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Winkler JK, Kommoss KS, Toberer F, Enk A, Maul LV, Navarini AA, Hudson J, Salerni G, Rosenberger A, Haenssle HA. Performance of an automated total body mapping algorithm to detect melanocytic lesions of clinical relevance. Eur J Cancer 2024; 202:114026. [PMID: 38547776 DOI: 10.1016/j.ejca.2024.114026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/21/2024]
Abstract
IMPORTANCE Total body photography for skin cancer screening is a well-established tool allowing documentation and follow-up of the entire skin surface. Artificial intelligence-based systems are increasingly applied for automated lesion detection and diagnosis. DESIGN AND PATIENTS In this prospective observational international multicentre study experienced dermatologists performed skin cancer screenings and identified clinically relevant melanocytic lesions (CRML, requiring biopsy or observation). Additionally, patients received 2D automated total body mapping (ATBM) with automated lesion detection (ATBM master, Fotofinder Systems GmbH). Primary endpoint was the percentage of CRML detected by the bodyscan software. Secondary endpoints included the percentage of correctly identified "new" and "changed" lesions during follow-up examinations. RESULTS At baseline, dermatologists identified 1075 CRML in 236 patients and 999 CRML (92.9%) were also detected by the automated software. During follow-up examinations dermatologists identified 334 CRMLs in 55 patients, with 323 (96.7%) also being detected by ATBM with automated lesions detection. Moreover, all new (n = 13) or changed CRML (n = 24) during follow-up were detected by the software. Average time requirements per baseline examination was 14.1 min (95% CI [12.8-15.5]). Subgroup analysis of undetected lesions revealed either technical (e.g. covering by clothing, hair) or lesion-specific reasons (e.g. hypopigmentation, palmoplantar sites). CONCLUSIONS ATBM with lesion detection software correctly detected the vast majority of CRML and new or changed CRML during follow-up examinations in a favourable amount of time. Our prospective international study underlines that automated lesion detection in TBP images is feasible, which is of relevance for developing AI-based skin cancer screenings.
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
| | | | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Lara V Maul
- Department of Dermatology, University Hospital of Basel, Basel, Switzerland
| | | | - Jeremy Hudson
- North Queensland Skin Centre, Townsville, Queensland, Australia
| | - Gabriel Salerni
- Department of Dermatology, Hospital Provincial del Centenario de Rosario- Universidad Nacional de Rosario, Rosario, Argentina
| | - Albert Rosenberger
- Institute of Genetic Epidemiology, University Medical Center, Georg-August University of Goettingen, Goettingen, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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2
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Kälber KA, Enk A, Hartmann M. Acyclovir-resistant HSV-2 induced genital ulcerations. J Dtsch Dermatol Ges 2024. [PMID: 38679785 DOI: 10.1111/ddg.15397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 05/01/2024]
Affiliation(s)
| | - Alexander Enk
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg
| | - Martin Hartmann
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg
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3
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Linse KP, Enk A, Toberer F. [Primary hyperoxaluria type 1-a rare hereditary metabolic disorder as cause of livedo racemosa]. Dermatologie (Heidelb) 2024; 75:321-324. [PMID: 38167780 DOI: 10.1007/s00105-023-05276-6] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/05/2024]
Abstract
Livedo racemosa is characterized by a bizarrely configurated lightning figure-like appearance with striated to reticulated, livid erythematous macules and results from a reduced perfusion of the respective skin area, which can have different underlying pathophysiologies. A rare but relevant cause, especially in young patients with end-stage kidney failure, is primary hyperoxaluria type 1 (PH1), a hereditary metabolic disorder in which oxalate accumulates in the body.
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Affiliation(s)
- Kai-Philipp Linse
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Alexander Enk
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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4
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Kommoss KS, Bieler T, Ringen J, Lehmann A, Mihalceanu S, Hobohm L, Keller K, Brand A, Fischer B, Kramer D, Wild J, Waisman A, Enk A, Schäkel K, Heikenwälder M, Karbach S. A simple tool for evaluation of inflammation in psoriasis: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio as markers in psoriasis patients and related murine models of psoriasis-like skin disease. J Mol Med (Berl) 2024; 102:247-255. [PMID: 38127137 PMCID: PMC10857970 DOI: 10.1007/s00109-023-02406-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 11/04/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
Objective parameters to quantify psoriatic inflammation are needed for interdisciplinary patient care, as well as preclinical experimental models. This study evaluates neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in psoriasis patients and five murine models of psoriasis-like skin disease based on topical imiquimod application and overexpression of IL-17A under different promotors. We performed a single-center prospective observational study in a German population, investigating psoriasis patients prior to, 4 weeks, and 16 weeks post begin of systemic anti-inflammatory therapy. Psoriasis area and severity index (PASI), blood count, and C-reactive protein (CRP) levels were attained at each timepoint. Additionally, five murine models of psoriasis-like skin disease involving five distinct experimental procedures differing in time of disease-onset and severity were investigated regarding PLR and NLR. Of 43 recruited psoriasis patients, 34 patients were followed up to 16 weeks. The cohort was 69.77% male, showing a median age of 32.0 years (range 19.0-67.0; IQR 26). The median PASI decreased from 16.35 (8.0-50.0; 10.20) to 1.6 (0-10.3; 2.56) after 16 weeks of systemic therapy. Spearman's correlation showed statistically significant positive correlation for NLR with PASI (rs = 0.27, p = 0.006), however not for PLR. NLR, but not PLR, was significantly associated with PASI in a multiple linear regression analysis including age, sex, psoriasis arthritis, and smoking. In the murine models of psoriasis-like skin disease, both NLR and PLR were significantly increased in the acute-severe models compared to controls (p < 0.001, p = 0.005, and p = 0.02, respectively), demonstrating gradually less increased values from severe-acute to mild-late-onset psoriatic phenotype. NLR was significantly associated with PASI in psoriatic patients as well as psoriatic phenotype in different murine psoriasis models. Our data warrants investigation of NLR in psoriasis patients and preclinical psoriasis models as an objective biomarker of psoriatic skin inflammation. KEY MESSAGES : NLR, but not PLR, showed a statistically significant positive correlation with Psoriasis Area and Severity Index (PASI) in our human psoriasis cohort. Both NLR and PLR were significantly increased in murine psoriasis models compared to matched controls, with gradually less increased values from severe-acute to mild-late-onset psoriatic phenotype. NLR may represent an easily available, cheap, and objective parameter to monitor psoriatic inflammation in both clinical patient routine, as well as preclinical experimental murine models.
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Affiliation(s)
- Katharina S Kommoss
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany.
