Novel and potential future therapeutic options in systemic autoimmune diseases

Autoimmune inflammation is caused by the loss of tolerance to specific self-antigens and can result in organ-specific or systemic disorders. Systemic autoimmune diseases affect a significant portion of the population with an increasing rate of incidence, which means that is essential to have effective therapies to control these chronic disorders. Unfortunately, several patients with systemic autoimmune diseases do not respond at all or just partially respond to available conventional synthetic disease-modifying antirheumatic drugs and targeted therapies. However, during the past few years, some new medications have been approved and can be used in real-life clinical settings. Meanwhile, several new candidates appeared and can offer promising novel treatment options in the future. Here, we summarize the newly available medications and the most encouraging drug candidates in the treatment of systemic lupus erythematosus, rheumatoid arthritis, Sjögren's disease, systemic sclerosis, systemic vasculitis, and autoimmune myositis.

Identifying novel disease genes and revealing the pathomechanism of monogenic diseases

Diseases are caused by genetic and/or environmental factors. It is important to understand the pathomechanism of monogenic diseases that are caused only by genetic factors, especially prenatal- or childhood-onset diseases for pediatricians. Identifying "novel" disease genes and elucidating how genomic changes lead to human phenotypes would develop new therapeutic approaches for rare diseases for which no fundamental cure has yet been established. Genomic analysis has evolved along with the development of analytical techniques, from Sanger sequencing (first-generation sequencing) to techniques such as comparative genomic hybridization, massive parallel short-read sequencing (using a next-generation sequencer or second-generation sequencer) and long-read sequencing (using a next-next generation sequencer or third-generation sequencer). I have been researching human genetics using conventional and new technologies, together with my mentors and numerous collaborators, and have identified genes responsible for more than 60 diseases. Here, an overview of genomic analyses of monogenic diseases that aims to identify novel disease genes, and several examples using different approaches depending on the disease characteristics are presented.

The Unknown Role of Periostin in Psoriatic Epidermal Hyperplasia

Psoriasis is an inflammatory skin disease that affects 1-2% of the general population. The pathomechanism is based on type 1 immunological reactions. Hyperplasia of the epidermis in psoriasis is a result of disrupted epidermal architecture due to increased synthesis and expression of extracellular matrix proteins. In our study, we analyzed the involvement of periostin (POSTN) in the pathogenesis of psoriasis, as one of the extracellular matrix proteins belonging to the fasciclin family. The study group consisted of 70 patients with psoriasis, while the control group comprised 30 healthy individuals. The serum concentrations of POSTN, Il-6, Il-17, Il-22, TNF-α and IFN-γ were measured in all participants. The severity of psoriasis was determined using the PASI (Psoriasis Area and Severity Index) score. The presence of POSTN in biopsy samples of 50 patients was assessed using the direct immunofluorescence method. The results were subjected to statistical analysis. The serum concentrations of POSTN, Il-6, Il-17, Il-22, TNF-α and IFN-γ in the study group are significantly higher than in the control group. Positive correlation has been demonstrated between the PASI score and the investigated cytokines, but not with POSTN. There was no statistically significant correlation between the POSTN level and the cytokines levels. POSTN deposits were localized in the epidermis in 66% of patients with psoriasis. The role of POSTN in the pathogenesis of psoriasis remains unclear. The mechanisms inducing the synthesis and expression of POSTN in psoriatic skin are not yet fully understood. Further research is needed to enhance our understanding of the mechanism underlying epidermal hyperplasia in psoriasis.

[The significance of omega-3 fatty acids in the treatment of non-alcoholic fatty liver disease]

Today, non-alcoholic fatty liver disease is the most common chronic liver disease, yet there is no clearly accepted effective therapy. What is certain is that the number of people suffering from the disease is increasing, making prevention, treatment and recognition of co-morbidities of paramount importance. Current evidence suggests that the development of non-alcoholic fatty liver disease may be due to pathological factors of different origins. The main risk factors include genetic factors, acquired environmental influences and lifestyle. Lifestyle modification, i.e., the elimination or reduction of these harmful factors, can reverse liver damage, depending on the stage of the disease. In this summary statement, we review the pathophysiology of non-alcoholic fatty liver disease, risk factors and therapeutic options, within that in particular lifestyle modification (dietary changes, increasing physical activity, weight loss). Furthermore, we also show the importance of omega-3 fatty acids such as eicosapentaenoic acid and docosahexaenoic acid in detail. With our knowledge, the personalized treatment of non-alcoholic fatty liver disease can be elaborated. Orv Hetil. 2023; 164(33): 1294-1299.

The presence and severity of epilepsy coincide with reduced γ-aminobutyrate and cortical excitatory markers in succinic semialdehyde dehydrogenase deficiency

OBJECTIVE

Succinic semialdehyde dehydrogenase deficiency (SSADHD) is a rare inherited metabolic disorder caused by a defect of γ-aminobutyrate (GABA) catabolism. Despite the resultant hyper-GABAergic environment facilitated by the metabolic defect, individuals with this disorder have a paradoxically high prevalence of epilepsy. We aimed to study the characteristics of epilepsy in SSADHD and its concordance with GABA-related metabolites and neurophysiologic markers of cortical excitation.

METHODS

Subjects in an international natural history study of SSADHD underwent clinical assessments, electroencephalography, transcranial magnetic stimulation (TMS), magnetic resonance spectroscopy for GABA/N-acetyl aspartate quantification, and plasma GABA-related metabolite measurements.

RESULTS

A total of 61 subjects with SSADHD and 42 healthy controls were included in the study. Epilepsy was present in 49% of the SSADHD cohort. Over time, there was an increase in severity in 33% of the subjects with seizures. The presence of seizures was associated with increasing age (p = .001) and lower levels of GABA (p = .002), γ-hydroxybutyrate (GHB; p = .004), and γ-guanidinobutyrate (GBA; p = .003). Seizure severity was associated with increasing age and lower levels of GABA-related metabolites as well as lower TMS-derived resting motor thresholds (p = .04). The cutoff values with the highest discriminative ability to predict seizures were age > 9.2 years (p = .001), GABA < 2.57 μmol·L-1 (p = .002), GHB < 143.6 μmol·L-1 (p = .004), and GBA < .075 μmol·L-1 (p = .007). A prediction model for seizures in SSADHD was comprised of the additive effect of older age and lower plasma GABA, GHB, and GBA (area under the receiver operating characteristic curve of .798, p = .008).

SIGNIFICANCE

Epilepsy is highly prevalent in SSADHD, and its onset and severity correlate with an age-related decline in GABA and GABA-related metabolite levels as well as TMS markers of reduced cortical inhibition. The reduction of GABAergic activity in this otherwise hyper-GABAergic disorder demonstrates a concordance between epileptogenesis and compensatory responses. These findings may furthermore inform the timing of molecular interventions for SSADHD.

Oxidative Stress Induced by Selenium Deficiency Contributes to Inflammation, Apoptosis and Necroptosis in the Lungs of Calves

Selenium is an essential trace element for health that can only be obtained through food. However, the pathological processes of selenium deficiency in cattle have received little attention. This study investigated the effects of selenium deficiency on oxidative stress, apoptosis, inflammation, and necroptosis in the lungs of weaning calves compared with healthy calves as controls. The lung selenium content and the expression of 11 selenoproteins mRNA in selenium-deficient calves were substantially reduced compared with the controls. Pathological results showed engorged alveolar capillaries, thickened alveolar septa, and diffuse interstitial inflammation throughout the alveolar septa. The levels of GSH and T-AOC, as well as the CAT, SOD, and TrxR activities, were significantly decreased compared with healthy calves. MDA and H₂O₂ were significantly elevated. Meanwhile, the apoptosis activation in the Se-D group was validated. Next, in the Se-D group, several pro-inflammatory cytokines showed higher expression. Further research revealed that the lungs in the Se-D group experienced inflammation via hyperactive NF-κB and MAPK pathways. The high level of expression of c-FLIP, MLKL, RIPK1, and RIPK3 indicated that necroptosis also causes lung damage during selenium deficiency.

