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Leštan Ramovš Z, Sodin-Šemrl S, Lakota K, Čučnik S, Manevski D, Zbačnik R, Zupančič M, Verbič M, Terčelj M. Correlation of the High-Resolution Computed Tomography Patterns of Intrathoracic Sarcoidosis with Serum Levels of SAA, CA 15.3, SP-D, and Other Biomarkers of Interstitial Lung Disease. Int J Mol Sci 2023; 24:10794. [PMID: 37445972 DOI: 10.3390/ijms241310794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Studies on the serum biomarkers of granulomatous inflammation and pulmonary interstitial disease in intrathoracic sarcoidosis have shown conflicting results. We postulated that differences in the concentrations of serum biomarkers can be explained by the heterogenous patterns of sarcoidosis seen on thoracic HRCT. Serum biomarker levels in 79 consecutive patients, newly diagnosed with intrathoracic sarcoidosis, were compared to our control group of 56 healthy blood donors. An analysis was performed with respect to HRCT characteristics (the presence of lymph node enlargement, perilymphatic or peribronchovascular infiltrates, ground-glass lesions, or fibrosis), CXR, and disease extent. Serum levels of CXCL9, CXCL10, CTO, and CCL18 were statistically significantly increased in all patients compared to controls. Serum levels of CA15.3 were statistically significantly increased in all patients with parenchymal involvement. SAA was increased in patients with ground-glass lesions while SP-D levels were statistically significantly increased in patients with lung fibrosis. Only SP-D and CA15.3 showed a significant correlation to interstitial disease extent. In conclusion, we found that sarcoidosis patients with different HRCT patterns of intrathoracic sarcoidosis have underlying biochemical differences in their serum biomarkers transcending Scadding stages. The stratification of patients based on both radiologic and biochemical characteristics could enable more homogenous patient selection for further prognostic studies.
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Affiliation(s)
- Zala Leštan Ramovš
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Snežna Sodin-Šemrl
- Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, 6000 Koper, Slovenia
| | - Katja Lakota
- Faculty of Mathematics, Natural Sciences and Information Technologies (FAMNIT), University of Primorska, 6000 Koper, Slovenia
- Department of Rheumatology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Saša Čučnik
- Department of Rheumatology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Damjan Manevski
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Rok Zbačnik
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Mirjana Zupančič
- Laboratory Department, Children's Hospital, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Martin Verbič
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Marjeta Terčelj
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
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Zupančič D, Terčelj M, Štrus B, Veranič P. How to obtain good morphology and antigen detection in the same tissue section? Protoplasma 2017; 254:1931-1939. [PMID: 28188396 DOI: 10.1007/s00709-017-1085-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 01/31/2017] [Indexed: 06/06/2023]
Abstract
Most human and animal biopsy samples are routinely embedded in paraffin since this enables the pathologist or researcher to obtain excellent morphology and simplifies storage. Nevertheless, in many cases, the antigen of interest cannot be detected in paraffin section. The alternative available for good immunohistochemistry is preparation of cryosections, which usually provide decent antigen preservation and are frequently used for immunofluorescence. However, cryosections often do not provide efficient morphological details of tissues and cells for pathologic evaluation. In order to obtain good antigen preservation and improve tissue and cell morphology after freezing, we tested three different fixations and freezing methodologies and compared them to routine formaldehyde fixation and paraffin embedding. As a model system, we selected the epithelium of the rat urinary bladder and trachea. On all samples, haematoxylin and eosin staining was performed as well as immunofluorescence with antibodies against tight junction protein ZO-1 and against intermediate filament cytokeratin 7. The best compromise between morphology and immunofluorescence was obtained with "sucrose impregnation prior to freezing" method. Moreover, this procedure is also quicker in comparison to standard paraffin section preparation. To check the clinical relevance of our study, this method was used for human biopsy samples of neoplastic urothelial and bronchial mucosa lesions. Besides good immunofluorescence results, the morphology of these samples was well preserved. We therefore propose that cryosection preparation with sucrose impregnation prior to freezing should be further exploited in other clinical and veterinary applications, since it enables good morphology and antigen preservation.
