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Alvarado SM, Cohen OG, Lattanzio K, Haun P, Gelfand JM, Loren AW, Chung J, Baumrin E. Histopathologic Analysis of Chronic Cutaneous Graft-Versus-Host Disease. Am J Dermatopathol 2024:00000372-990000000-00419. [PMID: 39288748 DOI: 10.1097/dad.0000000000002841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
ABSTRACT Chronic graft-versus-host disease (cGVHD) is the leading cause of morbidity and nonrelapse mortality after allogeneic hematopoietic cell transplantation. Skin biopsy of cGVHD is recommended when clinical features are not diagnostic, yet the histopathologic features of skin cGVHD are not well described. The objective of this study is to describe the histopathologic features of skin cGVHD in epidermal, sclerotic, and combination cGVHD. Of 49 patients with skin cGVHD, 30 of 49 (61.2%) were male, and mean age was 55 years (SD 11.1). Clinically, 33 of 49 (67.3%) had epidermal cGVHD (E-cGVHD), 1 of 49 (2.1%) had sclerotic cGVHD (S-cGVHD), and 15 of 49 (30.6%) had combination disease. The 49 patients corresponded to 83 unique pathologic specimens with 67 of 83 (80.7%) taken from E-cGVHD, and 16 of 83 (19.3%) from S-cGVHD lesions. Nearly all biopsy specimens from E-cGVHD showed minimal features of active GVHD, including apoptosis in the epidermal basal layer (n = 63, 94.0%), vacuolar change (n = 62, 92.5%), and lymphocyte satellitosis (n = 57, 85.1%). The predominant histologic pattern of E-cGVHD was lichen planus/interface dermatitis (n = 31, 47.0%). S-cGVHD specimens also showed minimal features of active GVHD with apoptosis of the epidermal basal layer (n = 11, 68.8%) and vacuolar change (n = 8, 50.0%). In addition, S-cGVHD showed sclerosis of the papillary and reticular dermis and subcutaneous septae (n = 8, 50.0%; n = 11, 68.8%; n = 5, 31.2%, respectively). The predominant histologic pattern of S-cGVHD was lichen sclerosus/morphea-like pattern (n = 10, 62.5%). Although minimal pathologic features of active GVHD are common, the majority of cGVHD biopsies share features with the inflammatory skin diseases that they clinically resemble. Complete histologic reporting is recommended with implications for disease endotyping and personalized therapy.
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Affiliation(s)
| | - Olivia G Cohen
- Department of Dermatology, University of Virginia Medical Center, Charlottesville, VA
| | | | - Paul Haun
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Alison W Loren
- Blood and Marrow Transplant, Cell Therapy and Transplant Program, Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jina Chung
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Emily Baumrin
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA
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Tierney E, Evans P, Broderick V, Wynn R, Irvine AD. Successful response to dupilumab in a refractory case of atopic dermatitis-like chronic cutaneous graft-versus-host disease. Br J Dermatol 2024; 190:581-583. [PMID: 38123149 DOI: 10.1093/bjd/ljad526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 12/10/2023] [Accepted: 01/13/2024] [Indexed: 12/23/2023]
Abstract
Therapeutic strategies with proven efficacy for chronic cutaneous graft-versus-host disease (GvHD) are limited, with long-term oral glucocorticoids remaining the first-line treatment. Prolonged treatment with glucocorticoids contributes to the significantly increased risk of nonrelapse mortality and substantial deficit in quality of life reported in paediatric transplant patients with chronic GvHD. We report a case of atopic dermatitis-like chronic cutaneous GvHD responding to dupilumab, allowing for the eventual withdrawal of oral glucocorticoids.