Lung T cell response in COVID-19

The COVID-19 pandemic has shown the potentially devastating impact of novel respiratory infections worldwide. Insightful data obtained in the last years have shed light on the pathophysiology of SARS-CoV-2 infection and the role of the inflammatory response in driving both the resolution of the disease and uncontrolled deleterious inflammatory status in severe cases. In this mini-review, we cover some important aspects of the role of T cells in COVID-19 with a special focus on the local response in the lung. We focus on the reported T cell phenotypes in mild, moderate, and severe COVID-19, focusing on lung inflammation and on both the protective and damaging roles of the T cell response, also highlighting the open questions in the field.

Molecular Mechanisms of RSV and Air Pollution Interaction: A Scoping Review

RSV is one of the major infectious agents in paediatrics, and its relationship with air pollution is frequently observed. However, the molecular basis of this interaction is sparsely reported. We sought to systematically review the existing body of literature and identify the knowledge gaps to answer the question: which molecular mechanisms are implied in the air pollutants-RSV interaction? Online databases were searched for original studies published before August 2022 focusing on molecular mechanisms of the interaction. The studies were charted and a narrative synthesis was based upon three expected directions of influence: a facilitated viral entry, an altered viral replication, and an inappropriate host reaction. We identified 25 studies published between 1993 and 2020 (without a noticeable increase in the number of studies) that were performed in human (n = 12), animal (n = 10) or mixed (n = 3) models, and analysed mainly cigarette smoke (n = 11), particulate matter (n = 4), nanoparticles (n = 3), and carbon black (n = 2). The data on a damage to the epithelial barrier supports the hypothesis of facilitated viral entry; one study also reported accelerated viral entry upon an RSV conjugation to particulate matter. Air pollution may result in the predominance of necrosis over apoptosis, and, as an effect, an increased viral load was reported. Similarly, air pollution mitigates epithelium function with decreased IFN-γ and Clara cell secretory protein levels and decreased immune response. Immune response might also be diminished due to a decreased viral uptake by alveolar macrophages and a suppressed function of dendritic cells. On the other hand, an exuberant inflammatory response might be triggered by air pollution and provoke airway hyperresponsiveness (AHR), prolonged lung infiltration, and tissue remodeling, including a formation of emphysema. AHR is mediated mostly by increased IFN-γ and RANTES concentrations, while the risk of emphysema was related to the activation of the IL-17 → MCP-1 → MMP-9 → MMP-12 axis. There is a significant lack of evidence on the molecular basics of the RSV-air pollution interaction, which may present a serious problem with regards to future actions against air pollution effects. The major knowledge gaps concern air pollutants (mostly the influence of cigarette smoke was investigated), the mechanisms facilitating an acute infection or a worse disease course (since it might help plan short-term, especially non-pharmacological, interventions), and the mechanisms of an inadequate response to the infection (which may lead to a prolonged course of an acute infection and long-term sequelae). Thus far, the evidence is insufficient regarding the broadness and complexity of the interaction, and future studies should focus on common mechanisms stimulated by various air pollutants and a comparison of influence of the different contaminants at various concentrations.

[Is aseptic loosening of joint prostheses aseptic?]

The observed changes in the periarticular space may be caused by both mechanical action and biological reactions. Periprosthetic infections are the most common cause of loosening and destructive changes in the joints, however, the diagnosis of an aseptic reaction is not always fully obvious. Micromovements between the implant and the surrounding bone can cause remodeling of the bone trabeculae and migration of fibroblasts into the voids between the implant surface and the bone. In addition, repetitive stresses can induce fibroblast proliferation. On the other hand, the residues arising from the wear of implanted materials in the joints may play an important role in the process of loosening of prostheses - both aseptic and septic. Direct interactions between the released molecule and the macrophage surface are sufficient to activate osteoclastogenic signaling pathways. You cannot ignore allergic reactions to metals used in prostheses in patients undergoing arthroplasty. Demonstration of hypersensitivity to the components of dentures in some cases requires the use of appropriate material in order not to cause an inflammatory allergic reaction. Emerging treatment strategies using mesenchymal stem cells (MSCs) are aimed at improving the initial implant integration and preventing periprosthetic osteolysis. It should be emphasized, however, that the diagnosis of aseptic loosening in many clinical situations raises doubts, because it is at the root of everyone.

Advances and perspective on animal models and hydrogel biomaterials for diabetic wound healing

Diabetic wounds are a common complication in diabetes patients. Due to peripheral nerve damage and vascular dysfunction, diabetic wounds are prone to progress to local ulcers, wound gangrene and even to require amputation, bringing huge psychological and economic burdens to patients. However, the current treatment methods for diabetic wounds mainly include wound accessories, negative pressure drainage, skin grafting and surgery; there is still no ideal treatment to promote diabetic wound healing at present. Appropriate animal models can simulate the physiological mechanism of diabetic wounds, providing a basis for translational research in treating diabetic wound healing. Although there are no animal models that can fully mimic the pathophysiological mechanisms of diabetic wounds in humans, it is vital to explore animal simulation models used in basic research and preclinical studies of diabetic wounds. In addition, hydrogel materials are regarded as a promising treatment for diabetic wounds because of their good antimicrobial activity, biocompatibility, biodegradation and appropriate mechanical properties. Herein, we review and discuss the different animal models used to investigate the pathological mechanisms of diabetic wounds. We further discuss the promising future application of hydrogel biomaterials in diabetic wound healing.

Cell cycle disturbances in mucopolysaccharidoses: Transcriptomic and experimental studies on cellular models

Mucopolysaccharidoses (MPS) are a group of lysosomal storage diseases caused by defects in genes coding for proteins involved in degradation of glycosaminoglycans (GAGs). These complex carbohydrates accumulate in cells causing their serious dysfunctions. Apart from the physical GAG storage, secondary and tertiary changes may contribute significantly to the pathomechanism of the disease. Among processes which were not systematically investigated in MPS cells to date there is the cell cycle. Here, we studied perturbances in this crucial cellular process in majority of MPS types. Transcriptomic analyses indicated that expression of many genes coding for proteins involved in the cell cycle is dysregulated in all tested MPS cells. Importantly, levels of transcripts of particular genes were changed in the same manner (i.e. either up- or down-regulated) in most or all types of the disease, indicating a common mechanism of the dysregulation. Flow cytometric studies demonstrated that the cell cycle is disturbed in all MPS types, with increased fractions of cells in the G₀/G₁ phase in most types and decreased fractions of cells in the G₂/M phase in all types. We found that increased levels of cyclin D1 and disturbed timing of its appearance during the cell cycle may contribute to the mechanism of dysregulation of this process in MPS. Reduction of GAG levels by either a specific enzyme or genistein-mediated inhibition of synthesis of these compounds improved, but not fully corrected, the cell cycle in MPS fibroblasts. Therefore, it is suggested that combination of the therapeutic approaches devoted to reduction of GAG levels with cyclin D1 inhibitors might be considered in further works on developing effective treatment procedures for MPS.

