Lesional Infiltration of Eosinophils, Basophils, and M2 Macrophages Expressing Eotaxin-1 and Eotaxin-3 in Granuloma Faciale, but not in Erythema Elevatum Diutinum

Abstract is missing (Short communication)

Possible Association of Interleukin-31/-31RA Signalling and Basophils with Itch in Porokeratosis

is missing (Short communication).

Efficacy of aluminum chloride in severe regorafenib-associated hand-foot skin reactions: a single-arm trial

BACKGROUND

Regorafenib, a multikinase inhibitor, causes a high frequency of hand-foot skin reactions (HFSRs). The present study evaluated the efficacy of topical aluminum chloride, a perspiration suppressant, in reducing the severity of hand-foot skin reactions (HFSRs) caused by regorafenib.

METHODS

The present single-arm study included patients with metastatic colorectal cancer receiving regorafenib. Aluminum chloride ointment was applied topically one week prior to the start of regorafenib treatment, and the observation period was 12 weeks. The primary endpoint was the incidence of regorafenib-related grade 3 HFSR. Secondary endpoints were the incidence of all grades of HFSR, time to any grade of HFSR, time to improvement from grade 2 or higher to grade 1 or lower, treatment discontinuation rate, treatment interruption rate or dosage reduction due to HFSR, and incidence of adverse effects of aluminum chloride.

RESULTS

In total 28 patients were enrolled, and 27 patients were analyzed. The incidence of grade 3 HFSR was 7.4%, meeting the primary endpoint. The incidence of all grades of HFSR was 66.7%, and the median time to the occurrence of any grade of HFSR was 15 days. No patients discontinued or reduced the regorafenib dosage because of HFSR. The most common reason for the interruption of regorafenib therapy was liver dysfunction in nine patients (33%) and HFSR in three patients (11%). No serious adverse events related to aluminum chloride were observed.

CONCLUSIONS

Aluminum chloride ointment, a drug commonly used in routine practice to treat hyperhidrosis, is safe to use, has no serious side effects, and may be effective in reducing the occurrence of severe, regorafenib-related HFSR.

TRAIL REGISTRATION

ClinicalTrials.gov. identifier: jRCTs031180096, Registered on 25/01/2019.

Improvement in the elution performance of an N,N,N',N-tetraoctyl diglycolamide impregnated extraction chromatography adsorbent using neodymium via micro-particle-induced X-ray emission analysis

An adsorbent used for the recovery of trivalent minor actinides (MA(III); Am and Cm) from high level liquid waste generated from reprocessing of spent nuclear fuel was subjected to micro-particle induced X-ray emission (micro-PIXE) analysis to improve its elution performance. The experimental adsorbent comprised SiO₂ particles, a polymer coating, and an N,N,N',N'-tetraoctyl diglycolamide (TODGA). The particles to be analyzed were subjected to Nd adsorption and an elution operation, but Nd in the adsorbent was found to be uniformly distributed. This might have been caused by individual differences in the amount of impregnated TODGA. The remaining Nd species were not localized to a specific part of the adsorbent after the adsorption operation. Some Nd elements were retained in the adsorbent after elution, probably because of the poor diffusion of the mobile phase inside the adsorbent. An adsorbent having a different microstructure from the first was then evaluated, and rapid elution was observed on new adsorbent along micro-PIXE analysis.

Increased touch-evoked itch (punctate hyperknesis) in postherpetic itch: Implications of reduced intraepidermal nerve fibers representing small fiber neuropathy

Chronic itch conditions are often accompanied by neural itch sensitization, known as hyperknesis (excessive itch induced by stimuli that would normally induce only mild itching or pain) and alloknesis (considerable itch evoked by light tactile stimuli). Herpes zoster (shingles) can cause neuropathic itch (postherpetic itch), although it is unknown whether hyperknesis accompanies postherpetic itch. The authors report five patients with postherpetic itch who showed increased touch-evoked itch (punctate hyperknesis) in the affected skin areas compared with the contralateral site. Collected skin biopsy specimens from two patients showed histopathologically detected reduced intraepidermal nerve fibers in the affected skin areas, reflective of small C/Aδ fiber neuropathy. In one case, improvement in itching and comparable levels of touch-evoked itch on the affected and contralateral sites were noted after 6 months without any medication, accompanied by restored intraepidermal nerve fibers proven through rebiopsy of the affected site. Reduced intraepidermal nerve fibers could be one of the precipitating factors for postherpetic itch and its associated punctate hyperknesis.

