scholarly journals Clinical Presentations, Pathogenesis, and Therapy of Sarcoidosis: State of the Art

2020 ◽  
Vol 9 (8) ◽  
pp. 2363
Author(s):  
Francesca Polverino ◽  
Elisabetta Balestro ◽  
Paolo Spagnolo
Keyword(s):  
Clinical Course ◽  
State Of The Art ◽  
Systemic Disease ◽  
Unknown Etiology ◽  
Therapeutic Approaches ◽  
Epidemiologic Factors ◽  
Adaptive Immune ◽  
Clinical Presentations ◽  
Specific Organ ◽  
Noncaseating Granulomas

Sarcoidosis is a systemic disease of unknown etiology characterized by the presence of noncaseating granulomas that can occur in any organ, most commonly the lungs. Early and accurate diagnosis of sarcoidosis remains challenging because initial presentations may vary, many patients are asymptomatic, and there is no single reliable diagnostic test. Prognosis is variable and depends on epidemiologic factors, mode of onset, initial clinical course, and specific organ involvement. From a pathobiological standpoint, sarcoidosis represents an immune paradox, where an excessive spread of both the innate and the adaptive immune arms of the immune system is accompanied by a state of partial immune anergy. For all these reasons, the optimal treatment for sarcoidosis remains unclear, with corticosteroid therapy being the current gold standard for those patients with significantly symptomatic or progressive pulmonary disease or serious extrapulmonary disease. This review is a state of the art of clinical presentations and immunological features of sarcoidosis, and the current therapeutic approaches used to treat the disease.

Etiology and Immunopathogenesis of Sarcoidosis: Novel Insights

2017 ◽  
Vol 38 (04) ◽  
pp. 404-416 ◽  
Author(s):  
Marcel Veltkamp ◽  
Bob Meek ◽  
David Moller ◽  
Els Beijer
Keyword(s):  
Immune System ◽  
Complex Disease ◽  
Systemic Disease ◽  
Adaptive Immune System ◽  
Unknown Etiology ◽  
Disease Pathogenesis ◽  
Amyloid A ◽  
Adaptive Immune ◽  
Etiologic Agents ◽  
Noncaseating Granulomas

AbstractSarcoidosis is a disorder of unknown etiology. It is a systemic disease, frequently involving the lungs, skin, eyes, and lymph nodes. It is characterized by formation of noncaseating granulomas at the site(s) of disease. Sarcoidosis has a complex disease pathogenesis, with involvement of both the innate and adaptive immune systems. Several innate immune system receptors including NOD-like receptors and Toll-like receptors appear to be involved in the development of sarcoidosis as well as cellular players such as dendritic cells and macrophages. Furthermore, lymphocytes from the adaptive immune system including Th1, Th17, regulatory T cells, and B cells are likely to play a role in the sarcoidosis disease pathogenesis as well. Possibly, genetic susceptibility and exposure to particular etiologic agents including mycobacterial and propionibacterial antigens, metals, and silica can cause sarcoidosis. Besides exogenous triggers, also self-compounds such as serum amyloid A and vimentin, have been found to play a role in the development of sarcoidosis. It is likely that sarcoidosis does not have one single cause but rather is the result of the interplay between different etiologic agents and the immune system in predisposed individuals.

scholarly journals Prognostic Biomarkers of Sarcoidosis: A Comparative Study of Serum Chitotriosidase, ACE, Lysozyme, and KL-6

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Laura Bergantini ◽  
Francesco Bianchi ◽  
Paolo Cameli ◽  
Maria Antonietta Mazzei ◽  
Annalisa Fui ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Lung Fibrosis ◽  
Clinical Utility ◽  
Clinical Course ◽  
Unknown Etiology ◽  
Serum Concentrations ◽  
Referral Centre ◽  
Clinical Presentations ◽  
Serum Detection

