Correlation of serum interleukin 17 and macrophage migration inhibitory factor levels with clinical response to intralesional Candida antigen and their potential use as predictors of clinical outcome in patients with multiple common warts

Interleukins in the Pathogenesis of Warts: Insight from the Last Decade-A Narrative Review

Human papillomavirus (HPV) is the etiological agent of a wide spectrum of diseases, from benign lesions to neoplasms. In most cases, in the first few years after infection, viral clearance occurs; however, in some cases, the infection remains persistent, allowing the progression of the lesions. The host immune response plays a key role in the resolution of the infection. The immune response to HPV is regulated by the dynamic interaction between numerous interleukins that exert pro- or anti-inflammatory effects. The role of interleukins in malignant lesions caused by HPV has been intensively studied, but in the case of benign lesions including warts, data are limited. This review compiles data from the last 10 years on the involvement of interleukins in the pathogenesis of warts, with the aim of providing new perspectives on this topic. Elucidating the role of interleukins will not only increase our knowledge of the pathogenesis of HPV infection but will also provide the foundation for the development of new therapies.

Efficacy of Intralesional Candida Injection in the Treatment of Cutaneous Warts: A Systematic Review and Meta-Analysis

Recent studies that examined the treatment efficacy of Candida antigen injection for both non-genital and genital warts yield inconsistent results. To address this, a systematic review and meta-analysis was conducted, comparing the treatment response between Candida antigen injection therapy and other intralesional immunotherapies across all types of warts. PubMed, Cochrane Library, and Embase were searched for relevant randomized controlled trials (RCTs) from inception to 16 September 2023, and 24 eligible RCTs were identified. A protocol was developed using the PRISM A-P checklist. In terms of complete clearance, intralesional Candida injection therapy demonstrated a significant improvement compared with saline (risk ratio [RR] 5.39; 95% confidence interval [CI] 3.49-8.33; I2=0%). However, no statistically significant differences were observed when compared with other therapies such as mumps-measles-rubella vaccines, purified protein derivative, vitamin D3, bivalent human papillomavirus vaccine, and zinc sulphate. Adverse effects associated with intralesional Candida therapy were generally reported as mild and manageable. In conclusion, intralesional Candida injection therapy for cutaneous warts may exhibit a superior complete and distant response rate. Nevertheless, owing to a limited sample size and other limitations, future research should aim for larger studies to provide more conclusive evidence.

Expression Patterns of Macrophage Migration Inhibitory Factor and Its Gene Variants (MIF-173 G˃C) in Verruca Vulgaris

INTRODUCTION

Verruca vulgaris is a benign hyperkeratotic proliferation of the epidermis. Few studies look at the differences in serum and tissue macrophage migration inhibitory factor (MIF) levels in verruca vulgaris, as well as its gene polymorphisms that have yet to be explored. The current study provided in-depth evaluation of MIF in serum and tissues of patients with verruca vulgaris, and establishes for the first time the possible association of MIF gene polymorphisms with common warts.

METHODS

This case-control study included 50 patients who were diagnosed clinically as common warts in comparison with 50 age and sex-matched controls. Clinical examination was done on all included cases. Serum MIF was measured using enzyme-linked immunosorbent assay (ELISA), while its tissue expression was analyzed using Western blotting and immunohistochemical techniques for the included participants. Analysis of MIF-173 G˃C single nucleotide polymorphism was performed by polymerase chain reaction (PCR) using restriction fragment length polymorphism (RFLP) technique.

RESULTS

The overall results revealed significantly lower MIF tissue expression in lesional and perilesional skin biopsies from cases compared to the controls using Western blot and immunohistochemical analysis. Yet, the difference in the serum MIF levels between cases and controls was not significant (p ˃ 0.05). GC genotype of the studied MIF rs755622 G>C SNP could be considered as a protective genetic factor against the occurrence of verruca vulgaris among Egyptians with OR (95% CI) equal 0.444 (0.199-0.989).

CONCLUSION

MIF and its genetic variants are thought to play a pathogenic role in verruca vulgaris development and recurrence.