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Griffin L, Ho L, Akhurst RJ, Arron ST, Boggs JME, Conlon P, O'Kelly P, Toland AE, Epstein EH, Balmain A, Bastian BC, Moloney FJ, Murphy GM, Laing ME. Genetic polymorphism in Methylenetetrahydrofolate Reductase chloride transport protein 6 ( MTHFR CLCN6) gene is associated with keratinocyte skin cancer in a cohort of renal transplant recipients. Skin Health Dis 2022; 2:e95. [PMID: 35677930 PMCID: PMC9168012 DOI: 10.1002/ski2.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/18/2022]
Abstract
Background Renal transplant recipients (RTRs) are at increased risk of keratinocyte cancer (KC), especially cutaneous squamous cell carcinoma (cSCC). Previous studies identified a genetic variant of the Methylenetetrahydrofolate Reductase (MTHFR) gene, C677T, which conferred a risk for diagnosis of cSCC in Irish RTRs. Objective We sought to find further genetic variation in MTHFR and overlap genes that may be associated with a diagnosis of KC in RTRs. Methods Genotyping of a combined RTR population (n = 821) from two centres, Ireland (n = 546) and the USA (n = 275), was performed. This included 290 RTRs with KC and 444 without. Eleven single nucleotide polymorphisms (SNPs) in the MTHFR gene and seven in the overlap gene MTHFR Chloride transport protein 6 (CLCN6) were evaluated and association explored by time to event analysis (from transplant to first KC) using Cox proportional hazards model. Results Polymorphism at MTHFR CLCN6 (rs9651118) was significantly associated with KC in RTRs (HR 1.50, 95% CI 1.17–1.91, p < 0.00061) and cSCC (HR 1.63, 95% CI 1.14–2.34, p = 0.007). A separate SNP, MTHFR C677T, was also significantly associated with KC in the Irish population (HR 1.31, 95% CI 1.05–1.63, p = 0.016), but not American RTRs. Conclusions We report the association of a SNP in the MTHFR overlap gene, CLCN6 and KC in a combined RTR population. While the exact function of CLCN6 is not known, it is proposed to be involved in folate availability. Future applications could include incorporation in a polygenic risk score for KC in RTRs to help identify those at increased risk beyond traditional risk factor assessment.
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Affiliation(s)
- L Griffin
- Department of Dermatology University Hospital Galway Galway Ireland
| | - L Ho
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - R J Akhurst
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - S T Arron
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - J M E Boggs
- Department of Dermatology University Hospital Galway Galway Ireland
| | - P Conlon
- Department of Nephrology Beaumont Hospital Dublin 9 Ireland
| | - P O'Kelly
- Department of Nephrology Beaumont Hospital Dublin 9 Ireland
| | - A E Toland
- Department of Molecular Virology, Immunology and Medical Genetics Comprehensive Cancer Centre Ohio State University Columbus Ohio USA
| | - E H Epstein
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - A Balmain
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - B C Bastian
- Helen Diller Family Comprehensive Cancer Center University of California San Francisco California USA
| | - F J Moloney
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - G M Murphy
- Department of Dermatology Beaumont Hospital Dublin 9 Ireland
| | - M E Laing
- Department of Dermatology University Hospital Galway Galway Ireland.,Department of Dermatology Beaumont Hospital Dublin 9 Ireland.,Department of Medicine National University of Ireland Galway Ireland
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Affiliation(s)
- A M O'Mahony
- Cork University Hospital, Wilton, Cork, Ireland.
| | - G M Murphy
- Cork University Hospital, Wilton, Cork, Ireland
| | - M T Henry
- Cork University Hospital, Wilton, Cork, Ireland
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Affiliation(s)
- G M Murphy
- St John's Hospital for Diseases of the Skin, London
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Jennings L, Cummins R, Murphy GM, Gulmann C, O'Kane M. HRAS
mutation in phacomatosis pigmentokeratotica without extracutaneous disease. Clin Exp Dermatol 2017; 42:791-792. [DOI: 10.1111/ced.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- L. Jennings
- Department of Dermatology; Beaumont Hospital; Beaumont Road Dublin 9 Ireland
| | - R. Cummins
- Department of Pathology; Royal College of Surgeons in Ireland; Beaumont Hospital; Dublin Ireland
| | - G. M. Murphy
- Department of Dermatology; Beaumont Hospital; Beaumont Road Dublin 9 Ireland
| | - C. Gulmann
- Department of Histopathology; Beaumont Hospital; Beaumont Road Dublin 9 Ireland
| | - M. O'Kane
- Department of Dermatology; Beaumont Hospital; Beaumont Road Dublin 9 Ireland
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Lembo S, Hawk JLM, Murphy GM, Kaneko K, Young AR, McGregor JM, Walker SL, Palmer RA. Aberrant gene expression with deficient apoptotic keratinocyte clearance may predispose to polymorphic light eruption. Br J Dermatol 2017; 177:1450-1453. [PMID: 27873316 DOI: 10.1111/bjd.15200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Lembo
- Department of Clinical Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, Salerno, Italy
| | - J L M Hawk
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - G M Murphy
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland
| | - K Kaneko
- Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust and The University of Nottingham, Nottingham, NG7 2NR, U.K
| | - A R Young
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - J M McGregor
- Department of Cell Biology and Cutaneous Research, Blizzard Institute, Barts and The London School of Medicine and Dentistry, London, E1 2AT, U.K
| | - S L Walker
- St John's Institute of Dermatology, King's College London, London, SE1 9RT, U.K
| | - R A Palmer
- Princess Margaret Hospital, Osborne Road, Windsor, SL4 3SJ, U.K
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Abstract
A relatively rapid and specific method for the estimation of serum individual bile acids, conjugated and free, in small volumes (1 ml) of sera from patients with liver disease has been developed. This method has been applied to a study of 25 patients with liver disease. Cholestatic liver disease has been found to be associated with an increase in serum monohydroxy bile acids which appear to be of an unsaturated nature. No association was found between the concentration of any particular bile acid and the presence or absence of pruritus.
