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Fujita Y, Suzuki S, Sato M, Matsushita T, Yoshihara S. Anti-TIF-1γ Positive Juvenile Dermatomyositis Diagnosed with Atopic Dermatitis. Indian J Pediatr 2024; 91:739-740. [PMID: 37651063 DOI: 10.1007/s12098-023-04822-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Yuji Fujita
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan.
| | - Shotaro Suzuki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Megumi Sato
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
| | - Takashi Matsushita
- Department of Dermatology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan
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Brooks SG, Yosipovitch G. Unmet needs in treating itch: reaching beyond eczema. J DERMATOL TREAT 2024; 35:2351487. [PMID: 38945542 DOI: 10.1080/09546634.2024.2351487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE Pruritus is an unpleasant sensation that creates the urge to scratch. In many chronic conditions, relentless pruritus and scratching perpetuates a vicious itch-scratch cycle. Uncontrolled itch can detrimentally affect quality of life and may lead to sleep disturbance, impaired concentration, financial burden, and psychological suffering. Recent strides have been made to develop guidelines and investigate new therapies to treat some of the most common severely pruritic conditions, however, a large group of diseases remains underrecognized and undertreated. The purpose of this article is to provide a comprehensive review of the challenges hindering the treatment of pruritus. METHODS An online search was performed using PubMed, Web of Science, Google Scholar, and ClinicalTrials.gov from 1994 to 2024. Included studies were summarized and assessed for quality and relevance in treating pruritus. RESULTS Several barriers to treating pruritus emerged, including variable presentation, objective measurement of itch, and identifying therapeutic targets. Itch associated with autoimmune conditions, connective tissue diseases, genodermatoses, cutaneous T-cell lymphoma, and pruritus of unknown origin were among the etiologies with the greatest unmet needs. CONCLUSION Treating pruritus poses many challenges and there are many itchy conditions that have no yet been addressed. There is an urgent need for large-scale controlled studies to investigate potential targets for these conditions and novel therapies.
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Affiliation(s)
- Sarah G Brooks
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Yamamura Y, Nakashima C, Otsuka A. Interplay of cytokines in the pathophysiology of atopic dermatitis: insights from Murin models and human. Front Med (Lausanne) 2024; 11:1342176. [PMID: 38590314 PMCID: PMC10999685 DOI: 10.3389/fmed.2024.1342176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
The pathogenesis of atopic dermatitis (AD) is understood to be crucially influenced by three main factors: dysregulation of the immune response, barrier dysfunction, and pruritus. In the lesional skin of AD, various innate immune cells, including Th2 cells, type 2 innate lymphoid cells (ILC2s), and basophils, produce Th2 cytokines [interleukin (IL)-4, IL-5, IL-13, IL-31]. Alarmins such as TSLP, IL-25, and IL-33 are also produced by epidermal keratinocytes, amplifying type 2 inflammation. In the chronic phase, not only Th2 cells but also Th22 and Th17 cells increase in number, leading to suppression of filaggrin expression by IL-4, IL-13, and IL-22, which further deteriorates the epidermal barrier function. Dupilumab, which targets IL-4 and IL-13, has shown efficacy in treating moderate to severe AD. Nemolizumab, targeting IL-31RA, effectively reduces pruritus in AD patients. In addition, clinical trials with fezakinumab, targeting IL-22, have demonstrated promising results, particularly in severe AD cases. Conversely, in murine models of AD, several cytokines, initially regarded as promising therapeutic targets, have not demonstrated sufficient efficacy in clinical trials. IL-33 has been identified as a potent activator of immune cells, exacerbating AD in murine models and correlating with disease severity in human patients. However, treatments targeting IL-33 have not shown sufficient efficacy in clinical trials. Similarly, thymic stromal lymphopoietin (TSLP), integral to type 2 immune responses, induces dermatitis in animal models and is elevated in human AD, yet clinical treatments like tezepelumab exhibit limited efficacy. Therapies targeting IL-1α, IL-5, and IL-17 also failed to achieve sufficient efficacy in clinical trials. It has become clear that for treating AD, IL-4, IL-13, and IL-31 are relevant therapeutic targets during the acute phase, while IL-22 emerges as a target in more severe cases. This delineation underscores the necessity of considering distinct pathophysiological aspects and therapeutic targets in AD between mouse models and humans. Consequently, this review delineates the distinct roles of cytokines in the pathogenesis of AD, juxtaposing their significance in human AD from clinical trials against insights gleaned from AD mouse models. This approach will improve our understanding of interspecies variation and facilitate a deeper insight into the pathogenesis of AD in humans.
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Affiliation(s)
| | - Chisa Nakashima
- Department of Dermatology, Faculty of Medicine, Kindai University Hospital, Osaka, Japan
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Peng Q, Wu Y, Li Y, Lu C, Yao R, Hu S, Ma N, Chen S, Yang X, Ma P. The IL-31/TRPV1 pathway mediates allergic asthma exacerbated by DINP dermal exposure in OVA-sensitized Balb/c mice. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169613. [PMID: 38154627 DOI: 10.1016/j.scitotenv.2023.169613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/05/2023] [Accepted: 12/21/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The potential role of dermal exposure diisononyl phthalate (DINP) as an adjuvant in allergic inflammation and asthma has been suggested. However, the current findings do not provide enough evidence to support this claim. OBJECTIVES The purpose of this investigation was to examine the impact and mechanisms of allergic asthma exacerbation through the dermal exposure to DINP. METHODS The study was undertaken using OVA-sensitized mice. Lung histopathology and airway hyperreactivity (AHR) were assessed. Expression levels of immunoglobulins (t-IgE, OVA-IgE and OVA-IgG1), cytokines (IL-31, IL-4, IL-5, IL-6, IL-13 and INF-γ), and TRPV1 were measured. To investigate the mechanism by which allergic asthma worsens due to dermal exposure to DINP, the blockade analysis using the IL-31 antagonist SB-431542 and the TRPV1 antagonist capsazepine (CZP) were performed. RESULTS The findings of the study revealed that the simultaneous exposure to DINP and OVA resulted in an increase in inspiratory resistance (Ri) and expiratory resistance (Re), a decrease in the minimum value of lung dynamic compliance (Cldyn), and worsened airway remodeling. Additionally, it was found that this exposure led to an increase in the levels of IL-31 and TRPV1, which are biomarkers of Th2 cytokines (IL-4, IL-5, IL-6, and IL-13), as well as immunoglobulins (Total IgE, OVA-lgE, and OVA-IgG1), while decreasing the biomarker of Th1 cytokines (IFN-γ). However, these impairments showed improvement after the administration of SB-431542 or CZP. CONCLUSION The findings of this research indicate that the IL-31/TRPV1 pathway plays a moderating function in OVA-induced allergic asthma worsened by dermal exposure to DINP.
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Affiliation(s)
- Qi Peng
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Yang Wu
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Yan Li
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Chan Lu
- XiangYa School of Public Health, Central South University, Changsha 410078, China
| | - Runming Yao
- Joint International Research Laboratory of Green Buildings and Built Environments (Ministry of Education), Chongqing University, Chongqing 400045, China
| | - Siyuan Hu
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Ning Ma
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Shaohui Chen
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China
| | - Xu Yang
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China; Hubei Industrial Technology Research Institute of Intelligent Health, Xianning 437100, China
| | - Ping Ma
- Key Laboratory of Environmental Related Diseases and One Health, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, China.
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5
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Sevim E, Kobrin D, Casal-Dominguez M, Pinal-Fernandez I. A comprehensive review of dermatomyositis treatments - from rediscovered classics to promising horizons. Expert Rev Clin Immunol 2024; 20:197-209. [PMID: 37842905 DOI: 10.1080/1744666x.2023.2270737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Dermatomyositis (DM) is a rare inflammatory disease with diverse cutaneous and systemic manifestations, often associated with myositis-specific antibodies. Managing patients with refractory DM, or individuals presenting pecific complications, like calcinosis or rapidly progressive interstitial lung disease, presents unique challenges. AREAS COVERED This review explores current and promising treatment options for DM, drawing from clinical studies, case series, and case reports that consider the underlying disease pathophysiology. EXPERT OPINION Recent advancements have improved our understanding and management of DM. The discovery of distinct DM autoantibodies and their correlation with specific clinical phenotypes has transformed patient categorization and enhanced our knowledge of the pathogenesis of the disease. Intravenous immunoglobulin, a well-established treatment in dermatomyositis, has regained prominence and a large randomized clinical trial has reaffirmed its efficacy, confirming it as an effective therapeutic option in this group of patients. Identification of the type I interferon pathway as a key pathogenic mechanism in DM has opened up new avenues for more effective treatment strategies. Blocking the JAK/STAT pathway offers potential for improved management of refractory patients and prevention of highly morbid complications. These recent advancements have significantly impacted the management and care of dermatomyositis patients, enabling tailored approaches, targeted interventions, and improved outcomes for individuals affected by this complex condition.
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Affiliation(s)
- Ecem Sevim
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Dale Kobrin
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Maria Casal-Dominguez
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Iago Pinal-Fernandez
- Muscle Disease Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sanchez II, Herrera HO, Elsensohn A, Lee BA, Kraus CN. Dermatomyositis with Eosinophils. Dermatopathology (Basel) 2023; 10:310-317. [PMID: 38131900 PMCID: PMC10742320 DOI: 10.3390/dermatopathology10040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Dermatomyositis is an idiopathic inflammatory myopathy that often presents with symmetric proximal skeletal muscle weakness and characteristic skin findings. Typical skin biopsy findings include vacuolar changes of the basal layer, increased dermal mucin, and a predominantly lymphocytic infiltrate. We report a case of dermatomyositis presenting as intensely pruritic papules and plaques, with initial histopathology being atypical of dermatomyositis due to the presence of eosinophils. The initial biopsy demonstrated a superficial dermatitis with eosinophils, initially thought to represent a drug eruption. A second biopsy of the same cutaneous manifestation was performed at a later time given high clinical suspicion for dermatomyositis and demonstrated a more classic vacuolar interface dermatitis with increased mucin and an absence of eosinophils. Notably, increased pruritus was specifically associated with the lesion that demonstrated tissue eosinophilia. The case illustrates the importance of considering tissue eosinophilia in the histologic presentation of dermatomyositis.
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Affiliation(s)
| | - Henry O. Herrera
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Ashley Elsensohn
- Departments of Dermatology and Pathology, Loma Linda University, Loma Linda, CA 92354, USA
| | - Bonnie A. Lee
- Department of Dermatology, University of California Irvine, Irvine, CA 92697, USA; (B.A.L.); (C.N.K.)
| | - Christina N. Kraus
- Department of Dermatology, University of California Irvine, Irvine, CA 92697, USA; (B.A.L.); (C.N.K.)
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Karstarli Bakay OS, Demir B, Cicek D, Erol D, Aşçı Toraman Z, Gural Y, Maurer M. In chronic spontaneous urticaria, IgE and C-reactive protein are linked to distinct microRNAs and interleukin-31. Clin Transl Allergy 2023; 13:e12290. [PMID: 37632245 PMCID: PMC10405150 DOI: 10.1002/clt2.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic spontaneous urticaria (CSU) is a common and disabling disease. Assessments of IgE and C-reactive protein (CRP) are recommended in the diagnostic work-up, but the role and clinical relevance of these biomarkers are not well characterized. Moreover, it remains unknown if elevated levels of IgE or CRP are linked to CSU microRNA (miRNA) signatures or interleukin 31 (IL-31). METHODS We measured IgE and CRP serum levels in 47 CSU patients (and 45 healthy controls) and determined CSU disease activity using the urticaria activity score (UAS7). Expression levels of miR-155 and miR-221 were assessed by RT-PCR, and IL-31 levels were determined by ELISA. RESULTS Total IgE and CRP levels were independently increased in CSU patients. IgE and CRP levels were highest and lowest in patients with high and mild disease activity. IgE levels correlated with miR-155 levels, whereas CRP levels correlated with miR-221 levels. miR-155 and miR-221 were significantly overexpressed in CSU patients. ROC analyses linked miRNA-155 and CSU with a sensitivity of 79% and specificity of 87%, and miRNA-221 and CSU with a sensitivity of 75% and specificity of 91%. High CRP and miR-221 expression levels were linked to elevated levels of IgG anti-TPO and IL-31. CONCLUSION IgE and CRP are useful biomarkers for disease activity in CSU, with distinct miRNA profiles. High CRP and miR-221 levels may point to autoimmune CSU and a role for IL-31.