344 Dupilumab significantly improves itch and skin lesions in patients with prurigo nodularis: pooled results from two phase 3 trials (LIBERTY-PN PRIME and PRIME2)

Prurigo nodularis (PN), a chronic inflammatory and pruritic skin condition with severely itchy skin nodules, substantially affects the quality of life and is often inadequately controlled with topical medications. Recently, the US Food and Drug Administration approved dupilumab as the first systemic therapy for PN. Two randomized clinical trials with similar designs, LIBERTY-PN PRIME (NCT04183335) and PRIME2 (NCT04202679), demonstrated the efficacy and safety of dupilumab in adults with PN inadequately controlled with topical medications or for whom those who were inadvisable. To report the efficacy of dupilumab on pruritus and skin lesions in PN, as well as its safety, by analysing pooled data from PRIME and PRIME2 trials, given their similar trial design. PRIME and PRIME2 were multicentre, randomized, placebo-controlled, double-blinded, phase 3 trials, which comprised a 2–4-week screening, 24-week treatment and 12-week follow-up period. Itch severity was measured by Worst Itch Numerical Rating Scale (WI-NRS), ranging from 0 (no itch) to 10 (worst itch imaginable). The severity of skin lesions was assessed using Investigator’s Global Assessment for PN-Stage (IGA PN-S), as score 0 (no nodules), 1 (1–5 nodules), 2 (6–19 nodules), 3 (20–99 nodules) or 4 (over 100 nodules). To be eligible for enrolment patients had WI-NRS ≥7, and IGA PN-S score of 3 or 4. Patients received subcutaneous dupilumab 300 mg (loading dose, 600 mg) or matched placebo every 2 weeks for 24 weeks. Efficacy endpoints were the proportion of patients with a WI-NRS score reduction of ≥4 points, the proportion of patients who achieved an IGA PN-S score of 0 or 1, and the proportion of patients who achieved concomitantly WI-NRS reduction of ≥4 points and IGA PN-S score of 0 or 1, at week 12 and at week 24. At baseline, demographic and disease characteristics were balanced between the PRIME and PRIME2 pooled dupilumab (n = 153), and pooled placebo groups (n = 158). All but 1 patient had used prior topical medications for PN, and 66.2% had used off-label systemic medications. Despite prior therapies, at baseline, the overall mean (standard deviation) WI-NRS score was 8.5 (1.0); 66.3% of patients had 20–99 nodules, and 33.7% had over 100 nodules. At week 12, the ≥4-point reduction in WI-NRS in the dupilumab group was achieved by 62 patients (40.5%), and at week 24, by 90 (58.8%), compared with 30 patients (19.0%) in the placebo group at each time point (P < 0.0001 for both). An IGA PN-S score of 0 or 1 was achieved by 44 (28.8%) patients in the dupilumab group vs. 19 (12.0%) in the placebo group at week 12 (P = 0.0002), and, respectively, by 71 (46.4%) vs. 27 (17.1%) patients at week 24 (P < 0.0001). The concomitant reduction in WI-NRS by ≥4 points and IGA PN-S score of 0 or 1 was achieved by 28 (18.3%) patients in the dupilumab group vs. 11 (7.0%) in the placebo group at week 12 (P = 0.0021), and, respectively, by 54 (35.3%) vs. 14 (8.9%) patients at week 24 (P < 0.0001). The rate of treatment-emergent adverse events was 59.9% with dupilumab and 51.0% with placebo. The most common adverse events were headache (5.3% vs. 5.7%), neurodermatitis (2.0% vs. 5.7%), skin infections (3.9% vs. 7.6%) and injection-site reactions (3.9% vs. 5.7%) in dupilumab vs. placebo groups. Dupilumab demonstrated clinically meaningful and statistically significant improvements in itch and skin lesions vs. placebo in patients with PN, confirming the findings from individual PRIME and PRIME2 studies. The safety profile of dupilumab was consistent with the known safety profile in its approved indications.

IL-31 and IL-31 receptor alpha in pemphigus: Contributors to more than just itch?

Pemphigus is an autoimmune blistering disorder with four major subtypes: pemphigus vulgaris (PV), pemphigus vegetans (PVe), pemphigus foliaceus (PF), and pemphigus herpetiformis (PH). Among them, PF and PH present itching as a clinical feature; however, the mechanisms behind the pruritus are still unclear. In this report, we sought to investigate the expression of a type 2 inflammation-related pruritogenic cytokine IL-31 and its receptor subunit IL-31RA through immunofluorescence staining analysis. The number of eosinophils, basophils, and mast cells, and the expression levels of thymic stromal lymphopoietin (TSLP) and periostin were also investigated. Evaluation showed an increase in the number of dermal IL-31⁺ cells and IL-31RA⁺ cells in PH and PVe. Epidermal expression of IL-31RA increased in PV, PF, and PVe, but not in PH, compared to healthy individuals. The number of dermal eosinophils and basophils was also increased in PVe and PH. The number of dermal mast cells and expression levels of TSLP and periostin did not change among pemphigus subtypes and healthy controls. Collectively, enhanced IL-31/IL-31RA signaling and the increased numbers of dermal eosinophils and basophils may participate in itching in PH. On the other hand, IL-31/IL-31RA signaling seemed unable to provoke itching in PVe, a non-pruritic subtype of pemphigus, although it might contribute to epidermal thickening and dermal fibrosis.

Summary of the current status of clinically diagnosed cases of Schnitzler syndrome in Japan

BACKGROUND

Schnitzler syndrome is a rare disorder with chronic urticaria, and there is no report summarizing the current status in Japan.

METHODS

A nationwide survey of major dermatology departments in Japan was conducted in 2019. We further performed a systematic search of PubMed and Ichushi-Web, using the keywords "Schnitzler syndrome" and "Japan" then contacted the corresponding authors or physicians for further information.

