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Costa Blasco M, Doyle C, Diong S, Ni Raghallaigh S. Use of biologics for psoriasis in solid organ transplant recipients. Australas J Dermatol 2024; 65:276-279. [PMID: 38623950 DOI: 10.1111/ajd.14292] [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: 12/12/2023] [Revised: 02/05/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024]
Abstract
Biologics have significantly advanced the treatment of inflammatory disorders, including psoriasis. However, their use in immunosuppressed patients, such as those with solid-organ transplants, is less understood. These patients often face dermatological issues, but inflammatory skin diseases are rare due to their immunosuppressive treatments. Our study aims to assess biologics' effectiveness in such immunocompromised patients. We report a case from our institution of a 29-year-old man with a history of psoriasis, who underwent a kidney transplant and later developed erythroderma. He did not respond to traditional treatments and was successfully treated with adalimumab, leading to the discontinuation of MMF. We also reviewed literature in solid organ transplant patients with psoriasis. Our findings, based on 10 articles, indicate a cautious approach to using biologics in this group, with further research needed for efficacy and safety.
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Affiliation(s)
- Marta Costa Blasco
- Department of Dermatology, Beaumont University Hospital, Dublin, Ireland
| | - Claire Doyle
- Department of Dermatology, Beaumont University Hospital, Dublin, Ireland
| | - Sophie Diong
- Department of Dermatology, Beaumont University Hospital, Dublin, Ireland
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Schultz BG, Bullano M, Paratane D, Rajagopalan K. Cytomegalovirus related hospitalization costs among hematopoietic stem cell and solid organ transplant recipients treated with maribavir versus investigator-assigned therapy: A US-based study. Transpl Infect Dis 2024; 26:e14216. [PMID: 38221739 DOI: 10.1111/tid.14216] [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: 05/11/2023] [Revised: 10/19/2023] [Accepted: 12/02/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Cytomegalovirus (CMV) infections among hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients impose a significant health care resource utilization (HCRU)-related economic burden. Maribavir (MBV), a novel anti-viral therapy (AVT), approved by the United States Food and Drug Administration for post-transplant CMV infections refractory (with/without resistance) to conventional AVTs has demonstrated lower hospital length of stay (LOS) versus investigator-assigned therapy (IAT; valgancilovir, ganciclovir, foscarnet, or cidofovir) in a phase 3 trial (SOLSTICE). This study estimated the HCRU costs of MBV versus IAT. METHODS An economic model was developed to estimate HCRU costs for patients treated with MBV or IAT. Mean per-patient-per-year (PPPY) HCRU costs were calculated using (i) annualized mean hospital LOS in SOLSTICE, and (ii) CMV-related direct costs from published literature. Probabilistic sensitivity analysis with Monte-Carlo simulations assessed model robustness. RESULTS Of 352 randomized patients receiving MBV (n = 235) or IAT (n = 117) for 8 weeks in SOLSTICE, 40% had HSCT and 60% had SOT. Mean overall PPPY HCRU costs of overall hospital-LOS were $67,205 (95% confidence interval [CI]: $33,767, $231,275) versus $145,501 (95% CI: $62,064, $589,505) for MBV and IAT groups, respectively. Mean PPPY ICU and non-ICU stay costs were: $32,231 (95% CI: $5,248, $184,524) versus $45,307 (95% CI: $3,957, $481,740) for MBV and IAT groups, and $82,237 (95% CI: $40,397, $156,945) MBV versus $228,329 (95% CI: $94,442, $517,476) for MBV and IAT groups, respectively. MBV demonstrated cost savings in over 99.99% of simulations. CONCLUSIONS This analysis suggests that Mean PPPY HCRU costs were 29%-64% lower with MBV versus other-AVTs.
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Affiliation(s)
- Bob G Schultz
- US Medical Affairs Outcomes Research, Takeda Pharmaceuticals U.S.A., Inc., Lexington, Massachusetts, USA
| | - Michael Bullano
- US Medical Affairs Outcomes Research, Takeda Pharmaceuticals U.S.A., Inc., Lexington, Massachusetts, USA
| | - Deepika Paratane
- Health Economics and Outcomes Research, Anlitiks, Inc., Windermere, Florida, USA
| | - Krithika Rajagopalan
- Health Economics and Outcomes Research, Anlitiks, Inc., Windermere, Florida, USA
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Alshukairi AN, Al-Qahtani AA, Obeid DA, Dada A, Almaghrabi RS, Al-Abdulkareem MA, Alahideb BM, Alsanea MS, Alsuwairi FA, Alhamlan FS. Molecular Epidemiology of SARS-CoV-2 and Clinical Manifestations among Organ Transplant Recipients with COVID-19. Viruses 2023; 16:25. [PMID: 38257726 PMCID: PMC10819349 DOI: 10.3390/v16010025] [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: 05/24/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 01/24/2024] Open
Abstract
RNA viruses, including SARS-CoV-2, rely on genetic mutation as a major evolutionary mechanism, leading to the emergence of variants. Organ transplant recipients (OTRs) may be particularly vulnerable to such mutations, making it crucial to monitor the spread and evolution of SARS-CoV-2 in this population. This cohort study investigated the molecular epidemiology of SARS-CoV-2 by comparing the SARS-CoV-2 whole genome, demographic characteristics, clinical conditions, and outcomes of COVID-19 illness among OTRs (n = 19) and non-OTRs with (n = 38) or without (n = 30) comorbid conditions. Most patients without comorbidities were female, whereas most OTRs were male. Age varied significantly among the three groups: patients with comorbidities were the oldest, and patients without comorbidities were the youngest. Whole-genome sequencing revealed that OTRs with mild disease had higher numbers of unusual mutations than patients in the other two groups. Additionally, OTRs who died had similar spike monoclonal antibody resistance mutations and 3CLpro mutations, which may confer resistance to nirmatrelvir, ensitrelvir, and GC37 therapy. The presence of those unusual mutations may impact the severity of COVID-19 illness in OTRs by affecting the virus's ability to evade the immune system or respond to treatment. The higher mutation rate in OTRs may also increase the risk of the emergence of new virus variants. These findings highlight the importance of monitoring the genetic makeup of SARS-CoV-2 in all immunocompromised populations and patients with comorbidity.
