1
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Deng M, Odhiambo WO, Qin M, To TT, Brewer GM, Kheshvadjian AR, Cheng C, Agak GW. Analysis of Intracellular Communication Reveals Consistent Gene Changes Associated with Early-Stage Acne Skin. RESEARCH SQUARE 2024:rs.3.rs-4402048. [PMID: 38854033 PMCID: PMC11160929 DOI: 10.21203/rs.3.rs-4402048/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
A comprehensive understanding of the intricate cellular and molecular changes governing the complex interactions between cells within acne lesions is currently lacking. Herein, we analyzed early papules from six subjects with active acne vulgaris, utilizing single-cell and high-resolution spatial RNA sequencing. We observed significant changes in signaling pathways across seven different cell types when comparing lesional skin samples (LSS) to healthy skin samples (HSS). Using CellChat, we constructed an atlas of signaling pathways for the HSS, identifying key signal distributions and cell-specific genes within individual clusters. Further, our comparative analysis revealed changes in 49 signaling pathways across all cell clusters in the LSS- 4 exhibited decreased activity, whereas 45 were upregulated, suggesting that acne significantly alters cellular dynamics. We identified ten molecules, including GRN, IL-13RA1 and SDC1 that were consistently altered in all donors. Subsequently, we focused on the function of GRN and IL-13RA1 in TREM2 macrophages and keratinocytes as these cells participate in inflammation and hyperkeratinization in the early stages of acne development. We evaluated their function in TREM2 macrophages and the HaCaT cell line. We found that GRN increased the expression of proinflammatory cytokines and chemokines, including IL-18, CCL5, and CXCL2 in TREM2 macrophages. Additionally, the activation of IL-13RA1 by IL-13 in HaCaT cells promoted the dysregulation of genes associated with hyperkeratinization, including KRT17, KRT16, and FLG. These findings suggest that modulating the GRN-SORT1 and IL-13-IL-13RA1 signaling pathways could be a promising approach for developing new acne treatments.
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Affiliation(s)
| | | | - Min Qin
- University of California (UCLA)
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2
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Huang L, Yang S, Yu X, Fang F, Zhu L, Wang L, Zhang X, Yang C, Qian Q, Zhu T. Association of different cell types and inflammation in early acne vulgaris. Front Immunol 2024; 15:1275269. [PMID: 38357543 PMCID: PMC10864487 DOI: 10.3389/fimmu.2024.1275269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Acne vulgaris, one of the most common skin diseases, is a chronic cutaneous inflammation of the upper pilosebaceous unit (PSU) with complex pathogenesis. Inflammation plays a central role in the pathogenesis of acne vulgaris. During the inflammatory process, the innate and adaptive immune systems are coordinately activated to induce immune responses. Understanding the infiltration and cytokine secretion of differential cells in acne lesions, especially in the early stages of inflammation, will provide an insight into the pathogenesis of acne. The purpose of this review is to synthesize the association of different cell types with inflammation in early acne vulgaris and provide a comprehensive understanding of skin inflammation and immune responses.
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Affiliation(s)
- Lei Huang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shuyun Yang
- Department of Dermatology, The People’s Hospital of Baoshan, Baoshan, Yunnan, China
| | - Xiuqin Yu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fumin Fang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Liping Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lu Wang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoping Zhang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Changzhi Yang
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qihong Qian
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tingting Zhu
- Department of Dermatology, The First Affiliated Hospital of Soochow University, Suzhou, China
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3
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Jin Z, Song Y, He L. A review of skin immune processes in acne. Front Immunol 2023; 14:1324930. [PMID: 38193084 PMCID: PMC10773853 DOI: 10.3389/fimmu.2023.1324930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
Acne vulgaris is one of the most prevalent skin conditions, affecting almost all teenagers worldwide. Multiple factors, including the excessive production of sebum, dysbiosis of the skin microbiome, disruption of keratinization within hair follicles, and local inflammation, are believed to trigger or aggravate acne. Immune activity plays a crucial role in the pathogenesis of acne. Recent research has improved our understanding of the immunostimulatory functions of microorganisms, lipid mediators, and neuropeptides. Additionally, significant advances have been made in elucidating the intricate mechanisms through which cutaneous innate and adaptive immune cells perceive and transmit stimulatory signals and initiate immune responses. However, our understanding of precise temporal and spatial patterns of immune activity throughout various stages of acne development remains limited. This review provides a comprehensive overview of the current knowledge concerning the immune processes involved in the initiation and progression of acne. Furthermore, we highlight the significance of detailed spatiotemporal analyses, including analyses of temporal dynamics of immune cell populations as well as single-cell and spatial RNA sequencing, for the development of targeted therapeutic and prevention strategies.
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Affiliation(s)
| | | | - Li He
- Skin Health Research Center, Yunnan Characteristic Plant Extraction Laboratory, Kunming, Yunnan, China
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4
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Kraaijvanger R, Veltkamp M. The Role of Cutibacterium acnes in Sarcoidosis: From Antigen to Treatable Trait? Microorganisms 2022; 10:microorganisms10081649. [PMID: 36014067 PMCID: PMC9415339 DOI: 10.3390/microorganisms10081649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022] Open
Abstract
Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes) is considered to be a non-pathogenic resident of the human skin, as well as mucosal surfaces. However, it also has been demonstrated that C. acnes plays a pathogenic role in diseases such as acne vulgaris or implant infections after orthopedic surgery. Besides a role in infectious disease, this bacterium also seems to harbor immunomodulatory effects demonstrated by studies using C. acnes to enhance anti-tumor activity in various cancers or vaccination response. Sarcoidosis is a systemic inflammatory disorder of unknown causes. Cultures of C. acnes in biopsy samples of sarcoidosis patients, its presence in BAL fluid, tissue samples as well as antibodies against this bacterium found in serum of patients with sarcoidosis suggest an etiological role in this disease. In this review we address the antigenic as well as immunomodulatory potential of C. acnes with a focus on sarcoidosis. Furthermore, a potential role for antibiotic treatment in patients with sarcoidosis will be explored.
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Affiliation(s)
- Raisa Kraaijvanger
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
| | - Marcel Veltkamp
- Interstitial Lung Diseases Centre of Excellence, Department of Pulmonology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
- Division of Hearth and Lungs, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence:
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5
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Ouyang K, Oparaugo N, Nelson AM, Agak GW. T Cell Extracellular Traps: Tipping the Balance Between Skin Health and Disease. Front Immunol 2022; 13:900634. [PMID: 35795664 PMCID: PMC9250990 DOI: 10.3389/fimmu.2022.900634] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/23/2022] [Indexed: 11/30/2022] Open
Abstract
The role of extracellular traps (ETs) in the innate immune response against pathogens is well established. ETs were first identified in neutrophils and have since been identified in several other immune cells. Although the mechanistic details are not yet fully understood, recent reports have described antigen-specific T cells producing T cell extracellular traps (TETs). Depending on their location within the cutaneous environment, TETs may be beneficial to the host by their ability to limit the spread of pathogens and provide protection against damage to body tissues, and promote early wound healing and degradation of inflammatory mediators, leading to the resolution of inflammatory responses within the skin. However, ETs have also been associated with worse disease outcomes. Here, we consider host-microbe ET interactions by highlighting how cutaneous T cell-derived ETs aid in orchestrating host immune responses against Cutibacterium acnes (C. acnes), a commensal skin bacterium that contributes to skin health, but is also associated with acne vulgaris and surgical infections following joint-replacement procedures. Insights on the role of the skin microbes in regulating T cell ET formation have broad implications not only in novel probiotic design for acne treatment, but also in the treatment for other chronic inflammatory skin disorders and autoimmune diseases.
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Affiliation(s)
- Kelsey Ouyang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
- Division of Dermatology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Nicole Oparaugo
- David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Amanda M. Nelson
- Department of Dermatology, Penn State University College of Medicine, Hershey, PA, United States
| | - George W. Agak
- Division of Dermatology, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- *Correspondence: George W. Agak,
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Say YH, Sio YY, Heng AHS, Ng YT, Matta SA, Pang SL, Teh KF, Wong YR, Rawanan Shah SM, Reginald K, Chew FT. Golgin A7 Family Member B (GOLGA7B) is a plausible novel gene associating high glycaemic index diet with acne vulgaris. Exp Dermatol 2022; 31:1208-1219. [PMID: 35416335 DOI: 10.1111/exd.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 01/30/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
While the IGF1/FoxO1/mTORC1 signalling pathway is a well-established nutrigenomic link between high glycaemic index (GI)/glycaemic load (GL) diet and acne vulgaris, other signalling pathways remain elusive. Therefore, we aimed to investigate other genes that are involved in the high GI/GL diet-acne link, using our Singapore/Malaysia population epidemiological, genomics and transcriptomics data. High GI/GL dietary habit of 3,207 acne cases (1,869 and 1,341 further classified into severity and scarring grades, respectively) and 2,521 controls were evaluated based on Quality of Diet based on Glycaemic Index Score (QDGIS). Overlapping concordant differentially expressed genes (DEGs) between acne case-controls and QDGIS poor-moderate/good classes were identified from whole-transcriptome sequencing data of PBMC of a subset of participants. Finally, we assessed the expression quantitative trait loci (eQTL) association of single nucleotide polymorphisms (SNPs) of the concordant DEGs. Daily intake of fruits significantly reduced the risk of acne presentation, severity and scarring by up to 48.5%. Those with good QDGIS had significantly lower risk of mild and moderate/severe acne, and grade 1/2 acne scarring. Sequential filtering identified four overlapping concordant DEGs that were significantly associated with acne and QDGIS, namely GOLGA7B, SNCB, LOC102723849 and LOC283683. Combining transcriptome and genetic association data, we identified intronic SNP rs1953947 in GOLGA7B as an eQTL for acne. In conclusion, we identified GOLGA7B as a plausible novel gene that links high GI/GL with acne, and hence propose a model for the involvement of Golga7b in high GI/GL diet-acne pathogenesis, which includes palmitoyl acyltransferase zDHHC5, fatty acid translocase CD36 and palmitic acid.
