1
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Alter M. [Hidradenitis suppurativa]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:497-506. [PMID: 38512397 DOI: 10.1007/s00105-024-05321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin and systemic disease that is associated with considerable discomfort and a significant reduction in the quality of life. Despite a significantly increased understanding of the disease, the diagnosis is still delayed for many years. Delayed patient access to suitable treatment often leads to disease progression with increased surgical interventions and the occurrence of possible comorbidities. In recent years, there has been an improved understanding of the pathophysiology and, as a result the authorization of modern therapeutic agents for HS. The treatment of HS is based on three treatment pillars: surgery, antibiotics and biologics. Additionally, risk factors, such as smoking and obesity should be positively influenced. Knowledge of comorbidities and their interdisciplinary treatment is important for the individualized care of patients.
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Affiliation(s)
- M Alter
- Klinik für Dermatologie, Johannes-Wesling-Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, 32429, Minden, Deutschland.
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Nilforoushzadeh MA, Heidari N, Heidari A, Ghane Y, Hosseini S, Lotfi Z, Jaffary F, Nobari MN, Aghamiri ZS, Nobari NN. Efficacy and safety of radiofrequency in the treatment of hidradenitis suppurativa; a systematic review. Lasers Med Sci 2024; 39:139. [PMID: 38795173 DOI: 10.1007/s10103-024-04077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/06/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND AIMS Hidradenitis suppurativa (HS) is an inflammatory skin disease affecting apocrine gland-bearing sites of the body. Radiofrequency (RF) is a minimally invasive method that acts by minimizing thermal damage to the dermis, resulting in collagen synthesis and scar improvement. We systematically reviewed the efficacy and safety of RF in treating HS. METHODS A systematic search was performed up to November 18th, 2023, in PubMed/Medline, Ovid Embase, and Web of Science. Clinical studies with English full texts were included. The National Institute of Health (NIH) Quality Assessment Tool for clinical trials and Methodological quality and synthesis of case series and case reports by Murad et al. were utilized for critical appraisal. RESULTS Out of 55 identified studies, 11 met our inclusion criteria with 167 subjects who underwent RF therapy alone or combined with an intense pulsed laser (IPL), known as LAight®. LAight® significantly improved clinical outcomes in mild-to-moderate HS patients based on the Dermatology Life Quality Index (DLQI), International Hidradenitis Suppurativa Score System (IHS4), Pain-Numerical Rating Scale (NRS), and Hidradenitis Suppurativa Clinical Response (HiSCR). Moreover, RF therapy alone significantly alleviated the clinical manifestations in patients with mild-to-moderate HS. Additionally, fractional microneedling RF significantly decreased HS-associated inflammatory markers. RF was found to be safe with limited adverse events. However, in moderate-to-severe HS, RF has failed to yield satisfactory results. CONCLUSION RF is a safe energy-based method with promising outcomes, especially for long-term application in mild-to-moderate HS. In moderate-to-severe cases, RF should be combined with a systemic medication for further beneficial impacts.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Yekta Ghane
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedayin Hosseini
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Lotfi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
| | - Fariba Jaffary
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Minou Najar Nobari
- Department of Orofacial Pain and Dysfunction, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Zahra Sadat Aghamiri
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Najar Nobari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Lee MJ, Hammouda MB, Miao W, Okafor A, Jin Y, Sun H, Jain V, Markovtsov V, Diao Y, Gregory SG, Zhang JY. UBE2N is essential for maintenance of skin homeostasis and suppression of inflammation. J Invest Dermatol 2024:S0022-202X(24)00376-2. [PMID: 38796140 DOI: 10.1016/j.jid.2024.04.017] [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: 01/05/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 05/28/2024]
Abstract
UBE2N, a Lys63-ubiquitin conjugating enzyme, plays critical roles in embryogenesis and immune system development and function. However, its roles in adult epithelial tissue homeostasis and pathogenesis are unclear. We generated conditional mouse models that deleted Ube2n in skin cells in a temporally and spatially controlled manner. We found that Ube2n-knockout (KO) in the adult skin keratinocytes induced a range of inflammatory skin defects characteristic of psoriatic and actinic keratosis. These included inflammation, epidermal and dermal thickening, parakeratosis, and increased immune cell infiltration, as well as signs of edema and blistering. Single cell transcriptomic analyses and RT-qPCR showed that Ube2n KO keratinocytes expressed elevated myeloid cell chemo-attractants such as Cxcl1 and Cxcl2 and decreased the homeostatic T lymphocyte chemo-attractant Ccl27a. Consistently, the infiltrating immune cells were predominantly myeloid-derived cells including neutrophils and M1-like macrophages that expressed high levels of inflammatory cytokines such as Il1β and Il24. Pharmacological blockade of the IL-1 receptor associated kinases (IRAK1/4) alleviated inflammation, epidermal and dermal thickening, and immune infiltration of the Ube2n mutant skin. Together, these findings highlight a key role of keratinocyte-UBE2N in maintenance of epidermal homeostasis and skin immunity, and identify IRAK1/4 as potential therapeutic target for inflammatory skin disorders.
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Affiliation(s)
- Min Jin Lee
- Department of Dermatology, Duke University, Durham, NC, USA; Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, USA
| | | | - Wanying Miao
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Arinze Okafor
- Department of Cell Biology, Duke University, Durham, NC, USA
| | - Yingai Jin
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Huiying Sun
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Vaibhav Jain
- Duke Molecular Physiology Institute, Durham, NC, USA
| | | | - Yarui Diao
- Department of Cell Biology, Duke University, Durham, NC, USA
| | | | - Jennifer Y Zhang
- Department of Dermatology, Duke University, Durham, NC, USA; Department of Pathology, Duke University, Durham, NC, USA.
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4
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Williams SC, Garcet S, Hur H, Miura S, Gonzalez J, Navrazhina K, Yamamura-Murai M, Yamamura K, Li X, Frew J, Fischetti VA, Sela U, Krueger JG. Gram-negative anaerobes elicit a robust keratinocytes immune response with potential insights into HS pathogenesis. Exp Dermatol 2024; 33:e15087. [PMID: 38685821 DOI: 10.1111/exd.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/02/2024]
Abstract
Hidradenitis Suppurativa (HS) is a chronic autoinflammatory skin disease with activated keratinocytes, tunnel formation and a complex immune infiltrate in tissue. The HS microbiome is polymicrobial with an abundance of commensal gram-positive facultative (GPs) Staphylococcus species and gram-negative anaerobic (GNA) bacteria like Prevotella, Fusobacterium and Porphyromonas with increasing predominance of GNAs with disease severity. We sought to define the keratinocyte response to bacteria commonly isolated from HS lesions to probe pathogenic relationships between HS and the microbiome. Type strains of Prevotella nigrescens, Prevotella melaninogenica, Prevotella intermedia, Prevotella asaccharolytica, Fusobacterium nucleatum, as well as Staphylococcus aureus and the normal skin commensal Staphylococcus epidermidis were heat-killed and co-incubated with normal human keratinocytes. RNA was collected and analysed using RNAseq and RT-qPCR. The supernatant was collected from cell culture for protein quantification. Transcriptomic profiles between HS clinical samples and stimulated keratinocytes were compared. Co-staining of patient HS frozen sections was used to localize bacteria in lesions. A mouse intradermal injection model was used to investigate early immune recruitment. TLR4 and JAK inhibitors were used to investigate mechanistic avenues of bacterial response inhibition. GNAs, especially F. nucleatum, stimulated vastly higher CXCL8, IL17C, CCL20, IL6, TNF and IL36γ transcription in normal skin keratinocytes than the GPs S. epidermidis and S. aureus. Using RNAseq, we found that F. nucleatum (and Prevotella) strongly induced the IL-17 pathway in keratinocytes and overlapped with transcriptome profiles of HS patient clinical samples. Bacteria were juxtaposed to activated keratinocytes in vivo, and F. nucleatum strongly recruited murine neutrophil and macrophage migration. Both the TLR4 and pan-JAK inhibitors reduced cytokine production. Detailed transcriptomic profiling of healthy skin keratinocytes exposed to GNAs prevalent in HS revealed a potent, extensive inflammatory response vastly stronger than GPs. GNAs stimulated HS-relevant genes, including many genes in the IL-17 response pathway, and were significantly associated with HS tissue transcriptomes. The close association of activated keratinocytes with bacteria in HS lesions and innate infiltration in murine skin cemented GNA pathogenic potential. These novel mechanistic insights could drive future targeted therapies.
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Affiliation(s)
- Samuel C Williams
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
- The Rockefeller University-Memorial Sloan Kettering-Weill Cornell Medicine Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Hong Hur
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Shunsuke Miura
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Juana Gonzalez
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
- The Rockefeller University-Memorial Sloan Kettering-Weill Cornell Medicine Tri-Institutional MD-PhD Program, New York, New York, USA
| | - Mika Yamamura-Murai
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Kazuhiko Yamamura
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Xuan Li
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - John Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
- Department of Dermatology, Liverpool Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Vincent A Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, New York, USA
| | - Uri Sela
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York, New York, USA
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
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Stergianou D, Kanni T, Damoulari C, Giamarellos-Bourboulis EJ. An evaluation of secukinumab for the treatment of moderate-to-severe hidradenitis suppurativa. Expert Opin Biol Ther 2024; 24:225-232. [PMID: 38602836 DOI: 10.1080/14712598.2024.2343112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Until recently, biological therapy for hidradenitis suppurativa was limited to anti-tumor necrosis factor (TNF) blockade with adalimumab (ADA). However, not all patients respond to treatment with ADA. This highlighted the need for more therapeutic options. Interleukin (IL)-17/T-helper 17 (Th17) axis may play an important role in the pathophysiology of HS. Recently, the IL-17A inhibitor secukinumab, which targets IL-17A specifically and prevents it from interacting with the IL-17 receptor, has been FDA-approved for HS. AREAS COVERED Secukinumab, represents a novel therapeutic strategy in HS management. An overview of structural and pharmacological characteristics is provided. Described efficacy in clinical trials and case reports and safety data from is presented. EXPERT OPINION As response to anti-TNFas is lost over time, secukinumab has provided an alternative HS treatment option in clinical practice. Overall, secukinumab has shown good efficacy and a favorable side effect profile in HS clinical trials but may be avoided in patients with inflammatory bowel disease. Long-term and real-life data on the use of secukinumab are essential for improving decision-making in HS therapy.
