Vitamin D status, vitamin D receptor gene polymorphism, and haplotype in patients with cutaneous leishmaniasis: Correlation with susceptibility and parasite load index

BACKGROUND

CL endemicity was reported worldwide including in Saudi Arabia, imposing a major challenge on the health authorities. Vitamin D and its receptor (VDR) are key modulators of the immune response where the VDR is expressed. A remarkable lack of data exists in humans about the contribution of vitamin D and polymorphisms of the VDR gene in protozoan infections, especially cutaneous leishmaniasis (CL).

OBJECTIVE

This is the first work conducted to assess the relationship between vitamin D status, polymorphisms of the VDR gene (BsmI, ApaI, TaqI, and FokI), and VDR haplotype with parasite tissue load and susceptibility to CL.

METHODS

Fifty-two patients with confirmed CL (21 patients receiving vitamin D medication and 31 patients not receiving it) and 46 control subjects participated in this cross-sectional investigation. VDR genotyping was determined by restriction fragment length polymorphism analysis. Serum levels of 25-OH vitamin D were assessed using the ELISA method in all participants. The skin biopsy quantified the parasite load based on the Ridley parasitic index.

RESULTS

The mean serum level of 25-OH vitamin D in CL patients who were not receiving vitamin D therapy was significantly lower compared to CL patients on vitamin D therapy and controls (p <0.001 for both) and CL patients with no history of vitamin D therapy had a significantly higher frequency of vitamin D deficiency compared to CL patients on vitamin D therapy and controls (p < 0.05). Compared to CL patients with no history of vitamin D therapy, CL patients receiving vitamin D therapy had a significantly lower mean size of the lesion and RPI (p = 0.02, .03 respectively). The frequency of genotype "aa" and its "a" allele in ApaI SNP of VDR was significantly lower in CL patients compared to controls (p = 0.006 and 0.03 respectively). However, patients with CL had a considerably greater frequency of the "A" allele than the controls (p = 0.03), suggesting its role in CL susceptibility. There was no statistically significant difference between the two groups in the genotype and allele frequency distributions of BsmI, TaqI, and FokI (p > 0.05). When compared to controls, CL cases had a considerably greater frequency of the "B-A-T-F" haplotype (p = 0.04), and a significantly lower frequency of the "B-a-T-F" haplotype (p = 0.01) suggesting that these haplotypes may have the potential susceptibility or protection against CL respectively. The "Aa" genotype in ApaI SNP of VDR had considerably lower levels of vitamin D with higher parasite load compared to the "AA" and: aa" genotypes (p = 0.02,0.02 respectively). A significant negative correlation was found between the parasite load and 25-OH vitamin D levels (r2 = -0.53, p< 0.001).

CONCLUSIONS

According to these findings, vitamin D levels and "ApaI" VDR gene polymorphisms could affect the parasite load and susceptibility to infection, whereas BsmI, FokI, and TaqI polymorphisms did not. Correction of vitamin D levels may aid in CL management.

"To be or not to Be": Regulatory T cells in melanoma

In spite of progresses in the therapy of different malignancies, melanoma still remains as one of lethal types of skin tumor. Melanoma is almost easily treatable by surgery alone with higher overall survival rates when it is diagnosed at early stages. However, survival rates are decreased remarkably upon survival if the tumor is progressed to advanced metastatic stages. Immunotherapeutics have been prosperous in the development of anti-tumor responses in patients with melanoma through promotion of the tumor-specific effector T cells in vivo; nonetheless, suitable clinical outcomes have not been satisfactory. One of the underlying causes of the unfavorable clinical outcomes might stem from adverse effects of regulatory T (Treg) cell, which is a prominent mechanism of tumor cells to escape from tumor-specific immune responses. Evidence shows that a poor prognosis and low survival rate in patients with melanoma can be attributed to a higher Treg cell number and function in these subjects. As a result, to promote melanoma-specific anti-tumor responses, depletion of Treg cells appears to be a promising approach; even though the clinical efficacy of different approaches to attain appropriate Treg cell depletion has been inconsistent. Here in this review, the main purpose is to assess the role of Treg cells in the initiation and perpetuation of melanoma and to discuss effective strategies for Treg cell modulation with the aim of melanoma therapy.

