1
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Ghafari-Saravi A, Greiling TM. Recurrent bullous erythema multiforme due to oral contraceptive therapy. Int J Womens Dermatol 2024; 10:e142. [PMID: 38572265 PMCID: PMC10986911 DOI: 10.1097/jw9.0000000000000142] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Affiliation(s)
| | - Teri M. Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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2
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Velasco RC, Shao C, Cutler B, Strunck J, Kent G, Cassidy PB, Choate K, Greiling TM. Guselkumab for Pityriasis Rubra Pilaris and Dysregulation of IL-23/IL-17 and NFkB Signaling: A Nonrandomized Trial. JAMA Dermatol 2024:2817330. [PMID: 38598229 PMCID: PMC11007649 DOI: 10.1001/jamadermatol.2024.0257] [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] [Received: 09/13/2023] [Accepted: 01/29/2024] [Indexed: 04/11/2024]
Abstract
Importance There is no US Food and Drug Administration-approved treatment for pityriasis rubra pilaris (PRP), and it is common for patients to fail to experience improvement with several systemic options. Involvement of interleukin (IL) 23 suggests a potential therapeutic target. Objective To determine whether guselkumab, an IL-23p19 inhibitor, provides clinical improvement for participants with PRP and better understand gene and protein dysregulation in PRP. Design, Setting, and Participants This single-arm, investigator-initiated nonrandomized trial was conducted from October 2019 to August 2022 at a single-center academic university with participants from 8 states in the US. In total, 14 adults with moderate to severe PRP were enrolled; 12 completed the trial. Age-matched and sex-matched healthy controls provided skin and blood for proteomic and transcriptomic studies. The primary outcome was observed at 24 weeks, and additional follow-up occurred at 36 weeks. Intervention Guselkumab is a fully human immunoglobulin G1 λ monoclonal antibody that selectively binds and inhibits the p19 subunit of IL-23. Subcutaneous injections were given at the US Food and Drug Administration-approved dosing schedule for psoriasis over a 24-week period. Main Outcomes and Measures The primary outcome was the mean change in the Psoriasis Area Severity Index (PASI) score at week 24. Secondary outcomes included pruritus, Dermatology Life Quality Index score, clinical response at week 36, and association with transcriptomics and proteomics expression. Results A per-protocol analysis was performed for the cohort of 4 female and 8 male patients who had a mean (SD) age of 56.5 (18.7) years. The mean improvement in PASI score, pruritus, and Dermatology Life Quality Index score was 61.8% (P < .001), 62.3% (P = .001), and 60.2% (P < .001), respectively. Nine participants (75%) achieved a 50% improvement in PASI. Among these clinical responders, at week 36, 8 of 9 achieved PASI75, and 6 of 9 achieved PASI90. No participants had pathogenic CARD14 gene variations. There was 1 serious adverse event that was not associated with the study drug. Proteomics and gene expression profiles identified dysregulation of a predominance of inflammatory pathways (such as T helper 17 and nuclear factor κ B) in participants with PRP who later responded well to treatment with guselkumab and stronger dysregulation of keratinocyte development pathways in individuals who did not respond to guselkumab. Conclusion and Relevance The results of this nonrandomized trial suggest that guselkumab has efficacy in treating refractory moderate to severe adult PRP. Trial Registration ClinicalTrials.gov Identifier: NCT03975153.