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Affiliation(s)
- Daša Zupančič
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Marjeta Terčelj
- Department of Pulmonary and Allergic Diseases, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Bojan Štrus
- Department of Urology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000, Ljubljana, Slovenia
| | - Peter Veranič
- Institute of Cell Biology, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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Terčelj M, Salobir B, Rylander R. β-glucan in the lymph nodes in sarcoidosis and in Kveim-Siltzbach test reagent. Sarcoidosis Vasc Diffuse Lung Dis 2017; 34:130-135. [PMID: 32476834 DOI: 10.36141/svdld.v34i2.5844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 04/12/2017] [Indexed: 11/02/2022]
Abstract
Background: Previous studies have demonstrated a relationship between biomass of fungi exposure in the home and the risk of sarcoidosis. β-glucan was present in the bronchial alveolar lavage fluid (BALF) of patients with sarcoidosis. The Kveim-Siltzbach test reagent (KSTR) induces a sarcoidosis specific, granulomatous, cutaneous response and was used to establish the diagnosis. To date, the granuloma-inducing component of KSTR is still unknown. The present study was undertaken to investigate the presence of β-glucan in the lymph nodes of patients with sarcoidosis and to determine the relationship between the amounts of this agent with disease severity and to investigate the presence of β-glucan in KSTR. Materials and methods: Lymph node aspirations were collected by transbronchial needle aspiration (TBNA) in region R4 or 7 from patients with newly diagnosed sarcoidosis. The samples were treated to isolate β-glucan and analyzed using a Limulus-based assay. Cultures of Propionibacterium ac. and Mycobacterium gordonae as well as samples of Kveim-Siltzbach test reagent were analyzed to determine β-glucan content. Results: A significant relationship was observed between the amount of the β-glucan in the lymph nodes and the extent of granuloma formation in the lung parenchyma, and the size of the lymph nodes in the mediastinum (r=0.787, p=0.0001 and r=0.664, p<0.001 respectively, Spearman's test). The samples of Kveim-Siltzbach test reagent contained high levels of β-glucan. Cultures of Propionibacterium ac. and Mycobacterium gordonae contained β-glucan, the levels of which were lower in the Mycobacterium cultures. Comments: The results support the hypothesis that β-glucan, and thus fungal exposure, are involved in the pathogenesis of sarcoidosis. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 130-135).
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Affiliation(s)
- Marjeta Terčelj
- Department of Pulmonary Diseases and Allergy, University Medical Centre, Medical Faulty Ljubljana, Slovenia
| | - Barbara Salobir
- Department of Pulmonary Diseases and Allergy, University Medical Centre, Medical Faulty Ljubljana, Slovenia
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Stopinšek S, Ihan A, Salobir B, Terčelj M, Simčič S. Fungal cell wall agents and bacterial lipopolysaccharide in organic dust as possible risk factors for pulmonary sarcoidosis. J Occup Med Toxicol 2016; 11:46. [PMID: 27688795 PMCID: PMC5031305 DOI: 10.1186/s12995-016-0135-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/17/2016] [Indexed: 12/14/2022] Open
Abstract
Background Composition of organic dust is very complex, involving particles of microbial, animal and plant origin. Several environmental exposure studies associate microbial cell wall agents in organic dust with various respiratory symptoms and diseases. The aim of the present study was to investigate the in vitro effects of the co-exposure of fungal cell wall agents (FCWAs) and bacterial lipopolysaccharide (LPS) on inflammatory immune responses of peripheral blood mononuclear cells (PBMCs) from patients with pulmonary sarcoidosis. Methods PBMCs from 22 patients with pulmonary sarcoidosis and 20 healthy subjects were isolated and stimulated in vitro with FCWAs (soluble and particulate (1 → 3)-β-D-glucan, zymosan and chitosan) and/or LPS. Subsequently, cytokines were measured by ELISA and the mRNA expression of dectin-1, toll-like receptor 2 (TLR2), TLR4 and mannose receptor (MR) was analysed by real-time RT-PCR. Results Patients with sarcoidosis had a significantly higher secretion of inflammatory cytokines tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10 and IL-12 (1.7-fold, 2.0-fold, 2.2-fold, and 2.8-fold, respectively; all p < 0.05) after in vitro co-stimulation of PBMCs with FCWAs and LPS. We showed that PBMCs from patients with sarcoidosis had a higher baseline mRNA expression of dectin-1, TLR2, TLR4 and MR (6-fold, 11-fold, 18-fold, and 4-fold, respectively). Furthermore, we found a reduced expression of dectin-1, TLR2 and TLR4 after stimulation with FCWAs and/or LPS, although the reduction was significantly weaker in patients than in healthy subjects. Conclusions In conclusion, co-stimulation with FCWAs and LPS of PBMC from patients with sarcoidosis caused a weaker reduction of dectin-1, TLR2, TLR4 receptors expression, which could increase the sensitivity of PBMCs, leading to excessive inflammatory cytokine responses and result in the development or progression of pulmonary sarcoidosis.
