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Goel RR, Rook AH. Immunobiology and treatment of cutaneous T-cell lymphoma. Expert Rev Clin Immunol 2024:1-12. [PMID: 38450476 DOI: 10.1080/1744666x.2024.2326035] [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: 12/18/2023] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Primary cutaneous T cell lymphomas (CTCL) are a heterogenous group of non-Hodgkin lymphomas derived from skin-homing T cells. These include mycosis fungoides and its leukemic variant Sezary syndrome, as well as the CD30+ lymphoproliferative disorders. AREAS COVERED In this review, we provide a summary of the current literature on CTCL, with a focus on the immunopathogenesis and treatment of mycosis fungoides and Sezary syndrome. EXPERT OPINION Recent advances in immunology have provided new insights into the biology of malignant T cells. This in turn has led to the development of new therapies that modulate the immune system to facilitate tumor clearance or target specific aspects of tumor biology.
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Affiliation(s)
- Rishi R Goel
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology and Immune Health (I3H), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alain H Rook
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Goel RR, Rook AH. Psoralen Plus UVA Induces Local IFN Production and Antitumor Responses in Cutaneous T-Cell Lymphoma. J Invest Dermatol 2024; 144:449-450. [PMID: 37921716 DOI: 10.1016/j.jid.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Rishi R Goel
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Institute for Immunology and Immune Health (I3H), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alain H Rook
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Doğan PE, Akay BN, Vural S, Arı C, Yılmaz TE, Şanlı H. Risk of skin cancers in mycosis fungoides patients receiving PUVA therapy: A real-life experience from a single tertiary center. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:428-434. [PMID: 36967646 DOI: 10.1111/phpp.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/12/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma. Skin-directed therapies, including phototherapy, are the first-line treatment modalities. Psoralen plus ultraviolet A light photochemotherapy (PUVA) is quite effective in controlling the disease; however, long-term adverse effects, particularly carcinogenesis, are the cons of this treatment. OBJECTIVE There are various studies on the negative impact of PUVA on skin cancer in patients with autoimmune skin diseases. The data on the long-term effects of phototherapy on MF patients are scarce. METHODS All MF cases that received PUVA alone or combined with other treatments at a single tertiary center were analyzed. This study compared the development of non-melanoma skin cancers, melanoma, and solid organ tumors in MF patients with at least 5-year follow-up data with age- and sex-matched controls. RESULTS A total of 104 patients were included in the study. Ninety-two malignancies were detected in 16 (15.4%) patients, and six developed multiple malignancies. Skin cancers consisted of 56 basal cell carcinomas, 16 Bowen's disease, four squamous cell carcinomas, three melanomas, two basosquamous cell carcinomas, one Kaposi sarcoma, and one keratoacanthoma were found in nine (8.7%) patients. Eight patients developed three solid cancers and six lymphomas. The risk of developing skin cancer was associated with the total number of PUVA sessions (<250 vs ≥250 sessions; hazard ratio (HR) 4.44, 95% confidence interval (CI) 1.033-19.068; p = .045). 9 (13.2%) of 68 patients who had follow-ups for at least 5 years developed skin cancer. Compared to an age- and sex-matched cohort, the prevalence of new skin cancer was considerably greater (p = .009). CONCLUSIONS Patients with MF are predisposed to develop secondary malignancies, and continual exposure to PUVA may potentiate this risk. Annual digital dermoscopic follow-up in MF patients treated with UVA is advised for early diagnosis and treatment of secondary cutaneous malignancies.
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Affiliation(s)
- Pelin Ertop Doğan
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
- Faculty of Medicine, Dermatology Department, Zonguldak Bulent Ecevit University, 67600, Zonguldak, Turkey
| | - Bengü Nisa Akay
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
| | - Seçil Vural
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
- Department of Dermatology and Venereology, Koç University School of Medicine, 34010, Istanbul, Turkey
| | - Canan Arı
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
| | - Tuğçe Ertürk Yılmaz
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
| | - Hatice Şanlı
- Faculty of Medicine, Dermatology Department, Ankara University, 06230, Ankara, Turkey
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Wang Y, Wang Y, Li F, Zou J, Li X, Xu M, Yu D, Ma Y, Huang W, Sun X, Zhang Y. Psoralen Suppresses Lipid Deposition by Alleviating Insulin Resistance and Promoting Autophagy in Oleate-Induced L02 Cells. Cells 2022; 11:cells11071067. [PMID: 35406631 PMCID: PMC8997557 DOI: 10.3390/cells11071067] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/09/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) held a high global prevalence in recent decades. Hepatic lipid deposition is the major characteristic of NAFLD. We aim to explore the mechanisms of psoralen on lipid deposition in NAFLD. The effects of psoralen on insulin resistance, lipid deposition, the expression and membrane translocation of glucose transporter type 4 (GLUT4), autophagy, and lipogenesis enzymes were determined on sodium oleate-induced L02 cells. Chloroquine and 3-MA were employed. The AMP-activated protein kinase alpha (AMPKα) was knocked down by siRNA. Psoralen alleviated insulin resistance in sodium oleate-induced L02 hepatocytes by upregulating the expression and membrane translocation of GLUT4. Psoralen inhibited lipid accumulation by decreasing the expression of key lipogenesis enzymes. Psoralen promotes autophagy and the autophagic flux to enhance lipolysis. Psoralen promoted the fusion of the autophagosome with the lysosome. Both chloroquine and 3-MA blocked the effects of psoralen on autophagy and lipid accumulation. The AMPKα deficiency attenuated the effects of psoralen on autophagy and lipid accumulation. Our study demonstrated that as an antioxidant, psoralen attenuates NAFLD by alleviating insulin resistance and promoting autophagy via AMPK, suggesting psoralen to be a promising candidate for NAFLD.
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Affiliation(s)
- Yuhao Wang
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China;
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Yonglun Wang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Fang Li
- Department of Hepatopancreatobiliary Surgery, Sichuan Cancer Hospital and Institute, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, China;
| | - Jie Zou
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Xiaoqian Li
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Mengxia Xu
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Daojiang Yu
- Department of Plastic Surgery, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu 610051, China;
| | - Yijia Ma
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
| | - Wei Huang
- Department of Endocrinology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China;
| | - Xiaodong Sun
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
- Correspondence: (X.S.); or (Y.Z.); Tel.: +86-28-8550-1278 (X.S. & Y.Z.)
| | - Yuanyuan Zhang
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China;
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu 610041, China; (Y.W.); (J.Z.); (X.L.); (M.X.); (Y.M.)
- Correspondence: (X.S.); or (Y.Z.); Tel.: +86-28-8550-1278 (X.S. & Y.Z.)
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Vieyra-Garcia PA, Wolf P. A deep dive into UV-based phototherapy: Mechanisms of action and emerging molecular targets in inflammation and cancer. Pharmacol Ther 2020; 222:107784. [PMID: 33316286 DOI: 10.1016/j.pharmthera.2020.107784] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
UV-based phototherapy (including psoralen plus UVA (PUVA), UVB and UVA1) has a long, successful history in the management of numerous cutaneous disorders. Photoresponsive diseases are etiologically diverse, but most involve disturbances in local (and occasionally systemic) inflammatory cells and/or abnormalities in keratinocytes that trigger inflammation. UV-based phototherapy works by regulating the inflammatory component and inducing apoptosis of pathogenic cells. This results in a fascinating and complex network of simultaneous events-immediate transcriptional changes in keratinocytes, immune cells, and pigment cells; the emergence of apoptotic bodies; and the trafficking of antigen-presenting cells in skin-that quickly transform the microenvironment of UV-exposed skin. Molecular elements in this system of UV recognition and response include chromophores, metabolic byproducts, innate immune receptors, neurotransmitters and mediators such as chemokines and cytokines, antimicrobial peptides, and platelet activating factor (PAF) and PAF-like molecules that simultaneously shape the immunomodulatory effects of UV and their interplay with the microbiota of the skin and beyond. Phototherapy's key effects-proapoptotic, immunomodulatory, antipruritic, antifibrotic, propigmentary, and pro-prebiotic-promote clinical improvement in various skin diseases such as psoriasis, atopic dermatitis (AD), graft-versus-host disease (GvHD), vitiligo, scleroderma, and cutaneous T-cell lymphoma (CTCL) as well as prevention of polymorphic light eruption (PLE). As understanding of phototherapy improves, new therapies (UV- and non-UV-based) are being developed that will modify regulatory T-cells (Treg), interact with (resident) memory T-cells and /or utilize agonists and antagonists as well as antibodies targeting soluble molecules such as cytokines and chemokines, transcription factors, and a variety of membrane-associated receptors.
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Affiliation(s)
- Pablo A Vieyra-Garcia
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, Graz A-8036, Austria.
