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Kim CH, Hong SM, Kim S, Yu JI, Jung SH, Bang CH, Lee JH, Kim TG. Skin repair and immunoregulatory effects of myeloid suppressor cells from human cord blood in atopic dermatitis. Front Immunol 2024; 14:1263646. [PMID: 38264643 PMCID: PMC10803405 DOI: 10.3389/fimmu.2023.1263646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Previously, we achieved large-scale expansion of bone marrow-derived suppressor cells (MDSCs) derived from cluster of differentiation (CD)34+ cells cultured in human umbilical cord blood (hUCB) and demonstrated their immunomodulatory properties. In the present study, we assessed the therapeutic efficacy of hUCB-MDSCs in atopic dermatitis (AD). Methods Dermatophagoides farinae (Df)-induced NC/Nga mice (clinical score of 7) were treated with hUCB-MDSCs or a control drug. The mechanisms underlying the therapeutic effects of hUCB-MDSCs were evaluated. Results and discussion hUCB-MDSCs demonstrated immunosuppressive effects in both human and mouse CD4+ T cells. hUCB-MDSCs significantly reduced the clinical severity scores, which were associated with histopathological changes, and reduced inflammatory cell infiltration, epidermal hyperplasia, and fibrosis. Furthermore, hUCB-MDSCs decreased the serum levels of immunoglobulin E, interleukin (IL)-4, IL-5, IL-13, IL-17, thymus- and activation-regulated chemokines, and thymic stromal lymphopoietin. Additionally, they altered the expression of the skin barrier function-related proteins filaggrin, involucrin, loricrin, cytokeratin 10, and cytokeratin 14 and suppressed the activation of Df-restimulated T-cells via cell-cell interactions. hUCB-MDSCs promoted skin recovery and maintained their therapeutic effect even after recurrence. Consequently, hUCB-MDSC administration improved Df-induced AD-like skin lesions and restored skin barrier function. Our findings support the potential of hUCB-MDSCs as a novel treatment strategy for AD.
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Affiliation(s)
- Chang-Hyun Kim
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
| | - Seung-Min Hong
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
| | - Sueon Kim
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
| | - Jae Ik Yu
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
| | - Soo-Hyun Jung
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tai-Gyu Kim
- ViMedier Platform Group, ViGenCell Inc., Seoul, Republic of Korea
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Therapeutic anti-psoriatic effects of myeloid-derived suppressor cells in combination with systemic tacrolimus (FK-506) in an imiquimod-induced mouse model of psoriasis. Int Immunopharmacol 2020; 86:106553. [PMID: 32563057 DOI: 10.1016/j.intimp.2020.106553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/21/2022]
Abstract
Although tacrolimus (FK-506) has been shown to be an effective monotherapy for psoriasis, it does not always work well. Currently, combination therapy is frequently used to manage psoriasis because clinical trials have shown it may provide additive or synergistic benefits and reduce risks of adverse effects. Myeloid-derived suppressor cells (MDSCs) have potent immunomodulatory and anti-inflammatory properties in autoimmune diseases. We previously reported that MDSCs had protective effects in a murine model of imiquimod (IMQ)-induced psoriasis. The present study was undertaken to investigate the systemic immunomodulatory and therapeutic efficacy effects of MDSC plus FK-506 in an IMQ-induced mouse model of psoriasis and to investigate the immunomodulatory mechanisms involved. Systemic MDSC plus FK-506 therapy was found to have a significant anti-psoriatic effect in the murine model, to reduce levels of pro-inflammatory cytokines Th1 cytokines (TNF-α and IFN-γ) and Th17 cytokines (IL-17A and IL-23) in serum and skin. However, treatment with MDSCs or FK-506 alone had little impact. Furthermore, the anti-psoriatic effects of MDSC plus FK-506 were associated with histopathological reductions in inflammatory infiltration, epidermal hyperplasia, and hyperkeratosis. In addition, this combined treatment also attenuated IMQ-induced splenomegaly, and increased the proportion of CD4+CD25+FoxP3+ regulatory T (Treg) cells and decreased the proportions of CD4+IFN-γ+ Th1 cells and CD4+IL-17+ Th17 cells in spleen. Taken together, our results show systemic combination therapy with MDSCs and FK-506 had a better therapeutic effect in our IMQ-induced psoriasis model than either agent alone, and suggest that this combinatorial therapy might be useful for the management of autoimmune skin diseases like psoriasis.