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Affiliation(s)
- Rose C. Velasco
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Connie Shao
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Brett Cutler
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Jennifer Strunck
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Gail Kent
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Pamela B. Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Keith Choate
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Teri M. Greiling
- Department of Dermatology, Oregon Health & Science University, Portland
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3
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Ghafari-Saravi A, Greiling TM. Dupilumab for the Treatment of Severe Atopic Dermatitis in an Immunosuppressed Transplant Patient. Dermatitis 2024; 35:S109-S110. [PMID: 37566480 DOI: 10.1089/derm.2023.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Affiliation(s)
| | - Teri M Greiling
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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4
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Oprea Y, Kody S, Shakshouk H, Greiling TM, Anstey KM, Ortega-Loayza AG. What can inherited immunodeficiencies reveal about pyoderma gangrenosum? Exp Dermatol 2024; 33:e14954. [PMID: 37846943 PMCID: PMC10841371 DOI: 10.1111/exd.14954] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatosis that is occasionally associated with primary immunodeficiency. Though contributions from dysregulation of the innate immune system, neutrophil dysfunction and genetic predisposition have been postulated, the precise pathogenesis of PG has not yet been elucidated. This article reviews reported cases of coexisting PG and primary immunodeficiency in order to gain insight into the complex pathophysiology of PG. Our findings suggest that variations in genes such as RAG1, ITGB2, IRF2BP2 and NFκB1 might play a role in genetically predisposing patients to develop PG. These studies support the feasibility of the role of somatic gene variation in the pathogenesis of PG which warrants further exploration to guide targeted therapeutics.
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Affiliation(s)
- Yasmine Oprea
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Hadir Shakshouk
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Department of Dermatology and Andrology, Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Karen M Anstey
- Department of Medicine, Section of Allergy and Clinical Immunology, Oregon Health & Science University, Portland, Oregon, USA
| | - Alex G. Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
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5
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Velasco RC, Shao C, Greiling TM. Patient-reported cutaneous signs and symptoms of adult pityriasis rubra pilaris and correlation with quality of life and clinician-reported severity: A cross-sectional study. J Am Acad Dermatol 2024; 90:200-202. [PMID: 37748557 DOI: 10.1016/j.jaad.2023.08.100] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/22/2023] [Accepted: 08/19/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Rose C Velasco
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Connie Shao
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon.
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6
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Benedetti G, Shao C, Velasco R, Latour E, Callis S, Sanders K, Greiling TM. Rosacea changes during pregnancy: a single-center retrospective survey study. Int J Womens Dermatol 2023; 9:e113. [PMID: 37927369 PMCID: PMC10617829 DOI: 10.1097/jw9.0000000000000113] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Genevieve Benedetti
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Connie Shao
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Rose Velasco
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Emile Latour
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Sam Callis
- Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - Kim Sanders
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Teri M. Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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7
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Shao C, Velasco R, Greiling TM. The individual Pityriasis Rubra Pilaris area and severity index (iPRPASI): validity, reliability, and responsiveness of a novel patient-reported severity tool. Arch Dermatol Res 2023; 315:2933-2935. [PMID: 37532946 DOI: 10.1007/s00403-023-02682-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Connie Shao
- Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Ave CH16D, Portland, OR, 97239, USA
| | - Rose Velasco
- Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Ave CH16D, Portland, OR, 97239, USA
| | - Teri M Greiling
- Department of Dermatology, Oregon Health and Science University, 3303 SW Bond Ave CH16D, Portland, OR, 97239, USA.
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8
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Haynes D, Reiter T, Velasco R, Chang M, Kulkarni R, Kent G, Strunck J, Cassidy P, Greiling TM. Pityriasis Rubra Pilaris Transcriptomics Implicate T Helper 17 Signaling and Correlate with Response to Ixekizumab, with Distinct Gene Expression Profiles in Nonresponders. J Invest Dermatol 2023; 143:501-504.e1. [PMID: 36167251 DOI: 10.1016/j.jid.2022.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Taylor Reiter
- Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rose Velasco
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthew Chang
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Rajan Kulkarni
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Gail Kent
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jennifer Strunck
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Pamela Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA.
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9
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Morrison S, Gray A, Greiling TM. Improvement of primary vulvar Langerhans cell histiocytosis with lenalidomide. Int J Womens Dermatol 2022; 7:838-840. [PMID: 35028395 PMCID: PMC8714570 DOI: 10.1016/j.ijwd.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Steven Morrison
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Arielle Gray
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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10
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Ortega-Loayza AG, Friedman MA, Reese AM, Liu Y, Greiling TM, Cassidy PB, Marzano AV, Gao L, Fei SS, Rosenbaum JT. Molecular and cellular characterization of pyoderma gangrenosum: Implications for the use of gene expression. J Invest Dermatol 2021; 142:1217-1220.e14. [PMID: 34536481 DOI: 10.1016/j.jid.2021.08.431] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA.