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Affiliation(s)
- Emma Tierney
- Dermatology Department, CHI Crumlin Children's Hospital, Dublin, Ireland
| | - Pamela Evans
- National Paediatric Allogenic Haematopoietic Stem Cell Transplant and Cellular Therapy Unit, CHI at Crumlin, Dublin, Ireland
| | - Valerie Broderick
- National Paediatric Allogenic Haematopoietic Stem Cell Transplant and Cellular Therapy Unit, CHI at Crumlin, Dublin, Ireland
| | - Robert Wynn
- Paediatric Bone Marrow Transplant Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Alan D Irvine
- Dermatology Department, CHI Crumlin Children's Hospital, Dublin, Ireland
- Clinical Medicine, Trinity College Dublin, Ireland
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Horino S, Yamaguchi Y, Miyabayashi H, Aki H, Nanjo Y, Onuma M, Rikiishi T, Yabe H, Imaizumi M, Sato A, Miura K. Topical therapy and skin care for transplant-associated atopic dermatitis in children and adolescents. Pediatr Transplant 2024; 28:e14653. [PMID: 37990976 DOI: 10.1111/petr.14653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND New-onset allergic diseases, such as food allergy or atopic dermatitis, can develop after allogeneic transplantation. There are limited reports of new-onset atopic dermatitis after allogeneic hematopoietic stem cell transplantation in children and adolescents, and its treatment is yet to be established. The pathogenesis may differ from typical atopic dermatitis in terms of alloimmunity including graft-versus-host disease. METHODS We present five children and adolescents with new-onset atopic dermatitis after allogeneic hematopoietic stem cell transplantation. The characteristics and clinical profiles of skin treatment after hematopoietic stem cell transplantation are summarized. RESULTS Graft-versus-host disease prophylaxis included systemic tacrolimus for all patients. After hematopoietic stem cell transplantation, all patients achieved complete donor chimerism of the bone marrow and had acute graft-versus-host disease of the skin. After engraftment, all patients had skin lesions that met the international consensus diagnostic criteria for atopic dermatitis. None of the patients met the diagnostic criteria for chronic graft-versus-host disease. Topical therapy and skin care based on atopic dermatitis guidelines improved skin condition and atopic dermatitis severity scores in all patients. In addition, type 2 inflammatory markers improved accordingly. CONCLUSION Topical therapy and skin care may be effective for transplant-related atopic dermatitis after hematopoietic stem cell transplantation. When extensive dermatitis is observed after hematopoietic stem cell transplantation, this treatment may avoid excessive immunosuppressive therapy if it meets the diagnostic criteria for atopic dermatitis.
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Affiliation(s)
- Satoshi Horino
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | - Yuki Yamaguchi
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | | | - Haruka Aki
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
| | - Yuka Nanjo
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Masaei Onuma
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Takeshi Rikiishi
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Hiromasa Yabe
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Masue Imaizumi
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Atsushi Sato
- Department of Hematology and Oncology, Miyagi Children's Hospital, Miyagi, Japan
| | - Katsushi Miura
- Department of Allergy, Miyagi Children's Hospital, Miyagi, Japan
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Belmesk L, Hatami A, Powell J, Kokta V, Coulombe J. Successful use of dupilumab in recalcitrant pediatric atopic dermatitis-like graft-versus-host disease: A case series. JAAD Case Rep 2024; 44:11-16. [PMID: 38292582 PMCID: PMC10824674 DOI: 10.1016/j.jdcr.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Lina Belmesk
- Division of Dermatology, Department of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Afshin Hatami
- Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
| | - Victor Kokta
- Division of Pathology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
| | - Jerome Coulombe
- Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Universite de Montreal, Montreal, Quebec, Canada
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Chen J, Oshima T, Tomita T, Fukui H, Shinzaki S. Regulatory T cells Are Increased and Correlate With Mast Cells in Eosinophilic Esophagitis. J Neurogastroenterol Motil 2024; 30:29-37. [PMID: 38173156 PMCID: PMC10774801 DOI: 10.5056/jnm23040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/30/2023] [Accepted: 06/26/2023] [Indexed: 01/05/2024] Open
Abstract
Background/Aims The incidence of eosinophilic esophagitis (EoE) has been increasing recently. The role of regulatory T cells (Tregs) and correlations with other inflammatory cells in EoE remain unknown. We aim to clarify the role of Tregs and their correlations with inflammatory cells in EoE patients. Methods Biopsies from controls and EoE patients before and after treatments were analyzed. Eosinophil infiltration was evaluated by hematoxylin and eosin staining. Immunohistochemical staining was performed to examine infiltration of T cells, Tregs, and mast cells. Gene expressions of chemokines were evaluated by reverse transcription-quantitative polymerase chain reaction. Results Tregs and mast cells were increased in the esophageal epithelial layers of EoE patients. After treatments, Tregs and mast cells were decreased when histologic remission was achieved. Infiltration of Tregs correlated significantly with numbers of eosinophils and mast cells. Filaggrin mRNA was decreased in patients with EoE before treatment and upregulated after treatment, even when histologic remission was not achieved. Conclusions Tregs were increased in esophageal epithelium of patients with EoE, and correlated with mast cell infiltration.
