- Articles - Title: Identification of metal sensitization in sarcoid-like metal-exposed patients by the MELISA® lymphocyte proliferation test — a pilot study
- Articles - Abstract:
Fireman E, et al. Journal of Occupational Medicine and Toxicology (2016) 11:18 , DOI 10.1186/s12995-016-0101-1.
Background: Pulmonary function is often affected by the inhalation of metal particles. The resulting pathology might trigger various lung diseases, e.g., parenchymal lung fibrosis and granulomatous lung disorders. We previously demonstrated that 6% of tissue-proven sarcoid patients had a positive beryllium lymphocyte proliferation test (BeLPT),thus correcting the diagnosis to chronic beryllium disease. The aim of this study was to examine if Memory Lymphocyte Immnuno Stimulation Assay (MELISA®), currently used for non-pulmonary diseases, can identify metals other than beryllium that can also trigger sensitization and induce granulomatous disease. Methods: This pilot study included 13 sarcoid-like patients who underwent MELISA® . Eleven patients also underwent BeLPT. Biopsy samples were tested for metal content by scanning electron microscope. Eleven study patients had been exposed to metals at the workplace and 2 had silicone implants. Results: Two patients who had undergone BeLPT were positive for beryllium. MELISA® detected 9 patients (9/13, 69 %) who were positive for at least one of the tested metals: 4 reacted positively to nickel, 4 to titanium, 2 to chromium, 2 to beryllium, 2 to silica, and one each to palladium, mercury and lead. Conclusion: It is proposed that MELISA® can be exploited to also identify specific sensitization in individuals exposed to inhaled particles from a variety of metals.
- Articles - Download: Identification-of-metal-sensitization-in-sarcoid-like-metal-exposed-patients-.pdf
- Articles - Title: Allergy and autoimmunity caused by metals: A unifying concept
- Articles - Abstract:
Stejskal V, in Vaccines and Autoimmunity 2015 (eds Y. Shoenfeld, N. Agmon-Levin and L. Tomljenovic), John Wiley & Sons, Inc, Hoboken, NJ, USA. doi: 10.1002/9781118663721.ch5
Metals, such as mercury, aluminum, gold, and nickel, play a role in various allergic and autoimmune diseases. This chapter discusses the factors underlying their immunotoxic properties. Mercury (in the form of thimerosal) and aluminum are both ingredients in vaccines. They can also enter the body through dental restorative materials, cigarette smoke, and environmental pollution. These metals bind to autologous proteins and thus function as immunologocally active haptens. They also possess immunomodulating properties. Metal-specific responses are mediated by sensitized T cells and depend on the genetic makeup of the individual. This means that some individuals are resistant and others are susceptible. A better understanding of the immunopathological role of metals will contribute to improved treatment of immune-mediated diseases and hopefully to the development of safer vaccines.
- Articles - Download: Allergy-and-autoimmunity-caused-by-metals-.pdf
- Articles - Title: Increased frequency of delayed-type hypersensitivity to metals in patients with connective tissue disease
- Articles - Abstract:
Stejskal V, Reynolds T, Bjørklund G. Journal of Trace Elements in Medicine and Biology 2015; 31:230-236
Background: Connective tissue disease (CTD) is a group of inflammatory disorders of unknown etiology. Patients with CTD often report hypersensitivity to nickel. We examined the frequency of delayed-type hypersensitivity (DTH) (Type IV allergy) to metals in patients with CTD. Methods: Thirty-eight patients; 9 with systemic lupus erythematosus (SLE), 16 with rheumatoid arthritis (RA), and 13 with Sjögren’s syndrome (SS) and a control group of 43 healthy age- and sexmatched subjects were included in the study. A detailed metal exposure history was collected by questionnaire. Metal hypersensitivity was evaluated using the optimized lymphocyte transformation test LTT-MELISA (Memory Lymphocyte Immuno Stimulation Assay). Results: In all subjects, the main source of metal exposure was dental metal restorations. The majority of patients (87%) had a positive lymphocyte reaction to at least one metal and 63% reacted to two or more metals tested. Within the control group, 43% of healthy subjects reacted to one metal and only 18% reacted to two or more metals. The increased metal reactivity in the patient group compared with the control group was statistically significant (P < 0.0001). The most frequent allergens were nickel, mercury, gold and palladium. Conclusions: Patients with SLE, RA and SS have an increased frequency of metal DTH. Metals such as nickel, mercury and gold are present in dental restorative materials, and many adults are therefore continually exposed to metal ions through corrosion of dental alloys. Metal-related DTH will cause inflammation. Since inflammation is a key process in CTDs, it is possible that metal-specific T cell reactivity is an etiological factor in their development. The role of metal-specific lymphocytes in autoimmunity remains an exciting challenge for future studies.
