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Mortlock RD, Ma EC, Cohen JM, Damsky W. Assessment of Treatment-Relevant Immune Biomarkers in Psoriasis and Atopic Dermatitis: Toward Personalized Medicine in Dermatology. J Invest Dermatol 2023; 143:1412-1422. [PMID: 37341663 PMCID: PMC10830170 DOI: 10.1016/j.jid.2023.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/13/2023] [Indexed: 06/22/2023]
Abstract
Immunologically targeted therapies have revolutionized the treatment of inflammatory dermatoses, including atopic dermatitis and psoriasis. Although immunologic biomarkers hold great promise for personalized classification of skin disease and tailored therapy selection, there are no approved or widely used approaches for this in dermatology. This review summarizes the translational immunologic approaches to measuring treatment-relevant biomarkers in inflammatory skin conditions. Tape strip profiling, microneedle-based biomarker patches, molecular profiling from epidermal curettage, RNA in situ hybridization tissue staining, and single-cell RNA sequencing have been described. We discuss the advantages and limitations of each and open questions for the future of personalized medicine in inflammatory skin disease.
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Affiliation(s)
- Ryland D Mortlock
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Medical Scientist Training Program, Yale School of Medicine, New Haven, Connecticut, USA
| | - Emilie C Ma
- Yale College, Yale University, New Haven, Connecticut, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - William Damsky
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA; Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA.
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2
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Bong SK, Park NJ, Lee SH, Lee JW, Kim AT, Liu X, Kim SM, Yang MH, Kim YK, Kim SN. Trifuhalol A Suppresses Allergic Inflammation through Dual Inhibition of TAK1 and MK2 Mediated by IgE and IL-33. Int J Mol Sci 2022; 23:ijms231710163. [PMID: 36077570 PMCID: PMC9456157 DOI: 10.3390/ijms231710163] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
The activation and degranulation of immune cells play a pivotal role in allergic inflammation, a pathological condition that includes anaphylaxis, pruritus, and allergic march-related diseases. In this study, trifuhalol A, a phlorotannin isolated from Agarum cribrosum, inhibited the degranulation of immune cells and the biosynthesis of IL-33 and IgE in differentiated B cells and keratinocytes, respectively. Additionally, trifuhalol A suppressed the IL-33 and IgE-mediated activation of RBL-2H3 cells through the regulation of the TAK1 and MK2 pathways. Hence, the effect of trifuhalol A on allergic inflammation was evaluated using a Compound 48/80-induced systemic anaphylaxis mouse model and a house dust mite (HDM)-induced atopic dermatitis (AD) mouse model. Trifuhalol A alleviated anaphylactic death and pruritus, which appeared as an early-phase reaction to allergic inflammation in the Compound 48/80-induced systemic anaphylaxis model. In addition, trifuhalol A improved symptoms such as itching, edema, erythema, and hyperkeratinization in HDM-induced AD mice as a late-phase reaction. Moreover, the expression of IL-33 and thymic stromal lymphopoietin, inflammatory cytokines secreted from activated keratinocytes, was significantly reduced by trifuhalol A administration, resulting in the reduced infiltration of immune cells into the skin and a reduction in the blood levels of IgE and IL-4. In summarizing the above results, these results confirm that trifuhalol A is a potential therapeutic candidate for the regulation of allergic inflammation.
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Affiliation(s)
- Sim-Kyu Bong
- Natural Products Research Institute, Korea Institute of Sceience and Technology (KIST), Gangneung 25451, Korea
| | - No-June Park
- Natural Products Research Institute, Korea Institute of Sceience and Technology (KIST), Gangneung 25451, Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology, Seoul 02792, Korea
| | - Sang Heon Lee
- Natural Products Research Institute, Korea Institute of Sceience and Technology (KIST), Gangneung 25451, Korea
| | - Jin Woo Lee
- Natural Products Research Institute, Korea Institute of Sceience and Technology (KIST), Gangneung 25451, Korea
| | - Aaron Taehwan Kim
- Department of Food Science, University of Massachusetts, Amherst, MA 01003, USA
| | - Xiaoyong Liu
- Haizhibao Deutschland GmbH, Heiliggeistgasse 28, 85354 Freising, Germany
| | - Sang Moo Kim
- Department of Marine Food Science and Technology, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea
| | - Min Hye Yang
- College of Pharmacy, Pusan National University, Busan 46241, Korea
| | - Yong Kee Kim
- College of Pharmacy, Sookmyung Women's University, Seoul 04310, Korea
| | - Su-Nam Kim
- Natural Products Research Institute, Korea Institute of Sceience and Technology (KIST), Gangneung 25451, Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology, Seoul 02792, Korea
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3
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Chang HY, Wu S, Li Y, Guo L, Li Y, Shah DK. Effect of the Size of Protein Therapeutics on Brain Pharmacokinetics Following Systematic Administration. AAPS J 2022; 24:62. [DOI: 10.1208/s12248-022-00701-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/24/2022] [Indexed: 12/18/2022] Open
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Redhu D, Franke K, Aparicio-Soto M, Kumari V, Pazur K, Illerhaus A, Hartmann K, Worm M, Babina M. Mast cells instruct keratinocytes to produce TSLP - relevance of the tryptase/PAR-2 axis. J Allergy Clin Immunol 2022; 149:2053-2061.e6. [PMID: 35240143 DOI: 10.1016/j.jaci.2022.01.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Thymic stromal lymphopoietin (TSLP) promotes Th2 inflammation and is deeply intertwined with inflammatory dermatoses like atopic dermatitis. The mechanisms regulating TSLP are poorly defined. OBJECTIVE To investigate whether and by what mechanisms mast cells (MCs) foster TSLP responses in the cutaneous environment. METHODS Ex vivo and in vivo skin MC degranulation was induced by compound 48/80 in wildtype, PAR-2- and MC-deficient mice in the presence/absence of neutralizing antibodies, antagonists or exogenous mMCP6. Primary human keratinocytes (hKCs) and murine skin explants (mSEs) were stimulated with lysates/supernatants of human skin MCs, purified tryptase or MC-lysate diminished of tryptase. Chymase and histamine were also used. TSLP was quantified by ELISA, RT-qPCR and immunofluorescence staining. RESULTS Mrgprb2-activation elicited TSLP in intact skin, mainly in the epidermis. Responses were strictly MC-dependent and relied on PAR-2. Complementarily, TSLP was elicited by tryptase in mSEs. Exogenous mMCP6 could fully restore responsiveness in MC-deficient mSEs. Conversely, PAR-2-knockout mice were unresponsive to mMCP6, while displaying increased responsiveness to other inflammatory pathways, e.g. IL-1α. Indeed, IL-1α acted in concert with tryptase. In hKCs, MC-elicited TSLP generation was likewise abolished by tryptase inhibition or elimination. Chymase and histamine did not impact TSLP production, but histamine triggered IL-6, IL-8, and SCF. CONCLUSION MCs communicate with KCs more broadly than hitherto suspected. The tryptase-PAR-2 axis is a crucial component of this crosstalk, underlying MC-dependent stimulation of TSLP in neighboring KCs. Interference specifically with MC tryptase may offer a treatment option for disorders initiated or perpetuated by aberrant TSLP, such as atopic dermatitis. CLINICAL IMPLICATIONS Awareness of the crosstalk between MCs and KCs may permit improved management of skin disorders, e.g. by selective targeting of tryptase.
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Affiliation(s)
- Davender Redhu
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristin Franke
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marina Aparicio-Soto
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Vandana Kumari
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kristijan Pazur
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Illerhaus
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - Karin Hartmann
- Department of Dermatology, Division of Allergy, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Margitta Worm
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Magda Babina
- Department of Dermatology and Allergy, Allergy Center Charité, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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5
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Tang L, Cao X, Li X, Ding H. Topical application with conjugated linoleic acid ameliorates 2, 4-dinitrofluorobenzene-induced atopic dermatitis-like lesions in BALB/c mice. Exp Dermatol 2021; 30:237-248. [PMID: 33206422 DOI: 10.1111/exd.14242] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 12/21/2022]
Abstract
Atopic dermatitis (AD) is a multifactorial chronic inflammatory skin disease characterized by skin barrier dysfunction, eczematous lesions, pruritus, and abnormal immune responses. In this study, we assessed the therapeutic effect of topical applied conjugated linoleic acid (CLA) on a murine AD model that was developed by repetitive applications of 2, 4-dinitrofluorobenzene (DNFB). 2% or 5% CLA could markedly ameliorate AD-like skin lesions, scratching behaviour and skin inflammation as evidenced by the reduced inflammatory blood cells, IgE and Th2-related cytokine levels, and the infiltration of mast cells and inflammatory cells to the dermal tissues. Moreover, topical application with CLA modulated skin barrier repair including maintaining a balanced skin pH and increasing skin hydration, partially mediated by upregulating skin barrier-related protein, filaggrin (FLG). In addition, topical CLA significantly dose-dependently inhibited pro-inflammatory cytokines including interleukin (IL)-6, IL-1β, tumour necrosis factor (TNF)-α and pro-inflammatory enzyme expressions of inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) in inflamed mice skin. Its anti-inflammatory effect was associated with the inhibition of DNFB-stimulated IκBα and NF-κB p65 phosphorylation in mouse skin. Taken together, our results suggest that locally applied CLA exerts potentially protective effects against AD lesional skin at least in part, due to regulation of skin barrier function and inflammatory response.
