Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting

The use of nonstandardized and inadequately validated outcome measures in atopic eczema trials is a major obstacle to practising evidence-based dermatology. The Harmonising Outcome Measures for Eczema (HOME) initiative is an international multiprofessional group dedicated to atopic eczema outcomes research. In June 2011, the HOME initiative conducted a consensus study involving 43 individuals from 10 countries, representing different stakeholders (patients, clinicians, methodologists, pharmaceutical industry) to determine core outcome domains for atopic eczema trials, to define quality criteria for atopic eczema outcome measures and to prioritize topics for atopic eczema outcomes research. Delegates were given evidence-based information, followed by structured group discussion and anonymous consensus voting. Consensus was achieved to include clinical signs, symptoms, long-term control of flares and quality of life into the core set of outcome domains for atopic eczema trials. The HOME initiative strongly recommends including and reporting these core outcome domains as primary or secondary endpoints in all future atopic eczema trials. Measures of these core outcome domains need to be valid, sensitive to change and feasible. Prioritized topics of the HOME initiative are the identification/development of the most appropriate instruments for the four core outcome domains. HOME is open to anyone with an interest in atopic eczema outcomes research.

Questionnaires to assess chronic itch: a consensus paper of the special interest group of the International Forum on the Study of Itch

Chronic itch affects millions of patients worldwide and has a significant impact on quality of life. The assessment of itch and its associated effects is a significant component of clinical practice in itch management. Despite itch being a common complaint, there are few studies describing the use of structured questionnaires for evaluation and measurement of itch and its sensory and affective dimensions. The International Society of the Study of Itch (IFSI) has recently provided invaluable data on the use of visual analogue scales as an assessment tool for itch. However, it is clear that additional tools are needed to better assess the different dimensions of chronic itch and better tailor management. With this goal in mind, a Special Interest Group was initiated by members of IFSI to determine which of the various psychometric properties of itch questionnaires offer the greatest utility in the evaluation of chronic itch. This first consensus paper addresses what domains and structure of itch questionnaires need to be implemented to better assess chronic itch and guide therapy.

A randomized, open-label, multicenter trial of topical tacrolimus for the treatment of pruritis in patients with atopic dermatitis

Background

Pruritis caused by atopic dermatitis (AD) is not always well controlled by topical corticosteroid therapy, but use of tacrolimus often helps to soothe such intractable pruritis in clinical settings.

Objective

To determine the anti-pruritic efficacy of topical tacrolimus in treating AD in induction and maintenance therapy.

Methods

Prior to the study, patients were randomly allocated into two groups, induction therapy followed by tacrolimus monotherapy maintenance, and induction therapy followed by emollient-only maintenance. In the induction therapy, the patients were allowed to use topical tacrolimus and emollients in addition to a low dose (<10 g/week) of topical steroids. Patients showing relief from pruritis were allowed to proceed to maintenance therapy. Recurrence of pruritis in maintenance therapy was examined as a major endpoint.

Results

Two-thirds of patients (44/68; 64.7%) showed relief from pruritis after induction therapy. Pruritis recurred in 23.8% (5/21) of the tacrolimus monotherapy group and in 100% (21/21) of the emollient group during maintenance period, a difference that was statistically significant.

Conclusion

Use of topical tacrolimus is effective in controlling pruritis of AD compared to emollient.

ORAI1 genetic polymorphisms associated with the susceptibility of atopic dermatitis in Japanese and Taiwanese populations

Atopic dermatitis is a chronic inflammatory skin disease. Multiple genetic and environmental factors are thought to be responsible for susceptibility to AD. In this study, we collected 2,478 DNA samples including 209 AD patients and 729 control subjects from Taiwanese population and 513 AD patients and 1027 control subject from Japanese population for sequencing and genotyping ORAI1. A total of 14 genetic variants including 3 novel single-nucleotide polymorphisms (SNPs) in the ORAI1 gene were identified. Our results indicated that a non-synonymous SNP (rs3741596, Ser218Gly) associated with the susceptibility of AD in the Japanese population but not in the Taiwanese population. However, there is another SNP of ORAI1 (rs3741595) associated with the risk of AD in the Taiwanese population but not in the Japanese population. Taken together, our results indicated that genetic polymorphisms of ORAI1 are very likely to be involved in the susceptibility of AD.

