Abstract
Recent advances in pharmacology have greatly expanded the drug repertoire for treatment of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis. Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multisystemic disorder, a type of the ANCA-associated vasculitis. Important features of this disease are eosinophilia and anti-myeloperoxidase ANCA presence in around 30–70% of patients. Primary therapy of EGPA includes steroids and cytotoxic drugs, e.g., cyclophosphamide, azathioprine, or methotrexate. Nevertheless, some patients are refractory to this therapy. Alternative approaches include rituximab, mepolizumab, and intravenous immunoglobulin. Accumulating evidence highlight a new promising drug in EGPA therapy—imatinib mesylate (IM), tyrosine kinase inhibitor. This drug is a key pharmacological agent in treating various types of hematological malignancies and FIP1L1/PDGF-RA-positive hypereosinophilia. In this article, we present a case demonstrating successful treatment of EGPA with IM; we also discuss possible mechanisms of IM efficacy in EGPA treatment and future perspectives of this therapeutic approach.
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Comarmond C, Pagnoux C, Khellaf M, Cordier JF, Hamidou M, Viallard JF, Maurier F, Jouneau S, Bienvenu B, Puéchal X, Aumaître O, Guenno GL, Quellec AL, Cevallos R, Fain O, Godeau B, Seror R, Dunogué B, Mahr A, Guilpain P, Cohen P, Aouba A, Mouthon L, Guillevin L, for the French Vasculitis Study Group (2013) Eosinophilic granulomatosis with polyangiitis (Churg-Strauss): clinical characteristics and long-term followup of the 383 patients enrolled in the French Vasculitis Study Group cohort. Arthritis Rheum 65(1):270–281. https://doi.org/10.1002/art.37721
Groh M, Pagnoux C, Baldini C, Bel E, Bottero P, Cottin V, Dalhoff K, Dunogué B, Gross W, Holle J, Humbert M, Jayne D, Jennette JC, Lazor R, Mahr A, Merkel PA, Mouthon L, Sinico RA, Specks U, Vaglio A, Wechsler ME, Cordier JF, Guillevin L (2015) Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management. Eur J Intern Med 26(7):545–553. https://doi.org/10.1016/j.ejim.2015.04.022
Mohammad AJ, Hot A, Arndt F, Moosig F, Guerry M-J, Amudala N, Smith R, Sivasothy P, Guillevin L, Merkel PA, Jayne DRW (2016) Rituximab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg–Strauss). Ann Rheum Dis 75(2):396–401. https://doi.org/10.1136/annrheumdis-2014-206095
Jachiet M, Samson M, Cottin V, Kahn JE, Le Guenno G, Bonniaud P et al (2016) Anti-IgE monoclonal antibody (omalizumab) in refractory and relapsing eosinophilic granulomatosis with polyangiitis (Churg-Strauss): data on seventeen patients. Arthritis Rheumatol 68(9):2274–2282. https://doi.org/10.1002/art.39663
Detoraki A, Di Capua L, Varricchi G, Genovese A, Marone G, Spadaro G (2016) Omalizumab in patients with eosinophilic granulomatosis with polyangiitis: a 36-month follow-up study. J Asthma 53(2):201–206. https://doi.org/10.3109/02770903.2015.1081700
Aguirre-Valencia D, Posso-Osorio I, Bravo JC, Bonilla-Abadía F, Tobón GJ, Cañas CA (2017) Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Clin Rheumatol 36(9):2159–2162. https://doi.org/10.1007/s10067-017-3780-9
Metzgeroth G, Walz C, Erben P, Popp H, Schmitt-Graeff A, Haferlach C, Fabarius A, Schnittger S, Grimwade D, Cross NCP, Hehlmann R, Hochhaus A, Reiter A (2008) Safety and efficacy of imatinib in chronic eosinophilic leukaemia and hypereosinophilic syndrome—a phase-II study. Br J Haematol 143(5):707–715. https://doi.org/10.1111/j.1365-2141.2008.07294.x
