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Stevens SR, Rasband MN. Pleiotropic Ankyrins: Scaffolds for Ion Channels and Transporters. Channels (Austin) 2022; 16:216-229. [PMID: 36082411 PMCID: PMC9467607 DOI: 10.1080/19336950.2022.2120467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The ankyrin proteins (Ankyrin-R, Ankyrin-B, and Ankyrin-G) are a family of scaffolding, or membrane adaptor proteins necessary for the regulation and targeting of several types of ion channels and membrane transporters throughout the body. These include voltage-gated sodium, potassium, and calcium channels in the nervous system, heart, lungs, and muscle. At these sites, ankyrins recruit ion channels, and other membrane proteins, to specific subcellular domains, which are then stabilized through ankyrin's interaction with the submembranous spectrin-based cytoskeleton. Several recent studies have expanded our understanding of both ankyrin expression and their ion channel binding partners. This review provides an updated overview of ankyrin proteins and their known channel and transporter interactions. We further discuss several potential avenues of future research that would expand our understanding of these important organizational proteins.
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Affiliation(s)
- Sharon R. Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew N. Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA,CONTACT Matthew N. Rasband Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX77030, USA
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2
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Stevens SR, van der Heijden ME, Ogawa Y, Lin T, Sillitoe RV, Rasband MN. Ankyrin-R Links Kv3.3 to the Spectrin Cytoskeleton and Is Required for Purkinje Neuron Survival. J Neurosci 2022; 42:2-15. [PMID: 34785580 PMCID: PMC8741159 DOI: 10.1523/jneurosci.1132-21.2021] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 11/21/2022] Open
Abstract
Ankyrin scaffolding proteins are critical for membrane domain organization and protein stabilization in many different cell types including neurons. In the cerebellum, Ankyrin-R (AnkR) is highly enriched in Purkinje neurons, granule cells, and in the cerebellar nuclei (CN). Using male and female mice with a floxed allele for Ank1 in combination with Nestin-Cre and Pcp2-Cre mice, we found that ablation of AnkR from Purkinje neurons caused ataxia, regional and progressive neurodegeneration, and altered cerebellar output. We show that AnkR interacts with the cytoskeletal protein β3 spectrin and the potassium channel Kv3.3. Loss of AnkR reduced somatic membrane levels of β3 spectrin and Kv3.3 in Purkinje neurons. Thus, AnkR links Kv3.3 channels to the β3 spectrin-based cytoskeleton. Our results may help explain why mutations in β3 spectrin and Kv3.3 both cause spinocerebellar ataxia.SIGNIFICANCE STATEMENT Ankyrin scaffolding proteins localize and stabilize ion channels in the membrane by linking them to the spectrin-based cytoskeleton. Here, we show that Ankyrin-R (AnkR) links Kv3.3 K+ channels to the β3 spectrin-based cytoskeleton in Purkinje neurons. Loss of AnkR causes Purkinje neuron degeneration, altered cerebellar physiology, and ataxia, which is consistent with mutations in Kv3.3 and β3 spectrin causing spinocerebellar ataxia.
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Affiliation(s)
- Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas 77030
| | | | - Yuki Ogawa
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas 77030
| | - Tao Lin
- Department Pathology and Immunology, Baylor College of Medicine, Houston, Texas 77030
| | - Roy V Sillitoe
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas 77030
- Department Pathology and Immunology, Baylor College of Medicine, Houston, Texas 77030
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas 77030
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3
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Stevens SR, Longley CM, Ogawa Y, Teliska LH, Arumanayagam AS, Nair S, Oses-Prieto JA, Burlingame AL, Cykowski MD, Xue M, Rasband MN. Ankyrin-R regulates fast-spiking interneuron excitability through perineuronal nets and Kv3.1b K + channels. eLife 2021; 10:66491. [PMID: 34180393 PMCID: PMC8257253 DOI: 10.7554/elife.66491] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022] Open
Abstract
Neuronal ankyrins cluster and link membrane proteins to the actin and spectrin-based cytoskeleton. Among the three vertebrate ankyrins, little is known about neuronal Ankyrin-R (AnkR). We report AnkR is highly enriched in Pv+ fast-spiking interneurons in mouse and human. We identify AnkR-associated protein complexes including cytoskeletal proteins, cell adhesion molecules (CAMs), and perineuronal nets (PNNs). We show that loss of AnkR from forebrain interneurons reduces and disrupts PNNs, decreases anxiety-like behaviors, and changes the intrinsic excitability and firing properties of Pv+ fast-spiking interneurons. These changes are accompanied by a dramatic reduction in Kv3.1b K+ channels. We identify a novel AnkR-binding motif in Kv3.1b, and show that AnkR is both necessary and sufficient for Kv3.1b membrane localization in interneurons and at nodes of Ranvier. Thus, AnkR regulates Pv+ fast-spiking interneuron function by organizing ion channels, CAMs, and PNNs, and linking these to the underlying β1 spectrin-based cytoskeleton.
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Affiliation(s)
- Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Colleen M Longley
- Program in Developmental Biology, Baylor College of Medicine, Houston, United States.,The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States
| | - Yuki Ogawa
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Lindsay H Teliska
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | | | - Supna Nair
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Juan A Oses-Prieto
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Alma L Burlingame
- Department of Pharmaceutical Chemistry, University of California San Francisco, San Francisco, United States
| | - Matthew D Cykowski
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, United States
| | - Mingshan Xue
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States.,The Cain Foundation Laboratories, Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital, Houston, United States.,Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, United States
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States
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4
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Zhou X, He C, Ren J, Dai C, Stevens SR, Wang Q, Zamler D, Shingu T, Yuan L, Chandregowda CR, Wang Y, Ravikumar V, Rao AU, Zhou F, Zheng H, Rasband MN, Chen Y, Lan F, Heimberger AB, Segal BM, Hu J. Mature myelin maintenance requires Qki to coactivate PPARβ-RXRα-mediated lipid metabolism. J Clin Invest 2021; 130:2220-2236. [PMID: 32202512 DOI: 10.1172/jci131800] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 01/17/2020] [Indexed: 12/25/2022] Open
Abstract
Lipid-rich myelin forms electrically insulating, axon-wrapping multilayers that are essential for neural function, and mature myelin is traditionally considered metabolically inert. Surprisingly, we discovered that mature myelin lipids undergo rapid turnover, and quaking (Qki) is a major regulator of myelin lipid homeostasis. Oligodendrocyte-specific Qki depletion, without affecting oligodendrocyte survival, resulted in rapid demyelination, within 1 week, and gradually neurological deficits in adult mice. Myelin lipids, especially the monounsaturated fatty acids and very-long-chain fatty acids, were dramatically reduced by Qki depletion, whereas the major myelin proteins remained intact, and the demyelinating phenotypes of Qki-depleted mice were alleviated by a high-fat diet. Mechanistically, Qki serves as a coactivator of the PPARβ-RXRα complex, which controls the transcription of lipid-metabolism genes, particularly those involved in fatty acid desaturation and elongation. Treatment of Qki-depleted mice with PPARβ/RXR agonists significantly alleviated neurological disability and extended survival durations. Furthermore, a subset of lesions from patients with primary progressive multiple sclerosis were characterized by preferential reductions in myelin lipid contents, activities of various lipid metabolism pathways, and expression level of QKI-5 in human oligodendrocytes. Together, our results demonstrate that continuous lipid synthesis is indispensable for mature myelin maintenance and highlight an underappreciated role of lipid metabolism in demyelinating diseases.
