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Luchicchi A, Muñoz‐Gonzalez G, Halperin ST, Strijbis E, van Dijk LHM, Foutiadou C, Uriac F, Bouman PM, Schouten MAN, Plemel J, 't Hart BA, Geurts JJG, Schenk GJ. Micro-diffusely abnormal white matter: An early multiple sclerosis lesion phase with intensified myelin blistering. Ann Clin Transl Neurol 2024; 11:973-988. [PMID: 38425098 PMCID: PMC11021636 DOI: 10.1002/acn3.52015] [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: 11/20/2023] [Revised: 01/03/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Multiple sclerosis (MS) is a chronic central nervous system disease whose white matter lesion origin remains debated. Recently, we reported subtle changes in the MS normal appearing white matter (NAWM), presenting with an increase in myelin blisters and myelin protein citrullination, which may recapitulate some of the prodromal degenerative processes involved in MS pathogenesis. Here, to clarify the relevance of these changes for subsequent MS myelin degeneration we explored their prevalence in WM regions characterized by subtly reduced myelination (dubbed as micro-diffusely abnormal white matter, mDAWM). METHODS We used an in-depth (immuno)histochemistry approach in 27 MS donors with histological presence of mDAWM and 5 controls. An antibody panel against degenerative markers was combined and the presence of myelin/axonal aberrations was analyzed and compared with the NAWM from the same cases/slices/regions. RESULTS mDAWM-defined areas exhibit ill-defined borders, no signs of Wallerian degeneration, and they associate with visible veins. Remarkably, such areas present with augmented myelin blister frequency, enhanced prevalence of polar myelin phospholipids, citrullination, and degradation of myelin basic protein (MBP) when compared with the NAWM. Furthermore, enhanced reactivity of microglia/macrophages against citrullinated MBP was also observed in this tissue. INTERPRETATION We report a new histologically defined early phase in MS lesion formation, namely mDAWM, which lacks signs of Wallerian pathology. These results support the prelesional nature of the mDAWM. We conceptualize that evolution to pathologically evident lesions comprises the previously documented imbalance of axo-myelinic units (myelin blistering) leading to their degeneration and immune system activation by released myelin components.
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Affiliation(s)
- Antonio Luchicchi
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Gema Muñoz‐Gonzalez
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Saar T. Halperin
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Eva Strijbis
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
- Department of NeurologyAmsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Laura H. M. van Dijk
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Chrisa Foutiadou
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Florence Uriac
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
| | - Piet M. Bouman
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Maxime A. N. Schouten
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Jason Plemel
- Department of NeuroscienceUniversity of AlbertaEdmontonAlbertaCanada
| | - Bert A. 't Hart
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Jeroen J. G. Geurts
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
| | - Geert J. Schenk
- Department of Anatomy and NeurosciencesAmsterdam University Medical Centers, location VU Medical Center, Amsterdam NeuroscienceAmsterdamthe Netherlands
- MS Centrum Amsterdam, Amsterdam University Medical Centers, location VU Medical CenterAmsterdamthe Netherlands
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Antoniadis J, Gomes De Pinho Q, Koubi M, Macagno N, Benyamine A, Granel B. [A bullous eruption]. Rev Med Interne 2024; 45:253-254. [PMID: 38705594 DOI: 10.1016/j.revmed.2024.03.004] [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: 02/06/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 05/07/2024]
Affiliation(s)
- J Antoniadis
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - Q Gomes De Pinho
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - M Koubi
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - N Macagno
- Service d'anatomie pathologique et de neuropathologie, hôpital Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - A Benyamine
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseille, France.
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Karakioulaki M, Eyerich K, Patsatsi A. Advancements in Bullous Pemphigoid Treatment: A Comprehensive Pipeline Update. Am J Clin Dermatol 2024; 25:195-212. [PMID: 38157140 PMCID: PMC10866767 DOI: 10.1007/s40257-023-00832-1] [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] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
ABASTRACT Bullous pemphigoid (BP) is a common autoimmune bullous disease affecting mainly the elderly, with rising incidence due to increased life expectancy. This disease is characterized by tense bullous lesions on normal or erythematous skin, accompanied by pruritus. BP pathogenesis involves autoantibodies against hemidesmosomal proteins BP180 and BP230, leading to detachment at the dermo-epidermal junction as well as blister formation. BP is associated with coexisting comorbidities and drug exposure, and its management often requires high doses or chronic use of systemic glucocorticoids, posing risks of adverse effects. This review focuses on novel treatment options for BP, exploring therapies targeting different immune pathways. Rituximab, a CD20 monoclonal antibody, depletes B-lymphocytes and has shown efficacy in severe cases. Dupilumab, targeting interleukin (IL)-4 receptor α and thus blocking IL-4 and IL-13, downregulates type 2 helper (Th2) responses and has demonstrated promising results. Targeting eosinophil-related molecules using bertilimumab and AKST4290 has yielded positive results in clinical trials. Omalizumab, an immunoglobulin (Ig) E antibody, can reduce disease severity and allows corticosteroid tapering in a number of cases. Complement inhibitors such as nomacopan and avdoralimab are being investigated. IL-17 and IL-23 inhibitors such as secukinumab and tildrakizumab have shown potential in a limited number of case reports. Neonatal Fc receptor antagonists such as efgartigimod are under investigation. Additionally, topical therapies and Janus kinase inhibitors are being explored as potential treatments for BP. These novel therapies offer promising alternatives for managing BP, with potential to improve outcomes and reduce high cumulative doses of systemic corticosteroids and related toxicities. Further research, including controlled clinical trials, is needed to establish their efficacy, safety, and optimal dosing regimens for BP management.
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Affiliation(s)
- Meropi Karakioulaki
- Department of Dermatology and Venerology, Medical Center, University Hospital Freiburg, Freiburg, Germany
| | - Kilian Eyerich
- Department of Dermatology and Venerology, Medical Center, University Hospital Freiburg, Freiburg, Germany
| | - Aikaterini Patsatsi
- Second Department of Dermatology, School of Medicine, Papageorgiou Hospital, Aristotle University, Thessaloníki, Greece.
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Çetinarslan T, Fölster-Holst R, Van Gysel D, Buchner M, Happle R. Incontinentia pigmenti Stage 1 is not simply vesiculo-bullous but vesiculo-pustular. Pediatr Dermatol 2024; 41:182-183. [PMID: 38284782 DOI: 10.1111/pde.15465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/10/2023] [Indexed: 01/30/2024]
Abstract
Incontinentia pigmenti (IP) is a rare X-linked dominant, male-lethal disorder characterized by pathognomic skin lesions. As described in the literature the typical cutaneous changes follow the pattern of Blaschko's lines and develop in four stages that usually start at birth. Stage 1 is called vesicular, bullous or inflammatory. The vesicles are rapidly filled with eosinophils and thus turn into pustules. Thus, the term "pustular" is relevant to the first phase of IP, and the stage can be considered as "vesiculopustular/inflammatory" to be more precise than "vesicular" or "bullous."
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Affiliation(s)
| | - Regina Fölster-Holst
- Department of Dermatology, Venereology and Allergology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Dirk Van Gysel
- Department of Pediatrics, OLV Hospital Aalst, Aalst, Belgium
- Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Matthias Buchner
- Department of Dermatology, Venereology and Allergology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Rudolf Happle
- Department of Dermatology, Medical Center - University of Freiburg, Freiburg, Germany
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Smith KN, Maddy AJ, Motaparthi K. Lupus erythematosus-specific bullous lesions. Dermatol Online J 2023; 29. [PMID: 38478668 DOI: 10.5070/d329662997] [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: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 05/01/2024] Open
Abstract
Lupus erythematosus (LE)-specific bullous lesions are often difficult to distinguish from other bullous diseases presenting in patients with systemic lupus erythematosus. Herein, we describe a 49-year-old woman with systemic lupus erythematosus with recurrent tense bullae on the forearms. Clinical, histopathologic, and serologic findings led to the diagnosis of LE-specific bullous lesions. We also summarize the diagnostic clues for distinguishing LE-specific bullous lesions, bullous systemic lupus erythematosus, and erythema multiforme-like lesions in LE (Rowell syndrome).
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Affiliation(s)
| | | | - Kiran Motaparthi
- Department of Dermatology, University of Florida, Gainesville, Florida, USA.