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Affiliation(s)
- Dimitra Stergianou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Theodora Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Christina Damoulari
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Kirby JS, Okun MM, Alavi A, Bechara FG, Zouboulis CC, Brown K, Santos LL, Wang A, Bibeau KB, Kimball AB, Porter ML. Efficacy and safety of the oral Janus kinase 1 inhibitor povorcitinib (INCB054707) in patients with hidradenitis suppurativa in a phase 2, randomized, double-blind, dose-ranging, placebo-controlled study. J Am Acad Dermatol 2024; 90:521-529. [PMID: 37871805 DOI: 10.1016/j.jaad.2023.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Janus kinase 1 inhibition may alleviate hidradenitis suppurativa (HS)-associated inflammation and improve symptoms. OBJECTIVE To assess efficacy and safety of povorcitinib (selective oral Janus kinase 1 inhibitor) in HS. METHODS This placebo-controlled phase 2 study randomized patients with HS 1:1:1:1 to receive povorcitinib 15, 45, or 75 mg or placebo for 16 weeks. Primary and key secondary end points were mean change from baseline in abscess and inflammatory nodule count and percentage of patients achieving HS Clinical Response at week 16. RESULTS Of 209 patients randomized (15 mg, n = 52; 45 mg, n = 52; 75 mg, n = 53; placebo, n = 52), 83.3% completed the 16-week treatment. At week 16, povorcitinib significantly reduced abscess and inflammatory nodule count from baseline (least squares mean [SE] change: 15 mg, -5.2 [0.9], P = .0277; 45 mg, -6.9 [0.9], P = .0006; 75 mg, -6.3 [0.9], P = .0021) versus placebo (-2.5 [0.9]). More povorcitinib-treated patients achieved HS Clinical Response at week 16 (15 mg, 48.1%, P = .0445; 45 mg, 44.2%, P = .0998; 75 mg, 45.3%, P = .0829) versus placebo (28.8%). A total of 60.0% and 65.4% of povorcitinib- and placebo-treated patients had adverse events. LIMITATIONS Baseline lesion counts were mildly imbalanced between groups. CONCLUSION Povorcitinib demonstrated efficacy in HS, with no evidence of increased incidence of adverse events among doses.
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Martin M Okun
- Department of Dermatology, Fort Memorial Hospital, Fort Atkinson, Wisconsin
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Falk G Bechara
- Department of Dermatology, Allergology and Venereology, Ruhr University Bochum, Bochum, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Kurt Brown
- Incyte Corporation, Wilmington, Delaware
| | | | - Annie Wang
- Incyte Corporation, Wilmington, Delaware
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martina L Porter
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Huang MY, Armstrong AW. Janus-kinase inhibitors in dermatology: A review of their use in psoriasis, vitiligo, systemic lupus erythematosus, hidradenitis suppurativa, dermatomyositis, lichen planus, lichen planopilaris, sarcoidosis and graft-versus-host disease. Indian J Dermatol Venereol Leprol 2024; 90:30-40. [PMID: 38031699 DOI: 10.25259/ijdvl_15_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/01/2023] [Indexed: 12/01/2023]
Abstract
Recent studies on molecular pathways have elucidated novel therapeutic approaches in inflammatory and autoimmune skin disorders. Specifically, the dysregulation of the Janus kinase signal transducer and activator of transcription (JAK-STAT) cascade plays a central role in the pathogenesis of many skin conditions. JAK inhibitors, with their ability to selectively target immune responses, are potential treatment options. Using the National Library of Medicine, we provide a comprehensive review of the use of United States Food and Drug Administration (FDA)-approved and emerging JAK or tyrosine kinase 2 (TYK2) inhibitors in a wide range of dermatologic conditions, including psoriasis, vitiligo, systemic lupus erythematosus, hidradenitis suppurativa, dermatomyositis, lichen planus, lichen planopilaris, sarcoidosis and graft-versus-host disease. In patients with psoriasis, oral deucravacitinib (TYK2 inhibitor) has been approved as a once-daily therapy with demonstrated superiority and efficacy over apremilast and placebo and tolerable safety profiles. In patients with vitiligo, topical ruxolitinib (JAK1 inhibitor) is approved as a twice-daily treatment for repigmentation. The efficacy of several other JAK inhibitors has also been demonstrated in several clinical trials and case studies for systemic lupus erythematosus, hidradenitis suppurativa, dermatomyositis, lichen planus, lichen planopilaris, sarcoidosis and graft-versus-host disease. Further investigations with long-term clinical trials are necessary to confirm their utility in treatment and safety for these diseases.
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Affiliation(s)
- Margaret Y Huang
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, United States
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Stancic BH, Boer J, Dolenc-Voljč M, Jemec GBE. The Role of Intra-Follicular Shear Forces in Hidradenitis Suppurativa. Skin Pharmacol Physiol 2024; 36:302-303. [PMID: 38176392 DOI: 10.1159/000536067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Bor Hrvatin Stancic
- Dermatovenerology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jurr Boer
- Department of Dermatology, Deventer Hospital, Schalkhaar, The Netherlands
| | - Mateja Dolenc-Voljč
- Dermatovenerology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital and Health Sciences Faculty, Auckland, New Zealand
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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9
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Jin L, Chen Y, Muzaffar S, Li C, Mier-Aguilar CA, Khan J, Kashyap MP, Liu S, Srivastava R, Deshane JS, Townes TM, Elewski BE, Elmets CA, Crossman DK, Raman C, Athar M. Epigenetic switch reshapes epithelial progenitor cell signatures and drives inflammatory pathogenesis in hidradenitis suppurativa. Proc Natl Acad Sci U S A 2023; 120:e2315096120. [PMID: 38011564 PMCID: PMC10710069 DOI: 10.1073/pnas.2315096120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 11/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a complex inflammatory skin disease with undefined mechanistic underpinnings. Here, we investigated HS epithelial cells and demonstrated that HS basal progenitors modulate their lineage restriction and give rise to pathogenic keratinocyte clones, resulting in epidermal hyperproliferation and dysregulated inflammation in HS. When comparing to healthy epithelial stem/progenitor cells, in HS, we identified changes in gene signatures that revolve around the mitotic cell cycle, DNA damage response and repair, as well as cell-cell adhesion and chromatin remodeling. By reconstructing cell differentiation trajectory and CellChat modeling, we identified a keratinocyte population specific to HS. This population is marked by S100A7/8/9 and KRT6 family members, triggering IL1, IL10, and complement inflammatory cascades. These signals, along with HS-specific proinflammatory cytokines and chemokines, contribute to the recruitment of certain immune cells during the disease progression. Furthermore, we revealed a previously uncharacterized role of S100A8 in regulating the local chromatin environment of target loci in HS keratinocytes. Through the integration of genomic and epigenomic datasets, we identified genome-wide chromatin rewiring alongside the switch of transcription factors (TFs), which mediated HS transcriptional profiles. Importantly, we identified numerous clinically relevant inflammatory enhancers and their coordinated TFs in HS basal CD49fhigh cells. The disruption of the S100A enhancer using the CRISPR/Cas9-mediated approach or the pharmacological inhibition of the interferon regulatory transcription factor 3 (IRF3) efficiently reduced the production of HS-associated inflammatory regulators. Our study not only uncovers the plasticity of epidermal progenitor cells in HS but also elucidates the epigenetic mechanisms underlying HS pathogenesis.
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Affiliation(s)
- Lin Jin
- Center for Epigenomics and Translational Research in Inflammatory Skin Diseases, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
| | - Yunjia Chen
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL35294
| | - Suhail Muzaffar
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
| | - Chao Li
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL35294
| | - Carlos A. Mier-Aguilar
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - Jasim Khan
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
| | - Mahendra P. Kashyap
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
| | - Shanrun Liu
- Institutional Research Core Program, Flow Cytometry and Singe Cell Core, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - Ritesh Srivastava
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
| | - Jessy S. Deshane
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - Tim M. Townes
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, Birmingham, AL35294
| | - Boni E. Elewski
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - Craig A. Elmets
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - David K. Crossman
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL35294
| | - Chander Raman
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
| | - Mohammad Athar
- Center for Epigenomics and Translational Research in Inflammatory Skin Diseases, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL35294
- Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL35294
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10
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Lee MJ, Hammouda MB, Miao W, Okafor A, Jin Y, Sun H, Jain V, Markovtsov V, Diao Y, Gregory SG, Zhang JY. UBE2N is essential for maintenance of skin homeostasis and suppression of inflammation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.01.569631. [PMID: 38105982 PMCID: PMC10723344 DOI: 10.1101/2023.12.01.569631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
UBE2N, a Lys63-ubiquitin conjugating enzyme, plays critical roles in embryogenesis and immune system development and function. However, its roles in adult epithelial tissue homeostasis and pathogenesis are unclear. We generated conditional mouse models that deleted Ube2n in skin cells in a temporally and spatially controlled manner. We found that Ube2n-knockout (KO) in the adult skin keratinocytes induced a range of inflammatory skin defects characteristic of psoriatic and actinic keratosis. These included eczematous inflammation, epidermal and dermal thickening, parakeratosis, and increased immune cell infiltration, as well as signs of edema and blistering. Single cell transcriptomic analyses and RT-qPCR showed that Ube2n KO keratinocytes expressed elevated myeloid cell chemo-attractants such as Cxcl1 and Cxcl2 and decreased the homeostatic T lymphocyte chemo-attractant, Ccl27a. Consistently, the infiltrating immune cells of Ube2n-KO skin were predominantly myeloid-derived cells including neutrophils and M1-like macrophages that were highly inflammatory, as indicated by expression of Il1β and Il24. Pharmacological blockade of the IL-1 receptor associated kinases (IRAK1/4) alleviated eczema, epidermal and dermal thickening, and immune infiltration of the Ube2n mutant skin. Together, these findings highlight a key role of keratinocyte-UBE2N in maintenance of epidermal homeostasis and skin immunity and identify IRAK1/4 as potential therapeutic target for inflammatory skin disorders.
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Affiliation(s)
- Min Jin Lee
- Department of Dermatology, Duke University, Durham, NC, USA
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, USA
| | | | - Wanying Miao
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Arinze Okafor
- Department of Cell Biology, Duke University, Durham, NC, USA
| | - Yingai Jin
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Huiying Sun
- Department of Dermatology, Duke University, Durham, NC, USA
| | - Vaibhav Jain
- Duke Molecular Physiology Institute, Durham, NC, USA
| | | | - Yarui Diao
- Department of Cell Biology, Duke University, Durham, NC, USA
| | | | - Jennifer Y Zhang
- Department of Dermatology, Duke University, Durham, NC, USA
- Department of Pathology, Duke University, Durham, NC, USA
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11
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Sabat R, Gudjonsson JE, Brembilla NC, van Straalen KR, Wolk K. Biology of Interleukin-17 and Novel Therapies for Hidradenitis Suppurativa. J Interferon Cytokine Res 2023; 43:544-556. [PMID: 37824200 DOI: 10.1089/jir.2023.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Skin disorders affect ∼40% of the human population. One of the most debilitating cutaneous disorders is Hidradenitis suppurativa (HS), a noncommunicable chronic inflammatory disease with an estimated global prevalence of 0.4% to 2.5%. In January 2011, high levels of IL-17 were discovered in skin lesions of HS patients. In the following years, translational and clinical research led to a better understanding of the pathogenesis of HS. In June 2023, more than 12 years after the initial note, secukinumab, an anti-IL-17A monoclonal antibody, was approved for the treatment of moderate to severe HS. This is the next milestone in improving the treatment of these patients after the approval of the anti-TNF-α monoclonal antibody adalimumab in 2015. In this review article, we present the IL-17 pathway in HS and discuss the use of secukinumab as a therapeutic option for this disease. Our review starts with a description of the epidemiology, clinical features, etiology, and pathogenesis of HS. An overview of the IL-17/IL-17 receptor system in general and a detailed description of the known facts about the expression and action of IL-17 in HS follow. Afterward, we consider the results of clinical trials evaluating the safety and efficacy of IL-17 inhibitors in HS. Finally, a comparison is made between secukinumab and adalimumab and the characteristics of the patients that may be particularly suitable for each of these biologics are described.