| | - Marcia A Friedman
- Department of Medicine, Division of Arthritis and Rheumatic Disease, Oregon Health & Science University, Portland, Oregon, USA
| | - Ashley M Reese
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Yuangang Liu
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Pamela B Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Portland, Oregon, USA
| | - Lina Gao
- Oregon National Primate Research Center Bioinformatics & Biostatistics Core, Portland, Oregon, USA
| | - Suzanne S Fei
- Oregon National Primate Research Center Bioinformatics & Biostatistics Core, Portland, Oregon, USA
| | - James T Rosenbaum
- Department of Medicine, Division of Arthritis and Rheumatic Disease, Oregon Health & Science University, Portland, Oregon, USA
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11
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Haynes D, Pampari A, Topham C, Schwarzenberger K, Heath M, Zou J, Greiling TM. Patient Experience Surveys Reveal Gender-Biased Descriptions of Their Care Providers. J Med Syst 2021; 45:90. [PMID: 34468879 DOI: 10.1007/s10916-021-01766-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Patient experience surveys (PES) are collected by healthcare systems as a surrogate marker of quality and published unedited online for the purpose of transparency, but these surveys may reflect gender biases directed toward healthcare providers. This retrospective study evaluated PES at a single university hospital between July 2016 and June 2018. Surveys were stratified by overall provider rating and self-identified provider gender. Adjectives from free-text survey comments were extracted using natural language processing techniques and applied to a statistical machine learning model to identify descriptors predictive of provider gender. 109,994 surveys were collected, 17,395 contained free-text comments describing 687 unique providers. The mean overall rating between male (8.84, n = 8558) and female (8.80, n = 8837) providers did not differ (p = 0.149). However, highly-rated male providers were more often described for their agentic qualities using adjectives such as "informative," "forthright," "superior," and "utmost" (OR 1.48, p < 0.01)-whereas highly-rated female providers were more often described by their communal qualities through adjectives such as "empathetic," "sweet," "warm," "attentive," and "approachable" (OR 2.11, p < 0.0001). PES may contain gender stereotypes, raising questions about their impact on physicians and their validity as a quality metric which must be balanced with the need for unedited transparency. Future prospective studies are needed to further characterize this trend across geographically and racially diverse healthcare providers.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Anusri Pampari
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA
| | - Christina Topham
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Kathryn Schwarzenberger
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Michael Heath
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - James Zou
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA.
| | - Teri M Greiling
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA.
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12
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Hajar T, Latour EJ, Haynes D, Topham C, Hill EE, Simpson EL, Greiling TM. Low-dose methotrexate in dermatology: the utility of serological monitoring in a real-world cohort. J DERMATOL TREAT 2021; 33:2161-2167. [PMID: 34148493 DOI: 10.1080/09546634.2021.1937476] [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: 10/21/2022]
Abstract
When prescribing low-dose methotrexate, frequent serological testing is recommended in the dermatologic literature, although much of the supporting data is extrapolated from non-dermatologic conditions. We performed a retrospective cohort study to determine the cumulative incidence and timing of low-dose methotrexate-associated serological abnormalities over the first year of therapy, in a pragmatic cohort of patients with dermatologic compared to non-dermatologic diagnoses. Laboratory values recorded included white blood cell count, hemoglobin, platelet count, estimated glomerular filtration rate, alanine aminotransferase, and aspartate aminotransferase. Among 1376 patients, there were no cases of methotrexate-associated grade 4/very severe lab abnormality or fatality. Baseline risk factors associated with moderate-to-severe lab abnormalities included non-dermatologic diagnoses, low hemoglobin, low estimated glomerular filtration rate, and elevated transaminases. The incidence of moderate-to-severe lab abnormalities was 4.4% among all patients, 3.1% among patients with dermatologic diagnoses, and 2.3% among patients with normal baseline lab values. Lab abnormalities led to discontinuation of therapy in 0.8% of patients. Serious changes did not occur in the first two weeks of therapy. We conclude that the cumulative incidence of low-dose methotrexate-associated lab abnormality was lower in patients with dermatologic diagnoses or normal baseline testing and these factors may be used to adjust monitoring practices.
