101
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Seishima M, Fujii K, Mizutani Y. Generalized Pustular Psoriasis in Pregnancy: Current and Future Treatments. Am J Clin Dermatol 2022; 23:661-671. [PMID: 35704168 DOI: 10.1007/s40257-022-00698-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disease characterized by sudden widespread eruption of sterile pustules with or without systemic symptoms. GPP may be life threatening in cases with severe complications such as cardiovascular failure, acute respiratory distress syndrome, and serious infections. Impetigo herpetiformis (IH) is a GPP that is induced and exacerbated by pregnancy and occurs most frequently during the last trimester. IH may result in poor or fatal neonatal outcomes, including placental insufficiency, fetal abnormalities, stillbirth, and early neonatal death. Most patients have prompt remission in the postpartum period; however, earlier appearance and more severe symptoms are observed during subsequent pregnancies. Appropriate treatment and close monitoring of the mother and fetus are vital for the management of patients with IH. Particular attention is required for the management of patients with IH to avoid an influence on the fetus. However, data regarding treatments for GPP in pregnant women are sparse. Over the last decade, many patients with IH have been treated with cyclosporine, corticosteroids, tumor necrosis factor-α inhibitors, interleukin (IL)-17 and IL-12/23 inhibitors, and granulocyte and monocyte adsorption apheresis (GMA). GMA may be an important option for patients with IH as it is presently one of the safest available therapeutic options, but there have been no reports to fully confirm its safety in pregnant patients with GPP. Alternatively, based on recent advances in the understanding of the role of the IL-36 axis in the pathogenesis of GPP, biologic agents that target the IL-36 pathway may demonstrate promising efficacy in IH.
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Affiliation(s)
- Mariko Seishima
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan. .,Department of Dermatology, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu, 500-8523, Japan.
| | - Kento Fujii
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan
| | - Yoko Mizutani
- Department of Dermatology, Gifu University Graduate School of Medicine, 1-1, Yanagido, Gifu, 501-1194, Japan
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102
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Hernandez Santana YE, Irwin N, Walsh PT. IL-36: a therapeutic target for ulcerative colitis? Expert Opin Ther Targets 2022; 26:507-512. [PMID: 35634891 DOI: 10.1080/14728222.2022.2084381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yasmina E Hernandez Santana
- National Children's Research Centre, Children's Health Ireland Crumlin, Dublin 12, Ireland.,Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Ireland
| | - Naoise Irwin
- National Children's Research Centre, Children's Health Ireland Crumlin, Dublin 12, Ireland.,Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Ireland
| | - Patrick T Walsh
- National Children's Research Centre, Children's Health Ireland Crumlin, Dublin 12, Ireland.,Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Ireland
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103
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Reich K, Augustin M, Gerdes S, Ghoreschi K, Kokolakis G, Mößner R, Mrowietz U, Navarini AA, Pinter A, Schäkel K, Staubach P, Sticherling M, Thaçi D, Wilsmann-Theis D. Generalisierte pustulöse Psoriasis: Überblick zum Status quo und Ergebnisse einer Diskussionsrunde. J Dtsch Dermatol Ges 2022; 20:753-772. [PMID: 35711041 DOI: 10.1111/ddg.14764_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Kristian Reich
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf (UKE)
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf (UKE)
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt- Universität zu Berlin
| | - Georgios Kokolakis
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, korporatives Mitglied der Freien Universität Berlin und der Humboldt- Universität zu Berlin
| | - Rotraut Mößner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
| | - Ulrich Mrowietz
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Andreas Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Goethe-Universität, Frankfurt am Main
| | - Knut Schäkel
- Abteilung für Dermatologie, Universitätsklinikum Heidelberg
| | | | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Klinik für Dermatologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Diamant Thaçi
- Institut für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
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104
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Matarazzo L, Hernandez Santana YE, Walsh PT, Fallon PG. The IL-1 cytokine family as custodians of barrier immunity. Cytokine 2022; 154:155890. [DOI: 10.1016/j.cyto.2022.155890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
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105
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Reich K, Augustin M, Gerdes S, Ghoreschi K, Kokolakis G, Mößner R, Mrowietz U, Navarini AA, Pinter A, Schäkel K, Staubach P, Sticherling M, Thaçi D, Wilsmann-Theis D. Generalized pustular psoriasis: overview of the status quo and results of a panel discussion. J Dtsch Dermatol Ges 2022; 20:753-771. [PMID: 35674482 DOI: 10.1111/ddg.14764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare, severe, potentially life-threatening, autoinflammatory, neutrophilic skin disease that may be accompanied by fever and leukocytosis. This paper describes the current state of knowledge on GPP in terms of classification, (differential) diagnosis and prevalence. We present a comparison of the genetics and pathoimmunology of GPP and psoriasis vulgaris with the central mechanisms of autoimmunology and autoinflammation. The currently available therapeutic options, expert recommendations for therapy, and data from early clinical trials investigating targeted therapies will be summarized. We present the results of our discussion with 13 experts for psoriasis vulgaris and GPP and give an integrated overview of indication and therapy based on our personal experience and present an outlook on further research questions. Collectively, this article highlights the high unmet need in GPP, as there exists no satisfactory method of diagnosis or treatment to date and new treatment options will be of great therapeutic benefit to those affected.
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Affiliation(s)
- Kristian Reich
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sascha Gerdes
- Psoriasis-Center, Clinic for Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein/Campus Kiel, Kiel, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Georgios Kokolakis
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Rotraut Mößner
- Department of Dermatology, Venerology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrich Mrowietz
- Psoriasis-Center, Clinic for Dermatology, Venereology and Allergology, University Medical Center Schleswig-Holstein/Campus Kiel, Kiel, Germany
| | | | - Andreas Pinter
- Department of Dermatology, Venereology, and Allergology, Goethe University, Frankfurt am Main, Germany
| | - Knut Schäkel
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Michael Sticherling
- Deutsches Zentrum Immuntherapie, Department of Dermatology, Friedrich- Alexander University, Friedrich-Alexander University, Erlangen-Nuermberg, Erlangen, Germany
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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106
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Hawerkamp HC, Fahy CMR, Fallon PG, Schwartz C. Break on through: The role of innate immunity and barrier defence in atopic dermatitis and psoriasis. SKIN HEALTH AND DISEASE 2022; 2:e99. [PMID: 35677926 PMCID: PMC9168024 DOI: 10.1002/ski2.99] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/07/2022] [Accepted: 01/23/2022] [Indexed: 12/20/2022]
Abstract
The human skin can be affected by a multitude of diseases including inflammatory conditions such as atopic dermatitis and psoriasis. Here, we describe how skin barrier integrity and immunity become dysregulated during these two most common inflammatory skin conditions. We summarise recent advances made in the field of the skin innate immune system and its interaction with adaptive immunity. We review gene variants associated with atopic dermatitis and psoriasis that affect innate immune mechanisms and skin barrier integrity. Finally, we discuss how current and future therapies may affect innate immune responses and skin barrier integrity in a generalized or more targeted approach in order to ameliorate disease in patients.
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Affiliation(s)
- H C Hawerkamp
- Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin Dublin Ireland
| | - C M R Fahy
- Paediatric Dermatology Children's Health Ireland at Crumlin Dublin Ireland.,Royal United Hospitals NHS Foundation Trust Bath UK
| | - P G Fallon
- Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin Dublin Ireland.,National Children's Research Centre Our Lady's Children's Hospital Dublin Ireland.,Clinical Medicine Trinity College Dublin Dublin Ireland
| | - C Schwartz
- Trinity Biomedical Sciences Institute, School of Medicine, Trinity College Dublin Dublin Ireland.,Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene Universitätsklinikum Erlangen and Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg Erlangen Germany.,Medical Immunology Campus Erlangen FAU Erlangen-Nürnberg Erlangen Germany
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107
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Okubo Y, Umezawa Y, Sakurai S, Hoshii N, Nakagawa H. Efficacy and Safety of Certolizumab Pegol in Japanese Patients with Generalized Pustular Psoriasis and Erythrodermic Psoriasis: 52-Week Results. Dermatol Ther (Heidelb) 2022; 12:1397-1415. [PMID: 35622315 PMCID: PMC9209588 DOI: 10.1007/s13555-022-00741-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction We report an exploratory analysis of the efficacy and safety of certolizumab pegol (CZP) in Japanese patients with generalized pustular psoriasis (GPP) and erythrodermic psoriasis (EP) (NCT03051217). Methods Patients ≥ 20 years with GPP or EP were randomized 1:1 to open-label CZP 400 mg every 2 weeks (Q2W) or 200 mg Q2W (400 mg weeks 0/2/4) for 16 weeks; patients who achieved “much improved” or “very much improved” on the Global Improvement Score (GIS; for GPP) or a PASI 50 response (≥ 50% reduction from baseline Psoriasis Area and Severity Index; for EP) continued to week 52. Efficacy outcomes assessed included Clinical Global Impression of Improvement (CGI-I), Dermatology Life Quality Index (DLQI 0/1), and Itch Numeric Rating Scale (INRS 0). GIS and Japanese Dermatological Association (JDA) severity index were assessed in patients with GPP, and PASI and Physician’s Global Assessment (PGA) in patients with EP. Treatment-emergent adverse events (TEAEs) were evaluated through weeks 0–52. Results Of 22 patients randomized, 19 completed week 52. At week 16, all reported outcomes improved with both CZP doses and were generally maintained through week 52. At week 52, 6/7 GPP and 12/12 EP patients achieved CGI-I response (“improved” or “remission”). Also, 4/7 GPP and 7/12 EP patients achieved DLQI 0/1; 2/7 GPP and 2/12 EP patients achieved INRS 0. Meanwhile, 6/7 patients with GPP achieved GIS response, and JDA severity index was reduced from baseline. We found that 9/12 and 5/12 patients with EP achieved PASI 90 and PGA 0/1, respectively. Overall, three serious TEAEs were reported in three CZP 400 mg Q2W-treated patients. Conclusion CZP treatment over 16 weeks improved the signs and symptoms of GPP and EP, and improvements were maintained through week 52. No new safety signals were identified. Trial Registration ClinicalTrials.gov identifier, NCT03051217. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-022-00741-x.
