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Alhetheli G, Elneam AIA, Alsenaid A, Al-Dhubaibi M. Vitamin D Levels in Patients with and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clin Cosmet Investig Dermatol 2020; 13:759-765. [PMID: 33116739 PMCID: PMC7549021 DOI: 10.2147/ccid.s271500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/24/2020] [Indexed: 01/14/2023]
Abstract
Background Vitamin D plays a significant role in the function of the immune system and it influences many dermatological diseases such as psoriasis and atopic dermatitis. The prevalence of vitamin D deficiency is growing globally, with around 30–50% of people are known to have low levels of vitamin D. Acne vulgaris is a common inflammatory disorder of the pilosebaceous unit. Studies about the role of vitamin D in the pathogenesis of acne vulgaris have shown conflicting and nonconclusive results. Thus, the precise purpose of vitamin D has not yet been established. Objective First, to evaluate serum levels of vitamin D through a representative sample of patients with acne vulgaris and compare it with matched healthy controls. Second, to investigate if there is a relation between serum vitamin D level and the severity of acne vulgaris. Materials and Methods This cross-sectional study included 68 patients with acne vulgaris and 50 matched healthy controls. Serum 25-hydroxyvitamin D [25 (OH) D] levels were measured for both patients and healthy controls. Results The study yielded lower levels of serum 25-hydroxyvitamin D in patients with acne vulgaris than its level in healthy controls. This is statistically significant with P-value = 0.003. Regarding age, gender, and sun exposure, there is no significant variation in serum 25-hydroxyvitamin D level. Also, no significant difference between the severity of acne and serum 25-hydroxyvitamin D levels. Conclusion This study has shown clearly that vitamin D deficiency is more frequent in patients with acne with P-value = 0.003. However, no significant association between the serum level of 25-hydroxyvitamin D [25 (OH) D] and the severity of acne vulgaris. Further clinical trials on a larger scale are needed to address the importance of vitamin D in acne vulgaris. Specifically, determining whether treatment of acne with both topical vitamin D analogs and vitamin D supplementation is of significant effect.
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Affiliation(s)
- Ghadah Alhetheli
- Department of Dermatology and Cutaneous Surgery, College of Medicine, Qassim University, Buraidah, Saudi Arabia
| | - Ahmed Ibrahim Abd Elneam
- Clinical Biochemistry, Department of Basic Medical Sciences, College of Medicine, Shaqra University, Dawadmi, Saudi Arabia.,Molecular Genetics and Enzymology Department, Human Genetics Division, National Research Centre, Dokki 12622, Cairo, Egypt
| | - Adel Alsenaid
- Dermatology, Department of Medicine, College of Medicine, Shaqra University, Dawadmi, Saudi Arabia
| | - Mohammed Al-Dhubaibi
- Dermatology, Department of Medicine, College of Medicine, Shaqra University, Dawadmi, Saudi Arabia
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52
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Wu Y, Zhang G, Zhou M. Inhibitory and anti-inflammatory effects of two antimicrobial peptides moronecidin and temporin-1Dra against Propionibacterium acnes in vitro and in vivo. J Pept Sci 2020; 26:e3255. [PMID: 32567152 DOI: 10.1002/psc.3255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/20/2020] [Accepted: 05/10/2020] [Indexed: 12/30/2022]
Abstract
Proliferation of Propionibacterium acnes (P. acnes) is one of the main pathogenetic mechanisms of acne. Antimicrobial peptides with low-drug resistance and nonresidual are potential anti-acne agents. In this study, two antimicrobial peptides named temporin-1Dra and moronecidin were synthesized and tested their antimicrobial activity against P. acnes in vitro and in vivo. These two peptides inhibited the growth of Escherichia coli, Staphylococcus aureus, Candida albicans, and P. acnes. The minimal inhibitory concentrations (MICs) of temporin-1Dra and moronecidin to P. acnes were 30 and 10 μM, respectively. Both peptides exhibited strong resistance to heat and pH, but no obvious cytotoxicity to HaCaT cells. They also displayed persistent antimicrobial activities in the microbial challenge test. In the P. acnes-induced inflammation mouse model, moronecidin significantly decreased the ear swelling thickness in a concentration-dependent manner. At the 14th day after injection, 20 μg/day moronecidin reduced the ear swelling thickness to 46.15 ± 5.23% compared with the normal cream group. Tissue staining showed that moronecidin effectively reduced abscess and thickness of the dermis layer. Our results indicate that the antimicrobial peptide moronecidin could be developed as a potential natural anti-acne agent in the cosmetics or pharmaceutical industries.
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Affiliation(s)
- Yun Wu
- Guangdong Provincial Key Laboratory of Medical Molecular Diagnostics, Guangdong Medical University, Dongguan, China
| | - Guangxian Zhang
- School of Fundamental Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Maojun Zhou
- Department of Oncology, Laboratory of Structural Biology, NHC Key Laboratory of Cancer Proteomics, Xiangya Hospital, Central South University, Changsha, China
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53
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Farag AGA, Maraee AH, Rifaat Al-Sharaky D, Elshaib ME, Kohla MSM, Shehata WA. Tissue expression of IL-17A and FOXP3 in acne vulgaris patients. J Cosmet Dermatol 2020; 20:330-337. [PMID: 32413182 DOI: 10.1111/jocd.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES CD4+ T helper (Th) cells through its pro-inflammatory cell type, interleukin-17 (IL-17)-generating cells and its anti-inflammatory category forkhead box P3-positive (FOXP3+ ) regulatory T (Treg) cells, play a vital role in the immune balance in inflammatory disorders. Therefore, assessment of both IL-17 and FOXP3 in acne vulgaris (AV), a chronic inflammatory disease of the pilosebaceous unit, could be of value in understanding AV pathogenesis. This study aimed to investigate the immunohistochemical expression of IL-17A and FOXP3 in acne vulgaris lesions versus normal skin. METHODS Forty-five AV patients and 25 controls were included in this case-control study. Biopsies from participants were analyzed for IL-17A and FOXP3 immunohistochemical profiles using IL-17A and FOXP3 polyclonal antibodies. RESULTS Compared to controls, AV patients exhibited a significant increase of IL-17A percent of expression in epidermis (P ≤ .001), in lymphocytes in papillary dermis (P ≤ .001), and in perifollicular lymphocytic inflammatory infiltrate in AV lesions. Also, there was a significant elevation in FOXP3 percent of expression in epidermis (P = .049) and in lymphocytes in papillary dermis (P ≤ .027) in acne patients than control. A significant positive correlation between IL-17A expression in papillary lymphocytes and in epidermal keratinocyte was observed (r = .537, P = .001). In acne vulgaris patients, the associations between IL-17A and FOXP3 expressions could not reach level of significance. CONCLUSIONS There was an up-regulation of IL-17A and FOXP3 in acne vulgaris development, but with independent roles. Moreover, targeting of IL-17A and FOXP3 may open the door for development of new therapeutic agents in acne vulgaris treatment.
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Affiliation(s)
- Azza Gaber Antar Farag
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | - Alaa Hassan Maraee
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
| | | | | | | | - Wafaa Ahmed Shehata
- Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Shebin ElKom, Egypt
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Kim M, Yin J, Hwang IH, Park DH, Lee EK, Kim MJ, Lee MW. Anti-Acne Vulgaris Effects of Pedunculagin from the Leaves of Quercus mongolica by Anti-Inflammatory Activity and 5α-Reductase Inhibition. Molecules 2020; 25:molecules25092154. [PMID: 32380665 PMCID: PMC7249114 DOI: 10.3390/molecules25092154] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/01/2020] [Accepted: 05/03/2020] [Indexed: 12/16/2022] Open
Abstract
Quercus mongolica (QM)—a member of the Fagaceae family—has been used as traditional medicine in Korea, China and Mongolia as a treatment for inflammation of oral, genital or anal mucosa and for external inflammation of skin. To treat acne vulgaris (AV), we evaluated the inhibition of inflammatory cytokines (IL-6 and IL-8) of QM leaf extract (QML) and its main compound, pedunculagin (PD) in vitro and 5α-reductase inhibitory activity by western blotting. As results, QML and PD showed potent NO production inhibitory activity compared with the positive control (PC), NG-monomethyl-L-arginine (L-NMMA). QML and PD was also showed the decreases of IL-6 and IL-8 compared with the PC, EGCG and exhibited potent 5α-reductase type 1 inhibitory activities compared with the PC, dutasteride.
