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Vafaeian A, Mahmoudi H, Daneshpazhooh M. What is novel in the clinical management of pemphigus vulgaris? Expert Rev Clin Pharmacol 2024; 17:489-503. [PMID: 38712540 DOI: 10.1080/17512433.2024.2350943] [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: 02/17/2024] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Pemphigus, an uncommon autoimmune blistering disorder affecting the skin and mucous membranes, currently with mortality primarily attributed to adverse reactions resulting from treatment protocols. Additionally, the existing treatments exhibit a notable recurrence rate. The high incidence of relapse and the considerable adverse effects associated with treatment underscore the imperative to explore safer and more effective therapeutic approaches. Numerous potential therapeutic targets have demonstrated promising outcomes in trials or preliminary research stages. These encompass anti-CD-20 agents, anti-CD-25 agents, TNF-α inhibition, FAS Ligand Inhibition, FcRn inhibition, BAFF inhibition, Bruton's tyrosine kinase (BTK) inhibition, CAAR T Cells, JAK inhibition, mTOR inhibition, abatacept, IL-4 inhibition, IL-17 inhibition, IL-6 inhibition, polyclonal Regulatory T Cells, and autologous hematopoietic stem cell transplantation. AREAS COVERED The most significant studies regarding the impact and efficacy of the mentioned treatments on pemphigus were meticulously curated through a comprehensive search conducted on the PubMed database. Moreover, the investigations of interest cited in these studies were also integrated. EXPERT OPINION The efficacy and safety profiles of the other treatments under discussion do not exhibit the same level of robustness as anti-CD20 therapy, which is anticipated to endure as a critical element in pemphigus treatment well into the foreseeable future.
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Affiliation(s)
- Ahmad Vafaeian
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Mahmoudi
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Daneshpazhooh
- Autoimmune Bullous Diseases Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Dar SA, Das S, Hakami MA, Akhter N, Mustafa M, Jawed A, Bhattacharya SN, Banerjee BD, Ahmad A. Organochlorine pesticides disrupt T helper cell regulation and reduce IL-2 and IFN-γ favoring infection and production of autoantibodies among pemphigus patients. Toxicol In Vitro 2024; 95:105764. [PMID: 38101492 DOI: 10.1016/j.tiv.2023.105764] [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: 08/25/2023] [Revised: 11/19/2023] [Accepted: 12/10/2023] [Indexed: 12/17/2023]
Abstract
The list of environmental factors that trigger autoimmune diseases in genetically susceptible individuals has grown in the recent years and is far from complete. The possible intervention of the environment in triggering these diseases is ever more perceived by the clinicians. This study investigated the effect of environmental factors like organochlorine pesticides (OCPs) on proportions of different T lymphocyte subsets and their cytokine secretion in-vitro among pemphigus patients, before and after specific immunosuppressive therapy. Higher levels of OCPs like β-HCH (isoform of hexachlorohexane), α-endosulfan (a form of endosulfan) and p,p΄-DDE (a metabolite of o,p'-dichlorodiphenyltrichloroethane) were observed in the blood of pemphigus patients as compared to healthy controls. HCH and DDT exposure caused specific reduction in CD8+CD45RA+ and CD4+CD25+ T lymphocyte subpopulations in these patient PBMCs. A strong reduction in Th1 (IL-2 and IFN-γ) cytokines upon exposure to these OCPs in-vitro was also observed. These findings indicate that HCH and DDT have a significant impact on Th1 lymphocytes. Impaired production of these cytokines might favor infections and production of autoantibodies. We therefore speculate that the systemic absorption of the pesticide after the topical contact may be one of the factors triggering the immunological mechanism among pemphigus patients.
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Affiliation(s)
- Sajad Ahmad Dar
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi 110095, India; Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia.
| | - Shukla Das
- Department of Microbiology, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi 110095, India
| | - Mohammed Ageeli Hakami
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Shaqra University, Al- Quwayiyah 19254, Riyadh, Saudi Arabia
| | - Naseem Akhter
- Department of Biology, Arizona State University, Lake Havasu City, AZ 86403, USA
| | - Mohammad Mustafa
- Scientific Research Centre, Prince Sultan Military Medical City, Riyadh 12486, Saudi Arabia
| | - Arshad Jawed
- Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan 45142, Saudi Arabia
| | - Sambit Nath Bhattacharya
- Department of Dermatology & STD, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi 110095, India
| | - Basu Dev Banerjee
- Department of Biochemistry, University College of Medical Sciences (University of Delhi) & Guru Teg Bahadur Hospital, Delhi 110095, India
| | - Abrar Ahmad
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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Jordan SC, Balzer B, Nast C, Atienza J, Lim K, Kumar S, Nissen N, Shin B. Linear IgA bullous dermatosis and elevated bullous interleukin-6 levels: Responsive to treatment with Anti-IL-6 receptor monoclonals. Clin Case Rep 2023; 11:e6998. [PMID: 36860726 PMCID: PMC9969760 DOI: 10.1002/ccr3.6998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 03/03/2023] Open
Abstract
Linear IgA bullous dermatosis (LABD) is a rare autoimmune/inflammatory skin condition. Here, we report on a patient who developed treatment resistant LABD. At diagnosis, elevations of IL-6 and C-reactive protein in the blood and extreme elevations of IL-6 in LABD bullous fluid were seen. The patient responded well to tocilizumab (anti-IL-6 receptor) treatment.
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Affiliation(s)
- Stanley C. Jordan
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA,Transplantation & Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Bonnie Balzer
- Department of Pathology & Laboratory MedicineCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Cynthia Nast
- Department of Pathology & Laboratory MedicineCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Janet Atienza
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Katherine Lim
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Sanjeev Kumar
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Nicholas Nissen
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
| | - Bongha Shin
- Comprehensive Transplant CenterCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA,Transplantation & Immunology LaboratoryCedars‐Sinai Medical CenterLos AngelesCaliforniaUSA
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Bumiller-Bini Hoch V, Schneider L, Pumpe AE, Lüders E, Hundt JE, Boldt ABW. Marked to Die-Cell Death Mechanisms for Keratinocyte Acantholysis in Pemphigus Diseases. Life (Basel) 2022; 12:life12030329. [PMID: 35330080 PMCID: PMC8948972 DOI: 10.3390/life12030329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
Pemphigus is a group of blistering autoimmune diseases causing painful skin lesions, characterized by acantholysis and by the production of autoantibodies against, mainly, adhesion proteins. We reviewed the literature for molecules and/ or features involved in the 12 cell death pathways described by Nomenclature Committee on Cell Death, taking place in pemphigus patients, cell lines, or human skin organ cultures treated with sera or IgG from pemphigus patients or in pemphigus mouse models, and found 61 studies mentioning 97 molecules involved in cell death pathways. Among the molecules, most investigated were pleiotropic molecules such as TNF and CASP3, followed by FASL and CASP8, and then by FAS, BAX, BCL2, and TP53, all involved in more than one pathway but interpreted to function only within apoptosis. Most of these previous investigations focused only on apoptosis, but four recent studies, using TUNEL assays and/or electron microscopy, disqualified this pathway as a previous event of acantholysis. For PV, apoptolysis was suggested as a cell death mechanism based on pathogenic autoantibodies diversity, mitochondrial dysfunction, and p38 MAPK signaling. To answer those many questions that remain on cell death and pemphigus, we propose well-controlled, statistically relevant investigations on pemphigus and cell death pathways besides apoptosis, to overcome the challenges of understanding the etiopathology of pemphigus diseases.
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Affiliation(s)
- Valéria Bumiller-Bini Hoch
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba 81531-980, Brazil; (V.B.-B.H.); (L.S.)