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Affiliation(s)
- Liu Tang
- School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Xiaoqin Cao
- College of Medicine, Jianghan University, Wuhan, China
| | - Xiaolei Li
- School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
| | - Hong Ding
- School of Pharmaceutical Sciences, Wuhan University, Wuhan, China
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6
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Kühn H, Kolkhir P, Babina M, Düll M, Frischbutter S, Fok JS, Jiao Q, Metz M, Scheffel J, Wolf K, Kremer AE, Maurer M. Mas-related G protein-coupled receptor X2 and its activators in dermatologic allergies. J Allergy Clin Immunol 2020; 147:456-469. [PMID: 33071069 DOI: 10.1016/j.jaci.2020.08.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 12/13/2022]
Abstract
The Mas-related G protein-coupled receptor X2 (MRGPRX2) is a multiligand receptor responding to various exogenous and endogenous stimuli. Being highly expressed on skin mast cells, MRGPRX2 triggers their degranulation and release of proinflammatory mediators, and it promotes multicellular signaling cascades, such as itch induction and transmission in sensory neurons. The expression of MRGPRX2 by skin mast cells and the levels of the MRGPRX2 agonists (eg, substance P, major basic protein, eosinophil peroxidase) are upregulated in the serum and/or skin of patients with inflammatory and pruritic skin diseases, such as chronic spontaneous urticaria or atopic dermatitis. Therefore, MRGPRX2 and its agonists might be potential biomarkers for the progression of cutaneous inflammatory diseases and the response to treatment. In addition, they may represent promising targets for prevention and treatment of signs and symptoms in patients with skin diseases or drug reactions. To assess this possibility, this review explores the role and relevance of MRGPRX2 and its activators in cutaneous inflammatory disorders and chronic pruritus.
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Affiliation(s)
- Helen Kühn
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Pavel Kolkhir
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; I.M. Sechenov First Moscow State Medical University (Sechenov University), Division of Immune-mediated Skin Diseases, Moscow, Russia
| | - Magda Babina
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Miriam Düll
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Frischbutter
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jie Shen Fok
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Qingqing Jiao
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Martin Metz
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jörg Scheffel
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katharina Wolf
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas E Kremer
- Department of Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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7
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Anti-inflammatory effects of natural flavonoid diosmetin in IL-4 and LPS-induced macrophage activation and atopic dermatitis model. Int Immunopharmacol 2020; 89:107046. [PMID: 33045572 PMCID: PMC7545212 DOI: 10.1016/j.intimp.2020.107046] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
Diosmetin, a citrus flavonoid, has a variety of therapeutic properties such as antibacterial, anti-inflammatory and antioxidant effects. However, the effect of diosmetin on atopic dermatitis (AD) development has not been reported. This study thus aims to investigate whether diosmetin possesses inhibitory effects on AD development. A dinitrochlorobenzene (DNCB)-induced AD mouse model was used to evaluate the effects of diosmetin on AD development. Treatment with diosmetin significantly reduced the dermatitis score, thickness of epidermis and dermis and number of mast cells in comparison with the untreated group. Furthermore, immunohistochemical analysis using an anti-F4/80 antibody demonstrated that diosmetin significantly suppressed macrophage infiltration into the AD lesion. It was observed that the levels of pro-inflammatory cytokines (TNF-α, IL-4 and IL-1β) in skin lesion decreased in response to treatment with diosmetin. In addition, the anti-inflammatory effect of diosmetin was evaluated in LPS- or IL-4-induced a mouse macrophage cell line (raw 264.7). Diosmetin inhibited the production of nitric oxide and decreased the expression of inducible nitric oxide synthase (iNOS). Diosmetin not only suppressed the phosphorylation of MAP kinase (ERK 1/2, p38 and JNK) but the activation of JAK/STAT signaling. The mRNA analysis demonstrated that diosmetin also reduced the level of inflammatory cytokines such as IL-1β and IL-6. Collectively, these results demonstrate that diosmetin exhibits the inhibitory effect on AD, suggesting that diosmetin may be a potential therapeutic agent for this atopic disorder.
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8
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Conjugated linoleic acid attenuates 2,4-dinitrofluorobenzene-induced atopic dermatitis in mice through dual inhibition of COX-2/5-LOX and TLR4/NF-κB signaling. J Nutr Biochem 2020; 81:108379. [PMID: 32330842 DOI: 10.1016/j.jnutbio.2020.108379] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/10/2020] [Accepted: 03/13/2020] [Indexed: 01/18/2023]
Abstract
Conjugated linoleic acid (CLA), commonly found in beef, lamb and dairy products, has been reported to exhibit anti-inflammatory and antipruritus effects and to inhibit the release of chemical mediators such as histamine and eicosanoid in laboratory rodents. The chief objective of the study is to assess the efficacy of CLA on atopic dermatitis (AD) in mice and to explore possible mechanisms with CLA treatments. To develop a new therapy for AD, the anti-AD potential of CLA was investigated by inducing AD-like skin lesions in mice using 2,4-dinitrofluorobenzene. We evaluated dermatitis severity; histopathological changes; serum levels of T helper (Th) cytokines (interferon-γ, interleukin-4); changes in protein expression by western blotting and immunohistochemistry staining for cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), toll like receptor 4 (TLR-4), myeloid differentiation factor 88 (MyD88), nuclear factor-κB (NF-κB) and tumor necrosis factor α (TNF-α); and production of the proinflammatory lipid mediators, such as prostaglandin E2 and leukotriene B4, in the skin lesions. Treatment with CLA ameliorated the development of AD-like clinical symptoms and effectively inhibited epidermal hyperplasia and infiltration of mast cells and CD4+ T cells in the AD mouse skin. Total serum immunoglobulin E levels and the expression levels of Th1/Th2 cytokines and lipid mediators in dorsal skin were dramatically suppressed by CLA. Furthermore, CLA down-regulated the expressions of COX-2, 5-LOX, TLR4, MyD88, NF-κB and TNF-α. Taken together, our findings demonstrate the potential usefulness of CLA as an anti-inflammatory dietary supplement or drug for the prevention and management of AD skin diseases by modulating the COX-2/5-LOX and TLR4/MyD88/NF-κB signaling pathways.
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9
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Shin JY, Che DN, Cho BO, Kang HJ, Kim J, Jang SI. Commiphora myrrha inhibits itch-associated histamine and IL-31 production in stimulated mast cells. Exp Ther Med 2019; 18:1914-1920. [PMID: 31410154 DOI: 10.3892/etm.2019.7721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 05/16/2019] [Indexed: 12/15/2022] Open
Abstract
Commiphora myrrha (Myrrh) is widely recognized for its anti-inflammatory and antimicrobial properties, which are utilized for the treatment of oral ulcers, gingivitis, sinusitis, glomerulonephritis, brucellosis and a variety of skin disorders. The current study aimed to assess whether myrrh modulates itch-associated interleukin (IL)-31 cytokine production and histamine release in stimulated human mast cells (HMC-1). To realize this, molecular biology techniques including real-time quantitiative PCR, western blotting and ELISA were employed. The results indicated that Myrrh successfully suppressed phorbol myristate acetate and calcium ionophore-stimulated mRNA expression, and reduced the production of IL-31 in HMC-1 cells. In addition, myrrh served as a suppressor of extracellular signal-regulated kinase and NF-κB activation, indicating its mechanism in the prevention of HMC-1 cell IL-31 production. Myrrh also prevented the release of histamine in HMC-1 cells. Whilst the present study awaits in vivo support, the pharmacological actions of myrrh provide new indications as to its potential applicability for itch treatment, which cannot be treated with histamine receptor blockers alone.