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Affiliation(s)
- Xin Zhou
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chenxi He
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, and Key Laboratory of Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Jiangong Ren
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Congxin Dai
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Qianghu Wang
- Department of Bioinformatics, and Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Daniel Zamler
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Takashi Shingu
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Liang Yuan
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts, USA
| | - Chythra R Chandregowda
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yunfei Wang
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Visweswaran Ravikumar
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Arvind Uk Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Feng Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, and Institutes of Biomedical Sciences, Shanghai, China
| | - Hongwu Zheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, Texas, USA
| | - Yiwen Chen
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fei Lan
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, and Key Laboratory of Epigenetics and Metabolism, Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Amy B Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Benjamin M Segal
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,The Neurological Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Jian Hu
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, Texas, USA
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Abstract
Ankyrins are scaffolding proteins widely expressed throughout the nervous system. Ankyrins recruit diverse membrane proteins, including ion channels and cell adhesion molecules, into specialized subcellular membrane domains. These domains are stabilized by ankyrins interacting with the spectrin cytoskeleton. Ankyrin genes are highly associated with a number of neurological disorders, including Alzheimer's disease, schizophrenia, autism spectrum disorders, and bipolar disorder. Here, we discuss ankyrin function and their role in neurological disease. We propose mutations in ankyrins contribute to disease through two primary mechanisms: 1) altered neuronal excitability by disrupting ion channel clustering at key excitable domains, and 2) altered neuronal connectivity via impaired stabilization of membrane proteins.
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Affiliation(s)
- Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
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Liu CH, Stevens SR, Teliska LH, Stankewich M, Mohler PJ, Hund TJ, Rasband MN. Nodal β spectrins are required to maintain Na + channel clustering and axon integrity. eLife 2020; 9:52378. [PMID: 32052742 PMCID: PMC7018506 DOI: 10.7554/elife.52378] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/17/2020] [Indexed: 12/14/2022] Open
Abstract
Clustered ion channels at nodes of Ranvier are critical for fast action potential propagation in myelinated axons. Axon-glia interactions converge on ankyrin and spectrin cytoskeletal proteins to cluster nodal Na+ channels during development. However, how nodal ion channel clusters are maintained is poorly understood. Here, we generated mice lacking nodal spectrins in peripheral sensory neurons to uncouple their nodal functions from their axon initial segment functions. We demonstrate a hierarchy of nodal spectrins, where β4 spectrin is the primary spectrin and β1 spectrin can substitute; each is sufficient for proper node organization. Remarkably, mice lacking nodal β spectrins have normal nodal Na+ channel clustering during development, but progressively lose Na+ channels with increasing age. Loss of nodal spectrins is accompanied by an axon injury response and axon deformation. Thus, nodal spectrins are required to maintain nodal Na+ channel clusters and the structural integrity of axons.
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Affiliation(s)
- Cheng-Hsin Liu
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States
| | - Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | - Lindsay H Teliska
- Department of Neuroscience, Baylor College of Medicine, Houston, United States
| | | | - Peter J Mohler
- Department of Physiology and Cell Biology, The Ohio State University, Columbus, United States
| | - Thomas J Hund
- Biomedical Engineering, The Ohio State University, Columbus, United States
| | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine, Houston, United States.,Program in Developmental Biology, Baylor College of Medicine, Houston, United States
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7
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De Ferrari GM, Stevens SR, Ambrosio G, Leonardi S, McGuire DK, Armstrong PW, Green JB, Bethel MA, Holman RR, Peterson ED. P1877LDL-C treatment patterns and associated outcomes in patients with type 2 diabetes and CVD: insights from TECOS. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G M De Ferrari
- Coronary Care Unit – Fondazione IRCCS Policlinico San Matteo and University of Pavia, Department of Molecular Medicine, Pavia, Italy
| | - S R Stevens
- Duke Clinical Research Institute, Durham, United States of America
| | | | - S Leonardi
- Policlinic Foundation San Matteo IRCCS, Department of Cardiology, Pavia, Italy
| | - D K McGuire
- University of Texas Southwestern Medical School, Dallas, United States of America
| | | | - J B Green
- Duke Clinical Research Institute, Durham, United States of America
| | - M A Bethel
- Oxford Centre for Diabetes, Oxford, United Kingdom
| | - R R Holman
- Oxford Centre for Diabetes, Oxford, United Kingdom
| | - E D Peterson
- Duke Clinical Research Institute, Durham, United States of America
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8
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Yoshimura T, Stevens SR, Leterrier C, Stankewich MC, Rasband MN. Developmental Changes in Expression of βIV Spectrin Splice Variants at Axon Initial Segments and Nodes of Ranvier. Front Cell Neurosci 2017; 10:304. [PMID: 28123356 PMCID: PMC5226651 DOI: 10.3389/fncel.2016.00304] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022] Open
Abstract
Axon initial segments (AIS) and nodes of Ranvier are highly specialized axonal
membrane domains enriched in Na+ channels. These Na+ channel
clusters play essential roles in action potential initiation and propagation. AIS and
nodal Na+ channel complexes are linked to the actin cytoskeleton through
βIV spectrin. However, neuronal βIV spectrin exists as two main
splice variants: a longer βIVΣ1 variant with canonical N-terminal
actin and αII spectrin-binding domains, and a shorter βIVΣ6
variant lacking these domains. Here, we show that the predominant neuronal
βIV spectrin splice variant detected in the developing brain switches from
βIVΣ1 to βIVΣ6, and that this switch is correlated
with expression changes in ankyrinG (ankG) splice variants. We show that
βIVΣ1 is the predominant splice variant at nascent and developing AIS
and nodes of Ranvier, but with increasing age and in adults βIVΣ6
becomes the main splice variant. Remarkably, super-resolution microscopy revealed
that the spacing of spectrin tetramers between actin rings remains unchanged, but
that shorter spectrin tetramers may also be present. Thus, during development
βIV spectrin may undergo a switch in the splice variants found at AIS and
nodes of Ranvier.
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Affiliation(s)
- Takeshi Yoshimura
- Department of Neuroscience, Baylor College of MedicineHouston, TX, USA; Division of Neurobiology and Bioinformatics, National Institute for Physiological Sciences, National Institutes of Natural SciencesOkazaki, Japan
| | - Sharon R Stevens
- Department of Neuroscience, Baylor College of Medicine Houston, TX, USA
| | - Cristophe Leterrier
- CNRS, Center for Research in Neurobiology and Neurophysiology of Marseille (CRN2M) UMR 7286, Aix Marseille Université Marseille, France
| | | | - Matthew N Rasband
- Department of Neuroscience, Baylor College of Medicine Houston, TX, USA
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9
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Tian E, Stevens SR, Guan Y, Springer DA, Anderson SA, Starost MF, Patel V, Ten Hagen KG, Tabak LA. Galnt1 is required for normal heart valve development and cardiac function. PLoS One 2015; 10:e0115861. [PMID: 25615642 PMCID: PMC4304789 DOI: 10.1371/journal.pone.0115861] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 07/15/2014] [Accepted: 12/02/2014] [Indexed: 11/19/2022] Open
Abstract
Congenital heart valve defects in humans occur in approximately 2% of live births and are a major source of compromised cardiac function. In this study we demonstrate that normal heart valve development and cardiac function are dependent upon Galnt1, the gene that encodes a member of the family of glycosyltransferases (GalNAc-Ts) responsible for the initiation of mucin-type O-glycosylation. In the adult mouse, compromised cardiac function that mimics human congenital heart disease, including aortic and pulmonary valve stenosis and regurgitation; altered ejection fraction; and cardiac dilation, was observed in Galnt1 null animals. The underlying phenotype is aberrant valve formation caused by increased cell proliferation within the outflow tract cushion of developing hearts, which is first detected at developmental stage E11.5. Developing valves from Galnt1 deficient animals displayed reduced levels of the proteases ADAMTS1 and ADAMTS5, decreased cleavage of the proteoglycan versican and increased levels of other extracellular matrix proteins. We also observed increased BMP and MAPK signaling. Taken together, the ablation of Galnt1 appears to disrupt the formation/remodeling of the extracellular matrix and alters conserved signaling pathways that regulate cell proliferation. Our study provides insight into the role of this conserved protein modification in cardiac valve development and may represent a new model for idiopathic valve disease.