- Postgraduate Program in Genetics, Department of Genetics, Federal University of Paraná (UFPR), Curitiba 81531-980, Brazil
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany; (A.E.P.); (E.L.); (J.E.H.)
| | - Larissa Schneider
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba 81531-980, Brazil; (V.B.-B.H.); (L.S.)
| | - Anna Elisabeth Pumpe
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany; (A.E.P.); (E.L.); (J.E.H.)
| | - Emelie Lüders
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany; (A.E.P.); (E.L.); (J.E.H.)
| | - Jennifer Elisabeth Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23562 Lübeck, Germany; (A.E.P.); (E.L.); (J.E.H.)
| | - Angelica Beate Winter Boldt
- Laboratory of Human Molecular Genetics, Department of Genetics, Federal University of Paraná, Curitiba 81531-980, Brazil; (V.B.-B.H.); (L.S.)
- Correspondence:
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SAVOIA F, TABANELLI M, SECHI A, BARALDI C, BARDAZZI F, PATRIZI A. Etanercept for pemphigus vulgaris. Ital J Dermatol Venerol 2022; 156:10-11. [DOI: 10.23736/s2784-8671.18.06204-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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6
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Raef HS, Piedra-Mora C, Wong NB, Ma DJ, David CN, Robinson NA, Almela RM, Richmond JM. Gene Expression Analysis in Four Dogs With Canine Pemphigus Clinical Subtypes Reveals B Cell Signatures and Immune Activation Pathways Similar to Human Disease. Front Med (Lausanne) 2021; 8:723982. [PMID: 34660634 PMCID: PMC8511432 DOI: 10.3389/fmed.2021.723982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Pemphigus is a group of autoimmune-mediated mucocutaneous blistering diseases characterized by acantholysis. Pemphigus has also been recognized in dogs and shares similar clinical characteristics and variants with human pemphigus. While relationships between human and canine pemphigus have been reported, gene expression patterns across species have not been described in the literature. We sought to perform gene expression analysis of lesional skin tissue from four dogs with various forms of pemphigus to examine gene expression during spontaneous disease in dogs. We found increased T and B cell signatures in canine pemphigus lesions compared to controls, as well as significant upregulation of CCL3, CCL4, CXCL10, and CXCL8 (IL8), among other genes. Similar chemokine/cytokine expression patterns and immune infiltrates have been reported in humans, suggesting that these genes play a role in spontaneous disease. Direct comparison of our dataset to previously published human pemphigus datasets revealed five conserved differentially expressed genes: CD19, WIF1, CXCL10, CD86, and S100A12. Our data expands our understanding of pemphigus and facilitates identification of biomarkers for prediction of disease prognosis and treatment response, which may be useful for future veterinary and human clinical trials.
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Affiliation(s)
- Haya S Raef
- Department of Dermatology, UMass Medical School, Worcester, MA, United States.,Tufts University School of Medicine, Boston, MA, United States
| | - Cesar Piedra-Mora
- Clinical Sciences Department, Tufts Cummings School of Veterinary Medicine, Grafton, MA, United States
| | - Neil B Wong
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
| | - Diana Junyue Ma
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
| | | | - Nicholas A Robinson
- Clinical Sciences Department, Tufts Cummings School of Veterinary Medicine, Grafton, MA, United States
| | - Ramón M Almela
- Clinical Sciences Department, Tufts Cummings School of Veterinary Medicine, Grafton, MA, United States
| | - Jillian M Richmond
- Department of Dermatology, UMass Medical School, Worcester, MA, United States
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Bax CE, Chakka S, Concha JSS, Zeidi M, Werth VP. The effects of immunostimulatory herbal supplements on autoimmune skin diseases. J Am Acad Dermatol 2021; 84:1051-1058. [PMID: 32553683 PMCID: PMC7736300 DOI: 10.1016/j.jaad.2020.06.037] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/24/2022]
Abstract
The use of herbal supplements that promise to improve immune health has gained popularity among dermatology patients. However, there is little to no evidence that herbal supplements improve dermatologic conditions. Several in vitro and in vivo studies have shown that Spirulina platensis, Aphanizomenon flos-aqua, Chlorella, Echinacea, and alfalfa activate immune cells via certain cytokines and chemokines. Case reports suggest the association of ingesting immunostimulatory herbs and the clinical onset or flares of diseases characterized by an exaggerated immune response such as lupus erythematosus, dermatomyositis, and autoimmune blistering disorders. Therefore, it is imperative to investigate the prevalence of herbal supplement use in this patient population. In addition, in vitro studies should examine the underlying mechanisms by which herbs stimulate immune pathways that are already overactive in autoimmune patients.
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Affiliation(s)
- Christina E Bax
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Department of Dermatology, University of Pennsylvania
| | - Srita Chakka
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Department of Dermatology, University of Pennsylvania
| | - Josef Symon S Concha
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Department of Dermatology, University of Pennsylvania
| | - Majid Zeidi
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Department of Dermatology, University of Pennsylvania
| | - Victoria P Werth
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and the Department of Dermatology, University of Pennsylvania.
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8
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Scarsella L, Pollmann R, Amber KT. Autoreactive T cells in pemphigus: perpetrator and target. Ital J Dermatol Venerol 2020; 156:124-133. [PMID: 33179878 DOI: 10.23736/s2784-8671.20.06706-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pemphigus vulgaris (PV) is an autoimmune blistering disease, in which autoantibodies against epidermal cadherins, such as desmoglein (Dsg)1 and Dsg3, lead to the development of blisters and erosions on the skin and mucous membranes. Autoreactive CD4+ T cells are essential for the induction and perpetuation of the disease by interaction with B cells producing autoantibodies. PV has a strong genetic association with certain human leucocyte antigen (HLA) alleles with HLA-DRB1*04:02 and LA-DQB1*05:03 being the most prevalent in patients. Recently, genome-wide association studies have provided a new approach to identify single nucleotide polymorphisms, alongside the known association with HLA alleles. Loss of tolerance against Dsgs and other autoantigens is a critical event in the pathogenesis of PV. Epitope spreading contributes to the progression of PV, leading to an extension of the Dsg-specific autoimmune response to other molecular epitopes of autoantigens, such as desmocollins or muscarinic receptors. Alterations in CD4+CD25+ FoxP3+ regulatory T cells are thought to contribute to the development of PV representing a suitable target for therapeutic interventions. Several CD4+ T-cell subsets and cytokines are involved in the pathogenesis of PV, while Th2 cells are the extensively studied population. Recently, other T cell subsets like T follicular helper cells and Th17 have gained attention as new potential players in PV pathogenesis. The involvement of local autoantibody production in the lesional skin of PV patients in tertiary lymphoid organs is currently discussed but not yet clarified. In this study, we reviewed the current knowledge about the development, characteristics and function of autoreactive T cells in pemphigus and present current new T cell-targeted therapeutic approaches.
