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Zarfl M, Patra V, Bordag N, Quehenberger F, Golob-Schwarzl N, Gruber-Wackernagel A, Wolf P. Eradication of skin microbiota restores cytokine production and release in polymorphic light eruption. Exp Dermatol 2024; 33:e15034. [PMID: 38459631 DOI: 10.1111/exd.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
Polymorphic light eruption (PLE) has been mechanistically linked to cytokine abnormalities. Emerging preclinical evidence posits the skin microbiome as a critical modulator of ultraviolet (UV)-induced cytokine expression, thereby influencing subsequent immune responses. This intricate relationship remains underexplored in the context of PLE. Hence, we investigated the differential responses between disinfected and non-disinfected skin following both single and repetitive exposures to solar-simulated UV radiation in patients with PLE. An experimental, half-body pilot study was conducted involving six PLE patients and 15 healthy controls. Participants' skin was exposed to single and multiple doses of solar-simulated UV radiation, both in disinfected and in non-disinfected skin areas. The co-primary outcomes were PLE score and cytokine expression in blister fluid analysed through OLINK proteomic profiling. Secondary outcomes were erythema, pigmentation, induction of apoptotic cells in vacuum-generated suction blisters, and density of infiltrate in skin biopsies of PLE patients. Among the 71 cytokines analysed, baseline expression levels of 20 specific cytokines-integral to processes such as apoptosis, inflammation, immune cell recruitment, cellular growth, and differentiation-were significantly impaired in PLE patients compared with healthy controls. Notably, skin disinfection reversed the observed cytokine imbalances following a single UV exposure at the minimal erythema dose (MED) level and exhibited even more pronounced effects after multiple UV exposures. However, no significant differences were evident in PLE score, erythema, pigmentation, or rates of apoptotic cell induction upon UV radiation. These findings provide evidence for UV-driven cytokine regulation by the skin microbiota and imply microbiome involvement in the PLE immune response.
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Affiliation(s)
- Maximilian Zarfl
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
| | - Vijaykumar Patra
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
- Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale, U1111, Université Claude Bernard Lyon 1, Lyon, France
- Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université de Lyon, Lyon, France
| | - Natalie Bordag
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
| | - Franz Quehenberger
- Medical University of Graz, Institute for Medical Informatics, Statistics and Documentation, Graz, Austria
| | - Nicole Golob-Schwarzl
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
| | - Alexandra Gruber-Wackernagel
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Research Unit for Photodermatology, Medical University of Graz, Graz, Austria
- Medical University of Graz, BioMedTech, Graz, Austria
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Orro K, Salk K, Abram K, Arshavskaja J, Meikas A, Karelson M, Neuman T, Kingo K, Spee P. Assessment of soluble skin surface protein levels for monitoring psoriasis vulgaris in adult psoriasis patients using non-invasive transdermal analysis patch: A pilot study. Front Med (Lausanne) 2023; 10:1072160. [PMID: 36936209 PMCID: PMC10019527 DOI: 10.3389/fmed.2023.1072160] [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: 10/17/2022] [Accepted: 02/06/2023] [Indexed: 03/06/2023] Open
Abstract
To improve the care of patients with chronic inflammatory skin conditions, such as psoriasis, there is a need for diagnostic methods that can facilitate personalized medicine. This exploratory pilot study aimed to determine whether non-invasive measurements of inflammation-related proteins from psoriatic skin can be sampled using the FibroTx Transdermal Analysis Patch (TAP) to assess disease severity and monitor pharmacodynamic changes. Ten healthy volunteers and 44 psoriasis vulgaris patients were enrolled in the exploratory pilot study. Skin surface protein measurements for healthy and lesional skin were performed using TAP. Patients' scores of psoriasis activity and severity (PASI) were documented, and differences in the thickness of skin layers were determined using sonography. The study assessed the skin surface protein levels of psoriasis patients undergoing whole-body treatment with narrow-band UVB to evaluate whether the levels of the skin surface proteins IL-1α, IL-1RA CXCL-1/2, and hBD-1 were associated with the disease activity and severity measurements. Using TAP technology, it was observed that there were clear differences in levels of IL-1α, IL-1RA, CXCL-1/2, and hBD-1 between psoriasis lesional and non-lesional skin. In addition, a positive correlation between CXCL-1/2 and desquamation, and between CXCL-1/2 and SLEB thickness was observed. During UVB treatment, the TAP measurements revealed a clear reduction of IL-1RA, CXCL 1/2, and hBD-1 on lesional skin. Further, skin surface measurements of IL-1RA and CXCL-1/2 displayed a different profile than those achieved by visual scoring of local inflammation, thus indicating that measuring the 'molecular root' of inflammation appears to have value as an objective, non-invasive biomarker measurement for scoring disease severity.