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Affiliation(s)
- Sanja Stopinšek
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, SI-1000 Ljubljana, Slovenia
| | - Alojz Ihan
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, SI-1000 Ljubljana, Slovenia
| | - Barbara Salobir
- Department for Respiratory and Allergic Diseases, University Medical Centre, Zaloška 2, SI-1000 Ljubljana, Slovenia
| | - Marjeta Terčelj
- Department for Respiratory and Allergic Diseases, University Medical Centre, Zaloška 2, SI-1000 Ljubljana, Slovenia
| | - Saša Simčič
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Zaloška 4, SI-1000 Ljubljana, Slovenia
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Harlander M, Salobir B, Zupančič M, Terčelj M. Bronchoalveolar lavage chitotriosidase activity as a biomarker of sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 32:313-317. [PMID: 26847098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/09/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Chitotriosidase (CTO) was shown to be a good biomarker of sarcoidosis. Increased levels in bronchoalveolar lavage fluid (BALF) were reported and associated with more severe forms of the disease. OBJECTIVES The aim of the study was to evaluate the value of CTO in BALF as a routine biomarker of sarcoidosis. METHODS The study included 85 patients in 9 control subjects in whom serum and BALF CTO were measured. RESULTS Significantly higher CTO levels were detected in BALF of sarcoidosis patients than in control subjects (p < 0.001). There was good correlation between serum and BALF CTO levels in sarcoidosis patients (Spearman's Rho 0.481, p < 0.001). Serum but not BALF CTO had good correlation with clinical parameters. Only in a group of patients with BALF CTO above upper normal range there was association of BALF CTO with impaired FVC (p = 0.020) and chest radiograph score (0-2 vs. 3-4, p = 0.016). CONCLUSIONS In comparison to serum CTO no additional benefit of determining CTO in BAL for routine sarcoidosis workup was shown.
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Affiliation(s)
- Matevž Harlander
- Department of Pulmonary diseases, University Medical Centre Ljubljana.
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Fakin A, Terčelj M, Vidović Valentinčič N. Frequency of IWOS Suggestive Ocular Signs in Slovenian Uveitis Patients with Confirmed Pulmonary Sarcoidosis. Ocul Immunol Inflamm 2015; 24:660-664. [DOI: 10.3109/09273948.2015.1063669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ana Fakin
- Eye Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Marjeta Terčelj
- Clinic of Pulmonary Disease and Allergy, University Medical Centre, Ljubljana, Slovenia
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Harlander M, Maver A, Terčelj M, Salobir B, Peterlin B. Common chitotriosidase duplication gene polymorphism and clinical outcome status in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2015; 32:194-199. [PMID: 26422563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/18/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND Chitotriosidase has been found to be useful as a sarcoidosis biomarker. In patients with better outcome lower values were observed. Some subjects have 24-base pair duplication in the chitotriosidase gene (CHIT1) that results in the production of inactive enzyme. This might influence the outcome of sarcoidosis and account for described observations. OBJECTIVES The aim of this study was to correlate common CHIT1 duplication polymorphism and clinical outcome status in sarcoidosis (COS). METHODS This retrospective study comprised 180 patients with sarcoidosis. COS at 3, 5 and 10 years was determined and correlated with CHIT1 24-base pair duplication polymorphism. CHIT1 genotyping was done by the PCR method. RESULTS There was no significant correlation between CHIT1 24-base pair duplication polymorphism and COS at 3, 5 or 10 years but a subgroup analysis showed higher frequency of patients with Loefgren's syndrome (50% vs. 17.1%) and better COS in CHIT1 24-base pair duplication homozygotes vs. all other subjects in major COS groups (no, minimal and persistent disease) at 3 years (p=0.025) and borderline significant at 5 years (p = 0.090). CONCLUSIONS In this study no correlation between CHIT1 24-base pair duplication polymorphism and COS was shown, but possible protective role of homozygous condition for CHIT1 24-base pair duplication polymorphism is suggested.