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Affiliation(s)
- Yukari Okubo
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
| | - Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinya Sakurai
- UCB Pharma, 8 Chome-17-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Naoki Hoshii
- UCB Pharma, 8 Chome-17-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
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108
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Mariem E, Emna B, Khadija S, Slaheddine M, Faiza F, Hamida T, Noura B. Pustular Psoriasis of Pregnancy: Clinical and Genetic Characteristics in a Series of 8 Patients and Review of the Literature. Dermatol Ther 2022; 35:e15593. [DOI: 10.1111/dth.15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ennouri Mariem
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
| | - Bahloul Emna
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | - Sellami Khadija
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | | | - Fakhfakh Faiza
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
| | - Turki Hamida
- Department of Dermatology, CHU Hedi Chaker, Sfax Sfax University TUNISIA
| | - Bougacha‐Elleuch Noura
- Laboratory of Molecular and Functional Genetics, Faculty of Sciences of Sfax Sfax University TUNISIA
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109
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Schett G, Rahman P, Ritchlin C, McInnes IB, Elewaut D, Scher JU. Psoriatic arthritis from a mechanistic perspective. Nat Rev Rheumatol 2022; 18:311-325. [PMID: 35513599 DOI: 10.1038/s41584-022-00776-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/13/2022]
Abstract
Psoriatic arthritis (PsA) is part of a group of closely related clinical phenotypes ('psoriatic disease') that is defined by shared molecular pathogenesis resulting in excessive, prolonged inflammation in the various tissues affected, such as the skin, the entheses or the joints. Psoriatic disease comprises a set of specific drivers that promote an aberrant immune response and the consequent development of chronic disease that necessitates therapeutic intervention. These drivers include genetic, biomechanical, metabolic and microbial factors that facilitate a robust and continuous mobilization, trafficking and homing of immune cells into the target tissues. The role of genetic variants involved in the immune response, the contribution of mechanical factors triggering an exaggerated inflammatory response (mechanoinflammation), the impact of adipose tissue and altered lipid metabolism and the influence of intestinal dysbiosis in the disease process are discussed. Furthermore, the role of key cytokines, such as IL-23, IL-17 and TNF, in orchestrating the various phases of the inflammatory disease process and as therapeutic targets in PsA is reviewed. Finally, the nature and the mechanisms of inflammatory tissue responses inherent to PsA are summarized.
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Affiliation(s)
- Georg Schett
- Department of Medicine 3, Friedrich Alexander University Erlangen-Nuremberg and Universitaets-klinikum Erlangen, Erlangen, Germany. .,Deutsches Zentrum Immuntherapie DZI, Friedrich Alexander University Erlangen-Nuremberg and Universitaets-klinikum Erlangen, Erlangen, Germany.
| | - Proton Rahman
- St. Clare's Mercy Hospital, St. John's, Newfoundland, Canada
| | - Christopher Ritchlin
- Division of Allergy, Immunology and Rheumatology, University of Rochester Medical Center Rochester, Rochester, NY, USA
| | - Iain B McInnes
- College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Dirk Elewaut
- VIB-UGent Center for Inflammation Research and Ghent University Hospital, Ghent, Belgium
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology, NYU Grossman School of Medicine, New York, NY, USA
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110
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Choon SE, Bachelez H. Time to accurately determine the burden of generalized pustular psoriasis at the population level. Br J Dermatol 2022; 186:919-920. [PMID: 35484790 DOI: 10.1111/bjd.21588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah and Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia
| | - Hervé Bachelez
- Department of Dermatology, AP-HP, Hôpital Saint-Louis, Laboratory of Genetic Diseases, INSERM U1163, Imagine Institute, Université de Paris, Paris, France
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111
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Halioua B, Chelli C, Misery L, Taieb J, Taieb C. Sleep Disorders and Psoriasis: An Update. Acta Derm Venereol 2022; 102:adv00699. [PMID: 35191513 PMCID: PMC9574693 DOI: 10.2340/actadv.v102.1991] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.
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112
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Hwang J, Rick J, Hsiao J, Shi VY. A review of IL-36: an emerging therapeutic target for inflammatory dermatoses. J DERMATOL TREAT 2022; 33:2711-2722. [PMID: 35470744 DOI: 10.1080/09546634.2022.2067819] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND IL-36 cytokines are members of the IL-1 superfamily. Increasing evidence in the IL-36 pathway demonstrates their potential as a therapeutic target for treating inflammatory skin diseases, such as generalized pustular psoriasis (GPP). OBJECTIVE A narrative review was written to further study preclinical and clinical evidence for the role of IL-36 in psoriasis, atopic dermatitis (AD), hidradenitis suppurativa (HS), acne, autoimmune blistering diseases, and neutrophilic dermatoses. RESULTS IL-36 has important downstream effects such as inducing expression of inflammatory cytokines, antimicrobial peptides, and growth factors. Increased expression of IL-36 cytokines has been observed in the lesional skin of patients with psoriasis. Studies of other inflammatory skin diseases have also noted similar findings, albeit to a lesser extent. IL-36 inhibition has been shown to be effective in GPP and is currently being studied for other inflammatory skin diseases. CONCLUSIONS The IL-36 pathway contributes to pathogenesis of many inflammatory skin diseases and is a promising therapeutic target.
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Affiliation(s)
- Jonwei Hwang
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Jonathan Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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113
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Yang W, Dong H, Wang P, Xu Z, Xian J, Chen J, Wu H, Lou Y, Lin D, Zhong B. IL-36γ and IL-36Ra Reciprocally Regulate Colon Inflammation and Tumorigenesis by Modulating the Cell-Matrix Adhesion Network and Wnt Signaling. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2103035. [PMID: 35119210 PMCID: PMC8981487 DOI: 10.1002/advs.202103035] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/14/2021] [Indexed: 05/07/2023]
Abstract
Inflammatory bowel disease and colorectal cancer are associated with dysregulation of cytokine networks. However, it is challenging to target cytokines for effective intervention because of the overlapping functions and unpredictable interactions of cytokines in such diverse networks. Here, it is shown that IL-36γ and IL-36Ra, an agonist and an antagonist for IL-36R signaling respectively, reciprocally regulate the experimental colitis and the colon cancer development in mice. Knockout or neutralization of IL-36γ alleviates dextran sulfate sodium (DSS)-induced colitis and inhibits colon cancer development, whereas knockout of IL-36Ra exacerbates DSS-induced colitis and promotes colonic tumorigenesis in multiple colon cancer models in mice. Mechanistically, IL-36γ upregulates extracellular matrix and cell-matrix adhesion molecules and facilitates Wnt signaling, which is mitigated by IL-36Ra or IL-36γ neutralizing antibody. Consistently, IL-36γ levels are positively correlated with extracellular matrix levels and β-catenin levels in human colorectal tumor biopsies. These findings suggest the critical role of IL-36γ and IL-36Ra in gut inflammation and tumorigenesis and indicate that targeting the IL-36γ/IL-36Ra signal balance provides potential therapeutic strategy for inflammatory bowel disease and gastrointestinal cancers.
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Affiliation(s)
- Wei Yang
- Department of Gastrointestinal SurgeryMedical Research InstituteZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Department of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
- Wuhan Research Center for Infectious Diseases and CancerChinese Academy of Medical SciencesWuhan430071China
| | - Hong‐Peng Dong
- Department of Gastrointestinal SurgeryMedical Research InstituteZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Department of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
| | - Peng Wang
- Department of Gastrointestinal SurgeryMedical Research InstituteZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Department of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
| | - Zhi‐Gao Xu
- Institute of Hepatobiliary Diseases and Transplant CenterZhongnan Hospital of Wuhan UniversityWuhan430071China
| | - Jiahuan Xian
- Yurogen Biosystems LLC (Wuhan)666 Gaoxin Avenue, Building C6, Donghu DistrictWuhan430064China
| | - Jiachen Chen
- Yurogen Biosystems LLC (Wuhan)666 Gaoxin Avenue, Building C6, Donghu DistrictWuhan430064China
| | - Hai Wu
- Yurogen Biosystems LLC (Wuhan)666 Gaoxin Avenue, Building C6, Donghu DistrictWuhan430064China
| | - Yang Lou
- Yurogen Biosystems LLC (Wuhan)666 Gaoxin Avenue, Building C6, Donghu DistrictWuhan430064China
| | - Dandan Lin
- Cancer CenterRenmin Hospital of Wuhan UniversityWuhan430061China
| | - Bo Zhong
- Department of Gastrointestinal SurgeryMedical Research InstituteZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Department of VirologyCollege of Life SciencesWuhan UniversityWuhan430072China
- Wuhan Research Center for Infectious Diseases and CancerChinese Academy of Medical SciencesWuhan430071China
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114
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Ornelas J, Cordoro KM. Clinical Decisions in Pediatric Psoriasis. Dermatol Clin 2022; 40:145-166. [DOI: 10.1016/j.det.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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115
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Interleukin-38 in Health and Disease. Cytokine 2022; 152:155824. [DOI: 10.1016/j.cyto.2022.155824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 12/13/2022]
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116
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Wang L, Pan J, Jin H. Profiling and multivariate analysis of serum cytokines in patients with generalized pustular psoriasis. EUR J INFLAMM 2022. [DOI: 10.1177/20587392221076450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Generalized pustular psoriasis (GPP) is a chronic autoinflammatory disease characterized by fever, erythema, and sterile pustules occurring over large areas of the skin. The immunopathogenesis of GPP remains poorly understood. We aimed to profile serum cytokine levels in patients with GPP and analyze treatment-associated changes in cytokine levels. Methods: Twenty-four patients who were diagnosed with GPP and received drug treatment, together with 28 unaffected controls, were recruited in this study. Levels of 27 cytokines in serum samples from pre- and post-treated patients as well as unaffected controls were assessed using a Bio-Plex multiplex immunoassay. Multivariate analysis of cytokine levels and clinical parameters was conducted. Results: Serum levels of interleukins interleukin (IL)-1β, IL-1Ra, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 (p70), IL-13, IL-17, granulocyte colony-stimulating factor (G-CSF), interferon-γ (IFN-γ), IFN-γ-induced protein 10 (IP-10), monocyte chemoattractant protein-1, tumor necrosis factor-α, and vascular endothelial growth factor were significantly elevated (p < .05) in patients with GPP compared with controls. Serum levels of IL-6, G-CSF, IL-8, IFN-γ, IL1-Ra, IL-10, IL-13, and IL-1β were correlated with GPP severity (r > 0.4, p < .001). Following treatment, serum levels of IL-6, IL-7, IL-12, IFN-γ, IL-1β, IL-4, IL-8, IL-10, IL-13, G-CSF, and IP-10 were significantly decreased (p < .05) compared with pretreatment levels. Among these cytokines, levels of IL-6, IL-7, IL-8, IL-12, IL-13, and IP-10 were reduced to normal levels. Conclusion: GPP patients exhibited markedly elevated levels of cytokines and chemokines involved in both type 1 and type 2 immune responses, suggesting hypercytokinemia occurs in GPP patients. IL-6 showed the strongest correlation with GPP disease severity and other clinical parameters such as CRP level and fever, thus representing an index for GPP severity. Our data comprehensively documented the cytokine profiles of GPP patients and may provide insights into GPP pathogenesis.