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Affiliation(s)
- Robert Sabat
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Eli Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Taubman Medical Research Institute, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Moran B, Smith CM, Zaborowski A, Ryan M, Karman J, Dunstan RW, Smith KM, Hambly R, Musilova J, Petrasca A, Fabre A, O'Donnell M, Hokamp K, Mills KHG, Housley WJ, Winter DC, Kirby B, Fletcher JM. Targeting the NLRP3 inflammasome reduces inflammation in hidradenitis suppurativa skin. Br J Dermatol 2023; 189:447-458. [PMID: 37243544 DOI: 10.1093/bjd/ljad184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Treatment for the debilitating disease hidradenitis suppurativa (HS) is inadequate in many patients. Despite an incidence of approximately 1%, HS is often under-recognized and underdiagnosed, and is associated with a high morbidity and poor quality of life. OBJECTIVES To gain a better understanding of the pathogenesis of HS, in order to design new therapeutic strategies. METHODS We employed single-cell RNA sequencing to analyse gene expression in immune cells isolated from involved HS skin vs. healthy skin. Flow cytometry was used to quantify the absolute numbers of the main immune populations. The secretion of inflammatory mediators from skin explant cultures was measured using multiplex and enzyme-linked immunosorbent assays. RESULTS Single-cell RNA sequencing analysis identified a significant enrichment in the frequency of plasma cells, T helper (Th) 17 cells and dendritic cell subsets in HS skin, and the immune transcriptome was distinct and more heterogeneous than healthy skin. Flow cytometry revealed significantly increased numbers of T cells, B cells, neutrophils, dermal macrophages and dendritic cells in HS skin. Genes and pathways associated with Th17 cells, interleukin (IL)-17, IL-1β and the NLRP3 inflammasome were enhanced in HS skin, particularly in samples with a high inflammatory load. Inflammasome constituent genes principally mapped to Langerhans cells and a subpopulation of dendritic cells. The secretome of HS skin explants contained significantly increased concentrations of inflammatory mediators, including IL-1β and IL-17A, and culture with an NLRP3 inflammasome inhibitor significantly reduced the secretion of these, as well as other, key mediators of inflammation. CONCLUSIONS These data provide a rationale for targeting the NLRP3 inflammasome in HS using small-molecule inhibitors that are currently being tested for other indications.
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Affiliation(s)
- Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Ryan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Jozsef Karman
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Robert W Dunstan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Kathleen M Smith
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Roisin Hambly
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jana Musilova
- Education and Research Centre, University College Dublin, Dublin, Ireland
| | - Andreea Petrasca
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital and School of Medicine, University College Dublin, Ireland
| | | | - Karsten Hokamp
- Department of Genetics, School of Genetics and Microbiology, Smurfit Institute of Genetics
| | - Kingston H G Mills
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - William J Housley
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Desmond C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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13
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Balić A, Marinović B, Bukvić Mokos Z. The genetic aspects of hidradenitis suppurativa. Clin Dermatol 2023; 41:551-563. [PMID: 37652193 DOI: 10.1016/j.clindermatol.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Genetic aspects have a substantial role in hidradenitis suppurativa (HS) pathogenesis. A positive family history of HS occurs in about one-third of HS cases and is significantly higher in patients with early onset of the disease. Recent twin studies have shown a high heritability in HS, fortifying the importance of genetic factors in disease pathogenesis. Based on existing knowledge on the genomics of HS, the disease can be categorized as familial HS, sporadic, syndromic HS, and "HS plus" associated with other syndromes. In familial HS, autosomal dominant transmission is proposed, and monogenic inheritance is rare. This monogenic trait is related to mutations of γ-secretase component genes and Notch signaling or defects in inflammasome function. With newly discovered gene mutations, such as those related to innate and adaptive immunity, skin microbiome, inflammasome, epidermal homeostasis, and keratinization pathway, we can define HS as a polygenic, multifactorial, autoinflammatory disease. To fully elucidate the genetic aspects of HS, we need extensive, long-term global collaborations.
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Affiliation(s)
- Anamaria Balić
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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14
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Sun Q, Broadaway KA, Edmiston SN, Fajgenbaum K, Miller-Fleming T, Westerkam LL, Melendez-Gonzalez M, Bui H, Blum FR, Levitt B, Lin L, Hao H, Harris KM, Liu Z, Thomas NE, Cox NJ, Li Y, Mohlke KL, Sayed CJ. Genetic Variants Associated With Hidradenitis Suppurativa. JAMA Dermatol 2023; 159:930-938. [PMID: 37494057 PMCID: PMC10372759 DOI: 10.1001/jamadermatol.2023.2217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is a common and severely morbid chronic inflammatory skin disease that is reported to be highly heritable. However, the genetic understanding of HS is insufficient, and limited genome-wide association studies (GWASs) have been performed for HS, which have not identified significant risk loci. Objective To identify genetic variants associated with HS and to shed light on the underlying genes and genetic mechanisms. Design, Setting, and Participants This genetic association study recruited 753 patients with HS in the HS Program for Research and Care Excellence (HS ProCARE) at the University of North Carolina Department of Dermatology from August 2018 to July 2021. A GWAS was performed for 720 patients (after quality control) with controls from the Add Health study and then meta-analyzed with 2 large biobanks, UK Biobank (247 cases) and FinnGen (673 cases). Variants at 3 loci were tested for replication in the BioVU biobank (290 cases). Data analysis was performed from September 2021 to December 2022. Main Outcomes and Measures Main outcome measures are loci identified, with association of P < 1 × 10-8 considered significant. Results A total of 753 patients were recruited, with 720 included in the analysis. Mean (SD) age at symptom onset was 20.3 (10.57) years and at enrollment was 35.3 (13.52) years; 360 (50.0%) patients were Black, and 575 (79.7%) were female. In a meta-analysis of the 4 studies, 2 HS-associated loci were identified and replicated, with lead variants rs10512572 (P = 2.3 × 10-11) and rs17090189 (P = 2.1 × 10-8) near the SOX9 and KLF5 genes, respectively. Variants at these loci are located in enhancer regulatory elements detected in skin tissue. Conclusions and Relevance In this genetic association study, common variants associated with HS located near the SOX9 and KLF5 genes were associated with risk of HS. These or other nearby genes may be associated with genetic risk of disease and the development of clinical features, such as cysts, comedones, and inflammatory tunnels, that are unique to HS. New insights into disease pathogenesis related to these genes may help predict disease progression and novel treatment approaches in the future.
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Affiliation(s)
- Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | | | - Sharon N. Edmiston
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Kristen Fajgenbaum
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Tyne Miller-Fleming
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linnea Lackstrom Westerkam
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- University of North Carolina at Chapel Hill School of Medicine
| | | | - Helen Bui
- Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | - Brandt Levitt
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lan Lin
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Honglin Hao
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill
- Sociology Department, University of North Carolina at Chapel Hill
| | - Zhi Liu
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Nancy J. Cox
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Christopher J. Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
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15
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Molinelli E, Gioacchini H, Sapigni C, Diotallevi F, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. New Insight into the Molecular Pathomechanism and Immunomodulatory Treatments of Hidradenitis Suppurativa. Int J Mol Sci 2023; 24:ijms24098428. [PMID: 37176138 PMCID: PMC10179439 DOI: 10.3390/ijms24098428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the intertriginous areas. It is accompanied by pain, malodourous secretion and a dramatically decreased quality of life. Although the pathogenesis has not been entirely elucidated, the primary event is follicular hyperkeratosis of the pilosebaceous apocrine unit. Since the registration of the tumor necrosis factor-alpha inhibitor Adalimumab in 2015, several cytokines have been implicated in the pathomechanism of HS and the research of novel therapeutic targets has been intensified. We provide an update on the inflammatory cytokines with a central role in HS pathogenesis and the most promising target molecules of future HS management.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Helena Gioacchini
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Federico Diotallevi
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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16
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Martora F, Scalvenzi M, Ruggiero A, Potestio L, Battista T, Megna M. Hidradenitis Suppurativa and JAK Inhibitors: A Review of the Published Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040801. [PMID: 37109759 PMCID: PMC10146646 DOI: 10.3390/medicina59040801] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
Background: Hidradenitis suppurativa (HS), also known as acne inversa or Verneuil's disease, is a chronic, inflammatory, recurrent, and debilitating skin disease of the hair follicles characterized by inflammatory, painful, deep-rooted lesions in the areas of the body characterized by the presence of the apocrine glands. Unfortunately, huge unmet needs still remain for its treatment. Objective: The purpose of our review was collecting all cases, case series, trials, and ongoing studies available in the literature on the use of this class of drugs for HS. Materials and Methods: The investigated manuscripts included trials, reviews, letters to the editor, real-life studies, case series, and reports. Manuscripts were identified, screened, and extracted for the relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Results: We selected 56 articles of which 25 met the selection criteria for our review. Among the JAK inhibitors to date, there is only one published clinical trial in the literature (Janus kinase 1 inhibitor INCB054707), a real-life study with 15 patients up to week 24 in which upadacitinib was used and a case series where tofacitinib was successfully used. Conversely, there are several ongoing clinical trials. Conclusions: Results to date in the literature show promising levels of efficacy and the safety of JAK inhibitors in HS. Several clinical trials are underway from which it will be very important to compare the available data. There are still too few studies conducted with a low sample size, so it remains critical to investigate this issue further in the future with a real-life study involving a large sample of patients in order to provide safe and viable therapeutic alternatives for HS.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Luca Potestio
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Teresa Battista
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Matteo Megna
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
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17
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Schell SL, Cong Z, Sennett ML, Gettle SL, Longenecker AL, Goldberg SR, Kirby JS, Helm MF, Nelson AM. Keratinocytes and immune cells in the epidermis are key drivers of inflammation in hidradenitis suppurativa providing a rationale for novel topical therapies. Br J Dermatol 2023; 188:407-419. [PMID: 36680309 DOI: 10.1093/bjd/ljac096] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 11/12/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating inflammatory skin disease characterized by painful nodules, drainage and scarring in skin folds. Injectable adalimumab is the only drug approved by the US Food and Drug Administration for the treatment of HS. Although systemic Janus kinase (JAK) inhibitors show promise, serious side-effects have been reported. There are no highly effective topical treatments for HS; furthermore, the contribution of epidermal keratinocytes to the intense inflammation has largely been unexplored. OBJECTIVES We investigated the role of keratinocytes and epidermal immune cells in HS inflammation at all Hurley stages of disease severity. We aimed to determine whether ruxolitinib can mitigate inflammation from keratinocytes and to develop a better understanding of how topical therapeutics might benefit patients with HS. METHODS We used skin samples from 87 patients with HS (Hurley stages I-III) and 39 healthy controls to compare keratinocyte- and immune cell-driven epidermal inflammation, in addition to the response of lesional HS keratinocytes to treatment with interferon (IFN)-γ and ruxolitinib. We used haematoxylin and eosin staining, immunohistochemistry, immunoblotting and quantitative reverse-transcription polymerase chain reaction assessments in whole skin, isolated epidermis, and cultured keratinocytes from healthy controls and both nonlesional and lesional HS skin to identify and define epidermal and keratinocyte-mediated inflammation in HS and how this may be targeted by therapeutics. RESULTS HS lesional keratinocytes autonomously secreted high levels of chemokines, such as CCL2, CCL3 and CXCL3, which recruited neutrophils, CD8 T cells, and natural killer cells to the epidermis. Keratinocytes were the dominant source of tumour necrosis factor-α and interleukin (IL)-6 in HS lesions with little to no contribution from underlying dermal immune cells. In the presence of IFN-γ, which is dependent on immune cell infiltrate in vivo, keratinocytes expressed increased levels of additional cytokines including IL-1β, IL-12, IL-23 and IL-36γ. The JAK inhibitor ruxolitinib mitigated the expression of inflammatory cytokines and chemokines in HS lesional keratinocytes, thus providing a rationale for future study as a topical treatment for HS. CONCLUSIONS This study demonstrates that keratinocytes actively recruit immune cells to HS epidermis and interactions between these cells drive a broad inflammatory profile in HS epidermis. Targeting epidermal inflammation in HS with novel topical formulations may be highly efficacious with reduced systemic side-effects.
