The K veim response: still useful, still a puzzle.

Munro, Colin S.; Mitchell, D. N.

doi:10.1136/thx.42.5.321

Cited by 56 publications

(28 citation statements)

References 46 publications

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“…Our initial studies of SAA were prompted by recognition that the biophysical properties of the granuloma-inducing component of sarcoidosis tissues had striking parallels to the properties of amyloid or prion fibrils (12,14,15). Despite the often intense staining of SAA in sarcoidosis granulomas, sites of SAA deposition were not associated with typical features of amyloid fibril aggregation as evidenced by the lack of widespread Congo red birefringence or staining with serum amyloid P. However, Congo red staining of amyloid or prion fibrils may significantly underestimate the presence of amyloid or prion proteins in tissues, suggesting there may be aggregates of SAA below the level of detection by this analytic method (27,28).…”

Section: Discussionmentioning

confidence: 99%

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Serum Amyloid A Regulates Granulomatous Inflammation in Sarcoidosis through Toll-like Receptor-2

Chen¹,

Song²,

Willett³

et al. 2010

Am J Respir Crit Care Med

211

198

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Section: Discussionmentioning

confidence: 99%

“…The Kveim reaction provides a biologically relevant in vivo model of granuloma formation in sarcoidosis (12). In this reaction, insoluble homogenates of sarcoidosis tissues injected intradermally into patients with sarcoidosis induce epithelioid granulomas indistinguishable from spontaneously arising granulomas.…”

mentioning

confidence: 99%

Serum Amyloid A Regulates Granulomatous Inflammation in Sarcoidosis through Toll-like Receptor-2

Chen¹,

Song²,

Willett³

et al. 2010

Am J Respir Crit Care Med

211

198

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“…Importantly, the physicochemical properties of the granulomainducing component of the Kveim reagent have been defined by in vivo studies of patients with sarcoidosis. These properties include the following: relative resistance to neutral detergents, heat, acidity, organic solvents, nucleases, and proteases (15,16). The fact that Kveim reactivity is abrogated by potent denaturants suggests a protein component is responsible for the granulomainducing activity (17).…”

Section: The Kveim Reactionmentioning

confidence: 99%

State of the Art. Potential Etiologic Agents in Sarcoidosis

Möller

2007

Proceedings of the American Thoracic Society

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The etiology of sarcoidosis remains uncertain. The hallmark of sarcoidosis is the epithelioid granuloma, which serves as a necessary starting point for considering disease etiology. Any etiologic agent of sarcoidosis must also explain the typical clinical behaviors and characteristic immunopathologic features of the disease. One clinical observation that serves as a bridge to the etiology of sarcoidosis is the Kveim reaction. In this reaction, local epithelioid granulomas develop several weeks after the intradermal injection of homogenates of sarcoidosis tissue. Our group capitalized on the known properties of the Kveim reagent to search for candidate pathogenic tissue antigens in sarcoidosis without other a priori hypotheses regarding possible microbial or autoimmune etiologies. Using a limited proteomics approach based on the physicochemical properties of Kveim reagent, we detected a limited number of poorly soluble antigenic proteins in sarcoidosis tissues by protein immunoblotting, using sarcoidosis sera. Matrix-associated laser desorption/ ionization-time of flight mass spectrometry identified one of these antigens to be the Mycobacterium tuberculosis catalase-peroxidase protein (mKatG). We found IgG responses to recombinant mKatG in more than 50% of patients with sarcoidosis but rarely in purified protein derivative (PPD)-negative control subjects. These findings support the conclusion that mKatG is a tissue antigen and target of the adaptive immune response in sarcoidosis, providing further evidence of a mycobacterial etiology in a subset of sarcoidosis. More generally, the approach used in these studies might be employed to discover and validate other candidate pathogenic antigens in sarcoidosis or other granulomatous disorders.

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“…A positive Kveim response to sarcoid tissue (homogenised spleens) injected intradermally, with epithelioid granulo mas found on punch biopsy 4-6 weeks after injection, is virtually diagnostic of sarcoidosis [7], The test is highly specific (false positives 0.7-2%) but the sensitivity varies from 26 to 50% in extra thoracic sarcoidosis [7], Although sarcoidosis has been reported as a cause of BIH [8], BIH as a presenting feature of sarcoidosis (with out non-neurological manifestations) is not generally re cognised. Neurosarcoidosis should be considered as a diagnosis in any patient with BIH who subsequently develops unusual features.…”

Section: Discussionmentioning

confidence: 99%