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Berhan A, Damtie S, Almaw A, Legesse B, Sharew B, Getie B, Erkihun M, Solomon Y. The Role of Extracorporeal Photopheresis in the Management of Graft Versus Host Disease: Narrative Review. Immunotargets Ther 2024; 13:235-246. [PMID: 38689598 PMCID: PMC11060171 DOI: 10.2147/itt.s457366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/02/2024] Open
Abstract
Hematopoietic stem cell donation is a method used to treat both blood-related and non-blood-related malignancies. Graft-versus-host disease is a potentially life-threatening complication that can occur following a stem cell transplant from a donor. This happens after the transplanted grafts attack the recipient's body as foreign cells, causing significant morbidity and mortality. Clinically, this condition can be classified as acute or chronic based on onset and pathophysiology. This review aims to provide an overview of recent studies on extracorporeal photopheresis as a treatment strategy option for graft-versus-host-diseased patients. It will explain how it treats graft-versus-host disease, summarize its promising effects, and provide future recommendations for its use in treating this illness. Extracorporeal photopheresis is used to treat graft-versus-host disease by collecting and separating white blood cells from the patient. This blood is fractionated into different parts, and white blood cells undergo treatment with 8-methoxy psoralen, a photoactivable drug, before exposure to ultraviolet light A. Lastly, the cells that have been treated are reinfused into the recipient's body. It prompts the programmed cell death of lymphocytes and the engulfment of cellular debris by host antigen-presenting, leading to a subsequent rise in T regulatory cells. However, more experimental and randomized controlled studies are required to identify the best patient selection requirements, environments, and treatment regimens for graft-versus-host disease.
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Affiliation(s)
- Ayenew Berhan
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shewaneh Damtie
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Andargachew Almaw
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Legesse
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekele Sharew
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Birhanu Getie
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulat Erkihun
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
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Dey S, Vieyra-Garcia PA, Joshi AA, Trajanoski S, Wolf P. Modulation of the skin microbiome in cutaneous T-cell lymphoma delays tumour growth and increases survival in the murine EL4 model. Front Immunol 2024; 15:1255859. [PMID: 38646524 PMCID: PMC11026597 DOI: 10.3389/fimmu.2024.1255859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 03/21/2024] [Indexed: 04/23/2024] Open
Abstract
Cutaneous T-cell lymphomas (CTCL) are a group of lymphoproliferative disorders of skin-homing T cells causing chronic inflammation. These disorders cause impairment of the immune environment, which leads to severe infections and/or sepsis due to dysbiosis. In this study, we elucidated the host-microbial interaction in CTCL that occurs during the phototherapeutic treatment regime and determined whether modulation of the skin microbiota could beneficially affect the course of CTCL. EL4 T-cell lymphoma cells were intradermally grafted on the back of C57BL/6 mice. Animals were treated with conventional therapeutics such as psoralen + UVA (PUVA) or UVB in the presence or absence of topical antibiotic treatment (neomycin, bacitracin, and polymyxin B sulphate) as an adjuvant. Microbial colonisation of the skin was assessed to correlate with disease severity and tumour growth. Triple antibiotic treatment significantly delayed tumour occurrence (p = 0.026), which prolonged the survival of the mice (p = 0.033). Allocation to phototherapeutic agents PUVA, UVB, or none of these, along with antibiotic intervention, reduced the tumour growth significantly (p = 0.0327, p ≤ 0.0001, p ≤ 0.0001 respectively). The beta diversity indices calculated using the Bray-Curtis model showed that the microbial population significantly differed after antibiotic treatment (p = 0.001). Upon modulating the skin microbiome by antibiotic treatment, we saw an increase in commensal Clostridium species, e.g., Lachnospiraceae sp. (p = 0.0008), Ruminococcaceae sp. (p = 0.0001)., Blautia sp. (p = 0.007) and a significant reduction in facultative pathogens Corynebacterium sp. (p = 0.0009), Pelomonas sp. (p = 0.0306), Streptococcus sp. (p ≥ 0.0001), Pseudomonas sp. (p = 0.0358), and Cutibacterium sp. (p = 0.0237). Intriguingly, we observed a significant decrease in Staphylococcus aureus frequency (p = 0.0001) but an increase in the overall detection frequency of the Staphylococcus genus, indicating that antibiotic treatment helped regain the microbial balance and increased the number of non-pathogenic Staphylococcus populations. These study findings show that modulating microbiota by topical antibiotic treatment helps to restore microbial balance by diminishing the numbers of pathogenic microbes, which, in turn, reduces chronic inflammation, delays tumour growth, and increases survival rates in our CTCL model. These findings support the rationale to modulate the microbial milieu during the disease course of CTCL and indicate its therapeutic potential.
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MESH Headings
- Animals
- Microbiota/drug effects
- Mice
- Skin/microbiology
- Skin/pathology
- Skin/immunology
- Skin/drug effects
- Skin Neoplasms/microbiology
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- Lymphoma, T-Cell, Cutaneous/microbiology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Cutaneous/drug therapy
- Lymphoma, T-Cell, Cutaneous/therapy
- Mice, Inbred C57BL
- Disease Models, Animal
- Anti-Bacterial Agents/therapeutic use
- Anti-Bacterial Agents/pharmacology
- Anti-Bacterial Agents/administration & dosage
- Cell Line, Tumor
- Female
- Humans
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Affiliation(s)
- Saptaswa Dey
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | | | - Aaroh Anand Joshi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Slave Trajanoski
- Core Facility Computational Bioanalytics, Medical University of Graz, Graz, Austria
| | - Peter Wolf
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
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Cho A, Paulitschke V, Knobler R. Mode of action, indications and recommendations on extracorporeal photopheresis (ECP). J Dtsch Dermatol Ges 2023; 21:1369-1380. [PMID: 37723908 DOI: 10.1111/ddg.15167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/02/2023] [Indexed: 09/20/2023]
Abstract
Extracorporeal photopheresis (ECP) has gained importance in the treatment of several diseases. Initially introduced as a new therapeutic modality for the treatment of patients with cutaneous T-cell lymphoma, the indications for the use of ECP have expanded to include hematology and transplantation immunology. Extracorporeal photopheresis has found its place in the treatment plan of cutaneous T-cell lymphoma, systemic sclerosis, graft-versus-host disease, organ transplantation such as heart and lung, sometimes as first-line therapy and very often in combination with various systemic immunosuppressive therapies. The procedure basically consists of three steps: leukapheresis, photoactivation and reinfusion. The following article presents possible theories about the mechanism of action, which is not yet fully understood, and discusses the five most common indications for ECP treatment with corresponding therapy recommendations.