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Tabea Bieler
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Heidelberg, Germany
| | - Julia Ringen
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Annika Lehmann
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Silvia Mihalceanu
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Karsten Keller
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- Department of Sports Medicine, Medical Clinic VII, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Brand
- Institute of Molecular Medicine, University Medical Center Mainz, Mainz, Germany
| | - Berenice Fischer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Daniela Kramer
- Department of Dermatology, University Medical Center of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Johannes Wild
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)-Partner Site RheinMain (Mainz), Mainz, Germany
| | - Ari Waisman
- Institute of Molecular Medicine, University Medical Center Mainz, Mainz, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- The M3 Research Center, Institute for Interdisciplinary Research On Cancer Metabolism and Chronic Inflammation, Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Susanne Karbach
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Center for Cardiology-Cardiology I, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK)-Partner Site RheinMain (Mainz), Mainz, Germany
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5
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Bertlich M, Bertlich I, Plümacher N, Hadaschik E, Enk A, Hoffmann JHO. High-dose intravenous immunoglobulin co-treatment prolongs time-to-treatment escalation in autoimmune bullous diseases: A monocentric retrospective cohort study. J Eur Acad Dermatol Venereol 2024; 38:e74-e76. [PMID: 37595621 DOI: 10.1111/jdv.19437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Affiliation(s)
- M Bertlich
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - I Bertlich
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - N Plümacher
- Department of Electrical Engineering and Computer Science, University of Kassel, Kassel, Germany
| | - E Hadaschik
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Dermatology, University of Duisburg-Essen, Essen, Germany
| | - A Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - J H O Hoffmann
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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6
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Orru' S, Bierbaum S, Enk A, Hengel H, Hoffelner M, Huzly D, Keller-Stanislawski B, Mahler V, Mockenhaupt M, Oberle D. Skin manifestations after immunisation with an adjuvanted recombinant zoster vaccine, Germany, 2020. Euro Surveill 2023; 28:2300261. [PMID: 38099347 PMCID: PMC10831415 DOI: 10.2807/1560-7917.es.2023.28.50.2300261] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/19/2023] [Indexed: 12/17/2023] Open
Abstract
BackgroundShortly after the launch of a novel adjuvanted recombinant zoster vaccine (RZV), Shingrix, cases of suspected herpes zoster (HZ) or zoster-like skin reactions following immunisation were reported.AimWe aimed to investigate if these skin manifestations after administration of RZV could be HZ.MethodsBetween April and October 2020, general practitioners (GP) reporting a suspected case of HZ or zoster-like skin manifestation after RZV vaccination to the Paul-Ehrlich-Institut, the German national competent authority, were invited to participate in the study. The GP took a sample of the skin manifestation, photographed it and collected patient information on RZV vaccination and the suspected adverse event. We analysed all samples by PCR for varicella-zoster virus (VZV) and herpes-simplex virus (HSV) and genotyped VZV-positive samples. In addition, cases were independently assessed by two dermatologists.ResultsEighty eligible cases were enrolled and 72 could be included in the analysis. Of the 72 cases, 45 were female, 33 were 60-69 years old, 32 had skin symptoms in the thoracic and 27 in the cervical dermatomes. Twenty-seven samples tested PCR positive for VZV (all genotyped as wild-type, WT), three for HSV-1 and five for HSV-2.ConclusionIt may be difficult to distinguish HZ, without a PCR result, from other zoster-like manifestations. In this study, VZV-PCR positive dermatomal eruptions occurring in the first weeks after immunisation with RZV were due to WT VZV, which is not unexpected as HZ is a common disease against which the vaccine is unlikely to provide full protection at this time.
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Affiliation(s)
- Stefano Orru'
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
| | - Sibylle Bierbaum
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hartmut Hengel
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | - Marcus Hoffelner
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
| | - Daniela Huzly
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Microbiology, Virology and Hygiene, Institute of Virology, Medical Center, University of Freiburg, Freiburg, Germany
- German Consulting Laboratory for HSV and VZV, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Vera Mahler
- Division of Allergology, Paul-Ehrlich-Institut, Langen, Germany
| | - Maja Mockenhaupt
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Doris Oberle
- Division of Safety of Biomedicines and Diagnostics, Paul-Ehrlich-Institut, Langen, Germany
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Majenka P, Loquai C, Schöning T, Enk A, Hassel J. Acute low back pain as infusion-related reaction to monoclonal antibodies. Front Oncol 2023; 13:1161818. [PMID: 37941549 PMCID: PMC10627944 DOI: 10.3389/fonc.2023.1161818] [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: 06/02/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023] Open
Abstract
Monoclonal antibodies, such as PD-1 inhibitors, are increasingly used in various cancers. Acute low back pain as infusion-related reaction (IRR) to monoclonal antibodies is poorly described. We report a bicentric series of 10 cases of acute low back pain due to administration of monoclonal antibodies directed against PD-1/PD-L1 for skin cancer treatment in patients treated at University Hospital Heidelberg and University Medical Center Mainz (Germany). The management of IRR symptoms was immediate interruption of infusion and analgesia leading to quick improvement and complete symptom relief in all patients. Our findings suggest that the risk of developing low back pain as IRR is depending on the concentration of the administered drug. Low back pain as IRR can be managed by early interruption of infusion and by decreasing the infusion rate or concentration in following administrations.
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Affiliation(s)
- Pawel Majenka
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Tilman Schöning
- Department of Pharmacy, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Yilmaz K, Haeberle S, Kim YO, Fritzler MJ, Weng SY, Goeppert B, Raker VK, Steinbrink K, Schuppan D, Enk A, Hadaschik EN. Regulatory T-cell deficiency leads to features of autoimmune liver disease overlap syndrome in scurfy mice. Front Immunol 2023; 14:1253649. [PMID: 37818371 PMCID: PMC10561387 DOI: 10.3389/fimmu.2023.1253649] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Scurfy mice have a complete deficiency of functional regulatory T cells (Treg) due to a frameshift mutation in the Foxp3 gene. The impaired immune homeostasis results in a lethal lymphoproliferative disorder affecting multiple organs, including the liver. The autoimmune pathology in scurfy mice is in part accompanied by autoantibodies such as antinuclear antibodies (ANA). ANA are serological hallmarks of several autoimmune disorders including autoimmune liver diseases (AILD). However, the underlying pathogenesis and the role of Treg in AILD remain to be elucidated. The present study therefore aimed to characterize the liver disease in scurfy mice. Methods Sera from scurfy mice were screened for ANA by indirect immunofluorescence assay (IFA) and tested for a wide range of AILD-associated autoantibodies by enzyme-linked immunosorbent assay, line immunoassay, and addressable laser bead immunoassay. CD4+ T cells of scurfy mice were transferred into T cell-deficient B6/nude mice. Monoclonal autoantibodies from scurfy mice and recipient B6/nude mice were tested for ANA by IFA. Liver tissue of scurfy mice was analyzed by conventional histology. Collagen deposition in scurfy liver was quantified via hepatic hydroxyproline content. Real-time quantitative PCR was used to determine fibrosis-related hepatic gene expression. Hepatic immune cells were differentiated by flow cytometry. Results All scurfy mice produced ANA. AILD-associated autoantibodies, predominantly antimitochondrial antibodies, were detected at significantly higher levels in scurfy sera. CD4+ T cells from scurfy mice were sufficient to induce anti-dsDNA autoantibodies and ANA with an AILD-related nuclear envelope staining pattern. Liver histology revealed portal inflammation with bile duct damage and proliferation, as in primary biliary cholangitis (PBC), and interface hepatitis with portal-parenchymal necroinflammation, as found in autoimmune hepatitis (AIH). In scurfy liver, TNFα and fibrosis-related transcripts including Col1a1, Timp1, Acta2, Mmp2, and Mmp9 were upregulated. The level of proinflammatory monocytic macrophages (Ly-6Chi) was increased, while M2-type macrophages (CD206+) were downregulated compared to wildtype controls. Despite severe hepatic inflammation, fibrosis did not develop within 25 days, which is close to the lifespan of scurfy mice. Discussion Our findings suggest that Treg-deficient scurfy mice spontaneously develop clinical, serological, and immunopathological characteristics of AILD with overlapping features of PBC and AIH.
