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Papara C, Karsten CM, Ujiie H, Schmidt E, Schmidt-Jiménez LF, Baican A, Freire PC, Izumi K, Bieber K, Peipp M, Verschoor A, Ludwig RJ, Köhl J, Zillikens D, Hammers CM. The relevance of complement in pemphigoid diseases: A critical appraisal. Front Immunol 2022; 13:973702. [PMID: 36059476 PMCID: PMC9434693 DOI: 10.3389/fimmu.2022.973702] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Pemphigoid diseases are autoimmune chronic inflammatory skin diseases, which are characterized by blistering of the skin and/or mucous membranes, and circulating and tissue-bound autoantibodies. The well-established pathomechanisms comprise autoantibodies targeting various structural proteins located at the dermal-epidermal junction, leading to complement factor binding and activation. Several effector cells are thus attracted and activated, which in turn inflict characteristic tissue damage and subepidermal blistering. Moreover, the detection of linear complement deposits in the skin is a diagnostic hallmark of all pemphigoid diseases. However, recent studies showed that blistering might also occur independently of complement. This review reassesses the importance of complement in pemphigoid diseases based on current research by contrasting and contextualizing data from in vitro, murine and human studies.
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Affiliation(s)
- Cristian Papara
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Christian M. Karsten
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | | | - Adrian Baican
- Department of Dermatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Patricia C. Freire
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
| | - Kentaro Izumi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Katja Bieber
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Matthias Peipp
- Division of Antibody-Based Immunotherapy, Department of Medicine II, Christian-Albrechts-University of Kiel and University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Admar Verschoor
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Jörg Köhl
- Institute of Systemic Inflammation Research, University of Lübeck, Lübeck, Germany
- Division of Immunobiology, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Christoph M. Hammers
- Department of Dermatology, University of Lübeck, Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
- *Correspondence: Christoph M. Hammers,
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Rodrigues SC, Cardoso RMS, Freire PC, Gomes CF, Duarte FV, Neves RPD, Simões-Correia J. Immunomodulatory Properties of Umbilical Cord Blood-Derived Small Extracellular Vesicles and Their Therapeutic Potential for Inflammatory Skin Disorders. Int J Mol Sci 2021; 22:9797. [PMID: 34575956 PMCID: PMC8468428 DOI: 10.3390/ijms22189797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/26/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023] Open
Abstract
Umbilical cord blood (UCB) has long been seen as a rich source of naïve cells with strong regenerative potential, likely mediated by paracrine signals. More recently, small extracellular vesicles (sEV), such as exosomes, have been shown to play essential roles in cell-to-cell communication, via the transport of numerous molecules, including small RNAs. Often explored for their potential as biomarkers, sEV are now known to have regenerative and immunomodulating characteristics, particularly if isolated from stem cell-rich tissues. In this study, we aim to characterize the immunomodulating properties of umbilical cord blood mononuclear cell-derived sEV (UCB-MNC-sEV) and explore their therapeutic potential for inflammatory skin diseases. UCB-MNC-sEV were shown to shift macrophages toward an anti-inflammatory phenotype, which in turn exert paracrine effects on fibroblasts, despite previous inflammatory stimuli. Additionally, the incubation of PBMC with UCB-MNC-sEV resulted in a reduction of total CD4+ and CD8+ T-cell proliferation and cytokine release, while specifically supporting the development of regulatory T-cells (Treg), by influencing FOXP3 expression. In a 3D model of psoriatic skin, UCB-MNC-sEV reduced the expression of inflammatory and psoriatic markers IL6, IL8, CXCL10, COX2, S100A7, and DEFB4. In vivo, UCB-MNC-sEV significantly prevented or reversed acanthosis in imiquimod-induced psoriasis, and tendentially increased the number of Treg in skin, without having an overall impact on disease burden. This work provides evidence for the anti-inflammatory and tolerogenic effect of UCB-MNC-sEV, which may be harnessed for the treatment of Th17-driven inflammatory skin diseases, such as psoriasis.