Azizi G, Mirshafiey A (2013) Imatinib mesylate: an innovation in treatment of autoimmune diseases. Recent Pat Inflamm Allergy Drug Discov 7(3):259–267. https://doi.org/10.2174/1872213X113079990021
Wallace E, Gewin L (2013) Imatinib: novel treatment of immune-mediated kidney injury. J Am Soc Nephrol 24(5):694–701. https://doi.org/10.1681/ASN.2012080818
Paniagua RT, Sharpe O, Ho PP, Chan SM, Chang A, Higgins JP, Tomooka BH, Thomas FM, Song JJ, Goodman SB, Lee DM, Genovese MC, Utz PJ, Steinman L, Robinson WH (2006) Selective tyrosine kinase inhibition by imatinib mesylate for the treatment of autoimmune arthritis. J Clin Invest 116(10):2633–2642. https://doi.org/10.1172/JCI28546
Josselin-Mahr L, Werbrouck-Chiraux A, Garderet L, Cabane J (2014) Efficacy of imatinib mesylate in a case of Churg–Strauss syndrome: evidence for the pathogenic role of a tyrosine kinase? Rheumatology 53(2):378–379. https://doi.org/10.1093/rheumatology/ket261
Erre GL, Pardini S, Cuccuru L, Taras L, Passiu G (2015) Is there a role for imatinib mesylate in the treatment of eosinophilic granulomatosis with polyangiitis? Jt Bone Spine 82(1):72–73. https://doi.org/10.1016/j.jbspin.2014.06.004
Klaeger S, Heinzlmeir S, Wilhelm M, Polzer H, Vick B, Koenig PA, et al. (2017) The target landscape of clinical kinase drugs. Science 358:eaan4368. https://doi.org/10.1126/science.aan4368
Buchdunger E, Cioffi CL, Law N, Stover D, Ohno-Jones S, Druker BJ, Lydon NB (2000) Abl protein-tyrosine kinase inhibitor STI571 inhibits in vitro signal transduction mediated by c-kit and platelet-derived growth factor receptors. J Pharmacol Exp Ther 295(1):139–145
Winger JA, Hantschel O, Superti-Furga G, Kuriyan J (2009) The structure of the leukemia drug imatinib bound to human quinone reductase 2 (NQO2). BMC Struct Biol 9(1):1–12. https://doi.org/10.1186/1472-6807-9-7
Kälsch AI, Soboletzki M, Schmitt WH, Van Der Woude FJ, Hochhaus A, Yard BA et al (2008) Imatinib mesylate, a new kid on the block for the treatment of anti-neutrophil cytoplasmic autoantibodies-associated vasculitis? Clin Exp Immunol 151(3):391–398. https://doi.org/10.1111/j.1365-2249.2007.03572.x
Seggewiss R, Loré K, Greiner E, Magnusson MK, Price DA, Douek DC, Dunbar CE, Wiestner A (2005) Imatinib inhibits T-cell receptor-mediated T-cell proliferation and activation in a dose-dependent manner. Blood 105(6):2473–2479. https://doi.org/10.1182/blood-2004-07-2527
Chen J, Schmitt A, Chen B, Rojewski M, Ringhoffer M, Von Harsdorf S et al (2007) Imatinib impairs CD8+ T lymphocytes specifically directed against the leukemia-associated antigen RHAMM/CD168 in vitro. Cancer Immunol Immunother 56(6):849–861. https://doi.org/10.1007/s00262-006-0232-9
Dewar AL, Cambareri AC, Zannettino ACW, Miller BL, Doherty KV, Hughes TP, Lyons AB (2005) Macrophage colony-stimulating factor receptor c-fms is a novel target of imatinib. Blood 105(8):3127–3132. https://doi.org/10.1182/blood-2004-10-3967
Ohashi A, Kinoshita K, Isozaki K, Nishida T, Shinomura Y, Kitamura Y, Hirota S (2004) Different inhibitory effect of imatinib on phosphorylation of mitogen-activated protein kinase and Akt and on proliferation in cells expressing different types of mutant platelet-derived growth factor receptor-alpha. Int J Cancer 111(3):317–321. https://doi.org/10.1002/ijc.20305
Hellmich B, Ehlers S, Csernok E, Gross WL (2003) Update on the pathogenesis of Churg-Strauss syndrome. Clin Exp Rheumatol 21(Suppl 32):S69–77
