1
|
Current Knowledge of the Molecular Pathogenesis of Cutaneous Lupus Erythematosus. J Clin Med 2023; 12:jcm12030987. [PMID: 36769633 PMCID: PMC9918007 DOI: 10.3390/jcm12030987] [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: 01/06/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune disease, which can be limited to the skin or associated with systemic lupus erythematosus (SLE). Gene expression analysis has revealed that both the innate and adaptive immune pathways are activated in CLE. Ultraviolet (UV) light, the predominant environmental factor associated with CLE, induces apoptosis in keratinocytes, and the endogenous nucleic acids released from the apoptotic cells are recognized via pattern recognition receptors, including Toll-like receptors. This leads to the production of type I interferon, a major contributor to the pathogenesis of CLE, by plasmacytoid dendritic cells. UV irradiation can also induce the externalization of autoantigens, such as SS-A/Ro, exposing them to circulating autoantibodies. T-helper 1 cells have been reported to play important roles in the adaptive immune response to CLE. Other environmental factors associated with CLE include drugs and cigarette smoke. Genetic factors also confer a predisposition to the development of CLE, and many susceptibility genes have been identified. Monogenetic forms of CLE also exist. This article aims to review current knowledge about the pathogenesis of CLE. A better understanding of the environmental, genetic, and immunoregulatory factors that drive CLE may provide important insights for the treatment of CLE.
Collapse
|
2
|
Wang S, Li T, Wang Y, Wang M, Liu Y, Zhang X, Zhang L. 5-Fluorouracil and actinomycin D lead to erythema multiforme drug eruption in chemotherapy of invasive mole: Case report and literature review. Medicine (Baltimore) 2022; 101:e31678. [PMID: 36451432 PMCID: PMC9704884 DOI: 10.1097/md.0000000000031678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
RATIONALE 5-Fluorouracil (5-FU) and actinomycin D (ActD) are often used in chemotherapy for various cancers. Side effects are more common in bone marrow suppression, liver function impairment, and gastrointestinal responses. Skin effects are rare and easy to be ignored by doctors and patients, which can lead to life-threatening consequence. PATIENT CONCERNS We reported a 45-year-old woman patient developed skin erythema and fingernail belt in chemotherapy of 5-FU and ActD. DIAGNOSIS Erythema multiforme drug eruption. INTERVENTIONS Laboratory tests including blood and urine routine, liver and kidney function, electrolytes and coagulation function and close observation. OUTCOMES The rash was gone and the nail change returned. LESSONS Delays in diagnosis or treatment may lead to serious consequence. We should pay attention to the dosage of 5-FU and ActD, monitor adverse reactions strictly, to reduce occurrence of skin malignant events.
Collapse
Affiliation(s)
- Shan Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Tengfei Li
- Departments of General Surgery, The Second Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuan Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Mengdi Wang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yibin Liu
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Xiaoguang Zhang
- Departments of Dermatology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Lijuan Zhang
- Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
- * Correspondence: Lijuan Zhang, Departments of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China (e-mail: )
| |
Collapse
|
3
|
Inaba Y, Kanazawa N, Yoshimasu T, Shimokawa T, Nosaka M, Kondo T, Furukawa F. Severer lupus erythematosus-like skin lesions in MRL/lpr mice with homozygous Kit wsh/wsh mutation. Mod Rheumatol 2017; 28:319-326. [PMID: 28696798 DOI: 10.1080/14397595.2017.1341591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To clarify the roles of mast cells (MCs) on the pathogenesis of lupus erythematosus (LE)-like skin lesions on MRL/lpr mice. METHODS MRL/lpr mice were mated with C57BL/6-Kitwsh/wsh mice and the heterozygous F1 mice were 10 times backcrossed with the parental MRL/lpr to generate MRL/lpr-Kitwsh/wsh mice. MC-deficient MRL/lpr-Kitwsh/wsh mice were compared with MRL/lpr-Kit+/+ and MRL/lpr-Kitwsh/+ mice with intact MCs. RESULTS MRL/lpr-Kitwsh/wsh mice developed skin lesions without infiltrating MCs. As similar skin lesions on MRL/lpr-Kit+/+ mice and MRL/lpr-Kitwsh/+ mice contain comparable number of MCs, these mice were collectively analyzed as MRL/lpr mice with MCs. Compared with MRL/lpr mice with MCs, skin lesions developed earlier and showed consistently higher severity, with significantly higher mRNA expressions of many inflammatory cytokines in the dorsal skin on MRL/lpr mice without MCs. Furthermore, survival rate was significantly lower in MRL/lpr mice without MCs. The number of infiltrating MCs significantly increased in association with the severity of skin lesions in MRL/lpr mice with MCs. CONCLUSIONS These results demonstrated that MCs are infiltrated to suppress the progression of LE-like skin lesions in MRL/lpr mice.