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Affiliation(s)
- Abeer N. Alshukairi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah 21362, Saudi Arabia; (A.N.A.); (A.D.)
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
| | - Ahmed A. Al-Qahtani
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Dalia A. Obeid
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (D.A.O.); (R.S.A.)
| | - Ashraf Dada
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah 21362, Saudi Arabia; (A.N.A.); (A.D.)
| | - Reem S. Almaghrabi
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (D.A.O.); (R.S.A.)
| | - Maha A. Al-Abdulkareem
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Basma M. Alahideb
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Madain S. Alsanea
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Feda A. Alsuwairi
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
| | - Fatimah S. Alhamlan
- College of Medicine, Alfaisal University, Riyadh 11211, Saudi Arabia;
- Department of Infection and Immunity, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia; (M.A.A.-A.); (B.M.A.); (M.S.A.); (F.A.A.)
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
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Zauner R, Wimmer M, Dorfer S, Ablinger M, Koller U, Piñón Hofbauer J, Guttmann-Gruber C, Bauer JW, Wally V. Transcriptome-Guided Drug Repurposing for Aggressive SCCs. Int J Mol Sci 2022; 23:ijms23021007. [PMID: 35055192 PMCID: PMC8780441 DOI: 10.3390/ijms23021007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023] Open
Abstract
Despite a significant rise in the incidence of cutaneous squamous cell carcinoma (SCC) in recent years, most SCCs are well treatable. However, against the background of pre-existing risk factors such as immunosuppression upon organ transplantation, or conditions such as recessive dystrophic epidermolysis bullosa (RDEB), SCCs arise more frequently and follow a particularly aggressive course. Notably, such SCC types display molecular similarities, despite their differing etiologies. We leveraged the similarities in transcriptomes between tumors from organ transplant recipients and RDEB-patients, augmented with data from more common head and neck (HN)-SCCs, to identify drugs that can be repurposed to treat these SCCs. The in silico approach used is based on the assumption that SCC-derived transcriptome profiles reflect critical tumor pathways that, if reversed towards healthy tissue, will attenuate the malignant phenotype. We determined tumor-specific signatures based on differentially expressed genes, which were then used to mine drug-perturbation data. By leveraging recent efforts in the systematic profiling and cataloguing of thousands of small molecule compounds, we identified drugs including selumetinib that specifically target key molecules within the MEK signaling cascade, representing candidates with the potential to be effective in the treatment of these rare and aggressive SCCs.
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Affiliation(s)
- Roland Zauner
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
- Correspondence:
| | - Monika Wimmer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Sonja Dorfer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Michael Ablinger
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Ulrich Koller
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Josefina Piñón Hofbauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Christina Guttmann-Gruber
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
| | - Johann W. Bauer
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
- Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University, 5020 Salzburg, Austria
| | - Verena Wally
- EB House Austria, Research Program for Molecular Therapy of Genodermatoses, Department of Dermatology and Allergology, University Hospital of the Paracelsus Medical University Salzburg, 5020 Salzburg, Austria; (M.W.); (S.D.); (M.A.); (U.K.); (J.P.H.); (C.G.-G.); (J.W.B.); (V.W.)
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Neuberger A, Menzer C, Volk N, Enk AH, Hadaschik EN, Lonsdorf AS. Expression of p53 up-regulated modulator of apoptosis (PUMA) in non-melanoma skin cancer of long-term immunosuppressed solid organ transplant recipients compared to immunocompetent patients. Eur J Dermatol 2021; 31:609-15. [PMID: 34903507 DOI: 10.1684/ejd.2021.4133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The risk of UV radiation (UVR)-induced non-melanoma skin cancer (NMSC) is dramatically increased in immunosuppressed organ transplant recipients compared to immunocompetent patients. In the skin, p53 up-regulated modulator of apoptosis (PUMA) is a central regulator of apoptosis in response to UVR damage and immune response regulation. Data on the expression of PUMA in patients with NMSC relative to immune status is limited To study differences in the expression and distribution of PUMA in cutaneous SCC and BCC by immunohistochemistry between immunocompetent patients and organ transplant recipients, and the effect of CsA-containing immunosuppressive maintenance regimens on this expression. PUMA expression in SCC (n = 34) and BCC (n = 20) was analysed comparatively by immunohistochemical staining in matched cohorts of 27 immunocompetent patients and 27 organ transplant recipients SCC and BCC showed unequivocal positive PUMA expression, however, there was no significant difference in NMSC between organ transplant recipients and immunocompetent patients. A 17% reduction in staining score for PUMA in SCC, but not in BCC, of organ transplant recipients treated with a cyclosporin (CsA)-containing regimen was noted compared to organ transplant recipients without chronic CsA intake (p = 0.0381) PUMA expression in SCC, but not BCC, is significantly reduced by CsA-containing therapy, suggesting a disturbance of apoptosis by iatrogenic immunosuppression with a divergent impact on SCC and BCC.
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Arne V, Canan G, Marjan G. A narrative review on the outcome of primary cutaneous melanomas arising in solid organ transplant recipients. Eur J Dermatol 2021; 31:364-71. [PMID: 34080979 DOI: 10.1684/ejd.2021.4067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic immunosuppression is a risk factor for cutaneous melanoma, as indicated by the increased incidence among solid organ transplant recipients (OTRs). The outcome of post-transplant melanomas has not frequently been investigated. The aim of this narrative review was to investigate overall survival (OS) and melanoma-specific mortality (MSM) of primary cutaneous melanomas (CM) among OTRs compared to the outcome of cutaneous melanomas arising in immunocompetent patients. A systematic literature search was conducted in PubMed to identify studies reporting on primary CM among OTRs and their outcome. The search was restricted to the English language and included investigations through to April 1st, 2019. Of the seven articles included, all except one reported a lower OS for primary CM among OTRs compared to immunocompetent patients. In these six investigations, MSM was increased, but not relative to Clark level, Breslow thickness or American Joint Committee on Cancer (AJCC) stage. A lower OS can be expected among OTRs with primary CM. There is still much heterogeneity in MSM adjusted for Breslow thickness, AJCC staging and Clark level, with no conclusive answers. Prospective studies are needed to clarify MSM for this specific patient group.