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Affiliation(s)
- Yee-How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Anna Hwee Sing Heng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Yu Ting Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Sri Anusha Matta
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Sze Lei Pang
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Keng Foo Teh
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Yi Ru Wong
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Smyrna Moti Rawanan Shah
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Kavita Reginald
- Department of Biological Sciences, School of Medical and Life Sciences, Sunway University, Malaysia
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
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7
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Dreno B, Chavda R, Julia V, Khammari A, Blanchet-Réthoré S, Krishnaswamy JK. Transcriptomics Analysis Indicates Trifarotene Reverses Acne-Related Gene Expression Changes. Front Med (Lausanne) 2021; 8:745822. [PMID: 34746181 PMCID: PMC8569320 DOI: 10.3389/fmed.2021.745822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Trifarotene is a topical retinoid selective for retinoic acid receptor gamma that was recently approved for treatment of acne vulgaris. We performed a gene expression analysis to identify the molecular and cellular impact of trifarotene treatment on acne papules. Methods: In this open-label prospective study, subjects with moderate inflammatory acne of the back were treated with trifarotene 0.005% or vehicle cream on dedicated areas for 27 days, and 4 biopsies were collected from each subject (1 from skin without a visible acne lesion and three at the site of an acne papule: one baseline, one after vehicle treatment, and one after trifarotene treatment). Large scale gene expression profiling of the biopsies was performed using Affymetrix technology, treatment-specific gene expression profiles were generated using statistical modeling, and pathway analysis was performed. Using single-cell RNAseq data, in silico deconvolution of transcriptomics data was performed to identify cellular signatures. Results: We discovered a unique set of 67 genes modulated by trifarotene that are primarily involved in cellular migration, inflammation, and extracellular matrix reorganization. Changes in cellular expression were similar in both trifarotene-treated and spontaneously-resolving lesions. However, only trifarotene treatment impacted SPP1+ macrophages, a subset of highly proliferative macrophages recently identified in fibrotic tissue. Conclusions: These results show that trifarotene has a novel action in acne treatment by affecting epidermal and immune components of acne pathogenesis.
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8
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Eliasse Y, Leveque E, Garidou L, Battut L, McKenzie B, Nocera T, Redoules D, Espinosa E. IL-17 + Mast Cell/T Helper Cell Axis in the Early Stages of Acne. Front Immunol 2021; 12:740540. [PMID: 34650562 PMCID: PMC8506309 DOI: 10.3389/fimmu.2021.740540] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Acne is a multifactorial disease driven by physiological changes occurring during puberty in the pilosebaceous unit (PSU) that leads to sebum overproduction and a dysbiosis involving notably Cutibacterium acnes. These changes in the PSU microenvironment lead to a shift from a homeostatic to an inflammatory state. Indeed, immunohistochemical analyses have revealed that inflammation and lymphocyte infiltration can be detected even in the infraclinical acneic stages, highlighting the importance of the early stages of the disease. In this study, we utilized a robust multi-pronged approach that included flow cytometry, confocal microscopy, and bioinformatics to comprehensively characterize the evolution of the infiltrating and resident immune cell populations in acneic lesions, beginning in the early stages of their development. Using a discovery cohort of 15 patients, we demonstrated that the composition of immune cell infiltrate is highly dynamic in nature, with the relative abundance of different cell types changing significantly as a function of clinical lesion stage. Within the stages examined, we identified a large population of CD69+ CD4+ T cells, several populations of activated antigen presenting cells, and activated mast cells producing IL-17. IL-17+ mast cells were preferentially located in CD4+ T cell rich areas and we showed that activated CD4+ T cells license mast cells to produce IL-17. Our study reveals that mast cells are the main IL-17 producers in the early stage of acne, underlying the importance of targeting the IL-17+ mast cell/T helper cell axis in therapeutic approaches.
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Affiliation(s)
- Yoan Eliasse
- Inserm, U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Toulouse, France.,Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Edouard Leveque
- Inserm, U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Toulouse, France.,Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Lucile Garidou
- Department of Pharmacology, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Louise Battut
- Inserm, U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Toulouse, France.,Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Brienne McKenzie
- Inserm, U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Toulouse, France.,Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Thérèse Nocera
- Clinical Evaluation Center, Pierre Fabre Dermo-Cosmétique, Toulouse, France.,Dermatology Department, University Hospital Larrey, Toulouse, France
| | - Daniel Redoules
- Department of Pharmacology, Pierre Fabre Dermo-Cosmétique, Toulouse, France
| | - Eric Espinosa
- Inserm, U1037, Centre de Recherche en Cancérologie de Toulouse (CRCT), Toulouse, France.,Université de Toulouse, Université Paul Sabatier, Toulouse, France
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9
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Singh A, Khurana A, Sardana K, Dixit N, Chitkara A. Correlation of Serum 25-Hydroxy Vitamin D and Interleukin-17 Levels with Disease Severity in Acne Vulgaris. Indian J Dermatol 2021; 66:291-296. [PMID: 34446953 PMCID: PMC8375544 DOI: 10.4103/ijd.ijd_551_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The association of Vitamin D (vit.D) and Interleukin 17 (IL-17) with acne vulgaris is uncertain in spite of induction of IL-17 by Propionibacterium acnes (P. acnes) and the role of vit.D in various inflammatory skin disorders including acne. The objectives of present study were to evaluate the levels of serum 25-hydroxyvitamin D3 [25(OH)D] and IL-17 in acne patients and age- and sex-matched controls and to compare them with the severity of acne as measured by Global Acne Grading System (GAGS). Methods: The study included 50 patients of acne and 30 healthy controls. Serum 25(OH) D and IL-17 levels were measured using chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA), respectively. Results: Vitamin D deficiency was detected in 28% of patients with acne but only in 6.7% of the healthy controls (P value 0.022). The levels of 25(OH)D were inversely associated with the severity of acne (P < 0.001). The mean serum IL-17 levels were significantly raised (P < 0.001) in acne patients (8.215 ± 5.33 pg/mL) as compared to controls (2.486 ± 2.12 pg/mL). A significant rise in levels of IL-17 was observed with the severity of acne (P < 0.001). Further, a highly significant negative correlation (Correlation Coefficient: -0.668) was noted between serum IL-17 and 25(OH) D levels along with disease severity in acne patients (P value < 0.001). Conclusions: Raised IL-17 levels in acne correlate negatively with vit.D deficiency and both are significantly more prevalent in patients with acne as compared to healthy controls.
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Affiliation(s)
- Ajeet Singh
- Department of Dermatology and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi, Delhi, India
| | - Ananta Khurana
- Department of Dermatology and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi, Delhi, India
| | - Kabir Sardana
- Department of Dermatology and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi, Delhi, India
| | - Niharika Dixit
- Department of Dermatology and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi, Delhi, India
| | - Anubhuti Chitkara
- Department of Dermatology and Biochemistry, PGIMER and Dr. Ram Manohar Lohia Hospital New Delhi, Delhi, India
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Kurokawa I, Layton AM, Ogawa R. Updated Treatment for Acne: Targeted Therapy Based on Pathogenesis. Dermatol Ther (Heidelb) 2021; 11:1129-1139. [PMID: 34115308 PMCID: PMC8322376 DOI: 10.1007/s13555-021-00552-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Indexed: 12/18/2022] Open
Abstract
Previous approaches to acne management have focused on the four main factors implicated in acne, namely, androgen-mediated sebogenesis (considered integral to acne), hyperkeratinization, colonization with Cutibacterium acnes, and inflammation related to both innate and adaptive mechanisms. Recent advances have facilitated potential novel approaches to acne management, as the pathophysiology and the immunological aspects related to acne and wound healing have evolved. Particular targets that have been shown to be closely involved in acne pathophysiology and wound healing include interleukin (IL)-1β, IL-17, IL-23, and tumor necrosis factor alpha (TNFα). Biological antibodies targeting IL-1β, IL-17, IL-23, and TNFα could provide novel approaches for treating severe acne and related disorders. Acne is primarily a disease associated with sebogenesis. Monosaturated free acids are important components. Insulin growth factor 1 (IGF-1) promotes the proliferation and differentiation of sebocytes and IL-1β. Research into the microbiome may also provide insights into potential future therapeutic options for acne. Scars, both atrophic and hypertrophic, are common sequelae to acne. Risk factors associated with the development of acne scars include genetic, systemic, local, and lifestyle factors. Pro-inflammatory cytokines have been shown to play a crucial role in the development of acne-induced hypertrophic scars. Treatment for extensive inflammatory keloid scarring is limited. Surgery and postoperative radiotherapy are two possible options. Transforming growth factor-β (TGFβ), IL-6, matrix metalloproteinase (MMP), IGF-1, and B cells are found in keloid or hypertrophic scar tissues. Biological antibodies targeting these cytokines may be a potential strategy for the prevention and treatment of this type of scar in the future. Future treatment for acne should embrace approaches that target the main etiological factors of acne. In particular, specific emphasis on aggressive treatment in the acute inflammatory phase to reduce the likelihood of scarring and other clinical sequelae, such as pigmentary changes would be highly desirable. Treatment for established acne-induced sequelae should also be considered.