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Mee JB. Diagnostic Techniques in Autoimmune Blistering Diseases. Br J Biomed Sci 2023; 80:11809. [PMID: 38074463 PMCID: PMC10704243 DOI: 10.3389/bjbs.2023.11809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023]
Abstract
Autoimmune blistering diseases (AIBD) comprise a heterogeneous group of uncommon disorders of the skin and mucous membranes, characterised by antibodies targeting structural proteins within epithelial tissue and the underlying basement membrane. There can be significant overlap in clinical presentation of these diseases and accurate diagnosis relies on the detection and characterisation of relevant autoantibodies. Immunofluorescence provides the gold-standard diagnostic tool for these diseases, identifying both tissue-bound autoantibodies in biopsy material using direct immunofluorescence and circulating antibodies in serum through indirect immunofluorescence. Following advances in the identification and subsequent characterisation of numerous antigenic targets in these diseases, the development of antigen-specific tests, in particular, enzyme-linked immunosorbent assays on serum specimens, has provided a third key tool to not only identify, but also quantify AIBD autoantibodies. This quantification has proven particularly useful in monitoring disease activity and informing clinical management decisions. Accurate diagnosis of these diseases is important since optimal treatment strategies differ between them and, prognostically, some diagnoses are associated with an increased risk of malignancy. This review outlines the molecular pathology underlying the major AIBD and describes how the three principal techniques can be used in combination, to provide best practice for diagnosis and treatment monitoring.
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Affiliation(s)
- John B. Mee
- Immunodermatology Laboratory, St John’s Institute of Dermatology, Synnovis Analytics, St Thomas’ Hospital, London, United Kingdom
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López-Vera E, López-Riquelme I, García-Hirschfeld JM, Godoy-Díaz DJ. Asymptomatic wide erosive, erythematous, and bullous lesions in an elder woman. Int J Dermatol 2023; 62:1345-1346. [PMID: 37828781 DOI: 10.1111/ijd.16681] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/15/2023] [Accepted: 04/01/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Eduardo López-Vera
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Irene López-Riquelme
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Daniel J Godoy-Díaz
- Dermatology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
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Gedon NKY, Bizikova P, Olivry T, Mendoza-Kuznetsova E, Oberkirchner U, Robertson JB, Linder KE. Histopathological characterisation of trunk-dominant canine pemphigus foliaceus, and comparison with classic facial and insecticide-triggered forms. Vet Dermatol 2023; 34:425-440. [PMID: 37316895 DOI: 10.1111/vde.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND While the clinical features were described recently, the histopathological characterisation of trunk-dominant canine pemphigus foliaceus (PF) is lacking, and whether it differs from classic facial or insecticide-triggered PF is unknown. HYPOTHESIS/OBJECTIVES This study describes the histopathological findings of trunk-dominant PF, and compares the results to classic facial and insecticide-triggered PF. ANIMALS Skin biopsies from 103 dogs with clinically characterised trunk-dominant (n = 33), classic facial (n = 26) and insecticide-triggered PF (n = 44) were included. MATERIALS AND METHODS Histological sections, randomised and blinded, were scored for over 50 morphological parameters of pustules, epidermis, dermis, adnexa and crusts. Intact pustule area and width were measured by digital microscopy. RESULTS In trunk-dominant PF, 77 intact pustules were predominantly subcorneal (0.0019-1.940 mm2 area, 0.0470-4.2532 mm wide), and contained from one to over 100 acantholytic keratinocytes. Pustules had boat acantholytic cells, corneocytes, perinuclear eosinophilic rings, neutrophil rosettes, acantholytic cell necrosis, rafts, cling-ons and/or eosinophils. Peripustular epidermal spongiosis, necrosis and lymphocyte exocytosis occurred, as did follicular pustules. Mixed dermal inflammation often contained eosinophils. Trunk-dominant PF did not differ from the other PF groups except for few parameters, such as having fewer rafts (p = 0.003). Additional autoimmune inflammatory patterns occurred in all PF groups. CONCLUSIONS AND CLINICAL RELEVANCE Trunk-dominant PF and other canine PF variants are histologically similar, which indicates shared pathomechanisms. The identification of common boat acantholytic cells and corneocyte separation has implications for the mechanisms of acantholysis. The diversity of histopathological and polyautoimmunity features support complicated immune mechanisms. Finally, results indicate that diagnostic biopsies cannot differentiate between these PF variants in dogs.
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Affiliation(s)
| | - Petra Bizikova
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Thierry Olivry
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | | | | | - Keith Emerson Linder
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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Sato T, Chiba T, Nakahara T, Watanabe K, Sakai S, Noguchi N, Noto M, Ueki S, Kono M. Eosinophil-derived galectin-10 upregulates matrix metalloproteinase expression in bullous pemphigoid blisters. J Dermatol Sci 2023; 112:6-14. [PMID: 37640566 DOI: 10.1016/j.jdermsci.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 07/02/2023] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an autoimmune bullous disease in which abundant eosinophils accumulate in the blisters. Galectin-10 abounds in the cytoplasm of eosinophils and is released as a result of eosinophil extracellular trap cell death (EETosis). OBJECTIVE To identify EETosis and the pathological roles of galectin-10 in BP. METHODS EETosis and galectin-10 in BP blisters were confirmed by immunofluorescence and transmission electron microscopy. The concentrations of galectin-10 in serum and blister fluid from BP patients were studied by ELISA. The matrix metalloproteinase (MMP) expression in BP blisters was immunohistochemically compared to that in healthy controls. As an in vitro assay, normal human epidermal keratinocytes (NHEKs) and normal human dermal fibroblasts (NHDFs) were stimulated with galectin-10, followed by MMP expression measurement by real-time PCR and ELISA. The signaling pathways activated by galectin-10 were studied using Western blotting and confirmed by inhibition assays. RESULTS Galectin-10-containing eosinophil infiltration and the extracellular deposition of major basic protein were observed in BP blisters. The ultrastructural characteristics of tissue eosinophils indicated piecemeal degranulation and EETosis. In the BP patients, the concentration of galectin-10 was higher in the blister fluid than in the serum. Several types of MMPs were upregulated in BP blisters. Galectin-10 upregulated the production of MMPs through the pathways of p38 MAPK, ERK and JNK in NHEKs and NHDFs. CONCLUSION In the BP blisters, the eosinophils underwent EETosis and released galectin-10. Galectin-10 might contribute to BP blister formation through the production of MMPs by keratinocytes and fibroblasts.
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Affiliation(s)
- Takahiko Sato
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takahito Chiba
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Watanabe
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Sawako Sakai
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Natsuko Noguchi
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Mai Noto
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Michihiro Kono
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
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Kitayama S, Makino T, Hayashi M, Mizawa M, Ishii N, Hashimoto T, Shimizu T. Usefulness of immunofluorescence overlay antigen mapping in the identification of autoantigen in anti-p200 pemphigoid. J Dermatol 2023; 50:1194-1198. [PMID: 37082790 DOI: 10.1111/1346-8138.16810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Anti-p200 pemphigoid is a rare subepidermal blistering disease showing immunoglobulin G (IgG) autoantibodies reactive with a 200-kDa protein. In most patients, serum IgG antibodies react with laminin γ1. The diagnosis of anti-p200 pemphigoid is occasionally difficult, mainly due to the lack of standardized tests. We performed fluorescence overlay antigen mapping by laser scanning confocal microscopy (FOAM-LSCM) to identify autoantigens in an anti-p200 pemphigoid patient and assessed its usefulness for the diagnosis. A 71-year-old man presented with blisters and erosions on the bilateral forearms. No mucosal lesions were observed. Laboratory examinations revealed mild leukocytosis and antinuclear antibody negativity. A histopathological examination showed subepidermal blisters with neutrophil infiltration. Direct immunofluorescence showed linear IgG staining along the basement membrane zone. Indirect immunofluorescence using 1 M NaCl-split skin sections revealed IgG reactivity on the dermal side. Immunoblotting detected circulating IgG autoantibodies that reacted with a 200-kDa protein. Accordingly, anti-p200 pemphigoid was diagnosed. FOAM-LSCM revealed that the patient's IgG signals were co-localized with laminin γ1 but were observed above type VII collagens. A direct immunofluorescent analysis for IgG deposition patterns showed an n-serrated pattern. Thus, FOAM-LSCM may be useful for diagnosing anti-p200 pemphigoid.
