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Gerber PA, Buhren BA, Bölke E, Philipp-Dormston WG, Homey B, Schrumpf H. Time- and Dose-Dependent Effects of Hyaluronidase on the Degradation of Different Hyaluronan-Based Fillers In Vitro. Plast Reconstr Surg 2023; 151:560-567. [PMID: 36730370 DOI: 10.1097/prs.0000000000009916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hyaluronidase (HYAL) is regarded as the standard for the management of complications associated with hyaluronan (HA)-based fillers. Therefore, the understanding of interactions of HA fillers and HYAL is essential. METHODS Nine different commercially available HA fillers (Belotero, Juvéderm, and Restylane) with varying degrees of cross-linking were used for the analysis. Fluorescently dyed HA fillers were individually incubated with varying doses of HYAL [bovine HYAL (Hylase "Dessau"; Riemser Pharma, Germany); 5, 10, and 20 U/mL] or sodium chloride and monitored by time-lapse microscopy. HA filler degradation was assessed as a decrease in fluorescence intensity of HA filler plus HYAL compared to HA filler plus control, quantified by computerized image analysis. RESULTS HA fillers show significant differences in their reaction to HYAL. Levels of degradation of HA fillers are positively correlated with increasing concentrations of HYAL. At the highest concentration of HYAL (20 U/mL), all fillers except one (Belotero Volume) reached a significant level of degradation at 5 to 9 hours. CONCLUSIONS In this study, the authors show that most HA fillers can be dissolved by HYAL in a dose- and time-dependent manner. Of note, the fillers' technology and degree of cross-linking seem to exert stronger effects on the degradability by HYAL as compared to the concentration of HA. CLINICAL RELEVANCE STATEMENT The authors' in vitro analyses support clinical recommendations stating that in the case of a vascular filler incident, HYAL should be applied early and at significant doses ("Time is skin!"). CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
- Peter Arne Gerber
- From the Department of Dermatology, Medical Faculty, University Hospital Duesseldorf.,Dermatologie am Luegplatz
| | - Bettina A Buhren
- From the Department of Dermatology, Medical Faculty, University Hospital Duesseldorf
| | - Edwin Bölke
- From the Department of Dermatology, Medical Faculty, University Hospital Duesseldorf
| | | | - Bernhard Homey
- From the Department of Dermatology, Medical Faculty, University Hospital Duesseldorf
| | - Holger Schrumpf
- From the Department of Dermatology, Medical Faculty, University Hospital Duesseldorf
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Kubo H, Czerwinski S, Schrumpf H, Buhren B, Prodinger P, Krauspe R, Pilge H. Rifampicin has - Compared to clindamycin - A dose and time dependent effect on hMSCs during osteogenic differentiation in vitro. J Orthop 2021; 26:49-53. [PMID: 34305347 DOI: 10.1016/j.jor.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Background The effects of rifampicin and clindamycin on human mesenchymal stromal cell (hMSC) were examined. Methods hMSC were cultured with rifampicin and clindamycin (0.5 μg/ml, 5 μg/ml, 50 μg/ml) and examinations of proliferation (Bromodeoxyuridine), calcification (Alizarin red) and mineralization (alkaline phosphatase) were performed after 7th, 14th and 21st days. Results With rifampicin (50 μg/ml) cultured hMSC showed a significant negative effect during proliferation, mineralization (7, 14 and 21 days) and calcification (21 days). Clindamycin seems to have no effect. Conclusions Rifampicin in a dosage of 50 μg/ml showed a negative impact on proliferation, mineralization and calcification of hMSC after 21 days.
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Affiliation(s)
- Hannes Kubo
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Sarah Czerwinski
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Holger Schrumpf
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Bettina Buhren
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics and Trauma Surgery, Clinic Director: Prof. Joachim Windolf, Moorenstr. 5, D-40225, Duesseldorf, Germany
| | - Peter Prodinger
- Krankenhaus Agatharied, Abteilung für Unfallchirurgie und Orthopädie, Norbert Kerkel Platz, D-83734, Hausham, Germany
| | - Ruediger Krauspe
- Professor Emeritus of the Orthopedic Department, University Duesseldorf, Germany
| | - Hakan Pilge
- Orthopaedicum Munich, Charles-de-Gaulle-Str. 4, 81737, Munich, Germany
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Buhren BA, Schrumpf H, Gorges K, Reiners O, Bölke E, Fischer JW, Homey B, Gerber PA. Dose- and time-dependent effects of hyaluronidase on structural cells and the extracellular matrix of the skin. Eur J Med Res 2020; 25:60. [PMID: 33228813 PMCID: PMC7686775 DOI: 10.1186/s40001-020-00460-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Hyaluronic acid (hyaluronan; HA) is an essential component of the extracellular matrix (ECM) of the skin. The HA-degrading enzyme hyaluronidase (HYAL) is critically involved in the HA-metabolism. Yet, only little information is available regarding the skin’s HA–HYAL interactions on the molecular and cellular levels. Objective To analyze the dose- and time-dependent molecular and cellular effects of HYAL on structural cells and the HA-metabolism in the skin. Materials and methods Chip-based, genome-wide expression analyses (Affymetrix® GeneChip PrimeView™ Human Gene Expression Array), quantitative real-time PCR analyses, enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (DAB), and in vitro wound healing assays were performed to assess dose-dependent and time-kinetic effects of HA and HYAL (bovine hyaluronidase, Hylase “Dessau”) on normal human dermal fibroblasts (NHDF), primary human keratinocytes in vitro and human skin samples ex vivo. Results Genome-wide expression analyses revealed an upregulation of HA synthases (HAS) up to 1.8-fold change in HA- and HYAL-treated NHDF. HA and HYAL significantly accelerated wound closure in an in vitro model for cutaneous wound healing. HYAL induced HAS1 and HAS2 mRNA gene expression in NHDF. Interestingly, low concentrations of HYAL (0.015 U/ml) resulted in a significantly higher induction of HAS compared to moderate (0.15 and 1.5 U/ml) and high concentrations (15 U/ml) of HYAL. This observation corresponded to increased concentrations of HA measured by ELISA in conditioned supernatants of HYAL-treated NHDF with the highest concentrations observed for 0.015 U/ml of HYAL. Finally, immunohistochemical analysis of human skin samples incubated with HYAL for up to 48 h ex vivo demonstrated that low concentrations of HYAL (0.015 U/ml) led to a pronounced accumulation of HA, whereas high concentrations of HYAL (15 U/ml) reduced dermal HA-levels. Conclusion HYAL is a bioactive enzyme that exerts multiple effects on the HA-metabolism as well as on the structural cells of the skin. Our results indicate that HYAL promotes wound healing and exerts a dose-dependent induction of HA-synthesis in structural cells of the skin. Herein, interestingly the most significant induction of HAS and HA were observed for the lowest concentration of HYAL.
