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Ishihara R, Watanabe R, Shiomi M, Katsushima M, Fukumoto K, Yamada S, Okano T, Hashimoto M. Exploring the Link between Varicella-Zoster Virus, Autoimmune Diseases, and the Role of Recombinant Zoster Vaccine. Biomolecules 2024; 14:739. [PMID: 39062454 PMCID: PMC11274381 DOI: 10.3390/biom14070739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
The varicella-zoster virus (VZV) is a human neurotropic herpes virus responsible for varicella and herpes zoster (HZ). Following primary infection in childhood, VZV manifests as varicella (chickenpox) and enters a period of latency within the dorsal root ganglion. A compromised cellular immune response due to aging or immunosuppression triggers viral reactivation and the development of HZ (shingles). Patients with autoimmune diseases have a higher risk of developing HZ owing to the immunodeficiency associated with the disease itself and/or the use of immunosuppressive agents. The introduction of new immunosuppressive agents with unique mechanisms has expanded the treatment options for autoimmune diseases but has also increased the risk of HZ. Specifically, Janus kinase (JAK) inhibitors and anifrolumab have raised concerns regarding HZ. Despite treatment advances, a substantial number of patients suffer from complications such as postherpetic neuralgia for prolonged periods. The adjuvanted recombinant zoster vaccine (RZV) is considered safe and effective even in immunocompromised patients. The widespread adoption of RZV may reduce the health and socioeconomic burdens of HZ patients. This review covers the link between VZV and autoimmune diseases, assesses the risk of HZ associated with immunosuppressant use, and discusses the benefits and risks of using RZV in patients with autoimmune diseases.
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Affiliation(s)
- Ryuhei Ishihara
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Mayu Shiomi
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Masao Katsushima
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Kazuo Fukumoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Shinsuke Yamada
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Tadashi Okano
- Center for Senile Degenerative Disorders (CSDD), Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka 545-8585, Japan
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Nair V, Fishbein GA, Padera R, Seidman MA, Castonguay M, Leduc C, Tan CD, Rodriguez ER, Maleszewski JJ, Miller D, Romero M, Lomasney J, d'Amati G, De Gaspari M, Rizzo S, Angelini A, Basso C, Litovsky S, Buja LM, Stone JR, Veinot JP. Consensus statement on the processing, interpretation and reporting of temporal artery biopsy for arteritis. Cardiovasc Pathol 2023; 67:107574. [PMID: 37683739 DOI: 10.1016/j.carpath.2023.107574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common systemic vasculitis in adults in Europe and North America, typically involving the extra-cranial branches of the carotid arteries and the thoracic aorta. Despite advances in noninvasive imaging, temporal artery biopsy (TAB) remains the gold standard for establishing a GCA diagnosis. The processing of TAB depends largely on individual institutional protocol, and the interpretation and reporting practices vary among pathologists. To address this lack of uniformity, the Society for Cardiovascular Pathology formed a committee tasked with establishing consensus guidelines for the processing, interpretation, and reporting of TAB specimens, based on the existing literature. This consensus statement includes a discussion of the differential diagnoses including other forms of arteritis and noninflammatory changes of the temporal artery.
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Affiliation(s)
- Vidhya Nair
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - Gregory A Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Robert Padera
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael A Seidman
- Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mathieu Castonguay
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles Leduc
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Carmela D Tan
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Dylan Miller
- Intermountain Central Laboratory, Salt Lake City, UT, USA
| | - Maria Romero
- Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jon Lomasney
- Department of Pathology, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University, Rome, Italy
| | - Monica De Gaspari
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Silvio Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - James R Stone
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - John P Veinot
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Risk of, and risk factors for, vasculopathy associated with acute herpes zoster. J Stroke Cerebrovasc Dis 2023; 32:106891. [PMID: 36473399 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106891] [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: 05/24/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 12/10/2022] Open
Abstract
OBJECTIVES We aimed to summarize the known risk of vasculopathy (stroke, myocardial infarction [MI], and transient ischemic attack [TIA]) after herpes zoster (HZ) and the impact of antiviral treatment and vaccination against HZ on the risk of vasculopathy. MATERIALS AND METHODS A narrative literature review was conducted in PubMed to identify evidence published in the past 15 years that was relevant to the scope of this article. RESULTS Ten studies reported that HZ was associated with an increased risk of stroke and one UK study reported no association. Four studies reported that HZ was associated with an increased risk of MI, and four reported that HZ was associated with an increased risk of TIA. Two studies reported that antiviral treatment was associated with a reduced risk of stroke and an additional two studies reported no association between antiviral treatment and the risk of stroke. In addition, two studies reported that vaccination against HZ using the live zoster vaccine (ZVL) was associated with a reduced risk of stroke, and an additional two studies reported that the risk of stroke or MI after HZ was similar between ZVL vaccinated and unvaccinated individuals. CONCLUSIONS HZ is associated with an increased risk of stroke, MI, or TIA (strongest association is between HZ and stroke). Further studies are needed to determine whether antiviral treatment or ZVL vaccination influence the risk of HZ-associated vasculopathy. In addition, the effect of the recombinant zoster vaccine on the risk of HZ-associated vasculopathy should be studied.
