1
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Hanona PF, Ezekwudo D, Fullmer J, Allen T, Jaiyesimi I. An aggressive case of a thoracic undifferentiated SMARCA4-deficient tumor with extensive pleural involvement. Thorac Cancer 2024; 15:847-851. [PMID: 38390699 PMCID: PMC10995709 DOI: 10.1111/1759-7714.15230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 02/24/2024] Open
Abstract
SMARCA4-deficient undifferentiated thoracic tumors are a rare phenomenon. A 40-year-old male was newly diagnosed with SMARCA4-deficient undifferentiated non-small cell lung cancer. He had a history of heavy smoking and job-related exposure to metal dust and melted nickel. CT imaging showed numerous right-sided pleural masses and soft tissue plaques, but no metastases. CT-guided biopsy of a pleural mass confirmed the diagnosis. He was prescribed six cycles of carboplatin paclitaxel, and follow-up imaging showed largely stable disease. Treatment was changed to nivolumab due to shortness of breath, and he received one cycle of nivolumab without considerable side effects. Unfortunately, during the second cycle of his nivolumab, the patient presented with new weakness. Imaging showed spinal cord metastasis and he underwent a laminectomy; he was subsequently followed up as an outpatient. The objective of this publication was to explore SMARCA4-deficient undifferentiated thoracic tumors, other related SMARCA4-deficient tumors, and their overall pattern of presentation. The genetic aberrations of this case are compared to recent publications that also discuss genetic aberrations commonly occurring with this disease process, with an ultimate goal of hastening detection and adding to the library of treatment results.
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Affiliation(s)
- Paul F. Hanona
- Department of Hematology and OncologyCorewell Health – William Beaumont University HospitalRoyal OakMichiganUSA
| | - Daniel Ezekwudo
- Department of Hematology and OncologyCorewell Health – William Beaumont University HospitalRoyal OakMichiganUSA
| | - Joseph Fullmer
- Department of Hematology and OncologyCorewell Health – William Beaumont University HospitalRoyal OakMichiganUSA
| | - Timothy Allen
- Department of Hematology and OncologyCorewell Health – William Beaumont University HospitalRoyal OakMichiganUSA
| | - Ishmael Jaiyesimi
- Department of Hematology and OncologyCorewell Health – William Beaumont University HospitalRoyal OakMichiganUSA
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2
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Zhao Y, Kant S, Kesarwani P, Hubert C, Nakano I, Fullmer J, Chinnaiyan P. MODL-02. GLIOMA ORGANOID MODEL PHENOTYPICALLY RECAPITULATES KEY ASPECTS OF MALIGNANT TRANSFORMATION IN GLIOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9661222 DOI: 10.1093/neuonc/noac209.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Glioblastoma (GBM) displays extensive intra-tumoral heterogeneity, serving as a major obstacle for effective treatment. The identification of molecular subtypes offered promise for personalized treatment regimens in GBM, however, it has seen been determined these subtypes are reflective of intra- rather than inter-tumoral heterogeneity, with proneural (PN) and mesenchymal (MES) subtypes corresponding to the infiltrative edge and peri-necrotic core of a tumor, respectively. Further, plasticity between subtypes has been identified, with PN-to-MES transition being described as a mode of resistance. Our laboratory utilizes patient-derived, subtype-specific GBM neurospheres as a model to understand GBM heterogeneity and have previously demonstrated that these models faithfully recapitulate human disease, with PN-neurospheres expressing Olig2, having a metabolic phenotype consistent with low-grade glioma, and an indolent growth pattern in vivo when compared to aggressive, CD44 expressing MES-neurospheres. In parallel, our group demonstrated 3D-organoid models of GBM recapitulate the tumor ecology of this malignancy ex vivo. Therefore, we sought to determine if this model could be utilized to provide a window into the plasticity of GBM molecular subtypes. Consistent with their phenotype when grown as neurospheres, MES-organoids had a homogeneous distribution of proliferating cells and retained CD44 expression. In contrast, cellular heterogeneity emerged in PN organoids that could be morphologically divided into an outer, cell-dense rim and an inner core with a lower cell density. The outer rim, recapitulating a perivascular niche, contained proliferating cells, and the inner core contained necrotic cells, mimicking the hypoxic microenvironment of GBM. Intriguingly, PN organoids retained Olig2 expression in the edge, however, actively transitioned into a MES-like state in the core, expressing CD44 and metabolic reprogramming consistent with malignant transformation. Collectively, these finding support that microenvironment contributes towards PN-MES transition and PN organoid models may serve as a tool to provide a window into specific molecular and metabolic factors contributing towards transformation.