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Affiliation(s)
- G. M. Murphy
- Department of Medicine, Royal Free Hospital, London, W.C.1
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Martin FL, Maghsoudloo M, Murphy GM, Alison MR. Rat Liver Hyperplasia: Polyamine Concentrations Maintained Despite Ornithine Decarboxylase Inhibition. Int J Toxicol 2016. [DOI: 10.1080/109158198226747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The polyamines (putrescine, spermidine, spermine) and the key enzyme controlling their synthesis (ornithine decarboxylase, ODC) are considered important for many adaptive growth responses. In most epithelial cell populations enhanced proliferation is preceded by or associated with elevated ODC activity. We investigated whether inhibition of ODC activity reduces hepatic proliferation after mitogenic challenge. Rats maintained on a 2% oral solution of the L-ornithine analogue α-difluoromethylornithine (DFMO) were compared to positive controls in their response to mitogenic challenge. Adaptive growth was induced by partial hepatectomy (PH), or by a single dose of either phenobarbital (PB) (100 mg kg-1, gastric tube), cyproterone acetate (CPA) (100 mg kg-1, ip) or clofibrate (500 mg kg-1, gastric tube). Although these stimuli normally elevate ODC levels, DFMO proved to be a powerful inhibitor. Inhibition of ODC activity correlated with the absence of detectable levels of putrescine; without DFMO, putrescine levels were approximately 200 nmol g-1 wet weight in each case following mitogenic challenge. Proliferation, as measured by 5-bromo-2′-deoxyuridine (BrdUrd) labeling at 24 h following stimulation, was largely unaffected by DFMO, and hepatic levels of spermidine and spermine were not significantly reduced. The hepatic levels of these downstream polyamines were high despite ODC inhibition, indicating an important role for them in these adaptive growth responses. These data suggest that an alternative polyamine metabolism pathway not affected by DFMO might be in operation here, or that an exogenous source of polyamines might exist.
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Affiliation(s)
- F. L. Martin
- Department of Histopathology, Royal Postgraduate Medical School, London, United Kingdom
| | - M. Maghsoudloo
- Gastroenterology Unit, Guy's Hospital, London, United Kingdom
| | - G. M. Murphy
- Gastroenterology Unit, Guy's Hospital, London, United Kingdom
| | - M. R. Alison
- Department of Histopathology, Royal Postgraduate Medical School, London, United Kingdom
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Ray A, Tennakoon L, Keller J, Sarginson JE, Ryan HS, Murphy GM, Lazzeroni LC, Trivedi MH, Kocsis JH, DeBattista C, Schatzberg AF. ABCB1 (MDR1) predicts remission on P-gp substrates in chronic depression. Pharmacogenomics J 2014; 15:332-9. [PMID: 25487678 DOI: 10.1038/tpj.2014.72] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/04/2014] [Accepted: 09/19/2014] [Indexed: 01/16/2023]
Abstract
The hypothesis that allelic variation in the multidrug resistance-1 (MDR1 or ABCB1) gene encoding the P-glycoprotein (P-gp) blood-brain barrier efflux pump is associated with remission and side effects was tested in chronic major depression patients treated with P-gp substrates. In 83 patients from the REVAMP trial, frequency of and time to remission as well as side effects was tested among genotype groups at 6 ABCB1 single nucleotide polymorphisms (SNPs). These six SNPs are significantly associated with remission and time to remission, with minor allele carriers on rs2235040 and rs9282564 attaining statistical significance after controlling for the other ABCB1 SNPs. The six ABCB1 SNPs are also significantly associated with the average side effects. However, here common homozygotes on rs2235040 and rs9282564 demonstrated significantly higher side effects after controlling for the effects of the other ABCB1 SNPs. These findings confirm and extend previous observations that minor alleles of two ABCB1 SNPs predict remission to treatment with substrates and demonstrate that common homozygotes on these SNPs experience greater side effects. Results point to the potential importance of ABCB1 variation for personalized medicine approaches to treating depression.
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Affiliation(s)
- A Ray
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - L Tennakoon
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - J Keller
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - J E Sarginson
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - H S Ryan
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - G M Murphy
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - L C Lazzeroni
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - M H Trivedi
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - J H Kocsis
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - C DeBattista
- Department of Psychiatry, Stanford University, Stanford, CA, USA
| | - A F Schatzberg
- Department of Psychiatry, Stanford University, Stanford, CA, USA
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Seçkin D, Barete S, Euvrard S, Francès C, Kanitakis J, Geusau A, Del Marmol V, Harwood CA, Proby CM, Ali I, Güleç AT, Durukan E, Lebbé C, Alaibac M, Laffitte E, Cooper S, Bouwes Bavinck JN, Murphy GM, Ferrándiz C, Mørk C, Cetkovská P, Kempf W, Hofbauer GFL. Primary cutaneous posttransplant lymphoproliferative disorders in solid organ transplant recipients: a multicenter European case series. Am J Transplant 2013; 13:2146-53. [PMID: 23718915 DOI: 10.1111/ajt.12281] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [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: 11/21/2012] [Revised: 03/30/2013] [Accepted: 04/08/2013] [Indexed: 01/25/2023]
Abstract
Primary cutaneous posttransplant lymphoproliferative disorders (PTLD) are rare. This retrospective, multicenter study of 35 cases aimed to better describe this entity. Cases were (re)-classified according to the WHO-EORTC or the WHO 2008 classifications of lymphomas. Median interval between first transplantation and diagnosis was 85 months. Fifty-seven percent of patients had a kidney transplant. Twenty-four cases (68.6%) were classified as primary cutaneous T cell lymphoma (CTCL) and 11 (31.4%) as primary cutaneous B cell PTLD. Mycosis fungoides (MF) was the most common (50%) CTCL subtype. Ten (90.9%) cutaneous B cell PTLD cases were classified as EBV-associated B cell lymphoproliferations (including one plasmablastic lymphoma and one lymphomatoid granulomatosis) and one as diffuse large B cell lymphoma, other, that was EBV-negative. Sixteen (45.7%) patients died after a median follow-up of 19.5 months (11 [68.8%] with CTCL [6 of whom had CD30(+) lymphoproliferative disorders (LPD)] and 5 [31.2%] with cutaneous B cell PTLD. Median survival times for all patients, CTCL and cutaneous B cell PTLD subgroups were 93, 93, and 112 months, respectively. Survival rates for MF were higher than those for CD30(+) LPD. The spectrum of primary CTCL in organ transplant recipients (OTR) is similar to that in the general population. The prognosis of posttransplant primary cutaneous CD30(+) LPD is worse than posttransplant MF and than its counterpart in the immunocompetent population. EBV-associated cutaneous B cell LPD predominates in OTR.
