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Josephs DH, Nakamura M, Bax HJ, Dodev TS, Muirhead G, Saul L, Karagiannis P, Ilieva KM, Crescioli S, Gazinska P, Woodman N, Lombardelli C, Kareemaghay S, Selkirk C, Lentfer H, Barton C, Canevari S, Figini M, Downes N, Dombrowicz D, Corrigan CJ, Nestle FO, Jones PS, Gould HJ, Blower PJ, Tsoka S, Spicer JF, Karagiannis SN. An immunologically relevant rodent model demonstrates safety of therapy using a tumour-specific IgE. Allergy 2018; 73:2328-2341. [PMID: 29654623 PMCID: PMC6492130 DOI: 10.1111/all.13455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Designing biologically informative models for assessing the safety of novel agents, especially for cancer immunotherapy, carries substantial challenges. The choice of an in vivo system for studies on IgE antibodies represents a major impediment to their clinical translation, especially with respect to class-specific immunological functions and safety. Fcε receptor expression and structure are different in humans and mice, so that the murine system is not informative when studying human IgE biology. By contrast, FcεRI expression and cellular distribution in rats mirror that of humans. METHODS We are developing MOv18 IgE, a human chimeric antibody recognizing the tumour-associated antigen folate receptor alpha. We created an immunologically congruent surrogate rat model likely to recapitulate human IgE-FcεR interactions and engineered a surrogate rat IgE equivalent to MOv18. Employing this model, we examined in vivo safety and efficacy of antitumour IgE antibodies. RESULTS In immunocompetent rats, rodent IgE restricted growth of syngeneic tumours in the absence of clinical, histopathological or metabolic signs associated with obvious toxicity. No physiological or immunological evidence of a "cytokine storm" or allergic response was seen, even at 50 mg/kg weekly doses. IgE treatment was associated with elevated serum concentrations of TNFα, a mediator previously linked with IgE-mediated antitumour and antiparasitic functions, alongside evidence of substantially elevated tumoural immune cell infiltration and immunological pathway activation in tumour-bearing lungs. CONCLUSION Our findings indicate safety of MOv18 IgE, in conjunction with efficacy and immune activation, supporting the translation of this therapeutic approach to the clinical arena.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/metabolism
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Cell Line, Tumor
- Folate Receptor 1/immunology
- Humans
- Immunoglobulin E/administration & dosage
- Immunoglobulin E/adverse effects
- Immunoglobulin E/immunology
- Immunoglobulin E/therapeutic use
- Immunoglobulin G/immunology
- Immunoglobulin G/metabolism
- Immunotherapy/methods
- Mice
- Models, Animal
- Neoplasms/pathology
- Neoplasms/therapy
- Protein Binding
- Rats
- Receptors, IgE/metabolism
- Statistics, Nonparametric
- Treatment Outcome
- Tumor Necrosis Factor-alpha/blood
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Affiliation(s)
- D. H. Josephs
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - M. Nakamura
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
| | - H. J. Bax
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - T. S. Dodev
- Randall Centre for Cell and Molecular BiophysicsKing's College LondonLondonUK
| | - G. Muirhead
- Department of InformaticsFaculty of Natural and Mathematical SciencesKing's College LondonLondonUK
| | - L. Saul
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - P. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - K. M. Ilieva
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
| | - S. Crescioli
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
| | - P. Gazinska
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - N. Woodman
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - C. Lombardelli
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - S. Kareemaghay
- King's Health Partners Cancer BiobankSchool of Cancer & Pharmaceutical SciencesKing's College LondonLondonUK
| | - C. Selkirk
- Biotherapeutics Development UnitCancer Research UKSouth MimmsUK
| | - H. Lentfer
- Biotherapeutics Development UnitCancer Research UKSouth MimmsUK
| | - C. Barton
- Centre for Drug DevelopmentCancer Research UKLondonUK
| | - S. Canevari
- Department of Applied Research and Technology DevelopmentFondazione IRCCS Istituto Nazionale dei TumouriMilanItaly
| | - M. Figini
- Department of Applied Research and Technology DevelopmentFondazione IRCCS Istituto Nazionale dei TumouriMilanItaly
| | | | - D. Dombrowicz
- CHU LilleInstitut Pasteur de LilleInsermUniv. LilleLilleFrance
| | - C. J. Corrigan
- Medical Research Council & Asthma UK Centre in Allergic Mechanisms of AsthmaKing's College LondonLondonUK
| | - F. O. Nestle
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Immunology and Inflammation Therapeutic Research AreaSanofi USCambridgeMAUSA
| | - P. S. Jones
- Centre for Drug DevelopmentCancer Research UKLondonUK
| | - H. J. Gould
- Randall Centre for Cell and Molecular BiophysicsKing's College LondonLondonUK
| | - P. J. Blower
- Imaging Chemistry & BiologyDivision of Imaging Sciences and Biomedical EngineeringSt. Thomas's HospitalKing's College LondonLondonUK
| | - S. Tsoka
- Department of InformaticsFaculty of Natural and Mathematical SciencesKing's College LondonLondonUK
| | - J. F. Spicer
- School of Cancer & Pharmaceutical SciencesGuy's HospitalKing's College LondonLondonUK
| | - S. N. Karagiannis
- St. John's Institute of DermatologySchool of Basic & Medical BiosciencesKing's College LondonLondonUK
- Breast Cancer Now Research UnitSchool of Cancer & Pharmaceutical SciencesGuy's Cancer CentreKing's College LondonLondonUK
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Seidel JA, Vukmanovic‐Stejic M, Muller‐Durovic B, Patel N, Fuentes‐Duculan J, Henson SM, Krueger JG, Rustin MHA, Nestle FO, Lacy KE, Akbar AN. Skin resident memory CD8 + T cells are phenotypically and functionally distinct from circulating populations and lack immediate cytotoxic function. Clin Exp Immunol 2018; 194:79-92. [PMID: 30030847 PMCID: PMC6156810 DOI: 10.1111/cei.13189] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
The in-depth understanding of skin resident memory CD8+ T lymphocytes (TRM ) may help to uncover strategies for their manipulation during disease. We investigated isolated TRM from healthy human skin, which expressed the residence marker CD69, and compared them to circulating CD8+ T cell populations from the same donors. There were significantly increased proportions of CD8+ CD45RA- CD27- T cells in the skin that expressed low levels of killer cell lectin-like receptor G1 (KLRG1), CD57, perforin and granzyme B. The CD8+ TRM in skin were therefore phenotypically distinct from circulating CD8+ CD45RA- CD27- T cells that expressed high levels of all these molecules. Nevertheless, the activation of CD8+ TRM with T cell receptor (TCR)/CD28 or interleukin (IL)-2 or IL-15 in vitro induced the expression of granzyme B. Blocking signalling through the inhibitory receptor programmed cell death 1 (PD)-1 further boosted granzyme B expression. A unique feature of some CD8+ TRM cells was their ability to secrete high levels of tumour necrosis factor (TNF)-α and IL-2, a cytokine combination that was not seen frequently in circulating CD8+ T cells. The cutaneous CD8+ TRM are therefore diverse, and appear to be phenotypically and functionally distinct from circulating cells. Indeed, the surface receptors used to distinguish differentiation stages of blood T cells cannot be applied to T cells in the skin. Furthermore, the function of cutaneous TRM appears to be stringently controlled by environmental signals in situ.
