Para-Clinical and Immunological Evaluation in Buerger's Disease as a Suspected Autoimmune Disease: Case Series

Abstract

Background: Autoimmunity causes the loss of normal immune homeostasis and involves the presence of autoantibodies and inflammation. Thromboangiitis obliterans or Buerger's disease (BD) refers to a type of vascular obstructive syndrome, with tobacco exposure accounting for disease formation and progression. However, the current understanding of autoimmunity is unclear in the context of BD, and the scientific findings are not enough to support autoimmune mechanisms. This study was aimed at investigating autoimmunity factors in patients with BD. Methods: Clinical and experimental examinations were performed on 80 patients with BD. The diagnostic work-up for autoimmunity was composed of IgM rheumatoid factor (RF), anti-nuclear antibodies (ANA), The erythrocyte sedimentation rate (ESR), anti-cyclic citrullinated peptide (CCP) antibodies, Antiphospholipid antibodies (APA), Anti-cardiolipin antibodies (ACLA), anti-double-stranded DNA (ds-DNA), and extractable nuclear antigen (ENA) profile. Immunomarkers were detected using the quantitative enzyme-linked immunosorbent assay (ELISA). Results: Raynaud's phenomenon (84.93%), cold sensitivity (76.25%), and claudication (73.75%) were the most common symptoms in the BD patients. Also, 64.29% represented with high ANA levels and positive RF, while 42.11% were found with increased ANA and ESR levels. The ANA/RF positive BD patients had ESR> 15 mm/hr and a high prevalence of cold sensitivity, claudication, and Raynaud's phenomenon (p> 0.05). Conclusions: There is a possibility of a non-specific autoimmune disposition among BD patients. RF and ANA could be considered for predicting disease progression.

The Potential Association of Human Leukocyte Antigen (HLA)-A and -B with COVID-19 Mortality: A Neglected Risk Factor

“…Patients infected with this novel COVID-19 virus have severe pneumonia signs like fever, tiredness, dry cough and acute respiratory distress (1). The human leukocyte antigen (HLA) has been correlated with many various diseases, in which the profile of these alleles varies significantly between different populations throughout the diseased persons (3). Therefore it is significant to evaluate the relationship between different HLA alleles and disease among various racial groups (3).…”

Therapeutic angiogenesis in Buerger’s disease: reviewing the treatment landscape

“…Genetic predisposition certainly plays a role as several polymerase chain reaction (PCR)-based studies have identified specific human leukocyte antigen (HLA) class I and II alleles associated with increased odds of developing Buerger’s disease. 9 – 11 In susceptible individuals, exposure to tobacco may incite an aberrant immune reaction toward endothelium via toll-like receptor (TLR) signaling and the TLR-MyD88-NFκB pathway. 12 Serologic analyses have also found increased levels of circulating pro-inflammatory (IL-1β, TNF-α, and IL-6), type 1 helper cell (IFN-γ and IL-12), and type 2 helper cell cytokine profiles (IL-4, IL-5, and IL-13) in patients with Buerger’s disease, as well as those of type 17 helper cells (IL-17 and IL-23) which are strongly associated with autoimmunity.…”

Acute Posterior Multifocal Placoid Pigment Epitheliopathy Complicated by Fatal Cerebral Vasculitis: Response

“…Furthermore, the existence of shared vs nonoverlapping genetic associations, for example, immune system–related haplotypes or the like, may shed light on whether the entities should most properly be regarded as representing a continuum along a pathophysiologic spectrum vs as being entirely distinct. With respect to the particular entities at hand, APMPPE has been reported (in a series of 30 cases) to be associated with the HLA haplotypes HLA-DR2 (57% of cases) and HLA-B7 (40% of cases) (12), whereas Buerger disease has been reported in association with HLA-A9 and HLA-B5 (13), as well as (in the Iranian population) HLA-A3, HLA-A24, HLA-A31, HLA-A11, HLA-B27, HLA-B15, HLA-B7, HLA-B51, HLA-B44, HLA-DRB1*16, HLA-DRB1*04, HLA-DRB1*14, HLA-DRB1*03, and HLA-DRB1*15 (14), among others. Thus, HLA-B7 is the only haplotype association reported to date that is shared by both diseases.…”