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Affiliation(s)
| | - Betül Demir
- Department of DermatologyFirat University Faculty of MedicineElazigTurkey
| | - Demet Cicek
- Department of DermatologyFirat University Faculty of MedicineElazigTurkey
| | - Deniz Erol
- Department of Medical GeneticsFirat University Faculty of MedicineElazigTurkey
| | - Zulal Aşçı Toraman
- Department of MicrobiologyFirat University Faculty of MedicineElazigTurkey
| | - Yunus Gural
- Division of StatisticsFirat University Faculty of ScienceElazigTurkey
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE)Institute of AllergologyCharité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology, and ImmunologyBerlinGermany
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Vincze A, Herczeg-Lisztes E, Szabó K, Béldi TG, Nagy-Vincze M, Pór Á, Varga J, Dankó K, Biró T, Tóth BI, Griger Z. Pruritogenic molecules in the skin of patients with dermatomyositis. Front Med (Lausanne) 2023; 10:1168359. [PMID: 37250649 PMCID: PMC10213747 DOI: 10.3389/fmed.2023.1168359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/03/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Pruritus is a common excruciating symptom in systemic autoimmune diseases such as dermatomyositis (DM) but the pathogenesis is not fully understood. We intended to investigate the targeted expression analysis of candidate molecules involved in the development of pruritus in lesional vs. non-lesional skin samples of patients affected with active DM. We looked for correlations between the investigated pruriceptive signaling molecules, disease activity, and itching sensation of DM patients. Methods Interleukins (IL-33 and IL-6), tumor necrosis factor α (TNF-α), peroxisome proliferator-activated receptor γ (PPAR-γ), and ion channels belonging to the transient receptor potential (TRP) family were analyzed. The expression of TNF-α, PPAR-γ, IL-33, IL-6, and TRP channels in lesional DM skin was evaluated by RT-qPCR and immunohistochemistry and was compared with non-lesional DM skin samples. Pruritus, disease activity, and damage of DM were evaluated by the 5-D itch scale and Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), respectively. Statistical analysis was performed with IBM SPSS 28 software. Results A total of 17 active DM patients participated in the study. We could show that the itching score was positively correlated with the CDASI activity score (Kendall's tau-b = 0.571; p = 0.003). TNF-α gene expression was significantly higher in lesional DM skin than in non-lesional DM skin (p = 0.009) and differed in the subgroups of patients with different itch intensities (p = 0.038). The mRNA expression of lesional IL-6 correlated positively with 5-D itch and CDASI activity score (Kendall's tau-b = 0.585; p = 0.008 and 0.45; p = 0.013, respectively). TRPV4 expressions were positively correlated with CDASI damage score (Kendall's tau-b = 0.626; p < 0.001), but the mRNA expressions of the TRP family, PPAR-γ, IL-6, and IL-33 were not different in lesional and non-lesional samples. Immunohistochemistry analysis did not find significant alterations in the expressions of TNF-α, PPAR-γ, IL-6, and IL-33 in lesional and non-lesional regions. Discussion Our results argue that cutaneous disease activity, TNF-α, and IL-6 might play a central role in DM-associated itch, while TRPV4 plays a central role in tissue regeneration.
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Affiliation(s)
- Anett Vincze
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Erika Herczeg-Lisztes
- Laboratory for Cellular and Molecular Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Katalin Szabó
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Gábor Béldi
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Melinda Nagy-Vincze
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ágnes Pór
- Department of Pathology, Gyula Kenézy University Hospital, University of Debrecen, Debrecen, Hungary
| | - József Varga
- Division of Nuclear Medicine, Department of Medical Imaging, University of Debrecen, Debrecen, Hungary
| | - Katalin Dankó
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Biró
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs István Tóth
- Laboratory for Cellular and Molecular Physiology, Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Griger
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Cannabinoid Compounds as a Pharmacotherapeutic Option for the Treatment of Non-Cancer Skin Diseases. Cells 2022; 11:cells11244102. [PMID: 36552866 PMCID: PMC9777118 DOI: 10.3390/cells11244102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
The endocannabinoid system has been shown to be involved in various skin functions, such as melanogenesis and the maintenance of redox balance in skin cells exposed to UV radiation, as well as barrier functions, sebaceous gland activity, wound healing and the skin's immune response. In addition to the potential use of cannabinoids in the treatment and prevention of skin cancer, cannabinoid compounds and derivatives are of interest as potential systemic and topical applications for the treatment of various inflammatory, fibrotic and pruritic skin conditions. In this context, cannabinoid compounds have been successfully tested as a therapeutic option for the treatment of androgenetic alopecia, atopic and seborrhoeic dermatitis, dermatomyositis, asteatotic and atopic eczema, uraemic pruritis, scalp psoriasis, systemic sclerosis and venous leg ulcers. This review provides an insight into the current literature on cannabinoid compounds as potential medicines for the treatment of skin diseases.
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10
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Cirino PV, Hordinsky M, McAdams B, Romiti R. Small fiber neuropathy and intractable scalp pruritus in dermatomyositis patients. SKIN HEALTH AND DISEASE 2022; 3:e173. [PMID: 36751316 PMCID: PMC9892427 DOI: 10.1002/ski2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
Background Scalp pruritus is a common symptom in Dermatomyositis (DM) patients. There are indications that small nerve fibers neuropathy could be involved in this symptom, however the etiology of scalp pruritus is not fully understood. Objectives To assess epidermal nerve fiber (ENF) density of dermatomyositis patients with scalp pruritus by biopsy by confocal microscopy and immunohistochemistry with subsequent imaging analysis. Methods DM patients with severe scalp pruritus from the dermatology outpatient clinic were compared to healthy volunteers. Two 4-mm scalp skin biopsies were obtained above the right ear in the parietal region and below the occipital protuberance in the occipital region. Biopsy specimens were incubated with primary antibodies to protein gene product (PGP 9.5), calcitonin gene-related peptide (CGRP), substance P (SP) were used to visualize nerve fibers (ENF) and collagen IV was used to label the epidermal basement membrane. The number of ENFs per millimeter was counted and recorded as the mean of ± SD of counts in 16 images at two micrometer increments/sections, two from each of the samples. ENF densities were compared between groups and a multiple linear regression model was applied to associated factors with ENF density. Results Fifteen DM patients with severe scalp pruritus and 12 healthy volunteers were included in the study. The mean number of ENF/mm in occipital region of DM group was 16.0 ± 13.9 while the control group in the same region was 99.8 ± 33.1. In parietal region the number of ENF/mm of DM group was 18.0 ± 20.7 while in control group was 50.4 ± 17.4 (p < 0.001). Conclusion DM patients with pruritus could have some impairment of small nerve fiber density that could explain their recalcitrant scalp pruritus.
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Affiliation(s)
| | - Maria Hordinsky
- Department of DermatologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Brian McAdams
- Department of NeurologyUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Ricardo Romiti
- Department of DermatologyUniversity of São PauloSao PauloBrazil
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11
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Werth VP, Hejazi E, Pena SM, Haber J, Zeidi M, Reddy N, Okawa J, Feng R, Bashir MM, Gebre K, Jadoo AS, Concha JSS, Dgetluck N, Constantine S, White B. Safety and Efficacy of Lenabasum, a Cannabinoid Receptor Type 2 Agonist, in Patients with Dermatomyositis with Refractory Skin Disease: A Randomized Clinical Trial. J Invest Dermatol 2022; 142:2651-2659.e1. [PMID: 35490744 PMCID: PMC10226779 DOI: 10.1016/j.jid.2022.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/04/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment options are limited for skin disease in dermatomyositis. Lenabasum is a cannabinoid receptor type 2 agonist that triggers the resolution of inflammation. OBJECTIVE The objective of this study was to evaluate the safety and efficacy of lenabasum in patients with refractory cutaneous dermatomyositis. DESIGN This study was a single-center, double-blind, randomized, placebo-controlled phase 2 study conducted from July 2015 to August 2017. POPULATION The population included subjects aged ≥18 years with at least moderately active dermatomyositis skin activity by Cutaneous Dermatomyositis Disease Area and Severity Index activity ≥ 14 and failure or intolerance to hydroxychloroquine. INTERVENTION Participants received 20 mg lenabasum daily for 28 days and then 20 mg twice per day for 56 days or placebo. MAIN OUTCOMES AND MEASURES The primary outcome was a change in Cutaneous Dermatomyositis Disease Area and Severity Index activity. Safety and other secondary efficacy assessments were performed till day 113. RESULTS A total of 22 subjects were randomized to lenabasum (n = 11) or placebo (n = 11). No serious or severe adverse events were related to lenabasum, and no participants discontinued the study. The adjusted least-squares mean for Cutaneous Dermatomyositis Disease Area and Severity Index activity decreased more for lenabasum, and the difference was significant on day 113 (least-squares mean [standard error] difference = ‒6.5 [3.1], P = 0.038). Numerically greater improvements were seen in multiple secondary efficacy outcomes and biomarkers with lenabasum. CONCLUSION Lenabasum treatment was well tolerated and was associated with greater improvement in Cutaneous Dermatomyositis Disease Area and Severity Index activity and multiple efficacy outcomes. TRIAL REGISTRATION This study was registered at ClinicalTrials.gov, NCT02466243.
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Affiliation(s)
- Victoria P Werth
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Emily Hejazi
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sandra M Pena
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jessica Haber
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Majid Zeidi
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin Reddy
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joyce Okawa
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rui Feng
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Muhammad M Bashir
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kirubel Gebre
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Arvin S Jadoo
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Josef Symon S Concha
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, U.S. Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Elhage KG, Zhao R, Nakamura M. Advancements in the Treatment of Cutaneous Lupus Erythematosus and Dermatomyositis: A Review of the Literature. Clin Cosmet Investig Dermatol 2022; 15:1815-1831. [PMID: 36105749 PMCID: PMC9467686 DOI: 10.2147/ccid.s382628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022]
Abstract
Background Cutaneous lupus erythematosus (CLE) and dermatomyositis (DM) are autoimmune diseases that present with a wide variety of cutaneous manifestations. In both cases, first-line therapy includes topical corticosteroids. Patients may present with more widespread disease requiring systemic treatments, including corticosteroids, traditional immunosuppressants, or antimalarials. Due to their complex nature, both CLE and DM remain difficult to treat and continue to cause significant distress to patients. Objective To summarize the most recent literature on the safety and efficacy of novel treatment modalities for CLE and DM. Methods A literature search was conducted on PubMed using search terms “(dermatomyositis) AND (treatment)” and “(cutaneous lupus) AND (treatment)”. Additional search terms included specific names of biologic agents, phosphodiesterase inhibitors (apremilast), and JAK inhibitors. Results JAK inhibitors, PDE-4 inhibitors, and biologics have shown promise in reducing cutaneous symptoms of both CLE and DM, including reduction in SLE Disease Activity Index 2000 (SLEDAI-2K), Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI), British Isles Lupus Assessment Group (BILAG), Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI), and Disease Activity Score (DAS). Conclusion While there have been recent advancements in the treatment for CLE and DM, further research and clinical trials are required to better elucidate which therapy is best for individual patients.