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Borik-Heil L, Geroldinger A, Dunkler D, Geusau A. The spectrum of skin diseases in four different types of organ-transplant recipients: a comparative single-centre cohort study. Eur J Dermatol 2021; 31:65-74. [PMID: 33648926 DOI: 10.1684/ejd.2021.3967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) are at marked increased risk of skin cancer and skin infections compared to the general population. OBJECTIVES The purpose of this study was to acquire long-term incidence data on commonly occurring skin diseases in four different transplant groups. MATERIALS & METHODS This retrospective single-centre cohort study included 621 OTR. By counting defined malignant, inflammatory, infectious or drug-related skin conditions per patient and visit, incidence rates (IR) for the different groups of OTR were calculated as cases per 1000-patient years and cumulative incidences of non-melanoma skin cancer (NMSC), respectively. RESULTS Overall, 2,309 non-malignant skin conditions and 340 NMSC were registered. Skin infections were most common (51.4%), followed by inflammatory skin conditions (35.6%) and sun-induced skin damage (32.9%). Kidney transplant recipients (KTR) had a 4.7-fold (95% CI: 2.7-8.0; p < 0.0001), 2.6-fold (95% CI: 1.2-5.3; p = 0.0098) and 5.4-fold (95% CI: 2.8-10.3; - < 0.0001) higher IR for oral candidiasis, oral aphthosis and herpes simplex virus infections, respectively, compared to the other OTR. Pruritus was most commonly reported in liver transplant recipients (95% CI: 1.3-5.3; p = 0.0047). KTR and lung transplant recipients (LuTR) had a 10.7-fold (95% CI:3.6-43.2; p < 0.0001) higher IR of steroid induced acne. KTR had a 1.6-fold (95% CI: 1.1-2.3; p = 0.0096) higher IR of squamous cell carcinoma compared to the other groups. The incidence of basal cell carcinoma was 2.5-fold higher (95% CI: 1.7-3.6; p < 0.0001) in LuTR, compared to the other OTR. CONCLUSION This study provides additional organ-specific incidence data on non-malignant skin diseases and skin cancer in OTR.
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Wheless L, Baker L, Edwards L, Anand N, Birdwell K, Hanlon A, Chren MM. Development of Phenotyping Algorithms for the Identification of Organ Transplant Recipients: Cohort Study. JMIR Med Inform 2020; 8:e18001. [PMID: 33156808 PMCID: PMC7759442 DOI: 10.2196/18001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/21/2020] [Accepted: 10/31/2020] [Indexed: 12/20/2022] Open
Abstract
Background Studies involving organ transplant recipients (OTRs) are often limited to the variables collected in the national Scientific Registry of Transplant Recipients database. Electronic health records contain additional variables that can augment this data source if OTRs can be identified accurately. Objective The aim of this study was to develop phenotyping algorithms to identify OTRs from electronic health records. Methods We used Vanderbilt’s deidentified version of its electronic health record database, which contains nearly 3 million subjects, to develop algorithms to identify OTRs. We identified all 19,817 individuals with at least one International Classification of Diseases (ICD) or Current Procedural Terminology (CPT) code for organ transplantation. We performed a chart review on 1350 randomly selected individuals to determine the transplant status. We constructed machine learning models to calculate positive predictive values and sensitivity for combinations of codes by using classification and regression trees, random forest, and extreme gradient boosting algorithms. Results Of the 1350 reviewed patient charts, 827 were organ transplant recipients while 511 had no record of a transplant, and 12 were equivocal. Most patients with only 1 or 2 transplant codes did not have a transplant. The most common reasons for being labeled a nontransplant patient were the lack of data (229/511, 44.8%) or the patient being evaluated for an organ transplant (174/511, 34.1%). All 3 machine learning algorithms identified OTRs with overall >90% positive predictive value and >88% sensitivity. Conclusions Electronic health records linked to biobanks are increasingly used to conduct large-scale studies but have not been well-utilized in organ transplantation research. We present rigorously evaluated methods for phenotyping OTRs from electronic health records that will enable the use of the full spectrum of clinical data in transplant research. Using several different machine learning algorithms, we were able to identify transplant cases with high accuracy by using only ICD and CPT codes.
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Affiliation(s)
- Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura Baker
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - LaVar Edwards
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nimay Anand
- Meharry Medical College, Nashville, TN, United States
| | - Kelly Birdwell
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Allison Hanlon
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Mary-Margaret Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, United States
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Moscarella E, Di Brizzi EV, Casari A, De Giorgi V, Di Meo N, Fargnoli MC, Lacarrubba F, Micali G, Pellacani G, Peris K, Piaserico S, Calzavara-Pinton P, Quaglino P, Sollena P, Zalaudek I, Zane C, Argenziano G. Italian expert consensus paper on the management of patients with actinic keratoses. Dermatol Ther 2020; 33:e13992. [PMID: 32648324 DOI: 10.1111/dth.13992] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 01/15/2023]
Abstract
Two round tables involving experts were organized in order to reach a consensus on the management of patients with actinic keratosis (AK). In the first, seven clinical questions were selected and analyzed by a systematic literature review, using a Population, Intervention, Control, and Outcomes framework; in the second, the experts discussed relevant evidences and a consensus statement for each question was developed. Consensus was reached among experts on how to best treat AK patients with respect to different clinical scenarios and special populations. Lesion-directed treatments are preferred in patients with few AKs. Patients with multiple AKs are challenging, with more than one treatment usually needed to achieve complete lesion clearance or a high lesion response rate, therapy should be personalized, based on previous treatments, patient, and lesion characteristics. Methyl aminolevulinate-PDT, DL (day light) PDT, and imiquimod cream were demonstrated to have the lowest percentage of new AKs after post treatment follow-up. For IMQ 5% and 3.75%, a higher intensity of skin reactions is associated with higher efficacy. Photodynamic therapy (PDT) is the most studied treatment for AKs on the arms. Regular sunscreen use helps preventing new AKs. Oral nicotinamide 500 mg twice daily, systemic retinoids and regular sunscreen use were demonstrated to reduce the number of new squamous cell carcinomas in patients with AKs. Limited evidence is available for the treatment of AKs in organ transplant recipients. There is no evidence in favor or against the use of any of the available treatments in patients suffering from hematological cancer.