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Affiliation(s)
- Shohei Kitayama
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Teruhiko Makino
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Masao Hayashi
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Megumi Mizawa
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tadamichi Shimizu
- Department of Dermatology, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
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Kishimoto M, Komine M, Okada H, Sato A, Kamiya K, Maekawa T, Murata S, Ohtsuki M. Three cases of subcorneal pustular dermatosis with immunohistochemical examinations. J Dermatol 2023; 50:1150-1155. [PMID: 37288510 DOI: 10.1111/1346-8138.16850] [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: 01/14/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
Subcorneal pustular dermatosis, a rare, benign skin disease, is a type of neutrophilic dermatosis. The authors reported three cases of subcorneal pustular dermatosis. In case 1, a 9-year-old girl developed a skin rash with blisters following a mycoplasma infection and had a flare-up due to a common cold. She was successfully treated with a topical corticosteroid. In case 2, a 70-year-old woman who had been treated for rheumatoid arthritis with adalimumab, salazosulfapyridine, and leflunomide developed 3- to 5-mm pustules on her trunk and thighs 4 days after flu vaccination. The rash disappeared with drug withdrawal and treatment with diaminodiphenyl sulfone. In case 3, an 81-year-old man, who was diagnosed with pyoderma gangrenosum at 61 years old, developed multiple small flaccid pustules on his trunk and extremities due to an infection in the arteriovenous shunt area on the forearm. The pustule disappeared with intravenous antibiotic therapy; however, the pustules subsequently flared up along with ulcers typical of pyoderma gangrenosum. He was given oral prednisolone therapy, which was effective for the small pustules and some ulcers. Immunohistochemical examination of the three cases revealed neutrophilic infiltration in the subcorneal layer of the epidermis. The pustules contained neutrophils as well as some CD68+ and a few CD1a+ cells. The epidermis and dermis were more predominantly infiltrated by CD4+ cells than by CD8+ cells. Positive stainings for interleukin 8, interleukin 36γ, and phospho-extracellular signal-regulated kinases 1 and 2 were observed in the upper layers of the epidermis below the pustules. Although the pathogenesis of subcorneal pustular dermatosis has not been clarified, the current results suggest that a variety of inflammatory cells, including those responsible for both innate and acquired immunity, are involved in the accumulation of neutrophils in subcorneal pustular dermatosis.
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Affiliation(s)
- Megumi Kishimoto
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirofumi Okada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsuko Sato
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoru Murata
- Murata Dermatology Clinic, Shimotsuke, Tochigi, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Waters M, Dobry A, Le ST, Shinkai K, Beachkofsky TM, Davis MDP, Dominguez AR, Kroshinsky D, Markova A, Micheletti RG, Mostaghimi A, Pasieka HB, Rosenbach M, Seminario-Vidal L, Trinidad J, Albrecht J, Altman EM, Arakaki R, Ardern-Jones M, Bridges AG, Cardones AR, Chadha AA, Chen JK, Chen ST, Cheng K, Daveluy S, DeNiro KL, Harp J, Keller JJ, King B, Korman AM, Lowenstein EJ, Luxenberg E, Mancuso JB, Mauskar MM, Milam P, Motaparthi K, Nelson CA, Nguyen CV, Nutan F, Ortega-Loayza AG, Patel T, Rahnama-Moghadam S, Rekhtman S, Rojek NW, Sarihan M, Shaigany S, Sharma TR, Shearer SM, Shields BE, Strowd LC, Tartar DM, Thomas C, Wanat KA, Walls AC, Zaba LC, Ziemer CM, Maverakis E, Kaffenberger BH. Development of a Skin-Directed Scoring System for Stevens-Johnson Syndrome and Epidermal Necrolysis: A Delphi Consensus Exercise. JAMA Dermatol 2023; 159:772-777. [PMID: 37256599 PMCID: PMC10838134 DOI: 10.1001/jamadermatol.2023.1347] [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] [Indexed: 06/01/2023]
Abstract
Importance Scoring systems for Stevens-Johnson syndrome and epidermal necrolysis (EN) only estimate patient prognosis and are weighted toward comorbidities and systemic features; morphologic terminology for EN lesions is inconsistent. Objectives To establish consensus among expert dermatologists on EN terminology, morphologic progression, and most-affected sites, and to build a framework for developing a skin-directed scoring system for EN. Evidence Review A Delphi consensus using the RAND/UCLA appropriateness criteria was initiated with a core group from the Society of Dermatology Hospitalists to establish agreement on the optimal design for an EN cutaneous scoring instrument, terminology, morphologic traits, and sites of involvement. Findings In round 1, the 54 participating dermatology hospitalists reached consensus on all 49 statements (30 appropriate, 3 inappropriate, 16 uncertain). In round 2, they agreed on another 15 statements (8 appropriate, 7 uncertain). There was consistent agreement on the need for a skin-specific instrument; on the most-often affected skin sites (head and neck, chest, upper back, ocular mucosa, oral mucosa); and that blanching erythema, dusky erythema, targetoid erythema, vesicles/bullae, desquamation, and erosions comprise the morphologic traits of EN and can be consistently differentiated. Conclusions and Relevance This consensus exercise confirmed the need for an EN skin-directed scoring system, nomenclature, and differentiation of specific morphologic traits, and identified the sites most affected. It also established a baseline consensus for a standardized EN instrument with consistent terminology.
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Affiliation(s)
- Margo Waters
- The Ohio State University College of Medicine, Columbus
| | - Allison Dobry
- Department of Dermatology, University of California, San Francisco
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Arturo R Dominguez
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | | | - Alina Markova
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert G Micheletti
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helena B Pasieka
- Departments of Dermatology, Uniformed Services University, Bethesda, Maryland
- The Burn Center, MedStar Washington Hospital Center, Washington, DC
| | - Misha Rosenbach
- Department of Dermatology and Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - John Trinidad
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Joerg Albrecht
- Department of Medicine, Division of Dermatology, Cook County Health, Chicago, Illinois
| | - Emily M Altman
- Department of Dermatology, University of New Mexico Health Sciences Center, Albuquerque
| | - Ryan Arakaki
- Department of Dermatology, University of California, San Francisco
| | | | - Alina G Bridges
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Adela R Cardones
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Angad A Chadha
- Section of Dermatology, University of Chicago, Chicago, Illinois
| | - Jennifer K Chen
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Steven T Chen
- Department of Dermatology, Massachusetts General Hospital, Boston
| | - Kyle Cheng
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Joanna Harp
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Jesse J Keller
- Department of Dermatology, Oregon Health and Science University, Portland
| | - Brett King
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Abraham M Korman
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus
| | - Eve J Lowenstein
- Department of Dermatology, SUNY Downstate Medical Center and Kings County Medical Center, Oceanside, New York
| | - Erin Luxenberg
- Department of Dermatology, Hennepin Healthcare, Minneapolis, Minnesota
| | | | - Melissa M Mauskar
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Philip Milam
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville
| | - Caroline A Nelson
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Fnu Nutan
- Department of Dermatology, Virginia Commonwealth University Medical Center, Richmond
| | | | - Tejesh Patel
- Department of Dermatology, University of Tennessee Health Science Center, Memphis
| | | | - Sergey Rekhtman
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine
| | - Mansi Sarihan
- Department of Dermatology, Valleywise Health-Creighton University, University of Arizona, Mayo Clinic, Phoenix, Arizona
| | - Sheila Shaigany
- Departments of Dermatology and Anatomic Pathology, Donald and Barbara Zucker School for Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Timmie R Sharma
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sabrina M Shearer
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Cristina Thomas
- Departments of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Andrew C Walls
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lisa C Zaba
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Carolyn M Ziemer
- Department of Dermatology, University of North Carolina Chapel Hill, Chapel Hill
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13
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Roque CA, Lima BR, de Oliveira GV, Nascimento LM. Giant and potentially malignant bullae in a dog. Open Vet J 2023; 13:241-246. [PMID: 37073247 PMCID: PMC10105785 DOI: 10.5455/ovj.2023.v13.i2.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Primary lung neoplasms are, frequently represented by solid, solitary, or multiple formations. However, malignant cavitary lesions may be presented as lung adenocarcinomas. Those malignant lesions differ from benignant bullae by the thickness heterogeneity of its surrounding shape. CASE DESCRIPTION The present clinical case reports a 14-year-old female dog, of mixed breed, with an increase in the coughs frequency, fatigue, and exercise intolerance. A chest X-ray was taken, a large emphysematous cystic area was found, with thickened and irregular walls located in the left caudal pulmonary lobe, which measured 8 × 7.5 × 3 cm, and rejected the bronchial branch corresponding to the left caudal pulmonary lobe, in addition to thickening of the bronchial walls, compatible with bronchopathy. The tomographic examination of the cavity showed an air content structure, oval to round in shape, with irregular thick hyperattenuating walls measuring approximately 0.4 cm in thickness, occupying more than 30% of the left hemithorax, and pulmonary lobectomy was chosen. Histopathology confirmed the diagnosis of bronchoalveolar adenocarcinoma, with the presence of sparse areas of necrosis and dystrophic calcification. CONCLUSION The present case successfully diagnosed a malignant bulae, after a surgical remove. The tomographic finds although not confirmatory, suggest a malignant component by the shape and thickness of its wall. The tomographic exam is of great importance, because only through it, it is possible to evaluate if there is lymph node or pleural involvement or the presence of small metastasis foci. There is indication for surgery and histopathological examination of the piece for a definitive diagnosis.