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Affiliation(s)
- Kadri Orro
- Department of Chemistry and Biotechnology, Tallinn University of Technology, Tallinn, Estonia
- FibroTx LLC, Tallinn, Estonia
- *Correspondence: Kadri Orro,
| | | | - Kristi Abram
- Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
- Clinic of Dermatology, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | | | | | - Maire Karelson
- Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
- Clinic of Dermatology, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | | | - Külli Kingo
- Clinic of Dermatology, Tartu University Hospital, Tartu, Estonia
- Clinic of Dermatology, Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | - Pieter Spee
- FibroTx LLC, Tallinn, Estonia
- PS! Pharmaconsult, Alleroed, Denmark
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McBain AJ, O'Neill CA, Amezquita A, Price LJ, Faust K, Tett A, Segata N, Swann JR, Smith AM, Murphy B, Hoptroff M, James G, Reddy Y, Dasgupta A, Ross T, Chapple IL, Wade WG, Fernandez-Piquer J. Consumer Safety Considerations of Skin and Oral Microbiome Perturbation. Clin Microbiol Rev 2019; 32:e00051-19. [PMID: 31366612 PMCID: PMC6750131 DOI: 10.1128/cmr.00051-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Microbiomes associated with human skin and the oral cavity are uniquely exposed to personal care regimes. Changes in the composition and activities of the microbial communities in these environments can be utilized to promote consumer health benefits, for example, by reducing the numbers, composition, or activities of microbes implicated in conditions such as acne, axillary odor, dandruff, and oral diseases. It is, however, important to ensure that innovative approaches for microbiome manipulation do not unsafely disrupt the microbiome or compromise health, and where major changes in the composition or activities of the microbiome may occur, these require evaluation to ensure that critical biological functions are unaffected. This article is based on a 2-day workshop held at SEAC Unilever, Sharnbrook, United Kingdom, involving 31 specialists in microbial risk assessment, skin and oral microbiome research, microbial ecology, bioinformatics, mathematical modeling, and immunology. The first day focused on understanding the potential implications of skin and oral microbiome perturbation, while approaches to characterize those perturbations were discussed during the second day. This article discusses the factors that the panel recommends be considered for personal care products that target the microbiomes of the skin and the oral cavity.