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Affiliation(s)
- J. A. Seidel
- Division of Infection and ImmunityUniversity College LondonUK
| | | | - B. Muller‐Durovic
- Division of Infection and ImmunityUniversity College LondonUK
- Department of BiomedicineUniversity of BaselBaselSwitzerland
| | - N. Patel
- Division of Infection and ImmunityUniversity College LondonUK
| | - J. Fuentes‐Duculan
- Laboratory for Investigative DermatologyThe Rockefeller UniversityNew YorkUSA
| | - S. M. Henson
- Division of Infection and ImmunityUniversity College LondonUK
- Present address:
William Harvey Research Institute Queen Mary University of LondonCharterhouse SquareLondon EC1M 6BQ
| | - J. G. Krueger
- Laboratory for Investigative DermatologyThe Rockefeller UniversityNew YorkUSA
| | | | - F. O. Nestle
- NIHR Biomedical Research Centre, Cutaneous Medicine and ImmunotherapySt John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, Guy’s Hospital, King’s College LondonLondonUK
| | - K. E. Lacy
- NIHR Biomedical Research Centre, Cutaneous Medicine and ImmunotherapySt John’s Institute of Dermatology, Division of Genetics and Molecular Medicine, Guy’s Hospital, King’s College LondonLondonUK
| | - A. N. Akbar
- Division of Infection and ImmunityUniversity College LondonUK
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3
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Bachelez H, Viguier M, Tebbey PW, Lowes M, Suárez-Fariñas M, Costanzo A, Nestle FO. The mechanistic basis for psoriasis immunopathogenesis: translating genotype to phenotype. Report of a workshop, Venice, 2012. Br J Dermatol 2014; 169:283-6. [PMID: 23941252 DOI: 10.1111/bjd.12347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 01/04/2023]
Abstract
The International Psoriasis Council, a global nonprofit organization dedicated to advancing psoriasis research and treatment, led an initiative to better define the pathogenic mechanisms that constitute psoriasis. In September 2012, a workshop was held at the 42nd Annual European Society for Dermatological Research in Venice, Italy. By assembling a panel of global dermatology and immunology experts, the objective was to evaluate the current status of the science explaining the mechanism of disease in psoriasis, e.g. dysregulation of the skin immune system and perturbations of epidermal homeostasis. The workshop consisted of four oral presentations, which addressed key topics in psoriasis, delivered by Hervé Bachelez (Paris, France), Antonio Costanzo (Rome, Italy), Michelle Lowes (New York, NY, U.S.A.) and Frank Nestle (London, U.K.). A global expert panel was assembled to stimulate dialogue and debate: Kevin Cooper (Cleveland, OH, U.S.A.), Michel Gilliet (Lausanne, Switzerland), Joerg Prinz (Munich, Germany), Martin Röcken (Tubingen, Germany), Jens Schroeder (Kiel, Germany), Manuelle Viguier (Paris, France), Mayte Suárez-Fariñas (New York, NY, U.S.A.) and Cristina Zielinski (Berlin, Germany). Collectively, the presentations demonstrated the significant advances in understanding immune regulation that have occurred over the past decade by virtue of the study of psoriasis subtypes, phenotypic manifestations and genetic associations. Elucidating the pathogenic and genetic basis of psoriasis holds the promise of a complete understanding of disease mechanisms, predictors of treatment response, novel drug development strategies and customized therapeutic regimens for the individual patient.
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Affiliation(s)
- H Bachelez
- Department of Dermatology, Saint-Louis Hospital, Sorbonne Paris Cité University Paris Diderot, Paris, France.
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4
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Girolomoni G, Griffiths CEM, Krueger J, Nestle FO, Nicolas JF, Prinz JC, Puig L, Ståhle M, van de Kerkhof PCM, Allez M, Emery P, Paul C. Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper. J DERMATOL TREAT 2014; 26:103-12. [DOI: 10.3109/09546634.2014.880396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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5
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Strohal R, Kirby B, Puig L, Girolomoni G, Kragballe K, Luger T, Nestle FO, Prinz JC, Ståhle M, Yawalkar N. Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol 2013; 28:1661-9. [PMID: 24372845 PMCID: PMC4258087 DOI: 10.1111/jdv.12350] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/18/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psoriatic arthritis (PsA) and co-morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate-to-severe psoriasis. Often these co-morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co-morbidities is lacking. OBJECTIVE To prepare expert recommendations to improve the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis. METHODS A systematic literature review was conducted on some common co-morbidities of psoriasis-cardiovascular (CV) diseases (including obesity, hypertension, hyperglycaemia and dyslipidaemia), psychological co-morbidities (including depression, alcohol abuse and smoking) and PsA-to establish the incidence and impact of each. Data gaps were identified and a Delphi survey was carried out to obtain consensus on the detection and management of each co-morbidity. The expert panel members for the Delphi survey comprised 10 dermatologists with substantial clinical expertise in managing moderate-to-severe psoriasis patients, as well as a cardiologist and a psychologist (see appendix) with an interest in dermatology. Agreement was defined using a Likert scale of 1-7. Consensus regarding agreement for each statement was defined as ≥75% of respondents scoring either 1 (strongly agree) or 2 (agree). RESULTS The expert panel members addressed several topics including screening, intervention, monitoring frequency, and the effects of anti-psoriatic treatment on each co-morbidity. Consensus was achieved on 12 statements out of 22 (3 relating to PsA, 4 relating to psychological factors, 5 relating to CV factors). The panel members felt that dermatologists have an important role in screening their psoriasis patients for PsA and in assessing them for psychological and CV co-morbidities. In most cases, however, patients should be referred for specialist management if other co-morbidities are detected. CONCLUSION This article provides useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.
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Affiliation(s)
- R Strohal
- Department of Dermatology, Federal Academic Teaching Hospital, Feldkirch, Austria
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6
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Abstract
Dendritic cells (DC) are a family of bone-marrow-derived professional antigen presenting cells (APC) with sparse, but wide, tissue distribution (1). They are classified primarily based on their localization: as interdigitating reticulum cells when present in lymphoid organs, as veiled cells when present in afferent lymph, as Langerhans cells when present in the epidermis, and as dermal dendritic cells when found in the dermis. Although DC are widely dispersed throughout the body, they exhibit many common features: an irregular shape with elongated dendritic processes, a distinctive cell-surface phenotype, low buoyant density, active motility, and the ability to stimulate vigorous proliferation of unprimed T cells. Like other professional APC such as macrophages and B cells, DC are able to ingest, process, and present antigen (Ag) in the context of major histocompatability (MHC) molecules. However, owing to their high expression of MHC class I and II, as well as costimulatory molecules and adhesion molecules, DC have the ability to induce primary T-cell-dependent immune responses in vivo and in vitro. This unique feature gives dendritic cells a central role in controlling immunity.
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Affiliation(s)
- M F Gilliet
- Department of Dermatology, University of Zurich Medical School, Zurich, Switzerland
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7
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Rudman SM, Josephs DH, Cambrook H, Karagiannis P, Gilbert AE, Dodev T, Hunt J, Koers A, Montes A, Taams L, Canevari S, Figini M, Blower PJ, Beavil AJ, Nicodemus CF, Corrigan C, Kaye SB, Nestle FO, Gould HJ, Spicer JF, Karagiannis SN. Harnessing engineered antibodies of the IgE class to combat malignancy: initial assessment of FcɛRI-mediated basophil activation by a tumour-specific IgE antibody to evaluate the risk of type I hypersensitivity. Clin Exp Allergy 2011; 41:1400-13. [PMID: 21569129 DOI: 10.1111/j.1365-2222.2011.03770.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND IgE antibodies, sequestered into tissues and retained locally by the high-affinity IgE receptor, FcɛRI, on powerful effector cells such as mast cells, macrophages and eosinophils, may offer improvements in the therapy of solid tumours. The chimeric antibody, MOv18 IgE, against the human ovarian carcinoma antigen, folate receptor α (FRα), is more effective than its IgG1 counterpart in xenograft models of ovarian cancer. Although MOv18 IgE binds to a single epitope on FRα and cannot cross-link IgE receptors on basophils, there remains a risk that components in the circulation of ovarian cancer patients might cross-link FRα-MOv18-IgE-receptor-FcɛRI complexes on basophils to cause type I hypersensitivity. OBJECTIVE To assess the propensity for MOv18 used in a therapeutic setting to cause FcɛRI-mediated type I hypersensitivity. METHODS As validated readouts of the potential for MOv18 to cause FcɛRI-mediated type I hypersensitivity we measured release of a granule-stored mediator from a rat basophilic leukaemia cell line RBL SX-38 stably transfected with human tetrameric (αβγ2) FcɛRI, and induction of CD63 on blood basophils from patients with ovarian carcinoma and healthy controls ex vivo. RESULTS Serum FRα levels were increased in ovarian cancer patients compared with healthy controls. MOv18 IgE alone, or in the presence of its antigen recombinant human FRα, or of healthy volunteer (n=14) or ovarian carcinoma patient (n=32) sera, did not induce RBL SX-38 cell degranulation. Exposure to FRα-expressing ovarian tumour cells at target-to-effector ratios expected within tumours induced degranulation. MOv18 IgE did not induce expression of CD63 in blood basophils from either healthy volunteers (n=6), or cancer patients, despite detectable levels of circulating FRα (n=5). CONCLUSION AND CLINICAL RELEVANCE These encouraging data are compatible with the hypothesis that, when ovarian carcinoma patients are treated with MOv18, FcɛRI-mediated activation of effector cells occurs within the tumour mass but not in the circulation mandating, with due caution, further pre-clinical studies.