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Affiliation(s)
- D Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey.
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Arron ST, Jennings L, Nindl I, Rosl F, Bouwes Bavinck JN, Seçkin D, Trakatelli M, Murphy GM. Viral oncogenesis and its role in nonmelanoma skin cancer. Br J Dermatol 2011; 164:1201-13. [PMID: 21418174 DOI: 10.1111/j.1365-2133.2011.10322.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In recent years, the contribution of viruses to cutaneous oncogenesis has steadily gained recognition. The archetype is human herpesvirus 8, which is well established as the causative agent in Kaposi sarcoma. Other viruses believed to play a role in nonmelanoma skin cancer include human papillomavirus and the recently described Merkel cell polyomavirus. We review the mechanisms by which these three viruses interact with the host cell, ultraviolet radiation and immunosuppression to result in carcinogenesis.
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Affiliation(s)
- S Tuttleton Arron
- Department of Dermatology, University of California, San Francisco, CA, USA
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Jennings L, Ho WL, Gulmann C, Murphy GM. Churg-Strauss syndrome secondary to antileucotriene therapy in a patient not receiving oral corticosteroids. Clin Exp Dermatol 2010; 34:e430-1. [PMID: 19747303 DOI: 10.1111/j.1365-2230.2009.03431.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Abstract
Ultraviolet (UV) radiation is a complete carcinogen. The effects of UV radiation are mediated via direct damage to cellular DNA in the skin and suppression of image surveillance mechanisms. In the context of organ transplantation, addiction of drugs which suppress the immune system add greatly to the carcinogenicity of UV radiation. This review considers the mechanisms of such effects.
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Affiliation(s)
- G M Murphy
- Department of Dermatology, Beaumont & Mater Misericordiae Hospital, Dublin, Ireland.
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13
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Laing ME, Dicker P, Murphy GM. Toll-like receptor 4, 7 and 8 polymorphisms have no association with nonmelanoma skin cancer in renal transplant patients. Br J Dermatol 2009; 161:715-7. [PMID: 19614650 DOI: 10.1111/j.1365-2133.2009.09370.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Gibson G, Murphy GM. Spironolactone treatment of porphyria cutanea tarda-associated hirsutism. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639409080568] [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: 11/13/2022]
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Abstract
Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and cyclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis.
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Affiliation(s)
- R Hughes
- Department of Dermatology, The Adelaide and Meath Hospital, Incorporating the National Children's Hospital Tallaght, Dublin, Ireland
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Abstract
Melanoma incidence continues to rise in most countries. This is of grave concern, given the mortality rate in a relatively young population. Current staging tools are limited in their ability to predict accurately those at risk of metastatic disease, relapse and treatment failure. This overview comprehensively reviews relevant literature, with the focus on the last 5 years, and discusses the current state of traditional and emerging novel methods of staging for melanoma and their effect on prognosis in this population.
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Affiliation(s)
- L Jennings
- Department of Dermatology, Beaumont Hospital, Beaumont, Dublin, Ireland.
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McQuillan RF, O'Seaghdha CM, Bagatto A, Manusamy M, Errakiah N, Sinnott C, O’Kelly P, Murphy GM, Conlon PJ. The effect of switching from calcineurin inhibitor to sirolimus on the incidence of skin cancers in kidney transplant recipients. J Eur Acad Dermatol Venereol 2009; 23:330-1. [DOI: 10.1111/j.1468-3083.2008.02882.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Sweet's syndrome (SS), a rare reactive neutrophilic dermatosis, has been reported to occur in association with a variety of systemic disorders, categorized by von den Diesch into idiopathic, paraneoplastic, pregnancy and parainflammatory subgroups. The parainflammatory group has been well defined, and includes a wide spectrum of infectious triggers and disorders of immune dysregulation. To date, however, no cases of SS have been described in the context of common variable immunodeficiency (CVID). We report a case of paediatric-onset SS, previously reported as idiopathic, with a subsequent diagnosis of CVID.