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Affiliation(s)
- Ara Cho
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Verena Paulitschke
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Robert Knobler
- University Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Cho A, Paulitschke V, Knobler R. Wirkweise, Indikationen und Therapieempfehlungen der extrakorporalen Photopherese (ECP). J Dtsch Dermatol Ges 2023; 21:1369-1381. [PMID: 37946642 DOI: 10.1111/ddg.15167_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/02/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungDie extrakorporale Photopherese (ECP) hat in jüngster Zeit bei der Behandlung verschiedener Krankheiten an Bedeutung gewonnen. Ursprünglich als neue Therapie zur Behandlung von Patienten mit kutanem T‐Zell‐Lymphom vorgestellt, hat sich der Indikationsbereich für die ECP auf Hämatologie und Transplantationsimmunologie erweitert. Die ECP hat ihren festen Platz im Therapieplan bei kutanen T‐Zell‐Lymphomen, systemischer Sklerose, Graft‐versus‐Host‐Erkrankung, Organtransplantationen wie Herz und Lunge, teilweise als Erstlinientherapie und sehr häufig in Kombination mit verschiedenen systemischen immunsuppressiven Therapien. Das Verfahren besteht im Wesentlichen aus drei Schritten: Leukapherese, Photoaktivierung und Reinfusion. Im folgenden Artikel werden die noch nicht vollständig verstandenen Wirkmechanismen dargestellt, die fünf häufigsten Indikationen für die Behandlung mit ECP diskutiert und Therapieempfehlungen für die jeweilige Indikation gegeben.
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Affiliation(s)
- Ara Cho
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Verena Paulitschke
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
| | - Robert Knobler
- Universitätsklinik für Dermatologie, Medizinische Universität Wien, Wien, Österreich
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Tsai YC, Schlaepfer T, Ignatova D, Chang YT, Valaperti A, Amarov B, Blanchard G, Pehr K, Vonow-Eisenring M, Urosevic-Maiwald M, Hoetzenecker W, Pascolo S, Iselin C, Fassnacht C, Dimitriou F, Bobrowicz M, Guenova E. Boost of innate immunity cytokines as biomarkers of response to extracorporeal photopheresis in patients with leukaemic cutaneous T-cell lymphoma. Br J Dermatol 2023; 189:603-611. [PMID: 37409661 DOI: 10.1093/bjd/ljad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has emerged as a systemic first-line immunomodulatory therapy in leukaemic cutaneous T-cell lymphoma (L-CTCL) and is now beginning to be utilized in other T-cell-mediated diseases. Although ECP has been used for nearly 30 years, its mechanisms of action are not sufficiently understood, and biomarkers for response are scarce. OBJECTIVES We aimed to investigate the immunomodulatory effects of ECP on cytokine secretion patterns in patients with L-CTCL, to help elucidate its mechanism of action. METHODS A total of 25 patients with L-CTCL and 15 healthy donors (HDs) were enrolled in this retrospective cohort study. Concentrations of 22 cytokines were simultaneously quantified by using multiplex bead-based immunoassays. Neoplastic cells in patients' blood were evaluated by flow cytometry. RESULTS Firstly, we observed a distinct cytokine profile pattern difference between L-CTCLs and HDs. There was a significant loss of tumour necrosis factor (TNF)-α, and significant increase of interleukins (IL)-9, IL-12 and IL-13 in the sera of patients with L-CTCL compared with HDs. Secondly, patients with L-CTCL who received ECP were classified as treatment responders and nonresponders according to the quantitative reduction of malignant burden in their blood. We evaluated cytokine levels in culture supernatants from patients' peripheral blood mononuclear cells (PBMCs) at baseline and 27 weeks after ECP initiation. Strikingly, PBMCs purified from ECP responders released statistically higher concentrations of innate immune cytokines IL-1α, IL-1β, granulocyte-macrophage colony-stimulating factor (GM-CSF) and TNF-α in comparison with ECP nonresponders. In parallel, responders showed clearance of erythema, reduction of malignant clonal T cells in the blood, and a potent boost of relevant innate immune cytokines in individual patients with L-CTCL. CONCLUSIONS Taken together, our results demonstrate that ECP stimulates the innate immune network, and facilitates redirection of the tumour-biased immunosuppressive microenvironment towards proactive antitumour immune responses. The alterations of IL-1α, IL-1β, GM-CSF and TNF-α can be used as biomarkers of response to ECP in patients with L-CTCL.
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Affiliation(s)
- Yi-Chien Tsai
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | - Yun-Tsan Chang
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | - Boyko Amarov
- Institute of Statistics and Econometrics, Faculty of Economics and Business Administration, Sofia University 'St Kliment Ohridski', Sofia, Bulgaria
| | - Gabriela Blanchard
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kevin Pehr
- Division of Dermatology, McGill University, Jewish General Hospital, and Lady Davis Institute for Medical Research, Montreal, Canada
| | | | | | | | | | - Christoph Iselin
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Emmanuella Guenova
- Department of Dermatology, Lausanne University Hospital (CHUV), and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Departments of Dermatology
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Goldberg I, Granot G, Telerman A, Partouche S, Shochat T, Halperin E, Gafter-Gvili A, Shargian L, Yeshurun M, Raanani P, Wolach O, Yahalom V. Extracorporeal photopheresis induces NETosis in neutrophils derived from patients with chronic graft-vs-host disease. J Clin Apher 2023; 38:615-621. [PMID: 37439388 DOI: 10.1002/jca.22073] [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: 11/15/2022] [Revised: 05/25/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Extracorporeal photopheresis (ECP) is considered an effective treatment for patients with chronic graft vs host disease (cGVHD) and demonstrates efficacy in ameliorating GVHD. The mechanism by which ECP acts against cGVHD is not fully understood. Preliminary observations have hinted at the potential involvement of neutrophil extracellular traps (NETs) formation in the pathogenesis of cGVHD. We aimed to assess the influence of ECP on the formation of NETs in patients with cGVHD as a potential mechanism in this setting. METHODS Patients treated with ECP for cGVHD at the Rabin Medical Center were included in this study. Blood samples were obtained at three different time points: before starting an ECP cycle, at the end of the first day of treatment, and 24 h following the initiation of the ECP treatment cycle. Neutrophils were harvested from all blood samples. NET formation was assessed by measurement of NET-bound specific neutrophil elastase activity and by immunofluorescence staining. RESULTS Six patients (two females and four males) with cGVHD were included in the study. We observed a significant increase in NET formation among all six patients following ECP. Net-bound specific neutrophil elastase activity was elevated from a median value of 2.23 mU/mL (interquartile range [IQR] 2.06-2.47 mU/mL) at baseline to a median value of 13.06 mU/mL (IQR 10.27-15.97 mU/mL) immediately after the treatment and to a peak median value of 14.73 mU/mL (IQR 9.6-22.38 mU/mL) 24 h following the initiation of the ECP cycle. A qualitative assessment of NET formation using immunofluorescence staining has demonstrated markedly increased expression of citrullinated histone H3, a marker of NET formation, following ECP treatment. CONCLUSIONS Our preliminary data indicate that ECP induces NET formation among patients with cGVHD. The contribution of increased NET formation to the therapeutic effect of cGVHD should be further investigated.