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Cochrane Database Syst Rev 2020; 9:CD013206. [PMID: 32927498 PMCID: PMC8128359 DOI: 10.1002/14651858.cd013206.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Eczema is a common and chronic, relapsing, inflammatory skin disorder. It seriously impacts quality of life and economic outcomes, especially for those with moderate to severe eczema. Various treatments allow sustained control of the disease; however, their relative benefit remains unclear due to the limited number of trials directly comparing treatments. OBJECTIVES To assess the comparative efficacy and safety of different types of systemic immunosuppressive treatments for moderate to severe eczema using NMA and to generate rankings of available systemic immunosuppressive treatments for eczema according to their efficacy and safety. SEARCH METHODS We searched the following databases up to August 2019: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. SELECTION CRITERIA All randomised controlled trials (RCTs) of systemic immunosuppressive agents for moderate to severe atopic eczema when compared against placebo or any other eligible eczema treatment. DATA COLLECTION AND ANALYSIS We synthesised data using pair-wise analysis and NMA to compare treatments and rank them according to their effectiveness. Effectiveness was assessed primarily by determining the proportion of participants who achieved at least 75% improvement in the Eczema Area and Severity Index (EASI75) and improvement in the Patient-Oriented Eczema Measure (POEM). Safety was evaluated primarily by considering the proportion of participants with serious adverse events (SAEs) and infection. We deemed short-term follow-up as ≤ 16 weeks and long-term follow-up as > 16 weeks. We assessed the certainty of the body of evidence from the NMA for these primary outcomes using six domains of CiNEMA grading. MAIN RESULTS We included a total of 74 studies, with 8177 randomised participants. Approximately 55% of participants were male, with average age of 32 years (range 2 to 84 years), although age and gender were unreported for 419 and 902 participants, respectively. Most of the included trials were placebo controlled (65%), 34% were head-to-head studies (15% assessed the effects of different doses of the same drug), and 1% were multi-armed studies with both an active comparator and a placebo. All trials included participants with moderate to severe eczema, but 62% of studies did not separate data by severity; 38% of studies assessed only severe eczema. The total duration of included trials ranged from 2 weeks to 60 months, whereas treatment duration varied from a single dose (CIM331, KPL-716) to 60 months (methotrexate (MTX)). Seventy studies were available for quantitative synthesis; this review assessed 29 immunosuppressive agents from three classes of interventions. These included (1) conventional treatments, with ciclosporin assessed most commonly; (2) small molecule treatments, including phosphodiesterase (PDE)-4 inhibitors, tyrosine kinase inhibitors, and Janus kinase (JAK) inhibitors; and (3) biological treatments, including anti-CD31 receptors, anti-interleukin (IL)-22, anti-IL-31, anti-IL-13, anti-IL-12/23p40, anti-OX40, anti-TSLP, anti-CRTH2, and anti-immunoglobulin E (IgE) monoclonal antibodies, but most commonly dupilumab. Most trials (73) assessed outcomes at a short-term duration ranging from 2 to 16 weeks, whereas 33 trials assessed long-term outcomes, with duration ranging from 5 to 60 months. All participants were from a hospital setting. Fifty-two studies declared a source of funding, and of these, pharmaceutical companies funded 88%. We rated 37 studies as high risk; 21, unclear risk, and 16, low risk of bias, with studies most commonly at high risk of attrition bias. Network meta-analysis suggests that dupilumab ranks first for effectiveness when compared with other biological treatments. Dupilumab is more effective than placebo in achieving EASI75 (risk ratio (RR) 3.04, 95% confidence interval (CI) 2.51 to 3.69) and improvement in POEM score (mean difference 7.30, 95% CI 6.61 to 8.00) at short-term follow-up (high-certainty evidence). Very low-certainty evidence means we are uncertain of the effects of dupilumab when compared with placebo, in terms of the proportion of participants who achieve EASI75 (RR 2.59, 95% CI 1.87 to 3.60) at longer-term follow-up. Low-certainty evidence indicates that tralokinumab may be more effective than placebo in achieving short-term EASI75 (RR 2.54, 95% CI 1.21 to 5.34), but there was no evidence for tralokinumab to allow us to assess short-term follow-up of POEM or long-term follow-up of EASI75. We are uncertain of the effect of ustekinumab compared with placebo in achieving EASI75 (long-term follow-up: RR 1.17, 95% CI 0.40 to 3.45; short-term follow-up: RR 0.91, 95% CI 0.28 to 2.97; both very low certainty). We found no evidence on ustekinumab for the POEM outcome. We are uncertain whether other immunosuppressive agents that targeted our key outcomes influence the achievement of short-term EASI75 compared with placebo due to low- or very low-certainty evidence. Dupilumab and ustekinumab were the only immunosuppressive agents evaluated for longer-term EASI75. Dupilumab was the only agent evaluated for improvement in POEM during short-term follow-up. Low- to moderate-certainty evidence indicates a lower proportion of participants with SAEs after treatment with QAW039 and dupilumab compared to placebo during short-term follow-up, but low- to very low-certainty evidence suggests no difference in SAEs during short-term follow-up of other immunosuppressive agents compared to placebo. Evidence for effects of immunosuppressive agents on risk of any infection during short-term follow-up and SAEs during long-term follow-up compared with placebo was of low or very low certainty but did not indicate a difference. We did not identify differences in other adverse events (AEs), but dupilumab is associated with specific AEs, including eye inflammation and eosinophilia. AUTHORS' CONCLUSIONS Our findings indicate that dupilumab is the most effective biological treatment for eczema. Compared to placebo, dupilumab reduces eczema signs and symptoms in the short term for people with moderate to severe atopic eczema. Short-term safety outcomes from clinical trials did not reveal new safety concerns with dupilumab. Overall, evidence for the efficacy of most other immunosuppressive treatments for moderate to severe atopic eczema is of low or very low certainty. Given the lack of data comparing conventional with newer biological treatments for the primary outcomes, there remains high uncertainty for ranking the efficacy and safety of conventional treatments such as ciclosporin and biological treatments such as dupilumab. Most studies were placebo-controlled and assessed only short-term efficacy of immunosuppressive agents. Further adequately powered head-to-head RCTs should evaluate comparative long-term efficacy and safety of available treatments for moderate to severe eczema.
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Affiliation(s)
- Ratree Sawangjit
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand
| | - Piyameth Dilokthornsakul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Antonia Lloyd-Lavery
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | | | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah, USA
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Geenen SR, Schumann T, Müller TJJ. Fluorescent Donor-Acceptor Psoralen Cruciforms by Consecutive Suzuki-Suzuki and Sonogashira-Sonogashira One-Pot Syntheses. J Org Chem 2020; 85:9737-9750. [PMID: 32575986 DOI: 10.1021/acs.joc.0c01059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Two novel donor-acceptor cruciform topologies are efficiently synthesized by site-selective Suzuki-Suzuki and Sonogashira-Sonogashira multicomponent reactions starting from a bromo-triflato-functionalized psoralen scaffold. In addition to tunability of photophysical properties, such as absorption and emission, many derivatives possess partially high relative fluorescence quantum yields in solution and fluoresce strongly in the solid state. Additionally, the promising compounds show solvatochromism and acidochromic effects. In addition, 8-p-anisyl-5-p-cyanophenyl-substituted psoralen exhibits aggregation-induced emission properties. Experimentally (applying the Lippert-Mataga model) and computationally (TD-DFT calculations), the pronounced charge transfer character of the longest wavelength absorption band was confirmed.
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Affiliation(s)
- Sarah R Geenen
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
| | - Torben Schumann
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
| | - Thomas J J Müller
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
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Geenen SR, Presser L, Hölzel T, Ganter C, Müller TJJ. Electronic Finetuning of 8-Methoxy Psoralens by Palladium-Catalyzed Coupling: Acidochromicity and Solvatochromicity. Chemistry 2020; 26:8064-8075. [PMID: 32048795 PMCID: PMC7383860 DOI: 10.1002/chem.201905676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Indexed: 12/21/2022]
Abstract
Differently 5‐substituted 8‐methoxypsoralens can be synthesized by an efficient synthetic route with various cross‐coupling methodologies, such as Suzuki, Sonogashira and Heck reaction. Compared to previously synthesized psoralens, thereby promising daylight absorbing compounds as potentially active agents against certain skin diseases can be readily accessed. Extensive investigations of all synthesized psoralen derivatives reveal fluorescence in the solid state as well as several distinctly emissive derivatives in solution. Donor‐substituted psoralens exhibit remarkable photophysical properties, such as high fluorescence quantum yields and pronounced emission solvatochromicity and acidochromicity, which were scrutinized by Lippert–Mataga and Stern–Volmer plots. The results indicate that the compounds exceed the limit of visible light, a significant factor for potential applications as an active agent. In addition, (TD)DFT calculations were performed to elucidate the underlying electronic structure and to assign experimentally obtained data.