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55
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Kemeriz F, Tuncer SÇ, Acar EM, Tuğrul B. Evaluation of 25-hydroxy vitamin D levels and disease severity in patients with acne vulgaris. Dermatol Ther 2020; 33:e13393. [PMID: 32268447 DOI: 10.1111/dth.13393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/17/2020] [Accepted: 04/04/2020] [Indexed: 12/17/2022]
Abstract
Acne vulgaris is a multifactorial skin disorder. Many etiological factors are speculated to contribute to the pathogenesis of acne, one of these is vitamin D deficiency. Previous studies reported contradictory results about serum 25 hydroxy vitamin D (25-OH vitamin D) levels, its association with acne, some claimed that acne lesion might improve with vitamin D supplementation. We aimed to assess serum 25-OH vitamin D levels in acne patients, identify their relation with disease severity in a larger study group. The study included 134 acne patients, 129 controls. Acne disease severity was identified with Global Acne Grading Scale (GAGS) scores. Serum 25-OH vitamin D levels were measured in all groups. Serum 25-OH vitamin D levels were significantly lower in acne patients than in controls (P < .001). The prevalence of vitamin D deficiency was significantly higher in acne group than in control group (77.6% vs 63.9%; P = .041). There was a negative-strong statistically significant correlation detected between serum 25-OH vitamin D levels and GAGS scores in patient group (P < .001; r = -.910). According to these results, we claim that evaluating serum 25-OH vitamin D levels in acne patients, vitamin D supplementation as a treatment option may be a consideration for further studies.
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Affiliation(s)
- Funda Kemeriz
- Department of Dermatology, Aksaray University Faculty of Medicine, Aksaray, Turkey
| | - Sibel Çiğdem Tuncer
- Department of Biochemistry, Aksaray University Faculty of Medicine, Aksaray, Turkey
| | - Emine Müge Acar
- Department of Dermatology, Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Burcu Tuğrul
- Department of Dermatology, Health Science University Ankara Oncology Training and Research Hospital, Ankara, Turkey
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56
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Bocquet-Trémoureux S, Corvec S, Khammari A, Dagnelie MA, Boisrobert A, Dreno B. Acne fulminans and Cutibacterium acnes phylotypes. J Eur Acad Dermatol Venereol 2020; 34:827-833. [PMID: 31715640 DOI: 10.1111/jdv.16064] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acne fulminans (AF) is a rare and severe form of inflammatory acne. It is characterized by a sudden worsening of acne with appearance of ulceronecrotic lesions, which can be associated with systemic signs. Its pathophysiology and the best therapeutic strategy are only partially known. OBJECTIVE Our main objectives were to describe the clinical and biological profile of AF patients and to determine whether there was a difference in Cutibacterium acnes phylotype in AF compared to acne vulgaris. The secondary objective was to assess the efficacy of different therapies. METHODS A retrospective observational study was conducted in all patients followed for AF in our department between 2008 and 2018. Bacteriological samples were taken from each patient to analyse C. acnes phylotype distribution. The therapeutic response was assessed using the ECLA and GEA scales. RESULTS Fifteen patients with a median age of 15 years were included (12 men, 80%). A family history of acne was found in 86.7% of patients. Nine patients (60%) had isotretinoin-induced AF. Only one patient (6.7%) showed systemic signs. The bacteriological culture was positive for C. acnes in 80% of patients. The predominant phylotype was IA1 in 60% of patients, corresponding to the predominant phylotype in acne vulgaris. Only 33.3% of patients were in remission after a first-line treatment with systemic corticosteroids, alone or in combination. Seven patients were treated with biotherapy, including five successfully with secukinumab. CONCLUSION Our results suggest that there is no specific C. acnes phylotype associated with AF, raising the hypothesis that acute inflammation associated with AF may be more related to an abnormal cutaneous innate immunity activation. The use of preventive strategies, the impact of combined treatments and an assessment of the role of biotherapies, especially anti-IL-17, in AF treatment remain to be more investigated.
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Affiliation(s)
| | - S Corvec
- CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France.,Department of Bacteriology, CHU Nantes, Nantes, France
| | - A Khammari
- Department of Dermatology, CHU Nantes, Nantes, France.,CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
| | - M-A Dagnelie
- CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
| | - A Boisrobert
- Department of Dermatology, CHU Nantes, Nantes, France
| | - B Dreno
- Department of Dermatology, CHU Nantes, Nantes, France.,CIC 1413, CRCINA Inserm U 1232, University Nantes, Nantes, France
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57
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Ahmed Mohamed A, Salah Ahmed EM, Abdel-Aziz RTA, Eldeeb Abdallah HH, El-Hanafi H, Hussein G, Abbassi MM, El Borolossy R. The impact of active vitamin D administration on the clinical outcomes of acne vulgaris. J DERMATOL TREAT 2020; 32:756-761. [PMID: 31868550 DOI: 10.1080/09546634.2019.1708852] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Acne vulgaris is one of the most common chronic inflammatory skin disorder affecting millions of people worldwide. Vitamin D deficiency has a role in various inflammatory skin diseases as acne. This study aimed to investigate the serum level of 25 hydroxy vitamin D in acne patients and to assess the efficacy and safety of active vitamin D in management of acne. This study was conducted on 100 patients with acne and 100 healthy controls, then the 100 acne patients were randomized to either the study group that received 0.25ug alfacalcidol daily or the placebo group that received oral placebo during the 3 months study period. Serum levels of 25-hydroxy-vitamin D were significantly lower in acne patients than in healthy control and were inversely correlated to the severity of acne. After alfacalcidol administration, the study group showed significant higher level of 25(OH) D levels (p < .05) compared to placebo group. In addition, median serum level of IL6 and TNFα significantly decreased (p < .05) in the study group in comparison to placebo group and as compared to their baseline results. Acne patients are more commonly to have vitamin D deficiency as compared to healthy people and hence, alfacalcidol might have a beneficial role in the acne management with no reported side effects.
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Affiliation(s)
- Amal Ahmed Mohamed
- Department of Biochemistry & Molecular Biology, National Hepatology & Tropical Medicine Research Institute, Cairo, Egypt
| | - Eman Mohamed Salah Ahmed
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Rasha T A Abdel-Aziz
- Department of Dermatology, STDs and Andrology, Faculty of medicine, Minia University, Minia, Egypt
| | | | - Hadeel El-Hanafi
- Clinical and Chemical Pathology, Kasr El-Einy hospitals, Cairo University, Cairo, Egypt
| | - Ghada Hussein
- Department of Clinical Pathology, National Institute of Diabetes and Endocrinology (NIDE), Cairo, Egypt
| | - Maggie M Abbassi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Radwa El Borolossy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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58
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and acne vulgaris and conglobata—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0045-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata.
Methods
The present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic.
Results
From pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%).
Conclusions
In summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.
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59
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Schneider AM, Nelson AM. Skin microbiota: Friend or foe in pediatric skin health and skin disease. Pediatr Dermatol 2019; 36:815-822. [PMID: 31588632 DOI: 10.1111/pde.13955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The human integument and gastrointestinal tract host unique microbial ecosystems. Within the last decade, research has focused on understanding the contributions of the microbiota to human health and disease. The majority of skin microbiome studies involve adults. This review focuses on key studies conducted within the pediatric population and provides a framework for future skin microbiome work in this ever-expanding field. This article begins by exploring the skin microbiome at birth and reviews the impact of delivery mode on infant skin colonization. How skin microbial colonization evolves from infancy to adulthood and normal development impacts the abundance of skin commensals such as Streptococcus, Staphylococcus, and Cutibacterium is also highlighted. Finally, several skin microbiome research studies in common pediatric skin conditions are reviewed, including body odor, atopic dermatitis (AD), and acne. The bacteria involved in metabolizing sweat, the impact on body odor, and how this process evolves from childhood to adulthood is outlined. In AD, different bacteria genera that predominate in children and adults and the impact of current AD therapies on skin microbiota are explored. Finally, in acne, the understanding of how Cutibacterium acnes contributes to acne pathogenesis and how acne therapies impact the skin microbial communities is reviewed.
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Affiliation(s)
- Andrea M Schneider
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Amanda M Nelson
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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60
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Bernardini N, Skroza N, Tolino E, Mambrin A, Anzalone A, Balduzzi V, Colapietra D, Marchesiello A, Michelini S, Proietti I, Potenza C. IL-17 and its role in inflammatory, autoimmune, and oncological skin diseases: state of art. Int J Dermatol 2019; 59:406-411. [PMID: 31663126 PMCID: PMC7216999 DOI: 10.1111/ijd.14695] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 08/05/2019] [Accepted: 09/20/2019] [Indexed: 01/02/2023]
Abstract
Recent data support the theory of the involvement of IL‐17 in the pathogenesis of several chronic inflammatory skin diseases (psoriasis, atopic dermatitis, acne, hidradenitis suppurativa) and autoimmune skin diseases (alopecia areata, vitiligo, bullous diseases). Even if the role of IL‐17 in inflammatory and autoimmune diseases has been reported extensively, its role in tumor is still controversial. Some reports show that Th17 cells eradicate tumors, while others reveal that they promote the initiation and early growth of tumors. Herein, we review the role of IL‐17 in the involvement of some common dermatologic diseases: psoriasis, atopic dermatitis, hidradenitis suppurativa, acne, vitiligo, melanoma, and nonmelanoma skin cancers.