Collapse
Affiliation(s)
- Yutaka Inaba
- a Department of Dermatology , Wakayama Medical University , Wakayama , Japan
| | - Nobuo Kanazawa
- a Department of Dermatology , Wakayama Medical University , Wakayama , Japan
| | - Takashi Yoshimasu
- a Department of Dermatology , Wakayama Medical University , Wakayama , Japan.,b Department of Dermatology , Arida Municipal Hospital , Wakayama , Japan
| | - Toshio Shimokawa
- c Clinical Study Support Center , Wakayama Medical University , Wakayama , Japan
| | - Mizuho Nosaka
- d Department of Forensic Medicine , Wakayama Medical University , Wakayama , Japan
| | - Toshikazu Kondo
- d Department of Forensic Medicine , Wakayama Medical University , Wakayama , Japan
| | - Fukumi Furukawa
- a Department of Dermatology , Wakayama Medical University , Wakayama , Japan
| |
Collapse
|
4
|
Baggio R, Chavel P, Tisseau L, Darrieux L, Safa G. [Subacute cutaneous lupus erythematosus induced by 5-fluorouracil]. Presse Med 2017; 46:876-879. [PMID: 28666566 DOI: 10.1016/j.lpm.2017.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/15/2017] [Accepted: 05/29/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
- Raphaëlle Baggio
- Centre hospitalier de Saint-Brieuc, service de dermatologie, 10, rue Marcel-Proust, 22000 Saint-Brieuc, France
| | - Pascale Chavel
- Centre hospitalier de Saint-Brieuc, service d'hémato-oncologie, 10, rue Marcel-Proust, 22000 Saint-Brieuc, France
| | - Laurent Tisseau
- Cabinet Armor pathologie, 4, place Konrad-Adenauer, 22194 Plérin, France
| | - Laure Darrieux
- Centre hospitalier de Saint-Brieuc, service de dermatologie, 10, rue Marcel-Proust, 22000 Saint-Brieuc, France
| | - Gilles Safa
- Centre hospitalier de Saint-Brieuc, service de dermatologie, 10, rue Marcel-Proust, 22000 Saint-Brieuc, France.
| |
Collapse
|
5
|
Ishida T, Takahashi S, Lai CY, Nojima M, Yamamoto R, Takeuchi E, Takeuchi Y, Higashihara M, Nakauchi H, Otsu M. Multiple allogeneic progenitors in combination function as a unit to support early transient hematopoiesis in transplantation. J Exp Med 2016; 213:1865-80. [PMID: 27503070 PMCID: PMC4995077 DOI: 10.1084/jem.20151493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/06/2016] [Indexed: 12/23/2022] Open
Abstract
Cord blood (CB) is a valuable donor source in hematopoietic cell transplantation. However, the initial time to engraftment in CB transplantation (CBT) is often delayed because of low graft cell numbers. This limits the use of CB. To overcome this cell dose barrier, we modeled an insufficient dose CBT setting in lethally irradiated mice and then added hematopoietic stem/progenitor cells (HSCs/HPCs; HSPCs) derived from four mouse allogeneic strains. The mixture of HSPCs rescued recipients and significantly accelerated hematopoietic recovery. Including T cells from one strain favored single-donor chimerism through graft versus graft reactions, with early hematopoietic recovery unaffected. Furthermore, using clinically relevant procedures, we successfully isolated a mixture of CD34(+) cells from multiple frozen CB units at one time regardless of HLA-type disparities. These CD34(+) cells in combination proved transplantable into immunodeficient mice. This work provides proof of concept that when circumstances require support of hematopoiesis, combined multiple units of allogeneic HSPCs are capable of early hematopoietic reconstitution while allowing single-donor hematopoiesis by a principal graft.
