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Sagües‐Sesé E, García‐Casares N, Álvarez‐Twose I. Cognitive, neuropsychiatric and neurological alterations in mastocytosis: A systematic review. Clin Transl Allergy 2023; 13:e12319. [PMID: 38146805 PMCID: PMC10718195 DOI: 10.1002/clt2.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Mastocytosis manifests with multisystemic symptoms, often involving the nervous system. Numerous cognitive, neuropsychiatric and neurological alterations have been reported in multiple observational studies. METHODS We performed a qualitative systematic literature review of reported data consulting the electronic databases Medline, Scopus, Web of Science, Cochrane, and BASE until June 2023. RESULTS We selected 24 studies in which the majority showed that a high proportion of mastocytosis patients suffer cognitive, neuropsychiatric and neurological alterations. The most common disorders and estimated ranges of frequency observed in adults were depression (68%-75%), anxiety, high stress or irritability (27%-54%), cognitive impairment (27%-39%, primarily affecting memory skills), and headaches (55%-69%). Attention challenges and learning difficulties were reported in children at a rate of 13%, while neurodevelopmental disorders occurred at rates of 8%-12%. Frequent white abnormalities in mastocytosis patients with concomitant psychocognitive symptoms have been reported although neuroimaging studies have been performed rarely in this population. CONCLUSION Further studies with more comprehensive and homogeneous evaluations and neuroimaging and histological analysis should be performed for a better understanding of these manifestations. An earlier detection and proper management of these symptoms could greatly improve the quality of life of these patients.
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Affiliation(s)
- Elena Sagües‐Sesé
- Departamento de Medicina, Facultad de MedicinaUniversidad de MálagaMálagaSpain
| | - Natalia García‐Casares
- Departamento de Medicina, Facultad de MedicinaUniversidad de MálagaMálagaSpain
- Centro de Investigaciones Médico‐Sanitarias (CIMES), Fundación General de la Universidad de Málaga, Universidad de MálagaMálagaSpain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND)MálagaSpain
| | - Ivan Álvarez‐Twose
- Instituto de Estudios de Mastocitosis de Castilla‐La Mancha (CLMast)Reference Center for Mastocytosis and CIBERONCToledoSpain
- Spanish Network on Mastocytosis (REMA)Toledo and SalamancaSpain
- Instituto de Investigación Sanitaria de Castilla‐La Mancha (IDISCAM)ToledoSpain
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Di Mauro P, Anzivino R, Distefano M, Borzì DD. Systemic mastocytosis: The roles of histamine and its receptors in the central nervous system disorders. J Neurol Sci 2021; 427:117541. [PMID: 34139449 DOI: 10.1016/j.jns.2021.117541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/28/2022]
Abstract
Mastocytosis is a rare disease of clonal hematological disorders characterized by a pathological accumulation of Mast Cells (MCs) in different tissues, with variable symptomatology and prognosis. Signs and symptoms of Systemic Mastocytosis (SM) are due to pathological infiltration of MCs and to the release of chemical mediators, mainly histamine. Patients with SM may also present with neurological symptoms or complications. The pathophysiology of these neurological disorders remains uncertain to this day, but it can be associated with the infiltration of tissue mastocytes, release of mastocytes' mediators or both. Moreover, there is a lot to understand about the role of neurological symptoms in SM and knowing, for example, what is the real frequency of neurological disorders in SM and if is present a relation between other SM subtypes, because it has been noted that the alteration of the histamine expression may be an initiating factor for susceptibility, gravity and progression of the epigenetic disease. In this review we explain the possible pathophysiological mechanism about neurological symptomatology found in some patients affected by SM, describing the role of histamine and its receptors in the nervous system and, in light of the results, what the future prospects may be for a more specific course of treatment.
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Affiliation(s)
- Paola Di Mauro
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia" A.O.U. "Policlinico - Vittorio Emanuele", University of Catania, Catania, Italy.
| | | | | | - Davide Domenico Borzì
- University of Catania, Italy and Italian Federation of Sports Medicine (FMSI), Rome, Italy
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Khan S. Fatal Cerebral Events Following Insect Stings May be Due to Inappropriate Mast Cell Activation. Ann Indian Acad Neurol 2020; 23:816. [PMID: 33688137 PMCID: PMC7900723 DOI: 10.4103/aian.aian_50_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 02/22/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sujoy Khan
- Consultant Immunologist, Hull University Teaching Hospitals NHS Trust, Castle Hill Hospital, Cottingham, HU16 5JQ, UK
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Georgin-Lavialle S, Gaillard R, Moura D, Hermine O. Mastocytosis in adulthood and neuropsychiatric disorders. Transl Res 2016; 174:77-85.e1. [PMID: 27063957 DOI: 10.1016/j.trsl.2016.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/04/2016] [Accepted: 03/15/2016] [Indexed: 12/18/2022]
Abstract
Patients with mastocytosis can display various disabling general and neuropsychological symptoms among one third of them, including general signs such as fatigue and musculoskeletal pain, which can have a major impact on quality of life. Neurological symptoms are less frequent and mainly consist of acute or chronic headache (35%), rarely syncopes (5%), acute onset back pain (4%), and in a few cases, clinical and radiological symptoms resembling or allowing the diagnosis of multiple sclerosis (1.3%). Headaches are associated with symptoms related to mast cell activation syndrome (flushes, prurit, and so forth) and more frequently present as migraine (37.5%), with often aura (66%). Depression-anxiety like symptoms can occur in 40% to 60% of the patients and cognitive impairment is not rare (38.6%). The pathophysiology of these symptoms could be linked to tissular mast cell infiltration or to mast cell mediators release or both. The tryptophan metabolism could be involved in mast cell-induced neuroinflammation through indoleamine-2,3-dioxygenase activation. Treatments targeting mast cell may be useful to target neuropsychological features associated with mastocytosis, including tyrosine kinase inhibitors.