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Affiliation(s)
- Nicoletta Bernardini
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Nevena Skroza
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Ersilia Tolino
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Alessandra Mambrin
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Alessia Anzalone
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Veronica Balduzzi
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Daniela Colapietra
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Anna Marchesiello
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Simone Michelini
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Ilaria Proietti
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
| | - Concetta Potenza
- Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy
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61
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Acharya P, Mathur M. Vitamin D deficiency in patients with acne vulgaris: A systematic review and meta-analysis. Australas J Dermatol 2019; 61:e146-e149. [PMID: 31578053 DOI: 10.1111/ajd.13165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Prakash Acharya
- Department of Dermatology, College of Medical Sciences, Bharatpur, Nepal
| | - Mahesh Mathur
- Department of Dermatology, College of Medical Sciences, Bharatpur, Nepal
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62
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Chen W, Zhao S, Zhu W, Wu L, Chen X. Retinoids as an Immunity-modulator in Dermatology Disorders. Arch Immunol Ther Exp (Warsz) 2019; 67:355-365. [PMID: 31552446 DOI: 10.1007/s00005-019-00562-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
The skin is the largest epithelial surface protecting the body from invading microbes. Vitamin A plays vital roles in the host defence of the skin, including promoting epithelial cell integrity, proliferation, and differentiation and even mediating immune responses. Furthermore, vitamin A derivatives, retinoid drugs, are widely used to treat skin diseases, such as acne and psoriasis. However, the immunoregulatory mechanisms of retinoids in dermatology have not been systematically described. In this paper, we discuss the immunological functions of retinoids during disease treatment, especially in skin disorders caused by exogenous infections.
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Affiliation(s)
- Wangqing Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Lisha Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
- Institute of Medical Sciences, Xiangya Hospital, Central South University, Changsha, China.
| | - Xiang Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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63
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Dagnelie MA, Corvec S, Saint-Jean M, Nguyen JM, Khammari A, Dréno B. Cutibacterium acnes phylotypes diversity loss: a trigger for skin inflammatory process. J Eur Acad Dermatol Venereol 2019; 33:2340-2348. [PMID: 31299116 DOI: 10.1111/jdv.15795] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/24/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acne has long been understood as a multifactorial chronic inflammatory disease of the pilosebaceous follicle, where Cutibacterium acnes (subdivided into six main phylotypes) is a crucial factor. In parallel, the loss of microbial diversity among the skin commensal communities has recently been shown as often accompanied by inflammatory skin disorders. OBJECTIVE This study investigated the association of C. acnes phylotype diversity loss and the impact on Innate Immune System (IIS) activation. METHODS The IIS response of skin after incubation with phylotypes IA1, II or III individually and with the combination of IA1 + II + III phylotypes, was studied in an in vitro skin explant system. The inflammatory response was monitored by immunohistochemistry and ELISA assays, targeting a selection of Innate Immune Markers (IIMs) (IL-6, IL-8, IL-10, IL-17, TGF-β). RESULTS IIMs were significantly upregulated in skin when being incubated with phylotype IA1 alone compared with the combination IA1 + II + III. In parallel, ELISA assays confirmed these results in supernatants for IL-17, IL-8 and IL-10. CONCLUSION We identify the loss of C. acnes phylotype diversity as a trigger for IIS activation, leading to cutaneous inflammation. These innovative data underline the possibility to set up new approaches to treat acne. Indeed, maintaining the balance between the different phylotypes of C. acnes may be an interesting target for the development of drugs.
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Affiliation(s)
- M-A Dagnelie
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - S Corvec
- Bacteriology Department, CHU Nantes, CRCINA, University Nantes, Nantes, France
| | - M Saint-Jean
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - J-M Nguyen
- Biostatistical Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - A Khammari
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - B Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
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64
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Ramasamy S, Barnard E, Dawson TL, Li H. The role of the skin microbiota in acne pathophysiology. Br J Dermatol 2019; 181:691-699. [PMID: 31342510 DOI: 10.1111/bjd.18230] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of skin microbiota in acne remains to be fully elucidated. Initial culture-based investigations were hampered by growth rate and selective media bias. Even with less biased genomic methods, sampling, lysis and methodology, the task of describing acne pathophysiology remains challenging. Acne occurs in sites dominated by Cutibacterium acnes (formerly Propionibacterium acnes) and Malassezia species, both of which can function either as commensal or pathogen. OBJECTIVES This article aims to review the current state of the art of the microbiome and acne. METHODS The literature regarding the microbiome and acne was reviewed. RESULTS It remains unclear whether there is a quantitative difference in microbial community distribution, making it challenging to understand any community shift from commensal to pathogenic nature. It is plausible that acne involves (i) change in the distribution of species/strains, (ii) stable distribution with pathogenic alteration in response to internal (intermicrobe) or external stimuli (host physiology or environmental) or (iii) a combination of these factors. CONCLUSIONS Understanding physiological changes in bacterial species and strains will be required to define their specific roles, and identify any potential intervention points, in acne pathogenesis and treatment. It will also be necessary to determine whether any fungal species are involved, and establish whether they play a significant role. Further investigation using robust, modern analytic tools in longitudinal studies with a large number of participants, may make it possible to determine whether the microbiota plays a causal role, is primarily involved in exacerbation, or is merely a bystander. It is likely that the final outcome will show that acne is the result of complex microbe-microbe and community-host interplay.
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Affiliation(s)
- S Ramasamy
- Skin Research Institute Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - E Barnard
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA, U.S.A
| | - T L Dawson
- Skin Research Institute Singapore, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Drug Discovery, College of Pharmacy, Medical University of South Carolina, Charleston, SC, U.S.A
| | - H Li
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, CA, U.S.A.,UCLA-DOE Institute for Genomics and Proteomics, Los Angeles, CA, U.S.A
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65
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Lee YB, Byun EJ, Kim HS. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med 2019; 8:jcm8070987. [PMID: 31284694 PMCID: PMC6678709 DOI: 10.3390/jcm8070987] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Acne is a highly prevalent inflammatory skin condition involving sebaceous sties. Although it clearly develops from an interplay of multiple factors, the exact cause of acne remains elusive. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Cutibacterium acnes (C. acnes; formerly called Propionibacterium acnes) is commonly found in sebum-rich areas and its over-proliferation has long been thought to contribute to the disease. However, information provided by advanced metagenomic sequencing has indicated that the cutaneous microbiota in acne patients and acne-free individuals differ at the virulent-specific lineage level. Acne also has close connections with the gastrointestinal tract, and many argue that the gut microbiota could be involved in the pathogenic process of acne. The emotions of stress (e.g., depression and anxiety), for instance, have been hypothesized to aggravate acne by altering the gut microbiota and increasing intestinal permeability, potentially contributing to skin inflammation. Over the years, an expanding body of research has highlighted the presence of a gut–brain–skin axis that connects gut microbes, oral probiotics, and diet, currently an area of intense scrutiny, to acne severity. This review concentrates on the skin and gut microbes in acne, the role that the gut–brain–skin axis plays in the immunobiology of acne, and newly emerging microbiome-based therapies that can be applied to treat acne.
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Affiliation(s)
- Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Eun Jung Byun
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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66
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Analysis of Potential Genes and Pathways Involved in the Pathogenesis of Acne by Bioinformatics. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3739086. [PMID: 31281837 PMCID: PMC6590534 DOI: 10.1155/2019/3739086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/04/2019] [Accepted: 05/23/2019] [Indexed: 12/16/2022]
Abstract
Acne is the eighth most frequent disease worldwide. Inflammatory response runs through all stages of acne. It is complicated and is involved in innate and adaptive immunity. This study aimed to explore the candidate genes and their relative signaling pathways in inflammatory acne using data mining analysis. Microarray data GSE6475 and GSE53795, including 18 acne lesion tissues and 18 matched normal skin tissues, were obtained. Differentially expressed genes (DEGs) were filtered and subjected to functional and pathway enrichment analyses. Protein-protein interaction (PPI) network and module analyses were also performed based on the DEGs. In this work, 154 common DEGs, including 145 upregulated and 9 downregulated, were obtained from two microarray profiles. Gene Ontology and pathway enrichment of DEGs were clustered using significant enrichment analysis. A PPI network containing 110 nodes/DEGs was constructed, and 31 hub genes were obtained. Four modules in the PPI network, which mainly participated in chemokine signaling pathway, cytokine-cytokine receptor interaction, and Fc gamma R-mediated phagocytosis, were extracted. In conclusion, aberrant DEGs and pathways involved in acne pathogenesis were identified using bioinformatic analysis. The DEGs included FPR2, ITGB2, CXCL8, C3AR1, CXCL1, FCER1G, LILRB2, PTPRC, SAA1, CCR2, ICAM1, and FPR1, and the pathways included chemokine signaling pathway, cytokine-cytokine receptor interaction, and Fc gamma R-mediated phagocytosis. This study could serve as a basis for further understanding the pathogenesis and potential therapeutic targets of inflammatory acne.