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Affiliation(s)
- Ichiro Kurokawa
- Department of Dermatology, Meiwa Hospital, 4-31, Agenaruo-cho, Nishinomiya, Hyogo, 663-8186, Japan.
| | - Alison M Layton
- Department of Dermatology, Harrogate and District Foundation Trust, Lancaster Park Road, Harrogate, HG2 7SX, UK
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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11
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Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms 2021; 9:303. [PMID: 33540667 PMCID: PMC7913060 DOI: 10.3390/microorganisms9020303] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Cutibacterium acnes is a member of the skin microbiota found predominantly in regions rich in sebaceous glands. It is involved in maintaining healthy skin and has long been considered a commensal bacterium. Its involvement in various infections has led to its emergence as an opportunist pathogen. Interactions between C. acnes and the human host, including the human skin microbiota, promote the selection of C. acnes strains capable of producing several virulence factors that increase inflammatory capability. This pathogenic property may be related to many infectious mechanisms, such as an ability to form biofilms and the expression of putative virulence factors capable of triggering host immune responses or enabling C. acnes to adapt to its environment. During the past decade, many studies have identified and characterized several putative virulence factors potentially involved in the pathogenicity of this bacterium. These virulence factors are involved in bacterial attachment to target cells, polysaccharide-based biofilm synthesis, molecular structures mediating inflammation, and the enzymatic degradation of host tissues. C. acnes, like other skin-associated bacteria, can colonize various ecological niches other than skin. It produces several proteins or glycoproteins that could be considered to be active virulence factors, enabling the bacterium to adapt to the lipophilic environment of the pilosebaceous unit of the skin, but also to the various organs it colonizes. In this review, we summarize current knowledge concerning characterized C. acnes virulence factors and their possible implication in the pathogenicity of C. acnes.
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Affiliation(s)
- Constance Mayslich
- NSERM Institut Cochin, INSERM U1016-CNRS UMR8104, Equipe de Biologie Cutanée, Université de Paris, 75014 Paris, France; (C.M.); (P.A.G.)
| | - Philippe Alain Grange
- NSERM Institut Cochin, INSERM U1016-CNRS UMR8104, Equipe de Biologie Cutanée, Université de Paris, 75014 Paris, France; (C.M.); (P.A.G.)
- Service de Dermatologie-Vénéréologie, Groupe Hospitalier APHP.5, CNR IST Bactériennes—Laboratoire Associé Syphilis, 75014 Paris, France
| | - Nicolas Dupin
- NSERM Institut Cochin, INSERM U1016-CNRS UMR8104, Equipe de Biologie Cutanée, Université de Paris, 75014 Paris, France; (C.M.); (P.A.G.)
- Service de Dermatologie-Vénéréologie, Groupe Hospitalier APHP.5, CNR IST Bactériennes—Laboratoire Associé Syphilis, 75014 Paris, France
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12
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Valente Duarte de Sousa IC. An overview of sarecycline for the treatment of moderate-to-severe acne vulgaris. Expert Opin Pharmacother 2020; 22:145-154. [PMID: 32924666 DOI: 10.1080/14656566.2020.1813279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Sarecycline is a novel, tetracycline-class antibiotic specifically designed to treat inflammatory acne. It offers a narrow spectrum of activity (mainly against Cutinebacterium acnes), and it shows less in vitro activity than other tetracyclines against enteric Gram-negative bacteria, offering advantages over older tetracyclines by decreasing the disruption of the gastrointestinal microbiome and the likelihood of developing bacterial resistance. AREAS COVERED The drug's pharmacology, safety profile, and clinical efficacy are discussed. Results of phase I, II and III clinical trials have shown that 1.5 mg/kg/day sarecycline is safe, well tolerated and more effective than placebo in treating inflammatory acne in patients 9 years old and older. Furthermore, sarecycline's narrow spectrum of activity leads to a lower incidence of undesirable off-target antibacterial effects and consequently less adverse events such as diarrhea, fungal overgrowth and vaginal candidiasis. EXPERT OPINION Sarecycline could become the first-line antibiotic therapy used in acne in the near future as it is an effective option for treating inflammatory acne lesions. Due to its narrow spectrum of activity, it could have a more adequate safety profile than older tetracyclines; however, head-to-head trials comparing the efficacy and safety profile of sarecycline with other tetracyclines are still needed to prove sarecycline's superiority.
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Abstract
Multidisciplinary investigations into the pathogenesis of acne have significantly progressed over the past three years. Studies of the etiology of acne from the perspectives, for example, of sebaceous gland biology, sebum, genetics, keratinization, differentiation, hair cycles, immunology, bacteriology, and wound healing have elucidated its pathogenesis. This has led to the development of new therapies and paved the way for advanced studies that will enable the further evolution of acne treatment.
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Affiliation(s)
- Ichiro Kurokawa
- Department of Dermatology, Acne Clinical Research Center, Meiwa Hospital, Nishinomiya, Hyogo, 663-8186, Japan
| | - Keisuke Nakase
- Department of Microbiology, Tokyo University of Pharmacy and Life Sciences, Hachioji, Tokyo, 192-0392, Japan
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Valente Duarte de Sousa IC. Evaluating FMX-101 as a promising therapeutic for the treatment of acne. Expert Opin Pharmacother 2020; 21:741-746. [PMID: 32037906 DOI: 10.1080/14656566.2020.1721461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Oral minocycline is a mainstay of therapy for moderate-to-severe acne; however, systemic side effects which include hepatotoxicity, lupus-like syndrome, drug hypersensitivity syndrome, autoimmune hepatitis, polyarteritis nodosa, gastrointestinal side effects and skin hyperpigmentation are of concern. Topical antibiotics commonly used in acne, such as erythromycin and clindamycin, present high P. acnes resistance rates which has opened the market for new topical antibiotics. FMX-101 is a novel topical minocycline foam that has shown promising results in phase I, II and III trials for the treatment of moderate-to-severe acne with a better safety profile than oral minocycline. AREAS COVERED The author provides an overview FMX-101 including its clinical efficacy and safety. The author then provides their expert opinion on this treatment and its potential for the treatment option for acne. EXPERT OPINION The topical foam formulation of FMX-101 has been shown to reduce both inflammatory and non-inflammatory lesions and to improve IGA scores in patients with moderate-to-severe acne without significant systemic absorption thus limiting associated side effects. Overall, the proven efficacy and safety profile of FMX-101, together with the low systemic absorption, high skin tolerability and cosmetically acceptable foam formulations render this novel therapy an important addition to the acne treatment armamentarium.
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High-throughput sequencing reveals the diversity of TCR β chain CDR3 repertoire in patients with severe acne. Mol Immunol 2020; 120:23-31. [PMID: 32045771 DOI: 10.1016/j.molimm.2020.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/16/2020] [Accepted: 01/31/2020] [Indexed: 02/08/2023]
Abstract
Acne is a common chronic inflammatory skin disease, and the inflammation immune response runs through all stages of acne lesions. In this study, we use a combination of multiplex-PCR and high-throughput sequencing technologies to analyze T cell receptor β chain CDR3 (complementarity-determining region 3) in peripheral blood isolated from severe acne patients. Once compared with healthy controls, we propose to identify acne-relevant CDR3 peptides. Our results reveal that the diversity of T cell receptor β chain (TRB) CDR3 sequences in the peripheral blood of the severe acne vulgaris (SA) group differed from that of the control group. In addition, we find 10 TRB CDR3 sequences, amino acid sequences and V-J combinations with significantly different expressions between the SA group and the non-acne (NA) group (P < 0.0001). These findings may contribute to a better understanding of the role of immunity in the pathogenesis of acne and may serve as biomarkers for evaluating risk or prognosis of severe acne disease in future.
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Pande S, Deshmukh G, Dhoot D, Andhorikar N. An open-label, prospective, comparative, double-arm clinical trial to evaluate the safety and effectiveness of minocycline extended-release formulation compared with minocycline immediate-release formulation in the management of patients with papulopustular acne. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2020. [DOI: 10.4103/ijdd.ijdd_47_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Knackstedt R, Knackstedt T, Gatherwright J. The role of topical probiotics in skin conditions: A systematic review of animal and human studies and implications for future therapies. Exp Dermatol 2019; 29:15-21. [DOI: 10.1111/exd.14032] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/27/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023]
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18
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Lee YB, Byun EJ, Kim HS. Potential Role of the Microbiome in Acne: A Comprehensive Review. J Clin Med 2019; 8:jcm8070987. [PMID: 31284694 PMCID: PMC6678709 DOI: 10.3390/jcm8070987] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/03/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Acne is a highly prevalent inflammatory skin condition involving sebaceous sties. Although it clearly develops from an interplay of multiple factors, the exact cause of acne remains elusive. It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients. Cutibacterium acnes (C. acnes; formerly called Propionibacterium acnes) is commonly found in sebum-rich areas and its over-proliferation has long been thought to contribute to the disease. However, information provided by advanced metagenomic sequencing has indicated that the cutaneous microbiota in acne patients and acne-free individuals differ at the virulent-specific lineage level. Acne also has close connections with the gastrointestinal tract, and many argue that the gut microbiota could be involved in the pathogenic process of acne. The emotions of stress (e.g., depression and anxiety), for instance, have been hypothesized to aggravate acne by altering the gut microbiota and increasing intestinal permeability, potentially contributing to skin inflammation. Over the years, an expanding body of research has highlighted the presence of a gut–brain–skin axis that connects gut microbes, oral probiotics, and diet, currently an area of intense scrutiny, to acne severity. This review concentrates on the skin and gut microbes in acne, the role that the gut–brain–skin axis plays in the immunobiology of acne, and newly emerging microbiome-based therapies that can be applied to treat acne.