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Jung AY, Heo MJ, Kim YH. Glucosamine has an antiallergic effect in mice with allergic asthma and rhinitis. Int Forum Allergy Rhinol 2017; 7:763-769. [PMID: 28558148 DOI: 10.1002/alr.21967] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/18/2017] [Accepted: 05/02/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Glucosamine (GlcN) is generally used as a dietary supplement because of its antiinflammatory effects. We evaluated the antiallergic effect of GlcN in mice with allergic asthma and rhinitis. METHODS Thirty-two mice were allocated equally into 4 groups (n = 8). In group A (control), we performed intraperitoneal/intranasal challenge using sterile saline. In group B (asthma/rhinitis), we used ovalbumin for intraperitoneal/intranasal challenge to induce allergic asthma and rhinitis. In groups C and D (GlcN treatment), mice were given 1% and 5% GlcN throughout the period of ovalbumin challenge, respectively. We measured serum total and ovalbumin-specific immunoglobulin E (IgE), cytokine titers (interleukin-1, -4, -5, -6, -10, and -17; tumor necrosis factor-α; and interferon-γ), and the number of inflammatory cells (eosinophils, neutrophils, lymphocytes) in bronchoalveolar lavage (BAL) fluid. We also performed histopathologic examination of the lung and nasal cavity. Finally, we performed real-time polymerase chain reaction for the genes Bcl-2, EC-SOD, VEGF, caspase-3, Bax, COX-2, Hif-1α, and heme oxygenase-1. RESULTS Compared with group B, group D had significant serum total and ovalbumin-specific IgE decreases after GlcN treatment (p < 0.05). Titers for IL-4, IL-5, IL-6, and IL-17 in BAL fluid were significantly decreased in group D (p < 0.05). Eosinophils in BAL fluid were significantly decreased in group D compared with group B (p < 0.05). Groups C and D showed significant improvement of inflammation compared with group B. Group D had significant downregulation of EC-SOD, Bax, Hif-1α, and heme oxygenase-1 compared with group B. CONCLUSION GlcN had a significant antiallergic effect in mice with allergic asthma and rhinitis.
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Affiliation(s)
- Ah-Yeoun Jung
- WCSL of INtegrated Human Airway-on-a-chip, Department of Otorhinolaryngology, Inha University, Incheon, Korea
| | - Min-Jeong Heo
- WCSL of INtegrated Human Airway-on-a-chip, Department of Otorhinolaryngology, Inha University, Incheon, Korea
| | - Young Hyo Kim
- WCSL of INtegrated Human Airway-on-a-chip, Department of Otorhinolaryngology, Inha University, Incheon, Korea
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Shi C, Liu P, He Y, Liu Y, Feng X, Fu D. Drug-loaded poly(d,l-lactide-co-glycolide) microspheres as treatment for allergic contact dermatitis in mice model. J BIOACT COMPAT POL 2017. [DOI: 10.1177/0883911517690759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allergic contact dermatitis is a common skin disease and the current treatment always along with frequent medication and side effect. In this research, poly(d,l-lactide- co-glycolide) microspheres encapsulating tacrolimus are first employed as a therapy of allergic contact dermatitis in mice model by subcutaneous injection. Allergic contact dermatitis is successfully induced in BALB/c mice by repeated painting of dinitrofluorobenzene on mice ear. Tacrolimus is efficiently encapsulated into poly(d,l-lactide- co-glycolide) microspheres by emulsion evaporation method, and then the microspheres are subcutaneously injected into dermatitis-suffered BALB/c mice. We find that the dermatitis mice treated with tacrolimus-loaded microspheres get a sustained suppression on ear swelling, dermatitis index, inflammatory cell accumulation, and serum immunoglobulin E concentration. The curative effect of tacrolimus-loaded microspheres is similar to daily tacrolimus injection and is even better in the inhibition of ear swelling. Dermatitis mice treated with blank microspheres get no curative effect during the whole experiment. The data suggest that subcutaneous injection of drug-loaded microspheres could be a potential candidate for the management of allergic contact dermatitis.