Terrier B, Bièche I, Maisonobe T, Laurendeau I, Rosenzwajg M, Kahn J-E, et al. (2010) IL-25: a cytokine linking eosinophils and adaptive immunity in Churg-Strauss syndrome. Blood 116(22):4523–4531. https://doi.org/10.1182/blood-2010-02-267542
Suzuki N, Sasaki N, Utsumi Y, Nagashima H, Nakamura Y, Yamashita M, Yamauchi K, Sawai T (2013) Effects of imatinib mesylate on pulmonary allergic vasculitis in a murine model. Int J Rheum Dis 16(4):455–462. https://doi.org/10.1111/1756-185X.12075
Tapper EB, Knowles D, Heffron T, Lawrence EC, Csete M (2009) Portopulmonary hypertension: imatinib as a novel treatment and the Emory experience with this condition. Transplant Proc 41(5):1969–1971. https://doi.org/10.1016/j.transproceed.2009.02.100
Lozano E, Segarra M, García-Martínez A, Hernández-Rodríguez J, Cid MC (2008) Imatinib mesylate inhibits in vitro and ex vivo biological responses related to vascular occlusion in giant cell arteritis. Ann Rheum Dis 67(11):1581–1588. https://doi.org/10.1136/ard.2007.070805
Gągało I, Rusiecka I, Kocić I (2015) Tyrosine kinase inhibitor as a new therapy for ischemic stroke and other neurologic diseases: is there any hope for a better outcome? Curr Neuropharmacol 13(6):836–844. https://doi.org/10.2174/1570159X13666150518235504
Emmi G, Silvestri E, Marconi R, Carrai V, Fanelli T, Zucchini P, Marasca R, Vannucchi AM, Emmi L, Prisco D, Vaglio A (2015) First report of FIP1L1-PDGFRα-positive eosinophilic granulomatosis with polyangiitis. Rheumatol (United Kingdom) 54(9):1751–1753. https://doi.org/10.1093/rheumatology/kev242
Terabe F, Kitano M, Kawai M, Kuwahara Y, Hirano T, Arimitsu J, Hagihara K, Shima Y, Narazaki M, Tanaka T, Kawase I, Sano H, Ogata A (2009) Imatinib mesylate inhibited rat adjuvant arthritis and PDGF-dependent growth of synovial fibroblast via interference with the Akt signaling pathway. Mod Rheumatol 19(5):522–529. https://doi.org/10.1007/s10165-009-0193-x
Aono Y, Nishioka Y, Inayama M, Ugai M, Kishi J, Uehara H, Izumi K, Sone S (2005) Imatinib as a novel antifibrotic agent in bleomycin-induced pulmonary fibrosis in mice. Am J Respir Crit Care Med 171(11):1279–1285. https://doi.org/10.1164/rccm.200404-531OC
van Steensel L, Paridaens D, Schrijver B, Dingjan GM, van Daele PLA, Martin van Hagen P et al (2009) Imatinib mesylate and AMN107 inhibit PDGF-signaling in orbital fibroblasts: a potential treatment for Graves’ ophthalmopathy. Invest Ophthalmol Vis Sci 50(7):3091–3098. https://doi.org/10.1167/iovs.08-2443
Wang S (2005) Imatinib mesylate blocks a non-Smad TGF- pathway and reduces renal fibrogenesis in vivo. FASEB J 19(1):1–11. https://doi.org/10.1096/fj.04-2370com
Shiha GE, Abu-Elsaad NM, Zalata KR, Ibrahim TM (2014) Tracking anti-fibrotic pathways of nilotinib and imatinib in experimentally induced liver fibrosis: an insight. Clin Exp Pharmacol Physiol 41(10):788–797. https://doi.org/10.1111/1440-1681.12286
Spiera RF, Gordon JK, Mersten J, Magro C, Mehta M, Wildman H et al (2010) Imatinib mesylate (Gleevec) in the treatment of diffuse cutaneous systemic sclerosis: results of a one year, phase IIa, single arm, open label clinical trial. Arthritis Rheum 62:2193. https://doi.org/10.1002/art.29957
Akhmetshina A, Venalis P, Dees C, Busch N, Zwerina J, Schett G, Distler O, Distler JHW (2009) Treatment with imatinib prevents fibrosis in different preclinical models of systemic sclerosis and induces regression of established fibrosis. Arthritis Rheum 60(1):219–224. https://doi.org/10.1002/art.24186
