Experimental inoculation of laboratory animals with samples collected from sarcoidal patients and molecular diagnostic evaluation of the results.
ABSTRACT Studies on the implication of mycobacteria in the pathogenesis of sarcoidosis have generated conflicting results. In an attempt to further elucidate the etiology of the disease, we obtained broncho-alveolar lavage (BAL) samples from sarcoidal patients, which were subsequently used for intra-tracheal inoculation of a group of rabbits. Patients were characterized as sarcoidal on the grounds of clinical, radiographic, histological and microbiological testing. Four months following inoculation, lung and alveolar lymph node specimens were collected from the animals and were examined by means of histology and microbiology, as well as by a polymerase chain reaction (PCR) assay, targeted to DNA sequences of the Mycobacterium tuberculosis and Mycobacterium avium complexes. All of the twenty five BAL-inoculated rabbits revealed evidence of lobar pneumonia, with thirteen developing lesions of non-caseous granulomatous inflammation, similar to those observed in sarcoidal patients. Microbiological cultivation of lung and alveolar lymph node material, Zihl-Neelsen staining of corresponding tissue sections and PCR analysis of extracted DNA yielded no evidence of mycobacterial infection. Identical processing of biopsies originating from the martyrs, formerly inoculated with drinking water or disinfected BAL, revealed no pathological signs. Our findings suggest that BAL samples from patients with sarcoidosis may carry an agent that produces a disease characterized by similar histological lesions in rabbits. However, culture, and PCR, could not identify this agent as a member of Mycobacterium tuberculosis, or Mycobacterium avium complexes.
[show abstract] [hide abstract]
ABSTRACT: Despite its recognition as a distinct granulomatous disease for over a century, the etiology of sarcoidosis remains to be defined. Since the early 1900s, infectious agents have been suspected in causing sarcoidosis. For much of this time, mycobacteria were considered a likely culprit, yet until recently, the supporting evidence has been tenuous at best. In this review, we evaluate the reported association between mycobacteria and sarcoidosis. Historically, mycobacterial infection has been investigated using histologic stains, cultures of lesional tissue or blood, and identification of bacterial nucleic acids or bacterial antigens. More recently, advances in biochemical, molecular, and immunological methods have produced a more rigorous analysis of the antigenic drivers of sarcoidosis. The result of these efforts indicates that mycobacterial products likely play a role in at least a subset of sarcoidosis cases. This information, coupled with a better understanding of genetic susceptibility to this complex disease, has therapeutic implications.American Journal of Respiratory Cell and Molecular Biology 06/2011; 45(5):899-905. · 5.13 Impact Factor