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Affiliation(s)
- E Tian
- Developmental Glycobiology Section, Laboratory of Cell and Developmental Biology, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
| | - Sharon R. Stevens
- Section on Biological Chemistry, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
| | - Yu Guan
- Section on Biological Chemistry, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
| | - Danielle A. Springer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States of America
| | - Stasia A. Anderson
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, United States of America
| | - Matthew F. Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, United States of America
| | - Vyomesh Patel
- Oral and Pharyngeal Cancer Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
| | - Kelly G. Ten Hagen
- Developmental Glycobiology Section, Laboratory of Cell and Developmental Biology, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
| | - Lawrence A. Tabak
- Section on Biological Chemistry, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, United States of America
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10
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Stevens SR, Ke MS, Birol A, Terhune MH, Parry EJ, Ross C, Mostow EN, Gilliam AC, Cooper KD. A simple clinical scoring system to improve the sensitivity and standardization of the diagnosis of mycosis fungoides type cutaneous T-cell lymphoma: logistic regression of clinical and laboratory data. Br J Dermatol 2003; 149:513-22. [PMID: 14510983 DOI: 10.1046/j.1365-2133.2003.05458.x] [Citation(s) in RCA: 27] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The diagnosis of mycosis fungoides (MF) is notoriously difficult to establish because in the early stages, histological features may be nonspecific or merely suggestive. OBJECTIVES To standardize the diagnosis of MF. METHODS We studied 138 patients with suspected MF referred over a 7-year period to a university department of a dermatology-based cutaneous lymphoma clinic. Six diagnostic criteria were evaluated: clinical morphology, clinical distribution, skin biopsy T-cell receptor gene rearrangement (TCR-GR), skin biopsy pan T-cell marker loss > or = 2, skin biopsy CD4/CD8 ratio > or = 6, and skin biopsy diffuse epidermal HLA-DR expression. These six clinical and laboratory criteria were compared by logistic regression analysis in patients with histologically diagnosed MF and those with benign disease. RESULTS Of the 138 patients, 74 had histology of MF, 47 of benign dermatoses and 17 were indeterminate. Close associations were found between a histological diagnosis of MF and TCR-GR (odds ratio 14.4), classical morphology (7.5), classical distribution (2.5) and diffuse epidermal HLA-DR expression (2.8). Logistic regression models were developed depending on the availability of data (either TCR-GR or HLA-DR). Probabilities for correctly diagnosing MF compared with histology as the 'gold standard' were derived from these logistic regression models. A scoring system assigning point values based on these probabilities was then created in order to assist the clinician in making the diagnosis. If using TCR-GR data, a positive TCR-GR = 2.5 points, the presence of classical morphology = 2.0 points, and the presence of classical distribution = 1.5 points. A total score of > or = 3.5 points assigns a high probability (> 85%) of having MF. If using HLA-DR expression, then the presence of classical morphology = 2.5 points, a positive diffuse epidermal HLA-DR expression = 2.0 points, and the presence of classical distribution = 1.5 points. In this case, a total score of > or = 4.0 points assigns a high probability (> 85%) of MF. CONCLUSIONS The logistic regression models and scoring systems integrate clinical and laboratory assessments, allow rapid probability estimation, and provide a threshold for the diagnosis of MF in an objective, standardized manner.
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Affiliation(s)
- S R Stevens
- Department of Dermatology, University Hospital of Cleveland, and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5028, USA.
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11
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Abstract
Both in vivo skin immune responses and the skin's reaction to sun exposure integrate a complex interplay of biologic responses. The complexity and multiplicity of events that occur in the skin during an immune response make it a sensitive indication of both UVB and UVA-induced changes in the skin by sun damage, as well as those changes that are prevented by various sunscreens. Sunscreens are the most effective and widely available intervention for sun damage, other than sun avoidance or clothing. However, sunscreens vary widely in their relative ability to screen various UV waveband components, and their testing has been variably applied to outcomes other than for erythema to determine the sunburn protection factor (SPF), a measure primarily of UVB filtration only. Determination of an immune protection factor (IPF) has been proposed as an alternative or adjunctive measure to SPF, and recent studies show IPF can indeed detect added in vivo functionality of sunscreens, such as high levels of UVA protection, that SPF cannot. Clarification of the definition of IPF, however, is required. Excellent data are available on quantification of the IPF for restoring the afferent or induction arm of contact sensitivity, but other immune parameters have also been measured. Proposed here is nomenclature for whether the IPF is measured using contact sensitivity induction (IPF-CS-I), contact sensitivity elicitation (IPF-CS-E), delayed-type hypersensitivity elicitation (IPF-DTH-E), antigen-presenting cell function (IPF-APC-FXN) or numbers (IPF-APC-#), and cytokine modification such as IL-10 (i.e. IPF-cyto-IL-10). Similar nomenclatures could be used for other measures of skin function protection (i.e. DNA damage, p53 induction, oxidation products, etc.). A review of in vivo human studies, in which sunscreens are used to intervene in a UV-induced modulation of immune response, cells or cytokines, highlights the technical variables and statistical approaches which must also be standardized in the context of an IPF for regulatory or product claim purposes. Development of such IPF standards would allow the integration of both UVB and nonUVB (UVA, blue and possible IR) solar waveband effect-reversals, could be applied to integrate effects of other ingredients with protective function (i.e. antioxidants, retinoids, or other novel products), and would spur development of more advanced and complete protection products.
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Affiliation(s)
- K D Cooper
- Department of Dermatology and Skin Study Center, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH, USA
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12
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Baron ED, Barzilai D, Johnston G, Kawashima M, Takigawa M, Nakagawa H, Graham-Brown RAC, Stevens SR. Atopic dermatitis management: comparing the treatment patterns of dermatologists in Japan, U.S.A. and U.K. Br J Dermatol 2002; 147:710-5. [PMID: 12366417 DOI: 10.1046/j.1365-2133.2002.04895.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND The incidence of atopic dermatitis (AD) is increasing worldwide. No large-scale study has previously compared the therapeutic management of this condition in different countries. OBJECTIVES The purpose of this study was to determine the treatment preferences of dermatologists in Japan, the U.S.A. and the U.K., and investigate their relationship with certain factors pertaining to the physician and his practice. METHODS A questionnaire was sent to all registered members of dermatological societies in Japan, the U.S.A. and the U.K. Responses were collated and statistical analysis performed using chi2, Mantel-Haenszel and Breslow heterogeneity tests. RESULTS Three thousand six hundred and eighty-eight completed surveys were returned. U.S.A. and U.K. physicians were significantly more aggressive in prescribing systemic medications, such as steroids, antibiotics and immunosuppressants, compared with those in Japan. Japanese dermatologists also utilized topical steroids significantly less. The use of alternative remedies was highest in Japan. All three countries had a relatively high degree of optimism for topical immunosuppressants, but less so for other emerging therapies. CONCLUSIONS Both similarities and differences in the therapy of AD exist in the three countries studied. Factors related to the physician, patient population and culture may influence these observations.