MoSBi: Automated signature mining for molecular stratification and subtyping

Molecular patient stratification and disease subtyping are ongoing and high-impact problems that rely on the identification of characteristic molecular signatures. Current computational methods show high sensitivity to custom parameterization, which leads to inconsistent performance on different molecular data. Our new method, MoSBi (molecular signature identification using biclustering), 1) enables so far unmatched high performance for stratification and subtyping across datasets of various different biomolecules, 2) provides a scalable solution for visualizing the results and their correspondence to clinical factors, and 3) has immediate practical relevance through its automatic workflow where individual selection, parameterization, screening, and visualization of biclustering algorithms is not required. MoSBi is a major step forward with a high impact for clinical and wet-lab researchers.

The improving access to increasing amounts of biomedical data provides completely new chances for advanced patient stratification and disease subtyping strategies. This requires computational tools that produce uniformly robust results across highly heterogeneous molecular data. Unsupervised machine learning methodologies are able to discover de novo patterns in such data. Biclustering is especially suited by simultaneously identifying sample groups and corresponding feature sets across heterogeneous omics data. The performance of available biclustering algorithms heavily depends on individual parameterization and varies with their application. Here, we developed MoSBi (molecular signature identification using biclustering), an automated multialgorithm ensemble approach that integrates results utilizing an error model-supported similarity network. We systematically evaluated the performance of 11 available and established biclustering algorithms together with MoSBi. For this, we used transcriptomics, proteomics, and metabolomics data, as well as synthetic datasets covering various data properties. Profiting from multialgorithm integration, MoSBi identified robust group and disease-specific signatures across all scenarios, overcoming single algorithm specificities. Furthermore, we developed a scalable network-based visualization of bicluster communities that supports biological hypothesis generation. MoSBi is available as an R package and web service to make automated biclustering analysis accessible for application in molecular sample stratification.

Ndufs4 knockout mouse models of Leigh syndrome: pathophysiology and intervention

Mitochondria are small cellular constituents that generate cellular energy (ATP) by oxidative phosphorylation (OXPHOS). Dysfunction of these organelles is linked to a heterogeneous group of multisystemic disorders, including diabetes, cancer, ageing-related pathologies and rare mitochondrial diseases. With respect to the latter, mutations in subunit-encoding genes and assembly factors of the first OXPHOS complex (complex I) induce isolated complex I deficiency and Leigh syndrome. This syndrome is an early-onset, often fatal, encephalopathy with a variable clinical presentation and poor prognosis due to the lack of effective intervention strategies. Mutations in the nuclear DNA-encoded NDUFS4 gene, encoding the NADH:ubiquinone oxidoreductase subunit S4 (NDUFS4) of complex I, induce 'mitochondrial complex I deficiency, nuclear type 1' (MC1DN1) and Leigh syndrome in paediatric patients. A variety of (tissue-specific) Ndufs4 knockout mouse models were developed to study the Leigh syndrome pathomechanism and intervention testing. Here, we review and discuss the role of complex I and NDUFS4 mutations in human mitochondrial disease, and review how the analysis of Ndufs4 knockout mouse models has generated new insights into the MC1ND1/Leigh syndrome pathomechanism and its therapeutic targeting.

The relationship between malignant tumors and ischemic stroke: II. Chronology of diagnoses and treatment of strokes

Összefoglaló. A malignus daganatok és a stroke együttesen gyakran fordulnak elő a stroke tradicionális rizikófaktoraival (magas vérnyomás, hyperlipidaemia, cukorbetegség, elhízás, dohányzás) rendelkező betegekben. Az elmúlt évtized kutatási eredményei alátámasztották, hogy a rosszindulatú daganatban szenvedő betegekben szignifikánsan nagyobb a stroke kockázata. A malignus daganatokhoz társuló stroke a leggyakrabban a malignus daganat diagnózisát követő fél-egy év során jelentkezik. A kapcsolat a másik irányban is létezik: stroke-betegek követése során malignus daganat szignifikánsan gyakrabban jelent meg, mint a stroke-mentes kontrollcsoportban. A daganatot a leginkább a stroke utáni első hat hónapban diagnosztizálják. A korábban nem ismert rosszindulatú daganat időnként az akut stroke kezelése során derül ki. Ismeretlen eredetű stroke (cryptogen stroke) hátterében rosszindulatú tumorhoz társuló hiperkoagulabilitás is feltételezhető. A háttérben a leggyakrabban tüdőrák áll, ezt az emlőcarcinoma és a melanoma követi. Jelenleg nincs ajánlás a felismert malignus daganatok esetében a stroke primer prevenciójára. A malignus tumor mellett jelentkező akut ischaemiás stroke kezelésére a rekombináns szöveti plazminogénaktivátorral történő intravénás thrombolysis alkalmazható a várható túlélés és a vérzésveszély mérlegelésével; a mechanikus thrombectomia alkalmazásáról kevés az adat, irányelvszintű ajánlások még nincsenek. A másodlagos stroke-prevencióra a kis molekulasúlyú heparinnal történő antikoagulálást javasolják. Jelenleg még nem ismerjük pontos részleteiben a daganat által okozott hiperkoaguláció mechanizmusát, ezért még nem ismert, hogy mi a legjobb módszer tumoros betegeknél a stroke megelőzésére. Nincsenek jól definiált ajánlások arra sem, hogy milyen esetekben lenne indokolt tumorkeresés cryptogen stroke-os betegekben. Orv Hetil. 2022; 163(2): 43-51. Summary. Cancer and stroke occur in similar patient populations, and they have similar traditional risk factors (hypertension, hyperlipidemia, obesity, diabetes, and smoking), therefore, it is beneficial to study the relationship between cancer and stroke. Patients diagnosed with cancer have an increased incidence of acute ischemic cerebral events within the first 6 months up to a year post diagnosis. The reverse relationship is also true for patients diagnosed with stroke and then cancer. Interestingly, patients may have a stroke as their first indication to an underlying developing cancer and will most often be diagnosed with cancer sometime within six months to a year after the cerebral incident. When cancer is diagnosed immediately after a cryptogenic stroke (unknown etiology), the stroke may be a result of cancer-associated hypercoagulability. The most common malignancies observed in the cancer-stroke patients are lung, breast and melanoma. Currently, there are no pharmacologic recommendations for primary stroke prevention in cancer patients. For acute ischemic stroke, life expectancy and the potential for hemorrhagic complications should be considered when deciding on thrombolytic treatment. Only a few case series have been reported on mechanical thrombectomy in malignancies, and there are no guideline recommendations yet. Secondary prevention is advised through low molecular weight heparin. Understanding cancer-associated hypercoagulability and the ways we can prevent the combined effects of cancer and stroke is a crucial gap that requires further studies. Additionally, guides to aid in the recognition of underlying malignancy in patients suffering from cryptogenic stroke need to be established. Orv Hetil. 2022; 163(2): 43-51.

