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Giang J, van Doorn MBA, Diercks GFH, de Cordoba SR, van den Bosch TPP, Schreurs MWJ, Poppelaars F, Damman J. Successful pharmacological intervention at different levels of the complement system in an in vitro complement fixation model for bullous pemphigoid. Exp Dermatol 2023; 32:632-640. [PMID: 36704908 DOI: 10.1111/exd.14755] [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] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023]
Abstract
Bullous pemphigoid (BP) is characterized by deposition of immunoglobulins and complement along the epidermal basement membrane (BM). In humans, there is a lack of functional studies targeting the complement system (CS). This study investigates activation of all complement pathways in BP skin biopsies. Moreover, pharmacological inhibition at different levels of the CS was investigated using anti-complement compounds in a complement fixation BP assay. In this retrospective study, 21 frozen biopsies from BP patients were stained by direct immunofluorescence for C1q, MBL, ficolin-2, C4d, properdin, C3c and C5b-9. Sera from 10 patients were analysed in a complement fixation assay in the presence of C1 inhibitor, anti-factor B monoclonal antibody (mAb), anti-C3 mAb and anti-C5 mAb and compared with dexamethasone. The two readouts were the quantity of complement deposited along the BM and the release of sC5b-9 in the supernatant. Our results show classical and alternative complement pathway activation in BP skin biopsies, but could not demonstrate significant lectin pathway activation. In contrast to dexamethasone, complement deposition along the BM could be selectively inhibited by anti-C1 and anti- factor B. More downstream, selective intervention at the level of C3 and C5 could effectively reduce complement deposition along the BM and the release of sC5b-9 in the supernatant. This study shows that selective intervention in either the classical, alternative or terminal pathway prevented deposition of complement along the BM in an in vitro BP model. The results of our study greatly encourage the clinical development of complement inhibitors for the treatment of BP.
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Affiliation(s)
- Jenny Giang
- Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.,Centre for Human Drug Research, Leiden, The Netherlands
| | - Gilles F H Diercks
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Santiago Rodriguez de Cordoba
- Centro de Investigaciones Biológicas, Consejo Superior de Investigaciones Científicas, Madrid, Spain.,Centro de Investigación Biomédica en Enfermedades Raras, Madrid, Spain
| | | | - Marco W J Schreurs
- Department of Immunology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Felix Poppelaars
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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2
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Giang J, Mooyaart AL, Martens-de Kemp SR, Jaspars L, Wakkee M, Eijken E, Voogt W, Dinjens WNM, Damman J. Hedgehog pathway mutations are involved in the pathogenesis of plaque-type "trichoblastoma": A report of two cases. J Cutan Pathol 2023. [PMID: 36607280 DOI: 10.1111/cup.14389] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/21/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
We present two cases of plaque-type trichoblastoma with atypical foci. A rare variant of trichoblastoma is the plaque variant, which is characterized by poor circumscription and locally infiltrative growth pattern. These lesions mostly require multiple stages of Mohs micrographic surgery. Debate still exists whether this variant should be considered as a benign entity or as "low-grade" malignant counterpart of trichoblastoma. In this report we describe two cases of plaque-type trichoblastoma with atypical foci, which harbored somatic mutations in the Hedgehog pathway, thus should be acknowledged as intermediate malignancies. In addition, extensive molecular workup of both the trichoblastic and atypical component in sequential lesions in the same patient was performed.
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Affiliation(s)
- Jenny Giang
- Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Antien L Mooyaart
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Lies Jaspars
- Department of Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC, University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - Erik Eijken
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, The Netherlands
| | - Walter Voogt
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Winand N M Dinjens
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
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3
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van Straalen KR, Dudink K, Aarts P, van der Zee HH, van den Bosch TPP, Giang J, Prens EP, Damman J. Complement activation in Hidradenitis suppurativa: Covert low-grade inflammation or innocent bystander? Front Immunol 2022; 13:953674. [PMID: 36211440 PMCID: PMC9535337 DOI: 10.3389/fimmu.2022.953674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a complex and multifactorial pathogenesis involving both the innate and adaptive immune system. Despite limited evidence for local complement activation, conflicting results have been published on the role of systemic complement activation in HS. It was hypothesized that complement was consumed in highly inflamed HS skin, trapping complement from the circulation. Therefore, the aim of this study was to evaluate this local complement deposition in HS skin lesions using routine and commonly used complement antibodies.Direct immunofluorescence for C1q, C3c, C4d, C5b-9, and properdin was performed on frozen tissue sections of 19 HS patients and 6 controls. C5a receptor 1 (C5aR1) was visualized using immunohistochemistry.Overall, we found no significant local complement deposition in HS patients versus controls regarding C1q, C3c, C4d, C5b-9, or properdin on either vessels or immune cells. C5aR1 expression was exclusively found on immune cells, predominantly neutrophilic granulocytes, but not significantly different relatively to the total infiltrate in HS lesions compared with controls. In conclusion, despite not being able to confirm local complement depositions of C1q, C3c, C4d, or properdin using highly sensitive and widely accepted techniques, the increased presence of C5aR1 positive immune cells in HS suggests the importance of complement in the pathogenesis of HS and supports emerging therapies targeting this pathway.