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Affiliation(s)
- Andrew J McBain
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
| | - Catherine A O'Neill
- Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
| | - Alejandro Amezquita
- Unilever, Safety & Environmental Assurance Centre (SEAC), Sharnbrook, United Kingdom
| | - Laura J Price
- Unilever, Safety & Environmental Assurance Centre (SEAC), Sharnbrook, United Kingdom
| | - Karoline Faust
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Bacteriology, Rega Institute, Leuven, Belgium
| | - Adrian Tett
- Department CIBIO, University of Trento, Trento, Italy
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Jonathan R Swann
- Division of Integrative Systems Medicine and Digestive Diseases, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | - Tom Ross
- University of Tasmania, Hobart, Tasmania, Australia
| | - Iain L Chapple
- Periodontal Research Group, The University of Birmingham, Birmingham, United Kingdom
| | - William G Wade
- Centre for Host-Microbiome Interactions, King's College London, London, United Kingdom
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4
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Lembo S, Caiazzo G, Balato N, Monfrecola G, Patra V, Wolf P, Balato A. Polymorphic light eruption and IL-1 family members: any difference with allergic contact dermatitis? Photochem Photobiol Sci 2018; 16:1471-1479. [PMID: 28812775 DOI: 10.1039/c7pp00142h] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polymorphic light eruption (PLE) is described as a delayed-type hypersensitivity reaction (DTHR) toward a de novo light-induced antigen, yet to be identified. In effect, the inflammatory pathways of PLE and allergic contact dermatitis (ACD) share common patterns in terms of the mediators involved from the innate and adaptive immune system participating in the DTHR. As we have previously highlighted the role of interleukin (IL)-1 family members in ACD, we hypothesised that the same mediators could have similar functions in PLE. Our research aimed to assess the expression of certain IL-1family members in PLE patients vs. controls, and to compare it with ACD. The study population comprised 17 patients with PLE, 5 affected by ACD and 10 healthy controls in the same age range. Lesional and healthy skin samples were collected respectively from patients and donors. IL-36α, IL-36β, IL-36γ, IL-36 receptor antagonist (Ra), IL-1β, IL-33 gene and protein expressions were evaluated through RT-PCR and immunohistochemistry. Circulating proteins in the PLE patients were analysed by using western blot. The IL-36γ gene expression was significantly increased in PLE lesions compared to that in healthy controls and ACD lesions (***p < 0.001; ##p < 0.01 respectively), whereas the other analyzed ILs were more expressed in ACD. Immunohistochemical analysis revealed that IL-36α and IL-36γ protein levels were increased in PLE lesions compared to those of the healthy samples (***p < 0.001). Furthermore the IL-36γ plasma level was increased in PLE patients vs. controls (*p < 0.05). Our findings indicate that the IL-1 family pro-inflammatory members are increased in PLE with distinct differences from those in ACD, in particular with regard to IL-36γ mRNA regulation. Their role as activators of the local, and perhaps systemic, immune response, or as inhibitors of the immune tolerance machinery, needs further investigation.
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Affiliation(s)
- S Lembo
- Department of Medicine, Surgery and Dentistry, "Scuola Medica Salernitana" University of Salerno, Italy.
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5
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Patra V, Mayer G, Gruber-Wackernagel A, Horn M, Lembo S, Wolf P. Unique profile of antimicrobial peptide expression in polymorphic light eruption lesions compared to healthy skin, atopic dermatitis, and psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 34:137-144. [PMID: 29044786 PMCID: PMC5888155 DOI: 10.1111/phpp.12355] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/05/2017] [Indexed: 12/01/2022]
Abstract
Background Polymorphic light eruption (PLE) has been attributed to type IV, most likely delayed‐type hypersensitivity response (adaptive immunity) but little is known on innate immunity, especially antimicrobial peptides (AMPs) in the disease. Abnormalities in AMP expression have been linked to pathological skin conditions such as atopic dermatitis (AD) and psoriasis. Methods Antimicrobial peptide profiling was carried out in PLE skin samples (n,12) compared with that of healthy (n,13), atopic (n,6), and psoriatic skin (n,6). Results Compared to healthy skin, we observed increased expression of psoriasin and RNAse7 (both mostly in stratum granulosum of the epidermis), HBD‐2 (in the cellular infiltrate of the dermis), and LL37 (mostly in and around blood vessels and glands) in PLE lesional skin, a similar expression profile as present in psoriatic skin and different to that of AD (with little or no expression of psoriasin, RNAse7, HBD‐2, and LL37). HBD‐3 was downregulated in PLE compared to its high expression in the epidermis and dermis of healthy skin, AD, and psoriasis. Conclusion The unique profile of differentially expressed AMPs in PLE implies a role in the pathophysiology of the disease, possibly directly or indirectly linked to the microbiome of the skin.
