schnitzler syndrome. METHODS In this phase II, randomized placebo-controlled multicenter study, 20 patients with active disease enrolled in 4 German study centers. Patients were randomly assigned to receive single subcutaneous canakinumab 150 mg or placebo injections for 7 days, followed by a 16-week open-label phase with canakinumab injections on confirmed relapse of symptoms. The primary end point was the proportion of patients with complete clinical response evaluated by physician global assessment at day 7. Key secondary end points included changes in patient-reported disease activity (Schnitzler activity score), inflammation markers (C-reactive protein and serum amyloid A), and quality-of-life assessments (Dermatology Life Quality Index and 36-item short form health survey). RESULTS The proportion of patients with complete clinical response at day 7 was significantly higher (P = .001) in the canakinumab-treated group (n = 5 of 7) than in the placebo group (n = 0 of 13). Levels of inflammation markers C-reactive protein and serum amyloid A and quality-of-life scores were significantly reduced in canakinumab-treated but not in placebo-treated individuals. Positive effects continued up to 16 weeks. Adverse events were manageable and included respiratory tract infections, gastrointestinal symptoms, and hypertension. CONCLUSIONS In this first placebo-controlled study, canakinumab was effective in patients with Schnitzler syndrome, and thus canakinumab may be further evaluated as a therapeutic option for this rare disease.
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Affiliation(s)
- Karoline Krause
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Autoinflammation Reference Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | - Nicola Wagner
- Department of Dermatology, Klinikum Darmstadt, Darmstadt, Germany
| | - Jörg Fischer
- Department of Dermatology and Allergy, Universitätsklinik Tübingen, Tübingen, Germany
| | - Karsten Weller
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Metz
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin K Church
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany; Autoinflammation Reference Center Charité, Charité - Universitätsmedizin Berlin, Berlin, Germany
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27
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Kambe N. Role for mast cells in Schnitzler's syndrome: here mast cells master a rash, too. Br J Dermatol 2015; 173:323-4. [PMID: 26346079 DOI: 10.1111/bjd.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N Kambe
- Department of Dermatology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
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