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MESH Headings
- Animals
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/genetics
- Antibodies, Monoclonal, Murine-Derived/immunology
- Antibody Specificity
- Antigens, Neoplasm/immunology
- Basophils/immunology
- Carcinoma/immunology
- Carcinoma/therapy
- Cell Degranulation
- Cell Line, Tumor
- Female
- Folate Receptor 1/blood
- Folate Receptor 1/immunology
- Folate Receptor 1/metabolism
- Humans
- Hypersensitivity, Immediate/etiology
- Hypersensitivity, Immediate/immunology
- Immunoglobulin E/genetics
- Immunoglobulin E/immunology
- Ovarian Neoplasms/immunology
- Ovarian Neoplasms/therapy
- Protein Engineering
- Rats
- Receptors, IgE/immunology
- Tetraspanin 30/metabolism
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Affiliation(s)
- S M Rudman
- NIHR Biomedical Research Centre at Guy's and St Thomas's Hospitals and King's College London, Cutaneous Medicine & Immunotherapy Unit, St John's Institute of Dermatology, Division of Genetics & Molecular Medicine, King's College London School of Medicine, Guy's Hospital, King's College London, London, UK
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8
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Mak R, Hundhausen C, Botti E, Laggner U, Grys K, Tosi I, Nestle FO. Demonstration of novel innate immune cells in psoriasis. Lab Invest 2010. [PMCID: PMC3007760 DOI: 10.1186/1479-5876-8-s1-p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Abstract
This review emphasizes how translation from bench research to clinical knowledge and vice versa has resulted in considerable progress in understanding the immunopathogenesis of psoriasis. First, the journey in understanding the pathogenic mechanisms behind psoriasis is described. The roles of different components of the adaptive and innate immune systems involved in driving the inflammatory response are explained. Discovery of new immune pathways i.e. the IL23/Th17 axis and its subsequent impact on the development of novel biological therapies is highlighted. Identification of potential targets warranting further research for future therapeutic development are also discussed.
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Affiliation(s)
- R K H Mak
- St. John's Institute of Dermatology. King's College London School of Medicine. London, United Kingdom.
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10
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Laggner U, Lopez JS, Perera G, Warbey VS, Sita-Lumsden A, O'Doherty MJ, Hayday A, Harries M, Nestle FO. Regression of melanoma metastases following treatment with the n-bisphosphonate zoledronate and localised radiotherapy. Clin Immunol 2009; 131:367-73. [PMID: 19250873 DOI: 10.1016/j.clim.2009.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
Abstract
We report a case of regression of pulmonary and bony metastases in a patient with malignant melanoma following palliative treatment with systemic zoledronate and localised radiotherapy to the bone. Zoledronate is a potent new bisphosphonate used for the treatment of metabolic bone diseases including bone metastases due to its inhibitory effect on osteoclasts. In the context of metastatic cancer zoledronate is routinely used to improve bone pain and reduce the frequency of skeletal events. There is also an increasing body of evidence suggesting that bisphosphonates exhibit anti-tumour properties. Bisphosphonates are able to activate Vgamma9Vdelta2 gamma-delta T cells which can be key players in the immune defence against malignant cells. Furthermore bisphosphonates have direct anti-proliferative, anti-metastatic and pro-apoptotic effects on tumour cells. These actions, together with their low side effect profile, may prove to be useful therapeutic tools in the treatment of cancer even in the absence of bone metastases. On the basis of this case report we here review the current literature on present preclinical and clinical studies using bisphosphonates for the treatment of cancer.
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Affiliation(s)
- U Laggner
- St John's Institute of Dermatology, King's College London, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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11
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Abstract
BACKGROUND Type I interferons (IFNs) play an important role in the pathogenesis of many autoimmune disorders including psoriasis. In the presence of IFN-alpha and granulocyte/macrophage colony-stimulating factor (GM-CSF), monocytes differentiate into dendritic cells (DCs) referred to as IFN-DCs. IFN-DCs potentially mimic DC populations involved in psoriasis and express a wide range of Toll-like receptor (TLR) subtypes. OBJECTIVES Recently, it was shown that single-stranded RNA (ssRNA) triggers TLR7 and TLR8; therefore we studied ssRNA, as a surrogate for ssRNA viruses and their impact on IFN-DCs. METHODS We established culture conditions for IFN-DCs, generated from plastic adherent monocytes using GM-CSF plus IFN-alpha. For DC stimulation ssRNA40, a 20-mer ssRNA oligonucleotide was used. The phenotypic analysis of DC preparations was performed using flow cytometry. The production of various cytokines was analysed by enzyme-linked immunosorbent assay, and real-time quantitative polymerase chain reaction was used to quantify TLR and cytokine gene expression. The ability of IFN-DCs to stimulate allogeneic T-cell proliferation was evaluated in a mixed leucocyte reaction. RESULTS We found that IFN-DCs express mRNA for TLR7 and TLR8 and that ssRNA stimulation significantly improves their costimulatory molecule expression, stabilizes their phenotype and enhances their capacity to stimulate naive T-cell proliferation. Unstimulated IFN-DCs did not produce bioactive interleukin (IL)-12 and produced low levels of other proinflammatory cytokines. In contrast, ssRNA stimulation led to a significant production of IL-12p70, IL-1beta, IL-6 and tumour necrosis factor alpha. IFN-DCs contained mRNA for IL-12p35, IL-12p40, IL-23p19, IL-27p28 and IL-27EBI, which was further increased by incubation with ssRNA. CONCLUSIONS Our study sheds light on a potential role for IFN-alpha and viral infections in triggering DC populations in psoriasis. These results provide additional data for the better understanding of human autoimmune and antiviral responses and may also have implications for strategies developing cancer immunotherapy.
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Affiliation(s)
- A Farkas
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland.
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13
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Farkas A, Conrad C, Tonel G, Borbenyi Z, Kemeny L, Dobozy A, Nestle FO. Current State and Perspectives of Dendritic Cell Vaccination in Cancer Immunotherapy. Skin Pharmacol Physiol 2006; 19:124-31. [PMID: 16612139 DOI: 10.1159/000092592] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Accepted: 06/23/2005] [Indexed: 11/19/2022]
Abstract
Recent progress in the approach towards immunotherapy of cancer consists in molecular definition of tumor antigens, new tools for phenotypical and functional characterization of tumor-specific effector cells and clinical use of novel adjuvants for optimal stimulation of a cancer-specific immune response such as dendritic cells. In spite of these advances and immunological as well as clinical responses in selected patients, mechanisms involved in dendritic-cell-based cancer immunotherapy are still poorly understood. Therefore, a standardized study design and small pilot trials are needed to explore open scientific questions in future clinical trials. This review focuses on the different parameters of dendritic cell biology relevant to cancer immunotherapy and on innovative approaches to hopefully enhance the efficacy of dendritic cell vaccination.