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Affiliation(s)
- G M O'Regan
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
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Matin RN, Mesher D, Proby CM, McGregor JM, Bouwes Bavinck JN, del Marmol V, Euvrard S, Ferrandiz C, Geusau A, Hackethal M, Ho WL, Hofbauer GFL, Imko-Walczuk B, Kanitakis J, Lally A, Lear JT, Lebbe C, Murphy GM, Piaserico S, Seckin D, Stockfleth E, Ulrich C, Wojnarowska FT, Lin HY, Balch C, Harwood CA. Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases. Am J Transplant 2008; 8:1891-900. [PMID: 18786232 DOI: 10.1111/j.1600-6143.2008.02326.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients have a higher incidence of melanoma compared to the general population but the prognosis of this potentially fatal skin cancer in this group of patients has not yet been established. To address this, we undertook a multicenter retrospective analysis to assess outcome for 100 melanomas (91 posttransplant and 9 pretransplant) in 95 individuals. Data were collected in 14 specialist transplant dermatology clinics across Europe belonging to the Skin Care in Organ Transplant Patients, Europe (SCOPE) Network, and compared with age, sex, tumor thickness and ulceration status-matched controls from the American Joint Committee on Cancer (AJCC) melanoma database. Outcome for posttransplant melanoma was similar to that of the general population for T1 and T2 tumors (< or = 2 mm thickness); but was significantly worse for T3 and T4 tumors (> 2 mm thickness); all nine individuals with a pretransplant melanoma survived without disease recurrence following organ transplantation. These data have implications for both cutaneous surveillance in organ transplant recipients and management of transplant-associated melanoma.
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Affiliation(s)
- R N Matin
- Centre for Cutaneous Research and Department of Dermatology, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
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O'Grady A, Dunne C, O'Kelly P, Murphy GM, Leader M, Kay E. Differential expression of matrix metalloproteinase (MMP)-2, MMP-9 and tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 in non-melanoma skin cancer: implications for tumour progression. Histopathology 2008; 51:793-804. [PMID: 18042068 DOI: 10.1111/j.1365-2559.2007.02885.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To investigate the expression of matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2 in non-melanoma skin cancer (NMSC) and to compare their expression between different tumour types and with clinicopathological factors. METHODS AND RESULTS A study of 11 normal skin, 29 Bowen's disease (BD), 40 squamous cell carcinoma (SCC) and 38 basal cell carcinoma (BCC) samples for MMP-2, MMP-9, TIMP-1 and TIMP-2 expression was carried out using immunohistochemistry and in situ hybridization. The expression of all metalloproteinases was greater in tumours than in normal skin. MMP-2 and MMP-9 expression was more extensive in the stroma of SCC than of BCC or BD. TIMP-1 expression was greater in the stroma of BCC than of SCC or BD and TIMP-2 expression was greater in the stroma of SCC than of BD. There was a correlation between increased metalloproteinase expression and depth of lesion (MMP-2 and TIMP-2), inflammation (MMP-2, MMP-9, TIMP-1 and TIMP-2) and microvessel density (MMP-2, MMP-9 and TIMP-2). CONCLUSIONS MMP-2, MMP-9, TIMP-1 and TIMP-2 play an important role in the pathogenesis of non-melanoma skin cancer, but differ significantly in their expression levels between the tumour types examined. The immunoexpression of these proteins may be useful indicators of cutaneous cancer invasion and progression.
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Affiliation(s)
- A O'Grady
- Department of Histopathology, Beaumont Hospital & Royal College of Surgeons in Ireland, Dublin, Ireland.
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Fallon JC, Patchett S, Gulmann C, Murphy GM. Mycobacterium marinum infection complicating Crohn's disease, treated with infliximab. Clin Exp Dermatol 2007; 33:43-5. [DOI: 10.1111/j.1365-2230.2007.02564.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We report the case of anaphylactic reaction to carboxymethylcellulose, a dispersant in corticosteroid preparation and contrast media. Skin prick testing in this patient revealed a positive response to carboxymethylcellulose at a dilution of 1/1000. Anaphylaxis secondary to carboxymethylcellulose has previously been reported. To avoid further problems, this patient was advised to alert medical staff for the presence of allergy to carboxymethylcellulose in the event of the need for further interventional procedures. Care should be taken when giving intradermal steroids to patients with a history of anaphylaxis after contrast media.
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Affiliation(s)
- M E Laing
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland.
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McMahon MA, Wynne B, Murphy GM, Kearns G. Recurrence of Kawasaki disease in an adult patient with cholecystitis. Ir Med J 2007; 100:400-1. [PMID: 17491541] [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: 05/15/2023]
Abstract
We report recurrence of Kawasaki disease in a 20-year-old man eighteen years after the primary episode. Athough sixty-nine cases have been reported among adults in the literature, this represents only the second case of Kawasaki disease recurring in an adult patient after childhood presentation. Our patient presented with the characteristic mucocutaneous features, fever, arthralgia, epigastric pain and cholecystitis. His presentation was complicated by arthralgias and abnormal liver function tests, which are more common in the adult patient. The diagnosis was made based on clinical findings after the exclusion of other causes of persistent febrile illness. He was successfully treated with high dose aspirin and intravenous immunoglobulin therapy. Despite a second presentation of Kawasaki disease our patient did not have any demonstrable coronary arterial involvement. Although typically a self-limiting disease, cardiac complications can cause significant morbidity and mortality in those not treated with aspirin and IVIG. This report serves to highlight that late recurrence of Kawasaki disease may develop in adults many decades after the initial presentation. A twenty-year-old male, presented to the Emergency department with a one-week history of general malaise. He complained of sore throat, 5-day history of fever (39 degree celsius), epigastric discomfort, rash, nausea, vomiting, generalised arthralgia and myalgia. He was jaundiced with dark urine and pale stools. He had been commenced on oral penicillin three times a day for possible streptococcal infection after the rash had occurred. Past medical history was notable for a previous episode of Kawasaki disease (KD) at 2 years of age, after which there were no adverse sequelae, a history of asthma and non-alcoholic fatty liver disease.
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Affiliation(s)
- M A McMahon
- Department of Rheumatology, Beaumont Hospital, Dublin.
