Silica in oral drugs as a possible sarcoidosis-inducing antigen

The pathological hallmarks of sarcoidosis are systemic non-caseating granulomas resulting from CD4+ T cells' interaction with antigenpresenting cells.1 The ACCESS (A Case-Control Etiologic Study of Sarcoidosis) study was not able to identify the cause of sarcoidosis, but yielded important findi...

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Bibliographic Details
Published in:The Lancet (British edition) 2009-06, Vol.373 (9679), p.1943-1944
Main Authors: Solà, Rosa, Boj, Montserrat, Hernandez-Flix, Salvador, Camprubí, Mercé
Format: Article
Language:English
Subjects:
Administration, Oral
Antigens
Antigens - adverse effects
Antihypertensive Agents - chemistry
Bisoprolol - chemistry
Causality
Chemistry, Pharmaceutical
Doxazosin - chemistry
Drug therapy
Environmental risk
Genetics
Humans
Hypersensitivity
Hypertension - drug therapy
Internal Medicine
Male
Medical research
Middle Aged
Particle size
Pharmaceutical Vehicles - adverse effects
Sarcoidosis, Pulmonary - chemically induced
Sarcoidosis, Pulmonary - diagnosis
Silica
Silicon Dioxide - adverse effects
Tetrazoles - chemistry
Valine - analogs & derivatives
Valine - chemistry
Valsartan
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Summary:The pathological hallmarks of sarcoidosis are systemic non-caseating granulomas resulting from CD4+ T cells' interaction with antigenpresenting cells.1 The ACCESS (A Case-Control Etiologic Study of Sarcoidosis) study was not able to identify the cause of sarcoidosis, but yielded important findings about familial and environmental risks that have advanced our understanding of this disease. The HLA-DRB1 associations reported in ACCESS, along with the results of two recently completed genome scans of sarcoidosis in white Germans and African-Americans, respectively, have further defined the genetics of sarcoidosis.5 The biological plausibility of a relation between exposure to silica and autoimmune and inflammatory disorders has already been proposed.4 Silica granuloma is a delayed hypersensitivity response to crystalline silica having a particle size of more than 1900 nm.4 In our case, the suggestion is that the response to the anhydrous colloidal silica component of the medication (with a particle size range of 1.5 nm) is probably the end result of an immune and inflammatory response originating in the intestine in a genetically susceptible host.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(09)61057-6