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Affiliation(s)
- Sophie Georgin-Lavialle
- Service de médecine Interne, Hôpital Tenon, Université Pierre et Marie Curie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphaël Gaillard
- Laboratoire de "Physiopathologie des maladies Psychiatriques", Centre de Psychiatrie et Neurosciences U894, INSERM; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Service de Psychiatrie, Centre Hospitalier Sainte-Anne, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine Paris Descartes, Paris, France; Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - Daniela Moura
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France
| | - Olivier Hermine
- Centre de référence des mastocytoses, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker Enfants malades, Paris, France; INSERM U1163 and CNRS ERL 8254 and Laboratory of Physiopathology and Treatment of Hematological Disorders Hôpital Necker-Enfants malades, Institut Imagine, Paris, France; Service d'hématologie adulte, Université Paris Descartes, Sorbonne, Paris Cité, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Hôpital Necker-Enfants malades, Paris, France.
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Moura DS, Sultan S, Georgin-Lavialle S, Pillet N, Montestruc F, Gineste P, Barete S, Damaj G, Moussy A, Lortholary O, Hermine O. Depression in patients with mastocytosis: prevalence, features and effects of masitinib therapy. PLoS One 2011; 6:e26375. [PMID: 22031830 PMCID: PMC3198767 DOI: 10.1371/journal.pone.0026375] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/26/2011] [Indexed: 12/16/2022] Open
Abstract
Depression in patients with mastocytosis is often reported but its prevalence and characteristics are not precisely described. In addition, the impact of therapies targeting mast cells proliferation, differentiation and degranulation on psychic symptoms of depression have never been investigated. Our objective was to determine the prevalence and to describe features of depression in a large cohort of mastocytosis patients (n = 288) and to investigate the therapeutic impact of the protein kinase inhibitor masitinib in depression symptoms. The description of depression was based on the analysis of a database with Hamilton scores using Principal Component Analysis (PCA). Efficacy of masitinib therapy was evaluated using non parametric Wilcoxon test for paired data within a three months period (n = 35). Our results show that patients with indolent mastocytosis present an elevated prevalence of depression (64%). Depression was moderate in 56% but severe in 8% of cases. Core symptoms (such as psychic anxiety, depressed mood, work and interests) characterized depression in mastocytosis patients. Masitinib therapy was associated with significant improvement (67% of the cases) of overall depression, with 75% of recovery cases. Global Quality of Life slightly improved after masitinib therapy and did not predicted depression improvement. In conclusion, depression is very frequent in mastocytosis patients and masitinib therapy is associated with the reduction its psychic experiences. We conclude that depression in mastocytosis may originate from processes related to mast cells activation. Masitinib could therefore be a useful treatment for mastocytosis patients with depression and anxiety symptoms.