Collapse
Affiliation(s)
- Takashi Ishida
- Department of Hematology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Satoshi Takahashi
- Division of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Chen-Yi Lai
- Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Masanori Nojima
- Division of Advanced Medicine Promotion, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| | - Ryo Yamamoto
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Emiko Takeuchi
- Department of Immunology, Kitasato University Graduate School of Medical Science, Kanagawa 252-0374, Japan
| | - Yasuo Takeuchi
- Department of Nephrology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Masaaki Higashihara
- Department of Hematology, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Hiromitsu Nakauchi
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305
| | - Makoto Otsu
- Division of Stem Cell Therapy, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan Division of Stem Cell Processing, Center for Stem Cell Biology and Regenerative Medicine, Institute of Medical Science, University of Tokyo, Tokyo 108-0071, Japan
| |
Collapse
|
6
|
Schmitz MK, Botte DA, Sotto MN, Borba EF, Bonfa E, de Mello SBV. Increased corticotropin-releasing hormone (CRH) expression in cutaneous lupus lesions. Lupus 2015; 24:854-61. [DOI: 10.1177/0961203315569335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/18/2014] [Indexed: 01/09/2023]
Abstract
Objective Corticotropin-releasing hormone (CRH) and pro-opiomelanocortin (POMC) axis activation leads to the production of hormones, such as adrenocorticotrophic hormone (ACTH) and the α-melanocyte stimulating hormone (α-MSH). Data regarding the role of these hormones in systemic lupus erythematosus (SLE) are scarce. In the present study we aim to evaluate the participation of this axis in the cutaneous involvement of SLE. Methods Seventeen SLE patients were clinically evaluated, and biopsies from affected and unaffected skin of these patients were compared with 17 healthy control individuals. Immunohistochemical analyses for CRH, ACTH, α-MSH, and MC-1R were performed, and the serum levels of α-MSH, IL-1, IL-1ra, IL-6, IL-10, IL-12p70, IL-17, TNF-α, and IFN-γ were measured. Results The affected skin of the SLE patients exhibited higher CRH expression in the deep dermis compared to the skin of the controls ( p = 0.024), whereas the tissue expression of ACTH, cortisol, α-MSH and its receptor MC-1R were comparable in SLE patients and controls. Higher serum levels of IFN-γ ( p = 0.041), TNF-α ( p = 0.001) and IL-6 ( p = 0.049) were observed in SLE patients compared with controls, while α-MSH levels were similar in both groups. Conclusion The novel finding of elevated CRH expression solely in the affected skin deep dermis supports the notion of a cutaneous local dysfunction of the CRH-POMC axis in the pathogenesis of cutaneous SLE lesions.
Collapse
Affiliation(s)
- M K Schmitz
- Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - D A Botte
- Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - M N Sotto
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E F Borba
- Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - E Bonfa
- Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - S B V de Mello
- Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| |
Collapse
|
7
|
Li Z, Jiang N, Xu Y. The concurrence of subacute cutaneous lupus erythematosus and hand-foot syndrome in a patient undergoing capecitabine chemotherapy. Australas J Dermatol 2014; 57:e14-6. [PMID: 25495707 DOI: 10.1111/ajd.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/09/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Zhiming Li
- Department of Dermatology and Venereology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - Nanyan Jiang
- Department of Dermatology and Venereology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| | - Yunsheng Xu
- Department of Dermatology and Venereology; First Affiliated Hospital of Wenzhou Medical University; Wenzhou Zhejiang China
| |
Collapse
|
8
|
Lupus cutané subaigu induit par la capécitabine : un cas. Ann Dermatol Venereol 2014; 141:593-7. [DOI: 10.1016/j.annder.2014.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/08/2014] [Accepted: 06/19/2014] [Indexed: 11/23/2022]
|
9
|
Kindem S, Llombart B, Requena C, Ruiz A, Traves V, Guillen C, Sanmartin O. Subacute cutaneous lupus erythematosus after treatment with capecitabine. J Dermatol 2012; 40:75-6. [DOI: 10.1111/j.1346-8138.2012.01646.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sabrina Kindem
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Beatriz Llombart
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Celia Requena
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Amparo Ruiz
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Victor Traves
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Carlos Guillen
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| | - Onofre Sanmartin
- Departments of Dermatology, Oncological Medicine, Anatomical Pathology; Valencia Institute of Oncology; Valencia; Spain
| |
Collapse
|
10
|
Clonal expansion of Epstein–Barr virus (EBV)-infected γδ T cells in patients with chronic active EBV disease and hydroa vacciniforme-like eruptions. Int J Hematol 2012; 96:443-9. [DOI: 10.1007/s12185-012-1156-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
|
11
|
Mikita N, Ikeda T, Ishiguro M, Furukawa F. Recent advances in cytokines in cutaneous and systemic lupus erythematosus. J Dermatol 2011; 38:839-49. [PMID: 21767292 DOI: 10.1111/j.1346-8138.2011.01237.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Lupus erythematosus (LE) includes a broad spectrum of diseases from a cutaneous-limited type to a systemic type. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease which affects multiple organs. Cutaneous lupus erythematosus (CLE) includes skin symptoms seen in SLE and cutaneous-limited LE. Although immune abnormalities, as well as heritable, hormonal and environmental factors, are involved in the pathology of LE, the actual pathogenesis is still unclear. Recently, the involvement of various cytokines has been shown in the pathogenesis of LE. Moreover, some trials with biological agents targeted specific cytokines are also ongoing for SLE. In this article, we review the contributions of major cytokines such as interferon, tumor necrosis factor-α and interleukin-18 to LE, especially SLE and CLE.