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Affiliation(s)
- Matevž Harlander
- Department of pulmonary diseases, University Medical Centre Ljubljana.
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Mlakar P, Salobir B, Čobo N, Strašek J, Prezelj M, Debevc A, Jug B, Terčelj M, Šabovič M. The effect of cardioprotective diet rich with natural antioxidants on chronic inflammation and oxidized LDL during cardiac rehabilitation in patients after acute myocardial infarction. Int J Cardiol Heart Vasc 2015; 7:40-48. [PMID: 28785643 PMCID: PMC5497189 DOI: 10.1016/j.ijcha.2015.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/20/2014] [Accepted: 02/01/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Chronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention after acute myocardial infarction (AMI). The aim of our study was to determine the effect of diet, rich with natural antioxidants, added to physical activity (as a part of cardiac rehabilitation (CR) program) on inflammatory markers and ox-LDL, a marker of oxidative stress, closely involved in the process of chronic inflammation. METHODS 41 male patients after AMI undergoing CR were divided into a diet group (supervised cardioprotective diet throughout the CR), and control group (CR without diet). We measured hsCRP, leucocytes, neutrophils, IL-6, oxLDL, exercise capacity and classic risk factors before and after CR program. RESULTS Patients from the diet group presented with a significant decline in classic risk factors (BMI, waist circumference, waist to hip ratio, systolic blood pressure, heart rate, blood glucose, total cholesterol, LDL, TAG) and inflammatory markers (hsCRP, leucocytes, neutrophils) compared to control group. Furthermore, when studying nonsmokers, we observed significant decline of oxLDL in the diet group. CONCLUSIONS The addition of cardioprotective diet, rich with natural antioxidants, to physical activity as a part of a CR program, positively modifies not just classic risk factors and exercise capacity, but also diminishes chronic inflammation markers. These effects, and oxLDL decline were most prominent in nonsmoking patients.
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Key Words
- AMI, acute myocardial infarction
- Acute myocardial infarction
- BMI, body mass index
- BP, blood pressure
- CAD, coronary artery disease
- CR, cardiac rehabilitation
- Cardiac rehabilitation
- Cardioprotective diet
- HDL, high density lipoprotein
- IL-6, interleukin 6
- Inflammation
- LDL, low density lipoprotein
- Oxidized LDL
- Smoking
- TAG, triglycerides
- hsCRP, high sensitivity CRP
- oxLDL, oxidized LDL
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Affiliation(s)
- Polona Mlakar
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia.,Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Barbara Salobir
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | | | - Janja Strašek
- Health Resort Šmarješke Toplice, Šmarješke Toplice, Slovenia
| | - Marija Prezelj
- Clinical Institute of Clinical Chemistry and Biochemistry, University Medical Center, Ljubljana, Slovenia
| | - Ana Debevc
- Cardial Medical Centre, Zaloška 69, 1000 Ljubljana, Slovenia
| | - Borut Jug
- Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Marjeta Terčelj
- Department of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Mišo Šabovič
- Department of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
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Mlakar P, Salobir B, Čobo N, Jug B, Terčelj M, Šabovič M. The Effect of Short-Term Cardiac Rehabilitation After Acute Myocardial Infarction on High-Sensitivity C-Reactive Protein. Metab Syndr Relat Disord 2014; 12:149-55. [DOI: 10.1089/met.2013.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Polona Mlakar
- Clinic of Pulmonary Diseases and Allergy and Clinic of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Barbara Salobir
- Clinic of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Borut Jug
- Clinic of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Marjeta Terčelj
- Clinic of Pulmonary Diseases and Allergy, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mišo Šabovič
- Clinic of Preventive Cardiology and Vascular Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