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Affiliation(s)
- Kareem G Elhage
- University of California San Francisco, San Francisco, CA, USA
| | | | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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13
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O'Brien MA, Hsu S, Shevchenko A, Quartey A. Dupilumab Failure in Treating Dermatomyositis-Associated Pruritus. Cureus 2022; 14:e28270. [PMID: 36158442 PMCID: PMC9491795 DOI: 10.7759/cureus.28270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Dermatomyositis (DM) is a multisystem inflammatory condition with diverse cutaneous and systemic symptoms. Both muscle and skin involvement are common and can occur simultaneously or sequentially, or individuals can have muscle- or skin-limited disease. Skin involvement in DM can be extensive, and pruritus is one of the most problematic symptoms for the patient. Its pathophysiology is poorly understood, making management challenging for clinicians. A limited number of therapeutic agents target pruritus in DM, adding another challenge for clinicians. Previous case reports suggest dupilumab as a treatment for pruritus in DM. However, our patient experienced no relief. Our patient’s failure of dupilumab suggests that its targets, interleukin (IL)-4 and IL-13, do not play a significant role in the pruritus of DM. It is possible that targeting other small molecules in inflammatory pathways could greatly alleviate pruritus for individuals with DM. Further studies need to be conducted to extrapolate the mechanism of pruritus in DM so that individuals with DM can find more significant relief.
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14
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Sun Y, Li DF, Zhang YL, Liang X, Li TF. Characterisation of Disease Patterns of Dermatomyositis with Different Initial Manifestations. Int J Gen Med 2022; 15:6519-6528. [PMID: 35971527 PMCID: PMC9375547 DOI: 10.2147/ijgm.s372658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the characteristics and prognoses of dermatomyositis (DM) by comparing the difference in initial symptoms. Patients and Methods A retrospective analysis was performed on the patients diagnosed with DM from 1 January 2019 to 1 January 2021. Based on the firstly presented symptoms, patients were divided into five groups, namely rash group, muscle weakness group, arthritis group, respiratory symptom group and atypical symptom group. Clinical and laboratory data were recorded. All patients were followed up until 31 May 2021. Results In total 136 DM patients, rash (40%) was the most common initial symptom, followed by respiratory symptoms (22%), arthritis (20%), muscle weakness (10%) and atypical symptoms (8%). Rash group and atypical group had a higher positive rate of anti-TIF1γ antibodies than arthritis group and respiratory symptom group (P < 0.05). Respiratory symptom and arthritis groups had a higher positive rate of anti-Ro52 antibodies than rash and muscle weakness groups (P < 0.05). Respiratory group had a higher incidence of ILD than rash and atypical groups. The FVC and DLCO in respiratory group were significantly lower than rash group, arthritis group and atypical group (P < 0.05). The survival rate of rash group was significantly higher than muscle weakness group and arthritis group (P < 0.05). Conclusion DM patients with different initial manifestations had different myositis antibodies and prognoses.
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Affiliation(s)
- Yue Sun
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Dai-Feng Li
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Yin-Li Zhang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Xu Liang
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
| | - Tian-Fang Li
- Department of Rheumatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People's Republic of China
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15
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Wong LS, Lee CH, Yen YT. Increased Epidermal Nerve Growth Factor without Small-Fiber Neuropathy in Dermatomyositis. Int J Mol Sci 2022; 23:ijms23169030. [PMID: 36012289 PMCID: PMC9408946 DOI: 10.3390/ijms23169030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Small-fiber neuropathy (SFN) is suggested to be involved in the pathogenesis of some types of autoimmune connective tissue diseases. SFN with a reduction in epidermal nerve fibers might affect sensory fibers and cause neuropathic symptoms, such as pruritus and pain, which are common in both dermatomyositis (DM) and cutaneous lupus erythematosus (CLE). Nerve growth factor (NGF) has been recognized as important in nociception by regulating epidermal nerve fiber density and sensitizing the peripheral nervous system. The present study aimed to investigate whether SFN was associated with the cutaneous manifestations of DM and CLE. We also investigated the relationship between SFN and axon guidance molecules, such as NGF, amphiregulin (AREG), and semaphorin (Sema3A) in DM and CLE. To explore the molecular signaling, interleukin (IL)-18 and IL-31, which have been implicated in the cutaneous manifestation and neuropathic symptoms in DM, were examined in keratinocytes. Our results revealed that intraepidermal nerve fiber density (IENFD) was unchanged in patients with DM, but significantly reduced in IENFD in patients with CLE compared with healthy control. Increased epidermal expression of NGF and decreased expression of Sema3A were demonstrated in patients with DM. Furthermore, IL-18 and IL-31 both induced the production of NGF from keratinocytes. Taken together, IL-18 and IL-31 mediated epidermal NGF expression might contribute to the cutaneous neuropathic symptoms in DM, while SFN might be important for CLE.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Ta Yen
- Department of Dermatology, Fooyin University Hospital, Pingtung 928, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Correspondence: ; Tel.: +886-8-8323146; Fax: +886-7-7337612
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16
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High Serum IL-31 Concentration Is Associated with Itch among Renal Transplant Recipients. J Clin Med 2022; 11:jcm11154309. [PMID: 35893400 PMCID: PMC9332266 DOI: 10.3390/jcm11154309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 02/05/2023] Open
Abstract
Chronic itch (CI) is a common symptom caused by both dermatological and systemic disorders. CI is also a frequent, burdensome symptom among renal transplant recipients (RTR); however, its pathophysiology is not fully understood. The aim of this study was to assess the differences in concentration of IL-31 among itchy RTR. The study was performed on a group of selected 129 RTRs (54 itchy and 75 non-itchy patients). Itch severity was assessed with the use of the numeral rating scale (NRS) and the 4-item itch questionnaire (4IIQ). Every subject had his blood drawn to measure the concentration of IL-31. The results were subsequently compared and correlated. The mean concentration differed significantly between RTR suffering from itch (602.44 ± 534.5 pg/mL), non-itchy RTR (161.49 ± 106.61 pg/mL), and HC (110.33 ± 51.81 pg/mL) (p < 0.001). Post-hoc analysis revealed a statistically significantly increased IL-31 serum concentration in itchy RTR in comparison to the non-itchy RTR group (p < 0.001) and HC (p < 0.001). No significant difference was observed in IL-31 serum levels between non-itchy RTRs and HC. No correlation between IL-31 and itch intensity was found. The results of our study clearly demonstrate the association between IL-31 levels and CI in patients after renal transplantation.
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17
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Wong LS, Yen YT. Autoimmune Connective Tissue Diseases-Related Pruritus: Proper Diagnosis and Possible Mechanisms. Diagnostics (Basel) 2022; 12:diagnostics12071772. [PMID: 35885674 PMCID: PMC9317505 DOI: 10.3390/diagnostics12071772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Pruritus is a well-known bothersome symptom among skin disorders, especially inflammatory skin disorders. Lately, a high prevalence of pruritus in patients with autoimmune connective tissue diseases (ACTDs) has been revealed. Patients with ACTDs may suffer from varying degrees of pruritus, which affect their quality of life. However, it is rarely recognized both by patients and physicians. Meanwhile, pruritus is not only a symptom but is also related to the disease severity of some ACTDs. The pathophysiology of ACTD related pruritus is ambiguous. This review summarizes the features and possible mechanisms of ACTD-related pruritus, which might lead to proper diagnosis and treatment.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
| | - Yu-Ta Yen
- Department of Dermatology, Fooying University Hospital, Pentong 928, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 80420, Taiwan
- Correspondence: ; Tel.: +886-8-8323146
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18
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Luo YB, Liu Y, Li Q, Duan H, Luo Z, Yang H, Xu L. Integrating 16S rRNA gene sequencing and metabolomics to evaluate the association between gut microbiota and serum metabolites in patients with myositis. J Appl Microbiol 2022; 133:2547-2559. [PMID: 35858765 DOI: 10.1111/jam.15724] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
AIMS Gut microbiota and metabolites have a profound impact on the maintenance of body health. In this study, we assessed the association between gut microbiota and serum metabolite changes in myositis using 16S rRNA gene sequencing and metabolomics to provide new ideas for screening and treating myositis. METHODS AND RESULTS Blood and fecal samples were collected from twenty myositis patients and twenty healthy control subjects. Then, 16S rRNA gene sequencing, enzyme-linked immunosorbent assays, and untargeted metabolomics study were performed to evaluate the relationship between gut microbiota and serum metabolites in patients with myositis. Compared to healthy control subjects, the blood samples from the patients with myositis had elevated levels of interleukin-4 (IL-4), tumor necrosis factor-α (TNF-α), and malondialdehyde (MDA), and decreased superoxide dismutase (SOD) levels. The increase in Bacteroidota (including Bacteroides and Parabacteroides, but not Prevotella) and the decrease in Firmicutes in the patients were accompanied by functional changes in amino acid and lipid metabolism. The gut microbiota (Bacteroides and Parabacteroides) were negatively correlated with the differential serum metabolites (glutamate and taurine). The differential serum metabolites (glutamate, pyrrolidonecarboxylic acid, and taurine) were also correlated with inflammatory factors (IL-4 and TNF-α) and oxidative stress indexes (MDA and SOD). CONCLUSION Dysbiosis of gut microbiota in patients with myositis was accompanied by changes in inflammatory factors, oxidative stress indexes, and small molecule metabolites in serum. SIGNIFICANCE AND IMPACT OF STUDY Blood and fecal biomarkers could be used for screening myositis.
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Affiliation(s)
- Yue-Bei Luo
- Department of Neurology, Xiangya Hospital, Central South University.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yangtengyu Liu
- Department of Rheumatology & Immunology, Xiangya Hospital, Central South University
| | - Qiuxiang Li
- Department of Neurology, Xiangya Hospital, Central South University
| | - Huiqian Duan
- Department of Neurology, Xiangya Hospital, Central South University
| | - Zhaohui Luo
- Department of Neurology, Xiangya Hospital, Central South University
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University
| | - Liqun Xu
- Department of Neurology, Xiangya Hospital, Central South University.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Danieli MG, Antonelli E, Piga MA, Claudi I, Palmeri D, Tonacci A, Allegra A, Gangemi S. Alarmins in autoimmune diseases. Autoimmun Rev 2022; 21:103142. [PMID: 35853572 DOI: 10.1016/j.autrev.2022.103142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/10/2022] [Indexed: 12/18/2022]
Abstract
Alarmins are endogenous, constitutively expressed, chemotacting and immune activating proteins or peptides released because of non-programmed cell death (i.e. infections, trauma, etc). They are considered endogenous damage-associated molecular patterns (DAMPs), able to induce a sterile inflammation. In the last years, several studies highlighted a possible role of different alarmins in the pathogenesis of various autoimmune and immune-mediated diseases. We reviewed the relevant literature about this topic, for about 160 articles. Particularly, we focused on systemic autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis, idiopathic inflammatory myopathies, ANCA-associated vasculitides, Behçet's disease) and cutaneous organ-specific autoimmune diseases (vitiligo, psoriasis, alopecia, pemphigo). Finally, we discussed about future perspectives and potential therapeutic implications of alarmins in autoimmune diseases. In fact, identification of receptors and downstream signal transducers of alarmins may lead to the identification of antagonistic inhibitors and agonists, with the capacity to modulate alarmins-related pathways and potential therapeutic applicability.
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Affiliation(s)
- Maria Giovanna Danieli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, via Tronto 10/A, 60126 Torrette di Ancona, Italy; Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Eleonora Antonelli
- PostGraduate School of Internal Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Mario Andrea Piga
- Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Ilaria Claudi
- Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Davide Palmeri
- Postgraduate School of Allergy and Clinical Immunology, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy (IFC-CNR), Via G. Moruzzi 1, 56124 Pisa, Italy.
| | - Alessandro Allegra
- Division of Haematology, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.
| | - Sebastiano Gangemi
- School and Operative Unit of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.