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Affiliation(s)
- Luca Scarsella
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Robert Pollmann
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany -
| | - Kyle T Amber
- Department of Dermatology, University of Illinois, Chicago, IL, USA
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Kaya Erdogan H, Yuksel Canakci N, Acer E, Korkmaz C, Yılmaz E, Saracoglu ZN. Successful treatment of pemphigus foliaceous and ankylosing spondylitis with infliximab and methotrexate: A case report. Dermatol Ther 2020; 33:e13801. [PMID: 32520405 DOI: 10.1111/dth.13801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hilal Kaya Erdogan
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Nihan Yuksel Canakci
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Ersoy Acer
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Cengiz Korkmaz
- Department of Internal Medicine, Division of Rheumatology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Evrim Yılmaz
- Department of Pathology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Zeynep Nurhan Saracoglu
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
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Pathogenic and protective roles of cytokines in pemphigus: A systematic review. Cytokine 2020; 129:155026. [DOI: 10.1016/j.cyto.2020.155026] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/02/2020] [Accepted: 01/31/2020] [Indexed: 12/23/2022]
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Autoimmune bullous skin diseases, pemphigus and pemphigoid. J Allergy Clin Immunol 2020; 145:1031-1047. [DOI: 10.1016/j.jaci.2020.02.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
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Grando SA, Rigas M, Chernyavsky A. Rationale for including intravenous immunoglobulin in the multidrug protocol of curative treatment of pemphigus vulgaris and development of an assay predicting disease relapse. Int Immunopharmacol 2020; 82:106385. [PMID: 32172211 DOI: 10.1016/j.intimp.2020.106385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/29/2022]
Abstract
Analysis of reported outcomes of treatment of pemphigus vulgaris (PV) patients demonstrated that the multidrug approach offers a lower relapse rate compared to the FDA-approved prednisone/rituximab regimen. The multidrug protocol protects keratinocytes from autoantibody attack by systemic corticosteroids and mitochondrion-protecting drugs, selectively eliminates pathogenic autoantibodies by intravenous immunoglobulin (IVIg) and inhibits autoantibody production by cytotoxic immunosuppressors. Therefore, IVIg should be always added to the prednisone/rituximab regimen that does not eliminate circulating autoantibodies. To decrease risk for relapse to a minimum, PV should be maintained in full clinical remission until the critical mass of autoreactive plasma cells dies off. The two major factors that determine patient's risk for a relapse are the composition of the pool of pathogenic autoantibodies and the innate abilities of keratinocytes to sustain an autoantibody attack. As it is currently impossible to evaluate the risk for a relapse, development of a biomarker assay that could do so would be helpful in a long-term management of PV patients. We compared the magnitude of cytochrome c (CytC) release in keratinocytes by serum from PV patients in acute disease stage vs. remission and identified very strong positive correlation with disease severity. PV patients whose serum contained autoantibodies requiring higher amounts of normal IgG to neutralize their ability to release CytC were found to be at a higher risk for disease relapse. However, lack of very strong statistical correlation suggested that CytC is not an ideal biomarker to predict disease relapse, which should prompt a search for alternative candidates.
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Affiliation(s)
- Sergei A Grando
- Department of Dermatology, University of California Irvine, CA, USA.
| | | | - Alex Chernyavsky
- Department of Dermatology, University of California Irvine, CA, USA
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Cole EF, Sami N, Feldman RJ. Updates on diagnosis and management of autoimmune blistering diseases. GIORN ITAL DERMAT V 2019; 155:46-64. [PMID: 31804056 DOI: 10.23736/s0392-0488.19.06517-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last several decades, advances in the understanding of the pathogenesis of autoimmune blistering diseases has resulted in significant improvements in diagnosis and management. These improvements include new diagnostic assays and therapies targeted at specific disease mediators. Furthermore, the abundance of new therapies in clinic trials for autoimmune blistering diseases will translate to an enhanced therapeutic armamentarium for clinicians. The aim of this article is to review new developments in the understanding of autoimmune blistering diseases and to summarize advancements in their diagnosis and management.
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Affiliation(s)
- Emily F Cole
- Emory Autoimmune Blistering Disease Clinic, Emory Department of Dermatology, Atlanta, GA, USA
| | - Naveed Sami
- Department of Dermatology, University of Central Florida, Orlando, FL, USA -
| | - Ron J Feldman
- Emory Autoimmune Blistering Disease Clinic, Emory Department of Dermatology, Atlanta, GA, USA
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Bilgic A, Murrell DF. What is novel in the clinical management of pemphigus. Expert Rev Clin Pharmacol 2019; 12:973-980. [DOI: 10.1080/17512433.2019.1670059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- A. Bilgic
- Antalya Training and Research Hospital, Dermatology Clinic, University of Health Sciences, Antalya, Turkey
| | - D. F. Murrell
- St George Hospital, Department of Dermatology, University of New South Wales, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Timóteo RP, Sales-Campos H, Silva MV, da Silva DAA, Da Silva Catarino J, de Sousa MAD, Júnior VR, de Andrade E Silva LE, Bittencourt ACS, Carneiro ÉM, Oliveira CJF. Pemphigus foliaceus patients (Fogo Selvagem) treated with kinesiotherapy presented lower levels of proinflammatory cytokines. J Exerc Rehabil 2019; 15:460-467. [PMID: 31316942 PMCID: PMC6614764 DOI: 10.12965/jer.1938146.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/24/2019] [Indexed: 11/27/2022] Open
Abstract
Fogo Selvagem (FS) is a rare autoimmune disease characterized by acantholysis and inflammation of the epidermis. It was evidenced in this disease the increase of proinflammatory cytokines levels which can be influenced by physical activities. Kinesiotherapy, as physiotherapeutic interventions, was associated improvement levels of the quality of live, mainly the pain. Understanding the impact of such methodology in immunology of the FS, may constitute an alternative and effective approach. We compare the levels of serum cytokines and chemokines between nine patients with FS submitted to kinesiotherapy for 12 weeks and ten patients not submitted to kinesiotherapy. The kinesiotherapy was composed by self-stretching followed by a resistance training for upper and lower limbs. The protocol was carried out in three sections of eight to ten repetitions with 70% of the maximum load measured by test maximum of ten repetitions. After strengthening period patients performed a passive stretching. The training sessions lasted 50 min and were performed 3 times a week at least 12 weeks. Cytokines and chemokines were assessed in plasma using enzyme-linked immunosorbent assay and/or cytometric bead array. Patients with FS were being kinesiotherapy presented minors levels of interferon-γ, interleukin (IL)-17, IL-22, and IL-15 when compared to those not submitted to kinesiotherapy. No differences were observed for the detection of the chemokines chemokine ligand (CCL)-2, CCL-3, CCL-5, CCL-11, C-X-C motif chemokine 8 (CXCL-8), and CXCL-10. These results suggest that kinesiotherapy had a positive impact on inflammatory markers that are associated with disease worsening in FS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Élida Mara Carneiro
- Physiotherapy Division (EBSERH/UFTM). Clinical Hospital of Federal University of Triângulo Mineiro, Uberaba, Brazil
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Didona D, Maglie R, Eming R, Hertl M. Pemphigus: Current and Future Therapeutic Strategies. Front Immunol 2019; 10:1418. [PMID: 31293582 PMCID: PMC6603181 DOI: 10.3389/fimmu.2019.01418] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Pemphigus encompasses a heterogeneous group of autoimmune blistering diseases, which affect both mucous membranes and the skin. The disease usually runs a chronic-relapsing course, with a potentially devastating impact on the patients' quality of life. Pemphigus pathogenesis is related to IgG autoantibodies targeting various adhesion molecules in the epidermis, including desmoglein (Dsg) 1 and 3, major components of desmosomes. The pathogenic relevance of such autoantibodies has been largely demonstrated experimentally. IgG autoantibody binding to Dsg results in loss of epidermal keratinocyte adhesion, a phenomenon referred to as acantholysis. This in turn causes intra-epidermal blistering and the clinical appearance of flaccid blisters and erosions at involved sites. Since the advent of glucocorticoids, the overall prognosis of pemphigus has largely improved. However, mortality persists elevated, since long-term use of high dose corticosteroids and adjuvant steroid-sparing immunosuppressants portend a high risk of serious adverse events, especially infections. Recently, rituximab, a chimeric anti CD20 monoclonal antibody which induces B-cell depletion, has been shown to improve patients' survival, as early rituximab use results in higher disease remission rates, long term clinical response and faster prednisone tapering compared to conventional immunosuppressive therapies, leading to its approval as a first line therapy in pemphigus. Other anti B-cell therapies targeting B-cell receptor or downstream molecules are currently tried in clinical studies. More intriguingly, a preliminary study in a preclinical mouse model of pemphigus has shown promise regarding future therapeutic application of Chimeric Autoantibody Receptor T-cells engineered using Dsg domains to selectively target autoreactive B-cells. Conversely, previous studies from our group have demonstrated that B-cell depletion in pemphigus resulted in secondary impairment of T-cell function; this may account for the observed long-term remission following B-cell recovery in rituximab treated patients. Likewise, our data support the critical role of Dsg-specific T-cell clones in orchestrating the inflammatory response and B-cell activation in pemphigus. Monitoring autoreactive T-cells in patients may indeed provide further information on the role of these cells, and would be the starting point for designating therapies aimed at restoring the lost immune tolerance against Dsg. The present review focuses on current advances, unmet challenges and future perspectives of pemphigus management.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Roberto Maglie
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany.,Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy.,Section of Dermatology, Departement of Health Sciences, University of Florence, Florence, Italy
| | - Rüdiger Eming
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
| | - Michael Hertl
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany
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Porro AM, Hans Filho G, Santi CG. Consensus on the treatment of autoimmune bullous dermatoses: pemphigus vulgaris and pemphigus foliaceus - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:20-32. [PMID: 31166407 PMCID: PMC6544031 DOI: 10.1590/abd1806-4841.2019940206] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/30/2019] [Indexed: 02/08/2023] Open
Abstract
Pemphigus are intraepidermal autoimmune bullous dermatoses that occur with
lesions on the skin and / or mucous membranes. The most frequent types are
pemphigus vulgaris and pemphigus foliaceus (classic and endemic). This consensus
aims to present a complete and updated review of the treatment of these two more
frequent forms of pemphigus, based on the literature and the personal experience
of the authors. In moderate and severe cases of pemphigus vulgaris and
foliaceus, systemic corticosteroid therapy (prednisone or prednisolone) is the
treatment of choice. Adjuvant drugs, usually immunosuppressive drugs
(azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide) may be
prescribed as corticosteroid sparers in refractory cases or with
contraindications to corticosteroids to minimize side effects. In severe and
nonresponsive cases, corticosteroids in the form of intravenous pulse therapy,
immunoglobulin and plasmapheresis / immunoadsorption can be administered.