Kuo WL, Yu MC, Lee JF, Tsai CN, Chen TC, Chen MF (2012) Imatinib mesylate improves liver regeneration and attenuates liver fibrogenesis in CCL 4-treated mice. J Gastrointest Surg 16(2):361–369. https://doi.org/10.1007/s11605-011-1764-7
Elmholdt TR, Buus NH, Ramsing M, Olesen AB (2013) Antifibrotic effect after low-dose imatinib mesylate treatment in patients with nephrogenic systemic fibrosis: an open-label non-randomized, uncontrolled clinical trial. J Eur Acad Dermatol Venereol 27(6):779–784. https://doi.org/10.1111/j.1468-3083.2011.04398.x
Bournia VK, Evangelou K, Sfikakis PP (2013) Therapeutic inhibition of tyrosine kinases in systemic sclerosis: a review of published experience on the first 108 patients treated with Imatinib. Semin Arthritis Rheum 42(4):377–390. https://doi.org/10.1016/j.semarthrit.2012.06.001
Guo L, Chen XX, Gu YY, Zou HJ, Ye S (2012) Low-dose imatinib in the treatment of severe systemic sclerosis: a case series of six Chinese patients and literature review. Clin Rheumatol 31(9):1395–1400. https://doi.org/10.1007/s10067-012-2032-2
Horton JA, Chung EJ, Hudak KE, Sowers A, Thetford A, White AO, Mitchell JB, Citrin DE (2013) Inhibition of radiation-induced skin fibrosis with imatinib. Int J Radiat Biol 89(3):162–170. https://doi.org/10.3109/09553002.2013.741281
Daniels CE, Lasky JA, Limper AH, Mieras K, Gabor E, Schroeder DR, Imatinib-IPF Study Investigators (2010) Imatinib treatment for idiopathic pulmonary fibrosis: randomized placebo-controlled trial results. Am J Respir Crit Care Med 181(6):604–610. https://doi.org/10.1164/rccm.200906-0964OC
Prey S, Ezzedine K, Doussau A, Grandoulier AS, Barcat D, Chatelus E, Diot E, Durant C, Hachulla E, de Korwin-Krokowski JD, Kostrzewa E, Quemeneur T, Paul C, Schaeverbeke T, Seneschal J, Solanilla A, Sparsa A, Bouchet S, Lepreux S, Mahon FX, Chene G, Taïeb A (2012) Imatinib mesylate in scleroderma-associated diffuse skin fibrosis: a phase II multicentre randomized double-blinded controlled trial. Br J Dermatol 167(5):1138–1144. https://doi.org/10.1111/j.1365-2133.2012.11186.x
Savikko J, Rintala JM, Rintala SE, Koskinen PK, von Willebrand E (2011) Early short-term imatinib treatment is sufficient to prevent the development of chronic allograft nephropathy. Nephrol Dial Transplant 26(9):3026–3032. https://doi.org/10.1093/ndt/gfq790
Zoja C, Corna D, Rottoli D, Zanchi C, Abbate M, Remuzzi G (2006) Imatinib ameliorates renal disease and survival in murine lupus autoimmune disease. Kidney Int 70(1):97–103. https://doi.org/10.1038/sj.ki.5001528
Sadanaga A, Nakashima H, Masutani K, Miyake K, Shimizu S, Igawa T, Sugiyama N, Niiro H, Hirakata H, Harada M (2005) Amelioration of autoimmune nephritis by imatinib in MRL/lpr mice. Arthritis Rheum 52(12):3987–3996. https://doi.org/10.1002/art.21424
Hudkins KL, Gilbertson DG, Carling M, Taneda S, Hughes SD, Holdren MS, Palmer TE, Topouzis S, Haran AC, Feldhaus AL, Alpers CE (2004) Exogenous PDGF-D is a potent mesangial cell mitogen and causes a severe mesangial proliferative glomerulopathy. J Am Soc Nephrol 15(2):286–298. https://doi.org/10.1097/01.ASN.0000108522.79652.63
Taneda S, Hudkins KL, Cui Y, Farr AG, Alpers CE, Segerer S (2003) Growth factor expression in a murine model of cryoglobulinemia. Kidney Int 63(2):576–590. https://doi.org/10.1046/j.1523-1755.2003.00778.x