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Affiliation(s)
- Jae Young Shin
- Department of Health Management, Jeonju University, Jeonju, Jeollabuk 55069, Republic of Korea
| | - Denis Nchang Che
- Department of Health Management, Jeonju University, Jeonju, Jeollabuk 55069, Republic of Korea.,Department of Food Science and Technology, Chonbuk National University, Jeonju, Jeollabuk 54896, Republic of Korea
| | - Byoung Ok Cho
- Department of Health Management, Jeonju University, Jeonju, Jeollabuk 55069, Republic of Korea.,Research Institute, ATO Q&A Co., Ltd., Jeonju, Jeollabuk 54840, Republic of Korea
| | - Hyun Ju Kang
- Research Institute, ATO Q&A Co., Ltd., Jeonju, Jeollabuk 54840, Republic of Korea
| | - Jisu Kim
- Department of Health Management, Jeonju University, Jeonju, Jeollabuk 55069, Republic of Korea
| | - Seon Il Jang
- Department of Health Management, Jeonju University, Jeonju, Jeollabuk 55069, Republic of Korea.,Research Institute, ATO Q&A Co., Ltd., Jeonju, Jeollabuk 54840, Republic of Korea
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10
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Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. Pain 2019; 160:2661-2678. [DOI: 10.1097/j.pain.0000000000001678] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Chung K, Pitcher T, Grant AD, Hewitt E, Lindstrom E, Malcangio M. Cathepsin S acts via protease-activated receptor 2 to activate sensory neurons and induce itch-like behaviour. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2019; 6:100032. [PMID: 31223140 PMCID: PMC6565756 DOI: 10.1016/j.ynpai.2019.100032] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/19/2023]
Abstract
Chronic itch is a debilitating condition characterised by excessive scratching and is a symptom frequently reported in skin diseases such as atopic dermatitis. It has been proposed that release of the cysteine protease Cathepsin S (CatS) from skin keratinocytes or immune cells resident in or infiltrating the skin could act as a pruritogen in chronic itch conditions. CatS is known to activate protease-activated receptor 2 (PAR2). We therefore hypothesised that enzymatic activation of neuronally expressed PAR2 by CatS was responsible for activation of sensory neurons and transmission of itch signals. Intradermally-injected human recombinant (hr)-CatS or the PAR2 agonist, SLIGRL-NH2 behaved as pruritogens by causing scratching behaviour in mice. Hr-CatS-induced scratching behaviour was prevented by CatS inhibitors and PAR2 antagonists and reduced by 50% in TRPV1-/- mice compared with wild-type mice, whilst no significant reduction in scratching behaviour was observed in TRPA1-/- mice. Cultured dorsal root ganglion (DRG) cells showed an increase in [Ca2+]i following incubation with hr-CatS, and the percentage of neurons that responded to hr-CatS decreased in the presence of a PAR2 antagonist or in cultures of neurons from TRPV1-/- mice. Taken together, our results indicate CatS acts as a pruritogen via PAR2 activation in TRPV1-expressing sensory neurons.
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Affiliation(s)
- Keshi Chung
- Wolfson Centre for Age-Related Diseases, King’s College London, UK
| | - Thomas Pitcher
- Wolfson Centre for Age-Related Diseases, King’s College London, UK
| | - Andrew D. Grant
- Wolfson Centre for Age-Related Diseases, King’s College London, UK
| | | | | | - Marzia Malcangio
- Wolfson Centre for Age-Related Diseases, King’s College London, UK
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12
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Baumann KY, Church MK, Clough GF, Quist SR, Schmelz M, Skov PS, Anderson CD, Tannert LK, Giménez-Arnau AM, Frischbutter S, Scheffel J, Maurer M. Skin microdialysis: methods, applications and future opportunities-an EAACI position paper. Clin Transl Allergy 2019; 9:24. [PMID: 31007896 PMCID: PMC6456961 DOI: 10.1186/s13601-019-0262-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/25/2019] [Indexed: 12/20/2022] Open
Abstract
Skin microdialysis (SMD) is a versatile sampling technique that can be used to recover soluble endogenous and exogenous molecules from the extracellular compartment of human skin. Due to its minimally invasive character, SMD can be applied in both clinical and preclinical settings. Despite being available since the 1990s, the technique has still not reached its full potential use as a tool to explore pathophysiological mechanisms of allergic and inflammatory reactions in the skin. Therefore, an EAACI Task Force on SMD was formed to disseminate knowledge about the technique and its many applications. This position paper from the task force provides an overview of the current use of SMD in the investigation of the pathogenesis of chronic inflammatory skin diseases, such as atopic dermatitis, chronic urticaria, psoriasis, and in studies of cutaneous events during type 1 hypersensitivity reactions. Furthermore, this paper covers drug hypersensitivity, UVB-induced- and neurogenic inflammation, and drug penetration investigated by SMD. The aim of this paper is to encourage the use of SMD and to make the technique easily accessible by providing an overview of methodology and applications, supported by standardized operating procedures for SMD in vivo and ex vivo.
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Affiliation(s)
- Katrine Y Baumann
- RefLab ApS, Copenhagen, Denmark.,2Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin K Church
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Sven Roy Quist
- 5Clinic of Dermatology, Otto-von-Guericke University, Magdeburg, Germany.,Skin Center MDZ, Mainz, Germany
| | - Martin Schmelz
- 7Department of Experimental Pain Research, CBTM, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Per Stahl Skov
- RefLab ApS, Copenhagen, Denmark.,8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Chris D Anderson
- 9Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Line Kring Tannert
- 8Odense Research Center for Anaphylaxis (ORCA), Department of Dermatology and Allergy Center, Odense University Hospital, Odense, Denmark
| | - Ana Maria Giménez-Arnau
- 10Department of Dermatology, Hospital del Mar, Institut Mar d'Investigacions Mèdiques, Universitat Autònoma, Barcelona, Spain
| | - Stefan Frischbutter
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Jörg Scheffel
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Marcus Maurer
- 3Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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13
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Che DN, Cho BO, Shin JY, Kang HJ, Kim JS, Oh H, Kim YS, Jang SI. Apigenin Inhibits IL-31 Cytokine in Human Mast Cell and Mouse Skin Tissues. Molecules 2019; 24:molecules24071290. [PMID: 30987029 PMCID: PMC6479805 DOI: 10.3390/molecules24071290] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 11/26/2022] Open
Abstract
IL-31 is a recently discovered cytokine that is produced not only in T-cells but also in mast cells. It is strongly implicated to play a key role in inflammatory diseases and in the pathogenesis of itch in atopic dermatitis. Apigenin, a flavonoid of plant origin has numerous biological applications. In this study, we showed that apigenin modulates IL-31 mRNA, protein expression, and release in stimulated human mast (HMC-1) by inhibiting the phosphorylation activation of MAPK and NF-κB. To determine whether apigenin has similar effects in vivo, using Compound 48/80, we developed an atopic dermatitis itch model in mice and found an increase in IL-31 expression in the skin. We also revealed that apigenin prevents the infiltration and degranulation of mast cells and suppressed mRNA and protein expression of IL-31 in the skin of mice. These results provide a new suggestion of the potential applicability of apigenin for treatment of various inflammatory diseases and itch mediated by IL-31.
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Affiliation(s)
- Denis Nchang Che
- Department of Food Science and Technology, Chonbuk National University, Jeonju-si, Jeollabuk-do 54896, Korea.
- Department of Health Management, Jeonju University, Jeonju-si, Jeollabuk-do 55069, Korea.
| | - Byoung Ok Cho
- Department of Health Management, Jeonju University, Jeonju-si, Jeollabuk-do 55069, Korea.
- Research Institute, Ato Q&A Co., Ltd., Jeonju-si, Jeollabuk-do 54840, Korea.
| | - Jae Young Shin
- Research Institute, Ato Q&A Co., Ltd., Jeonju-si, Jeollabuk-do 54840, Korea.
| | - Hyun Ju Kang
- Research Institute, Ato Q&A Co., Ltd., Jeonju-si, Jeollabuk-do 54840, Korea.
| | - Ji-Su Kim
- Department of Health Management, Jeonju University, Jeonju-si, Jeollabuk-do 55069, Korea.
| | - Hyeonhwa Oh
- Department of Food Science and Technology, Chonbuk National University, Jeonju-si, Jeollabuk-do 54896, Korea.
| | - Young-Soo Kim
- Department of Food Science and Technology, Chonbuk National University, Jeonju-si, Jeollabuk-do 54896, Korea.
| | - Seon Il Jang
- Department of Health Management, Jeonju University, Jeonju-si, Jeollabuk-do 55069, Korea.
- Research Institute, Ato Q&A Co., Ltd., Jeonju-si, Jeollabuk-do 54840, Korea.