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67
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Propionibacterium acnes and Acne Vulgaris: New Insights from the Integration of Population Genetic, Multi-Omic, Biochemical and Host-Microbe Studies. Microorganisms 2019; 7:microorganisms7050128. [PMID: 31086023 PMCID: PMC6560440 DOI: 10.3390/microorganisms7050128] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/25/2022] Open
Abstract
The anaerobic bacterium Propionibacterium acnes is believed to play an important role in the pathophysiology of the common skin disease acne vulgaris. Over the last 10 years our understanding of the taxonomic and intraspecies diversity of this bacterium has increased tremendously, and with it the realisation that particular strains are associated with skin health while others appear related to disease. This extensive review will cover our current knowledge regarding the association of P. acnes phylogroups, clonal complexes and sequence types with acne vulgaris based on multilocus sequence typing of isolates, and direct ribotyping of the P. acnes strain population in skin microbiome samples based on 16S rDNA metagenomic data. We will also consider how multi-omic and biochemical studies have facilitated our understanding of P. acnes pathogenicity and interactions with the host, thus providing insights into why certain lineages appear to have a heightened capacity to contribute to acne vulgaris development, while others are positively associated with skin health. We conclude with a discussion of new therapeutic strategies that are currently under investigation for acne vulgaris, including vaccination, and consider the potential of these treatments to also perturb beneficial lineages of P. acnes on the skin.
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68
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Navarro-Triviño F, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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69
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Ebrahim AA, Mustafa AI, El‐Abd AM. Serum interleukin‐17 as a novel biomarker in patients with acne vulgaris. J Cosmet Dermatol 2019; 18:1975-1979. [DOI: 10.1111/jocd.12934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/20/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Adel A. Ebrahim
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Benha University Benha Egypt
| | - Amany Ibrahim Mustafa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Benha University Benha Egypt
| | - Awad Mohamed El‐Abd
- Department of Medical Biochemistry, Faculty of Medicine Benha University Benha Egypt
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70
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Abd‐Elmaged WM, Nada EA, Hassan MH, Elsadek BEM, Abdelrahim EA, Ahmed NS, Toghan R, Ahmed HTI. Lesional and circulating levels of interleukin‐17 and 25‐hydroxycholecalciferol in active acne vulgaris: Correlation to disease severity. J Cosmet Dermatol 2019; 18:671-676. [DOI: 10.1111/jocd.12715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Wafaa M. Abd‐Elmaged
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Sohag University Sohag Egypt
| | - Essam A. Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Sohag University Sohag Egypt
| | - Mohammed H. Hassan
- Department of Medical Biochemistry and Molecular Biology, Qena Faculty of Medicine South Valley University Qena Egypt
| | - Bakheet E. M. Elsadek
- Department of Biochemistry and Molecular Biology, Faculty of Pharmacy Al‐Azhar University, Assiut Branch Assiut Egypt
| | - Eman A. Abdelrahim
- Department of Histology, Qena Faculty of Medicine South Valley University Qena Egypt
| | - Nagwa S. Ahmed
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine Sohag University Sohag Egypt
| | - Rana Toghan
- Department of Medical Physiology, Qena Faculty of Medicine South Valley University Qena Egypt
| | - Heba T. I. Ahmed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Sohag University Sohag Egypt
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71
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Cong TX, Hao D, Wen X, Li XH, He G, Jiang X. From pathogenesis of acne vulgaris to anti-acne agents. Arch Dermatol Res 2019; 311:337-349. [PMID: 30859308 DOI: 10.1007/s00403-019-01908-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/03/2019] [Accepted: 03/05/2019] [Indexed: 02/05/2023]
Abstract
Acne vulgaris is a cutaneous chronic inflammatory disorder with complex pathogenesis. Four factors play vital roles in acne pathophysiology: hyperseborrhea and dysseborrhea, altered keratinization of the pilosebaceous duct, Cutibacterium acnes (C. acnes) and inflammation. The main hormones responsible for the development of acne vulgaris include androgens, insulin and insulin-like growth factor-1. Other factors involved in this process are corticotropin-releasing hormone, α-melanocyte-stimulating hormone and substance P. Wnt/β-catenin signaling pathway, phosphoinositide 3-kinase (PI3K)/Akt pathway, mitogen-activated protein kinase pathway, adenosine 5'-monophosphate-activated protein kinase pathway and nuclear factor kappa B pathway participate in the modulation of sebocyte, keratinocyte and inflammatory cell (e.g. lymphocytes, monocytes, macrophages, neutrophils) activity. Among all the triggers and pathways mentioned above, IGF-1-induced PI3K/Akt/Forkhead box protein O1/mammalian target of rapamycin (mTOR) C1 pathway is the most important signaling responsible for acne pathogenesis. Commonly used anti-acne agents include retinoids, benzoyl peroxide, antibiotics and hormonal agents (e.g. spironolactone, combination oral contraceptive and flutamide). New approaches including peroxisome proliferator-activated receptor γ modifier, melanocortin receptor antagonists, epigallocatechin-3-gallate, metformin, olumacostat glasaretil, stearoyl-CoA desaturase inhibitor omiganan pentahydrochloride, KDPT, afamelanotide, apremilast and biologics have been developed as promising treatments for acne vulgaris. Although these anti-acne agents have various pharmacological effects against the diverse pathogenesis of acne, all of them have a synergistic mode of action, the attenuation of Akt/mTORC1 signaling and enhancement of p53 signal transduction. In addition to drug therapy, diet with no hyperglycemic carbohydrates, no milk and dairy products is also beneficial for treatment of acne.
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Affiliation(s)
- Tian-Xin Cong
- Department of Dermatology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Dan Hao
- Department of Dermatology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Wen
- Department of Dermatology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Hua Li
- Department of Dermatology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu He
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, 610041, People's Republic of China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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72
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Navarro-Triviño FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:262-272. [PMID: 30857638 DOI: 10.1016/j.ad.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 02/07/2023] Open
Abstract
In recent years, the growing interest in the role played by vitamin D in skin disease has given rise to the publication of many studies of the relationship between this vitamin and certain skin conditions. As dermatologists, we need to understand, among other aspects, how vitamin D is synthesized and the main sources in humans, as well as plasma levels and the factors that can modify them. Of particular interest are the latest discoveries about the role of vitamin D in skin diseases such as lupus erythematosus, ichthyosis, atopic dermatitis, hidradenitis suppurativa, acne, alopecia areata, androgenetic alopecia, melanoma, and nonmelanoma skin cancer. Also of interest is the importance of vitamin D as adjuvant therapy in patients on long-term treatment with corticosteroids. In this review, we provide an overview of the most important and most recent information regarding the relationship between vitamin D and skin disease and discuss the importance of assessing individual vitamin D status and correcting deficiencies.
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Affiliation(s)
- F J Navarro-Triviño
- Unidad de Dermatología Médico-Quirúrgica y Venereología, Hospital Comarcal Alcalá la Real, Jaén, España.
| | - S Arias-Santiago
- Unidad de Gestión Clínica de Dermatología y Venereología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Y Gilaberte-Calzada
- Servicio de Dermatología, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España
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73
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Andersson T, Ertürk Bergdahl G, Saleh K, Magnúsdóttir H, Stødkilde K, Andersen CBF, Lundqvist K, Jensen A, Brüggemann H, Lood R. Common skin bacteria protect their host from oxidative stress through secreted antioxidant RoxP. Sci Rep 2019; 9:3596. [PMID: 30837648 PMCID: PMC6401081 DOI: 10.1038/s41598-019-40471-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 02/18/2019] [Indexed: 02/07/2023] Open
Abstract
Cutibacterium acnes is an abundant skin commensal with several proposed mutualistic functions. A protein with strong antioxidant activity was recently identified from the C. acnes secretome. This protein, termed RoxP, facilitated aerobic bacterial growth in vitro and ex vivo. As reducing events naturally occurred outside of the bacterial cell, it was further hypothesized that RoxP could also serve to modulate redox status of human skin. The biological function of RoxP was here assessed in vitro and in vivo, through oxidatively stressed cell cultures and through protein quantification from skin affected by oxidative disease (actinic keratosis and basal cell carcinoma), respectively. 16S rDNA amplicon deep sequencing and single locus sequence typing was used to correlate bacterial prevalence to cutaneous RoxP abundances. We show that RoxP positively influence the viability of monocytes and keratinocytes exposed to oxidative stress, and that a congruent concentration decline of RoxP can be observed in skin affected by oxidative disease. Basal cell carcinoma was moreover associated with microbial dysbiosis, characterized by reduced C. acnes prevalence. C. acnes's secretion of RoxP, an exogenous but naturally occurring antioxidant on human skin, is likely to positively influence the human host. Results furthermore attest to its prospective usability as a biopharmaceutical.