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Affiliation(s)
- Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Eun Jung Byun
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Korea.
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea.
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19
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Lim HJ, Jeon YD, Kang SH, Shin MK, Lee KM, Jung SE, Cha JY, Lee HY, Kim BR, Hwang SW, Lee JH, Sugita T, Cho O, Myung H, Jin JS, Lee YM. Inhibitory effects of Euphorbia supina on Propionibacterium acnes-induced skin inflammation in vitro and in vivo. Altern Ther Health Med 2018; 18:263. [PMID: 30261862 PMCID: PMC6161423 DOI: 10.1186/s12906-018-2320-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/05/2018] [Indexed: 01/04/2023]
Abstract
Background Euphorbia supina (ES) plant has been used as treatment for inflammatory conditions. The antibacterial effect and the anti-inflammatory mechanism of ES for Propionibacterium (P.) acnes-induced inflammation in THP-1 cells and acne animal model remain unclear. Therefore, the objective of the present study was to determine the antibacterial and anti-inflammatory activities of ES against P. acnes, the etiologic agent of skin inflammation. Method The antibacterial activities of ES were tested with disc diffusion and broth dilution methods. Cytotoxicity of ES at different doses was evaluated by the MTT assay. THP-1 cells were stimulated by heat-killed P. acnes in the presence of ES. The pro-inflammatory cytokines and mRNA levels were measured by ELISA and real-time-PCR. MAPK expression was analyzed by Western blot. The living P. acnes was intradermally injected into the ear of BLBC/c mice. Subsequently, chemical composition of ES was analyzed by liquids chromatography-mass spectrometry (LC-MS). Result ES had stronger antibacterial activity against P. acnes and inhibitory activity on lipase. ES had no significant cytotoxicity on THP-1 cells. ES suppressed the mRNA levels and production of IL-8, TNF-a, IL-1β in vitro. ES inhibited the expression levels of pro-inflammatory cytokines and the MAPK signaling pathway. Ear thickness and inflammatory cells were markedly reduced by ES treatment. Protocatechuic acid, gallic acid, quercetin, and kaempferol were detected by LC-MS analysis in ES. Conclusions Our results demonstrate antibacterial and anti-inflammatory activities of ES extract against P. acnes. It is suggested that ES extract might be used to treatment anti-inflammatory skin disease. Electronic supplementary material The online version of this article (10.1186/s12906-018-2320-8) contains supplementary material, which is available to authorized users.
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Mattii M, Lovászi M, Garzorz N, Atenhan A, Quaranta M, Lauffer F, Konstantinow A, Küpper M, Zouboulis C, Kemeny L, Eyerich K, Schmidt-Weber C, Törőcsik D, Eyerich S. Sebocytes contribute to skin inflammation by promoting the differentiation of T helper 17 cells. Br J Dermatol 2018; 178:722-730. [DOI: 10.1111/bjd.15879] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- M. Mattii
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - M. Lovászi
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - N. Garzorz
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - A. Atenhan
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - M. Quaranta
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - F. Lauffer
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - A. Konstantinow
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - M. Küpper
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Dessau Germany
| | - L. Kemeny
- Department of Dermatology and Allergology; University of Szeged; Szeged Hungary
| | - K. Eyerich
- Department of Dermatology and Allergy; Technische Universität Munich; Munich Germany
| | - C.B. Schmidt-Weber
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
| | - D. Törőcsik
- Department of Dermatology; Faculty of Medicine; University of Debrecen; Debrecen Hungary
| | - S. Eyerich
- ZAUM - Center for Allergy and Environment; Technische Universität and Helmholtz Center Munich; Member of the German Center for Lung Research (DZL); Biedersteinerstraße 29 80802 Munich Germany
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21
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Yu Y, Champer J, Agak GW, Kao S, Modlin RL, Kim J. Different Propionibacterium acnes Phylotypes Induce Distinct Immune Responses and Express Unique Surface and Secreted Proteomes. J Invest Dermatol 2016; 136:2221-2228. [PMID: 27377696 DOI: 10.1016/j.jid.2016.06.615] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/02/2016] [Accepted: 06/20/2016] [Indexed: 12/23/2022]
Abstract
Propionibacterium acnes is a skin commensal bacterium that contributes to the development of acne vulgaris and other infections. Recent work revealed that P. acnes clinical isolates can be classified into distinct phylotypes, several of which have associations with healthy skin or acne. We sought to determine if these phylotypes induce different immunological responses and express protein factors that may contribute to their disease associations. We found that acne-associated P. acnes phylotypes induced 2- to 3-fold higher levels of IFN-γ and IL-17 in peripheral blood mononuclear cells compared with healthy phylotypes. On the other hand, P. acnes phylotypes associated with healthy skin induced 2- to 4-fold higher levels of IL-10. Comparative proteomic analysis of P. acnes phylotypes revealed a differential expression of several proteins, including an adhesion protein that was expressed at least 10-fold higher in acne-associated phylotypes and a cell surface hydrolase expressed in all phylotypes except those associated with healthy skin. Taken together, our data provide insight into how specific P. acnes phylotypes influence immune responses and the pathogenesis of acne.
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Affiliation(s)
- Yang Yu
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jackson Champer
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - George W Agak
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Stephanie Kao
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Robert L Modlin
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA; Department of Microbiology, Immunology and Molecular Genetics, University of California Los Angeles, Los Angeles, California, USA
| | - Jenny Kim
- Division of Dermatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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22
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Assessment of serum levels of cathelicidin and vitamin D in acne vulgaris. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2016. [DOI: 10.1097/01.ewx.0000480714.99599.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Suh DH, Kwon HH. What's new in the physiopathology of acne? Br J Dermatol 2016; 172 Suppl 1:13-9. [PMID: 25645151 DOI: 10.1111/bjd.13634] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 12/25/2022]
Abstract
There are four central factors that contribute to acne physiopathology: the inflammatory response, colonization with Propionibacterium acnes, increased sebum production and hypercornification of the pilosebaceous duct. In addition, research in the areas of diet and nutrition, genetics and oxidative stress is also yielding some interesting insights into the development of acne. In this paper we review some of the most recent research and novel concepts revealed in this work, which has been published by researchers from diverse academic disciplines including dermatology, immunology, microbiology and endocrinology. We discuss the implications of their findings (particularly in terms of opportunities to develop new therapies), highlight interrelationships between these novel factors that could contribute to the pathology of acne, and indicate where gaps in our understanding still exist.
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Affiliation(s)
- D H Suh
- Department of Dermatology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
| | - H H Kwon
- Department of Dermatology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, South Korea
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24
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Namazi MR, Parhizkar AR, Jowkar F. Serum levels of hypersensitive-C-reactive protein in moderate and severe acne. Indian Dermatol Online J 2015. [PMID: 26225329 PMCID: PMC4513404 DOI: 10.4103/2229-5178.160256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Elevation of C-reactive protein (CRP) has been reported to occur in psoriasis, urticaria, acne, rosacea and many other dermatological and nondermatological conditions. Chronic systemic inflammation has been implicated in the development of neuropsychiatric/degenerative disorders, atherosclerosis, coronary artery disease, diabetes mellitus and even carcinogenesis. The present study is designed to determine whether the level of inflammation created by acne vulgaris could be high enough to raise the serum levels of high-sensitive CRP. MATERIALS AND METHODS Forty-two patients with moderate and severe acne vulgaris were enrolled, along with 44 age and sex matched healthy blood donors as controls. Hypersensitive-CRP (Hs-CRP) was measured in both groups. RESULTS Hypersensitive-C-reactive protein levels in the case group varied between 0 and 28.1 μg/ml with an average of 2.24 ± 4.87 μg/ml (mean ± standard deviation) and a median of 0.6 μg/ml (interquartile range [IQR] =0.3, 1.4 μg/ml). Hs-CRP levels of the control group varied between 0 and 14 μg/ml with an average of 3.12 ± 3.67 μg/ml and a median of 1.5 μg/ml (IQR = 0.55, 5.0 μg/ml). No significant difference of Hs-CRP level between the two groups was seen (t = -0.961, 95% confidence interval: Lower = -2.6942, upper = 0.9377; P = 0.339). Additionally, no significant difference in the level of Hs-CRP was noted between the moderate and severe acne groups (95% confidence interval: Lower = -5.2495, upper = 1.6711; P = 0.165). CONCLUSION Acne vulgaris, even in its severe grades (excluding acne fulminans and acne conglobata), does not induce significant inflammation at the systemic level.
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Affiliation(s)
- M R Namazi
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran ; Department of Liverpool Hospital Dermatology, Conjoint Faculty Member, University of New South Wales, Sydney, Australia
| | - A R Parhizkar
- Department of Dermatology, Fasa University of Medical Sciences, Fasa, Iran
| | - F Jowkar
- Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Abstract
The mechanisms of inflammation in acne are currently subject of intense investigation. This study focused on the activation of adaptive and innate immunity in clinically early visible inflamed acne lesions and was performed in two independent patient populations. Biopsies were collected from lesional and non-lesional skin of acne patients. Using Affymetrix Genechips, we observed significant elevation of the signature cytokines of the Th17 lineage in acne lesions compared to non-lesional skin. The increased expression of IL-17 was confirmed at the RNA and also protein level with real-time PCR (RT-PCR) and Luminex technology. Cytokines involved in Th17 lineage differentiation (IL-1β, IL-6, TGF-β, IL23p19) were remarkably induced at the RNA level. In addition, proinflammatory cytokines and chemokines (TNF-α, IL-8, CSF2 and CCL20), Th1 markers (IL12p40, CXCR3, T-bet, IFN-γ), T regulatory cell markers (Foxp3, IL-10, TGF-β) and IL-17 related antimicrobial peptides (S100A7, S100A9, lipocalin, hBD2, hBD3, hCAP18) were induced. Importantly, immunohistochemistry revealed significantly increased numbers of IL-17A positive T cells and CD83 dendritic cells in the acne lesions. In summary our results demonstrate the presence of IL-17A positive T cells and the activation of Th17-related cytokines in acne lesions, indicating that the Th17 pathway is activated and may play a pivotal role in the disease process, possibly offering new targets of therapy.