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Affiliation(s)
- E D Baron
- University Hospitals Research Institute, Cleveland, OH, USA
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13
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Affiliation(s)
- E D Baron
- Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44145, USA
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14
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Abstract
Allergic skin disorders in the elderly may arise from contact with or ingestion of offending allergens. Itching associated with skin allergy must be distinguished from other causes of itching in the elderly such as xerosis, itching due to systemic disease and bullous disease. Although elderly people have somewhat decreased cell-mediated immunity and may be harder to sensitise under experimental conditions, they have had many years to acquire allergic responses, and therefore develop contact dermatitis frequently. Patch testing is a valuable tool to diagnose contact allergy and should be used often in the elderly, particularly in patients at high risk of contact dermatitis, such as those with chronic lower extremity dermatitis or ulcers due to venous stasis. When prescribing topical medications to high risk patients, a knowledge of the common sensitisers is important. In addition to allergy to medicaments and dressings used to treat stasis ulcers, contact allergy to dental prostheses and medications used to treat ocular disease are common in the elderly as a result of increased usage and exposure. Rash caused by ingested allergens is much more commonly due to medications than to food in the elderly. Allergic noneczematous dermatoses in the elderly are commonly drug-induced. Urticarial skin reactions are often associated with the administration of antibacterials, nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants or opioids. Morbilliform rashes are a common sign of systemic reaction to anticonvulsants, gold, allopurinol or diuretics. Phototoxic reactions may be associated with the administration of tetracyclines, diuretics, NSAIDs and antihyperglycaemic agents. Patient-specific variables such as HLA type and concomitant medication may affect the likelihood of an allergic response to medication. Many elderly patients take multiple medications, which can make diagnosis of drug allergy difficult because diagnosis is most commonly accomplished by observing clinical response once the medication is withdrawn. In the case of lichenoid cutaneous reactions, clinical improvement may take several months after withdrawal of the offending drug. Laboratory tests to detect drug-induced allergic skin disorders may be available in the future.
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Affiliation(s)
- S T Nedorost
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Ohio, USA
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15
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Chen G, McCormick TS, Hammerberg C, Ryder-Diggs S, Stevens SR, Cooper KD. Basal keratinocytes from uninvolved psoriatic skin exhibit accelerated spreading and focal adhesion kinase responsiveness to fibronectin. J Invest Dermatol 2001; 117:1538-45. [PMID: 11886520 DOI: 10.1046/j.0022-202x.2001.01535.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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] [Indexed: 11/20/2022]
Abstract
We previously proposed that the keratinocyte hyperproliferative state in psoriatic skin results from a combination of T cell cytokine interaction with basal keratinocytes that exist in a primed state. We now provide evidence that basal keratinocytes from psoriatic uninvolved skin are in a preactivated state with regard to their interaction with fibronectin. Freshly isolated basal keratinocytes (K(1)/K(10)(-)) from non-lesional psoriatic skin demonstrated a significantly higher percentage of spreading cells 1 h after plating on fibronectin-coated plates than keratinocytes isolated from normal skin (p =0.0002). No differences were observed on collagen-laminin-coated plates, however. The keratinocyte spreading on fibronectin-coated plates involved alpha 5 beta 1 and alpha V beta 1 integrins. To address the potential signaling cascades that may respond to integrin changes in psoriatic keratinocytes, focal adhesion kinase changes were assessed. The percentage of keratinocytes from psoriatic uninvolved skin that exhibit positive focal adhesion kinase staining was significantly greater than the percentage from healthy volunteers after 1 h incubation on fibronectin (p =0.006). Additionally, focal adhesion kinase isolated from uninvolved psoriatic keratinocytes had a greater degree of tyrosine phosphorylation. Thus, the proliferative effect of fibronectin in combination with T cell lymphokines on psoriatic uninvolved basal keratinocyte progenitors may be due to abnormal in vivo integrin-driven focal adhesion kinase activity and downstream signaling.
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Affiliation(s)
- G Chen
- Department of Dermatology, University Hospitals of Cleveland and Case Western Reserve University, Ohio 44106-5028, USA
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16
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Affiliation(s)
- K D Cooper
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-5028, USA.
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17
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Baron ED, Heeger PS, Hricik DE, Schulak JA, Tary-Lehmann M, Stevens SR. Immunomodulatory effect of extracorporeal photopheresis after successful treatment of resistant renal allograft rejection. Photodermatol Photoimmunol Photomed 2001; 17:79-82. [PMID: 11338406 DOI: 10.1034/j.1600-0781.2001.017002079.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Acute renal allograft rejection contributes to patient morbidity. Standard immunosuppressives are only partially effective and have significant side effects. Extracorporeal photopheresis (ECP) has been effective in reversing the acute rejection process. T cell cytokine expression is implicated in rejection and tolerance but actual changes in the cytokine profile of ECP-treated individuals have not been documented. METHODS ECP was administered to a patient with acute renal allograft rejection resistant to other immunosuppressives. Enzyme-linked immunosorbent spot (ELISPOT) assay was performed to determine the frequency of mitogen-induced cytokine-producing cells before and after ECP. RESULTS ECP resulted in resolution of rejection; serum creatinine concentration fell from 7.1 to 2.2 mg/dl; ELISPOT revealed a three-fold increase in the frequency of IL-5 producing cells; IFN-gamma:IL-5 ratio shifted from 2.73 pre-treatment to 1.01 post-treatment. CONCLUSION Effective therapy of acute allograft rejection with ECP alters the peripheral blood cytokine profile towards "type 2" cytokines, suggesting that alteration of T cell cytokine profiles may contribute to the resolution of the process.
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Affiliation(s)
- E D Baron
- Department of Dermatology, Case Western Reserve University, OH, USA
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18
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Kremer IB, Stevens SR, Gould JW, DiCarlo J, Quinby GE, Cooper KD. Intradermal granulocyte-macrophage colony-stimulating factor alters cutaneous antigen-presenting cells and differentially affects local versus distant immunization in humans. Clin Immunol 2000; 96:29-37. [PMID: 10873425 DOI: 10.1006/clim.2000.4876] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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] [Indexed: 11/22/2022]
Abstract
We hypothesized that intradermal delivery of granulocyte-macrophage colony-stimulating factor (GM-CSF) would alter the number and differentiation state of local antigen-presenting cells and thereby alter immunization strength at that site in humans. GM-CSF or placebo was administered intradermally on consecutive days prior to contact sensitization at that site. In GM-CSF-treated skin, epidermal CD1a(+)S100(+) Langerhans cells were reduced in number and had altered morphology, while the number of dermal CD1a(+), HLA-DR(+), and S100(+) cells was increased. In the deep dermis CD68(+) macrophages were increased. Expression of the APC activation markers CD40 and ICAM-1 was also increased in the dermis. Subjects were sensitized to DNCB through GM-CSF- or placebo-pretreated skin and to DPCP through untreated skin. Subjects immunized through GM-CSF-treated sites exhibited 64% greater elicitation responses to DNCB than placebo-treated subjects. GM-CSF-treated subjects also showed 43% lower responses to DPCP than placebo-treated subjects. The difference between DNCB (local) and DPCP (distant) responses was significantly greater for GM-CSF-treated subjects than for placebo responses (n = 8, P < 0.05). Therefore, local immunization site pretreatment with intradermal GM-CSF enhances immunization efficiency at that site.