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Affiliation(s)
- Yi Zhao
- Beaumont Health , Royal Oak, MI , USA
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3
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Aeschliman J, Richter K, Villagomez K, Kennis K, Fullmer J. 341 Improving care for pregnant people with cystic fibrosis by increasing knowledge of obstetric providers. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01031-1] [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: 11/05/2022]
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4
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Cascardo C, Ismail A, Fullmer J, Davila F. Anti-NMDA receptor encephalitis with initial negative markers: diagnostic and therapeutic challenges of a refractory case with 9-month-long follow-up. BMJ Case Rep 2022; 15:15/6/e249126. [PMID: 35764337 PMCID: PMC9240890 DOI: 10.1136/bcr-2022-249126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is a progressively debilitating, frequently fatal disease caused by autoantibodies against the NMDA receptor. Risk of delayed treatment is high due to variable presentations, lack of awareness and potential false negative diagnostic studies. In this case report, a woman in her 20s presented with psychiatric manifestations and rapidly declined. Dyskinetic movements and dysautonomia were observed. Initial cerebrospinal fluid and serum anti-NMDA receptor antibodies were negative. MRI was inconclusive. Electroencephalography demonstrated extreme delta brush. Pelvic CT revealed an adnexal teratoma. She remained refractory to treatment until day 126 when, after two cycles of cyclophosphamide, she started to improve. She participated in rehabilitation with eventual discharge home on day 269. Recognising the variable presentations of anti-NMDA receptor encephalitis is important in avoiding misdiagnosis and delayed treatment. If clinical suspicion remains high despite negative results, repeat testing should be pursued. Clinical response should guide treatment decisions in refractory cases.
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Affiliation(s)
- Camilla Cascardo
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | | | - Joseph Fullmer
- Pathology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Francisco Davila
- Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA
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5
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Tsoi LC, Patrick MT, Shuai S, Sarkar MK, Chi S, Ruffino B, Billi AC, Xing X, Uppala R, Zang C, Fullmer J, He Z, Maverakis E, Mehta NN, White BEP, Getsios S, Helfrich Y, Voorhees JJ, Kahlenberg JM, Weidinger S, Gudjonsson JE. Cytokine responses in nonlesional psoriatic skin as clinical predictor to anti-TNF agents. J Allergy Clin Immunol 2022; 149:640-649.e5. [PMID: 34343561 PMCID: PMC9451046 DOI: 10.1016/j.jaci.2021.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/14/2021] [Accepted: 07/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND A major issue with the current management of psoriasis is our inability to predict treatment response. OBJECTIVE Our aim was to evaluate the ability to use baseline molecular expression profiling to assess treatment outcome for patients with psoriasis. METHODS We conducted a longitudinal study of 46 patients with chronic plaque psoriasis treated with anti-TNF agent etanercept, and molecular profiles were assessed in more than 200 RNA-seq samples. RESULTS We demonstrated correlation between clinical response and molecular changes during the course of the treatment, particularly for genes responding to IL-17A/TNF in keratinocytes. Intriguingly, baseline gene expressions in nonlesional, but not lesional, skin were the best marker of treatment response at week 12. We identified USP18, a known regulator of IFN responses, as positively correlated with Psoriasis Area and Severity Index (PASI) improvement (P = 9.8 × 10-4) and demonstrate its role in regulating IFN/TNF responses in keratinocytes. Consistently, cytokine gene signatures enriched in baseline nonlesional skin expression profiles had strong correlations with PASI improvement. Using this information, we developed a statistical model for predicting PASI75 (ie, 75% of PASI improvement) at week 12, achieving area under the receiver-operating characteristic curve value of 0.75 and up to 80% accurate PASI75 prediction among the top predicted responders. CONCLUSIONS Our results illustrate feasibility of assessing drug response in psoriasis using nonlesional skin and implicate involvement of IFN regulators in anti-TNF responses.