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Affiliation(s)
- Tamar Hajar
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.,Department of Dermatology,University of Colorado, Denver, CO, USA
| | - Emile J Latour
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Christina Topham
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.,Department of Dermatology, University of Utah, Salt Lake City, UT, USA
| | - Emma E Hill
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Teri M Greiling
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
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13
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Haynes D, Strunck JL, Topham CA, Ortega-Loayza AG, Kent G, Cassidy PB, Hu R, Choate K, Wang Z, Liu Y, Greiling TM. Evaluation of Ixekizumab Treatment for Patients With Pityriasis Rubra Pilaris: A Single-Arm Trial. JAMA Dermatol 2021; 156:668-675. [PMID: 32293641 DOI: 10.1001/jamadermatol.2020.0932] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Pityriasis rubra pilaris is a rare and disabling cutaneous disease that is frequently recalcitrant to conventional therapies and appears to involve interleukin (IL)-17 overexpression. Objective To investigate the clinical response and safety of ixekizumab in treating pityriasis rubra pilaris. Design, Setting, and Participants Single-arm, investigator-initiated trial conducted in adult patients with moderate to severe pityriasis rubra pilaris at a single-center academic university from June 2018 to January 2020. A total of 41 patients were screened, 12 were enrolled, and 11 completed the full duration of therapy. A referred, consecutive sample was used during participant selection. The treatment period and primary outcome occurred over 24 weeks with additional patient follow-up through 36 weeks. Intervention Subcutaneous administration of ixekizumab, a humanized IgG4 antibody that binds IL-17A, at the US Food and Drug Administration-approved dosing schedule for treatment of psoriasis for 24 weeks. Main Outcomes and Measures The primary outcome was the mean change in Psoriasis Area and Severity Index at 24 weeks. Secondary outcomes included change in affected body surface area, quality of life, induction of sustained remission, and association of improvement with CARD14 genetic variations and cutaneous cytokine expression. Results A total of 12 white patients (mean [SD] age, 49.8 [15.1] years; 8 male [67%]) were enrolled between June 2018 and April 2019, with 11 completing the full course of intervention. The mean (SEM) improvements in Psoriasis Area and Severity Index, affected body surface area, and Dermatology Life Quality Index were 15.2 (2.1) (P < .0001), 29.8% (9.3%) (P = .009), and 9.5 (2.5) (P = .004), respectively. The 4 participants with the most improvement in Psoriasis Area and Severity Index at week 24 stayed in remission at week 36 (defined as lack of increase in Psoriasis Area and Severity Index from week 24 through week 36), off therapy. Relative dermal IL-17A expression decreased by a 1.9 log-fold change. No participants had known pathogenic CARD14 variations. There were no serious adverse events. Conclusions and Relevance In this single-armed trial, ixekizumab was associated with reduced clinical signs and symptoms of pityriasis rubra pilaris in a subset of patients, including those in whom other systemic therapies have failed. Trial Registration ClinicalTrials.gov Identifier: NCT03485976.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Jennifer L Strunck
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Christina A Topham
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | | | - Gail Kent
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Pamela B Cassidy
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Ronghua Hu
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Keith Choate
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Zhiping Wang
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Yuangang Liu
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon
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14
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Haynes D, Strunck JL, Said J, Tam I, Varedi A, Topham CA, Olamiju B, Wei BM, Erickson MK, Wang LL, Tan A, Stoner R, Hartman RI, Lilly E, Grossman D, Curtis JA, Westerdahl JS, Leventhal JS, Choi JN, Chu EY, Ming ME, Stein JA, Liebman TN, Berry E, Greiling TM. Association between halo nevi and melanoma in adults: A multicenter retrospective case series. J Am Acad Dermatol 2020; 84:1164-1166. [PMID: 32822787 DOI: 10.1016/j.jaad.2020.08.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/10/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health & Science University, Portland
| | | | - Jordan Said
- Harvard Medical School, Boston, Massachusetts
| | - Idy Tam
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Amir Varedi
- Huntsman Cancer Institute, University of Utah, Salt Lake City
| | | | - Brianna Olamiju
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Brian M Wei
- Department of Dermatology, Yale University, New Haven, Connecticut
| | - Maia K Erickson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Leo L Wang
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Andrea Tan
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Ryan Stoner
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Rebecca I Hartman
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Department of Dermatology, VA Integrated Service Network (VISN-1), Jamaica Plain, Massachusetts
| | - Evelyn Lilly
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas Grossman
- Huntsman Cancer Institute, University of Utah, Salt Lake City; Department of Dermatology, University of Utah, Salt Lake City
| | - Julia A Curtis
- Department of Dermatology, University of Utah, Salt Lake City
| | | | | | - Jennifer N Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily Y Chu
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael E Ming
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer A Stein
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Tracey N Liebman
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, New York
| | - Elizabeth Berry
- Department of Dermatology, Oregon Health & Science University, Portland
| | - Teri M Greiling
- Department of Dermatology, Oregon Health & Science University, Portland.