Collapse
Affiliation(s)
- Naoya Mikita
- Department of Dermatology, Wakayama Medical University, Wakayama Department of Dermatology, Hashimoto Municipal Hospital, Hashimoto, Japan.
| | | | | | | |
Collapse
|
12
|
Moyano Almagro B, Contreras Steyls M, López Navarro N, Gallego Domínguez E, Herrera Acosta E, Gallardo Pérez MA, Herrera Ceballos E. Occurrence of Subacute Cutaneous Lupus Erythematosus After Treatment With Systemic Fluorouracil. J Clin Oncol 2011; 29:e613-5. [DOI: 10.1200/jco.2011.35.0686] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Animal models of lupus. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
14
|
Furukawa F, Yoshimasu T, Kanazawa N. [Pathogenesis of cutaneous lupus erythematosus from LE-prone mice]. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2010; 33:169-73. [PMID: 20818144 DOI: 10.2177/jsci.33.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mouse models are similar but not identical to human diseases. However, they are important for research into the pathogenesis underlying autoimmune diseases because they allow us to evaluate similarities and differences between human diseases and mouse models. There are many inbred strains of systemic lupus erythematosus (SLE)-prone mice including New Zealand Black (NZB), F1 hybrids of NZB x New Zealand White (NZW) (B/W F1), MRL/Mp-lpr/lpr (MRL/lpr), and BXSB mice. The postulated etiology of these murine diseases includes many genetic and extrinsic factors such as retroviruses, an impaired balance of T cell interaction, ultraviolet irradiation, etc. For examples, genetic studies of MRL/lpr mice revealed that the appearance of macroscopic LE-like skin lesions needs the lpr mutation plus an additional factor in an autosomal dominant fashion. The candidate is ultraviolet (UV) B light, the susceptibility to which is regulated by the genetic background. Such abnormalities described in SLE now span the spectrum from innate immunity to acquired immunity. In this review, based on historical review, we focus on skin lesions from the well-studied MRL/lpr and B/W F1 mouse and discuss how SLE-prone mice can contribute to a better understanding of cutaneous LE pathogenesis.
Collapse
|
15
|
The protective effects of ultraviolet A1 irradiation on spontaneous lupus erythematosus-like skin lesions in MRL/lpr mice. Clin Dev Immunol 2009; 2009:673952. [PMID: 19434230 PMCID: PMC2673515 DOI: 10.1155/2009/673952] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Accepted: 02/21/2009] [Indexed: 01/29/2023]
Abstract
We investigated the effects of ultraviolet A1 (UVA1) irradiation on spontaneous lupus erythematosus- (LE-) like skin lesions of MRL/lpr mice, using a disease prevention model. UVA1 irradiation significantly inhibited the development of LE-like skin lesions, without obvious changes of the disease including renal disease and serum antinuclear antibody levels. Besides the massive infiltration of mast cells in the LE-like skin lesions, in the nonlesional skins, more mast cells infiltrated in the UVA1-irradiated group compared with the nonirradiated group. Although apoptotic cells were remarkably seen in the dermis of UVA1-irradiated mice, those cells were hardly detectable in the dermis of the nonirradiated mice without skin lesions. Further analysis showed that some of those apoptotic cells were mast cells. Thus, UVA1 might exert its effects, at least in part, through the induction of the apoptosis of pathogenic mast cells. Our results supported the clinical efficacy of UVA1 irradiation for skin lesions of lupus patients.