[The relationship between malignant tumors and ischemic stroke: I. Thrombosis development and shared risk factors]

Összefoglaló. A malignus daganat és a stroke egy-egy betegnél gyakran kombinálódik, sokszor egyidejűleg diagnosztizálják, vagy rövid idő telik el a két kórkép felismerése között. Az együttes megjelenés hátterében elsősorban a hasonló tradicionális rizikófaktorok állhatnak: az idősebb életkor, a magas vérnyomás, a hyperlipidaemia, a cukorbetegség, az elhízás és a dohányzás. Az átfedő kockázati tényezőkön túl a daganat által okozott hiperkoaguláció artériás és vénás thrombosis kialakulásához vezethet. A hiperkoaguláció hátterének kutatása főként a thrombocyták és a szöveti faktor aktiválására és a heparanáz fokozott expressziójára fókuszált, és felvetődött a neutrophil extracelluláris csapdák szerepe is. A daganat által okozott hiperkoagulációhoz társuló cryptogen (tradicionális rizikófaktor nélküli) stroke-ban sokszor található magasabb D-dimer-szint, és a CT/MRI-képeken gyakrabban látszanak multifokális, több ér ellátási területében megjelenő ischaemiás laesiók, melyek ritkábban fordulnak elő a tradicionális rizikófaktorokkal magyarázható stroke-okban. Az előzőkön kívül a daganatok kezelésére alkalmazott kemoterápia és sugárterápia is emeli a stroke kockázatát. A malignus daganatokhoz társuló stroke-ok megelőzése érdekében további vizsgálatok szükségesek a daganat által okozott hiperkoaguláció és vascularis változások pontosabb megértéséhez. Orv Hetil. 2022; 163(1): 3-11. Summary. Cancer and stroke have long been studied individually, but their detrimental forces together have also been a strong point of focus. The occurrence of both cancer and stroke in a patient is often a reflection of their similar risk factors (hypertension, hyperlipidemia, diabetes, obesity, and smoking), however, a subgroup of the cancer stroke population is believed to occur due to cancer-associated hypercoagulability. A deeper look into the cancer-associated hypercoagulable environment has indicated that thrombosis may be explained by cancer's role in several factors, including activation of platelets and tissue factor, elevated expression of heparanase and influence on neutrophilic extracellular traps. When a cryptogenic stroke (stroke lacking the aforementioned risk factors) occurs due to the cancer-induced hypercoagulation state, patient serum D-dimer levels have been found elevated, and CT/MRI images of the brain have shown multivascular infarctions compared to stroke patients with traditional risk factors. Additionally, cancer treatment - chemotherapy and radiation - have also been found to increase the occurrence of cerebral vascular thrombosis. Further investigations are required to better understand cancer-associated vascular pathophysiologic changes and how to discern their unique strokes compared to strokes from other etiologies. With these insights, the prevalence of strokes in the cancer population could be decreased. Orv Hetil. 2022; 163(1): 3-11.

Atrial Failure: What Do We Know About It?

Heart failure is the end of all pathological conditions in the heart. Most accepted paradigms in heart failure are always preceded by left ventricle disfunction. Currently, there are several clinical studies that show that heart failure may occur without prior left ventricular dysfunction. Left atrial dysfunction may play a more important role in heart failure than previously expected. Failure of the left atrium can exist independently of left ventricle dysfunction and mitral valve abnormalities. Atrial failure, just like left ventricular failure, can lead to global heart failure. Etiology, pathomechanism and clinical symptoms of atrial failure are complex and not well understood. This review will explain atrial failure.

Exploring the Diverse Immune and Genetic Landscape of Psoriatic Arthritis

Psoriatic arthritis (PsA) is characterized by delays in diagnosis and modest effect of treatment in terms of joint response. An understanding of molecular pathomechanisms may aid in developing diagnostic and prognostic models. Genetic susceptibility (e.g., HLA class I genes, IL-23-related genes) can be responsible for the pattern of psoriatic manifestations and affinity for tissue involvement. Gene expression analysis indicates an inflammatory profile that is distinct for PsA, but disparate across tissues. This has clinical implications, as for example, dual blockade of IL-17A and IL-17F can lead to superior clinical effects if there is differential expression of IL-17 receptors in tissues. Structural and functional impairment of barrier tissue, including host-microbiome interactions, may be the source of immune activation. Interplay between different cell populations of innate and adaptive immunity is emerging, potentially providing a link between the transition of skin-to-joint disease. Th17 subsets, IL-17A, IL-17F and IL-23 are crucial in PsA pathogenesis, with both clinical and experimental evidence suggesting a differential molecular landscape in cutaneous and articular compartments.

Pathogeneses and Imaging Features of Cerebral White Matter Lesions of Vascular Origins

White matter lesion (WML), also known as white matter hyperintensities or leukoaraiosis, was first termed in 1986 to describe the hyperintense signals on T2-weighted imaging (T2WI) and fluid-attenuated inversion recovery (FLAIR) maps. Over the past decades, a growing body of pathophysiological findings regarding WMLs have been discovered and discussed. Currently, the generally accepted WML pathogeneses mainly include hypoxia-ischemia, endothelial dysfunction, blood-brain barrier disruption, and infiltration of inflammatory mediators or cytokines. However, none of them can explain the whole dynamics of WML formation. Herein, we primarily focus on the pathogeneses and neuroimaging features of vascular WMLs. To achieve this goal, we searched papers with any type published in PubMed from 1950 to 2020 and cross-referenced the keywords including “leukoencephalopathy”, “leukoaraiosis”, “white matter hyperintensity”, “white matter lesion”, “pathogenesis”, “pathology”, “pathophysiology”, and “neuroimaging”. Moreover, references of the selected articles were browsed and searched for additional pertinent articles. We believe this work will supply the robust references for clinicians to further understand the different WML patterns of varying vascular etiologies and thus make customized treatment.

The Pathophysiology and Treatment of Essential Tremor: The Role of Adenosine and Dopamine Receptors in Animal Models

Essential tremor (ET) is one of the most common neurological disorders that often affects people in the prime of their lives, leading to a significant reduction in their quality of life, gradually making them unable to independently perform the simplest activities. Here we show that current ET pharmacotherapy often does not sufficiently alleviate disease symptoms and is completely ineffective in more than 30% of patients. At present, deep brain stimulation of the motor thalamus is the most effective ET treatment. However, like any brain surgery, it can cause many undesirable side effects; thus, it is only performed in patients with an advanced disease who are not responsive to drugs. Therefore, it seems extremely important to look for new strategies for treating ET. The purpose of this review is to summarize the current knowledge on the pathomechanism of ET based on studies in animal models of the disease, as well as to present and discuss the results of research available to date on various substances affecting dopamine (mainly D3) or adenosine A1 receptors, which, due to their ability to modulate harmaline-induced tremor, may provide the basis for the development of new potential therapies for ET in the future.

Ndufs4 knockout mouse models of Leigh syndrome: pathophysiology and intervention

Mitochondria are small cellular constituents that generate cellular energy (ATP) by oxidative phosphorylation (OXPHOS). Dysfunction of these organelles is linked to a heterogeneous group of multisystemic disorders, including diabetes, cancer, ageing-related pathologies and rare mitochondrial diseases. With respect to the latter, mutations in subunit-encoding genes and assembly factors of the first OXPHOS complex (complex I) induce isolated complex I deficiency and Leigh syndrome. This syndrome is an early-onset, often fatal, encephalopathy with a variable clinical presentation and poor prognosis due to the lack of effective intervention strategies. Mutations in the nuclear DNA-encoded NDUFS4 gene, encoding the NADH:ubiquinone oxidoreductase subunit S4 (NDUFS4) of complex I, induce ‘mitochondrial complex I deficiency, nuclear type 1’ (MC1DN1) and Leigh syndrome in paediatric patients. A variety of (tissue-specific) Ndufs4 knockout mouse models were developed to study the Leigh syndrome pathomechanism and intervention testing.

Here, we review and discuss the role of complex I and NDUFS4 mutations in human mitochondrial disease, and review how the analysis of Ndufs4 knockout mouse models has generated new insights into the MC1ND1/Leigh syndrome pathomechanism and its therapeutic targeting.