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Affiliation(s)
| | - Holger Schrumpf
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Katharina Gorges
- Department of Pharmacology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Oliver Reiners
- Department of Pharmacology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jens W Fischer
- Department of Pharmacology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Peter Arne Gerber
- Department of Dermatology, University Hospital Duesseldorf, Duesseldorf, Germany. .,Dermatologie am Luegplatz, Duesseldorf, Germany.
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Duan YG, Wehry UP, Buhren BA, Schrumpf H, Oláh P, Bünemann E, Yu CF, Chen SJ, Müller A, Hirchenhain J, Lierop A, Novak N, Cai ZM, Krüssel JS, Schuppe HC, Haidl G, Gerber PA, Allam JP, Homey B. CCL20-CCR6 axis directs sperm-oocyte interaction and its dysregulation correlates/associates with male infertility‡. Biol Reprod 2020; 103:630-642. [PMID: 32412043 DOI: 10.1093/biolre/ioaa072] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/28/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
The interaction of sperm with the oocyte is pivotal during the process of mammalian fertilization. The limited numbers of sperm that reach the fallopian tube as well as anatomic restrictions indicate that human sperm-oocyte encounter is not a matter of chance but a directed process. Chemotaxis is the proposed mechanism for re-orientating sperm toward the source of a chemoattractant and hence to the oocyte. Chemokines represent a superfamily of small (8-11 kDa), cytokine-like proteins that have been shown to mediate chemotaxis and tissue-specific homing of leukocytes through binding to specific chemokine receptors such as CCRs. Here we show that CCR6 is abundantly expressed on human sperms and in human testes. Furthermore, radioligand-binding experiments showed that CCL20 bound human sperm in a specific manner. Conversely, granulosa cells of the oocyte-surrounding cumulus complex as well as human oocytes represent an abundant source of the CCR6-specific ligand CCL20. In human ovaries, CCL20 shows a cycle-dependent expression pattern with peak expression in the preovulatory phase and CCL20 protein induces chemotactic responses of human sperm. Neutralization of CCL20 in ovarian follicular fluid significantly impairs sperm migratory responses. Conversely, analyses in infertile men with inflammatory conditions of the reproductive organs demonstrate a significant increase of CCL20/CCR6 expression in testis and ejaculate. Taken together, findings of the present study suggest that CCR6-CCL20 interaction may represent an important factor in directing sperm-oocyte interaction.
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Affiliation(s)
- Yong-Gang Duan
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital
| | - U P Wehry
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - B A Buhren
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - H Schrumpf
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - P Oláh
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany.,Department of Dermatology, Venereology and Oncodermatology, Medical Faculty, University of Pécs, Pécs, Hungary
| | - E Bünemann
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - C-F Yu
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - S-J Chen
- Depatment of Minimally Invasive Gynecologic Surgery, Beijing Obstetrics and Gynaecology Hospital, Capital Medical University, 100006 Beijing, PR China
| | - A Müller
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - J Hirchenhain
- Department of Obstetrics and Gynecology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - A Lierop
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - N Novak
- Department of Dermatology and Allergy, Andrology Unit, University of Bonn, 53105 Bonn, Germany
| | - Zhi-Ming Cai
- Shenzhen Key Laboratory of Fertility Regulation, Center of Assisted Reproduction and Embryology, The University of Hong Kong - Shenzhen Hospital
| | - J S Krüssel
- Department of Obstetrics and Gynecology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - H-C Schuppe
- Department of Obstetrics and Gynecology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - G Haidl
- Department of Dermatology and Allergy, Andrology Unit, University of Bonn, 53105 Bonn, Germany
| | - P A Gerber
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - J-P Allam
- Department of Dermatology and Allergy, Andrology Unit, University of Bonn, 53105 Bonn, Germany
| | - B Homey
- Department of Dermatology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
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Harmsen JF, Franz A, Mayer C, Zilkens C, Buhren BA, Schrumpf H, Krauspe R, Behringer M. Tensiomyography parameters and serum biomarkers after eccentric exercise of the elbow flexors. Eur J Appl Physiol 2018; 119:455-464. [DOI: 10.1007/s00421-018-4043-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/26/2018] [Indexed: 01/31/2023]
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Mor JM, Matthaei M, Schrumpf H, Koch KR, Bölke E, Heindl LM. Transcanalicular laser dacryocystorhinostomy for acquired nasolacrimal duct obstruction: an audit of 104 patients. Eur J Med Res 2018; 23:58. [PMID: 30446006 PMCID: PMC6238333 DOI: 10.1186/s40001-018-0355-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE External dacryocystorhinostomy (DCR) is considered as the gold standard in the treatment of acquired nasolacrimal duct obstruction. However, many advances have been made towards the development of modern minimally invasive therapies. These new techniques were proven less harmful to the patients' skin and medial palpebral structures with their palpebral-canalicular pump mechanism. Options include endonasal and transcanalicular procedures. Here, we report on our 2-year experience with the surgical technique, results and complications of transcanalicular laser-assisted DCR. METHODS This is a retrospective study. A total of 104 patients with acquired nasolacrimal duct obstruction underwent transcanalicular laser-assisted DCR combined with bicanalicular silicon intubation. We then analyzed intra-/post-operative complications and subjective and objective success rates. The institutional ethics committee ruled that approval was not necessary. The trial was registered with the German Clinical Trials Register (DRKS00012879). RESULTS Transcanalicular laser-assisted DCR in combination with bicanalicular silicon intubation could be performed surgically successfully in 101 patients (97%). In three cases (3%) using the superior canalicular approach, positioning of the laser instrument at the anteroinferior rim of the middle turbinate failed. Complications included thermal injury to the canaliculus (one), canalicular infection (two) and silicon tube prolapse (ten). Functional success (resolution of preoperative symptoms) was achieved in 80 cases (77%), functional failure occured in 24 cases with all patients reporting persisting epiphora, 15 reporting failure to irrigate the nasolacrimal duct and 15 requiring secondary external DCR. CONCLUSIONS Laser-assisted DCR shows promising results with few complications. It seems well suited as a second-step procedure after failed recanalization and before external DCR.
