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Schmid F, Kerl-French K, Meier-Schiesser B, Lehmberg K, Hoeger PH. Ustekinumab for pyoderma gangrenosum-like skin ulcerations in late-onset leukocyte adhesion deficiency. J Allergy Clin Immunol Glob 2024; 3:100233. [PMID: 38560722 PMCID: PMC10981098 DOI: 10.1016/j.jacig.2024.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 04/04/2024]
Abstract
Background Leukocyte adhesion deficiency type 1 (LAD-1) is a congenital immunodeficiency leading to impaired trafficking of neutrophils to inflammation sites. Solitary or multiple pyoderma gangrenosum (PG)-like skin ulcers (PGLUs) have been reported previously in 13 children (aged 0.5-19 years) with LAD-1. Objective Our aim was to report the case of a 10-year-old boy presenting with PGLUs as the first manifestation of LAD-1 treated with ustekinumab. Methods We obtained in situ cytokine profiles. Results PGLUs were triggered by cutaneous ringworm infection (Trichophyton tonsurans). Skin biopsy samples showed increased intralesional expression of IL-17A, Il-23, and IL-1β as compared with their expression in healthy controls. After an unsuccessful attempt at treatment with oral methylprednisolone, ustekinumab induced regression of the ulcerations, associated with complete normalization of the cytokine profile. Conclusions PGLUs, triggered by ringworm infection, can be a late harbinger of LAD-1. Ustekinumab is a safe and effective therapeutic option for patients with LAD-1 and PGLUs while bridging the time until stem cell transplantation.
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Affiliation(s)
- Florian Schmid
- Department of Pediatrics, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
| | | | | | - Kai Lehmberg
- Department of Pediatric Haematology and Oncology, University of Hamburg, Hamburg, Germany
| | - Peter H. Hoeger
- Department of Pediatrics, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
- Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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2
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Ramirez-Fort MK, Gilman CK, Alexander JS, Meier-Schiesser B, Gower A, Olyaie M, Vaidya N, Vahidi K, Li Y, Lange CS, Fort M, Deurdulian C. Gender and disease-inclusive nomenclature consolidation of theragnostic target, prostate-specific membrane antigen (PSMA) to folate hydrolase-1 (FOLH1). Front Med (Lausanne) 2024; 10:1304718. [PMID: 38444631 PMCID: PMC10913592 DOI: 10.3389/fmed.2023.1304718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/31/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Marigdalia K. Ramirez-Fort
- BioFort, Guaynabo, Puerto Rico
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- University of California at Los Angeles (UCLA) Health System, Los Angeles, CA, United States
| | - Casey K. Gilman
- BioFort, Guaynabo, Puerto Rico
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | - Jacob S. Alexander
- BioFort, Guaynabo, Puerto Rico
- San Juan Bautista School of Medicine, Caguas, Puerto Rico
| | | | - Arjan Gower
- University of California at Los Angeles (UCLA) Health System, Los Angeles, CA, United States
| | - Mojtaba Olyaie
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- University of California at Los Angeles (UCLA) Health System, Los Angeles, CA, United States
| | - Neel Vaidya
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
| | - Kiarash Vahidi
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
| | - Yuxin Li
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- University of California at Los Angeles (UCLA) Health System, Los Angeles, CA, United States
| | - Christopher S. Lange
- BioFort, Guaynabo, Puerto Rico
- Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
| | | | - Corinne Deurdulian
- Veterans Affairs (VA) Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- University of California at Los Angeles (UCLA) Health System, Los Angeles, CA, United States
- University of Southern California, Los Angeles, CA, United States
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3