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Affiliation(s)
- Lam C. Tsoi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA,Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor MI, USA,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA,Correspondence should be addressed to: Lam C Tsoi () and Johann E Gudjonsson (), Med Sci I, 1301 E Catherine St, Ann Ann, MI, 48109, USA, Phone number: 734-764-7069
| | - Matthew T. Patrick
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Shao Shuai
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA,Department of Dermatology, Xijing hospital, Fourth Military Medical University, Xi’an, Shannxi, China
| | - Mrinal K. Sarkar
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sunyi Chi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Bethany Ruffino
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allison C. Billi
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ranjitha Uppala
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Cheng Zang
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Joseph Fullmer
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zhi He
- Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Emanual Maverakis
- Department of Dermatology, School of Medicine, UC-Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Nehal N. Mehta
- Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | - Spiro Getsios
- Department of Dermatology, Northwestern University, Chicago, IL 60611, USA
| | - Yolanda Helfrich
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John J. Voorhees
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J. Michelle Kahlenberg
- Divison of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA,Correspondence should be addressed to: Lam C Tsoi () and Johann E Gudjonsson (), Med Sci I, 1301 E Catherine St, Ann Ann, MI, 48109, USA, Phone number: 734-764-7069
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6
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Schwartz S, Pai S, Beachler D, Fullmer J. 135: Improving cystic fibrosis (CF) patient registry timely data entry. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01560-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Aeschliman J, Richter K, Tayar J, Fullmer J. 225: Improving center communication for pregnant cystic fibrosis (CF) patients. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01650-7] [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: 11/24/2022]
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8
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Fatemi S, Qu E, Fullmer J. Anti-NMDA-Receptor Encephalitis in a Patient with Ovarian Teratoma, Harboring Brain Histology of Varying Developmental Stages and Regions with Chronic Inflammation. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Anti-NMDA-receptor encephalitis is a subacute, autoimmune disorder thought to be caused by autoantibodies directed against the N-methyl-D-aspartate (NMDA) receptor. Clinical symptoms of anti-NMDAR encephalitis may mimic schizophrenia and psychotic spectrum disorders or substance-induced psychosis. Although initially described in association with ovarian teratomas in women, anti-NMDAR encephalitis has been reported in individuals without paraneoplastic association, as well as in males. Herein, we report a case of a 29-year-old woman with suicidal ideation and other neuropsychiatric manifestations who was found to have a right ovarian cystic mass by imaging study. Microscopically, the resected ovarian mass is composed of mature skin, fat, cartilage and neural tissues. Nerve, ganglions and multiple brain tissues are present. Cerebellum including external granular cell layer (normally only seen in infants), cerebrum-like, choroid plexus and other neural elements are present. There is peripheral lymphoplasmacytic infiltrates around and within the neuroglial matrix. Cerebral spinal fluid was concurrently tested positive for Anti-NMDAR. The combined clinical, histological, and laboratory findings confirmed the above diagnosis. Although Anti-NMDAR encephalitis is a familiar entity to many clinical psychiatrist and neurologists, it is less commonly reported in the pathology literature. Its resultant relationship to cystic teratoma warrants awareness of this condition by pathologists.