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Affiliation(s)
| | - Bruno Roque Lima
- Omega Imagem Veterinária, Av. Washington Luis, Vila Matias, Brazil
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14
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Di Zenzo G, Floriddia G, Rossi S, Mariotti F, Primerano A, Condorelli AG, Didona B, Castiglia D. Case report: bullous pemphigoid development underlies dystrophic epidermolysis bullosa disease worsening. Front Immunol 2022; 13:929286. [PMID: 35967298 PMCID: PMC9374178 DOI: 10.3389/fimmu.2022.929286] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/04/2022] [Indexed: 11/18/2022] Open
Abstract
Autoimmune response to cutaneous basement membrane components superimposed on a genetic skin fragility disease, hereditary epidermolysis bullosa (EB), has been described, but its effects on disease course remain unclear. We report a 69-year-old individual with congenital skin fragility and acral trauma-induced blistering that had suddenly worsened with the onset of severe itch and diffuse spontaneous inflammatory blisters. Next-generation sequencing identified compound heterozygous null and missense COL7A1 mutations, allowing the diagnosis of recessive dystrophic EB. However, the patient’s clinical history prompted us to investigate whether he might have developed a pathological autoimmune response against basement membrane components. Tissue-bound and circulating IgG antibodies to the major bullous pemphigoid (BP) antigen, BP180, were detected in the patient’s skin and serum, respectively, consistent with a diagnosis of BP. Corticosteroid therapy was initiated resulting in remission of BP manifestations. EB patients presenting rapid disease worsening should be investigated for the development of a concomitant autoimmune blistering disease.
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Affiliation(s)
- Giovanni Di Zenzo
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Giovanna Floriddia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Feliciana Mariotti
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Alessia Primerano
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Angelo Giuseppe Condorelli
- Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Biagio Didona
- Rare Skin Disease Center, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Daniele Castiglia
- Laboratory of Molecular and Cell Biology, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- *Correspondence: Daniele Castiglia,
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15
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Alrashdan MS, Kamaguchi M. Management of mucous membrane pemphigoid: a literature review and update. Eur J Dermatol 2022; 32:312-321. [PMID: 36065531 DOI: 10.1684/ejd.2021.4132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mucous membrane pemphigoid (MMP) is a rare group of heterogeneous chronic autoimmune diseases that predominantly manifest as blistering of the mucous membranes. MMP lesions often heal with scarring, which may result in impaired organ function and significant morbidity. The exact pathogenic mechanisms of MMP are still largely unknown while the diagnosis is based on a combination of clinical, histological and immuno-pathological findings. Several treatment modalities of MMP are available and are reported in the literature, however, such treatment options are principally guided by expert opinions and descriptive reports. Non-specific immunosuppression, especially corticosteroids, remains the mainstay of treatment, which often leads to severe adverse effects. Therefore, safer and more effective therapeutic modalities are required. This comprehensive literature review outlines the current knowledge and recent advances in the field of MMP management, with particular emphasis on the oral variant of MMP.
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Affiliation(s)
- Mohammad S Alrashdan
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah Department of Oral Medicine and Oral Surgery, Faculty of Dentistry, Jordan University of Science and Technology
| | - Mayumi Kamaguchi
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Hokkaido, Japan
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16
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Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease affecting the general population worldwide. A fever and cough are the common clinical presentations of COVID-19. In most of these patients, computed tomography (CT) shows bilateral peripheral ground-glass opacities. We herein report a case of hemoptysis and lung bulla in the convalescent phase of COVID-19. Based on the clinical observations, alveolar destruction was likely associated with hemoptysis and bulla formation. Therefore, we suggest the follow-up of COVID-19 patients whose clinical parameters indicate alveolar damage, even after their symptoms improve.
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Affiliation(s)
- Lubna Sato
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Noriko Kinoshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Takato Nakamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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17
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Affiliation(s)
- Ji-Hyun Moon
- Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Julie Huynh
- Children's Hospital at Westmead, Westmead, NSW, Australia
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18
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Hayashi K, Shimokawa T, Yamagata M, Yoneda K. Inhibition of α 2-adrenoceptor is renoprotective in 5/6 nephrectomy-induced chronic kidney injury rats. J Pharmacol Sci 2021; 145:79-87. [PMID: 33357783 DOI: 10.1016/j.jphs.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/28/2020] [Accepted: 11/02/2020] [Indexed: 11/20/2022] Open
Abstract
In the present study, we investigated the renoprotective effects of long-term treatment with yohimbine, an α2-adrenoceptor inhibitor, in a 5/6 nephrectomy-induced chronic kidney disease (CKD) rat model. Male Sprague-Dawley rats were randomly allocated into the following groups: sham-operated, 5/6-nephrectomized (5/6 Nx), 5/6 Nx + low or high dose of yohimbine (0.3 or 3.0 mg/L in drinking water, respectively), and 5/6 Nx + hydralazine (250 mg/L in drinking water). The 5/6 Nx group presented with renal dysfunction, hypertension, noradrenaline overproduction, and histopathological injuries. Blood pressure decreased in both the yohimbine- and hydralazine-treated groups. Treatment with high dose of yohimbine, but not hydralazine, apparently attenuated urinary protein excretion and noradrenaline concentration of renal venous plasma. Renal fibrosis and upregulated fibrosis-related gene expression were suppressed by high dose of yohimbine. Furthermore, yohimbine, but not hydralazine, treatment ameliorated the urinary concentration ability. These findings suggest that long-term yohimbine treatment can be a useful therapeutic option to prevent the progression of CKD.
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Affiliation(s)
- Kohei Hayashi
- Laboratory of Clinical Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, 3-11-1 Nishikiori-kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Takaomi Shimokawa
- Laboratory of Clinical Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, 3-11-1 Nishikiori-kita, Tondabayashi, Osaka, 584-8540, Japan.
| | - Masayo Yamagata
- Laboratory of Clinical Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, 3-11-1 Nishikiori-kita, Tondabayashi, Osaka, 584-8540, Japan
| | - Kozo Yoneda
- Laboratory of Clinical Pharmacology, Faculty of Pharmacy, Osaka Ohtani University, 3-11-1 Nishikiori-kita, Tondabayashi, Osaka, 584-8540, Japan.
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19
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Affiliation(s)
- Amy K Bieber
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Lu Yin
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
| | - Kristen Lo Sicco
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York
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20
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Jha N. Bullous fixed drug eruption related to multivitamins. Dermatol Online J 2020; 26:13030/qt3150z9d2. [PMID: 33054952] [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: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023] Open
Abstract
Multivitamins are commonly consumed over-the-counter supplements. Drug reactions related to multivitamins are rare and very few cases have been reported. This is a case of a young woman who developed bullous fixed drug eruption to multivitamins.
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Affiliation(s)
- Niharika Jha
- Department of Dermatology, Acharya Shree Bhikshu Hospital, Delhi.
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21
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Lee JH, Liu PH, Cheng KY, Tsai MJ. Woman With Dyspnea. Ann Emerg Med 2020; 76:e1-e2. [PMID: 32591128 DOI: 10.1016/j.annemergmed.2020.01.006] [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] [Received: 12/04/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Jian-Heng Lee
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Pang Hsu Liu
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Kai-Yuan Cheng
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan.