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Affiliation(s)
- Daniela Silva Moura
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
- Université Paris Descartes, Sorbonne, Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA 4057, IUPDP Institut de Psychologie, Paris, France
| | - Serge Sultan
- Université Paris Descartes, Sorbonne, Paris Cité, Laboratoire de Psychopathologie et Processus de Santé EA 4057, IUPDP Institut de Psychologie, Paris, France
- Université de Montréal, Centre de Recherche du CHU Sainte-Justine, Montréal, Canada
| | - Sophie Georgin-Lavialle
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
- CNRS UMR 8147, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants malades, Paris, France
| | | | | | | | - Stéphane Barete
- Département de dermatologie, Centre de référence des mastocytoses, Hôpital Tenon, Université Pierre et Marie Curie, Paris, France
| | - Gandhi Damaj
- Service d'hématologie, CHU d'Amiens, Université Jules–Vernes Picardie, Amiens, France
| | - Alain Moussy
- AB Science, S.A., Paris, France
- Association Française pour les initiatives et la recherche sur les mastocytes et les mastocytoses (AFIRMM), Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne, Paris Cité, Service de maladies infectieuses et tropicales, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
| | - Olivier Hermine
- Université Paris Descartes, Sorbonne, Paris Cité, Service d'hématologie, Centre de référence des mastocytoses, Hôpital Necker Enfants malades, Paris, France
- CNRS UMR 8147, Université Paris Descartes, Sorbonne, Paris Cité, Hôpital Necker-Enfants malades, Paris, France
- AB Science, S.A., Paris, France
- Association Française pour les initiatives et la recherche sur les mastocytes et les mastocytoses (AFIRMM), Paris, France
- * E-mail:
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Smith JH, Butterfield JH, Pardanani A, DeLuca GC, Cutrer FM. Neurologic symptoms and diagnosis in adults with mast cell disease. Clin Neurol Neurosurg 2011; 113:570-4. [DOI: 10.1016/j.clineuro.2011.05.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 01/06/2011] [Accepted: 05/10/2011] [Indexed: 11/28/2022]
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Abstract
Mast cells are resident in the brain and contain numerous mediators, including neurotransmitters, cytokines, and chemokines, that are released in response to a variety of natural and pharmacological triggers. The number of mast cells in the brain fluctuates with stress and various behavioral and endocrine states. These properties suggest that mast cells are poised to influence neural systems underlying behavior. Using genetic and pharmacological loss-of-function models we performed a behavioral screen for arousal responses including emotionality, locomotor, and sensory components. We found that mast cell deficient Kit(W-sh/W-sh) (sash(-/-)) mice had a greater anxiety-like phenotype than WT and heterozygote littermate control animals in the open field arena and elevated plus maze. Second, we show that blockade of brain, but not peripheral, mast cell activation increased anxiety-like behavior. Taken together, the data implicate brain mast cells in the modulation of anxiety-like behavior and provide evidence for the behavioral importance of neuroimmune links.
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Hermine O, Lortholary O, Leventhal PS, Catteau A, Soppelsa F, Baude C, Cohen-Akenine A, Palmérini F, Hanssens K, Yang Y, Sobol H, Fraytag S, Ghez D, Suarez F, Barete S, Casassus P, Sans B, Arock M, Kinet JP, Dubreuil P, Moussy A. Case-control cohort study of patients' perceptions of disability in mastocytosis. PLoS One 2008; 3:e2266. [PMID: 18509466 PMCID: PMC2386235 DOI: 10.1371/journal.pone.0002266] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 03/24/2008] [Indexed: 01/08/2023] Open
Abstract
Background Indolent forms of mastocytosis account for more than 90% of all cases, but the types and type and severity of symptoms and their impact on the quality of life have not been well studied. We therefore performed a case-control cohort study to examine self-reported disability and impact of symptoms on the quality of life in patients with mastocytosis. Methodology/Principal Findings In 2004, 363 mastocytosis patients and 90 controls in France were asked to rate to their overall disability (OPA score) and the severity of 38 individual symptoms. The latter was used to calculate a composite score (AFIRMM score). Of the 363 respondents, 262 were part of an ongoing pathophysiological study so that the following data were available: World Health Organization classification, standard measures of physical and psychological disability, existence of the D816V KIT mutation, and serum tryptase level. The mean OPA and AFIRMM scores and the standard measures of disability indicated that most mastocytosis patients suffer from disabilities due to the disease. Surprisingly, the patient's measurable and perceived disabilities did not differ according to disease classification or presence or absence of the D816V KIT mutation or an elevated (≥20 ng/mL) serum tryptase level. Also, 32 of the 38 AFIRMM symptoms were more common in patients than controls, but there were not substantial differences according to disease classification, presence of the D816V mutation, or the serum tryptase level. Conclusions On the basis of these results and for the purposes of treatment, we propose that mastocytosis be first classified as aggressive or indolent and that indolent mastocytosis then be categorized according to the severity of patients' perceived symptoms and their impact on the quality of life. In addition, it appears that mastocytosis patients suffer from more symptoms and greater disability than previously thought, that mastocytosis may therefore be under-diagnosed, and that the symptoms of the indolent forms of mastocytosis might be due more to systemic release of mediators than mast cell burden.
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Affiliation(s)
- Olivier Hermine
- Service de Dermatologie, Centre de référence sur la mastocytose, Hôpital Necker, Paris, France.
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Butterfield JH. Systemic Mastocytosis: Clinical Manifestations and Differential Diagnosis. Immunol Allergy Clin North Am 2006; 26:487-513. [PMID: 16931290 DOI: 10.1016/j.iac.2006.05.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Mast cells produce symptoms by local and remote effects of mediator release and by their presence in increased numbers in normal tissue and bone marrow, where they damage and impair normal organ function. Moreover, mast cells are long-lived and heterogeneous in their response to secretagogues and to inhibitors of mediator release. Clinicians sorting out the diagnosis of SM on the basis of presenting signs and symptoms continue to have their diagnostic skills challenged because of the rarity of this disorder, the fact that many symptoms of SM are present in more common disorders, and the multiple guises that SM may assume at the time of presentation.
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Affiliation(s)
- Joseph H Butterfield
- Division of Allergic Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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