Iyoda M, Hudkins KL, Becker-Herman S, Wietecha TA, Banas MC, Guo S, Meyer-Bahlburg A, Kowalewska J, Liu G, Ziegler SF, Rawlings DJ, Alpers CE (2009) Imatinib suppresses cryoglobulinemia and secondary membranoproliferative glomerulonephritis. J Am Soc Nephrol 20(1):68–77. https://doi.org/10.1681/ASN.2008010036
Agosti V, Corbacioglu S, Ehlers I, Waskow C, Sommer G, Berrozpe G, Kissel H, Tucker CM, Manova K, Moore MAS, Rodewald HR, Besmer P (2004) Critical role for Kit-mediated Src kinase but not PI 3-kinase signaling in pro T and pro B cell development. J Exp Med 199(6):867–878. https://doi.org/10.1084/jem.20031983
Lam QLK, Lo CKC, Zheng BJ, Ko KH, Osmond DG, Wu GE, Rottapel R, Lu L (2007) Impaired V(D)J recombination and increased apoptosis among B cell precursors in the bone marrow of c-Abl-deficient mice. Int Immunol 19(3):267–276. https://doi.org/10.1093/intimm/dxl143
Wallace E, Fogo AB, Schulman G (2012) Imatinib therapy for non-infection-related type II cryoglobulinemia with membranoproliferative glomerulonephritis. Am J Kidney Dis 59(1):122–125. https://doi.org/10.1053/j.ajkd.2011.08.016
Scheinfeld N (2006) Imatinib mesylate and dermatology part 2: a review of the cutaneous side effects of imatinib mesylate. Vol. 5, J Drugs Dermat: JDD. p. 228–31
Mumprecht S, Matter M, Pavelic V, Ochsenbein AF (2006) Imatinib mesylate selectively impairs expansion of memory cytotoxic T cells without affecting the control of primary viral infections. Blood 108(10):3406–3413. https://doi.org/10.1182/blood-2006-04-018705
Napier RJ, Rafi W, Cheruvu M, Powell KR, Zaunbrecher MA, Bornmann W, Salgame P, Shinnick TM, Kalman D (2011) Imatinib-sensitive tyrosine kinases regulate mycobacterial pathogenesis and represent therapeutic targets against tuberculosis. Cell Host Microbe 10(5):475–485. https://doi.org/10.1016/j.chom.2011.09.010
Müller AMS, Martens UM, Hofmann SC, Bruckner-Tuderman L, Mertelsmann R, Lübbert M (2006) Imatinib mesylate as a novel treatment option for hypereosinophilic syndrome: two case reports and a comprehensive review of the literature. Ann Hematol 85(1):1–16. https://doi.org/10.1007/s00277-005-1084-7
Baccarani M, Cilloni D, Rondoni M, Ottaviani E, Messa F, Merante S, Tiribelli M, Buccisano F, Testoni N, Gottardi E, de Vivo A, Giugliano E, Iacobucci I, Paolini S, Soverini S, Rosti G, Rancati F, Astolfi C, Pane F, Saglio G, Martinelli G (2007) The efficacy of imatinib mesylate in patients with FIP1L1-PDGFRα-positive hypereosinophilic syndrome. Results of a multicenter prospective study. Haematologica 92(9):1173–1179. https://doi.org/10.3324/haematol.11420
Khoury P, Desmond R, Pabon A, Holland-Thomas N, Ware JM, Arthur DC, Kurlander R, Fay MP, Maric I, Klion AD (2016) Clinical features predict responsiveness to imatinib in platelet-derived growth factor receptor-alpha-negative hypereosinophilic syndrome. Allergy Eur J Allergy Clin Immunol 71(6):803–810. https://doi.org/10.1111/all.12843
Helbig G (2016) Imatinib mesylate for unmutated hypereosinophilic syndromes: does it work? Eur J Intern Med 32:e19–e20. https://doi.org/10.1016/j.ejim.2016.02.024
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Beketova, T.V., Volkov, M.Y., Naryshkin, E.A. et al. Imatinib mesylate use in refractory eosinophilic granulomatosis with polyangiitis: a literature review and a case report. Clin Rheumatol 37, 1729–1735 (2018). https://doi.org/10.1007/s10067-018-4018-1
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DOI: https://doi.org/10.1007/s10067-018-4018-1