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Affiliation(s)
- Lingyan Wang
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
| | - Jing Pan
- Department of Dermatology, Beijing Jishuitan Hospital, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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117
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Horneff G, Schütz C, Rösen-Wolff A. [Autoinflammation-A clinical and genetic challenge]. Hautarzt 2022; 73:309-322. [PMID: 35286425 DOI: 10.1007/s00105-022-04970-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the last two decades clinical rheumatological practice has been confronted with a steadily increasing number of autoinflammatory diseases, the immunological pathomechanisms of which have been elucidated and in part can be clinically well classified. Whereas targeted genetic diagnostics previously served to confirm a clinically suspected diagnosis, genetic sequencing technology has much improved and enables a new diagnostic approach via high-throughput sequencing, e.g., panel sequencing, whole exome and whole genome sequencing. Thus, the decision to make a diagnosis clinically and/or genetically, has become a daily challenge. This article contrasts the clinical, immunological and genetic aspects of autoinflammatory diseases.
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Affiliation(s)
- Gerd Horneff
- Zentrum für Allgemeine Pädiatrie und Neonatologie, Asklepios Klinik Sankt Augustin, Arnold Janssen Str. 29, 53757, Sankt Augustin, Deutschland. .,Zentrum für Kinder- und Jugendmedizin, Universität Köln, Köln, Deutschland.
| | - Catharina Schütz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Angela Rösen-Wolff
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
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118
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van de Kerkhof PCM. From Empirical to Pathogenesis-Based Treatments for Psoriasis. J Invest Dermatol 2022; 142:1778-1785. [DOI: 10.1016/j.jid.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
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119
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Wang X, Liang Y, Wang H, Zhang B, Soong L, Cai J, Yi P, Fan X, Sun J. The Protective Role of IL-36/IL-36R Signal in Con A-Induced Acute Hepatitis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:861-869. [PMID: 35046104 PMCID: PMC8830780 DOI: 10.4049/jimmunol.2100481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/07/2021] [Indexed: 12/23/2022]
Abstract
The IL-36 family, including IL-36α, IL-36β, IL-36γ, and IL-36R antagonist, belong to the IL-1 superfamily. It was reported that IL-36 plays a role in immune diseases. However, it remains unclear how IL-36 regulates inflammation. To determine the role of IL-36/IL-36R signaling pathways, we established an acute hepatitis mouse model (C57BL/6) by i.v. injection of the plant lectin Con A. We found that the levels of IL-36 were increased in the liver after Con A injection. Our results demonstrated the infiltrated neutrophils, but not the hepatocytes, were the main source of IL-36 in the liver. Using the IL-36R-/- mouse model (H-2b), we surprisingly found that the absence of IL-36 signals led to aggravated liver injury, as evidenced by increased mortality, elevated serum alanine aminotransferase and aspartate aminotransferase levels, and severe liver pathological changes. Further investigations demonstrated that a lack of IL-36 signaling induced intrahepatic activation of CD4+ and CD8+ T lymphocytes and increased the production of inflammatory cytokines. In addition, IL-36R-/- mice had reduced T regulatory cell numbers and chemokines in the liver. Together, our results from the mouse model suggested a vital role of IL-36 in regulating T cell function and homeostasis during liver inflammation.
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Affiliation(s)
- Xiaofang Wang
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX
| | - Yuejin Liang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX
| | - Hui Wang
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | - Biao Zhang
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX
- Department of Histology and Embryology, Guangdong Medical University, Zhanjiang, Guangdong, China; and
| | - Lynn Soong
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
| | - Jiyang Cai
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX
| | - Panpan Yi
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan, China;
| | - Xuegong Fan
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, Hunan, China;
| | - Jiaren Sun
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX;
- Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
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120
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Role of Interleukin 36 in Generalised Pustular Psoriasis and Beyond. Dermatol Ther (Heidelb) 2022; 12:315-328. [PMID: 35060076 PMCID: PMC8850521 DOI: 10.1007/s13555-021-00677-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Indexed: 12/30/2022] Open
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121
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Hou PC, Jr Aala W, Lee YR, Guevara BEK, Chen PC, McGrath JA, Hsu CK. Transcriptomic response of peripheral blood mononuclear cells to secukinumab in an 8-year-old boy with juvenile generalized pustular psoriasis. J Eur Acad Dermatol Venereol 2022; 36:e378-e381. [PMID: 35023595 DOI: 10.1111/jdv.17922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/03/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Ping-Chen Hou
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wilson Jr Aala
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Rong Lee
- School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Peng-Chieh Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - John A McGrath
- St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, UK
| | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,International Center for Wound Repair and Regeneration (iWRR), National Cheng Kung University, Tainan, Taiwan
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122
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Macleod T, Berekmeri A, Bridgewood C, Stacey M, McGonagle D, Wittmann M. The Immunological Impact of IL-1 Family Cytokines on the Epidermal Barrier. Front Immunol 2022; 12:808012. [PMID: 35003136 PMCID: PMC8733307 DOI: 10.3389/fimmu.2021.808012] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022] Open
Abstract
The skin barrier would not function without IL-1 family members, but their physiological role in the immunological aspects of skin barrier function are often overlooked. This review summarises the role of IL-1 family cytokines (IL-1α, IL-1β, IL-1Ra, IL-18, IL-33, IL-36α, IL-36β, IL-36γ, IL-36Ra, IL-37 and IL-38) in the skin. We focus on novel aspects of their interaction with commensals and pathogens, the important impact of proteases on cytokine activity, on healing responses and inflammation limiting mechanisms. We discuss IL-1 family cytokines in the context of IL-4/IL-13 and IL-23/IL-17 axis-driven diseases and highlight consequences of human loss/gain of function mutations in activating or inhibitory pathway molecules. This review highlights recent findings that emphasize the importance of IL-1 family cytokines in both physiological and pathological cutaneous inflammation and emergent translational therapeutics that are helping further elucidate these cytokines.
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Affiliation(s)
- Tom Macleod
- School of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom.,Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Anna Berekmeri
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Charlie Bridgewood
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
| | - Martin Stacey
- School of Molecular and Cellular Biology, University of Leeds, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom.,National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), The Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Miriam Wittmann
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom.,National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), The Leeds Teaching Hospitals, Leeds, United Kingdom
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123
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Calabrese L, Fiocco Z, Satoh TK, Peris K, French LE. Therapeutic potential of targeting IL-1 family cytokines in chronic inflammatory skin diseases. Br J Dermatol 2022; 186:925-941. [PMID: 34990008 DOI: 10.1111/bjd.20975] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/15/2021] [Accepted: 12/30/2021] [Indexed: 11/27/2022]
Abstract
The interleukin-1 (IL-1) family of cytokines is a central regulator of a myriad of immunological responses. It comprises several cytokines, including those belonging to the IL-1, IL-36 and IL-18 subfamilies, as well as IL-33. The IL-1 family primarily plays a role in orchestrating innate immune responses but also in adaptive immunity. Increased interest in the IL-1 family occurred following the discovery that dysregulation of IL-1 signalling underlies the pathogenesis of several monogenic auto-inflammatory diseases, characterized by sterile inflammation involving the skin and other organs. This also provided increased understanding of the role of innate immunity and the IL-1 family in polygenic auto-inflammatory skin conditions, such as neutrophilic dermatoses, as well as in some of the most common chronic inflammatory skin diseases, such as psoriasis or hidradenitis suppurativa. Several therapeutic agents have been developed to inhibit the IL-1 family members and their signalling pathways. These have shown therapeutic efficacy in several chronic inflammatory skin disorders. The aim of this review is to thoroughly describe the consequences of pathological dysregulation of IL-1, IL-33, IL-36, IL-18 pathways in dermatological conditions and to provide a forward-looking update on therapeutic strategies targeting signalling by IL-1 family cytokines.