Immunobiological drugs, particularly rituximab, appear as a promising
alternative. For milder cases, smaller doses of oral corticosteroid, dapsone and
topical corticosteroids are options. At the end flowcharts are presented as
suggestions for a therapeutic approach for patients with pemphigus vulgaris and
pemphigus foliaceus.
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Affiliation(s)
- Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Günter Hans Filho
- Dermatology Service, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Claudia Giuli Santi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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18
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Bilgic Temel A, Murrell DF. Pharmacological advances in pemphigus. Curr Opin Pharmacol 2019; 46:44-49. [PMID: 30974409 DOI: 10.1016/j.coph.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/26/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023]
Abstract
This is an updated review of the literature on the emerging therapeutic options for the treatment of pemphigus to provide better care for patients. There is an increasing range of molecules targeted for pemphigus therapy against CD20, Bruton tyrosine kinase, chimeric antigen receptor, T-cell immune components, B-cell activating factor, proliferation-inducing ligand (APRIL), CD25, p38 mitogen-activated protein kinase (p38MAPK) and cytokine modulation therapies (anti-IL-4, anti-IL-6). The main aim of the current new therapies is to provide specific pathology-focused therapeutic options which have long-term sustainable therapeutic effects on disease progress, cause less side effects without systemic immunosuppression, and have less risk of getting antibodies against the medication during treatment.
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Affiliation(s)
- Asli Bilgic Temel
- St George Hospital, UNSW Department of Dermatology, Kogarah, Sydney, NSW 2217, Australia
| | - Dedee F Murrell
- St George Hospital, UNSW Department of Dermatology, Kogarah, Sydney, NSW 2217, Australia.
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Hans-Filho G, Aoki V, Bittner NRH, Bittner GC. Fogo selvagem: endemic pemphigus foliaceus. An Bras Dermatol 2018; 93:638-650. [PMID: 30156612 PMCID: PMC6106655 DOI: 10.1590/abd1806-4841.20188235] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/07/2018] [Indexed: 11/22/2022] Open
Abstract
Fogo selvagem or endemic pemphigus foliaceus is an autoimmune acantholytic anti-cadherin bullous disease that primarily affects seborrheic areas, which might disseminate. Brazil has the world's largest number of patients, mainly in the Central-West region, but the disease has also been reported in other South American countries. It affects young people and adults who have been exposed to rural areas, with occurrence of familial cases. Anti-desmoglein-1 autoantibodies are directed against desmosomal structures, with loss of adhesion of the upper layers of the epidermis, causing superficial blisters. The etiology is multifactorial and includes genetic, immune, and environmental factors, highlighting hematophagous insect bites; drug-related factors are occasionally involved. Flaccid blisters readily rupture to yield erosive-crusty lesions that sometimes resemble seborrheic dermatitis, actinic keratosis, and chronic cutaneous lupus erythematosus. The clinical presentation varies from localized to disseminated lesions. Clinical suspicion should be confirmed with histopathological and immunofluorescence tests, among others. The progression is usually chronic, and therapy varies according to clinical presentation, but generally requires systemic corticosteroid therapy associated with adjuvant immunosuppressive treatment to decrease the adverse effects of corticosteroids. Once the disease is under control, many patients remain stable on low-dose medication, and a significant proportion achieve remission.
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Affiliation(s)
- Günter Hans-Filho
- Department Dermatology, Faculdade de Medicina, Universidade Federal
de Mato Grosso do Sul, Campo Grande (MS), Brazil
- Dermatology Service, Hospital Maria Aparecida Pedrossian,
Universidade Federal de Mato Grosso do Sul, Campo Grande (MS), Brazil
| | - Valéria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de
São Paulo, São Paulo (SP), Brazil
| | - Nelise Ritter Hans Bittner
- Dermatology Service, Hospital Maria Aparecida Pedrossian,
Universidade Federal de Mato Grosso do Sul, Campo Grande (MS), Brazil
| | - Guilherme Canho Bittner
- Dermatology Service, Hospital Maria Aparecida Pedrossian,
Universidade Federal de Mato Grosso do Sul, Campo Grande (MS), Brazil
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20
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Pollmann R, Schmidt T, Eming R, Hertl M. Pemphigus: a Comprehensive Review on Pathogenesis, Clinical Presentation and Novel Therapeutic Approaches. Clin Rev Allergy Immunol 2018; 54:1-25. [DOI: 10.1007/s12016-017-8662-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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21
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Pedroni MN, Hirotsu C, Porro AM, Tufik S, Andersen ML. The role of sleep in pemphigus: a review of mechanisms and perspectives. Arch Dermatol Res 2017; 309:659-664. [PMID: 28726005 DOI: 10.1007/s00403-017-1765-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 07/06/2017] [Accepted: 07/11/2017] [Indexed: 12/25/2022]
Abstract
Pemphigus is an autoimmune bullous disease that causes the development of blisters and erosions on the skin and/or mucosa. Its inflammatory process is mediated by cytokines, which interact with sleep in a bidirectional manner. Pain, a frequent symptom due to pemphigus lesions, is well known to impair sleep quality. Depression is also associated with pemphigus and pro-inflammatory cytokines and may impair sleep. Additionally, a common relationship among other dermatological diseases and sleep has increasingly been described. Poor sleep quality is associated with an increased risk for autoimmune diseases, and insomnia is a comorbidity that has recently been associated with pemphigus. Thus, this review will explore the evidence supporting the likely bidirectional relationship between pemphigus and sleep quality and its possible mechanisms involved. This approach covering both pemphigus and sleep will open a research avenue for future studies focusing on the efficacy of the sleep disorders treatment in patients with pemphigus. In the long term, this may provide relevant information to dermatologists regarding new strategies for the management of pemphigus clinical condition, allowing possibly a better quality of life for the patients.