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Affiliation(s)
- Idan Goldberg
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine F - Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Galit Granot
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Alona Telerman
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Shirly Partouche
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Tzippy Shochat
- Statistical Consulting Unit, Beilinson Hospital, Rabin Medical Centre, Petah Tikva, Israel
| | - Erez Halperin
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Anat Gafter-Gvili
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Liat Shargian
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Yeshurun
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pia Raanani
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Wolach
- Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Yahalom
- Sackler School Medicine, Tel Aviv University, Tel Aviv, Israel
- Blood Services & Apheresis Institute, Rabin Medical Center, Petah Tikva, Israel
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Akilov OE. What Does the Future Hold for Biomarkers of Response to Extracorporeal Photopheresis for Mycosis Fungoides and Sézary Syndrome? Cells 2023; 12:2321. [PMID: 37759543 PMCID: PMC10527589 DOI: 10.3390/cells12182321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Extracorporeal photopheresis (ECP) is an FDA-approved immunotherapy for cutaneous T-cell lymphoma, which can provide a complete response in some patients. However, it is still being determined who will respond well, and predictive biomarkers are urgently needed to target patients for timely treatment and to monitor their response over time. The aim of this review is to analyze the current state of the diagnostic, prognostic, and disease state-monitoring biomarkers of ECP, and outline the future direction of the ECP biomarker discovery. Specifically, we focus on biomarkers of response to ECP in mycosis fungoides and Sézary syndrome. The review summarizes the current knowledge of ECP biomarkers, including their limitations and potential applications, and identifies key challenges in ECP biomarker discovery. In addition, we discuss emerging technologies that could revolutionize ECP biomarker discovery and accelerate the translation of biomarker research into clinical practice. This review will interest researchers and clinicians seeking to optimize ECP therapy for cutaneous T-cell lymphoma.
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Affiliation(s)
- Oleg E Akilov
- Cutaneous Lymphoma Program, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapy: Theory and practice. J Dtsch Dermatol Ges 2023; 21:882-897. [PMID: 37485907 DOI: 10.1111/ddg.15126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 07/25/2023]
Abstract
Despite the development of highly effective biologics for skin diseases such as psoriasis or atopic dermatitis, UVA and UVB therapy, alone or in combination, are still essential components of various guidelines. Phototherapy is not only a first-line treatment and highly effective for a number of skin diseases, but is also economical and has few side effects. The targeted use of UVA and UVB, if necessary, in combination with the photosensitizer psoralen in the context of PUVA therapy, enables the dermatologist to effectively treat a wide variety of skin diseases. Indications for phototherapy include epidermal diseases such as atopic dermatitis, psoriasis and vitiligo, as well as photodermatoses, mycosis fungoides, graft-versus-host disease and deep dermal diseases such as scleroderma. This article reviews the physical principles, molecular mechanisms, current treatment regimens, and individual indications for phototherapy and photochemotherapy.
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Affiliation(s)
- Bernadett Kurz
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Mark Berneburg
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Wolfgang Bäumler
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Sigrid Karrer
- Department for Dermatology, University Hospital Regensburg, Regensburg, Germany
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Mayer W, Mayr J, Koch F, Rechberger U, Gasser W, Hermann M, Kempel A, Edlinger M, Schennach H. Increasing the collection flow rate to 2 mL/min is effective and reduces the procedure time in off-line photopheresis. Transfusion 2023; 63:1546-1553. [PMID: 37422880 DOI: 10.1111/trf.17469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) treatment, mostly based on apheresis technology, is used for immunomodulation in various diseases such as cutaneous T-cell lymphoma, graft versus host disease and other (auto)immune disorders. The aim of this study was to collect high cell counts and purity in shorter procedure times using an ECP off-line system with an increased collection flow rate of 2 mL/min to a target volume of 200 mL buffy coat. STUDY DESIGN AND METHODS In this prospective study, data of routinely performed off-line photopheresis treatments were collected and analyzed at the Central Institute for Blood Transfusion & Department of Immunology (ZIB) of the Tirol Kliniken, to assess absolute cell counts and procedure times and to calculate collection efficiencies (CE2). RESULTS A total of 22 patients participated in this study. The processed blood volume was 4312 mL, the collection time 120 min, overall procedure time 157 min and the absolute cell counts of treated white blood cells (WBC) and mononuclear cells (MNC) were 5.0 and 4.3 × 109 respectively (median values). The calculated CE2 for WBC and MNC was 21.1% and 58.5%, the proportion of treated MNCs of the total number of MNCs present was 55.0%. CONCLUSION The data presented in this study show high therapeutically effective cell counts collected with a high MNC purity within a shorter overall collection/procedure time due to an increased collection flow rate.