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Abstract
The characteristics of malignant melanoma arising in transplant patients are not clearly delineated. We describe clinical and histological features of malignant melanoma in five transplant patients. All transplant patients with melanoma arising post-transplantation had a previous history of skin cancer. Two had a history of internal organ malignancy. Three patients had thick malignant melanomas (Clark level III or higher, or >0.76 mm Breslow thickness). Lymph-node metastases occurred in one patient with cutaneous melanoma. Local cutaneous metastases occurred in one patient. Mean duration from transplantation to melanoma was 15.6 years. Two cases of aggressive metastatic melanoma responded well to cessation of immunosuppression. Three patients with nonmetastatic disease responded well to conventional complete excision and continuation of immunosuppression.
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Affiliation(s)
- M E Laing
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland.
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MESH Headings
- Adult
- Dermatitis, Occupational/diagnosis
- Dermatitis, Occupational/etiology
- Dermatitis, Occupational/pathology
- Diagnosis, Differential
- Eggs/adverse effects
- Female
- Food Handling
- Food Hypersensitivity/diagnosis
- Food Hypersensitivity/etiology
- Food Hypersensitivity/pathology
- Hand Dermatoses/diagnosis
- Hand Dermatoses/etiology
- Hand Dermatoses/pathology
- Humans
- Hypersensitivity, Delayed/diagnosis
- Hypersensitivity, Delayed/etiology
- Hypersensitivity, Delayed/pathology
- Hypersensitivity, Immediate/diagnosis
- Hypersensitivity, Immediate/etiology
- Hypersensitivity, Immediate/pathology
- Latex Hypersensitivity/diagnosis
- Latex Hypersensitivity/etiology
- Latex Hypersensitivity/pathology
- Skin Tests
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Affiliation(s)
- M E Laing
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland.
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Otley CC, Berg D, Ulrich C, Stasko T, Murphy GM, Salasche SJ, Christenson LJ, Sengelmann R, Loss GE, Garces J. Reduction of immunosuppression for transplant-associated skin cancer: expert consensus survey. Br J Dermatol 2006; 154:395-400. [PMID: 16445766 DOI: 10.1111/j.1365-2133.2005.07087.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [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: 11/30/2022]
Abstract
BACKGROUND Reduction of immunosuppression is considered a reasonable adjuvant therapeutic strategy in solid-organ transplant recipients experiencing multiple or high-risk skin cancers. However, the literature provides no guidance about what threshold of cancer development would warrant initiation of reduction of immunosuppression. OBJECTIVES To develop expert consensus guidelines for initiation of reduction of transplant-associated immunosuppression for solid-organ transplant recipients with severe skin cancer. METHODS An expert consensus panel was convened by the International Transplant Skin Cancer Collaborative and Skin Care for Organ Transplant Patients Europe Reduction of Immunosuppression Task Force. Thirteen hypothetical patient scenarios with graduated morbidity and mortality risks were presented and mean and mode expert opinions about appropriate level of reduction of systemic immunosuppression (mild, moderate, severe) were generated. RESULTS Mild reduction of transplant-associated immunosuppression was considered warranted once multiple skin cancers per year developed or with individual high-risk skin cancers. Moderate reduction was considered appropriate when patients experienced > 25 skin cancers per year or for skin cancers with a 10% 3-year risk of mortality. Severe reduction was considered warranted only for life-threatening skin cancers. CONCLUSIONS Reduction of immunosuppression is considered a reasonable adjuvant management strategy for transplant recipients with numerous or life-threatening skin cancers. Proposed guidelines are presented for the graduated reduction of immunosuppression coincident with the increasing skin cancer risks.
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Affiliation(s)
- C C Otley
- Department of Dermatology, University of Washington, Seattle, USA.
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Moloney FJ, Dicker P, Conlon PJ, Shields DC, Murphy GM. The frequency and significance of thiopurine S
-methyltransferase gene polymorphisms in azathioprine-treated renal transplant recipients. Br J Dermatol 2006; 154:1199-200. [PMID: 16704656 DOI: 10.1111/j.1365-2133.2006.07239.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moloney FJ, Comber H, O'Lorcain P, O'Kelly P, Conlon PJ, Murphy GM. A population-based study of skin cancer incidence and prevalence in renal transplant recipients. Br J Dermatol 2005; 154:498-504. [PMID: 16445782 DOI: 10.1111/j.1365-2133.2005.07021.x] [Citation(s) in RCA: 295] [Impact Index Per Article: 15.5] [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: 10/25/2022]
Abstract
BACKGROUND Cancers occurring following solid organ transplantation are a rapidly growing public health concern. Defining the extent of the problem has been limited by surveillance systems with incomplete registration of cases and the paucity of reliable national incidence data. OBJECTIVES To determine the incidence of all cancers following renal transplantation and to make a detailed examination of trends and patterns associated with postrenal transplant skin cancers. METHODS Integration of data from the national renal transplant database and the national cancer registry in Ireland enabled accurate determination of the number of renal transplant recipients (RTRs) with skin cancers and other malignancies in the time period 1 January 1994 to 31 December 2001. RESULTS We demonstrated a biphasic increase in skin cancer incidence following renal transplantation, determined by the age at transplantation. There was a steady increase in risk for older RTRs (age 50+ years) from year 2 post-transplant, whereas the increased risk in younger RTRs (age < 50 years) occurred later but much more significantly, reaching 200 times the risk for an age-matched nontransplanted population by year 6 post-transplant. The number of nonmelanoma skin cancers (NMSCs) registered in RTRs accounted for 1% of all NMSCs registered nationally over the study period. The standardized incidence rates for invasive NMSC (33-fold increase) and in situ carcinoma of the skin (65-fold increase) were significantly increased (P < 0.05). The risk for invasive squamous cell carcinoma (SCC) was increased 82-fold compared with the nontransplanted population. Male RTRs were at particular risk of invasive SCC at sun-exposed sites such as the scalp and the external ear. Risk of malignant melanoma and Kaposi sarcoma were also increased relative to the nontransplanted population. CONCLUSIONS This comprehensive national study illustrates how rates of skin cancer in Irish RTRs have influenced the national incidence of skin cancer. The high incidence of SCC, basal cell carcinoma and Bowen's disease in the early post-transplant period for older patients and the cumulative risk in younger patients with increased duration of transplantation highlight the importance of implementing early and continued cancer surveillance regimens post-transplant.