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Affiliation(s)
- Tilde Andersson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gizem Ertürk Bergdahl
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Karim Saleh
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | | | | | | | - Katarina Lundqvist
- Division of Dermatology and Venereology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Dermatology, Skane University Hospital, Lund, Sweden
| | - Anders Jensen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | | | - Rolf Lood
- Division of Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
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74
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Daoussis D, Konstantopoulou G, Kraniotis P, Sakkas L, Liossis SN. Biologics in SAPHO syndrome: A systematic review. Semin Arthritis Rheum 2019; 48:618-625. [DOI: 10.1016/j.semarthrit.2018.04.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/30/2018] [Accepted: 04/16/2018] [Indexed: 02/08/2023]
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75
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Abstract
Rosacea is a common chronic inflammatory skin disease of the central facial skin and is of unknown origin. Currently, two classifications of rosacea exist that are based on either "preformed" clinical subtypes (erythematotelangiectatic, papulopustular, phymatous, and ocular) or patient-tailored analysis of the presented rosacea phenotype. Rosacea etiology and pathophysiology are poorly understood. However, recent findings indicate that genetic and environmental components can trigger rosacea initiation and aggravation by dysregulation of the innate and adaptive immune system. Trigger factors also lead to the release of various mediators such as keratinocytes (for example, cathelicidin, vascular endothelial growth factor, and endothelin-1), endothelial cells (nitric oxide), mast cells (cathelicidin and matrix metalloproteinases), macrophages (interferon-gamma, tumor necrosis factor, matrix metalloproteinases, and interleukin-26), and T helper type 1 (T H1) and T H17 cells. Additionally, trigger factors can directly communicate to the cutaneous nervous system and, by neurovascular and neuro-immune active neuropeptides, lead to the manifestation of rosacea lesions. Here, we aim to summarize the recent advances that preceded the new rosacea classification and address a symptom-based approach in the management of patients with rosacea.
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Affiliation(s)
- Joerg Buddenkotte
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - Martin Steinhoff
- Department of Dermatology and Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar.,Medical School, Qatar University, Doha, Qatar.,Weill Cornell Medicine, New York, NY, USA
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76
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A systematic review and meta-analysis of randomized controlled trials to evaluating the trend of cytokines to vitamin A supplementation in autoimmune diseases. Clin Nutr 2018; 38:2038-2044. [PMID: 30473441 DOI: 10.1016/j.clnu.2018.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Vitamin A is considered as a supplement that effect on autoimmune diseases. We aimed to systematically review the effect of vitamin A on cytokines in patients with autoimmune disease. METHODS Two researchers searched Scopus and PubMed until May 2018. Researchers extracted data from 6 eligible published papers. Extracted data included the gene expression of the inflammatory and anti-inflammatory cytokines. RESULTS Fixed effect analysis of the WMD (95% CI) of the changes in gene expression showed that gene expression of the inflammatory (IL-17, IFN-γ and T-bet) and anti-inflammatory (TGF-β and FOXP3) cytokines significantly decreased and increased due to vitamin A supplementation in patients with autoimmune (Multiple sclerosis and atherosclerosis) diseases. CONCLUSIONS Vitamin A supplementation effects on gene expression and may improve serum level of cytokines and clinical signs of autoimmune disease but there is no adequate evidence.
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77
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Wang Y, Hata TR, Tong YL, Kao MS, Zouboulis CC, Gallo RL, Huang CM. The Anti-Inflammatory Activities of Propionibacterium acnes CAMP Factor-Targeted Acne Vaccines. J Invest Dermatol 2018; 138:2355-2364. [DOI: 10.1016/j.jid.2018.05.032] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/05/2018] [Accepted: 05/03/2018] [Indexed: 10/28/2022]
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78
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Plasma 25-Hydroxy Vitamin D is not Associated with Acne Vulgaris. Nutrients 2018; 10:nu10101525. [PMID: 30336597 PMCID: PMC6212990 DOI: 10.3390/nu10101525] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022] Open
Abstract
Few studies have investigated the association between Acne vulgaris (AV) and vitamin D level. In this study we aimed to investigate the association between 25-hydroxyvitamin D (25-OH-VitD) level and AV in a country with plenty of sunshine. A cross-sectional study was conducted on 714 adolescents who were randomly selected from public schools using multistage cluster random sampling with probability proportional to size. 25-OH-VitD levels were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The Global Acne Grading System (GAGS) was used to assess the severity of AV. Data on potential confounders were collected from the parents through a self-administered questionnaire, and from the adolescents using a face-to-face interview. Of 714 participants, 351 (41.16%) were males. The mean (standard deviation (SD)) age was 12.28 (0.81) years. AV was observed in 479 (67.1%) adolescents. There was no significant association between 25-OH-VitD level and clinically assessed AV before or after adjusting for potential confounders. This was consistent whether 25-OH-VitD was fitted as a continuous variable or categorized using acceptable cutoff points or tertiles. In this study vitamin D status was not associated with AV, therefore our data do not support vitamin D supplementation either to treat or to prevent AV.
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79
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Wertenteil S, Strunk A, Garg A. Overall and subgroup prevalence of acne vulgaris among patients with hidradenitis suppurativa. J Am Acad Dermatol 2018; 80:1308-1313. [PMID: 30287328 DOI: 10.1016/j.jaad.2018.09.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence establishing a link between acne vulgaris (AV) and hidradenitis suppurativa (HS) is limited, and the burden of AV in adults with HS is unknown. OBJECTIVE To determine the prevalence of AV among adults with HS and determine the strength of this association. METHODS Cross-sectional analysis identifying adults with AV among patients with and without HS by using electronic health record data from a population-based sample of more than 55 million patients. RESULTS The prevalence of AV among adults with HS was 15.2% (7315 of 48,085) compared with 2.9% (497,360 of 16,899,470) for adults without HS (P < .001). The prevalence was greatest among patients with HS who were female (5870 of 35,790 [16.4%]), were 18 to 44 years old (5260 of 28,870 [18.2%]), were nonwhite (3120 of 17,825 [17.5%]), were obese (5430 of 35,135 [15.5%]), and had polycystic ovarian syndrome (685 of 2385 [28.7%]). Patients with HS had 4.51 [95% confidence interval, 4.40-4.63] times the odds of having AV than did patients without HS, with the higher likelihood of having AV persisting across all subgroups of patients with HS. The association between HS and AV was generally stronger for patients who were male, and 65 years of age or older. LIMITATIONS Influence of disease severity in HS, or in acne, on the strength of the association could not be assessed. CONCLUSION Patients with HS may benefit from assessment of acne status and optimization of comanagement strategies.
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Affiliation(s)
- Sara Wertenteil
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
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80
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Slaby O, McDowell A, Brüggemann H, Raz A, Demir-Deviren S, Freemont T, Lambert P, Capoor MN. Is IL-1β Further Evidence for the Role of Propionibacterium acnes in Degenerative Disc Disease? Lessons From the Study of the Inflammatory Skin Condition Acne Vulgaris. Front Cell Infect Microbiol 2018; 8:272. [PMID: 30155445 PMCID: PMC6103242 DOI: 10.3389/fcimb.2018.00272] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022] Open
Abstract
The pathogenesis of degenerative disc disease is a complex and multifactorial process in which genetics, mechanical trauma, altered loading and nutrition present significant etiological factors. Infection of the intervertebral disc with the anaerobic bacterium Propionibacterium acnes is now also emerging as a potentially new etiological factor. This human commensal bacterium is well known for its long association with the inflammatory skin condition acne vulgaris. A key component of inflammatory responses to P. acnes in acne appears to be interleukin (IL)-1β. Similarly, in degenerative disc disease (DDD) there is compelling evidence for the fundamental roles of IL-1β in its pathology. We therefore propose that P. acnes involvement in DDD is biologically very plausible, and that IL-1β is the key inflammatory mechanism driving the host response to P. acnes infection. Since there is a solid theoretical basis for this phenomenon, we further propose that the relationship between P. acnes infection and DDD is causal.