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Affiliation(s)
- Matheus Negrao Pedroni
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Camila Hirotsu
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Adriana Maria Porro
- Departamento de Dermatologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, Napoleão de Barros, 925, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
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22
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Abstract
Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucous membranes. The mean platelet volume (MPV) is an index of platelet activation reported to be influenced by inflammation. We investigated the MPV in patients with PV relative to controls. This case–control study included 160 patients with PV and 640 age- and sex-matched controls. The MPV, platelet count, and other inflammatory parameters were measured for all study participants. A significantly decreased MPV was observed in patients with PV compared with controls, 9.1 (1.5) fL versus 10.3 (1.4) fL, P < .001. A significant negative association between MPV and PV was demonstrated in multivariate analysis (odds ratio, 0.59; 95% confidence interval, 0.51-0.68, P < .0001). Patients having PV with laryngeal involvement had significantly lower MPVs than those without involvement of the larynx, 8.81 (1.5) fL versus 9.32 (1.4) fL, P = .032. Disease activity (before and after treatment) does not affect the MPV. Patients with PV showed decreased MPV values compared to healthy controls. The MPV may be a feasible diagnostic marker in patients with PV.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, University of Haifa, Haifa, Israel
| | - Wesal Shihade
- Biobank and Unit of Epidemiology, Rambam Health Care Campus, University of Haifa, Haifa, Israel
| | - Shira Zelber-Sagi
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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23
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Lee SH, Hong WJ, Kim SC. Analysis of Serum Cytokine Profile in Pemphigus. Ann Dermatol 2017; 29:438-445. [PMID: 28761292 PMCID: PMC5500709 DOI: 10.5021/ad.2017.29.4.438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/26/2016] [Accepted: 09/29/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pemphigus is a group of autoimmune blistering diseases affecting skin and mucous membranes. While pemphigus is an autoantibody mediated disease, the role of T cells and cytokines in the pathogenesis is being increasingly recognized. OBJECTIVE This study was conducted to observe alterations in the serum cytokine levels of patients with pemphigus vulgaris (PV), pemphigus foliaceous (PF), paraneoplastic pemphigus (PNP) and compare with bullous pemphigoid (BP) and healthy subjects. METHODS A total of 75 subjects (28 PV, 13 PF, 7 PNP, 7 BP, and 20 healthy controls) were included, all patients in active disease state. Serum levels of interferon (IFN)-γ, interleukin (IL)-4, IL-6, IL-17A, IL-10, tumor necrosis factor (TNF)-α, and IL-8 were measured by enzyme-linked immunosorbent assay. RESULTS The median concentration of IFN-γ was lower in PV and BP patients compared to control (0.77, 0.34 and 1.63 pg/ml, respectively). IL-6 and IL-10 was significantly higher in PNP patients compared to control (4.92 and 0.24 pg/ml for IL-6, 0.86 and <0.12 pg/ml for IL-10, respectively). IL-8 was increased significantly in PV and PNP patients compared with control (11.85, 31.5 and 8.31 pg/ml, respectively). For IL-4, IL-17A and TNF-α, no significant difference was observed between the five groups. CONCLUSION The decreased level of IFN-γ in PV may imply suppressed Th1 response in the active disease stage. A Th2 predominant response is suggested in the active stage of PNP, with elevated serum levels of IL-6 and IL-10. Increased level of proinflammatory cytokine IL-8 is observed in the sera of PV and PNP patients.
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Affiliation(s)
- Sang Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jin Hong
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Chan Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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24
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Hirose M, Kasprick A, Beltsiou F, Dieckhoff Schulze K, Schulze FS, Samavedam UK, Hundt JE, Pas HH, Jonkman MF, Schmidt E, Kalies K, Zillikens D, Ludwig RJ, Bieber K. Reduced skin blistering in experimental epidermolysis bullosa acquisita after anti-TNF treatment. Mol Med 2016; 22:918-926. [PMID: 27999842 DOI: 10.2119/molmed.2015.00206] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/12/2016] [Indexed: 12/30/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is a difficult-to-treat subepidermal autoimmune blistering skin disease (AIBD) with circulating and tissue-bound anti-type VII collagen antibodies. Different reports have indicated an increased concentration of tumor necrosis factor alpha (TNF) in the serum and blister fluid of patients with subepidermal AIBDs. Furthermore, successful anti-TNF treatment has been reported for individual patients with AIBDs. Here, we show that in mice, induction of experimental EBA by repeated injections of rabbit-anti mouse type VII collagen antibodies led to increased expression of TNF in skin, as determined by real-time PCR and immunohistochemistry. To investigate if the increased TNF expression is of functional relevance in experimental EBA, we inhibited TNF function using the soluble TNF receptor fusion protein etanercept (Enbrel®) or a monoclonal antibody to murine TNF. Interestingly, mice receiving either of these two treatments showed significantly milder disease progression than controls. In addition, immunohistochemical staining demonstrated reduced numbers of macrophages in lesional skin in mice treated with TNF inhibitors compared to controls. Furthermore, etanercept treatment significantly reduced the disease progression in immunization-induced EBA. In conclusion, the increased expression of TNF in experimental EBA is of functional relevance, as both the prophylactic blockade of TNF and the therapeutic use of etanercept impaired the induction and progression of experimental EBA. Thus, TNF is likely to serve as a new therapeutic target for EBA and AIBDs with a similar pathogenesis.
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Affiliation(s)
- Misa Hirose
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Foteini Beltsiou
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | | | | | | | - Jennifer E Hundt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Hendri H Pas
- Department of Dermatology, University of Groningen, Groningen, the Netherlands
| | - Marcel F Jonkman
- Department of Dermatology, University of Groningen, Groningen, the Netherlands
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | | | - Detlef Zillikens
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany.,Department of Dermatology, Allergology and Venereology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany
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25
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Abstract
Background: Infliximab is a chimeric monoclonal antibody that binds specifically to human tumor necrosis factor-alpha (TNF-α), decreasing the effect of the cytokine in inflammatory diseases. Objective: The aim of this study was to review the efficacy and safety of infliximab in the treatment of dermatological diseases. Methods: A MEDLINE search (1966–January 2003), using the keyword “infliximab” was performed to find relevant articles pertaining to the use of infliximab in dermatology. Results: Infliximab has been used in the following dermatological diseases: psoriasis, Behçet's disease, graft versus host disease, hidradenitis suppurativa, panniculitis, pyoderma gangrenosum, SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome, sarcoidosis, subcorneal pustular dermatosis, Sweet's syndrome, toxic epidermal necrolysis, and Wegener's granulomatosis. There is a generally good safety profile for infliximab, which is similar to that when it is used to treat Crohn's disease and rheumatoid arthritis. Conclusion: Although not approved for use in dermatological diseases, there have been numerous reports of the efficacy of infliximab in cutaneous inflammatory diseases. The most promise lies in those diseases that have increased amounts of TNF-α in the cutaneous lesions, such as psoriasis.
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Affiliation(s)
- Aditya K. Gupta
- Division of Dermatology, Department of Medicine, Sunnybrook and Women's College Health Sciences Center (Sunnybrook site) and the University of Toronto, Toronto, Canada
- Mediprobe Laboratories Inc., London, Ontario, Canada
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26
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Vodo D, Sarig O, Geller S, Ben-Asher E, Olender T, Bochner R, Goldberg I, Nosgorodsky J, Alkelai A, Tatarskyy P, Peled A, Baum S, Barzilai A, Ibrahim SM, Zillikens D, Lancet D, Sprecher E. Identification of a Functional Risk Variant for Pemphigus Vulgaris in the ST18 Gene. PLoS Genet 2016; 12:e1006008. [PMID: 27148741 PMCID: PMC4858139 DOI: 10.1371/journal.pgen.1006008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/05/2016] [Indexed: 12/13/2022] Open
Abstract
Pemphigus vulgaris (PV) is a life-threatening autoimmune mucocutaneous blistering disease caused by disruption of intercellular adhesion due to auto-antibodies directed against epithelial components. Treatment is limited to immunosuppressive agents, which are associated with serious adverse effects. The propensity to develop the disease is in part genetically determined. We therefore reasoned that the delineation of PV genetic basis may point to novel therapeutic strategies. Using a genome-wide association approach, we recently found that genetic variants in the vicinity of the ST18 gene confer a significant risk for the disease. Here, using targeted deep sequencing, we identified a PV-associated variant residing within the ST18 promoter region (p<0.0002; odds ratio = 2.03). This variant was found to drive increased gene transcription in a p53/p63-dependent manner, which may explain the fact that ST18 is up-regulated in the skin of PV patients. We then discovered that when overexpressed, ST18 stimulates PV serum-induced secretion of key inflammatory molecules and contributes to PV serum-induced disruption of keratinocyte cell-cell adhesion, two processes previously implicated in the pathogenesis of PV. Thus, the present findings indicate that ST18 may play a direct role in PV and consequently represents a potential target for the treatment of this disease.