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Affiliation(s)
- Stephanie L Schell
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Zhaoyuan Cong
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Mackenzie L Sennett
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Samantha L Gettle
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amy L Longenecker
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Stephanie R Goldberg
- General Surgery and Trauma, Mary Washington Medical Center, Fredericksburg, VA, USA
| | - Joslyn S Kirby
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Matthew F Helm
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amanda M Nelson
- Department of Dermatology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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18
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A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
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Serum Immunoglobulin G Is a Marker of Hidradenitis Suppurativa Disease Severity. Int J Mol Sci 2022; 23:ijms232213800. [PMID: 36430277 PMCID: PMC9698525 DOI: 10.3390/ijms232213800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the skin that is brought about by autoinflammation and hyperkeratosis at the pilosebaceous unit. The clinical severity of HS can be measured using static (Hurley Severity Scoring (HSS)) and/or dynamic (International HS Severity Scoring System (IHS4)) severity scoring instruments. However, few clinically available serological parameters have been found to correlate with disease severity. In this study, we sought to investigate the role of serum immunoglobulin (Ig) G, M and A levels as biomarkers of disease severity and to compare them with other, more conventional inflammatory indices, such as the erythrocyte sedimentation rate, C-reactive protein, the neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio and the systemic immune-inflammation index. In this cross-sectional study, patients were recruited from the only dermatology referral centre in Malta, Europe, and subjected to clinical examination and the assessment of inflammatory and immunologic parameters. Serum IgG, M and A levels were assessed using the Atellica® NEPH 630 System (SIEMENS-Healthineers AF, Erlangen, Germany) nephelometric analyser. Serum IgG, M and A levels correlate with both dynamic and static HS severity scoring systems. Serum IgG behaves as a marker of severe HS disease as categorised by HSS and the IHS4. Our findings suggest that the serum IgG level can be used in the clinical setting as a biomarker of disease severity and, therefore, as an adjunct to clinical severity scoring.
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20
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Kimball AB, Loesche C, Prens EP, Bechara FG, Weisman J, Rozenberg I, Jarvis P, Peters T, Roth L, Wieczorek G, Kolbinger F, Jemec GBE. IL-17A is a pertinent therapeutic target for moderate-to-severe hidradenitis suppurativa: Combined results from a pre-clinical and phase II proof-of-concept study. Exp Dermatol 2022; 31:1522-1532. [PMID: 35638561 PMCID: PMC9804780 DOI: 10.1111/exd.14619] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 01/09/2023]
Abstract
Hidradenitis Suppurativa (HS) is a chronic, recurrent, inflammatory, follicular skin disease whose pathology is complex and not fully understood. The objective of this study was to elucidate the role of IL-17A in moderate-to-severe HS. Transcriptomic and histological analyses were conducted on ex vivo HS (n = 19; lesional and non-lesional) and healthy control (n = 8) skin biopsies. Further, a Phase II exploratory, randomized, double-blind, placebo-controlled study was carried out in moderate-to-severe HS patients. Patients were treated with either CJM112 300 mg (n = 33), a fully human anti-IL-17A IgG1/κ monoclonal antibody, or placebo (n = 33). The main outcome of the translational analyses was to identify IL-17A-producing cells and indications of IL-17A activity in HS lesional skin. The primary objective of the clinical study was to determine the efficacy of CJM112 in moderate-to-severe HS patients by HS-Physician Global Assessment (HS-PGA) responder rate at Week 16. Transcriptomic and histopathologic analyses revealed the presence of heterogeneous cell types in HS lesional skin; IL-17A gene signatures were increased in HS lesional vs non-lesional or healthy skin. High expression of IL-17A was localized to T cells, neutrophils, and mast cells, confirming the transcriptional data. Clinically, the proportion of Week 16 HS-PGA responders was significantly higher (p = 0.03) in the CJM112 group vs placebo (32.3% vs 12.5%). This study elucidated the role of the IL-17A pathway in HS pathogenesis and clinically validated the IL-17A pathway in moderate-to-severe HS patients in a proof-of-concept study using the anti-IL-17A-specific antibody CJM112.
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Affiliation(s)
- Alexa B. Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of DermatologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Christian Loesche
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Errol P. Prens
- Department of DermatologyErasmus University Medical CentreRotterdamNetherlands
| | - Falk G. Bechara
- Department of Dermatology, Venereology and AllergologyRuhr‐University BochumBochumGermany
| | | | - Izabela Rozenberg
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Philip Jarvis
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Thomas Peters
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Lukas Roth
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Grazyna Wieczorek
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Frank Kolbinger
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zeeland University Hospital, Roskilde, Health Sciences FacultyUniversity of CopenhagenRoskildeDenmark
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21
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de Oliveira ASLE, Bloise G, Moltrasio C, Coelho A, Agrelli A, Moura R, Tricarico PM, Jamain S, Marzano AV, Crovella S, Cavalcanti Brandão LA. Transcriptome Meta-Analysis Confirms the Hidradenitis Suppurativa Pathogenic Triad: Upregulated Inflammation, Altered Epithelial Organization, and Dysregulated Metabolic Signaling. Biomolecules 2022; 12:1371. [PMID: 36291580 PMCID: PMC9599370 DOI: 10.3390/biom12101371] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/21/2022] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory skin condition clinically characterized by recurrent painful deep-seated nodules, abscesses, and sinus tracks in areas bearing apocrine glands, such as axillae, breasts, groins, and buttocks. Despite many recent advances, the pathophysiological landscape of HS still demands further clarification. To elucidate HS pathogenesis, we performed a meta-analysis, set analysis, and a variant calling on selected RNA-Sequencing (RNA-Seq) studies on HS skin. Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling. Upregulation of specific genes, such as KRT6, KRT16, serpin-family genes, and SPRR3 confirms the early involvement of hair follicles and the impairment of barrier function in HS lesioned skin. In addition, our results suggest that adipokines could be regarded as biomarkers of HS and metabolic-related disorders. Finally, the RNA-Seq variant calling identified several mutations in HS patients, suggesting potential new HS-related genes associated with the sporadic form of this disease. Overall, this study provides insights into the molecular pathways involved in HS and identifies potential HS-related biomarkers.
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Affiliation(s)
| | - Giovanna Bloise
- Department of Pathology, Federal University of Pernambuco, Recife 50670-901, Brazil
- Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Antonio Coelho
- Hospital Israelita Albert Einstein, São Paulo 05652-000, Brazil
| | - Almerinda Agrelli
- Laboratory of Nanostructured Materials (LMNANO), Center for Strategic Technologies Northeastern (CETENE), Av. Prof. Luís Freire, 1-Cidade Universitária, Recife 50740-545, Brazil
| | - Ronald Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Stéphane Jamain
- Translational Neuropsychiatry, Univ. Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha 2713, Qatar
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22
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van Straalen KR, Dudink K, Aarts P, van der Zee HH, van den Bosch TPP, Giang J, Prens EP, Damman J. Complement activation in Hidradenitis suppurativa: Covert low-grade inflammation or innocent bystander? Front Immunol 2022; 13:953674. [PMID: 36211440 PMCID: PMC9535337 DOI: 10.3389/fimmu.2022.953674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a complex and multifactorial pathogenesis involving both the innate and adaptive immune system. Despite limited evidence for local complement activation, conflicting results have been published on the role of systemic complement activation in HS. It was hypothesized that complement was consumed in highly inflamed HS skin, trapping complement from the circulation. Therefore, the aim of this study was to evaluate this local complement deposition in HS skin lesions using routine and commonly used complement antibodies.Direct immunofluorescence for C1q, C3c, C4d, C5b-9, and properdin was performed on frozen tissue sections of 19 HS patients and 6 controls. C5a receptor 1 (C5aR1) was visualized using immunohistochemistry.Overall, we found no significant local complement deposition in HS patients versus controls regarding C1q, C3c, C4d, C5b-9, or properdin on either vessels or immune cells. C5aR1 expression was exclusively found on immune cells, predominantly neutrophilic granulocytes, but not significantly different relatively to the total infiltrate in HS lesions compared with controls. In conclusion, despite not being able to confirm local complement depositions of C1q, C3c, C4d, or properdin using highly sensitive and widely accepted techniques, the increased presence of C5aR1 positive immune cells in HS suggests the importance of complement in the pathogenesis of HS and supports emerging therapies targeting this pathway.
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Affiliation(s)
- K. R. van Straalen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - K. Dudink
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - P. Aarts
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - H. H. van der Zee
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - T. P. P. van den Bosch
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Giang
- Department of Pathology, Maasstad Hospital, Rotterdam, Netherlands
| | - E. P. Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Damman
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: J. Damman,
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23
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Kashyap MP, Khan J, Sinha R, Jin L, Atigadda V, Deshane JS, Ahmed AR, Kilic A, Raman C, Mukhtar MS, Elmets CA, Athar M. Advances in molecular pathogenesis of hidradenitis suppurativa: Dysregulated keratins and ECM signaling. Semin Cell Dev Biol 2022; 128:120-129. [PMID: 35131152 PMCID: PMC9232849 DOI: 10.1016/j.semcdb.2022.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 12/12/2022]
Abstract
Hidradenitis suppurativa (HS) is characterized by deep-seated, highly inflamed, and painful lumps/abscesses, fistulae, and sinus tracts that grow extensively deep in the dermis and are highly immunogenic in nature. In about one-third of the HS patients there is strong evidence for the role of γ-secretase mutations along with dysregulated Notch signaling. However, the contribution of dysregulated Notch signaling in HS pathogenesis in relation to hair follicle alterations and hyper-activation of the immune system remains undefined. A genome-wide association study (GWAS), proteomic data and functional investigations of identified sequence variants in HS pathology are not fully revealing. The disease initiation or progression may involve bacterial infection besides intrinsic functional defects in keratinocytes, which may be key to further exacerbate immune cell infiltration and cytokine production in and around the lesional tissue. The absence of a suitable animal model that could fully recapitulate the pathogenesis of HS is a major impediment for proper understanding the underlying mechanisms and development of effective treatments. The presence of extracellular matrix (ECM) degradation products along with dysregulation in keratinocytes and, dermal fibroblasts ultimately affect immune regulation and are various components of HS pathogenesis. Bacterial infection further exacerbates the complexity of the disease progression. While anti-TNFα therapy shows partial efficacy, treatment to cure HS is absent. Multiple clinical trials targeting various cytokines, complement C5a and ECM products are in progress. This review provides state-of-the-art information on these aspects with a focus on dysregulated keratinocyte and immune cells; and role of ECM, and Keratin functions in this regard.