Priming, Triggering, Adaptation and Senescence (PTAS): A Hypothesis for a Common Damage Mechanism of Steatohepatitis

Understanding the pathomechanism of steatohepatitis (SH) is hampered by the difficulty of distinguishing between causes and consequences, by the broad spectrum of aetiologies that can produce the phenotype, and by the long time-span during which SH develops, often without clinical symptoms. We propose that SH develops in four phases with transitions: (i) priming lowers stress defence; (ii) triggering leads to acute damage; (iii) adaptation, possibly associated with cellular senescence, mitigates tissue damage, leads to the phenotype, and preserves liver function at a lower level; (iv) finally, senescence prevents neoplastic transformation but favours fibrosis (cirrhosis) and inflammation and further reduction in liver function. Escape from senescence eventually leads to hepatocellular carcinoma. This hypothesis for a pathomechanism of SH is supported by clinical and experimental observations. It allows organizing the various findings to uncover remaining gaps in our knowledge and, finally, to provide possible diagnostic and intervention strategies for each stage of SH development.

Altered stress granule disassembly: links to neurodegenerative disease?

A recent study by Gwon et al. identified context-specific ubiquitination of G3BP1 as critical for stress granule disassembly via VCP and the adaptor FAF2. This study provides new insights into stress granule dynamics, with potential implications for neurodegenerative disease.

Can rodent models elucidate the pathomechanisms of genetic epilepsy?

Autosomal dominant sleep-related hypermotor epilepsy (ADSHE; previously autosomal dominant nocturnal frontal lobe epilepsy, ADNFLE), originally reported in 1994, was the first distinct genetic epilepsy shown to be caused by CHNRA4 mutation. In the past two decades, we have identified several functional abnormalities of mutant ion channels and their associated transmissions using several experiments involving single-cell and genetic animal (rodent) models. Currently, epileptologists understand that functional abnormalities underlying epileptogenesis/ictogenesis in humans and rodents are more complicated than previously believed and that the function of mutant molecules alone cannot contribute to the development of epileptogenesis/ictogenesis but play important roles in the development of epileptogenesis/ictogenesis through formation of abnormalities in various other transmission systems before epilepsy onset. Based on our recent findings using genetic rat ADSHE models, harbouring Chrna4 mutant, corresponding to human S284L-mutant CRHNA4, this review proposes a hypothesis associated with tripartite synaptic transmission in ADSHE pathomechanisms induced by mutant ACh receptors.

Current Perspective Regarding the Immunopathogenesis of Drug-Induced Hypersensitivity Syndrome/Drug Reaction with Eosinophilia and Systemic Symptoms (DIHS/DRESS)

Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS) is a severe type of adverse drug eruption associated with multiorgan involvement and the reactivation of human herpesvirus 6, which arises after prolonged exposure to certain drugs. Typically, two waves of disease activity occur during the course of DIHS/DRESS; however, some patients experience multiple waves of exacerbation and remission of the disease. Severe complications, some of which are related to cytomegalovirus reactivation, can be fatal. DIHS/DRESS is distinct from other drug reactions, as it involves herpes virus reactivation and can lead to the subsequent development of autoimmune diseases. The association between herpesviruses and DIHS/DRESS is now well established, and DIHS/DRESS is considered to arise as a result of complex interactions between several herpesviruses and comprehensive immune responses, including drug-specific immune responses and antiviral immune responses, each of which may be mediated by distinct types of immune cells. It appears that both CD4 and CD8 T cells are involved in the pathogenesis of DIHS/DRESS but play distinct roles. CD4 T cells mainly initiate drug allergies in response to drug antigens, and then herpesvirus-specific CD8 T cells that target virus-infected cells emerge, resulting in tissue damage. Regulatory T-cell dynamics are also suggested to contribute to the diverse symptoms of DIHS/DRESS. However, the pathomechanisms of this complex disease remain largely unknown. In particular, how viral infections contribute to the pathogenesis of DIHS/DRESS and why autoimmune sequelae arise in DIHS/DRESS are yet to be elucidated. This review describes the clinical features of DIHS/DRESS, including the associated complications and sequelae, and discusses recent advances in our understanding of the immunopathogenic mechanisms of DIHS/DRESS.

Pyrethroids: How They Affect Human and Animal Health?

Pyrethroids are pesticides commonly used in crop protection; in the forestry, wood, and textile industries; as well as in medicine and veterinary medicine to treat parasitic crustacean infestations. They have been found to be relatively safe for humans and animals. Pyrethroids are recommended for personal protection against malaria and virus Zika by the World Health Organization. Pyrethroids act on voltage-gated sodium channels, which cause an influx of sodium ions into the nerve cells and permanent depolarization. They also influence activities of enzymes, especially in nerve and liver cells. Contact of pyrethroids with the skin, digestive tract, and respiratory tract results in their penetration into the body. Due to the importance of the subject, a summary of the current state of knowledge on the toxic effects of pyrethroids was presented in the comprehensive review by Chrustek et al, published in journal Medicina. Particular attention was paid to nephrotoxic, hepatotoxic, cardiotoxic, immunotoxic, neurotoxic, and behavioral effects of pyrethroids on human and animal bodies. It could be added that pyrethroids generate oxidative stress, which modifies DNA, RNA, protein, lipid and carbohydrate molecules. However, public awareness of the possible negative effects of the use of insecticides is still low. Further research should be carried out to clarify the molecular basis of the pathomechanism of pyrethroid detrimental action. Proper dissemination of the results seems to be of first importance for public health.

Cellular Stress in the Pathogenesis of Muscular Disorders-From Cause to Consequence

Cellular stress has been considered a relevant pathogenetic factor in a variety of human diseases. Due to its primary functions by means of contractility, metabolism, and protein synthesis, the muscle cell is faced with continuous changes of cellular homeostasis that require rapid and coordinated adaptive mechanisms. Hence, a prone susceptibility to cellular stress in muscle is immanent. However, studies focusing on the cellular stress response in muscular disorders are limited. While in recent years there have been emerging indications regarding a relevant role of cellular stress in the pathophysiology of several muscular disorders, the underlying mechanisms are to a great extent incompletely understood. This review aimed to summarize the available evidence regarding a deregulation of the cellular stress response in individual muscle diseases. Potential mechanisms, as well as involved pathways are critically discussed, and respective disease models are addressed. Furthermore, relevant therapeutic approaches that aim to abrogate defects of cellular stress response in muscular disorders are outlined.

Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm

Hidradenitis suppurativa is one of the most distressing dermatological conditions and has a significant negative impact on patients' quality of life. However, the exact pathogenic mechanisms remain incompletely understood and-therefore-efficient therapies are still lacking. The current manuscript focuses on new findings on its pathogenic mechanisms and aims to provide practical therapy recommendations.

Mutation-Dependent Pathomechanisms Determine the Phenotype in the Bestrophinopathies

Best vitelliform macular dystrophy (BD), autosomal dominant vitreoretinochoroidopathy (ADVIRC), and the autosomal recessive bestrophinopathy (ARB), together known as the bestrophinopathies, are caused by mutations in the bestrophin-1 (BEST1) gene affecting anion transport through the plasma membrane of the retinal pigment epithelium (RPE). To date, while no treatment exists a better understanding of BEST1-related pathogenesis may help to define therapeutic targets. Here, we systematically characterize functional consequences of mutant BEST1 in thirteen RPE patient cell lines differentiated from human induced pluripotent stem cells (hiPSCs). Both BD and ARB hiPSC-RPEs display a strong reduction of BEST1-mediated anion transport function compared to control, while ADVIRC mutations trigger an increased anion permeability suggesting a stabilized open state condition of channel gating. Furthermore, BD and ARB hiPSC-RPEs differ by the degree of mutant protein turnover and by the site of subcellular protein quality control with adverse effects on lysosomal pH only in the BD-related cell lines. The latter finding is consistent with an altered processing of catalytic enzymes in the lysosomes. The present study provides a deeper insight into distinct molecular mechanisms of the three bestrophinopathies facilitating functional categorization of the more than 300 known BEST1 mutations that result into the distinct retinal phenotypes.