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Schuermann M, Richter C, Tanadini M, Steigmiller K, Burri E, Guillet C, Luchsinger I, Meier-Schiesser B, Boesch A, Nägeli M, Hafner J. Zinc Oxide Patches Are a Highly Effective Treatment for Chronic Prurigo: A Randomized Split-Body Study. Dermatology 2023; 239:996-1006. [PMID: 37673045 DOI: 10.1159/000533799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Chronic prurigo (CPG) presents with pruriginous lesions and reduced quality of life (QoL). Established treatment options are often unsatisfying. Little is known about the efficacy of topical occlusive treatments. Patients often report rapid relief of symptoms when using topical occlusive zinc oxide patches (ZOP). We, therefore, aimed to assess the efficacy of ZOP. METHODS In this randomized controlled split-body crossover study, 22 participants were analyzed, receiving three treatments sequentially: ZOP, topical betamethasone 17-valerate (topical glucocorticosteroids [TGCs]), and both ZOP and TGC combined (ZOP + TGC). Each intervention was applied to either the right or left side of the body for seven consecutive days. Outcomes were a count of active excoriated pruriginous lesions (APLs), itch, recurrence of APL, QoL, and treatment comfort. They were assessed through photographs and questionnaires: modified Prurigo Activity and Severity Score, modified Itchy Quality of Life Questionnaire, and Therapy Comfort Score. RESULTS We observed a significant reduction of 46% in APL count for ZOP (95% CI from 30% to 58%, p value: <0.0001). Similar reduction was seen for ZOP + TGC, and a lower reduction was seen for TGC alone (48% [95% CI from 33% to 60%, p value: <0.0001] vs. 26% [95% CI from 4% to 43%, p value: 0.02]). APL counts on the non-treated side remained stable. Significant reduction in itch was observed after all treatments, with the largest improvement for ZOP + TGC, followed by TGC and, lastly, ZOP alone (-2.3 units [95% CI from -3.5 to -1.1, p value: 0.00015] vs. -1.5 units [95% CI from -2.8 to -0.3, p value: 0.01 vs. -1.4 units [95% CI from -2.6 to -0.2, p value: 0.02]). QoL increased significantly after ZOP + TGC as well as after TGC (-8.3 units [95% CI from -13.6 to -3.1, p value: 0.0018] vs. -5.7 units [95% CI from -10.9 to -0.5, p value: 0.03]). A good subjective response concerning treatment comfort was observed. CONCLUSION ZOP are effective in reducing APL after 1 week of treatment. Adding TGC to ZOP did not add considerable benefit in reducing APL. All three treatments reduced itch and improved QoL, with the largest improvement shown by ZOP combined with TGC. Patients tolerated ZOP well and reported no adverse events. We therefore suggest ZOP combined with TGC as an effective, fast-acting, low-cost treatment for reducing APL and itch in patients with CPG.
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Affiliation(s)
- Manuel Schuermann
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
| | - Clara Richter
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland,
| | | | | | - Elias Burri
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
| | - Isabelle Luchsinger
- Dermatology Department, Pediatric Skin Center, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Andrea Boesch
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
| | - Jürg Hafner
- Department of Dermatology, University Hospital Zurich USZ, Zurich, Switzerland
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4
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Kraehenbuehl L, Schneider S, Pawlik L, Mangana J, Cheng P, Dummer R, Meier-Schiesser B. Cutaneous Adverse Events of Systemic Melanoma Treatments: A Retrospective Single-Center Analysis. Pharmaceuticals (Basel) 2023; 16:935. [PMID: 37513847 PMCID: PMC10383648 DOI: 10.3390/ph16070935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/28/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Recent progress in the treatment of advanced melanoma has led to the improved survival of affected patients. However, novel treatments also lead to considerable and distinct skin toxicity. To further characterize cutaneous adverse events (AE) of systemic treatments, we conducted a single-center retrospective study of biopsy-proven cutaneous adverse events of melanoma treatment over a period of 10 years at the University Hospital of Zurich, Switzerland. In 102 identified patients, 135 individual skin AEs developed. Immune checkpoint blockade (ICB) was causal for 81 skin AEs, and 54 were related to targeted therapies (TT). Recorded types of skin AEs included lichenoid, maculopapular, acneiform, urticarial, panniculitis, folliculitis, psoriasiform, granulomatous, eczematous, and others. The incidence of skin AEs was higher with TT (18.54%) than with ICB (9.64%, p = 0.0029). Most AEs were low-grade, although 19.21% of AEs were common terminology criteria for adverse events (CTCAE) Grades 3 or 4. A large spectrum of skin AEs was documented during treatment of advanced melanoma, and distinct phenotypes were observed, depending on treatment classes. AEs occurred earlier during treatment with TT than with ICB, and distinct types of skin AEs were associated with respective treatment classes. This study comprehensively describes skin AEs occurring during systemic treatment for melanoma at a single center.