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Affiliation(s)
- I B Kremer
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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19
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Bowen GM, Peters NT, Fivenson DP, Su LD, Nousari HC, Anhalt GJ, Cooper KD, Stevens SR. Lichenoid dermatitis in paraneoplastic pemphigus: a pathogenic trigger of epitope spreading? Arch Dermatol 2000; 136:652-6. [PMID: 10815859 DOI: 10.1001/archderm.136.5.652] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND In select cases, lichen planus has been observed to be a paraneoplastic condition sometimes associated with paraneoplastic pemphigus, a disease featuring autoantibodies directed against plakin proteins, desmogleins 3 and 1, and a still uncharacterized 170-kd antigen. Epitope spreading describes the phenomenon where underlying chronic inflammation leads to the sequential recognition of new epitopes on self-proteins over time. OBSERVATIONS Five of 6 patients diagnosed as having paraneoplastic pemphigus had concomitant clinical and histological features of lichen planus. In 1 patient, results of the initial indirect immunofluorescence on rat bladder were negative and only 2 of the 5 antigens were identified by immunoprecipitation. After 1 year of worsening disease, repeated testing confirmed the presence of antibodies directed against all 6 of the implicated antigens, supportive of our hypothesis that epitope spreading may occur in paraneoplastic pemphigus. CONCLUSIONS Lichenoid eruptions may predispose to an early evolutionary stage of paraneoplastic pemphigus. Cell-mediated autoimmunity at the dermoepidermal junction may promote the exposure of self-antigens and the development of subsequent and progressive humoral autoimmunity. As such, paraneoplastic pemphigus may demonstrate epitope spreading in a human, humoral-mediated autoimmune disease.
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Affiliation(s)
- G M Bowen
- Department of Dermatology, University of Utah, Salt Lake City 84132, USA.
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20
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Stevens SR. Mapping the literature of cytotechnology. Bull Med Libr Assoc 2000; 88:172-7. [PMID: 10783973 PMCID: PMC35217] [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: 02/16/2023]
Abstract
The major purpose of this study was to identify and assess indexing coverage of core journals in cytotechnology. It was part of a larger project sponsored by the Nursing and Allied Health Resources Section of the Medical Library Association to map the literature of allied health. Three representative journals in cytotechnology were selected and subjected to citation analysis to determine what journals, other publication types, and years were cited and how often. Bradford's Law of Scattering was applied to the resulting list of cited journals to identify core titles in the discipline, and five indexes were searched to assess coverage of these core titles. Results indicated that the cytotechnology journal literature had a small core but wide dispersion: one third of the 21,021 journal citations appeared in only 3 titles; another third appeared in an additional 26 titles; the remaining third were scattered in 1,069 different titles. Science Citation Index Expanded rated highest in indexing coverage of the core titles, followed by MEDLINE, EMBASE/Excerpta Medica, HealthSTAR, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The study's results also showed that journals were the predominantly cited format and that citing authors relied strongly on more recent literature.
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Affiliation(s)
- S R Stevens
- Raymon H. Mulford Library, Medical College of Ohio, Toledo 43614, USA
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21
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22
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Parry EJ, Stevens SR, Gilliam AC, Horvath N, el-Charif M, Spiro TP, Adler LP, Shina D, Kinsella T, Heyman EN, Cooper KD, Wood GS. Management of cutaneous lymphomas using a multidisciplinary approach. Arch Dermatol 1999; 135:907-11. [PMID: 10456338 DOI: 10.1001/archderm.135.8.907] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- E J Parry
- Salford Royal Hospitals, National Health Service Trust, Manchester, England
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23
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Stevens SR, Bowen GM, Duvic M, King LE, Knobler R, Lim HW, Margolis D, Parry EJ, Rook AH, Stricklin GP, Suchin KR, Tharp MD, Vonderheid E, Zic JA. Effectiveness of photopheresis in Sézary syndrome. Arch Dermatol 1999; 135:995-7. [PMID: 10456362 DOI: 10.1001/archderm.135.8.995-a] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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24
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Ellis CN, Stevens SR, Blok BK, Taylor RS, Cooper KD. Interferon-gamma therapy reduces blood leukocyte levels in patients with atopic dermatitis: correlation with clinical improvement. Clin Immunol 1999; 92:49-55. [PMID: 10413652 DOI: 10.1006/clim.1999.4731] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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] [Indexed: 11/22/2022]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease with abnormalities of both cellular and humoral immunity. Subcutaneous recombinant human interferon-gamma (IFN-gamma) provides therapeutic benefit to AD patients. In contrast to expectations, IFN-gamma does not cause a decrease in the elevated levels of circulating IgE levels in AD patients. We sought to determine cellular targets of IFN-gamma treatment that might explain its clinical benefit. Therefore, we evaluated blood leukocyte subsets by multiparameter flow cytometry in AD patients receiving IFN-gamma (n = 10) or placebo (n = 11) therapy compared to untreated normal volunteers (n = 14). Treated patients demonstrated reductions in WBC, eosinophil, and lymphocyte counts. Compared to normals, there was a reduced CD4/CD8 ratio in AD patients among activated, large mononuclear cells that was partially corrected with IFN-gamma treatment. Clinical improvement correlated with reductions in WBC (r = 0.9, P = 0.0003), eosinophil (r = 0.7, P = 0.035) and lymphocyte (r = 0.8, P = 0.013) counts, and with normalization of the CD4/CD8 ratio among large lymphocytes (r = 0.9, P = 0.04). The data indicate two potential modes of action for INF-gamma in AD. One mechanism represents normalization of selected immunologic abnormalities in AD; a second mechanism may be the modest reduction of circulating inflammatory cells. Adequacy of IFN-gamma therapy of AD may depend on bringing about these changes.
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Affiliation(s)
- C N Ellis
- Department of Dermatology, University of Michigan Medical School and Veterans Affairs Medical Center, Ann Arbor, Michigan 48109, USA
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25
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Affiliation(s)
- S R Stevens
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland; Dermatology Service, Cleveland VA Medical Center, Cleveland, Ohio 44106, USA
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26
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Affiliation(s)
- J W Gould
- Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, OH 44106-5028, USA
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27
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Abstract
After UV exposure of skin, epidermal Langerhans cells (LC) are depleted, whereas CD11b+CD36 CD1a- monocytes/macrophages (UV-Mphi) infiltrate. Different immunological outcomes in vivo are mediated by LC (sensitization) and UV-Mphi (tolerance) which may be related to the distinct T cell activation states that these antigen-presenting cells (APC) induce. We previously demonstrated that CD4+ T lymphocytes activated by UV-Mphi are, in contrast to LC-activated T cells, IL-2Ralpha deficient, and we hypothesize that this differential T cell activation is related to differences in co-stimulatory molecules between UV-Mphi and LC. Using four-color flow cytometry, we found a reduced capacity to up-regulate expression of the important co-stimulatory molecules CD40, B7-1 and B7-2 by UV-Mphi relative to LC. This alteration in co-stimulatory molecule expression was selective, because UV-Mphi express equal levels of ICAM-1 and ICAM-3, and increased levels of LFA-1, relative to LC. After bidirectional signaling with T cells during alloantigen presentation, UV-Mphi still exhibited less CD40 and B7-1 than LC. Addition of IFN-gamma induced CD40 and B7-1 expression on UV-Mphi and restored IL-2Ralpha expression on UV-Mphi-activated T cells but had no effect on IL-2Ralpha on resting or LC-activated T cells. The restoration of IL-2Ralpha expression on UV-Mphi-activated T cells by IFN-gamma was inhibited (67 %, p = 0.005) by addition of neutralizing anti-CD40. Therefore, differences in co-stimulatory molecule expression, in particular CD40, on UV-Mphi and LC are critical in determining the distinct T cell activation induced by these APC.