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Affiliation(s)
- Kaan Yilmaz
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Haeberle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Yong Ook Kim
- Institute of Translational Immunology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shih-Yen Weng
- Institute of Translational Immunology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Benjamin Goeppert
- Institute of Tissue Medicine and Pathology, University of Bern, Bern, Switzerland
- Institute of Pathology and Neuropathology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Verena K. Raker
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Kerstin Steinbrink
- Department of Dermatology, University Hospital Muenster, Muenster, Germany
| | - Detlef Schuppan
- Institute of Translational Immunology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Eva N. Hadaschik
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, University Hospital of Essen, Essen, Germany
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Kommoss KS, Enk A, Heikenwälder M, Waisman A, Karbach S, Wild J. Kardiovaskuläre Komorbidität bei Psoriasis - Entzündung in Psoriasis betrifft nicht nur die Haut. J Dtsch Dermatol Ges 2023; 21:718-726. [PMID: 37427741 DOI: 10.1111/ddg.15071_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/24/2023] [Indexed: 07/11/2023]
Affiliation(s)
- Katharina S Kommoss
- Universitäts-Hautklinik Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
- Abteilung für Chronische Entzündung und Krebs, Deutsches Krebsforschungszentrum Heidelberg (DKFZ), Heidelberg
| | - Alexander Enk
- Universitäts-Hautklinik Heidelberg, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Mathias Heikenwälder
- Abteilung für Chronische Entzündung und Krebs, Deutsches Krebsforschungszentrum Heidelberg (DKFZ), Heidelberg
| | - Ari Waisman
- Institut für Molekulare Medizin, Universitätsmedizin Mainz
- Forschungszentrum für Immuntherapie, Universitätsmedizin Mainz der Johannes Gutenberg-Universität Mainz
| | - Susanne Karbach
- Zentrum für Kardiologie - Kardiologie I, Universitätsmedizin Mainz
- Zentrum für Thrombose und Hämostase, Universitätsmedizin Mainz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) - Partnerseite RheinMain
| | - Johannes Wild
- Zentrum für Kardiologie - Kardiologie I, Universitätsmedizin Mainz
- Zentrum für Thrombose und Hämostase, Universitätsmedizin Mainz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) - Partnerseite RheinMain
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10
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Linse KP, Enk A, Hoffmann J. [Dermato-neuro syndrome-an acute and life-threatening complication of scleromyxedema Arndt-Gottron]. Dermatologie (Heidelb) 2023:10.1007/s00105-023-05159-w. [PMID: 37284981 PMCID: PMC10244840 DOI: 10.1007/s00105-023-05159-w] [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] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Scleromyxedema Arndt-Gottron is the systemic variant of lichen myxedematosus in which mucin accumulation occurs in the dermis. The disease is usually chronically progressive and extracutaneous manifestations or complications are possible. The pathogenesis is unknown and the disease is usually associated with monoclonal gammopathy. High-dose intravenous immunoglobulins (IVIg) are considered to be an effective therapy. We report the case of a patient who developed dermato-neuro syndrome following an interruption of IVIg treatment and a SARS-CoV‑2 infection. A similar episode occurred 2 years earlier in association with an influenza A infection. Dermato-neuro syndrome is a potentially lethal neurological complication which is characterized by fever, delirium, convulsions, and coma.
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Affiliation(s)
- Kai-Philipp Linse
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Alexander Enk
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Jochen Hoffmann
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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11
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Winkler JK, Blum A, Kommoss K, Enk A, Toberer F, Rosenberger A, Haenssle HA. Assessment of Diagnostic Performance of Dermatologists Cooperating With a Convolutional Neural Network in a Prospective Clinical Study: Human With Machine. JAMA Dermatol 2023; 159:621-627. [PMID: 37133847 PMCID: PMC10157508 DOI: 10.1001/jamadermatol.2023.0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/05/2023] [Indexed: 05/04/2023]
Abstract
Importance Studies suggest that convolutional neural networks (CNNs) perform equally to trained dermatologists in skin lesion classification tasks. Despite the approval of the first neural networks for clinical use, prospective studies demonstrating benefits of human with machine cooperation are lacking. Objective To assess whether dermatologists benefit from cooperation with a market-approved CNN in classifying melanocytic lesions. Design, Setting, and Participants In this prospective diagnostic 2-center study, dermatologists performed skin cancer screenings using naked-eye examination and dermoscopy. Dermatologists graded suspect melanocytic lesions by the probability of malignancy (range 0-1, threshold for malignancy ≥0.5) and indicated management decisions (no action, follow-up, excision). Next, dermoscopic images of suspect lesions were assessed by a market-approved CNN, Moleanalyzer Pro (FotoFinder Systems). The CNN malignancy scores (range 0-1, threshold for malignancy ≥0.5) were transferred to dermatologists with the request to re-evaluate lesions and revise initial decisions in consideration of CNN results. Reference diagnoses were based on histopathologic examination in 125 (54.8%) lesions or, in the case of nonexcised lesions, on clinical follow-up data and expert consensus. Data were collected from October 2020 to October 2021. Main Outcomes and Measures Primary outcome measures were diagnostic sensitivity and specificity of dermatologists alone and dermatologists cooperating with the CNN. Accuracy and receiver operator characteristic area under the curve (ROC AUC) were considered as additional measures. Results A total of 22 dermatologists detected 228 suspect melanocytic lesions (190 nevi, 38 melanomas) in 188 patients (mean [range] age, 53.4 [19-91] years; 97 [51.6%] male patients). Diagnostic sensitivity and specificity significantly improved when dermatologists additionally integrated CNN results into decision-making (mean sensitivity from 84.2% [95% CI, 69.6%-92.6%] to 100.0% [95% CI, 90.8%-100.0%]; P = .03; mean specificity from 72.1% [95% CI, 65.3%-78.0%] to 83.7% [95% CI, 77.8%-88.3%]; P < .001; mean accuracy from 74.1% [95% CI, 68.1%-79.4%] to 86.4% [95% CI, 81.3%-90.3%]; P < .001; and mean ROC AUC from 0.895 [95% CI, 0.836-0.954] to 0.968 [95% CI, 0.948-0.988]; P = .005). In addition, the CNN alone achieved a comparable sensitivity, higher specificity, and higher diagnostic accuracy compared with dermatologists alone in classifying melanocytic lesions. Moreover, unnecessary excisions of benign nevi were reduced by 19.2%, from 104 (54.7%) of 190 benign nevi to 84 nevi when dermatologists cooperated with the CNN (P < .001). Most lesions were examined by dermatologists with 2 to 5 years (96, 42.1%) or less than 2 years of experience (78, 34.2%); others (54, 23.7%) were evaluated by dermatologists with more than 5 years of experience. Dermatologists with less dermoscopy experience cooperating with the CNN had the most diagnostic improvement compared with more experienced dermatologists. Conclusions and Relevance In this prospective diagnostic study, these findings suggest that dermatologists may improve their performance when they cooperate with the market-approved CNN and that a broader application of this human with machine approach could be beneficial for dermatologists and patients.
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Affiliation(s)
- Julia K. Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
| | - Katharina Kommoss
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Albert Rosenberger
- Institute of Genetic Epidemiology, University Medical Center, Georg-August University of Goettingen, Goettingen, Germany
| | - Holger A. Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Bertlich I, Hartmann J, Hartschuh W, Enk A, Toberer F. Lymphatic vessel involvement in primary cutaneous B-cell lymphoma: A common finding? J Cutan Pathol 2023. [PMID: 37248781 DOI: 10.1111/cup.14440] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Cutaneous B-cell lymphoma (CBCL) is part of dermatopathological routine diagnostics. However, in contrast to cutaneous T-cell lymphomas, there are only a few studies on the prevalence and possible clinical impact of lymphatic vessel involvement. Therefore, this pilot study aimed to quantify the prevalence of lymphovascular involvement in CBCL and to assess the association between lymphovascular involvement and recurrence. METHODS Thirty-nine patients from two tertiary care hospitals diagnosed with CBCL were retrospectively identified and their biopsies were histopathologically examined for the presence of lymphatic vessel involvement using H&E stain, and CD20 and D2-40 immunohistochemistry. Clinical data were retrieved from our digital documentation files. RESULTS Thirty patients were included in the evaluation (nPCFCL = 15, nPCMZL = 10, and nPCLBCL = 5). Lymphovascular involvement occurred in all three types of lymphoma and was present in 14/30 specimens. The presence of lymphatic involvement did not show a significant impact on recurrence rate (p = 0.150). CONCLUSIONS This immunohistochemical pilot study shows that lymphovascular involvement is a relatively frequent finding in primary CBCL. Although no definitive conclusion can be drawn from our findings because of the small sample size, there were no strong signs of tendencies for recurrence in either group. Future studies with larger sample size are warranted to assess the possible clinical implications.