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Stamatis P, Turesson C, Michailidou D, Mohammad AJ. Pathogenesis of giant cell arteritis with focus on cellular populations. Front Med (Lausanne) 2022; 9:1058600. [PMID: 36465919 PMCID: PMC9714577 DOI: 10.3389/fmed.2022.1058600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/31/2022] [Indexed: 08/27/2023] Open
Abstract
Giant cell arteritis (GCA), the most common non-infectious vasculitis, mainly affects elderly individuals. The disease usually affects the aorta and its main supra-aortic branches causing both general symptoms of inflammation and specific ischemic symptoms because of the limited blood flow due to arterial structural changes in the inflamed arteries. The pathogenesis of the GCA is complex and includes a dysregulated immune response that affects both the innate and the adaptive immunity. During the last two decades several studies have investigated interactions among antigen-presenting cells and lymphocytes, which contribute to the formation of the inflammatory infiltrate in the affected arteries. Toll-like receptor signaling and interactions through the VEGF-Notch-Jagged1 pathway are emerging as crucial events of the aberrant inflammatory response, facilitating among others the migration of inflammatory cells to the inflamed arteries and their interactions with the local stromal milieu. The increased use of checkpoint inhibitors in cancer immunotherapy and their immune-related adverse events has fed interest in the role of checkpoint dysfunction in GCA, and recent studies suggest a dysregulated check point system which is unable to suppress the inflammation in the previously immune-privileged arteries, leading to vasculitis. The role of B-cells is currently reevaluated because of new reports of considerable numbers of plasma cells in inflamed arteries as well as the formation of artery tertiary lymphoid organs. There is emerging evidence on previously less studied cell populations, such as the neutrophils, CD8+ T-cells, T regulatory cells and tissue residing memory cells as well as for stromal cells which were previously considered as innocent bystanders. The aim of this review is to summarize the evidence in the literature regarding the cell populations involved in the pathogenesis of GCA and especially in the context of an aged, immune system.
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Affiliation(s)
- Pavlos Stamatis
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Rheumatology, Sunderby Hospital, Luleå, Sweden
| | - Carl Turesson
- Rheumatology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Despina Michailidou
- Division of Rheumatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Aladdin J. Mohammad
- Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
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Yu E, Chang JR. Giant Cell Arteritis: Updates and Controversies. FRONTIERS IN OPHTHALMOLOGY 2022; 2:848861. [PMID: 38983551 PMCID: PMC11182101 DOI: 10.3389/fopht.2022.848861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/23/2022] [Indexed: 07/11/2024]
Abstract
Abstract Giant cell arteritis (GCA) is a systemic granulomatous vasculitis affecting the medium and large-size arteries, and may present with a range of ophthalmic findings. This review will cover GCA epidemiology, pathophysiology, clinical presentation, diagnostic workup, and treatment. Epidemiology and Pathophysiology GCA is commonly found in elderly patients and individuals of Scandinavian descent. Recent publications suggest it may be more common in African Americans and Hispanics than previously thought. It is very rare in Asian and Middle-Eastern populations, and there is little data regarding African populations. Genetic studies have identified increased risk associated with HLA-DRB1*04. Rather than a response to a specific antigen such as varicella zoster virus, current immunology research suggests that GCA results from changes associated with the aging immune system. Clinical presentation to Ophthalmology Arteritic anterior ischemic optic neuropathy is the most common ophthalmic manifestation of GCA, but central or branch retinal artery occlusion, ophthalmic artery occlusion, cranial neuropathies causing diplopia, and more rarely anterior segment ischemia and anisocoria may also occur. Clinical testing including visual field testing, OCT, OCT-A, ICG and fluorescein angiography can be helpful in suggesting a diagnosis in addition to the clinical exam. Diagnostic Workup GCA is ultimately a clinical diagnosis, but it is usually supported with lab results, pathology, and/or imaging. Temporal artery biopsy (TAB) remains the gold standard diagnostic test although its sensitivity is debated and practice patterns still vary with respect to sample length and whether unilateral or simultaneous bilateral biopsies are performed. Some studies have reported higher sensitivity of ultrasounds over TAB, with added benefits of time efficiency and cost effectiveness, promoting the diagnostic use of ultrasounds. MRI and even PET CT protocols offer additional options for less invasive diagnostic testing. Treatment Vision-threatening GCA is treated acutely with emergent admission for intravenous methylprednisolone, and long-term high dose oral corticosteroids remain the standard of care, despite common and sometimes serious side effects. The use of steroid-sparing alternatives such as tocilizumab is becoming more common and additional agents are being investigated.