P1-02-10: Vimentin Expression; as a Prognostic Factor and a Possible Molecular Target of Triple Negative Breast Cancer

BACKGROUND: Triple negative breast cancer (TNBC), characterized by absence of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2), is typically associated with aggressive tumor phenotype and poor prognosis. TNBC is also considered highly heterogeneous disease. Since TNBC lacks efficient therapeutic target, it is generally treated with nonspecific cytotoxic agents. A better understanding of molecular and histopathological features of TNBC is of great importance, in order to develop a new therapeutic strategy and to improve the prognosis of TNBC. TNBC has many similarities with basal-like breast cancer (BLBC), and is also associated with stemness and BRCAness. In addition, recent studies suggest links between TNBC and epithelial-mesenchymal transition (EMT). To identify prognostic biomarkers and novel therapeutic targets, we investigated the expression of the factors associated with EMT in TNBC.

MATERIALS and METHODS: Sporadic invasive breast cancer specimens were obtained from 659 Japanese patients who underwent surgery in our department between 1994 and 2010, and 90(14%) cases were diagnosed as TNBC. The E-cadherin and vimentin mRNA expression was evaluated by quantitative RT-PCR. The E-cadherin, vimentin, CK5/6 and epidermal growth factor receptor(EGFR) protein expression was assessed by immunohistochemistry. In this study, we defined TNBC with positive expression of CK5/6 and/or EGFR as BLBC, and TNBC with low expression of E-cadherin and positive expression of vimentin as EMT-type.

RESULTS: Compared with non-TNBC cases, E-cadherin mRNA expression was significantly lower in TNBC cases (p=0.0012). Immunohistochemically, E-cadherin expression was significantly lower (p=0.0001) and vimentin expression was significantly higher (p=0.0049) in TNBC cases. Vimentin expression was associated with younger age (&lt;50 years old, p=0.021), high nuclear grade (p=0.017) and high Ki67 expression (p&lt;.001) in TNBC. Among the patients with TNBC, vimentin expression was significantly associated with poor prognosis, in terms of disease free survival (p=0.0059) and overall survival (p=0.013). Multivariate analysis showed that vimentin expression was an independent prognostic factor for both disease free survival (p=0.017) and overall survival (p=0.012). Among TNBC cases, 52(63%) cases were BLBCs and 15(18%) cases were EMT-type. Among BLBC patients, vimentin expression was also associated with significantly shorter disease free survival (p=0.0085) and overall survival (p=0.0057). The patients with both BLBC and EMT-type features showed especially poor prognosis(P=0.05). CONCLUSION: These findings suggest that elevated expression of vimentin attributes to the aggressive phenotype in TNBC patients. Vimentin expression might be useful as a molecular marker for prognosis of TNBC, and vimentin may represent a novel therapeutic target of TNBC.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-10.

Variants of C-C motif chemokine 22 (CCL22) are associated with susceptibility to atopic dermatitis: case-control studies

Atopic dermatitis (AD) is a common inflammatory skin disease caused by multiple genetic and environmental factors. AD is characterized by the local infiltration of T helper type 2 (Th2) cells. Recent clinical studies have shown important roles of the Th2 chemokines, CCL22 and CCL17 in the pathogenesis of AD. To investigate whether polymorphisms of the CCL22 gene affect the susceptibility to AD, we conducted association studies and functional studies of the related variants. We first resequenced the CCL22 gene and found a total of 39 SNPs. We selected seven tag SNPs in the CCL22 gene, and conducted association studies using two independent Japanese populations (1^st population, 916 cases and 1,032 controls; 2^nd population 1,034 cases and 1,004 controls). After the association results were combined by inverse variance method, we observed a significant association at rs4359426 (meta-analysis, combined P = 9.6×10⁻⁶; OR, 0.74; 95% CI, 0.65–0.85). Functional analysis revealed that the risk allele of rs4359426 contributed to higher expression levels of CCL22 mRNA. We further examined the allelic differences in the binding of nuclear proteins by electrophoretic mobility shift assay. The signal intensity of the DNA-protein complex derived from the G allele of rs223821, which was in absolute LD with rs4359426, was higher than that from the A allele. Although further functional analyses are needed, it is likely that related variants play a role in susceptibility to AD in a gain-of-function manner. Our findings provide a new insight into the etiology and pathogenesis of AD.