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Affiliation(s)
- Laura Calabrese
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Zeno Fiocco
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Takashi K Satoh
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
| | - Ketty Peris
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida
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Abstract
Generalized pustular psoriasis (GPP) is a rare, potentially life-threatening disease characterized by episodes of widespread sterile macroscopic pustules, with or without systemic inflammation and/or plaque psoriasis. Multiple GPP subtypes have been described, from acute GPP of von Zumbusch to milder, annular pustular psoriasis. Generalized pustular psoriasis mainly affects adults, with a female preponderance, but juvenile GPP also occurs. Flares are a hallmark of GPP and may occur de novo or be provoked by triggers, including withdrawal of systemic corticosteroids, infections, stress, pregnancy, and menstruation. Severity of flares varies widely between patients, and between flares in an individual patient. Significant flares are often accompanied by systemic symptoms, notably fever, general malaise, and extracutaneous manifestations such as arthritis, uveitis, and neutrophilic cholangitis. Common laboratory abnormalities include neutrophilia, elevated C-reactive protein levels, hypocalcemia, and abnormal liver function tests. The clinical course of GPP is highly variable; it can be a relapsing disease with recurrent flares and no pustulation between flares or a persistent disease with perpetual mild pustulation punctuated with flares of greater severity. Patients may have multiple flares per year or a flare every few years. Most flares last 2–5 weeks and approximately 50% require hospitalization. Life-threatening complications include sepsis and renal, hepatic, respiratory, and heart failure. Reported mortality rates are 2–16%.
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125
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Assessment of the Pharmacokinetics and Safety of Spesolimab, a Humanised Anti-interleukin-36 Receptor Monoclonal Antibody, in Healthy Non-Japanese and Japanese Subjects: Results from Phase I Clinical Studies. Clin Pharmacokinet 2022; 61:1771-1787. [PMID: 36451029 PMCID: PMC9734218 DOI: 10.1007/s40262-022-01176-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVE The interleukin-36 signalling pathway is associated with pathogenesis of a number of inflammatory diseases. Spesolimab is a selective, humanised, IgG1 antibody that targets the interleukin-36 receptor. We aimed to evaluate the pharmacokinetics, safety and tolerability of single and multiple doses of spesolimab in healthy non-Japanese and Japanese subjects. METHODS Five phase I clinical studies (three placebo-controlled dose-escalation, two open-label) were conducted in healthy volunteers; single or multiple doses of spesolimab were administered by intravenous infusion or subcutaneous injection. Plasma samples were collected to investigate the pharmacokinetics of spesolimab and evaluate changes with respect to dose, frequency of dosing, formulation and injection site. Immunogenicity, safety and tolerability were also assessed. RESULTS Intravenous spesolimab exhibited target-mediated drug disposition at low doses (0.01-0.3 mg/kg) and linear kinetics at doses ≥ 0.3 mg/kg. Steady state was not attained after the fourth weekly dose because of the long half-life (3-5 weeks). Bioavailability of subcutaneous spesolimab increased with increasing dose over the range of 150-600 mg and was higher when administered to the thigh than to the abdomen. The pharmacokinetic profile was consistent between Japanese and non-Japanese subjects. Positive anti-drug antibody responses occurred during the terminal phase of the spesolimab concentration-time profile in 26.7-33.3% and 16.7-37.5% of subjects receiving intravenous and subcutaneous spesolimab, respectively. The impact of anti-drug antibodies on spesolimab pharmacokinetics was low in healthy volunteers, with the impact on spesolimab plasma concentrations only observed in a few subjects at higher titres (≥ 11,400). No serious adverse events were reported; intravenous doses up to 1200 mg were well tolerated in healthy volunteers. CONCLUSIONS The pharmacokinetic profile and safety data obtained from these phase I clinical studies have been used to guide spesolimab dosing in clinical studies of patients with interleukin-36-mediated diseases. CLINICAL TRIAL REGISTRATION For Studies 1-5, NCT02525679, NCT02852824, NCT03100903, NCT03123094, NCT03617835.
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126
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Affiliation(s)
- Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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127
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Abstract
Generalized pustular psoriasis (GPP) is a severe rare skin disease characterized by widespread eruption of sterile superficial macroscopic pustules with or without systemic inflammation. Generalized pustular psoriasis flares may lead to life-threatening multiorgan complications, which highlights the need for rapid and accurate diagnosis. However, the rarity of the disease and its heterogeneous cutaneous and extracutaneous symptoms, and the resemblance of symptoms to other skin conditions, pose considerable challenges to the timely diagnosis and treatment of patients with GPP. Current laboratory tests used for GPP diagnosis are generally not GPP specific, and are mainly focused on the assessment of inflammatory markers and clinical and histopathologic features of GPP, and emerging genetic screening approaches. A differential diagnosis to distinguish GPP from other similar conditions requires careful assessment of the patient’s skin symptoms, potential disease triggers, medical history, histopathologic features, laboratory tests, and clinical disease course. The comprehensive interpretation of these assessments can be challenging owing to the lack of standardized global guidelines. While there is currently a lack of standardized international guidelines for the diagnosis of GPP, recent advances in our understanding of the genetics and pathogenesis of the disease have provided new opportunities to enhance diagnosis. In the future, defining specific GPP subtypes using genetic and histopathologic strategies will guide therapeutic decisions, allowing patients to achieve their treatment goals without delay. In this article, we provide an overview of the current diagnostic methods, differential diagnostic strategies, and future advances in the diagnosis of GPP, as well as features of GPP variants.
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Affiliation(s)
| | - Melinda Gooderham
- SKiN Centre for Dermatology and Queen's University, Peterborough, ON, Canada
| | - Ricardo Romiti
- Department of Dermatology, University of São Paulo, São Paulo, Brazil
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128
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Akiyama M. Autoinflammatory keratinization diseases: The concept, diseases involved, and pathogeneses. DERMATOL SIN 2022. [DOI: 10.4103/1027-8117.365590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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129
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Treatment Options and Goals for Patients with Generalized Pustular Psoriasis. Am J Clin Dermatol 2022; 23:51-64. [PMID: 35061230 PMCID: PMC8801408 DOI: 10.1007/s40257-021-00658-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2021] [Indexed: 12/17/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare, severe neutrophilic skin disorder characterized by sudden widespread eruption of superficial sterile pustules with or without systemic inflammation. GPP flares can be life-threatening if untreated due to potential severe complications such as cardiovascular failure and serious infections. Currently, there are no GPP-specific therapies approved in the USA or Europe. Retinoids, cyclosporine, and methotrexate are the most commonly used non-biologic therapies for GPP. The evidence that supports the currently available treatment options is mainly based on case reports and small, open-label, single-arm studies. However, recent advances in our understanding of the pathogenic mechanisms of GPP and the identification of gene mutations linked to the disease have paved the way for the development of specific targeted therapies that selectively suppress the autoinflammatory and autoimmune mechanisms induced during GPP flares. Several biologic agents that target key cytokines involved in the activation of inflammatory pathways, such as tumor necrosis factor-α blockers and interleukin (IL)-17, IL-23, and IL-12 inhibitors, have emerged as potential treatments for GPP, with several being approved in Japan. The evidence supporting the efficacy of these agents is mainly derived from small, uncontrolled trials. A notable recent advance is the discovery of IL36RN mutations and the central role of IL-36 receptor ligands in the pathogenesis of GPP, which has defined key therapeutic targets for the disease. Biologic agents that target the IL-36 pathway have demonstrated promising efficacy in patients with GPP, marking the beginning of a new era of targeted therapy for GPP.
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130
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Transient Induction of Fever in the Imiquimod C57BL/6 Mouse Model of Psoriasis-Like Disease Involves IL-1 and IL-6 but Not IL-36. J Invest Dermatol 2022; 142:247-251.e2. [PMID: 34280465 PMCID: PMC8688218 DOI: 10.1016/j.jid.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 01/03/2023]
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131
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Zheng M, Jullien D, Eyerich K. The Prevalence and Disease Characteristics of Generalized Pustular Psoriasis. Am J Clin Dermatol 2022; 23:5-12. [PMID: 35061224 PMCID: PMC8801400 DOI: 10.1007/s40257-021-00664-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 12/11/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare disease that has only recently benefited from a consistent definition and clinical coding standard. A lack of disease awareness combined with clinical similarities to other types of psoriasis have historically complicated the diagnosis of GPP. It is now clear that GPP requires a differential diagnosis from psoriasis vulgaris (plaque psoriasis), and better understanding of the genetic characteristics underlying GPP may improve the accuracy of diagnoses in the future. GPP can present at any age but is most common in the fifth decade of life. There appears to be a female preponderance in GPP, although there is notable variability in prevalence by geographical region and between ethnicities. GPP is potentially life-threatening, associated with several serious complications, and may require emergency treatment, particularly for complications arising from systemic inflammation. As with many rare diseases, there are inherent challenges to understanding the epidemiology of GPP. In addition to small patient numbers, estimating the prevalence of rare diseases is further complicated by studies that use non-standardized methodologies and that are conducted in different populations. These complications in data gathering have led to marked variability in GPP case estimates by geographical region and between ethnicities. There is ongoing research into disease characteristics, and insights into regional measures of prevalence are essential to increasing our understanding of GPP.