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Affiliation(s)
- Ines Bertlich
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Julia Hartmann
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Kommoss KS, Winkler JK, Mueller-Christmann C, Bardehle F, Toberer F, Stolz W, Kraenke T, Hofmann-Wellenhof R, Blum A, Enk A, Rosenberger A, Haenssle HA. Observational study investigating the level of support from a convolutional neural network in face and scalp lesions deemed diagnostically 'unclear' by dermatologists. Eur J Cancer 2023; 185:53-60. [PMID: 36963352 DOI: 10.1016/j.ejca.2023.02.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND The clinical diagnosis of face and scalp lesions (FSL) is challenging due to overlapping features. Dermatologists encountering diagnostically 'unclear' lesions may benefit from artificial intelligence support via convolutional neural networks (CNN). METHODS In a web-based classification task, dermatologists (n = 64) diagnosed a convenience sample of 100 FSL as 'benign', 'malignant', or 'unclear' and indicated their management decisions ('no action', 'follow-up', 'treatment/excision'). A market-approved CNN (Moleanalyzer-Pro®, FotoFinder Systems, Germany) was applied for binary classifications (benign/malignant) of dermoscopic images. RESULTS After reviewing one dermoscopic image per case, dermatologists labelled 562 of 6400 diagnoses (8.8%) as 'unclear' and mostly managed these by follow-up examinations (57.3%, n = 322) or excisions (42.5%, n = 239). Management was incorrect in 58.8% of 291 truly malignant cases (171 'follow-up' or 'no action') and 43.9% of 271 truly benign cases (119 'excision'). Accepting CNN classifications in unclear cases would have reduced false management decisions to 4.1% in truly malignant and 31.7% in truly benign lesions (both p < 0.01). After receiving full case information 239 diagnoses (3.7%) remained 'unclear' to dermatologists, now triggering more excisions (72.0%) than follow-up examinations (28.0%). These management decisions were incorrect in 32.8% of 116 truly malignant cases and 76.4% of 123 truly benign cases. Accepting CNN classifications would have reduced false management decisions to 6.9% in truly malignant lesions and to 38.2% in truly benign cases (both p < 0.01). CONCLUSIONS Dermatologists mostly managed diagnostically 'unclear' FSL by treatment/excision or follow-up examination. Following CNN classifications as guidance in unclear cases seems suitable to significantly reduce incorrect decisions.
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Affiliation(s)
| | - Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | - Felicitas Bardehle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Wilhelm Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Teresa Kraenke
- Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
| | | | - Andreas Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Albert Rosenberger
- Department of Genetic Epidemiology, University of Goettingen, Goettingen, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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14
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Kommoss KS, Enk A, Heikenwälder M, Waisman A, Karbach S, Wild J. Cardiovascular comorbidity in psoriasis - psoriatic inflammation is more than just skin deep. J Dtsch Dermatol Ges 2023. [PMID: 37186503 DOI: 10.1111/ddg.15071] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/06/2022] [Accepted: 02/24/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is a growing understanding of inflammation in psoriasis beyond its dermatological manifestation, towards systemic inflammation. Management of possible comorbidities encompassing psychological, metabolic and cardiovascular disease is recommended in national and international dermatology guidelines for treatment of psoriasis patients. Vice versa, psoriasis is being recognized as a new risk factor for cardiovascular inflammation within the cardiological community. METHODS A review of the literature was conducted. Key points regarding epidemiological, mechanistic and management aspects were summarized and put into context for physicians treating psoriasis patients. RESULTS Efforts are currently being made to better understand the mechanistic underpinnings of systemic inflammation within psoriatic inflammation. Studies looking to "hit two birds with one stone" regarding specifically cardiovascular comorbidities of psoriasis patients using established systemic dermatological therapies have so far provided heterogeneous data. The diagnosis of psoriasis entails preventive and therapeutic consequences regarding concomitant diseases for the individual patient. CONCLUSIONS The knowledge of comorbidities in psoriasis calls for pronounced interdisciplinary care of psoriasis patients, to which this article highlights efforts regarding vascular inflammation and cardiovascular disease.
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Affiliation(s)
- Katharina S Kommoss
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Mathias Heikenwälder
- Division of Chronic Inflammation and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ari Waisman
- Institute for Molecular Medicine, University Medical Center of Mainz, Mainz, Germany
- Research Center for Immunotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Susanne Karbach
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
| | - Johannes Wild
- Center for Cardiology - Cardiology I, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK) - Partner site RheinMain, Germany
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15
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Silva-Vilches C, Bolduan V, Alabdullah M, Steinbrink K, Probst HC, Enk A, Mahnke K. Topical Application of Adenosine A 2-Type Receptor Agonists Prevents Contact Hypersensitivity Reactions in Mice by Affecting Skin Dendritic Cells. J Invest Dermatol 2023; 143:408-418.e6. [PMID: 36174716 DOI: 10.1016/j.jid.2022.07.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
Adenosine (Ado) produced by skin and skin migratory CD73+ dendritic cells is critically involved in tolerance to haptens. We therefore investigated the use of Ado receptor agonists for the treatment of contact hypersensitivity reactions. A2A- 4-[2-[[6-Amino-9-(N-ethyl-β-D-ribofuranuronamidosyl)-9H-purin-2-yl]amino] ethyl]benzenepropanoic acid hydrochloride (CGS) and A2B- 2-[[6-Amino-3,5-dicyano-4-[4-[cyclopropylmethoxy]phenyl]-2-pyridinyl]thio]-acetamide (BAY) specific Ado receptor agonists were epicutaneously applied to the skin before sensitization and challenge with DNFB. Both agonists reduced ear swelling compared with solvent controls. This was accompanied by fewer activated T cells in the skin after the challenge and by higher numbers of T cells expressing anergic markers such as LAG-3, CD137, PD-1, CD272, and TIM-3 in the lymph nodes of CGS-treated groups. In ear tissue, Ado receptor agonist treatment reduced the production of proinflammatory cytokines and chemokines as well as the infiltration by neutrophils after sensitization. Moreover, reduced numbers of skin migratory dendritic cells producing less IL-12 and exhibiting lower expression of CD86 were recorded in lymph nodes after sensitization. In cocultures of skin migratory dendritic cells from CGS-treated mice with T cells, reduced proliferation of T cells and decreased secretion of proinflammatory cytokines compared with that of solvent controls were apparent. In conclusion, topical application of Ado receptor agonists to the skin prevents sensitization of T cells against haptens by reducing the migration and activation of skin migratory dendritic cells.
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Affiliation(s)
- Cinthia Silva-Vilches
- Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - Vanessa Bolduan
- Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - Mohamad Alabdullah
- Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - Kerstin Steinbrink
- Department of Dermatology, University Hospital Münster, Westfälische Wilhelms-University Münster, Münster, Germany
| | | | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University of Heidelberg, Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University Hospital Heidelberg, Ruprecht Karls University of Heidelberg, Heidelberg, Germany.
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16
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Da M, Chen L, Enk A, Mahnke K. Tolerance to 2,4-Dinitrofluorobenzene‒Induced Contact Hypersensitivity Is Mediated by CD73-Expressing Tissue-homing Regulatory T Cells. J Invest Dermatol 2022; 143:1011-1022.e8. [PMID: 36539031 DOI: 10.1016/j.jid.2022.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/01/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
Regulatory T cells (Tregs) express CD73, an ectonucleotidase that converts adenosine (Ado) monophosphate to Ado, which has been shown to suppress immune reactions. To investigate the role(s) of CD73+ Tregs during the induction of tolerance, we used a 2,4-dinitrofluorobenzene‒driven contact hypersensitivity model, in which tolerance can be induced by pretreating wild type mice with 2,4-dinitrothiocyanobenzene. CD73-deficient mice were unable to acquire tolerance. Likewise, transfer of CD73‒/‒ Tregs failed to suppress 2,4-dinitrofluorobenzene‒induced ear swelling in wild type mice, whereas transfer of wild type‒derived Tregs into CD73‒/‒ mice re-established tolerance. This indicates a crucial role of CD73+ Tregs for skin-induced tolerance. Furthermore, we found that 2,4-dinitrothiocyanobenzene induces more activated CD73+ tissue-homing Tregs (marked by Ki-67, CTLA4, CCR4, CD103, CCR6, and CD49b expression) in draining lymph nodes and blood, eventually accumulating in the skin. The application of anti-CD73 antibodies that block CD73-derived Ado production as well as the injection of Ado deaminase, which degrades Ado in tissues, abrogated tolerance induction. Thus, our data indicate that CD73+ Ado-producing Tregs are crucial for the regulation of contact hypersensitivity reactions and tolerance induction in the skin and that manipulating the function(s) of CD73 in tissues may offer a tool to influence autoimmunity and inflammation in vivo.