Methods/Case Report
Case Report
Results (if a Case Study enter NA)
NA
Conclusion
Anti-NMDA-receptor encephalitis is related to cystic teratoma, therefore pathologists need to be aware of this condition.
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Affiliation(s)
- S Fatemi
- Pathology, William Beaumont, Novi, Michigan, UNITED STATES
| | - E Qu
- Pathology, William Beaumont, Novi, Michigan, UNITED STATES
| | - J Fullmer
- Pathology, William Beaumont, Novi, Michigan, UNITED STATES
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9
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Shao S, Tsoi LC, Sarkar MK, Xing X, Xue K, Uppala R, Berthier CC, Zeng C, Patrick M, Billi AC, Fullmer J, Beamer MA, Perez-White B, Getsios S, Schuler A, Voorhees JJ, Choi S, Harms P, Kahlenberg JM, Gudjonsson JE. IFN-γ enhances cell-mediated cytotoxicity against keratinocytes via JAK2/STAT1 in lichen planus. Sci Transl Med 2020; 11:11/511/eaav7561. [PMID: 31554739 DOI: 10.1126/scitranslmed.aav7561] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/31/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022]
Abstract
Lichen planus (LP) is a chronic debilitating inflammatory disease of unknown etiology affecting the skin, nails, and mucosa with no current FDA-approved treatments. It is histologically characterized by dense infiltration of T cells and epidermal keratinocyte apoptosis. Using global transcriptomic profiling of patient skin samples, we demonstrate that LP is characterized by a type II interferon (IFN) inflammatory response. The type II IFN, IFN-γ, is demonstrated to prime keratinocytes and increase their susceptibility to CD8+ T cell-mediated cytotoxic responses through MHC class I induction in a coculture model. We show that this process is dependent on Janus kinase 2 (JAK2) and signal transducer and activator of transcription 1 (STAT1), but not JAK1 or STAT2 signaling. Last, using drug prediction algorithms, we identify JAK inhibitors as promising therapeutic agents in LP and demonstrate that the JAK1/2 inhibitor baricitinib fully protects keratinocytes against cell-mediated cytotoxic responses in vitro. In summary, this work elucidates the role and mechanisms of IFN-γ in LP pathogenesis and provides evidence for the therapeutic use of JAK inhibitors to limit cell-mediated cytotoxicity in patients with LP.
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Affiliation(s)
- Shuai Shao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China.,Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mrinal K Sarkar
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ke Xue
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China
| | - Ranjitha Uppala
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Celine C Berthier
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chang Zeng
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Matthew Patrick
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Allison C Billi
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joseph Fullmer
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Maria A Beamer
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Spiro Getsios
- Department of Dermatology, Northwestern University, Chicago, IL 60611, USA
| | - Andrew Schuler
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - John J Voorhees
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Sung Choi
- Pediatric Hematology/Oncology, Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109, USA
| | - Paul Harms
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI 48109, USA.