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14
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Zschiebsch K, Fischer C, Wilken‐Schmitz A, Geisslinger G, Channon K, Watschinger K, Tegeder I. Mast cell tetrahydrobiopterin contributes to itch in mice. J Cell Mol Med 2019; 23:985-1000. [PMID: 30450838 PMCID: PMC6349351 DOI: 10.1111/jcmm.13999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/25/2018] [Accepted: 10/13/2018] [Indexed: 12/28/2022] Open
Abstract
GTP cyclohydrolase (GCH1) governs de novo synthesis of the enzyme cofactor, tetrahydrobiopterin (BH4), which is essential for biogenic amine production, bioactive lipid metabolism and redox coupling of nitric oxide synthases. Overproduction of BH4 via upregulation of GCH1 in sensory neurons is associated with nociceptive hypersensitivity in rodents, and neuron-specific GCH1 deletion normalizes nociception. The translational relevance is revealed by protective polymorphisms of GCH1 in humans, which are associated with a reduced chronic pain. Because myeloid cells constitute a major non-neuronal source of BH4 that may contribute to BH4-dependent phenotypes, we studied here the contribution of myeloid-derived BH4 to pain and itch in lysozyme M Cre-mediated GCH1 knockout (LysM-GCH1-/- ) and overexpressing mice (LysM-GCH1-HA). Unexpectedly, knockout or overexpression in myeloid cells had no effect on nociceptive behaviour, but LysM-driven GCH1 knockout reduced, and its overexpression increased the scratching response in Compound 48/80 and hydroxychloroquine-evoked itch models, which involve histamine and non-histamine dependent signalling pathways. Mechanistically, GCH1 overexpression increased BH4, nitric oxide and hydrogen peroxide, and these changes were associated with increased release of histamine and serotonin and degranulation of mast cells. LysM-driven GCH1 knockout had opposite effects, and pharmacologic inhibition of GCH1 provided even stronger itch suppression. Inversely, intradermal BH4 provoked scratching behaviour in vivo and BH4 evoked an influx of calcium in sensory neurons. Together, these loss- and gain-of-function experiments suggest that itch in mice is contributed by BH4 release plus BH4-driven mediator release from myeloid immune cells, which leads to activation of itch-responsive sensory neurons.
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Affiliation(s)
- Katja Zschiebsch
- Institute of Clinical PharmacologyGoethe‐University HospitalFrankfurtGermany
| | - Caroline Fischer
- Institute of Clinical PharmacologyGoethe‐University HospitalFrankfurtGermany
| | | | - Gerd Geisslinger
- Institute of Clinical PharmacologyGoethe‐University HospitalFrankfurtGermany
| | - Keith Channon
- Division of Cardiovascular MedicineUniversity of OxfordOxfordUK
| | - Katrin Watschinger
- Division of Biological ChemistryBiocenterMedical University of InnsbruckInnsbruckAustria
| | - Irmgard Tegeder
- Institute of Clinical PharmacologyGoethe‐University HospitalFrankfurtGermany
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15
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Barr TP, Garzia C, Guha S, Fletcher EK, Nguyen N, Wieschhaus AJ, Ferrer L, Covic L, Kuliopulos A. PAR2 Pepducin-Based Suppression of Inflammation and Itch in Atopic Dermatitis Models. J Invest Dermatol 2018; 139:412-421. [PMID: 30287285 DOI: 10.1016/j.jid.2018.08.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/09/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
PAR2 has been proposed to contribute to lesion formation and intense itch in atopic dermatitis. Here, we tested the ability of a cell-penetrating pepducin, PZ-235, to mitigate the potentially deleterious effects of PAR2 in models of atopic dermatitis. PZ-235 significantly inhibited PAR2-mediated expression of inflammatory factors NF-κB, TSLP, TNF-α, and differentiation marker K10 by 94%-98% (P < 0.001) in human keratinocytes and suppressed IL-4 and IL-13 by 68%-83% (P < 0.05) in mast cells. In delayed pepducin treatment models of oxazolone- and DNFB-induced dermatitis, PZ-235 significantly attenuated skin thickening by 43%-100% (P < 0.01) and leukocyte crusting by 57% (P < 0.05), and it inhibited ex vivo chemotaxis of leukocytes toward PAR2 agonists. Daily PZ-235 treatment of filaggrin-deficient mice exposed to dust mite allergens for 8 weeks significantly suppressed total leukocyte and T-cell infiltration by 50%-68%; epidermal thickness by 60%-77%; and skin thickening, scaling, excoriation, and total lesion severity score by 46%-56%. PZ-235 significantly reduced itching caused by wasp venom peptide degranulation of mast cells in mice by 51% (P < 0.05), which was comparable to the protective effects conferred by PAR2 deficiency. Taken together, these results suggest that a PAR2 pepducin may confer broad therapeutic benefits as a disease-modifying treatment for atopic dermatitis and itch.
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Affiliation(s)
- Travis P Barr
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Chris Garzia
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Srijoy Guha
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth K Fletcher
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nga Nguyen
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Adam J Wieschhaus
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Lluis Ferrer
- Department of Dermatology, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Lidija Covic
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Athan Kuliopulos
- Center of Hemostasis and Thrombosis Research, Tufts Medical Center, Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
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16
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Stigmasterol Alleviates Cutaneous Allergic Responses in Rodents. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3984068. [PMID: 30140696 PMCID: PMC6081592 DOI: 10.1155/2018/3984068] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/14/2018] [Accepted: 06/25/2018] [Indexed: 12/16/2022]
Abstract
The therapeutic potential of stigmasterol, a natural steroid alcohol with established immune-modulatory properties, was assessed on allergic cutaneous responses. We examined its suppressive effect on immunoglobulin E (IgE)-mediated active cutaneous anaphylaxis (ACA), compound 48/80 (C48/80)-induced pruritus, and irritant dermatitis induced by 12-O-tetradecanoylphorbol-13-acetate (TPA). Stigmasterol at 10–100 mg/kg significantly inhibited ACA with reduction in reaction area and concentration of the extravasated Evans blue dye. Given at 50 and 100 mg/kg, stigmasterol significantly inhibited C48/80-induced scratching behaviour when compared to saline-treated C48/80-injected control. Skin histopathology of injected sites confirmed that stigmasterol reduced mast cell trafficking and degranulation associated with C48/80-induced pruritus. Stigmasterol controlled inflammatory features such as ear skin oedema and neutrophilia and also reduced serum levels of TNFα induced by topical application of TPA. Epidermal layer thickening and inflammatory cell infiltration of ear skin tissue were significantly reduced by stigmasterol. Taken together, stigmasterol demonstrates significant potential as a molecule of interest in allergic skin disease therapy.
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17
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Fisetin inhibits IL-31 production in stimulated human mast cells: Possibilities of fisetin being exploited to treat histamine-independent pruritus. Life Sci 2018; 201:121-129. [DOI: 10.1016/j.lfs.2018.03.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/09/2018] [Accepted: 03/27/2018] [Indexed: 11/19/2022]
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18
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Ashigai H, Komano Y, Wang G, Kawachi Y, Sunaga K, Yamamoto R, Takata R, Miyake M, Yanai T. Effect of administrating polysaccharide from black currant ( Ribes nigrum L.) on atopic dermatitis in NC/Nga mice. BIOSCIENCE OF MICROBIOTA FOOD AND HEALTH 2017; 37:19-24. [PMID: 29387518 PMCID: PMC5787412 DOI: 10.12938/bmfh.17-014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/07/2017] [Indexed: 01/15/2023]
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease that causes dry skin and functional disruption of the skin barrier. AD is often accompanied by allergic inflammation. AD patient suffer from heavy itching,
and their quality of life is severely affected. Some pharmaceuticals for AD have some side effects such as skin atrophy. So it is necessary to develop mild solutions such as food ingredients without side effects. There
are various causes of AD. It is especially induced by immunological imbalances such as IFN-γ reduction. IFN-γ has an important role in regulating IgE, which can cause an allergy reaction. NC/Nga mice develop AD and IgE
hyperproduction. In a previous study, we revealed that administration of polysaccharide from black currant (R. nigrum) has an effect on immunomodulation. It induces IFN-γ production from myeloid
dendritic cells. We named this polysaccharide cassis polysaccharide (CAPS). In this report, we studied the effect of administering CAPS on atopic dermatitis in NC/Nga mice. Thirty NC/Nga mice that developed symptoms of
atopic dermatitis were used. We divided them into three groups (control, CAPS administration 12 mg/kg/day, CAPS administration 60 mg/kg/day). For 4 weeks, we evaluated clinical score, serum IgE levels, gene expression of
spleen, and skin pathology. We revealed that CAPS administration improves atopic dermatitis symptoms. We also found that CAPS administration suppresses IgE hyperproduction and induces IFN-γ gene transcription in the
spleen. Finally, we confirmed that CAPS administration suppresses mast cell migration to epidermal skin. These results indicated that CAPS has an effect on AD.
