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Gagna CE, Yodice AN, D'Amico J, Elkoulily L, Gill SM, DeOcampo FG, Rabbani M, Kaur J, Shah A, Ahmad Z, Lambert MW, Clark Lambert W. Novel B-DNA dermatophyte assay for demonstration of canonical DNA in dermatophytes: Histopathologic characterization by artificial intelligence. Clin Dermatol 2024; 42:233-258. [PMID: 38185195 DOI: 10.1016/j.clindermatol.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
We describe a novel assay and artificial intelligence-driven histopathologic approach identifying dermatophytes in human skin tissue sections (ie, B-DNA dermatophyte assay) and demonstrate, for the first time, the presence of dermatophytes in tissue using immunohistochemistry to detect canonical right-handed double-stranded (ds) B-DNA. Immunohistochemistry was performed using anti-ds-B-DNA monoclonal antibodies with formalin-fixed paraffin-embedded tissues to determine the presence of dermatophytes. The B-DNA assay resulted in a more accurate identification of dermatophytes, nuclear morphology, dimensions, and gene expression of dermatophytes (ie, optical density values) than periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), or hematoxylin and eosin (H&E) stains. The novel assay guided by artificial intelligence allowed for efficient identification of different types of dermatophytes (eg, hyphae, microconidia, macroconidia, and arthroconidia). Using the B-DNA dermatophyte assay as a clinical tool for diagnosing dermatophytes is an alternative to PAS, GMS, and H&E as a fast and inexpensive way to accurately detect dermatophytosis and reduce the number of false negatives. Our assay resulted in superior identification, sensitivity, life cycle stages, and morphology compared to H&E, PAS, and GMS stains. This method detects a specific structural marker (ie, ds-B-DNA), which can assist with diagnosis of dermatophytes. It represents a significant advantage over methods currently in use.
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Affiliation(s)
- Claude E Gagna
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA; Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
| | - Anthony N Yodice
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Juliana D'Amico
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Lina Elkoulily
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Shaheryar M Gill
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Francis G DeOcampo
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Maryam Rabbani
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Jai Kaur
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Aangi Shah
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Zainab Ahmad
- Department of Biological and Chemical Sciences, College of Arts and Sciences, New York Institute of Technology, Old Westbury, New York, USA
| | - Muriel W Lambert
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Department of Pathology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Dermatology, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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Ahn MH, Han JH, Chwae YJ, Jung JY, Suh CH, Kwon JE, Kim HA. Neutrophil Extracellular Traps May Contribute to the Pathogenesis in Adult-onset Still Disease. J Rheumatol 2019; 46:1560-1569. [PMID: 31043551 DOI: 10.3899/jrheum.181058] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Release of neutrophil extracellular traps (NET) has been described as an effector mechanism of polymorphonuclear neutrophils in several inflammatory diseases. Thus, this study was performed to evaluate the role of NET in the pathogenesis of adult-onset Still disease (AOSD). METHODS We determined the serum levels of NET molecules and investigated their associations with clinical disease activities in patients with AOSD. Further, we analyzed the differences in the NETosis response in AOSD patients compared to healthy controls (HC). To explore the in vivo involvement of NET in AOSD, we performed immunohistochemical analysis of skin and lymph node (LN) biopsies for proteins related to NET in patients with active AOSD. RESULTS Serum levels of cell-free DNA, myeloperoxidase (MPO)-DNA complex, and α-defensin were significantly increased in patients with AOSD compared to HC. Serum levels of the NET molecules, cell-free DNA, MPO-DNA, and α-defensin were correlated with several disease activity markers for AOSD. In followup of patients with AOSD after treatment with corticosteroid, the levels of cell-free DNA and α-defensin decreased significantly. On immunohistochemistry, neutrophil elastase-positive and MPO-positive inflammatory cells were detected in skin and LN of patients with AOSD, and were expressed in fiber form in the lesions. The serum from patients with active AOSD induced NETosis in neutrophils from HC. NET molecules induced interleukin 1β production in monocytes, representing a novel mechanism in the pathogenesis of AOSD. CONCLUSION The findings presented here suggest that NET may contribute to the inflammatory response and pathogenesis in AOSD.
