1
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Petrasca A, Hambly R, Kearney N, Smith CM, Pender EK, Mac Mahon J, O'Rourke AM, Ismaiel M, Boland PA, Almeida JP, Kennedy C, Zaborowski A, Murphy S, Winter D, Kirby B, Fletcher JM. Metformin has anti-inflammatory effects and induces immunometabolic reprogramming via multiple mechanisms in hidradenitis suppurativa. Br J Dermatol 2023; 189:730-740. [PMID: 37648653 DOI: 10.1093/bjd/ljad305] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/17/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Targeting immunometabolism has shown promise in treating autoimmune and inflammatory conditions. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease involving painful lesions in apocrine gland-bearing skin. Therapeutic options for HS are limited and often ineffective; thus, there is a pressing need for improved treatments. To date, metabolic dysregulation has not been investigated in HS. As HS is highly inflammatory, we hypothesized that energy metabolism is dysregulated in these patients. Metformin, an antidiabetic drug, which is known to impact on cellular metabolic and signalling pathways, has been shown to have anti-inflammatory effects in cancer and arthritis. While metformin is not licensed for use in HS, patients with HS taking metformin show improved clinical symptoms. OBJECTIVE To assess the effect and mechanism of action of metformin in HS. METHODS To assess the effect of metformin in vivo, we compared the immune and metabolic profiles of peripheral blood mononuclear cells (PBMCs) of patients with HS taking metformin vs. those not taking metformin. To examine the effect of metformin treatment ex vivo, we employed a skin explant model on skin biopsies from patients with HS not taking metformin, which we cultured with metformin overnight. We used enzyme-linked immunosorbent assays, multiplex cytokine assays and quantitative real-time polymerase chain reaction (RT-PCR) to measure inflammatory markers, and Seahorse flux technology and quantitative RT-PCR to assess glucose metabolism. RESULTS We showed that metabolic pathways are dysregulated in the PBMCs of patients with HS vs. healthy individuals. In metformin-treated patients, these metabolic pathways were restored and their PBMCs had reduced inflammatory markers following long-term metformin treatment. In the skin explant model, we found that overnight culture with metformin reduced inflammatory cytokines and chemokines and glycolytic genes in lesions and tracts of patients with HS. Using in vitro assays, we found that metformin may induce these changes via the NLR family pyrin domain containing 3 (NLRP3) inflammasome and the AMP-activated protein kinase (AMPK)-mammalian target of rapamycin (mTOR) pathway, which is linked to glycolysis and protein synthesis. CONCLUSIONS Our study provides insight into the mechanisms of action of metformin in HS. The anti-inflammatory effects of metformin support its use as a therapeutic agent in HS, while its effects on immunometabolism suggest that targeting metabolism is a promising therapeutic option in inflammatory diseases, including HS.
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Affiliation(s)
- Andreea Petrasca
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Roisin Hambly
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, Dublin, Ireland
| | - Niamh Kearney
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, Dublin, Ireland
| | - Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily K Pender
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, Dublin, Ireland
| | - Julie Mac Mahon
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, Dublin, Ireland
| | - Aoife M O'Rourke
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Mohamed Ismaiel
- Department of Surgery, St. Michael's Hospital, Dublin, Ireland
| | | | - Jose P Almeida
- Department of Surgery, St. Michael's Hospital, Dublin, Ireland
| | - Czara Kennedy
- Department of Surgery, St. Michael's Hospital, Dublin, Ireland
| | | | - Siun Murphy
- Department of Plastic Reconstructive and Aesthetic Surgery, Blackrock Clinic, Dublin, Ireland
| | - Desmond Winter
- Department of Surgery, St. Michael's Hospital, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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2
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Moran B, Smith CM, Zaborowski A, Ryan M, Karman J, Dunstan RW, Smith KM, Hambly R, Musilova J, Petrasca A, Fabre A, O'Donnell M, Hokamp K, Mills KHG, Housley WJ, Winter DC, Kirby B, Fletcher JM. Targeting the NLRP3 inflammasome reduces inflammation in hidradenitis suppurativa skin. Br J Dermatol 2023; 189:447-458. [PMID: 37243544 DOI: 10.1093/bjd/ljad184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Treatment for the debilitating disease hidradenitis suppurativa (HS) is inadequate in many patients. Despite an incidence of approximately 1%, HS is often under-recognized and underdiagnosed, and is associated with a high morbidity and poor quality of life. OBJECTIVES To gain a better understanding of the pathogenesis of HS, in order to design new therapeutic strategies. METHODS We employed single-cell RNA sequencing to analyse gene expression in immune cells isolated from involved HS skin vs. healthy skin. Flow cytometry was used to quantify the absolute numbers of the main immune populations. The secretion of inflammatory mediators from skin explant cultures was measured using multiplex and enzyme-linked immunosorbent assays. RESULTS Single-cell RNA sequencing analysis identified a significant enrichment in the frequency of plasma cells, T helper (Th) 17 cells and dendritic cell subsets in HS skin, and the immune transcriptome was distinct and more heterogeneous than healthy skin. Flow cytometry revealed significantly increased numbers of T cells, B cells, neutrophils, dermal macrophages and dendritic cells in HS skin. Genes and pathways associated with Th17 cells, interleukin (IL)-17, IL-1β and the NLRP3 inflammasome were enhanced in HS skin, particularly in samples with a high inflammatory load. Inflammasome constituent genes principally mapped to Langerhans cells and a subpopulation of dendritic cells. The secretome of HS skin explants contained significantly increased concentrations of inflammatory mediators, including IL-1β and IL-17A, and culture with an NLRP3 inflammasome inhibitor significantly reduced the secretion of these, as well as other, key mediators of inflammation. CONCLUSIONS These data provide a rationale for targeting the NLRP3 inflammasome in HS using small-molecule inhibitors that are currently being tested for other indications.