Collapse
|
16
|
Furukawa F, Yoshimasu T, Yamamoto Y, Kanazawa N, Tachibana T. Mast cells and histamine metabolism in skin lesions from MRL/MP-lpr/lpr mice. Autoimmun Rev 2009; 8:495-9. [PMID: 19162242 DOI: 10.1016/j.autrev.2008.12.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
It is likely that mast cell and histamine metabolism are involved in autoimmune tissue injury such as cutaneous lupus erythematosus (LE) because different histamine receptors can regulate Th1 and Th2 cells. In order to verify the role of the axis of mast cell-histamine metabolism-histamine receptor, the autoimmune mouse has been investigated. The MRL/Mp-lpr/lpr (MRL/lpr) mouse is a good model for the spontaneous development of skin lesions similar to those seen in human LE. In skin lesions from MRL/l mice, there are many infiltrating T cells and mast cells in the dermis and impaired histamine metabolism, in which the low activity of histamine-N-methyltransferase and the related prolonged effects of histamine in the skin tissue seem to play a definite pathological role in the development of spontaneous lupus-like eruptions. The expression of H2R on the mast cell decreases within these skin lesions at 5 months of age. It is interesting that the activity of HMT runs in parallel with the expression of H2R over the time course of the skin changes in MRL/l mice, but the relationship between these two observations remains obscure. The accumulation of mast cells expressing H2R and prolonged effects of histamine may occur to regulate the production of Th1 and Th2 cytokines in the skin lesions of MRL/l mice.
Collapse
Affiliation(s)
- Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama City, Japan.
| | | | | | | | | |
Collapse
|
17
|
Weger W, Kränke B, Gerger A, Salmhofer W, Aberer E. Occurrence of subacute cutaneous lupus erythematosus after treatment with fluorouracil and capecitabine. J Am Acad Dermatol 2008; 59:S4-6. [PMID: 18625380 DOI: 10.1016/j.jaad.2007.06.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 06/17/2007] [Accepted: 06/29/2007] [Indexed: 01/17/2023]
Abstract
Capecitabine, an oral fluoropyrimidine and 5-fluorouracil (FU) prodrug recently approved for the treatment of metastatic colon and breast cancer, is currently under investigation in patients with gastric cancer. It has the advantage of oral administration, and good tolerability with its activity being comparable with intravenous 5-FU. Lupus erythematosus and lupuslike drug eruptions have been observed after 5-FU treatment, but so far no cases of subacute cutaneous lupus erythematosus have been described in patients treated either with capecitabine or 5-FU. We report a patient who developed subacute cutaneous lupus erythematosus after administration of 5-FU and capecitabine.
Collapse
Affiliation(s)
- Wolfgang Weger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | | | | | | |
Collapse
|
18
|
Correale P, Tagliaferri P, Fioravanti A, Del Vecchio MT, Remondo C, Montagnani F, Rotundo MS, Ginanneschi C, Martellucci I, Francini E, Cusi MG, Tassone P, Francini G. Immunity feedback and clinical outcome in colon cancer patients undergoing chemoimmunotherapy with gemcitabine + FOLFOX followed by subcutaneous granulocyte macrophage colony-stimulating factor and aldesleukin (GOLFIG-1 Trial). Clin Cancer Res 2008; 14:4192-9. [PMID: 18593999 DOI: 10.1158/1078-0432.ccr-07-5278] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE GOLFIG chemoimmunotherapy regimen proved to be a safe and very active chemoimmunotherapy regimen in advanced colon cancer patients. We have thus investigated the immunobiological feedback to the treatment and its possible correlation with the clinical outcome of these patients. EXPERIMENTAL DESIGN This clinical and immunologic study involved 46 patients, 27 males and 19 females, enrolled in the GOLFIG-1 phase II trial who received gemcitabine (1,000 mg/m(2) on days 1 and 15), oxaliplatin (85 mg/m(2) on days 2 and 16), levofolinic acid (100 mg/m(2) on days 1, 2, 15, and 16), and 5-fluorouracil (400 mg/m(2) as a bolus, and 800 mg/m(2) as a 24-hour infusion on days 1, 2, 15, and 16) followed by s.c. granulocyte macrophage colony-stimulating factor (100 mug, on days 3-7) and interleukin 2 (0.5 x 10(6) IU twice a day on days 8-14 and 17-29). RESULTS The regimen was confirmed to be safe and very active in pretreated patients with metastatic colorectal cancer. A subgroup analysis of these patients revealed a prolonged time to progression and survival in six patients who developed late signs of autoimmunity. A multivariate analysis validated the occurrence of autoimmunity signs as an independent predictor of favorable outcome. A parallel immunologic study detected in the peripheral blood mononuclear cells of these patients a progressive increase in lymphocyte and eosinophil counts, amplification in central memory, a marked depletion of immunosuppressive regulatory T cells, and activation of colon cancer-specific cytotoxic T cells. CONCLUSIONS Our results suggest that immunity feedback to GOLFIG regimen and its antitumor activity are tightly correlated.