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Affiliation(s)
- Meihong Da
- Department of Dermatology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Luxia Chen
- Department of Dermatology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Karsten Mahnke
- Department of Dermatology, University Hospital Heidelberg, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
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Hartmann J, Keller A, Enk A, Gholam P. Hemodynamic changes during conventional and daylight photodynamic therapy of actinic keratoses - a randomized controlled trial. J DERMATOL TREAT 2022; 33:3022-3027. [PMID: 35775704 DOI: 10.1080/09546634.2022.2097160] [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] [Indexed: 10/17/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) is an effective treatment for actinic keratosis (AK). However, pain and hypertension are important side effects of conventional PDT (c-PDT). Several studies have demonstrated that daylight PDT (dl-PDT) is less painful while being as effective as c-PDT. OBJECTIVE To observe the effect of c-PDT and dl-PDT on different hemodynamic parameters (systolic blood pressure and diastolic blood pressure, pulse rate, and peripheral oxygen saturation). METHODS Fifty patients with AK on the head were enrolled into this prospective, randomized, controlled study and treated with c-PDT or dl-PDT in a 1:1 ratio. Hemodynamic parameters were measured at four different time points during treatment. Pain was quantified using a visual analog scale. AK was counted before treatment and after one month. RESULTS C-PDT is associated with significantly more pain, a significant increase in blood pressure and a higher rate of patients with grade 3 hypertension. Whereas dl-PDT is almost painless and does not lead to any changes in hemodynamic parameters. For both treatments, a similar lesion response rate was found after one month. CONCLUSIONS dl-PDT has a better tolerability while being as effective as c-PDT and therefore may be the more favorable treatment option in certain patient groups.
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Affiliation(s)
- J Hartmann
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - A Keller
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - A Enk
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - P Gholam
- Department of Dermatology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
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18
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Bertlich I, Bertlich M, Enk A, Hoffmann J, Toberer F, Fink C. Pellagra ohne Niacinmangel? J Dtsch Dermatol Ges 2022; 20:1228-1230. [PMID: 36162036 DOI: 10.1111/ddg.14843_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ines Bertlich
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Maya Bertlich
- Abteilung für Dermatologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Alexander Enk
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Jochen Hoffmann
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Christine Fink
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Keller A, Hartmann J, Enk A, Gholam P. Pulse rate and blood pressure changes during low-irradiance PDT compared with conventional PDT in the treatment of facial actinic keratoses: A retrospective study. Photodermatol Photoimmunol Photomed 2022; 38:435-441. [PMID: 34967470 DOI: 10.1111/phpp.12764] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/19/2021] [Accepted: 12/27/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Conventional photodynamic therapy (c-PDT) is a highly effective treatment for actinic keratoses. Besides pain as the main side effect, blood pressure (BP) increases and hypertensive crises may occur during treatment. Reducing the irradiation intensity while keeping the total dose constant (low-irradiance PDT) can achieve a clinically relevant reduction in pain. This study aimed to evaluate the influence of li-PDT on the BP and pulse (PR) during therapy and the incidence of post-interventional hypertension compared with c-PDT. METHODS We retrospectively analyzed the treatment data of 79 patients (39 c-PDT and 40 li-PDT). BP and PR measurements were performed in all patients before PDT, at mid-exposure, and immediately after PDT. In addition, the pain was assessed by using the visual analog scale. RESULTS Patients treated with li-PDT reported significantly lower pain than those receiving c-PDT (p < .0005). Additionally, they showed less systolic (SBP) and diastolic (DBP) BP increase (∆SBP: p < .0005, ∆DBP: p = .015) and overall lower absolute BP values (SBP: p < .0005, DBP: p = .008) compared with c-PDT. They were also significantly less likely to develop post-interventional hypertension (p = .037) or higher stages of arterial hypertension. Regarding PR, there was no difference in absolute values between both groups, but the increase from onset to half irradiation duration was significantly higher in c-PDT (p = .013). CONCLUSIONS Li-PDT is an excellent option to reduce the elevation of arterial BP and decrease the incidence of post-interventional hypertension and hypertensive crisis. This finding has considerable relevance, especially with the risk profile of many PDT patients in mind (advanced age and cardiovascular history).
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Affiliation(s)
- Aric Keller
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Hartmann
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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20
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Bertlich I, Bertlich M, Enk A, Hoffmann J, Toberer F, Fink C. Pellagra without niacin deficiency? J Dtsch Dermatol Ges 2022; 20:1228-1230. [PMID: 35979943 DOI: 10.1111/ddg.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ines Bertlich
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maya Bertlich
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Hoffmann
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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21
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Ramcke T, Enk A, Hoffmann J. Facial Edema as a Sign of a Rare Severe Drug Reaction. Dtsch Arztebl Int 2022; 119:550. [PMID: 36384929 PMCID: PMC9677542 DOI: 10.3238/arztebl.m2022.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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22
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Toberer F, Winkler JK, Haenssle HA, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H, Helbig D. Metabolic Signature of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: Expression of Hypoxia-inducible Factor-1α and Several of Its Downstream Targets. Acta Dermatovenerol Croat 2022; 30:25-31. [PMID: 36153716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Metabolic reprogramming mediated by hypoxia-inducible factors play a crucial role in many human cancers. HIF-1α is activated under hypoxic conditions and is considered a key regulator of oxygen homoeostasis during tumor proliferation under hypoxia. Aim of this research was to analyze the immunohistochemical expression of HIF-1α, VEGF-A, Glut-1, MCT4, and CAIX in atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS). 21 paraffin-embedded AFX and 22 PDS were analysed by immunohistochemistry, namely HIF-1α, VEGF-A (referred to as VEGF throughout the manuscript), Glut-1, MCT4, and CAIX. To quantify the protein expression, we considered the percentage of positive tumor cells (0: 0%, 1: up to 1%, 2: 2-10%, 3: 11-50%, 4: >50%) in relation to the staining intensity (0: negative, 1: low, 2: medium, 3: strong). HIF-1α expression (mean ± SD) in AFX (9.33±2.92) was significantly stronger than that in PDS (5.90±4.38; P= 0.007), whereas the expression of VEGF, Glut-1, MCT4, and CAIX did not show differences between AFX and PDS. When comparing all tumors without subgroup stratification, the expression of HIF-1α (P= 0.044) and MCT4 (P= 0.036) was significantly stronger in ulcerated tumors than in tumors without ulceration. Our findings provide the first evidence that HIF-1α-induced metabolic reprogramming may contribute to the pathogenesis of AFX and PDS. HIF-1α expression seems to be higher in AFX than in PDS, and ulcerated tumors show higher expression levels of HIF-1α and MCT4 irrespective of the diagnosis.
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Affiliation(s)
- Ferdinand Toberer
- Ferdinand Toberer, MD, Department of Dermatology, Venerology and Allergology, University Medical Center, Ruprecht-Karls-University Im Neuenheimer Feld 440, 69120 Heidelberg, Germany;
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Ramcke T, Bolduan V, Vicari E, Yilmaz K, Bertlich I, Goletz S, Mindorf S, Hoffmann J, Schmidt E, Enk A, Hadaschik E. Anti-BP230 only bullous pemphigoid constitutes a distinct disease subgroup with characteristic serological and clinical features. J Invest Dermatol 2022; 142:3110-3113.e8. [PMID: 35671826 DOI: 10.1016/j.jid.2022.05.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Torben Ramcke
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Vanessa Bolduan
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Elisabeth Vicari
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Kaan Yilmaz
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ines Bertlich
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Swantje Mindorf
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Jochen Hoffmann
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Enno Schmidt
- Department of Dermatology, University of Lübeck, Lübeck, Germany; Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Alexander Enk
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Hadaschik
- Department of Dermatology, Heidelberg University Hospital, Heidelberg, Germany; Department of Dermatology, Essen University Hospital, Essen, Germany
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Da M, Chen L, Enk A, Ring S, Mahnke K. The Multifaceted Actions of CD73 During Development and Suppressive Actions of Regulatory T Cells. Front Immunol 2022; 13:914799. [PMID: 35711418 PMCID: PMC9197450 DOI: 10.3389/fimmu.2022.914799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Adenosine (Ado) has been shown to have immunosuppressive effects in a variety of diseases. It can either be released directly into the extracellular environment by cells, or it can be produced by degradation of ATP within the extracellular spaces. This extracellular pathway is facilitated by the concerted actions of the ectoenzymes CD39 and CD73. In a first step CD39 dephosphorylates ATP to ADP and AMP, respectively, and in a second step CD73 converts AMP to Ado. Thus, activity of CD73 on the cell surface of cells is the rate limiting step in the generation of extracellular Ado. Among T cells, CD73 is most abundantly expressed by regulatory T cells (Tregs) and is even upregulated after their activation. Functionally, the generation of Ado by CD73+ Tregs has been shown to play a role in immune suppression of dendritic cells, monocytes and T cells, and the defined expression of CD73 by Tregs in immunosuppressive environments, such as tumors, made CD73 a novel checkpoint inhibitor. Therefore, therapeutical intervention by anti-CD73 antibodies or by chemical inhibitors of the enzymatic function is currently under investigation in some preclinical animal models. In the following we summarize the expression pattern and the possible functions of CD73 in T cells and Tregs, and exemplify novel ways to manipulate CD73 functions in Tregs to stimulate anti-tumor immunity.