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Affiliation(s)
- Elvira Moscarella
- Dermatology Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Alice Casari
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Nicola Di Meo
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Maria Concetta Fargnoli
- Dermatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | | | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli -IRCCS, Rome, Italy
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine, University of Padova, Padova, Italy
| | | | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Pietro Sollena
- Institute of Dermatology, Università Cattolica, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli -IRCCS, Rome, Italy
| | - Iris Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Cristina Zane
- Department of Dermatology, Spedali Civili, Brescia, Italy
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Hussein L, Perrett CM. Treatment of sebaceous gland hyperplasia: a review of the literature. J DERMATOL TREAT 2020; 32:866-877. [PMID: 32011918 DOI: 10.1080/09546634.2020.1720582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sebaceous gland hyperplasia (SGH) is a benign cutaneous proliferation of the sebaceous glands that primarily affects the elderly group and frequently appears in individuals receiving long-term ciclosporin therapy such as organ transplant recipients. In the latter group, SGHs are usually multiple in number and occur predominantly on the face. Patients may find their appearance cosmetically undesirable and, in some cases, may result in significant negative psychological impact. There is, therefore, a demand for safe and effective treatment for SGH particularly in this patient group. A variety of treatment modalities have been previously described including electrodessication,surgery, cryotherapy, oral isotretinoin, lasers, and topical photodynamic therapy (PDT). METHODS The objective of this paper is to review the various treatment modalities for SGH. We performed a systematic literature review using the National Library of Medicine's PubMed Database, whereby we included articles that met the following criteria: published in English, not focused on SGH in rhinophyma, studies with adult sample with SGH lesions, and studies with patients with SGH related to ciclosporin. RESULTS Our findings show that the literature is categorized according to the treatment modalities ranging from conventional techniques such as oral isotretinoin and cryotherapy to more advanced topical PDT, lasers and a combination of both. We found that effectiveness does not depend on the technique itself but instead on the number of lesions, financial cost, psychological factors, skin phototype and age. CONCLUSIONS Our work shows that SGH can be treated effectively by customizing the treatment modality according to different parameters, while effectively maintaining clearance of SGH lesions with best cosmetic outcome.
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Affiliation(s)
- Lama Hussein
- Department of Dermatology, University College London Hospital, London, UK
| | - Conal M Perrett
- Department of Dermatology, University College London Hospital, London, UK
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Maor D, Vajdic CM, Cumming S, Fahey V, Bala HR, Snaidr V, Brennand S, Goh MSY, Chong AH. Melanoma in a cohort of organ transplant recipients: Experience from a dedicated transplant dermatology clinic in Victoria, Australia. J Am Acad Dermatol 2019; 83:773-779. [PMID: 31706934 DOI: 10.1016/j.jaad.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 10/02/2018] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is limited information on the profile of melanomas diagnosed in a specialist transplant dermatology clinic. OBJECTIVE To describe the incidence and characteristics of incident primary melanomas in a cohort of organ transplant recipients (OTRs) attending a specialized transplant dermatology clinic and determine the number of pigmented lesions needed to excise for every melanoma diagnosed. METHODS A retrospective study of 327 OTRs monitored by an Australian clinic during a 10-year period. RESULTS There were 11 incident melanomas diagnosed during a total follow-up of 1280 patient-years. The mean interval between the first transplant and diagnosis was 5.5 years. Only 2 melanomas were >1 mm in Breslow thickness. Seven melanomas (64%) arose de novo. A contiguous nevus was present in 4 cases. Metastatic disease did not develop in the melanoma patients during the follow-up period, and all remain alive. The needed to excise for every melanoma diagnosed ratio was 16:1. LIMITATIONS The crude incidence rates were age standardized, unlike the comparison rates of melanoma in the general population, and the cohort was small. CONCLUSION Most melanomas diagnosed in OTR patients attending a specialized transplant dermatology service were detected early. Our data suggest early detection may reduce the proportion of OTRs presenting with thick melanomas, thus improving prognosis and patient outcomes. A needed to excise for every melanoma diagnosed ratio of 16:1 is not unreasonable for this cohort of high-risk patients. To our knowledge, this is the first time this ratio has been calculated for a cohort of OTRs.
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Affiliation(s)
- Danit Maor
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales
| | - Simon Cumming
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | | | - Harini R Bala
- Skin and Cancer Foundation Victoria, Carlton, Victoria
| | | | | | - Michelle S Y Goh
- Skin and Cancer Foundation Victoria, Carlton, Victoria; Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria
| | - Alvin H Chong
- Skin and Cancer Foundation Victoria, Carlton, Victoria; Department of Dermatology, St Vincent's Hospital Melbourne, Melbourne, Victoria; Department of Medicine (Dermatology), St Vincent's Hospital Clinical School, The University of Melbourne, Melbourne, Victoria.