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Affiliation(s)
- Chen Shi
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
| | - Ping Liu
- Department of Orthopaedics, Liyuan Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
| | - Yu He
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
| | - Yongwei Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
| | - Xiaobo Feng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
| | - Dehao Fu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology (HUST), Wuhan, P.R. China
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Lee YS, Choi JH, Lee JH, Lee HW, Lee W, Kim WT, Kim TY. Extracellular superoxide dismutase ameliorates house dust mite-induced atopic dermatitis-like skin inflammation and inhibits mast cell activation in mice. Exp Dermatol 2016; 25:630-5. [PMID: 27061078 DOI: 10.1111/exd.13028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 01/25/2023]
Abstract
Extracellular superoxide dismutase (EC-SOD) is an enzyme that catalyses the dismutation of superoxide anions. It has multiple functions, such as reactive oxygen species scavenging, anti-angiogenic, anti-inflammatory, antichemotatic and antitumor activities. Recently, we demonstrated that EC-SOD inhibits ovalbumin-induced allergic airway inflammation in mice. However, the anti-allergic effect of EC-SOD on skin tissue and the role of EC-SOD in mast cells, which are important for allergic responses, have not been well studied. In this study, we investigated whether EC-SOD can alleviate atopic dermatitis in mice and inhibit mast cell activation. Treatment with human recombinant EC-SOD ameliorated house dust mite-induced atopic dermatitis in mice. Furthermore, the levels of pro-allergic cytokine gene expression and histamine release increased in EC-SOD KO mast cells and decreased in EC-SOD overexpressing mast cells, suggesting that EC-SOD inhibits mast cell activation. Consistently, a passive cutaneous anaphylaxis experiment showed more blood leakage from EC-SOD KO mouse ear skin, implying that the lack of EC-SOD increases allergic responses. These results suggest that EC-SOD inhibits mast cell activation and atopic dermatitis and that the loss of EC-SOD causes more severe allergic responses, implying that EC-SOD might be a good drug candidate for treatment of allergic disorders, such as atopic dermatitis.
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Affiliation(s)
- Yun Sang Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Department of Otolaryngology, School of Medicine, Ajou University, Suwon, Korea
| | - Jung-Hye Choi
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Hyun Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han-Woong Lee
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, South Korea
| | - Weontae Lee
- Department of Biochemistry, College of Life Science and Biotechnology, Yonsei University, Seoul, South Korea
| | - Woo Taek Kim
- Department of Systems Biology, College of life Science and Biotechnology, Yonsei University, Seoul, South Korea
| | - Tae-Yoon Kim
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Protease inhibitor reduces airway response and underlying inflammation in cockroach allergen-induced murine model. Inflammation 2015; 38:672-82. [PMID: 25052477 DOI: 10.1007/s10753-014-9976-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Protease(s) enhances airway inflammation and allergic cascade. In the present study, effect of a serine protease inhibitor was evaluated in mouse model of airway disease. Mice were sensitized with cockroach extract (CE) or Per a 10 and treated with 4-(2-aminoethyl) benzenesulfonyl fluoride hydrochloride (AEBSF) 1 h before or after challenge to measure airway response. Mice were euthanized to collect bronchoalveolar lavage fluid (BALF), blood, and lung to evaluate inflammation. AEBSF treatment significantly reduced the AHR in allergen-challenged mice in dose-dependent manner (p≤ 0.01). IgE (p≤0.05) and Th2 cytokines (p≤0.05) were significantly reduced in treated mice. AEBSF treatment lowered total cell (p≤0.05), eosinophil (p≤0.05), and neutrophil (p≤0.05) in BALF and lung tissue. Oxidative stress parameters were impaired on treatment in allergen-challenged mice (p≤0.05). AEBSF had therapeutic effect in allergen-induced airway resistance and underling inflammation and had potential for combination or as add-on therapy for respiratory diseases.