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20
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Cytokines and chemokines modulation of itch. Neuroscience 2022; 495:74-85. [PMID: 35660453 DOI: 10.1016/j.neuroscience.2022.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/07/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
Itch (pruritus) is a common cutaneous symptom widely associated with many skin complaints, and chronic itch can be a severe clinical problem. The onset and perpetuation of itch are linked to cytokines, such as interleukin (IL)-31, IL-4, IL-13, IL-33, thymic stromal lymphopoietin, and tumor necrosis factor-alpha, and chemokines, such as chemokine (C-C motif) ligand 2 and C-X-C motif chemokine ligand 10. This review highlights research that has attempted to determine the attributes of various cytokines and chemokines concerning the development and modulation of itch. Through such research, clinical approaches targeting cytokines and/or chemokines may arise, which may further the development of itch therapeutics.
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21
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The Serum Level of IL-31 in Patients with Chronic Kidney Disease-Associated Pruritus: What Can We Expect? Toxins (Basel) 2022; 14:toxins14030197. [PMID: 35324695 PMCID: PMC8955714 DOI: 10.3390/toxins14030197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic-kidney-disease-associated pruritus (CKD-aP) is one of the most common and burdensome dermatological symptoms affecting patients undergoing dialysis, and its etiopathogenesis has still not been fully discovered. This study was designed to investigate the possible contribution of interleukin-31 (IL-31) to the pathogenesis of itch in patients undergoing maintenance hemodialysis (HD). We evaluated the serum level of IL-31 in HD patients with pruritus, in HD patients without pruritus and in healthy controls, as well as its correlation to the severity of itch. The study enrolled 175 adult subjects. The participants were divided into three groups. Group A included 64 patients on maintenance HD with CKD-aP, Group B included 62 patients on maintenance HD not reporting CKD-aP and Group C included 49 healthy controls. Pruritus severity was assessed using the Numerical Rating Scale (NRS), and the serum levels of IL-31 were measured. The results showed that the IL-31 serum level was significantly higher in the itchy group (p < 0.001) in comparison to the patients free from pruritus. Moreover, a marginal trend towards significance (r = 0.242, p = 0.058) was observed between the IL-31 serum level and itch intensity. Our study supports earlier findings on the extended role of IL-31 in the development of CKD-aP.
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22
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Szöllősi AG, Oláh A, Lisztes E, Griger Z, Tóth BI. Pruritus: A Sensory Symptom Generated in Cutaneous Immuno-Neuronal Crosstalk. Front Pharmacol 2022; 13:745658. [PMID: 35321329 PMCID: PMC8937025 DOI: 10.3389/fphar.2022.745658] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022] Open
Abstract
Pruritus or itch generated in the skin is one of the most widespread symptoms associated with various dermatological and systemic (immunological) conditions. Although many details about the molecular mechanisms of the development of both acute and chronic itch were uncovered in the last 2 decades, our understanding is still incomplete and the clinical management of pruritic conditions is one of the biggest challenges in daily dermatological practice. Recent research revealed molecular interactions between pruriceptive sensory neurons and surrounding cutaneous cell types including keratinocytes, as well as resident and transient cells of innate and adaptive immunity. Especially in inflammatory conditions, these cutaneous cells can produce various mediators, which can contribute to the excitation of pruriceptive sensory fibers resulting in itch sensation. There also exists significant communication in the opposite direction: sensory neurons can release mediators that maintain an inflamed, pruritic tissue-environment. In this review, we summarize the current knowledge about the sensory transduction of pruritus detailing the local intercellular interactions that generate itch. We especially emphasize the role of various pruritic mediators in the bidirectional crosstalk between cutaneous non-neuronal cells and sensory fibers. We also list various dermatoses and immunological conditions associated with itch, and discuss the potential immune-neuronal interactions promoting the development of pruritus in the particular diseases. These data may unveil putative new targets for antipruritic pharmacological interventions.
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Affiliation(s)
- Attila Gábor Szöllősi
- Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Erika Lisztes
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Griger
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balázs István Tóth
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- *Correspondence: Balázs István Tóth,
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Shakshouk H, Deschaine MA, Wetter DA, Drage LA, Ernste FC, Gibson LE, Lehman JS. Do histopathological features correlate with systemic manifestations in dermatomyositis? Analysis of 42 skin biopsy specimens from 22 patients. J Cutan Pathol 2022; 49:442-447. [PMID: 35080246 DOI: 10.1111/cup.14203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding whether specific histopathologic features on skin biopsy are predictive of systemic associations in dermatomyositis would be useful to guide clinical screening. METHODS Via retrospective medical record search, clinical and laboratory findings of patients with dermatomyositis were documented. Existing skin biopsy slides were re-reviewed blindly. RESULTS Of all biopsy specimens (n=42), the most frequent histopathological finding was vacuolar interface dermatitis (95%). Other features included perivascular lymphocytic infiltrate (71%), increased dermal mucin (40%), vessel wall thickening (12%), follicular plugging (9.5%) and dermal sclerosis (7%). Neutrophilic infiltrate was observed in 3 biopsies from a patient with adualimumab-associated DM. Vasculitis was not observed. There was no statistically significant difference in the presence of any histopathological feature and that of various systemic manifestations [i.e. myopathy, interstitial lung disease (ILD) and malignancy]. However, we observed that dense lichenoid infiltrate rather than pauci-inflammatory changes correlated with severe itching (p < 0.001) Patients with MDA-5 antibodies were significantly more likely to have vasculopathy than those without (p=0.029*). CONCLUSIONS No dermatopathological feature was reliably predictive of myopathy, ILD or malignancy. This finding implies that regardless of histopathologic findings, patients should be screened for associated conditions, as clinically indicated.
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Affiliation(s)
| | - Maria A Deschaine
- Department of Dermatology, Florida State University, Tallahassee, FL, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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24
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Roberson EDO, Mesa RA, Morgan GA, Cao L, Marin W, Pachman LM. Transcriptomes of peripheral blood mononuclear cells from juvenile dermatomyositis patients show elevated inflammation even when clinically inactive. Sci Rep 2022; 12:275. [PMID: 34997119 PMCID: PMC8741808 DOI: 10.1038/s41598-021-04302-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/20/2021] [Indexed: 12/31/2022] Open
Abstract
In juvenile dermatomyositis (JDM), the most common pediatric inflammatory myopathy, weakness is accompanied by a characteristic rash that often becomes chronic and is associated with vascular damage. We hoped to understand the molecular underpinnings of JDM, particularly when untreated, which would facilitate the identification of novel mechanisms and clinical targets that might disrupt disease progression. We studied the RNA-Seq data from untreated JDM peripheral blood mononuclear cells (PBMCs; n = 11), PBMCs from a subset of the same patients when clinically inactive (n = 8/11), and separate samples of untreated JDM skin and muscle (n = 4 each). All JDM samples were compared to non-inflammatory control tissues. The untreated JDM PBMCs showed a strong signature for type1 interferon response, along with IL-1, IL-10, and NF-κB. Surprisingly, PBMCs from clinically inactive JDM individuals had persistent immune activation that was enriched for IL-1 signaling. JDM skin and muscle both showed evidence for type 1 interferon activation and genes related to antigen presentation and decreased expression of cellular respiration genes. Additionally, we found that PBMC gene expression correlates with disease activity scores (DAS; skin, muscle, and total domains) and with nailfold capillary end row loop number (an indicator of microvascular damage). This included otoferlin, which was significantly increased in untreated JDM PBMCs and correlated with all 3 DAS domains. Overall, these data demonstrate that PBMC transcriptomes are informative of molecular disruptions in JDM and provide transcriptional evidence of chronic inflammation despite clinical quiescence.
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Affiliation(s)
- Elisha D O Roberson
- Division of Rheumatology, Department of Medicine, Washington University, 660 South Euclid Avenue, MSC 8045-0020-10, St. Louis, MO, 63110, USA. .,Department of Genetics, Washington University, St. Louis, MO, USA.
| | - Rosana A Mesa
- Division of Rheumatology, Department of Medicine, Washington University, 660 South Euclid Avenue, MSC 8045-0020-10, St. Louis, MO, 63110, USA
| | - Gabrielle A Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA
| | - Li Cao
- Division of Rheumatology, Department of Medicine, Washington University, 660 South Euclid Avenue, MSC 8045-0020-10, St. Louis, MO, 63110, USA
| | - Wilfredo Marin
- Cure JM Center of Excellence in Juvenile Myositis (JM) Research and Care, Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Lauren M Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL, 60611, USA. .,Cure JM Center of Excellence in Juvenile Myositis (JM) Research and Care, Stanley Manne Children's Research Institute, Chicago, IL, USA. .,Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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25
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Maddukuri S, Patel J, Diaz DA, Chen KL, Wysocka M, Bax C, Li Y, Ravishankar A, Grinnell M, Zeidi M, Reddy N, Concha JSS, Bashir MM, Okawa J, White B, Werth VP. Cannabinoid type 2 receptor (CB2R) distribution in dermatomyositis skin and peripheral blood mononuclear cells (PBMCs) and in vivo effects of Lenabasum TM. Arthritis Res Ther 2022; 24:12. [PMID: 34983619 PMCID: PMC8725283 DOI: 10.1186/s13075-021-02665-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background Lenabasum is a cannabinoid type 2 receptor (CB2R) reverse agonist that demonstrates anti-inflammatory effects in vivo and in vitro in dermatomyositis (DM) and is currently being investigated for therapeutic potential. The purpose of our study is to investigate CB2R distribution as well as the effects of lenabasum in DM. Methods Immunohistochemistry staining (IHC) was utilized to examine immune cell and cytokine production changes in lesional DM skin biopsies from lenabasum and placebo-treated patients. CB2R expression in various immune cell populations within DM skin was investigated with image mass cytometry (IMC), whereas flow cytometry elucidated CB2R expression in DM peripheral blood mononuclear cells (PBMCs) as well as cytokine production by CB2R-expressing cell populations. Results After 12 weeks of lenabasum treatment, IHC staining showed that CD4+ T cells, CB2R, IL-31, IFN-γ, and IFN-β cytokines were downregulated. IFN-γ and IFN-β mRNA decreased in lesional DM skin but not in PBMCs. IMC findings revealed that CB2R was upregulated in DM lesional skin compared to HC skin and DM PBMCs (p<0.05). In DM skin, CB2R was upregulated on dendritic cells, B cells, T cells, and macrophages while dendritic cells had the greatest expression in both DM skin and PBMCs (p<0.05). These CB2R+ cells in the skin produce IL-31, IL-4, IFN-γ, and IFN-β. Conclusion Our findings of differential CB2R expression based on location and cell type suggest modes by which lenabasum may exert anti-inflammatory effects in DM and highlights dendritic cells as potential therapeutic targets. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02665-x.
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Affiliation(s)
- Spandana Maddukuri
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Patel
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - De Anna Diaz
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen L Chen
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Wysocka
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christina Bax
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yubin Li
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adarsh Ravishankar
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Madison Grinnell
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Majid Zeidi
- Department of Pathology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Nithin Reddy
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Josef Symon S Concha
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Muhammad M Bashir
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joyce Okawa
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Victoria P Werth
- Department of Dermatology, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA. .,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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26
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Roh YS, Choi J, Sutaria N, Kwatra SG. Itch: Epidemiology, clinical presentation, and diagnostic workup. J Am Acad Dermatol 2022; 86:1-14. [PMID: 34428534 PMCID: PMC8678917 DOI: 10.1016/j.jaad.2021.07.076] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 01/03/2023]
Abstract
Itch, or pruritus, is the uncomfortable sensation underlying the desire to scratch. Itch is a very common complaint in the general population that can result from dermatologic, systemic (eg, renal, hepatobiliary, endocrine), paraneoplastic, neuropathic, and psychogenic etiologies. Chronic itch is associated with significant sleep disturbances and profoundly reduces overall quality of life. Certain populations, including elderly and African Americans, are at increased risk of experiencing heightened burden of itch. Because of the variable clinical presentation and wide-ranging etiologies, itch presents a challenge for clinicians. The initial evaluation should include a complete blood count, with differential, hepatic, renal, and thyroid function testing along with diabetes screening. Further testing should be guided by history and physical examination findings. There should be a heightened concern for underlying malignancy in individuals older than 60 years of age who have a history of liver disease and diffuse itch less than 12 months of duration. For individuals with chronic pruritus of unknown origin, increased blood eosinophils may serve as a biomarker of T helper cell type 2 polarization and response to immunomodulator therapies. In this first part of a 2-part continuing medical education series, we describe the broader epidemiology and specific conditions associated with itch and the clinical presentation and diagnostic workup for patients with itch.