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Affiliation(s)
- I B Kremer
- Department of Dermatology, Case Western Reserve University, Cleveland 44106, USA.
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28
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Stevens SR, Hanifin JM, Hamilton T, Tofte SJ, Cooper KD. Long-term effectiveness and safety of recombinant human interferon gamma therapy for atopic dermatitis despite unchanged serum IgE levels. Arch Dermatol 1998; 134:799-804. [PMID: 9681342 DOI: 10.1001/archderm.134.7.799] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the long-term effects of recombinant human interferon gamma treatment of atopic dermatitis (AD). DESIGN Case series. Patients were treated for up to 24 months. SETTING University dermatology outpatient clinics in Ann Arbor, Mich, and Portland, Ore. PATIENTS Twenty-four of 32 eligible patients who participated in a previously reported, 12-week, double-blind, placebo-controlled study of recombinant human interferon gamma treatment for AD were enrolled. INTERVENTION Patients self-administered recombinant human interferon gamma, 50 microg/m2, by daily subcutaneous injection. MAIN OUTCOME MEASURES Overall response; body surface area of involvement; clinical severity scores for pruritus, erythema, edema, excoriations, dryness, scaling, and lichenification; other atopic symptoms; and laboratory parameters, including serum IgE levels, were monitored at quarterly visits. Results at 1 and 2 years were compared with baseline values. RESULTS All efficacy parameters improved (P<.05). For example, pruritus was reduced by 50% after both 1 (n=24, P<.001) and 2 (n=16, P=.005) years. Allergic conjunctivitis and allergic rhinitis also improved (P<.01). Eosinophil counts decreased significantly (P<.001). IgE levels increased. Clinical improvement more closely correlated with changes in eosinophil counts (r=0.3-0.5) than with changes in IgE levels (r=0.0-0.2). Only 1 patient discontinued therapy because of adverse effects (flulike symptoms). CONCLUSIONS The initial efficacy and adverse effects reported for recombinant human interferon gamma treatment of patients with AD were maintained after 2 years of long-term use. Recombinant human interferon gamma seems to be a well-tolerated and effective agent in the long-term therapy of patients with AD. Therapies that correct cellular immune defects, but not humoral immune defects, may be effective in the treatment of patients with AD.
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Affiliation(s)
- S R Stevens
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106-5028, USA.
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Gilliam AC, Kremer IB, Yoshida Y, Stevens SR, Tootell E, Teunissen MB, Hammerberg C, Cooper KD. The human hair follicle: a reservoir of CD40+ B7-deficient Langerhans cells that repopulate epidermis after UVB exposure. J Invest Dermatol 1998; 110:422-7. [PMID: 9540986 DOI: 10.1046/j.1523-1747.1998.00162.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [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] [Indexed: 02/07/2023]
Abstract
The ability of skin to maintain its protective structural and functional integrity depends on both resident and circulating cells. Until now, it was thought that dendritic antigen presenting cells of epidermis (Langerhans cells) were replaced by circulating bone marrow derived precursors. Here we show by immunostaining studies of timed biopsies taken from human skin after ultraviolet exposure, that hair follicle is a critical reservoir of Langerhans cells that repopulate epidermis depleted of Langerhans cells by a single four minimal erythema dose of ultraviolet B. Immunostaining with antibodies to thymidine dimers showed that ultraviolet B only penetrated the superficial hair follicle opening, whereas deeper follicle was relatively protected. Langerhans cells migrating from hair follicle into epidermis 72 h after ultraviolet exposure have a partial deficiency of molecules important to T cell costimulation. We used four color flow cytometry to show that Langerhans cells isolated from epidermis 72 h after ultraviolet B can upregulate CD40 but not B7-1 or B7-2 expression in culture, suggesting a different phenotype of hair follicle Langerhans cells. Therefore, the hair follicle is a specialized immune compartment of the skin that serves as an intermediate reservoir of Langerhans cells between bone marrow and epidermis, and that may play a critical role in immune surveillance.
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Affiliation(s)
- A C Gilliam
- Department of Dermatology, Case Western Reserve University and University Hospitals of Cleveland, Ohio 44106, USA
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30
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Chan LS, Vanderlugt CJ, Hashimoto T, Nishikawa T, Zone JJ, Black MM, Wojnarowska F, Stevens SR, Chen M, Fairley JA, Woodley DT, Miller SD, Gordon KB. Epitope spreading: lessons from autoimmune skin diseases. J Invest Dermatol 1998; 110:103-9. [PMID: 9457902 DOI: 10.1046/j.1523-1747.1998.00107.x] [Citation(s) in RCA: 240] [Impact Index Per Article: 9.2] [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] [Indexed: 02/06/2023]
Abstract
Autoimmune diseases are initiated when patients develop aberrant T and/or B cell responses against self proteins. These responses presumably are directed to single immunogenic epitopes on these proteins. Recent data in animal models of autoimmune diseases suggest that the targets of immune responses in autoimmunity do not remain fixed, but can be extended to include other epitopes on the same protein or other proteins in the same tissue, a phenomenon termed "epitope spreading." The "epitope spreading" phenomenon also applies to situations in which tissue damage from a primary inflammatory process causes the release and exposure of a previously "sequestered" antigen, leading to a secondary autoimmune response against the newly released antigen. In experimental autoimmune animal diseases, "epitope spreading" seems to have significant physiologic importance in determining the course and duration of disease. In this paper, we review the current concepts in animal models of autoimmune diseases in order to define the "epitope spreading" phenomenon, and we then propose how this phenomenon might play a significant role in the development and the course of autoimmune skin diseases. Hopefully, an understanding of "epitope spreading" will help the dermatology community to better understand the pathogenesis of autoimmune skin diseases and to rationally fashion disease-specific immune therapy in the future.
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Affiliation(s)
- L S Chan
- VA Chicago Health Care System, Department of Dermatology, Northwestern University Medical School, Illinois 60611-3010, USA
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31
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Chan SC, Brown MA, Willcox TM, Li SH, Stevens SR, Tara D, Hanifin JM. Abnormal IL-4 gene expression by atopic dermatitis T lymphocytes is reflected in altered nuclear protein interactions with IL-4 transcriptional regulatory element. J Invest Dermatol 1996; 106:1131-6. [PMID: 8618052 DOI: 10.1111/1523-1747.ep12340181] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [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] [Indexed: 01/31/2023]
Abstract
Among the atopic disease, atopic dermatitis is characterized by the highest levels of serum IgE and by increased peripheral blood T-cell interleukin-4 (IL-4) production. IL-4 promotes IgE synthesis by B cells and stimulates the growth of IL-4-producing T cells and may contribute to the pathogenesis of this disease. In this study, in situ hybridization established that atopic dermatitis patients have a higher frequency of IL-4-producing peripheral blood T cell when compared to normal subjects. These in vivo-derived T cells were used to examine the signaling requirements of IL-4 production and the nuclear factors that associate with a critical IL-4 transcriptional regulatory element between -88 and -60 relative to the IL-4 transcription initiation site, the activation responsive element. We demonstrate that, as in T-cell lines, proteins belonging to the NF-AT and AP-1 family of transcription factors are present in stimulated cell extracts and specifically associate with the activation responsive element. Dysregulated IL-4 production is reflected in the nuclear proteins that associated this element. Using gel shift assays, we found that 12 of 12 nuclear extracts from stimulated atopic T cells formed the activation-dependent protein-DNA complex, compared to only 2 of 12 normal T-cell extracts. Activation complex formation correlated with the relative level of IL-4 mRNA and protein produced in stimulated T cells, suggesting that abnormal IL-4 gene expression in atopic disease may be linked to alterations in nuclear protein interactions with these promoter elements.