Purpose. Sarcoidosis is a systemic granulomatous disease with unknown etiology. Many clinical presentations have been reported, and acute disease needs to be distinguished from subacute and chronic disease. The unpredictable clinical course of the disease prompted us to evaluate the clinical utility of biomarker serum detection in sarcoidosis follow-up. Methods. Serum concentrations of chitotriosidase, ACE, KL-6, and lysozyme were analyzed by different methods in a population of 74 sarcoidosis patients (46 on steroid therapy at sampling) regularly monitored at Siena Sarcoidosis Regional Referral Centre and in a group of controls with the aim of comparing their contribution to clinical management of sarcoidosis patients. Results. KL-6 concentrations were significantly elevated in sarcoidosis patients with lung fibrosis and were significantly correlated with DLco and CPI score, while chitotriosidase was significantly higher in patients with extrapulmonary localizations. With a cut-off value of 303.5 IU/ml, KL-6 showed the best sensitivity (78%), while chitotriosidase reported the best specificity (85%) among the biomarkers. Conclusions. KL-6 is a reliable biomarker of fibrotic lung involvement in sarcoidosis patients. Among biomarkers, KL-6 showed the best sensitivity and serum chitotriosidase the best specificity, even in patients on chronic steroid therapy, and seemed to correlate with extrapulmonary localizations.

scholarly journals Epidemiology of Sarcoidosis in the Precarpathian region of Ukraine

2019 ◽  
Vol 8 (12) ◽  
pp. 3375-3379
Keyword(s):  
Mortality Rate ◽  
Environmental Factors ◽  
Patient Management ◽  
Clinical Course ◽  
Disease Incidence ◽  
Modern Medicine ◽  
Unknown Etiology ◽  
Prevalence Rates ◽  
Therapeutic Approaches ◽  
The North

Despite considerable advances in modern medicine, it must be admitted that sarcoidosis is still a disease with unknown etiology, hardly predictable clinical course and, as a result, it is characterized by a variety of diagnostic and therapeutic approaches to patient management. We have studied the morbidity and prevalence rates of sarcoidosis of respiratory organs in Precarpathian region for a 5-year period on the basis of information provided by district and city pulmonologists, phthisiologists and general practitioners for the period of 2011-2015. The incidence of sarcoidosis in Precarpathian region is on average 2.8 new cases per 100 thousand adults per year, which exceeds the corresponding indices not only in the southern (1.1 per 100 thousand adults), but also in the northern (2.6 per 100 thousand) regions of Ukraine. The prevalence of active sarcoidosis reaches 5.0 cases per 100,000 people; the disease incidence in the north of the region is 1.5 times higher as compared with the southern regions. In the territories with increased man-made load the mortality rate is 2.5 times higher than the average index registered in the region, while the prevalence rate is 1.9 times higher, correspondingly. Summing up the results of the study it may be concluded that sarcoidosis has long ceased to be a rare disease and the morbidity and prevalence rates of this ailment depend on geographical and environmental factors.

Is Alzheimer disease a failure of mobilizing immune defense? Lessons from cognitively fit oldest-old

2019 ◽  
Vol 21 (1) ◽  
pp. 7-19 ◽  
Keyword(s):  
Alzheimer Disease ◽  
Cognitive Aging ◽  
Oldest Old ◽  
Adaptive Immune Response ◽  
Effector T Cells ◽  
Immune Defense ◽  
Supporting Evidence ◽  
Therapeutic Approaches ◽  
Related Data ◽  
Adaptive Immune

Multifaceted evidence supports the hypothesis that inflammatory-immune mechanisms contribute to Alzheimer disease (AD) neuropathology and genetic association of several immune specific genes (TREM2, CR1, and CD33) suggests that maladaptive immune responses may be pivotal drivers of AD pathogenesis. We reviewed microglia-related data from postmortem AD studies and examined supporting evidence from AD animal models to answer the following questions: i) What is the temporal sequence of immune activation in AD progression and what is its impact on cognition? ii) Are there discordant, "primed", microglia responses in AD vs successful cognitive aging? iii) Does central nervous system (CNS) repair in aging depend on recruitment of the elements of cellular adaptive immune response such as effector T cells, and can the recruitment of systemic immune cells ameliorate AD neuropathology? iv) How effective are the immune-system-based therapeutic approaches currently employed for the treatment of AD?