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10
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Billi A, Gharaee-Kermani M, Fullmer J, Tsoi A, Hill B, Gruszka D, Ludwig J, Xing X, Estadt S, Wolf S, Rizvi S, Berthier C, Hodgin J, Beamer M, Sarkar M, Uppala R, Shao S, Harms P, Verhaegen M, Voorhees J, Wen F, Ward N, Dlugosz A, Kahlenberg M, Gudjonsson J. 640 The female-biased factor VGLL3 drives cutaneous and systemic autoimmunity. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Billi AC, Gharaee-Kermani M, Fullmer J, Tsoi LC, Hill BD, Gruszka D, Ludwig J, Xing X, Estadt S, Wolf SJ, Rizvi SM, Berthier CC, Hodgin JB, Beamer MA, Sarkar MK, Liang Y, Uppala R, Shao S, Zeng C, Harms PW, Verhaegen ME, Voorhees JJ, Wen F, Ward NL, Dlugosz AA, Kahlenberg JM, Gudjonsson JE. The female-biased factor VGLL3 drives cutaneous and systemic autoimmunity. JCI Insight 2019; 4:127291. [PMID: 30996136 PMCID: PMC6538382 DOI: 10.1172/jci.insight.127291] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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] [Received: 01/08/2019] [Accepted: 03/12/2019] [Indexed: 01/18/2023] Open
Abstract
Autoimmune disease is 4 times more common in women than men. This bias is largely unexplained. Female skin is "autoimmunity prone," showing upregulation of many proinflammatory genes, even in healthy women. We previously identified VGLL3 as a putative transcription cofactor enriched in female skin. Here, we demonstrate that skin-directed overexpression of murine VGLL3 causes a severe lupus-like rash and systemic autoimmune disease that involves B cell expansion, autoantibody production, immune complex deposition, and end-organ damage. Excess epidermal VGLL3 drives a proinflammatory gene expression program that overlaps with both female skin and cutaneous lupus. This includes increased B cell-activating factor (BAFF), the only current biologic target in systemic lupus erythematosus (SLE); IFN-κ, a key inflammatory mediator in cutaneous lupus; and CXCL13, a biomarker of early-onset SLE and renal involvement. Our results demonstrate that skin-targeted overexpression of the female-biased factor VGLL3 is sufficient to drive cutaneous and systemic autoimmune disease that is strikingly similar to SLE. This work strongly implicates VGLL3 as a pivotal orchestrator of sex-biased autoimmunity.
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Affiliation(s)
| | | | | | - Lam C. Tsoi
- Department of Dermatology
- A. Alfred Taubman Medical Research Institute
- Department of Biostatistics, Center for Statistical Genetics
- Department of Computational Medicine and Bioinformatics, and
| | - Brett D. Hill
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Dennis Gruszka
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jessica Ludwig
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Shannon Estadt
- Division of Rheumatology, Department of Internal Medicine
- Immunology Program
| | - Sonya J. Wolf
- Division of Rheumatology, Department of Internal Medicine
- Immunology Program
| | - Syed Monem Rizvi
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Jeffrey B. Hodgin
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Shuai Shao
- Department of Dermatology
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | | | - Paul W. Harms
- Department of Dermatology
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Fei Wen
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole L. Ward
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrzej A. Dlugosz
- Department of Dermatology
- Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - J. Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine
- A. Alfred Taubman Medical Research Institute
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12
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Liang Y, Fullmer J, Verhaegen M, Wolf S, Xing X, Harms P, Ward N, Kahlenberg J, Dlugosz A, Gudjonsson J. 041 The female-biased factor VGLL3 drives lupus-like skin inflammation in vivo. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.045] [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: 11/24/2022]
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13
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Presutto E, Chappell M, Fullmer J, Ezhapilli S. Posterior fossa medulloblastoma in an atypical extra-axial location: A case report. Radiol Case Rep 2018; 13:365-370. [PMID: 29904474 PMCID: PMC5999935 DOI: 10.1016/j.radcr.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
Medulloblastoma is the most common posterior fossa tumor of childhood typically within the fourth ventricle. However, extra-axial medulloblastoma in posterior fossa is an uncommon diagnosis. We report a case in a 33-month-old male who presented with repeated complaints of abdominal pain, intermittent emesis, and diarrhea, and diagnosed with right cerebellar extra-axial medulloblastoma, which was surgically resected. Majority of the reported extra-axial medulloblastoma in posterior fossa in the United States are located in the cerebellopontine angle. However, to the best of our knowledge, our case is the first to document medulloblastoma occurring exclusively in the cerebellar hemispheric extra-axial space rather than the cerebellopontine angle. Although the diagnosis can present as a radiological dilemma, a systematic multimodality imaging approach can aid in narrowing the differential diagnosis and timely management. In this case report, we will discuss the imaging characteristics, differential diagnosis, and management strategies, alongside a brief review of the world literature of extra-axial medulloblastoma.