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15
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Brockman R, Wills A, Greiling TM, Leitenberger S, Fett N. Calcinosis cutis arising in morphea: a case series. Dermatol Online J 2020; 26:13030/qt26c9m00s. [PMID: 32815688] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023] Open
Abstract
Calcinosis cutis, although common in systemic sclerosis, has been rarely reported in patients with morphea. We describe four patients with calcinosis cutis arising within morphea plaques, discuss their treatments and outcomes, and review previously published cases. Current management recommendations for concomitant morphea and dystrophic calcinosis cutis are based on limited data and expert opinion, which has primarily focused on reduction of active inflammation and reduction of symptoms related to calcinosis or ulceration. In most cases, no improvement of calcinosis was noted. The use of intralesional corticosteroids to active lesions in conjunction with systemic treatment, including methotrexate when indicated, appear promising treatments to halt progression of the disease. Surgical excision seems to be the most definitive treatment for calcinosis affecting morphea plaques, but the current literature lacks details regarding disease recurrence following operative management.
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Affiliation(s)
- R Brockman
- Department of Dermatology, Oregon Health and Science University, Portland, OR.
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16
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17
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Greiling TM, Dehner C, Chen X, Hughes K, Iñiguez AJ, Boccitto M, Ruiz DZ, Renfroe SC, Vieira SM, Ruff WE, Sim S, Kriegel C, Glanternik J, Chen X, Girardi M, Degnan P, Costenbader KH, Goodman AL, Wolin SL, Kriegel MA. Commensal orthologs of the human autoantigen Ro60 as triggers of autoimmunity in lupus. Sci Transl Med 2019; 10:10/434/eaan2306. [PMID: 29593104 DOI: 10.1126/scitranslmed.aan2306] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 11/17/2017] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
The earliest autoantibodies in lupus are directed against the RNA binding autoantigen Ro60, but the triggers against this evolutionarily conserved antigen remain elusive. We identified Ro60 orthologs in a subset of human skin, oral, and gut commensal bacterial species and confirmed the presence of these orthologs in patients with lupus and healthy controls. Thus, we hypothesized that commensal Ro60 orthologs may trigger autoimmunity via cross-reactivity in genetically susceptible individuals. Sera from human anti-Ro60-positive lupus patients immunoprecipitated commensal Ro60 ribonucleoproteins. Human Ro60 autoantigen-specific CD4 memory T cell clones from lupus patients were activated by skin and mucosal Ro60-containing bacteria, supporting T cell cross-reactivity in humans. Further, germ-free mice spontaneously initiated anti-human Ro60 T and B cell responses and developed glomerular immune complex deposits after monocolonization with a Ro60 ortholog-containing gut commensal, linking anti-Ro60 commensal responses in vivo with the production of human Ro60 autoantibodies and signs of autoimmunity. Together, these data support that colonization with autoantigen ortholog-producing commensal species may initiate and sustain chronic autoimmunity in genetically predisposed individuals. The concept of commensal ortholog cross-reactivity may apply more broadly to autoimmune diseases and lead to novel treatment approaches aimed at defined commensal species.