scholarly journals Principles and Challenges in anti-COVID-19 Vaccine Development

2021 ◽  
pp. 1-11
Author(s):  
Zuzana Strizova ◽  
Jitka Smetanova ◽  
Jirina Bartunkova ◽  
Tomas Milota
Keyword(s):  
Clinical Trials ◽  
Immune Responses ◽  
Vaccine Development ◽  
Viral Vector ◽  
Health It ◽  
Therapeutic Approaches ◽  
Clinical Phase ◽  
Adaptive Immune ◽  
Limited Efficacy ◽  
Safe Vaccine

The number of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients keeps rising in most of the European countries despite the pandemic precaution measures. The current antiviral and anti-inflammatory therapeutic approaches are only supportive, have limited efficacy, and the prevention in reducing the transmission of SARS-CoV-2 virus is the best hope for public health. It is presumed that an effective vaccination against SARS-CoV-2 infection could mobilize the innate and adaptive immune responses and provide a protection against severe forms of coronavirus disease 2019 (COVID-19) disease. As the race for the effective and safe vaccine has begun, different strategies were introduced. To date, viral vector-based vaccines, genetic vaccines, attenuated vaccines, and protein-based vaccines are the major vaccine types tested in the clinical trials. Over 80 clinical trials have been initiated; however, only 18 vaccines have reached the clinical phase II/III or III, and 4 vaccine candidates are under consideration or have been approved for the use so far. In addition, the protective effect of the off-target vaccines, such as <i>Bacillus</i> Calmette-Guérin and measles vaccine, is being explored in randomized prospective clinical trials with SARS-CoV-2-infected patients. In this review, we discuss the most promising anti-COVID-19 vaccine clinical trials and different vaccination strategies in order to provide more clarity into the ongoing clinical trials.

Schwannomas of the Nose and Paranasal Sinuses

1993 ◽  
Vol 7 (2) ◽  
pp. 59-65 ◽  
Author(s):  
John R. Wanamaker ◽  
Hayes H. Wanamaker ◽  
Bernard Kotton ◽  
Greg D. Akers ◽  
Pierre Lavertu
Keyword(s):  
Paranasal Sinuses ◽  
Clinical Presentation ◽  
Clinical Course ◽  
Diagnostic Techniques ◽  
Therapeutic Approaches ◽  
Management Philosophy ◽  
Nose And Paranasal Sinuses ◽  
Therapeutic Tools ◽  
Diagnostic Work ◽  
Work Up

Schwannomas are benign neoplasms arising from the peripheral nerve sheath. The sinonasal tract is an unusual location for these neoplasms. Because of their rarity, few series have been reported. Five previously unreported cases of schwannomas of the nose and paranasal sinuses are presented that illustrate the spectrum of disease. The clinical presentation, diagnostic work-up, clinical course, and diverse therapeutic approaches will be discussed. A management philosophy based on the diversity of these tumors and their clinical behavior, and incorporating the new diagnostic and therapeutic tools available to the clinician will be presented. The implications of newer diagnostic techniques including sinonasal endoscopy, magnetic resonance imaging, and immuno-chemistry in the diagnosis and treatment of these tumors will be discussed.

Potential therapeutic approaches in paraquat poisoning: a narrative review

2021 ◽  
Author(s):  
Amir Ghabousian ◽  
Saeed Safari ◽  
Niloufar Ansari
Keyword(s):  
Signaling Pathways ◽  
Cell Injury ◽  
Clinical Course ◽  
Medical Condition ◽  
Case Fatality ◽  
Therapeutic Approaches ◽  
Traditional Treatment ◽  
Current Review ◽  
Novel Therapeutic Strategies ◽  
Cell Signaling Pathways

Paraquat dichloride (PQ) poisoning is a relatively rare yet critical medical condition that has a high case fatality rate. Lung tissue is highly susceptible to PQ-induced injury, and respiratory failure is the leading cause of death in these patients. Unfortunately, there is a lack of an effective therapeutic approach to ameliorate outcomes. It is well-known that PQ interferes with a variety of cell signaling pathways and induces the generation of reactive oxygen species (ROS), which ultimately results in cell injury. The traditional treatment decisions have not been able to significantly change the clinical course of PQ poisoning. Moreover, novel therapeutic strategies for PQ poisoning have centered on the inhibition of PQ-induced signaling pathways. In the current review, we sought to provide a bird’s-eye view of the available therapeutic approaches in patients with PQ poisoning.