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Affiliation(s)
- Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czechia
| | - Andrew McDowell
- Northern Ireland Centre for Stratified Medicine, School of Biomedical Sciences, Ulster University, Londonderry, United Kingdom
| | | | - Assaf Raz
- Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, NY, United States
| | | | - Tony Freemont
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Peter Lambert
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Manu N Capoor
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Laboratory of Bacterial Pathogenesis and Immunology, Rockefeller University, New York, NY, United States
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81
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Abstract
As we gain a greater understanding of acne pathogenesis, both new agents as well as new uses for established drugs are being considered for the treatment of acne vulgaris. Multiple clinical trials assessing new formulations or combinations of established acne treatments have been conducted, and novel uses of antimicrobials such as modified diallyl disulfide oxide and nitric oxide are being assessed in clinical trials. There are also a multitude of new therapies currently being studied that target the inflammatory cascade of acne pathogenesis, including sebosuppressive and anti-inflammatory phytochemicals, and small molecule inhibitors targeting sebaceous glands and enzymes, among others. Laser and light therapy is also being modified for the treatment of acne through combination methods with metal nanoshells and vacuum assistance. Probiotics have gained popularity in medicine as greater knowledge of the microbiome and its effects on multiple organ systems is being elucidated. Studies describing the positive effects of certain ammonia-oxidizing bacterial strains in the regulation of the skin's inflammatory response are ongoing. Therapies for acne are constantly evolving and current gold-standard acne therapy may be supplemented with novel treatment modalities in the near future.
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Affiliation(s)
- Megha K Trivedi
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Suzana S Bosanac
- School of Medicine, University of California-Davis, Sacramento, CA, USA
| | - Raja K Sivamani
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA
- Department of Biological Sciences, California State University, Sacramento, CA, USA
| | - Larissa N Larsen
- Department of Dermatology, University of California, Davis, 3301 C Street, Suite 1400, Sacramento, CA, 95816, USA.
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82
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Salem I, Ramser A, Isham N, Ghannoum MA. The Gut Microbiome as a Major Regulator of the Gut-Skin Axis. Front Microbiol 2018; 9:1459. [PMID: 30042740 PMCID: PMC6048199 DOI: 10.3389/fmicb.2018.01459] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022] Open
Abstract
The adult intestine hosts a myriad of diverse bacterial species that reside mostly in the lower gut maintaining a symbiosis with the human habitat. In the current review, we describe the neoteric advancement in our comprehension of how the gut microbiota communicates with the skin as one of the main regulators in the gut-skin axis. We attempted to explore how this potential link affects skin differentiation and keratinization, its influence on modulating the cutaneous immune response in various diseases, and finally how to take advantage of this communication in the control of different skin conditions.
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Affiliation(s)
- Iman Salem
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Amy Ramser
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Nancy Isham
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
| | - Mahmoud A. Ghannoum
- Center for Medical Mycology, Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
- Dermatology, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
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83
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Törőcsik D, Kovács D, Póliska S, Szentkereszty-Kovács Z, Lovászi M, Hegyi K, Szegedi A, Zouboulis CC, Ståhle M. Genome wide analysis of TLR1/2- and TLR4-activated SZ95 sebocytes reveals a complex immune-competence and identifies serum amyloid A as a marker for activated sebaceous glands. PLoS One 2018; 13:e0198323. [PMID: 29927962 PMCID: PMC6013244 DOI: 10.1371/journal.pone.0198323] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/17/2018] [Indexed: 11/18/2022] Open
Abstract
Toll-like receptors (TLR) 2 and 4 are active in sebaceous glands and play a central role in the development of acne. Still, there is only limited knowledge on their effect on sebocytes. In this work we performed global gene expression profile analysis with functional clustering of the differentially regulated genes of TLR1/2 (PAM3CSK4)- and TLR4 (lipopolysaccharide [LPS])-activated SZ95 sebocytes. Both TLR1/2- and 4-activation promoted inflammation in a similar manner already at an early time-point (6 hours), regulating genes involved in inflammation, wound healing and chemotaxis reflecting a more complex cytokine and chemokine regulation than previously known. Importantly, lipid metabolism, the primary feature of sebocytes, was affected at the level of gene expression only at a later time point (24 hours) indicating that sebocytes prioritize to exert a pro-inflammatory phenotype when confronted with a danger signal. Supporting the biological relevance of our results, a meta-analysis revealed that the genes showing the strongest up-regulation were also found up-regulated in acne. Of these genes, serum amyloid A 1/2 (SAA1/2) was confirmed to be a suitable protein marker for in vivo activated sebocytes, underlining their immune-competence, which is structurally defined within sebaceous glands of acne and rosacea skin samples. Altogether our findings demonstrate that sebocytes are not only positioned at the end point of inflammation but are actively involved in shaping the inflammatory response with putative diagnostic and therapeutic relevance.
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Affiliation(s)
- Dániel Törőcsik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Dóra Kovács
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szilárd Póliska
- Department of Biochemistry and Molecular Biology, Genomic Medicine and Bioinformatics Core Facility, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Marianna Lovászi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Hegyi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Szegedi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Division of Dermatological Allergology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodore Fontane, Dessau, Germany
| | - Mona Ståhle
- Unit of Dermatology and Venereology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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84
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Reichrath J, Saternus R, Vogt T. Challenge and perspective: the relevance of ultraviolet (UV) radiation and the vitamin D endocrine system (VDES) for psoriasis and other inflammatory skin diseases. Photochem Photobiol Sci 2018; 16:433-444. [PMID: 28054069 DOI: 10.1039/c6pp00280c] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
During evolution, the ability of many organisms to synthesize vitamin D photochemically represented, and still represents, a major driving factor for the development of life on earth. In humans because not more than 10-20% of the requirement of vitamin D can be satisfied by the diet (under most living conditions in the US and Europe), the remaining 80-90% need to be photochemically synthesized in the skin through the action of solar or artificial ultraviolet-B (UV-B) radiation. The skin is a key organ of the human body's vitamin D endocrine system (VDES), representing both the site of vitamin D synthesis and a target tissue for biologically active vitamin D metabolites. Human keratinocytes contain the enzymatic machinery (CYP27B1) for the synthesis of the biologically most active natural vitamin D metabolite 1,25-dihydroxyvitamin D3 (1,25(OH)2D3), representing an autonomous vitamin D3 pathway. Cutaneous production of 1,25(OH)2D3 may mediate intracrine, autocrine and paracrine effects on keratinocytes and on neighboring cells. Many skin cells (including keratinocytes, sebocytes, fibroblasts, melanocytes, macrophages and other skin immune cells) express the vitamin D receptor (VDR), an absolute pre-requisite for exerting genomic effects of 1,25(OH)2D3 and analogs. The VDR is a member of the superfamily of trans-acting transcriptional regulatory factors, which also contains the steroid and thyroid hormone receptors as well as the retinoid-X receptors (RXR) and retinoic acid receptors (RAR). A large body of evidence, including cDNA microarray analyses of mRNAs, indicates that as many as 500-1000 genes may be controlled by VDR ligands that regulate a broad variety of cellular functions including growth, differentiation, and apoptosis. Clinical and laboratory investigations, including the observation that 1,25(OH)2D3 is very effective in inducing the terminal differentiation and in inhibiting the proliferation of cultured human keratinocytes have resulted in the use of 1,25(OH)2D3 and analogs for the treatment of psoriasis. Focussing on the UV-induced cutaneous synthesis of vitamin D, this review gives an update on the relevance of the VDES and of UV radiation for the management of psoriasis and other inflammatory skin diseases.
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Affiliation(s)
- Jörg Reichrath
- Center for Clinical and Experimental Photo-Dermatology, The Saarland University Hospital, 66421 Homburg, Germany and Department of Dermatology, The Saarland University Hospital, 66421 Homburg, Germany.
| | - Roman Saternus
- Center for Clinical and Experimental Photo-Dermatology, The Saarland University Hospital, 66421 Homburg, Germany and Department of Dermatology, The Saarland University Hospital, 66421 Homburg, Germany.
| | - Thomas Vogt
- Center for Clinical and Experimental Photo-Dermatology, The Saarland University Hospital, 66421 Homburg, Germany and Department of Dermatology, The Saarland University Hospital, 66421 Homburg, Germany.
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85
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Melnik BC, John SM, Chen W, Plewig G. T helper 17 cell/regulatory T-cell imbalance in hidradenitis suppurativa/acne inversa: the link to hair follicle dissection, obesity, smoking and autoimmune comorbidities. Br J Dermatol 2018; 179:260-272. [PMID: 29573406 DOI: 10.1111/bjd.16561] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Disintegration of the infundibula of terminal hair follicles (HFs) in intertriginous skin areas exhibits the histological hallmark of hidradenitis suppurativa (HS)/acne inversa, featuring a dissecting terminal hair folliculitis. Elevated serum levels of interleukin (IL)-17 and local increase in the ratio of proinflammatory T helper (Th)17 cells and anti-inflammatory regulatory T cells (Tregs) have been reported. Perifollicular Tregs play a key role in HF stem cell homeostasis and infundibular integrity. OBJECTIVES In this review, we evaluate the Th17/Treg ratio in HS, its aggravating conditions and associated comorbidities. Furthermore, we intended to clarify whether drugs with reported beneficial effects in the treatment of HS readjust the deviated Th17/Treg axis. METHODS PubMed-listed, peer-reviewed original research articles characterizing Th17/Treg regulation in HS/acne inversa and associated comorbidities were selected for this review. RESULTS This review presents HS as a disease that exhibits an increased Th17/Treg ratio. Perifollicular deficiencies in Treg numbers or function may disturb HF stem cell homeostasis, initiating infundibular dissection of terminal HFs and perifollicular inflammation. The Th17/Treg imbalance is aggravated by obesity, smoking and decreased Notch signalling. In addition, HS-associated autoimmune diseases exhibit a disturbed Th17/Treg axis resulting in a Th17-dominant state. All drugs that have beneficial effects in the treatment of HS normalize the Th17/Treg ratio. CONCLUSIONS HS immunopathogenesis is closely related to deviations of the Th17/Treg balance, which may negatively affect Treg-controlled HF stem cell homeostasis and infundibular integrity. Pharmacological intervention should not only attenuate Th17/IL-17 signalling, but should also improve Treg function in order to stabilize HF stem cell homeostasis and infundibular integrity.