Collapse
Affiliation(s)
- Pierpaolo Correale
- Section of Medical Oncology, Department "Giorgio Segre" of Pharmacology, Rheumatology Unit, Siena University School of Medicine, Siena, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Correale P, Fioravanti A, Bertoldi I, Montagnani F, Miracco C, Francini G. Occurrence of autoimmunity in a long-term survivor with metastatic colon carcinoma treated with a new chemo-immunotherapy regimen. J Chemother 2008; 20:278-81. [PMID: 18467257 DOI: 10.1179/joc.2008.20.2.278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
GOLFIG-1 chemo-immunotherapy is a new translational anticancer regimen based on the combined use of gemcitabine, oxalipatin, levofolinic acid and infusional 5-fluorouracil together with the subcutaneous administration immunoadjuvant cytokines (GM-CSF and ultra low dose IL-2). This regimen, tested in a phase II trial, was safe and very active in patients with metastatic colorectal carcinoma and it has been shown to have powerful immunobiological activity. Treatment with the GOLFIG regimen resulted in the induction of a colon cancer specific cell mediated immune response associated with a significant reduction in the percentage of peripheral regulatory T (T(reg)) cells, a very immunosuppressive lymphocyte subset which is commonly over-represented in cancer patients. These cells are able to prevent the occurrence of autoimmunity in response to immunological stimuli, thus their malfunctioning has been associated with the occurrence of auto-immune diseases but may also be responsible for more efficient anticancer immune reaction. In this manuscript we describe a clinical case concerning a patient with metastatic colon carcinoma who responded to the GOLFIG regimen, showed symptoms of autoimmunity [Discoid Lupus Erythematosus (DLE)] and had a very long survival.
Collapse
Affiliation(s)
- P Correale
- Section of Medical Oncology, Department of Clinical Medicine and Immunological Sciences, Siena University School of Medicine, Siena, Italy
| | | | | | | | | | | |
Collapse
|
20
|
Adachi A, Horikawa T. Paclitaxel-induced cutaneous lupus erythematosus in patients with serum anti-SSA/Ro antibody. J Dermatol 2007; 34:473-6. [PMID: 17584326 DOI: 10.1111/j.1346-8138.2007.00313.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Two women (aged 46 and 56 years) developed annular erythema on their sun-exposed skin, including their forearms and faces, after biweekly i.v. administration of paclitaxel for 3-4 months to treat breast cancer. Both cases showed interface changes of basal keratinocytes and high titers of serum anti-SSA/Ro antibody. The diagnoses of paclitaxel-induced cutaneous lupus erythematosus (LE) were made because the skin eruptions cleared rapidly within 3 weeks after the paclitaxel treatment was discontinued. Paclitaxel is proposed to be a causative agent that can provoke cutaneous LE.
Collapse
Affiliation(s)
- Atsuko Adachi
- Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Kakogawa, Japan.