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12
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Venuti A, Lohse S, Tommasino M, Smola S. Cross-talk of cutaneous beta human papillomaviruses and the immune system: determinants of disease penetrance. Philos Trans R Soc Lond B Biol Sci 2019; 374:20180287. [PMID: 30955489 PMCID: PMC6501898 DOI: 10.1098/rstb.2018.0287] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Accepted: 01/23/2019] [Indexed: 12/19/2022] Open
Abstract
Human papillomaviruses (HPVs) infect the epithelia of skin or mucosa, where they can induce hyperproliferative lesions. More than 220 different HPV types have been characterized and classified into five different genera. Mucosal high-risk HPVs are causative for cancers of the anogenital region and oropharynx. Clinical data from patients with the rare genetic disorder epidermodysplasia verruciformis (EV) indicate that genus beta-HPVs cooperate with ultraviolet (UV) radiation in the development of cutaneous squamous cell carcinoma. In addition, epidemiological and biological findings indicate that beta-HPV types play a role in UV-mediated skin carcinogenesis also in non-EV individuals. However, the mechanisms used by these cutaneous viruses to promote epithelial carcinogenesis differ significantly from those of mucosal HPVs. Recent studies point to a delicate cross-talk of beta-HPVs with the cell-autonomous immunity of the host keratinocytes and the local immune microenvironment that eventually determines the fate of cutaneous HPV infection and the penetrance of disease. This review gives an overview of the critical interactions of genus beta-HPVs with the local immune system that allow the virus to complete its life cycle, to escape from extrinsic immunity, and eventually to cause chronic inflammation contributing to skin carcinogenesis. This article is part of the theme issue 'Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses'.
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Affiliation(s)
- Assunta Venuti
- 1 Infections and Cancer Biology Group, International Agency for Research on Cancer , 150 Cours Albert Thomas, Lyon 69008 , France
| | - Stefan Lohse
- 2 Institute of Virology, Saarland University Medical Center , Kirrbergerstr. Building 47, 66421 Homburg/Saar , Germany
| | - Massimo Tommasino
- 1 Infections and Cancer Biology Group, International Agency for Research on Cancer , 150 Cours Albert Thomas, Lyon 69008 , France
| | - Sigrun Smola
- 2 Institute of Virology, Saarland University Medical Center , Kirrbergerstr. Building 47, 66421 Homburg/Saar , Germany
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13
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Stenman C, Gonzalez H, Gillstedt M, Dellgren G, Hasséus B, Holmberg E, Rexius H, Öhman J, Paoli J. Degree of differentiation of cutaneous squamous cell carcinoma: a comparison between a Swedish cohort of organ transplant recipients and immunocompetent patients. Dermatol Pract Concept 2018; 8:330-336. [PMID: 30479868 PMCID: PMC6246062 DOI: 10.5826/dpc.0804a18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 02/25/2018] [Accepted: 05/23/2018] [Indexed: 12/14/2022] Open
Abstract
Background Organ transplant recipients (OTRs) have a very high risk of developing cutaneous squamous cell carcinoma (cSCC). Immunosuppressed OTRs may have a higher proportion of poorly differentiated cSCC than non-OTRs. Objectives The aim of this study was to investigate the degree of differentiation of cSCCs in OTRs compared with immunocompetent individuals. Patients/Methods Data from the Swedish Cancer Registry were crosschecked with data from the Transplant registry of the Transplant Institute at Sahlgrenska University Hospital in Gothenburg, Sweden. All OTRs with a diagnosis of cSCC, basosquamous carcinoma, and/or cSCC in situ established at the Department of Dermatology, Sahlgrenska University Hospital, during 2002–2015 were included. The control group consisted of non-OTRs with the same diagnoses during the same time period. Results During 2002–2015, 82 OTRs diagnosed with 515 tumors and 883 non-OTRs with 1,247 tumors were included. OTRs developed 0.47 tumors/year vs 0.10 tumors/year for non-OTRs, but no significant differences were observed in the degree of tumor differentiation of invasive cSCCs between OTRs and non-OTRs (P = 0.4). The distribution of poorly, moderately, and well-differentiated invasive cSCCs among OTRs and non-OTRs were 8.5% vs 12.5%, 22.1% vs 29.9%, and 69.4% vs 57.6%, respectively. Conclusions OTRs do not develop a higher proportion of poorly differentiated cSCCs than non-OTRs.
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Affiliation(s)
- Caroline Stenman
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helena Gonzalez
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Göran Dellgren
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg Sweden
| | - Helena Rexius
- Department of Cardiothoracic Surgery and Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Öhman
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Saxena S, Gee J, Klieger S, Kajon A, Petersen H, Zaoutis T, Fisher B. Invasive Fungal Disease in Pediatric Solid Organ Transplant Recipients. J Pediatric Infect Dis Soc 2018; 7:219-225. [PMID: 28992290 PMCID: PMC6097577 DOI: 10.1093/jpids/pix041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 06/01/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at risk for invasive fungal disease (IFD). Data on IFD burden in pediatric patients are limited. We aimed to determine the incidence and outcome of IFD in a large cohort of pediatric patients who underwent SOT. METHODS A single-center cohort of pediatric patients who underwent SOT between 2000 and 2013 was assembled retrospectively. The patients were followed for 180 days after transplant or until death to determine the presence or absence of IFD. The 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group Consensus Group criteria were used to define IFD as proven or probable. The incidence of IFD, all-cause mortality rate, and case-fatality rate at 180 days were calculated. RESULTS Among 584 pediatric patients who underwent SOT, 13 patients sustained 14 episodes of IFD (candidiasis, aspergillosis, and mucormycosis). The overall incidence was 2.2% (14.3 IFD events per 100000 patient-days). The IFD rates according to transplant type were 12.5% (1 of 8) (heart/lung), 11.4% (4 of 35) (lung), 4.7% (8 of 172) (liver), 0% (0 of 234) (kidney), and 0% (0 of 135) (heart). Three patients with IFD (2 lung and 1 heart/lung) died, and all these deaths were deemed likely attributable to the IFD; the case-fatality rate was 21.4% (3 of 14). CONCLUSIONS The overall incidence of IFD in these pediatric SOT recipients was low but varied across transplant type, with heart/lung and lung recipients having the highest IFD rate. Given the attributable case-fatality rate, the risk of death resulting from IFD is potentially high. More data on groups at higher risk, such as lung transplant recipients, are needed to guide targeted antifungal prophylaxis.