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Affiliation(s)
- Sarah R Geenen
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Lysander Presser
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Torsten Hölzel
- Institut für Anorganische Chemie und Strukturchemie I, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Christian Ganter
- Institut für Anorganische Chemie und Strukturchemie I, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Thomas J J Müller
- Institut für Organische Chemie und Makromolekulare Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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Vieyra-Garcia PA, Wolf P. Extracorporeal Photopheresis: A Case of Immunotherapy Ahead of Its Time. Transfus Med Hemother 2020; 47:226-235. [PMID: 32595427 DOI: 10.1159/000508479] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 12/18/2022] Open
Abstract
Extracorporeal photopheresis (ECP) is a cell-based immunotherapy that involves the reinfusion of autologous leukocytes after exposure to psoralen and UVA. The treatment has been used for over 30 years, at first on patients with cutaneous T-cell lymphoma (CTCL) and later for the management of patients with graft-versus-host disease (GvHD), sclerosing disorders, atopic dermatitis, and other diseases that may share the common driving factor of a pathogenic T-cell clone or clones in blood circulation. Patients with clinical improvement mount an antigen-specific immune response that may have tolerance traits in the case of GvHD or anticlonal cytotoxic characteristics in the case of CTCL. The exact mechanisms that dictate one response or the other are not fully understood, but the evidence accumulated so far indicates that multiple events occur simultaneously and consequentially contribute to the end result. These include contact of cells with the outside (plastics and tubing of the ECP apparatus), exposure to psoralen and UVA that activates platelets, monocytes, and other myeloid cells, the release of damage-associated molecular patterns, differentiation of monocytes into dendritic cells, and generation and successive presentation of numerous antigens after the phagocytosis of apoptotic cells. Once reintroduced, the ECP product increases the frequency and activity of regulatory T cells (Tregs), shifts the systemic cytokine balance, and promotes extravasation of immune cells that together shape the effects of this treatment. In this review, we summarize the seminal work and most recent literature of the therapeutic mechanisms and reflect on future avenues of improvements and applications of ECP.
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Affiliation(s)
| | - Peter Wolf
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
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El Sayed H, Shalaby S, Abdel-Halim MRE, Aboelfadl DM, Samir N. Efficacy of doxycycline in the treatment of early stages of mycosis fungoides: a randomized controlled trial. J DERMATOL TREAT 2019; 32:424-431. [PMID: 31526286 DOI: 10.1080/09546634.2019.1667474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mycosis fungoides is the most common type of primary cutaneous T cell lymphomas. Doxycycline promoted apoptosis in different human malignant cell lines and in vivo models. OBJECTIVES To test for the therapeutic efficacy of doxycycline in comparison to PUVA in early stages of classic MF and its effect on T cell apoptosis. METHODS Thirty-six patients were randomized into either: doxycycline 200 mg daily (n = 18) or PUVA (3 weekly sessions) (n = 18) for 12 weeks. The primary outcome (therapeutic efficacy) was defined in terms of objective response rate (ORR) which was measured according to changes in the modified severity weighted assessment tool (mSWAT). RESULTS Doxycycline achieved significantly less ORR (partial response) in comparison to PUVA (11.1%, 50%, respectively, p = .016). The percent reduction in mSWAT, CAILS, histopathology score and CD3 expression was significantly less in the doxycycline group (p = .001, p = .001, p ˂ .001, and p = .004, respectively). Within the doxycycline group, changes in mSWAT and CAILS showed no correlation with changes in the CD3 or Bcl-2 expression. Gastric upset was significantly more encountered in the doxycycline group (p = .001). CONCLUSION Doxycycline is not suitable as a sole agent in the treatment of early stages of classic MF, acting mainly by anti-inflammatory rather apoptotic function. REGISTER NUMBER NCT03454945 (www.clinicaltrials.gov).
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Affiliation(s)
- H El Sayed
- Dermatology Department, Faculty of Medicine, Kasr Al Aini University Hospital, Cairo University, Giza, Egypt
| | - S Shalaby
- Dermatology Department, Faculty of Medicine, Kasr Al Aini University Hospital, Cairo University, Giza, Egypt
| | - M R E Abdel-Halim
- Dermatology Department, Faculty of Medicine, Kasr Al Aini University Hospital, Cairo University, Giza, Egypt
| | - D M Aboelfadl
- Pathology Department, National Research Institute, Cairo, Egypt
| | - N Samir
- Dermatology Department, Faculty of Medicine, Kasr Al Aini University Hospital, Cairo University, Giza, Egypt
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11
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Diekmann J, Gontcharov J, Fröbel S, Torres Ziegenbein C, Zinth W, Gilch P. The Photoaddition of a Psoralen to DNA Proceeds via the Triplet State. J Am Chem Soc 2019; 141:13643-13653. [DOI: 10.1021/jacs.9b06521] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Janina Diekmann
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Julia Gontcharov
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik and Center for Integrated Protein Science Munich CIPSM, Ludwig-Maximilians-Universität München, Oettingenstrasse 67, 80538 München, Germany
| | - Sascha Fröbel
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Christian Torres Ziegenbein
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
| | - Wolfgang Zinth
- Lehrstuhl für BioMolekulare Optik, Fakultät für Physik and Center for Integrated Protein Science Munich CIPSM, Ludwig-Maximilians-Universität München, Oettingenstrasse 67, 80538 München, Germany
| | - Peter Gilch
- Institut für Physikalische Chemie, Heinrich-Heine-Universität Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany
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12
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Tatsuno K, Yamazaki T, Hanlon D, Han P, Robinson E, Sobolev O, Yurter A, Rivera-Molina F, Arshad N, Edelson RL, Galluzzi L. Extracorporeal photochemotherapy induces bona fide immunogenic cell death. Cell Death Dis 2019; 10:578. [PMID: 31371700 PMCID: PMC6675789 DOI: 10.1038/s41419-019-1819-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 07/15/2019] [Indexed: 12/12/2022]
Abstract
Extracorporeal photochemotherapy (ECP) is employed for the management of cutaneous T cell lymphoma (CTCL). ECP involves the extracorporeal exposure of white blood cells (WBCs) to a photosensitizer, 8-methoxypsoralen (8-MOP), in the context of ultraviolet A (UVA) radiation, followed by WBC reinfusion. Historically, the therapeutic activity of ECP has been attributed to selective cytotoxicity on circulating CTCL cells. However, only a fraction of WBCs is exposed to ECP, and 8-MOP is inactive in the absence of UVA light, implying that other mechanisms underlie the anticancer effects of ECP. Recently, ECP has been shown to enable the physiological differentiation of monocytes into dendritic cells (DCs) that efficiently cross-present tumor-associated antigens (TAAs) to CD8+ T lymphocytes to initiate cognate immunity. However, the source of TAAs and immunostimulatory signals for such DCs remains to be elucidated. Here, we demonstrate that 8-MOP plus UVA light reduces melanoma cell viability along with the emission of ICD-associated danger signals including calreticulin (CALR) exposure on the cell surface and secretion of ATP, high mobility group box 1 (HMGB1) and type I interferon (IFN). Consistently, melanoma cells succumbing to 8-MOP plus UVA irradiation are efficiently engulfed by monocytes, ultimately leading to cross-priming of CD8+ T cells against cancer. Moreover, malignant cells killed by 8-MOP plus UVA irradiation in vitro vaccinate syngeneic immunocompetent mice against living cancer cells of the same type, and such a protection is lost when cancer cells are depleted of calreticulin or HMGB1, as well as in the presence of an ATP-degrading enzyme or antibodies blocking type I IFN receptors. ECP induces bona fide ICD, hence simultaneously providing monocytes with abundant amounts of TAAs and immunostimulatory signals that are sufficient to initiate cognate anticancer immunity.
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Affiliation(s)
- Kazuki Tatsuno
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Takahiro Yamazaki
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
| | - Douglas Hanlon
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Patrick Han
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Eve Robinson
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Olga Sobolev
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Alp Yurter
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | | | - Najla Arshad
- Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA
| | - Richard L Edelson
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA. .,Comprehensive Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
| | - Lorenzo Galluzzi
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA. .,Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA. .,Sandra and Edward Meyer Cancer Center, New York, NY, USA. .,Université Paris Descartes/Paris V, Paris, France.
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13
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Guillon CD, Jan YH, Foster N, Ressner J, Heck DE, Laskin JD, Heindel ND. Synthetically modified methoxsalen for enhanced cytotoxicity in light and dark reactions. Bioorg Med Chem Lett 2018; 29:619-622. [PMID: 30638875 DOI: 10.1016/j.bmcl.2018.12.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/13/2018] [Accepted: 12/21/2018] [Indexed: 01/09/2023]
Abstract
Linear furocoumarins, also known as psoralens, are clinically useful photo-activated pharmaceuticals employed to address hyperproliferative skin diseases. Seven diverse cytotoxic pharmacophores have been synthetically attached to 8-methoxypsoralen via a 5-amino functionality. The resulting unique set of compounds was evaluated for dark and light toxicity against PAM212 keratinocytes in culture.