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Affiliation(s)
- S C Chan
- Department of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA
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32
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Stevens SR, Shibaki A, Meunier L, Cooper KD. Suppressor T cell-activating macrophages in ultraviolet-irradiated human skin induce a novel, TGF-beta-dependent form of T cell activation characterized by deficient IL-2r alpha expression. The Journal of Immunology 1995. [DOI: 10.4049/jimmunol.155.12.5601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Because UV-induced epidermal macrophages (UV-Mph) preferentially activate CD4+ T suppressor-inducer cells and induce tolerance, we hypothesized that they differentially up-regulate T cell early activation genes compared with constitutive epidermal APC, Langerhans cells. We used epidermal cells from UV-exposed (UV-EC) and control (C-EC) human skin to stimulate allogeneic CD4+ T lymphocytes. Reverse transcriptase-PCR revealed that both C-EC (Langerhans cells) and UV-EC (UV-Mph) induced 10(3)- to 10(6)-fold increases in IL-2 mRNA. However, while T cells stimulated by C-EC for 48 h showed a greater than 10(3)-fold increase in IL-2R alpha mRNA, those stimulated by UV-EC did not (n = 5, p = 0.004). Flow cytometry demonstrated that 4.1 +/- 2.3% of unstimulated CD4+ lymphocytes expressed cell surface IL-2R alpha, which increased to 15.7 +/- 1.8% upon stimulation by C-EC for 48 h, but stimulation by UV-EC failed to increase the IL-2R alpha+ population (n = 3, p = 0.038). The addition of neutralizing anti-TGF-beta Abs to UV-EC-stimulated cultures restored CD4+ cell surface IL-2R alpha expression to 12.9 +/- 0.2%. CD4+ T cell activation by UV-Mph is distinct from previously described models of tolerance such as Th2 activation (IFN-gamma mRNA was induced and IL-4 mRNA was not) and Th1 anergy (IL-2 mRNA levels induced by UV-EC and C-EC were similar). Furthermore, costimulatory signals were provided by UV-Mph; CTLA4-Ig and LFA-3-Ig fusion proteins and Abs to CD2, LFA-3, LFA-1, and ICAM-1 inhibited UV-Mph-induced T cell proliferation. Thus, the altered immune outcome induced by UV-Mph (tolerization) compared with Langerhans cells (sensitization) is reflected as a novel mechanism of initial CD4+ T cell early activation gene expression characterized by TGF-beta-dependent deficient IL-2R alpha expression.
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Affiliation(s)
- S R Stevens
- Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109, USA
| | - A Shibaki
- Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109, USA
| | - L Meunier
- Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109, USA
| | - K D Cooper
- Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109, USA
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Stevens SR, Shibaki A, Meunier L, Cooper KD. Suppressor T cell-activating macrophages in ultraviolet-irradiated human skin induce a novel, TGF-beta-dependent form of T cell activation characterized by deficient IL-2r alpha expression. J Immunol 1995; 155:5601-7. [PMID: 7499843] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Because UV-induced epidermal macrophages (UV-Mph) preferentially activate CD4+ T suppressor-inducer cells and induce tolerance, we hypothesized that they differentially up-regulate T cell early activation genes compared with constitutive epidermal APC, Langerhans cells. We used epidermal cells from UV-exposed (UV-EC) and control (C-EC) human skin to stimulate allogeneic CD4+ T lymphocytes. Reverse transcriptase-PCR revealed that both C-EC (Langerhans cells) and UV-EC (UV-Mph) induced 10(3)- to 10(6)-fold increases in IL-2 mRNA. However, while T cells stimulated by C-EC for 48 h showed a greater than 10(3)-fold increase in IL-2R alpha mRNA, those stimulated by UV-EC did not (n = 5, p = 0.004). Flow cytometry demonstrated that 4.1 +/- 2.3% of unstimulated CD4+ lymphocytes expressed cell surface IL-2R alpha, which increased to 15.7 +/- 1.8% upon stimulation by C-EC for 48 h, but stimulation by UV-EC failed to increase the IL-2R alpha+ population (n = 3, p = 0.038). The addition of neutralizing anti-TGF-beta Abs to UV-EC-stimulated cultures restored CD4+ cell surface IL-2R alpha expression to 12.9 +/- 0.2%. CD4+ T cell activation by UV-Mph is distinct from previously described models of tolerance such as Th2 activation (IFN-gamma mRNA was induced and IL-4 mRNA was not) and Th1 anergy (IL-2 mRNA levels induced by UV-EC and C-EC were similar). Furthermore, costimulatory signals were provided by UV-Mph; CTLA4-Ig and LFA-3-Ig fusion proteins and Abs to CD2, LFA-3, LFA-1, and ICAM-1 inhibited UV-Mph-induced T cell proliferation. Thus, the altered immune outcome induced by UV-Mph (tolerization) compared with Langerhans cells (sensitization) is reflected as a novel mechanism of initial CD4+ T cell early activation gene expression characterized by TGF-beta-dependent deficient IL-2R alpha expression.
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Affiliation(s)
- S R Stevens
- Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109, USA
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Bowen GM, Stevens SR, Dubin HV, Siddiqui J, Cooper KD. Diagnosis of Sézary syndrome in a patient with generalized pruritus based on early molecular study and flow cytometry. J Am Acad Dermatol 1995; 33:678-80. [PMID: 7673506 DOI: 10.1016/0190-9622(95)91309-2] [Citation(s) in RCA: 9] [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: 01/26/2023]
Affiliation(s)
- G M Bowen
- Department of Dermatology, University of Michigan, Ann Arbor 48109-0530, USA
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Metzman MS, Stevens SR, Griffiths CE, Ross CW, Barnett JM, Cooper KD. A clinical and histologic mycosis fungoides simulant occurring as a T-cell infiltrate coexisting with B-cell leukemia cutis. J Am Acad Dermatol 1995; 33:341-5. [PMID: 7615882 DOI: 10.1016/0190-9622(95)91430-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 02/08/2023]
Abstract
One year after the onset of chronic lymphocytic leukemia, an elderly man had scaly cutaneous plaques on the thighs that clinically and histologically resembled the mycosis fungoides type of cutaneous T-cell lymphoma. Two years later the patient had indurated, red dermal nodules on the face that clinically and histologically were characteristic of cutaneous chronic lymphocytic leukemia. Immunophenotyping results from a facial nodule confirmed the presence of a B-cell infiltrate (CD20+). Immunophenotyping of a lesion on the right thigh showed that half the cells were composed of a CD2+, CD45RO+ (UCHL-1+) upper dermal and focally epidermotropic population of T cells consistent with mycosis fungoides; however, these T cells coexisted with an equal number of CD20+ B cells arranged in distinct clusters. DNA from the thigh lesion exhibited a B-cell immunoglobulin gene rearrangement, but the T-cell receptor gene rearrangements were germline. In this case, the evidence favors a mycosis fungoides simulant occurring as a reactive T-cell infiltrate to an underlying B-cell chronic lymphocytic leukemia.