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Affiliation(s)
- Junji Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
| | - Shinichiro Shinzaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Japan
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Kim HM, Kang YM, Jin BR, Lee H, Lee DS, Lee M, An HJ. Morus alba fruits attenuates atopic dermatitis symptoms and pathology in vivo and in vitro via the regulation of barrier function, immune response and pruritus. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 109:154579. [PMID: 36610150 DOI: 10.1016/j.phymed.2022.154579] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/14/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Morus alba fruits (MAF) belong to the Moraceae family, which are known to be effective in treating diabetic, autoimmune, and hormonal diseases owing to its low toxicity. MAF, as excerpted from Donguibogam, a representative Korean medical encyclopedia protected by UNESCO, has been widely used to treat lumbago, arthritis, and diabetes. Based on these effects, MAF is investigated for unidentified effects of atopic dermatitis, characterized by complex etiology of skin barrier dysfunction, inflammation, and chronic pruritus. METHODS The antioxidant, inflammatory, and immunomodulatory properties of MAF and its bioactive compounds have been widely reported. According to an examination of 1-chloro-2,4-dinitrobenzene-induced AD-like skin lesions in NC/Nga mice, AD symptoms, such as increased dermatitis score, scratching frequency, immunoglobulin E, trans-epidermal water loss, epidermal thickness, and infiltration of mast cells, were relieved by topical MAF administration. They effectively attenuated cytokines and chemokines, such as interleukin (IL)-4, IL-5, IL-6, IL-8, IL-13, IL-17A, IL-22, IL-1β, tumor necrosis factor-α, thymic stromal lymphopoietin (TSLP), thymic- and activation-regulated chemokine, normal T cell expression, and macrophage-derived chemokine secretion at the mRNA level in TNF-α/IFN-γ induced HaCaT (human immortalized keratinocyte) cells. RESULTS Both in vivo and in vitro models, MAF increased the expression of filaggrin, involucrin, and loricrin, as well as inhibited the activation of Janus kinase 2, signal transducer and activator of transcription proteins 1, and mitogen-activated protein kinase pathways, including extracellular signal-regulated kinase, c-jun N-terminal kinase, and p38. Moreover, MAF reduced the expression of TSLP and periostin, which play important roles in skin pruritus as chronic pruritogenic factors. CONCLUSION These data indicate that MAF could be used as a potential treatment for AD-like skin lesions by regulating the inflammatory response, improving physical skin barriers, and relieving symptomatic pruritus.
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Affiliation(s)
- Hye-Min Kim
- Department of Pharmacology, College of Korean Medicine, Sangji University, Wonju, Gangwon-do, 26339, Republic of Korea
| | - Yun-Mi Kang
- Korean Medicine (KM)-Application Center, Korea Institute of Oriental Medicine (KIOM), 70 Cheomdan-ro, Dong-gu, Daegu, 41062, Republic of Korea
| | - Bo-Ram Jin
- Department of Oriental Pharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Hwan Lee
- Department of Pharmacy, College of Pharmacy, Chosun University, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Dong-Sung Lee
- Department of Pharmacy, College of Pharmacy, Chosun University, Dong-gu, Gwangju, 61452, Republic of Korea
| | - Minho Lee
- Department of Life Science, Dongguk University-Seoul, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea.
| | - Hyo-Jin An
- Department of Oriental Pharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, 02447, Republic of Korea.
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Larijani M, Zarowin D, Wohlschlaeger A, Perman MJ, Treat JR. Atopic dermatitis-like graft-versus-host disease treated with dupilumab. Pediatr Dermatol 2022; 40:320-322. [PMID: 36268606 DOI: 10.1111/pde.15146] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
The mainstay of treatment for atopic dermatitis (AD)-like graft-versus-host disease (GVHD) in both pediatric and adult patients includes oral corticosteroids with or without other systemic immunosuppressive therapies. To our knowledge, we report the first case series of dupilumab in the treatment of AD-like GVHD in a pediatric cohort of four patients, where we observed clinical improvement of GVHD as well as a reduction in itch in 3/4 (75%) patients. Our findings suggest that dupilumab is not only effective in treating AD-like GVHD, but also reduces systemic immunosuppression in the pediatric transplant population. The ability to reduce the length and amount of immunosuppression as well as improve quality of life suggest that dupilumab may serve as a safe and effective therapeutic option in our transplant population with GVHD.