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Affiliation(s)
- B C Melnik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - S M John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - W Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - G Plewig
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
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86
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Chen YE, Fischbach MA, Belkaid Y. Skin microbiota-host interactions. Nature 2018; 553:427-436. [PMID: 29364286 DOI: 10.1038/nature25177] [Citation(s) in RCA: 375] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/28/2017] [Indexed: 12/23/2022]
Abstract
The skin is a complex and dynamic ecosystem that is inhabited by bacteria, archaea, fungi and viruses. These microbes-collectively referred to as the skin microbiota-are fundamental to skin physiology and immunity. Interactions between skin microbes and the host can fall anywhere along the continuum between mutualism and pathogenicity. In this Review, we highlight how host-microbe interactions depend heavily on context, including the state of immune activation, host genetic predisposition, barrier status, microbe localization, and microbe-microbe interactions. We focus on how context shapes the complex dialogue between skin microbes and the host, and the consequences of this dialogue for health and disease.
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Affiliation(s)
- Y Erin Chen
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.,Department of Bioengineering and ChEM-H, Stanford University, Stanford, California, USA
| | - Michael A Fischbach
- Department of Bioengineering and ChEM-H, Stanford University, Stanford, California, USA
| | - Yasmine Belkaid
- NIAID Microbiome Program, National Institute of Allergy and Infectious Disease, NIH, Bethesda, Maryland, USA.,Mucosal Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Disease, NIH, Bethesda, Maryland, USA
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87
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Hall JB, Cong Z, Imamura-Kawasawa Y, Kidd BA, Dudley JT, Thiboutot DM, Nelson AM. Isolation and Identification of the Follicular Microbiome: Implications for Acne Research. J Invest Dermatol 2018; 138:2033-2040. [PMID: 29548797 DOI: 10.1016/j.jid.2018.02.038] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022]
Abstract
Our understanding of the microbiome and the role of Propionibacterium acnes in skin homeostasis and acne pathogenesis is evolving. Multiple methods for sampling and identifying the skin's microbiome exist, and understanding the differences between the abilities of various methods to characterize the microbial landscape is warranted. This study compared the microbial diversity of samples obtained from the cheeks of 20 volunteers, collected by surface swab, pore strips, and cyanoacrylate glue follicular biopsy, all sequenced with 16S rRNA sequencing (V1-V3) and whole-genome metagenomic sequencing. The sequencing method of choice influenced the detection of microbial profiles as whole-genome sequencing captured more species diversity, including viruses, compared with 16S sequencing. The relative abundance of bacterial or fungal species and overall diversity did not differ between sampling methods. However, the viral composition of the skin's surface is unique compared with the follicle, suggesting distinct viral niches within the skin. P. acnes bacteria, ribotypes, and bacteriophages were identified equally by all sampling methods indicating that the sampling method, whether for the skin's surface or follicle, does not impact P. acnes-related characterization and that all may be equally useful for acne-related research studies.
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Affiliation(s)
- Jacob B Hall
- Department of Genomics and Genome Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zhaoyuan Cong
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Yuka Imamura-Kawasawa
- Institute for Personalized Medicine, Departments of Biochemistry and Molecular Biology and Pharmacology, Penn State College of Medicine, Pennsylvania, USA
| | - Brian A Kidd
- Department of Genomics and Genome Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joel T Dudley
- Department of Genomics and Genome Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane M Thiboutot
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amanda M Nelson
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
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88
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Stewart TJ, Bazergy C. Hormonal and dietary factors in acne vulgaris versus controls. DERMATO-ENDOCRINOLOGY 2018; 10:e1442160. [PMID: 29904568 PMCID: PMC5997051 DOI: 10.1080/19381980.2018.1442160] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/13/2018] [Indexed: 12/21/2022]
Abstract
Background: Acne vulgaris is an inflammatory skin disorder with not as yet fully understood pathogenesis. In this controlled study, we assessed acne vulgaris patients for several possible pathogenic factors such as vitamin D deficiency, vegan diet, increased body mass index (BMI) and positive anti-transglutaminase antibody. Methods: We screened 10 years of records at a family medicine clinic for patients diagnosed with acne vulgaris. In eligible subjects, we collected data regarding 25-hydroxylvitamin D levels, BMI, dietary preference and serum IgA tissue transglutaminase levels. Controls were age- (+/− 12 months) and sex-matched patients seen during the study period without a diagnosis of acne vulgaris. Results: 453 patients were given a diagnosis of acne vulgaris during the study period. Compared with controls, we found significant associations between vitamin D deficiency (<50nmol/L), and/or positive transglutaminase antibody level (>4.0U/mL) and a diagnosis of acne vulgaris. Conclusions: Our study adds important information to the current body of literature in pursuit of elucidating the pathogenesis of this complex multifactorial disease.
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Affiliation(s)
- Thomas Jonathan Stewart
- Darlinghurst Medical Centre, Darlinghurst, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Carl Bazergy
- Kogarah Railway Medical Centre, Kogarah, Sydney, Australia
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89
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El‐Hamd MA, El Taieb MA, Ibrahim HM, Aly SS. Vitamin D levels in acne vulgaris patients treated with oral isotretinoin. J Cosmet Dermatol 2018; 18:16-20. [DOI: 10.1111/jocd.12503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Mohammed Abu El‐Hamd
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Sohag University Sohag Egypt
| | - Moustafa A El Taieb
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Aswan University Aswan Egypt
| | - Hassan M Ibrahim
- Department of Dermatology, Venereology and Andrology Faculty of Medicine South Valley University Qina Egypt
| | - Sanaa S Aly
- Department of Clinical Pathology Faculty of Medicine South Valley University Qina Egypt
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90
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Contassot E, French LE. Propionibacterium acnes Strains Differentially Regulate the Fate of Th17 Responses in the Skin. J Invest Dermatol 2018; 138:251-253. [DOI: 10.1016/j.jid.2017.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/23/2022]
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91
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Mattii M, Lovászi M, Garzorz N, Atenhan A, Quaranta M, Lauffer F, Konstantinow A, Küpper M, Zouboulis C, Kemeny L, Eyerich K, Schmidt-Weber C, Törőcsik D, Eyerich S. Sebocytes contribute to skin inflammation by promoting the differentiation of T helper 17 cells. Br J Dermatol 2018; 178:722-730. [DOI: 10.1111/bjd.15879] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- M. Mattii
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - M. Lovászi
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - N. Garzorz
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - A. Atenhan
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - M. Quaranta
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - F. Lauffer
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - A. Konstantinow
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - M. Küpper
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau Germany
| | - L. Kemeny
- Department of Dermatology and Allergology; University of Szeged; Szeged Hungary
| | - K. Eyerich
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - C.B. Schmidt-Weber
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - D. Törőcsik
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - S. Eyerich
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
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92
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Sherwani MA, Tufail S, Muzaffar AF, Yusuf N. The skin microbiome and immune system: Potential target for chemoprevention? PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2018; 34:25-34. [PMID: 28766918 PMCID: PMC7289174 DOI: 10.1111/phpp.12334] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/08/2023]
Abstract
There has been increasing interest in understanding the role of the human microbiome in skin diseases. Microbiome studies are being utilized in skin cancer research in numerous ways. Commensal bacteria are being studied as a potential tool to judge the biggest environmental risk of skin cancer, ultraviolet (UV) radiation. Owing to the recognized link of skin microbes in the process of inflammation, there have been theories linking commensal bacteria to skin cancer. Viral metagenomics has also provided insight into virus linked forms of skin cancers. Speculations can be drawn for skin microbiome that in a manner similar to gut microbiome, they can be involved in chemoprevention of skin cancer. Nonetheless, there are definitely huge gaps in our knowledge of the relationship of microbiome and skin cancers, especially in relation to chemoprevention. The utilization of microbiome in skin cancer research seems to be a promising field and may help yield novel skin cancer prevention and treatment options. This review focuses on recent utilization of the microbiome in skin cancer research, and it explores the potential of utilizing the microbiome in prevention, earlier diagnosis, and treatment of skin cancers.