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Affiliation(s)
- Lukas Kraehenbuehl
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Stephanie Schneider
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Laura Pawlik
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Phil Cheng
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich (USZ), University of Zurich (UZH), 8091 Zurich, Switzerland
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5
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Stadler PC, Oschmann A, Kerl-French K, Maul JT, Oppel EM, Meier-Schiesser B, French LE. Acute generalized exanthematous pustulosis: clinical characteristics, pathogenesis and management. Dermatology 2023:000529218. [PMID: 36702114 DOI: 10.1159/000529218] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Acute generalized exanthematous pustulosis (AGEP) is a potentially severe adverse cutaneous drug reaction, which typically occurs within 24-48 hours after the intake of the culprit drug. SUMMARY AGEP is characterized by numerous sterile subcorneal pustules on erythematous skin and in less than a third of cases it can be associated with organ manifestations possibly leading to life-threatening symptoms (e.g. cholestasis, nephritis, lung and bone marrow involvement). In contrast to generalized pustular psoriasis (GPP) it can involve mucosal regions and typically resolves rapidly if the culprit drug is removed and adequate therapy with topical or systemic steroids administered. Diagnosis based on patient history, clinical signs and characteristic cutaneous histology is rarely challenging. Identification of the culprit drug may be aided by patch testing or lymphocyte transformation tests that are of limited value. KEY MESSAGES Recent experimental data reviewed herein are supportive of an early role of drug-induced innate immune activation and innate cytokines such as interleukin (IL)-1, IL-36 and IL-17 in the pathogenesis of AGEP. This explains the rapid onset and neutrophilic character of the cutaneous inflammation, but also provide new avenues for in vitro tests aimed at better identifying the culprit drug. Lymphocyte transformation tests for Identification of the culprit drug are from limitied value.
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6
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Maul JT, Guillet C, Oschmann A, Maul LV, Meier-Schiesser B, Stadler PC, French LE, Kerl K. Cutaneous lichenoid drug eruptions: A narrative review evaluating demographics, clinical features and culprit medications. J Eur Acad Dermatol Venereol 2023; 37:965-975. [PMID: 36652271 DOI: 10.1111/jdv.18879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Cutaneous lichenoid drug eruptions (LDE) are adverse drug reactions (ADR) characterized by symmetric, erythematous, violaceous papules reminiscent but rarely fully characteristic of lichen planus (LP). We aimed to analyse the literature describing cases of LDE within the last 20 years to provide additional insight into culprit drugs, typical latency to onset of the eruption, the spectrum of clinical presentations, severity and management. A literature search was conducted in MEDLINE between January 2000 and 27 January 2021. The keywords 'lichenoid drug rash' and 'lichenoid drug eruption' were used. Cases were included if LDE diagnosis was made, and culprit drugs were identified. A total of 323 cases with LDE were identified from 163 published case reports and studies. The mean patient age was 58.5 years (1 month to 92 years), and 135 patients (41.8%) were female. Checkpoint inhibitors (CKI) were the most frequently reported culprit drugs (136 cases; 42.1%), followed by tyrosine kinase inhibitors (TKI) (39 cases; 12.0%) and anti-TNF-α-monoclonal antibodies (13 cases; 4.0%). The latency between initiation of the drug and manifestation was 15.7 weeks (range: 0.1-208 weeks). After discontinuing the culprit drug, the median time to resolution was 14.2 weeks (range: 0.71-416 weeks). One hundred thirty-six patients (42.1%) were treated with topical, and 54 patients (16.7%) with systemic glucocorticoids. Overall, we conclude that, albeit rare, LDE is challenging to diagnose ADR induced by mostly CKI, TKI, and biologics. Treatment modalities resemble that of lichen planus, and the culprit drugs had to be discontinued in only 26%, which is low compared with other types of adverse drug reactions. This is probably due to the low risk of aggravation (e.g. toxic epidermal necrolysis) if the drug is continued and the benefit/risk ratio favouring the drug, as is often the case in cancer therapy.