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Affiliation(s)
- A Farkas
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
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14
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Reich K, Nestle FO, Papp K, Ortonne JP, Wu Y, Bala M, Evans R, Guzzo C, Li S, Dooley LT, Griffiths CEM. Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial. Br J Dermatol 2006; 154:1161-8. [PMID: 16704649 DOI: 10.1111/j.1365-2133.2006.07237.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis has a well-documented, markedly negative effect on patient quality of life. OBJECTIVES To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis. METHODS The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg(-1) induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen. RESULTS At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores (P < 0.001) and SF-36 physical and mental component summary scores (P < 0.001) than placebo-treated patients. Significant improvement (P < 0.001) was also seen in all eight SF-36 subscales, and was greatest for the "Bodily Pain" and "Social Functioning" scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 (P < 0.001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50. CONCLUSIONS Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement.
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Affiliation(s)
- K Reich
- Department of Dermatology, Georg-August University, Göttingen, Germany
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15
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Schadendorf D, Ugurel S, Schuler-Thurner B, Nestle FO, Enk A, Bröcker EB, Grabbe S, Rittgen W, Edler L, Sucker A, Zimpfer-Rechner C, Berger T, Kamarashev J, Burg G, Jonuleit H, Tüttenberg A, Becker JC, Keikavoussi P, Kämpgen E, Schuler G. Dacarbazine (DTIC) versus vaccination with autologous peptide-pulsed dendritic cells (DC) in first-line treatment of patients with metastatic melanoma: a randomized phase III trial of the DC study group of the DeCOG. Ann Oncol 2006; 17:563-70. [PMID: 16418308 DOI: 10.1093/annonc/mdj138] [Citation(s) in RCA: 318] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This randomized phase III trial was designed to demonstrate the superiority of autologous peptide-loaded dendritic cell (DC) vaccination over standard dacarbazine (DTIC) chemotherapy in stage IV melanoma patients. PATIENTS AND METHODS DTIC 850 mg/m2 intravenously was applied in 4-week intervals. DC vaccines loaded with MHC class I and II-restricted peptides were applied subcutaneously at 2-week intervals for the first five vaccinations and every 4 weeks thereafter. The primary study end point was objective response (OR); secondary end points were toxicity, overall (OS) and progression-free survival (PFS). RESULTS At the time of the first interim analysis 55 patients had been enrolled into the DTIC and 53 into the DC-arm (ITT). OR was low (DTIC: 5.5%, DC: 3.8%), but not significantly different in the two arms. The Data Safety & Monitoring Board recommended closure of the study. Unscheduled subset analyses revealed that patients with normal serum LDH and/or stage M1a/b survived longer in both arms than those with elevated serum LDH and/or stage M1c. Only in the DC-arm did those patients with (i) an initial unimpaired general health status (Karnofsky = 100) or (ii) an HLA-A2+/HLA-B44- haplotype survive significantly longer than patients with a Karnofsky index <100 (P = 0.007 versus P = 0.057 in the DTIC-arm) or other HLA haplotypes (P = 0.04 versus P = 0.57 in DTIC-treated patients). CONCLUSIONS DC vaccination could not be demonstrated to be more effective than DTIC chemotherapy in stage IV melanoma patients. The observed association of overall performance status and HLA haplotype with overall survival for patients treated by DC vaccination should be tested in future trials employing DC vaccines.
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Affiliation(s)
- D Schadendorf
- Skin Cancer Unit, German Cancer Research Center & University Hospital Mannheim, Mannheim.
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16
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Boyman O, Conrad C, Dudli C, Kielhorn E, Nickoloff BJ, Nestle FO. Activation of dendritic antigen-presenting cells expressing common heat shock protein receptor CD91 during induction of psoriasis. Br J Dermatol 2005; 152:1211-8. [PMID: 15948984 DOI: 10.1111/j.1365-2133.2005.06701.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis is a common and chronic relapsing inflammatory skin disorder. Although a role for T cells in mediating the induction and maintenance of psoriatic lesions is well established, mechanisms responsible for activation of T cells by antigen-presenting cells (APCs) during disease relapse are poorly understood. OBJECTIVES (i) To determine whether expression of the common heat shock protein (HSP) receptor CD91 correlated with development of psoriasis in a mouse model of psoriasis, (ii) to characterize the lesional cells on which CD91 was expressed, and (iii) to investigate whether CD91+ cells in psoriasis showed signs of activation. METHODS Two systems were used in order to study the above-mentioned objectives: (i) skin biopsies taken directly from patients with psoriasis (either psoriatic plaques or symptomless prepsoriatic skin) or from healthy donors, respectively, or (ii) (human) skin biopsies collected during development of psoriasis using a novel xenograft mouse model of psoriasis. The skin samples were then either processed for analysis by light microscopy, or labelled with fluorochrome-conjugated antibodies and analysed by confocal laser scanning microscopy. RESULTS We observed a markedly increased number of CD91+ cells which paralleled development of new psoriatic lesions in the psoriasis mouse model and in established psoriatic plaques compared with symptomless prepsoriatic or healthy skin. Morphology as well as cell-specific markers showed that CD91 was predominantly expressed by dermal dendritic APCs characterized by activation of nuclear factor-kappaB signalling and the presence of tumour necrosis factor-alpha, an important proinflammatory cytokine in the immunopathogenesis of psoriasis. In addition, HSP70, a ligand for CD91, was increased in keratinocytes in close vicinity to CD91-bearing APCs in psoriatic lesions. CONCLUSIONS These findings indicate massive presence of CD91+ dendritic cells juxtaposed to lesional keratinocytes expressing HSP70, and suggest a novel pathophysiological pathway and therapeutic target for this chronic inflammatory skin disease.
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Affiliation(s)
- O Boyman
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, CH-8091 Zurich, Switzerland
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17
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Abstract
BACKGROUND Nephrogenic fibrosing dermopathy (NFD) is a recently described cutaneous fibrosing disorder associated with renal dysfunction. Patients present with thickened skin or oedematous skin with indurated papules and plaques involving extremities and trunk, and often associated with disabling contracture of the adjacent joints. The aetiology and pathogenesis remain largely unknown. As a consequence, therapeutic measures with proven efficacy are nonexistent to date. OBJECTIVES To consider treatment with extracorporal photopheresis (ECP) in three patients. Patients We report three new cases of NFD with the characteristic clinical and pathological features. Two patients required haemodialysis due to end-stage renal failure, despite prior renal transplantation. One patient had renal dysfunction but was never on dialysis, nor had she been transplanted. ECP treatment was administered at intervals of 2-4 weeks. RESULTS All three patients showed a softening of the skin lesions and a marked improvement of the joint motility starting after four cycles of ECP. One patient developed a complete regression of her skin lesions after 16 cycles of ECP, and response to therapy was observed despite constantly elevated renal values. CONCLUSION These data indicate that ECP may represent a valuable therapeutic option for NFD.
