What is the role of microbes in the etiology of granulomatosis with polyangiitis (GPA)?

Updated: Aug 31, 2021
  • Author: Christopher L Tracy, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

The role of microbes in the pathogenesis of AAV has also been explored, although the mechanism has not been fully explained. The first evidence for this was discovered by Stegeman et al, who noted that nasal carriage of Staphylococcus aureus is associated with relapses of GPA (relative risk, 9.0) and prophylactic treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) can reduce the likelihood of relapse by 60%. [18]

Since then, there has been the discovery that complementary PR3, which shows homology with certain S aureus –derived peptides, may induce antibodies to PR3. [31] Additionally, at least in rat models, infection with gram-negative bacteria may lead to the development of AAV in susceptible individuals. [32]


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