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Affiliation(s)
- VijayKumar Patra
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Gerlinde Mayer
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Alexandra Gruber-Wackernagel
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Michael Horn
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Serena Lembo
- Department of Medicine, Surgery, and Dentistry, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Peter Wolf
- Research Unit for Photodermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, Medical University of Graz, Graz, Austria
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Landeck L, Jakasa I, Dapic I, Lutter R, Thyssen JP, Skov L, Braun A, Schön MP, John SM, Kezic S, Brans R. The effect of epidermal levels of urocanic acid on 25-hydroxyvitamin D synthesis and inflammatory mediators upon narrowband UVB irradiation. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:214-23. [DOI: 10.1111/phpp.12249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Lilla Landeck
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Department of Dermatology; Ernst von Bergmann General Hospital; Teaching Hospital Charité University Medicine Berlin; Potsdam Germany
| | - Ivone Jakasa
- Laboratory for Analytical Chemistry; Department of Chemistry and Biochemistry; Faculty of Food Technology and Biotechnology; University of Zagreb; Zagreb Croatia
| | - Irena Dapic
- Laboratory for Analytical Chemistry; Department of Chemistry and Biochemistry; Faculty of Food Technology and Biotechnology; University of Zagreb; Zagreb Croatia
| | - René Lutter
- Departments of Respiratory Medicine and Experimental Immunology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Jacob P. Thyssen
- Department of Dermato-Allergology; Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - Lone Skov
- Department of Dermato-Allergology; Gentofte Hospital; University of Copenhagen; Hellerup Denmark
| | - Andrea Braun
- Department of Dermatology, Venereology, and Allergology; University Medical Center Göttingen; Georg August University; Göttingen Germany
- Lower Saxony Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
| | - Michael P. Schön
- Department of Dermatology, Venereology, and Allergology; University Medical Center Göttingen; Georg August University; Göttingen Germany
- Lower Saxony Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
| | - Swen M. John
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Lower Saxony Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
| | - Sanja Kezic
- Coronel Institute for Occupational Health; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory; University of Osnabrück; Osnabrück Germany
- Lower Saxony Institute of Occupational Dermatology; University of Osnabrück and University Medical Center Göttingen; Osnabrück/Göttingen Germany
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7
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Affiliation(s)
- Frank R de Gruijl
- Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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8
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Jensen MR, Simonsen L, Karlsmark T, Lanng C, Bülow J. Higher vascular endothelial growth factor-C concentration in plasma is associated with increased forearm capillary filtration capacity in breast cancer-related lymphedema. Physiol Rep 2015; 3:3/6/e12403. [PMID: 26059032 PMCID: PMC4510618 DOI: 10.14814/phy2.12403] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Breast cancer-related lymphedema (BCRL) is a frequent, chronic and debilitating swelling that mainly affects the ipsilateral arm and develops as a complication to breast cancer treatment. The pathophysiology is elusive opposing development of means for prediction and treatment. We have earlier shown that the forearm capillary filtration coefficient (CFC) is increased bilaterally in BCRL. In this study, we aimed to elucidate if increased CFC is associated with low-grade inflammation and/or vascular endothelial growth factor-c (VEGF-C) signaling. Fourteen patients with unilateral BCRL and nine matched breast cancer controls without BCRL participated. Forearm CFC was measured by venous congestion strain gauge plethysmography, and suction blisters were induced medially on the upper arms. Concentrations of 17 selected cytokines, VEGF-C, and total protein were measured in blister fluid and in plasma. Forearm CFC was higher bilaterally in BCRL subjects (P ≤ 0.036). No differences between forearms were found in either group. Plasma VEGF-C concentrations were significantly higher in the BCRL subjects (P < 0.001). In BCRL subjects, monocyte chemotactic protein 1 (MCP-1) (P = 0.009) and total protein (P = 0.035) concentrations were higher in blister fluid from edematous arms compared with nonedematous arms. No differences were found in interstitial cytokine or total protein concentrations between arms in control subjects. Higher plasma concentration of VEGF-C is a possible cause of bilaterally increased forearm CFC in BCRL subjects. Interstitially increased MCP-1 levels may augment local microvascular protein permeability in BCRL.