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Affiliation(s)
- Mahendra Pratap Kashyap
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Jasim Khan
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Rajesh Sinha
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Lin Jin
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Venkatram Atigadda
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Jessy S Deshane
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Ayesha R Ahmed
- Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA
| | - Ali Kilic
- Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Chander Raman
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - M Shahid Mukhtar
- Department of Biology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Craig A Elmets
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA
| | - Mohammad Athar
- UAB Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham AL35294, USA.
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24
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Chopra D, Arens RA, Amornpairoj W, Lowes MA, Tomic-Canic M, Strbo N, Lev-Tov H, Pastar I. Innate immunity and microbial dysbiosis in hidradenitis suppurativa – vicious cycle of chronic inflammation. Front Immunol 2022; 13:960488. [PMID: 35967376 PMCID: PMC9368759 DOI: 10.3389/fimmu.2022.960488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/01/2022] [Indexed: 11/29/2022] Open
Abstract
Hidradenitis Suppurativa (HS) is a chronic multifactorial inflammatory skin disease with incompletely understood mechanisms of disease pathology. HS is characterized by aberrant activation of the innate immune system, resulting in activation of pathways that aim to protect against pathogenic microorganisms, and also contribute to failure to resolve inflammation. Imbalance in innate immunity is evident in deregulation of host antimicrobial peptides (AMPs) and the complement system associated with the microbiome dysbiosis. The pathology is further complicated by ability of pathogens associated with HS to overcome host immune response. Potential roles of major AMPs, cathelicidin, defensins, dermcidin, S100 proteins, RNAse 7 and complement proteins are discussed. Dysregulated expression pattern of innate immunity components in conjunction with bacterial component of the disease warrants consideration of novel treatment approaches targeting both host immunity and pathogenic microbiome in HS.
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Affiliation(s)
- Divya Chopra
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Rachel A. Arens
- College of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, United States
| | - Watcharee Amornpairoj
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michelle A. Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, United States
| | - Marjana Tomic-Canic
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Natasa Strbo
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Hadar Lev-Tov
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Irena Pastar, ; Hadar Lev-Tov,
| | - Irena Pastar
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
- *Correspondence: Irena Pastar, ; Hadar Lev-Tov,
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25
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Frings VG, Jopp L, Srivastava M, Presser D, Goebeler M, Schmidt M. Stress signaling and STAT1 activation characterize the keratinocytic gene expression pattern in Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:2488-2498. [PMID: 35881108 DOI: 10.1111/jdv.18465] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathogenetic factors generating the innate immune signal necessary for T cell activation, initiation and chronification of Hidradenitis suppurativa (HS, also known as Acne inversa) are still poorly understood. Emerging evidence suggests that a defective keratinocyte function critically contributes to HS disease development and progression. OBJECTIVES To elucidate the role of keratinocytes in HS lesion formation, we compared the transcriptomes of lesional and perilesional epidermis isolated from HS patients by RNA sequencing (RNA Seq). METHODS Pairwise-matched lesional and perilesional HS skin samples of five different donors were obtained and epidermal keratinocytes freshly isolated and processed for RNA extraction and RNA seq. Lesionally regulated genes were analyzed by large scale promotor analysis and functional annotation clustering to identify epidermally overrepresented transcription factor binding sites and functionally related gene groups. Results were experimentally validated with independent epidermal isolates of patient-matched lesional and perilesional HS skin employing qRT-PCR, cell culture, immunoblot, and immunostaining. RESULTS We show that HS is characterized by a strong epidermal stress state evident by a significant overrepresentation of an AP-1-driven gene signature and a substantial activation of the stress-activated cJun N-terminal kinase (JNK) pathway in lesional epidermis. Additionally, our data reveal a strong induction of STAT1 activation in lesional HS epidermis that likely results from IFNγ production and triggered expression of key inflammatory genes coordinating innate immune activation and the adaptive T cell response in HS. CONCLUSIONS Our data implicate a key role of stress signaling and JAK/STAT1 activation in disease progression of HS and suggest interference with JAK/STAT1 signaling as a potentially promising therapeutic approach for HS.
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Affiliation(s)
- V G Frings
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - L Jopp
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - M Srivastava
- Core Unit Systemmedizin (SysMed), Medical Faculty, University of Würzburg, Würzburg, Germany
| | - D Presser
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
| | - M Schmidt
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Germany
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26
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Davila ML, Xu M, Huang C, Gaddes ER, Winter L, Cantorna MT, Wang Y, Xiong N. CCL27 is a crucial regulator of immune homeostasis of the skin and mucosal tissues. iScience 2022; 25:104426. [PMID: 35663027 PMCID: PMC9157018 DOI: 10.1016/j.isci.2022.104426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/30/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Abundant immune cells reside in barrier tissues. Understanding the regulation of these cells can yield insights on their roles in tissue homeostasis and inflammation. Here, we report that the chemokine CCL27 is critical for establishment of resident lymphocytes and immune homeostasis in barrier tissues. CCL27 expression is associated with normal skin and hair follicle development independent of commensal bacterial stimulation, indicative of a homeostatic role for the chemokine. Accordingly, in the skin of CCL27-knockout mice, there is a reduced presence and dysregulated localization of T cells that express CCR10, the cognate receptor to CCL27. Besides, CCL27-knockout mice have overreactive skin inflammatory responses in an imiquimod-induced model of psoriasis. Beyond the skin, CCL27-knockout mice have increased infiltration of CCR10+ T cells into lungs and reproductive tracts, the latter of which also exhibit spontaneous inflammation. Our findings demonstrate that CCL27 is critical for immune homeostasis across barrier tissues.
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Affiliation(s)
- Micha L Davila
- Immunology and Infectious Disease Graduate Program, The Pennsylvania State University, University Park, PA 16802, USA.,Department of Microbiology, Immunology and Molecular Genetics, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7758, San Antonio, TX 78229, USA
| | - Ming Xu
- Department of Microbiology, Immunology and Molecular Genetics, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7758, San Antonio, TX 78229, USA
| | - Chengyu Huang
- Department of Microbiology, Immunology and Molecular Genetics, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7758, San Antonio, TX 78229, USA
| | - Erin R Gaddes
- Department of Biomedical Engineering, 526 CBEB, The Pennsylvania State University, University Park, PA 16802, USA
| | - Levi Winter
- Pathobiology Graduate Program, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Margherita T Cantorna
- Pathobiology Graduate Program, Department of Veterinary and Biomedical Sciences, The Pennsylvania State University, University Park, PA 16802, USA
| | - Yong Wang
- Department of Biomedical Engineering, 526 CBEB, The Pennsylvania State University, University Park, PA 16802, USA
| | - Na Xiong
- Department of Microbiology, Immunology and Molecular Genetics, Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, Mail Code 7758, San Antonio, TX 78229, USA.,Department of Medicine-Division of Dermatology and Cutaneous Surgery University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
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27
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Ex Vivo Culture Models of Hidradenitis Suppurativa for Defining Molecular Pathogenesis and Treatment Efficacy of Novel Drugs. Inflammation 2022; 45:1388-1401. [PMID: 35301634 PMCID: PMC9940461 DOI: 10.1007/s10753-022-01629-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 11/05/2022]
Abstract
Hidradenitis suppurativa (HS) is a complex and debilitating inflammatory skin disease for which no effective treatment is available currently. This is partly because of the lack of adequate human or animal models for defining the pathobiology of the disease. Here, we describe the development of air-liquid (A-L) interface, liquid-submersion (L-S), and bioreactor (Bio) ex vivo skin culture models. All three ex vivo platforms were effective for culturing skin samples for up to 14 days. Tissue architecture and integrity remained intact for at least 3 days for healthy skin and 14 days for HS skin. Up to day 3, no significant differences were observed in % early apoptotic cells among all three platforms. However, late apoptotic/necrotic cell death was increased in HS skin at day 3 in A-L and Bio culture. These cultures efficiently support the growth of various cells populations, including keratinocytes and immune cells. Profiling inflammatory gene signatures in HS skin from these ex vivo cultures showed dynamic changes in expression at day 3 and day 14. All three culture platforms were necessary to represent the inflammatory gene status of HS skin at day 0, suggesting that not all gene clusters were identically altered in each culture method. Similarly, cytokine/chemokine profiling of the supernatants from vehicle- and drug-treated ex vivo HS cultures again showed a better prediction of drug efficacy against HS. Overall, development of these three culture systems collectively provides a powerful tool to uncover the pathobiology of HS progression and screen various drugs against HS.
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28
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Tricarico PM, Moltrasio C, Gradišek A, Marzano AV, Flacher V, Boufenghour W, von Stebut E, Schmuth M, Jaschke W, Gams M, Boniotto M, Crovella S. Holistic health record for Hidradenitis suppurativa patients. Sci Rep 2022; 12:8415. [PMID: 35589750 PMCID: PMC9120068 DOI: 10.1038/s41598-022-11910-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease with a complex etiopathogenesis whose treatment poses a challenge in the clinical practice. Here, we present a novel integrated pipeline produced by the European consortium BATMAN (Biomolecular Analysis for Tailored Medicine in Acne iNversa) aimed at investigating the molecular pathways involved in HS by developing new diagnosis algorithms and building cellular models to pave the way for personalized treatments. The objectives of our european Consortium are the following: (1) identify genetic variants and alterations in biological pathways associated with HS susceptibility, severity and response to treatment; (2) design in vitro two-dimensional epithelial cell and tri-dimensional skin models to unravel the HS molecular mechanisms; and (3) produce holistic health records HHR to complement medical observations by developing a smartphone application to monitor patients remotely. Dermatologists, geneticists, immunologists, molecular cell biologists, and computer science experts constitute the BATMAN consortium. Using a highly integrated approach, the BATMAN international team will identify novel biomarkers for HS diagnosis and generate new biological and technological tools to be used by the clinical community to assess HS severity, choose the most suitable therapy and follow the outcome.