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Affiliation(s)
- Min Zheng
- Dermatology Department, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.
| | - Denis Jullien
- Department of Dermatology, Faculty of Medicine Lyon-Est, Hôpital Edouard Herriot, University of Lyon, Lyon, France
| | - Kilian Eyerich
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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132
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The Role of Interleukins in the Pathogenesis of Dermatological Immune-Mediated Diseases. Adv Ther 2022; 39:4474-4508. [PMID: 35997892 PMCID: PMC9395905 DOI: 10.1007/s12325-022-02241-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/22/2022] [Indexed: 01/30/2023]
Abstract
Autoimmune inflammatory diseases are primarily characterized by deregulated expression of cytokines, which drive pathogenesis of these diseases. A number of approved and experimental therapies utilize monoclonal antibodies against cytokine proteins. Cytokines can be classified into different families including the interleukins, which are secreted and act on leukocytes, the tumor necrosis factor (TNF) family, as well as chemokine proteins. In this review article, we focus on the interleukin family of cytokines, of which 39 members have been identified to this date. We outline the role of each of these interleukins in the immune system, and various dermatological inflammatory diseases with a focused discussion on the pathogenesis of psoriasis and atopic dermatitis. In addition, we describe the roles of various interleukins in psychiatric, cardiovascular, and gastrointestinal comorbidities. Finally, we review clinical efficacy and safety data from emerging late-phase anti-interleukin therapies under development for psoriasis and atopic dermatitis. Collectively, additional fundamental and clinical research remains necessary to fully elucidate the roles of various interleukin proteins in the pathogenesis of inflammatory dermatologic diseases, and treatment outcomes in patients.
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Reisner DV, Johnsson FD, Kotowsky N, Brunette S, Valdecantos W, Eyerich K. Impact of Generalized Pustular Psoriasis from the Perspective of People Living with the Condition: Results of an Online Survey. Am J Clin Dermatol 2022; 23:65-71. [PMID: 35061229 PMCID: PMC8777175 DOI: 10.1007/s40257-021-00663-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare disease characterized by episodic worsening (flares). Knowledge of the burden of GPP and the experience of affected individuals is limited. AIMS To conduct a survey of people living with GPP to understand how they experience GPP flares, which therapies they have received and are receiving, and how GPP impacts their activities of daily living. METHODS The online survey consisted of 43 questions answered by individuals recruited from an opt-in market research database. The research team performed a targeted outreach to identify individuals with GPP. The survey included screening questions to determine if potential participants qualified for inclusion. Eligible individuals were US residents aged ≥ 18 years who self-reported that they had been diagnosed with GPP. Respondents provided consent to participate and received compensation (fair market value) for their time. RESULTS Between August 4 and 14, 2020, 66 people living with GPP in the USA were surveyed. Most participants were female, aged 40-59 years, had been diagnosed ≥ 1 year previously, and had experienced ≥ 2 flares in the past year. A substantial proportion of respondents had symptoms for years, had consulted multiple healthcare professionals, and experienced misdiagnoses before receiving a diagnosis of GPP. Emotional stress was the most common cause of flares and many respondents reported a fear of flares. Respondents defined flares by the presence of itching, an increase in the size of the affected area, more crusts or pustules, and fatigue. A change in mood was the most burdensome symptom. Most respondents were receiving topical corticosteroids and only approximately one-third felt their condition was well controlled. GPP had an impact on activities of daily living even in the absence of flares and many respondents felt that their physician did not understand the level of emotional, psychological, or physical pain caused by GPP. CONCLUSIONS GPP imposes a substantial emotional burden on patients, with wide-ranging impacts on activities of daily living beyond the physical discomfort of skin lesions.
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Abstract
Generalized pustular psoriasis (GPP) is a rare, severe form of pustular psoriasis characterized by widespread, recurrent episodes of neutrophil-rich pustule formation in the epidermis, which can be accompanied by fever and systemic inflammation. Recent clinical, histologic, and genetic evidence indicates that GPP is a distinct entity from plaque psoriasis, with different cytokine pathways predominant in the manifestation of each disease. The interleukin-36 (IL-36) signaling cascade plays a key role in regulating the innate immune system, and its dysregulation appears central to the pathogenesis of GPP. The altered expression of various IL-36 pathway constituents has been shown to cause a positive feedback loop of uncontrolled signaling and excess production of inflammatory cytokines, which in turn leads to chemokine induction and neutrophil recruitment in the epidermis. Given the potentially life-threatening nature of GPP episodes, drug interventions that rapidly achieve disease resolution are required. Early phase data indicate that treatments targeting various components of the IL-36 inflammatory cascade represent promising areas of research. However, there are currently no therapeutic agents specifically approved for GPP in the USA or Europe. Understanding the inflammatory pathways, associated risk factors, and role of neutrophils in the manifestation and perpetuation of GPP flares remains a key goal in developing effective therapeutics. In this article, we summarize the current understanding of GPP, describe novel therapeutic opportunities, and detail how the unique pathophysiology of the disease may inform future treatment strategies.
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Affiliation(s)
| | - Lluis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Haskamp S, Frey B, Becker I, Schulz-Kuhnt A, Atreya I, Berking C, Pauli D, Ekici AB, Berges J, Mößner R, Wilsmann-Theis D, Sticherling M, Uebe S, Kirchner P, Hüffmeier U. Transcriptomes of MPO-deficient patients with generalized pustular psoriasis reveals expansion of CD4+ cytotoxic T cells and an involvement of the complement system. J Invest Dermatol 2021; 142:2149-2158.e10. [PMID: 34973310 DOI: 10.1016/j.jid.2021.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
Generalized pustular psoriasis (GPP) is a severe psoriatic subtype characterized by epidermal neutrophil infiltration. Although variants in IL36RN and MPO have been shown to affect immune cells, a systematic analysis of neutrophils and peripheral blood mononuclear cells (PBMCs) subsets and their differential gene expression dependent on MPO genotypes was not performed yet. We assessed transcriptomes of MPO-deficient patients using single cell RNA-sequencing (scRNAseq) of PBMCs and RNA-sequencing of neutrophils in stable disease state. Cell type annotation by multimodal reference mapping of scRNAseq data was verified by flow cytometry of surface and intracellular markers; proportions of CD4+ cytotoxic T-lymphocytes (CTLs) and other CD4+ effector cells were increased in GPP, while frequencies of naïve CD4+ T cells were significantly lower. The expression of FGFBP2 marking CD4+ CTLs and CD8+ effector memory T-cells (TEMs) was elevated in GPP patients with disease-contributing variants compared to non-carriers (p=0.0015). In neutrophils, differentially expressed genes (DEGs) were significantly enriched in genes of the classical complement activation pathway. Future studies assessing affected cell-types and pathways will show their contribution to GPP's pathogenesis, and indicate whether findings can be transferred to the acute epidermal situation and whether depletion or inactivation of CD4+ CTLs may be a reasonable therapeutic approach.
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Affiliation(s)
- Stefan Haskamp
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Translational Radiobiology, Universitätsklinikum Erlangen, Erlangen 91054, Germany
| | - Ina Becker
- Department of Radiation Oncology, Translational Radiobiology, Universitätsklinikum Erlangen, Erlangen 91054, Germany
| | - Anja Schulz-Kuhnt
- Department of Medicine 1, Kussmaul Campus for Medical Research & Translational Research Center, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Imke Atreya
- Department of Medicine 1, Kussmaul Campus for Medical Research & Translational Research Center, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - David Pauli
- Department of Dermatology, University Hospital Erlangen, Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arif B Ekici
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Berges
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rotraut Mößner
- Department of Dermatology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - Michael Sticherling
- Department of Dermatology, University Hospital Erlangen, Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Steffen Uebe
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Kirchner
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
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Bachelez H, Choon SE, Marrakchi S, Burden AD, Tsai TF, Morita A, Navarini AA, Zheng M, Xu J, Turki H, Anadkat MJ, Rajeswari S, Hua H, Vulcu SD, Hall D, Tetzlaff K, Thoma C, Lebwohl MG. Trial of Spesolimab for Generalized Pustular Psoriasis. N Engl J Med 2021; 385:2431-2440. [PMID: 34936739 DOI: 10.1056/nejmoa2111563] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Generalized pustular psoriasis (GPP) is a rare, life-threatening, inflammatory skin disease characterized by widespread eruption of sterile pustules. Interleukin-36 signaling is involved in the pathogenesis of this disorder. Spesolimab, a humanized anti-interleukin-36 receptor monoclonal antibody, is being studied for the treatment of GPP flares. METHODS In a phase 2 trial, we randomly assigned patients with a GPP flare in a 2:1 ratio to receive a single 900-mg intravenous dose of spesolimab or placebo. Patients in both groups could receive an open-label dose of spesolimab on day 8, an open-label dose of spesolimab as a rescue medication after day 8, or both and were followed to week 12. The primary end point was a Generalized Pustular Psoriasis Physician Global Assessment (GPPGA) pustulation subscore of 0 (range, 0 [no visible pustules] to 4 [severe pustulation]) at the end of week 1. The key secondary end point was a GPPGA total score of 0 or 1 (clear or almost clear skin) at the end of week 1; scores range from 0 to 4, with higher scores indicating greater disease severity. RESULTS A total of 53 patients were enrolled: 35 were assigned to receive spesolimab and 18 to receive placebo. At baseline, 46% of the patients in the spesolimab group and 39% of those in the placebo group had a GPPGA pustulation subscore of 3, and 37% and 33%, respectively, had a pustulation subscore of 4. At the end of week 1, a total of 19 of 35 patients (54%) in the spesolimab group had a pustulation subscore of 0, as compared with 1 of 18 patients (6%) in the placebo group (difference, 49 percentage points; 95% confidence interval [CI], 21 to 67; P<0.001). A total of 15 of 35 patients (43%) had a GPPGA total score of 0 or 1, as compared with 2 of 18 patients (11%) in the placebo group (difference, 32 percentage points; 95% CI, 2 to 53; P = 0.02). Drug reactions were reported in 2 patients who received spesolimab, in 1 of them concurrently with a drug-induced hepatic injury. Among patients assigned to the spesolimab group, infections occurred in 6 of 35 (17%) through the first week; among patients who received spesolimab at any time in the trial, infections had occurred in 24 of 51 (47%) at week 12. Antidrug antibodies were detected in 23 of 50 patients (46%) who received at least one dose of spesolimab. CONCLUSIONS In a phase 2 randomized trial involving patients with GPP, the interleukin-36 receptor inhibitor spesolimab resulted in a higher incidence of lesion clearance at 1 week than placebo but was associated with infections and systemic drug reactions. Longer and larger trials are warranted to determine the effect and risks of spesolimab in patients with pustular psoriasis. (Funded by Boehringer Ingelheim; Effisayil 1 ClinicalTrials.gov number, NCT03782792.).