| | | |
Collapse
|
21
|
Adachi A, Nagai H, Horikawa T. Anti-SSA/Ro Antibody as a Risk Factor for Fluorouracil-Induced Drug Eruptions Showing Acral Erythema and Discoid-Lupus-Erythematosus-Like Lesions. Dermatology 2006; 214:85-8. [PMID: 17191054 DOI: 10.1159/000096919] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 07/07/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is well known that fluorouracil (FU) agents frequently induce discoid-lupus-erythematosus (DLE)-like eruptions and acral erythema in Japan. However, the etiology of these drug eruptions caused by FU agents has not been clarified yet. OBJECTIVE To determine if the existence of anti-SSA/Ro antibody may be a risk factor for FU-agent-induced DLE-like eruptions and acral erythema. PATIENTS AND METHODS Six patients with FU-agent-induced drug eruptions showing DLE-like lesions and acral erythema were enrolled in this study. The titers of anti-SSA/Ro antibody in the sera and the histopathology of the skin lesions were examined. RESULTS Biopsy specimens from DLE-like eruptions and all 5 examined acral erythema cases showed lichenoid change of the basal keratinocytes. Direct immunofluorescence studies revealed deposition of immunoglobulins along the basement membrane zone in the lesions of both DLE-like eruptions and acral erythema. Further, all 6 cases had high titers of serum anti-SSA/Ro antibody, which did not decline within 6 months after cessation of the causative drug. CONCLUSION We propose that anti-SSA/Ro antibody may be a risk factor for FU-agent-induced drug eruptions showing acral erythema and DLE-like eruptions.
Collapse
Affiliation(s)
- Atsuko Adachi
- Department of Dermatology, Hyogo Prefectural Kakogawa Hospital, Kakogawa, Japan.
| | | | | |
Collapse
|
22
|
Hiroi A, Ito T, Seo N, Uede K, Yoshimasu T, Ito M, Nakamura K, Ito N, Paus R, Furukawa F. Male New Zealand Black/KN mice: a novel model for autoimmune-induced permanent alopecia? Br J Dermatol 2006; 155:437-45. [PMID: 16882186 DOI: 10.1111/j.1365-2133.2006.07204.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Irreversible, permanent and scarring alopecia is associated with several autoimmune diseases, including all autoimmune connective tissue disorders. The pathogenesis of autoimmune-induced permanent alopecia (APA) is still poorly understood, and instructive, simple mouse models for the study of APA are needed urgently. During the course of our studies in a well-established mouse model for chronic rheumatoid arthritis, the New Zealand Black/KN (NZB/KN) mouse, we noticed that ageing male NZB/KN mice developed spontaneous APA. OBJECTIVES To study whether alopecia seen in ageing male NZB/KN mice displays key features of human APA and may, thus, be a useful new mouse model for clinically relevant APA research. METHODS NZB/KN, the F1 hybrid of NZW/N Slc x NZB/KN (W/BKN F1), the F1 hybrid of NZB/KN x NZW/N Slc (BKN/W F1), and the F2 hybrid of W/BKN F1 x W/BKN F1 mice were employed in this study, in order to check which strain carries the highest risk of alopecia development. Besides routine histology, CD3, CD4 and CD8 expression as well as immunoglobulin (Ig) G and IgM deposition in hair follicles were investigated by immunohistology/immunofluorescence. Mast cell distribution/degranulation and Ki-67 (proliferation)/TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labelling) (apoptosis) positive cells were also analysed. RESULTS Only F2 male NZB/KN mice were prone to develop alopecia, suggesting that Y chromosome-associated gene(s) are involved in the pathogenesis of APA, which incidence rises with increasing age. The lesional alopecia skin in 12-month-old male NZB/KN mice showed a sharp decline in hair follicle density, thus meeting a key criterion of permanent alopecia. Both macroscopically and histologically, the alopecia seen in these mice resembled in many respects different stages of clinical APA, such as alopecia associated with chronic discoid lupus erythematosus (DLE) in humans. Lesional APA hair follicles in mice displayed intrafollicular and perifollicular mononuclear cell infiltrates, as well as an increased number of activated (degranulated) perifollicular mast cells. In the fully developed lesion, many CD4+ cells were seen in perifollicular locations, including the epithelial stem cell region (bulge), and also contained a few CD8+ T cells. IgM deposits were found in the follicular basement membrane zone (BMZ). Both in the bulge and the hair matrix region of the affected anagen hair follicles, there were signs of massive keratinocyte apoptosis. CONCLUSIONS Our currently available data suggest that male but not female NZB/KN mice may indeed represent a suitable mouse model for APA, with some similarities to the permanent alopecia seen in human DLE patients, although additional and confirmatory investigations are needed before this mouse strain can be accepted as a murine equivalent of APA in humans.