Neuromuscular Diseases Due to Chaperone Mutations: A Review and Some New Results

Skeletal muscle and the nervous system depend on efficient protein quality control, and they express chaperones and cochaperones at high levels to maintain protein homeostasis. Mutations in many of these proteins cause neuromuscular diseases, myopathies, and hereditary motor and sensorimotor neuropathies. In this review, we cover mutations in DNAJB6, DNAJB2, αB-crystallin (CRYAB, HSPB5), HSPB1, HSPB3, HSPB8, and BAG3, and discuss the molecular mechanisms by which they cause neuromuscular disease. In addition, previously unpublished results are presented, showing downstream effects of BAG3 p.P209L on DNAJB6 turnover and localization.

Are Migraine With and Without Aura Really Different Entities?

Background: Migraine research is booming with the rapidly developing neuroimaging tools. Structural and functional alterations of the migrainous brain were detected with MRI. The outcome of a research study largely depends on the working hypothesis, on the chosen measurement approach and also on the subject selection. Against all evidence from the literature that migraine subtypes are different, most of the studies handle migraine with and without aura as one disease. Methods: Publications from PubMed database were searched for terms of "migraine with aura," "migraine without aura," "interictal," "MRI," "diffusion weighted MRI," "functional MRI," "compared to," "atrophy" alone and in combination. Conclusion: Only a few imaging studies compared the two subforms of the disease, migraine with aura, and without aura, directly. Functional imaging investigations largely agree that there is an increased activity/activation of the brain in migraine with aura as compared to migraine without aura. We propose that this might be the signature of cortical hyperexcitability. However, structural investigations are not equivocal. We propose that variable contribution of parallel, competing mechanisms of maladaptive plasticity and neurodegeneration might be the reason behind the variable results.

[Pathogenetic conditions of treatment of infections caused by antibiotic-resistant strains Klebsiella pneumoniae]

Klebsiella pneumoniae belongs to the Enterobacteriaceae family and is responsible for 70% of human infections. From 20 to 80% strains of Klebsiella pneumoniae reveal resistance to first line antibiotics, including cephalosporins, fluoroquinolones and aminoglycosides, as well as carbapenems. Due to the resistance found in MDR (multidrug resistant) Klebsiella pneumoniae is classified according to the sequence types (ST), which are defined on the basis of the nucleotide sequence in the 7 loci (mdh, infB, tonB, gapA, phoE, pgi, and rpoB). Klebsiella pneumoniae uses several methods to protect against the effects of the human immune system. It affects receptors that recognize patterns expressed on epithelial cells and the immune system that are responsible for initiating signal cascades and phagocytic influences, including Toll-like receptors (TLRs) 2 and 4. Activates interleukins (IL) 12 (IL-12) and IL-23p40 by natural stimulation and leads to a decrease in the level of activation of interferon gamma (IFN-γ), IL-17, tumor necrosis factor (TNF-α) and IL-1β, resulting in neutrophil and macrophage inflow and induction of humoral and cellular responses. Capsular polysaccharides and other components of the bacterial cell membrane protect it from the natural mechanisms of resistance, making it resistant to beta-defensins against bacteria. Increased virulence of Klebsiella pneumoniae is related to the protein structure associated with the capsule, especially in strains with increased virulence (HV - hypervirulent), lipopolysaccharides (LPS), siderophores and cilia (fimbriae). Today, two main types of Klebsiella pneumoniae strains are distinguished depending on the mechanism of resistance to antibiotics: strains that express beta-lactamases with extended spectrum (ESBL - extended spectrum beta-lactamases) that are resistant to cephalosporins and monobactams and strains that reveal the expression of carbapenemases, which they show resistance to available beta-lactams, including carbapenes. Polymyxins are useful in the treatment of patients infected with Klebsiella pneumoniae NDM (New Delhi metallo-beta-lactamase), where the effectiveness of therapy is greater when colistin is used together with carbapenem or rifampicin or tigecycline. The introduced abivactam in combination with ceftazidime is a promising therapeutic combination in severe infections. Similar clinical assessments were obtained with sulbactam, especially in combination with meropenem and colistin.

Depressive Symptoms After PCB Exposure: Hypotheses for Underlying Pathomechanisms via the Thyroid and Dopamine System

Polychlorinated biphenyls’ (PCB) exposure has been reported to be associated with depressive symptoms, which is correlated to lower dopamine- (DA) and thyroxine-concentrations (T4). T4 is necessary for DA-synthesis and it binds to transthyretin (TTR) being transported into the brain. PCBs can displace T4 by binding to TTR itself, being transported into the brain and disturbing DA-synthesis, where depressive symptoms might occur. Consequently, the free T4-concentration (fT4) increases when PCBs bind to TTR. The interaction of PCBs with fT4 and its associations with the main DA metabolite, homovanillic acid (HVA), and depressive symptoms were investigated. In total, 116 participants (91.6% men) were investigated, who took part in three annual examinations (t1–t3) of the HELPcB health surveillance program. Blood was collected for measuring PCBs, hydroxy PCBs (OH-PCBs), and fT4 and urine for HVA. Depressive Symptoms were assessed with a standardized questionnaire. Interactions were tested cross-sectionally with multiple hierarchical regressions and longitudinally with mixed effect models. Related to HVA, an interaction was cross-sectionally found for lower-chlorinated PCBs (LPCBs) and dioxin-like PCBs (dlPCBs); longitudinally only for LPCBs. Related to depressive symptoms, the interaction was found for LPCBs, dlPCBs, and OH-PCBs; longitudinally again only for LPCBs. The results give first hints that a physiological process involving the thyroid and DA system is responsible for depressive symptoms after PCB exposure.

Modeling the Long-Term Consequences of Repeated Blast-Induced Mild Traumatic Brain Injuries

Repeated mild traumatic brain injury (rmTBI) caused by playing collision sports or by exposure to blasts during military operations can lead to late onset, chronic diseases such as chronic traumatic encephalopathy (CTE), a progressive neurodegenerative condition that manifests in increasingly severe neuropsychiatric abnormalities years after the last injury. Currently, because of the heterogeneity of the clinical presentation, confirmation of a CTE diagnosis requires post-mortem examination of the brain. The hallmarks of CTE are abnormal accumulation of phosphorylated tau protein, TDP-43 immunoreactive neuronal cytoplasmic inclusions, and astroglial abnormalities, but the pathomechanism leading to these terminal findings remains unknown. Animal modeling can play an important role in the identification of CTE pathomechanisms, the development of early stage diagnostic and prognostic biomarkers, and pharmacological interventions. Modeling the long-term consequences of blast rmTBI in animals is especially challenging because of the complexities of blast physics and animal-to-human scaling issues. This review summarizes current knowledge about the pathobiologies of CTE and rmbTBI and discusses problems as well as potential solutions related to high-fidelity modeling of rmbTBI and determining its long-term consequences.