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Affiliation(s)
| | - Saba Tufail
- Department of Biochemistry, Faculty of Medicine, Aligarh Muslim University, Aligarh, UP, India
| | | | - Nabiha Yusuf
- Department of Dermatology, University of Alabama at Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, AL, USA
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93
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Identification of low oxygen-tolerating bacteria in prostate secretions of cancer patients and discussion of possible aetiological significance. Sci Rep 2017; 7:15164. [PMID: 29123122 PMCID: PMC5680220 DOI: 10.1038/s41598-017-13782-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/02/2017] [Indexed: 01/25/2023] Open
Abstract
The microaerophylic organism Propionibacterium acnes has shown consistent association with prostate cancer (PC). Studies linking circumcision with reduced PC further support anaerobes involvement as circumcision reduces anaerobe colonisation on the glans penis. A 1988 study linked anaerobes with PC but considered them as opportunists in necrotic tumour. A hypothesis that a “Helicobacter-like” process causes PC justified this pilot study. Active surveillance patients were enrolled. Post-prostate massage urine samples were screened using the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) technique for bacterial identification after culture in anaerobic and aerobic conditions. 8 out of 18 patients (41%) had either obligate anaerobic (n = 5) or microaerophilic (n = 4, one of whom also had anaerobes) organisms identified. None of 10 control samples contained obligate anaerobes. Although mean PSA was 63% higher in those with low oxygen tolerating bacteria, two high outliers resulted in this difference being non-significant. Given the substantially higher proportion of PC patients with organisms growing in a low concentration of oxygen when combined with previous studies compared to controls, the degree of significance was as high as smoking 5–9 cigarettes a day and needs further investigation. Translational research in trials combining Vitamin D and aspirin have begun as part of such investigation.
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Mehta-Ambalal S. Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2017; 10:18-24. [PMID: 29344316 PMCID: PMC5749694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Female acne is often associated with clinical signs of hyperandrogenism or metabolic syndrome. Various hormonal and biochemical factors as well as Vitamin D deficiency play a role in the etiopathogenesis of acne, and it is important to be able to detect the altered marker(s) indicative of certain abnormalities in order to diagnose and treat the cause. However, interpretation of these markers can be difficult, as there is ambiguity as to what is considered "normal" or "abnormal." The aim of this study was to explore the associations that acne might have with certain clinical, hormonal, and biological factors among female patients with acne. Additionally, the available literature was reviewed in order to determine the prevalence of these associations, discussion of which is provided. The author's investigations reveal a very high prevalence of abnormal metabolic and hormonal statuses among women with acne, indicating the need for dermatologists to maintain a high index of suspician for other disorders, especially metabolic disorders (and in particular, polycystic ovary syndrome), when treating female patients with acne.
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Affiliation(s)
- Sujata Mehta-Ambalal
- Dr. Mehta-Ambalal is a private practitioner and visiting dermatologist with Shalby Hospitals in Ahmedabad, Gujarat, India
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95
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Agak GW, Kao S, Ouyang K, Qin M, Moon D, Butt A, Kim J. Phenotype and Antimicrobial Activity of Th17 Cells Induced by Propionibacterium acnes Strains Associated with Healthy and Acne Skin. J Invest Dermatol 2017; 138:316-324. [PMID: 28864077 DOI: 10.1016/j.jid.2017.07.842] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/14/2017] [Accepted: 07/26/2017] [Indexed: 12/13/2022]
Abstract
Studies of the human skin microbiome suggest that Propionibacterium acnes strains may contribute differently to skin health and disease. However, the immune phenotype and functions of T helper type 17 (Th17) cells induced by healthy (PH) versus acne (PA) skin-associated P. acnes strains are currently unknown. We stimulated peripheral blood mononuclear cells from healthy donors and observed that PA strains induce higher IL-17 levels than PH strains. We next generated PH and PA strain-specific Th17 clones and show that P. acnes strains induce Th17 cells of varied phenotype and function that are stable in the presence of IL-2 and IL-23. Although PH- and PA-specific clones expressed similar levels of LL-37 and DEFB4, only PH-specific clones secreted molecules sufficient to kill P. acnes. Furthermore, electron microscopic studies showed that supernatants derived from activated PH and not PA-specific clones exhibited robust bactericidal activity against P. acnes, and complete breaches in the bacterial cell envelope were observed. This antimicrobial activity was independent of IL-26, because both natural IL-26 released by Th17 clones and rhIL-26 lacked antimicrobial potency against P. acnes. Overall, our data suggest that P. acnes strains may differentially modulate the CD4+ T-cell responses, leading to the generation of Th17 cells that may contribute to either homeostasis or acne pathogenesis.
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Affiliation(s)
- George W Agak
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
| | - Stephanie Kao
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kelsey Ouyang
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Min Qin
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Moon
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ahsan Butt
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jenny Kim
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; California NanoSystems Institute, University of California, Los Angeles, California, USA
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96
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97
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Lomholt HB, Scholz CFP, Brüggemann H, Tettelin H, Kilian M. A comparative study of Cutibacterium (Propionibacterium) acnes clones from acne patients and healthy controls. Anaerobe 2017; 47:57-63. [PMID: 28434779 DOI: 10.1016/j.anaerobe.2017.04.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/22/2017] [Accepted: 04/14/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cutibacterium (Propionibacterium) acnes is assumed to play an important role in the pathogenesis of acne. OBJECTIVES To examine if clones with distinct virulence properties are associated with acne. METHODS Multiple C. acnes isolates from follicles and surface skin of patients with moderate to severe acne and healthy controls were characterized by multilocus sequence typing. To determine if CC18 isolates from acne patients differ from those of controls in the possession of virulence genes or lack of genes conducive to a harmonious coexistence the full genomes of dominating CC18 follicular clones from six patients and five controls were sequenced. RESULTS Individuals carried one to ten clones simultaneously. The dominating C. acnes clones in follicles from acne patients were exclusively from the phylogenetic clade I-1a and all belonged to clonal complex CC18 with the exception of one patient dominated by the worldwide-disseminated and often antibiotic resistant clone ST3. The clonal composition of healthy follicles showed a more heterogeneous pattern with follicles dominated by clones representing the phylogenetic clades I-1a, I-1b, I-2 and II. Comparison of follicular CC18 gene contents, allelic versions of putative virulence genes and their promoter regions, and 54 variable-length intragenic and inter-genic homopolymeric tracts showed extensive conservation and no difference associated with the clinical origin of isolates. CONCLUSIONS The study supports that C. acnes strains from clonal complex CC18 and the often antibiotic resistant clone ST3 are associated with acne and suggests that susceptibility of the host rather than differences within these clones may determine the clinical outcome of colonization.
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Affiliation(s)
- H B Lomholt
- Department of Biomedicine, Faculty of Health, Aarhus University, DK-8000 Aarhus, Denmark.
| | - C F P Scholz
- Department of Biomedicine, Faculty of Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - H Brüggemann
- Department of Biomedicine, Faculty of Health, Aarhus University, DK-8000 Aarhus, Denmark
| | - H Tettelin
- Department of Microbiology and Immunology, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - M Kilian
- Department of Biomedicine, Faculty of Health, Aarhus University, DK-8000 Aarhus, Denmark
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98
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Proteomic and transcriptomic investigation of acne vulgaris microcystic and papular lesions: Insights in the understanding of its pathophysiology. Biochim Biophys Acta Gen Subj 2017; 1861:652-663. [DOI: 10.1016/j.bbagen.2016.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/11/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022]
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99
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Sardana K, Verma G. Propionibacterium acnes and the Th1/Th17 Axis, Implications in Acne Pathogenesis and Treatment. Indian J Dermatol 2017; 62:392-394. [PMID: 28794550 PMCID: PMC5527720 DOI: 10.4103/ijd.ijd_483_16] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acne vulgaris is one of the most commonly seen conditions and the immunological link is a topic of active research. Recently, the Th17 pathway has been found to play a pivotal role in acne. The adaptive immune response toward Propionibacterium acnes leads to activation of Th17 axis. Consequently, the Th17 cytokines (IL-17, IL-1 β, IL-6, and tumor growth factor, in turn, activate the various pathogenic steps in acne. Drugs such as Vitamin D3 and isotretinoin which target the Th17 pathway may offer an additional pathway for their therapeutic response.
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Affiliation(s)
- Kabir Sardana
- Department of Dermatology & STD, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Gunjan Verma
- Department of Dermatology & STD, PGIMER and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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100
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Yamamoto T, Okabe H. Cutaneous Sarcoid with Livedoid Changes in a Patient with Hashimoto's Thyroiditis. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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