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Affiliation(s)
- F J Moloney
- Nephrology, Beaumont Hospital, Dublin, Ireland.
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Abstract
BACKGROUND Skin cancer, caused by solar ultraviolet (UV) radiation, is a growing problem in Europe. Reliable data on occupational exposure of outdoor workers are needed to develop protective strategies. OBJECTIVES To compare UV radiation exposure patterns between outdoor workers in two European populations. METHODS Fifty-three gardeners, 31 Irish and 22 Danish (age range 24-69 years) wore personal UV dosimeters, measuring time-stamped UV doses continuously during a 4-month summer period. The current and historical sun exposure pattern was recorded by means of a diary and questionnaire. Assessment of pigmentation, naevi, freckles and solar lentigines was performed. The relationship between UV dose and sun exposure pattern was analysed. RESULTS Regarding work days, the Irish had a significantly lower percentage of ambient UV exposure than the Danes, 4.5% vs. 8.1%; a lower UV dose per day, 0.97 standard erythema dose (SED) vs. 1.6 SED; a lower UV dose between 12.00 and 15.00 h, 0.43 SED vs. 0.75 SED; and fewer hours with positive dosimeter measurements, 3.2 h vs. 4.8 h (all values are medians, P < 0.01). Regarding days off work, the same patterns emerged for both UV doses and exposure hours. The Irish had significantly fewer days off than the Danes, median 21 days vs. 49 days, and fewer days with risk behaviour (sunbathing/exposing upper body), median 0 days vs. 8 days (P < 0.01). CONCLUSIONS The lower UV exposure received by the Irish gardeners may have been due to indoor breaks during peak ambient UV. Other contributing factors may include differences in natural shade between the parks. Our data suggest that consideration of such factors in scheduling of outdoor work can significantly reduce the occupational UV exposure.
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Affiliation(s)
- E Thieden
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen, Denmark.
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Affiliation(s)
- M E Laing
- Regional Centre of Dermatology, Mater Hospital, Dublin, Ireland.
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O'Hara R, Schröder CM, Kraemer HC, Kryla N, Cao C, Miller E, Schatzberg AF, Yesavage JA, Murphy GM. Nocturnal sleep apnea/hypopnea is associated with lower memory performance in APOE ε4 carriers. Neurology 2005; 65:642-4. [PMID: 16116137 DOI: 10.1212/01.wnl.0000173055.75950.bf] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [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: 11/15/2022] Open
Abstract
The authors investigated the relationship between obstructive sleep apnea/hypopnea (OSAH) and cognition in 36 older adults, 18 APOE ε4 carriers, and 18 non-carriers. Greater numbers of respiratory events negatively impacted memory function in ε4 carriers only. This is the first study to provide preliminary evidence for a negative interaction of APOE ε4 and OSAH on memory in older adults, which may have important implications for treating cognitive decline and delaying dementia onset.
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Affiliation(s)
- R O'Hara
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305-5550, USA.
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Abstract
BACKGROUND The immunosuppressive therapy a patient requires to sustain a functioning renal allograft in the long term is associated with various skin complications. While quality of life (QoL) after renal transplantation has been studied, no publications document the effect of post-transplant dermatological complications on QoL. OBJECTIVES The objective of the study was to document the prevalence of the skin diseases that commonly occur in association with post-transplant immunosuppression. A general dermatological quality of life questionnaire, the Dermatology Life Quality Index (DLQI), was used to assess the QoL effect of these cutaneous complications. The study was designed to examine further the impact of age, sex, duration since transplant and immunosuppressive regimen on the DLQI score of renal transplant recipients (RTR). METHODS One hundred and seventy-three RTR completed the DLQI, were interviewed and examined for evidence of common post-transplant skin diseases. RESULTS Sixteen per cent of RTR had DLQI scores >6, reflecting a significant impact on their QoL. Dry skin, itch, hypertrichosis, sebaceous gland hyperplasia, acne, genital warts and a history of >4 herpes simplex virus type 1 infections in the past year were all found to have a significant impact on the quality of life (P < 0.05). Multivariate analysis revealed that the greatest impact on QoL was in RTR who were younger, female and with multiple skin problems (P < 0.05). CONCLUSIONS The dermatological complications of immunosuppressive therapy are common in RTR and can significantly impair QoL in certain individuals. Visible, infectious and cosmetic skin problems had most impact on QoL while a history of skin cancer had a lesser impact. Early dermatological referral and careful choice of immunosuppression may enhance the QoL, particularly in young and female RTR.
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Affiliation(s)
- F J Moloney
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland.