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Affiliation(s)
- Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Anton Gradišek
- Department of Intelligent System, Jožef Stefan Institute, Jamova Cesta 39, 1000, Ljubljana, Slovenia
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Vincent Flacher
- Laboratory CNRS I2CT/UPR3572 Immunology, Immunopathology and Therapeutic Chemistry, Strasbourg Drug Discovery and Development Institute (IMS), Institut de Biologie Moléculaire Et Cellulaire, University of Strasbourg, Strasbourg, France
| | - Wacym Boufenghour
- Laboratory CNRS I2CT/UPR3572 Immunology, Immunopathology and Therapeutic Chemistry, Strasbourg Drug Discovery and Development Institute (IMS), Institut de Biologie Moléculaire Et Cellulaire, University of Strasbourg, Strasbourg, France
| | - Esther von Stebut
- Department of Dermatology, University of Cologne, Kerpenerstr. 62, 50935, Cologne, Germany
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Wolfram Jaschke
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Austria
| | - Matjaž Gams
- Department of Intelligent System, Jožef Stefan Institute, Jamova Cesta 39, 1000, Ljubljana, Slovenia
| | - Michele Boniotto
- INSERM, IMRB, Translational Neuropsychiatry, F-94010, University Paris Est Créteil, Créteil, France
| | - Sergio Crovella
- Biological Sciences Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha, Qatar
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29
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Claessens AAE, van Alphen TC, Lapid O, Hoogbergen MM, Ovadja ZN. Use of Patient-Reported Outcome Measures in the Surgical Treatment of Hidradenitis Suppurativa: A Systematic Review. Dermatol Surg 2022; 48:411-417. [PMID: 35333200 DOI: 10.1097/dss.0000000000003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgery is considered to be the best treatment for recurrent hidradenitis suppurativa (HS). Although it is necessary to assess the effect on health-related quality of life (HR-QoL), patient-reported outcome measures (PROMs) are scarce and heterogeneously used in the literature about the surgical treatment of HS. OBJECTIVE The aim of this study was to provide a review of the complete literature for different PROMs used in the surgical treatment of HS and to assess their methodological qualities. METHODS A systematic literature search of PubMed, Medline, Cochrane, CINAHL, and Embase with an assessment following the COnsensus-based standards for the Selection of health status Measurement INstrument criteria. RESULTS The search identified 218 articles, with the inclusion of 6 studies for analysis. Identified PROMs were as follows: the Dermatology Life Quality Index (DLQI), the Derriford Appearance Scale-24 (DAS-24), and the Work Productivity and Activity Impairment (WPAI). These non-disease-specific PROMs seem to have poor results concerning development and content validation. CONCLUSION The DLQI, WPAI, and DAS-24 are generic PROMs with poor methodological qualities for PROM development and content validation. Hidradenitis suppurativa-specific instruments are not used in available studies because they have been developed recently and, therefore, partially validated. More research is needed to further investigate methodological qualities of HS-specific instruments.
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Affiliation(s)
- Anouk A E Claessens
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Tert C van Alphen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht (UMC Utrecht), Utrecht, the Netherlands
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30
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van Straalen KR, Prens EP, Gudjonsson JE. Insights into hidradenitis suppurativa. J Allergy Clin Immunol 2022; 149:1150-1161. [PMID: 35189127 DOI: 10.1016/j.jaci.2022.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models.
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Affiliation(s)
- Kelsey R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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31
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Liu C, Liu X, Wang R, Chen L, Zhao H, Zhou Y. A Novel NCSTN Mutation in a Three-Generation Chinese Family with Hidradenitis Suppurative. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1540774. [PMID: 35368949 PMCID: PMC8970804 DOI: 10.1155/2022/1540774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/11/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
Abstract
Objective Hidradenitis suppurativa (HS) is a rare autosomal dominant condition characterized by inflamed nodules, cysts, deep abscesses, draining sinuses in the axillae, inguinal, and anogenital regions. Mutations in the NCSTN gene have been perceived to be responsible for the major underlying changes in the disorder. The purpose of this study is to identify a novel gene mutation in a Chinese family with HS. Methods A Chinese family with HS present was investigated. The proband had manifested with multiple draining sinuses on the posterior neck, chest, bilateral axillae, and perineal regions. DNA was isolated from the peripheral blood of the family members. The encoding exons with introns of the NCSTN gene were analyzed by polymerase chain reactions (PCR) and direct DNA sequencing. Sanger sequencing was performed to confirm the next-generation sequencing results and to analyze each mutation's familial segregation. Furthermore, the identified mutation was localized onto a 3D structure model using the DeepView Swiss-PdbViewer 4.1 software. Results In this family comprising 10 HS patients, one novel mutation of the NCSTN gene was identified, involving a deletion mutation (c.447delC(p.N150Ifs∗52)) in the NCSTN gene resulting in a frameshift and the new formation of a hydrogen bond. Conclusion Our study reports the identification of a novel mutation that causes familial HS and could expand the spectrum of mutations in the γ-secretase genes underlying HS.
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Affiliation(s)
- Chengling Liu
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xingchen Liu
- Department of Pathology, Changhai Hospital, Navy Medical University, Shanghai 200433, China
| | - Rui Wang
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Lang Chen
- Beijing Mygenostics Co, LTD., Beijing 101318, China
| | - Hua Zhao
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Yong Zhou
- Department of Dermatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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32
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Manfredini M, Chello C, Ciardo S, Guida S, Chester J, Lasagni C, Bigi L, Farnetani F, Bettoli V, Pellacani G. Hidradenitis Suppurativa: morphologic and vascular study of nodular inflammatory lesions by means of optical coherence tomography. Exp Dermatol 2022; 31:1076-1082. [PMID: 35263469 DOI: 10.1111/exd.14560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis Suppurativa (HS) is an inflammatory disease characterized by a recurrent-remission trend and clinical lesions that range from asymptomatic to inflamed, deep-seated nodules with scarring and suppuration. OBJECTIVE To identify morphologic and vascular features of HS nodules by means of dynamic optical coherence tomography (D-OCT) and to define if they are correlated to patient endotype and risk of disease progression. METHODS A set of standardized clinical pictures and D-OCT images were acquired from 57 inflammatory nodules of 40 patients affected by HS. A set of 20 clinical and D-OCT images were acquired from 20 healthy volunteers as a control group. The comparison of D-OCT features among HS and control group was analyzed. The correlation between HS patient endotype and D-OCT features of the lesions was calculated. RESULTS D-OCT enabled to identify vascular and morphological aspects characterizing HS nodular inflammatory lesions. In addition, several D-OCT features were significantly different among distinct disease endotypes. CONCLUSION The characterization of HS nodular inflammatory lesions through D-OCT, corresponding to blood vessel dilation and inflammatory associated hyper-vascularization, may have important clinical consequences in the assessment of HS risk of progression, therapeutic decisions and treatment efficacy monitoring.
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Affiliation(s)
- M Manfredini
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Chello
- Dermatology Section, Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Biomedico University hospital, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - S Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Guida
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Lasagni
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Bigi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - V Bettoli
- Department of Dermatology, University of Ferrara, Ferrara, Italy
| | - G Pellacani
- Dermatology, Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
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Autoantibodies Present in Hidradenitis Suppurativa Correlate with Disease Severity and Promote the Release of Proinflammatory Cytokines in Macrophages. J Invest Dermatol 2022; 142:924-935. [PMID: 34606886 PMCID: PMC8860851 DOI: 10.1016/j.jid.2021.07.187] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/11/2022]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a debilitating inflammatory skin disorder that is characterized by nodules that lead to the development of connected tunnels and scars as it progresses from Hurley stages I to III. HS has been associated with several autoimmune diseases, including inflammatory bowel disease and spondyloarthritis. We previously reported dysregulation of humoral immune responses in HS, characterized by elevated serum total IgG, B-cell activation, and antibodies recognizing citrullinated proteins. In this study, we characterized IgG autoreactivity in HS sera and lesional skin compared with those in normal healthy controls using an array-based high-throughput autoantibody screening. The Cy3-labeled anti-human assay showed the presence of autoantibodies against nuclear antigens, cytokines, cytoplasmic proteins, extracellular matrix proteins, neutrophil proteins, and citrullinated antigens. Most of these autoantibodies were significantly elevated in stages II‒III in HS sera and stage III in HS skin lesions compared with those of healthy controls. Furthermore, immune complexes containing both native and citrullinated versions of antigens can activate M1 and M2 macrophages to release proinflammatory cytokines such as TNF-α, IL-8, IL-6, and IL-12. Taken together, the identification of specific IgG autoantibodies that recognize circulating and tissue antigens in HS suggests an autoimmune mechanism and uncovers putative therapeutic targets.
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Navrazhina K, Frew JW, Grand D, Williams SC, Hur H, Gonzalez J, Garcet S, Krueger JG. IL-17RA blockade by brodalumab decreases inflammatory pathways in hidradenitis suppurativa skin and serum. Br J Dermatol 2022; 187:223-233. [PMID: 35191018 PMCID: PMC9356983 DOI: 10.1111/bjd.21060] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/26/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory skin disease with dysregulation of the IL-17 axis. Recently we reported clinical benefit of brodalumab, a human anti-IL-17 receptor A (IL-17RA) monoclonal antibody, in moderate-to-severe HS. OBJECTIVES To characterize the molecular response to brodalumab in HS skin and serum, and to identify biomarkers of treatment response. METHODS Ten participants that received 210 mg/1.5mL brodalumab subcutaneously at week 0, 1, 2, 4 and every 2 weeks after were included in this molecular profiling study (NCT03960268). RNA-sequencing and immunohistochemistry of nonlesional, perilesional and lesional HS skin biopsies, and Olink high throughput proteomics of serum at baseline, week 4 and week 12 were assessed. RESULTS At week 12, brodalumab led to a decrease of overall inflammation, and improvement of psoriasis-, keratinocyte- and neutrophil-related pathways. Despite perilesional and lesional skin having no differentially expressed genes at baseline, treatment response was best assessed in perilesional skin. In serum, brodalumab treatment decreased pathways involved in neutrophil inflammation. Patients with higher baseline expression of neutrophil-associated Lipocalin-2 (LCN2) in the skin and IL-17A in the serum demonstrated greater decreases of HS-related inflammatory cytokines as measured in skin biopsies at week 12. CONCLUSIONS IL-17RA inhibition by brodalumab impacts several pathogenic inflammatory axes in HS. Perilesional skin provides a valid and robust assessment of treatment response. Expression of LCN2 in skin and IL-17A in serum may be used as biomarkers to stratify patients that may have a superior molecular response to brodalumab =.
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Affiliation(s)
- Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA.,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY, USA
| | - John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - David Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Samuel C Williams
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA.,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY, USA
| | - Hong Hur
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA
| | - Juana Gonzalez
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
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35
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Navrazhina K, Garcet S, Frew JW, Zheng X, Coats I, Guttman-Yassky E, Krueger JG. The inflammatory proteome of hidradenitis suppurativa skin is more expansive than that of psoriasis vulgaris. J Am Acad Dermatol 2022; 86:322-330. [PMID: 34339761 PMCID: PMC8800946 DOI: 10.1016/j.jaad.2021.07.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although hidradenitis suppurativa (HS) shares some transcriptomic and cellular infiltrate features with psoriasis, their skin proteome remains unknown. OBJECTIVE To define and compare inflammatory protein biomarkers of HS and psoriasis skin. METHODS We assessed 92 inflammatory biomarkers in HS (n = 13), psoriasis (n = 11), and control skin (n = 11) using Olink high-throughput proteomics. We also correlated HS skin and blood biomarkers using proteomics and RNA sequencing. RESULTS We identified 57 differentially expressed proteins (DEPs) in lesional psoriasis and 64 DEPs in lesional HS skin, compared to healthy controls. Both HS and psoriasis lesional skin demonstrated a significant upregulation of T helper 1 and T helper 17 proteins. Healthy-appearing perilesional HS skin had 63 DEPs compared to healthy controls. Nonlesional HS and psoriasis skin had 24 and 7 DEPs, respectively, compared to healthy controls. Tumor necrosis factor and 8 other proteins were significantly correlated with clinical severity in perilesional HS skin (2 cm from a nodule). LIMITATIONS Inclusion of only moderate-to-severe patients and the cohort size. CONCLUSION HS has a greater inflammatory profile and is more diffusely distributed compared with psoriasis. Proteins correlated with disease severity are potential disease mediators. Perilesional skin is comparably inflamed to lesional skin, suggesting the need to treat beyond skin nodules.