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Affiliation(s)
- Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Carole Guillet
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Anna Oschmann
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Pia-Charlotte Stadler
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany.,Dr. Philip Frost, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Katrin Kerl
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
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7
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Stäger R, Tastanova A, Ramelyte E, Levesque M, Dummer R, Meier-Schiesser B. 243P Skin biopsies for pharmacodynamic studies of tebentafusp: A novel bispecific molecule against the melanocytic antigen gp100. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Meier-Schiesser B, Mellett M, Ramirez-Fort MK, Maul JT, Klug A, Winkelbeiner N, Fenini G, Schafer P, Contassot E, French LE. Phosphodiesterase-4 Inhibition Reduces Cutaneous Inflammation and IL-1β Expression in a Psoriasiform Mouse Model but Does Not Inhibit Inflammasome Activation. Int J Mol Sci 2021; 22:ijms222312878. [PMID: 34884681 PMCID: PMC8657753 DOI: 10.3390/ijms222312878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/14/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Apremilast (Otezla®) is an oral small molecule phosphodiesterase 4 (PDE4) inhibitor approved for the treatment of psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s disease. While PDE4 inhibition overall is mechanistically understood, the effect of apremilast on the innate immune response, particularly inflammasome activation, remains unknown. Here, we assessed the effect of apremilast in a psoriasis mouse model and primary human cells. Psoriatic lesion development in vivo was studied in K5.Stat3C transgenic mice treated with apremilast for 2 weeks, resulting in a moderate (2 mg/kg/day) to significant (6 mg/kg/day) resolution of inflamed plaques after 2-week treatment. Concomitantly, epidermal thickness dramatically decreased, the cutaneous immune cell infiltrate was reduced, and proinflammatory cytokines were significantly downregulated. Additionally, apremilast significantly inhibited lipopolysaccharide- or anti-CD3-induced expression of proinflammatory cytokines in peripheral mononuclear cells (PBMCs). Notably, inflammasome activation and secretion of IL-1β were not inhibited by apremilast in PBMCs and in human primary keratinocytes. Collectively, apremilast effectively alleviated the psoriatic phenotype of K5.Stat3 transgenic mice, further substantiating PDE4 inhibitor-efficiency in targeting key clinical, histopathological and inflammatory features of psoriasis. Despite lacking direct effect on inflammasome activation, reduced priming of inflammasome components upon apremilast treatment reflected the indirect benefit of PDE4 inhibition in reducing inflammation.
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Affiliation(s)
- Barbara Meier-Schiesser
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
- Correspondence: ; Tel.: +41-43-255-11-11
| | - Mark Mellett
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
| | | | - Julia-Tatjana Maul
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
| | - Annika Klug
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
| | - Nicola Winkelbeiner
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
| | - Gabriele Fenini
- Department of Dermatology, University Hospital Zurich (USZ), Raemistrasse 100, 8091 Zurich, Switzerland; (M.M.); (J.-T.M.); (A.K.); (N.W.); (G.F.)
| | - Peter Schafer
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ 08540, USA;
| | - Emmanuel Contassot
- Department of Biomedicine, Dermatology Department, Basel University Hospital, University of Basel, Hebelstrasse 20, 4031 Basel, Switzerland;
| | - Lars E. French
- Department of Dermatology, Ludwigs-Maximilians-University, Frauenlobstraße 9-11, 80337 Munich, Germany;
- Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, 1600 NW 10th Avenue, Miami, FL 33136, USA
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9
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Ramirez-Fort MK, Meier-Schiesser B, Lachance K, Mahase SS, Church CD, Niaz MJ, Liu H, Navarro V, Nikolopoulou A, Kazakov DV, Contassot E, Nguyen DP, Sach J, Hadravsky L, Sheng Y, Tagawa ST, Wu X, Lange CS, French LE, Nghiem PT, Bander NH. Folate hydrolase-1 (FOLH1) is a novel target for antibody-based brachytherapy in Merkel cell carcinoma. Skin Health Dis 2021; 1. [PMID: 34541577 PMCID: PMC8447486 DOI: 10.1002/ski2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Backgrounds Folate Hydrolase‐1 (FOLH1; PSMA) is a type II transmembrane protein, luminally expressed by solid tumour neo‐vasculature. Monoclonal antibody (mAb), J591, is a vehicle for mAb‐based brachytherapy in FOLH1+ cancers. Brachytherapy is a form of radiotherapy that involves placing a radioactive material a short distance from the target tissue (e.g., on the skin or internally); brachytherapy is commonly accomplished with the use of catheters, needles, metal seeds and antibody or small peptide conjugates. Herein, FOLH1 expression in primary (p) and metastatic (m) Merkel cell carcinoma (MCC) is characterized to determine its targeting potential for J591‐brachytherapy. Materials & Methods Paraffin sections from pMCC and mMCC were evaluated by immunohistochemistry for FOLH1. Monte Carlo simulation was performed using the physical properties of conjugated radioisotope lutetium‐177. Kaplan–Meier survival curves were calculated based on patient outcome data and FOLH1 expression. Results Eighty‐one MCC tumours were evaluated. 67% (54/81) of all cases, 77% (24/31) pMCC and 60% (30/50) mMCC tumours were FOLH1+. Monte Carlo simulation showed highly localized ionizing tracks of electrons emitted from the targeted neo‐vessel. 42% (34/81) of patients with FOLH1+/− MCC had available survival data for analysis. No significant differences in our limited data set were detected based on FOLH1 status (p = 0.4718; p = 0.6470), staining intensity score (p = 0.6966; p = 0.9841) or by grouping staining intensity scores (− and + vs. ++, +++, +++) (p = 0.8022; p = 0.8496) for MCC‐specific survival or recurrence free survival, respectively. Conclusions We report the first evidence of prevalent FOLH1 expression within MCC‐associated neo‐vessels, in 60‐77% of patients in a large MCC cohort. Given this data, and the need for alternatives to immune therapies it is appropriate to explore the safety and efficacy of FOLH1‐targeted brachytherapy for MCC. What's already known about this topic? We report the first evidence of prevalent folate hydrolase‐1 (FOLH1; also known as prostate‐specific membrane antigen) expression within MCC‐associated neovessels.