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Affiliation(s)
| | - Yi-Hua Jan
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ 08854, USA
| | - Natalie Foster
- Department of Chemistry, Lehigh University, Bethlehem, PA 18015 USA
| | - Joel Ressner
- Department of Chemistry, Lehigh University, Bethlehem, PA 18015 USA
| | - Diane E Heck
- Department of Environmental Health Science, New York Medical College, Valhalla, NY 10595, USA
| | - Jeffrey D Laskin
- Department of Environmental and Occupational Health, Rutgers University School of Public Health, Piscataway, NJ 08854, USA
| | - Ned D Heindel
- Department of Chemistry, Lehigh University, Bethlehem, PA 18015 USA
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Sawangjit R, Dilokthornsakul P, Lloyd-Lavery A, Chua S, Lai NM, Dellavalle R, Chaiyakunapruk N. Systemic treatments for eczema: a network meta-analysis. Hippokratia 2018. [DOI: 10.1002/14651858.cd013206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ratree Sawangjit
- Faculty of Pharmacy, Mahasarakham University; Department of Clinical Pharmacy; 41/20 Kham Riang Kantharawichai Mahasarakham Thailand 44150
| | - Piyameth Dilokthornsakul
- Naresuan University; Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences; 99 Tha Pho Muang Phitsanulok Thailand 65000
| | - Antonia Lloyd-Lavery
- Oxford University Hospitals NHS Foundation Trust; Department of Dermatology; Churchill Hospital Roosevelt Drive Oxford UK OX3 7LE
| | - Sean Chua
- urong East St21 Blk288A #03-358 Singapore Singapore 601288
| | - Nai Ming Lai
- Taylor's University; School of Medicine; Subang Jaya Malaysia
| | - Robert Dellavalle
- University of Colorado School of Medicine; Denver VA Medical Center 1055 Clermont St. #165 Denver Colorado USA 80220
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15
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Pro-inflammatory Cytokines, Biomarkers, Genetics and the Immune System: A Mechanistic Approach of Depression and Psoriasis. ACTA ACUST UNITED AC 2018; 47:177-186. [DOI: 10.1016/j.rcp.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 10/14/2016] [Accepted: 03/27/2017] [Indexed: 11/18/2022]
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16
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Patrizi A, Raone B, Ravaioli GM. Safety and Efficacy of Phototherapy in the Management of Eczema. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 996:319-331. [DOI: 10.1007/978-3-319-56017-5_27] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Wolf P, Byrne SN, Limon-Flores AY, Hoefler G, Ullrich SE. Serotonin signalling is crucial in the induction of PUVA-induced systemic suppression of delayed-type hypersensitivity but not local apoptosis or inflammation of the skin. Exp Dermatol 2016; 25:537-43. [PMID: 26914366 PMCID: PMC4927393 DOI: 10.1111/exd.12990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 12/26/2022]
Abstract
Psoralen and UVA (PUVA) has immunosuppressive and proapoptotic effects, which are thought to be responsible alone or in combination for its therapeutic efficacy. However, the molecular mechanism by which PUVA mediates its effects is not well understood. Activation of the serotonin (5-hydroxytryptamine, 5-HT) pathway has been suggested to be involved in the modulation of T-cell responses and found to mediate UVB-induced immune suppression. In particular, the activation of the 5-HT2A receptor has been proposed as one mechanism responsible for UV-induced immune suppression. We therefore hypothesized that 5-HT may play a role in PUVA-induced effects. The model of systemic suppression of delayed-type hypersensitivity (DTH) to Candida albicans was used to study immune function after exposure of C3H and KIT(W) (-Sh/W-Sh) mice to a minimal inflammatory dose of topical PUVA. The intra-peritoneal injection of the 5-HT2 receptor antagonist ketanserin or cyproheptadine or an anti-5-HT antibody immediately before PUVA exposure entirely abrogated suppression of DTH but had no significant effect on inflammation, as measured by swelling and cellular infiltration of the skin, and apoptosis as determined by the number of sunburn cells in C3H mice. Importantly, the systemic injection of 5-HT recapitulated PUVA immune suppression of DTH but did not induce inflammation or apoptosis in the skin. KIT(W) (-Sh/W-Sh) mice (exhibiting myelopoietic abnormalities, including lack of 5-HT-containing mast cells) were resistant to PUVA-induced suppression of DTH but not local skin swelling. Thus, this points towards a crucial role of 5-HT signalling in PUVA-induced immune suppression but not inflammation or apoptosis in situ in the skin.
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Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz
| | - Scott N. Byrne
- Cellular Photoimmunology Group, Infectious Diseases and Immunology, Sydney Medical School, the Charles Perkins Centre at The University of Sydney, Australia
| | - Alberto Y. Limon-Flores
- Laboratory of Immunology, Faculty of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Mexico
| | - Gerald Hoefler
- Institute for Pathology, Medical University of Graz, Graz, A-8036, Austria
| | - Stephen E. Ullrich
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030
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18
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Exploring the Physiological Link between Psoriasis and Mood Disorders. Dermatol Res Pract 2015; 2015:409637. [PMID: 26550011 PMCID: PMC4624926 DOI: 10.1155/2015/409637] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 09/27/2015] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic, immune-mediated skin condition with a high rate of psychiatric comorbidity, which often goes unrecognized. Beyond the negative consequences of mood disorders like depression and anxiety on patient quality of life, evidence suggests that these conditions can worsen the severity of psoriatic disease. The mechanisms behind this relationship are not entirely understood, but inflammation seems to be a key feature linking psoriasis with mood disorders, and physiologic modulators of this inflammation, including the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, demonstrate changes with psychopathology that may be contributory. Cyclical disruptions in the secretion of the sleep hormone, melatonin, are also observed in both depression and psoriasis, and with well-recognized anti-inflammatory and antioxidant activity, this aberration may represent a shared contributor to both conditions as well as common comorbidities like diabetes and cardiovascular disease. While understanding the complexities of the biological mechanisms at play will be key in optimizing the management of patients with comorbid psoriasis and depression/anxiety, one thing is certain: recognition of psychiatric comorbidity is an imperative first step in effectively treating these patients as a whole. Evidence that improvement in mood decreases psoriasis severity underscores how psychological awareness can be critical to clinicians in their practice.
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Patrizi A, Raone B, Ravaioli GM. Management of atopic dermatitis: safety and efficacy of phototherapy. Clin Cosmet Investig Dermatol 2015; 8:511-20. [PMID: 26491366 PMCID: PMC4599569 DOI: 10.2147/ccid.s87987] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Atopic dermatitis (AD) is a common chronic inflammatory skin disease that can affect all age groups. It is characterized by a relapsing course and a dramatic impact on quality of life for patients. Environmental interventions together with topical devices represent the mainstay of treatment for AD, in particular emollients, corticosteroids, and calcineurin inhibitors. Systemic treatments are reserved for severe cases. Phototherapy represents a valid second-line intervention in those cases where non-pharmacological and topical measures have failed. Different forms of light therapy are available, and have showed varying degrees of beneficial effect against AD: natural sunlight, narrowband (NB)-UVB, broadband (BB)-UVB, UVA, UVA1, cold-light UVA1, UVA and UVB (UVAB), full-spectrum light (including UVA, infrared and visible light), saltwater bath plus UVB (balneophototherapy), Goeckerman therapy (coal tar plus UVB radiation), psoralen plus UVA (PUVA), and other forms of phototherapy. In particular, UVA1 and NB-UVB have gained importance in recent years. This review illustrates the main trials comparing the efficacy and safety of the different forms of phototherapy. No sufficiently large randomized controlled studies have been performed as yet, and no light modality has been defined as superior to all. Parameters and dosing protocols may vary, although clinicians mainly refer to the indications included in the American Academy of Dermatology psoriasis guidelines devised by Menter et al in 2010. The efficacy of phototherapy (considering all forms) in AD has been established in adults and children, as well as for acute (UVA1) and chronic (NB-UVB) cases. Its use is suggested with strength of recommendation B and level of evidence II. Home phototherapy can also be performed; this technique is recommended with strength C and level of evidence III. Phototherapy is generally considered to be safe and well tolerated, with a low but established percentage of short-term and long-term adverse effects, with the most common being photodamage, xerosis, erythema, actinic keratosis, sunburn, and tenderness. A carcinogenic risk related to UV radiation has not been excluded. Phototherapy also has some limitations related to costs, availability, and patient compliance. In conclusion, phototherapy is an optimal second-line treatment for AD. It can be used as monotherapy or in combination with systemic drugs, in particular corticosteroids. It must be performed conscientiously, especially in children, and must take into account the patient's features and overall condition.
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Affiliation(s)
- Annalisa Patrizi
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Beatrice Raone
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Giulia Maria Ravaioli
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
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20
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Kubanov AA, Zhilova MB. Revisited the potential risks of carcinogenicity of phototherapy in patients with psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2014. [DOI: 10.25208/0042-4609-2014-90-5-60-67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents published data on the assessment of the risk of cancerogenicity of multiple courses of phototherapy methods such as PUVA therapy and UVB-311 in psoriatic patients. The authors analyzed the incidence of malignant skin neoplasms (squamous cell carcinoma, basal cell carcinoma, malignant skin melanoma) among psoriatic patients from different population groups taking into account the cumulative radiation doses and number of procedures.