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Affiliation(s)
- Joel M Mor
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany.
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Holger Schrumpf
- Department of Dermatology, University of Dusseldorf, Düsseldorf, Germany
| | - Konrad R Koch
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, University of Dusseldorf, Düsseldorf, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany
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Weber GC, Firouzi P, Baran AM, Bölke E, Schrumpf H, Buhren BA, Homey B, Gerber PA. Treatment of onychomycosis using a 1064-nm diode laser with or without topical antifungal therapy: a single-center, retrospective analysis in 56 patients. Eur J Med Res 2018; 23:53. [PMID: 30355363 PMCID: PMC6199788 DOI: 10.1186/s40001-018-0340-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Currently available treatment options for onychomycosis such as topical and systemic antifungals are often of limited efficacy, difficult to administer or associated with relevant side effects. Non-ablative laser therapy is proposed to represent a safe alternative without the disadvantages of drugs. Yet, to date, the efficacy of laser therapy for onychomycosis is discussed controversially. Against this background, we performed a systematic retrospective analysis of our clinical experience of 4 years of onychomycosis treatment applying a long-pulsed 1.064-nm diode laser. Methods We retrospectively evaluated the records of 56 patients with microscopic and culturally proven onychomycosis affecting a toenail of the hallux and other toes, who had been treated with a long-pulsed 1.064-nm diode laser (FOX, A.C.R. Laser GmbH, Nuremberg) during the time period of July 2013–December 2016 with or without concomitant topical antifungals. Thereof, 27 patients received laser treatment and 29 patients received laser treatment in combination with local antifungals. We conducted a mean of 3.9 laser treatments at 2–6-week intervals. The primary endpoint of our analysis was clinical improvement; secondary endpoints were complete remission of fungal pathogens in fungal culture and in microscopy. Results Clinical improvement was achieved in 56% of patients treated with laser only after a mean of 4.5 treatments and in 69% of patients treated with laser in combination with topical antifungals after a mean of 3.6 treatments. Cultural healing was detected in 63% of patients treated with laser only after a mean of 5.4 treatments, vs. 86% of patients treated with laser and concomitant topical antifungals after a mean of 4.8 treatments. Microscopic healing (complete healing) with the absence of fungal pathogens was achieved in 11% of patients after a mean of 4.7 treatments with laser only, vs. 21% of patients treated with laser and concomitant topical antifungals after a mean of 4 treatments. No relevant adverse effects were observed. Conclusions The 1.064-nm diode laser is an effective and safe option for the treatment of onychomycosis. Of note, the combination with topical antifungals will increase overall treatment efficacy and reduce the time to healing. Particularly, patients with contraindications against systemic antifungals may benefit from this multimodal therapeutic approach. Our data, moreover, suggest that treatment efficacy is positively correlated with the total number of laser treatments.
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Affiliation(s)
- G C Weber
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - P Firouzi
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - A M Baran
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - E Bölke
- Department of Radiation Oncology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - H Schrumpf
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - B A Buhren
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - B Homey
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany
| | - P A Gerber
- Department of Dermatology, Heinrich-Heine-University, 40225, Düsseldorf, Germany.
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Braun SA, Baran J, Schrumpf H, Buhren BA, Bölke E, Homey B, Gerber PA. Ingenol mebutate induces a tumor cell-directed inflammatory response and antimicrobial peptides thereby promoting rapid tumor destruction and wound healing. Eur J Med Res 2018; 23:45. [PMID: 30266096 PMCID: PMC6161468 DOI: 10.1186/s40001-018-0343-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Ingenol mebutat (IM)-gel is effective for the topical treatment of epithelial tumors, including actinic keratoses (AKs) or anogenital warts (AGW). AK patients treated with IM develop intensified inflammatory reactions on sights of prior clinical visible or palpable AKs as compared to the surrounding actinically damaged skin, suggesting the induction of a tumor cell-directed inflammation. AGW patients treated with IM develop even stronger inflammatory reactions with large erosions, suggesting a directed inflammatory response against HPV-infected keratinocytes. Of note, even widespread erosions heal very fast without any superinfections. Here, we set out to elucidate underlying molecular and cellular mechanisms of these clinical observations. METHODS The effects of IM (10-9-10-5 M) on the expression and translation of a comprehensive set of chemokines (CXCL1, CXCL8, CXCL9, CXCL10, CXCL11, CXCL14, CCL2, CCL5, CCL20, CCL27) and antimicrobial peptides (AMP) (HBD1, HBD2, HBD3, LL37, RNase7) were analyzed in primary human epithelial keratinocytes (HEK) and a set of epithelial cancer cell lines by RT-qPCR and ELISA in vitro. To study the possible effects of different concentrations of IM on migratory, respectively wound healing responses, an in vitro scratch assay was conducted on HEK. RESULTS Ingenol mebutat significantly and dose-dependently induced the expression of proinflammatory chemokines (CXCL8, CCL2) and AMP (RNase7, HBD3) in HEK and epithelial cancer cell lines. A significantly stronger induction of CXCL8 and CCL2 was observed in our tested tumor cells as compared to HEK. We did not observe any significant effect of IM on HEK migration, respectively wound healing responses in vitro for any tested concentration (10-9, 10-8, 10-6 M) except 10-7 M, which induced a significant inhibition. CONCLUSIONS Our data suggest that tumor cells are more susceptible to IM as compared to differentiated HEK. This is evident by a stronger IM-mediated induction of proinflammatory chemokines in tumor cells, which may result in a tumor cell-directed inflammatory response and rapid tumor destruction. In addition, IM induces AMP in keratinocytes and seems not to severely interfere with keratinocyte migration, which contributes to a fast and uncomplicated wound healing. Surprising is a selective inhibition of keratinocyte migration by IM at the concentration of 10-7 M pointing to very dose depending biological effects, induced by IM.