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Affiliation(s)
- Wolfgang Mayer
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jonas Mayr
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Felix Koch
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Ulrike Rechberger
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Werner Gasser
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
| | - Martin Hermann
- Department of Anesthesia and Intensive Care Medicine at the Medical University Innsbruck, Innsbruck, Austria
| | - Angela Kempel
- Pharmametrics GmbH, Institute for Health Economics & Epidemiology, Freiburg, Germany
| | - Michael Edlinger
- Institute of Medical Statistics and Informatics, Medical University Innsbruck, Innsbruck, Austria
| | - Harald Schennach
- Central Institute for Blood Transfusion & Department of Immunology (ZIB), Tirol Kliniken GmbH, Innsbruck, Austria
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Kurz B, Berneburg M, Bäumler W, Karrer S. Phototherapie in Theorie und Praxis. J Dtsch Dermatol Ges 2023; 21:882-898. [PMID: 37574671 DOI: 10.1111/ddg.15126_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/12/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungDie Therapie oder Kombinationstherapie mit UV‐A‐ oder UV‐B‐Strahlen ist trotz der Entwicklung hochwirksamer Biologika bei Hauterkrankungen wie Psoriasis oder atopischer Dermatitis nach wie vor unverzichtbarer Bestandteil verschiedener Leitlinienempfehlungen. Die Phototherapie ist nicht nur eine sehr effektive Erstlinientherapie bei verschiedenen Hauterkrankungen, sondern auch kostengünstig und nebenwirkungsarm. Der gezielte Einsatz von UV‐A und UV‐B, gegebenenfalls auch in Kombination mit dem Photosensibilisator Psoralen im Rahmen einer PUVA‐Therapie, ermöglicht dem Dermatologen eine effektive Behandlung verschiedener Hautkrankheiten. Indikationen für die Phototherapie sind epidermale Erkrankungen wie die atopische Dermatitis, die Psoriasis und die Vitiligo, ferner Photodermatosen, die Mycosis fungoides, die Graft‐versus‐Host‐Erkrankung sowie tiefe dermale Erkrankungen wie die Sklerodermie. Dieser Artikel gibt einen Überblick über die physikalischen Grundlagen, die molekularen Mechanismen, die derzeitigen Behandlungsmethoden und die einzelnen Indikationen für die Phototherapie und die Photochemotherapie.
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Affiliation(s)
- Bernadett Kurz
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Mark Berneburg
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Wolfgang Bäumler
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
| | - Sigrid Karrer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg
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Del Fante C, Klersy C, Barone E, De Vitis S, Troletti D, Mortellaro C, Musella V, Perotti C. Validation of a new automated irradiation system for off-line ECP. Transfus Apher Sci 2023:103724. [PMID: 37202323 DOI: 10.1016/j.transci.2023.103724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Extracorporeal photopheresis (ECP) is a cell therapy originally employed for cutaneous T cell lymphoma and later for GvHD, solid organ rejection and other immunological diseases demonstrating an excellent safety profile. Mononuclear cell (MNCs) apoptosis triggered by UV-A light irradiation in the presence of 8-methoxypsoralene has a key role in priming the cells, ultimately leading to immunomodulation. We report preliminary data about an evaluation of the new automated irradiator device LUMILIGHT (Pelham Crescent srl) for off-line ECP. Fifteen MNCs samples collected by apheresis from 15 adult patients undergoing ECP at our Center were cultured immediately after irradiation along with untreated samples and evaluated at 24, 48 and 72 h timepoints for T cell apoptosis and viability by flow cytometry with Annexin V and Propide Iodidum staining. Post irradiation Hematocrit (HCT), calculated by the device, was compared with that of the automated cell counter. Bacterial contamination was also tested. In irradiated samples after 24-48 and 72 h, the average total apoptosis was 47 %, 70 % and 82 %, respectively, showing a significant difference from untreated samples; residual viable lymphocytes at 72 h were, on average, 18 %. The greatest initiation of apoptosis occurred from 48 h of irradiation onwards. Average early apoptosis of irradiated samples decreased over time (26 %, 17 % and 10 % at 24, 48 and 72 h, respectively). HCT measured by LUMILIGHT was over-estimated, possibly due to the low pre irradiation red blood cell contamination. Bacterial tests resulted negative. Our study showed the LUMILIGHT device to be a valid instrument for MNCs irradiation with good handling and no major technical problems as well as no adverse events in the patients. Our data need to be confirmed in larger studies.
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Affiliation(s)
- Claudia Del Fante
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics and clinical trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Eugenio Barone
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona De Vitis
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Troletti
- Cell manipulation laboratory, Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Mortellaro
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valeria Musella
- Biostatistics and clinical trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cesare Perotti
- Immunohaematology and Transfusion Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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12
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Ali MM, Gedde-Dahl T, Osnes LT, Perrier F, Veierød MB, Tjønnfjord GE, Iversen PO. Extracorporeal photopheresis as graft-versus-host disease prophylaxis: a randomized controlled trial: Prophylactic extracorporeal photopheresis to prevent graft-versus-host disease. Transplant Cell Ther 2023:S2666-6367(23)01133-8. [PMID: 36878428 DOI: 10.1016/j.jtct.2023.02.023] [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: 09/15/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only curative option for many patients diagnosed with hematological malignancies. A major obstacle is graft-versus-host disease (GvHD) causing significant morbidity and mortality. Extracorporeal photopheresis (ECP) is an increasingly applied GvHD treatment, partly due to its favourable safety profile. In contrast, the use of ECP in preventing GvHD is sparse, and randomized controlled trials (RCTs) are lacking. OBJECTIVE We therefore conducted a RCT to assess if ECP applied post-transplant, could prevent the development of GvHD within the first year of transplantation. STUDY DESIGN We enrolled 157 patients (18-74 years) with a hematological malignancy receiving first allo-HSCT: 76 randomized to the intervention group and 81 to the control group. ECP was initiated directly upon engraftment and was planned twice weekly for two weeks, then once weekly for four weeks. GvHD, relapse, and death were analyzed with Cox regression analysis. RESULTS During the first year, 45 patients in the intervention and 52 control patients developed GvHD (HR=0.82, 95% CI 0.55-1.22, P=0.32). There were no differences in acute or chronic GvHD or its organ distribution in this intention-to-treat RCT. A per-protocol analysis revealed a significant difference in GvHD between the intervention (per-protocol; n=39 of 76) and the control group (n=77), 46% vs 68%, respectively, (HR 0.47, 95% CI 0.27-0.80, P=0.006). Relapse occurred in 15 patients in the intervention group and in 11 patients among the controls (HR=1.38, 95% CI 0.64-3.01, P=0.42). GvHD-free relapse-free (GRFS) survival, event-free survival, overall survival and non-relapse mortality did not differ significantly between the two study groups. No significant difference in immune reconstitution between the two study groups was revealed. CONCLUSION This first intention-to-treat RCT, investigating ECP as GvHD prophylaxis in allo-HSCT for hematological malignancy does not support the use of ECP as adjunct to standard drug-based GvHD-prophylaxis. This trial was registered at www. CLINICALTRIALS gov as #NCT03204721.