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Affiliation(s)
- Mads Radmer Jensen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital University Hospital of Copenhagen, Copenhagen, Denmark Department of Dermatology, Copenhagen Wound Healing Centre Copenhagen Lymphoedema Centre Bispebjerg Hospital University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lene Simonsen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital University Hospital of Copenhagen, Copenhagen, Denmark
| | - Tonny Karlsmark
- Department of Dermatology, Copenhagen Wound Healing Centre Copenhagen Lymphoedema Centre Bispebjerg Hospital University Hospital of Copenhagen, Copenhagen, Denmark
| | - Charlotte Lanng
- Department of Breast Surgery, Herlev Hospital University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jens Bülow
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital University Hospital of Copenhagen, Copenhagen, Denmark Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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9
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de Gruijl FR, Rhodes LE. Explaining a possible protective role of polymorphous light eruption against skin cancer. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.09.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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10
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Wolf P, Gruber-Wackernagel A, Rinner B, Griesbacher A, Eberhard K, Groselj-Strele A, Mayer G, Stauber RE, Byrne SN. Phototherapeutic hardening modulates systemic cytokine levels in patients with polymorphic light eruption. Photochem Photobiol Sci 2013; 12:166-73. [PMID: 22949107 DOI: 10.1039/c2pp25187f] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The etiopathogenesis of polymorphic light eruption (PLE) has been linked to impaired UV-immunosuppression, Langerhans cell (LC) retention, and an absence of neutrophil infiltration into UV-exposed PLE skin. We have previously shown that photohardening restores the impaired neutrophil responsiveness to the chemoattractants leucotriene B4 and formyl-methionyl-leucyl-phenylalanin in PLE patients. The aim of this study was to investigate whether photohardening modulates baseline chemokine and cytokine levels which would alter chemoresponsiveness and hence immune function in PLE patients. Sixteen PLE patients received photohardening therapy for 4-9 weeks by 311 nm UVB. Plasma samples were taken both before and within 48 h of the penultimate phototherapeutic exposure. Plasma from these 16 patients, 8 non-irradiated PLE patients, and 14 control subjects was analyzed for IL-1β, CXCL8 (IL-8), IL-10, IL-17, TNF, CCL2 (MCP-1), CCL5 (RANTES), CCL11 (eotaxin), and CCL22 (MDC). These cytokines and chemokines were measured in early spring (March to April) and again in late spring (April to June). PLE patients had a significantly elevated level of CCL11 (p = 0.003) and IL-1β (p = 0.002) in early spring (before phototherapy). In late spring, after phototherapy, PLE patients had significantly elevated CCL2 (p = 0.002) and TNF (p = 0.002) but a trend for lowered plasma levels of CXCL8 (p = 0.021). When comparing the cytokine shifts from early to late spring, while healthy controls and non-UV-irradiated PLE patients showed an increase, PLE patients undergoing photohardening exhibited a trend for decrease in IL-1β (p = 0.012). Taken together, our results indicate that photohardening may alter the complex cytokine milieu in PLE, in particular via IL-1β, helping to normalise the pathophysiologic response to subsequent UV exposure.