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MESH Headings
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Gene Rearrangement
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Mycosis Fungoides/etiology
- Mycosis Fungoides/genetics
- Mycosis Fungoides/pathology
- Skin Neoplasms/etiology
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocytes
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Affiliation(s)
- M S Metzman
- Cutaneous Lymphoma Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, USA
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Affiliation(s)
- K R Hamlet
- Department of Dermatology, University of Michigan, Ann Arbor, USA
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Griffiths TW, Stevens SR, Cooper KD. Acute erythroderma as an exclusion criterion for idiopathic CD4+ T lymphocytopenia. Arch Dermatol 1994; 130:1530-3. [PMID: 7986126] [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: 01/28/2023]
Abstract
BACKGROUND Idiopathic CD4+ T lymphocytopenia is defined as a CD4+ T lymphocytopenia of less than 0.3 x 10(9)/L that is not associated with human immunodeficiency virus, other immunodeficiency, or immunosuppressive therapy. The associated clinical course and laboratory findings are variable. We describe a subset of patients whose peripheral CD4+ T-lymphocytopenia was transient, and suggest a pathomechanism for this phenomenon. OBSERVATIONS We describe three patients with cutaneous T-cell lymphoma, atopic dermatitis, or psoriasis in whom acute erythroderma was concomitant with a peripheral CD4+ T lymphocytopenia that normalized after resolution of the erythroderma. Immunoperoxidase staining of skin biopsy specimens and quantitative estimation of CD4+ T lymphocytes in the cutaneous and peripheral blood compartments demonstrated that the peripheral CD4+ T lymphocytopenia in these cases most probably resulted from sequestration of CD4+ T lymphocytes in the skin. The skin of an erythrodermic patient appears capable of sequestering 10(10) to 10(11) CD4+ T lymphocytes, whereas the peripheral blood compartment contains in the range of 10(9) CD4+ T lymphocytes. CONCLUSIONS We propose that CD4+ T lymphocytopenia can occur as a result of acute erythroderma of multiple causes and that acute erythroderma associated with transient CD4+ T lymphocytopenia be considered as an exclusion criterion for idiopathic peripheral blood CD4+ T lymphocytopenia.
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Affiliation(s)
- T W Griffiths
- Department of Dermatology, University of Michigan Medical Center, Ann Arbor
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Stevens SR, Griffiths CE, Anhalt GJ, Cooper KD. Paraneoplastic pemphigus presenting as a lichen planus pemphigoides-like eruption. Arch Dermatol 1993; 129:866-9. [PMID: 8323308] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Paraneoplastic pemphigus refers to a specific disease entity in which neoplasia is associated with severe mucosal ulceration and polymorphous cutaneous eruptions, sometimes resembling erythema multiforme. Direct immunofluorescence and indirect immunofluorescence on standard substrates are similar to pemphigus vulgaris; however, paraneoplastic pemphigus serum uniquely binds to all epithelia and has distinctive immunoprecipitation characteristics. OBSERVATIONS A 63-year-old woman with chronic lymphocytic leukemia developed a severe, mucocutaneous, vesiculobullous eruption with the clinical and histopathologic characteristics of lichen planus pemphigoides evolving into a Stevens-Johnson-like presentation and the immunofluorescence findings of pemphigus vulgaris. Evaluation of her serum confirmed the presence of autoantibodies specific for paraneoplastic pemphigus by indirect immunofluorescence and immunoprecipitation criteria. CONCLUSION The spectrum of paraneoplastic pemphigus must now be expanded to include cases that present clinically and histologically as a lichen planus pemphigoides-like eruption.
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Affiliation(s)
- S R Stevens
- Department of Dermatology, University of Michigan, Ann Arbor
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Stevens SR, Griffiths TW, Cooper KD. CD4+ T-lymphocytopenia without HIV infection. N Engl J Med 1993; 328:1849. [PMID: 8099199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Stevens SR. Impact of changing health care economics on Michigan hospital libraries: report of a survey. Bull Med Libr Assoc 1990; 78:140-5. [PMID: 2328362 PMCID: PMC225363] [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: 12/31/2022]
Abstract
In an attempt to determine how efforts to contain the soaring cost of U.S. health care in the 1980s have affected the size and stature of Michigan hospital libraries, a survey was sent out in April 1988 to 156 hospitals across the state. Fifteen of the 97 responding institutions did not maintain libraries during the survey period and were subsequently excluded from the study. Total FTEs in the 82 responding libraries decreased by 6.1%. In the 69 libraries reporting budget data, materials budgets increased, but by less than 7% a year. Eighteen of the 82 libraries had positions reclassified, with 12 (14.6%) assigned downgrades. The trend toward reduced size and perceived value of hospital libraries that emerged from the survey points to the need for regular collection of comprehensive hospital library statistics to assist hospital librarians in effective direction of their profession's course.
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Affiliation(s)
- S R Stevens
- Sladen Library, Henry Ford Hospital, Detroit, Michigan 48202
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Heskel NS, Chan SC, Thiel ML, Stevens SR, Casperson LS, Hanifin JM. Elevated umbilical cord blood leukocyte cyclic adenosine monophosphate-phosphodiesterase activity in children with atopic parents. J Am Acad Dermatol 1984; 11:422-6. [PMID: 6090514 DOI: 10.1016/s0190-9622(84)70184-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We found cyclic adenosine monophosphate-phosphodiesterase (cAMP-PDE) activity to be significantly elevated in the umbilical cord blood mononuclear leukocytes of forty-two children with one atopic parent (3.2 +/- 0.3) and in eighteen children with two atopic parents (4.2 +/- 0.7) as compared to twenty-two children with two nonatopic parents (1.9 +/- 0.2) (p less than 0.005). Among those newborns with one atopic parent, mean PDE activities were significantly elevated in cord blood cells regardless of whether only the father was atopic, thus eliminating the possibility of transplacental enzyme passage. Follow-up evaluations of twenty-four children, age 6 months or older, suggest that infants with elevated PDE activity at birth have an increased likelihood of developing dermatitis and/or "atopic features." Further long-term studies will determine the predictive value of newborn mononuclear leukocyte PDE activity.
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Butler JM, Ebertz M, Chan SC, Stevens SR, Sobieszczuk D, Hanifin JM. Basophil histamine release in atopic dermatitis and its relationship to disordered cyclic nucleotide metabolism. Acta Derm Venereol Suppl (Stockh) 1985; 114:55-60. [PMID: 2408432 DOI: 10.2340/000155551145560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Maximal histamine release (HR) from leucocytes, in response to Concanavalin A (Con A) was significantly higher in a group of 16 adults with moderate to severe atopic dermatitis (AD) when compared to 13 non-atopic adults. In a further 4 adults with AD, HR was similar to that in the normals, suggesting the existence of 'high releaser' and 'low releaser' subsets within the AD group. Leucocyte cyclic AMP phosphodiesterase (PDE) activity was significantly higher in the 'high releaser' group compared to the 'low releaser' and normal groups. High and low HR responses showed strong correlations with high and low PDE. Pre-treatment of leucocytes from 'high releasers' with the experimental PDE PDE inhibitor RO-20-1724 reduced the HR to normal levels. These findings suggest that increased histamine 'releasability' in AD is related to abnormalities in cyclic nucleotide regulation. No significant HR could be demonstrated in response to a range of concentrations of methacholine in 'high releaser' atopics and normals. Methacholine also did not affect HR in response to maximal Con A stimulation in 'high releaser' atopics. Basophil percentages within the leucocyte preparation and the histamine content per basophil, were not significantly different between the atopics and normals. Con A-stimulated histamine release did not correlate significantly with serum IgE levels.
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