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Affiliation(s)
- M Gilliet
- Department of Dermatology, Zurich University Hospital, Gloriastrasse 31, 8091 Zurich, Switzerland
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18
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Nestle FO, Nickoloff BJ. From classical mouse models of psoriasis to a spontaneous xenograft model featuring use of AGR mice. Ernst Schering Res Found Workshop 2005:203-12. [PMID: 15526944 DOI: 10.1007/3-540-26811-1_11] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Affiliation(s)
- F O Nestle
- Department of Dermatology, Medical School, University of Zurich, Switzerland
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Schadendorf D, Nestle FO, Broecker EB, Enk A, Grabbe S, Ugurel S, Edler L, Schuler G. Dacarbacine (DTIC) versus vaccination with autologous peptide-pulsed dendritic cells (DC) as first-line treatment of patients with metastatic melanoma: Results of a prospective-randomized phase III study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Schadendorf
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - F. O. Nestle
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - E.-B. Broecker
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - A. Enk
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - S. Grabbe
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - S. Ugurel
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - L. Edler
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
| | - G. Schuler
- German Cancer Research Center, Mannheim, Germany; University Hospital Zurich, Zurich, Switzerland; University Hospital, Würzburg, Germany; University Hospital, Mainz, Germany; University Hospital, Münster, Germany; German Cancer Research Center, Heidelberg, Germany; University Hospital, Erlangen, Germany
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20
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Affiliation(s)
- F O Nestle
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
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21
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Heinzerling LM, Kempf W, Kamarashev J, Hafner J, Nestle FO. Treatment of verrucous carcinoma with imiquimod and CO2 laser ablation. Dermatology 2003; 207:119-22. [PMID: 12835572 DOI: 10.1159/000070963] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2002] [Accepted: 12/31/2002] [Indexed: 11/19/2022] Open
Abstract
An 82-year-old female patient presented with a large perianal hyperkeratotic tumor extending into the anal canal. Staging did not reveal any metastatic spread. Diagnosis of verrucous carcinoma or Buschke-Löwenstein tumor, respectively, was based on typical clinical and histologic features. Moreover, human papillomavirus 6b DNA sequences could be detected by PCR. Surgical excision could not be performed due to the general health status of the patient; thus, alternative therapy methods were necessary. Treatment with imiquimod cream 5% (Aldara), a topical immune response modifier applied once a day and left for 12 h, led to significant partial tumor regression and clear demarcation of the tumor. The remaining tumor, now feasible for treatment with CO2 laser, was removed in two sessions in local anesthesia. In a third session, tumor parts in the anal canal were vaporized. This case demonstrates that the combination of imiquimod and CO2 laser ablation is an effective treatment option for verrucous carcinoma.
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22
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Kamarashev J, Lor P, Forster A, Heinzerling L, Burg G, Nestle FO. Generalised pustular psoriasis induced by cyclosporin a withdrawal responding to the tumour necrosis factor alpha inhibitor etanercept. Dermatology 2002; 205:213-6. [PMID: 12218252 DOI: 10.1159/000063919] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a 50-year-old male patient with a 15-year history of psoriasis including mutilating psoriatic arthritis, in whom the withdrawal of cyclosporin A induced a generalised pustular exacerbation and a aggravation of the joint condition. Two weekly injections of 25 mg of the tumour necrosis factor alpha inhibitor etanercept led to a rapid improvement of his psoriatic arthritis, as well as regression of the pustular eruption, while residual erythema was still present. The clinical response was reflected by an increase in circulating interleukin (IL) 10 and a decrease in IL-6 and IL-8 serum levels during treatment. We conclude that etanercept may be a safe and effective therapy not only in severe psoriatic arthritis, but also in cases of pustular rebound after withdrawal of immunosuppressive agents.
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Affiliation(s)
- J Kamarashev
- Department of Dermatology, University Hospital, Zurich, Switzerland
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23
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Lor P, Krueger U, Kempf W, Burg G, Nestle FO. Monoclonal rearrangement of the T cell receptor gamma-chain in lichenoid pigmented purpuric dermatitis of gougerot-blum responding to topical corticosteroid therapy. Dermatology 2002; 205:191-3. [PMID: 12218245 DOI: 10.1159/000063912] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Lichenoid pigmented purpuric dermatitis of Gougerot-Blum belongs to a group of closely related disorders which are termed pigmented purpuric dermatoses. It clinically manifests itself with grouped lichenoid papules in association with purpuric lesions. We report a case of lichenoid pigmented purpuric dermatitis of Gougerot-Blum with a heavy band-like CD4-positive lymphocytic infiltrate and clonal rearrangements of the gamma-chain of the T cell receptors as detected by polymerase chain reaction/denaturing gradient gel electrophoresis. Monoclonal expansion of T cells in combination with certain histological features of mycosis fungoides (MF) might support a biological relationship between lichenoid pigmented purpuric dermatitis of Gougerot-Blum and MF. However, prompt clinical response to topical steroid therapy supports the benign clinical nature of our case.
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Affiliation(s)
- P Lor
- Department of Dermatology, University Hospital, Zurich, Switzerland
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24
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Abstract
Melanoma is one of the prototypic immunogenic tumors. Various immunotherapeutic approaches for melanoma have been developed in the past decades. Recent scientific progress includes the discovery of defined melanoma antigens, new tools for monitoring of an anti-cancer immune response and application of novel adjuvants for amplification of the immune response such as dendritic cells. These and other advances in the field of melanoma vaccines will be discussed.
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Affiliation(s)
- F O Nestle
- Department of Dermatology, University of Zürich Hospital, Germany.
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25
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Hofbauer GFL, Böni R, Simmen D, Mihic D, Nestle FO, Burg G, Dummer R. Histological, immunological and molecular features of a nasal mucosa primary melanoma associated with nasal melanosis. Melanoma Res 2002; 12:77-82. [PMID: 11828261 DOI: 10.1097/00008390-200202000-00011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nasal mucosa melanoma is a rare entity that may occur together with nasal melanosis. The histological and immunological features and loss of heterozygosity analysis of such lesions have not been reported to date. In the study presented here short-term cell cultures were established from the patient's melanoma and subsequent relapses. Histology, immunohistochemistry, reverse transcription-polymerase chain reaction enzyme-linked immunosorbent assay, human leukocyte antigen analysis, microdissection with subsequent polymerase chain reaction for analysis of loss of heterozygosity were used to characterize the tumour and other cells. Melanoma of the nasal cavity was found, with a surrounding proliferation of atypical melanocytes corresponding to nasal melanosis. Immunoreactivity was found for S-100, gp100, tyrosinase and MelanA protein. Loss of heterozygosity for a p16-flanking marker was found in the tumour and the melanotic cells. Short-term cell cultures expressed tyrosinase and MUC18 at the mRNA level and intercellular adhesion molecule-1 (ICAM-1) and interleukin-12 receptor at the protein level. This is the first time short-term cell cultures have been established and analysed from such a tumour. Melanoma-associated antigens were identified within the tumour. The melanoma and the melanotic cells showed loss of heterozygosity for the p16 gene, which is implicated in melanoma development. This points to a common origin in tumorigenesis. Pathways of tumour escape, such as expression of CD54 and interleukin-10, were observed. The clinical, immunological and molecular features suggest that nasal melanosis should be followed closely.
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Affiliation(s)
- G F L Hofbauer
- Department of Dermatology, Head and Neck Surgery, University Hospital, Gloriastrasse 31, 8091 Zürich, Switzerland
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26
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Hofbauer GF, Kessler B, Kempf W, Nestle FO, Burg G, Dummer R. Multilesional primary cutaneous diffuse large B-cell lymphoma responsive to antibiotic treatment. Dermatology 2002; 203:168-70. [PMID: 11586019 DOI: 10.1159/000051735] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Borrelia burgdorferi infection has been implicated in cutaneous B-cell lymphoma. We report a case of multilesional primary cutaneous large B-cell lymphoma without extracutaneous spread in a patient with elevated B. burgdorferi titers. After antibiotic therapy, clinical remission and a subsequent drop in B. burgdorferi antibody titers were obtained.
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MESH Headings
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Borrelia burgdorferi/immunology
- Doxycycline/therapeutic use
- Female
- Humans
- Lyme Disease/blood
- Lyme Disease/immunology
- Lyme Disease/prevention & control
- Lymphoma, B-Cell/blood
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/blood
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Remission Induction
- Skin/drug effects
- Skin/pathology
- Skin Neoplasms/blood
- Skin Neoplasms/drug therapy
- Skin Neoplasms/pathology
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Affiliation(s)
- G F Hofbauer
- Department of Dermatology, University Hospital, Zürich, Switzerland
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Affiliation(s)
- R Dummer
- Dept. of Dermatology, University Hospital of Zurich, Switzerland.