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26
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Kistowska M, Meier B, Proust T, Feldmeyer L, Cozzio A, Kuendig T, Contassot E, French LE. Propionibacterium acnes promotes Th17 and Th17/Th1 responses in acne patients. J Invest Dermatol 2014; 135:110-118. [PMID: 25010142 DOI: 10.1038/jid.2014.290] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/27/2014] [Accepted: 06/04/2014] [Indexed: 12/12/2022]
Abstract
Propionibacterium acnes is a Gram-positive commensal bacterium thought to be involved in the pathogenesis of acne vulgaris. Although the ability of P. acnes in the initiation of pro-inflammatory responses is well documented, little is known about adaptive immune responses to this bacterium. The observation that infiltrating immune cells consist mainly of CD4(+) T cells in the perifollicular space of early acne lesions suggests that helper T cells may be involved in immune responses caused by the intra-follicular colonization of P. acnes. A recent report showing that P. acnes can induce IL-17 production by T cells suggests that acne might be a T helper type 17 (Th17)-mediated disease. In line with this, we show in this work that, in addition to IL-17A, both Th1 and Th17 effector cytokines, transcription factors, and chemokine receptors are strongly upregulated in acne lesions. Furthermore, we found that, in addition to Th17, P. acnes can promote mixed Th17/Th1 responses by inducing the concomitant secretion of IL-17A and IFN-γ from specific CD4(+) T cells in vitro. Finally, we show that both P. acnes-specific Th17 and Th17/Th1 cells can be found in the peripheral blood of patients suffering from acne and, at lower frequencies, in healthy individuals. We therefore identified P. acnes-responding Th17/Th1 cells as, to our knowledge, a previously unreported CD4(+) subpopulation involved in inflammatory acne.
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Affiliation(s)
| | - Barbara Meier
- Department of Dermatology, University Hospital, Zürich, Switzerland
| | - Tatiana Proust
- Department of Dermatology, University Hospital, Zürich, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology and Venereology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Antonio Cozzio
- Department of Dermatology, University Hospital, Zürich, Switzerland
| | - Thomas Kuendig
- Department of Dermatology, University Hospital, Zürich, Switzerland
| | | | - Lars E French
- Department of Dermatology, University Hospital, Zürich, Switzerland.
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27
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Pretsch A, Nagl M, Schwendinger K, Kreiseder B, Wiederstein M, Pretsch D, Genov M, Hollaus R, Zinssmeister D, Debbab A, Hundsberger H, Eger A, Proksch P, Wiesner C. Antimicrobial and anti-inflammatory activities of endophytic fungi Talaromyces wortmannii extracts against acne-inducing bacteria. PLoS One 2014; 9:e97929. [PMID: 24887557 PMCID: PMC4041568 DOI: 10.1371/journal.pone.0097929] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/26/2014] [Indexed: 12/13/2022] Open
Abstract
Acne vulgaris is the most common skin disease, causing significant psychosocial problems such as anxiety and depression similar to a chronic illness for those afflicted. Currently, obtainable agents for acne treatment have limited use. Thus, development of novel agents to treat this disease is a high medical need. The anaerobic bacterium Propionibacterium acnes has been implicated in the inflammatory phase of acne vulgaris by activating pro-inflammatory mediators such as the interleukin-8 (IL-8) via the NF-κB and MAPK pathways. Talaromyces wortmannii is an endophytic fungus, which is known to produce high bioactive natural compounds. We hypothesize that compound C but also the crude extract from T. wortmannii may possess both antibacterial activity especially against P. acnes and also anti-inflammatory properties by inhibiting TNF-α-induced ICAM-1 expression and P. acnes-induced IL-8 release. Treatment of keratinocytes (HaCaT) with P. acnes significantly increased NF-κB and activator protein-1 (AP-1) activation, as well as IL-8 release. Compound C inhibited P. acnes-mediated activation of NF-κB and AP-1 by inhibiting IκB degradation and the phosphorylation of ERK and JNK MAP kinases, and IL-8 release in a dose-dependent manner. Based on these results, compound C has effective antimicrobial activity against P. acnes and anti-inflammatory activity, and we suggest that this substance or the crude extract are alternative treatments for antibiotic/anti-inflammatory therapy for acne vulgaris.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Abdesamad Debbab
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich-Heine University, Düsseldorf, Germany
| | - Harald Hundsberger
- Medical and Pharmaceutical Biotechnology, University of Applied Sciences, Krems, Austria
| | - Andreas Eger
- Medical and Pharmaceutical Biotechnology, University of Applied Sciences, Krems, Austria
| | - Peter Proksch
- Institute of Pharmaceutical Biology and Biotechnology, Heinrich-Heine University, Düsseldorf, Germany
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28
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Abstract
Recent advances in our understanding of inflammatory skin diseases now afford an opportunity to delve deeper into microbial/host interactions in acne. Agak et al. report that Propionibacterium acnes induces IL-17 expression in peripheral blood mononuclear cells and present new evidence that IL-17+ cells are found in the perifollicular infiltrate of comedones. Additional studies are needed to assess the clinical relevance of IL-17 in acne.
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Agak GW, Qin M, Nobe J, Kim MH, Krutzik SR, Tristan GR, Elashoff D, Garbán HJ, Kim J. Propionibacterium acnes Induces an IL-17 Response in Acne Vulgaris that Is Regulated by Vitamin A and Vitamin D. J Invest Dermatol 2014; 134:366-373. [PMID: 23924903 PMCID: PMC4084940 DOI: 10.1038/jid.2013.334] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 03/26/2013] [Accepted: 04/06/2013] [Indexed: 12/05/2022]
Abstract
Acne vulgaris is the most common skin disorder affecting millions of people worldwide and inflammation resulting from the immune response targeting Propionibacterium acnes has a significant role in its pathogenesis. In this study, we have demonstrated that P. acnes is a potent inducer of T helper 17 (Th17) and Th1, but not Th2 responses in human peripheral blood mononuclear cells (PBMCs). P. acnes stimulated expression of key Th17-related genes, including IL-17A, RORα, RORc, IL-17RA, and IL-17RC, and triggered IL-17 secretion from CD4(+), but not from CD8(+) T cells. Supernatants from P. acnes-stimulated PBMCs were sufficient to promote the differentiation of naive CD4(+)CD45RA T cells into Th17 cells. Furthermore, we found that the combination of IL-1β, IL-6, and transforming growth factor-β-neutralizing antibodies completely inhibited P. acnes-induced IL-17 production. Importantly, we showed that IL-17-expressing cells were present in skin biopsies from acne patients but not from normal donors. Finally, vitamin A (all-trans retinoic acid) and vitamin D (1,25-dihydroxyvitamin D3) inhibited P. acnes-induced Th17 differentiation. Together, our data demonstrate that IL-17 is induced by P. acnes and expressed in acne lesions and that both vitamin A and D could be effective tools to modulate Th17-mediated diseases such as acne.
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MESH Headings
- Acne Vulgaris/immunology
- Acne Vulgaris/microbiology
- Acne Vulgaris/pathology
- CD4-Positive T-Lymphocytes/cytology
- CD4-Positive T-Lymphocytes/immunology
- CD4-Positive T-Lymphocytes/microbiology
- Cell Differentiation/immunology
- Gram-Positive Bacterial Infections/immunology
- Gram-Positive Bacterial Infections/pathology
- Humans
- Interleukin-17/immunology
- Interleukin-17/metabolism
- Interleukins/immunology
- Interleukins/metabolism
- Nuclear Receptor Subfamily 1, Group F, Member 1/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 1/metabolism
- Nuclear Receptor Subfamily 1, Group F, Member 3/immunology
- Nuclear Receptor Subfamily 1, Group F, Member 3/metabolism
- Propionibacterium acnes/immunology
- Receptors, Interleukin/immunology
- Receptors, Interleukin/metabolism
- Receptors, Interleukin-17/immunology
- Receptors, Interleukin-17/metabolism
- Th1 Cells/cytology
- Th1 Cells/immunology
- Th1 Cells/microbiology
- Th17 Cells/cytology
- Th17 Cells/immunology
- Th17 Cells/microbiology
- Vitamin A/metabolism
- Vitamin D/immunology
- Interleukin-22
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Affiliation(s)
- George W Agak
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Min Qin
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer Nobe
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Myung-Hwa Kim
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Dermatology, College of Medicine, Dankook University, Seoul, South Korea
| | - Stephan R Krutzik
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Grogan R Tristan
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hermes J Garbán
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jenny Kim
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA; Department of Dermatology, Greater Los Angeles Healthcare System Veterans Affairs, Los Angeles, California, USA.
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Tlish MM, Yelistratova AS, Gluzmin MI. Practical aspects of administering Acnecutan for the treatment of acne in teenagers. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal of the study: to study the efficacy and tolerance of Acnecutan for the treatment of acne in teenager patients. Materials and methods. The study involved 43 patients aged 12-18 with moderate to severe acne, who received Acnecutan* as a monotherapy. The skin process dynamics was assessed visually based on the Basic Acne Severity Index (BASI). Results. Clinical recovery was achieved in 39 patients (90.7% of all cases), and clinical improvement was observed in 4 patients (9.3%). Conclusion. The results of Acnecutan administration demonstrate a high level of its efficacy and tolerance in teenagers. To assess the stability of the results achieved and to draw final conclusions, the patients will be followed up within a year after the end of the therapy. Therefore, the drug can be recommended as a monotherapy for acne of different clinical forms in teenager patients.