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Affiliation(s)
| | - Julia Baran
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Holger Schrumpf
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Orthopedics, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Bettina Alexandra Buhren
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Department of Orthopedics, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Peter Arne Gerber
- Department of Dermatology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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Buhren BA, Schrumpf H, Bölke E, Kammers K, Gerber PA. Standardized in vitro analysis of the degradability of hyaluronic acid fillers by hyaluronidase. Eur J Med Res 2018; 23:37. [PMID: 30122153 PMCID: PMC6100712 DOI: 10.1186/s40001-018-0334-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background Hyaluronidase is a hyaluronic acid (HA) metabolizing enzyme, which is approved as an adjuvant for infiltration anesthesia. The “off-label” use of hyaluronidase is regarded as gold standard for the management of HA-filler-associated complications. Yet, up to date there are only few studies that have systematically assessed the degradability of different HA-fillers by hyaluronidase. Objective To analyze the interactions of HA-fillers and hyaluronidase in a time-dependent manner using a novel standardized in vitro approach. Methods Comparable HA-fillers, Belotero Balance Lidocaine (BEL; Merz), Emervel classic (EMV; Galderma) and Juvederm Ultra 3 (JUV; Allergan), were incubated with a fluorescent dye and bovine hyaluronidase (HYAL; Hylase “Dessau”, Riemser) or control (NaCl) and monitored by time-lapse videomicroscopy. The degradation of HA-fillers was assessed as decrease in fluorescence intensity of HA-filler plus hyaluronidase vs. HA-filler plus control, quantified by computer-assisted image analysis (ImageJ). Results Hyaluronidase showed a significant degradation of the HA-fillers BEL and EMV. Degradation was measurable at 5 h (BEL) and 7 h (EMV), respectively; significance was reached at 14 h (BEL) and 13 h (EMV). No effect of hyaluronidase was observed for JUV. Conclusion Time-lapse microscopy enables systematically, standardized, comparative in vitro analyses of the interactions of hyaluronidase and HA-fillers.
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Affiliation(s)
- Bettina Alexandra Buhren
- Departments of Dermatology, Medical Faculty, Research Laboratory for Dermatology and Immunology, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Holger Schrumpf
- Departments of Dermatology, Medical Faculty, Research Laboratory for Dermatology and Immunology, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Edwin Bölke
- Departments of Radiation Oncology, Medical Faculty, Research Laboratory for Dermatology and Immunology, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Kai Kammers
- Division of Biostatistics and Bioinformatics, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter Arne Gerber
- Departments of Dermatology, Medical Faculty, Research Laboratory for Dermatology and Immunology, Heinrich-Heine-University Duesseldorf, University Hospital Duesseldorf, Duesseldorf, Germany.
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Franz A, Joseph L, Mayer C, Harmsen JF, Schrumpf H, Fröbel J, Ostapczuk MS, Krauspe R, Zilkens C. The role of oxidative and nitrosative stress in the pathology of osteoarthritis: Novel candidate biomarkers for quantification of degenerative changes in the knee joint. Orthop Rev (Pavia) 2018; 10:7460. [PMID: 30057720 PMCID: PMC6042053 DOI: 10.4081/or.2018.7460] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/19/2017] [Accepted: 12/24/2017] [Indexed: 01/08/2023] Open
Abstract
Osteoarthritis (OA) is the most frequently diagnosed joint disorder worldwide with increasing prevalence and crucial impact on the quality of life of affected patients through chronic pain, decreasing mobility and invalidity. Although some risk factors, such as age, obesity and previous joint injury are well established, the exact pathogenesis of OA on a cellular and molecular level remains less understood. Today, the role of nitrosative and oxidative stress has not been investigated conclusively in the pathogenesis of OA yet. Therefore, the objective of this study was to identify biological substances for oxidative and nitrosative stress, which mirror the degenerative processes in an osteoarthritic joint. 69 patients suffering from a diagnosed knee pain participated in this study. Based on the orthopedic diagnosis, patients were classified into an osteoarthritis group (OAG, n=24) or in one of two control groups (meniscopathy, CG1, n=11; anterior cruciate ligament rupture, CG2, n=34). Independently from the study protocol, all patients underwent an invasive surgical intervention which was used to collect samples from the synovial membrane, synovial fluid and human serum. Synovial biopsies were analyzed histopathologically for synovitis (Krenn-Score) and immunohistochemically for detection of end products of oxidative (8-isoprostane F2α) and nitrosative (3-nitrotyrosine) stress. Additionally, the fluid samples were analyzed for 8-isoprostane F2α and 3-nitrotyrosine by competitive ELISA method. The analyzation of inflammation in synovial biopsies revealed a slight synovitis in all three investigated groups. Detectable concentrations of 3-nitrotyrosine were reported in all three investigated groups without showing any significant differences between the synovial biopsies, fluid or human serum. In contrast, significant increased concentrations of 8-isoprostane F2α were detected in OAG compared to both control groups. Furthermore, our data showed a significant correlation between the histopathological synovitis and oxidative stress in OAG (r=0.728, P<0.01). There were no significant differences between the concentrations of 8-isoprostane F2α in synovial fluid and human serum. The findings of the current study support the hypothesis that oxidative and nitrosative stress are components of the multi-factory pathophysiological formation of OA. It seems reasonable that an inflammatory process in the synovial membrane triggers the generation of oxidative and nitrosative acting substances which can lead to a further degradation of the articular cartilage. Based on correlations between the observed degree of inflammation and investigated biomarkers, especially 8-isoprostane F2α seems to be a novel candidate biomarker for OA. However, due to the finding that also both control groups showed increased concentrations of selected biomarkers, future studies have to validate the diagnostic potential of these biomarkers in OA and in related conditions of the knee joint.
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Affiliation(s)
| | - Laura Joseph
- Department of Orthopedics, University Hospital Duesseldorf.,Department of Neurology, Johanna-Etienne Hospital, Neuss
| | | | | | | | - Julia Fröbel
- Institute of Molecular and Clinical Immunology, Otto-von- Guericke-University Magdeburg
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Braun SA, Schrumpf H, Buhren BA, Homey B, Gerber PA. Laser-assisted drug delivery: mode of action and use in daily clinical practice. J Dtsch Dermatol Ges 2018; 14:480-8. [PMID: 27119468 DOI: 10.1111/ddg.12963] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Topical application of pharmaceutical agents is a basic principle of dermatological therapy. However, the effective barrier function of the skin significantly impairs the bioavailability of most topical drugs. Fractional ablative lasers represent an innovative strategy to overcome the epidermal barrier in a standardized, contact-free manner. The bioavailability of topical agents can be significantly enhanced using laser-assisted drug delivery (LADD). In recent years, the principle of LADD has become well established for various dermatological indications. Herein, we review the current literature on LADD and present potential future applications.