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Affiliation(s)
- Dan Vodo
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofer Sarig
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Shamir Geller
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Edna Ben-Asher
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Tsviya Olender
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Ron Bochner
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ilan Goldberg
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Judith Nosgorodsky
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anna Alkelai
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Pavel Tatarskyy
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Alon Peled
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Saleh M. Ibrahim
- Institute of Experimental Dermatology, University of Luebeck, Luebeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, University of Luebeck, Luebeck, Germany
| | - Doron Lancet
- Department of Molecular Genetics, Weizmann Institute of Science, Rehovot, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Department of Human Molecular Genetics and Biochemistry, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- * E-mail:
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27
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Dar SA, Akhter N, Haque S, Singh T, Mandal RK, Ramachandran VG, Bhattacharya SN, Banerjee BD, Das S. Tumor necrosis factor (TNF)-α -308G/A (rs1800629) polymorphism distribution in North India and its association with pemphigus: Case-control study and meta-analysis. Autoimmunity 2016; 49:179-87. [PMID: 26761187 DOI: 10.3109/08916934.2015.1134512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pemphigus is an autoimmune blistering disorder of skin and/or mucosal surfaces characterized by intraepithelial lesions and immunoglobulin-G autoantibodies against desmogleins (proteins critical in cell-to-cell adhesion). Genetic, immunological, hormonal, and environmental factors are known to contribute to its etiology. Tumor necrosis factor-alpha (TNF-α) which plays a key role in pathogenesis of many infectious and inflammatory diseases has been found in high levels in lesional skin and sera of pemphigus patients. However, studies on association of single nucleotide polymorphism (SNP) in promoter region of TNF-α at position -308 affecting G to A transition with pemphigus has been scarce. This study was conducted to evaluate the TNF-α -308G/A SNP distribution in North Indian cohort, and to define the association between the TNF-α -308G/A SNP distribution and pemphigus, globally, by means of meta-analysis. TNF-α -308G/A SNP in pemphigus patients was investigated by cytokine genotyping using genomic DNA by PCR with sequence-specific primers. Meta-analysis of the data, including four previously published studies from other populations, was performed to generate a meaningful relationship. The results of our case-control study indicate non-significant differences between patients and controls in TNF-α -308G/A SNP. The meta-analysis also revealed that TNF-α -308G/A SNP is not associated with pemphigus risk in population at large; however, it may be contributing towards autoimmune phenomenon in pemphigus by being a part of its multi-factorial etiology. This study provides evidence that the TNF-α -308G/A polymorphism is not associated with overall pemphigus susceptibility. Nevertheless, further studies on specific ethnicity and pemphigus variants are necessary to validate the findings.
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Affiliation(s)
- Sajad Ahmad Dar
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India .,b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia
| | - Naseem Akhter
- c Department of Laboratory Medicine, Faculty of Applied Medical Sciences , Albaha University , Albaha , Kingdom of Saudi Arabia
| | - Shafiul Haque
- b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia .,d Centre for Drug Research, Faculty of Pharmacy, University of Helsinki , Helsinki , Finland
| | - Taru Singh
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
| | - Raju Kumar Mandal
- b Research and Scientific Studies Unit, College of Nursing and Allied Health Sciences, University of Jazan , Jazan , Kingdom of Saudi Arabia
| | | | | | - Basu Dev Banerjee
- f Department of Biochemistry , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
| | - Shukla Das
- a Department of Microbiology , University College of Medical Sciences (University of Delhi) & GTB Hospital , Delhi , India
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Gregoriou S, Efthymiou O, Stefanaki C, Rigopoulos D. Management of pemphigus vulgaris: challenges and solutions. Clin Cosmet Investig Dermatol 2015; 8:521-7. [PMID: 26543381 PMCID: PMC4622091 DOI: 10.2147/ccid.s75908] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The main objective in the treatment of pemphigus vulgaris is to control the disease, prevent relapses, and avoid adverse events associated with the prolonged use of steroids and immunosuppressive agents. Systemic corticosteroids remain the gold standard treatment for pemphigus vulgaris. Azathioprine and mycophenolate mofetil are the first line of steroid-sparing treatment. Rituximab is extremely effective in recalcitrant pemphigus, when other treatments fail to control the disease. The European Dermatology Forum recommends tapering prednisolone by 25% every 2 weeks after the consolidation phase, and a 5 mg reduction every 4 weeks when the dose is reduced to <20 mg. If the patient relapses, options include increasing steroids back to the previous dose, adding an immunosuppressant if using steroid monotherapy, or replacing a first-line immunosuppressant by another if already on combination therapy.
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Affiliation(s)
- Stamatis Gregoriou
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Ourania Efthymiou
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Christina Stefanaki
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
| | - Dimitris Rigopoulos
- 2nd Department of Dermatology and Venereology, University of Athens Medical School, Attikon Hospital, Athens, Greece
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Caso F, Iaccarino L, Bettio S, Ometto F, Costa L, Punzi L, Doria A. Refractory pemphigus foliaceus and Behçet's disease successfully treated with tocilizumab. Immunol Res 2014; 56:390-7. [PMID: 23572430 DOI: 10.1007/s12026-013-8411-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Pemphigus foliaceus (PF) and Behçet's disease (BD) are immune-mediated conditions which are usually treated with corticosteroids, immunosuppressants, and, when refractory, with biologic agents. In both diseases, interleukin (IL)-6 serum levels are increased driving the immune-mediated inflammatory process. Tocilizumab is a humanized monoclonal antibody, targeting IL6-receptor, used in the treatment of rheumatoid arthritis. Besides the current indication, it has been recently administered to patients with refractory immune inflammatory diseases as an off-label treatment. Here, we report the case of a woman affected with PF and BD, who did not respond to corticosteroids, immunosuppressants, and biologic agents including adalimumab, anakinra, and infliximab. A complete, long-lasting, clinical, and serological remission was achieved only with tocilizumab. To the best of our knowledge, the association between PF and BD has never been reported. Moreover, only two cases of BD and no cases of PF treated with tocilizumab have been described to date. A literature review on the use of biologic agents on patients with PF and BD was also carried out.
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Affiliation(s)
- Francesco Caso
- Division of Rheumatology, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
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Amber KT, Staropoli P, Shiman MI, Elgart GW, Hertl M. Autoreactive T cells in the immune pathogenesis of pemphigus vulgaris. Exp Dermatol 2013; 22:699-704. [DOI: 10.1111/exd.12229] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Kyle T. Amber
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
| | - Patrick Staropoli
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
| | - Michael I. Shiman
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
| | - George W. Elgart
- Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine; Miami FL USA
| | - Michael Hertl
- Department of Dermatology and Allergology; Philipps-Universität; Marburg Germany
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Hünefeld C, Mezger M, Kern JS, Nyström A, Bruckner-Tuderman L, Müller I, Handgretinger R, Röcken M. One goal, different strategies--molecular and cellular approaches for the treatment of inherited skin fragility disorders. Exp Dermatol 2013; 22:162-7. [PMID: 23489418 DOI: 10.1111/exd.12084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 12/29/2022]
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of inherited diseases characterized by the formation of blisters in the skin and mucosa. There is no cure or effective treatment for these potentially severe and fatal diseases. Over the past few years, several reports have proposed different molecular strategies as new therapeutic options for the management of EB. From classical vector-based gene therapy to cell-based strategies such as systemic application of bone marrow stem cells or local application of fibroblasts, a broad range of molecular approaches have been explored. This array also includes novel methods, such as protein replacement therapy, gene silencing and the use of induced pluripotent stem cells (iPCs). In this review, we summarize current concepts of how inherited blistering diseases might be treated in the future and discuss the opportunities, promises, concerns and risks of these innovative approaches.