Histamine differentially regulates the production of Th1 and Th2 chemokines by keratinocytes through histamine H1 receptor

Histamine is a biological amine that plays an important role in allergic responses. However, the involvement of histamine signaling in late allergic responses in the skin is poorly understood. Therefore, we attempted to investigate the involvement of histamine signaling in late allergic responses, especially in keratinocytes (KCs). HaCaT KCs and normal human KCs (NHKs) predominantly expressed histamine H1 receptor (H1R) and H2 receptor (H2R). Histamine suppressed tumor necrosis factor α (TNF-α)- and interferon-γ (IFN-γ)-induced production of CC chemokine ligand 17(CCL17), a type 2 T-helper (Th2) chemokine, by HaCaT KCs. It suppressed the phosphorylation of p38 mitogen-activated protein (MAP) kinase, but not that of extracellular signal-regulated kinases (ERKs), and TNF-α- and IFN-γ-induced nuclear factor κB (NFκB) activity. In contrast, histamine enhanced the production of CXC chemokine ligand 10 (CXCL10), a Th1 chemokine, by TNF-α- and IFN-γ-stimulated HaCaT KCs and NHKs. TNF-α- and IFN-γ-induced CXCL10 production was upregulated by suppression of p38 MAP kinase or NF-κB activity, which could explain histamine involvement. We concluded that histamine suppresses CCL17 production by KCs by suppressing p38 MAP kinase and NF-κB activity through H1R and may act as a negative-feedback signal for existing Th2-dominant inflammation by suppressing CCL17 and enhancing CXCL10 production.

The development of Th1-mediated sarcoidosis improves the clinical course of Th2-mediated atopic dermatitis

Sarcoidosis is a chronic multisystem disease of unknown origin, which is characterized by T-helper-1 (Th1)-mediated immune responses. On the other hand, atopic dermatitis (AD) is characterized by Th2-mediated immune responses. We recently experienced an interesting case of AD in which the patient experienced a significant resolution of AD after the onset of sarcoidosis. We herein describe the details of his clinical course and discuss the impact of negative cross-regulation between Th1 and Th2 immune responses.

Prevalence of intestinal parasites and genotyping of Giardia intestinalis in pet shop puppies in east Japan

The current study examined the prevalence of intestinal parasites and genotypes of Giardia intestinalis in puppies from nine pet shops in east Japan. Fresh fecal samples from 1794 puppies (≦3 months old) were collected on one occasion. Giardia spp. was examined for specific coproantigen using ELISA kit (SNAP®Giardia, IDEXX Laboratories, Inc., USA). Other intestinal parasites were detected microscopically using the formalin-ethyl acetate sedimentation technique. Genotyping was determined for the random 29 stool samples identified as Giardia spp. positive using PCR and direct sequencing of the glutamate dehydrogenase (gdh) gene. Overall prevalence of protozoan Giardia spp. and Cystoisospora spp. revealed 23.4% and 11.3%, respectively. Prevalence of ascarids, Strongyloides spp. and hookworms were recorded 1.8%, 1.1% and 0.1%, respectively. Protozoan Giardia spp. and Cystoisospora spp., thus, represent important pathogens among pet shop puppies. All genotyped G. intestinalis isolates were belonged to assemblage C or D, identified as dog-specific genotypes. Zoonotic assemblage A and B were not demonstrated. The result suggests that the risk of zoonotic transmission of G. intestinalis from pet shops puppies to humans may be quite low in Japan.

Secondary cutaneous candidiasis with eosinophilia

Cutaneous candidiasis is a common skin infection caused by the Candida species, especially in intertriginous areas, and neutrophils usually infiltrate histopathologically. We describe a case of secondary cutaneous candidiasis which spread extensively to the trunk and extremities and showed marked dermal eosinophilia. This case and a similar reported case suggest that Candida can sometimes cause cutaneous inflammation predominantly composed of eosinophils.