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Vitiello P, Sagnelli C, Ronchi A, Franco R, Caccavale S, Mottola M, Pastore F, Argenziano G, Creta M, Calogero A, Fiorelli A, Casale B, Sica A. Multidisciplinary Approach to the Diagnosis and Therapy of Mycosis Fungoides. Healthcare (Basel) 2023; 11:healthcare11040614. [PMID: 36833148 PMCID: PMC9957453 DOI: 10.3390/healthcare11040614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Mycosis fungoides is the most common primary cutaneous T-cell lymphoma, characterized by skin-homing CD4+ T cells derivation, indolent course, and low-grade of malignancy. Mycosis fungoides's classic type typically onsets with cutaneous erythematous patches, plaque, and tumor. In WHO-EORTC classification, folliculotropic mycosis fungoides, pagetoid reticulosis, and granulomatous slack skin are recognized as distinct variants of mycosis fungoides, because of their clinical and histological features, behavior, and /or prognosis. Mycosis fungoides often shows diagnostic difficulties, due to its absence of specific features and lesional polymorphism. A patient's treatment requires staging. In about 10% of cases, mycosis fungoides can progress to lymph nodes and internal organs. Prognosis is poor at advanced stage and management needs a multidisciplinary team approach. Advanced stage disease including tumors, erythroderma, and nodal, visceral, or blood involvement needs skin directed therapy associated with systemic drugs. Skin directed therapy includes steroids, nitrogen mustard, bexarotene gel, phototherapy UVB, and photochemiotherapy, i.e., total skin electron radiotherapy. Systemic therapies include retinoids, bexarotene, interferon, histone deacetylase inhibitors, photopheresis, targeted immunotherapy, and cytotoxic chemotherapy. Complexity of mycosis fungoides associated with long-term chronic evolution and multiple therapy based on disease stage need a multidisciplinary team approach to be treated.
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Affiliation(s)
- Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-39-3810-7860
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Maria Mottola
- Department of Heart Surgery and Transplantations, AORN Dei Colli-V Monaldi, 80131 Naples, Italy
| | | | - Giuseppe Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Armando Calogero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
| | - Beniamino Casale
- Department of Pneumology and Tisiology, AO Dei Colli-V. Monaldi, 80131 Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80131 Naples, Italy
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Travaglino A, Russo D, Varricchio S, Pignatiello S, Baldo A, Picardi M, Pane F, Mascolo M. Prognostic Significance of CD30 in Transformed Mycosis Fungoides. Am J Clin Pathol 2021; 156:350-355. [PMID: 33769436 DOI: 10.1093/ajcp/aqaa261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Several studies suggested that CD30 expression is a favorable prognostic marker in transformed mycosis fungoides (tMF). However, evidence in this field is still unclear. This systematic review and meta-analysis aimed to evaluate the prognostic significance of CD30 in tMF. METHODS Electronic databases were searched from their inception to June 2020 for all studies assessing the prognostic value of CD30 in tMF. Pooled hazard ratio (HR) for death was calculated; a P value less than .05 was considered significant. Inconsistency index (I2) was used to assess statistical heterogeneity among studies. RESULTS Seven studies with 323 patients were included. CD30 expression in tMF was significantly associated with a decreased hazard of death both on univariate (HR, 0.459; 95% confidence interval [CI], 0.319-0.660; P < .001) and multivariate analysis (HR, 0.503; 95% CI, 0.345-0.734; P < .001), and the statistical heterogeneity among studies was null in all analyses (I2 = 0%). CONCLUSIONS tMF cases with CD30 expression in large cells have a hazard of death two times lower than CD30-negative cases.
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Affiliation(s)
- Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section Naples, Italy
| | - Sara Pignatiello
- Department of Advanced Biomedical Sciences, Pathology Section Naples, Italy
| | - Antonello Baldo
- Department of Clinical Medicine and Surgery, Dermatology Section Naples, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II,” Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II,” Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section Naples, Italy
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Discepolo V, Catzola A, Pierri L, Mascolo M, Della Casa F, Vastarella M, Smith G, Travaglino A, Punziano A, Nappa P, Staibano S, Bruzzese E, Fabbrocini G, Guarino A, Alessio M. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2111369. [PMID: 34110396 PMCID: PMC8193438 DOI: 10.1001/jamanetworkopen.2021.11369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. OBJECTIVE To examine the association of chilblain-like lesions with SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. MAIN OUTCOMES AND MEASURES Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. RESULTS Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. CONCLUSIONS AND RELEVANCE This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.