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21
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Chowdhari S, Saini N. hsa-miR-4516 mediated downregulation of STAT3/CDK6/UBE2N plays a role in PUVA induced apoptosis in keratinocytes. J Cell Physiol 2014; 229:1630-8. [PMID: 24610393 DOI: 10.1002/jcp.24608] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Abstract
Psoriasis is a chronic inflammatory skin disorder mediated by cross-talk occurring between epidermal keratinocytes, dermal vascular cells and immunocytes. Literature reveals that Signal transducer and activator of transcription 3 (STAT3), a protein involved in transmitting extracellular signals to the nucleus, is a possible important link between keratinocytes and immunocytes and is crucial to the development of psoriasis. Although photochemotherapy using UV in combination with 8 methoxypsoralen is one of the most effective therapy for moderate to severe plaque psoriasis, its mechanism of action is largely unknown. Herein, we studied the change in miRNA profiles of cultured human keratinocytes (HaCaT cells) before and after in vitro PUVA treatment by 8 methoxypsoralen and found significant up regulation of hsa-miR-4516. We for the first time demonstrate that ectopic expression of hsa-miR-4516 directly targets STAT3 protein by binding to its 3'UTR in HaCaT cells as confirmed by Luciferase reporter assays and Western blot analysis. We further show that overexpression of hsa-miR-4516 downregulates STAT3, p-STAT3, CDK6, and UBE2N proteins that are consistently upregulated in psoriasis and induces apoptosis in HaCaT cells. We also observed that anti-miR-4516 treatment was able to partially inhibit PUVA-induced apoptosis, suggesting that miR-4516 is involved in PUVA-induced apoptosis. Taken together, these results not only indicate the mechanistic involvement of hsa-miR-4516 in PUVA mediated effects by down-regulating STAT3 in HaCaT keratinocytes, but also highlight the potential of hsa-miR-4516 in development of novel therapeutic strategies. J. Cell. Physiol. 229: 1630-1638, 2014. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Shruti Chowdhari
- Functional Genomics Unit, CSIR, Institute of Genomics and Integrative Biology, Delhi, India
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22
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El-Mofty M, Mostafa WZ, Yousef R, Abdel Halim MRE, El Hawary M, Abdel Kader H, Assaad S, Ghannam BB. Broadband ultraviolet A in the treatment of psoriasis vulgaris: a randomized controlled trial. Int J Dermatol 2014; 53:1157-64. [DOI: 10.1111/ijd.12317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Medhat El-Mofty
- Department of Dermatology; Phototherapy Unit Kasr Al Aini (PUKA); Cairo Egypt
| | - Wedad Z. Mostafa
- Department of Dermatology; Phototherapy Unit Kasr Al Aini (PUKA); Cairo Egypt
| | - Randa Yousef
- Department of Dermatology; Phototherapy Unit Kasr Al Aini (PUKA); Cairo Egypt
| | | | - Marwa El Hawary
- Department of Dermatology; Phototherapy Unit Kasr Al Aini (PUKA); Cairo Egypt
| | - Hanaa Abdel Kader
- Department of Histology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - Soheir Assaad
- Department of Histology; Faculty of Medicine; Cairo University; Cairo Egypt
| | - Bahaa B. Ghannam
- Department of Pathology; Faculty of Medicine; Al Azhar University; Cairo Egypt
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Cytotoxic and genotoxic effects of acitretin, alone or in combination with psoralen-ultraviolet A or narrow-band ultraviolet B-therapy in psoriatic patients. Mutat Res 2013; 753:42-7. [PMID: 23474391 DOI: 10.1016/j.mrgentox.2012.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 11/13/2012] [Accepted: 12/22/2012] [Indexed: 02/08/2023]
Abstract
Acitretin is currently used alone or combined with PUVA (psoralen + UVA) or with narrow-band ultraviolet B (NBUVB), to treat moderate and severe psoriasis. However, little is known about the potential genotoxic/carcinogenic risk and the cytostatic/cytotoxic effects of these treatments. Our aim was to study the cytotoxic and genotoxic effects of acitretin - alone or in combination with PUVA or NBUVB - by performing studies with blood from patients with psoriasis vulgaris who were treated with acitretin, acitretin+PUVA or acitretin+NBUVB for 12 weeks, and in vitro studies with blood from healthy volunteers, which was incubated with acitretin at different concentrations. The cytotoxic and genotoxic effects were evaluated by the cytokinesis-blocked micronucleus test and the comet assay. Our results show that psoriatic patients treated with acitretin alone or with acitretin+NBUVB, did not show genotoxic effects. In addition, these therapies reduced the rate of proliferation and induced apoptosis and necrosis of lymphocytes; the same occurred with lymphocyte cultures incubated with acitretin (1.2-20μM). The acitretin+PUVA reduced also the proliferation rate, and increased the necrotic lymphocytes. Our studies suggest that therapy with acitretin alone or combined with NBUVB, as used in psoriatic patients, does not show genotoxic effects, reduces the rate of proliferation and induces apoptosis and necrosis of lymphocytes. The combination of acitretin with PUVA also reduces the proliferation rate and increases the number of necrotic lymphocytes. However, as it induced slight genotoxic effects, further studies are needed to clarify its genotoxic potential.
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El-Domyati M, Moftah NH, Nasif GA, Abdel-Wahab HM, Barakat MT, Abdel-Aziz RT. Evaluation of apoptosis regulatory proteins in response to PUVA therapy for psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2013; 29:18-26. [DOI: 10.1111/phpp.12012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Moetaz El-Domyati
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
| | - Noha H. Moftah
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
| | - Ghada A. Nasif
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
| | - Hossam M. Abdel-Wahab
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
| | - Manal T. Barakat
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
| | - Rasha T. Abdel-Aziz
- Department of Dermatology, STD's and Andrology; Al-Minya University; Al-Minya; Egypt
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Aydin F, Levent Y, Nilgun S, Pancar YE, Yasar TA. Implications of bax, fas, and p53 in the pathogenesis of early-stage mycosis fungoides and alterations in expression following photochemotherapy. Indian J Dermatol 2012; 56:501-4. [PMID: 22121263 PMCID: PMC3221208 DOI: 10.4103/0019-5154.87130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: The underlying molecular basis of mycosis fungoides (MF) has not yet been clarified. However, defects in apoptosis may contribute to its pathogenesis. Aim: We investigated the expression of Bax, Fas, and p53 in early-stage MF patients and any alterations in expression following photochemotherapy. Materials and Methods: Bax, Fas, and p53 expressions were studied by immunohistochemistry in both keratinocytes and lymphocytes on paraffin-embedded skin specimens from 27 early-stage MF patients. Results: Bax, Fas, and p53 staining was shown in the lymphocytes in 0/27, 26/27, and 11/27 patients at the time of diagnosis, whereas these ratios were 0/27, 9/27, and 0/27, respectively, after psoralen plus ultraviolet A (PUVA) treatment. The decrease in p53 and Fas expression in the lymphocytes was found statistically significant. Bax, Fas, and p53 staining in the keratinocytes was shown in 5/27, 27/27, and 25/27 patients at the time of diagnosis, whereas these ratios were 0/27, 22/27, and 4/27, respectively, after PUVA treatment. The decrease in p53, Fas, and Bax expression in the keratinocytes was found statistically significant. Conclusion: Although Bax seems unrelated with early-stage MF, Fas and p53 expression in the lymphocytes may contribute to the understanding of the pathogenesis of this disease.
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Affiliation(s)
- Fatma Aydin
- Ondokuz Mayis University, School of Medicine, Departments of Dermatology and Pathology, Samsun, Turkey
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26
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Grundmann SA, Beissert S. Modern aspects of phototherapy for atopic dermatitis. J Allergy (Cairo) 2011; 2012:121797. [PMID: 22220185 PMCID: PMC3246755 DOI: 10.1155/2012/121797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 10/24/2011] [Indexed: 11/30/2022] Open
Abstract
Phototherapy has still great importance in the treatment of atopic dermatitis, though costs, compliance, and long-term risks narrow its relevance. In spite of its long history, up to now, the therapeutic regimes are mostly empirical. Narrowband UVB und UVA1 are the most frequently applied regimens in atopic dermatitis with proven efficacy. However, even for these modalities randomized prospective and controlled studies are still pending. Advances in photoimmunology and molecular biology had demonstrated that phototherapy targets inflammatory cells, alters cytokine production, and has a significant antimicrobial effect within atopic skin. This paper summarizes the current literature on the different regimes of phototherapy and also discusses therapeutic modalities like photochemotherapy and extracorporeal photopheresis. These more complex regimes should be restricted to severe cases of atopic dermatitis, which are refractory to topical treatment.
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27
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Zhilova MB, Butareva MM, Volnukhin VA, Zhilova MB, Butareva MM, Volnukhin VA. Currentaspects of psoriasis phototherapy. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The review covers current aspects of ultraviolet therapy for patients suffering from psoriasis. It describes mechanisms of action
as well as early and remote side effects of the current phototherapy methods. The review also presents data from literature about
the risk of their cancerogenicity. It also discusses approaches to the optimization of phototherapy in view of risks and benefits for the patient.