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Affiliation(s)
- Shikha Saxena
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jerica Gee
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania
| | - Sarah Klieger
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania
| | - Adriana Kajon
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - Hans Petersen
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia,Department of Pediatrics, University of Pennsylvania, Philadelphia,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia,Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania
| | - Brian Fisher
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia,Department of Pediatrics, University of Pennsylvania, Philadelphia,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia,Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness Research, Children’s Hospital of Philadelphia, Pennsylvania,Correspondence: B. Fisher, DO, MSCE, Division of Infectious Diseases, Children’s Hospital of Philadelphia, 34th and Civic Center Boulevard, CHOP North, Suite 1515, Philadelphia, PA 19104 ()
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15
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Koletsa T, Petrakis G, Karayannopoulou G, Euvrard S, Kanitakis J. mTOR Signalling Pathway-protein Expression in Post-transplant Cutaneous Squamous-cell Carcinomas Before and After Conversion to mTOR-inhibitors. Anticancer Res 2018; 38:3319-3322. [PMID: 29848679 DOI: 10.21873/anticanres.12597] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Inhibitors of the mammalian target of rapamycin (mTORis) exert immunosuppressive and antitumor effects and are used in organ-transplant recipients (OTR) as immunosuppressants able to reduce skin tumor burden. This study investigated the effects of mTORis on the expression of mTOR pathway proteins in cutaneous squamous-cell carcinomas (SCC) developing in OTR, before and after switching to mTORis. MATERIALS AND METHODS An immunohistochemical study was performed on 23 SCC sections excised from OTR with post-transplant SCC, before or after switch to mTORis, with antibodies against pAkt, pmTOR and PI3K. RESULTS pmTOR expression was found in 8/12 SCC pre-switch, and in 8/11 SCC post-switch, to mTORis. All (but 2) SCC expressed PI3K, and all SCCs expressed pAkt. CONCLUSION mTORis do not significantly change the immunohistochemical expression of molecules upstream of the mTOR inhibition (pmTOR, PI3K, pAkt), in cutaneous SCC.
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Affiliation(s)
- Triantafyllia Koletsa
- Department of Pathology, AHEPA Hospital, Aristotelian University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Petrakis
- Department of Pathology, AHEPA Hospital, Aristotelian University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Karayannopoulou
- Department of Pathology, AHEPA Hospital, Aristotelian University of Thessaloniki, Thessaloniki, Greece
| | - Sylvie Euvrard
- Department of Dermatology, Ed. Herriot Hospital, Lyon, France
| | - Jean Kanitakis
- Department of Dermatology, Ed. Herriot Hospital, Lyon, France .,Department of Pathology, Ed. Herriot Hospital, Lyon, France
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16
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Borgogna C, Olivero C, Lanfredini S, Calati F, De Andrea M, Zavattaro E, Savoia P, Trisolini E, Boldorini R, Patel GK, Gariglio M. β-HPV Infection Correlates with Early Stages of Carcinogenesis in Skin Tumors and Patient-Derived Xenografts from a Kidney Transplant Recipient Cohort. Front Microbiol 2018; 9:117. [PMID: 29459852 PMCID: PMC5807414 DOI: 10.3389/fmicb.2018.00117] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/18/2018] [Indexed: 11/15/2022] Open
Abstract
Many malignancies that occur in high excess in kidney transplant recipients (KTRs) are due to viruses that thrive in the setting of immunosuppression. Keratinocyte carcinoma (KC), the most frequently occurring cancer type in KTR, has been associated with skin infection by human papillomavirus (HPV) from the beta genus. In this report, we extend our previous investigation aimed at identifying the presence of active β-HPV infection in skin tumors from KTRs through detection of viral protein expression. Using a combination of antibodies raised against the E4 and L1 proteins of the β-genotypes, we were able to visualize infection in five tumors [one keratoacanthoma (KA), three actinic keratoses (AKs), and one seborrheic keratoses (SKs)] that were all removed from two patients who had been both transplanted twice, had developed multiple KCs, and presented with a long history of immunosuppression (>30 years). These infected tissues displayed intraepidermal hyperplasia and increased expression of the ΔNp63 protein, which extended into the upper epithelial layers. In addition, using a xenograft model system in nude mice displaying a humanized stromal bed in the site of grafting, we successfully engrafted three AKs, two of which were derived from the aforementioned KTRs and displayed β-HPV infection in the original tumor. Of note, one AK-derived xenograft, along with its ensuing lymph node metastasis, was diagnosed as squamous cell carcinoma (SCC). In the latter, both β-HPV infection and ΔNp63 expression were no longer detectable. Although the overall success rate of engrafting was very low, the results of this study show for the first time that β-HPV+ and ΔNp63+ intraepidermal hyperplasia can indeed progress to an aggressive SCC able to metastasize. Consistent with a series of reports attributing a causative role of β-HPV at early stages of skin carcinogenesis through ΔNp63 induction and increased keratinocytes stemness, here we provide in vivo evidence that these events are also occurring in the affected skin of KTRs. Due to these β-HPV-driven molecular pathways, the nascent tumor cell is able to acquire a high enough number of carcinogenic insults that its proliferation and survival will eventually become independent of viral gene expression.