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Affiliation(s)
- Hiroshi Ashigai
- Research Laboratories for Health Science & Food Technologies, Kirin Company, Ltd., 1-17-1 Namamugi, Tsurumi-ku, Yokohama, Kanagawa 230-8628, Japan
| | - Yuta Komano
- Research Laboratories for Health Science & Food Technologies, Kirin Company, Ltd., 1-17-1 Namamugi, Tsurumi-ku, Yokohama, Kanagawa 230-8628, Japan
| | - Guanying Wang
- Research Laboratories for Health Science & Food Technologies, Kirin Company, Ltd., 1-17-1 Namamugi, Tsurumi-ku, Yokohama, Kanagawa 230-8628, Japan
| | - Yasuji Kawachi
- Research Laboratories for Health Science & Food Technologies, Kirin Company, Ltd., 1-17-1 Namamugi, Tsurumi-ku, Yokohama, Kanagawa 230-8628, Japan
| | - Kazuko Sunaga
- Marketing Department, Mercian Corporation, 4-10-2 Nakano, Nakano-ku, Tokyo 164-0001, Japan
| | - Reiko Yamamoto
- Research Laboratories for Wine Technologies, Kirin Company, Ltd., 4-9-1 Johnan, Fujisawa, Kanagawa 251-0057, Japan
| | - Ryoji Takata
- Research Laboratories for Wine Technologies, Kirin Company, Ltd., 4-9-1 Johnan, Fujisawa, Kanagawa 251-0057, Japan
| | - Mika Miyake
- Research Laboratories for Health Science & Food Technologies, Kirin Company, Ltd., 1-17-1 Namamugi, Tsurumi-ku, Yokohama, Kanagawa 230-8628, Japan
| | - Takaaki Yanai
- Research Laboratories for Wine Technologies, Kirin Company, Ltd., 4-9-1 Johnan, Fujisawa, Kanagawa 251-0057, Japan
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19
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Lotts T, Agelopoulos K, Phan NQ, Loser K, Schmaus G, Luger TA, Ständer S. Dihydroavenanthramide D inhibits mast cell degranulation and exhibits anti-inflammatory effects through the activation of neurokinin-1 receptor. Exp Dermatol 2017; 26:739-742. [PMID: 27892633 DOI: 10.1111/exd.13265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
Chronic pruritus is difficult to treat. Current treatment options are frequently ineffective and new therapeutic approaches are urgently needed. Avenanthramides are active substances in oats that exhibit anti-inflammatory effects. Their potential to interrupt pruritus mechanisms was investigated in this study. It was found that the synthetic analog dihydroavenanthramide D (DHAvD) can interact with the neurokinin-1 receptor (NK1R) and inhibit mast cell degranulation. DHAvD also affects inflammatory processes and reduces secretion of the cytokine interleukin-6. Our findings indicate that DHAvD may act as a NK1R inhibitor and could be a promising candidate for topical treatments of chronic pruritus.
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Affiliation(s)
- Tobias Lotts
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Konstantin Agelopoulos
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Ngoc Q Phan
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Karin Loser
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Experimental Dermatology and Immunobiology of the Skin, University Hospital Münster, Münster, Germany
| | | | - Thomas A Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, University of Münster, Münster, Germany.,Department of Dermatology, Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
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20
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Park KD, Pak SC, Park KK. The Pathogenetic Effect of Natural and Bacterial Toxins on Atopic Dermatitis. Toxins (Basel) 2016; 9:toxins9010003. [PMID: 28025545 PMCID: PMC5299398 DOI: 10.3390/toxins9010003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022] Open
Abstract
Atopic dermatitis (AD) is a common allergic skin disease that is associated with chronic, recurrent eczematous and pruritic lesions at the flexural folds caused by interacting factors related to environmental and immune system changes. AD results in dry skin, and immunoglobulin E-mediated allergic reactions to foods and environmental allergens. While steroids and anti-histamines temporarily relieve the symptoms of AD, the possibility of side effects from pharmacological interventions remains. Despite intensive research, the underlying mechanisms for AD have not been clarified. A study of Staphylococcus aureus (S. aureus) established the role of its toxins in the pathogenesis of AD. Approximately 90% of patients with AD experience S. aureus colonization and up to 50%–60% of the colonizing S. aureus is toxin-producing. Any damage to the protective skin barrier allows for the entry of invading allergens and pathogens that further drive the pathogenesis of AD. Some natural toxins (or their components) that have therapeutic effects on AD have been studied. In addition, recent studies on inflammasomes as one component of the innate immune system have been carried out. Additionally, studies on the close relationship between the activation of inflammasomes and toxins in AD have been reported. This review highlights the literature that discusses the pathogenesis of AD, the role of toxins in AD, and the positive and negative effects of toxins on AD. Lastly, suggestions are made regarding the role of inflammasomes in AD.
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Affiliation(s)
- Kyung-Duck Park
- Department of Dermatology, College of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea.
| | - Sok Cheon Pak
- School of Biomedical Sciences, Charles Sturt University, Panorama Avenue, Bathurst NSW 2795, Australia.
| | - Kwan-Kyu Park
- Department of Pathology, College of Medicine, Catholic University of Daegu, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea.
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21
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Hawro T, Lehmann S, Altrichter S, Fluhr JW, Zuberbier T, Church MK, Maurer M, Metz M. Skin provocation tests may help to diagnose atopic dermatitis. Allergy 2016; 71:1745-1752. [PMID: 27472813 DOI: 10.1111/all.12995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common skin disorder. Its diagnosis relies on clinical judgment. Mild and untypical manifestations may cause diagnostic difficulties. Biomarkers for the differential diagnostic workup of AD are needed. OBJECTIVE To test whether the results of skin provocation with cowhage, an established model of histamine-independent pruritus, and histamine are different in AD patients and healthy subjects and whether these tests may be used as diagnostic markers of AD. METHODS Twenty-two AD patients and 18 healthy controls were subjected to topical cowhage provocation and skin prick testing with histamine and assessed for differences in the quality, intensity, and persistence of itch, for wheal diameter, volume, and flare size and intensity. RESULTS Patients with AD, compared with healthy controls, exhibited significantly smaller histamine-induced flares (P < 0.01) and markedly longer itch persistence after provocation with cowhage (P < 0.01). Both parameters showed good diagnostic properties for AD (area under the receiver operating characteristic (ROC) curve 0.78 and 0.80, respectively). The persistence of cowhage-induced itch for at least 30 min and a histamine-induced flare of less than 2 cm in diameter were reliable thresholds for the diagnosis of AD. If combinations of the results of both tests were used, their sensitivity and specificity of diagnosing AD were up to 91% and 94%, respectively. CONCLUSION The clinical benefit of cowhage and histamine skin provocation tests should be investigated in further studies. Long persistence of cowhage-induced itch and diminished histamine-induced flare in nonlesional skin may support diagnosis of AD.
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Affiliation(s)
- T. Hawro
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - S. Lehmann
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - S. Altrichter
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - J. W. Fluhr
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - T. Zuberbier
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. K. Church
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. Maurer
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - M. Metz
- Department of Dermatology and Allergy; Allergie-Centrum Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
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22
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Microdialysis of Large Molecules. J Pharm Sci 2016; 105:3233-3242. [DOI: 10.1016/j.xphs.2016.08.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/01/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022]
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23
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Hoeck EA, Marker JB, Gazerani P, H. Andersen H, Arendt-Nielsen L. Preclinical and human surrogate models of itch. Exp Dermatol 2016; 25:750-7. [DOI: 10.1111/exd.13078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Emil A. Hoeck
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Jens B. Marker
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Parisa Gazerani
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Hjalte H. Andersen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
| | - Lars Arendt-Nielsen
- SMI; Department of Health Science and Technology; Faculty of Medicine; Aalborg University; Aalborg E Denmark
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24
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Chillo O, Kleinert EC, Lautz T, Lasch M, Pagel JI, Heun Y, Troidl K, Fischer S, Caballero-Martinez A, Mauer A, Kurz ARM, Assmann G, Rehberg M, Kanse SM, Nieswandt B, Walzog B, Reichel CA, Mannell H, Preissner KT, Deindl E. Perivascular Mast Cells Govern Shear Stress-Induced Arteriogenesis by Orchestrating Leukocyte Function. Cell Rep 2016; 16:2197-2207. [PMID: 27524614 DOI: 10.1016/j.celrep.2016.07.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 06/23/2016] [Accepted: 07/17/2016] [Indexed: 01/08/2023] Open
Abstract
The body has the capacity to compensate for an occluded artery by creating a natural bypass upon increased fluid shear stress. How this mechanical force is translated into collateral artery growth (arteriogenesis) is unresolved. We show that extravasation of neutrophils mediated by the platelet receptor GPIbα and uPA results in Nox2-derived reactive oxygen radicals, which activate perivascular mast cells. These c-kit(+)/CXCR-4(+) cells stimulate arteriogenesis by recruiting additional neutrophils as well as growth-promoting monocytes and T cells. Additionally, mast cells may directly contribute to vascular remodeling and vascular cell proliferation through increased MMP activity and by supplying growth-promoting factors. Boosting mast cell recruitment and activation effectively promotes arteriogenesis, thereby protecting tissue from severe ischemic damage. We thus find that perivascular mast cells are central regulators of shear stress-induced arteriogenesis by orchestrating leukocyte function and growth factor/cytokine release, thus providing a therapeutic target for treatment of vascular occlusive diseases.