What does this study add? Herein, FOLH1 expression in Merkel cell carcinoma neovasculature is validated, and the therapeutic mechanism of specific, systemic targeting of disseminated disease with antibody‐based brachytherapy, is defined.
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Affiliation(s)
- M K Ramirez-Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico, USA.,Department of Urology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - B Meier-Schiesser
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - K Lachance
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - S S Mahase
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York, USA
| | - C D Church
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - M J Niaz
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - H Liu
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - V Navarro
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - A Nikolopoulou
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - D V Kazakov
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland.,Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - E Contassot
- Department of Dermatology, University Hospital of Zürich, Zürich, Switzerland
| | - D P Nguyen
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - J Sach
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - L Hadravsky
- Sikl's Department of Pathology, Medical Faculty in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Y Sheng
- Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - S T Tagawa
- Department of Urology, Weill Cornell Medicine, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - X Wu
- Shanghai Proton and Heavy Ion Center, Shanghai, China.,Innovative Cancer Institute, Miami, Florida, USA
| | - C S Lange
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico, USA.,Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - L E French
- Department of Dermatology, Münich University Hospital, Münich, Germany
| | - P T Nghiem
- Department of Dermatology, University of Washington, Seattle, Washington, USA
| | - N H Bander
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
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10
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Stäger R, Stanhope S, Greenshields-Watson A, Collins L, Ramelyte E, Kolm I, Dummer R, Meier-Schiesser B. 1772P Demonstration of T cell redirection and immune activation in skin rash following tebentafusp treatment. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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11
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Schmidt V, Lalevée S, Ziadlou R, Oro S, Barau C, De Prost N, Nägeli M, Meier-Schiesser B, Navarini A, French L, Contassot E, Brüggen M. LB818 Diverse immune response changes during different adjuvant treatments in Epidermal Necrolysis patients. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Deinsberger J, Brugger J, Tschandl P, Meier-Schiesser B, Anzengruber F, Bossart S, Tzaneva S, Petzelbauer P, Böhler K, Beltraminelli H, Hafner J, Weber B. Differentiating Arteriolosclerotic Ulcers of Martorell from Other Types of Leg Ulcers Based on Vascular Histomorphology. Acta Derm Venereol 2021; 101:adv00449. [PMID: 33856037 PMCID: PMC9367051 DOI: 10.2340/00015555-3804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinical differential diagnosis of arteriolosclerotic ulcers of Martorell is challenging due to the lack of clearly affirmative instrument-based diagnostic criteria. The aim of this study was to develop vascular histomorphological diagnostic criteria differentiating Martorell ulcers from other types of leg ulcers. The histomorphology of patients diagnosed with arteriolosclerotic ulcers of Martorell (n = 67) was compared with that of patients with venous leg ulcers, necrotizing leukocytoclastic vasculitis, pyoderma gangrenosum, and non-ulcerative controls (n = 15 each). In a multivariable logistic regression model, the rates of arteriolar calcification (odds ratio (OR) 42.71, 95% confidence interval (CI) 7.43–443.96, p < 0.001) and subendothelial hyalinosis (OR 29.28, 95% CI 4.88–278.21, p < 0.001) were significantly higher in arteriolosclerotic ulcers of Martorell. Arteriolar cellularity was significantly lower in Martorell ulcers than in controls (OR 0.003, 95 CI < 0.001–0.97, p = 0.05). However, the wall-to-lumen ratio was similar in all ulcers (OR 0.975, 95% CI 0.598–2.04, p = 0.929). Based on the Youden index, a wall cellularity of < 0.24 cells/100 μm2 was determined as the optimum cut-off point (sensitivity 0.955, specificity 0.944). Thus, arteriolar calcification, subendothelial hyalinosis, and arteriolar cellularity revealed high discriminatory power for arteriolosclerotic ulcers of Martorell.