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Abstract
A 60-year-old Swiss woman presented with a 1-year history of periorbital hemorrhagic papules, a tendency to develop hematoma due to minor trauma and shortness of breath. The personal medical history included surgery for bilateral carpal tunnel syndrome (CTS) 2 years ago. Clinical and laboratory findings included macroglossia, Bence-Jones proteinuria, reticular lung infiltrates, thickening of the ventricular walls in echocardiography and increase in atypical plasma cells in the bone marrow. The coexistence of the specific symptoms of CTS, macroglossia and cutaneous lesions should immediately alert the physician to the probable existence of plasma-cell-dyscrasia-related systemic amyloidosis.
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Affiliation(s)
- F O Nestle
- Department of Dermatology, University of Zürich Medical School, Zürich, Switzerland.
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Abstract
CD1 proteins are a family of cell surface molecules that present lipid antigens to T cells. We investigated skin dendritic cells and monocyte-derived dendritic cells for expression of CD1 molecules using a panel of 10 different monoclonal antibodies focusing on the recently described CD1d molecule. By immunohistochemical analysis, CD1d expression in normal human skin was restricted to dendritic appearing cells in the papillary dermis mainly located in a perivascular localization. Langerhans cells did not show detectable CD1d expression in situ. Epidermal/dermal cell suspensions analyzed by flow cytometry demonstrated distinct subpopulations of HLA-DR positive dermal dendritic cells expressing CD1a, CD1b, and CD1c. CD1d was expressed on HLA-DRbright dermal antigen-presenting cells in dermal suspensions (16% +/- 3.6%), as well as on highly enriched dermal dendritic cells migrating out of skin explants (60.5% +/- 8.0%). Migrated mature dermal dendritic cells coexpressed CD83 and CD1d. Western blot analysis on microdissected skin sections revealed the presence of a 50-55 kDa CD1d molecule in dermis, suggesting that CD1d is highly glycosylated in skin. Both immature and mature monocyte-derived dendritic cells cultured in autologous plasma expressed CD1d molecules. In contrast, culture in fetal bovine serum downregulated CD1d expression. In conclusion, antigen-presenting cells in skin express different sets of CD1 molecules including CD1d and might play a role in lipid antigen presentation in various skin diseases. Differential expression of CD1 molecules depending on culture conditions might have an impact on clinical applications of dendritic cells for immunotherapy.
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Affiliation(s)
- G Gerlini
- Department of Dermatology, University of Zürich Medical School, Zürich, Switzerland
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30
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Prignano F, Gerlini G, Fossombroni V, Pimpinelli N, Giannotti B, Nestle FO, Romagnoli P. Control of the differentiation state and function of human epidermal Langerhans cells by cytokines in vitro. J Eur Acad Dermatol Venereol 2001; 15:433-40. [PMID: 11763385 DOI: 10.1046/j.1468-3083.2001.00304.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Langerhans cells can originate in vitro from immature precursors stimulated with granulocyte macrophage-colony-stimulating factor (GM-CSF), tumour necrosis factor (TNF)-alpha and stem cell factor (SCF). We asked whether these cytokines also control the differentiation state of Langerhans cells within the epidermis and upon leaving this tissue. We harvested sheets of human epidermis by controlled dispase hydrolysis of keratomes, cultured them in RPMI and 10% fetal calf serum for 48 h and analysed the sheets and the cells migrated spontaneously into the medium, most of which were Langerhans cells containing Birbeck granules. By flow cytometry, the intensity of CD1a expression was reduced quite evenly among Langerhans cells migrated from sheets within 48 h. The cells in the sheets underwent loss of dendrites, with a significant reduction in the cell perimeter that was prevented by GM-CSF and TNF-alpha together. Either of these cytokines induced expression of CD18 by cells in the sheets and those in the medium. Moreover, TNF-alpha induced expression of CD54 by cells in the medium, but not by those retained in the sheets, whereas human SCF induced, dose dependently, expression of CD54 by cells in the sheets, but not from those in the medium. The proliferation of allogeneic lymphocytes was much higher when stimulating Langerhans cells were harvested from cultures with any cytokine, rather than from cultures without cytokines. We conclude the following: (i) GM-CSF and TNF-alpha help to maintain full differentiation of Langerhans cells within the epidermis; (ii) cytokine influence on Langerhans cells adhesiveness is in part context dependent; and (iii) pretreatment with cytokines influences positively the number or accessory activity of Langerhans cells on lymphocytes during subsequent mixed leucocyte reaction.
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Affiliation(s)
- F Prignano
- Department of Anatomy, Histology and Forensic Medicine, University of Florence, Italy.
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Abstract
As dendritic cells increasingly become the adjuvant of choice in new approaches to cancer immunotherapy, a degree of protocol standardization is required to aid future large-scale clinical trials.
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Affiliation(s)
- F O Nestle
- Department of Dermatology, University of Zürich Medical School, Zürich, Switzerland
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Abstract
Several pathogenetic factors such as peripheral neuropathy, vasculopathy and infection are responsible for the development of diabetic foot ulcerations. An important factor contributing to the high infection risk in diabetic patients is a defect in neutrophil granulocytes. Deficiencies in neutrophil chemotaxis, phagocytosis and respiratory burst activity with the decrease of the super- and peroxids are known to be associated with diabetes. Granulocyte-colony stimulating factor (G-CSF) increases the release of neutrophils from the bone marrow and improves neutrophil function. A 78-year old patient with non-insulin-dependent diabetes presented with ulcerations of both big toes and a malum perforans on the right sole. He also had generalized arteriosclerosis as well as a polyneuropathy with a dry foot and typical foot deformation as well as decreased in sensitivity. Intensive local care for 35 days led to no improvement of the ulcerations. Then G-CSF (Neupogen) was administered in a total dose of 165 million IU over 11 days; the daily dose varied between 15-30 million IU depending on the absolute leucocyte count. In addition 500 mg of oral ciprofloxacin (Ciproxin) was given b.i.d. This treatment led to a significant improvement of the lesions. Within 11 days cost analysis suggests G-CSF may be a cost-effective addition to antimicrobial therapy in diabetic foot infection.
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Affiliation(s)
- O P Kreyden
- Dermatologische Klinik des Universitätsspitals Zürich, Gloriastrasse 31, CH-8091 Zürich
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Kreyden OP, Borradori L, Trüeb RM, Burg G, Nestle FO. [Successful therapy with tetracycline and nicotinamide in cicatricial pemphigoid]. Hautarzt 2001; 52:247-50. [PMID: 11284073 DOI: 10.1007/s001050051299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We describe a case of cicatricial pemphigoid in a 92-year-old female with extensive mucocutaneous involvement. She developed extensive hemorrhagic blistering with severely bleeding lesions, that healed with scarring. The conjunctivae showed extensive synechia. The diagnosis was based on clinical and histopathological features as well as immunofluorescence findings and immunoblot analysis. There was no clinical response to topical corticosteroids. The patient was given tetracycline and nicotinamid and showed rapid improvement of the mucocutaneous lesions within a few weeks. The clinical features, differential diagnosis and various treatment modalities of cicatricial pemphigoid are briefly reviewed, whereby the use of tetracycline and nicotinamide is discussed as an alternative effective and safe therapy for this potentially incapacitating condition.