Collapse
Affiliation(s)
- A Hiroi
- Department of Dermatology, Wakayama Medical University, Kimiidera 811-1, Wakayama, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Kluger N, Bessis D, Guillot B. Chronic cutaneous lupus flare induced by systemic 5-fluorouracil. J DERMATOL TREAT 2006; 17:51-3. [PMID: 16467025 DOI: 10.1080/09546630500475591] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
5-Fluorouracil is an antineoplastic antimetabolite responsible for a variety of cutaneous reactions. We report a case of chronic cutaneous lupus flare related to systemic 5-fluorouracil administration for breast cancer in a patient with documented history of chronic cutaneous lupus.
Collapse
Affiliation(s)
- N Kluger
- Department of Dermatology, Hôpital Saint Eloi, Montpellier, France
| | | | | |
Collapse
|
24
|
Abstract
Cutaneous lupus erythematosus (CLE) is a heterogenous disorder with a wide range of skin manifestations. Therefore, it has been difficult to develop a unifying concept for classifying CLE from the dermatologic perspective in the past. In 2004, the classification system was updated and includes now acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Additional rarely described variants are not listed as separate entities but are included in the classical forms. Diagnosis of the different subtypes of CLE is made by considering genetic, clinical, histopathologic, and immunoserologic findings, with a systematic analysis of individual criteria. In the past years, the etiology and pathogenesis of CLE has been subject of intensive research and it has been shown by several groups that exogenous factors, such as ultraviolet light and drugs, can induce CLE. The first part of this review will enable the reader to identify the various clinical manifestations of CLE and to employ characteristic criteria to assess differential diagnostic considerations.
Collapse
MESH Headings
- Biopsy
- Complement System Proteins/analysis
- Diagnosis, Differential
- Fluorescent Antibody Technique, Direct
- Humans
- Immunoglobulins/analysis
- Lupus Erythematosus, Cutaneous/classification
- Lupus Erythematosus, Cutaneous/diagnosis
- Lupus Erythematosus, Cutaneous/etiology
- Lupus Erythematosus, Cutaneous/pathology
- Lupus Erythematosus, Discoid/classification
- Lupus Erythematosus, Discoid/diagnosis
- Lupus Erythematosus, Discoid/etiology
- Lupus Erythematosus, Discoid/pathology
- Panniculitis, Lupus Erythematosus/classification
- Panniculitis, Lupus Erythematosus/diagnosis
- Panniculitis, Lupus Erythematosus/etiology
- Panniculitis, Lupus Erythematosus/pathology
- Skin/pathology
Collapse
Affiliation(s)
- A Kuhn
- Hautklinik der Heinrich-Heine-Universität Düsseldorf.
| | | | | | | |
Collapse
|
25
|
Nishide T, Yoshimasu T, Ikeda T, Seo N, Ohtani T, Furukawa F. Cytokine profiles of skin lesions in murine lupus models. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.descs.2005.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
26
|
Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000175939.68435.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Furukawa F, Yoshimasu T. Animal models of spontaneous and drug-induced cutaneous lupus erythematosus. Autoimmun Rev 2005; 4:345-50. [PMID: 16081025 DOI: 10.1016/j.autrev.2005.01.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Skin lesions are one of the most common manifestations of lupus erythematosus (LE) disorders such as systemic LE and discoid LE. The etiology of cutaneous LE is not fully understood. To address this issue, appropriate animal models frequently clarify the etiology and pathogenesis of autoimmune diseases, although no single animal model perfectly mimics a human disease. A common dermatological finding in many SLE-prone mouse strains is the deposition of immunoglobulins at the dermoepidermal junction. Over the past decade, the most exciting and important finding has been the discovery of the Fas-defect in the pathogenesis of the autoimmune MRL/lpr mouse, which is a good model for the spontaneous development of skin lesions similar to those seen in human LE. The analysis of MRL/lpr mice showed a close association between immunoglobulin deposits and the appearance of skin lesions. Transgenic and knock out mice have advanced the investigation of cutaneous LE. Furthermore, the model of drug-induced cutaneous LE can yield additional insight since the trigger is clear in drug-induced LE. Cutaneous LE lesions can also be induced in TCRalpha-/- mice treated with fluorouracil and ultraviolet B light irradiation. Studies on both spontaneous and experimental models will elucidate the pathogenesis of complicated and multifactorial cutaneous LE.
Collapse
Affiliation(s)
- Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
| | | |
Collapse
|
28
|
Robin Goodfellow (43-6). Rheumatology (Oxford) 2004. [DOI: 10.1093/rheumatology/keh235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
29
|
|