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Affiliation(s)
- Mi-Hyun Ahn
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Jae Ho Han
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Young-Jun Chwae
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Ju-Yang Jung
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Chang-Hee Suh
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Ji Eun Kwon
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea.,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work
| | - Hyoun-Ah Kim
- From the departments of Rheumatology, Pathology, and Microbiology, Ajou University School of Medicine, Suwon, Korea. .,M.H. Ahn, PhD, Department of Rheumatology, Ajou University School of Medicine; J.H. Han, MD, PhD, Department of Pathology, Ajou University School of Medicine; Y.J. Chwae, MD, PhD, Department of Microbiology, Ajou University School of Medicine; J.Y. Jung, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; C.H. Suh, MD, PhD, Department of Rheumatology, Ajou University School of Medicine; J.E. Kwon, MD, PhD, Department of Pathology, Ajou University School of Medicine; H.A. Kim, MD, PhD, Department of Rheumatology, Ajou University School of Medicine. M.H. Ahn and J.H. Han contributed equally to this work.
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Gagna CE, Chan NJ, Farnsworth PN, Kuo HR, Kanthala TR, Patel AH, Patel NH, Law A, Patel PP, Richards SA, Yam T, Nici A, Lambert WC. Localization and quantification of intact, undamaged right-handed double-stranded B-DNA, and denatured single-stranded DNA in normal human epidermis and its effects on apoptosis and terminal differentiation (denucleation). Arch Dermatol Res 2009; 301:659-72. [PMID: 19517127 DOI: 10.1007/s00403-009-0965-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 05/11/2009] [Accepted: 05/15/2009] [Indexed: 11/24/2022]
Abstract
Quantification of two types of nucleic acids [double-stranded (ds-) and single-stranded (ss-) DNA] was performed to understand the distribution of DNA within the epidermal strata and to examine the effects of DNA structure on gene expression, viz., apoptosis and terminal differentiation. In addition, we examined the precise starting point of cell death within the epidermis (suprabasal layer); examined how DNA structure affects gene expression of melanocytes; and characterized the "transitional cells" located between the stratum granulosum and stratum corneum, viz., epidermal phase transition zone (EPTZ). Ultrasensitive anti-DNA antibody probes (ds-DNA, ss-DNA), the Feulgen reaction, histological stains (morphological characterization) and the terminal deoxyribonucleotidyl transferase (TUNEL) assay (apoptosis) were used to characterize cell death in normal human epidermis. This study characterized, for the first time, the deterioration of right-handed ds-B-DNA and the increase in denatured ss-DNA during epidermal maturation. For the first time, this approach also allowed for the quantitative and qualitative characterization of DNA content and structure in all epidermal strata, using anti-ds-B-DNA and anti-ss-DNA antibodies. In order to improve the retention and quality of DNA, a novel histotechnological processing procedure was used. The results indicate that the largest decline in DNA occurred within the stratum granulosum, followed by the EPTZ, and the stratum spinosum. Not all epidermal nuclei lost DNA, indicating two differentiating keratinocyte pathways, viz., apoptotic and non-apoptotic. Both pathways united in the stratum granulosum. These results suggest that keratinocyte terminal differentiation and apoptosis are distinct cellular events, cell death begins earlier than expected, and molecular epidermal events take place in a gradual and orderly manner within keratinocytes. During maturation, ds-B-DNA decreases as ss-DNA increases. Therefore, during differentiation of keratinocytes, both DNA content and DNA structure are altered.
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Affiliation(s)
- Claude E Gagna
- Department of Pathology and Laboratory Medicine, The University of Medicine and Dentistry of New Jersey-Medical School, Newark, NJ 07103, USA.
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