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Jung GW, Tse JE, Guiha I, Rao J. Prospective, Randomized, Open-Label Trial Comparing the Safety, Efficacy, and Tolerability of an Acne Treatment Regimen with and without a Probiotic Supplement and Minocycline in Subjects with Mild to Moderate Acne. J Cutan Med Surg 2013; 17:114-22. [DOI: 10.2310/7750.2012.12026] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Systemic antibiotics are an effective treatment for acne vulgaris. However, intolerable side effects may invariably occur. Objective: To determine whether probiotics reduce the side effects imparted by systemic antibiotics while working synergistically with the latter in treating inflammatory acne. Methods: Forty-five 18- to 35-year-old females were randomly assigned to one of three arms in this prospective, open-label study. Group A received probiotic supplementation, whereas group B received only minocycline. Group C was treated with both probiotic and minocycline. Clinical and subjective assessments were completed at baseline and during the 2-, 4-, 8-, and 12-week follow-up visits. Results: All patients demonstrated a significant improvement in total lesion count 4 weeks after treatment initiation ( p < .001), with continued improvement seen with each subsequent follow-up visit ( p < .01). At the 8- and 12-week follow-up visits, group C had a significant decrease in total lesion count versus groups A ( p < .001) and B ( p < .01). Two patients (13%) from group B failed to complete the study secondary to vaginal candidiasis. Conclusion: Probiotics may be considered a therapeutic option or adjunct for acne vulgaris by providing a synergistic antiinflammatory effect with systemic antibiotics while also reducing potential adverse events secondary to chronic antibiotic use.
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Affiliation(s)
- Gordon W. Jung
- From the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB; Shape MD, Edmonton, AB; Acne Clinics of Canada, Edmonton, AB; and Dermatology and Cosmetic Laser Associates of La Jolla, La Jolla, CA
| | - Jennifer E. Tse
- From the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB; Shape MD, Edmonton, AB; Acne Clinics of Canada, Edmonton, AB; and Dermatology and Cosmetic Laser Associates of La Jolla, La Jolla, CA
| | - Isabella Guiha
- From the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB; Shape MD, Edmonton, AB; Acne Clinics of Canada, Edmonton, AB; and Dermatology and Cosmetic Laser Associates of La Jolla, La Jolla, CA
| | - Jaggi Rao
- From the Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB; Shape MD, Edmonton, AB; Acne Clinics of Canada, Edmonton, AB; and Dermatology and Cosmetic Laser Associates of La Jolla, La Jolla, CA
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Bowe WP, Glick JB, Shalita AR. Solodyn and Updates on Topical and Oral Therapies for Acne. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0014-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Popovic S, Urbán E, Lukic M, Conlon JM. Peptides with antimicrobial and anti-inflammatory activities that have therapeutic potential for treatment of acne vulgaris. Peptides 2012; 34:275-82. [PMID: 22374306 DOI: 10.1016/j.peptides.2012.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 11/23/2022]
Abstract
The pathogenesis of acne vulgaris is multifactorial involving infection of the pilosebaceous unit with Propionibacterium acnes and a cytokine-mediated inflammatory response. Five frog skin-derived antimicrobial peptides ([D4k]ascaphin-8, [G4K]XT-7, [T5k]temporin-DRa, brevinin-2GU, and B2RP-ERa), chosen for their low hemolytic activity against human erythrocytes, were assessed for their effects on the growth of clinical isolates of P. acnes and on the release of pro-inflammatory and anti-inflammatory cytokines from peripheral blood mononuclear (PBM) cells. All peptides inhibited the growth of P. acnes with the highest potency exhibited by [D4k]ascaphin-8 (minimum inhibitory concentration, MIC=3-12.5 μM). Release of TNF-α from concanavalin A (ConA)-stimulated PBM cells was significantly reduced by [D4k]ascaphin-8, [G4K]XT-7, brevinin-2GU, and B2RP-ERa (1 and 20 μg/ml) and by [T5k]temporin-DRa (20 μg/ml). Release of IFN-γ from unstimulated PBM cells was significantly reduced by [D4k]ascaphin-8 and brevinin-2GU (1 and 20 μg/ml). No peptide showed significant effects on Il-17 release. Release of the anti-inflammatory cytokines TGF-β, IL-4, and IL-10 from both unstimulated and ConA-treated PBM cells was significantly increased by [T5k]temporin-DRa and B2RP-ERa (1 and 20μg/ml). The potent activities of [D4k]ascaphin-8 and [T5k]temporin-DRa in inhibiting the growth of P. acnes and the release of pro-inflammatory cytokines, and in stimulating the release of anti-inflammatory cytokines suggest a possible therapeutic role in the treatment of acne vulgaris.
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Affiliation(s)
- Suzana Popovic
- Department of Immunology and Microbiology, Faculty of Medicine, University of Kragujevac, Serbia
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Grange PA, Weill B, Dupin N, Batteux F. Does inflammatory acne result from imbalance in the keratinocyte innate immune response? Microbes Infect 2010; 12:1085-90. [PMID: 20691803 DOI: 10.1016/j.micinf.2010.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/27/2010] [Indexed: 11/26/2022]
Abstract
Acne is a multifactorial chronic disease affecting around 80% of teenage population. The pathogenesis of acne involves inflammatory reactions and colonization by the Propionibacterium acnes (P. acnes) strain. P. acnes stimulates the keratinocytes involved in the innate immune response, the intensity of which could be influenced either by bacterial intrinsic factors or by endogenous factors of the host.
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Affiliation(s)
- Philippe A Grange
- Laboratoire de Recherche en Dermatologie, EA 1833, Faculté de Médecine, Université Paris Descartes, 75679 Paris Cedex 14, France
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Severi G, Shannon BA, Hoang HN, Baglietto L, English DR, Hopper JL, Pedersen J, Southey MC, Sinclair R, Cohen RJ, Giles GG. Plasma concentration of Propionibacterium acnes antibodies and prostate cancer risk: results from an Australian population-based case-control study. Br J Cancer 2010; 103:411-5. [PMID: 20606679 PMCID: PMC2920014 DOI: 10.1038/sj.bjc.6605757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 04/15/2010] [Accepted: 06/01/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Recent studies in prostatic tissue suggest that Propionibacterium acnes (P. acnes), a bacterium associated with acne that normally lives on the skin, is the most prevalent bacterium in the prostate and in men with benign prostatic hyperplasia. Its prevalence is higher in samples from patients subsequently diagnosed with prostate cancer. The aim of our study was to test whether circulating levels of P. acnes antibodies are associated with prostate cancer risk and tumour characteristics using plasma samples from a population-based case-control study. METHODS We measured plasma concentration of P. acnes antibodies for 809 cases and 584 controls using a recently developed ELISA assay. We compared antibody titres between cases and controls using unconditional logistic regression adjusted for batch and variables associated with the study design (i.e., age, year of selection and centre). The primary analysis included P. acnes titres in the model as a dichotomous variable using the median value for controls as the cut-off value. RESULTS P. acnes antibody titres for both cases and controls ranged from 1 : 16 (i.e., low concentration) to 1 : 65,536 (i.e., high concentration; median value=1 : 1024). The odds ratio for prostate cancer associated with titres at or above the median value was 0.73 (95% CI 0.58-0.91, P=0.005). The association appeared to be particularly strong for advanced prostate cancer (AJCC Stage grouping III-IV) for which the odds ratio was 0.59 (95% CI 0.43-0.81, P=0.001) but there was insufficient evidence that the association differed by tumour stage (p heterogeneity=0.07). CONCLUSION These results need to be confirmed in prospective studies but they are consistent with the hypothesis that P. acnes has a role in prostate cancer.
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Affiliation(s)
- G Severi
- Cancer Epidemiology Centre, The Cancer Council of Victoria, Melbourne, Victoria 3053, Australia.
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Skurkovich S, Skurkovich B, Kelly J. Anticytokine therapy, particularly anti-IFN-gamma, in Th1-mediated autoimmune diseases. Expert Rev Clin Immunol 2010; 1:11-25. [PMID: 20477651 DOI: 10.1586/1744666x.1.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anticytokine therapy was proposed in 1974 in Nature, in which it was stated that hyperproduced interferon can cause autoimmune disease and anti-interferon can be therapeutic. In 1989, the use of antibodies to tumor necrosis factor-alpha in combination with antibodies to certain types of interferon was proposed to treat various autoimmune diseases, including AIDS. The first anticytokine therapy was conducted in 1975. Anti-interferon-gamma has brought improved and often striking results in the treatment of various T-helper 1-mediated autoimmune diseases, including inflammatory skin diseases. Anti-interferon-gamma may be a universal treatment for these conditions. In AIDS and other virus-induced autoimmune diseases, the virus may stimulate cytokines (interferons), which increase, rather than halt, viral replication. Tumor necrosis factor-alpha inhibitors have also shown good clinical results, however, they may result in complications and are ineffective in some autoimmune diseases.