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22
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De Maeyer RPH, van de Merwe RC, Louie R, Bracken OV, Devine OP, Goldstein DR, Uddin M, Akbar AN, Gilroy DW. Blocking elevated p38 MAPK restores efferocytosis and inflammatory resolution in the elderly. Nat Immunol 2020; 21:615-625. [PMID: 32251403 PMCID: PMC7983074 DOI: 10.1038/s41590-020-0646-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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: 05/15/2019] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Abstract
Increasing age alters innate immune-mediated responses; however, the mechanisms underpinning these changes in humans are not fully understood. Using a human dermal model of acute inflammation, we found that, although inflammatory onset is similar between young and elderly individuals, the resolution phase was substantially impaired in elderly individuals. This arose from a reduction in T cell immunoglobulin mucin receptor-4 (TIM-4), a phosphatidylserine receptor expressed on macrophages that enables the engulfment of apoptotic bodies, so-called efferocytosis. Reduced TIM-4 in elderly individuals was caused by an elevation in macrophage p38 mitogen-activated protein kinase (MAPK) activity. Administering an orally active p38 inhibitor to elderly individuals rescued TIM-4 expression, cleared apoptotic bodies and restored a macrophage resolution phenotype. Thus, inhibiting p38 in elderly individuals rejuvenated their resolution response to be more similar to that of younger people. This is the first resolution defect identified in humans that has been successfully reversed, thereby highlighting the tractability of targeting pro-resolution biology to treat diseases driven by chronic inflammation.
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Affiliation(s)
| | | | - Rikah Louie
- Division of Medicine, University College London, London, UK
| | | | - Oliver P Devine
- Division of Infection and Immunity, University College London, London, UK
| | - Daniel R Goldstein
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mohib Uddin
- Respiratory Global Medicines Development, AstraZeneca, Gothenburg, Sweden
| | - Arne N Akbar
- Division of Infection and Immunity, University College London, London, UK
| | - Derek W Gilroy
- Division of Medicine, University College London, London, UK.
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23
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Weijns ME, Starink TM, van Doorn R. [A 12-year-old girl with blisters on the arm]. Ned Tijdschr Geneeskd 2020; 164:D4474. [PMID: 32406635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This case concerns a girl with geometrically round blisters, mainly on the left arm since 1 month. Histopathologic examination of a skin biopsy showed a necrotic epidermis with subepidermalclefting suggesting thermal damage. Recently, similar thermal burns have been observed more often in adolescents following a so-called 'deo challenge'.
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24
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Mirastschijski U, Schwab I, Coger V, Zier U, Rianna C, He W, Maedler K, Kelm S, Radtke A, Belge G, Lindner P, Stahl F, Scharpenberg M, Lasota L, Timm J. Lung Surfactant Accelerates Skin Wound Healing: A Translational Study with a Randomized Clinical Phase I Study. Sci Rep 2020; 10:2581. [PMID: 32054903 PMCID: PMC7018835 DOI: 10.1038/s41598-020-59394-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/30/2019] [Accepted: 01/28/2020] [Indexed: 01/10/2023] Open
Abstract
Lung surfactants are used for reducing alveolar surface tension in preterm infants to ease breathing. Phospholipid films with surfactant proteins regulate the activity of alveolar macrophages and reduce inflammation. Aberrant skin wound healing is characterized by persistent inflammation. The aim of the study was to investigate if lung surfactant can promote wound healing. Preclinical wound models, e.g. cell scratch assays and full-thickness excisional wounds in mice, and a randomized, phase I clinical trial in healthy human volunteers using a suction blister model were used to study the effect of the commercially available bovine lung surfactant on skin wound repair. Lung surfactant increased migration of keratinocytes in a concentration-dependent manner with no effect on fibroblasts. Significantly reduced expression levels were found for pro-inflammatory and pro-fibrotic genes in murine wounds. Because of these beneficial effects in preclinical experiments, a clinical phase I study was initiated to monitor safety and tolerability of surfactant when applied topically onto human wounds and normal skin. No adverse effects were observed. Subepidermal wounds healed significantly faster with surfactant compared to control. Our study provides lung surfactant as a strong candidate for innovative treatment of chronic skin wounds and as additive for treatment of burn wounds to reduce inflammation and prevent excessive scarring.
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Affiliation(s)
- Ursula Mirastschijski
- Center for Biomolecular Interactions Bremen, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany.
| | - Igor Schwab
- Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte, Bremen, Germany
| | - Vincent Coger
- Department of Experimental Plastic Surgery, Kerstin Reimers Laboratory for Regeneration Biology, Hannover Medical School, Hannover, Germany
| | - Ulrich Zier
- Center for Biomolecular Interactions Bremen, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Carmela Rianna
- Institute of Biophysics, University of Bremen, Bremen, Germany
| | - Wei He
- Center for Biomolecular Interactions Bremen, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Kathrin Maedler
- Center for Biomolecular Interactions Bremen, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Sørge Kelm
- Center for Biomolecular Interactions Bremen, Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Arlo Radtke
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Gazanfer Belge
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Patrick Lindner
- Institute of Technical Chemistry, Leibniz University Hannover, Hannover, Germany
| | - Frank Stahl
- Institute of Technical Chemistry, Leibniz University Hannover, Hannover, Germany
| | - Martin Scharpenberg
- University of Bremen, Competence Center for Clinical Trials Bremen, Bremen, Germany
| | - Lukas Lasota
- University of Bremen, Competence Center for Clinical Trials Bremen, Bremen, Germany
| | - Jürgen Timm
- University of Bremen, Competence Center for Clinical Trials Bremen, Bremen, Germany
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25
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Abstract
Collagen XVII (COL17) is a hemidesmosomal transmembrane protein in the skin, which, in several autoimmune blistering skin diseases, may be targeted by autoantibodies. In addition, loss-of-function mutations in the COL17A1 gene induce a subtype of junctional epidermolysis bullosa. The extracellular domain of COL17 can be physiologically cleaved from the cell surface by ADAM family proteins in a process known as ectodomain shedding. COL17 ectodomain shedding is thought to be associated with the migration and proliferation of keratinocytes. Furthermore, the C-terminal cleavage of COL17 may be associated with basement membrane formation. COL17 can be targeted by various proteases, including MMP9, neutrophil elastase, plasmin and granzyme B, which may be associated with blister formation in pemphigoid diseases. Interestingly, cleavage of COL17 may induce neoepitopes on the proteolysed fragments, and such induction is associated with dynamic structural changes. This review summarizes the current understanding of cleavage of COL17, and how such cleavage relates to blistering skin diseases.
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Affiliation(s)
- Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.
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26
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Grandhi R, Bazewicz CG, Tjarks BJ, Lin G, Ferringer TC, Hossler EW. Distinct violaceous plaques in conjunction with blisters. Cutis 2020; 105:62-72. [PMID: 32186528] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Radhika Grandhi
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | | | - B Joel Tjarks
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - George Lin
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Tammie C Ferringer
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Eric W Hossler
- Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA
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27
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Sousa S, Santos MJ. Juvenile bullous systemic lupus erythematosus - case report. Acta Reumatol Port 2020; 45:74-75. [PMID: 32608382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune subepidermal blistering disease, with few cases described in childhood. We report a case of bullous systemic lupus erythematosus refractory to corticosteroid therapy in a 16-year-old female who was successfully treated with low dose dapsone. We highlight the rarity and the relevance of skin biopsy for a correct diagnosis of BSLE.
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28
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Afsar FS, Cun S, Seremet S. Neonatal sucking blister. Dermatol Online J 2019; 25:13030/qt33b1w59j. [PMID: 32045151] [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: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023] Open
Abstract
Neonatal sucking blisters result from vigorous sucking on hand or forearm in utero. Clinically, one observes a tense, fluid-filled blister, which when ruptured forms an erosion. We report a female neonate with a sucking blister on the distal dorsal aspect of her left forearm. These benign bullae should be differentiated from other diseases of the newborn through their presentation, characteristic morphology, and self-limiting course.
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Affiliation(s)
- F Sule Afsar
- Department of Dermatology, Ataturk Research and Training Hospital, Izmir.
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29
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Olvera-Cortés V, Pulido-Díaz N, Orellana-Arauco ÁR. Discoloration and bullous lesions on the hands. Cutis 2019; 104:E6-E8. [PMID: 31774895] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Verónica Olvera-Cortés
- Dermatology Department, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico
| | - Nancy Pulido-Díaz
- Dermatology Department, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico
| | - Álvaro Rhony Orellana-Arauco
- Dermatology Department, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico
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30
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Bucher JL, Ahmed M. Serous and hemorrhagic bullae on the leg. Cutis 2019; 104:204-212. [PMID: 31774888] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Mehwish Ahmed
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
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31
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Sandre M, Osmond A, Ghazarian D, Ghiasi N. Bullous leukemia cutis: a rare clinical subtype. Dermatol Online J 2019; 25:13030/qt68z1v55d. [PMID: 31329394] [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: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 06/10/2023] Open
Abstract
Leukemia cutis represents infiltration of the skin by malignant leukocytes and typically presents as firm, red-brown papules and nodules. The bullous clinical subtype is considered a rare entity and can be a diagnostic challenge. This case describes a patient with bullous leukemia cutis mimicking vesiculobullous skin disease.