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Affiliation(s)
- Mary Larijani
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Diana Zarowin
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Anne Wohlschlaeger
- Blood and Marrow Transplant Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Marissa J Perman
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James R Treat
- The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Sun X, Xia M, Liu J, Cui J, Zhang Y, Sun R, Cui X. lnc-AC145676.2.1-6-3 plays an important role in intestinal acute graft-versus-host disease through the regulation of interleukin-1β. Int J Lab Hematol 2022; 44:759-768. [PMID: 35441492 DOI: 10.1111/ijlh.13852] [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: 01/20/2022] [Revised: 03/26/2022] [Accepted: 04/03/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute graft-versus-host disease (aGVHD) is one of the major complications of allogeneic hematopoietic stem cell transplantation, and the liver, skin, and gastrointestinal tract are the main target organs. The most common type is intestinal aGVHD. Long noncoding RNAs (lncRNAs) have coregulatory functions and participate in a variety of intracellular regulatory processes. We investigated the expression of lncRNAs and their mechanisms in the development of aGVHD. METHODS The participants included 15 patients with aGVHD and 4 healthy controls (HCs). To generate profiles of abnormally expressed lncRNAs, peripheral blood mononuclear cell (PBMC) lncRNAs from four patients and four HCs were validated by high-throughput sequencing and quantitative real-time-PCR (qRT-PCR). A number of databases, including Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, miRanda, TargetScan, and Metascape, were used for bioinformatics analysis. Bioinformatics analysis indicated that overexpression of lnc-AC145676.2.1-6-3 might induce aGVHD via the interleukin (IL)-1β axis and a downstream miRNA. After the higher levels of lnc-AC145676.2.1-6-3 in other patients were confirmed by qRT-PCR, serum IL-1β, IL-6, and tumor necrosis factor-α were measured by enzyme linked immunosorbent assays. RESULTS In our study, a large number of lncRNAs were found in PBMCs of patients with intestinal aGVHD, and bioinformatics analysis showed that the upregulated lncRNA lnc-AC145676.2.1-6-3 probably affected the progression of intestinal aGVHD by regulating the hsa-miR-3064-5p/IL-1β axis. In addition, the changes in lncRNA expression levels were positively correlated with the clinical characteristics of intestinal aGVHD. CONCLUSION Our results suggest that lncRNAs in PBMCs may become new biomarkers and therapeutic targets for intestinal aGVHD.
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Affiliation(s)
- Xiaoqi Sun
- Department of Traditional Chinese Medicine, Shandong University of Traditional, Chinese Medicine, Jinan, China
| | - Mengting Xia
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jiang Liu
- Department of Osteoporosis, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jinwei Cui
- Jingwu Road Primary School of Jinan, Jinan, China
| | - Yanyu Zhang
- Department of Traditional Chinese Medicine, Shandong University of Traditional, Chinese Medicine, Jinan, China
| | - Runjie Sun
- Department of Traditional Chinese Medicine, Shandong University of Traditional, Chinese Medicine, Jinan, China
| | - Xing Cui
- Department of Hematology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.,Center of Oncology and Hematology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine/Shandong Hospital of Integrated Traditional Chinese and Western Medicine, Jinan, China
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RNA sequencing of chronic GVHD skin lesions defines shared and unique inflammatory pathways characterizing lichen planus and morphea. Blood Adv 2022; 6:2805-2811. [PMID: 35008096 PMCID: PMC9092416 DOI: 10.1182/bloodadvances.2021004707] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/12/2021] [Indexed: 11/20/2022] Open
Abstract
Cutaneous involvement of chronic graft-versus-host disease (cGVHD) has a wide range of manifestations including a lichenoid form with a currently assumed mixed Th1/Th17 signature and a sclerotic form with Th1 signature. Despite substantial heterogeneity of innate and adaptive immune cells recruited to the skin and of the different clinical manifestations, treatment depends mainly on the severity of the skin involvement, and relies on systemic, high-dose glucocorticoids alone or in combination with a calcineurin inhibitor. We performed the first study using RNAseq to profile and compare the transcriptome of lichen planus cGVHD (n=8), morphea cGVHD (n=5), and healthy controls (n=6). Our findings revealed shared and unique inflammatory pathways to each cGVHD subtype that are both pathogenic and targetable. In particular, the deregulation of IFN signaling pathway was strongly associated with cutaneous cGVHD, whereas the triggering receptor expressed on myeloid cells-1 (TREM-1) pathway was found to be specific of lichen planus and likely contributes to its pathogenesis. The results were confirmed at a protein level by performing immunohistochemistry staining and at a transcriptomic level using Real-Time quantitative PCR.
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