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Affiliation(s)
| | - Holger Schrumpf
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
| | | | - Bernhard Homey
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
| | - Peter Arne Gerber
- Department of Dermatology, Heinrich Heine University, Düsseldorf, Germany
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Wiegand C, Buhren BA, Bünemann E, Schrumpf H, Homey B, Frykberg RG, Lurie F, Gerber PA. A novel native collagen dressing with advantageous properties to promote physiological wound healing. J Wound Care 2017; 25:713-720. [PMID: 27974008 DOI: 10.12968/jowc.2016.25.12.713] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Chronic hard-to-heal wounds generate high costs and resource use in western health systems and are the focus of intense efforts to improve healing outcomes. Here, we introduce a novel native collagen (90 %):alginate (10 %) wound dressing and compare it with the established oxidised dressings Method: Matrices were analysed by atomic force microscopy (AMF), scanning electron microscopy (SEM), and immunoelectron microscopy for collagen types I, III and V. Viability assays were performed with NIH-3T3 fibroblasts. Matrix metalloproteinase (MMP) binding was analysed, and the effect of the wound dressings on platelet-derived growth factor B homodimer (PDGF-BB) was investigated. RESULTS Unlike oxidised regenerated cellulose (ORC)/collagen matrix and ovine forestomach matrix (OFM), the three-dimensional structure of the native collagen matrix (NCM) was found to be analogous to intact, native, dermal collagen. Fibroblasts seeded on the NCM showed exponential growth whereas in ORC/collagen matrix or OFM, very low rates of proliferation were observed after 7 days. MMP sequestration was effective and significant in the NCM. In addition, the NCM was able to significantly stabilise PDGF-BB in vitro. CONCLUSION We hypothesise that the observed microstructure of the NCM allows for an effective binding of MMPs and a stabilisation and protection of growth factors and also promotes the ingrowth of dermal fibroblasts, potentially supporting the re commencement of healing in previously recalcitrant wounds. DECLARATION OF INTEREST This work was supported by BSN Medical, Hamburg, Germany.
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Affiliation(s)
- C Wiegand
- Department of Dermatology, University Medical Centre Jena, Jena, Germany
| | - B A Buhren
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - E Bünemann
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - H Schrumpf
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - B Homey
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - R G Frykberg
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - F Lurie
- Jobst Vascular Institute, Toledo, OH US
| | - P A Gerber
- Department of Dermatology, University Hospital Düsseldorf, Düsseldorf, Germany
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Gerber PA, Buhren BA, Schrumpf H, Hevezi P, Bölke E, Sohn D, Jänicke RU, Belum VR, Robert C, Lacouture ME, Homey B. Mechanisms of skin aging induced by EGFR inhibitors. Support Care Cancer 2016; 24:4241-8. [PMID: 27165055 DOI: 10.1007/s00520-016-3254-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/26/2016] [Indexed: 01/18/2023]
Abstract
BACKGROUND The mechanisms of skin aging have not been completely elucidated. Anecdotal data suggests that EGFR inhibition accelerates aging-like skin changes. OBJECTIVE The objective of the study was to evaluate the clinical characteristics and investigate the cellular and molecular mechanisms underlying skin changes associated with the use of EFGRIs. PATIENTS AND METHODS Patients during prolonged treatment with EGFRIs (>3 months) were analyzed for aging-like skin changes. Baseline EGFR expression was compared in young (<25 years old) vs. old (> 65 years old) skin. In addition, the regulation of extracellular matrix, senescence-associated genes, and cell cycle status was measured in primary human keratinocytes treated with erlotinib in vitro. RESULTS There were progressive signs of skin aging, including xerosis cutis, atrophy, rhytide formation, and/or actinic purpura in 12 patients. Keratinocytes treated with erlotinib in vitro showed a significant down-modulation of hyaluronan synthases (HAS2 and HAS3), whereas senescence-associated genes (p21, p53, IL-6, maspin) were upregulated, along with a G1 cell cycle arrest and stronger SA β-Gal activity. There was significantly decreased baseline expression in EGFR density in aged skin, when compared to young controls. CONCLUSIONS EGFR inhibition results in molecular alterations in keratinocytes that may contribute to the observed skin aging of patients treated with respective targeted agents.
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Affiliation(s)
- Peter Arne Gerber
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany.
| | - Bettina Alexandra Buhren
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany
| | - Holger Schrumpf
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany
| | - Peter Hevezi
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany
| | - Edwin Bölke
- Clinic and Polyclinic, Radiation Therapy and Radiooncology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Dennis Sohn
- Laboratory of Molecular Radiooncology, Radiation Therapy and Radiooncology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Reiner U Jänicke
- Laboratory of Molecular Radiooncology, Radiation Therapy and Radiooncology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Viswanath Reddy Belum
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caroline Robert
- Dermatology Service and Paris-Sud University, Gustave Roussy Cancer Campus, Villejuif-Paris Sud, Paris, France
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University of Düsseldorf, Moorenstrasse 5, D-40225, Duesseldorf, Germany
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Braun SA, Schrumpf H, Buhren BA, Homey B, Gerber PA. Laser assisted Drug Delivery: Grundlagen und Praxis. J Dtsch Dermatol Ges 2016; 14:480-9. [DOI: 10.1111/ddg.12963_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buhren BA, Schrumpf H, Hoff NP, Bölke E, Hilton S, Gerber PA. Hyaluronidase: from clinical applications to molecular and cellular mechanisms. Eur J Med Res 2016; 21:5. [PMID: 26873038 PMCID: PMC4752759 DOI: 10.1186/s40001-016-0201-5] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 02/05/2016] [Indexed: 12/22/2022] Open
Abstract
Over the past 60 years, hyaluronidase has been successfully utilized in ophthalmic surgery and is now being implemented in dermatosurgery as well as in other surgical disciplines. The enzyme is considered a “spreading factor” as it decomplexes hyaluronic acid (also called hyaluronan, HA), an essential component of the extracellular matrix (ECM). When applied as an adjuvant, hyaluronidase enhances the diffusion capacity and bioavailability of injected drugs. Therefore, the enzyme has been used as a local adjuvant to increase the diffusion capacity of local anesthetics, increasing the analgesic efficacy, and the anesthetized area particularly in the first minutes following injection, resulting in diminished intra- and postoperative pain. In aesthetic medicine, the off-label use of hyaluronidase is considered the gold standard for the management of HA-filler-associated complications. Here, we review the clinical use, underlying biological mechanisms, and future directions for the application of hyaluronidase in surgical and aesthetic medicine.