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Affiliation(s)
- Sílvia C. Rodrigues
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), CNC—Center for Neuroscience and Cell Biology, University of Coimbra, 3004-517 Coimbra, Portugal
| | - Renato M. S. Cardoso
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
| | - Patricia C. Freire
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
| | - Cláudia F. Gomes
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
| | - Filipe V. Duarte
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
| | - Ricardo Pires das Neves
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
- CNC—Center for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- IIIUC—Institute of Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
| | - Joana Simões-Correia
- Exogenus Therapeutics, S.A., 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (P.C.F.); (C.F.G.); (F.V.D.); (R.P.d.N.)
- CNC—Center for Neuroscience and Cell Biology, CIBB—Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, 3004-517 Coimbra, Portugal
- IIIUC—Institute of Interdisciplinary Research, University of Coimbra, 3030-789 Coimbra, Portugal
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Rodrigues SC, Cardoso RMS, Gomes CF, Duarte FV, Freire PC, Neves R, Simoes-Correia J. Toxicological Profile of Umbilical Cord Blood-Derived Small Extracellular Vesicles. Membranes (Basel) 2021; 11:membranes11090647. [PMID: 34564463 PMCID: PMC8472372 DOI: 10.3390/membranes11090647] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 01/08/2023]
Abstract
The development and adoption of cell therapies has been largely limited by difficulties associated with their safety, handling, and storage. Extracellular vesicles (EV) have recently emerged as a likely mediator for the therapeutic effect of cells, offering several advantages over cell therapies. Due to their small size and inability to expand and metastasize, EV are generally considered safer than cell transplantation. Nevertheless, few studies have scrutinized the toxicity profile of EV, particularly after repeated high-dose administration. The present study aimed to evaluate a preparation of small EV obtained from umbilical cord blood mononuclear cells (UCB-MNC-sEV) for its cytotoxicity in different cell lines, as well as its differential accumulation, distribution, and toxicity following repeated intravenous (IV) administrations in a rodent model. In vitro, repeated sEV exposure in concentrations up to 1 × 1011 particles/mL had no deleterious impact on the viability or metabolic activity of peripheral blood mononuclear cells, THP-1 monocytes, THP-1-derived macrophages, normal dermal human fibroblasts, or human umbilical vein endothelial cells. DiR-labelled sEV, injected intravenously for four weeks in healthy rats, were detected in clearance organs, particularly the kidneys, spleen, and liver, similarly to control dye. Moreover, repeated administrations for six and twelve weeks of up to 1 × 1010 total particles of sEV dye were well-tolerated, with no changes in general haematological cell counts, or kidney and liver toxicity markers. More importantly, unlabelled sEV likewise did not induce significant alterations in cellular and biochemical blood parameters, nor any morphological changes in the heart, kidney, lung, spleen, or liver tissue. In sum, our data show that UCB-MNC-sEV have no significant toxicity in vitro or in vivo, even when administered repeatedly at high concentrations, therefore confirming their safety profile and potential suitability for future clinical use.
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Affiliation(s)
- Silvia C. Rodrigues
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research (IIIUC), Center for Neuroscience and Cell Biology (CNC), University of Coimbra, 3004-531 Coimbra, Portugal
| | - Renato M. S. Cardoso
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
| | - Claudia F. Gomes
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
| | - Filipe V. Duarte
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
- Center for Neurosciences and Cell Biology (CNC), University of Coimbra, 3004-517 Coimbra, Portugal
| | - Patricia C. Freire
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
| | - Ricardo Neves
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
- Center for Neurosciences and Cell Biology (CNC), University of Coimbra, 3004-517 Coimbra, Portugal
- Institute for Interdisciplinary Research (3Is), University of Coimbra, 3030-789 Coimbra, Portugal
| | - Joana Simoes-Correia
- Exogenus Therapeutics, S.A., Biocant Park, Núcleo 4, Lote 2, 3060-197 Cantanhede, Portugal; (S.C.R.); (R.M.S.C.); (C.F.G.); (F.V.D.); (P.C.F.); (R.N.)
