ABSTRACT
Sarcoidosis is a multisystem granulomatous disease of unknown cause, histologically characterised by non-caseating granulomas. Sarcoidosis most commonly affects the lungs, but all organs can be involved, and there is a variable natural course from an asymptomatic state to a progressive disease. Sarcoidosis is a diagnosis of exclusion, and CT scan, endobronchial ultrasound-guided trans-bronchial needle aspiration and fluorodeoxyglucose positron emission tomography facilitate the diagnostic workup. Patients with severe symptoms or threatening organ damage require systemic treatment.
Subject(s)
Sarcoidosis , Disease Progression , Humans , Radiography , Sarcoidosis/diagnosis , Sarcoidosis/diagnostic imaging , Sarcoidosis/drug therapy , Sarcoidosis/physiopathology , Sarcoidosis, Pulmonary/diagnosis , Sarcoidosis, Pulmonary/diagnostic imaging , Sarcoidosis, Pulmonary/drug therapy , Sarcoidosis, Pulmonary/physiopathologyABSTRACT
Human studies have demonstrated a correlation between noncoding polymorphisms of "the pain protective" haplotype in the GCH1 gene that encodes for GTP cyclohydrolase I (GTPCH1)-which leads to reduced tetrahydrobiopterin (BH4) production in cell systems-and a diminished perception of experimental and clinical pain. Here, we investigate whether heterozygous mutations in the GCH1 gene which lead to a profound BH4 reduction in patients with dopa-responsive dystonia (DRD) have any effect on pain sensitivity. The study includes an investigation of GCH1-associated biomarkers and pain sensitivity in a cohort of 22 patients with DRD and 36 controls. The patients with DRD had, when compared with controls, significantly reduced levels of BH4, neopterin, biopterin, and GTPCH1 in their urine, blood, or cytokine-stimulated fibroblasts, but their pain response with respect to non-painful stimulation, (acute) stimulus-evoked pain, or pain response after capsaicin-induced sensitization was not significantly different. A family-specific cohort of 11 patients with DRD and 11 controls were included in this study. The patients with DRD were heterozygous for the pain protective haplotype in cis with the GCH1 disease-causing mutation, c.899T>C. No effect on pain perception was observed for this combined haplotype. In conclusion, a reduced concentration of BH4 is not sufficient to alter ongoing pain sensitivity or evoked pain responses.