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Affiliation(s)
- Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Ryan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Jozsef Karman
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Robert W Dunstan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Kathleen M Smith
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Roisin Hambly
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jana Musilova
- Education and Research Centre, University College Dublin, Dublin, Ireland
| | - Andreea Petrasca
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital and School of Medicine, University College Dublin, Ireland
| | | | - Karsten Hokamp
- Department of Genetics, School of Genetics and Microbiology, Smurfit Institute of Genetics
| | - Kingston H G Mills
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - William J Housley
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Desmond C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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3
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Hambly R, Kearney N, Hughes R, Fletcher JM, Kirby B. Metformin Treatment of Hidradenitis Suppurativa: Effect on Metabolic Parameters, Inflammation, Cardiovascular Risk Biomarkers, and Immune Mediators. Int J Mol Sci 2023; 24:ijms24086969. [PMID: 37108132 PMCID: PMC10138328 DOI: 10.3390/ijms24086969] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a common cutaneous and systemic inflammatory disease with a significant impact on mental health and quality of life. It is associated with obesity, insulin resistance, metabolic syndrome, cardiovascular (CV) disease, and increased all-cause mortality. Metformin is used frequently in HS treatment and is effective for some patients. The mechanism of action of metformin in HS is unknown. A case-control study of 40 patients with HS (20 on metformin and 20 controls) was conducted to assess differences in metabolic markers, inflammation (C-reactive protein [CRP], serum adipokines, and CV risk biomarkers), and serum immune mediators. Body mass index (BMI), insulin resistance (77%), and metabolic syndrome (44%) were high overall, but not significantly different between the groups. This highlights the need for co-morbidity screening and management. A significant reduction in fasting insulin and a trend towards a reduction in insulin resistance were identified in the metformin group compared with pre-treatment levels. CV risk biomarkers were significantly favourable in the metformin group (lymphocytes, monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio). CRP was lower in the metformin group but was not statistically significant. Adipokines were dysregulated overall but were not different between the two groups. Serum IFN-γ, IL-8, TNF-α, and CXCL1 trended lower in the metformin group but did not reach significance. These results suggest that metformin improves CV risk biomarkers and insulin resistance in patients with HS. When the results of this study are considered alongside other studies in HS and related conditions, it is likely that metformin also has beneficial effects on metabolic markers and systemic inflammation in HS (CRP, serum adipokines, and immune mediators), warranting further research.
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Affiliation(s)
- Roisin Hambly
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Niamh Kearney
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Rosalind Hughes
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, D04 T6F4 Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Brian Kirby
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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4
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Smith CM, Hambly R, Gatault S, Iglesias-Martinez LF, Kearns S, Rea H, Marasigan V, Lynam-Loane K, Kirthi S, Hughes R, Fletcher JM, Kolch W, Kirby B. B-cell-derived transforming growth factor-β may drive the activation of inflammatory macrophages and contribute to scarring in hidradenitis suppurativa. Br J Dermatol 2023; 188:290-310. [PMID: 36763877 DOI: 10.1093/bjd/ljac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 01/22/2023]
Abstract
Lesional HS skin was analysed using RNA-sequencing to assess the predicted functional interplay between B cells and macrophages. Our findings support the idea that TGF-beta plays a key role in HS pathogenesis. It is likely that the development of tunnels and scarring in HS is closely related to a chronic activation of TGF-beta signalling.