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Affiliation(s)
| | - Holger Schrumpf
- Department of Dermatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Norman-Philipp Hoff
- Department of Dermatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Said Hilton
- Medical Skin Center Dr. Hilton & Partners, Düsseldorf, Germany.
| | - Peter Arne Gerber
- Department of Dermatology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
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Gerber PA, Buhren BA, Schrumpf H, Homey B, Zlotnik A, Hevezi P. The top skin-associated genes: a comparative analysis of human and mouse skin transcriptomes. Biol Chem 2014; 395:577-91. [PMID: 24497224 DOI: 10.1515/hsz-2013-0279] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/30/2014] [Indexed: 11/15/2022]
Abstract
The mouse represents a key model system for the study of the physiology and biochemistry of skin. Comparison of skin between mouse and human is critical for interpretation and application of data from mouse experiments to human disease. Here, we review the current knowledge on structure and immunology of mouse and human skin. Moreover, we present a systematic comparison of human and mouse skin transcriptomes. To this end, we have recently used a genome-wide database of human gene expression to identify genes highly expressed in skin, with no, or limited expression elsewhere - human skin-associated genes (hSAGs). Analysis of our set of hSAGs allowed us to generate a comprehensive molecular characterization of healthy human skin. Here, we used a similar database to generate a list of mouse skin-associated genes (mSAGs). A comparative analysis between the top human (n=666) and mouse (n=873) skin-associated genes (SAGs) revealed a total of only 30.2% identity between the two lists. The majority of shared genes encode proteins that participate in structural and barrier functions. Analysis of the top functional annotation terms revealed an overlap for morphogenesis, cell adhesion, structure, and signal transduction. The results of this analysis, discussed in the context of published data, illustrate the diversity between the molecular make up of skin of both species and grants a probable explanation, why results generated in murine in vivo models often fail to translate into the human.
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Ushach I, Burkhardt AM, Martinez C, Hevezi PA, Gerber PA, Buhren BA, Schrumpf H, Valle-Rios R, Vazquez MI, Homey B, Zlotnik A. METEORIN-LIKE is a cytokine associated with barrier tissues and alternatively activated macrophages. Clin Immunol 2014; 156:119-27. [PMID: 25486603 DOI: 10.1016/j.clim.2014.11.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/19/2014] [Accepted: 11/22/2014] [Indexed: 01/16/2023]
Abstract
Cytokines are involved in many functions of the immune system including initiating, amplifying and resolving immune responses. Through bioinformatics analyses of a comprehensive database of gene expression (BIGE: Body Index of Gene Expression) we observed that a small secreted protein encoded by a poorly characterized gene called meteorin-like (METRNL), is highly expressed in mucosal tissues, skin and activated macrophages. Further studies indicate that Metrnl is produced by Alternatively Activated Macrophages (AAM) and M-CSF cultured bone marrow macrophages (M2-like macrophages). In the skin, METRNL is expressed by resting fibroblasts and IFNγ-treated keratinocytes. A screen of human skin-associated diseases showed significant over-expression of METRNL in psoriasis, prurigo nodularis, actinic keratosis and atopic dermatitis. METRNL is also up-regulated in synovial membranes of human rheumatoid arthritis. Taken together, these results indicate that Metrnl represents a novel cytokine, which is likely involved in both innate and acquired immune responses.
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Affiliation(s)
- Irina Ushach
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Amanda M Burkhardt
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Cynthia Martinez
- Department of Dermatology, School of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Peter A Hevezi
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Peter Arne Gerber
- Department of Dermatology, School of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | | | - Holger Schrumpf
- Department of Dermatology, School of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Ricardo Valle-Rios
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA; Present address: Laboratory of Immunology and Proteomics, Children's Hospital of Mexico, Mexico, D.F. 06720, Mexico
| | - Monica I Vazquez
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA
| | - Bernhard Homey
- Department of Dermatology, School of Medicine, University of Duesseldorf, Duesseldorf, Germany
| | - Albert Zlotnik
- Department of Physiology and Biophysics, University of California Irvine, Irvine, CA, USA; Institute for Immunology, University of California Irvine, Irvine, CA, USA.
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Hilton S, Schrumpf H, Buhren BA, Bölke E, Gerber PA. Hyaluronidase injection for the treatment of eyelid edema: a retrospective analysis of 20 patients. Eur J Med Res 2014; 19:30. [PMID: 24886711 PMCID: PMC4063423 DOI: 10.1186/2047-783x-19-30] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 05/06/2014] [Indexed: 02/08/2023] Open
Abstract
Background Hyaluronidase (Hylase Dessau®) is a hyaluronic acid-metabolizing enzyme, which has been shown to loosen the extracellular matrix, thereby improving the diffusion of local anesthetics. Lower eyelid edema is a common post-interventional complication of cosmetic procedures performed in the lid region, such as the injection of hyaluronic acid fillers for tear-trough augmentation. The purpose of this study was to validate the efficacy of hyaluronidase in the management of lower eyelid edema. Methods We performed a retrospective analysis with 20 patients with lower eyelid edema. Most patients (n = 14) presented with edema following hyaluronic acid injection (tear-trough augmentation), whereas the minority (n = 6) were treated due to idiopathic edema (malar edema or malar mounds). Patients were treated by local infiltration of approximately 0.2 ml to 0.5 ml of hyaluronidase (Hylase Dessau® 20 IU to 75 IU) per eyelid. Photographs were taken prior to and seven days after infiltration. Results Hyaluronidase was found to reduce effectively and rapidly or resolve eyelid edema after a single injection. No relevant adverse effects were observed. However, it must be noted that a hyaluronidase injection may also dissolve injected hyaluronic acid fillers and may therefore negatively affect tear-trough augmentations. While the effects of a treatment for edema due to tear-trough augmentation were permanent, malar edema and malar mounds reoccurred within two to three weeks. Conclusion The infiltration of hyaluronidase is rapid, safe and currently the only effective option for the management of eyelid edema. No relevant adverse effects were observed.
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Affiliation(s)
| | | | | | | | - Peter Arne Gerber
- Department of Dermatology, Heinrich-Heine University Dusseldorf, Medical Faculty, Moorenstr 5, D-40225 Dusseldorf, Germany.