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Affiliation(s)
- Teri M Greiling
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA.,Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Carina Dehner
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Xinguo Chen
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, Stockholm SE-171 77, Sweden.,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Kevin Hughes
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, Stockholm SE-171 77, Sweden.,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Alonso J Iñiguez
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Marco Boccitto
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, Stockholm SE-171 77, Sweden.,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Daniel Zegarra Ruiz
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Stephen C Renfroe
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Silvio M Vieira
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - William E Ruff
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Soyeong Sim
- Department of Medicine, Integrated Cardio Metabolic Centre (ICMC), Heart and Vascular Theme, Karolinska Institute, Stockholm SE-171 77, Sweden.,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Christina Kriegel
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Julia Glanternik
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Xindi Chen
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Michael Girardi
- Department of Dermatology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Patrick Degnan
- Department of Microbial Pathogenesis and Yale Microbial Sciences Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Karen H Costenbader
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Andrew L Goodman
- Department of Microbial Pathogenesis and Yale Microbial Sciences Institute, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sandra L Wolin
- Department of Cell Biology, Yale University School of Medicine, New Haven, CT 06510, USA. .,Bioscience, Cardiovascular, Renal & Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Martin A Kriegel
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06510, USA. .,Section of Rheumatology, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA
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18
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Sawka E, Foster E, Greiling TM. Pruritic Plaque on the Arm After Treatment for Neurosyphilis. Am J Med 2019; 132:583-584. [PMID: 30576631 DOI: 10.1016/j.amjmed.2018.11.043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Erika Sawka
- Oregon Health and Science University, Department of Dermatology, Portland, Ore
| | - Erin Foster
- Oregon Health and Science University, Department of Dermatology, Portland, Ore
| | - Teri M Greiling
- Oregon Health and Science University, Department of Dermatology, Portland, Ore.
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19
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Zegarra-Ruiz DF, El Beidaq A, Iñiguez AJ, Lubrano Di Ricco M, Manfredo Vieira S, Ruff WE, Mubiru D, Fine RL, Sterpka J, Greiling TM, Dehner C, Kriegel MA. A Diet-Sensitive Commensal Lactobacillus Strain Mediates TLR7-Dependent Systemic Autoimmunity. Cell Host Microbe 2018; 25:113-127.e6. [PMID: 30581114 DOI: 10.1016/j.chom.2018.11.009] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [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: 06/06/2018] [Revised: 08/27/2018] [Accepted: 11/16/2018] [Indexed: 12/22/2022]
Abstract
Western lifestyle is linked to autoimmune and metabolic diseases, driven by changes in diet and gut microbiota composition. Using Toll-like receptor 7 (TLR7)-dependent mouse models of systemic lupus erythematosus (SLE), we dissect dietary effects on the gut microbiota and find that Lactobacillus reuteri can drive autoimmunity but is ameliorated by dietary resistant starch (RS). Culture of internal organs and 16S rDNA sequencing revealed TLR7-dependent translocation of L. reuteri in mice and fecal enrichment of Lactobacillus in a subset of SLE patients. L. reuteri colonization worsened autoimmune manifestations under specific-pathogen-free and gnotobiotic conditions, notably increasing plasmacytoid dendritic cells (pDCs) and interferon signaling. However, RS suppressed the abundance and translocation of L. reuteri via short-chain fatty acids, which inhibited its growth. Additionally, RS decreased pDCs, interferon pathways, organ involvement, and mortality. Thus, RS exerts beneficial effects in lupus-prone hosts through suppressing a pathobiont that promotes interferon pathways implicated in the pathogenesis of human autoimmunity.