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Affiliation(s)
- Matthew Sandre
- Division of Dermatology, University of Toronto, Toronto, Ontario.
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32
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Blackcloud P, Dupuy E, Kang Y, Smart C, Hsiao J. Bullous acral eruption related to secukinumab. Dermatol Online J 2019; 25:13030/qt9q7937xb. [PMID: 31329391] [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: 07/12/2019] [Accepted: 07/12/2019] [Indexed: 06/10/2023] Open
Abstract
Skin reactions related to secukinumab are uncommon. Although the initial phase 3 studies of this medication reported infection and urticaria as adverse cutaneous events, other cases of unique adverse events have since been reported. We are presenting a patient who developed an exuberant hand and foot reaction after starting secukinumab.
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Affiliation(s)
- Paul Blackcloud
- Division of Dermatology, UCLA Medical Center, Los Angeles, CA.
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33
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Haley CT, Tyring SK. A 22-Year-Old Man With Painful Vesicles on His Flank. JAMA 2019; 321:1213-1214. [PMID: 30830143 DOI: 10.1001/jama.2019.0107] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Stephen K Tyring
- Center for Clinical Studies, Webster, Texas
- Department of Dermatology, University of Texas Health Science Center at Houston
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34
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Hisaw L, Twu O, Rodriguez L, Holland V, Young L. Bothersome blisters: localized epidermolysis bullosa simplex. Cutis 2019; 103:E24-E26. [PMID: 31039243] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Lisa Hisaw
- Department of Dermatology, Kaiser Permanente, Richmond, California, USA
| | - Olivia Twu
- Department of Dermatology, University of California, San Francisco, USA
| | | | - Vanessa Holland
- Division of Dermatology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
| | - Lorraine Young
- Division of Dermatology, Ronald Reagan UCLA Medical Center, Los Angeles, USA
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35
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Farmer C, Patel D, Pimentel JD, Shwayder T. Large hemorrhagic plaque with central crusting. Cutis 2019; 103:68-80. [PMID: 30893389] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Caitlin Farmer
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Devika Patel
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jason D Pimentel
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tor Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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36
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Yasuda S, Yatsuyanagi E, Sugawara Y, Taniguchi M. [Two-staged Operation for Bilateral Giant Bullae Successfully Performed with Veno-venous Extracorporeal Membrane Oxygenation( V-V ECMO) for First Surgery]. Kyobu Geka 2018; 71:944-947. [PMID: 30310007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
57-year-old man with bilateral giant lung bullae was admitted to our hospital for dyspnea on exertion as his chief complaint. The size and shape of right lung bullae were bigger and more complicated than those of left lung bullae. He underwent 2-staged bullectomy by video-assisted thoracoscopic surgery (VATS). Left lung bullectomy was expected to be more safely done, and was performed with veno-venous extracorporeal membrane oxygenation( V-V ECMO) prior to right side without any complications. The right lung bullectomy was performed 6 months after 1st operation without V-V ECMO. These reoperations were necessary due to postoperative air leak, however, his respiratory condition was well maintained by his left lung which had already been remarkably improved.
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Affiliation(s)
- Shunsuke Yasuda
- Department of Thoracic Surgery, Obihiro Hospital, Obihiro, Japan
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37
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Reid J, Zamuner S, Edwards K, Rumley S, Nevin K, Feeney M, Zecchin C, Fernando D, Wisniacki N. In vivo affinity and target engagement in skin and blood in a first-time-in-human study of an anti-oncostatin M monoclonal antibody. Br J Clin Pharmacol 2018; 84:2280-2291. [PMID: 29900565 PMCID: PMC6138480 DOI: 10.1111/bcp.13669] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 05/04/2018] [Accepted: 05/28/2018] [Indexed: 01/30/2023] Open
Abstract
AIMS The oncostatin M (OSM) pathway drives fibrosis, inflammation and vasculopathy, and is a potential therapeutic target for inflammatory and fibrotic diseases. The aim of this first-time-in-human experimental medicine study was to assess the safety, tolerability, pharmacokinetics and target engagement of single subcutaneous doses of GSK2330811, an anti-OSM monoclonal antibody, in healthy subjects. METHODS This was a phase I, randomized, double-blind, placebo-controlled, single-dose escalation, first-time-in-human study of subcutaneously administered GSK2330811 in healthy adults (NCT02386436). Safety and tolerability, GSK2330811 pharmacokinetic profile, OSM levels in blood and skin, and the potential for antidrug antibody formation were assessed. The in vivo affinity of GSK2330811 for OSM and target engagement in serum and skin blister fluid (obtained via a skin suction blister model) were estimated using target-mediated drug disposition (TMDD) models in combination with compartmental and physiology-based pharmacokinetic (PBPK) models. RESULTS Thirty subjects were randomized to receive GSK2330811 and 10 to placebo in this completed study. GSK2330811 demonstrated a favourable safety profile in healthy subjects; no adverse events were serious or led to withdrawal. There were no clinically relevant trends in change from baseline in laboratory values, with the exception of a reversible dose-dependent reduction in platelet count. GSK2330811 exhibited linear pharmacokinetics over the dose range 0.1-6 mg kg-1 . The estimated in vivo affinity (nM) of GSK2330811 for OSM was 0.568 [95% confidence interval (CI) 0.455, 0.710] in the compartmental with TMDD model and 0.629 (95% CI 0.494, 0.802) using the minimal PBPK with TMDD model. CONCLUSIONS Single subcutaneous doses of GSK2330811 were well tolerated in healthy subjects. GSK2330811 demonstrated sufficient affinity to achieve target engagement in systemic circulation and target skin tissue, supporting the progression of GSK2330811 clinical development.
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Affiliation(s)
- Juliet Reid
- ImmunoInflammationGlaxoSmithKlineStevenageUK
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38
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Anderson ED, Sastalla I, Earland NJ, Mahnaz M, Moore IN, Otaizo-Carrasquero F, Myers TG, Myles CA, Datta SK, Myles IA. Prolonging culture of primary human keratinocytes isolated from suction blisters with the Rho kinase inhibitor Y-27632. PLoS One 2018; 13:e0198862. [PMID: 30208113 PMCID: PMC6135349 DOI: 10.1371/journal.pone.0198862] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/27/2018] [Indexed: 12/20/2022] Open
Abstract
Keratinocytes are the most abundant cell type in the epidermis. They prevent desiccation and provide immunological and barrier defense against potential pathogens such as Staphylococcus aureus and Candida albicans. The study of this first line of immune defense may be hindered by invasive isolation methods and/or improper culture conditions to support stem cell maintenance and other potential mechanisms contributing to long-term subcultivation in vitro. Primary keratinocytes have been successfully isolated from blister roofs induced by negative pressure, which separates the epidermis from the dermis in vivo in human subjects. This method allows collection of pure epidermal cells without dermal contamination in a minimally invasive manner. However, the isolated keratinocytes differentiate and senesce when cultured in vitro beyond five passages. Here, we present evidence that the Rho kinase (ROCK) inhibitor Y-27632 can be used to effectively increase the proliferative capabilities of keratinocytes isolated using the suction blister method, similar to what has been previously reported for primary keratinocytes isolated using alternative methods. We show that the increase in passage number is directly correlated to delayed differentiation, and that cells passaged long term with the inhibitor retain their ability to stratify in organotypic raft cultures and respond to cytokine treatment; additionally, the late passage cells have a heterogeneous mix of differentiated and non-differentiated cells which may be predicted by a ratio of select differentiation markers. The described method presents a minimally invasive procedure for keratinocyte isolation and prolonged culture that allows analysis of keratinocyte function in both healthy volunteers and patients with dermatologic diseases.