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Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
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The mechanisms and consequences of ultraviolet-induced immunosuppression in the skin and eye. Eye Contact Lens 2011; 37:176-84. [PMID: 21709488 DOI: 10.1097/icl.0b013e31821d7573] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultraviolet radiation (UVR) of the skin results in immune suppression to antigens encountered shortly after the exposure. The pathways leading to the downregulation in immunity are complex, initiated by chromophores located at the surface of the skin and ending with the generation of immunosuppressive mediators and regulatory cells. Ultraviolet-induced immunosuppression can be considered not only as beneficial, such as in preventing chronic inflammatory responses and allergic and automimmune reactions, but it can also be detrimental, such as in the lack of control of skin tumors and infectious diseases. The eye is an immune privileged site through a wide variety of mechanisms that allow selected immune responses without causing inflammation. The role of UVR in altering immune responses in the eye is not clear and is discussed in relation to photokeratitis, herpetic stromal keratitis, and pterygium.
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Smith E, Kiss F, Porter RM, Anstey AV. A review of UVA-mediated photosensitivity disorders. Photochem Photobiol Sci 2011; 11:199-206. [PMID: 22127510 DOI: 10.1039/c1pp05191a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A number of skin conditions are characterised by photosensitivity to UVA. Some of these are exclusively UVA-mediated conditions, while others include UVA in the action spectrum which also include UVB and/or visible light. This review aims to describe this diverse range of conditions for non-dermatologist scientists with an interest in this topic. As such, clinical details, including treatments, are brief and succinct. Recent advances in understanding the pathogenesis of these conditions is highlighted.
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Affiliation(s)
- E Smith
- Cardiff and Vale University Health Board, Heath Park, Cardiff, United Kingdom CF14 4XN
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13
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Norval M, Halliday GM. The consequences of UV-induced immunosuppression for human health. Photochem Photobiol 2011; 87:965-77. [PMID: 21749399 DOI: 10.1111/j.1751-1097.2011.00969.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Exposure to UV radiation can cause suppression of specific immune responses. The pathways leading to the down-regulation are complex, starting from the absorption of UV photons by chromophores in the skin and ending with local and systemic changes in immune mediators, the generation of T and B regulatory cells and inhibition of effector and memory T cell activation. The consequences for human health are thought to be both beneficial and adverse. The former are illustrated by protection against polymorphic light eruption, and possible protection against T cell-mediated autoimmune diseases and asthma. The latter are illustrated by skin cancer, cutaneous lupus erythematosus and infectious diseases including vaccination. Many outstanding questions remain in this rapidly developing and controversial area, not least what advice to give the general public regarding their sun exposure. While considerable advances have been made in the development of strategies that preserve the health benefits of sunlight exposure and decrease its detrimental effects, further research is required before optimal levels of protection are achieved.
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Affiliation(s)
- Mary Norval
- Biomedical Sciences, University of Edinburgh, Edinburgh, Scotland.
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14
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Gruber-Wackernagel A, Heinemann A, Konya V, Byrne SN, Singh TP, Hofer A, Legat F, Wolf P. Photohardening restores the impaired neutrophil responsiveness to chemoattractants leukotriene B4 and formyl-methionyl-leucyl-phenylalanin in patients with polymorphic light eruption. Exp Dermatol 2011; 20:473-6. [PMID: 21410775 DOI: 10.1111/j.1600-0625.2011.01264.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A failure to induce immune suppression after UV exposure has been implicated in the pathogenesis of polymorphic light eruption (PLE). This immunological resistance has been linked to an impaired neutrophil infiltration into the skin following UV exposure. Therapeutic photohardening can restore this abnormal neutrophil infiltration in PLE skin and is thought to be responsible for the prophylactic efficacy. The aim of this study was to elucidate the pathogenic mechanism of the described neutrophil deficiency in PLE. Peripheral blood neutrophil responses to the chemoattractants leukotriene B4 (LTB(4)) and formyl-methionyl-leucyl-phenylalanin (fMLP) were investigated in vitro. Samples from 10 patients with PLE before and after 6 weeks of photohardening therapy were assessed. Flow cytometry was used to measure the changes associated with neutrophil activation. We found a significantly reduced neutrophil responsiveness to LTB(4) and fMLP in PLE patients, which was restored to normal levels after phototherapy. Indeed, PLE neutrophil responsiveness to these two chemoattractants after (but not before) phototherapy was similar to that of age- and sex-matched healthy control subjects. This indicates that an abnormal chemotactic potential to neutrophils is a crucial factor in the pathogenesis of PLE. Normalization following photohardening may therefore account for the therapeutic efficacy by restoring UV-induced neutrophil skin infiltration. Our results reveal a completely novel pathogenic mechanism involved in PLE and offer unique targets for therapy.