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Kim CH, Cheong KA, Lim WS, Park HM, Lee AY. Effects of low-dose light-emitting-diode therapy in combination with water bath for atopic dermatitis in NC/Nga mice. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2015; 32:34-43. [PMID: 26479265 DOI: 10.1111/phpp.12220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/08/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Light-emitting diode (LED) phototherapy and water bath therapy have beneficial effect on atopic dermatitis (AD)-like skin disease. However, not all current treatments work well and alternative therapies are need. The contribution of combination therapy with low-dose 850 nm LED and water bath was investigated on dermatophagoides farina (Df)-induced dermatitis in NC/Nga mice. METHODS Low-dose LED (10, 15, and 20 J/cm(2) ) irradiation, water bath (36 ± 1°C) were administered separately and together to the Df-induced NC/Nga mice in acrylic jar once a day for 2 weeks. RESULTS Combined therapy with low-dose LED therapy and water bath therapy significantly ameliorated the development of AD-like skin lesions. These effects were correlated with the suppression of total IgE, NO, histamine, and Th2-mediated immune responses. Furthermore, combination therapy significantly reduced the infiltration of inflammatory cells and the induction of thymic stromal lymphopoietin (TSLP) in the skin lesions. The beneficial therapeutic effects of this combination therapy might regulate by the inhibition of various immunological responses including Th2-mediated immune responses, inflammatory mediators such as IgE, histamine, and NO, as well as inflammatory cells. CONCLUSIONS The combination therapy of LED and water bath might be used as an efficacious, safe, and steroid-free alternative therapeutic strategy for the treatment of AD.
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Affiliation(s)
- Chang-Hyun Kim
- Graduate School of Medicine, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Kyung Ah Cheong
- Department of Dermatology, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Won Suk Lim
- Department of Dermatology, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Hyung-Moo Park
- Division of Electronics and Electrical Engineering, Dongguk University, Seoul, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea
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Kim CH, Kim JY, Lee AY. Therapeutic and immunomodulatory effects of glucosamine in combination with low-dose cyclosporine a in a murine model of imiquimod-induced psoriasis. Eur J Pharmacol 2015; 756:43-51. [PMID: 25796200 DOI: 10.1016/j.ejphar.2015.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/16/2015] [Accepted: 03/03/2015] [Indexed: 11/18/2022]
Abstract
Although cyclosporine A (CsA) is a potent immunomodulating agent and is commonly used as a systemic agent for the management of psoriasis patients, current clinical treatments are not always effective due to the clinical inefficacy of low-doses and numerous harmful effects of higher doses. Currently, the combined use of two other systemic drugs often has better therapeutic efficacy and is safer than low or high dose of a single drug. Glucosamine (Glu) also has immunomodulatory properties for autoimmune diseases. The aims of our study were to investigate the therapeutic efficacy of Glu in combination with low-dose CsA on imiquimod (IMQ)-induced psoriasis-like dermatitis in mice and to determine its immunomodulatory mechanism. We found that combined treatment with Glu (300 mg/kg) and low-dose (10 or 20mg/kg) CsA strongly ameliorated the development of psoriasis-like skin lesions and reduced the levels of Th1 cytokine (TNF-α) and Th17 cytokines (IL-17, IL-22, and IL-23) in the serum and dorsal skin. Histological findings also showed that the thickening of epidermis, stratum corneum, and inflammatory cell infiltration. Particularly, these combined treatments increased the number of CD4(+)CD25(+) regulatory T (Treg) cells in splenic. These results suggest that use of a combination of each drug might be used as an efficacious and safe alternative therapeutic strategy, as well as may provide an immunomodulatory approach for T cell-mediated autoimmune diseases, including psoriasis.