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Affiliation(s)
- O P Kreyden
- Dermatologische Klinik des Universitätsspitals Zürich, Gloriastrasse 31, CH-8091 Zürich
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Abstract
We report the case of a 26-year-old student with erosive skin changes on his oral and genital mucosa and skin as well as on his thighs twice after cocaine snorting. The second of these two episodes was documented histologically, and other underlying causes of disease were excluded. A diagnosis of recurring Stevens-Johnson syndrome was made. Treatment was initiated with bed rest, systemic prednisone at 1 mg/kg body weight and liquid nutrition. Mucosal changes resolved within 4 days. On follow-up the patient remained free of symptoms while abstaining from the particular cocaine street mix in question. Cocaine has been involved in seizures, headaches, ischemic strokes, intracerebral hemorrhage, cerebral vasculitis, Churg-Strauss vasculitis, palpable purpura and Henoch-Schönlein vasculitis. Bullous skin disease in association with cocaine has been reported in 1 patient. To our knowledge, we report the first case of Stevens-Johnson syndrome associated with cocaine snorting.
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Affiliation(s)
- G F Hofbauer
- Department of Dermatology, University Hospital, Zürich, Switzerland
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35
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Abstract
Melanoma tumor thickness is a major prognostic factor. Thin lesions, however, may metastasize, and sometimes thick tumors may not. To investigate the role of HLA class I-mediated antigen presentation, we correlated the expression of components of the antigen-processing machinery in primary melanoma lesions with their thickness and with the development of metastases. Seventeen formalin-fixed, paraffin-embedded primary melanomas thinner than 0.76 mm and 21 thicker than 1.50 mm were stained with anti-LMP2, -LMP7, -TAP1, -TAP2, -HLA class I and -beta2-microglobulin monoclonal antibodies. Twenty patients remained tumor-free in the follow-up period (10.5 +/- 1.8 years). Eighteen patients relapsed within a median period of 15.0 months following tumor excision. Expression of all markers in the tested lesions was down-regulated, the frequency ranging from about 40% for LMP and TAP subunits to about 70% for HLA class I antigens. Expression of all markers was not correlated with tumor thickness. Only TAP1 and TAP2 down-regulation was significantly (p = 0.026 and 0.042, respectively) correlated with the development of metastases. This correlation was independent of tumor thickness for TAP1. We suggest that TAP1 and probably TAP2 expression in primary lesions represents an independent prognostic marker in melanoma. Abnormalities in antigen presentation may account for the lack of absolute correlation between tumor thickness and prognosis.
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Affiliation(s)
- J Kamarashev
- Department of Dermatology, University Hospital, Zurich, Switzerland
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36
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Abstract
Dendritic cells (DC) are commonly viewed as the professional antigen-presenting cell. They capture antigens, migrate to appropriate lymphoid organs and initiate an antigen-specific CD4 and CD8 T cell response. Much is known about DC physiology, and it is now possible to culture, maintain and expand DC from different human sources, including hematopoietic progenitors in bone marrow and peripheral blood. Combined with the detection of an increasing number of tumor-associated antigens and T cell-recognized peptide epitopes, this has led to a new enthusiasm in the field of tumor immunotherapy and to various clinical applications in phase I/II studies on the treatment of different malignancies. This chapter will review the latest developments and give a brief update of the results obtained in studies of advanced melanoma, as well as provide a short overview of published results for other tumors.
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Affiliation(s)
- D Schadendorf
- Department of Dermatology, Mannheim Clinics, Germany
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37
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Abstract
A growing list of defined tumor-antigens opens the way to antigen specific immunotherapy of cancer. However current approaches are often limited in their potential to induce an effective anti-tumor response. Dendritic cells (DC) are natural adjuvants for the induction of antigen specific T cell response. They have been successfully used in clinical pilot trials to induce tumor specific immunity as well as clinical response in selected patients. Current research focuses on optimization of DC source, choice of antigen, antigen loading, mode of injection, as well as immuno-monitoring. Finally, a variety of immune escape mechanisms are operative at the tumor site and have to be overcome for successful vaccination.
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Affiliation(s)
- F O Nestle
- Department of Dermatology, University of Zurich Medical School, Switzerland
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38
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Carrozza PM, Nestle FO. Contact dermatitis from 'ecological' textile dyes. Contact Dermatitis 2000; 43:307-8. [PMID: 11016676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- P M Carrozza
- Department of Dermatology, University of Zürich Hospital, Switzerland
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39
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Affiliation(s)
- R Dummer
- Dermatologische Klinik, Universitätsspital Zürich.
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40
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Nestle FO, Hofbauer G, Burg G. Necrobiotic xanthogranuloma with monoclonal gammopathy of the IgG lambda type. Dermatology 2000; 198:434-5. [PMID: 10490307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- F O Nestle
- Department of Dermatology, University of Zurich Medical School, Switzerland.
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41
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Nestle FO. [Concepts for immune intervention in psoriasis vulgaris]. Praxis (Bern 1994) 2000; 89:1468-1470. [PMID: 11037618] [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] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Psoriasis vulgaris is a chronic inflammatory skin condition with a genetic background. Activated T-cells and their secreted products seem to play an essential role in the induction as well as the promotion of the psoriatic plaque. We will focus on some recent concepts on the immunopathogenesis of psoriasis highlighting the role of dendritic cells as initiators of the disease as well as the recruitment of disease specific T-cells. Concepts for immunointervention will be introduced.
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Affiliation(s)
- F O Nestle
- Dermatologische Klinik des Universitätsspitals Zürich.
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42
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Hofbauer GF, Burg G, Nestle FO. [Sporotrichoid infection with Mycobacterium marinum: successful therapy with oral tetracycline administration]. Hautarzt 2000; 51:349-52. [PMID: 10875074 DOI: 10.1007/s001050051131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Atypical mycobacterial infections of the skin present a diagnostic and therapeutic challenge to dermatologists in many instances. We report on a patient who was diagnosed with atypical mycobacteriosis in its rarer, sporotrichoid form. Possible differential diagnoses are discussed. Efficient therapy using minocycline is demonstrated.
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Affiliation(s)
- G F Hofbauer
- Dermatologische Klinik, Universitätsspital Zürich
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43
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Carrozza P, Häusermann P, Nestle FO, Burg G, Böni R. Clinical efficacy of narrow-band UVB (311 nm) combined with dithranol in psoriasis. An open pilot study. Dermatology 2000; 200:35-9. [PMID: 10681611 DOI: 10.1159/000018312] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For UVB, the most effective wavelength in clearing psoriatic lesions was found to be of 313 nm. The efficacy of whole body exposure to narrow-band UVB (311 nm) combined with dithranol in psoriasis has not been evaluated to date. OBJECTIVE Evaluation of the clinical efficacy of phototherapy with narrow-band UVB (311 nm) and dithranol for psoriasis by means of whole body exposures and analysis of the mean cumulative irradiation dose. METHODS In this open pilot study, 13 patients were treated for 4-5 weeks. Evaluation of the therapeutic efficacy was performed by comparing the Psoriasis Area and Severity Index (PASI) scores at baseline and after 4 weeks of treatment. The cumulative irradiation dose was also calculated. RESULTS Evaluation of the PASI scores showed a significant overall reduction of psoriatic lesions after 4 weeks of treatment. The cumulative irradiation dose was similar or lower to those found for phototherapy with narrow-band UVB alone. DISCUSSION In patients with widespread psoriasis, treatment with narrow-band UVB (311 nm) combined with dithranol is safe and effective, allowing reduction of the cumulative irradiation dose.
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Affiliation(s)
- P Carrozza
- Department of Dermatology, University Hospital Zurich, Switzerland.