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Affiliation(s)
- Hervé Bachelez
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Siew-Eng Choon
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Slaheddine Marrakchi
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - A David Burden
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Tsen-Fang Tsai
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Akimichi Morita
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Alexander A Navarini
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Min Zheng
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Jinhua Xu
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Hamida Turki
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Milan J Anadkat
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Sushmita Rajeswari
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Hairui Hua
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Sebastian D Vulcu
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - David Hall
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Kay Tetzlaff
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Christian Thoma
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
| | - Mark G Lebwohl
- From Service de Dermatologie, Assistance Publique-Hôpitaux de Paris Hôpital Saint-Louis, and INSERM Unité 1163, Imagine Institute of Genetic Diseases, Université de Paris - both in Paris (H.B.); the Department of Dermatology, Hospital Sultanah Aminah Johor Bahru, Clinical School Johor Bahru, Monash University Malaysia, Subang Jaya, Malaysia (S.-E.C.); the Dermatology Department, Hedi Chaker University Hospital, Sfax, Tunisia (S.M., H.T.); the Institute of Infection, Immunity, and Inflammation, University of Glasgow, Glasgow, United Kingdom (A.D.B.); the Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (T.-F.T.); the Department of Geriatric and Environmental Dermatology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan (A.M.); the Department of Dermatology, University Hospital Basel, Basel, Switzerland (A.A.N.); the Department of Dermatology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou (M.Z.), and the Department of Dermatology, Huashan Hospital, Fudan University (J.X.), and Boehringer Ingelheim (China) Investment Company (H.H.), Shanghai - all in China; Washington University School of Medicine, Division of Dermatology, St. Louis (M.J.A.); Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT (S.R., D.H.); Boehringer Ingelheim International, Ingelheim (S.D.V., K.T.), the Medical Clinic, Department of Sports Medicine, University of Tuebingen, Tuebingen (K.T.), and Boehringer Ingelheim International, Biberach (C.T.) - all in Germany; and the Icahn School of Medicine at Mount Sinai, New York (M.G.L.)
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137
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Neutrophil Extracellular Traps in Skin Diseases. Biomedicines 2021; 9:biomedicines9121888. [PMID: 34944704 PMCID: PMC8698493 DOI: 10.3390/biomedicines9121888] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/22/2022] Open
Abstract
Neutrophils are the primary innate immune cells, and serve as sentinels for invading pathogens. To this end, neutrophils exert their effector functions via phagocytosis, degranulation, reactive oxygen species generation, and neutrophil extracellular trap (NET) release. Pathogens and pathogen-derived components trigger NET formation, leading to the clearance of pathogens. However, NET formation is also induced by non-related pathogen proteins, such as cytokines and immune complexes. In this regard, NET formation can be induced under both non-sterile and sterile conditions. NETs are enriched by components with potent cytotoxic and inflammatory properties, thereby occasionally damaging tissues and cells and dysregulating immune homeostasis. Research has uncovered the involvement of NETs in the pathogenesis of several connective tissue diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and ANCA-associated vasculitis. In dermatology, several skin diseases clinically develop local or systemic sterile pustules and abscesses. The involvement of neutrophils and subsequent NET formation has recently been elucidated in these skin diseases. Therefore, this review highlights the NETs in these neutrophil-associated diseases.
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138
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Staels F, Collignon T, Betrains A, Gerbaux M, Willemsen M, Humblet-Baron S, Liston A, Vanderschueren S, Schrijvers R. Monogenic Adult-Onset Inborn Errors of Immunity. Front Immunol 2021; 12:753978. [PMID: 34867986 PMCID: PMC8635491 DOI: 10.3389/fimmu.2021.753978] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/22/2021] [Indexed: 12/28/2022] Open
Abstract
Inborn errors of immunity (IEI) are a heterogenous group of disorders driven by genetic defects that functionally impact the development and/or function of the innate and/or adaptive immune system. The majority of these disorders are thought to have polygenic background. However, the use of next-generation sequencing in patients with IEI has led to an increasing identification of monogenic causes, unravelling the exact pathophysiology of the disease and allowing the development of more targeted treatments. Monogenic IEI are not only seen in a pediatric population but also in adulthood, either due to the lack of awareness preventing childhood diagnosis or due to a delayed onset where (epi)genetic or environmental factors can play a role. In this review, we discuss the mechanisms accounting for adult-onset presentations and provide an overview of monogenic causes associated with adult-onset IEI.
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Affiliation(s)
- Frederik Staels
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | | | - Albrecht Betrains
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disease, KU Leuven, Leuven, Belgium
| | - Margaux Gerbaux
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium.,Vlaams Instituut voor Biotechnologie - Katholieke Universiteit (VIB-KU) Leuven Center for Brain and Disease Research, Leuven, Belgium
| | - Mathijs Willemsen
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium.,Vlaams Instituut voor Biotechnologie - Katholieke Universiteit (VIB-KU) Leuven Center for Brain and Disease Research, Leuven, Belgium
| | - Stephanie Humblet-Baron
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium
| | - Adrian Liston
- Department of Microbiology, Immunology and Transplantation, Laboratory of Adaptive Immunology, KU Leuven, Leuven, Belgium.,Laboratory of Lymphocyte Signalling and Development, Babraham Institute, Cambridge, United Kingdom
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Infectious and Inflammatory Disease, KU Leuven, Leuven, Belgium
| | - Rik Schrijvers
- Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium.,Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
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139
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Savic S, Coe J, Laws P. Autoinflammation: Interferonopathies and Other Autoinflammatory Diseases. J Invest Dermatol 2021; 142:781-792. [PMID: 34887082 DOI: 10.1016/j.jid.2021.07.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/19/2022]
Abstract
The family of autoinflammatory diseases (AIDs) continues to expand and now includes over 40 genetically defined disorders. Their defining feature is a dysregulated inflammatory innate immune response. Many AIDs have overlapping clinical characteristics, and dermatological manifestations are common. Autoinflammatory features have also been recognized in more common dermatological conditions such as psoriasis. Furthermore, there is an increasing understanding that immunodeficiencies, autoimmune disorders, and even some allergic disorders share overlapping autoinflammatory features. The discovery that certain somatic mutations, arising within the bone marrow and restricted to the myeloid cell lineage can cause acquired AID heralds a new era of discoveries in this field.
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Affiliation(s)
- Sinisa Savic
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, School of Medicine, University of Leeds, Leeds, United Kingdom; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), School of Medicine, University of Leeds, Leeds, United Kingdom; Department of Allergy and Clinical Immunology, The Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom.
| | - James Coe
- Leeds Centre for Dermatology, Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom
| | - Philip Laws
- Leeds Centre for Dermatology, Leeds Teaching Hospitals, National Health Service (NHS) Trust, Leeds, United Kingdom
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140
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Akiyama M. Pustular psoriasis as an autoinflammatory keratinization disease (AiKD): Genetic predisposing factors and promising therapeutic targets. J Dermatol Sci 2021; 105:11-17. [PMID: 34973880 DOI: 10.1016/j.jdermsci.2021.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 02/08/2023]
Abstract
Pustular psoriasis is a chronic inflammatory skin disease characterized by erythematous plaques with sterile pustules. It includes the distinct clinical entities generalized pustular psoriasis (GPP), acrodermatitis continua of Hallopeau (ACH) and palmoplantar pustular psoriasis (PPPP). Recently clarified pathomechanisms of pustular psoriasis indicate that hyperactivation of the skin innate immunity, including of the IL-1/IL-36 axis, plays an important role in the pathogenesis of pustular psoriasis. Autoinflammatory keratinization disease (AiKD) is the umbrella clinical entity for inflammatory keratinization disorders with genetic autoinflammatory pathomechanisms, and pustular psoriasis is a representative AiKD. To date, mutations/variants in five genes-IL36RN, CARD14, AP1S3, MPO and SERPINA3-have been reported to be genetic causative or predisposing factors for pustular psoriasis. The pathogenic mechanisms induced by the mutations/variants in these genes are all closely related to the excessive activation of skin innate immunity and autoinflammation. A number of biologics (e.g., tumor necrosis factor inhibitors, IL-17/IL-17 receptor inhibitors and IL-23 inhibitors) and granulocyte and monocyte adsorption apheresis are used to treat pustular psoriasis. Recently, based on novel information on the pathomechanisms of pustular psoriasis, which are mainly associated with autoinflammation, inhibitors of several pathogenic pathways, including of the IL-1, IL-36, IL-8 and granulocyte colony-stimulating factor signaling pathways, have been studied as emerging treatments.