[Pathomechanisms of podocyte injury in diabetic nephropathy and interventional effects of Chinese herbal medicine]

Podocyte injury is closely related to proteinuria in the progress of diabetic nephropathy(DN). The pathological characters of podocyte injury mainly refer to the change of podocyte form and function, including foot process effacement, reduction of podocyte number and density, podocyte apoptosis, podocyte epithelial-mesenchymal transdifferentiation(EMT)and podocyte hypertrophy. These pathological damages are controlled by multiple signaling pathways in the kidney, such as mammalian target of rapamycin(mTOR)/autophagy pathway, transforming growth factor(TGF)-β1 pathway and Notch pathway. For podocyte injuries induced by high glucose or in murine models of DN, some Chinese herbal medicine(CHM)extracts, such as multiglycoside of Tripterygium wilfordii(GTW), triptolide(TP), astragaloside IV(AS-IV), astragalus polysaccharide(APS)and Panax notoginseng saponins(PNS), have the protective effects in vivo or in vitro. The preliminary studies in China showed that GTW improves podocyte injury in the DN model rats probably through regulating the activity of mTORC1 signaling pathway in the kidney. Therefore, it is the developmental direction for the further study to clarify the interventional effects of CHM based on podocyte injury-related signaling pathway in DN.

Diet-Induced Hyperinsulinemia as a Key Factor in the Etiology of Both Benign Prostatic Hyperplasia and Essential Hypertension?

Benign prostatic hyperplasia and hypertension are common age-related comorbidities. Although the etiology of benign prostatic hyperplasia (BPH) is still largely unresolved and poorly understood, a significant age-independent association was found between BPH and hypertension, indicating a common pathophysiological factor for both diseases. It has previously been suggested that the development of essential hypertension may be related to diet-induced hyperinsulinemia. This study follows the question, whether BPH may develop due to the same mechanism, thereby explaining the well-known comorbidity of these 2 disorders. The scientific evidence presented shows that BPH and hypertension share the same pathophysiological changes, with hyperinsulinemia as the driving force. It further shows that significant dietary changes during human history cause disruption of a finely tuned metabolic balance that has evolved over millions of years of evolution: high-insulinemic food, typical of current “Western” diets, has the potential to cause hyperinsulinemia and insulin resistance, as well as an abnormally increased activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, alterations that play a pivotal role in the pathogenesis of BPH and hypertension.

[Non-alcoholic fatty liver disease, as a component of the metabolic syndrome, and its causal correlations with other extrahepatic diseases]

Non-alcoholic fatty liver disease is the most common non-infectious chronic liver-disease in our age, and is a spectrum of all the diseases associated with increased fat accumulation in the hepatocytes. Its development is promoted by sedentary life-style, over-feeding, and certain genetic predisposition. Prevalence in the adult population, even in Hungary is ~30%. In a part of cases, this disease may pass into non-alcoholic steatohepatitis, later into fibrosis, rarely into primary hepatocellular cancer. Fatty liver is closely and bidirectionally related to the metabolic syndrome and type 2 diabetes, and nowadays there is a general consensus that fatty liver is the hepatic manifestation of the metabolic sycndrome. The importance of the fatty liver has been highly emphasized recently. In addition to the progression into steatohepatitis, its causal relationship with numerous extrahepatic disorders has been discovered. In our overview, we deal with the epidemiology, pathomechanism of the disease, discuss the possibilities of diagnosis, its relationship with the intestinal microbiota, its recently recognized correlations with bile acids and their receptors, and its supposed correlations with the circadian CLOCK system. Hereinafter, we overview those extrahepatic disorders, which have been shown to be causal link with the non-alcoholic fatty liver disease. Among these, we emphasize the metabolic syndrome/type 2 diabetes, cardiovascular disorders, chronic kidney disease, sleep apnea/hypoventilation syndrome, inflammatory bowel disease, Alzheimer's disease, osteoporosis, and psoriasis, as well. Based on the above, it can be stated, that high risk individuals with non-alcoholic fatty liver disease need systemic care, and require the detection of other components of this systemic pathological condition. While currently specific therapy for the disease is not yet known, life-style changes, adequate use of available medicines can prevent disease progression. Promising research is under way, including drugs, manipulation of the intestinal flora or the possibility of therapeutic use of bile acid receptors, and also bariatric surgery. Orv Hetil. 2017; 158(52): 2051-2061.

Models in the Research Process of Psoriasis

Psoriasis is an ancient, universal chronic skin disease with a significant geographical variability, with the lowest incidence rate at the equator, increasing towards the poles. Insights into the mechanisms responsible for psoriasis have generated an increasing number of druggable targets and molecular drugs. The development of relevant in vitro and in vivo models of psoriasis is now a priority and an important step towards its cure. In this review, we summarize the current cellular and animal systems suited to the study of psoriasis. We discuss the strengths and limitations of the various models and the lessons learned. We conclude that, so far, there is no one model that can meet all of the research needs. Therefore, the choice model system will depend on the questions being addressed.

Topical E6005/RVT-501, a novel phosphodiesterase 4 inhibitor, for the treatment of atopic dermatitis

INTRODUCTION

Local adverse effects of steroid use and the burning sensation of calcineurin inhibitors impair patients' adherence to treatment and decrease the treatment response in atopic dermatitis (AD). Steroid phobia appears to be a psychological problem in patients with AD. Topical non-steroidal remedies are in demand. Areas covered: This manuscript reviews the current literature on preclinical and clinical studies regarding topical E6005/RVT-501, a novel phosphodiesterase 4 inhibitor. We also discuss the mechanistic background of E6005/RVT-501 in the treatment of AD. Expert opinion: Topical E6005/RVT-501 improves skin eruption and pruritus of pediatric and adult AD patients without any serious side effects. It is useful for mild to moderate lesions of AD in pediatric and adult patients. Topical E6005/RVT-501 is non-steroidal agent but its potency is equal to that of mild rank topical steroid, therefore, it may fit the demand of patients with steroid phobia. Its steroid-sparing effects may also be investigated in future clinical trials and may minimize the dose and frequency of topical steroids.

Kynurenines and PACAP in Migraine: Medicinal Chemistry and Pathogenetic Aspects

BACKGROUND

Migraine is a highly disabling neurovascular primary headache disorder, with its exact pathomechanism being still unrevealed. The current leading hypotheses are based on the sensitization and activation of the trigeminovascular system.

OBJECTIVE

To review the literature with focus on the effects of kynurenines (L-kynurenine and kynurenic acid) and pituitary adenylate cyclase-activating polypeptide on the regulation of the trigeminovascular system.

METHOD

A literature search was conducted to identify preclinical and clinical publications (198 references) by using the keywords 'kynurenines', 'pituitary adenylate cyclase-activating polypeptide', and 'migraine' in the database of MEDLINE/PubMed up to 10 September 2016 for topical review. Additional filters used included 'review', 'systematic review', 'original article', and 'English language'.

RESULTS

L-kynurenine and kynurenic acid act on the glutamatergic system at the level of the second-order nociceptive neurons in the trigeminal nucleus caudalis. Pituitary adenylate cyclase- activating polypeptide is released from the peripheral nerve endings of the trigeminal pseudounipolar neurons and causes vasodilation and mast cell degranulation, leading to consequent peripheral sensitization of the dural nociceptors. Centrally released pituitary adenylate cyclase-activating polypeptide in the trigeminal nucleus caudalis results in the central sensitization of the second-order neurons. The sensitization process leads to the characteristic features of migraine.

CONCLUSION

L-kynurenine, kynurenic acid, and pituitary adenylate cyclase-activating polypeptide may have fundamental roles in the initiation of migraine headache attacks.

