Nail involvement in Darier's disease: a case report

Production, safety and efficacy of iPSC-derived mesenchymal stromal cells in acute steroid-resistant graft versus host disease: a phase I, multicenter, open-label, dose-escalation study

The therapeutic potential of donor-derived mesenchymal stromal cells (MSCs) has been investigated in diverse diseases¹, including steroid-resistant acute graft versus host disease (SR-aGvHD)². However, conventional manufacturing approaches are hampered by challenges with scalability and interdonor variability, and clinical trials have shown inconsistent outcomes^3,4. Induced pluripotent stem cells (iPSCs) have the potential to overcome these challenges, due to their capacity for multilineage differentiation and indefinite proliferation^5,6. Nonetheless, human clinical trials of iPSC-derived cells have not previously been completed. CYP-001 (iPSC-derived MSCs) is produced using an optimized, good manufacturing practice (GMP)-compliant manufacturing process. We conducted a phase 1, open-label clinical trial (no. NCT02923375) in subjects with SR-aGvHD. Sixteen subjects were screened and sequentially assigned to cohort A or cohort B (n = 8 per group). One subject in cohort B withdrew before receiving CYP-001 and was excluded from analysis. All other subjects received intravenous infusions of CYP-001 on days 0 and 7, at a dose level of either 1 × 10⁶ cells per kg body weight, to a maximum of 1 × 10⁸ cells per infusion (cohort A), or 2 × 10⁶ cells per kg body weight, to a maximum dose of 2 × 10⁸ cells per infusion (cohort B). The primary objective was to assess the safety and tolerability of CYP-001, while the secondary objectives were to evaluate efficacy based on the proportion of participants who showed a complete response (CR), overall response (OR) and overall survival (OS) by days 28/100. CYP-001 was safe and well tolerated. No serious adverse events were assessed as related to CYP-001. OR, CR and OS rates by day 100 were 86.7, 53.3 and 86.7%, respectively. The therapeutic application of iPSC-derived MSCs may now be explored in diverse inflammatory and immune-mediated diseases.

Darier’s Disease, An Unusual Problem and Solution

A 46-year-old woman with Darier’s disease was referred suffering from severe nail involvement. The patient suffered constant nail infections and an intolerable cycle of progressively more deformity.

On examination the patient’s nails and nail folds were badly deformed.

Initially, as a test, a procedure was undertaken on the thumb alone. The operation was performed under tourniquet control with a digital nerve block. An eponychial flap was raised and nail complex excised. A full thickness skin graft was obtained from the groin. This was sutured into place with the proximal border of graft tucked under the eponychial fold. The results were excellent both surgically and cosmetically.

Subsequently, procedures were performed on the remaining nine digits.

Darier’s disease is extremely variable in its degree of nail involvement. This case highlights a surgical intervention that may help people with intractable associated nail disease.