Seminars in respiratory and critical care medicine
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Sarcoidosis is a chronic granulomatous disorder characterized by an accumulation of T lymphocytes, macrophages, and immune-effector cells within affected organs. The pathogenesis of sarcoidosis involves a complex interplay between immune and nonimmune cells, with myriad cytokines and chemokines involved in the orchestration and evolution of the granulomatous/fibrotic process. ⋯ Genetic polymorphisms influence the susceptibility to sarcoidosis as well as the evolution/prognosis of the disease among patients with sarcoidosis. This article discusses the complex immunological events and immune effector cells that are critical to the induction, evolution, and resolution of the sarcoid granulomatous response.
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Semin Respir Crit Care Med · Aug 2010
The etiologic role of infectious antigens in sarcoidosis pathogenesis.
Sarcoidosis is a disease of unknown etiology, characterized pathologically by noncaseating granulomas that most commonly involve the lung, skin, lymph nodes, and eyes. Syndromes with similar pathological and immunologic features to sarcoidosis such as chronic beryllium disease, hypersensitivity pneumonitis, and tuberculosis illustrate that granulomatous diseases may or may not have an infectious etiology. Although the etiology of sarcoidosis remains unknown, recent molecular, genetic, and immunologic studies strengthen the association of sarcoidosis with infectious antigens. ⋯ Recent discoveries regarding MHC class II alleles provide additional insight regarding the role of microbial antigens in sarcoidosis pathogenesis. Although further investigation is warranted, the recent progress of independent laboratories, using complementary techniques, strengthens the role of microbial antigens in sarcoidosis pathogenesis. These studies lay a strong foundation toward identifying therapeutic targets.