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28
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Ferenczi K, Ohtola J, Aubert P, Kessler M, Sugiyama H, Somani AK, Gilliam AC, Chen JZ, Yeh I, Matsuyama S, McCormick TS, Cooper KD. Malignant T cells in cutaneous T-cell lymphoma lesions contain decreased levels of the antiapoptotic protein Ku70. Br J Dermatol 2010; 163:564-71. [PMID: 20408834 DOI: 10.1111/j.1365-2133.2010.09812.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Malignant T cells in primary cutaneous T-cell lymphoma (CTCL) are genetically unstable and exhibit prolonged lifespans potentially explained by dysregulation of apoptosis, yet are responsive to apoptosis-inducing therapies. The heterodimeric protein Ku70/80 is known to play a role in DNA repair (Ku70 and Ku80) and inhibition of apoptosis (Ku70 only). OBJECTIVES To investigate the expression of Ku70/80 in CD3+ T cells derived from skin and blood in patients with CTCL and normal samples, as well as benign dermatoses. METHODS Normal (n=10), CTCL (n=9) and benign dermatoses (n=13) skin samples were stained for confocal imaging of Ku70/80 and CD3 and analysed using imaging software. Circulating CD4+ T cells in normal and CTCL peripheral blood were analysed by flow cytometry and Western blot for Ku70/80 expression (n=6). RESULTS Ku70 and Ku80 were significantly diminished in T cells of CTCL lesions relative to T cells of control skin. Decreased T-cell Ku70 expression was not a feature of the benign dermatoses psoriasis and contact dermatitis, suggesting that loss of Ku70/80 in CTCL is not simply the result of cutaneous inflammation. Reduced Ku70 was also noted in circulating CD4+ T cells in patients with CTCL with peripheral blood involvement. CONCLUSIONS Deficient expression or lack of Ku70/80 may result in genomic instability and play a role in tumorigenesis, as well as account for the increased susceptibility of malignant T cells to apoptosis-inducing treatment modalities in the setting of intrinsic resistance to apoptosis.
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Affiliation(s)
- K Ferenczi
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, Gottlieb A, Koo JY, Lebwohl M, Lim HW, Van Voorhees AS, Beutner KR, Bhushan R. Guidelines of care for the management of psoriasis and psoriatic arthritis. J Am Acad Dermatol 2010; 62:114-135. [DOI: 10.1016/j.jaad.2009.08.026] [Citation(s) in RCA: 245] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 08/07/2009] [Accepted: 08/12/2009] [Indexed: 11/26/2022]
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Role for CD4+CD25+ T Cells in Inhibition of Graft Rejection by Extracorporeal Photopheresis. J Heart Lung Transplant 2008; 27:616-22. [DOI: 10.1016/j.healun.2008.02.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Revised: 01/29/2008] [Accepted: 02/17/2008] [Indexed: 11/24/2022] Open
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Abstract
Drug-induced photosensitivity involves reactions to medication triggered by exposure of the skin to ultraviolet light. Medications that trigger reactions can be topical or oral. Following interaction of ultraviolet radiation with a chemical present in sufficient amounts in the skin, one of the several reactions may occur in susceptible patients, most commonly photoallergy or phototoxicity. These reactions can be diagnosed separately based on pathogenesis, clinical characteristics and histopathology. Phototoxic disorders have a higher incidence than photoallergic disorders. The action spectra for most photoallergens and phototoxins lie in the ultraviolet A range. Subtypes of drug-induced photosensitivity include dyschromia, pseudoporphyria, photo onycholysis, and lichenoid and telangiectatic reactions.
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Affiliation(s)
- Kevin R Stein
- New York Medical College, Department of Dermatology, Metropolitan Hospital Center, New York, NY 10029, USA
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Viola G, Fortunato E, Cecconet L, Disarò S, Basso G. Induction of apoptosis in Jurkat cells by photoexcited psoralen derivatives: Implication of mitochondrial dysfunctions and caspases activation. Toxicol In Vitro 2007; 21:211-6. [PMID: 17084583 DOI: 10.1016/j.tiv.2006.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 08/24/2006] [Accepted: 09/14/2006] [Indexed: 10/24/2022]
Abstract
The prevailing form of cell death in lymphocytes exposed to psoralen plus UVA light (PUVA), was investigated. We studied the well known drug 8-methoxypsoralen (8-MOP) and an angular derivatives: angelicin (ANG). We evaluated the induction of apoptosis in a human tumor T-cell line (Jurkat). Both compounds provoke a significant induction of apoptosis at 24h from irradiation as demonstrated by a remarkable percentage of cells Annexin-V positive. We investigated the effects of the psoralen derivatives upon UVA irradiation on the cell cycle. The flow cytometric analysis of propidium labeled cells indicates that treatment induces, in a dose dependent manner, a massive accumulation of cells, for both compounds, in G2-S phase after 24h from the irradiation. We have focused our attention on the mitochondrial functionality after irradiation in the presence of psoralen derivatives. We evaluated, by flow cytometry, (i) the mitochondrial potential (Deltapsi(mt)), (ii) the production of reactive oxygen species (ROS) and (iii) the oxidation of cardiolipin, a phospholipid restricted to the inner mitochondrial membrane. Furthermore the activation of caspases -3, -8 and -9 was also investigated. The obtained data indicated that, upon UVA irradiation, the two compounds induce a strong decrease in mitochondrial functions and activate caspase-3, -8 and -9.
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Affiliation(s)
- G Viola
- Department of Pharmaceutical Sciences, University of Padova, Italy.
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Ogino J, Saga K, Kagaya M, Kamada A, Hirosaki K, Kaneko R, Jimbow K. CD30+ large cell transformation of mycosis fungoides after psoralen plus ultraviolet A photochemotherapy. Br J Dermatol 2007; 156:148-51. [PMID: 17199582 DOI: 10.1111/j.1365-2133.2006.07566.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psoralen plus ultraviolet A (PUVA) photochemotherapy is widely used for the therapy of mycosis fungoides (MF). Clinical progression of MF is often associated with an increase in the size of tumour cells known as transformation. We report two patients with CD30+ large cell transformation that appeared after low-dose PUVA therapy for MF. Clinical data, histopathology, immunohistopathology and T-cell receptor gene rearrangement were studied. Nodules consisted of atypical large cells that expressed CD30. Monoclonal rearrangement of T-cell receptors was observed in one case. Low-dose PUVA therapy may be associated with CD30+ large cell transformation in patients with MF.
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Affiliation(s)
- J Ogino
- Department of Dermatology, Sapporo Medical University School of Medicine, Minami 1 Nishi 16, Chyuo-ku, Sapporo, Japan
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Wolf P, Nghiem DX, Walterscheid JP, Byrne S, Matsumura Y, Matsumura Y, Bucana C, Ananthaswamy HN, Ullrich SE. Platelet-activating factor is crucial in psoralen and ultraviolet A-induced immune suppression, inflammation, and apoptosis. THE AMERICAN JOURNAL OF PATHOLOGY 2006; 169:795-805. [PMID: 16936256 PMCID: PMC1579250 DOI: 10.2353/ajpath.2006.060079] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Psoralen plus UVA (PUVA) is used as a very effective treatment modality for various diseases, including psoriasis and cutaneous T-cell lymphoma. PUVA-induced immune suppression and/or apoptosis are thought to be responsible for the therapeutic action. However, the molecular mechanisms by which PUVA acts are not well understood. We have previously identified platelet-activating factor (PAF), a potent phospholipid mediator, as a crucial substance triggering ultraviolet B radiation-induced immune suppression. In this study, we used PAF receptor knockout mice, a selective PAF receptor antagonist, a COX-2 inhibitor (presumably blocking downstream effects of PAF), and PAF-like molecules to test the role of PAF receptor binding in PUVA treatment. We found that activation of the PAF pathway is crucial for PUVA-induced immune suppression (as measured by suppression of delayed type hypersensitivity to Candida albicans) and that it plays a role in skin inflammation and apoptosis. Downstream of PAF, interleukin-10 was involved in PUVA-induced immune suppression but not inflammation. Better understanding of PUVA's mechanisms may offer the opportunity to dissect the therapeutic from the detrimental (ie, carcinogenic) effects and/or to develop new drugs (eg, using the PAF pathway) that act like PUVA but have fewer side effects.
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MESH Headings
- Animals
- Apoptosis/drug effects
- Apoptosis/radiation effects
- Candida albicans/immunology
- Candidiasis/drug therapy
- Candidiasis/immunology
- Candidiasis/pathology
- Combined Modality Therapy/methods
- Female
- Ficusin/pharmacology
- Humans
- Hypersensitivity, Delayed/drug therapy
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/pathology
- Immune Tolerance/drug effects
- Immune Tolerance/immunology
- Immune Tolerance/radiation effects
- Immunosuppression Therapy/methods
- Inflammation/drug therapy
- Inflammation/immunology
- Inflammation/pathology
- Interleukin-10/immunology
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Male
- Mice
- Mice, Knockout
- PUVA Therapy/adverse effects
- PUVA Therapy/methods
- Platelet Activating Factor/immunology
- Platelet Membrane Glycoproteins/deficiency
- Platelet Membrane Glycoproteins/immunology
- Psoriasis/drug therapy
- Psoriasis/immunology
- Psoriasis/pathology
- Receptors, G-Protein-Coupled/deficiency
- Receptors, G-Protein-Coupled/immunology
- Signal Transduction/drug effects
- Signal Transduction/immunology
- Signal Transduction/radiation effects
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Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University Graz, Auenbrugger Platz 8, A-8036 Graz, Austria.