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Affiliation(s)
- Valentina Discepolo
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Maria Vastarella
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Grace Smith
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Paola Nappa
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Alessio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Mascolo M, Travaglino A, Varricchio S, Russo D, Sabattini E, Agostinelli C, Bertuzzi C, Baldo A, Pileri A, Picardi M, Pane F, Staibano S. Role of chromatin assembly factor-1/p60 and poly [ADP-ribose] polymerase 1 in mycosis fungoides. Virchows Arch 2020; 478:961-968. [PMID: 33098490 PMCID: PMC8099834 DOI: 10.1007/s00428-020-02952-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022]
Abstract
Mycosis fungoides (MF) represents the most common type of cutaneous lymphoma. In the majority of patients, the disease has a slow evolution and a protracted course; however, a subset of patients shows poor oncologic outcomes. Unfortunately, there are no reliable prognostic markers for MF, and the currently available treatments are only effective in a minority of patients. This study aimed to evaluate the expression and clinical significance of PARP-1 and CAF-1/p60 in MF. Sixty-four MF representatives of the different stages of disease were assessed by immunohistochemistry for PARP-1 and CAF-1/p60. The association of PARP-1 and CAF-1/p60 with the MF stage and outcome was assessed by using Fisher’s exact test and Kaplan-Meier survival analysis with the Log-rank test; a p value < 0.05 was considered significant. PARP-1 was overexpressed in 57.9% of MF and was significantly associated with a MF stage > II (p = 0.034) but not with the risk of death (p = 0.237). CAF-1/p60 was overexpressed in 26.8% of MF and was significantly associated with decreased overall survival (p < 0.001) but not with the MF stage (p = 1). A significant association was found between PARP-1 overexpression and CAF-1/p60 overexpression (p = 0.0025). Simultaneous overexpression of PARP-1 and CAF-1/p60 was significantly associated with decreased overall survival (p < 0.001), although less strongly than CAF-1/p60 alone (χ2 = 14.916 vs 21.729, respectively). In MF, PARP-1 is overexpressed in advanced stages, while CAF-1/p60 is overexpressed in the cases with shorter overall survival, appearing as a significant prognostic marker. A role for PARP-1 inhibitors and anti-CAF-1/p60 targeted therapy may be reasonably hypothesized in MF.
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Affiliation(s)
- Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Silvia Varricchio
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Elena Sabattini
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudio Agostinelli
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Clara Bertuzzi
- Haematopathology Unit, Department of Experimental Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonello Baldo
- Department of Clinical Medicine and Surgery, Dermatology Section, University of Naples "Federico II", Naples, Italy
| | - Alessandro Pileri
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples "Federico II", Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Section, School of Medicine, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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5
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Pérez C, Mondéjar R, García-Díaz N, Cereceda L, León A, Montes S, Durán Vian C, Pérez Paredes MG, González-Morán A, Alegre de Miguel V, Sanz Anquela JM, Frias J, Limeres MA, González LM, Martín Dávila F, Beltrán M, Mollejo M, Méndez JR, González MA, González García J, López R, Gómez A, Izquierdo F, Ramos R, Camacho C, Rodriguez-Pinilla SM, Martínez N, Vaqué JP, Ortiz-Romero PL, Piris MA. Advanced-stage mycosis fungoides: role of the signal transducer and activator of transcription 3, nuclear factor-κB and nuclear factor of activated T cells pathways. Br J Dermatol 2019; 182:147-155. [PMID: 31049933 DOI: 10.1111/bjd.18098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The malignant mechanisms that control the development of cutaneous T-cell lymphoma (CTCL) are beginning to be identified. Recent evidence suggests that disturbances in specific intracellular signalling pathways, such as RAS-mitogen-activated protein kinase, T-cell receptor (TCR)-phospholipase C gamma 1 (PLCG1)-nuclear factor of activated T cells (NFAT) and Janus kinase (JAK)-signal transducer and activator of transcription (STAT), may play an essential role in the pathogenesis of CTCL. OBJECTIVES To investigate the mechanisms controlling disease development and progression in mycosis fungoides (MF), the most common form of CTCL. METHODS We collected 100 samples that were submitted for diagnosis of, or a second opinion regarding, MF between 2001 and 2018, 80% of which were in the early clinical stages of the disease. Formalin-fixed paraffin-embedded tissues were used for histological review and to measure the expression by immunohistochemistry of surrogate markers of activation of the TCR-PLCG1-NFAT, JAK-STAT and NF-κB pathways. Folliculotropism and large-cell transformation were also examined. RESULTS NFAT and nuclear factor kappa B (NF-κB) markers showed a comparable activation status in early and advanced stages, while STAT3 activation was more frequent in advanced stages and was associated with large-cell transformation. Consistently with this observation, STAT3 activation occurred in parallel with MF progression in two initially MF-negative cases. A significant association of NFAT with NF-κB markers was also found, reflecting a common mechanism of activation in the two pathways. Genomic studies identified nine mutations in seven genes known to play a potential role in tumorigenesis in T-cell leukaemia/lymphoma, including PLCG1, JAK3 and STAT3, which underlies the activation of these key cell-survival pathways. A higher mutational allele frequency was detected in advanced stages. CONCLUSIONS Our results show that STAT3 is activated in advanced cases and is associated with large-cell transformation, while the activation of NFAT and NF-κB is maintained throughout the disease. These findings could have important diagnostic and therapeutic implications. What's already known about this topic? Mycosis fungoides is characterized by a clonal expansion of T cells in the skin. The mechanisms controlling disease development and progression are not fully understood. What does this study add? An association of the nuclear factor of activated T cells and nuclear factor kappa B pathways was found, which could reflect a common mechanism of activation. These pathways were activated in early and advanced stages at the same level. Signal transducer and activator of transcription 3 activation was associated with large-cell transformation and was more frequent in advanced stages. A genomic analysis of cutaneous T-cell lymphoma-associated genes was performed. Nine mutations were detected. What is the translational message? These results could have important implications for the treatment of MF in the near future.
