Author: Admin (---.vnnyca.adelphia.net)
Date: 08-03-02 21:14
Some of you have expressed concern that I am assuming that bacteria cause sarcoidosis without enough proof. The argument goes "If Bacteria and Silica and Beryllium are all found in granuloma then they must all be able to cause sarcoidosis".
So here is my detailed reasoning.
1. An immune response starts when T-lymphocytes (T-cells) are activated into CD-4 or CD-8 states by an immunogenic agent.
2. Nobody has managed to get Th1-cells to be activated by adding Beryllium to a BAL lung sample in a lab. Pathologists found Beryllium granules in the biopsy samples just like they found the bacterial samples, but that doesn't prove that Beryllium is an immunogenic agent which can directly cause inflammation. Every Berylliosis biopsy report that I have seen also found granuloma without any beryllium in them. These empty granuloma could be secondary to the Berylliosis or primary. Beryllium has been studied in a lot of detail, without any firm biochemical explanation emerging of exactly how it causes the run-away inflammation.
3. Silica, on the other hand, does induce a fibrotic response in normal people, but without the tendancy to the run-away inflammation of sarcoidosis. It typically increases the number of activated lymphocytes by a small factor of (approx 3 in the studies I reviewed). But it has a different biochemical mechanism, stimulating different cytokines, the ones causing fibrosis, different from those we normally attribute the typical Th1 response of sarcoidosis.
4. Titanium seems to be somewhere in the middle.
5. However, many studies have shown that Lipopolysaccharides, the outer 'skin' of gram-negative bacteria, do directly induce Th1 cytokine release and 1,25 dihydroxyvitamin D3 release. No dispute.
(The beryllium doesn't, the bugs do)
6. Inhaled particles should only affect the lungs. It is puzzling why other organs can be affected by inhaled particles. Bugs, on the other hand, make perfect sense, hiding in any soft tissue anywhere in the body and causing relapses from time to time.
Just becuase there are beryllium particles found in the biopsy sample from a sarcoid patient doesn't mean that the patient has berylliosis, in fact the opposite is usually the case. The lesions are similar, but not chemically identical (see Scadding, BMJ, 1950, p745)
And the disease Silicosis is a fibrotic disease, totally different from sarc. Just because you have a few silica particles in your lungs it does not mean that you have Silicosis.
"The Presence of Foreign Bodies Does Not Exclude the Diagnosis of Sarcoidosis "
That is why I believe the bugs are primary and the inhalants come into play later, either by chance, or by acting as a nucleation point for the granuloma to form around. Usually the pathologists manage to find "empty" granuloma in a sarcoidosis pathology report, this is the obvious signal to look for a bacterial infection.
Asbestos is quite a different problem, depositing a very nasty needle-like particle into the lungs, one that can cause significant bleeding without any inflammation at all. The response is often a mutagenic one (carcinogenic). I do think this may be a totally different 'particle'. In any case, it has a different outcome, progressing fairly rapidly.
I hope this is a help in understanding why I formed the opinion I did - that every sarc patient should assume that their sarc was caused by bacteria, and institute Minocin or such other anti-biotic treatments that their doctors might recommend.
..Trevor..
"The Use of Tetracyclines for the Treatment of Sarcoidosis"
(C)Copyright 2002
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"Auto-immune" is a concept which has previously worried me a little 