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Affiliation(s)
- K. R. van Straalen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - K. Dudink
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - P. Aarts
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - H. H. van der Zee
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - T. P. P. van den Bosch
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Giang
- Department of Pathology, Maasstad Hospital, Rotterdam, Netherlands
| | - E. P. Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Damman
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: J. Damman,
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Agahozo MC, Westenend PJ, van Bockstal MR, Hansum T, Giang J, Matlung SE, van Deurzen CHM. Correction: Immune response and stromal changes in ductal carcinoma in situ of the breast are subtype dependent. Mod Pathol 2021; 34:1039-1040. [PMID: 33122801 DOI: 10.1038/s41379-020-00707-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Mieke R van Bockstal
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Tim Hansum
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jenny Giang
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sanneke E Matlung
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Giang J, Biswas A, Mooyaart AL, Groenendijk FH, Dikrama P, Damman J. Trichoblastic carcinosarcoma with panfollicular differentiation (panfollicular carcinosarcoma) and CTNNB1 (beta-catenin) mutation. J Cutan Pathol 2020; 48:309-313. [PMID: 32623745 PMCID: PMC7891381 DOI: 10.1111/cup.13794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/24/2020] [Revised: 06/03/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022]
Abstract
We present a case of trichoblastic carcinosarcoma with panfollicular differentiation. An 80-year-old man presented with a lesion on the left ear, which had been present for several months. Histopathology revealed a well-demarcated neoplasm in the dermis composed of intimately intermingled malignant epithelial and mesenchymal cells. The epithelial component showed multilineage follicular differentiation toward all of the elements of a normal hair follicle. Molecular analysis revealed identical molecular aberrations in both epithelial and mesenchymal components including CTNNB1 and SUFU mutations. To the best of our knowledge, this is the first report of panfollicular carcinosarcoma and of the presence of a CTNNB1 mutation in trichoblastic carcinosarcoma.
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Affiliation(s)
- Jenny Giang
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Asok Biswas
- Department of Pathology, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Antien L Mooyaart
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Floris H Groenendijk
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Petra Dikrama
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Giang J, Seelen MAJ, van Doorn MBA, Rissmann R, Prens EP, Damman J. Complement Activation in Inflammatory Skin Diseases. Front Immunol 2018; 9:639. [PMID: 29713318 PMCID: PMC5911619 DOI: 10.3389/fimmu.2018.00639] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 12/21/2017] [Accepted: 03/14/2018] [Indexed: 01/02/2023] Open
Abstract
The complement system is a fundamental part of the innate immune system, playing a crucial role in host defense against various pathogens, such as bacteria, viruses, and fungi. Activation of complement results in production of several molecules mediating chemotaxis, opsonization, and mast cell degranulation, which can contribute to the elimination of pathogenic organisms and inflammation. Furthermore, the complement system also has regulating properties in inflammatory and immune responses. Complement activity in diseases is rather complex and may involve both aberrant expression of complement and genetic deficiencies of complement components or regulators. The skin represents an active immune organ with complex interactions between cellular components and various mediators. Complement involvement has been associated with several skin diseases, such as psoriasis, lupus erythematosus, cutaneous vasculitis, urticaria, and bullous dermatoses. Several triggers including auto-antibodies and micro-organisms can activate complement, while on the other hand complement deficiencies can contribute to impaired immune complex clearance, leading to disease. This review provides an overview of the role of complement in inflammatory skin diseases and discusses complement factors as potential new targets for therapeutic intervention.