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Affiliation(s)
- Julia Deinsberger
- Skin and Endothelium Research Division (SERD), Department of Dermatology, Medical University of Vienna, AT-1090 Vienna, Austria
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13
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Meier-Schiesser B, French LE. Autoinflammationssyndrome. J Dtsch Dermatol Ges 2021; 19:400-428. [PMID: 33709590 DOI: 10.1111/ddg.14332_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lars E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität München, Deutschland
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14
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Abstract
Autoinflammatory syndromes are a steadily growing group of inflammatory diseases caused by abnormal regulations of the innate immune system. The clinical presentation is multifaceted, but recurrent fever, skin involvement, joint inflammation and other systemic symptoms of inflammation are characteristic. In contrast to classic autoimmune diseases, autoantibodies or specific T cells are not involved in the pathogenesis. In fact, innate immunity plays the most important role in autoinflammation. While activation of the innate immune system is usually self-limiting in healthy individuals, mutations and dysregulation can lead to chronic and excessive activation of innate immune responses and to the development of autoinflammatory diseases.
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Affiliation(s)
| | - Lars E French
- Department of Dermatology, Ludwig-Maximilians University Hospital, Munich, Germany
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15
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Luchsinger I, Knöpfel N, Theiler M, Bonnet des Claustres M, Barbieux C, Schwieger-Briel A, Brunner C, Donghi D, Buettcher M, Meier-Schiesser B, Hovnanian A, Weibel L. Secukinumab Therapy for Netherton Syndrome. JAMA Dermatol 2021; 156:907-911. [PMID: 32459284 DOI: 10.1001/jamadermatol.2020.1019] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Netherton syndrome (NS) is a rare, severe genetic disorder of cornification with high morbidity. Treatment for NS has been notoriously difficult. Recent studies showed an upregulated helper T cell (TH) 17/interleukin 23 (IL-23) pathway in NS, suggesting the possibility of treatment strategies that target IL-17. Objective To evaluate the clinical response of NS to treatment with the IL-17 antagonist secukinumab. Design, Setting, and Participants This case series study reports the experience of compassionate use therapy with secukinumab in 4 patients with severe NS, including 2 children, from December 1, 2018, to December 1, 2019, with 3 patients still undergoing treatment at the time of final analysis. Data were analyzed from December 1, 2018, to December 1, 2019. Main Outcomes and Measures Expression of IL-17 in the skin was evaluated by immunohistochemical analysis, and serum cytokine concentrations were measured using a commercially available assay. Treatment response was assessed using the Ichthyosis Area and Severity Index (IASI) total score, including measures of erythema and scaling, the Dermatology Life Quality Index (DLQI), and the 5-D itch scale. Results In all 4 patients (age range, 9-27 years; 3 male and 1 female), immunostaining with an IL-17A antibody showed an increased number of positive cells in lesional skin. Cytokine assessment in serum samples revealed increased levels of CCL20. Treatment duration with secukinumab was 3 to 12 months at the time of this report. After 3 months of therapy, IASI scores were reduced by 44% to 88%, DLQI scores were reduced by 40% to 76%, and 5-D itch scale scores were reduced by 27% to 62%. This outcome was sustained at the 6-month follow-up. Two patients with an erythrodermic phenotype showed marked improvement of all parameters. A refractory palmoplantar eczematous eruption occurred in 2 patients, and a candidal nail infection developed in 2 patients. No severe adverse events were reported. Conclusions and Relevance This initial case series reporting the use of anti-IL-17 therapy in NS demonstrated marked cutaneous improvement, particularly in 2 pediatric patients with erythrodermic phenotypes. Further studies are needed to evaluate the long-term benefit of this potential treatment modality.