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Affiliation(s)
- C Pérez
- Translational Hematopathology, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - R Mondéjar
- Translational Hematopathology, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Service of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - N García-Díaz
- Departamento de Biología Molecular, Universidad de Cantabria, Infección, Inmunidad y Patología Digestive, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - L Cereceda
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Service of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - A León
- Pathology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - S Montes
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Pathology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - C Durán Vian
- Dermatology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - M G Pérez Paredes
- Dermatology Service, Marqués de Valdecilla University Hospital, Santander, Spain
| | - A González-Morán
- Dermatology Service, Complejo Hospitalario de Ávila, Ávila, Spain
| | - V Alegre de Miguel
- Dermatology Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - J M Sanz Anquela
- Cancer Registry and Pathology Department, Hospital Universitario Príncipe de Asturias and Department of Medicine and Medical Specialties, Faculty of Medicine, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - J Frias
- Dermatology Service, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - M A Limeres
- Pathology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Gran Canaria, Canarias, Spain
| | - L M González
- Pathology Service, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - F Martín Dávila
- Pathology Service, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - M Beltrán
- Pathology Service, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - M Mollejo
- Pathology Service, Complejo Hospitalario de Toledo, Toledo, Spain
| | - J R Méndez
- Pathology Service, Centro Médico de Asturias, Asturias, Spain
| | - M A González
- Pathology Service, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - J González García
- Pathology Service, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - R López
- Pathology Service, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - A Gómez
- Pathology Service, Hospital de la Marina Baixa, Alicante, Spain
| | - F Izquierdo
- Pathology Service, Complejo Asistencial Universitario de León, León, Spain
| | - R Ramos
- Pathology Service, University Hospital Son Espases, Palma de Mallorca, Spain
| | - C Camacho
- Pathology Service, C.H.U. Insular - Materno Infantil, Gran Canarias, Spain
| | - S M Rodriguez-Pinilla
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Service of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - N Martínez
- Translational Hematopathology, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain.,Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - J P Vaqué
- Departamento de Biología Molecular, Universidad de Cantabria, Infección, Inmunidad y Patología Digestive, Instituto de Investigación Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - P L Ortiz-Romero
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Dermatology Service, Hospital 12 de Octubre, Institute i+12 Medical School, University Complutense, Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain
| | - M A Piris
- Centro de Investigación Biomédica en Red Cáncer, Madrid, Spain.,Service of Pathology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
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TRAF2 and FKBP51 as possible markers for identification of suitable melanoma tumors for tumor necrosis factor-α inhibition. Melanoma Res 2019; 29:145-150. [PMID: 30451787 DOI: 10.1097/cmr.0000000000000553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tumor necrosis factor-α (TNF-α) is a pleiotropic cytokine, whose role in melanoma is controversial. Although high-dose TNF-α is approved for the treatment of patients with in transit-metastatic melanoma confined to the limb, diverse preclinical models of melanoma have shown that TNF-α can induce cell invasion. Biomarkers that can differentiate between the dual role of TNF-α are needed. TRAF2 is critical to TNF receptor-induced activation of nuclear factor-κB (NF-κB), allowing shifting from death to survival-signaling cascades. The large immunophilin FKBP51 acts as a scaffold and catalyst in the IκB kinase complex assembly and activation. Here, using microscopy and an electrophoretic mobility-shift assay, we provide further evidence in support of the essential role of FKBP51 in sustaining the TNF-α NF-κB signaling in melanoma. Through the cross-linking reaction with the chemical linker disuccinimidyl glutarate, we show that a direct interaction occurs between FKBP51 and TRAF2 in melanoma cells. Immunohistochemistry of tumor samples from 24 patients with cutaneous melanomas showed a correlation between the expressions of the two proteins. Given the association of FKBP51 and TRAF2 with TNF-α-induced NF-κB signaling and their correlation in tumor samples, we propose that the two proteins can be exploited as useful markers for the identification of those melanoma tumors that can benefit from TNF-α inhibition. Future studies will address this hypothesis.
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