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Li JM, Giver CR, Waller EK. Graft engineering using ex vivo methods to limit GVHD: Fludarabine treatment generates superior GVL effects in allogeneic BMT. Exp Hematol 2006; 34:895-904. [PMID: 16797417 DOI: 10.1016/j.exphem.2006.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 03/13/2006] [Accepted: 03/13/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To compare the abilities of different ex vivo methods of treating donor lymphocytes to inhibit graft-vs-host disease (GVHD) while preserving graft-vs-leukemia (GVL) activity in murine models of allogeneic bone marrow transplantation. METHODS Donor/recipient pairs included MHC fully mismatched, MHC haplomismatched, and MiHA mismatched strain combinations. T cell-depleted BM (TCD-BM) was transplanted in combination with untreated, fludarabine-treated, 7.5-Gy gamma-irradiated, or psoralen/UVA (PUVA)-treated splenocytes. GVL activity was studied by adding a lethal number of recipient-type lymphoma cells. Posttransplant survival was determined, and GVHD and GVL activity were assessed by clinical and pathological scoring. Hematopoietic chimerism and donor T-cell expansion were analyzed by flow cytometry of peripheral blood samples at 30 and 60 days posttransplant. RESULTS Allogeneic splenocytes treated with fludarabine, 7.5 Gy gamma-irradiation, or PUVA had significantly diminished GVHD activity, and all treated donor T cells facilitated engraftment by low-dose TCD-BM. Allogeneic splenocytes treated with fludarabine and, to a lesser extent, PUVA retained GVL activity and contributed more to donor T-cell chimerism compared to gamma-irradiated donor splenocytes. CONCLUSION Among ex vivo methods of treating donor T cells to limit their proliferative capacity, fludarabine exposure had the greatest differential ability to inhibit the GVHD activity of allogeneic lymphocytes, while preserving their GVL activity and ability to engraft recipients. Thus, ex vivo treatment with fludarabine was superior to gamma-irradiation or PUVA in separating GVL from GVHD activity in murine models of allogeneic bone marrow transplantation.
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Affiliation(s)
- Jian-Ming Li
- Emory University, Winship Cancer Institute, Hematology/Oncology, Atlanta, Ga., USA
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36
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Hovest MG, Brüggenolte N, Hosseini KS, Krieg T, Herrmann G. Senescence of human fibroblasts after psoralen photoactivation is mediated by ATR kinase and persistent DNA damage foci at telomeres. Mol Biol Cell 2006; 17:1758-67. [PMID: 16436511 PMCID: PMC1415309 DOI: 10.1091/mbc.e05-08-0701] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cellular senescence is a phenotype that is likely linked with aging. Recent concepts view different forms of senescence as permanently maintained DNA damage responses partially characterized by the presence of senescence-associated DNA damage foci at dysfunctional telomeres. Irradiation of primary human dermal fibroblasts with the photosensitizer 8-methoxypsoralen and ultraviolet A radiation (PUVA) induces senescence. In the present study, we demonstrate that senescence after PUVA depends on DNA interstrand cross-link (ICL) formation that activates ATR kinase. ATR is necessary for the manifestation and maintenance of the senescent phenotype, because depletion of ATR expression before PUVA prevents induction of senescence, and reduction of ATR expression in PUVA-senesced fibroblasts releases cells from growth arrest. We find an ATR-dependent phosphorylation of the histone H2AX (gamma-H2AX). After PUVA, ATR and gamma-H2AX colocalize in multiple nuclear foci. After several days, only few predominantly telomere-localized foci persist and telomeric DNA can be coimmunoprecipitated with ATR from PUVA-senesced fibroblasts. We thus identify ATR as a novel mediator of telomere-dependent senescence in response to ICL induced by photoactivated psoralens.
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37
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Reyes E, Jaén P, de las Heras E, Carrión F, Alvarez-Mon M, de Eusebio E, Alvare M, Cuevas J, González S, Villarrubia VG. Systemic immunomodulatory effects of Polypodium leucotomos as an adjuvant to PUVA therapy in generalized vitiligo: A pilot study. J Dermatol Sci 2006; 41:213-6. [PMID: 16423508 DOI: 10.1016/j.jdermsci.2005.12.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 11/24/2005] [Accepted: 12/15/2005] [Indexed: 10/25/2022]
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38
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Abstract
Living organisms are constantly exposed to detrimental agents both from the environment (e.g. ionizing radiation, ultraviolet light, natural and synthetic chemicals) and from endogenous metabolic processes (e.g. oxidative and hydrolytic reactions), resulting in modifications of proteins, lipids and DNA. Proteins and lipids are degraded and resynthesized, but the DNA is replicated only during cell division, when DNA damage may result in mutation fixation. Thus the DNA damage generated has the potential to lead to carcinogenesis, cell death, or other genetic disorders in the absence of efficient error-free repair. Because modifications in DNA sequence or structure may be incompatible with its essential role in preservation and transmission of genetic information from generation to generation, exquisitely sensitive DNA repair pathways have evolved to maintain genomic stability and cell viability. This review focuses on the repair and processing of genome destabilizing lesions and helical distortions that differ significantly from the canonical B-form DNA in mammalian cells. In particular, we discuss the introduction and processing of site-specific lesions in mammalian cells with an emphasis on psoralen interstrand crosslinks.
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Affiliation(s)
- Madhava C Reddy
- Department of Carcinogenesis, The University of Texas M. D. Anderson Cancer Center, Science Park-Research Division, Smithville, Texas 78957, USA
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39
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Phillips MA, Graves JE, Nunley JR. Alopecia areata presenting in 2 kidney-pancreas transplant recipients taking cyclosporine. J Am Acad Dermatol 2005; 53:S252-5. [PMID: 16227102 DOI: 10.1016/j.jaad.2005.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Revised: 01/21/2005] [Accepted: 03/07/2005] [Indexed: 11/21/2022]
Abstract
Alopecia areata (AA) is an autoimmune disease of uncertain pathogenesis, typically treated with immunomodulators. We report the paradoxical development of AA in two kidney-pancreas transplant recipients receiving immunosuppressive therapy, which included cyclosporine. Review of the literature revealed only 7 other cases of AA occurring in solid organ transplant recipients; all occurred during long-term cyclosporine therapy. The development of AA in this population highlights the complexity of this immunologic disease.
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Affiliation(s)
- Mariana Abraham Phillips
- Department of Dermatology, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
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40
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Molecular aspects of furocoumarin reactions: Photophysics, photochemistry, photobiology, and structural analysis. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY C-PHOTOCHEMISTRY REVIEWS 2005. [DOI: 10.1016/j.jphotochemrev.2005.08.002] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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41
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Hossain MS, Roback JD, Lezhava L, Hillyer CD, Waller EK. Amotosalen-treated donor T cells have polyclonal antigen-specific long-term function without graft-versus-host disease after allogeneic bone marrow transplantation. Biol Blood Marrow Transplant 2005; 11:169-80. [PMID: 15744235 DOI: 10.1016/j.bbmt.2004.12.332] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We have previously shown that amotosalen HCl (S-59 psoralen)-treated donor splenocytes, which have limited proliferative capacity in vitro, can protect major histocompatibility complex-mismatched bone marrow transplant (BMT) recipients from lethal murine cytomegalovirus infection without causing graft-versus-host disease. In this study, we further investigated the effects of amotosalen-treated donor T cells on immune reconstitution after allogeneic BMT. We were surprised to find that amotosalen-treated donor T cells persisted long-term in vivo, comprising 6% to 10% on average of the T-cell compartment of transplant recipients at 4 months after transplantation. Donor T cells derived from amotosalen-treated splenocytes were predominantly polyclonal CD44 hi/int CD8 + memory T cells and were functionally active, synthesizing interferon gamma in response to stimulation with murine cytomegalovirus antigen. Amotosalen-treated donor T cells, reisolated from BMT recipients' spleens >/=4 months after transplantation, proliferated in vitro, thus indicating repair of amotosalen-mediated DNA cross-links. Compared with infusion of untreated donor splenocytes, amotosalen-treated cells enhanced thymopoiesis by bone marrow-derived stem cells in BMT recipients. However, amotosalen treatment abrogated the thymopoietic activity of lymphoid progenitor cells among the donor splenocytes. Thus, infusion of amotosalen-treated donor T cells produced rapid immune reconstitution after major histocompatibility complex-mismatched BMT by transferring long-lived polyclonal memory T cells with antiviral activity and also by enhancing bone marrow-derived thymopoiesis. This is a novel approach to adoptive immunotherapy in allogeneic BMT.
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Affiliation(s)
- Mohammad Sohrab Hossain
- Department of Hematology and Oncology, Division of Stem Cell and Bone Marrow Transplantation, Winship Cancer Institute, Emory Universiy School of Medicine, Atlanta, Georgia, USA
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42
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Hamzavi I, Lui H. Using light in dermatology: an update on lasers, ultraviolet phototherapy, and photodynamic therapy. Dermatol Clin 2005; 23:199-207. [PMID: 15837151 DOI: 10.1016/j.det.2004.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Indications for light-based treatments, such as lasers, UV phototherapy, and photodynamic therapy, are rapidly increasing within the arena of skin disorders. Physicians can remain current in their understanding of these modalities if they understand a few basic principles outlined in this article. Once these concepts are understood, all the rapid advances can be kept in perspective and physicians can apply the most appropriate technology to the care of their patients while informing them about the limitations of overmarketed but poorly proved strategies.
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Affiliation(s)
- Iltefat Hamzavi
- Department of Dermatology, Wayne State University, Detroit, MI 48201, USA.