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Affiliation(s)
- Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Science Institute, Trinity College Dublin
| | - Roisin Hambly
- The Charles Centre, Department of Dermatology and.,University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.,Charles Institute of Dermatology and
| | - Solene Gatault
- Charles Institute of Dermatology and.,Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Sean Kearns
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Helen Rea
- The Charles Centre, Department of Dermatology and.,Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Vivien Marasigan
- The Charles Centre, Department of Dermatology and.,Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Kate Lynam-Loane
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Science Institute, Trinity College Dublin.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Walter Kolch
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland.,Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Brian Kirby
- The Charles Centre, Department of Dermatology and.,University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.,Charles Institute of Dermatology and
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5
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Kearney N, McCourt C, Hambly R, Hughes R, O’Kane D, Kirby B. Association of Biologic Treatment in Hidradenitis Suppurativa With Reduced Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio. JAMA Dermatol 2023; 159:222-224. [PMID: 36576747 PMCID: PMC9857331 DOI: 10.1001/jamadermatol.2022.5710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022]
Abstract
This cohort study assesses whether an association exists between biologic treatment for hidradenitis suppurativa and neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and monocyte-lymphocyte ratio.
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Affiliation(s)
- Niamh Kearney
- Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Collette McCourt
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Roisin Hambly
- Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Rosalind Hughes
- Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Donal O’Kane
- Department of Dermatology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Brian Kirby
- Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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6
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Johnston DGW, Hambly R, Kearney N, Tobin DJ, Kirby B. Cell-free DNA is elevated in the serum of patients with hidradenitis suppurativa. J Dermatol 2023; 50:271-273. [PMID: 36514882 PMCID: PMC10108301 DOI: 10.1111/1346-8138.16676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/15/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Daniel G W Johnston
- Discipline of Anatomy, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,UCD Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Roisin Hambly
- Charles Centre for Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh Kearney
- Charles Centre for Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond J Tobin
- UCD Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.,UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Brian Kirby
- UCD Charles Institute of Dermatology, University College Dublin, Dublin, Ireland.,Charles Centre for Dermatology, St Vincent's University Hospital, Dublin, Ireland
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7
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Hambly R, Gatault S, Smith CM, Iglesias-Martinez LF, Kearns S, Rea H, Marasigan V, Lynam-Loane K, Kirthi S, Hughes R, Fletcher JM, Kolch W, Kirby B. B-cell and complement signature in severe hidradenitis suppurativa that does not respond to adalimumab. Br J Dermatol 2023; 188:52-63. [PMID: 36689500 DOI: 10.1093/bjd/ljac007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with significant morbidity. The pathogenesis remains incompletely understood although immune dysregulation plays an important role. It is challenging to treat and approximately 50% of patients respond clinically to adalimumab, the only licensed treatment. OBJECTIVES To examine differences between lesional and nonlesional HS skin at baseline using bulk RNA sequencing, and to compare the transcriptome in the skin before and after 12 weeks of treatment with adalimumab. To examine transcriptomic differences between adalimumab responders and nonresponders using Hidradenitis Suppurativa Clinical Response and the International Hidradenitis Suppurativa Severity Score System (IHS4); and to compare transcriptomic differences based on disease severity (Hurley stage and IHS4). METHODS We completed bulk RNA sequencing on lesional and nonlesional skin samples of patients before and after 12 weeks of treatment with adalimumab. RESULTS Baseline differentially expressed genes and pathways between lesional and nonlesional skin highlighted chemokines and antimicrobial peptides produced by keratinocytes; B-cell function; T-cell-receptor, interleukin-17 and nuclear factor-κB signalling; and T-helper-cell differentiation. Transcriptomic differences were identified in lesional skin at baseline, between subsequent responders and nonresponders. Patients with severe HS who did not respond to adalimumab had enriched complement and B-cell activation pathways at baseline. In addition, logistic regression identified CCL28 in baseline lesional HS skin as a potential biomarker of treatment response. CONCLUSIONS This highlights the potential for targeting B-cell and complement pathways in HS treatment and the potential of stratifying patients at baseline to the most suitable treatment based on the skin transcriptome. CCL28 has not previously been identified in HS skin and has potential clinical relevance due to its antimicrobial function and homing of B and T cells at epithelial surfaces. Our results provide data to inform future translational and clinical studies on therapeutics in HS.