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Affiliation(s)
- Youkyung S. Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G. Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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27
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Chong BF, Werth V. Cutaneous Lupus Erythematosus and Dermatomyositis: Utilizing Assessment Tools for Treatment Efficacy. J Invest Dermatol 2021; 142:936-943. [PMID: 34952717 DOI: 10.1016/j.jid.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022]
Abstract
There have been important developments in defining cutaneous lupus erythematosus and dermatomyositis. The skin manifestations of these two diseases have a profound impact on QOL, with both emotional and symptomatic impacts that are important to address. The proliferation of potential therapeutic targets has made it important to make sure that these diseases are defined in a way that they can be included in translational and clinical studies of both localized and systemic forms of the diseases. There are now validated disease tools and QOL studies that are facilitating current and future scientific and therapeutic developments.
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Affiliation(s)
- Benjamin F Chong
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Victoria Werth
- Department of Dermatology, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
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28
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Lauinger J, Ghoreschi K, Volc S. Charakteristika von Dermatomyositis-Patienten mit und ohne Malignom-Assoziation. J Dtsch Dermatol Ges 2021; 19:1601-1612. [PMID: 34811902 DOI: 10.1111/ddg.14566_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/07/2021] [Indexed: 11/30/2022]
Abstract
HINTERGRUND Die Dermatomyositis gehört zur Gruppe der seltenen, idiopathischen, inflammatorischen Myositiden. Für die paraneoplastische Form der Dermatomyositis wurde in der Vergangenheit ein Zusammenhang mit Malignomen erkannt. Faktoren, die für eine Malignom-Assoziation sprechen, werden bis heute untersucht. PATIENTEN UND METHODIK Es wurden retrospektiv über einen Zeitraum von 15 Jahren die Daten von 63 Patienten mit Dermatomyositis analysiert. ERGEBNISSE Folgende Faktoren gaben einen Hinweis für eine Dermatomyositis mit Malignom-Assoziation: ein höheres Patientenalter (> 52 Jahre [P = 0,001], > 65 Jahre [P = 0,002], ≥ 75 Jahre [P = 0,002]), eine kürzere Zeit zwischen Erstmanifestation und Erstdiagnose (Malignom-Gruppe: 59 Tage vs. Nicht-Malignom-Gruppe: 137 Tage [P = 0,022]), eine Hautbeteiligung in Form von Gottron-Zeichen (P = 0,045), zentrofazialen Erythemen (P = 0,036) oder typischen Erythemen an den Ober-/Unterarmen (P = 0,019), eine oropharyngeale Beteiligung (P = 0,015) und eine GPT-Erhöhung (P = 0,031). Folgende Faktoren sprachen eher gegen eine Malignom-Assoziation: ein jüngeres Patientenalter (≤ 52 Jahre [P = 0,001], 40-65 Jahre [P = 0,045]) und Juckreiz (P = 0,026). SCHLUSSFOLGERUNGEN In der Literatur finden sich heterogene Ergebnisse zu den genannten Faktoren hinsichtlich ihrer Eignung als Marker für eine Malignom-Assoziation. Erschwert ist die Faktorenfindung aufgrund kleiner Studienpopulationen, wenigen prospektiven und kontrollierten Studien, die Einordnung von Populationen als Myositis-Patienten ohne Differenzierung und eine inkonsistente Verwendung der Nomenklatur. Mit unserer Studie wollen wir einen wichtigen Beitrag zur Identifizierung von Risikofaktoren bei Dermatomyositis mit Malignom-Assoziation leisten.
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Affiliation(s)
- Julia Lauinger
- Universitäts-Hautklinik, Eberhardt-Karls-Universität Tübingen
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin
| | - Sebastian Volc
- Universitäts-Hautklinik, Eberhardt-Karls-Universität Tübingen
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29
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Lauinger J, Ghoreschi K, Volc S. Characteristics of dermatomyositis patients with and without associated malignancy. J Dtsch Dermatol Ges 2021; 19:1601-1611. [PMID: 34738719 DOI: 10.1111/ddg.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/07/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Dermatomyositis belongs to the rare idiopathic, inflammatory myositis group. A previously postulated link between some cases of dermatomyositis and malignancy has been established in recent years. Criteria suggestive of a malignancy association are still being explored. PATIENTS AND METHODS We retrospectively analyzed data from 63 patients with dermatomyositis over a period of 15 years. RESULTS The following criteria argue for cancer-associated dermatomyositis: older age (> 52 years [P = 0.001], > 65 years [P = 0.002], ≥ 75 years [P = 0.002]), shorter time between manifestation and diagnosis of dermatomyositis (malignancy group: 59 days vs. non-malignancy group: 137 days [P = 0.022]), typical skin involvement such as Gottron sign (P = 0.045), centrofacial erythema (P = 0.036) and typical erythema on the upper arms and forearms (P = 0.019), oropharyngeal involvement (P = 0.015) and increased ALT (P = 0.031). The following criteria argue for non-cancer-associated dermatomyositis: younger age (≤ 52 years [P = 0.001], 40-65 years [P = 0.045]) and pruritus (P = 0.026). CONCLUSIONS The aforementioned criteria have been documented in the literature, but reported findings are heterogenous concerning the suitability of their markers for malignancy association. Small study populations, few prospective controlled studies, summarization of different forms of myositis and inconsistent use nomenclature contribute to biased results. Our study aims to make an important contribution toward the identification of risk factors in cancer-associated dermatomyositis.
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Affiliation(s)
- Julia Lauinger
- Department of Dermatology, University of Tübingen, Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Volc
- Department of Dermatology, University of Tübingen, Tübingen, Germany
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30
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Pathania YS. An overview of pruritus in autoimmune connective tissue diseases. Int J Dermatol 2021; 61:515-518. [PMID: 34716578 DOI: 10.1111/ijd.15965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/14/2021] [Accepted: 10/15/2021] [Indexed: 11/26/2022]
Abstract
Autoimmune connective tissue diseases (ACTD) are a broad spectrum of diseases including dermatomyositis, systemic lupus erythematosus, Sjogren syndrome, systemic sclerosis, and mixed connective tissue diseases. Pruritus is an unpleasant sensation leading to scratching. It is most commonly seen in dermatomyositis patients among ACTD. Itch can be mild to severe, hampering daily activities. It is often associated with disease severity. Apart from ACTD, pruritus may be due to antimalarial agents or due to adverse effects of medications used in ACTD. Therefore, it is prudent to find the pathogenesis of pruritus for adequate treatment. Pruritus in ACTD is underreported and undertreated. The article gives a comprehensive view of pruritus in ACTD, its pathogenesis, and management.
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Affiliation(s)
- Yashdeep Singh Pathania
- Department of Dermatology, Venereology and Leprology, All India Institute of Medical Sciences, Jodhpur, India
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31
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Sutaria N, Alphonse MP, Marani M, Parthasarathy V, Deng J, Wongvibulsin S, Williams K, Roh YS, Choi J, Bordeaux Z, Pritchard T, Dillen C, Semenov YR, Kwatra MM, Archer NK, Garza LA, Dong X, Kang S, Kwatra SG. Cluster analysis of circulating plasma biomarkers in prurigo nodularis reveals a distinct systemic inflammatory signature in African Americans. J Invest Dermatol 2021; 142:1300-1308.e3. [PMID: 34717952 PMCID: PMC9038640 DOI: 10.1016/j.jid.2021.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 01/26/2023]
Abstract
Patients with prurigo nodularis (PN) suffer from intractable itch and dramatic reduction in quality of life. While there is significant clinical heterogeneity in the presentation of PN, disease endotypes remain unknown. We assayed circulating plasma cytokine concentrations in PN patients (n=20) along with matched healthy controls and utilized an unsupervised machine learning algorithm to identify disease endotypes. We found two distinct clusters of PN patients with non-inflammatory (Cluster 1) and inflammatory (Cluster 2) plasma profiles. Cluster 2 had more African-Americans (82%, n=9 vs. 33%, n=3; P=0.028), higher worst-itch numeric rating scale scores (9.5±0.9 vs. 8.3±1.2; P=0.036), and lower quality of life as reflected by higher Dermatology Life Quality Index scores (21.9±6.4 vs. 13.0±4.1; P=0.015). In addition, Cluster 1 had a higher rate of myelopathy (67%, n=6 vs. 18%, n=2; P=0.028). Compared to Cluster 1, Cluster 2 had higher levels of IL-1α, IL-4, IL-5, IL-6, IL-10, IL-17A, IL-22, IL-25, and IFN-α. With population-level analysis, African-American PN patients had higher erythrocyte sedimentation rate, C-reactive protein, ferritin, eosinophils, and lower transferrin than Caucasian PN patients. These findings indicate discrete clusters of PN patients with plasma biomarker profiles corresponding to distinct demographic and clinical characteristics, potentially allowing for precision medicine approaches to treat PN.
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Affiliation(s)
- Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Melika Marani
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Varsha Parthasarathy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Junwen Deng
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shannon Wongvibulsin
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kyle Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Youkyung Sophie Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zachary Bordeaux
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thomas Pritchard
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carly Dillen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yevgeniy R Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC
| | - Nathan K Archer
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Luis A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xinzhong Dong
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD; The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.
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32
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Hawat T, Ballouz S, Megarbane H, Haber R. Pediatric discoid lupus erythematosus: Short report. Dermatol Ther 2021; 35:e15170. [PMID: 34676640 DOI: 10.1111/dth.15170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
Pediatric discoid lupus erythematosus (DLE) is a rare inflammatory skin disorder. This article aims to review all the available clinical and therapeutic data on reported cases of pediatric DLE. A systematic review of the literature was conducted using Pubmed and Embase with no limitation on publication date, sex, or nationality. Thirty-two articles were included with 201 cases, a mean age of 8.9 years (2 months-16 years) and an F:M ratio of 1.8. Lesions were located on the head and neck in 58.5% and were disseminated in 36.5% of the cases. Associated symptoms were pruritus (10.1%) and alopecia (8.7%). 12% progressed to systemic lupus erythematosus (SLE) and 14.5% had concurrent SLE. The only statistically significant predictor for progression to SLE was the onset of symptoms before or at the age of 10 years (p = 0.004). Treatments consisted mainly of sunscreens (26.3%), topical corticosteroids (24.3%), and oral antimalarials (25.3%). Retrospective nature of the included studies, small sample size, short duration of follow-up and limited data on the patients' demographics. Pediatric DLE affects mostly the head and neck, with a female predominance, a possible association with inflammatory and autoimmune diseases, and overall good treatment response and prognosis.