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Affiliation(s)
- Elizabeth Presutto
- SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Matthew Chappell
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Joseph Fullmer
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sajeev Ezhapilli
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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14
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Swindell WR, Beamer MA, Sarkar MK, Loftus S, Fullmer J, Xing X, Ward NL, Tsoi LC, Kahlenberg MJ, Liang Y, Gudjonsson JE. RNA-Seq Analysis of IL-1B and IL-36 Responses in Epidermal Keratinocytes Identifies a Shared MyD88-Dependent Gene Signature. Front Immunol 2018; 9:80. [PMID: 29434599 PMCID: PMC5796909 DOI: 10.3389/fimmu.2018.00080] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/11/2018] [Indexed: 12/14/2022] Open
Abstract
IL-36 cytokines have recently emerged as mediators of inflammation in autoimmune conditions including psoriasis vulgaris (PsV) and generalized pustular psoriasis (GPP). This study used RNA-seq to profile the transcriptome of primary epidermal keratinocytes (KCs) treated with IL-1B, IL-36A, IL-36B, or IL-36G. We identified some early IL-1B-specific responses (8 h posttreatment), but nearly all late IL-1B responses were replicated by IL-36 cytokines (24 h posttreatment). Type I and II interferon genes exhibited time-dependent response patterns, with early induction (8 h) followed by no response or repression (24 h). Altogether, we identified 225 differentially expressed genes (DEGs) with shared responses to all 4 cytokines at both time points (8 and 24 h). These involved upregulation of ligands (IL1A, IL1B, and IL36G) and activating proteases (CTSS) but also upregulation of inhibitors such as IL1RN and IL36RN. Shared IL-1B/IL-36 DEGs overlapped significantly with genes altered in PsV and GPP skin lesions, as well as genes near GWAS loci linked to autoimmune and autoinflammatory diseases (e.g., PsV, psoriatic arthritis, inflammatory bowel disease, and primary biliary cholangitis). Inactivation of MyD88 adapter protein using CRISPR/Cas9 completely abolished expression responses of such DEGs to IL-1B and IL-36G stimulation. These results provide a global view of IL-1B and IL-36 expression responses in epidermal KCs with fine-scale characterization of time-dependent and cytokine-specific response patterns. Our findings support an important role for IL-1B and IL-36 in autoimmune or autoinflammatory conditions and show that MyD88 adaptor protein mediates shared IL-1B/IL-36 responses.
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Affiliation(s)
- William R Swindell
- Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States
| | - Maria A Beamer
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Mrinal K Sarkar
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Shannon Loftus
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Fullmer
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Xianying Xing
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Nicole L Ward
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Michelle J Kahlenberg
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, Ann Arbor, MI, United States
| | - Yun Liang
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, MI, United States
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15
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Hazama A, Galgano M, Fullmer J, Hall W, Chin L. Affinity of Mucormycosis for Basal Ganglia in Intravenous Drug Users: Case Illustration and Review of Literature. World Neurosurg 2016; 98:872.e1-872.e3. [PMID: 27923750 DOI: 10.1016/j.wneu.2016.11.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 09/27/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/30/2022]
Abstract
Central nervous system mucormycosis is an aggressive fungal infection often ending in fatality. The usual circumstance is an immunocompromised individual presenting with rapidly progressive rhinocerebral involvement. An extremely rare variant of central nervous system mucormycosis isolated to the basal ganglia in an immunocompetent intravenous drug user is detailed in this manuscript. The patient was aggressively treated with aspiration of the fungal abscess and long-term intravenous antifungal agents.