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Affiliation(s)
- Roisin Hambly
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland
- Charles Institute of Dermatology
| | - Solene Gatault
- Charles Institute of Dermatology
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
| | - Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Sean Kearns
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Helen Rea
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Vivien Marasigan
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Kate Lynam-Loane
- Clinical Research Centre, St Vincent's University Hospital, Dublin, Ireland
| | - Shivashini Kirthi
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Rosalind Hughes
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Science Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Walter Kolch
- Systems Biology Ireland, School of Medicine, University College Dublin, Dublin, Ireland
- Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Brian Kirby
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland
- Charles Institute of Dermatology
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8
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Kearney N, Hambly R, Alsharqi A, Kirby B. 'Not relevant' responses in the era of COVID-19: are we underestimating Dermatology Life Quality Index values? Br J Dermatol 2021; 186:187-189. [PMID: 34427918 PMCID: PMC8652704 DOI: 10.1111/bjd.20705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022]
Abstract
Since March 2020, the UK and Ireland have entered a series of lockdowns in the wake of the coronavirus pandemic with restrictions resulting in the closure of nonessential retail, hospitality and sports with employees encouraged to work from home. In this retrospective study we have demonstrated a significant decrease in DLQI values, increase in the number of ‘not relevant’ responses (NRRs) in the DLQI and change between DLQI and the modified DLQI‐R during the pandemic. Given the restrictions imposed on our patients, it is important for clinicians to identify the number of NRRs in the DLQI and acknowledge the potential effect on treatment decisions and data collection for disease registries and clinical trials during the pandemic.
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Affiliation(s)
- N Kearney
- Department of Dermatology, St Vincent's University Hospital Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - R Hambly
- Department of Dermatology, St Vincent's University Hospital Dublin, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - A Alsharqi
- Department of Dermatology, St Vincent's University Hospital Dublin, Dublin, Ireland
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital Dublin, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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9
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Hambly R, Kirby B. Biologic survival in hidradenitis suppurativa: much done, more to do. Br J Dermatol 2021; 185:16-17. [PMID: 34121174 DOI: 10.1111/bjd.20399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/31/2022]
Affiliation(s)
- R Hambly
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Ireland
| | - B Kirby
- The Charles Centre, Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,University College Dublin School of Medicine and Medical Sciences, Dublin, Ireland.,Charles Institute of Dermatology, University College Dublin, Ireland
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10
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Lynch M, Malara A, Timoney I, Vencken S, Ahern T, Awdeh F, Sweeney C, Galligan M, Kelly G, Hughes R, Murad A, Hambly R, O'Shea D, Doran P, Kirby B. Sitagliptin and Narrow-Band Ultraviolet-B for Moderate Psoriasis (DINUP): A Randomised Controlled Clinical Trial. Dermatology 2021; 238:140-147. [PMID: 33866313 DOI: 10.1159/000514494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/04/2020] [Accepted: 01/17/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor licensed for the treatment of type 2 diabetes mellitus (T2DM), has been reported to improve psoriasis. OBJECTIVE We compared the effects of sitagliptin treatment, a DPP-4 inhibitor, in combination with narrow-band ultraviolet-B (NB-UVB) phototherapy compared to NB-UVB alone on psoriasis severity, quality of life, cardiovascular disease risk factors and immune parameters in people with moderate psoriasis without T2DM. METHODS In this 39-week, single-centre, randomised controlled trial, people were allocated randomly to receive sitagliptin for 24 weeks with NB-UVB or NB-UVB alone. The primary endpoint was the change in Psoriasis Area and Severity Index (PASI) from baseline to 24 weeks. We estimated that 120 participants would be needed to have 80% power to find a significant difference between the groups. RESULTS A total of 118 patients were randomised. The median (IQR) baseline PASI was 8.8 (7.5-11.6). At 24 weeks, the mean difference from baseline in PASI (-1.0 [95% CI -2.0 to 0.0]) was significantly larger in the sitagliptin/NB-UVB arm than in the NB-UVB-alone arm (p = 0.044). There were significant differences in the change in Hospital Anxiety and Depression Scale (-2.5 [95% CI -4.0 to -1.0]; p = 0.002) and EuroQol 5-item questionnaire (0.1 [95% CI 0.0-0.1]; p = 0.036) values from baseline to 24 weeks between the sitagliptin/NB-UVB and the NB-UVB-alone arm. There were no treatment-related serious adverse events. CONCLUSION Sitagliptin therapy combined with NB-UVB phototherapy significantly improved psoriasis severity, albeit modestly, compared to NB-UVB phototherapy alone in patients with moderate psoriasis without T2DM.