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Affiliation(s)
- Cinzia Borgogna
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
| | - Carlotta Olivero
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy.,School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Simone Lanfredini
- School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Federica Calati
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
| | - Marco De Andrea
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy.,Virology Unit, Department of Public Health and Pediatric Sciences, Turin Medical School, University of Turin, Turin, Italy
| | - Elisa Zavattaro
- Dermatology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Paola Savoia
- Dermatology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Elena Trisolini
- Pathology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Renzo Boldorini
- Pathology Unit, Department of Health Sciences, Novara Medical School, Novara, Italy
| | - Girish K Patel
- School of Biosciences, European Cancer Stem Cell Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Marisa Gariglio
- Virology Unit, Department of Translational Medicine, Novara Medical School, University of Eastern Piedmont, Novara, Italy
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17
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Leung VKY, Dobbinson SJ, Goodman DJ, Kanellis J, Chong AH. Skin cancer history, sun-related attitudes, behaviour and sunburn among renal transplant recipients versus general population. Australas J Dermatol 2017; 59:e106-e113. [PMID: 28332195 DOI: 10.1111/ajd.12591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/08/2016] [Accepted: 10/14/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Renal transplant recipients (RTR) have both an excessive skin cancer incidence and a high mortality rate. In Australia RTR receive extensive public education on skin cancer and many undergo further education pre/post-transplant. This study examines whether RTR have sufficiently rigorous sun protection behaviour compared with the general population. METHODS Altogether 179 RTR from two large Melbourne hospitals involving skin clinic teams in patient care were recruited to undergo cross-sectional telephone interviews. Comparisons were made with residents (25-69 years) surveyed using equivalent measures and methods in adjacent summers (2006-2007, n = 904; 2010-2011, n = 942) for regular population monitoring surveys. Multivariate analyses of weekend behaviour were adjusted for related ambient temperature records. RESULTS RTR were more compliant with sun protection behaviour on the weekend prior to interview than the residents surveyed. For example, for 2006-2007 and 2010-2011, the odds ratio and confidence intervals (CI 95%) were respectively: used sunscreen: 2.0 (1.1-3.8) and 2.8 (1.4-5.3); wore a long-sleeved top: 4.5 (2.4-8.5) and 3.6 (1.9-7.0). RTR sunburn prevalence (5%) appeared similar to that of residents (odds ratios comparing 2006-2007 and 2010-2011 0.6 [95% CI, 0.2-1.6] and 0.7 [95% CI, 0.3-1.9]). Despite generally good sun protection behaviour, many RTR (47%) had skin cancers treated. CONCLUSION The intensive education of RTR may have contributed to their better sun protection. Some RTR with excessive exposure to UV radiation introduction of may benefit from implementation of further photoprotection strategies. These findings may be particularly relevant to other RTR groups receiving education about sun protection.
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Affiliation(s)
- Vivian Ka Ying Leung
- Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Suzanne Jane Dobbinson
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David Josef Goodman
- Department of Nephrology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - John Kanellis
- Department of Nephrology, Monash University Department of Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Alvin Heong Chong
- Department of Medicine (Dermatology), St Vincent's Hospital, Melbourne, Victoria, Australia.,Skin and Cancer Foundation Inc., Melbourne, Victoria, Australia
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18
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Tirico MC, Neto CF, Cruz LL, Mendes-Sousa AF, Valkinir DE, Spina R, Oliveira WR. Clinical spectrum of phaeohyphomycosis in solid organ transplant recipients. JAAD Case Rep 2016; 2:465-9. [PMID: 27981220 DOI: 10.1016/j.jdcr.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Non-melanoma skin cancer (NMSC) is the most common malignancy among the Caucasian population. Photodynamic therapy (PDT) is gaining popularity for the treatment of basal cell carcinoma (BCC), Bowen's disease (BD) and actinic keratosis (AK). A topical or systemic exogenous photosensitiser, results in selective uptake by malignant cells. Protoporphyrin IX (PpIX) is produced then activated by the introduction of a light source. Daylight-mediated MAL (methyl aminolaevulinate) PDT for AKs has the advantage of decreased pain and better patient tolerance. PDT is an effective treatment for superficial BCC, BD and both individual and field treatment of AKs. Excellent cosmesis can be achieved with high patient satisfaction. Variable results have been reported for nodular BCC, with improved outcomes following pretreatment and repeated PDT cycles. The more aggressive basisquamous, morphoeic infiltrating subtypes of BCC and invasive squamous cell carcinoma (SCC) are not suitable for PDT. Prevention of "field cancerization" in organ transplant recipients on long-term immunosuppression and patients with Gorlin syndrome (naevoid basal cell carcinoma syndrome) is a promising development. The optimisation of PDT techniques with improved photosensitiser delivery to target tissues, new generation photosensitisers and novel light sources may expand the future role of PDT in NMSC management.
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Affiliation(s)
- Liezel L Griffin
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M6 8HD, UK.
| | - John T Lear
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester M6 8HD, UK.
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20
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Rizvi SM, Veierød MB, Thorsby PM, Helsing P. Vitamin D in Norwegian renal transplant recipients: A longitudinal study with repeated measurements in winter and summer. Eur J Dermatol 2015; 25:234-9. [PMID: 26412038 DOI: 10.1684/ejd.2015.2524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Organ transplant recipients (OTR) have an increased risk of non-melanoma skin cancer (NMSC) and are advised to avoid direct sunlight. OTR living in the Nordic countries are especially vulnerable to hypovitaminosis D as vitamin D production in the skin is restricted to the summer months. OBJECTIVES To investigate constitutional and external factors predicting hypovitaminosis and seasonal variation of vitamin D in renal transplant recipients (RTR) living in the vicinity of Oslo (59(o) N). METHODS Ninety-four RTR were included. Interviews covering dietary intake of vitamin D and sun exposure were performed and blood samples were collected in February and August 2013. Results Mean age of patients was 56.8 years and mean graft age 14.5 years. The mean daily total vitamin D intake was 11.8 μg, and the prevalence of hypovitaminosis D (<75 nmol/L) was 67.0% in winter and 56.4% in summer. Sunscreen users had significantly higher 25(OH)D than non-users (p = 0.03). Excluding patients having travelled to southern latitudes during the last three months before blood sampling, no statistical difference was found between winter and summer values of vitamin D (p = 0.60). Being male or having red/light blond hair colour increased vitamin D values significantly from winter to summer. CONCLUSIONS Hypovitaminosis D is relatively frequent in Norwegian RTR but not as frequent as earlier reported in studies of RTR from lower latitudes. Lack of seasonal variation in vitamin D may be explained by sun protective behaviour and high dietary intake of vitamin D among patients in this study.
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Abstract
Topical photodynamic therapy is an effective and safe noninvasive treatment for low-risk basal cell carcinoma, with the advantage of an excellent cosmetic outcome. Efficacy of photodynamic therapy in basal cell carcinoma is supported by substantial research and clinical trials. In this article, we review the procedure, indications and clinical evidences for the use of photodynamic therapy in the treatment of basal cell carcinoma.