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Noh M, Yeo H, Ko J, Kim HK, Lee CH. MAP17 is associated with the T-helper cell cytokine-induced down-regulation of filaggrin transcription in human keratinocytes. Exp Dermatol 2010; 19:355-62. [PMID: 19601982 DOI: 10.1111/j.1600-0625.2009.00902.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the meta-analysis of public microarray databases for different skin diseases, we revealed seven commonly up-regulated genes, DSG3, KRT6, MAP17, PLSCR1, RPM2, SOD2 and SPRR2B. We postulated that the genes selected from the meta-analysis may be potentially associated with the abnormal keratinocyte differentiation. To demonstrate this postulation, we alternatively evaluated whether the genes of interest in the meta-analysis can be regulated by T-helper (Th) cell cytokines in normal human epidermal keratinocytes (NHEK). We found that MAP17 was significantly up-regulated in response to interferon-gamma, interleukin 4 (IL-4), IL-6, IL-17A or IL-22 in NHEK. Interestingly, MAP17 was originally reported to interact with PDZK1; in turn, the PDZK1 gene is localized within the atopic dermatitis-linked region on human chromosome 1q21. In an attempt to evaluate whether MAP17 regulates the expression of cornified envelope-associated genes at the 1q21 locus, such as filaggrin, loricrin and involucrin, we found that the over-expression of MAP17 in HaCaT keratinocytes significantly decreased the expression of filaggrin. Taken together, the Th cell cytokine-induced up-regulation of MAP17 expression may be linked to the down-regulation of filaggrin in NHEK, which may be associated with the abnormal epidermal differentiation observed in the dermatological diseases.
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Affiliation(s)
- Minsoo Noh
- Skin Research Institute, AmorePacific Corporation R&D Center, Yongin, Gyeounggi-do, Republic of Korea.
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Increased interferon-γ, interleukin-12p40 and IL-8 production in Propionibacterium acnes-treated peripheral blood mononuclear cells from patient with acne vulgaris. J Dermatol Sci 2009; 55:47-52. [DOI: 10.1016/j.jdermsci.2009.02.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 02/25/2009] [Accepted: 02/27/2009] [Indexed: 11/17/2022]
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Abstract
Seborrhea, follicular hyperkeratosis, propionibacteria, and inflammatory reactions are the most important factors leading to acne. The combination of increased sebum producation and follicular hyperkeratosis facilitates an increased growth of Propionibacterium acnes. Its metabolic products lead to follicular inflammation and, in extreme cases, even to perifollicular abscesses. Sebum production is influenced by androgens, so that abnormalities in androgen levels can produce seborrhea and acne. Follicular hyperkeratosis may be triggered by a relative deficiency in linoleic acid, peroxides from sebum components, and especially by inflammatory mediators such as interleukin-1. Bacterial metabolic products such as lipases, proteases, or chemotactic factors lead to the perifollicular inflammation. This inflammation is not only a response to other pathogenetic factors, but also a cause of acne. An initial mild perifollicular inflammation can induce comedogenesis via a variety of mediators. The influence of dietary factors on the initiation and course of acne has recently received increased recognition. A connection has been postulated between acne and a high nutrients with glycemic index, as well as with milk products.
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Affiliation(s)
- K Degitz
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität Müchen, München, Deutschland.
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Abstract
BACKGROUND Acne results from the interplay of several pathophysiologic factors, in particular seborrhoea, follicular hyperkeratosis, propionibacteria and inflammation. Recently, it has become clear that inflammatory events are important not only in the course, but also in the initiation of the disease. OBJECTIVE The study undertook an evaluation of the effectiveness of currently available pharmacotherapeutic treatment options for acne. METHODS After a Medline-based literature search, this article critically reviewed substances used topically (among others, retinoids, antimicrobials, salicylic acid and azelaic acid) and systemically (antibiotics, isotretinoin, hormones and zinc) as well as their combinations with respect to pharmacology, clinical efficacy and side effects. RESULTS Modern acne pharmacotherapy provides substances that antagonize one or more of the major pathophysiologic factors of acne. When the clinical picture but also patients' motivation and wishes are appropriately considered, current pharmacotherapy of acne is rational and effective.
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Affiliation(s)
- Klaus Degitz
- Ludwig-Maximilian University, Department of Dermatology and Allergology, Munich, Germany.
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Michalak-Stoma A, Tabarkiewicz J, Olender A, Juszkiewicz-Borowiec M, Stoma F, Pietrzak A, Pozarowski P, Bartkowiak-Emeryk M. The effect of Propionibacterium acnes on maturation of dendritic cells derived from acne patients' peripherial blood mononuclear cells. Folia Histochem Cytobiol 2008; 46:535-9. [PMID: 19141410 DOI: 10.2478/v10042-008-0064-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Propionibacterium acnes (P. acnes) has been implicated in the pathogenesis of acne vulgaris which is the most common cutaneous disorder. It has a proinflammatory activity and takes part in immune reactions modulating the Th1/Th2 cellular response. The exposure of dendritic cells (DCs) to whole bacteria, their components, cytokines or other inflammatory stimuli and infectious agents induces differentiation from immature DCs into antigen-presenting mature DCs. The aim of the study was to evaluate the capability of P. acnes to induce the maturation of DCs. We stimulated monocyte derived dendritic cells (Mo-DCs) from acne patients with various concetrations of heat-killed P. acnes (10(6)-10(8) bacteria/ml) cultured from acne lesions. The results showed an increase in CD80+/CD86+/DR+ and CD83+/CD1a+/DR+ cells percentage depending on the concetration of P. acnes. The expression of CD83 and CD80 (shown as the mean fluorescence intensity - MFI) increased with higher concetrations of P. acnes. There were also significant correlations between MFI of CD83, CD80, CD86 and concetration of P. acnes. The study showed that P. acnes in the concetration of 10(8) bacteria/ml is most effective in the induction of Mo-DCs maturation. Futher studies concerning the influence on the function of T cells are needed.
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Thielitz A, Reinhold D, Vetter R, Bank U, Helmuth M, Hartig R, Wrenger S, Wiswedel I, Lendeckel U, Kähne T, Neubert K, Faust J, Zouboulis CC, Ansorge S, Gollnick H. Inhibitors of Dipeptidyl Peptidase IV and Aminopeptidase N Target Major Pathogenetic Steps in Acne Initiation. J Invest Dermatol 2007; 127:1042-51. [PMID: 16778789 DOI: 10.1038/sj.jid.5700439] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acne is a chronic disease hallmarked by sebaceous hyperplasia, follicular hyperkeratosis, and inflammation. Parallel targeting of these factors is required to treat acne effectively. Inhibitors of dipeptidyl peptidase IV (DP IV) and aminopeptidase N (APN) show strong anti-inflammatory effects on immune cells and therapeutic efficacy in autoimmune disorders. Our investigation focused on the expression and functional relevance of these ectopeptidases in three cell types which exhibit an altered phenotype in early acne lesions. We showed for the first time expression of DP IV and APN on human sebocytes. In the SZ95 sebocyte cell line, the DP IV inhibitors Lys[Z(NO2)]-thiazolidide and Lys[Z(NO2)]-pyrrolidide and the APN inhibitors actinonin and bestatin suppressed proliferation, enhanced terminal differentiation, and slightly decreased total neutral lipid production. The anti-inflammatory and differentiation-restoring cytokine IL-1 receptor antagonist was significantly upregulated in SZ95 sebocytes and the HaCaT keratinocyte cell line in the presence of inhibitors. Furthermore, the inhibitors suppressed proliferation and IL-2 production of Propionibacterium acnes-stimulated T cells ex vivo and enhanced the expression of the immunosuppressive cytokine transforming growth factor-beta1. Our data provide first evidence for a functional role of DP IV and APN in the sebaceous gland apparatus and for their inhibitors, used alone or in combination, as completely new substances possibly affecting acne pathogenesis in a therapeutic manner.
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Affiliation(s)
- Anja Thielitz
- Department of Dermatology and Venereology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
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Lodes MJ, Secrist H, Benson DR, Jen S, Shanebeck KD, Guderian J, Maisonneuve JF, Bhatia A, Persing D, Patrick S, Skeiky YAW. Variable expression of immunoreactive surface proteins of Propionibacterium acnes. MICROBIOLOGY-SGM 2007; 152:3667-3681. [PMID: 17159220 DOI: 10.1099/mic.0.29219-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite accumulating data implicating Propionibacterium acnes in a variety of diseases, its precise role in infection remains to be determined. P. acnes antigen-specific CD4(+) T cells are present in early inflamed acne lesions and may be involved in the inflammatory response; however, little is known about the specific antigens involved. In this study, B cell and T cell antigens from P. acnes expression libraries were cloned and evaluated and the four predominant proteins identified were investigated. Two of these antigens share some homology with an M-like protein of Streptococcus equi and have dermatan-sulphate-binding activity (PA-25957 and 5541). The remaining two antigens, PA-21693 and 4687, are similar to the product of the Corynebacterium diphtheriae htaA gene from the hmu ABC transport locus, although only one of these (PA-21693) is encoded within an hmu-like operon and conserved amongst a range of clinical isolates. All four proteins contain an LPXTG motif, although only PA-21693 contains a characteristic sortase-sorting signal. Variation in the expression of PA-4687, 25957 and 5541 is evident amongst clinical isolates and is generated both by frameshifts associated with the putative signal peptide and by variable numbers of repeat regions toward the carboxy-terminus, potentially generating heterogeneity of molecular mass and antigenic variation. In addition, in the case of PA-25957, a frameshift in a C-rich region at the extreme carboxy-terminus eliminates the LPXTG motif in some isolates. For the dermatan-sulphate-binding PA-25957, IgG1 antibody in serum from acne-positive donors was shown to be specific for the amino-terminal region of the protein, which also contains a CD4(+) T cell epitope. In contrast, serum from acne-negative donors shows an IgG2 and IgG3 antibody subclass response to the carboxy-terminal region. These data have implications for the potential role of P. acnes in inflammatory acne and other diseases.