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Affiliation(s)
- Maryan M Ali
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Tobias Gedde-Dahl
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv T Osnes
- Department of Immunology, Oslo University Hospital, Oslo, Norway
| | - Flavie Perrier
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Marit B Veierød
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Geir E Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Per O Iversen
- Department of Haematology, Oslo University Hospital, Oslo, Norway; Department of Nutrition, University of Oslo, Oslo, Norway
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13
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Bojanic I, Worel N, Pacini CP, Stary G, Piekarska A, Flinn AM, Schell KJ, Gennery AR, Knobler R, Lacerda JF, Greinix HT, Pulanic D, Crossland RE. Extracorporeal photopheresis as an immunomodulatory treatment modality for chronic GvHD and the importance of emerging biomarkers. Front Immunol 2023; 14:1086006. [PMID: 36875063 PMCID: PMC9981637 DOI: 10.3389/fimmu.2023.1086006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/01/2023] [Indexed: 02/19/2023] Open
Abstract
Haematopoietic stem cell transplantation (HSCT) is the treatment of choice for malignant haematological diseases. Despite continuous improvements in pre- and post-transplantation procedures, the applicability of allo-HSCT is limited by life-threatening complications such as graft-versus-host disease (GvHD), engraftment failure, and opportunistic infections. Extracorporeal photopheresis (ECP) is used to treat steroid resistant GvHD with significant success. However, the molecular mechanisms driving its immunomodulatory action, whilst preserving immune function, require further understanding. As ECP is safe to administer with few significant adverse effects, it has the potential for earlier use in the post-HSCT treatment of GvHD. Thus, further understanding the immunomodulatory mechanisms of ECP action may justify more timely use in clinical practice, as well as identify biomarkers for using ECP as first line or pre-emptive GvHD therapy. This review aims to discuss technical aspects and response to ECP, review ECP as an immunomodulatory treatment modality for chronic GvHD including the effect on regulatory T cells and circulating vs. tissue-resident immune cells and consider the importance of emerging biomarkers for ECP response.
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Affiliation(s)
- Ines Bojanic
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Center Zagreb, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Nina Worel
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Carolina P Pacini
- Hematology and Transplantation Immunology, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.,CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Ludwig Boltzmann Institute for Rare and Undiagnosed Diseases, Vienna, Austria
| | - Agnieszka Piekarska
- Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland
| | - Aisling M Flinn
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Kimberly J Schell
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew R Gennery
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.,Paediatric Stem Cell Transplant Unit, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - João F Lacerda
- Hematology and Transplantation Immunology, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Drazen Pulanic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia
| | - Rachel E Crossland
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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14
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Micellar Curcumin Substantially Increases the Antineoplastic Activity of the Alkylphosphocholine Erufosine against TWIST1 Positive Cutaneous T Cell Lymphoma Cell Lines. Pharmaceutics 2022; 14:pharmaceutics14122688. [PMID: 36559182 PMCID: PMC9781439 DOI: 10.3390/pharmaceutics14122688] [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: 10/31/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022] Open
Abstract
Cutaneous T-cell lymphoma (CTCL) is a rare form of cancer with local as well as systemic manifestations. Concomitant bacterial infections increase morbidity and mortality rates due to impaired skin barrier and immune deficiency. In the current study, we demonstrated that the in vitro anti-lymphoma potential of erufosine is diminished by TWIST1 expression and micellar curcumin substantially increases its antineoplastic activity. Pharmacokinetic analysis showed that the micellar curcumin (MCRM) used in our study was characterized by low zeta potential, slow release of curcumin, and fast cell membrane penetration. The combination ratio 1:4 [erufosine:MCRM] achieved strong synergism by inhibiting cell proliferation and clonogenicity. The combined antiproliferative effects were calculated using the symbolic mathematical software MAPLE 15. The synergistic combination strongly decreased the expression of TWIST1 and protein kinase B/Akt as proven by western blotting. Significant reductions in NF-κB activation, induction of apoptosis, and altered glutathione levels were demonstrated by corresponding assays. In addition, the synergistic combination enhanced the anti-staphylococcal activity and prevented biofilm formation, as shown by crystal violet staining. Taken together, the above results show that the development of nanotechnological treatment modalities for CTCL, based on rational drug combinations exhibiting parallel antineoplastic and antibacterial effects, may prove efficacious.