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Hassel JC, Schank TE, Smetak H, Mühlbauer J, Salzmann M, Machiraju D, Menzer C, Lang K, König L, Haefner MF, Hülsmeyer I, Kohler C, Spang R, Enk A, Debus J, Beckhove P. Evaluation of radio-immunotherapy sequence on immunological responses and clinical outcomes in patients with melanoma brain metastases (ELEKTRA). Oncoimmunology 2022; 11:2066609. [PMID: 35481285 PMCID: PMC9037491 DOI: 10.1080/2162402x.2022.2066609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In patients with melanoma brain metastases (MBM), a combination of radiotherapy (RT) with immune checkpoint inhibitors (ICI) is routinely used. However, the best sequence of radio-immunotherapy (RIT) remains unclear. In an exploratory phase 2 trial, MBM patients received RT (stereotactic or whole-brain radiotherapy depending on the number of MBM) combined with ipilimumab (ipi) ± nivolumab (nivo) in different sequencing (Rad-ICI or ICI-Rad). Comparators arms included patients treated with ipi-free systemic treatment or without RT (in MBM-free patients). The primary endpoints were radiological and immunological responses in the peripheral blood. Secondary endpoints were progression-free survival (PFS) and overall survival (OS). Of 106 screened, 92 patients were included in the study. Multivariate analysis revealed an advantage for patients starting with RT (Rad-ICI) for overall response rate (RR: p = .007; HR: 7.88 (95%CI: 1.76–35.27)) and disease control rate (DCR: p = .036; HR: 6.26 (95%CI: 1.13–34.71)) with a trend for a better PFS (p = .162; HR: 1.64 (95%CI: 0.8–3.3)). After RT plus two cycles of ipi-based ICI in both RIT sequences, increased frequencies of activated CD4, CD8 T cells and an increase in melanoma-specific T cell responses were observed in the peripheral blood. Lasso regression analysis revealed a significant clinical benefit for patients treated with Rad-ICI sequence and immunological features, including high frequencies of memory T cells and activated CD8 T cells in the blood. This study supports increasing evidence that sequencing RT followed by ICI treatment may have better effects on the immunological responses and clinical outcomes in MBM patients.
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Affiliation(s)
- Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Timo E. Schank
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Heiko Smetak
- Regensburg Center for Interventional Immunology, University Hospital Regensburg, Regensburg, Germany
| | - Jasmin Mühlbauer
- Regensburg Center for Interventional Immunology, University Hospital Regensburg, Regensburg, Germany
| | - Martin Salzmann
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Devayani Machiraju
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Christian Menzer
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Kristin Lang
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Matthias F. Haefner
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Ingrid Hülsmeyer
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
- The Immune Monitoring Unit, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Christian Kohler
- Statistical Bioinformatics Department, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Rainer Spang
- Statistical Bioinformatics Department, Institute of Functional Genomics, University of Regensburg, Regensburg, Germany
| | - Alexander Enk
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg. Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Philipp Beckhove
- Regensburg Center for Interventional Immunology, University Hospital Regensburg, Regensburg, Germany
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26
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Bertlich I, Enk A, Toberer F. [Plantar melanoma: A wolf in sheep's clothing]. Dtsch Med Wochenschr 2022; 147:351-354. [PMID: 35291043 DOI: 10.1055/a-1748-6050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND FINDINGS Amelanotic melanoma (AM) is a subtype of melanoma characterized by a diminished or lacking melanin synthesis. AM, especially ulcerated variants of the plantar region (AMP), are often clinically misdiagnosed, leading to a delay in treatment initiation. THERAPY AND FURTHER DEVELOPMENT We present a case series of 4 AMP and give a detailed overview about clinical features and the subsequent medical history of this severe disease. CONCLUSIONS AMP shows a variety of clinical presentations and particularly elderly patients with many accompanying medical conditions are in danger of incorrect clinical diagnoses. Therefore, we recommend to biopsy any amelanotic plantar ulcer or tumor that does not respond to treatment within 6 weeks to rule out AM.
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Affiliation(s)
- Ines Bertlich
- Dermatologie, Universitätsklinikum Heidelberg, INF 440, 69120 Heidelberg
| | - Alexander Enk
- Dermatologie, Universitätsklinikum Heidelberg, INF 440, 69120 Heidelberg
| | - Ferdinand Toberer
- Dermatologie, Universitätsklinikum Heidelberg, INF 440, 69120 Heidelberg
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27
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Dietrich C, Keller A, Enk A, Hoffmann J. Subcutaneous Panniculitis-like T-Cell Lymphoma: Brief Review and Report of Successful Treatment with Mycophenolate-mofetil. Clin Exp Dermatol 2022; 47:1360-1363. [PMID: 35188280 DOI: 10.1111/ced.15145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Carmen Dietrich
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Aric Keller
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Jochen Hoffmann
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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28
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Sies K, Winkler JK, Fink C, Bardehle F, Toberer F, Buhl T, Enk A, Blum A, Stolz W, Rosenberger A, Haenssle HA. Does sex matter? Analysis of sex-related differences in the diagnostic performance of a market-approved convolutional neural network for skin cancer detection. Eur J Cancer 2022; 164:88-94. [PMID: 35182926 DOI: 10.1016/j.ejca.2021.12.034] [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: 10/19/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advances in biomedical artificial intelligence may introduce or perpetuate sex and gender discriminations. Convolutional neural networks (CNN) have proven a dermatologist-level performance in image classification tasks but have not been assessed for sex and gender biases that may affect training data and diagnostic performance. In this study, we investigated sex-related imbalances in training data and diagnostic performance of a market-approved CNN for skin cancer classification (Moleanalyzer Pro®, Fotofinder Systems GmbH, Bad Birnbach, Germany). METHODS We screened open-access dermoscopic image repositories widely used for CNN training for distribution of sex. Moreover, the sex-related diagnostic performance of the market-approved CNN was tested in 1549 dermoscopic images stratified by sex (female n = 773; male n = 776). RESULTS Most open-access repositories showed a marked under-representation of images originating from female (40%) versus male (60%) patients. Despite these imbalances and well-known sex-related differences in skin anatomy or skin-directed behaviour, the tested CNN achieved a comparable sensitivity of 87.0% [80.9%-91.3%] versus 87.1% [81.1%-91.4%], specificity of 98.7% [97.4%-99.3%] versus 96.9% [95.2%-98.0%] and ROC-AUC of 0.984 [0.975-0.993] versus 0.979 [0.969-0.988] in dermoscopic images of female versus male origin, respectively. In the sample at hand, sex-related differences in ROC-AUCs were not statistically significant in the per-image analysis nor in an additional per-individual analysis (p ≥ 0.59). CONCLUSION Design and training of artificial intelligence algorithms for medical applications should generally acknowledge sex and gender dimensions. Despite sex-related imbalances in open-access training data, the diagnostic performance of the tested CNN showed no sex-related bias in the classification of skin lesions.