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Torretta S, Gaffuri M, Recalcati S, Marzano AV, Cantarella G, Iofrida E, Pignataro L. Pharyngolaryngeal location of Kaposi's sarcoma with airway obstruction in an HIV-negative patient. TUMORI JOURNAL 2013; 99:e208-10. [DOI: 10.1177/030089161309900514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Kaposi's sarcoma (KS) is a human herpes virus-8 (HHV-8)-associated angioproliferative disorder, and its occurrence may be favored by human immunodeficiency virus (HIV) infection and iatrogenic immunosuppression. It has also been postulated that a chronic inflammatory disease of the skin can pave the way to its development. KS generally involves mucosal and cutaneous sites, including the head and neck. An oropharyngeal location is quite common, but laryngeal involvement with possible upper airway obstruction and respiratory distress requiring tracheotomy is rare, and no hypopharyngeal locations have yet been reported. We describe the case of a 68-year-old male patient who developed KS after immunosuppressive treatment for pemphigus vulgaris, an autoimmune bullous disease presenting with blisters and erosions on the skin and the oral mucosa. KS was initially localized to the oral cavity and oropharynx, but subsequent involvement of the laryngeal and hypopharyngeal tract led to acute airway obstruction and the need for tracheotomy. This unique case of pharyngolaryngeal KS suggests that clinicians faced with purple nodular lesions should consider a differential diagnosis of KS in immunocompromised patients, even if they are HIV negative, and should carefully manage the patency of the upper airways.
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Affiliation(s)
- Sara Torretta
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Michele Gaffuri
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Sebastiano Recalcati
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Giovanna Cantarella
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Elisabetta Iofrida
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Lorenzo Pignataro
- Otolaryngology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Sharquie KE, Noaimi AA, Al-Jobori AA. Skin tumors and skin infections in kidney transplant recipients vs. patients with pemphigus vulgaris. Int J Dermatol 2013; 53:288-93. [DOI: 10.1111/j.1365-4632.2012.05708.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Khalifa E. Sharquie
- Chairman of Scientific Council of Dermatology & Venereology; Iraqi Board for Medical Specializations; Baghdad Iraq
| | - Adil A. Noaimi
- Department of Dermatology & Venereology; College of Medicine; University of Baghdad; Baghdad Iraq
| | - Ali A. Al-Jobori
- Department of Dermatology & Venereology; Baghdad Teaching Hospital; Baghdad Iraq
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Koga H, Tsuruta D, Ohyama B, Ishii N, Hamada T, Ohata C, Furumura M, Hashimoto T. Desmoglein 3, its pathogenecity and a possibility for therapeutic target in pemphigus vulgaris. Expert Opin Ther Targets 2013; 17:293-306. [DOI: 10.1517/14728222.2013.744823] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Polymorphisms of HLA microsatellite marker in Tunisian pemphigus foliaceus. Hum Immunol 2013; 74:104-9. [DOI: 10.1016/j.humimm.2012.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/18/2012] [Accepted: 10/03/2012] [Indexed: 12/25/2022]
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Deyhimi P, Tavakoli P. Study of apoptosis in oral pemphigus vulgaris using immunohistochemical marker Bax and TUNEL technique. J Oral Pathol Med 2012. [PMID: 23186378 DOI: 10.1111/jop.12022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pemphigus vulgaris (PV) is an autoimmune mucocutaneous disease presenting clinically with blisters or erosions of the skin and mucous membrane. The main histopathologic characteristic of this disease is suprabasal vesicles due to loss of cell-cell adhesion between keratinocytes named acantholysis. Studies have shown that apoptosis is increased in PV. The purpose of this study is to investigate the role of apoptosis in blister formation in PV. METHODS This cross-sectional study was conducted on 25 specimens of oral PV. The presence of apoptosis was evaluated using the TUNEL technique in the normal perilesional region, vesicle area, and acantholytic cells. Also, the expression of Bax pro-apoptotic marker was assessed by the biotin-streptavidin immunohistochemical method. SPSS software was used for Wilcoxon test analysis. P values <0.05 were considered significant. RESULTS The percentage and intensity staining of TUNEL-positive cells were noteworthy. There were statistically significant differences between basal and parabasal (P = 0.05), tombstone with vesicle roof (P = 0.038) and basal with tombstone (P = 0.038). However, the expression and staining intensity of pro-apoptotic marker Bax were weak, and no statistically significant differences were observed between the various areas. CONCLUSION The results obtained in the present study suggest that the process of apoptosis occurs early in PV because it was observed in the perilesional normal appearing tissue. Also, the process of apoptosis may cause exacerbation or speeding of the bulla formation. In other words, inhibition of apoptosis in the patients could reduce the severity of the lesions.
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Affiliation(s)
- Parviz Deyhimi
- Torabinegad Dental Research Center and Department of Oral & Maxillofacial Pathology, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
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Abstract
Pemphigus vulgaris (PV) is an autoimmune bullous skin disease where tolerance to the desmosomal protein desmoglein 3 (Dsg3), and perhaps additional epidermal targets, is lost, leading to the production of autoantibodies directed against cellular adhesion molecules. As auto-reactive T cells are involved in the induction and maintenance of antibody production, it has been hypothesized that cytokines play a crucial role in disease pathogenesis. Qualitative and quantitative alterations in cytokine profiles have been previously reported; however, despite recent advancements, the characterization of the disease supporting cytokine network in PV has yet to be fully elucidated. It is overwhelmingly suggested that PV is a TH2-mediated disease, confirmed by the majority of studies demonstrating an increase in TH2-type cytokines. Recently, a focus has been placed on the contribution of the newly discovered TH17 subset to autoimmune states, and current evidence suggests that this inflammatory pathway may play a role in PV as well. Anti-cytokine medications are on the forefront as potential therapeutic options, and the growing number of reports of clinical benefit serves to confirm the major contribution of various inflammatory mediators in the development of disease phenotype. This work aimed to comprehend the complexity of cytokine and T cell involvement in pemphigus, taking account of known information and emphasizing the areas where additional research would be of great benefit, particularly in pharmacological development and expansion of the pemphigus therapeutic armamentarium.
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Chriguer RS, Roselino AM, de Castro M. Glucocorticoid Sensitivity and Proinflammatory Cytokines Pattern in Pemphigus. J Clin Immunol 2012; 32:786-93. [DOI: 10.1007/s10875-012-9679-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 02/21/2012] [Indexed: 12/26/2022]
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Mosaad YM, Fathy H, Fawzy Z, El-Saied MA. Tumor necrosis factor-α -308 G>A and interleukin-6 -174 G>C promoter polymorphisms and pemphigus. Hum Immunol 2012; 73:560-5. [PMID: 22365967 DOI: 10.1016/j.humimm.2012.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/26/2012] [Accepted: 02/01/2012] [Indexed: 01/09/2023]
Abstract
The objective of this study was to analyze the possible involvement of the tumor necrosis factor (TNF)-α -308 G>A and interleukin-6 (IL-6) -174 G>C polymorphisms in the susceptibility and/or disease profile of pemphigus in Egyptian patients. Detection of TNF-α -308 G>A by amplification refractory mutation system and IL-6 -174 G>C by restriction fragment length polymorphism was performed for 70 patients and 203 controls. No significant differences were observed in the distribution of TNF-α -308 in pemphigus patients and controls. However, GA+AA genotypes were more frequent in pemphigus vulgaris (PV) patients only versus controls (p(c) = 0.046). The frequency of the C allele and CC/GC genotypes of IL-6 -174 was significantly higher in pemphigus patients and those with the 2 major clinical forms (PV and pemphigus foliaceus [PF]) compared with controls (p < 0.05). Comparison of the distribution of TNF-α -308 and IL-6 -174 variants in relation to clinical type of pemphigus (PV versus PF), activity score, recurrence, and demographic data of patients revealed no significant associations. The IL-6 -174 CC genotype represents a marker of increased susceptibility to pemphigus in Egyptian patients and GG genotype can be considered a low-risk genotype; TNF-α -308 A-containing genotypes contribute to the susceptibility to PV only.