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Affiliation(s)
- Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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141
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Romiti R, Hirayama ALDS, Arnone M, Magalhães RF. Generalized pustular psoriasis (von Zumbusch). An Bras Dermatol 2021; 97:63-74. [PMID: 34838431 PMCID: PMC8799844 DOI: 10.1016/j.abd.2021.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/03/2021] [Accepted: 05/04/2021] [Indexed: 11/19/2022] Open
Abstract
Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - André Luís da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Marcelo Arnone
- Department of Dermatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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142
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Genovese G, Moltrasio C, Cassano N, Maronese CA, Vena GA, Marzano AV. Pustular Psoriasis: From Pathophysiology to Treatment. Biomedicines 2021; 9:biomedicines9121746. [PMID: 34944562 PMCID: PMC8698272 DOI: 10.3390/biomedicines9121746] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Pustular psoriasis (PP) is a clinicopathological entity encompassing different variants, i.e., acute generalized PP (GPP), PP of pregnancy (impetigo herpetiformis), annular (and circinate) PP, infantile/juvenile PP, palmoplantar PP/palmoplantar pustulosis, and acrodermatitis continua of Hallopeau (ACH), which have in common an eruption of superficial sterile pustules on an erythematous base. Unlike psoriasis vulgaris, in which a key role is played by the adaptive immune system and interleukin (IL)-17/IL-23 axis, PP seems to be characterized by an intense inflammatory response resulting from innate immunity hyperactivation, with prominent involvement of the IL-36 axis. Some nosological aspects of PP are still controversial and debated. Moreover, owing to the rarity and heterogeneity of PP forms, data on prognosis and therapeutic management are limited. Recent progresses in the identification of genetic mutations and immunological mechanisms have promoted a better understanding of PP pathogenesis and might have important consequences on diagnostic refinement and treatment. In this narrative review, current findings in the pathogenesis, classification, clinical features, and therapeutic management of PP are briefly discussed.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, 76121 Barletta, Italy; (N.C.); (G.A.V.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.G.); (C.M.); (C.A.M.)
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, 20122 Milan, Italy
- Correspondence:
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143
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Ünsal P, Çerçi P, Açıkgöz ŞA, Keskin G, Ölmez Ü. Serum Levels of Interleukin-36 Alpha and Interleukin-36 Receptor
Antagonist In Behcet’s Syndrome. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1550-2069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background Behcet’s syndrome (BS) is a systemic vasculitic
disorder. This study aimed to investigate the levels of serum IL-36α and
IL-36Ra in patients with BS.
Material and Methods A total of 80 subjects (60 BS patients and 20 healthy
controls [HC]) were included.
Results The median IL-36α level was 0.11 ng/ml in
the BS group and 0.09 ng/ml in the HC group (p=0.058).
The mean IL-36Ra level was 13.62 pg/ml in the BS group and
13.26 pg/ml in the HC group (p=0.348). Serum IL-36Ra
levels of the active group were significantly higher (p=0.037). Patients
with oral ulcers and central nervous system involvement had higher serum IL36Ra
levels. In the BS group, a positive correlation was found between serum IL-36Ra
and CRP. In a multivariate analysis, the IL-36Ra level (OR=1.067;
95% CI=1.001–1.137; p=0.045) was independently
associated with disease activity.
Conclusion According to these findings, it is not clear whether such a
slight difference is clinically significant, but they suggest that the IL-36
cytokine family may play a role in the course of the disease.
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Affiliation(s)
- Pelin Ünsal
- Department of Internal Medicine, Ankara University Faculty of Medicine,
Ankara, Turkey
| | - Pamir Çerçi
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Şükrü Alper Açıkgöz
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Göksal Keskin
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ümit Ölmez
- Department of Internal Medicine, Division of Immunology and Allergy,
Ankara University Faculty of Medicine, Ankara, Turkey
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144
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Tanaka Y, Iwata Y, Saito K, Fukushima H, Watanabe S, Hasegawa Y, Akiyama M, Sugiura K. Cutaneous ischemia-reperfusion injury is exacerbated by IL-36 receptor antagonist deficiency. J Eur Acad Dermatol Venereol 2021; 36:295-304. [PMID: 34699104 DOI: 10.1111/jdv.17767] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Loss-of-function homozygous or compound heterozygous mutations in IL36RN, which encodes interleukin-36 receptor antagonist (IL-36Ra), has been implicated in the pathogenesis of skin disorders. However, the pathogenic role of IL-36Ra in cutaneous ischemia-reperfusion (I/R) injury remains unclear. OBJECTIVES We investigated the role of IL36Ra in cutaneous I/R injury. METHODS We examined I/R injury in Il36rn-/- mice. The area of wounds, numbers of infiltrated cells, apoptotic cells and neutrophil extracellular trap (NET) formation were assessed. The expression levels of various genes were analysed using real-time RT-PCR. The expression of high mobility group box 1 (HMGB1), an endogenous toll-like receptor (TLR) 4 ligand, was confirmed using immunohistology, and serum HMGB1 levels were measured by ELISA. Cytokine production by stimulated cultured J774A.1 and HaCaT cells was examined. RESULTS IL-36Ra deficiency resulted in significantly delayed wound healing and increased neutrophil and macrophage infiltration into the wound tissues. Il36rn-/- mice had increased mRNA expression levels of CXCL1, CXCL2, CCL4, TNF-α, TGF-β, IL-1β, IL-6 and IL-36γ relative to wild-type mice. Apoptosis was identified in keratinocytes by TUNEL assay. HMGB1 expression in the I/R site was decreased in both keratinocytes and adnexal cells, while serum HMGB1 levels were significantly elevated after reperfusion. The mRNA levels of various cytokines, including IL-1β, were elevated in J774A.1 cells through TLR4 signalling by HMGB1 stimulation. In addition, HaCaT cells stimulated with IL-1β showed significantly increased CXCL1, TNF-α, IL-6, IL-36β and IL-36γ mRNA expression. Furthermore, NET formation was increased by IL-36Ra deficiency. Finally, either the blockade of TLR4 signalling by TAK-242 or inhibition of NET formation by Cl-amidine normalized exacerbated I/R injury in Il36rn-/- mice. CONCLUSIONS This study indicated that IL-36Ra deficiency exacerbates cutaneous I/R injury due to excessive inflammatory cell recruitment, NET formation, and excessive cytokine and chemokine production via the TLR4 pathway by HMGB1 released from epidermal apoptotic cells.
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Affiliation(s)
- Y Tanaka
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Y Iwata
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - K Saito
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - H Fukushima
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - S Watanabe
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Y Hasegawa
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
| | - M Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - K Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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145
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Pustular psoriasis: Molecular pathways and effects of spesolimab in generalized pustular psoriasis. J Allergy Clin Immunol 2021; 149:1402-1412. [PMID: 34678325 DOI: 10.1016/j.jaci.2021.09.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/17/2021] [Accepted: 09/07/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The IL-36 pathway plays a key role in the pathogenesis of generalized pustular psoriasis (GPP). In a proof-of-concept clinical trial, treatment with spesolimab, an anti-IL-36 receptor antibody, resulted in rapid skin and pustular clearance in patients presenting with GPP flares. OBJECTIVE We sought to compare the molecular profiles of lesional and nonlesional skin from patients with GPP or palmoplantar pustulosis (PPP) with skin from healthy volunteers, and to investigate the molecular changes after spesolimab treatment in the skin and blood of patients with GPP flares. METHODS Pre- and post-treatment skin and blood samples were collected from patients with GPP who participated in a single-arm, phase I study (n = 7). Skin biopsies from patients with PPP (n = 8) and healthy volunteers (n = 16) were obtained for comparison at baseline. Biomarkers were assessed by RNA-sequencing, histopathology, and immunohistochemistry. RESULTS In GPP and PPP lesions, 1287 transcripts were commonly upregulated or downregulated. Selected transcripts from the IL-36 signaling pathway were upregulated in untreated GPP and PPP lesions. In patients with GPP, IL-36 pathway-related signatures, TH1/TH17 and innate inflammation signaling, neutrophilic mediators, and keratinocyte-driven inflammation pathways were downregulated by spesolimab as early as week 1. Spesolimab also decreased related serum biomarkers and cell populations in the skin lesions from patients with GPP, including CD3+ T, CD11c+, and IL-36γ+ cells and lipocalin-2-expressing cells. CONCLUSIONS In patients with GPP, spesolimab showed rapid modulation of commonly dysregulated molecular pathways in GPP and PPP, which may be associated with improved clinical outcomes.
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146
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Horneff G, Schütz C, Rösen-Wolff A. [Autoinflammation-A clinical and genetic challenge]. Z Rheumatol 2021; 80:953-965. [PMID: 34636972 DOI: 10.1007/s00393-021-01076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
In the last two decades clinical rheumatological practice has been confronted with a steadily increasing number of autoinflammatory diseases, the immunological pathomechanisms of which have been elucidated and in part can be clinically well classified. Whereas targeted genetic diagnostics previously served to confirm a clinically suspected diagnosis, genetic sequencing technology has much improved and enables a new diagnostic approach via high-throughput sequencing, e.g., panel sequencing, whole exome and whole genome sequencing. Thus, the decision to make a diagnosis clinically and/or genetically, has become a daily challenge. This article contrasts the clinical, immunological and genetic aspects of autoinflammatory diseases.