- Articles - Download: Increased-frequency-of-DTH-to-metals-in-patients-with-CTD.pdf
- Articles - Title: Carbon coated implants as a new solution for metal allergy in early-onset scoliosis: A case report and review of the literature
- Articles - Abstract:
Zielinski J, Lacy TA, Phillips JH. Spine Deformity 2(1):76-80 2014
STUDY DESIGN: Retrospective case report. OBJECTIVE: To report the first known case of immunological camouflage of a metal spinal implant with carbon coating. SUMMARY OF BACKGROUND DATA: Metal sensitivity is common and is a consideration when choosing orthopedic implants in susceptible individuals. The sensitivity often is to nickel, cobalt, or chromium, and titanium is used as a safe alternative. However, when the allergy is also to titanium, solutions may be much more difficult. This case describes an innovative solution to a complex metal allergy that includes titanium in a child requiring spinal instrumentation for early-onset scoliosis. METHODS: At age 6 years 7 months, the patient underwent an uncomplicated placement of bilateral posterior Vertical Expandable Prosthetic Titanium Ribs (VEPTRs; Synthes, Inc., West Chester, PA). At that time, there were no known metal allergies. At 3 weeks, the right side had become erythematous and had serosanguineous drainage. It briefly improved after each of 2 surgical debridements and a course of intravenous antibiotics, but within 6 weeks of the index procedure, the pain was still worsening. A titanium allergy was suspected and blood was sent for allergy testing. A test confirmed hypersensitivity to titanium, niobium, molybdenum, iron, and aluminum, among others. The remaining rod was removed. An in vivo trial for tolerance to high-grade stainless-steel implants was done. The implant was removed after 2 weeks because of systemic symptoms that occurred. RESULTS:A plasma-spray, carbon-coated VEPTR rod was designed. A rod sample was inserted into the patient's forearm for trial. After 3 months, there was no appreciable reaction. Carbon-coated VEPTRs were placed without complications. The patient has undergone multiple lengthening using the carbon-coated VEPTRs. CONCLUSIONS:In the rare patient with multiple allergies, choosing orthopedic implants can be challenging. An innovative carbon coating was applied by plasma spray to the VEPTR system, with good results. Access article HERE.
- Articles - Title: Diagnostic use of the lymphocyte transformation test-memory lymphocyte immunostimulation assay in confirming active Lyme borreliosis in clinically and serologically ambiguous cases
- Articles - Abstract:
Puri B, Segal D, Monro J. Int J Clin Exp Med 2014;7(12):5890-5892
Abstract: The aim of this study was to carry out an independent evaluation of the proposition that the lymphocyte transformation test-memory lymphocyte immunostimulation assay (LTT-MELISA) may be diagnostically useful in the confirmation of active Lyme borreliosis in clinically and serologically ambiguous cases. Blood samples from 54 patients consecutively presenting to a British center with clinical suspicion of Lyme borreliosis were tested for this disease by immunoglobulin M (IgM) and immunoglobulin G (IgG) Western blots and by LTT-MELISA. Forty-five of these patients had Western blot results which were negative for both IgM and IgG by the criteria of the Centers for Disease Control and Prevention (CDC); of these patients, 19 (42%) were LTT-MELISA-positive. Two of the patients who had IgM positive results by the CDC criteria were LTT-MELISA-negative. It is concluded that, for putative European-acquired Lyme borreliosis infections, it would be sensible to carry out both the LTT-MELISA and Western blot assay
- Articles - Download: Diagnostic-use-of-the-lymphocyte-transformation.pdf
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