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Affiliation(s)
- Tatiana Hawat
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon.,Lebanon-Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - Salwa Ballouz
- Lebanon-Faculty of Medicine, Balamand University, Beirut, Lebanon.,Department of Internal Medicine, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Hala Megarbane
- Department of Dermatology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Roger Haber
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA
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33
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Datsi A, Steinhoff M, Ahmad F, Alam M, Buddenkotte J. Interleukin-31: The "itchy" cytokine in inflammation and therapy. Allergy 2021; 76:2982-2997. [PMID: 33629401 DOI: 10.1111/all.14791] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/12/2022]
Abstract
The cytokine interleukin-31 has been implicated in the pathophysiology of multiple atopic disorders such as atopic dermatitis (AD), allergic rhinitis, and airway hyper-reactivity. In AD, IL-31 has been identified as one of the main "drivers" of its cardinal symptom, pruritus. Here, we summarize the mechanisms by which IL-31 modulates inflammatory and allergic diseases. TH 2 cells play a central role in AD and release high levels of TH 2-associated cytokines including IL-31, thereby mediating inflammatory responses, initiating immunoregulatory circuits, stimulating itch, and neuronal outgrowth through activation of the heterodimeric receptor IL-31 receptor A (IL31RA)/Oncostatin M receptor (OSMRβ). IL31RA expression is found on human and murine dorsal root ganglia neurons, epithelial cells including keratinocytes and various innate immune cells. IL-31 is a critical cytokine involved in neuroimmune communication, which opens new avenues for cytokine modulation in neuroinflammatory diseases including AD/pruritus, as validated by recent clinical trials using an anti-IL-31 antibody. Accordingly, inhibition of IL-31-downstream signaling may be a beneficial approach for various inflammatory diseases including prurigo. However, as to whether downstream JAK inhibitors directly block IL-31-mediated-signaling needs to be clarified. Targeting the IL-31/IL31RA/OSMRβ axis appears to be a promising approach for inflammatory, neuroinflammatory, and pruritic disorders in the future.
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Affiliation(s)
- Angeliki Datsi
- Institute for Transplantational Diagnostics and Cell Therapeutics University Hospital Düsseldorf Düsseldorf Germany
| | - Martin Steinhoff
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- Translational Research InstituteAcademic Health SystemHamad Medical Corporation Doha Qatar
- Dermatology Institute Academic Health SystemHamad Medical Corporation Doha Qatar
- Department of Dermatology Weill Cornell Medicine‐Qatar Doha Qatar
- Qatar UniversityCollege of Medicine Doha Qatar
| | - Fareed Ahmad
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- Translational Research InstituteAcademic Health SystemHamad Medical Corporation Doha Qatar
- Dermatology Institute Academic Health SystemHamad Medical Corporation Doha Qatar
| | - Majid Alam
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- Translational Research InstituteAcademic Health SystemHamad Medical Corporation Doha Qatar
- Dermatology Institute Academic Health SystemHamad Medical Corporation Doha Qatar
| | - Joerg Buddenkotte
- Department of Dermatology and Venereology Hamad Medical Corporation Doha Qatar
- Translational Research InstituteAcademic Health SystemHamad Medical Corporation Doha Qatar
- Dermatology Institute Academic Health SystemHamad Medical Corporation Doha Qatar
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Debeuf MEPH, van Onna M, Roland Marc Verstraeten VL. Resolution of shawl sign in dermatomyositis using pulsed dye laser. JAAD Case Rep 2021; 16:74-76. [PMID: 34541270 PMCID: PMC8435992 DOI: 10.1016/j.jdcr.2021.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Marloes van Onna
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Limburg, the Netherlands.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands
| | - Valerie Lydie Roland Marc Verstraeten
- Department of Dermatology, Maastricht University Medical Centre, Maastricht, Limburg, the Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, Limburg, the Netherlands
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35
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Patel J, Maddukuri S, Li Y, Bax C, Werth VP. Highly Multiplexed Mass Cytometry Identifies the Immunophenotype in the Skin of Dermatomyositis. J Invest Dermatol 2021; 141:2151-2160. [PMID: 33766508 PMCID: PMC8384654 DOI: 10.1016/j.jid.2021.02.748] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/31/2021] [Accepted: 02/17/2021] [Indexed: 01/06/2023]
Abstract
Dermatomyositis (DM) is a rare, systemic autoimmune disease that most frequently affects the skin, muscles, and lungs. The inflammatory infiltrate in the skin has not been fully characterized, and, in this study, we took a single-cell, unbiased approach using imaging mass cytometry. Substantial monocyte‒macrophage diversity was observed, with the CD14+ population correlating positively with Cutaneous Dermatomyositis Disease Area and Severity Index scores (P = 0.031). The T-cell compartment revealed CD4+ T, CD8+ T, and FOXP3+ T cells. Activated (CD69+) circulating memory T cells correlated positively with Cutaneous Dermatomyositis Disease Area and Severity Index scores (P = 0.0268). IFN-β protein was highly upregulated in the T-cell, macrophage, dendritic cell, and endothelial cell populations of DM skin. Myeloid dendritic cells expressed phosphorylated peroxisome proliferator‒activated receptor γ, phosphorylated IRF3, IL-4, and IL-31, and their quantity correlated with itch as measured in Skindex-29. Plasmacytoid dendritic cells colocalized with IFN-γ in addition to the known colocalization with IFN-β. Nuclear phosphorylated peroxisome proliferator‒activated receptor γ expression was found in the DM endothelium. Imaging mass cytometry allows us to characterize single cells in the immune cell population and identify upregulated cytokines and inflammatory pathways in DM. These findings have important implications for the development of future targeted therapies for DM.
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Affiliation(s)
- Jay Patel
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Spandana Maddukuri
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yubin Li
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christina Bax
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Brucki SMD, Adoni T, Almeida CMO, Andrade DCD, Anghinah R, Barbosa LM, Bazan R, Carvalho AADS, Carvalho W, Christo PP, Coletta MD, Conforto AB, Correa-Neto Y, Engelhardt E, França Junior MC, Franco C, VON Glehn F, Gomes HR, Houly CGDB, Kaup AO, Kowacs F, Kanashiro A, Lopes VG, Maia D, Manreza M, Martinez ARM, Martinez SCG, Nader SN, Neves LDO, Okamoto IH, Oliveira RAAD, Peixoto FDM, Pereira CB, Saba RA, Sampaio LPDB, Schilling LP, Silva MTT, Silva ER, Smid J, Soares CN, Sobreira-Neto M, Sousa NADC, Souza LCD, Teive HAG, Terra VC, Vale M, Vieira VMG, Zanoteli E, Prado G. Cannabinoids in Neurology - Position paper from Scientific Departments from Brazilian Academy of Neurology. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:354-369. [PMID: 34133518 DOI: 10.1590/0004-282x-anp-2020-0432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 01/02/2023]
Abstract
Cannabinoids comprehend endocannabinoids, phytocannabinoids, and synthetic cannabinoids, with actions both in the central and peripherical nervous systems. A considerable amount of publications have been made in recent years, although cannabis has been known for over a thousand years. Scientific Departments from the Brazilian Academy of Neurology described evidence for medical use in their areas. Literature is constantly changing, and possible new evidence can emerge in the next days or months. Prescription of these substances must be discussed with patients and their families, with knowledge about adverse events and their efficacy.
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Affiliation(s)
- Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital Santa Marcelina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Tarso Adoni
- Hospital Sírio-Libanês, Núcleo de Neurociências, São Paulo SP, Brazil.,Hospital Heliópolis, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Mauricio Oliveira Almeida
- Universidade Estadual do Amazonas, Departamento de Neurologia, Manaus AM, Brazil.,Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Daniel Ciampi de Andrade
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Renato Anghinah
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Luciana Mendonça Barbosa
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Faculdade de Ciências Médicas e Biológicas de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil
| | | | - William Carvalho
- Hospital Geral de Goiânia Dr Alberto Rassi, Departamento de Neurologia, Goiânia GO, Brazil
| | - Paulo Pereira Christo
- Santa Casa de Belo Horizonte, Departamento de Neurologia, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Hospital das Clínicas, Departamento de Neurologia, Belo Horizonte MG, Brazil
| | - Marcus Della Coletta
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus AM, Brazil
| | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Eliasz Engelhardt
- Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto, Departamento de Neurologia, Rio de Janeiro RJ, Brazil
| | | | | | - Felipe VON Glehn
- Universidade Estadual de Campinas, Instituto de Biologia, Genética, Imunologia e Bioagentes, Campinas SP, Brazil
| | - Helio Rodrigues Gomes
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Fernando Kowacs
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Clínica Médica, Porto Alegre RS, Brazil.,Hospital Moinhos de Vento, Serviço de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil
| | | | - Victor Gonçalves Lopes
- Hospital Federal dos Servidores do Estado, Departamento de Neurologia, São Paulo SP, Brazil
| | - Débora Maia
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Departamento de Neurologia, Belo Horizonte MG, Brazil
| | - Maria Manreza
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Saulo Nardy Nader
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | | | - Rogério Adas Ayres de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Fabiano de Melo Peixoto
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Cristiana Borges Pereira
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Roberta Arb Saba
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital do Servidor Público Estadual, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Lucas Porcello Schilling
- Pontifícia Universidade Católica do Rio Grande do Sul, São Lucas Hospital, Instituto do Cérebro, Porto Alegre RS, Brazil
| | | | - Emanuelle Roberta Silva
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Hospital Sírio-Libanês, Núcleo de Neurociências, São Paulo SP, Brazil
| | - Jerusa Smid
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Manoel Sobreira-Neto
- Universidade Federal do Ceará, Faculdade de Medicina, Departamento de Medicina Clínica, Fortaleza CE, Brazil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil
| | | | | | - Matheus Vale
- Faculdade de Medicina do ABC, Departamento de Neurologia, Santo André SP, Brazil
| | | | - Edmar Zanoteli
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Gilmar Prado
- Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
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37
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Ingrasci G, Lipman ZM, Hawash AA, Girolomoni G, Yosipovitch G. The pruritogenic role of the type 2 immune response in diseases associated with chronic itch. Exp Dermatol 2021; 30:1208-1217. [PMID: 34033148 DOI: 10.1111/exd.14401] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022]
Abstract
While there is a vast array of aetiologies that may lead to chronic pruritus, recent data suggests that many of these conditions share similar interactions between keratinocytes, nerves, and the immune system. Specifically, the type 2 immune response, including Th2 T Cells and their related cytokines, has been noted to play a major role in the development of pruritus in a variety of itchy conditions. To date, atopic dermatitis is the most striking example of this pathogenesis. However, the body of literature supporting its role in many other itchy conditions, including other inflammatory, bullous, as well as systemic diseases, continues to grow. In addition, new treatments targeting this type 2 immune system continue to be developed and investigated. In the current review, we present the current body of literature supporting the role of the type 2 immune response in itchy conditions beyond atopic dermatitis as well as potential therapeutic options that target this pathway for chronic itch.
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Affiliation(s)
- Giuseppe Ingrasci
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Zoe M Lipman
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | - Ahmed A Hawash
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
| | | | - Gil Yosipovitch
- Dr Phillip Frost Department of Dermatology and Miami Itch Center, University of Miami, Miami, FL, USA
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38
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Radonjic-Hoesli S, Brüggen MC, Feldmeyer L, Simon HU, Simon D. Eosinophils in skin diseases. Semin Immunopathol 2021; 43:393-409. [PMID: 34097126 PMCID: PMC8241748 DOI: 10.1007/s00281-021-00868-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023]
Abstract
Eosinophil infiltration is a common finding in a broad spectrum of skin diseases, despite the fact that the skin is devoid of eosinophils under physiologic conditions. Although cutaneous eosinophilia is reactive, cytokine-mediated in most cases, diseases with an intrinsic mutation-mediated clonal expansion of eosinophils can also manifest on the skin. As eosinophils are involved in host defense, regulate immune responses, generate pruritus, induce remodeling and fibrosis, and can cause tissue damage, they have the capacity to actively contribute to the pathogenesis of diseases. Recent research provided deeper insights in the mechanisms, e.g., bacterial and viral clearance, blister formation, recruitment of cytotoxic T cells, and generation of pruritus, by which eosinophils might come into action. This review aims at providing an overview on the clinical presentations of eosinophil-associated dermatoses and the current understanding of their pathogenic role in these diseases. Further, we discuss the effects of therapies targeting eosinophils.