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Affiliation(s)
- Gerd Horneff
- Zentrum für Allgemeine Pädiatrie und Neonatologie, Asklepios Klinik Sankt Augustin, Arnold Janssen Str. 29, 53757, Sankt Augustin, Deutschland. .,Zentrum für Kinder- und Jugendmedizin, Universität Köln, Köln, Deutschland.
| | - Catharina Schütz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Angela Rösen-Wolff
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
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147
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Menter A, Van Voorhees AS, Hsu S. Pustular Psoriasis: A Narrative Review of Recent Developments in Pathophysiology and Therapeutic Options. Dermatol Ther (Heidelb) 2021; 11:1917-1929. [PMID: 34626330 PMCID: PMC8611132 DOI: 10.1007/s13555-021-00612-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Pustular psoriasis is an unusual form of psoriasis that frequently presents clinical challenges for dermatologists. The condition presents with pustules on an erythematous background and has two distinct subtypes: localized disease on the palms and soles, called palmoplantar pustulosis (PPP), and generalized pustular psoriasis (GPP). The involvement of the fingers, toes, and nails is defined as a separate localized variant, acrodermatitis continua of Hallopeau, and is now thought to be a subset of PPP. The rarity of pustular psoriasis frequently makes the correct diagnosis problematic. In addition, treatment is limited by a relative lack of evidence-based therapeutic options. Current management is often based on existing therapies for standard plaque psoriasis. However, there remains a need for treatments with high, sustained efficacy and a rapid onset of action in pustular psoriasis. Recent advances in understanding of the pathogenesis of pustular psoriasis have provided insights into potential therapies. Treatment of pustular psoriasis is generally determined by the extent and severity of disease, and recent years have seen an increasing use of newer agents, including biologic therapies. Current classes of biologic therapies with US Food and Drug Administration and European Medicines Agency approval for treatment of moderate-to-severe plaque psoriasis in the USA (and elsewhere) include tumor necrosis factor alpha inhibitors (adalimumab, certolizumab pegol, etanercept, infliximab), interleukin (IL)-17 inhibitors (brodalumab, ixekizumab, secukinumab), an IL-12/23 inhibitor (ustekinumab), and IL-23 inhibitors (guselkumab, risankizumab, tildrakizumab). Recently, specific inhibitors of the IL-36 pathway have been evaluated in GPP and PPP, including spesolimab, an IL-36 receptor inhibitor which has shown promising results in GPP. The emerging drugs for pustular psoriasis offer the possibility of rapid and effective treatment with lower toxicities than existing therapies. Further research into agents acting on the IL-36 pathway and other targeted therapies has the potential to transform the future treatment of patients with pustular psoriasis. This article reviews the clinical features of PPP and GPP, and current understanding of the genetics and immunopathology of these conditions; it also provides an update on emerging treatments. Pustular psoriasis is a skin condition where people develop small pus-filled blisters on their skin. Pustular psoriasis may affect certain areas of the body, such as the palms and/or the soles. This is called palmoplantar pustulosis (PPP for short). Another type of pustular psoriasis can affect most of the body called generalized pustular psoriasis (GPP for short). Not many people have PPP or GPP. Around 5–12 in every 10,000 people worldwide develop PPP. GPP is even rarer, affecting only 2–7 out of every 1 million people. In addition to being relatively uncommon, these conditions are challenging to treat. This article aims to help doctors who treat skin conditions (dermatologists) to identify and treat people with pustular psoriasis. Currently there is no standard treatment for GPP and PPP in the USA or Europe, but several medicines are approved for treatment of GPP in Japan. Doctors often use treatments that have been shown to work in plaque psoriasis, which is the most common type of psoriasis, to treat people with GPP and PPP. Traditional treatments for PPP and GPP are often not effective. Researchers are working on developing new effective treatments for pustular psoriasis that may work more rapidly and have fewer side effects. These are expected to be available in the next few years.
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Affiliation(s)
- Alan Menter
- Department of Dermatology, Baylor Scott & White University, 3900 Junius Street, Suite 145, Dallas, TX 75246 USA
| | | | - Sylvia Hsu
- Department of Dermatology, Temple University School of Medicine, Philadelphia, PA USA
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148
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Wang P, Yang W, Guo H, Dong H, Guo Y, Gan H, Wang Z, Cheng Y, Deng Y, Xie S, Yang X, Lin D, Zhong B. IL-36γ and IL-36Ra Reciprocally Regulate NSCLC Progression by Modulating GSH Homeostasis and Oxidative Stress-Induced Cell Death. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2101501. [PMID: 34369094 PMCID: PMC8498882 DOI: 10.1002/advs.202101501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/31/2021] [Indexed: 05/05/2023]
Abstract
The balance between antioxidants and reactive oxygen species (ROS) critically regulates tumor initiation and progression. However, whether and how the tumor-favoring redox status is controlled by cytokine networks remain poorly defined. Here, it is shown that IL-36γ and IL-36Ra reciprocally regulate the progression of non-small cell lung cancer (NSCLC) by modulating glutathione metabolism and ROS resolution. Knockout, inhibition, or neutralization of IL-36γ significantly inhibits NSCLC progression and prolongs survival of the KrasLSL-G12D/+ Tp53fl/fl and KrasLSL-G12D/+ Lkb1fl/fl mice after tumor induction, whereas knockout of IL-36Ra exacerbates tumorigenesis in these NSCLC mouse models and accelerates death of mice. Mechanistically, IL-36γ directly upregulates an array of genes involved in glutathione homeostasis to reduce ROS and prevent oxidative stress-induced cell death, which is mitigated by IL-36Ra or IL-36γ neutralizing antibody. Consistently, IL-36γ staining is positively and negatively correlated with glutathione biosynthesis and ROS in human NSCLC tumor biopsies, respectively. These findings highlight essential roles of cytokine networks in redox for tumorigenesis and provide potential therapeutic strategy for NSCLC.
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Affiliation(s)
- Peng Wang
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Wuhan Research Center for Infectious Diseases and CancerChinese Academy of Medical SciencesWuhan430071China
| | - Wei Yang
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
| | - Hao Guo
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
| | - Hong‐Peng Dong
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
| | - Yu‐Yao Guo
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
| | - Hu Gan
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
| | - Zou Wang
- Wuhan Biobank Co., Ltd, WuhanWuhan430075China
| | | | - Yu Deng
- Department of Thoracic SurgeryTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China
| | - Shizhe Xie
- CAS Key Laboratory of Special PathogensWuhan Institute of VirologyCenter for Biosafety Mega‐ScienceChinese Academy of SciencesWuhan430071China
- University of Chinese Academy of SciencesBeijing100049China
| | - Xinglou Yang
- CAS Key Laboratory of Special PathogensWuhan Institute of VirologyCenter for Biosafety Mega‐ScienceChinese Academy of SciencesWuhan430071China
- University of Chinese Academy of SciencesBeijing100049China
| | - Dandan Lin
- Cancer CenterRenmin Hospital of Wuhan UniversityWuhan430060China
| | - Bo Zhong
- Department of Gastrointestinal SurgeryCollege of Life SciencesZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of Pulmonary and Critical Care MedicineZhongnan Hospital of Wuhan UniversityWuhan430071China
- Department of ImmunologyMedical Research Institute and Frontier Science Center for Immunology and MetabolismWuhan UniversityWuhan430071China
- Wuhan Research Center for Infectious Diseases and CancerChinese Academy of Medical SciencesWuhan430071China
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Abstract
The innate immunity works as a defence bullwark that safeguards healthy tissues with the power of detecting infectious agents in the human body: errors in the context of innate immunity identify autoinflammatory disorders (AIDs), which arise as bouts of aberrant inflammation with little or no involvement of T and B cells and neither recognized infections, nor associated autoimmune phenomena. Hereditary AIDs tend to have a pediatric-onset heralded by stereotyped inflammatory symptoms and fever, while AIDs without an ascertained cause, such as systemic juvenile idiopathic arthritis, derive from the interaction of genetic factors with environmental noxae and are unevenly defined. A dysregulated inflammasome activation promotes the best-known family of AIDs, as well as several degenerative and metabolic disorders, but also nuclear factor κB- and interferon-mediated conditions have been framed as AIDs: the zenith of inflammatory flares marks different phenotypes, but diagnosis may go unnoticed until adulthood due to downplayed symptoms and complex kaleidoscopic presentations. This review summarizes the main AIDs encountered in childhood with special emphasis on the clinical stigmata that may help establish a correct framework and blueprints to empower young scientists in the recognition of AIDs. The description focuses inflammasomopathies as paradigms of interleukinopathies, nuclear factor-κB -related disorders and interferonopathies. The challenges in the management of AIDs during childhood have been recently boosted by numerous therapeutic options derived from genomically-based approaches, which have led to identify targeted biologic agents as rationalized treatments and achieve more tangible perspectives of disease control.
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Affiliation(s)
- Raffaele Manna
- Department of Internal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Rare Diseases and Periodic Fevers Research Centre, Università Cattolica Sacro Cuore, Largo A. Gemelli no. 8, 00168, Rome, Italy.
- Rare Diseases and Periodic Fevers Research Centre, Università Cattolica Sacro Cuore, Rome, Italy.
| | - Donato Rigante
- Rare Diseases and Periodic Fevers Research Centre, Università Cattolica Sacro Cuore, Rome, Italy
- Department of Life Sciences and Public Health, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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150
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Yamanishi K, Imai Y. Alarmins/stressorins and immune dysregulation in intractable skin disorders. Allergol Int 2021; 70:421-429. [PMID: 34127380 DOI: 10.1016/j.alit.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/21/2021] [Indexed: 12/18/2022] Open
Abstract
Unlike other barrier epithelia of internal organs, the stratified squamous epithelium of the skin is always exposed to the external environment. However, the robust barrier structure and function of the skin are highly resistant against external insults so as to not easily allow foreign invasions. Upon sensing danger signals, the innate immunity system is promptly activated. This process is mediated by alarmins, which are released passively from damaged cells. Nuclear alarmins or stressorins are actively released from intact cells in response to various cellular stresses. Alarmins/stressorins are deeply involved in the disease processes of chronic skin disorders of an unknown cause, such as rosacea, psoriasis, and atopic dermatitis. Furthermore, alarmins/stressorins are also induced in the congenital skin disorders of ichthyosis and keratoderma due to defective keratinization. Studies on alarmin activation and its downstream pathways may help develop novel therapeutic agents for intractable skin disorders.
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