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Affiliation(s)
| | - Jessica R. Chang
- University of Southern California Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, United States
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Sauret A, Stievenart J, Smets P, Olagne L, Guelon B, Aumaître O, André M, Trefond L. Case of Giant Cell Arteritis After SARS-CoV-2 Vaccination: A Particular Phenotype? J Rheumatol 2022; 49:120. [PMID: 34599047 DOI: 10.3899/jrheum.210724] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Agathe Sauret
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
| | - Julien Stievenart
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
| | - Perrine Smets
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
| | - Louis Olagne
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
| | - Benedicte Guelon
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
| | - Olivier Aumaître
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
- Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France
| | - Marc André
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied
- Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France
| | - Ludovic Trefond
- CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
- Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France
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Bubak AN, Mescher T, Mariani M, Frietze SE, Hassell JE, Niemeyer CS, Como CN, Burnet AM, Subramanian PS, Cohrs RJ, Mahalingam R, Nagel MA. Targeted RNA Sequencing of Formalin-Fixed, Paraffin-Embedded Temporal Arteries From Giant Cell Arteritis Cases Reveals Viral Signatures. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1078. [PMID: 34493606 PMCID: PMC8424492 DOI: 10.1212/nxi.0000000000001078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Varicella zoster virus (VZV) antigen has been detected in temporal arteries (TAs) of individuals with giant cell arteritis (GCA), the most common systemic vasculitis in older adults. Thus, we explored the contribution of VZV to GCA pathogenesis. METHODS Formalin-fixed, paraffin-embedded TA sections from biopsy-positive GCA participants with VZV antigen (GCA/VZV-positive; n = 20) and without (GCA/VZV-negative, n = 20) and from normal participants with VZV antigen (control/VZV-positive, n = 11) and without (control/VZV-negative, n = 20) were analyzed by targeted RNA sequencing of the whole human transcriptome (BioSpyder TempO-Seq). Ingenuity pathway analysis and R-computational program were used to identify differentially expressed genes and pathways between groups. RESULTS Compared with control/VZV-negative TAs, GCA/VZV-negative and GCA/VZV-positive TAs were significantly enriched for human transcripts specific for pathways involved in viral infections, including viral entry, nuclear factor kappa B activation by viruses, and other pathogen-related immune activation pathways. Similarly, human gene sets supporting viral infection were found in control/VZV-positive TAs that showed no morphological signs of inflammation, suggesting that the enriched pathways were not nonspecific signatures of infiltrating immune cells. All GCA TAs and control/VZV-positive TAs showed enrichment of transcripts involved in vascular remodeling, including smooth muscle cell migration. DISCUSSION The detection of viral and immune activation pathways in GCA TAs supports a role for virus infection in GCA pathogenesis. In addition, the detection of viral pathways in control/VZV-positive TAs, along with vascular remodeling pathways, suggests that these samples may represent early infection with progression to clinical disease, depending on host and other environmental factors.