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Affiliation(s)
- Jenny Giang
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc A J Seelen
- Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Errol P Prens
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
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Hamann S, Giang J, De Maeseneer M, Nijsten T, van den Bos R. Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis. J Vasc Surg 2018. [DOI: 10.1016/j.jvs.2017.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hamann SAS, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR. Editor's Choice - Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis. Eur J Vasc Endovasc Surg 2017; 54:760-770. [PMID: 29033337 DOI: 10.1016/j.ejvs.2017.08.034] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [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: 05/17/2017] [Accepted: 08/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The most frequently used treatment options for great saphenous vein incompetence are high ligation with stripping (HL+S), endovenous thermal ablation (EVTA), mainly consisting of endovenous laser ablation (EVLA) or radiofrequency ablation, and ultrasound guided foam sclerotherapy (UGFS). The objective of this systematic review and meta-analysis was to compare the long-term efficacy of these different treatment modalities. METHODS A systematic literature search was performed. Randomised controlled trials (RCTs) with follow-up ≥ 5 years were included. Pooled proportions of anatomical success, which was the primary outcome, rate of recurrent reflux at the saphenofemoral junction (SFJ), and mean difference in venous clinical severity score (VCSS) were compared using a z test or Student t test. Quality of life data were assessed and described. RESULTS Three RCTs and 10 follow-up studies of RCTs were included of which 12 were pooled in the meta-analysis. In total, 611 legs were treated with EVLA, 549 with HL+S, 121 with UGFS, and 114 with HL+EVLA. UGFS had significantly lower pooled anatomical success rates than HL+S, EVLA, and EVLA with high ligation: 34% (95% CI 26-44) versus 83% (95% CI 72-90), 88% (95% CI 82-92), and 88% (95% CI 17-100) respectively; p ≤ .001. The pooled recurrent reflux rate at the SFJ was significantly lower for HL+S than UGFS (12%, 95% CI 7-20, vs. 29%, 95% CI 21-38; p ≤ .001) and EVLA (12%, 95% CI 7-20, vs. 22%, 95% CI 14-32; p = .038). VCSS scores were pooled for EVLA and HL+S, which showed similar improvements. CONCLUSION EVLA and HL+S show higher success rates than UGFS 5 years after GSV treatment. Recurrent reflux rates at the SFJ were significantly lower in HL+S than UGFS and EVLA. VCSS scores were similar between EVLA and HL+S.
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Affiliation(s)
- Sterre A S Hamann
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jenny Giang
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marianne G R De Maeseneer
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Renate R van den Bos
- Department of Dermatology, Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Malskat WSJ, Giang J, De Maeseneer MGR, Nijsten TEC, van den Bos RR. Randomized clinical trial of 940- versus 1470-nm endovenous laser ablation for great saphenous vein incompetence. Br J Surg 2015; 103:192-8. [DOI: 10.1002/bjs.10035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 01/14/2023]
Abstract
Abstract
Background
The independent effect of wavelength used for endovenous laser ablation (EVLA) on patient-reported outcomes, health-related quality of life (HRQoL), treatment success and complications has not yet been established in a randomized clinical trial. The aim was to compare two different wavelengths, with identical energy level and laser fibres, in patients undergoing EVLA.
Methods
Patients with great saphenous vein incompetence were randomized to receive 940- or 1470-nm EVLA. The primary outcome was pain at 1 week. Secondary outcomes were: patient satisfaction, duration of analgesia use and time without normal activities assessed at 1 week; HRQoL after 12 weeks; treatment success after 12 and 52 weeks; change in Venous Clinical Severity Score (VCSS) after 12 weeks; and adverse events at 1 and 12 weeks.
Results
A total of 142 legs were randomized (940-nm EVLA, 70; 1470-nm EVLA, 72). Patients in the 1470-nm laser group reported significantly less pain on a visual analogue scale than those in the 940-nm laser group: median (i.q.r.) score 3 (2–7) versus 6 (3–8) (P = 0·004). Duration of analgesia use was significantly shorter after 1470-nm EVLA: median (i.q.r.) 1 (0–3) versus 2 (0–5) days (P = 0·037). HRQoL and VCSS improved equally in both groups. There was no difference in treatment success rates. Complications were comparable in both groups, except for more superficial vein thrombosis 1 week after 1470-nm EVLA.
Conclusion
EVLA using a 1470-nm wavelength fibre was associated with improved postoperative pain and a reduction in analgesia use in the first week after surgery compared with use of a 940-nm fibre. Treatment success and adverse event rates were similar. Registration number: NCT01637181 (http://www.clinicaltrials.gov).
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Affiliation(s)
- W S J Malskat
- Department of Dermatology, Erasmus MC Burgemeesters' Jacobplein 51, 3015 CA Rotterdam, The Netherlands
| | - J Giang
- Department of Dermatology, Erasmus MC Burgemeesters' Jacobplein 51, 3015 CA Rotterdam, The Netherlands
| | - M G R De Maeseneer
- Department of Dermatology, Erasmus MC Burgemeesters' Jacobplein 51, 3015 CA Rotterdam, The Netherlands
| | - T E C Nijsten
- Department of Dermatology, Erasmus MC Burgemeesters' Jacobplein 51, 3015 CA Rotterdam, The Netherlands
| | - R R van den Bos
- Department of Dermatology, Erasmus MC Burgemeesters' Jacobplein 51, 3015 CA Rotterdam, The Netherlands
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