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Affiliation(s)
- Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Felicitas Bardehle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Andreas Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
| | - Wilhelm Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Albert Rosenberger
- Department of Genetic Epidemiology, University of Goettingen, Goettingen, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Toberer F, Winkler JK, Haenssle HA, Heinzel-Gutenbrunner M, Enk A, Hartschuh W, Helmbold P, Kutzner H. [Immunohistochemical analysis of a hypoxia-associated signature in melanomas with positive and negative sentinel lymph nodes : Hypoxia-associated signature of primary cutaneous melanomas]. Hautarzt 2022; 73:283-290. [PMID: 34997269 PMCID: PMC8964660 DOI: 10.1007/s00105-021-04934-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 12/01/2022]
Abstract
Metabolic reprogramming mediated by hypoxia-inducible factors and its downstream targets plays a crucial role in many human malignancies. Excessive proliferation of tumor cells under hypoxic conditions leads to metabolic reprogramming and altered gene expression enabling tumors to adapt to their hypoxic environment. Here we analyzed the metabolic signatures of primary cutaneous melanomas with positive and negative sentinel node status in order to evaluate potential differences in their metabolic signature. We found a positive correlation of the expression of glucose transporter 1 (GLUT-1) with tumor thickness and ulceration in all melanomas with subgroup analyses as well as in the subgroup with a negative sentinel node. Furthermore, the expression of vascular endothelial growth factor (VEGF) was positively correlated with the presence of ulceration in melanomas with positive sentinel node.
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Affiliation(s)
- Ferdinand Toberer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Julia K Winkler
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Holger A Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | | | - Alexander Enk
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Wolfgang Hartschuh
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Peter Helmbold
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Heinz Kutzner
- Dermatopathologie Bodensee, Friedrichshafen, Deutschland
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Bardehle F, Sies K, Enk A, Rosenberger A, Fink C, Haenssle H. Mikrovaskuläre Pathologien bei Patienten mit Psoriasis vulgaris mittels Nagelfalzkapillarmikroskopie identifiziert: Ergebnisse einer prospektiven kontrollierten Studie. J Dtsch Dermatol Ges 2021; 19:1736-1745. [PMID: 34894181 DOI: 10.1111/ddg.14606_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund: Die Psoriasis gilt als unabhängiger kardiovaskulärer Risikofaktor und Treiber einer Atherogenese. Mikrovaskuläre Veränderungen in psoriatischen Plaques sind gut beschrieben, wohingegen Veränderungen außerhalb betroffener Hautareale kaum untersucht wurden. In dieser Studie wurden Nagelfalzkapillaren von Psoriasispatienten in nicht betroffener Haut systematisch untersucht. Patienten und Methodik: Prospektive Studie mit Untersuchung von Nagelfalzkapillaren bei Psoriasispatienten im Vergleich zu gesunden Kontrollen mittels digitaler Videokapillarmikroskopie. Es wurden 21 kapillarmikroskopische Parameter bewertet und die Ergebnisse mit Charakteristika der Patienten und der Psoriasiserkrankung, mit Laborparametern und Messungen der Intima-Media-Dicke der Arteria carotis communis korreliert. Ergebnisse: Die 77 Psoriasispatienten (24 mit zusätzlicher Psoriasisarthritis) und 71 Kontrollen zeigten sich hinsichtlich demographischer Merkmale und relevanter Einflussfaktoren für eine Mikroangiopathie ausbalanciert. Im Vergleich zur Kontrollgruppe zeigten Psoriasispatienten eine signifikante Minderung der kapillaren Dichte, häufigere Kapillarerweiterung mit mehr Verzweigungen, Torquierungen und kapillaren Unregelmäßigkeiten. Zusätzlich zeigten Psoriasispatienten signifikant höhere inflammatorische Serummarker und eine gesteigerte Intima-Media-Dicke. In unserem Kollektiv bestand kein Zusammenhang zwischen Krankheitsdauer oder Schweregrad der Psoriasis und spezifischen Kapillarveränderungen. Schlussfolgerungen: Die Nagelfalzkapillaren der untersuchten Psoriasispatienten zeigten ausgeprägte mikrovaskuläre Veränderungen, welche mit erhöhten Markern einer systemischen Entzündung und Frühzeichen einer Atherosklerose korrelierten. Weitere Studien sind erforderlich, um die Rolle der digitalen Videokapillarmikroskopie in der Bewertung des kardiovaskulären Risikos von Psoriasispatienten zu untersuchen.
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31
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Kotzerke M, Mitri F, Enk A, Toberer F, Haenssle H. A Case of Extensive Grover’s Disease in a Patient with a History of Multiple Non-Melanoma Skin Cancers. Case Rep Dermatol 2021; 13:553-557. [PMID: 35082618 PMCID: PMC8739631 DOI: 10.1159/000519168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
We report on a 69-year-old man who presented with itching and erythematous papules on his torso and extremities, which were resistant to topical therapy with antibiotics and steroids. Physical examination revealed multiple erythematous papules on his back, neckline, and lower extremities. The lesions had appeared 4 years earlier and usually worsened with heat or extensive sweating. Histopathology of previous skin biopsies had shown multiple cutaneous squamous cell carcinomas or was non-conclusive. Thus, a re-biopsy was performed, revealing acanthosis and focal acantholytic dyskeratosis. These clinical and anamnestic findings lead to the diagnosis of extensive Grover’s disease (GD). Oral therapy with isotretinoin 30-mg QD led to the regression of the skin lesions. Topical adapalene, as well as topical corticosteroids, were later prescribed for maintenance therapy.
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Dick J, Kröhl V, Enk A, Hartschuh W, Gholam P. Improvement in Quality of Life and Pain in Patients With Hidradenitis Suppurativa After Wide Local Excision: A Prospective Study. Dermatol Surg 2021; 47:1556-1561. [PMID: 34537785 DOI: 10.1097/dss.0000000000003235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects patients' quality of life (QoL). OBJECTIVE To investigate changes in QoL in patients with HS after wide local excision (WLE) and to examine the level of pain, rate of postoperative complications, recurrences, and the time to complete wound closure. METHODS Fifty-five patients were enrolled in this prospective study. All patients underwent WLE of HS, followed by secondary wound healing. Dermatologic Life Quality Questionnaire, pain, and wound size were measured 1 day, 3 weeks, 3 months, and 6 months after surgery. RESULTS Dermatologic Life Quality Questionnaire and pain scores (mean ± SD) improved significantly (both p < .001) from 14.5 ± 7.3 and 3.7 ± 2.8 at baseline to 5.8 ± 6.9 and 0.8 ± 1.7, 6 months postoperatively, respectively. Wounds were closed completely by secondary intention after 4.4 ± 2.8 months. Sixteen patients (29.1%) experienced postoperative complications, local recurrences in the treated sites were observed in 11 patients (20%), and new lesions in untreated sites were observed in 5 cases (9.1%). CONCLUSION Wide local excision significantly improves patients' QoL and pain, and, given its low rate of recurrence and complications, should be considered as a first-line therapy, especially in patients with higher Hurley stages.