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Affiliation(s)
- Susanne Radonjic-Hoesli
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Charlotte Brüggen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
- Department of Dermatology, Hochgebirgsklinik Davos, Davos, Switzerland
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Department of Clinical Immunology and Allergology, Sechenov University, Moscow, Russia
- Laboratory of Molecular Immunology, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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39
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Samotij D, Szczęch J, Antiga E, Bonciani D, Caproni M, Chasset F, Dańczak-Pazdrowska A, Furukawa F, Hasegawa M, Hashizume H, Ikeda T, Islam A, Kim HJ, Lesiak A, Misery L, Mowla MR, Polańska A, Szepietowski JC, Tsuruta D, Verdelli A, Werth VP, Reich A. Clinical characteristics of itch in cutaneous lupus erythematosus: A prospective, multicenter, multinational, cross-sectional study. Lupus 2021; 30:1385-1393. [PMID: 34000879 DOI: 10.1177/09612033211016098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Pruritus is an important symptom frequently accompanying various inflammatory skin conditions and some recent data indicated that it may be associated with autoimmune connective tissue diseases. The aim of this study was to assess the frequency and clinical presentation of itch in CLE. METHODS A multinational, prospective, cross-sectional study was performed to assess the prevalence, intensity and clinical characteristic of pruritus in various subtypes of CLE. A total of 153 patients with active CLE lesions were included. Their age ranged between 17 and 82 years (mean 49.8 ± 15.4 years), and 115 patients (75.2%) were women. The disease activity and damage were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Pruritus severity was assessed with Numeric Rating Scale (NRS) and the 12-Item Pruritus Severity Scale. Dermatology Life Quality Index and EQ-5D questionnaire were used to measure quality of life. RESULTS Pruritus was present in 116 (76.8%) of patients of whom half had NRS scoring equal or above 4 points indicating moderate or severe pruritus. Most commonly itch was localized on the scalp, face (excluding ears and nose) and arms (40.5%, 36.2%, 31.9%, respectively). Sensations connected with pruritus were most frequently described as burning, tingling and like ants crawling feeling, but 31.9% patients described it as "pure itch". More than half of patients reported that pruritus was present every day, and it was most frequent during the evenings. The pruritus scoring and the CLASI activity score were significantly correlated (r = 0.42, p = 0.0001), while no correlation was found with the CLASI damage score (p = 0.16). Both the maximum and average itch intensity were correlated with systemic lupus erythematosus (SLE) activity measured with the Systemic Lupus Erythematosus Disease Activity Index. CONCLUSIONS Pruritus is a common, but frequently overlooked symptom of CLE. Its intensity correlates with the activity of CLE, but not with the skin damage. In more than a half of patients it occurs on a daily basis. The correlation between the intensity of pruritus and the activity of the skin lesions and the systemic involvement indicate that pruritus could be an individual indicator of both SLE and CLE activity.
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Affiliation(s)
- Dominik Samotij
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Justyna Szczęch
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Emiliano Antiga
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Diletta Bonciani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - François Chasset
- Faculty of Medicine, AP-HP, Dermatology Department, Sorbonne University, Tenon Hospital, Paris, France
| | | | - Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hideo Hashizume
- Department of Dermatology, Iwata City Hospital, Iwata, Japan
| | - Takaharu Ikeda
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Aminul Islam
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | - Hee Joo Kim
- Department of Dermatology, Gachon University College of Medicine, Incheon, South Korea
| | - Aleksandra Lesiak
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Mohammad Rafiqul Mowla
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Alice Verdelli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Victoria P Werth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Creszenz VAMC, Philadelphia, PA, USA
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
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40
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Roh YS, Choi J, Sutaria N, Belzberg M, Kwatra MM, Kwatra SG. IL-31 Inhibition as a Therapeutic Approach for the Management of Chronic Pruritic Dermatoses. Drugs 2021; 81:895-905. [PMID: 33881741 DOI: 10.1007/s40265-021-01521-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Chronic pruritus is a debilitating symptom with limited treatment options. Identifying molecular targets underlying chronic pruritic dermatoses is essential for the development of novel, targeted therapies. IL-31 is an important mediator of itch by integrating dermatologic, neural, and immune systems. IL-31 helps induce and maintain chronic pruritus via both indirect stimulation of inflammatory cells and through direct neural sensitization. IL-31 is overexpressed in various chronic pruritic skin conditions, and exogenous IL-31 induces itch and scratching behavior. Studies have demonstrated that IL-31R and IL-31 antagonism significantly reduces itch in patients with atopic dermatitis and prurigo nodularis, two extremely pruritic skin conditions. Emerging evidence, including recent phase II clinical trials of IL-31R antagonists, demonstrates that IL-31 plays an important role in itch signaling. Additional studies are ongoing to evaluate IL-31R and IL-31 antagonism as treatments of chronic pruritus.
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Affiliation(s)
- Youkyung S Roh
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Justin Choi
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Nishadh Sutaria
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Micah Belzberg
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA
| | - Madan M Kwatra
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
| | - Shawn G Kwatra
- Department of Dermatology, John Hopkins University School of Medicine, Cancer Research Building II Suite 206, 1550 Orleans Street, Baltimore, MD, 21231, USA.
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41
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Yombo DJK, Odayar V, Gupta N, Jegga AG, Madala SK. The Protective Effects of IL-31RA Deficiency During Bleomycin-Induced Pulmonary Fibrosis. Front Immunol 2021; 12:645717. [PMID: 33815402 PMCID: PMC8017338 DOI: 10.3389/fimmu.2021.645717] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/22/2021] [Indexed: 02/06/2023] Open
Abstract
Idiopathic Pulmonary Fibrosis (IPF) is a severe fibrotic lung disease characterized by excessive collagen deposition and progressive decline in lung function. Th2 T cell-derived cytokines including IL-4 and IL-13 have been shown to contribute to inflammation and fibrotic remodeling in multiple tissues. Interleukin-31 (IL-31) is a newly identified cytokine that is predominantly produced by CD4 Th2 T cells, but its signaling receptor IL-31RA is primarily expressed by non-hematopoietic cells. However, the potential role of the IL-31-IL31RA axis in pulmonary inflammation and fibrosis has remained largely unknown. To determine the role of IL-31RA deficiency in pulmonary fibrosis, wildtype, and IL-31RA knockout mice were treated with bleomycin and measured changes in collagen deposition and lung function. Notably, the loss of IL-31 signaling attenuated collagen deposition and lung function decline during bleomycin-induced pulmonary fibrosis. The total lung transcriptome analysis showed a significant reduction in fibrosis-associated gene transcripts including extracellular matrix and epithelial cell-associated gene networks. Furthermore, the lungs of human IPF showed an elevated expression of IL-31 when compared to healthy subjects. In support, the percentage of IL-31 producing CD4+ T cells was greater in the lungs and PBMCs from IPF patients compared to healthy controls. Our findings suggest a pathogenic role for IL-31/IL-31RA signaling during bleomycin-induced pulmonary fibrosis. Thus, therapeutic targeting the IL-31-IL-31RA axis may prevent collagen deposition, improve lung function, and have therapeutic potential in pulmonary fibrosis.
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Affiliation(s)
- Dan J K Yombo
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Varshini Odayar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Nishant Gupta
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Anil G Jegga
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Satish K Madala
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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42
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Pachman LM, Nolan BE, DeRanieri D, Khojah AM. Juvenile Dermatomyositis: New Clues to Diagnosis and Therapy. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021; 7:39-62. [PMID: 34354904 PMCID: PMC8336914 DOI: 10.1007/s40674-020-00168-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To identify clues to disease activity and discuss therapy options. RECENT FINDINGS The diagnostic evaluation includes documenting symmetrical proximal muscle damage by exam and MRI, as well as elevated muscle enzymes-aldolase, creatine phosphokinase, LDH, and SGOT-which often normalize with a longer duration of untreated disease. Ultrasound identifies persistent, occult muscle inflammation. The myositis-specific antibodies (MSA) and myositis-associated antibodies (MAA) are associated with specific disease course variations. Anti-NXP-2 is found in younger children and is associated with calcinosis; anti-TIF-1γ+ juvenile dermatomyositis has a longer disease course. The diagnostic rash-involving the eyelids, hands, knees, face, and upper chest-is the most persistent symptom and is associated with microvascular compromise, reflected by loss of nailfold (periungual) end row capillaries. This loss is associated with decreased bioavailability of oral prednisone; the bioavailability of other orally administered medications should also be considered. At diagnosis, at least 3 days of intravenous methyl prednisolone may help control the HLA-restricted and type 1/2 interferon-driven inflammatory process. The requirement for avoidance of ultraviolet light exposure mandates vitamin D supplementation. SUMMARY This often chronic illness targets the cardiovascular system; mortality has decreased from 30 to 1-2% with corticosteroids. New serological biomarkers indicate occult inflammation: ↑CXCL-10 predicts a longer disease course. Some biologic therapies appear promising.
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Affiliation(s)
- Lauren M. Pachman
- Northwestern Feinberg School of Medicine, Divisions of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Cure JM Center of Excellence in Juvenile Myositis Research and Care, The Stanley Manne Research Center for Children, Chicago, IL, USA
| | - Brian E. Nolan
- Northwestern Feinberg School of Medicine, Divisions of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Deidre DeRanieri
- Northwestern Feinberg School of Medicine, Divisions of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Amer M. Khojah
- Northwestern Feinberg School of Medicine, Divisions of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
- Division of Allergy/Immunology, Chicago, IL, USA, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Abstract
Pruritus is one of the most common and bothersome symptoms of skin disorders, and its clinical characteristics and related pathomechanisms have been well described in certain dermatologic conditions, such as atopic dermatitis and urticaria. Although pruritus is believed to be as common in cutaneous autoimmune connective tissue diseases (ACTDs) as in other inflammatory skin disorders, its true characteristics have not been elucidated either qualitatively or quantitatively. Pruritus is present in ACTDs with various prevalence rates, characteristics, and mechanisms depending on the disease types. Pruritus most frequently and severely affects the patients with dermatomyositis, in which itch is strongly correlated with disease activity and severity, thus increased itch could also indicate a disease flare. Patients with other ACTDs, including lupus erythematosus (LE), Sjögren syndrome (SS), morphea, and systemic sclerosis (SSc), also suffer from their fair share of pruritus. Unfortunately, the currently available treatments for ACTDs seem to have only limited and unsatisfactory effects to control pruritus. The extensive impact of pruritus on the patients’ quality of life (QOL) and functioning warrants more targeted and individualized approaches against pruritus in ACTDs. This review will address the prevalence, suggested pathogenesis based on currently available evidences, and potential treatment options of pruritus in various ACTDs of the skin.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gachon Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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44
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Kabashima K, Irie H. Interleukin-31 as a Clinical Target for Pruritus Treatment. Front Med (Lausanne) 2021; 8:638325. [PMID: 33644103 PMCID: PMC7906974 DOI: 10.3389/fmed.2021.638325] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
In recent years, the published literature has suggested the key involvement of the cytokine interleukin-31 (IL-31) in the symptomatology of pruritus, and both IL-31 and its receptor have become potential therapeutic targets for a range of pruritic diseases. Elevated levels of IL-31 or its receptor have been reported in the tissue or serum of patients with pruritic skin diseases, such as atopic dermatitis, prurigo nodularis, and psoriasis. Pruritus places a heavy burden on patients, and can have a negative impact on daily life, sleep, and mental health. Since current anti-pruritic treatments are often ineffective, affected patients are in urgent need of new therapies. As a result, drug development targeting the IL-31 pathway is evolving rapidly. To date, only nemolizumab, a humanized monoclonal antibody targeting the IL-31 receptor, has successfully completed late-stage clinical studies. This article will highlight our current clinical understanding of the role of IL-31 in pruritic disease, and explore recent progress in drug development as well as the anticipated future advances in this field.
