Abstract
Background Several studies demonstrated that Propionibacterium acnes (P. acnes) may be involved in sarcoidosis pathogenesis. Presence of P. acnes was found in granulomas of the majority of Japanese sarcoidosis patients. However, presence of P. acnes in tissue has never been related to sarcoidosis phenotypes and clinical outcome. Therefore, the aims of our study were to demonstrate whether P. acnes can be detected in granulomas of Dutch sarcoidosis patients and to investigate whether its presence is related to a clinical phenotype and/or course of disease.
Methods Sections of formalin fixed paraffin-embedded tissue blocks of 76 sarcoidosis patients were examined by immunostaining with a P. acnes-specific monoclonal antibody (PAB antibody) using a VENTANA BenchMark ULTRA. Clinical outcome status (COS) was determined and classified into two phenotype groups: A: resolved, minimal or persistent disease without treatment (COS 1–6) and B: persistent disease with need for treatment (COS 7–9).
Results P. acnes was detected in samples of 31 patients (41%) and located within granulomas in samples of 13 patients (17%). The frequency of P. acnes detected in granulomas at diagnosis was significantly higher in patients with phenotype B compared to patients with phenotype A (29% versus 0%, p=0.021).
Conclusion Presence of P. acnes in granulomas can be confirmed in Dutch sarcoidosis patients. It is intriguing that presence of P. acnes in granulomas is more frequently found in patients with chronic disease requiring treatment. This adds to the rationale that a subgroup of sarcoidosis patients might benefit from antibiotic therapy.
Abstract
Significantly more sarcoidosis patients with a chronic disease course requiring treatment had presence of P. acnes in granulomas. This contributes to the premise that it is relevant to further explore antibacterial therapy in sarcoidosis.
Footnotes
Author Contributions: EB contributed to data acquisition and analysis, statistical analysis and drafting and editing of the manuscript. KS participated in the design of the study, scored the staining results and edited the manuscript. YE developed the PAB antibody, advised on study design and edited the manuscript. KU reviewed the methods and advised on the automated staining protocol. JD cared out all the immunohistochemical stainings and developed the automated staining protocol. JG supervised the project and edited the manuscript. MV designed the study, supervised the project and edited the manuscript.
Support statement: This study is part of the TopZorg Lung grant funded by ZonMw (nr 842002001). This funder had no involvement in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; or in the decision to submit the paper for publication. ZonMw; DOI: http://dx.doi.org/10.13039/501100001826; Grant: 842002001.
Conflict of interest: Dr. Beijer has nothing to disclose.
Conflict of interest: Dr. Seldenrijk has nothing to disclose.
Conflict of interest: Dr. Eishi has nothing to disclose.
Conflict of interest: Keisuke Uchida has nothing to disclose.
Conflict of interest: Dr. Damen has nothing to disclose.
Conflict of interest: Dr. Grutters has nothing to disclose.
Conflict of interest: Dr. Veltkamp has nothing to disclose.
- Received July 10, 2020.
- Accepted November 5, 2020.
- Copyright ©ERS 2020
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