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43
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Abstract
Psoriasis is a chronic, incurable, disabling skin disease characterised by red, scaly plaques. Approximately 23% of psoriasis patients also have an accompanying arthritis that can become debilitating. Psoriasis has a stigmatising effect on its victims, who often feel socially isolated. Although the exact aetiology of psoriasis is still unknown, it is clearly an immune-mediated disease. Traditional therapies for psoriasis include topical drugs, such as corticosteroids, retinoids and vitamin D3 analogues; systemic drugs, such as methotrexate, ciclosporin and retinoids; and phototherapy. These mainstays of treatment are efficacious for the treatment of severe disease; however, most are associated with toxicities or are inconvenient. Recent advances in biotechnology have produced new pharmaceuticals that interfere with immune responses thought to be involved in the pathogenesis of psoriasis and other inflammatory diseases. The immunobiologicals, one new family of drugs, consist of monoclonal antibodies and fusion proteins. Many have demonstrated efficacy in treating psoriasis. Some appear to offer safety benefits over traditional therapies; further monitoring and surveillance of these agents is required to adequately establish safety profiles. This article discusses existing and emerging treatments for moderate-to-severe psoriasis.
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Affiliation(s)
- Melissa A Magliocco
- UMDNJ-Robert Wood Johnson Medical School, Clinical Research Center, 51 French Street, New Brunswick, NJ 08901-0019, USA.
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44
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Abstract
Alefacept is the first biologic agent approved for the treatment of chronic, moderate to severe plaque-type psoriasis. It is a fully human fusion toxin, which binds to CD2, blocks costimulatory signaling, and selectively induces apoptosis of activated memory T cells involved in the pathogenesis of psoriasis. Alefacept has a slow onset of action, peaking approximately 18 weeks after the first injection of a 12-week course. However, it has several important advantages over the existing conventional immunosuppressive therapies for psoriasis: it is associated with long remissions without the need for maintenance therapy; its efficacy improves with subsequent courses; and it has a high safety profile. This review summarizes the mechanism of action of alefacept and the results of the clinical trials, with special emphasis on efficacy, pharmacodynamic effects on circulating lymphocytes, and safety and tolerability. Current guidelines based on the best available data to date are also presented.
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Affiliation(s)
- Emmilia Hodak
- Department of Dermatology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
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45
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Besch R, Marschall C, Schuh T, Giovannangeli C, Kammerbauer C, Degitz K. Triple helix-mediated inhibition of gene expression is increased by PUVA. J Invest Dermatol 2004; 122:1114-20. [PMID: 15140212 DOI: 10.1111/j.0022-202x.2004.22521.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The combination of psoralens with UVA is used as PUVA therapy for psoriasis and other skin diseases. UVA-induced psoralen/DNA photoadducts act via suppression of DNA replication and cell proliferation, but do not sufficiently repress gene transcription. To explore whether PUVA may also be used for gene repression, psoralen was conjugated to a triplex-forming oligonucleotide (TFO) that targets a gene sequence of ICAM-1, a key molecule in cutaneous inflammation. Triplex formation between TFO and target sequence was detected by non-denaturing gel electrophoresis. UVA-irradiation induced psoralen cross-links at the triplex-duplex junction as verified by denaturing gel electrophoresis. When the target sequence was placed within the transcribed portion of the chloramphenicol acetyltransferase (CAT) gene, TFO inhibited CAT expression in A431 cells. Inhibition was sequence-specific, since a scrambled control oligonucleotide or mismatched or scrambled target sequences failed to inhibit CAT expression. Inhibition was not significant without UVA exposure, but was strongly enhanced by PUVA-mediated cross-links at the TFO target site. These results suggest that TFO may add a new quality to PUVA therapy by transcriptionally repressing pathogenically relevant genes, in addition to antiproliferative PUVA effects. TFO designed to repress only after PUVA activation may allow the development of a cutaneous organ specific strategy for gene repression.
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Affiliation(s)
- Robert Besch
- Department of Dermatology, Ludwig-Maximilians University, München, Germany
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46
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Matsumura Y, Ananthaswamy HN. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol 2004; 195:298-308. [PMID: 15020192 DOI: 10.1016/j.taap.2003.08.019] [Citation(s) in RCA: 704] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2003] [Accepted: 08/27/2003] [Indexed: 01/25/2023]
Abstract
Ultraviolet (UV) irradiation present in sunlight is an environmental human carcinogen. The toxic effects of UV from natural sunlight and therapeutic artificial lamps are a major concern for human health. The major acute effects of UV irradiation on normal human skin comprise sunburn inflammation (erythema), tanning, and local or systemic immunosuppression. At the molecular level, UV irradiation causes DNA damage such as cyclobutane pyrimidine dimers and (6-4) photoproducts, which are usually repaired by nucleotide excision repair (NER). Chronic exposure to UV irradiation leads to photoaging, immunosuppression, and ultimately photocarcinogenesis. Photocarcinogenesis involves the accumulation of genetic changes, as well as immune system modulation, and ultimately leads to the development of skin cancers. In the clinic, artificial lamps emitting UVB (280-320 nm) and UVA (320-400 nm) radiation in combination with chemical drugs are used in the therapy of many skin diseases including psoriasis and vitiligo. Although such therapy is beneficial, it is accompanied with undesirable side effects. Thus, UV radiation is like two sides of the same coin--on one side, it has detrimental effects, and on the other side, it has beneficial effects.
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Affiliation(s)
- Yasuhiro Matsumura
- Department of Dermatology, Kansai Medical University, Osaka 570-8507, Japan.
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47
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Inaoki M. [Pathogenesis and treatment of psoriasis vulgaris]. NIHON RINSHO MEN'EKI GAKKAI KAISHI = JAPANESE JOURNAL OF CLINICAL IMMUNOLOGY 2004; 27:77-86. [PMID: 15164928 DOI: 10.2177/jsci.27.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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48
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Middelkamp-Hup MA, Pathak MA, Parrado C, Garcia-Caballero T, Rius-Díaz F, Fitzpatrick TB, González S. Orally administered polypodium leucotomos extract decreases psoralen-UVA–induced phototoxicity, pigmentation, and damage of human skin. J Am Acad Dermatol 2004; 50:41-9. [PMID: 14699363 DOI: 10.1016/s0190-9622(03)02732-4] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of psoralen-UVA (PUVA) in patients of skin phototype I to II is limited by side effects of acute phototoxicity and possible long-term carcinogenesis. OBJECTIVE We sought to assess oral Polypodium leucotomos (PL) extract in decreasing PUVA-induced phototoxicity of human skin on a clinical and histologic level. METHODS A total of 10 healthy patients with skin phototypes II to III were exposed to PUVA alone (using 0.6 mg/kg oral 8-methoxypsoralen) and to PUVA with 7.5 mg/kg of oral PL. RESULTS Clinically, phototoxicity was always lower in PL-treated skin after 48 to 72 hours (P<.005), and pigmentation was also reduced 4 months later. Histologically, PL-treated skin showed a significant numeric reduction of sunburn cells (P=.05), preservation of Langerhans cells (P< or =.01), decrease of tryptase-positive mast cell infiltration (P<.05), and decrease of vasodilation (P< or =.01). No differences were found in Ki-67+ proliferating cells. CONCLUSIONS PL is an effective chemophotoprotector against PUVA-induced skin phototoxicity and leads to substantial benefits of skin protection against damaging effects of PUVA as evidenced by histology.
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Affiliation(s)
- Maritza A Middelkamp-Hup
- Wellman Laboratories of Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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Viola G, Facciolo L, Vedaldi D, Disarò S, Basso G, Dall'Acqua F. Differential response of linear and angular psoralens in PUVA-induced apoptosis in HL-60 cells. Photochem Photobiol Sci 2004; 3:237-9. [PMID: 14993937 DOI: 10.1039/b313729e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Treatment of cells with UVA radiation in combination with linear psoralens induces a cell-cycle block and subsequent apoptosis, whereas angular derivatives produce apoptosis without affecting the cellular cycle.
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Affiliation(s)
- Giampietro Viola
- Department of Pharmaceutical Sciences, University of Padua, via Marzolo 5, 35131 Padua, Italy.
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Abstract
Most photodermatoses represent indications for preventive ultraviolet (UV) phototherapy and/or psoralen plus ultraviolet A (PUVA) photochemotherapy. The aim of treatment is to prevent the outbreak of disease by increasing the patient's tolerance to sunlight. The mechanisms by which ultraviolet B (UVB) and PUVA induce such tolerance are not completely understood. Pigmentation and skin thickening may be important factors in the protective effect, but they cannot sufficiently explain the degree of protection induced. Other mechanisms that may be of critical importance for the therapeutic efficacy encompass a variety of immunomodulatory effects on human skin known to be induced by UVA, UVB, and PUVA. Obviously the mechanisms of prophylactic phototherapy are strongly intertwined with the pathogenesis of the photodermatoses. The possible mechanisms of photoprevention are discussed for polymorphic light eruption (PMLE), actinic prurigo, chronic actinic dermatitis, and solar urticaria.
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Affiliation(s)
- Herbert Hönigsmann
- Department of Dermatology, University of Vienna Medical School, Vienna, Austria.
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