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Affiliation(s)
- Kenji Kabashima
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Irie
- Department of Dermatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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45
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Nemmer JM, Kuchner M, Datsi A, Oláh P, Julia V, Raap U, Homey B. Interleukin-31 Signaling Bridges the Gap Between Immune Cells, the Nervous System and Epithelial Tissues. Front Med (Lausanne) 2021; 8:639097. [PMID: 33644104 PMCID: PMC7902767 DOI: 10.3389/fmed.2021.639097] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Pruritus represents one of the most common symptoms in dermatology and general medicine. Chronic pruritus severely impairs the quality of life of affected patients. During the last two decades a number of modulators and mediator of pruritus have been identified. Recently, Interleukin (IL)-31 and its receptor complex attracted significant interest, as clinical phase two studies demonstrated therapeutic efficacy of the neutralizing IL-31 receptor A (IL-31RA) antibody nemolizumab in patients suffering from atopic dermatitis or prurigo nodularis. IL-31 has also been shown to play relevant roles in allergic contact dermatitis, urticaria, mastocytosis, allergic rhinitis and asthma. Here, we summarize the current knowledge of the novel cytokine IL-31 and its receptor regarding cellular origin, regulation, signaling pathways and their involvement in biological processes such as pruritus, neuronal growth, inflammation, barrier dysfunction and tissue remodeling.
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Affiliation(s)
- Jana Maria Nemmer
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marcus Kuchner
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Angeliki Datsi
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Medical Faculty, Institute for Transplantation Diagnostics and Cell Therapy, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Péter Oláh
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Dermatology, Venereology and Oncodermatology, Medical Faculty, University of Pécs, Pécs, Hungary
| | | | - Ulrike Raap
- Division of Experimental Allergy and Immunodermatology, Department of Dermatology, University of Oldenburg, Oldenburg, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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46
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Yaseen B, Lopez H, Taki Z, Zafar S, Rosario H, Abdi BA, Vigneswaran S, Xing F, Arumalla N, Black S, Ahmad S, Kumar K, Gul R, Scolamiero L, Morris S, Bowman A, Stainer A, Rice A, Stock C, Renzoni E, Denton CP, Venturini C, Brown M, O'Reilly S, Stratton R. Interleukin-31 promotes pathogenic mechanisms underlying skin and lung fibrosis in scleroderma. Rheumatology (Oxford) 2021; 59:2625-2636. [PMID: 32365362 DOI: 10.1093/rheumatology/keaa195] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Cytokines released by infiltrating T cells may promote mechanisms leading to fibrosis in scleroderma. The aim of this study was to investigate the role of the Th2 cytokine IL-31, and its receptor IL-31RA, in scleroderma skin and lung fibrosis. METHODS IL-31 was measured by ELISA of plasma, and by immunochemistry of fibrotic skin and lung tissue of scleroderma patients. The receptor, IL-31RA, was assayed by qPCR of tissue resident cells. Next-generation sequencing was used to profile the responses of normal skin fibroblasts to IL-31. In wild-type Balb/c mice, IL-31 was administered by subcutaneous mini pump, with or without additional TGFβ, and the fibrotic reaction measured by histology and ELISA of plasma. RESULTS IL-31 was present at high levels in plasma and fibrotic skin and lung lesions in a subset of scleroderma patients, and the receptor overexpressed by downstream cells relevant to the disease process, including skin and lung fibroblasts, through loss of epigenetic regulation by miR326. In skin fibroblasts, IL-31 induced next generation sequencing profiles associated with cellular growth and proliferation, anaerobic metabolism and mineralization, and negatively associated with angiogenesis and vascular repair, as well as promoting phenotype changes including migration and collagen protein release via pSTAT3, resembling the activation state in the disease. In mice, IL-31 induced skin and lung fibrosis. No synergy was seen with TGFβ, which supressed IL-31RA. CONCLUSION IL-31/IL-31RA is confirmed as a candidate pro-fibrotic pathway, which may contribute to skin and lung fibrosis in a subset of scleroderma patients.
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Affiliation(s)
- Bodoor Yaseen
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Henry Lopez
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK.,MuriGenics, Inc, Vallejo, CA, USA
| | - Zeinab Taki
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Sara Zafar
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Henrique Rosario
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Bahja Ahmed Abdi
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Shivanee Vigneswaran
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Fiona Xing
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Nikita Arumalla
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Simon Black
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Sara Ahmad
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Kimti Kumar
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Rabia Gul
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Laura Scolamiero
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Sian Morris
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | - Alex Bowman
- Department of Respiratory Medicine, Imperial College London, Royal Brompton Campus
| | - Anna Stainer
- Department of Respiratory Medicine, Imperial College London, Royal Brompton Campus
| | - Alexandra Rice
- Department of Respiratory Medicine, Imperial College London, Royal Brompton Campus
| | - Carmel Stock
- Department of Respiratory Medicine, Imperial College London, Royal Brompton Campus
| | - Elisabetta Renzoni
- Department of Respiratory Medicine, Imperial College London, Royal Brompton Campus
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
| | | | - Max Brown
- Department of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Steven O'Reilly
- Department of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, UK
| | - Richard Stratton
- Centre for Rheumatology and Connective Tissue Diseases, Royal Free Hospital Campus, University College London Medical School, London, UK
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47
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Interleukin-31, a Potent Pruritus-Inducing Cytokine and Its Role in Inflammatory Disease and in the Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1290:111-127. [PMID: 33559859 DOI: 10.1007/978-3-030-55617-4_8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Substantial new information has emerged supporting the fundamental role of the cytokine interleukin-31 (IL-31) in the genesis of chronic pruritus in a broad array of clinical conditions. These include inflammatory conditions, such as atopic dermatitis and chronic urticaria, to autoimmune conditions such as dermatomyositis and bullous pemphigoid, to the lymphoproliferative disorders of Hodgkin's disease and cutaneous T-cell lymphoma. IL-31 is produced in greatest quantity by T-helper type 2 (Th2) cells and upon release, interacts with a cascade of other cytokines and chemokines to lead to pruritus and to a proinflammatory environment, particularly within the skin. Antibodies which neutralize IL-31 or which block the IL-31 receptor may reduce or eliminate pruritus and may diminish the manifestations of chronic cutaneous conditions associated with elevated IL-31. The role of IL-31 in these various conditions will be reviewed.
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48
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Quantitative Assessment of Eosinophils in Dermatomyositis Skin Biopsies With Correlation of Eosinophils to Pruritus and Other Clinical Features. Am J Dermatopathol 2020; 43:287-290. [PMID: 32852288 DOI: 10.1097/dad.0000000000001765] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The objective of this retrospective study was to analyze dermatomyositis skin biopsies for the presence of eosinophils and correlate this finding with other histopathologic and clinical characteristics. Cases of dermatomyositis evaluated in a single dermatologist's adult autoimmunity practice over a 2.5-year period were identified via ICD-10 diagnosis code. Dermatopathology archives were then searched for any corresponding biopsies consistent with dermatomyositis, and those identified were assessed for eosinophils, adnexal involvement, epidermal atrophy, dermal mucin, and basement membrane thickening. Histopathologic findings were correlated with key clinical features, including itch. A total of 39 biopsies from 17 patients were included. Eosinophils were noted in 44% of biopsies (n = 17) from 12 patients. Dermal mucin deposition and adnexal interface dermatitis were noted in 72% (n = 28) and 44% (n = 17) of biopsy specimens, respectively. Of 12 patients with eosinophils present in at least 1 biopsy specimen, 11 (92%) patients had a clinical history of pruritus of their skin lesions (P = 0.052). Limitations of this study include retrospective design and small number of patients.
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49
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Spiera R, Hummers L, Chung L, Frech TM, Domsic R, Hsu V, Furst DE, Gordon J, Mayes M, Simms R, Lafyatis R, Martyanov V, Wood T, Whitfield ML, Constantine S, Lee E, Dgetluck N, White B. Safety and Efficacy of Lenabasum in a Phase II, Randomized, Placebo-Controlled Trial in Adults With Systemic Sclerosis. Arthritis Rheumatol 2020; 72:1350-1360. [PMID: 32336038 PMCID: PMC7497006 DOI: 10.1002/art.41294] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
Objective To assess the safety and efficacy of lenabasum in diffuse cutaneous systemic sclerosis (dcSSc). Methods A randomized, double‐blind, placebo‐controlled, phase II study was conducted at 9 SSc clinics in the US. Adults with dcSSc of ≤6 years’ duration who were receiving stable standard‐of‐care treatment were randomized to receive lenabasum (n = 27) or placebo (n = 15). Lenabasum doses were 5 mg once daily, 20 mg once daily, or 20 mg twice daily for 4 weeks, followed by 20 mg twice daily for 8 weeks. Safety and efficacy were assessed at weeks 4, 8, 12, and 16. Results Adverse events (AEs) occurred in 63% of the lenabasum group and 60% of the placebo group, with no serious AEs related to lenabasum. Compared to placebo, lenabasum treatment was associated with greater improvement in the American College of Rheumatology Combined Response Index in diffuse cutaneous Systemic Sclerosis (CRISS) score and other efficacy outcome measures that assessed overall disease, skin involvement, and patient‐reported function. The median CRISS score increased in the lenabasum group during the study, reaching 0.33, versus 0.00 in the placebo group, at week 16 (P = 0.07 by 2‐sided mixed‐effects model repeated‐measures analysis). Gene expression in inflammation and fibrosis pathways was reduced, and inflammation and fibrosis were improved on histologic evaluation of skin biopsy specimens, in the lenabasum group compared to the placebo group (all P ≤ 0.05). Conclusion Despite a short trial duration in a small number of patients in this phase II study in dcSSc, our findings indicate that lenabasum improves efficacy outcomes and underlying disease pathology with a favorable safety profile.
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Affiliation(s)
| | - Laura Hummers
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lorinda Chung
- Stanford University School of Medicine, Stanford, California, and Palo Alto VA Health Care System, Palo Alto, California
| | - Tracy M Frech
- University of Utah, and Salt Lake City VA Health Care System
| | - Robyn Domsic
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Vivien Hsu
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel E Furst
- Arthritis Association of Southern California, Los Angeles, California
| | | | - Maureen Mayes
- University of Texas Health Science Center at Houston
| | - Robert Simms
- Boston University School of Medicine, Boston, Massachusetts
| | - Robert Lafyatis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Tammara Wood
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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50
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Abstract
INTRODUCTION Currently, there are no proven drugs that are FDA approved for the treatment of dermatomyositis (DM), even though multiple clinical trials are ongoing to evaluate safety and efficacy of novel therapeutics in DM. The purpose of this review is to highlight the biological plausibility, existing clinical evidence as well as completed and ongoing clinical trials for various drugs in pipeline for development for use in dermatomyositis. AREAS COVERED The drugs with the strongest evidence have been included in this review with a focus on the mechanism of their action pertaining to the disease process, clinical studies including completed and ongoing trials. With better understanding of the underlying pathophysiologic process, there are new molecular targets that have been identified that can be targeted by these novel drugs, predominantly biologic drugs. EXPERT OPINION There are various drugs being evaluated in phase II/III clinical trials that hold promise in DM. At the forefront of these are immunoglobulin, Lenabasum, and Abatacept for which phase III clinical trials are ongoing. In addition, promising clinical studies are ongoing or reported for KZR-616, anti-B cell therapy, anti-interferon drugs, and Repository Corticotrophin Injection (RCI).
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Affiliation(s)
- Tanya Chandra
- Internal Medicine Residency Program, University of Connecticut , Farmington, CT, USA
| | - Rohit Aggarwal
- Department of Medicine, Rheumatology and Clinical Immunology, University of Pittsburgh , Pittsburgh, PA, USA
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