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Harlander M, Salobir B, Zupančič M, Dolenšek M, Bavčar Vodovnik T, Terčelj M. Serial chitotriosidase measurements in sarcoidosis--two to five year follow-up study. Respir Med 2014; 108:775-82. [PMID: 24594143 DOI: 10.1016/j.rmed.2014.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 12/12/2013] [Accepted: 02/03/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Chitotriosidase (CTO) is a human chitinolytic enzyme secreted by activated macrophages and polymorphonuclear neutrophils. Albeit not specific for sarcoidosis, it is increased in over 90% of patients with active disease. The aims of this study were to correlate CTO measurements with clinical assessment of sarcoidosis and to test CTO as a marker of sarcoidosis relapse. METHODS 95 patients were followed-up for 24-60 months. Serial CTO measurements were performed every 3-6 months and correlated to clinical symptoms, lung function (FVC and DLco) and chest X-ray. In 38 patients clinical outcome status (COS) at 5 years was determined. RESULTS Initial CTO levels were significantly higher in patients with impaired FVC/DLco (p = 0.011 for both) but there was no correlation with standard chest X-ray stages. Patients with Loefgren's syndrome had significantly lower initial and control CTO level compared to other patients (p = 0.011 and p = 0.001, respectively). At follow-up there was a positive correlation of CTO and deterioration of clinical symptoms (p < 0.001), chest X-ray (p < 0.001) and FVC/DLco (p = 0.012 and p = 0.086, respectively). Control CTO levels were significantly lower in no disease groups versus minimal or persistent disease group as defined by COS (p = 0.003 and p < 0.001, respectively). At relapse CTO increased for 100% or more from baseline value in 12/14 patients. CONCLUSIONS It was shown that CTO correlates with certain sarcoidosis phenotypes (Loefgren's syndrome, COS) and that serial measurements of CTO correlate with clinical symptoms, chest radiographs and lung function.
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Affiliation(s)
- Matevž Harlander
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia.
| | - Barbara Salobir
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Mirjana Zupančič
- Laboratory Department, Children's Hospital, University Medical Center Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Marija Dolenšek
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Tanja Bavčar Vodovnik
- Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
| | - Marjeta Terčelj
- Department of Pulmonary Diseases, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia
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Terčelj M, Salobir B, Zupancic M, Wraber B, Rylander R. Inflammatory markers and pulmonary granuloma infiltration in sarcoidosis. Respirology 2013; 19:225-230. [PMID: 24372709 DOI: 10.1111/resp.12199] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/06/2013] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies have demonstrated increases of inflammatory mediators in sarcoidosis while epidemiological studies have also demonstrated an association with increased fungi exposure. This study measured the level of β-glucan in the lungs and of inflammatory mediators in serum, and correlated both with the extent of pulmonary granuloma infiltration. METHODS This is a cross-sectional study of 98 patients with sarcoidosis and 26 controls. β-glucan, a cell wall constituent of fungi, was measured in bronchoalveolar lavage. Inflammatory mediator levels were determined in serum. The extent of granuloma infiltration was estimated on the chest X-ray. Exposure to fungi at home was determined by taking air samples in bedrooms and analysing for the presence of β-N-acetylhexosaminidase. RESULTS Significantly, higher levels of β-glucan were found in broncho-alveolar lavage in subjects with sarcoidosis as compared with controls. There were significant positive relationships between the extent of granuloma infiltration and the levels of the different inflammatory mediators, except for interleukin-10. Domestic fungal exposure was higher among subjects with sarcoidosis. CONCLUSIONS This is the first time that a specific agent, previously suspected to be related to the risk of sarcoidosis, has been detected in the lung of subjects with sarcoidosis and related to the levels of inflammatory mediators and the degree of home exposure to fungi. The results suggest that exposure to fungi should be explored when investigating patients with sarcoidosis.