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Affiliation(s)
- Youssef M Mosaad
- Clinical Immunology Unit, Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura 35111, Egypt.
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Abstract
The goal of contemporary research in pemphigus vulgaris and pemphigus foliaceus is to achieve and maintain clinical remission without corticosteroids. Recent advances of knowledge on pemphigus autoimmunity scrutinize old dogmas, resolve controversies, and open novel perspectives for treatment. Elucidation of intimate mechanisms of keratinocyte detachment and death in pemphigus has challenged the monopathogenic explanation of disease immunopathology. Over 50 organ-specific and non-organ-specific antigens can be targeted by pemphigus autoimmunity, including desmosomal cadherins and other adhesion molecules, PERP cholinergic and other cell membrane (CM) receptors, and mitochondrial proteins. The initial insult is sustained by the autoantibodies to the cell membrane receptor antigens triggering the intracellular signaling by Src, epidermal growth factor receptor kinase, protein kinases A and C, phospholipase C, mTOR, p38 MAPK, JNK, other tyrosine kinases, and calmodulin that cause basal cell shrinkage and ripping desmosomes off the CM. Autoantibodies synergize with effectors of apoptotic and oncotic pathways, serine proteases, and inflammatory cytokines to overcome the natural resistance and activate the cell death program in keratinocytes. The process of keratinocyte shrinkage/detachment and death via apoptosis/oncosis has been termed apoptolysis to emphasize that it is triggered by the same signal effectors and mediated by the same cell death enzymes. The natural course of pemphigus has improved due to a substantial progress in developing of the steroid-sparing therapies combining the immunosuppressive and direct anti-acantholytic effects. Further elucidation of the molecular mechanisms mediating immune dysregulation and apoptolysis in pemphigus should improve our understanding of disease pathogenesis and facilitate development of steroid-free treatment of patients.
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Affiliation(s)
- Sergei A Grando
- Department of Dermatology, University of California, Irvine, CA 92697, USA.
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Abstract
T cells assume a fundamental function in immunosurveillance and maintenance of the cutaneous immune barrier, yet derangement of their requisite role effects a range of cutaneous autoimmune diseases with significant associated morbidity. While blistering skin diseases, such as pemphigus vulgaris (PV), pemphigus foliaceus (PF) and bullous pemphigoid (BP) are mediated by antibodies directed against autoantigens found in the skin, recent evidence has shown that T cell activation is crucial for the initiation and coordination of this humoral response. Non-blistering skin diseases, such as alopecia areata (AA), vitiligo (VL) and psoriasis (PS) are increasingly believed to be directly mediated by the activities of autoreactive T cells. Here, we examine T lymphocyte control of antibody-mediated and cell-mediated processes involved in the pathoimmunology of the above mentioned skin diseases.
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Affiliation(s)
- Selwyn Chow
- Department of Dermatology, Weill Medical College of Cornell University, New York, NY 10021, USA
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Javor J, Chmurova N, Parnicka Z, Ferencik S, Grosse-Wilde H, Buc M, Svecova D. TNF-alpha and IL-10 gene polymorphisms show a weak association with pemphigus vulgaris in the Slovak population. J Eur Acad Dermatol Venereol 2009; 24:65-8. [PMID: 19470040 DOI: 10.1111/j.1468-3083.2009.03260.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pemphigus vulgaris is a rare chronic autoimmune disease of skin and mucous membranes, with several cytokines participating in its development. The role of their gene polymorphisms in susceptibility to the disease is, however, not fully understood. OBJECTIVE The aim of our case-control study was to investigate whether some of 22 single nucleotide polymorphisms (SNPs) in 13 cytokine genes (IL-1alpha, IL-1beta, IL-1RI, IL-1Ra, IL-4Ralpha, IL-12, IFN-gamma, TGF-beta1, TNF-alpha, IL-2, IL-4, IL-6 and IL-10) are associated with pemphigus vulgaris in the Slovak population. METHODS DNA samples were obtained from 34 pemphigus vulgaris patients and 140 healthy controls of Slovak origin. Cytokine gene SNPs were determined using the polymerase chain reaction with sequence-specific primers (PCR-SSP) method. Results We found a weak association between pemphigus vulgaris and polymorphic variants in TNF-alpha and IL-10 genes only, with haplotypes TNF-alpha-308G/-238G and IL-10 -1082A/-819C/-592C being significantly overrepresented in pemphigus vulgaris patients (TNF-alpha GG: 94.12% vs. 82.86%, P = 0.0216; IL-10 ACC: 44.12% vs. 30.00%, P = 0.0309). CONCLUSIONS Our preliminary results suggest that certain TNF-alpha and IL-10 gene polymorphisms might contribute to genetic susceptibility to pemphigus vulgaris; however, their overall impact on disease development will be rather limited.
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Affiliation(s)
- J Javor
- Department of Immunology, Comenius University, Bratislava, Slovakia.
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Serum concentration of interleukin-6 is increased both in active and remission stages of pemphigus vulgaris. Mediators Inflamm 2008; 2008:875394. [PMID: 18584045 PMCID: PMC2435293 DOI: 10.1155/2008/875394] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 05/11/2008] [Indexed: 11/20/2022] Open
Abstract
As most studies on pemphigus vulgaris (PV) pathogenesis concern its active stage, we aimed to evaluate the serum concentration of TNF-α, IL-1, and IL-6 in PV patients in clinical remission. The study group consisted of sera from 19 PV patients in active stage and from 24 patients in clinical remission. 19 sera taken from healthy subjects served as the controls. Serum IL-6 concentrations in PV active and PV remission group were significantly higher when compared to the controls (P < .05). In patients in active stage of PV, a significant correlation between serum IL-1 and IL-6 concentrations was found (rP = 0.46; P < .05). We also found a negative correlation between TNF-α level and pemphigus antibodies titer in the patients from the remission group (rS = −0.47303; P < .02). Our data suggest that IL-6 and TNF-α may be involved in maintaining immunological disturbances in remission stage of PV.
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Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer 2008; 8:190. [PMID: 18605999 PMCID: PMC2464778 DOI: 10.1186/1471-2407-8-190] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/07/2008] [Indexed: 11/10/2022] Open
Abstract
Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
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Rigopoulos D, Korfitis C, Gregoriou S, Katsambas AD. Infliximab in dermatological treatment: beyond psoriasis. Expert Opin Biol Ther 2007; 8:123-33. [DOI: 10.1517/14712598.8.1.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Cirillo N, Lanza M, Femiano F, Gaeta GM, De Rosa A, Gombos F, Lanza A. If pemphigus vulgaris IgG are the cause of acantholysis, new IgG-independent mechanisms are the concause. J Cell Physiol 2007; 212:563-7. [PMID: 17474087 DOI: 10.1002/jcp.21111] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pemphigus vulgaris (PV) is a disease of epidermal adhesion. Its pathogenesis is currently traced back to the action of autoantibodies against antigens located within the intercellular substance of keratinocytes, such as desmogleins and acetylcholine receptors. In the present paper, we sought to elucidate the non-IgG-mediated effects of PV sera on keratinocytes. Results showed that PV sera depleted of IgG were able to induce well-defined changes on keratinocyte morphology and metabolic activity. Indeed, PV IgG-free sera determined marked alterations on cell shape, accompanied by partial loss of keratinocyte-keratinocyte interactions within 48 h after treatment. Furthermore, PV IgG-depleted sera caused a sharp reduction of cell viability along with a less sustained weakening of intercellular adhesion strength. In light of the above findings, loss of cell-cell adhesion in PV occurs as a result of the cooperating action of both IgG and non-IgG-mediated mechanisms. These data have remarkable consequences on experimental models of PV and might open new "biological" approaches to its therapy. Thus, researchers are well advised that PV pathophysiology cannot be faithfully reproduced by leaving non-IgG serum factors out of consideration.
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Affiliation(s)
- Nicola Cirillo
- Regional Center on Craniofacial Malformations-MRI, 1st School of Medicine and Surgery, II University of Naples, Naples, Italy.
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