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Affiliation(s)
- Omary Chillo
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Eike Christian Kleinert
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Thomas Lautz
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Manuel Lasch
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Judith-Irina Pagel
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany; Hospital of the University of Munich, Department of Anesthesiology, LMU Munich, 81377 Munich, Germany
| | - Yvonn Heun
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Kerstin Troidl
- Division of Arteriogenesis Research, Max Planck Institute for Heart and Lung Research, 61231 Bad Nauheim, Germany
| | - Silvia Fischer
- Institute for Biochemistry, Medical School, Justus-Liebig-Universität, 35392 Giessen, Germany
| | - Amelia Caballero-Martinez
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Annika Mauer
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany; Institute for Biochemistry, Medical School, Justus-Liebig-Universität, 35392 Giessen, Germany
| | - Angela R M Kurz
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Gerald Assmann
- Institute of Pathology, LMU Munich, 81377 Munich, Germany
| | - Markus Rehberg
- Institute for Stroke and Dementia Research, LMU Munich, 81377 Munich, Germany
| | - Sandip M Kanse
- Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway
| | - Bernhard Nieswandt
- Institute of Experimental Biomedicine, University Hospital and Rudolf Virchow Center, University of Würzburg, 97080 Würzburg, Germany
| | - Barbara Walzog
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Christoph A Reichel
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany; Hospital of the University of Munich, Department of Otorhinolaryngology, Head and Neck Surgery, LMU Munich, 81377 Munich, Germany
| | - Hanna Mannell
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany
| | - Klaus T Preissner
- Institute for Biochemistry, Medical School, Justus-Liebig-Universität, 35392 Giessen, Germany
| | - Elisabeth Deindl
- Walter-Brendel-Centre of Experimental Medicine, Ludwig-Maximilians-Universität (LMU) Munich, 81377 Munich, Germany.
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25
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Marsella R. Canine models of allergic skin disease. Vet Dermatol 2016; 27:326-7. [DOI: 10.1111/vde.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rosanna Marsella
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine; University of Florida; 2015 SW 16th Avenue Gainesville FL 32610 USA
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26
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Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out? Clin Rev Allergy Immunol 2015; 51:263-292. [DOI: 10.1007/s12016-015-8488-5] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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27
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Abstract
Histamine is one of the best-characterized pruritogens in humans. It is known to play a role in pruritus associated with urticaria as well as ocular and nasal allergic reactions. Histamine mediates its effect via four receptors. Antihistamines that block the activation of the histamine H₁receptor, H₁R, have been shown to be effective therapeutics for the treatment of pruritus associated with urticaria, allergic rhinitis, and allergic conjunctivitis. However, their efficacy in other pruritic diseases such as atopic dermatitis and psoriasis is limited. The other histamine receptors may also play a role in pruritus, with the exception of the histamine H₂receptor, H₂R. Preclinical evidence indicates that local antagonism of the histamine H₃receptor, H₃R, can induce scratching perhaps via blocking inhibitory neuronal signals. The histamine H₄receptor, H₄R, has received a significant amount of attention as to its role in mediating pruritic signals. Indeed, it has now been shown that a selective H₄R antagonist can inhibit histamine-induced itch in humans. This clinical result, in conjunction with efficacy in various preclinical pruritus models, points to the therapeutic potential of H₄R antagonists for the treatment of pruritus not controlled by antihistamines that target the H₁R.
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Affiliation(s)
- Robin L Thurmond
- Janssen Research and Development, L.L.C., San Diego, CA, 92121, USA,
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28
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Lyons JJ, Milner JD, Stone KD. Atopic dermatitis in children: clinical features, pathophysiology, and treatment. Immunol Allergy Clin North Am 2014; 35:161-83. [PMID: 25459583 DOI: 10.1016/j.iac.2014.09.008] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic skin condition resulting from disruption of the epithelial barrier and associated immune dysregulation in the skin of genetically predisposed hosts. AD generally develops in early childhood, has a characteristic age-dependent distribution and is commonly associated with elevated IgE, peripheral eosinophilia, and other allergic diseases. Medications such as antihistamines have demonstrated poor efficacy in controlling AD-associated itch. Education of patients regarding the primary underlying defects and provision of a comprehensive skin care plan is essential for disease maintenance and management of flares.
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Affiliation(s)
- Jonathan J Lyons
- Genetics and Pathophysiology of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Joshua D Milner
- Genetics and Pathophysiology of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Kelly D Stone
- Genetics and Pathophysiology of Allergy Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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29
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Receptors, cells and circuits involved in pruritus of systemic disorders. Biochim Biophys Acta Mol Basis Dis 2014; 1842:869-92. [DOI: 10.1016/j.bbadis.2014.02.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/16/2014] [Accepted: 02/18/2014] [Indexed: 12/12/2022]
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30
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Jin X, Zhao W, Kirabo A, Park SO, Ho WT, Sayeski PP, Zhao ZJ. Elevated levels of mast cells are involved in pruritus associated with polycythemia vera in JAK2V617F transgenic mice. THE JOURNAL OF IMMUNOLOGY 2014; 193:477-84. [PMID: 24920845 DOI: 10.4049/jimmunol.1301946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Pruritus occurs frequently in patients with polycythemia vera (PV), and the pathophysiology of PV-associated pruritus is unclear. We have previously demonstrated that transgenic mice expressing JAK2V617F displayed clear PV-like phenotypes. In the current study, we found frequent occurrence of pruritus with aged JAK2V617F transgenic mice and further investigated the underlying mechanisms by studying mast cells, key players in allergic reactions and anaphylaxis. Massive accumulations of mast cells were observed in the skin of pruritic JAK2V617F transgenic mice. In vitro culture yielded much higher mast cell counts from the bone marrow, spleen, peripheral blood, and peritoneal cavity of JAK2V617F transgenic mice than from controls. Cultured mast cells from JAK2V617F transgenic mice exhibited enhanced proliferative signals, relative resistance to cell death upon growth factor deprivation, and a growth advantage over control cells under suboptimal growth conditions. However, these mast cells displayed normal morphology and contained normal levels of mast cell proteases before and after degranulation. Finally, the JAK2 inhibitor G6 effectively reduced mast cell numbers and alleviated pruritus in JAK2V617F transgenic mice. Collectively, these data demonstrate that mast cells are involved in PV-associated pruritogenesis and that JAK2 inhibitors are potential antipruritus drugs.
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Affiliation(s)
- Xi Jin
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
| | - Wanke Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
| | - Annet Kirabo
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, FL 32611
| | - Sung O Park
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, FL 32611
| | - Wanting T Ho
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
| | - Peter P Sayeski
- Department of Physiology and Functional Genomics, University of Florida College of Medicine, Gainesville, FL 32611
| | - Zhizhuang J Zhao
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104; and
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Jeon IH, Kim HS, Kang HJ, Lee HS, Jeong SI, Kim SJ, Jang SI. Anti-inflammatory and antipruritic effects of luteolin from Perilla (P. frutescens L.) leaves. Molecules 2014; 19:6941-51. [PMID: 24871572 PMCID: PMC6271665 DOI: 10.3390/molecules19066941] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 01/18/2023] Open
Abstract
Perilla (Perilla frutescens L.) leaves have shown therapeutic efficacy in the treatment of inflammatory disorders, allergies, bronchial asthma, and systemic damage due to free radicals. In the present study we analyzed the active constituents in perilla leaves using high-performance liquid chromatography (HPLC) and isolated luteolin, a polyphenolic flavonoid. We investigated the anti-inflammatory and antipruritic properties of luteolin. Luteolin inhibited the secretion of inflammatory cytokines such as interleukin-1β (IL-1 β) and tumor necrosis factor-α (TNF-α) from human mast cells (HMC-1) stimulated with phorbol myristate acetate plus calcium ionophore A23187 in a dose-dependent manner. Luteolin also significantly reduced the histamine release from rat peritoneal mast cells stimulated by compound 48/80, a potent histamine liberator. Furthermore, the administration of luteolin markedly inhibited the scratching behavior and vascular permeability induced by pruritogens, such as compound 48/80 or serotonin, in ICR mice. These results suggested that luteolin has potential as a therapeutic agent against inflammation and itch-related skin diseases.
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Affiliation(s)
| | - Hyeon Soo Kim
- Department of Health & Science, Jeonju University, Jeonju 560-759, Korea.
| | | | - Hyun-Seo Lee
- Department of Health & Science, Jeonju University, Jeonju 560-759, Korea.
| | | | - Sang Jun Kim
- Jeonju Biomaterials Institute, Jeonju 561-360, Korea.