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15
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Castillo-Aleman YM. Beyond 8-methoxypsoralen as the photosensitizer for extracorporeal photopheresis. Front Oncol 2022; 12:996973. [PMID: 36578936 PMCID: PMC9791956 DOI: 10.3389/fonc.2022.996973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/27/2022] [Indexed: 12/31/2022] Open
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16
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Assessment of extracorporeal photopheresis related cell damage. Transfus Apher Sci 2022; 61:103472. [DOI: 10.1016/j.transci.2022.103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022]
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17
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Gambichler T, Chatzipantazi M, Stranzenbach R, Siebold A, Susok L. Impact of extracorporeal photopheresis on blood and coagulation parameters. Dermatol Ther 2022; 35:e15366. [PMID: 35141988 DOI: 10.1111/dth.15366] [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: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
Extracorporeal photopheresis (ECP) is considered a safe treatment modality. We aimed to assess blood parameters including coagulation during ECP over time. We performed a long-term retrospective single-center chart review (laboratory parameters) of adult patients (n = 172) who had received ECP for any indication. We observed a significant decrease (P < 0.05) in erythrocytes, hemoglobin, and leukocytes compared to baseline levels after only one ECP procedure. This decrease persisted after 3-, 6-, 9-, and 12-months of ECP. A significant pathological decline of hemoglobin was observed in a higher proportion (26.4% and 25.2%, respectively) of patients after 6 (P = 0.0007) and 12 (P = 0.012) months of ECP. Mean corpuscular volume as well as hematocrit was significantly decreased at 3-, 6-, 9-, and 12-months of evaluation compared to baseline (P < 0.05). After 9 and 12 months of ECP we observed a further decline in lymphocyte counts (P < 0.05). Various coagulation parameters did not change significantly during ECP treatment. Even though not all alterations observed in peripheral blood of ECP patients in the present study were of clinical significance, risk for developing persistent anemia must be considered in patients undergoing ECP. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thilo Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | | | | | - Alicia Siebold
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Laura Susok
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
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18
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Zubarovskaya N, Hofer-Popow I, Idzko M, Haas OA, Lawitschka A. SARS-CoV-2 Infection and Active, Multiorgan, Severe cGVHD After HSCT for Adolescent ALL: More Luck Than Understanding? A Case Report. Front Pediatr 2022; 9:775318. [PMID: 35096703 PMCID: PMC8795895 DOI: 10.3389/fped.2021.775318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022] Open
Abstract
Graft-vs. -host disease (GvHD) is a serious and complex immunological complication of haematopoietic stem cell transplantation (HSCT) and is associated with prolonged immunodeficiency and non-relapse mortality. Standard treatment of chronic GvHD comprises steroids in combination with other immunosuppressive agents. Extracorporeal photopheresis (ECP), with its immunomodulatory mechanism, is applied as part of steroid-sparing regimens for chronic GvHD. Immunocompromised, chronically ill patients are at particular risk of severe disease courses of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. T-cell immunity in SARS-CoV-2 infection is well-described but the role of the humoral immune responses is not fully understood. This case report describes a moderate course of SARS-CoV-2 infection in a patient <9 months after HSCT who was suffering from active, severe, chronic GvHD treated with prednisone and ECP. Following HSCT from a matched unrelated donor to cure acute lymphoblastic leukaemia, the 25-year-old male patient experienced multiple infectious complications associated with cytopenia, B-cell dyshomeostasis and autoantibody production followed by development of severe chronic GvHD thereafter at day +212. The steroid-sparing treatment plan consisted of supportive care, topical treatment, prednisone and ECP. He was diagnosed with SARS-CoV-2 infection at day +252, experiencing loss of smell and taste as well as a cough. The patient's oxygen saturation was between 94 and 97% on room air, and computed tomography images showed evolution of typical of SARS-CoV-2 infiltrates. In addition to cytopenia and immune dyshomeostasis, laboratory tests confirmed macrophage activating syndrome, transaminitis and Epstein-Barr virus viraemia. At that time, anti-SARS-CoV-2 monoclonal antibodies were not available in Austria and remdesivir seemed contraindicated. Surprisingly, despite severe lymphopenia the patient developed SARS-CoV-2-specific antibodies within 15 days, which was followed by clearance of SARS-CoV-2 and EBV with resolution of symptoms. Thereafter, parameters of immune dysregulation such as lymphopenia and B-cell dyshomeostasis, the latter characterised by elevated CD21low B cells and autoantibody expression, normalised. Moreover, we observed complete response of active chronic GvHD to treatment.
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Affiliation(s)
- Natalia Zubarovskaya
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Irene Hofer-Popow
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marco Idzko
- Department of Pulmonology, Medical University of Vienna, Vienna, Austria
| | - Oskar A. Haas
- Labdia Labordiagnostik GmbH, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
- St. Anna Children's Hospital, Pediatric Clinic, Medical University of Vienna, Vienna, Austria
| | - Anita Lawitschka
- Stem Cell Transplant Unit, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Cancer Research Institute, Vienna, Austria
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19
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Extracorporeal photopheresis in acute and chronic steroid‑refractory graft-versus-host disease: an evolving treatment landscape. Leukemia 2022; 36:2558-2566. [PMID: 36153436 PMCID: PMC9613461 DOI: 10.1038/s41375-022-01701-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
Patients with steroid-refractory graft-versus-host disease (GvHD) are known to have a poor prognosis and for decades no approved drug has been available to treat this serious condition. Although ruxolitinib, a selective Janus kinase (JAK)1/2 inhibitor demonstrated significantly higher response rates in randomized trials compared to the best available therapy, and thus, is of benefit in both acute as well as chronic GvHD, there is an urgent medical need to improve results, such as durability of responses, response in eye, liver and lung manifestations and reduction of infectious complications. In this "Review" article we would like to offer strategies for improving treatment results in patients with steroid-refractory GvHD by combining ruxolitinib with extracorporeal photopheresis (ECP), a leukapheresis-based immunomodulatory treatment frequently applied in T-cell mediated immune disease including GvHD. Our article explores key published evidence supporting the clinical efficacy of both ruxolitinib and ECP in the treatment of GvHD and highlights their potentially complementary mechanisms of action.
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20
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Sobkowiak-Sobierajska A, Lindemans C, Sykora T, Wachowiak J, Dalle JH, Bonig H, Gennery A, Lawitschka A. Management of Chronic Graft-vs.-Host Disease in Children and Adolescents With ALL: Present Status and Model for a Personalised Management Plan. Front Pediatr 2022; 10:808103. [PMID: 35252060 PMCID: PMC8894895 DOI: 10.3389/fped.2022.808103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Herein we review current practice regarding the management of chronic graft-vs.-host disease (cGvHD) in paediatric patients after allogeneic haematopoietic stem cell transplantation (HSCT) for acute lymphoblastic leukaemia (ALL). Topics covered include: (i) the epidemiology of cGvHD; (ii) an overview of advances in our understanding cGvHD pathogenesis; (iii) current knowledge regarding risk factors for cGvHD and prevention strategies complemented by biomarkers; (iii) the paediatric aspects of the 2014 National Institutes for Health-defined diagnosis and grading of cGvHD; and (iv) current options for cGvHD treatment. We cover topical therapy and newly approved tyrosine kinase inhibitors, emphasising the use of immunomodulatory approaches in the context of the delicate counterbalance between immunosuppression and immune reconstitution as well as risks of relapse and infectious complications. We examine real-world approaches of response assessment and tapering schedules of treatment. Furthermore, we report on the optimal timepoints for therapeutic interventions and changes in relation to immune reconstitution and risk of relapse/infection. Additionally, we review the different options for anti-infectious prophylaxis. Finally, we put forth a theory of a holistic view of paediatric cGvHD and its associated manifestations and propose a checklist for individualised risk evaluation with aggregated considerations including site-specific cGvHD evaluation with attention to each individual's GvHD history, previous medical history, comorbidities, and personal tolerance and psychosocial circumstances. To complement this checklist, we present a treatment algorithm using representative patients to inform the personalised management plans for patients with cGvHD after HSCT for ALL who are at high risk of relapse.