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Affiliation(s)
- Michael J Lodes
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Heather Secrist
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Darin R Benson
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Shyian Jen
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Kurt D Shanebeck
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Jeffrey Guderian
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | | | - Ajay Bhatia
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - David Persing
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
| | - Sheila Patrick
- Microbiology Building, School of Medicine and Dentistry, Queen's University Belfast, Grosvenor Road, Belfast BT12 6BN, UK
| | - Yasir A W Skeiky
- Corixa Corporation, Infectious Disease Research Institute, Seattle, WA 98101, USA
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Abstract
BACKGROUND Inflammatory, medium to severe acne vulgaris is treated with systemic antibiotics worldwide. The rationale is an effect on Propionibacterium acnes as well as the intrinsic anti-inflammatory properties of these antibiotics. Although there are no correlations between the number of P. acnes and the severity of the disease, associations between the degree of humoral and cellular immune responses towards P. acnes and the severity of acne have been reported. Exact data on practical use of these compounds, such as differential efficacy or side effects are unavailable. A summary of currently available studies is presented. METHODS The data of studies of systemic antibiotic therapy of acne vulgaris up to 1975, the summary of literature in English up to 1999, a systematic review of minocycline from 2002 as well as the data of randomized controlled studies published and listed in Medline thereafter were reviewed. RESULTS Tetracyclines [tetracycline 1,000 mg daily, doxycycline 100 (-200) mg daily, minocycline 100 (-200) mg daily, lymecycline 300 (-600) mg] and erythromycin 1 000 mg daily are significantly more effective than placebo in the systemic treatment of inflammatory acne. The data for tetracycline are best founded. Clindamycin is similarly effective. Co-trimoxazole and trimethoprim are likely to be effective. Clear differences between the tetracyclines or between tetracycline and erythromycin cannot be ascertained. The data for the combination with topical treatments [topical benzoyl peroxide (BPO) or retinoids] suggest synergistic effects. Therefore systemic antibiotics should not be used as monotherapy. In case of similar efficacy, other criteria, such as pharmacokinetics (doxycycline, minocycline, lymecycline have longer half-lives than tetracyclines), the rate of side-effects (tetracycline: side effect-rate approximately 4 % mild side effects; erythromycin: frequent gastrointestinal complaints; minocycline: rare, but potentially severe hypersensitivity reactions; doxycycline: dose-dependent phototoxic reactions), the resistance rate [percentage of resistant bacteria higher with erythromycin (approximately 50 %) than with tetracycline-therapy (approximately 20 %)], and the costs of therapy have to be taken into account. CONCLUSIONS The systemic antibiotic therapy of widespread papulo-pustular acne not amenable to a topical therapy is effective and well-tolerated. In general therapy can be carried out for 3 months and should be combined with BPO to prevent resistance.
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Affiliation(s)
- Falk Ochsendorf
- Department of Dermatology and Venereology, Clinic of the J.W. Goethe University, Frankfurt, Germany.
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47
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Seaton ED, Mouser PE, Charakida A, Alam S, Seldon PM, Seldon PE, Chu AC. Investigation of the mechanism of action of nonablative pulsed-dye laser therapy in photorejuvenation and inflammatory acne vulgaris. Br J Dermatol 2006; 155:748-55. [PMID: 16965424 DOI: 10.1111/j.1365-2133.2006.07429.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonablative lasers are widely used for treatment of wrinkles, atrophic scars and acne. These lasers stimulate dermal remodelling and collagen production, but the early molecular stimulus for this is unknown. The mechanism of nonablative lasers in inflammatory acne is variously suggested to be damage either to sebaceous glands or to Propionibacterium acnes. Their effects on cytokine production are unknown. OBJECTIVES To assess the in vivo effects of a short pulse duration nonablative pulsed-dye laser (NA-PDL) previously used for photorejuvenation and treatment of acne, on cytokine production, P. acnes colonization density and sebum excretion rate (SER). METHODS We examined the effect of NA-PDL (NliteV; Chromogenex Light Technologies, Llanelli, U.K.) on P. acnes colonization before and after laser therapy using a scrub-wash technique and culture at 0 and 24 h (n = 15), on SER using absorptive tape at 0, 2, 4, 8 and 12 weeks (n = 19) and on cytokine mRNA using reverse transcription-polymerase chain reaction from skin biopsies at 0, 3 and 24 h (n = 8). Results NA-PDL had no effect on P. acnes or SER. Transforming growth factor (TGF)-beta1 mRNA increased fivefold after 24 h and 15-fold in two subjects (P = 0.012). CONCLUSIONS TGF-beta is known to be a potent stimulus for neocollagenesis and a pivotal immunosuppressive cytokine which promotes inflammation resolution. Its upregulation by NA-PDL provides a possible unifying molecular mechanism linking stimulation of dermal remodelling in photorejuvenation with inhibition of inflammation in acne. Damage to P. acnes or sebaceous glands cannot explain the effect of this device in acne.
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Affiliation(s)
- E D Seaton
- Department of Dermatology, Hammersmith Hospital, Imperial College, London W12 0NN, UK.
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48
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Skurkovich S, Skurkovich B. Anticytokine therapy, especially anti-interferon-gamma, as a pathogenetic treatment in TH-1 autoimmune diseases. Ann N Y Acad Sci 2006; 1051:684-700. [PMID: 16127009 DOI: 10.1196/annals.1361.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We pioneered anticytokine therapy (ACT) in 1974 and 1989, proposing to remove interferon (IFN) and tumor necrosis factor (TNF)-alpha together with IFNs to treat various autoimmune diseases, including AIDS. This hypothesis was confirmed in different laboratories and opened a new line to produce and test different anticytokines. We have had good, sometimes striking results treating various Th1-mediated autoimmune diseases, including inflammatory skin diseases, using anti-IFN-gamma and sometimes anti-TNF-alpha. Anti-IFN-gamma may be a universal treatment for these conditions. Because TNF-alpha inhibitors, now successfully used in certain autoimmune disorders, have many severe side effects, there are opportunities for the development of other ACT and TNF-alpha antagonists with fewer side effects.
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Affiliation(s)
- Simon Skurkovich
- Advanced Biotherapy Inc., 802 Rollins Avenue, Rockville, MD 20852, USA.
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49
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Nagy I, Pivarcsi A, Kis K, Koreck A, Bodai L, McDowell A, Seltmann H, Patrick S, Zouboulis CC, Kemény L. Propionibacterium acnes and lipopolysaccharide induce the expression of antimicrobial peptides and proinflammatory cytokines/chemokines in human sebocytes. Microbes Infect 2006; 8:2195-205. [PMID: 16797202 DOI: 10.1016/j.micinf.2006.04.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 04/10/2006] [Accepted: 04/11/2006] [Indexed: 11/17/2022]
Abstract
Acne is a common skin disorder of the pilosebaceous unit. In addition to genetic, hormonal and environmental factors, abnormal colonization by Propionibacterium acnes has been implicated in the occurrence of acne via the induction of inflammatory mediators. To gain more insight into the role that sebocytes play in the innate immune response of the skin, particularly in acne, we compared the antimicrobial peptide and proinflammatory cytokine/chemokine expression at mRNA and protein levels, as well as the viability and differentiation of SZ95 sebocytes in response to co-culture with representative isolates of P. acnes type IA and type IB as well as Escherichia coli-derived lipopolysaccharide (LPS). We found that, in vitro, P. acnes type IA and IB isolates and LPS induced human beta-defensin-2 and proinflammatory cytokine/chemokine expression, and influenced sebocyte viability and differentiation. Our results provide evidence that sebocytes are capable of producing proinflammatory cytokines/chemokines and antimicrobial peptides, which may have a role in acne pathogenesis. Furthermore, since P. acnes types IA and IB differentially affect both the differentiation and viability of sebocytes, our data demonstrate that different strains of P. acnes vary in their capacity to stimulate an inflammatory response within the pilosebaceous follicle.
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Affiliation(s)
- István Nagy
- Department of Dermatology and Allergology, University of Szeged, Korányi fasor 6, 6720 Szeged, Hungary.
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50
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Skurkovich B, Skurkovich S. Inhibition of IFN-gamma as a method of treatment of various autoimmune diseases, including skin diseases. ERNST SCHERING RESEARCH FOUNDATION WORKSHOP 2006:1-27. [PMID: 16329644 DOI: 10.1007/3-540-37673-9_1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We pioneered anticytokine therapy (ACT) for autoimmune diseases (ADs). In 1974, we proposed that hyperproduced interferon (IFN) can bring AD and anti-IFN can be therapeutic. In 1989, we proposed removing tumor necrosis factor (TNF)-alpha together with certain types of IFN to treat various ADs. We found IFN in patients with different ADs and conducted the first clinical trial of ACT in 1975. Anti-IFN-gamma and anti-TNF-alpha work in similar ways, but the latter brings serious complications in some patients. We obtained good, sometimes striking, therapeutic effects treating many different Th-1-mediated ADs with anti-IFN-gamma, including rheumatoid arthritis, multiple sclerosis (MS), corneal transplant rejection, and various autoimmune skin diseases such as psoriasis, alopecia areata, vitiligo, acne vulgaris, and others. Anti-IFN-gamma was in some ways superior to anti-TNF-alpha, which was ineffective in MS. Anti-IFN-gamma therapy holds great promise for treating many Th-1 ADs, especially skin diseases.
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Affiliation(s)
- B Skurkovich
- Pediatric Infection Disease, Rhode Island Hospital, Providence, RI 2903, USA.
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