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Hetzer S, Buhren BA, Schrumpf H, Bölke E, Meller S, Kammers K, Gerber PA, Homey B. Retrospective analysis of the frequency of centrofacial telangiectasia in systemic sclerosis patients treated with bosentan or ilomedin. Eur J Med Res 2014; 19:2. [PMID: 24410934 PMCID: PMC3902062 DOI: 10.1186/2047-783x-19-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/27/2013] [Indexed: 11/10/2022] Open
Abstract
Background Bosentan is a dual endothelin receptor antagonist initially introduced for the treatment of pulmonary arterial hypertension and recently approved for the treatment of digital ulcers in patients with systemic sclerosis (SSc). Our clinical observations indicate that bosentan therapy may be associated with an increased frequency of centrofacial telangiectasia (TAE). Here, we sought to analyze the frequency of TAE in patients with SSc who were treated with either bosentan or the prostacyclin analog iloprost. Methods We conducted a retrospective analysis in 27 patients with SSc undergoing therapy with either bosentan (n = 11) or iloprost (n = 16). Standardized photodocumentations of all patients (n = 27) were obtained at a time point ten months after therapy initiation and analyzed. A subgroup of patients (bosentan: n = 6; iloprost: n = 6) was additionally photodocumented prior to therapy initiation, enabling an intraindividual analysis over the course of therapy. Results After ten months of therapy patients with SSc receiving bosentan showed a significantly (P = 0.0028) higher frequency of centrofacial TAE (41.6 ± 27.8) as compared to patients with SSc receiving iloprost (14.3 ± 13.1). Detailed subgroup analysis revealed that the frequency of TAE in the bosentan group (n = 6 patients) increased markedly and significantly (P = 0.027) by 44.4 after ten months of therapy (TAE at therapy initiation: 10.8 ± 5.1; TAE after ten months of therapy: 55.2 ± 29.8), whereas an only minor increase of 1.9 was observed in the iloprost group (n = 6 patients; TAE at therapy initiation: 18.3 ± 14.5; TAE after ten months of therapy: 20.2 ± 15.5), yet without reaching statistical significance (P = 0.420). Conclusions The use of bosentan may be associated with an increased frequency of TAE in patients with SSc. Patients should be informed about this potential adverse effect prior to therapy. Treatment options may include camouflage or laser therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University of Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany.
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Orth K, Knoefel WT, van Griensven M, Matuschek C, Peiper M, Schrumpf H, Gerber PA, Budach W, Bölke E, Buhren BA, Schauer M. Preventively enteral application of immunoglobulin enriched colostrums milk can modulate postoperative inflammatory response. Eur J Med Res 2013; 18:50. [PMID: 24266958 PMCID: PMC3879091 DOI: 10.1186/2047-783x-18-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 11/11/2013] [Indexed: 12/12/2022] Open
Abstract
Several studies demonstrated acute inflammatory response following traumatic injury. Inflammatory response during surgical interventions was verified by a significant increase of endotoxin plasma levels and a decrease of the endotoxin neutralizing capacity (ENC). However, the incidence of elevated endotoxin levels was significantly higher (89%) than detected bacterial translocation (35%). Thus parts or products of Gram-negative bacteria seem to translocate more easily into the blood circulation than whole bacteria. Along with the bacterial translocation, the inflammatory response correlated directly with the severity of the surgical intervention. In comparison after major and minor surgery Interleukin-6 (IL-6) and C-reactive protein (CRP) was also significantly different. Similar effects in mediator release were shown during endovascular stent graft placement and open surgery in infrarenal aortic aneurysm. Open surgery demonstrated a significant stronger endotoxin translocation and a decrease of ENC. Strategies to prevent translocation seem to be sensible. Colostrum is the first milk produced by the mammary glands within the first days after birth. It contains a complex system of immune factors and has a long history of use in traditional medicine. Placebo-controlled studies verified that prophylactic oral application of immunoglobulin-enriched colostrum milk preparation diminishes perioperative endotoxemia, prevents reduction of ENC and reduces postoperative CRP-levels, suggesting a stabilization of the gut barrier. This effect may be caused by immunoglobulin transportation by the neonatal receptor FcRn of the mucosal epithelium.In conclusion, there is an association of perioperative endotoxemia and the subsequent increase in mediators of the acute phase reaction in surgical patients. A prophylactic oral application of colostrum milk is likely to stabilize the gut barrier i.e. reduces the influx of lipopolysaccharides arising from Gram-negative bacterial pathogens and inhibits enterogenic endotoxemia. This appears to be a major mechanism underlying the therapeutic effect in patients at risk for Gram-negative septic shock.
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Affiliation(s)
- Klaus Orth
- Medical Faculty, Department of General, Visceral, and Thoracal Surgery, Asclepios Harz Hospitals, Goslar, Germany
| | - Wolfram Trudo Knoefel
- Medical Faculty, Department of General, Visceral-, and Pediatric Surgery, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany
| | - Martijn van Griensven
- Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christiane Matuschek
- Medical Faculty Department of Radiation Oncology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Moorenstrasse 5, Duesseldorf D-40225, Germany
| | - Matthias Peiper
- Medical Faculty, Department of General, Visceral, and Thoracal Surgery, Asclepios Harz Hospitals, Goslar, Germany
- Klinik für Allgemein-, Viszeral-, Gefäß- und Unfallchirurgie, Krankenhaus St. Joseph. Propsteistr. 2, Essen-Werden 45239, Germany
| | - Holger Schrumpf
- Medical Faculty Department of Dermatology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany
| | - Peter Arne Gerber
- Medical Faculty Department of Dermatology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany
| | - Wilfried Budach
- Medical Faculty Department of Radiation Oncology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Moorenstrasse 5, Duesseldorf D-40225, Germany
| | - Edwin Bölke
- Medical Faculty Department of Radiation Oncology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Moorenstrasse 5, Duesseldorf D-40225, Germany
| | - Bettina Alexandra Buhren
- Medical Faculty Department of Dermatology, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany
| | - Matthias Schauer
- Medical Faculty, Department of General, Visceral-, and Pediatric Surgery, Heinrich Heine Universität Düsseldorf, Germany University of Düsseldorf, Dusseldorf, Germany
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Hilton S, Heise H, Buhren BA, Schrumpf H, Bölke E, Gerber PA. Treatment of melasma in Caucasian patients using a novel 694-nm Q-switched ruby fractional laser. Eur J Med Res 2013; 18:43. [PMID: 24225160 PMCID: PMC3831591 DOI: 10.1186/2047-783x-18-43] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/29/2013] [Indexed: 11/12/2022] Open
Abstract
Background Melasma is a common hypermelanosis of the face. The use of a classical Q-switched ruby laser (QSRL) to treat melasma is discussed controversially and is associated with frequent adverse effects, such as hyper- or hypopigmentation. Recently a fractional-mode (FRx) QSRL was developed to minimize the adverse effects of classical QSRL. The objective of this research was to evaluate the efficacy and safety of a novel FRx-QSRL in the treatment of melasma in Caucasian patients. Methods We performed a retrospective study of 25 Caucasian melasma patients (Fitzpatrick skin types I to III). Patients received one to three FRx-QSRL treatments (Tattoostar FRx, Asclepion Laser Technologies, Jena, Germany) at pulse energies of 4 to 8 J/cm2. Three blinded investigators independently evaluated the melasma area and severity index (MASI) score before treatment and at the four- to six-week follow-ups. At additional three-month follow-ups, patients evaluated subjective improvement, pain and over-all satisfaction with the treatment according to a numeric analogue score (NAS). Side effects were documented. Results At four to six weeks post laser treatment for a mean of 1.4 sessions, we observed a significant (P = 0.0001) reduction of the MASI score from 6.54 to 1.98 (72.3%). Patients rated the pain of the intervention at a mean 2.46 points (0 = no pain; 10 = maximum pain), the improvement at a mean 5.55 points (0 = no improvement; 10 = maximum improvement) and the overall satisfaction at a mean 4.66 points (0 = not satisfied; 10 = maximum satisfaction). After three months, post-inflammatory hyperpigmentation (PIH) and/or recurring melasma were observed in 7 (28%) and 11 (44%) patients, respectively. Conclusion The 694-nm FRx-QSRL is a safe and effective option for treating melasma in Caucasian patients. Over periods of >3 months, PIH and/or recurring melasma may develop at significant rates and may reduce patient satisfaction. Multiple treatment sessions with lower pulse energies and/or a post-interventional therapy with hypopigmenting ointments and UV protection may help to minimize these complications.
