Nicotine as potential treatment for sarcoidosis

medical doctor looking at x-ray picture of lungs in hospitalSarcoidosis is one of the systemic diseases and is characterized by the formation of small inflammatory lumps (granulomas). It’s radiological image is very similar to other diseases, so it is often mistaken for cancer, lymphoma, tuberculosis and fungal diseases.

Changes can be located in each organ, but most often occupy lymph nodes and lungs. 60-70% of patients within a few months come to self-cure or remission. However, in the remaining patients the disease goes into chronic condition and progresses. Then untreated can lead to lung damage, pulmonary heart disease and even death.

The etiology of the disease has not been established so far, resulting in the lack of targeted therapy, and the treatment is mainly symptomatic. Currently it relies heavily on the use of steroids such as prednisone. Prolonged use of steroids implies serious side effects such as hypertension, osteoporosis, cataracts, and diabetes. Therefore, it is necessary to find safer alternative therapies that will reduce the occurrence of side effects.

Researches published in recent years have shown promising effects of nicotine in the treatment of sarcoidosis.
In 2013 dr Elliott Crouser said “The nicotine, a common component of cigarette smoke, strongly suppresses the immune system and reduces the type of inflammation that is characteristic of sarcoidosis in the lungs.”

The use of nicotine in patients with active forms of pulmonary sarcoidosis was well tolerated and led to a change in the immunological phenotype to this resembling asymptomatic patients.

In addition, experts from the Mayo Clinic have shown that sarcoidosis is less common in smokers than in people who do not smoke. Based on the results of another study, the authors found that smoking plays a protective role in the occurrence of sarcoidosis.

In the search for therapy, a team of Ohio State University researchers launched a small clinical trial to test the potential benefits of using nicotine patches as a treatment for sarcoidosis. Favorable research results prompted researchers to start a larger randomized trial in which patients were assigned to two groups: one placebo and the other one received nicotine patches. Patients were then evaluated for their lung function using modern CAT scans.

Nicotine therapy for the treatment of sarcoidosis is still in the study phase to confirm that it is safe for patients’ health and effective in combination with other approved drugs. There is not enough scientific evidence to support this therapy, so do not use it without consulting your doctor. More research and more data are needed to better understand this disease, improve current treatment standards, and help people suffering from sarcoidosis.

Written by: Anna Mroczek, Kamil Bałabuszek, Marta Misztal

Source: 1. Nicotine treatment improves Toll-like receptor 2 and Toll-like receptor 9 responsiveness in active pulmonary sarcoidosis. Julian MW, Shao G, Schlesinger LS, Huang Q, Cosmar DG, Bhatt NY, Culver DA, Baughman RP, Wood KL, Crouser ED5. Chest. 2013 Feb 1;143(2):461-470. doi: 10.1378/chest.12-0383.

2. Study of Nicotine Patches in Patients With Sarcoidosis Sponsor: Elliott Crouser MD Identifier: NCT00701207

3. Smoking, obesity and risk of sarcoidosis: A population-based nested case-control study.
Ungprasert P, Crowson CS, Matteson EL Respir Med. 2016 Nov;120:87-90. doi: 10.1016/j.rmed.2016.10.003. Epub 2016 Oct 11.

4. Nicotine Treatment for Pulmonary Sarcoidosis: A Clinical Trial Pilot Study Elliott Crouser MD, Principal Investigator, Ohio State University Identifier: NCT02265874

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