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Affiliation(s)
- Erik D. Anderson
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | - Inka Sastalla
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | - Noah J. Earland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | - Minai Mahnaz
- Comparative Medicine Branch, National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, United States of America
| | - Ian N. Moore
- Comparative Medicine Branch, National Institute of Allergy and Infectious Disease, National Institutes of Health, Rockville, MD, United States of America
| | - Francisco Otaizo-Carrasquero
- Genomic Technologies Section, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | - Timothy G. Myers
- Genomic Technologies Section, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | | | - Sandip K. Datta
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
| | - Ian A. Myles
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, United States of America
- * E-mail:
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Kamaguchi M, Iwata H, Ujiie H, Natsuga K, Nishie W, Kitagawa Y, Shimizu H. High Expression of Collagen XVII Compensates for its Depletion Induced by Pemphigoid IgG in the Oral Mucosa. J Invest Dermatol 2018; 138:1707-1715. [PMID: 29530535 DOI: 10.1016/j.jid.2018.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/26/2017] [Revised: 02/22/2018] [Accepted: 03/02/2018] [Indexed: 02/08/2023]
Abstract
The basement membrane zone consists of multiple components, including collagen XVII (COL17), which is the target of bullous pemphigoid. To our knowledge, no research has addressed the differences in basement membrane zone components between the skin and oral mucosa; therefore, we investigated the basement membrane zone proteins, with a focus on COL17. The mRNA and protein expression levels of COL17 were significantly higher in oral keratinocytes than in skin keratinocytes. Hemidesmosomal COL17 expression was markedly higher in oral keratinocytes than in skin keratinocytes, and its level was associated with adhesion strength. Oral keratinocytes adhered to the extracellular matrix more tightly than did skin keratinocytes in vitro. Based on these results, we attempt to explain the clinical diversity of bullous pemphigoid. COL17 depletion was more prominent in skin keratinocytes than in oral keratinocytes after treatment with COL17-NC16A mAbs, which have in vivo pathogenicity. COL17 C-terminus mAbs, which are not pathogenic, facilitated COL17 depletion in combination treatment with COL17-NC16A mAbs in both types of keratinocytes. In summary, the greater amount of COL17 in oral keratinocytes than in skin keratinocytes is associated with the higher strength of oral keratinocyte hemidesmosomal adhesion at the basement membrane zone. Our results may explain why bullous pemphigoid blistering tends to be more prevalent in the skin than in the oral mucosa.
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Affiliation(s)
- Mayumi Kamaguchi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshimasa Kitagawa
- Department of Oral Diagnosis and Medicine, Hokkaido University Graduate School of Dental Medicine, Sapporo, Japan
| | - Hiroshi Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Rangel HMDA, Rolim HT, Vidigal P, Araújo IDD, Cronemberger S. Healing modulation in glaucoma surgery after application of subconjunctival triamcinolone acetate alone or combined with mitomycin C: an experimetal study. Rev Col Bras Cir 2018; 45:e1861. [PMID: 30066737 DOI: 10.1590/0100-6991e-20181861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/10/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to study the efficacy and safety of the use of subconjunctival triamcinolone acetate alone or in combination with mitomycin C as a modulator of trabeculectomy healing in rabbits. METHODS we submitted thirty male, albino, New Zealand rabbits to bilateral trabeculectomy. We divided the animals into four experimental groups with 15 eyes per group: control, mitomycin C, triamcinolone acetate and triamcinolone acetate + mitomycin C. We performed aplanation tonometry and clinical analysis of the bleb through the Moorfields Graduation System in the postoperative period. For the evaluation of healing, we carried out the quantitative analysis of the inflammatory infiltrate (polymorphonuclear) through Hematoxylin & Eosin staining, and vascular proliferation, through immunohistochemistry. RESULTS we observed a significant decrease in postoperative intraocular pressure in all groups compared with the preoperative pressure (p<0.001). However, there was no difference between groups (p=0.186). The triamcinolone + mitomycin C acetate group presented better indices as for the maximum bleb height and vascularization of the bleb central area (p=0.001); in addition, there was a lower inflammatory response (p=0.001) and lower vascular proliferation (p=0.001) in the intermediate phase of the study compared with the monotherapies. CONCLUSION the combination of mitomycin C and triamcinolone acetate resulted in a synergistic action between these agents, with broader and more diffuse blebs, less inflammatory infiltrate and less vascular proliferation in the intermediate stages of follow-up in this animal model.
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Affiliation(s)
- Hayana Marques do Aragão Rangel
- Universidade Federal de Minas Gerais, Departamento de Oftalmologia, Belo Horizonte, MG, Brasil
- Santa Casa de Misericórdia de Belo Horizonte, Centro de Referência em Glaucoma e Catarata, Belo Horizonte, MG, Brasil
| | - Hévila Tamar Rolim
- Santa Casa de Misericórdia de Belo Horizonte, Centro de Referência em Glaucoma e Catarata, Belo Horizonte, MG, Brasil
- Universidade Federal de Rondônia, Departamento de Medicina, Porto Velho, RO, Brasil
| | - Paula Vidigal
- Universidade Federal de Minas Gerais, Departamento de Patologia, Belo Horizonte, MG, Brasil
| | - Ivana Duval de Araújo
- Universidade Federal de Minas Gerais, Departamento de Cirurgia, Belo Horizonte, MG, Brasil
| | - Sebastião Cronemberger
- Universidade Federal de Minas Gerais, Departamento de Oftalmologia, Belo Horizonte, MG, Brasil
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Affiliation(s)
| | - Gfh Diercks
- Erasmus Medical Centre, Rotterdam, Netherlands
- University Medical Centre, Groningen, Netherlands
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Pouw JN, Klooster K, Slebos DJ, van der Zeijden H. [Spontaneous clinical improvement in a COPD patient]. Ned Tijdschr Geneeskd 2018; 162:D2336. [PMID: 29372679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Bullous lung emphysema is a progressive disease, which may be partly explained by gradual expansion of bullae. These air-spaces arise after destruction of alveolar lung tissue. In some patients, bullae can merge into a giant bulla comprising more than 30% of the hemithorax. This bulla compresses surrounding relatively healthy lung parenchyma and regression results in improvement of pulmonary function, exertional tolerance and quality of life. This can be achieved with medication, surgery and with new experimental bronchoscopic lung volume reduction therapy. CASE DESCRIPTION A 58-year-old man presented at the outpatient clinic because of exertion-induced dyspnoea. Additional diagnostics revealed bullous lung emphysema in which the left lower lobe had been transformed into a single large bulla over the course of 7 years of monitoring. His exertional tolerance continued to decrease gradually until there was an unexpected spectacular improvement of his lung function. This improvement proved to be caused by spontaneous resorption of the bulla. CONCLUSION Patients with severe bullous lung emphysema may benefit from resorption of large bullae. This mostly requires treatment, but resorption sometimes can be a spontaneous occurrence.
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Affiliation(s)
- J N Pouw
- St. Antonius ziekenhuis, Utrecht en Nieuwegein
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Tewari-Singh N, Goswami DG, Kant R, Ammar DA, Kumar D, Enzenauer RW, Casillas RP, Croutch CR, Petrash JM, Agarwal R. Histopathological and Molecular Changes in the Rabbit Cornea From Arsenical Vesicant Lewisite Exposure. Toxicol Sci 2017; 160:420-428. [PMID: 28973427 PMCID: PMC5837587 DOI: 10.1093/toxsci/kfx198] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] [Indexed: 11/12/2022] Open
Abstract
Lewisite (LEW), a potent arsenical vesicating chemical warfare agent, poses a continuous risk of accidental exposure in addition to its feared use as a terrorist weapon. Ocular tissue is exquisitely sensitive to LEW and exposure can cause devastating corneal lesions. However, detailed pathogenesis of corneal injury and related mechanisms from LEW exposure that could help identify targeted therapies are not available. Using an established consistent and efficient exposure system, we evaluated the pathophysiology of the corneal injury in New Zealand white rabbits following LEW vapor exposure (at 0.2 mg/L dose) for 2.5 and 7.5 min, for up to 28 day post-exposure. LEW led to an increase in total corneal thickness starting at day 1 post-exposure and epithelial degradation starting at day 3 post-exposure, with maximal effect at day 7 postexposure followed by recovery at later time points. LEW also led to an increase in the number of blood vessels and inflammatory cells but a decrease in keratocytes with optimal effects at day 7 postexposure. A significant increase in epithelial-stromal separation was observed at days 7 and 14 post 7.5 min LEW exposure. LEW also caused an increase in the expression levels of cyclooxygenase-2, IL-8, vascular endothelial growth factor, and matrix metalloproteinase-9 at all the study time points indicating their involvement in LEW-induced inflammation, vesication, and neovascularization. The outcomes here provide valuable LEW-induced corneal injury endpoints at both lower and higher exposure durations in a relevant model system, which will be helpful to identify and screen therapies against LEW-induced corneal injury.