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Affiliation(s)
- Isabelle Luchsinger
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Knöpfel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Theiler
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Mathilde Bonnet des Claustres
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,Paris University, Paris, France
| | - Claire Barbieux
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,Paris University, Paris, France
| | - Agnes Schwieger-Briel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Corinne Brunner
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.,Pediatric Skin Center, Skin and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Davide Donghi
- Dermatology Practice, Centro Medico Bellinzona, Bellinzona, Switzerland
| | - Michael Buettcher
- Division of Pediatric Infectious Diseases, Children's Hospital Lucerne, Lucerne, Switzerland
| | | | - Alain Hovnanian
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,Paris University, Paris, France.,Department of Genetics, Necker Hospital for Sick Children, Paris, France
| | - Lisa Weibel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
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16
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Satoh TK, Mellett M, Meier-Schiesser B, Fenini G, Otsuka A, Beer HD, Rordorf T, Maul JT, Hafner J, Navarini AA, Contassot E, French LE. IL-36γ drives skin toxicity induced by EGFR/MEK inhibition and commensal Cutibacterium acnes. J Clin Invest 2020; 130:1417-1430. [PMID: 31805013 PMCID: PMC7269569 DOI: 10.1172/jci128678] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) and MEK inhibitors (EGFRi/MEKi) are beneficial for the treatment of solid cancers but are frequently associated with severe therapy-limiting acneiform skin toxicities. The underlying molecular mechanisms are poorly understood. Using gene expression profiling we identified IL-36γ and IL-8 as candidate drivers of EGFRi/MEKi skin toxicity. We provide molecular and translational evidence that EGFRi/MEKi in concert with the skin commensal bacterium Cutibacterium acnes act synergistically to induce IL-36γ in keratinocytes and subsequently IL-8, leading to cutaneous neutrophilia. IL-36γ expression was the combined result of C. acnes–induced NF-κB activation and EGFRi/MEKi–mediated expression of the transcription factor Krüppel-like factor 4 (KLF4), due to the presence of both NF-κB and KLF4 binding sites in the human IL-36γ gene promoter. EGFRi/MEKi increased KLF4 expression by blockade of the EGFR/MEK/ERK pathway. These results provide an insight into understanding the pathological mechanism of the acneiform skin toxicities induced by EGFRi/MEKi and identify IL-36γ and the transcription factor KLF4 as potential therapeutic targets.
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Affiliation(s)
- Takashi K Satoh
- Department of Dermatology, University of Zürich, Zürich, Switzerland
| | - Mark Mellett
- Department of Dermatology, University of Zürich, Zürich, Switzerland
| | | | - Gabriele Fenini
- Department of Dermatology, University of Zürich, Zürich, Switzerland
| | - Atsushi Otsuka
- Department of Dermatology, Kyoto University, Kyoto, Japan
| | - Hans-Dietmar Beer
- Department of Dermatology, University of Zürich, Zürich, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Tamara Rordorf
- Clinic for Oncology, University Hospital Zürich, Zürich, Switzerland
| | | | - Jürg Hafner
- Department of Dermatology, University of Zürich, Zürich, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Alexander A Navarini
- Department of Dermatology, University of Zürich, Zürich, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland.,Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | - Emmanuel Contassot
- Department of Dermatology, University of Zürich, Zürich, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Lars E French
- Department of Dermatology, University of Zürich, Zürich, Switzerland.,Medical Faculty, University of Zürich, Zürich, Switzerland.,Department of Dermatology and Allergology, Ludwig Maximilian University of Munich, Munich, Germany
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17
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Ramirez-Fort MK, Meier-Schiesser B, Niaz MJ, Niaz MO, Feily A, Fort M, Lange CS, Caba D. Dermatofibrosarcoma Protuberans: The Current State of Multidisciplinary Management. Skinmed 2020; 18:288-293. [PMID: 33160438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare, infiltrative, soft tissue tumor. It has a propensity for deep invasion but a low risk for distant metastasis. The classic presentation is a slowly progressive, painless, and erythematous to purpuric patch on the trunk or arms. A deep, subcutaneous punch biopsy or incisional biopsy should be performed for diagnosis in all suspected cases; wide undermining of the skin is to be avoided for minimizing the risk of tumor seeding and for retaining the feasibility of histopathologic examination of re-excisions. Histopathologic distinction of DFSP from dermatofibroma requires immunohistochemical assessment for CD34, factor XIIIa, nestin, apolipoprotein D, and cathepsin K. Management of this cutaneous sarcoma involves a multidisciplinary oncologic approach. Surgical excision is usually the first step in management. DFSP has a high propensity for local recurrence, even when surgical margins are negative; therefore, radiation therapy or rarely systemic therapy is recommended, especially for locally advanced or metastatic cases. The indolent nature of DFSP requires lifelong surveillance for recurrence; however, most recurrences occur within 3 years of the primary excision. The median time for the development of a local recurrence is estimated to be 32 months. An emerging theragnostic transmembrane receptor target, folate hydrolase-1 (FOLH1; prostate-specific membrane antigen), has been expressed in benign dermatofibromas and in high-grade sarcomatous phenotypes. These findings suggest that DFSP may also express FOLH1, which could allow for surveillance with FOLH1 PET/CT and antibody-mediated brachytherapy.