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Affiliation(s)
- Chang-Hyun Kim
- Graduate School of Medicine, Dongguk University Ilsan Hospital, South Korea
| | - Ji-Young Kim
- Department of Dermatology, Dongguk University Ilsan Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, 814 Siksa-dong, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-773, South Korea.
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Feng S, Nie L, Zou P, Suo J. Drug-loaded PLGA-mPEG microparticles as treatment for atopic dermatitis-like skin lesions in BALB/c mice model. J Microencapsul 2014; 32:201-9. [DOI: 10.3109/02652048.2014.995727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim CH, Cheong KA, Lee AY. 850nm light-emitting-diode phototherapy plus low-dose tacrolimus (FK-506) as combination therapy in the treatment of dermatophagoides farinae-induced atopic dermatitis-like skin lesions in NC/Nga mice. J Dermatol Sci 2013; 72:142-8. [DOI: 10.1016/j.jdermsci.2013.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/27/2013] [Accepted: 06/02/2013] [Indexed: 12/15/2022]
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Park MK, Cho SA, Lee HJ, Lee EJ, Kang JH, Kim YL, Kim HJ, Oh SH, Choi C, Lee H, Kim SY. Suppression of Transglutaminase-2 is Involved in Anti-Inflammatory Actions of Glucosamine in 12-O-Tetradecanoylphorbol-13-Acetate-Induced Skin Inflammation. Biomol Ther (Seoul) 2013; 20:380-5. [PMID: 24009824 PMCID: PMC3762271 DOI: 10.4062/biomolther.2012.20.4.380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 07/06/2012] [Accepted: 07/10/2012] [Indexed: 01/21/2023] Open
Abstract
Glucosamine (GS) is well known for the treatment of inflam-mation. However, the mechanism and efficacy of GS for skin inflammation are unclear. The aim of this study was to evaluate the effects and mechanism of GS in the mouse 12-O-tetradecanoyl 13-acetate (TPA)-induced ear edema model. TPA-induced ear edema was evoked in ICR or transglutaminase 2 (Tgase-2) (-/-) mice. GS was administered orally (10-100 mg/kg) or topically (0.5-2.0 w/v %) prior to TPA treatment. Orally administered GS at 10 mg/kg showed a 76 or 57% reduction in ear weight or myeloperoxidase, respectively, and a decreased expression of cyclooxy-genase-2 (COX-2), NF-κB and Tgase-2 in TPA-induced ear edema by western blot and immunohistochemistry. Role of Tgase-2 in TPA ear edema is examined using Tgase-2 (-/-) mice and TPA did not induce COX-2 expression in ear of Tgase-2 (-/-) mice. These observations suggested that Tgase-2 is involved in TPA-induced COX-2 expression in the inflamed ear of mice and anti-inflammatory effects of glucosamine is mediated through suppression of Tgase-2 in TPA ear edema.
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Affiliation(s)
- Mi Kyung Park
- College of Pharmacy, Dongguk University, Goyang 410-820, Republic of Korea
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Kim CH, Choi YS, Cheong KA, Lee AY. Mechanism underlying the effect of combined therapy using glucosamine and low-dose cyclosporine A on the development of atopic dermatitis-like skin lesions in NC/Nga mice. Int Immunopharmacol 2013; 15:424-32. [DOI: 10.1016/j.intimp.2013.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 12/08/2012] [Accepted: 01/07/2013] [Indexed: 11/16/2022]
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