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Affiliation(s)
- Marjeta Terčelj
- Clinic of Pulmonary Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Barbara Salobir
- Clinic of Pulmonary Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Mirjana Zupancic
- Laboratory Department, Children's Hospital, University Medical Center, Ljubljana, Slovenia
| | - Branka Wraber
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Terčelj M, Stopinšek S, Ihan A, Salobir B, Simčič S, Wraber B, Rylander R. In vitro and in vivo reactivity to fungal cell wall agents in sarcoidosis. Clin Exp Immunol 2011; 166:87-93. [PMID: 21910725 DOI: 10.1111/j.1365-2249.2011.04456.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Sarcoidosis is an inflammatory disease. Epidemiological and treatment studies suggest that fungi play a part in the pathogenesis. The aim of this work was to study the effect of fungal cell wall agents (FCWA) on the in vitro secretion of cytokines from peripheral blood monocytes from subjects with sarcoidosis and relate the results to fungal exposure at home and clinical findings. Subjects with sarcoidosis (n=22) and controls (n=20) participated. Peripheral blood mononuclear cells were stimulated with soluble or particulate β-glucan (S-glucan, P-glucan), chitin or lipopolysaccharide (LPS), whereafter tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-10 and IL-12 were measured. The severity of sarcoidosis was determined using a chest X-ray-based score. Serum cytokines (IL-2R, IL-6, IL-10 and IL-12) were determined. To measure domestic fungal exposure, air in the bedrooms was sampled on filters. N-acetylhexosaminidase (NAHA) on the filters was measured as a marker of fungal cell biomass. The induced secretion of cytokines was higher from peripheral blood mononuclear cells (PBMC) from subjects with sarcoidosis. P-glucan was more potent than S-glucan inducing a secretion. Chitin had a small effect. Among subjects with sarcoidosis there was a significant relation between the spontaneous PBMC production of IL-6, IL-10 and IL-12 and the NAHA levels at home. The P-glucan induced secretion of IL-12 was related to the duration of symptoms at the time of diagnosis. Their X-ray scores were related to an increased secretion of cytokines after stimulation with LPS or P-glucan. Subjects with sarcoidosis have a higher reactivity to FCWA in vitro and to home exposure. The influence of FCWA on inflammatory cells and their interference with the inflammatory defense mechanisms in terms of cytokine secretion could be important factors for the development of sarcoidosis.
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Affiliation(s)
- M Terčelj
- Department for Respiratory and Allergic Diseases, the University Medical Centre Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Slovenia Biofact Environmental Health Research Center, Lerum, Sweden.
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Stopinšek S, Ihan A, Wraber B, Terčelj M, Salobir B, Rylander R, Simčič S. Fungal cell wall agents suppress the innate inflammatory cytokine responses of human peripheral blood mononuclear cells challenged with lipopolysaccharide in vitro. Int Immunopharmacol 2011; 11:939-47. [DOI: 10.1016/j.intimp.2011.02.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 01/31/2011] [Accepted: 02/01/2011] [Indexed: 01/26/2023]
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Terčelj M, Salobir B, Harlander M, Rylander R. Fungal exposure in homes of patients with sarcoidosis - an environmental exposure study. Environ Health 2011; 10:8. [PMID: 21251285 PMCID: PMC3036600 DOI: 10.1186/1476-069x-10-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 01/20/2011] [Indexed: 05/07/2023]
Abstract
BACKGROUND There is increasing evidence that exposure to moulds (fungi) may influence the development of sarcoidosis. To assess the influence of the environmental exposure, a study was undertaken to determine the exposure to fungi in homes of subjects with sarcoidosis. METHODS Subjects were patients with clinically established sarcoidosis recruited during the period September 2007 till June 2010. Of these 55 were newly diagnosed and currently under treatment for less than one year, 25 had been treated and had no recurrence and 27 had been treated but had recurrence of the disease. Controls were healthy subjects without any respiratory symptoms (n = 30). Samples of air (about 2.5 m3) were taken in the bedroom of the subjects using a portable pump and cellulose ester filters. The filters were analysed for the content of the enzyme N-acetylhexosaminidase (NAHA) as a marker of fungal cell biomass, using a specific substrate and a fluorescent technique and expressed as NAHA units (U)/m3. RESULTS Compared to controls, subjects undergoing treatment of the disease (newly diagnosed or with recurrence) had significantly higher activities of NAHA in their homes than controls (33.6 and 39.9 vs 10.0 U/m3, p < 0.001 and <0.001). Among controls only 5 out of 30 subjects had levels of NAHA above the second quartile value (14 U/m3). In homes of subjects with newly diagnosed disease with treatment less than one year, values above 14 NAHA U/m3 were found among 35 out of 55 and among those with recurrent disease among 18 out of 27. CONCLUSIONS The higher activities of NAHA enzyme found in homes of subjects with active and recurrent sarcoidosis suggest that exposure to fungi is related to the risk of sarcoidosis. Further environmental studies to assess the importance of this exposure for subjects with sarcoidosis are warranted. The results suggest that remedial actions in homes with high levels of fungi may be justified.
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Affiliation(s)
- Marjeta Terčelj
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Barbara Salobir
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
| | - Matevz Harlander
- Clinic of Respiratory Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia
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