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Affiliation(s)
| | - Ketty Peris
- Institute of Dermatology, Catholic University of Rome, Rome, Italy
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22
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Forsberg A, Lennerling A, Fridh I, Karlsson V, Nilsson M. Understanding the Perceived Threat of the Risk of Graft Rejections: A Middle-Range Theory. Glob Qual Nurs Res 2015; 2:2333393614563829. [PMID: 28462294 PMCID: PMC5342851 DOI: 10.1177/2333393614563829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.
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Affiliation(s)
- Anna Forsberg
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Gothenburg, Göteborg, Sweden
| | - Isabell Fridh
- University of Gothenburg, Göteborg, Sweden.,University of Borås, Borås, Sweden
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23
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Wheless L, Jacks S, Mooneyham Potter KA, Leach BC, Cook J. Skin cancer in organ transplant recipients: more than the immune system. J Am Acad Dermatol 2014; 71:359-65. [PMID: 24725477 DOI: 10.1016/j.jaad.2014.02.039] [Citation(s) in RCA: 35] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 02/08/2023]
Abstract
Organ transplant recipients (OTRs) are at increased risk of developing nonmelanoma skin cancers. This has long been thought to be caused by immunosuppression and viral infection. However, skin cancer risk among individuals with AIDS or iatrogenic immunodeficiency does not approach the levels seen in OTRs, suggesting other factors play a critical role in oncogenesis. In clinical trials of OTRs, switching from calcineurin inhibitors to mammalian target of rapamycin inhibitors consistently led to a significant reduction in the risk of developing new skin cancers. New evidence suggests calcineurin inhibitors interfere with p53 signaling and nucleotide excision repair. These two pathways are associated with nonmelanoma skin cancer, and squamous cell carcinoma in particular. This finding may help explain the predominance of squamous cell carcinoma over basal cell carcinoma in this population. Mammalian target of rapamycin inhibitors do not appear to impact these pathways. Immunosuppression, viral infection, and impaired DNA repair and p53 signaling all interact in OTRs to create a phenotype of extreme risk for nonmelanoma skin cancer.
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Affiliation(s)
- Lee Wheless
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina; Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Sarah Jacks
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn Anne Mooneyham Potter
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Brian C Leach
- Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina.
| | - Joel Cook
- Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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24
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Seem DL, Lee I, Umscheid CA, Kuehnert MJ. Excerpt from PHS guideline for reducing HIV, HBV and HCV transmission through organ transplantation. Am J Transplant 2013; 13:1953-62. [PMID: 23890284 DOI: 10.1111/ajt.12386] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 01/25/2023]
Abstract
The intent of the PHS guideline is to improve organ transplant recipient outcomes by reducing the risk of unexpected HIV, HBV and HCV transmission, while preserving the availability of high-quality organs. An evidence-based approach was used to identify the most relevant studies and reports on which to formulate the recommendations. This excerpt from the guideline comprises (1) the executive summary; (2) 12 criteria for assessment of risk factors for recent HIV, HBV and HCV infection; (3) 34 recommendations on risk assessment (screening) of living and deceased donors; testing of living and deceased donors; informed consent discussion with transplant candidates; testing of recipients pre- and posttransplant; collection and/or storage of donor and recipient specimens; and tracking and reporting of HIV, HBV and HCV; and (4) 20 recommendations for further study. For the PHS guideline in its entirety, including the background, methodology and primary evidence underlying the recommendations, refer to the source document in Public Health Reports, accessible at http://www.publichealthreports.org/issuecontents.cfm?Volume=128&Issue=4. For more in-depth information on the evidence base, including tables of all study-level data, refer to Solid Organ Transplantation and the Probability of Transmitting HIV, HBV or HCV: A Systematic Review to Support an Evidence-Based Guideline, accessible at http://stacks.cdc.gov/view/cdc/12164/.
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Affiliation(s)
- D L Seem
- Office of Blood, Organ, and Other Tissue Safety, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
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25
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Ismail F, Mitchell L, Casabonne D, Gulati A, Newton R, Proby CM, Harwood CA. Specialist dermatology clinics for organ transplant recipients significantly improve compliance with photoprotection and levels of skin cancer awareness. Br J Dermatol 2006; 155:916-25. [PMID: 17034519 PMCID: PMC2423225 DOI: 10.1111/j.1365-2133.2006.07454.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [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: 12/25/2022]
Abstract
BACKGROUND Organ transplant recipients (OTRs) have 100-fold increased risk of developing squamous cell carcinomas. Cumulative exposure to ultraviolet radiation is the main risk factor and there is evidence that lack of dermatological surveillance may be responsible for poor levels of knowledge and photoprotection among OTRs. OBJECTIVES This study evaluated whether routine consultation in a specialist OTR dermatology clinic improves understanding of skin cancer risk and compliance with photoprotection measures. METHODS A cross-sectional questionnaire-based study was performed in a specialist OTR dermatology clinic at Bart's and the London NHS Trust, London, U.K. The subjects were 399 white-skinned patients under surveillance in a renal transplant clinic, who were sent a postal questionnaire from the renal transplant clinic. The main outcome measures were responses to the questionnaire regarding photoprotective practices and skin cancer risk awareness. RESULTS Two hundred and ninety-two of 399 (73%) responded, of whom 89% had previously attended the specialist dermatology clinic. Ninety-six per cent recalled receiving photoprotection advice at least once (85% from dermatologists); 92% reported use of sunscreen; 88% specifically dressed to photoprotect themselves; 96% directly avoided sun exposure during summer; 68% were aware that an increased risk of skin cancer was the reason that extra photoprotective measures were important after a transplant. Photoprotective measures and level of skin cancer awareness were significantly lower in those responders who had never attended the specialist clinic. No obvious bias was identified among nonresponders. CONCLUSIONS Skin cancer awareness and compliance with photoprotective measures in our patient population is generally greater than previously reported, suggesting that delivery of educational messages regarding skin cancer may be improved if provided in a specialist dermatological setting.
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Affiliation(s)
- F Ismail
- Centre for Cutaneous Research, Institute of Cell and Molecular Science, St Bartholomew's and the Royal London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK.
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