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Affiliation(s)
- Andrew N Bubak
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Teresa Mescher
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Michael Mariani
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Seth E Frietze
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - James E Hassell
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Christy S Niemeyer
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Christina N Como
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Anna M Burnet
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Prem S Subramanian
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Randall J Cohrs
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Ravi Mahalingam
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora
| | - Maria A Nagel
- From the Department of Neurology (A.N.B., T.M., J.E.H., C.S.N., C.N.C., A.M.B., P.S.S., R.J.C., R.M., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Medical Laboratory Sciences (M.M., S.E.F.), University of Vermont, Burlington; Department of Ophthalmology (P.S.S., M.A.N.), University of Colorado School of Medicine, Aurora; Department of Neurosurgery (P.S.S.), University of Colorado School of Medicine, Aurora; and Department of Immunology and Microbiology (R.J.C.), University of Colorado School of Medicine, Aurora.
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Verdijk RM, Ouwendijk WJD, Kuijpers RWAM, Verjans GMGM. No Evidence of Varicella-Zoster Virus Infection in Temporal Artery Biopsies of Anterior Ischemic Optic Neuropathy Patients With and Without Giant Cell Arteritis. J Infect Dis 2021; 223:109-112. [PMID: 32901261 PMCID: PMC7781446 DOI: 10.1093/infdis/jiaa566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/09/2020] [Indexed: 01/01/2023] Open
Abstract
Background To test the hypothesis that varicella-zoster virus (VZV) infection contributes to temporal arteritis pathogenesis, comprehensive in situ analysis was performed on temporal artery biopsies of 38 anterior ischemic optic neuropathy (AION) patients, including 14 (37%) with giant cell arteritis. Methods Biopsies were completely sectioned, and, on average, 146 serial sections per patient were stained for VZV glycoprotein E. Results Four of 38 AION patients showed VZV glycoprotein E staining, but VZV infection was not confirmed by staining for VZV IE63 protein and VZV-specific polymerase chain reaction on adjacent sections. Conclusions This study refutes the premise that VZV is casually related to AION with and without giant cell arteritis.
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Affiliation(s)
- Robert M Verdijk
- Department of Pathology, Section Ophthalmic Pathology, Erasmus Medical Center (MC) University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Werner J D Ouwendijk
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert W A M Kuijpers
- Department of Ophthalmology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,Department of Ophthalmology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Ophthalmology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Georges M G M Verjans
- Department of Viroscience, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Akiyama M, Ohtsuki S, Berry GJ, Liang DH, Goronzy JJ, Weyand CM. Innate and Adaptive Immunity in Giant Cell Arteritis. Front Immunol 2021; 11:621098. [PMID: 33717054 PMCID: PMC7947610 DOI: 10.3389/fimmu.2020.621098] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022] Open
Abstract
Autoimmune diseases can afflict every organ system, including blood vessels that are critically important for host survival. The most frequent autoimmune vasculitis is giant cell arteritis (GCA), which causes aggressive wall inflammation in medium and large arteries and results in vaso-occlusive wall remodeling. GCA shares with other autoimmune diseases that it occurs in genetically predisposed individuals, that females are at higher risk, and that environmental triggers are suspected to beget the loss of immunological tolerance. GCA has features that distinguish it from other autoimmune diseases and predict the need for tailored diagnostic and therapeutic approaches. At the core of GCA pathology are CD4+ T cells that gain access to the protected tissue niche of the vessel wall, differentiate into cytokine producers, attain tissue residency, and enforce macrophages differentiation into tissue-destructive effector cells. Several signaling pathways have been implicated in initiating and sustaining pathogenic CD4+ T cell function, including the NOTCH1-Jagged1 pathway, the CD28 co-stimulatory pathway, the PD-1/PD-L1 co-inhibitory pathway, and the JAK/STAT signaling pathway. Inadequacy of mechanisms that normally dampen immune responses, such as defective expression of the PD-L1 ligand and malfunction of immunosuppressive CD8+ T regulatory cells are a common theme in GCA immunopathology. Recent studies are providing a string of novel mechanisms that will permit more precise pathogenic modeling and therapeutic targeting in GCA and will fundamentally inform how abnormal immune responses in blood vessels lead to disease.