State of the Art — 1973

1973 ◽  
Vol 18 (3) ◽  
pp. 175-183 ◽  
Author(s):  
Nathan B. Epstein ◽  
Duane S. Bishop
Keyword(s):  
State Of The Art ◽  
Therapeutic Process ◽  
Scientific Discipline ◽  
Therapeutic Approaches ◽  
Training And Education ◽  
Rigorous Approach ◽  
The Family ◽  
Process And Outcome ◽  
Scientific Approach ◽  
Made In

In summary, it can be said that progress is being made in the field, but slowly. The ‘art’ is vigorous, vital and exciting. The ranks of family therapists are swelling and they are coming from backgrounds of different theoretical persuasions and with varying degrees of sophistication in their training and education. This mélange does lead to excitement and turbulence but often detracts from the necessary rigour that a scientific discipline must develop in order to reach maturity. Systems theory allows for easy conceptualization of one another's behaviour in the system, and permits a much clearer understanding of the therapeutic process based upon it, in contrast to therapeutic approaches based on other models. The authors found negotiation to be therapeutically effective when made explicit. In addition they place the focus on the ‘here and now’ and encourage the increased labeling by family members of interactions (affective and behavioural) and their effects (affective and behavioural), according to the Family Categories Schema previously referred to. Efforts are directed especially towards dealing with the current resistances to problem solutions. Epstein et al. have reported on an ongoing program of research which attempts to examine the process and outcome of family therapy (7,10,21,22,25,26). What is needed now is a more rigorous approach to research and the development of a necessary theoretical base in order that a more systematic and scientific approach can be developed for treating families.

Hepatitis B virus: from immunobiology to immunotherapy

2012 ◽  
Vol 124 (2) ◽  
pp. 77-85 ◽  
Author(s):  
Daniel Grimm ◽  
Maximilian Heeg ◽  
Robert Thimme
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Therapeutic Approaches ◽  
Major Health ◽  
Antiviral Therapies ◽  
Adaptive Immune ◽  
Host Interaction ◽  
Current State ◽  
B Virus ◽  
Chronic Hbv

Owing to the major limitations of current antiviral therapies in HBV (hepatitis B virus) infection, there is a strong need for novel therapeutic approaches to this major health burden. Stimulation of the host's innate and adaptive immune responses in a way that results in the resolution of viral infection is a promising approach. A better understanding of the virus–host interaction in acute and chronic HBV infection revealed several possible novel targets for antiviral immunotherapy. In the present review, we will discuss the current state of the art in HBV immunology and illustrate how control of infection could be achieved by immunotherapeutic interventions.

scholarly journals Treatment of infant leukemias: challenge and promise

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 596-600 ◽  
Author(s):  
Patrick Brown
Keyword(s):  
High Frequency ◽  
Clinical Presentation ◽  
State Of The Art ◽  
Poor Response ◽  
Cooperative Groups ◽  
Therapeutic Approaches ◽  
Unique Biology ◽  
Current Therapies ◽  
Epidemiologic Features ◽  
Infant Leukemia

Abstract Leukemia in infants is rare but generates tremendous interest due to its aggressive clinical presentation in a uniquely vulnerable host, its poor response to current therapies, and its unique biology that is increasingly pointing the way toward novel therapeutic approaches. This review highlights the key clinical, pathologic, and epidemiologic features of infant leukemia, including the high frequency of mixed lineage leukemia (MLL) gene rearrangements. The state of the art with regard to current approaches to risk stratified treatment of infant leukemia in the major international cooperative groups is discussed. Finally, exciting recent discoveries elucidating the molecular biology of infant leukemia are reviewed and novel targeted therapeutic strategies, including FLT3 inhibition and modulation of aberrant epigenetic programs, are suggested.

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