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Gruber-Wackernagel A, Bambach I, Legat FJ, Hofer A, Byrne SN, Quehenberger F, Wolf P. Randomized double-blinded placebo-controlled intra-individual trial on topical treatment with a 1,25-dihydroxyvitamin D₃ analogue in polymorphic light eruption. Br J Dermatol 2011; 165:152-63. [PMID: 21428979 DOI: 10.1111/j.1365-2133.2011.10333.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Polymorphic light eruption (PLE) is a very frequent photodermatosis whose pathogenesis may involve resistance to ultraviolet (UV)-induced immune suppression. Similar to UV radiation, calcitriol (1,25-dihydroxyvitamin D₃) and its analogues such as calcipotriol have been shown to exhibit immunosuppressive properties. OBJECTIVES We performed a randomized double-blinded placebo-controlled intraindividual half-body trial (NCT00871052) to investigate the preventive effect of a calcipotriol-containing cream in PLE. METHODS Thirteen patients with PLE (10 women, three men; mean age 37 years) pretreated their skin on two symmetrically located test fields with calcipotriol or placebo cream twice daily for 7 days before the start of photoprovocation testing with solar-simulated UV radiation. We established a specific PLE test score [AA + SI + 0·4 P (range 0-12), where AA is affected area score (range 0-4), SI is skin infiltration score (range 0-4) and P is pruritus score on a visual analogue scale (range 0-10)] to quantify PLE severity. RESULTS Photoprovocation led to PLE lesions in 12/13 (92%) patients. As shown by the PLE test score, compared with placebo calcipotrial pretreatment significantly reduced PLE symptoms in average by 32% (95% confidence interval 21-44%; P = 0·0022, exact Wilcoxon signed-rank test) throughout the observation period starting at 48 h until 144 h after the first photoprovocation exposure. At 48, 72 and 144 h calcipotriol pretreatment resulted in a lower PLE test score in 7 (58%), 9 (75%) and 10 (83%) of the 12 cases, respectively. Considering all time points together, calcipotriol diminished the PLE test score in all 12 photoprovocable patients (P = 0·0005; Wilcoxon signed-rank test). CONCLUSIONS These results suggest a potential therapeutic benefit of topical 1,25-dihydroxyvitamin D₃ analogues as prophylactic treatment in patients with PLE.