- Center for Neurosciences and Cell Biology (CNC), University of Coimbra, 3004-517 Coimbra, Portugal
- Correspondence:
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Cardoso RMS, Rodrigues SC, Gomes CF, Duarte FV, Romao M, Leal EC, Freire PC, Neves R, Simões‐Correia J. Development of an optimized and scalable method for isolation of umbilical cord blood-derived small extracellular vesicles for future clinical use. Stem Cells Transl Med 2021; 10:910-921. [PMID: 33577723 PMCID: PMC8133342 DOI: 10.1002/sctm.20-0376] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/10/2020] [Accepted: 12/24/2020] [Indexed: 12/16/2022] Open
Abstract
Extracellular vesicles (EV) are a promising therapeutic tool in regenerative medicine. These particles were shown to accelerate wound healing, through delivery of regenerative mediators, such as microRNAs. Herein we describe an optimized and upscalable process for the isolation of EV smaller than 200 nm (sEV), secreted by umbilical cord blood mononuclear cells (UCB-MNC) under ischemic conditions and propose quality control thresholds for the isolated vesicles, based on the thorough characterization of their protein, lipid and RNA content. Ultrafiltration and size exclusion chromatography (UF/SEC) optimized methodology proved superior to traditional ultracentrifugation (UC), regarding production time, standardization, scalability, and vesicle yield. Using UF/SEC, we were able to recover approximately 400 times more sEV per mL of media than with UC, and upscaling this process further increases EV yield by about 3-fold. UF/SEC-isolated sEV display many of the sEV/exosomes classical markers and are enriched in molecules with anti-inflammatory and regenerative capacity, such as hemopexin and miR-150. Accordingly, treatment with sEV promotes angiogenesis and extracellular matrix remodeling, in vitro. In vivo, UCB-MNC-sEV significantly accelerate skin regeneration in a mouse model of delayed wound healing. The proposed isolation protocol constitutes a significant improvement compared to UC, the gold-standard in the field. Isolated sEV maintain their regenerative properties, whereas downstream contaminants are minimized. The use of UF/SEC allows for the standardization and upscalability required for mass production of sEV to be used in a clinical setting.
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Affiliation(s)
| | - Silvia C. Rodrigues
- Exogenus Therapeutics, S.A, Biocant ParkCantanhedePortugal
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB)Institute for Interdisciplinary Research (IIIUC), CNC—Center for Neuroscience and Cell Biology, University of Coimbra.CoimbraPortugal
| | | | | | - Maryse Romao
- Institut CurieParis Sciences Lettres Research University, Centre National de la Recherche Scientifique, UMR 144ParisFrance
- Cell and Tissue Imaging Core Facility PICT‐IBiSAInstitut CurieParisFrance
| | - Ermelindo C. Leal
- CNC—Center for Neurosciences and Cell BiologyUniversity of CoimbraCoimbraPortugal
- 3Is—Institute for Interdisciplinary Research, University of CoimbraCoimbraPortugal
| | | | - Ricardo Neves
- Exogenus Therapeutics, S.A, Biocant ParkCantanhedePortugal
- CNC—Center for Neurosciences and Cell BiologyUniversity of CoimbraCoimbraPortugal
- 3Is—Institute for Interdisciplinary Research, University of CoimbraCoimbraPortugal
| | - Joana Simões‐Correia
- Exogenus Therapeutics, S.A, Biocant ParkCantanhedePortugal
- CNC—Center for Neurosciences and Cell BiologyUniversity of CoimbraCoimbraPortugal
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Tinoco RC, Figueira SE, Freire PC. Mucous antrectomy associated with vagotomy in duodenal ulcer. Int Surg 1982; 67:37-40. [PMID: 7096000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The authors describe the present surgical procedure for duodenal ulcer; this consists of vagotomy in association with resection of the antral mucosa, and sliding the fundus mucosa to cover the naked surface. The gastroduodenal junction is sewn as an enlarged Weimberg pyloroplasty. A series of 20 patients were operated upon, without complications, from 1972 to 1976. It is concluded that this technique has advantages over pyloroplasty: it has a low rate of morbidity and the safety of classical antrectomy, without its inconveniences.
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