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Affiliation(s)
- Kristina Navrazhina
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York; Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York
| | - Sandra Garcet
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - John W Frew
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Xiuzhong Zheng
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Israel Coats
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York.
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36
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Der Sarkissian S, Hessam S, Kirby JS, Lowes MA, Mintoff D, Naik HB, Ring HC, Suyien NC, Frew JW. Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review. JAMA Dermatol 2022; 158:300-313. [PMID: 35044423 DOI: 10.1001/jamadermatol.2021.4926] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. Objective To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. Evidence Review Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. Conclusions and Relevance Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
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Affiliation(s)
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco.,Associate Editor, JAMA Dermatology
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nisha Chandran Suyien
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia
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Zouboulis VA, Zouboulis KC, Zouboulis CC. Hidradenitis Suppurativa and Comorbid Disorder Biomarkers, Druggable Genes, New Drugs and Drug Repurposing-A Molecular Meta-Analysis. Pharmaceutics 2021; 14:pharmaceutics14010044. [PMID: 35056940 PMCID: PMC8779519 DOI: 10.3390/pharmaceutics14010044] [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: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
Chronic inflammation and dysregulated epithelial differentiation, especially of hair follicle keratinocytes, have been suggested as the major pathogenetic pathways of hidradenitis suppurativa/acne inversa (HS). On the other hand, obesity and metabolic syndrome have additionally been considered as an important risk factor. With adalimumab, a drug has already been approved and numerous other compounds are in advanced-stage clinical studies. A systematic review was conducted to detect and corroborate HS pathogenetic mechanisms at the molecular level and identify HS molecular markers. The obtained data were used to confirm studied and off-label administered drugs and to identify additional compounds for drug repurposing. A robust, strongly associated group of HS biomarkers was detected. The triad of HS pathogenesis, namely upregulated inflammation, altered epithelial differentiation and dysregulated metabolism/hormone signaling was confirmed, the molecular association of HS with certain comorbid disorders, such as inflammatory bowel disease, arthritis, type I diabetes mellitus and lipids/atherosclerosis/adipogenesis was verified and common biomarkers were identified. The molecular suitability of compounds in clinical studies was confirmed and 31 potential HS repurposing drugs, among them 10 drugs already launched for other disorders, were detected. This systematic review provides evidence for the importance of molecular studies to advance the knowledge regarding pathogenesis, future treatment and biomarker-supported clinical course follow-up in HS.
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Affiliation(s)
- Viktor A. Zouboulis
- Faculty of Medicine, Universitaetsklinikum Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany;
| | - Konstantin C. Zouboulis
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH) Zurich, 8092 Zurich, Switzerland;
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
- Correspondence: ; Tel.: +49-340-5014000
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Hidradenitis Suppurativa: Host-Microbe and Immune Pathogenesis Underlie Important Future Directions. JID INNOVATIONS 2021; 1:100001. [PMID: 34909706 PMCID: PMC8659377 DOI: 10.1016/j.xjidi.2021.100001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disease of the skin with a chronic, relapsing-remitting course. The pathogenesis of the disease is poorly understood and involves multiple factors, including genetics, environment, host-microbe interactions, and immune dysregulation. In particular, the composition of the cutaneous microbiome shifts as the disease progresses, although it is unclear whether this is a primary or secondary process. Trials with immunomodulatory therapy elucidate the role of specific immune pathways and cytokine signaling in disease mechanism, such as TNF-α, IL-1β, IL-12, IL-17, IL-23, and complement. Future studies should continue examining the causes of and contributing factors to microbial changes and immune dysregulation in HS pathogenesis.
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Key Words
- AMP, antimicrobial peptide
- BD, β-defensin
- BMI, body mass index
- DC, dendritic cell
- DCD, dermcidin
- GSC, γ-secretase complex
- HS, hidradenitis suppurativa
- HiSCR, hidradenitis suppurativa clinical response
- IBD, inflammatory bowel disease
- IHS4, International Hidradenitis Suppurativa Severity Score System
- KC, keratinocyte
- MMP, matrix metalloproteinase
- NET, neutrophil extracellular traps
- NMSC, nonmelanoma skin cancer
- PG, pyoderma gangrenosum
- RCT, randomized controlled trial
- SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis
- TLR, toll-like receptor
- Th, T helper type
- iNOS, inducible nitric oxide synthase
- pDC, plasmacytoid dendritic cell
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Dajnoki Z, Somogyi O, Medgyesi B, Jenei A, Szabó L, Gáspár K, Hendrik Z, Gergely P, Imre D, Póliska S, Törőcsik D, Zouboulis CC, Prens EP, Kapitány A, Szegedi A. Primary alterations during the development of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2021; 36:462-471. [PMID: 34724272 PMCID: PMC9298903 DOI: 10.1111/jdv.17779] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/02/2021] [Indexed: 12/01/2022]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory disease of the apocrine gland‐rich (AGR) skin region. The initial steps of disease development are not fully understood, despite intense investigations into immune alterations in lesional HS skin. Objectives We aimed to systematically investigate the inflammatory molecules involved in three stages of HS pathogenesis, including healthy AGR, non‐lesional HS and lesional HS skin, with the parallel application of multiple mRNA and protein‐based methods. Methods Immune cell counts (T cells, dendritic cells, macrophages), Th1/Th17‐related molecules (IL‐12B, TBX21, IFNG, TNFA, IL‐17, IL10, IL‐23A, TGFB1, RORC, CCL20), keratinocyte‐related sensors (TLR2,4), mediators (S100A7, S100A8, S100A9, DEFB4B, LCN2, CAMP, CCL2) and pro‐inflammatory molecules (IL1B, IL6, TNFA, IL‐23A) were investigated in the three groups by RNASeq, RT‐qPCR, immunohistochemistry and immunofluorescence. Results Epidermal changes were already detectable in non‐lesional HS skin; the epidermal occurrence of antimicrobial peptides (AMPs), IL‐1β, TNF‐α and IL‐23 was highly upregulated compared with healthy AGR skin. In lesional HS epidermis, TNF‐α and IL‐1β expression remained at high levels while AMPs and IL‐23 increased even more compared with non‐lesional skin. In the dermis of non‐lesional HS skin, signs of inflammation were barely detectable (vs. AGR), while in the lesional dermis, the number of inflammatory cells and Th1/Th17‐related mediators were significantly elevated. Conclusions Our findings that non‐lesional HS epidermal keratinocytes produce not only AMPs and IL‐1β but also high levels of TNF‐α and IL‐23 confirm the driver role of keratinocytes in HS pathogenesis and highlight the possible role of keratinocytes in the transformation of non‐inflammatory Th17 cells (of healthy AGR skin) into inflammatory cells (of HS) via the production of these mediators. The fact that epidermal TNF‐α and IL‐23 appear also in non‐lesional HS seems to prove these cytokines as excellent therapeutic targets.
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Affiliation(s)
- Z Dajnoki
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - O Somogyi
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - B Medgyesi
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - A Jenei
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - L Szabó
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Clinical Immunology and Allergology, University of Debrecen, Debrecen, Hungary
| | - K Gáspár
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Z Hendrik
- Department of Forensic Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - P Gergely
- Department of Forensic Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - D Imre
- Department of Pathology, Hetényi Géza County Hospital, Szolnok, Hungary
| | - S Póliska
- Genomic Medicine and Bioinformatics Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - D Törőcsik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - C C Zouboulis
- Genomic Medicine and Bioinformatics Core Facility, Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - E P Prens
- Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - A Kapitány
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A Szegedi
- Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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40
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Chu CB, Yang CC, Tsai SJ. Hidradenitis suppurativa: Disease pathophysiology and sex hormones. CHINESE J PHYSIOL 2021; 64:257-265. [PMID: 34975118 DOI: 10.4103/cjp.cjp_67_21] [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] [Indexed: 12/14/2022] Open
Abstract
Hidradenitis suppurativa is a cutaneous chronic inflammatory disease that is estimated to affect about 1% of the population and caused pain, malodorous discharge, disfigurement, and poor quality of life with psychosocial problems. The typical features are recurrent painful nodules, abscesses, and sinus tracts on the axillae, groins, gluteal areas, and anogenital regions since postpuberty. Smoking and obesity are two major triggering factors of hidradenitis suppurativa. Women are prone to have hidradenitis suppurativa than men in Western countries, but the male-to-female ratio is reversed in oriental countries. The disease severity can be affected by menstruation, pregnancy, and menopause. Furthermore, the phenotypes are different among men and women with hidradenitis suppurativa. Men are prone to have buttock involvement while women are prone to have axillary, groins, and submammary lesions. This review introduces the skin appendages and pathophysiology of hidradenitis suppurativa and then focuses on the sex difference and the effects of sex hormones on hidradenitis suppurativa and current hormone-associated treatments.
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Affiliation(s)
- Chia-Bao Chu
- Department of Dermatology, National Cheng Kung University Hospital; Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chao-Chun Yang
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine; International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | - Shaw-Jenq Tsai
- Institute of Basic Medical Sciences, College of Medicine; Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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41
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Federico A, Rossi A, Caro G, Magri F, Muscianese M, Di Fraia M, Carlesimo M. Are dissecting cellulitis and hidradenitis suppurativa different diseases? Clin Dermatol 2021; 39:496-499. [PMID: 34518010 DOI: 10.1016/j.clindermatol.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although dissecting cellulitis (DC) and hidradenitis suppurativa (HS) are classified separately, they share many clinical, dermatoscopic, pathogenetic, and histologic aspects, as well as therapeutic options. The association between DC, HS, and acne conglobata represents the follicular occlusion triad or follicular occlusion tetrad, which may include a pilonidal sinus. DC, also known as "folliculitis et perifolliculitis capitis abscendes et suffoidens," is classified as a secondary cicatricial and neutrophilic alopecia. It occurs with perifolliculitis of the scalp, dermal abscesses, sinus tract development, and secondary scarring alopecia. HS, sometimes known as acne inversa, is a chronic relapsing inflammatory disease afflicting apocrine gland-rich areas of the body with painful nodules and abscesses, sinus tracts, and scarring. Given the overlap between the clinical features and the pathogenesis of DC and HS, it would be more appropriate to consider these conditions as two different localizations of the same disease rather than two different pathologies, being a follicular occlusion disease occurring on the scalp and on the apocrine gland-rich areas of the body.