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Affiliation(s)
- Ali Hazama
- Department of Neurosurgery, Upstate Medical University Hospital, Syracuse, New York, USA.
| | - Michael Galgano
- Department of Neurosurgery, Upstate Medical University Hospital, Syracuse, New York, USA
| | - Joseph Fullmer
- Department of Pathology, Upstate Medical University Hospital, Syracuse, New York, USA
| | - Walter Hall
- Department of Neurosurgery, Upstate Medical University Hospital, Syracuse, New York, USA
| | - Lawrence Chin
- Department of Neurosurgery, Upstate Medical University Hospital, Syracuse, New York, USA
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16
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Alekseev O, Vaughn J, Taylor B, Barba L, Greiner J, Dickson C, Anderson C, Fullmer J, Vaskalis Z. Development of an ELISA to detect tumor-associated antigen tNASP in urine. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.90] [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: 11/12/2022] Open
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17
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Abstract
Pilocytic astrocytomas are histologically benign tumors, generally found in the pediatric population. Onset of symptoms is generally insidious, predominantly stemming from mass effect upon nearby structures. Patients harboring a pilocytic astrocytoma may present with gait disturbance, headaches, cranial nerve deficits, as well as hydrocephalus, depending on the exact location. Although cases of adult pilocytic astrocytomas in the adult population are described, they are quite uncommon. We present a case of an adult female presenting with acute neurological compromise resulting from an acutely hemorrhagic posterior fossa pilocytic astrocytoma. Her initial neurological assessment was consistent with a Glasgow coma scale of 4T, as the patient was experiencing decerebrate posturing. An emergent external ventricular drain was placed in the emergency department for acute hydrocephalus as a temporizing measure, prior to evacuation of the associated subdural and intratumoral hemorrhages, as well as resection of the mass. After a long hospital course and extensive rehabilitation, the patient made a remarkable recovery and eventually gave birth to a child via Caesarean section three years after her initial presentation.
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18
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Galgano M, Padalino DJ, Fullmer J, Krishnamurthy S. Acute Neurological Deterioration in an Adult with a Cerebellar Pilocytic Astrocytoma Accompanied by Intratumoral Hemorrhage, Subdural Hematoma, and Obstructive Hydrocephalus. Cureus 2014. [DOI: 10.7759/cureus.235] [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: 11/05/2022] Open
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19
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Abstract
Anti-Gal is a natural antibody specific for the alpha-galactosyl epitope. Previous studies suggested that Graves' disease (GD) patients had elevated anti-Gal titers compared to normal controls, but titers returned to normal after treatment. We developed an anti-Gal enzyme-linked immunosorbent assay (ELISA) using the property of anti-Gal to bind tightly to mouse laminin. We found no significant correlations between anti-Gal and thyroidstimulating immunoglobulin (TSI) or free thyroxine (T(4)) in untreated hyperthyroid GD patients (n = 15) without clinical ophthalmopathy or euthyroid, previously treated GD patients with ophthalmopathy. There was a significant regression between TSI and free T(4) in the hyperthyroid patients (p < 0.01). Addition of total anti- Gal antibody to the regression showed a trend toward improved correlation (p = 0.15 for improved correlation relative to TSI and free T(4) alone), suggesting it may stimulate GD thyroid tissue. However, in contrast to previous studies we found hyperthyroid patients (n = 20) had lower levels of anti-Gal immunoglobulin G (IgG) (18.4 +/- 4.0 vs. 41.8 +/- 8.9) than normals (n = 36 p < 0.05). Interestingly, hyperthyroid patients without clinical ophthalmopathy tended to have lower IgG anti-Gal levels than euthyroid patients with ophthalmopathy (p = 0.1). Hyperthyroidism significantly lowers anti-Gal, but the possible increase of anti-Gal in patients with ophthalmopathy suggests anti-Gal may play a role in ophthalmopathy, or may reflect the euthryoid status of these patients. This trend needs further study.
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Affiliation(s)
- Joseph Fullmer
- Department of Neuroscience, University of Minnesota, Minneapolis, USA
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