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Kim K. Neuroimmunological mechanism of pruritus in atopic dermatitis focused on the role of serotonin. Biomol Ther (Seoul) 2014; 20:506-12. [PMID: 24009842 PMCID: PMC3762292 DOI: 10.4062/biomolther.2012.20.6.506] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/14/2012] [Accepted: 10/16/2012] [Indexed: 12/22/2022] Open
Abstract
Although pruritus is the critical symptom of atopic dermatitis that profoundly affect the patients' quality of life, controlling and management of prurirtus still remains as unmet needs mainly due to the distinctive multifactorial pathogenesis of pruritus in atopic dermatitis. Based on the distinct feature of atopic dermatitis that psychological state of patients substantially influence on the intensity of pruritus, various psychotropic drugs have been used in clinic to relieve pruritus of atopic dermatitis patients. Only several psychotropic drugs were reported to show real antipruritic effects in atopic dermatitis patients including naltrexone, doxepin, trimipramine, bupropion, tandospirone, paroxetine and fluvoxamine. However, the precise mechanisms of antipruritic effect of these psychotropic drugs are still unclear. In human skin, serotonin receptors and serotonin transporter protein are expressed on skin cells such as keratinocytes, melanocytes, dermal fibroblasts, mast cells, T cells, natural killer cells, langerhans cells, and sensory nerve endings. It is noteworthy that serotonergic drugs, as well as serotonin itself, showed immune-modulating effect. Fenfluramine, fluoxetine and 2, 5-dimethoxy-4-iodoamphetamine significantly decreased lymphocyte proliferation. It is still questionable whether these serotonergic drugs exert the immunosuppressive effects via serotonin receptor or serotonin transporter. All these clinical and experimental reports suggest the possibility that antipruritic effects of selective serotonin reuptake inhibitors in atopic dermatitis patients might be at least partly due to their suppressive effect on T cells. Further studies should be conducted to elucidate the precise mechanism of neuroimmunological interaction in pruritus of atopic dermatitis.
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Affiliation(s)
- Kwangmi Kim
- College of Pharmacy, Dankook University, Cheonan 330-714, Republic of Korea
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33
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Shukla C, Bashaw E, Stagni G, Benfeldt E. Applications of dermal microdialysis: a review. J Drug Deliv Sci Technol 2014. [DOI: 10.1016/s1773-2247(14)50044-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yarbrough KB, Neuhaus KJ, Simpson EL. The effects of treatment on itch in atopic dermatitis. Dermatol Ther 2013; 26:110-9. [PMID: 23551368 DOI: 10.1111/dth.12032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pruritus causes significant impairment in the quality of life of patients suffering from atopic dermatitis. Treatments for itch in atopic dermatitis range from simple avoidance of pruritus triggers to more complicated systemic therapy. Several treatments aim to target specific mediators of itch in atopic dermatitis, whereas others improve pruritus by reducing inflammation. Currently the most effective treatments for atopic dermatitis-associated itch are primarily topical or systemic anti-inflammatory agents. Better management of pruritus in atopic dermatitis is an important goal and necessitates the development of novel targeted treatments as well as efficient use of current therapies.
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Affiliation(s)
- Kevin B Yarbrough
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon 97239-4501, USA
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35
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Cowdell F, Steventon K. Skin cleansing practices for older people: a systematic review. Int J Older People Nurs 2013; 10:3-13. [DOI: 10.1111/opn.12041] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 07/29/2013] [Indexed: 11/26/2022]
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Abstract
INTRODUCTION Chronic pruritus (CP), defined as itch lasting for > 6 weeks, is a burdensome symptom of several different diseases, dermatological and systemic, with a high negative impact on the quality of life of patients. Given the manifold aetiologies of CP, therapy is often difficult. In recent years, however, novel substances have been developed for treatment of certain CP entities and identified targets. AREAS COVERED In this review, the authors present a survey of targets currently believed to be promising (H4R, IL-31, MOR, KOR, GRPR, NGF, NK-1R, TRP channels) and related investigational drugs that are in the preclinical or clinical stage of development. Some substances have already undergone clinical testing, but only one of them (nalfurafine) has been licensed so far. Many of them are most likely to exert their effects on the skin and interfere there with the cutaneous neurobiology of CP. EXPERT OPINION Currently, the most promising candidates for new therapeutic agents in CP are neurokinin-1 receptor antagonists and substances targeting the kappa- or mu-opioid receptor, or both. They have the potential to target the neuronal pathway of CP and are thus of interest for several CP entities. The goal for the coming years is to validate these concepts and move forward in developing new drugs for the therapy of CP.
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Affiliation(s)
- Heike Benecke
- University Medicine Göttingen, Center Nanoscale Microscopy and Molecular Physiology of the Brain, Humboldtallee 23, 37073 Göttingen, Germany
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Melgaard L, Hersini KJ, Gazerani P, Petersen LJ. Retrodialysis: a review of experimental and clinical applications of reverse microdialysis in the skin. Skin Pharmacol Physiol 2013; 26:160-74. [PMID: 23751503 DOI: 10.1159/000351341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/11/2013] [Indexed: 12/15/2022]
Abstract
Microdialysis is a method that has been used for decades to recover endogenous mediators, metabolites and drugs from the interstitial space in several tissues of both animals and humans. The principle of microdialysis is the flux of compounds across a semipermeable membrane. The application of microdialysis as a method of drug delivery is a process referred to as retrodialysis, i.e. the introduction of a substance into the extracellular space via a microdialysis probe. Thus, microdialysis also offers opportunities to deliver mediators and drugs to target tissues by adding solutes to the perfusion medium. In this context, retrodialysis combines a method for minimally invasive delivery with a sampling method to study biological processes in health and disease. The aim of this review is to give insight into the use of retrodialysis by outlining examples of retrodialysis studies focusing on applications in skin in animal studies, human experimental investigations and clinical settings.
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Affiliation(s)
- L Melgaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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38
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Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. Cochrane Database Syst Rev 2013; 2013:CD007770. [PMID: 23450580 PMCID: PMC6823266 DOI: 10.1002/14651858.cd007770.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual. OBJECTIVES To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. SEARCH METHODS We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011. SELECTION CRITERIA We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema. DATA COLLECTION AND ANALYSIS Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators. MAIN RESULTS No randomised controlled trials met our inclusion criteria. AUTHORS' CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
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Affiliation(s)
- Christian J Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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39
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Apfelbacher CJ, van Zuuren EJ, Fedorowicz Z, Jupiter A, Matterne U, Weisshaar E. Oral H1 antihistamines as monotherapy for eczema. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [PMID: 23450580 DOI: 10.1002/14651858.cd012167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Eczema is a common skin disease in many countries, and although the majority of cases of eczema occur before the age of five years and often resolve during childhood or adolescence, it can also persist into adulthood. Itch is the most important aspect of eczema, often impacting significantly on the quality of life of an affected individual. OBJECTIVES To assess the effects of oral antihistamines (H1 antagonists) as monotherapy in children and adults with eczema. SEARCH METHODS We searched the following databases up to March 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 3), MEDLINE (from 1946), EMBASE (from 1974), and LILACS (from 1982). We examined the reference lists of excluded studies in order to identify further references to relevant trials. We searched trials registers for ongoing and unpublished trials. We also handsearched the abstracts of the International Research Workshops on eczema, as well as the conference proceedings of the European Academy of Dermatology and Venereology (EADV) and the European Academy of Allergology and Clinical Immunology (EAACI), from 2000 to 2011. SELECTION CRITERIA We sought to include randomised controlled trials that assessed the effects and safety of oral H1 antihistamines as monotherapy in children and adults with eczema. We excluded studies that compared an antihistamine versus another antihistamine and had no placebo control arm. We also excluded topical antihistamines and oral H1 antihistamines as 'add-on' therapy and studies using any concomitant therapy other than emollients or moisturisers, principally because some of these forms of concomitant therapy may be considered treatment modifiers in assessments of the effects of antihistamines on eczema. DATA COLLECTION AND ANALYSIS Our search retrieved 409 references to studies. Based on assessments of their titles, abstracts, or both, we excluded all except 36 of these studies. After evaluation of the full text of each report, we excluded a further 35 studies, and 1 study is awaiting classification pending a response from the trial investigators. MAIN RESULTS No randomised controlled trials met our inclusion criteria. AUTHORS' CONCLUSIONS There is currently no high-level evidence to support or refute the efficacy or safety of oral H1 antihistamines used as monotherapy for eczema. Because most of the studies allowed the use of concomitant medications and involved multi-therapeutic approaches, meaningful assessments of the individual effects of oral H1 antihistamines on eczema were not feasible. Although well-designed randomised controlled trials excluding concomitant medications appear to be needed, consideration should be given to the potential ethical issues raised with the use of antihistamines as monotherapy for the management of eczema by withholding the use of rescue or additional therapies. A further systematic review of studies in which concomitant therapies were permitted might be of value in determining the potential benefits of oral H1 antihistamines as add-on therapy.
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Affiliation(s)
- Christian J Apfelbacher
- Medical Sociology, Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany.