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Affiliation(s)
- Mitsuhiro Akiyama
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Shozo Ohtsuki
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gerald J Berry
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
| | - David H Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jörg J Goronzy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Cornelia M Weyand
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Abstract
Purpose of Review Giant cell arteritis (GCA), a medium and large vessel vasculitis occurring in the aged, remains a formidable disease, capable of taking both vision and life, through a multitude of vascular complications. Our understanding of the spectrum of its manifestations has grown over the years, to include limb claudication, aortitis, and cardiac disease, in addition to the more classic visual complications resulting from of ischemia to branches of the external and internal carotid arteries. While a clinical presentation of headache, jaw claudication, scalp tenderness, fever and other systemic symptoms and serum markers are together highly suggestive of the disease, diagnosis can be challenging in those cases in which classic symptoms are lacking. The purpose of this review is to update the reader on advances in the diagnosis and treatment of giant cell arteritis and to review our evolving understanding of the immunological mechanism underlying the disease, which have helped guide our search for novel therapies. Recent Findings There is increasing evidence supporting the use of Doppler ultrasound, dedicated post-contrast T1-weighted spin echo MRI of the scalp arteries and PET scan, which can together improve our diagnostic accuracy in cases in which temporal artery biopsy is either inconclusive or not feasible. Advances in our understanding of the immunological cascades underlying the disease have helped guide our search for steroid-sparing treatments for the GCA, the most important of which has been the IL-6 receptor antibody inhibitor tocilizumab, which has been shown to reduce cumulative steroid dose in a large multicenter, placebo-controlled prospective study. Other biologic agents, such as abatacept and ustekinumab have shown promise in smaller studies. Summary GCA is no longer a disease whose diagnosis is based exclusively on temporal artery biopsy and whose complications are prevented solely with the use of corticosteroids. Modern vascular imaging techniques and targeted immunologic therapies are heralding a new era for the disease, in which practitioners will hopefully be able to diagnosis it with greater accuracy and treat it with less ischemic complications and iatrogenic side effects.
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Abendroth A, Slobedman B. Varicella-Zoster Virus and Giant Cell Arteritis. J Infect Dis 2021; 223:4-6. [PMID: 32901280 DOI: 10.1093/infdis/jiaa567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Allison Abendroth
- Discipline of Infectious Diseases and Immunology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Barry Slobedman
- Discipline of Infectious Diseases and Immunology, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Stamatis P, Turkiewicz A, Englund M, Jönsson G, Nilsson JÅ, Turesson C, Mohammad AJ. Infections Are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden. J Rheumatol 2020; 48:251-257. [PMID: 32414956 DOI: 10.3899/jrheum.200211] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To investigate the association between infections and the subsequent development of giant cell arteritis (GCA) in a large population-based cohort from a defined geographic area in Sweden. METHODS Patients diagnosed with biopsy-confirmed GCA between 2000 and 2016 were identified through the database of the Department of Pathology in Skåne, the southernmost region of Sweden. For each GCA case, 10 controls matched for age, sex, and area of residence were randomly selected from the general population. Using the Skåne Healthcare Register, we identified all infection events prior to patients' date of GCA diagnosis and controls' index date. With infection as exposure, a conditional logistic regression model was employed to estimate the OR for developing GCA. The types of infections contracted nearest in time to the GCA diagnosis/index date were identified. RESULTS A total of 1005 patients with biopsy-confirmed GCA (71% female) and 10,050 controls were included in the analysis. Infections were more common among patients subsequently diagnosed with GCA compared to controls (51% vs 41%, OR 1.78, 95% CI 1.53-2.07). Acute upper respiratory tract infection (OR 1.77, 95% CI 1.47-2.14), influenza and pneumonia (OR 1.72, 95 % CI 1.35-2.19), and unspecified infections (OR 5.35, 95 % CI 3.46-8.28) were associated with GCA. Neither skin nor gastrointestinal infections showed a correlation. CONCLUSION Infections, especially those of the respiratory tract, were associated with subsequent development of biopsy-confirmed GCA. Our findings support the hypothesis that a range of infections may trigger GCA.
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Affiliation(s)
- Pavlos Stamatis
- P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences, Rheumatology, Lund University, Lund;
| | - Aleksandra Turkiewicz
- A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund
| | - Martin Englund
- A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund
| | - Göran Jönsson
- G. Jönsson, MD, PhD, Associate Professor of Infection Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund
| | - Jan-Åke Nilsson
- J.Å.Nilsson, BS, Statistician, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö
| | - Carl Turesson
- C. Turesson, MD, PhD, Professor of Rheumatology, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö
| | - Aladdin J Mohammad
- A.J. Mohammad, MD, MPH, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden, Department of Medicine, University of Cambridge, Cambridge, UK
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