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Affiliation(s)
| | | | - Rama Kant
- Department of Pharmaceutical Sciences
| | - David A Ammar
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | | | - Robert W Enzenauer
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
| | - Robert P Casillas
- Medical Countermeasures Division, MRIGlobal, Kansas City, Missouri 64110
| | - Claire R Croutch
- Medical Countermeasures Division, MRIGlobal, Kansas City, Missouri 64110
| | - J Mark Petrash
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
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45
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Higa K, Uchino Y, Kawashima M, Shimazaki J, Tsubota K, Shimmura S. [Accelerated Epithelial Proliferation in a Rabbit Model of Bullous Keratopathy]. Nippon Ganka Gakkai Zasshi 2017; 121:455-463. [PMID: 30088711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose: Long standing bullous keratopathy (BK) is associated with peripheral conjunctivalization and limbal deficiency. We hypothesized that cases of limbal deficiency may be induced due to accelerated proliferation of corneal epithelial cells. To investigate this hypothesis, we examined the influence of BK on the corneal epithelium in a rabbit model. Methods: Continuous curvilinear descemetorhexis was performed to remove a circular section of the corneal endothelium and Descemet's membrane (DM) using inverted Shinskey hook. Corneal tissue sections of BK eyes were observed by histochemical analysis using BrdU pulse chase methods for evaluation of corneal epithelial cell proliferation. Results: Rabbit corneas immediately became stromal edematous after DM stripping surgery, and a week later their thickness was five times that of control cornea. Vascularization of the peripheral cornea was observed in BK eyes, however, conjunctivalization was rarely observed at 6 weeks. The number of BrdU positive cells tended to be lower in the BK cornea epithelium compared to the control cornea epithelium. The number of Ki67 positive cells also showed a tendency to increase in the BK corneal epithelium. Telomere intensity in BK was similar to control corneal epithelium. Conclusion: BK may accelerate the proliferation of corneal epithelial cells in a rabbit model.
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Fujii M, Takahashi I, Honma M, Ishida-Yamamoto A. Bullous lichen planus accompanied by elevation of serum anti-BP180 autoantibody: A possible transitional mechanism to lichen planus pemphigoides. J Dermatol 2017; 44:e124-e125. [PMID: 28105695 DOI: 10.1111/1346-8138.13732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mizue Fujii
- Department of Dermatology, Kitami Red Cross Hospital, Kitami, Japan
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Ichiro Takahashi
- Department of Dermatology, Kitami Red Cross Hospital, Kitami, Japan
| | - Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
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Bhinder MA, Arshad MW, Zahoor MY, Shehzad W, Tariq M, Shabbir MI. Junctional Epidermolysis Bullosa (Non-Herlitz Type). J Coll Physicians Surg Pak 2017; 27:308-310. [PMID: 28599695] [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: 03/11/2016] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
Junctional epidermolysis bullosa (JEB) is a recessively inherited skin blistering disease and is caused due to abnormalities in proteins that hold layers of the skin. Herlitz JEB is the severe form and non-Herlitz JEB is the milder form. This report describes a case of congenitally affected male child aged 5 years, with skin blistering. He has mitten-like hands and soft skin blistering on hands, legs and knees. Symptoms almost disappeared at the age of 3 years but reappeared with increased severity after 6 months. Histopathological examination showed epidermal detachment with intact basal cell layer and sparse infiltrate of lymphocytes with few eosinophils in the dermis. There was no blistering on the moist lining of the mouth and digestive tract. Localized symptoms with less lethality and histopathological examination indicated the presence of non-Herlitz type of JEB. This is the first report which confirms the presence of non-Herlitz junctional epidermolysis bullosa in Pakistan.
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Affiliation(s)
- Munir Ahmad Bhinder
- Department of Human Genetics and Molecular Biology, University of Health Sciences, Lahore
| | - Muhammad Waqar Arshad
- Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad. Pakistan
| | - Muhammad Yasir Zahoor
- Department of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore
| | - Wasim Shehzad
- Department of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore
| | - Muhammad Tariq
- Division of Science and Technology, University of Education, Township, Lahore
| | - Muhammad Imran Shabbir
- Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad. Pakistan
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Lee B, Watanabe K, Haensel D, Sui JY, Dai X. Overexpression of Transcription Factor Ovol2 in Epidermal Progenitor Cells Results in Skin Blistering. J Invest Dermatol 2017; 137:1805-1808. [PMID: 28457910 DOI: 10.1016/j.jid.2017.02.985] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/18/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Briana Lee
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, California, USA
| | - Kazuhide Watanabe
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, California, USA
| | - Daniel Haensel
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, California, USA
| | - Jennifer Y Sui
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, California, USA
| | - Xing Dai
- Department of Biological Chemistry, School of Medicine, University of California, Irvine, California, USA.
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Engmann J, Rüdrich U, Behrens G, Papakonstantinou E, Gehring M, Kapp A, Raap U. Increased Activity and Apoptosis of Eosinophils in Blister Fluids, Skin and Peripheral Blood of Patients with Bullous Pemphigoid. Acta Derm Venereol 2017; 97:464-471. [PMID: 27868136 DOI: 10.2340/00015555-2581] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering skin disease that is more common in elderly individuals. The aim of this study was to determine the functional activity of eosinophils in patients with BP compared with healthy donors. Blood, skin and blister-derived eosinophils were strongly activated in patients with BP, seen by increased surface expression of CD69 compared with controls. CD11b was also increased in BP blood eosinophils, which may explain the striking accumulation of eosinophils in BP (1×106 per ml blister fluid). Furthermore, CCL26 was expressed by activated eosinophils in BP skin and in blister fluid. BP eosinophils also released IL-6, IL-8 and IL-1α in BP blister fluids. Apoptosis in cultivated BP eosinophils was increased and accompanied by enhanced surface externalization of CD95. Caspase 3 positive eosinophils in lesional BP skin and blister fluid also showed the initiation of apoptosis. These results reveal novel pathophysiological aspects of BP, with a strong activation pattern and increased apoptosis of eosinophils in the peripheral blood, skin and blister fluids.
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Affiliation(s)
- Judith Engmann
- Department of Dermatology and Allergy, Hannover Medical School, DE-30625 Hannover, Germany
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Simiczyjew A, Mazur AJ, Dratkiewicz E, Nowak D. Involvement of β- and γ-actin isoforms in actin cytoskeleton organization and migration abilities of bleb-forming human colon cancer cells. PLoS One 2017; 12:e0173709. [PMID: 28333953 PMCID: PMC5363831 DOI: 10.1371/journal.pone.0173709] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/15/2017] [Indexed: 12/13/2022] Open
Abstract
Amoeboid movement is characteristic for rounded cells, which do not form strong adhesion contacts with the ECM and use blebs as migratory protrusions. It is well known that actin is the main component of mature forms of these structures, but the exact role fulfilled by non-muscle actin isoforms β- and γ- in bleb formation and migration of these cells is still not fully understood. The aim of this study was to establish the role of β- and γ-actin in migration of bleb-forming cancer cells using isoform-specific antibodies and expression of fluorescently tagged actin isoforms. We observed, after staining with monoclonal antibodies, that both actins are present in these cells in the form of a cortical ring as well as in the area of blebs. Additionally, using simultaneous expression of differentially tagged β- and γ-actin in cells, we observed that the actin isoforms are present together in a single bleb. They were involved during bleb expansion as well as retraction. Also present in the area of these protrusions formed by both isoforms were the bleb markers–ezrin and myosin II. The overexpression of β- or γ-actin led to actin cytoskeletal rearrangement followed by the growth of migration and invasion abilities of examined human colon cancer cells, LS174T line. In summary these data prove that both actin isoforms have an impact on motility of bleb-forming cancer cells. Moreover, we conclude that monoclonal antibodies directed against actin isoforms in combination with the tagged actins are good tools to study their role in important biological processes.
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Affiliation(s)
- Aleksandra Simiczyjew
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Joliot-Curie 14a, Wroclaw, Poland
- * E-mail:
| | - Antonina Joanna Mazur
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Joliot-Curie 14a, Wroclaw, Poland
| | - Ewelina Dratkiewicz
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Joliot-Curie 14a, Wroclaw, Poland
| | - Dorota Nowak
- Department of Cell Pathology, Faculty of Biotechnology, University of Wroclaw, Joliot-Curie 14a, Wroclaw, Poland
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