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Affiliation(s)
| | - Caroline Lindemans
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.,Pediatric Blood and Bone Marrow Transplantation, Princess Máxima Center, Utrecht, Netherlands
| | - Tomas Sykora
- Department of Pediatric Hematology and Oncology - Haematopoietic Stem Cell Transplantation Unit, National Institute of Children's Diseases and Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Robert-Debré Hospital, Assistance Publique-Hôpitaux de Paris and University of Paris, Paris, France
| | - Halvard Bonig
- Goethe University Medical Center, Institute of Transfusion Medicine and Immunohematology, and German Red Cross Blood Center Frankfurt, Frankfurt, Germany
| | - Andrew Gennery
- Medical School, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anita Lawitschka
- Stem Cell Transplantation Unit, St. Anna Children's Hospital, Medical University Vienna, Vienna, Austria.,St. Anna Children's Cancer Research Institute, Vienna, Austria
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21
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Blood will tell: profiling Sézary syndrome. Blood 2021; 138:2450-2451. [PMID: 34914833 DOI: 10.1182/blood.2021013433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
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22
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Modification of Hemodialysis Membranes for Efficient Circulating Tumor Cell Capture for Cancer Therapy. Molecules 2021; 26:molecules26164845. [PMID: 34443432 PMCID: PMC8398911 DOI: 10.3390/molecules26164845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background: It is well known that more than 90% of cancer deaths are due to metastases. However, the entire tumorigenesis process is not fully understood, and it is evident that cells spreading from the primary tumor play a key role in initiating the metastatic process. Tumor proliferation and invasion also elevate the concentration of regular and irregular metabolites in the serum, which may alter the normal function of the entire human homeostasis and possibly causes cancer metabolism syndrome, also referred to as cachexia. Methods: We report on the modification of commercially available hemodialysis membranes to selectively capture circulating tumor cells from the blood stream by means of immobilized human anti-EpCAM antibodies on the inner surface of the fibers. All critical steps are described that required in situ addition of the immuno-affinity feature to hemodialyzer cartridges in order to capture EpCAM positive circulating tumor cells, which represents ~80% of cancer cell types. Results: The cell capture efficiency of the suggested technology was demonstrated by spiking HCT116 cancer cells both into buffer solution and whole blood and run through on the modified cartridge. Flow cytometry was used to quantitatively evaluate the cell clearance performance of the approach. Conclusions: The suggested modification has no significant effect on the porous structure of the hemodialysis membranes; it keeps its cytokine removal capability, addressing cachexia simultaneously with CTC removal.
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23
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Blaha M, Gasova Z, Berlin G, Audzijoniene J, Griskevicius A, Dykes J, Bhuiyanova Z, Lanska M, Eich T, Vrielink H, Witt V, Seval GC, Ilhan O, Stegmayr B. Analysis of extracorporeal photopheresis within the frame of the WAA register. Transfus Apher Sci 2021; 60:103172. [PMID: 34059472 DOI: 10.1016/j.transci.2021.103172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
The aim of the study was to investigate safety and if extracorporeal photopheresis (ECP) may change health criteria (HC) and quality of life (QoL). MATERIAL AND METHOD 560 patients (33 % women) were treated with ECP for a total of 13,871 procedures during a 17-years period. Mean age was 48 years (±18, range 3-81 years). Self-estimation of QoL was graded: 0 (suicidal) up to 10 (best ever) and HC: 0 (Bed ridden, ICU condition) up to 10 (athletic). Adverse events were analyzed. ANOVA and paired comparisons were performed. RESULTS Patients were treated due to graft versus host disease (GVHD, n = 317), skin lymphoma (n = 70), solid organ transplants (n = 47), skin diseases (n = 20) and other diseases (n = 106). Adverse events (AEs) were registered in 5.4 % of the first treatments and in 1.2 % of the subsequent procedures. Severe AEs were present in 0.04 % of all procedures. No patient died due to the procedure. Tingling and stitching were the most common AE. For those with GVHD an improvement was noticed within approximately 10 procedures of ECP in the severity stage, QoL (from a mean of 6.1 to 6.8, p < 0.002) and the HC (6.1 -> 6.4, p < 0.014) and improved further with added procedures. CONCLUSION Photopheresis is an established therapy with few side effects. The present study of soft variables indicate that GVHD shows benefits upon ECP within approximately 10 procedures in regard to the severity of mainly skin GVHD, and lower baseline levels of HC and QoL.
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Affiliation(s)
- M Blaha
- Faculty Nemocnice Hradec Kralove, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - Z Gasova
- Institute of Hematology and Blood Transfusion, UHKT, Prague, Czech Republic
| | - G Berlin
- Dept Clinical Immunology and Transfusion Medicine, and Dpt Biomedical Clinical Science, Linköping University, Linköping, Sweden
| | - J Audzijoniene
- Hematology, onkology and Transfusion Centre, University Hospital, Vilnius, Lithuania
| | - A Griskevicius
- Hematology, onkology and Transfusion Centre, University Hospital, Vilnius, Lithuania
| | - J Dykes
- Dept Hematology and Transfusion Medicine, University Lund, Lund, Sweden
| | - Z Bhuiyanova
- Institute of Hematology and Blood Transfusion, UHKT, Prague, Czech Republic
| | - M Lanska
- Faculty Nemocnice Hradec Kralove, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
| | - T Eich
- Dept Clinical Immunology and Transfusion Medicine, Uppsala Akademiska University Hospital, Uppsala, Sweden
| | | | - V Witt
- Apheresis Centres, St. Anna Kinderspital/MUW, Vienna, Austria
| | - G C Seval
- Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - O Ilhan
- Hematology, Ankara University School of Medicine, Ankara, Turkey
| | - B Stegmayr
- Dept Public Health and Clinical Medicine, Umea University, Umea, Sweden.