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40
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Han YS, Kim MS, Hwang JK. Macelignan Inhibits Histamine Release and Inflammatory Mediator Production in Activated Rat Basophilic Leukemia Mast Cells. Inflammation 2012; 35:1723-31. [DOI: 10.1007/s10753-012-9490-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Weller K, Soost S, Worm M, Maurer M, Zuberbier T. Atopic dermatitis and allergic rhinitis--do co-effects in therapy exist? J Dtsch Dermatol Ges 2012; 10:221-36; quiz 238-9. [PMID: 22304462 DOI: 10.1111/j.1610-0387.2011.07885.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopic dermatitis and allergic rhinitis frequently appear together in the same patients. The pathogenesis of both disorders is complex and still incompletely understood. Nevertheless, pathophysiological overlaps suggest the existence of potential therapeutic co-effects. While data pointing towards a positive effect of allergen elimination for both diseases is still limited, there is now increasing evidence showing beneficial effects of specific immunotherapy in patients suffering from atopic dermatitis and additional type I allergies. H(1)-antihistamines were also found to exert moderate positive effects on the symptoms of atopic dermatitis in single studies. In summary, a limited therapeutic co-effect of the above mentioned treatment options can be expected in case of the parallel existence of atopic dermatitis and allergic rhinitis in the same patient. More studies on this issue during the next years are desirable. In addition, a better understanding of the pathophysiology should have a positive impact on the treatment of atopic manifestations such as atopic dermatitis and allergic rhinitis.
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Affiliation(s)
- Karsten Weller
- Allergy Center Charité, Department of Dermatology, Venereology and Allergology, Charité-University Medicine, Charitéplatz 1, Berlin, Germany.
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42
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Hong J, Buddenkotte J, Berger TG, Steinhoff M. Management of itch in atopic dermatitis. ACTA ACUST UNITED AC 2011; 30:71-86. [PMID: 21767767 DOI: 10.1016/j.sder.2011.05.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Atopic dermatitis is a common, pruritic, inflammatory skin disorder. Chronic, localized, or even generalized pruritus is the diagnostic hallmark of atopic dermatitis, and its management remains a challenge for physicians. The threshold for itch and alloknesis is markedly reduced in these patients, and infections can promote exacerbation and thereby increase the itch. Modern management consists of anti-inflammatory, occasionally antiseptic, as well as antipruritic therapies to address the epidermal barrier as well as immunomodulation or infection. Mild forms of atopic dermatitis may be controlled with topical therapies, but moderate-to-severe forms often require a combination of systemic treatments consisting of antipruritic and immunosuppressive drugs, phototherapy, and topical compounds. In addition, patient education and a therapeutic regimen to help the patient cope with the itch and eczema are important adjuvant strategies for optimized long-term management. This review highlights various topical, systemic, and complementary and alternative therapies, as well as provide a therapeutic ladder for optimized long-term control of itch in atopic dermatitis.
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Affiliation(s)
- Judith Hong
- Department of Dermatology, University of California San Francisco, San Francisco, CA 94143, USA
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Papoiu AD, Wang H, Nattkemper L, Tey HL, Ishiuji Y, Chan YH, Schmelz M, Yosipovitch G. A study of serum concentrations and dermal levels of NGF in atopic dermatitis and healthy subjects. Neuropeptides 2011; 45:417-22. [PMID: 21893340 PMCID: PMC3659813 DOI: 10.1016/j.npep.2011.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 06/22/2011] [Accepted: 07/21/2011] [Indexed: 01/24/2023]
Abstract
Nerve growth factor (NGF) was reported to be increased in the serum and skin of atopic dermatitis (AD) patients, to the extent that serum nerve growth factor levels were proposed to serve as a marker of disease severity. We studied NGF levels in the serum and dermis using skin microdialysis and attempted to correlate them with disease severity. We also examined if potential differences between morning and evening levels of NGF can explain the phenomenon of nocturnal itch. In addition, neurogenic inflammation and itch were induced using histamine iontophoresis in lesional and non-lesional skin and the effect of experimental itch on dermal NGF concentration was examined. We found that systemic (serum) and eczematous skin levels of NGF in AD are significantly lower in comparison to healthy controls. Serum NGF decreases from morning to late afternoon in both groups. Interestingly, serum NGF levels were correlated to disease severity in the morning in AD, although the NGF concentration in AD were significantly lower than in the healthy group. The local itch and neurogenic inflammation induction via experimental histamine reduced local NGF levels in the eczema and non-lesional skin in atopics, but not in the healthy controls, where it was slightly increased. The higher the clinical severity of the eczema, a significantly less pronounced effect of neurogenic inflammation on the local levels of NGF was found. The availability of measurable NGF might be reduced by a higher expression of NGF receptors. The fluctuations of NGF levels during the day suggest a complex modulation of this neurotrophin, potentially linked to stress or to an altered neurophysiological mechanism.
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Affiliation(s)
- Alexandru D.P. Papoiu
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Hui Wang
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Leigh Nattkemper
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Hong Liang Tey
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Yozo Ishiuji
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Yiong-Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, 10 Medical Drive, Singapore 117597, Singapore
| | - Martin Schmelz
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gil Yosipovitch
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Corresponding author at: Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. Tel.: +1 (336) 716 2901; fax: +1 (336) 716 7732. (G. Yosipovitch)
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TRPA1 is required for histamine-independent, Mas-related G protein-coupled receptor-mediated itch. Nat Neurosci 2011; 14:595-602. [PMID: 21460831 PMCID: PMC3181150 DOI: 10.1038/nn.2789] [Citation(s) in RCA: 447] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/28/2011] [Indexed: 12/28/2022]
Abstract
Itch, the unpleasant sensation that evokes a desire to scratch, accompanies numerous skin and nervous system disorders. In many cases, pathological itch is insensitive to antihistamine treatment. Recent studies have identified members of the Mas-related G protein-coupled receptor (Mrgpr) family that are activated by mast cell mediators and promote histamine-independent itch. MrgprA3 and MrgprC11 act as receptors for the pruritogens chloroquine and BAM8-22, respectively. However, the signaling pathways and transduction channels activated downstream of these pruritogens are largely unknown. We found that TRPA1 is the downstream target of both MrgprA3 and MrgprC11 in cultured sensory neurons and heterologous cells. TRPA1 is required for Mrgpr-mediated signaling, as sensory neurons from TRPA1-deficient mice exhibited markedly diminished responses to chloroquine and BAM8-22. Similarly, TRPA1-deficient mice displayed little to no scratching in response to these pruritogens. Our findings indicate that TRPA1 is an essential component of the signaling pathways that promote histamine-independent itch.
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46
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Wu G, Su X. Antipruritic activity of extracts of Humulus scandens, the combinations of bioactive flavonoids. Fitoterapia 2010; 81:1073-8. [PMID: 20619323 DOI: 10.1016/j.fitote.2010.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Revised: 06/27/2010] [Accepted: 07/01/2010] [Indexed: 11/26/2022]
Abstract
The antipruritic effects of the ethanol fractions of Humulus scandens on the 4-AP (4-aminopyridine)-induced and chloroquine-induced scratching in ICR mice were examined. The 40% ethanol fractions of H. scandens suppressed both the 4-AP- and chloroquine-induced scratching behavior, which significantly inhibited degranulation of rat peritoneal mast cell and antigen-stimulated histamine release. Further studies proved that the 40% ethanol fractions of H. scandens decreased the content of IL4 in serum of chloroquine-induced scratching ICR mice. The results suggest that the 40% ethanol fractions of H. scandens has antipruritic effects on both antihistamine-resistant and -sensitive pruritus.
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Affiliation(s)
- Guanzhong Wu
- Department of Pharmacology, China Pharmaceutical University, Nanjing, China.
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Abstract
Pruritus (itch) is a major characteristic and one of the most debilitating symptoms in allergic and atopic diseases and the diagnostic hallmark of atopic dermatitis. Pruritus is regularly defined as an unpleasant sensation provoking the desire to scratch. Although we achieved rather good knowledge about certain inducers of itch such as neuropeptides, amines, mu-opioids, cytokines and proteases, for example, less is known about the pathophysiological specifities among the different diseases, and the therapeutic consequences which may derive thereoff. This review dissects the role of mediators, receptors and itch inhibitors on peripheral nerve endings, dorsal root ganglia, the spinal cord and the CNS leading to the amplification or - vice versa - suppression of pruritus. As the treatment of pruritus in allergic and atopic skin disease is still not satisfactory, knowing these pathways and mechanisms may lead to novel therapeutic approaches against this frequently encountered skin symptom.
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Affiliation(s)
- J Buddenkotte
- Deparment of Dermatology, Boltzmann Institute for Cell- and Immunobiology of Skin, University Hospital Münster, Münster, Germany
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48
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Histamine and Antihistamines in Atopic Dermatitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2010; 709:73-80. [DOI: 10.1007/978-1-4419-8056-4_8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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49
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Fujii M, Kohno S, Nabe T. Atopic dermatitis model of itching behavior in hairless mice. Inflamm Regen 2010. [DOI: 10.2492/inflammregen.30.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Affiliation(s)
- Aaron I. Vinik
- From the Strelitz Diabetes Center for Endocrine and Metabolic Disorders and Neuroendocrine Unit, Eastern Virginia Medical School, Norfolk, Virginia
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