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44
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Hofbauer GF, Nestle FO. Irritant contact dermatitis of the hands following thoracic sympathectomy. Contact Dermatitis 2000; 42:119-20. [PMID: 10703650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- G F Hofbauer
- Department of Dermatology, University Hospital Zürich, Switzerland
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Abstract
Dendritic cells (DC) are highly specialized professional antigen presenting cells which are pivotal for the initiation and control of the cytotoxic T cell response. Upon stimulation by cytokines, bacteria, or CD40L DC undergo a maturation process from an antigen-receptive state to a state of optimal stimulation of T cells. We investigated the composition of proteasomes of DC derived from human peripheral blood monocytes before and after stimulation by CD40L, LPS, or proinflammatory cytokines (TNF-alpha + IL-6 + IL-1beta). Immunoprecipitation of proteasomes and analysis on two-dimensional gels revealed that during maturation the inducible proteasome subunits LMP2, LMP7, and MECL-1 are up-regulated and that the neosynthesis of proteasomes is switched exclusively to the production of immunoproteasomes containing these subunits. The proteasome regulator PA28 is markedly up-regulated in mature DC and in addition a so - far unidentified 21-kDa protein co-precipitates with the proteasome in LPS - stimulated DC. These changes in proteasome composition may be functionally linked to special properties of DC like MHC class I up-regulation or cross-priming. Our findings imply that the spectrum of class I-bound peptides may change after DC maturation which could be relevant for the design of DC - based vaccines.
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Affiliation(s)
- A Macagno
- Research Department Cantonal Hospital St. Gall, St. Gallen, Switzerland
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Abstract
Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication after transplantation of solid organs. Highest incidence rates have been reported for lung transplant recipients. With the current treatment strategy for early onset PTLD, a reduction of immunosuppressive drugs, mortality of lung transplant recipients with PTLD remains high, due to both, incomplete control of PTLD and transplant rejection. We present a lung transplant recipient with a history of acute rejection and Epstein Barr virus-associated posttransplantation malignant non-Hodgkin's lymphoma. Extracorporeal photochemotherapy, in combination with a moderate reduction of immunosuppressive therapy, resulted in complete disappearance of PTLD. After a first year of follow-up, no further rejection and no recurrence of PTLD have occurred. Treatment with ECP, with its beneficial effects on both, rejection after organ transplantation and malignant lymphoma, may be a particularly valuable approach for the treatment of PTLD in patients after lung transplantation, with its increased risk for transplant rejection.
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Affiliation(s)
- O D Schoch
- Department of Internal Medicine, University Hospital Zurich, Switzerland
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47
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Hautmann C, Gratzl S, Simon D, Sigusch B, Nestle FO, Simon HU. [Cytokine-producing lymphoma T cells in the skin and peripheral blood associated with atopy and hypereosinophilia]. Hautarzt 1999; 50:743-7. [PMID: 10550362 DOI: 10.1007/s001050051061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 47 year old female with a history of hay fever and a family history of atopic eczema developed localized pruritic eczematous lesions over a three year period. The lesions became generalized within just three months. Episodes of recurrent erythroderma followed and became resistant towards any therapy. Many immediate and some delayed hypersensitivity reactions were diagnosed. In the peripheral blood, leukocytosis and hypereosinophilia were observed. In addition, levels of total IgE were highly increased in serum. Immunophenotyping of the peripheral blood T cells revealed evidence for a clonal expansion of highly activated CD4(+) T cells with reduced CD2 and CD5 surface expression. After a three-year course of severe disease, the diagnosis of a pleomorphic T cell lymphoma of the small-cell variant was established by histological examination and a polymerase-chain reaction technique to determine the rearrangements of the gamma chain of the T cell receptor. Moreover, analysis of cytokine gene expression suggested that the high IgE concentrations and eosinophil numbers observed in this patient were likely due to an increased IL-5 and IL-13 production by lymphoma T cells.
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MESH Headings
- CD4-Positive T-Lymphocytes
- Clone Cells
- Cytokines/biosynthesis
- Female
- Humans
- Hypereosinophilic Syndrome/pathology
- Immunoglobulin E/blood
- Immunophenotyping
- Interleukin-13/biosynthesis
- Interleukin-5/biosynthesis
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/metabolism
- Middle Aged
- Skin Neoplasms/pathology
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Affiliation(s)
- C Hautmann
- Klinik für Dermatologie und Allergie Davos
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48
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Kempf W, Adams V, Kleinhans M, Burg G, Panizzon RG, Campadelli-Fiume G, Nestle FO. Pityriasis rosea is not associated with human herpesvirus 7. Arch Dermatol 1999; 135:1070-2. [PMID: 10490111 DOI: 10.1001/archderm.135.9.1070] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the proposed association between pityriasis rosea and human herpesvirus 7 (HHV-7). DESIGN A retrospective cross-sectional survey. SETTING University medical center in Switzerland. PATIENTS Thirteen patients with pityriasis rosea and 14 persons with normal skin (control subjects). MAIN OUTCOME MEASURES Detection of HHV-7-specific DNA sequences and antigen (85-kd phosphoprotein [pp85]) by nested polymerase chain reaction and immunohistochemical analysis, respectively. RESULTS Human herpesvirus 7 DNA sequences and expression of the HHV-7-specific immunodominant pp85 antigen were found in 1 (8%) of 13 lesional skin biopsy specimens of pityriasis rosea. The prevalence of HHV-7 DNA sequences and antigens is even slightly lower in lesional skin of patients with pityriasis rosea than in clinically and morphologically normal skin of 14 control persons, in 2 of whom (14%) HHV-7 DNA sequences and antigens could be detected. CONCLUSION The low detection rate of HHV-7 DNA sequences and antigens argues strongly against a causative role for HHV-7 in the pathogenesis of pityriasis rosea.
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Affiliation(s)
- W Kempf
- Department of Dermatology, University Hospital, Zurich, Switzerland
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49
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Fritz TM, Kleinhans M, Nestle FO, Burg G, Dummer R. Combination treatment with extracorporeal photopheresis, interferon alfa and interleukin-2 in a patient with the Sézary syndrome. Br J Dermatol 1999; 140:1144-7. [PMID: 10354086 DOI: 10.1046/j.1365-2133.1999.02889.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Extracorporeal photopheresis is generally accepted as standard therapy for the leukaemic and erythrodermic variant of cutaneous T-cell lymphoma, the Sézary syndrome (SS). Because of the limited efficacy in some patients with SS, combination therapy is often necessary. We report a new combination therapy for an intensively treated 62-year-old woman with advanced SS (T4N1BM1, stage IVb). Previous treatment with PUVA, retinoids alone and in combination with photopheresis, chlorambucil, and chemotherapy using cyclophosphamide, doxorubicin, vincristine and prednisone failed and were associated with significant side-effects. Six cycles of combination therapy with extracorporeal photopheresis, low-dose interferon alfa and interleukin-2 resulted in fading of the erythroderma and in a decrease of Sézary cells in the white blood cell count. The CD4/CD8 ratio decreased from 66 to 6 and the proportion of CD4 + CD7 - cells from 47% to 11%. Only mild side-effects such as influenza-like symptoms, fever and nausea were observed. Two months after this therapy, the patient developed enlarged lymph nodes without erythroderma, and died 1 year later from the lymphoma. Combination therapy with extracorporeal photopheresis, interferon alfa and interleukin-2 might be useful in selected patients with SS.
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Affiliation(s)
- T M Fritz
- Department of Dermatology, University Hospital Zürich, Gloriastrasse 31, 8091 Zürich, Switzerland
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50
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Nestle FO, Tun Kyi A, Gilliet M, Dummer R, Burg G. [Vaccination therapy of malignant melanoma]. Ther Umsch 1999; 56:334-7. [PMID: 10420817 DOI: 10.1024/0040-5930.56.6.334] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is no cure for advanced melanoma. Chemo- or chemo-immunotherapy may lead to tumor regression in a minority of patients. New perspectives for treatment derive from recent efforts to develop vaccination strategies for melanoma. Insights into the immunobiology of this disease combined with the characterization of tumor specific peptide epitopes as well as appreciation of the crucial role of dendritic cells for the induction of anti-tumor immunity are beginning to be translated into the every day clinical practice.
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Affiliation(s)
- F O Nestle
- Dermatologische Klinik, Universitätsspital Zürich
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