RESULTS

Excluding duplicates, a total of 36 clinically diagnosed cases were identified from 1994 through the spring of 2022, with a male to female ratio of 1:1. The median age of onset was 56.5 years. It took 3.3 years from the first symptom, mostly urticaria, to reach the final diagnosis. The current status of 30 cases was ascertained; two patients developed B-cell lymphoma. SchS treatment was generally effective with high doses of corticosteroids, but symptoms sometimes recurred after tapering. Colchicine was administered in 17 cases and was effective in 8, but showed no effect in the others. Tocilizumab, used in six cases, improved laboratory abnormalities and symptoms, but lost its efficacy after several years. Rituximab, used in five cases, was effective in reducing serum IgM levels or lymphoma mass, but not in inflammatory symptoms. Four cases were treated with IL-1 targeting therapy, either anakinra or canakinumab, and achieved complete remission, except one case with diffuse large B-cell lymphoma.

CONCLUSIONS

Since Schnitzler syndrome is a rare disease, the continuous collection and long-term follow-up of clinical information is essential for its appropriate treatment and further understanding of its pathophysiology.

Proinflammatory role of basophils in oxazolone-induced chronic intestinal inflammation

BACKGROUND AND AIM

The functions of basophils have not been elucidated until recently because of their rarity. However, with recent developments in basophil-specific antibodies and basophil-deficient animals, the roles of basophils in various diseases related to chronic inflammation have been clarified. In this study, we aimed to investigate the roles of basophils in human ulcerative colitis (UC) and oxazolone (OXA) colitis using genetically engineered Mcpt8^DTR mice.

METHODS

Immunohistochemical staining of human colon specimens was performed to examine the involvement of basophils in the pathogenesis of UC. We examined the correlation between the number of infiltrating basophils and the UC endoscopic index of severity (UCEIS), Mayo score, and Matts score. We also examined the correlation between eosinophil count and basophil infiltration. In murine experiments, we examined whether basophil infiltration was involved in OXA-induced colitis and whether basophil depletion improved inflammation in Mcpt8^DTR mice.

RESULTS

Colonic basophil infiltration was significantly increased in patients with UC. There were significant correlations between UCEIS, Mayo score, Matts score, and the number of infiltrating basophils. In murine OXA-induced colitis, a significant increase in basophil infiltration was observed. When basophils were depleted by diphtheria toxin in Mcpt8^DTR mice, inflammation improved significantly and mRNA expression of some proinflammatory cytokines, including Tnf-α and Ifn-γ decreased significantly.

CONCLUSION

Basophil infiltration correlated with endoscopic, clinical, and pathological scores in human UC independently of eosinophil infiltration, and depletion of basophils ameliorated mucosal inflammation in murine OXA-induced colitis, collectively suggesting that basophils exert a proinflammatory role in chronic intestinal inflammation such as UC.

Dermal, but not Epidermal, Immune Reaction in Cutaneous Spiruroid Larva Migrans: Involvement of Basophils in Dermal Interleukin-33 and Thymic Stromal Lymphopoietin Expression

Abstract is missing (Short communication)

A phase II trial of stereotactic body radiotherapy in 4 fractions for patients with localized prostate cancer

Purpose/objective(s)

To report results from our phase II study of stereotactic body radiotherapy (SBRT) delivering 36 Gy in 4 fractions for patients with localized prostate cancer.

Materials/methods

We enrolled 55 patients treated with SBRT delivering 36 Gy in 4 fractions between 2015 to 2018. All patients were categorized as low-risk (n = 4), intermediate-risk (n = 31) or high-risk (n = 20) according to National Comprehensive Cancer Network criteria. Median age was 73 years (range 54–86 years). Two-thirds of patients (n = 37) had received androgen-deprivation therapy for 3–46 months (median, 31 months). Median duration of follow-up was 36 months (range 1–54 months). We used Radiation Therapy Oncology Group and National Cancer Institute—Common Toxicity Criteria version 4 for toxicity assessments. Quality of life (QOL) outcomes were also evaluated using the Expanded Prostate Cancer Index Composite (EPIC).

Results

Protocol treatments were completed for all patients. Six patients experienced biochemical failures. Among these six patients, three patients experienced clinical failure. One patient showed bone metastasis before biochemical failure. One patient died of gastric cancer. The 3-year biochemical control rate was 89.8%. Acute grade 2 genitourinary (GU) and gastrointestinal (GI) toxicities were observed in 5 patients (9%) and 6 patients (11%), respectively. No grade 3 or higher acute toxicities were observed. Late grade 2 GU and GI toxicities were observed in 7 patients (13%) and 4 patients (7%), respectively. Late grade 3 GU and GI toxicities were observed in 1 patient (1.8%) each. EPIC scores decreased slightly during the acute phase and recovered within 3 months after treatment.

Conclusion

Our phase II study showed that SBRT delivering 36 Gy in 4 fractions was safe and effective with favorable QOL outcomes, although this regimen showed slightly more severe toxicities compared to current standards.