A hypothesis on treatment strategy of severe multicentric Castleman disease with continuous renal replacement therapy.
Castleman disease
continuous renal replacement therapy
intensive care unit
Journal
Journal of cellular and molecular medicine
ISSN: 1582-4934
Titre abrégé: J Cell Mol Med
Pays: England
ID NLM: 101083777
Informations de publication
Date de publication:
Sep 2024
Sep 2024
Historique:
revised:
07
08
2024
received:
04
07
2024
accepted:
09
08
2024
medline:
10
9
2024
pubmed:
10
9
2024
entrez:
10
9
2024
Statut:
ppublish
Résumé
Castleman disease (CD) is a rare lymphoproliferative disorder, with non-specific clinical manifestations, often delayed diagnosis and treatment, which pose a significant challenge in the present times. Patients diagnosed with this disease have poor prognosis due to the limited treatment options. Multicentric CD occurs at multiple lymph node stations and is associated with a proinflammatory response that leads to the development of the so-called 'B symptoms'. IL-6 seems to be a key cytokine involved in various manifestations such as lymphadenopathies, hepatosplenomegaly, and polyclonal hypergammaglobulinemia. Its levels correlate with the activity of the disease. Other consequences of MCD include increased fibrinogen levels leading to deep vein thrombosis and thromboembolic disorders, high hepcidin levels causing anaemia, elevated VEGF levels promoting angiogenesis and vascular permeability, which, along with hypoalbuminemia, induce oedema, ascites, pleural and pericardial effusions, and in severe cases, generalized anasarca. In extreme cases multiple organ failure can occur, often resulting in death. We propose the use of continuous renal replacement therapy (CRRT) in managing severe multicentric CD. Our arguments are based on the principles that CRRT is able to remove IL-6 from circulation thus attenuating the cytokine storm, can influence hepcidin levels, and reduction in oedema, and is often used in multiple organ failure to regain homeostasis control. Therefore, it could be used as a therapy or bridge therapy in severe cases. To sustain our hypothesis with evidence, we have gathered several studies from the literature confirming the successful removal of cytokines, especially IL-6 from circulation, which can be used as a starting point.
Substances chimiques
Interleukin-6
0
Hepcidins
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e70026Subventions
Organisme : Ministry of Research, Innovation, and Digitalization of Romania (Henri Coandă). Ciprian Tomuleasa is funded by an international grant from the European Hematology Association (EHA-SWG Immunotherapy Project 2024 - CAR NK cells for tumor-associated macrophage immunomodulation - a new era of immunotherapy). David Kegyes, Bogdan Tigu, Vlad Moisoiu and Ciprian Tomuleasa are also funded by a bilateral collaboration grant between Romania and Moldova (PN-IV-P8-8.3-ROMD-2023-0036), as well as by a national grant of the Romanian Research Ministry (PNRR/2023/C9/MCID/I8) entitled 'Creating a Research Group of Excellence to develop cell and immune therapy technology to target the tumor microenvironment' (project code: CF 106/31.07.2024, contract number: 760278 /26.03.2024).
Informations de copyright
© 2024 The Author(s). Journal of Cellular and Molecular Medicine published by Foundation for Cellular and Molecular Medicine and John Wiley & Sons Ltd.
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