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Lichtenberger BM, Gerber PA, Holcmann M, Buhren BA, Amberg N, Smolle V, Schrumpf H, Boelke E, Ansari P, Mackenzie C, Wollenberg A, Kislat A, Fischer JW, Rock K, Harder J, Schroder JM, Homey B, Sibilia M. Epidermal EGFR Controls Cutaneous Host Defense and Prevents Inflammation. Sci Transl Med 2013; 5:199ra111. [DOI: 10.1126/scitranslmed.3005886] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gerber PA, Hevezi P, Buhren BA, Martinez C, Schrumpf H, Gasis M, Grether-Beck S, Krutmann J, Homey B, Zlotnik A. Systematic identification and characterization of novel human skin-associated genes encoding membrane and secreted proteins. PLoS One 2013; 8:e63949. [PMID: 23840300 PMCID: PMC3688712 DOI: 10.1371/journal.pone.0063949] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/07/2013] [Indexed: 11/19/2022] Open
Abstract
Through bioinformatics analyses of a human gene expression database representing 105 different tissues and cell types, we identified 687 skin-associated genes that are selectively and highly expressed in human skin. Over 50 of these represent uncharacterized genes not previously associated with skin and include a subset that encode novel secreted and plasma membrane proteins. The high levels of skin-associated expression for eight of these novel therapeutic target genes were confirmed by semi-quantitative real time PCR, western blot and immunohistochemical analyses of normal skin and skin-derived cell lines. Four of these are expressed specifically by epidermal keratinocytes; two that encode G-protein-coupled receptors (GPR87 and GPR115), and two that encode secreted proteins (WFDC5 and SERPINB7). Further analyses using cytokine-activated and terminally differentiated human primary keratinocytes or a panel of common inflammatory, autoimmune or malignant skin diseases revealed distinct patterns of regulation as well as disease associations that point to important roles in cutaneous homeostasis and disease. Some of these novel uncharacterized skin genes may represent potential biomarkers or drug targets for the development of future diagnostics or therapeutics.
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Affiliation(s)
- Peter Arne Gerber
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Hevezi
- Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States of America
| | | | - Cynthia Martinez
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - Holger Schrumpf
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - Marcia Gasis
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - Susanne Grether-Beck
- Institut für Umweltmedizinische Forschung, Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Jean Krutmann
- Institut für Umweltmedizinische Forschung, Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Bernhard Homey
- Department of Dermatology, University of Düsseldorf, Düsseldorf, Germany
| | - Albert Zlotnik
- Department of Physiology and Biophysics, University of California Irvine, Irvine, California, United States of America
- * E-mail:
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Gerber PA, Meller S, Eames T, Buhren BA, Schrumpf H, Hetzer S, Ehmann LM, Budach W, Bölke E, Matuschek C, Wollenberg A, Homey B. Management of EGFR-inhibitor associated rash: a retrospective study in 49 patients. Eur J Med Res 2012; 17:4. [PMID: 22472354 PMCID: PMC3351712 DOI: 10.1186/2047-783x-17-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 02/23/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In recent years inhibitors directed against the epidermal growth factor receptor (EGFR) have evolved as effective targeting cancer drugs. Characteristic papulopustular exanthemas, often described as acneiform rashes, are the most frequent adverse effect associated with this class of novel cancer drugs and develop in > 90% of patients. Notably, the rash may significantly compromise the patients' quality of life, thereby potentially leading to incompliance as well as dose reduction or even termination of the anti-EGFR therapy. Yet, an effective dermatologic management of cutaneous adverse effects can be achieved. Whereas various case reports, case series or expert opinions on the management of EGFR-inhibitor (EGFRI) induced rashes have been published, data on systematic management studies are sparse. METHODS Here, we present a retrospective, uncontrolled, comparative study in 49 patients on three established regimens for the management of EGFRI-associated rashes. RESULTS Strikingly, patients' rash severity improved significantly over three weeks of treatment with topical mometason furoate cream, topical prednicarbate cream plus nadifloxacin cream, as well as topical prednicarbate cream plus nadifloxacin cream plus systemic isotretinoin. CONCLUSIONS In summary our results demonstrate that EGFRI-associated rashes can be effectively managed by specific dermatologic interventions. Whereas mild to moderate rashes should be treated with basic measures in combination with topical glucocorticosteroids or combined regiments using glucocorticosteroids and antiseptics/antibiotics, more severe or therapy-resistant rashes are likely to respond with the addition of systemic retinoids.
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Affiliation(s)
- Peter Arne Gerber
- Department of Dermatology, University of Duesseldorf, Medical Faculty, Moorenstrasse 5, D-40225 Duesseldorf, Germany.
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