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MESH Headings
- Animals
- Autoimmunity
- Clostridiaceae
- DNA, Ribosomal/genetics
- Dendritic Cells/metabolism
- Diet
- Diet Therapy
- Disease Models, Animal
- Fatty Acids, Volatile/antagonists & inhibitors
- Fatty Acids, Volatile/metabolism
- Feces/microbiology
- Female
- Gastrointestinal Microbiome
- Germ-Free Life
- Glomerulonephritis/pathology
- Humans
- Hypersensitivity
- Interferon Type I/metabolism
- Kidney/pathology
- Lactobacillus/drug effects
- Lactobacillus/genetics
- Lactobacillus/pathogenicity
- Limosilactobacillus reuteri
- Lupus Erythematosus, Systemic/microbiology
- Lupus Erythematosus, Systemic/mortality
- Lupus Erythematosus, Systemic/pathology
- Membrane Glycoproteins/metabolism
- Mice
- Mice, Inbred C57BL
- RNA, Ribosomal, 16S/genetics
- Starch
- Survival Rate
- Toll-Like Receptor 7/metabolism
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Affiliation(s)
- Daniel F Zegarra-Ruiz
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Asmaa El Beidaq
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Alonso J Iñiguez
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | | | - Silvio Manfredo Vieira
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - William E Ruff
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Derek Mubiru
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Rebecca L Fine
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - John Sterpka
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Teri M Greiling
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Carina Dehner
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Martin A Kriegel
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06511, USA.
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20
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Gupta AS, Greiling TM, Ortega-Loayza AG. A systematic review of pyoderma gangrenosum with pulmonary involvement: clinical presentation, diagnosis and management. J Eur Acad Dermatol Venereol 2018; 32:e295-e297. [PMID: 29377399 DOI: 10.1111/jdv.14828] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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)
- A S Gupta
- School of Medicine, Virginia Commonwealth University, 1101 E Marshall St, 23284-2512, Richmond, VA, USA
| | - T M Greiling
- Department of Dermatology, Oregon Health & Sciences University, 3303 SW Bond Avenue, CHD 16D, Portland, OR, 97239, USA
| | - A G Ortega-Loayza
- Department of Dermatology, Oregon Health & Sciences University, 3303 SW Bond Avenue, CHD 16D, Portland, OR, 97239, USA
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21
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Clark JI, Arnett E, Clark JM, Greiling TM. In Vivo, Non Invasive Evaluation of the Self Assembly of Unfolding Proteins in Transparent Lens Cells. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.684.4] [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] [Indexed: 11/11/2022]
Affiliation(s)
- John I Clark
- Biological StructureUniversity of WashingtonSeattleWA
| | - Ernest Arnett
- Biological StructureUniversity of WashingtonSeattleWA
| | - Judy M Clark
- Biological StructureUniversity of WashingtonSeattleWA
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22
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Muchowski PJ, Ramsden R, Nguyen Q, Arnett EE, Greiling TM, Anderson SK, Clark JI. Noninvasive measurement of protein aggregation by mutant huntingtin fragments or alpha-synuclein in the lens. J Biol Chem 2007; 283:6330-6. [PMID: 18167346 DOI: 10.1074/jbc.m709678200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Many diverse human diseases are associated with protein aggregation in ordered fibrillar structures called amyloid. Amyloid formation may mediate aberrant protein interactions that culminate in neurodegeneration in Alzheimer, Huntington, and Parkinson diseases and in prion encephalopathies. Studies of protein aggregation in the brain are hampered by limitations in imaging techniques and often require invasive methods that can only be performed postmortem. Here we describe transgenic mice in which aggregation-prone proteins that cause Huntington and Parkinson disease are expressed in the ocular lens. Expression of a mutant huntingtin fragment or alpha-synuclein in the lens leads to protein aggregation and cataract formation, which can be monitored in real time by noninvasive, highly sensitive optical techniques. Expression of a mutant huntingtin fragment in mice lacking the major lens chaperone, alphaB-crystallin, markedly accelerated the onset and severity of aggregation, demonstrating that the endogenous chaperone activity of alphaB-crystallin suppresses aggregation in vivo. These novel mouse models will facilitate the characterization of protein aggregation in vivo and are being used in efficient and economical screens for chemical and genetic modifiers of disease-relevant protein aggregation.
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Affiliation(s)
- Paul J Muchowski
- Department of Pharmacology, University of Washington, Seattle, WA 98195, USA.
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