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Wisor JP, Edgar DM, Yesavage J, Ryan HS, McCormick CM, Lapustea N, Murphy GM. Sleep and circadian abnormalities in a transgenic mouse model of Alzheimer's disease: a role for cholinergic transmission. Neuroscience 2005; 131:375-85. [PMID: 15708480 DOI: 10.1016/j.neuroscience.2004.11.018] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [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] [Accepted: 11/16/2004] [Indexed: 11/18/2022]
Abstract
The Tg2576 mouse model of Alzheimer's disease (AD) exhibits age-dependent amyloid beta (Abeta) deposition in the brain. We studied electroencephalographically defined sleep and the circadian regulation of waking activities in Tg2576 mice to determine whether these animals exhibit sleep abnormalities akin to those in AD. In Tg2576 mice at all ages studied, the circadian period of wheel running rhythms in constant darkness was significantly longer than that of wild type mice. In addition, the increase in electroencephalographic delta (1-4 Hz) power that occurs during non-rapid eye movement sleep after sleep deprivation was blunted in Tg2576 mice relative to controls at all ages studied. Electroencephalographic power during non-rapid eye movement sleep was shifted to higher frequencies in plaque-bearing mice relative to controls. The wake-promoting efficacy of the acetylcholinesterase inhibitor donepezil was lower in plaque-bearing Tg2576 mice than in controls. Sleep abnormalities in Tg2576 mice may be due in part to a cholinergic deficit in these mice. At 22 months of age, two additional deficits emerged in female Tg2576 mice: time of day-dependent modulation of sleep was blunted relative to controls and rapid eye movement sleep as a percentage of time was lower in Tg2576 than in wild type controls. The rapid eye movement sleep deficit in 22 month-old female Tg2576 mice was abolished by brief passive immunization with an N-terminal antibody to Abeta. The Tg2576 model provides a uniquely powerful tool for studies on the pathophysiology of and treatments for sleep deficits and associated cholinergic abnormalities in AD.
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Affiliation(s)
- J P Wisor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Thomas LA, Veysey MJ, Murphy GM, Russell-Jones D, French GL, Wass JAH, Dowling RH. Octreotide induced prolongation of colonic transit increases faecal anaerobic bacteria, bile acid metabolising enzymes, and serum deoxycholic acid in patients with acromegaly. Gut 2005; 54:630-5. [PMID: 15831907 PMCID: PMC1774470 DOI: 10.1136/gut.2003.028431] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/09/2004] [Accepted: 07/14/2004] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acromegalic patients have slow colonic transit, increased rates of deoxycholic acid formation, and an increased prevalence of cholesterol gall stones, especially during long term octreotide treatment. However, the effects of this prolonged large bowel transit time on the numbers of faecal anaerobes and the activities of the enzyme systems which biotransform conjugated cholic acid into unconjugated deoxycholic acid (cholylglycine hydrolase and 7alpha-dehydroxylase) are unknown. METHODS Therefore, in 10 non-acromegalic controls, 11 acromegalic patients not treated with octreotide, and 11 acromegalics on long term (8-48 months) octreotide (100-200 mug three times daily subcutaneously), we measured large bowel transit time and, in freshly voided faeces, the activities of the two bile acid metabolising enzymes, and related the results to the proportion of deoxycholic acid in fasting serum. Moreover, in patients with acromegaly, we measured quantitative bacteriology in faeces. RESULTS Mean large bowel transit time in acromegalics not treated with octreotide (35 (SEM 6.5) hours) was 66% longer than that in non-acromegalic controls (21 (3.1) hours; NS) and became further prolonged during octreotide treatment (48 (6.6) hours; p<0.001). These octreotide induced changes in transit were associated, in acromegalic patients, with more total (15.0 (2.5) v 6.3 (1.3)x10(9) colony forming units (cfu)/g; p<0.05) and Gram positive (6.3 (2.3) v 3.2 (1.0)x10(9) cfu/g; p<0.05) faecal anaerobes. Mean faecal cholylglycine hydrolase activity in the long term octreotide group (22.0 (6.0)x10(-2) U/mg protein) was 138% greater than that in non-acromegalic controls (12.0 (6.0)x10(-2); p<0.01). Similarly, mean 7alpha-dehydroxylase activity in octreotide treated acromegalics (11.1 (1.18)x10(-4) U/mg protein) was 78% greater than that in patients not receiving long term octreotide (6.3 (0.5)x10(-4); p<0.001). The mean proportion of deoxycholic acid in fasting serum also increased from 18.0 (2.88)% in the untreated group to 29.6 (2.3)% during long term octreotide (p<0.05). There were significant linear relationships between large bowel transit time and: (i) faecal 7alpha-dehydroxylase activity; and (ii) the proportion of deoxycholic acid in fasting serum and between 7alpha-dehydroxylase activity and the proportion of deoxycholic acid in serum.Summary/interpretation: These data suggest that increased deoxycholic acid formation seen in acromegalics during octreotide treatment is due not only to the greater numbers of faecal anaerobes but also to increased activity of the rate limiting enzyme pathway (7alpha-dehydroxylation) converting cholic acid to deoxycholic acid.
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Affiliation(s)
- L A Thomas
- Gastroenterology Unit, Division of Medicine, GKT School of Medicine, Kings College, London, UK
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Abstract
An 8-year-old boy born prematurely at 26 weeks' gestation presented with a reticulate scar on the left cheek. This started as an eroded area on day 3 postpartum, followed by crusting and scarring. There were also linear scars on the left forearm, left lower back and abdomen. The clinical picture fits the entity of congenital erosive and vesicular dermatosis. This retrospective case report delineates the outcome with diagnosis only evident after an 8-year time period.
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Affiliation(s)
- Y Y Vun
- Our Lady of Lourdes Hospital, Dermatology, Drogheda, County Louth, Ireland.
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Abstract
Transplant medicine has seen many innovations over past decades and continues to evolve into the 21st century. Newer immunosuppressive strategies in renal transplantation are associated with better patient and graft survival rates; however, the adverse toxicities and long-term side effects associated with these agents present a number of challenges. Certain immunosuppressants are commonly used in dermatologic disorders, however, dermatologists may be less familiar with the clinical efficacy, side-effect profile, and dosage of newer immunosuppressive agents. A knowledge of the molecular and cellular mechanisms of action of these agents gives us a better understanding of how these agents contribute to the cutaneous and mucosal complications frequently seen post-transplant. With the advent of new immunosuppressive therapies and different treatment regimens, there is an increasing need for a multidisciplinary approach to balancing the risks and benefits of these medications to the individual transplant recipient. This review will highlight the different immunosuppressive agents and their effect on the skin while focusing on the evidence base to support the commonly used immunosuppressive regimes, newer protocols aimed at achieving maximum graft survival with minimal side effects, and important drug interactions with which all dermatologists should be familiar.