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Affiliation(s)
- Marigdalia K Ramirez-Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
- Department of Radiation Oncology, Caribbean Radiation Oncology Center, Bayamon, Puerto Rico
- Department of Urology, Weill Cornell Medicine, New York, NY;
| | - Barbara Meier-Schiesser
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
- Department of Dermatology, Zurich University Hospital, Zurich, Switzerland
| | - M Junaid Niaz
- Department of Medicine, Sharif Medical City Hospital, Lahore, Pakistan
| | - M Obaid Niaz
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Migdalia Fort
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
| | - Christopher S Lange
- Department of Life Sciences, BioFort®, Guaynabo, Puerto Rico
- Department of Radiation Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - David Caba
- Department of Surgical Oncology, Loma Linda Medical University, Loma Linda, CA
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18
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Vander Beken S, de Vries JC, Meier-Schiesser B, Meyer P, Jiang D, Sindrilaru A, Ferreira FF, Hainzl A, Schatz S, Muschhammer J, Scheurmann NJ, Kampilafkos P, Seitz AM, Dürselen L, Ignatius A, Kluth MA, Ganss C, Wlaschek M, Singh K, Maity P, Frank NY, Frank MH, Scharffetter-Kochanek K. Newly Defined ATP-Binding Cassette Subfamily B Member 5 Positive Dermal Mesenchymal Stem Cells Promote Healing of Chronic Iron-Overload Wounds via Secretion of Interleukin-1 Receptor Antagonist. Stem Cells 2019; 37:1057-1074. [PMID: 31002437 DOI: 10.1002/stem.3022] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/22/2019] [Indexed: 01/07/2023]
Abstract
In this study, we report the beneficial effects of a newly identified dermal cell subpopulation expressing the ATP-binding cassette subfamily B member 5 (ABCB5) for the therapy of nonhealing wounds. Local administration of dermal ABCB5+ -derived mesenchymal stem cells (MSCs) attenuated macrophage-dominated inflammation and thereby accelerated healing of full-thickness excisional wounds in the iron-overload mouse model mimicking the nonhealing state of human venous leg ulcers. The observed beneficial effects were due to interleukin-1 receptor antagonist (IL-1RA) secreted by ABCB5+ -derived MSCs, which dampened inflammation and shifted the prevalence of unrestrained proinflammatory M1 macrophages toward repair promoting anti-inflammatory M2 macrophages at the wound site. The beneficial anti-inflammatory effect of IL-1RA released from ABCB5+ -derived MSCs on human wound macrophages was conserved in humanized NOD-scid IL2rγ null mice. In conclusion, human dermal ABCB5+ cells represent a novel, easily accessible, and marker-enriched source of MSCs, which holds substantial promise to successfully treat chronic nonhealing wounds in humans. Stem Cells 2019;37:1057-1074.
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Affiliation(s)
- Seppe Vander Beken
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Juliane C de Vries
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | | | - Patrick Meyer
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Dongsheng Jiang
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Anca Sindrilaru
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Filipa F Ferreira
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Adelheid Hainzl
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Susanne Schatz
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Jana Muschhammer
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | | | | | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Ulm University, Ulm, Germany
| | - Mark A Kluth
- TICEBA GmbH, Heidelberg, Germany.,RHEACELL GmbH & Co. KG, Heidelberg, Germany
| | - Christoph Ganss
- TICEBA GmbH, Heidelberg, Germany.,RHEACELL GmbH & Co. KG, Heidelberg, Germany
| | - Meinhard Wlaschek
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Karmveer Singh
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Pallab Maity
- Department of Dermatology and Allergic Diseases, Ulm University, Ulm, Germany
| | - Natasha Y Frank
- Transplantation Research Center, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, USA.,Division of Genetics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Markus H Frank
- Transplantation Research Center, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Skin Disease Research Center, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Harvard Stem Cell Institute, Harvard University, Cambridge, Massachusetts, USA.,School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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