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Affiliation(s)
- Maeve Lynch
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland.,School of Health Sciences and Charles Institute, University College Dublin, Dublin, Ireland
| | - Anna Malara
- School of Health Sciences and Charles Institute, University College Dublin, Dublin, Ireland
| | - Irene Timoney
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Sebastian Vencken
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Tomas Ahern
- Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Fatima Awdeh
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Cheryl Sweeney
- School of Health Sciences and Charles Institute, University College Dublin, Dublin, Ireland
| | - Marie Galligan
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Genevieve Kelly
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Rosalind Hughes
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Aizuri Murad
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Roisin Hambly
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- School of Health Sciences and Charles Institute, University College Dublin, Dublin, Ireland.,Department of Endocrinology, St Vincent's University Hospital, Dublin, Ireland
| | - Peter Doran
- Clinical Research Centre, University College Dublin, Dublin, Ireland
| | - Brian Kirby
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland.,School of Health Sciences and Charles Institute, University College Dublin, Dublin, Ireland
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11
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Beizaei A, Gatault S, Rea H, Hambly R, Kearns S, Lynam-Loane K, Kirby B, Kolch W, Ebhardt A. 121 Mass Spectrometry-based Proteome Analysis of Skin Microdialysates. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.125] [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: 10/26/2022]
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12
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Affiliation(s)
- R. Hambly
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
- University College Dublin School of Medicine and Medical Sciences DublinIreland
- Wellcome‐Health Research Board Irish Clinical Academic Training (ICAT) DublinIreland
| | - B. Kirby
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
- University College Dublin School of Medicine and Medical Sciences DublinIreland
- Charles Institute of Dermatology University College Dublin Ireland
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13
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Affiliation(s)
- Lorraine Jennings
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
| | - Roisin Hambly
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Wellcome-Health Research Board, Irish Clinical Academic Training (ICAT), Dublin, Ireland
| | - Rosalind Hughes
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
| | - Blaithin Moriarty
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
| | - Brian Kirby
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, Dublin, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
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14
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Hambly R, Kelly A, Gilhooley E, Nic Dhonncha E, Murad A, Hughes R, Lally A, Kirby B. Medication adherence among patients with psoriasis on traditional systemic and biologics treatment. Br J Dermatol 2017; 178:e46-e48. [DOI: 10.1111/bjd.15856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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)
- R. Hambly
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - A. Kelly
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - E. Gilhooley
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - E. Nic Dhonncha
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - A. Murad
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - R. Hughes
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - A. Lally
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
| | - B. Kirby
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
- University College Dublin School of Medicine and Medical Sciences Dublin Ireland
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15
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Affiliation(s)
- R Hambly
- Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Lally
- Department of Dermatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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16
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Hambly R, Mansoor N, Quinlan C, Shah Z, Lenane P, Ralph N, Moloney FJ. Topical photodynamic therapy for primary Bowen disease and basal cell carcinoma: optimizing patient selection. Br J Dermatol 2017; 177:e55-e57. [PMID: 28028807 DOI: 10.1111/bjd.15281] [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] [Indexed: 11/30/2022]
Affiliation(s)
- R Hambly
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - N Mansoor
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - C Quinlan
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Z Shah
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - P Lenane
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,University College Dublin, School of Medicine, Dublin
| | - N Ralph
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,University College Dublin, School of Medicine, Dublin
| | - F J Moloney
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,University College Dublin, School of Medicine, Dublin
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17
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Hambly R, O'Higgins L, Hughes R. Response to: ‘Dermatological content of U.K. undergraduate curricula: where are we now?’. Br J Dermatol 2017; 177:593-594. [DOI: 10.1111/bjd.15505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Hambly
- The Charles Centre; Department of Dermatology; St Vincent's University Hospital; Elm Park Dublin Ireland
| | - L. O'Higgins
- Medical Student, University College Dublin School of Medicine and Medical Sciences; Dublin Ireland
| | - R. Hughes
- The Charles Centre; Department of Dermatology; St Vincent's University Hospital; Elm Park Dublin Ireland
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18
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Hambly R, Leonard N, Watkin N, Feighery C. A subtle streak. Clin Exp Dermatol 2016; 41:940-942. [PMID: 27766681 DOI: 10.1111/ced.12931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R Hambly
- Dermatology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
| | - N Leonard
- Pathology Department, St James's Hospital, Dublin, Ireland
| | - N Watkin
- Urology Department, St George's Hospital, London, UK
| | - C Feighery
- Dermatology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
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