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Affiliation(s)
- F J Moloney
- Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland.
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Moloney FJ, Kelly PO, Kay EW, Conlon P, Murphy GM. Maintenance versus reduction of immunosuppression in renal transplant recipients with aggressive squamous cell carcinoma. Dermatol Surg 2004; 30:674-8. [PMID: 15061854 DOI: 10.1111/j.1524-4725.2004.00155.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [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: 01/22/2023]
Abstract
BACKGROUND There has been a significant increase in skin cancers in transplant patients in recent years. Transplant recipients are also more likely to develop skin cancers that are locally invasive with the potential to metastasize early. OBJECTIVES This study aimed to determine the effect of significantly reducing or stopping immunosuppressive therapy on prognosis of aggressive squamous cell carcinomas (SCC) in renal transplant recipients (RTRs). PATIENTS/METHODS Retrospective study of nine patients with aggressive SCC identified two groups, one whose immunosuppressive therapy was not altered and the other who had their therapy stopped or significantly reduced. RESULTS Aggressive SCC all occurred on the head and neck, with five of the primary tumors originating from the ear. Using a Wilcoxon-Breslow test to compare equality of survivor functions, reducing or stopping immunosuppression was associated with the prolongation of metastatic disease-free survival period (p=0.023). CONCLUSIONS This nonrandomized pilot study suggests that reduction of immunosuppression in RTRs with aggressive SCC may improve prognosis compared to patients whose immunosuppression is unchanged. Allograft function may continue despite significant reduction of immunosuppression.
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Affiliation(s)
- F J Moloney
- Department of Dermatology, Beaumont Hospital, Dublin, Ireland
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Byrne JS, Abdul Razak AR, Patchett S, Murphy GM. Warfarin skin necrosis associated with protein S deficiency and a mutation in the methylenetetrahydrofolate reductase gene. Clin Exp Dermatol 2004; 29:35-6. [PMID: 14723717 DOI: 10.1111/j.1365-2230.2004.01443.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/28/2022]
Abstract
The use of warfarin is rarely complicated by skin necrosis. We describe a 50-year-old woman who presented with a left leg deep venous thrombosis and subsequent pulmonary embolism. She was initially anticoagulated with low-molecular weight heparin and subsequently warfarin. Within 4 days abdominal skin necrosis developed. Investigations revealed the presence of protein S deficiency and in addition, a mutation in the methylenetetrahydrofolate reductase gene (MTHFR). We present, to our best knowledge, the first case of warfarin skin necrosis associated with a methylenetetrahydrofolate reductase mutation.
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Affiliation(s)
- J S Byrne
- Department of Dermatology, Beaumont Hospital & Private Clinic, Beaumont, Dublin 9, Ireland
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Abstract
AIMS To investigate the concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol in the gall bladder bile obtained at surgery from patients with and without cholesterol gallstones. METHODS Gall bladder bile was collected during surgery, by puncture, from 20 patients with gallstones undergoing routine cholecystectomy and from eight patients with normal liver blood tests. Concentrations of bilirubin, bilirubin conjugates, phospholipid, and cholesterol were measured using standard procedures. RESULTS The proportion of total bilirubin that was unconjugated was significantly higher in the bile from patients with stones than in bile from control patients, whether or not the bile from either group was saturated with cholesterol or not. Indeed, the mean concentration of cholesterol was significantly higher in control bile samples. CONCLUSION The presence of stones was more closely related to the proportion of unconjugated bilirubin than to the degree of saturation of bile with cholesterol. Bilirubin and its metabolites probably play an important part in the formation of cholesterol gallstones.
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Affiliation(s)
- M K Dutt
- Gastrointestinal Laboratory, The Rayne Institute, St Thomas's Hospital, London SE1 7EH, UK
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Kaufmann R, Bibby AJ, Bissonnette R, Cambazard F, Chu AC, Decroix J, Douglas WS, Lowson D, Mascaro JM, Murphy GM, Stymne B. A new calcipotriol/betamethasone dipropionate formulation (Daivobet) is an effective once-daily treatment for psoriasis vulgaris. Dermatology 2003; 205:389-93. [PMID: 12444337 DOI: 10.1159/000066440] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [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 Topical corticosteroids and calcipotriol have been used separately for many years to treat psoriasis. A new combination ointment has been formulated, which contains both calcipotriol and the corticosteroid betamethasone dipropionate. OBJECTIVE To compare the combination ointment with betamethasone dipropionate ointment, calcipotriol ointment and ointment vehicle in patients with psoriasis vulgaris. METHODS 1,603 patients were randomised to one of the 4 double-blind treatments used once daily for 4 weeks. RESULTS The mean percentage change in the PASI at the end of treatment was -71.3 (combination), -57.2 (betamethasone), -46.1 (calcipotriol) and -22.7 (vehicle). The mean difference of combination minus betamethasone was -14.2 (95% CI: -17.6 to -10.8, p < 0.001), of combination minus calcipotriol -25.3 (95% CI: -28.7 to -21.9, p < 0.001) and of combination minus vehicle -48.3 (95% CI: -53.2 to -43.4, p < 0.001). 6.0% of patients (combination) reported local adverse reactions compared to 4.9% (betamethasone), 11.4% (calcipotriol) and 13.6% (vehicle). CONCLUSION Calcipotriol/betamethasone dipropionate combination ointment used once daily is well tolerated and more effective than either active constituent used alone.
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Affiliation(s)
- D S Lim
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland.
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