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Affiliation(s)
- A Gruber-Wackernagel
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036 Graz, Austria
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Ruutu MP, Chen X, Joshi O, Kendall MA, Frazer IH. Increasing mechanical stimulus induces migration of Langerhans cells and impairs the immune response to intracutaneously delivered antigen. Exp Dermatol 2011; 20:534-6. [DOI: 10.1111/j.1600-0625.2010.01234.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hofer A, Legat FJ, Gruber-Wackernagel A, Quehenberger F, Wolf P. Topical liposomal DNA-repair enzymes in polymorphic light eruption. Photochem Photobiol Sci 2011; 10:1118-28. [PMID: 21437317 DOI: 10.1039/c1pp05009e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Polymorphic light eruption (PLE) is a very frequent photodermatosis in Europe whose pathogenesis may involve resistance to UV-induced immune suppression and simultaneous immune reactions against skin photoneoantigens. We performed a randomized, double-blind, placebo-controlled intra-individual half-body trial to investigate the protective effect of an after-sun (AS) lotion containing DNA-repair enzymes (photolyase from Anacystis nidulans and Micrococcus luteus extract with endonuclease activity). Fourteen PLE patients were exposed to suberythemal doses of solar-simulated UV radiation on 4 consecutive days at 4 symmetrically located PLE-prone test fields per patient. The test fields were treated with (i) active AS lotion or (ii) a placebo lotion immediately after each UV exposure, or (iii) an SPF30 sunscreen before UV exposure or left untreated. All test fields were exposed to photoactivating blue light 1 h after each UV exposure. As shown by a newly established specific PLE test score (AA + SI + 0.4P [range, 0-12], where AA is affected area score [range, 0-4], SI is skin infiltration score [range, 0-4], and P is pruritus score on a visual analogue scale [range, 0-10]), PLE symptoms were significantly fewer on test sites treated with active AS lotion than on untreated (P = 0.00049) or placebo-treated test sites (P = 0.024). At 144 h after first UV exposure (the time point of maximal PLE symptoms), the mean test scores for untreated, active AS lotion-treated, and placebo-treated test fields were 4.39, 1.73 (61% reduction; 95% confidence interval (CI), 36% to 85%), and 3.20 (27% reduction; 95% CI, 3% to 51%), respectively. Pretreatment with SPF30 sunscreen completely prevented PLE symptoms in all patients. The present results indicate that DNA damage may trigger PLE and that the application of topical liposomes containing DNA repair enzymes to increase DNA repair may effectively prevent PLE.
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Affiliation(s)
- Angelika Hofer
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Auenbrugger Platz 8, A-8036, Graz, Austria
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UV-induced tolerance to a contact allergen is impaired in polymorphic light eruption. J Invest Dermatol 2010; 130:2578-82. [PMID: 20613777 DOI: 10.1038/jid.2010.181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Polymorphic light eruption (PLE) is a common skin disorder provoked by exposure to UVR. Its clinical symptoms resemble those of a contact allergic reaction. PLE is generally considered a T-cell-mediated autoimmune reaction toward a yet unidentified antigen formed in UVR-exposed skin. Predisposition to such an immune reaction may result from aberrant epitope formation, increased immune reactivity to a universal epitope, or diminished propensity to UVR-induced immunosuppression or to the induction of tolerance. In a study comprising a total of 24 PLE patients and 24 healthy sex- and age-matched controls, we found that both groups demonstrated similar immunosuppression of contact sensitization to diphenylcyclopropenone by earlier exposure to solar-simulating UVR. However, only 1 out of 13 PLE patients (8%) versus 6 out of 11 controls (55%) that had been immunosuppressed by UVR exhibited a state of immunotolerance toward the same allergen after 10-24 months (P=0.023). We conclude that the impaired propensity to UVR-induced allergen-specific immunotolerance may promote recurrent PLE.
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Wolf P, Byrne SN, Gruber-Wackernagel A. New insights into the mechanisms of polymorphic light eruption: resistance to ultraviolet radiation-induced immune suppression as an aetiological factor. Exp Dermatol 2009; 18:350- 6. [PMID: 19348001 DOI: 10.1111/j.1600-0625.2009.00859.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An abnormal immune response has long been thought responsible for the patho-aetiology of polymorphic light eruption, the most common photodermatosis. Recent evidence indicates that polymorphic light eruption patients are resistant to the immune suppressive effects of sunlight, a phenomenon that leads to the formation of skin lesions upon seasonal sun exposure. This immunological abnormality in polymorphic light eruption supports the concept of the biological significance and evolutionary logic of sunlight-induced immune suppression, i.e. the prevention of immune responses to photo-induced neo-antigens in the skin, thereby preventing autoimmunity and skin rashes. This article focuses on the immunological alterations in polymorphic light eruption and the pathogenic significance to the disease state and skin carcinogenesis.
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Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Graz, Austria.
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