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24
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Slomovich S, Bell J, Clerkin KJ, Habal MV, Griffin JM, Raikhelkar JK, Fried JA, Vossoughi SR, Finnigan K, Latif F, Farr MA, Sayer GT, Uriel N. Extracorporeal photopheresis and its role in heart transplant rejection: prophylaxis and treatment. Clin Transplant 2021; 35:e14333. [PMID: 33914369 DOI: 10.1111/ctr.14333] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 01/30/2023]
Abstract
Heart transplantation is the gold standard therapeutic option for select patients with end-stage heart failure. Unfortunately, successful long-term outcomes of heart transplantation can be hindered by immune-mediated rejection of the cardiac allograft, specifically acute cellular rejection, antibody-mediated rejection, and cardiac allograft vasculopathy. Extracorporeal photopheresis is a cellular immunotherapy that involves the collection and treatment of white blood cells contained in the buffy coat with a photoactive psoralen compound, 8-methoxy psoralen, and subsequent irradiation with ultraviolet A light. This process is thought to cause DNA and RNA crosslinking, ultimately leading to cell destruction. The true mechanism of therapeutic action remains unknown. In the last three decades, extracorporeal photopheresis has shown promising results and is indicated for a variety of conditions. The American Society for Apheresis currently recommends the use of extracorporeal photopheresis for the treatment of cutaneous T-cell lymphoma, scleroderma, psoriasis, pemphigus vulgaris, atopic dermatitis, graft-versus-host disease, Crohn's disease, nephrogenic systemic fibrosis, and solid organ rejection in heart, lung, and liver transplantation. In this review, we aim to explore the proposed effects of extracorporeal photopheresis and to summarize published data on its use as a prophylactic and therapy in heart transplant rejection.
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Affiliation(s)
- Sharon Slomovich
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jennifer Bell
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Kevin J Clerkin
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Marlena V Habal
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jan M Griffin
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Jayant K Raikhelkar
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Justin A Fried
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Sarah R Vossoughi
- Department of Pathology & Cell Biology, Columbia University, New York, NY, USA
| | - Katie Finnigan
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Farhana Latif
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Gabriel T Sayer
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University, New York, NY, USA
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25
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Husain I, Luo X. Apoptotic Donor Cells in Transplantation. Front Immunol 2021; 12:626840. [PMID: 33717145 PMCID: PMC7947657 DOI: 10.3389/fimmu.2021.626840] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022] Open
Abstract
Despite significant advances in prevention and treatment of transplant rejection with immunosuppressive medications, we continue to face challenges of long-term graft survival, detrimental medication side effects to both the recipient and transplanted organ together with risks for opportunistic infections. Transplantation tolerance has so far only been achieved through hematopoietic chimerism, which carries with it a serious and life-threatening risk of graft versus host disease, along with variability in persistence of chimerism and uncertainty of sustained tolerance. More recently, numerous in vitro and in vivo studies have explored the therapeutic potential of silent clearance of apoptotic cells which have been well known to aid in maintaining peripheral tolerance to self. Apoptotic cells from a donor not only have the ability of down regulating the immune response, but also are a way of providing donor antigens to recipient antigen-presenting-cells that can then promote donor-specific peripheral tolerance. Herein, we review both laboratory and clinical evidence that support the utility of apoptotic cell-based therapies in prevention and treatment of graft versus host disease and transplant rejection along with induction of donor-specific tolerance in solid organ transplantation. We have highlighted the potential limitations and challenges of this apoptotic donor cell-based therapy together with ongoing advancements and attempts made to overcome them.
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Affiliation(s)
- Irma Husain
- Department of Medicine, Duke University, Durham, NC, United States
| | - Xunrong Luo
- Department of Medicine, Duke University, Durham, NC, United States
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26
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Stege H, Ghoreschi K, Hünefeld C. [UV phototherapy : UV phototherapy and photodiagnostics-a practical overview]. Hautarzt 2021; 72:14-26. [PMID: 33394067 DOI: 10.1007/s00105-020-04744-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
UV phototherapy is an essential and efficient therapeutic option in the treatment of dermatological diseases. It is an integral part of multiple guidelines and maintains its high clinical significance despite the development of new therapeutic options for systemic treatment. Due to the difficult revenue situation, the market for ready-to-use products of psoralen and UV therapy devices is constantly changing.
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Affiliation(s)
- H Stege
- Klinik für Dermatologie, Klinikum Lippe, Röntgenstr. 18, 32756, Detmold, Deutschland.
| | - K Ghoreschi
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland
| | - C Hünefeld
- Klinik für Dermatologie, Venerologie u. Allergologie, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Deutschland.
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27
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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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28
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Skarga VV, Zadorozhny AD, Shilov BV, Nevezhin EV, Negrebetsky VV, Maslov MA, Lagunin AA, Malakhov MV. Prospective pharmacological effects of psoralen photoxidation products and their cycloadducts with aminothiols: chemoinformatic analysis. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2020. [DOI: 10.24075/brsmu.2020.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Psoralens are medicinal photosensitizing furocoumarins which are used in photochemotherapy and photoimmunotherapy of dermatoses. Psoralen photooxidation products may be involved in therapeutic effects, but the possible mechanisms of their action remain unclear. The study was aimed to assess the prospective pharmacological effects and mechanisms of activity for six previously identified ortho–hydroxyformyl-containing psoralen photooxidation products and their cycloadducts with aminothiols, as well as for structurally similar compounds (furocoumaric acid and tucaresol). Chemoinformatic analysis of the prospective pharmacological effects and mechanisms of action of these compounds was performed using the PASS and PharmaExpert software. The predicted pharmacological effects partially confirmed by previous studies highlight the possible involvement of psoralen photooxidation products in the effects of PUVA therapy or photopheresis during the course of dermatoses and proliferative disorders treatment. A broad spectrum of pharmacological effects found for furocoumaric acid and cycloadducts of coumarinic and benzofuranic photoproducts of psoralen with cysteine and homocysteine appoints new directions of research relating to therapeutic use of psoralens.
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Affiliation(s)
- VV Skarga
- Pirogov Russian National Research Medical University, Moscow, Russia; MIREA — Russian Technological University, Moscow, Russia
| | - AD Zadorozhny
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - BV Shilov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - EV Nevezhin
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - VV Negrebetsky
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - MA Maslov
- MIREA — Russian Technological University, Moscow, Russia
| | - AA Lagunin
- Pirogov Russian National Research Medical University, Moscow, Russia; Institute of Biomedical Chemistry (IBMC), Moscow, Russia
| | - MV Malakhov
- Pirogov Russian National Research Medical University, Moscow, Russia
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