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Affiliation(s)
- Alessandro Federico
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
| | - Alfredo Rossi
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gemma Caro
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Magri
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marta Muscianese
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Di Fraia
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marta Carlesimo
- Dermatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Yao Y, Frew JW, Thomsen SF, Ring HC. Antimicrobial peptides in hidradenitis suppurativa: a systematic review. Br J Dermatol 2021; 186:236-244. [PMID: 34498267 DOI: 10.1111/bjd.20750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease of the hair follicle defined by recurrent nodules, tunnels and scarring involving the intertriginous regions. HS is associated with microbial dysbiosis and immune dysregulation. In HS, an increasing number of studies have investigated antimicrobial peptides (AMPs). OBJECTIVES To provide an overview of the literature on AMPs in HS, and to discuss the potential role of AMPs in the pathogenesis of HS. METHODS PubMed, Embase and the Cochrane Library were searched. The titles, abstracts and full texts of all articles were manually screened. Additionally, the reference lists of the included articles were screened and hand searched for relevant studies. RESULTS The final literature sample comprised 18 retrospective and prospective studies (no reviews or commentaries) published between 2009 and 2020. CONCLUSIONS This review demonstrates the multitude of AMPs in HS. Although the methodology of the studies varied, the included studies indicate a consistent overexpression of human β-defensin (hBD)-2, S100A7, S100A8 and S100A9 at both the mRNA and protein levels, and a decreased expression of hBD-1. Overall, the studies point to a dysregulation of AMPs in both lesional and nonlesional HS skin.
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Affiliation(s)
- Y Yao
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - J W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Dermatology Research Group, Ingham Institute of Applied Medical Research, Sydney, Australia
| | - S F Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H C Ring
- Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
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43
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Rosi E, Fastame MT, Scandagli I, Di Cesare A, Ricceri F, Pimpinelli N, Prignano F. Insights into the Pathogenesis of HS and Therapeutical Approaches. Biomedicines 2021; 9:1168. [PMID: 34572354 PMCID: PMC8467309 DOI: 10.3390/biomedicines9091168] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, (auto)inflammatory disease primarily affecting apocrine gland-rich areas of the body. Although pathogenic mechanisms responsible for HS have not yet been fully elucidated, it is a multifactorial process whose main target is the terminal follicle. The role of the inflammatory process (and consequently of cytokine milieu) and of several other factors (genetics, lifestyle, hormonal status, microbiome, innate and adaptive immune systems) involved in HS pathogenesis has been investigated (and often defined) over the years with a view to transferring research results from bench to bedside and describing a unique and universally accepted pathogenetic model. This review will update readers on recent advances in our understanding of HS pathogenesis and novel (potential) medical therapies for patients with moderate-to-severe HS.
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Affiliation(s)
| | | | | | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy; (E.R.); (M.T.F.); (I.S.); (A.D.C.); (F.R.); (N.P.)
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44
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Johnston DGW, Kirby B, Tobin DJ. Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction? Exp Dermatol 2021; 30:1554-1568. [PMID: 34418166 DOI: 10.1111/exd.14451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The innate immune system of human skin consists of a multi-layered barrier consisting of cells and soluble effector molecules charged with maintaining homeostasis and responding to insults and infections. It has become increasingly clear that these barrier layers become compromised in skin diseases, especially in disorders of an (auto)inflammatory nature. In the case of hidradenitis suppurativa, great strides have been made in recent years in characterizing the underlying breakdown in homeostatic innate immunity, including an increasing understanding of the central role of the hair follicle in this process. This breakdown appears to occur at multiple levels: the pilosebaceous unit, associated epithelium, the cutaneous microbiome, alteration of immune cell function and local molecular events such as complement activation. This review seeks to summarize, contextualize and analyse critically our current understanding of how these innate immune barriers become dysregulated in the early stage(s) of hidradenitis suppurativa, and to speculate on where potential hidradenitis suppurativa research could be most fruitful.
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Affiliation(s)
- Daniel G W Johnston
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Brian Kirby
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,The Conway Institute, University College Dublin, Dublin 4, Ireland
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45
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Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells 2021; 10:cells10082094. [PMID: 34440863 PMCID: PMC8392140 DOI: 10.3390/cells10082094] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
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46
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Kashetsky N, Mufti A, Alabdulrazzaq S, Lytvyn Y, Sachdeva M, Rahat A, Yeung J. Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg 2021; 26:79-86. [PMID: 34365863 DOI: 10.1177/12034754211035667] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The IL-17 pathway is a potential therapeutic target shown to be implicated in hidradenitis suppurativa (HS), however, it remains unclear whether evidence from mechanistic studies may translate into clinical practice. This systematic review summarizes available treatment outcomes of IL-17 inhibitors in patients with HS. Embase, MEDLINE, PubMed, and clinicaltrials.gov were comprehensively searched on February 26, 2021 to include 16 original studies representing 128 patients with HS (mean age: 36.5 years; age range: 21-47 years; male: 50.0%). Treatment outcomes were reported for the following biologics: secukinumab (n = 105), brodalumab (n = 22), and ixekizumab (n = 1). Patients were classified as responders or non-responders according to achievement of a positive response/improvement based on criteria established for each included study. For secukinumab 57.1% (n = 60/105) of patients were responders in a mean response period of 16.2 weeks and 42.9% (n = 45/105) were non-responders; for brodalumab, 100.0% (n = 22/22) of patients were responders within 4.4 weeks; and the one patient treated with ixekizumab was a responder within 10 weeks. In conclusion, IL-17 inhibitors may serve as an effective therapeutic target in approximately two-thirds of patients with HS and can be considered in those who are refractory to other treatment modalities. We also stress the importance of consistent outcome measures to enhance evidence synthesis, decrease reporting bias, provide potential for future meta-analysis, and ultimately improve clinical outcomes for patients with HS.
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Affiliation(s)
- Nadia Kashetsky
- 7512 Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Asfandyar Mufti
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Yuliya Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Jensen Yeung
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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47
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Vellaichamy G, Dimitrion P, Zhou L, Ozog D, Lim HW, Liao W, Hamzavi IH, Mi QS. Insights from γ-Secretase: Functional Genetics of Hidradenitis Suppurativa. J Invest Dermatol 2021; 141:1888-1896. [PMID: 33836848 PMCID: PMC8316262 DOI: 10.1016/j.jid.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/18/2021] [Accepted: 01/31/2021] [Indexed: 01/09/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, relapsing, and remitting inflammatory disease of the skin with significant heritability and racial disposition. The pathogenesis of HS remains enigmatic, but occlusion of the terminal hair follicle and dysregulation of the local innate immune response may contribute to pathogenesis. Genetic predisposition might also contribute to disease susceptibility and phenotypic heterogeneity because mutations in γ-secretase have been found to underlie a minor but characteristic subset of patients with HS. In this review, we synthesized the current data on γ-secretase in HS, evaluated its importance in the context of disease pathobiology, and discussed avenues of future studies.
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Affiliation(s)
- Gautham Vellaichamy
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, USA
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, USA; Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, USA; Wayne State University School of Medicine, Detroit, Michigan, USA; Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
| | - David Ozog
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Henry W Lim
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Iltefat H Hamzavi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, USA; Wayne State University School of Medicine, Detroit, Michigan, USA; Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA.
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48
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Nikolakis G, Kokolakis G, Kaleta K, Wolk K, Hunger R, Sabat R, Zouboulis CC. [Pathogenesis of hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:658-665. [PMID: 34228138 DOI: 10.1007/s00105-021-04853-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis. In addition to a sporadic form, a familial form is reported in around 40% of patients, for whom an autosomal dominant (AD) inheritance with reduced gene penetrance is assumed. The phenotype of the disease with inflammatory nodules, abscesses and secreting sinus tracts suggests an infectious origin, but the exact role of the bacteria detected in HS pathogenesis remains unclear. Smoking and metabolic syndrome are regarded as important trigger factors in HS, with obesity and hormonal changes playing a pathogenic role in the latter. Ultimately, Toll-like receptors, antimicrobial peptides, immune cells and key cytokines are involved in the excessive inflammatory reaction of HS and are also the targets of future therapies.
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Affiliation(s)
- G Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland. .,European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.
| | - G Kokolakis
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - K Kaleta
- Klinik für Dermatologie und Venerologie, Jagiellonen-Universität, Krakow, Polen
| | - K Wolk
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - R Hunger
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Klinik für Dermatologie, Inselspital, Bern Universitätsklinikum, Bern Universität, Bern, Schweiz
| | - R Sabat
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland.,European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland
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49
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[Clinical, pathology-associated and molecular biomarkers of hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:666-675. [PMID: 34213572 DOI: 10.1007/s00105-021-04848-8] [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: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Hidradenitis suppurativa/acne inversa is a scarring disease of the intertrigines that is now intensively researched. Improved pathogenetic understanding has led to the introduction of tumor necrosis factor alpha (TNF‑α) inhibition, which represents a major advance over traditional broad immunosuppression and antibiotic administration. In addition, a wide range of newer and promising treatments is or is about to be clinically evaluated. These include various specific antibodies against cytokines and the complement system and small molecules. Successful use of the individual drugs depends on the stratification of suitable patient groups with the help of clinically relevant biomarkers. While molecular investigations have shown a number of possible biomarkers and/or therapeutic target molecules, the detection of robust predictive biomarkers is still in its initial phase. In summary, the therapeutic options for hidradenitis suppurativa/acne inversa are improving through the introduction of new drugs, possibly in combination with surgical interventions, whereby the possibilities for predictive therapeutic decisions through the discovery of biomarkers would revolutionize the chances of therapeutic success.
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50
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Schell SL, Schneider AM, Nelson AM. Yin and Yang: A disrupted skin microbiome and an aberrant host immune response in hidradenitis suppurativa. Exp Dermatol 2021; 30:1453-1470. [PMID: 34018644 DOI: 10.1111/exd.14398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/03/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
The skin microbiome plays an important role in maintaining skin homeostasis by controlling inflammation, providing immune education and maintaining host defense. However, in many inflammatory skin disorders the skin microbiome is disrupted. This dysbiotic community may contribute to disease initiation or exacerbation through the induction of aberrant immune responses in the absence of infection. Hidradenitis suppurativa (HS) is a complex, multifaceted disease involving the skin, innate and adaptive immunity, microbiota and environmental stimuli. Herein, we discuss the current state of HS skin microbiome research and how microbiome components may activate pattern recognition receptor (PRR) pathways, metabolite sensing pathways and antigenic receptors to drive antimicrobial peptide, cytokine, miRNA and adaptive immune cell responses in HS. We highlight the major open questions that remain to be addressed and how antibiotic therapies for HS likely influence both microbial burden and inflammation. Ultimately, we hypothesize that the two-way communication between the skin microbiome and host immune response in HS skin generates a chronic positive feed-forward loop that perpetuates chronic inflammation, tissue destruction and disease exacerbation.
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Affiliation(s)
- Stephanie L Schell
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Andrea M Schneider
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Amanda M Nelson
- Department of Dermatology, Penn State Health Hershey Medical Center, Hershey, PA, USA
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