[Pathomechanism and treatment of gut microbiota dysbiosis in chronic kidney disease and interventional effects of Chinese herbal medicine]

The gut microbiota dysbiosis is one of the risk factors in the progression from the advanced chronic kidney disease（CKD）to uremia, characterized by the reduction of probiotics and the increase of opportunistic pathogens including urease-related microbes, endotoxin-related microbes and toxin-related microbes, which can produce uremic toxins. According to the core point of "the gut-kidney axis" theory and "the chronic kidney disease-colonic axis" concept, the gut microbiota dysbiosis aggravates renal damage by accumulating uremic toxins and inducing the systemic micro-inflammation. The preliminary clinical trials and animal experiments show that the probiotics biologicals from Lactobacillus acidophilus or Bifidobacterium, and the prebiotics including inulin and galactooligosaccharides, as well as lubiprostone and activated carbon adsorbents can be used for improving dysfunction of CKD patients with the gut microbiota dysbiosis via reducing uremic toxins and inhibiting the systemic micro-inflammation. But not only that, it is reported that, to some extent, a number of the single Chinese herbal medicine（CHM）, the CHM prescriptions and the CHM extracts（emodin, etc.）with oral or enema administration can also regulate the gut microbiota dysbiosis, protect the intestinal epithelial barrier, reduce uremic toxins accumulation and delay CKD progression. Thereinto, Dahuang Gancao Decoction（the concentrated granule TJ-84）, a classical CHM prescription of rhubarb, can ameliorate uremic toxins accumulation in the animal models with renal failure probably through targeting the gut-kidney axis triggered from gut microbiota, but not targeting the kidney. Based on these results, the interventional studies targeting the gut microbiota-related pathological factors such as tight junction proteins, helper T cells and regulatory T cells in the intestinal tract of the advanced CKD patients will become one of the key development directions in the future.

Pemphigus, a pathomechanism of acantholysis

Autoantibodies to the desmosomal proteins desmoglein 1 and 3 cause pemphigus foliaceus and pemphigus vulgaris, which are characterised by keratinocyte dissociation (acantholysis) and intraepidermal blister formation. The passive transfer of pathogenic anti-desmoglein antibodies induces blisters in mice in vivo and the loss of keratinocyte adhesion in vitro. The pathogenetic mechanisms of acantholysis due to anti-desmoglein autoantibodies are not fully understood. However, recent studies have revealed that signalling-dependent and signalling-independent pathways are operative in the loss of cell adhesion. In this review, we focus on the pathomechanism of acantholysis due to autoantibodies to desmogleins and recent therapeutic approaches.

Treatment of Chronic Migraine with OnabotulinumtoxinA: Mode of Action, Efficacy and Safety

Background: Chronic migraine is a common, highly disabling, underdiagnosed and undertreated entity of migraine. It affects 0.9%–2.2% of the general adult population. The present paper overviews the preclinical and clinical data regarding the therapeutic effect of onabotulinumtoxinA in chronic migraineurs. Methods: A literature search was conducted in the database of PubMed up to 20 May 2015 for articles related to the pathomechanism of chronic migraine, the mode of action, and the efficacy, safety and tolerability of onabotulinumtoxinA for the preventive treatment of chronic migraine. Results: The pathomechanism of chronic migraine has not been fully elucidated. The mode of action of onabotulinumtoxinA in the treatment of chronic migraine is suggested to be related to the inhibition of the release of calcitonin gene-related peptide and substance P in the trigeminovascular system. Randomized clinical trials demonstrated that long-term onabotulinumtoxinA fixed-site and fixed-dose (155–195 U) intramuscular injection therapy was effective and well tolerated for the prophylactic treatment of chronic migraine. Conclusions: Chronic migraine is a highly devastating entity of migraine. Its exact pathomechanism is unrevealed. Two-third of chronic migraineurs do not receive proper preventive medication. Recent clinical studies revealed that onabotulinumtoxinA was an efficacious and safe treatment for chronic migraine.

Analysis of skin patch test results and metalloproteinase-2 levels in a patient with contact dermatitis

Introduction

The complex course of skin reactions that contact eczema involves is due in part to abnormalities of the extracellular matrix function. Proteins that degrade extracellular matrix components include metalloproteinases (MMP), which are divided into subcategories depending on the chemical structure and substrate specificity.

Aim

To analyse patch test results in contact dermatitis patients and to assess MMP-2 levels during skin lesion exacerbation and remission.

Material and methods

Fifty patients suffering from contact eczema were qualified to the study and 20 healthy volunteers as a control group. The study group patients had epidermal skin tests performed with the “European Standard” set. To assess the MMP-2 level in serum, venous blood was drawn, twice from study group patients – during contact dermatitis exacerbation and remission periods – and once from control group patients. Assessment of MMP-2 in serum was done with ELISA immunoassay. To verify the proposed hypotheses, parametric and nonparametric significance tests were used.

Results

Hands were the most frequent location of contact dermatitis. Nickel (II) sulphate was the most frequent sensitizing substance. Mean MMP-2 levels were statistically higher in the study group both in contact dermatitis exacerbation and remission periods than in the control group. There was no statistically significant difference between MMP-2 levels and skin patch test results.

Conclusions

Nickel is one of the most allergenic contact allergens in patients with contact dermatitis. Metalloproteinase-2 is a good marker of contact dermatitis in various stages of the disease.

New insights on the pathomechanisms of inflammatory bowel disease

Pathogenesis of inflammatory bowel disease (IBD) remains an enigma on whether germs, genes or a combination of these two with excessive immune responses to gut-associated bacteria explicates its pathomechanisms. The incidence of IBD is 0.76747 per 100,000 in Central Indonesia, as shown in the Project Indonesian IBD ACCESS 2012 progress report. This result, together with other epidemiological studies in Asia, may conclusively reflect increased rates of the disease, while its pathogenesis still undoubtedly obscured. However, knowledge of the pathophysiology of IBD is rapidly growing, abreast with new developments. A series of recent updates in core pathomechanisms such as bacterial, endoplasmic reticulum stress, new immune cell populations, T-cell differentiation and function, mucosal immune defenses and oxidative stress are relevant pathomechanism keypoints in IBD.

New insights on the pathomechanisms of inflammatory bowel disease

Pathogenesis of inflammatory bowel disease (IBD) remains an enigma on whether germs, genes or a combination of these two with excessive immune responses to gut-associated bacteria explicates its pathomechanisms. The incidence of IBD is 0.76747 per 100,000 in Central Indonesia, as shown in the Project Indonesian IBD ACCESS 2012 progress report. This result, together with other epidemiological studies in Asia, may conclusively reflect increased rates of the disease, while its pathogenesis still undoubtedly obscured. However, knowledge of the pathophysiology of IBD is rapidly growing, abreast with new developments. A series of recent updates in core pathomechanisms such as bacterial, endoplasmic reticulum stress, new immune cell populations, T-cell differentiation and function, mucosal immune defenses and oxidative stress are relevant pathomechanism keypoints in IBD.

Sacroiliac joint pain as an important element of psoriatic arthritis diagnosis

Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by the coexistence of arthritis with psoriasis of the skin and nails. The sacroiliac joints were observed in 34-78% of patients with psoriatic arthritis. Due to such a high prevalence of SIJ dysfunction, understanding pathophysiology of pain and the associated pain pattern becomes a very important aspect of PsA diagnosis. As far as the etiology of SI joint dysfunction is concerned, it has not been disambiguated yet. Among the main causative factors, injuries and strains of the structures surrounding the joint are noted. Joint pathology usually manifests itself by pain occurring within the area of the joint. The causes of pain may be divided into two categories: intra-articular and extra-articular. Pain caused by the SI joint may be nociceptive or neural in nature, whereas the pain pattern characteristic of the joint correlates with its innervation and is consistent with S2 dorsal rami.