Sun-Exposed versus Sun-Protected Cutaneous Basal Cell Carcinoma: Clinico-Pathological Profile and p16 Immunostaining

Introduction: Although widespread, BCC is still relatively poorly understood in regards to pathogenesis and prognosis, particularly the lesions formed on anatomical sites away from sun exposure. With the aim of deepening our understanding of the pathogenesis and clinico-pathological correlations of BCCs, we conducted this study. Methods: Tissue blocks and data of 52 Egyptian patients diagnosed with BCC were retrieved for clinical information and inclusion criteria, then re-examined histologically; p16 immunostaining was carried out and evaluated for analysis and comparison between the two groups, i.e., sun-exposed and sun-protected. Results: Sex, age, clinical suspicion, tumor size, recurrence status, and histologic variants did not show a significant difference between the sun-protected and sun-exposed groups; however, the mean ages recorded were 67.2 vs. 62.7 for the sun-protected and sun-exposed groups, respectively. A total of 52% of BCCs were positive for p16. The sun-protected lesions showed p16 positivity in 61% of cases, whereas 49% of the sun-exposed lesions were positive with no significant difference. There was a significant difference in p16 expression between the recurrent and non-recurrent lesions. Conclusions: A significant difference was seen in the case of cancer recurrence, where all the recurrent BCCs in this study demonstrated negative p16 immunostaining of the primary lesions; however, the positively stained cases in total were 52% of BCCs. The mean patient age of the sun-protected group was much higher than in previous peer studies. We assume that the biological, prognostic, and clinical aspects of p16 protein expression in BCCs are still far from being clearly understood. Further studies are highly recommended, with more focus on its role in the pathogenesis and the prognostic factors.

Vigorous exercise-induced unilateral eosinophilic fasciitis: rare and easily misdiagnosed subtype

The hallmark of eosinophilic fasciitis (EF) is painful symmetric skin stiffness and limb sclerosis with deep fascia inflammation. Two cases of unilateral EF have been reported in the literature but were not related to strenuous physical activity. In this report, a young female presenting with unilateral scleroderma-like skin changes, blood and tissue eosinophilia, and hypergammaglobulinemia proven to be EF after strenuous physical activity is described. This case represents the first case reported in the current literature of unilateral EF after vigorous exercise. A skin to muscle biopsy and magnetic resonance imaging (MRI) study indicated classic EF features. Cases of unilateral eosinophilic fasciitis are under-recognized and have rarely been described in the literature. EF requires a high index of suspicion to be diagnosed accurately and differentiated from another scleroderma variant, especially localized types. Early diagnosis and management of unilateral EF are very crucial because EF management and prognosis are completely different from other scleroderma mimics. EF heals rapidly in response to glucocorticoid or combination therapy. In the current case, corticosteroids alone failed to induce complete disease remission, but with the addition of methotrexate, complete resolution of both skin and systemic features was obtained. She is now in good health with no medication use. The current literature review indicates that this the first reported case of unilateral EF after vigorous exercise.

A novel approach to teaching dermatology and plastic surgery in a combined module for undergraduate medical students

Introduction: Medical students need to be equipped with the knowledge and skills to serve their communities properly. Interdisciplinary integration by merging similar disciplines together at the level of planning and implementation is a novel idea. Objectives: The aim is to describe the methods and steps that were followed to plan and implement a module in dermatology and plastic surgery for the fifth year medical students of Albaha University Faculty of Medicine, to explain how two similar courses can be designed and merged into one module. Methods: We followed the Kern's six steps for curriculum development in order to plan and implement the dermatology and plastic surgery module. Questionnaires were applied to measure the degree of both students and staff satisfactions about all Kern' steps of the dermatology-plastic surgery interdisciplinary course. Non-parametric t-test was used in the statistical results of Likert scale. Results and discussion: According to these steps, the module committee identifies the problem and assesses the needs of the targeted learners. Then, goals and objectives of the module and educational strategies were determined. Finally, the evaluation and feedback were obtained from both faculty and students. Using a Likert scale to measure the degree of the satisfactions among students and staff for Kern'steps, no significant P-value was obtained for course evaluation steps, in contrast to the goals/objectives, educational strategies and implementation steps in which significant P-values were obtained. Conclusion: Implementing Kern's methodology for curriculum development resulted in the integrated module of dermatology and plastic surgery with no major problems at all levels.