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Affiliation(s)
- Julika Dick
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Haut-und Laserzentrum Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Ramcke T, Vicari E, Bolduan V, Enk A, Hadaschik E. Bullous pemphigoid (BP) patients with selective IgG autoreactivity against BP230: Review of a rare but valuable cohort with impact on the comprehension of the pathogenesis of BP. J Dermatol Sci 2021; 105:72-79. [DOI: 10.1016/j.jdermsci.2021.11.011] [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] [Received: 08/24/2021] [Revised: 11/12/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
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34
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Winkler JK, Tschandl P, Toberer F, Sies K, Fink C, Enk A, Kittler H, Haenssle HA. Monitoring patients at risk for melanoma: May convolutional neural networks replace the strategy of sequential digital dermoscopy? Eur J Cancer 2021; 160:180-188. [PMID: 34840028 DOI: 10.1016/j.ejca.2021.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Sequential digital dermoscopy (SDD) is applied for early melanoma detection by uncovering dynamic changes of monitored lesions. Convolutional neural networks (CNN) are capable of high diagnostic accuracies similar to trained dermatologists. OBJECTIVES To investigate the capability of CNN to correctly classify melanomas originally diagnosed by mere dynamic changes during SDD. METHODS A retrospective cross-sectional study using image quartets of 59 high-risk patients each containing one melanoma diagnosed by dynamic changes during SDD and three nevi (236 lesions). Two validated CNN classified quartets at baseline or after SDD follow-up at the time of melanoma diagnosis. Moreover, baseline quartets were rated by 26 dermatologists. The main outcome was the number of quartets with correct classifications. RESULTS CNN-1 correctly classified 9 (15.3%) and CNN-2 8 (13.6%) of 59 baseline quartets. In baseline images, CNN-1 attained a sensitivity of 25.4% (16.1%-37.8%) and specificity of 92.7% (87.8%-95.7%), whereas CNN-2 of 28.8% (18.8%-41.4%) and 75.7% (68.9%-81.4%). Expectedly, after SDD follow-up CNN more readily detected melanomas resulting in improved sensitivities (CNN-1: 44.1% [32.2%-56.7%]; CNN-2: 49.2% [36.8%-61.6%]). Dermatologists were told that each baseline quartet contained one melanoma, and on average, correctly classified 24 (22-27) of 59 quartets. Correspondingly, accepting a baseline quartet to be appropriately classified whenever the highest malignancy score was assigned to the melanoma within, CNN-1 and CNN-2 correctly classified 28 (47.5%) and 22 (37.3%) of 59 quartets, respectively. CONCLUSIONS The tested CNN could not replace the strategy of SDD. There is a need for CNN capable of integrating information on dynamic changes into analyses.
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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35
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Bardehle F, Sies K, Enk A, Rosenberger A, Fink C, Haenssle H. Nailfold videocapillaroscopy identifies microvascular pathologies in psoriasis vulgaris: Results of a prospective controlled study. J Dtsch Dermatol Ges 2021; 19:1736-1744. [PMID: 34792866 DOI: 10.1111/ddg.14606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/23/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis is considered an independent cardiovascular risk factor, evidentially driving atherosclerosis. However, little is known about changes in the microvasculature of non-lesional skin in psoriasis patients. This study systematically examined capillary pathologies in psoriasis patients by digital video nailfold capillaroscopy. PATIENTS AND METHODS Prospective study comparing nailfold capillaries of psoriasis patients with those of healthy controls. Nailfold capillaries were evaluated for 21 parameters and results were correlated with characteristics of patients and psoriatic disease, laboratory parameters, and measurements of carotid intima-media thickness. RESULTS 77 psoriasis patients (24 patients with additional psoriatic arthritis) and 71 controls were well-matched for demographic features and for relevant confounding factors causing microangiopathy. In comparison with controls, psoriasis patients showed a significant loss of capillaries, capillary expansion with increased ramifications and tortuosity and capillary irregularities. Moreover, in psoriasis patients we found significantly elevated serum markers of inflammation and significantly increased intima-media-thickness measurements. We found no effect of disease duration nor disease activity on capillary changes. CONCLUSIONS Nailfold capillaries of psoriasis patients showed marked microvascular abnormalities accompanied by increased markers of systemic inflammation and atherosclerosis. Prospective cohort studies are needed to assess the role of nailfold capillaroscopy for predicting the cardiovascular risk of psoriasis patients.
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Affiliation(s)
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Germany
| | | | - Christine Fink
- Department of Dermatology, University of Heidelberg, Germany
| | - Holger Haenssle
- Department of Dermatology, University of Heidelberg, Germany
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Pilz R, Opálka L, Majcher A, Grimm E, Van Maldergem L, Mihalceanu S, Schäkel K, Enk A, Aubin F, Bursztejn AC, Brischoux-Boucher E, Fischer J, Sandhoff R. Formation of keto-type ceramides in palmoplantar keratoderma based on biallelic KDSR mutations in patients. Hum Mol Genet 2021; 31:1105-1114. [PMID: 34686882 DOI: 10.1093/hmg/ddab309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
Functional skin barrier requires sphingolipid homeostasis. 3-ketodihydrosphingosine reductase or KDSR is a key enzyme of sphingolipid anabolism catalyzing the reduction of 3-ketodihydrosphingosine to sphinganine. Biallelic mutations in the KDSR gene may cause erythrokeratoderma variabilis et progressive-4, later specified as PERIOPTER syndrome, emphasizing a characteristic periorifical and ptychotropic erythrokeratoderma. We report another patient with compound heterozygous mutations in KDSR, born with generalized harlequin ichthyosis, which progressed into palmoplantar keratoderma. To determine whether patient-associated KDSR mutations lead to KDSR substrate accumulation and/or unrecognized sphingolipid downstream products in stratum corneum we analyzed lipids of this and previously published patients with non-identical biallelic mutations in KDSR. In stratum corneum of both patients we identified hitherto unobserved skin ceramides with an unusual keto-type sphingoid base in lesional and non-lesional areas, which accounted for up to 10% of the measured ceramide species. Furthermore, an overall shorter mean chain length of free and bound sphingoid bases was observed-shorter mean chain length of free sphingoid bases was also observed in lesional psoriasis vulgaris SC, but not generally in lesional atopic dermatitis SC. Formation of keto-type ceramides is probably due to a bottle neck in metabolic flux through KDSR and a bypass by ceramide synthases, which highlights the importance of tight intermediate regulation during sphingolipid anabolism and reveals substrate deprivation as potential therapy.
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Affiliation(s)
- Robert Pilz
- Lipid Pathobiochemistry Group, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, 69120, Heidelberg, Germany
| | - Lukáš Opálka
- Lipid Pathobiochemistry Group, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Skin Barrier Research Group, Department of Organic and Bioorganic Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Adam Majcher
- Lipid Pathobiochemistry Group, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Skin Barrier Research Group, Department of Organic and Bioorganic Chemistry, Faculty of Pharmacy in Hradec Králové, Charles University, 500 05 Hradec Králové, Czech Republic
| | - Elisabeth Grimm
- Lipid Pathobiochemistry Group, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.,Faculty of Biosciences, Heidelberg University, 69120, Heidelberg, Germany
| | - Lionel Van Maldergem
- Centre de Génétique Humaine, Université de Franche-Comté, 25000, Besançon, France.,Clinical Investigation Center 1431, National Institute of Health and Medical Research (INSERM), University Hospital, 25000, Besançon, France
| | - Silvia Mihalceanu
- Department of Dermatology, Medical Faculty of the University of Heidelberg, 69120, Heidelberg, Germany
| | - Knut Schäkel
- Department of Dermatology, Medical Faculty of the University of Heidelberg, 69120, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, Medical Faculty of the University of Heidelberg, 69120, Heidelberg, Germany
| | - François Aubin
- Service de Dermatologie et INSERM 1098 RIGHT, CHU et UFR Santé, 25000, Besançon France
| | | | | | - Judith Fischer
- Institute of Human Genetics, Medical Center, Faculty of Medicine, University of Freiburg, 79106, Freiburg im Breisgau, Germany
| | - Roger Sandhoff
- Lipid Pathobiochemistry Group, German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany
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37
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Bolduan V, Haeberle S, Vicari E, Ramcke T, Enk A, Hadaschik E. 012 Pathogenic murine anti-BP230 autoantibody 20B12: Elucidating the mechanism of blister formation. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.013] [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: 11/30/2022]
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38
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Vicari E, Haeberle S, Bolduan V, Ramcke T, Vorobyev A, Goletz S, Iwata H, Ludwig R, Schmidt E, Enk A, Hadaschik E. 006 Pathogenic autoantibody derived from Treg-deficient scurfy mice targets Type VII Collagen and induces Epidermolysis bullosa acquisita-like blistering disease. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.007] [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: 11/26/2022]
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39
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Hoffmann JHO, Knoop C, Enk A, Hadaschik EN. Detailed Long-term Dynamics of Neutrophil-to-Lymphocyte Ratio under Biologic Treatment Reveals Differential Effects of Tumour Necrosis Factor-alpha and Interleukin 12/23 Antagonists. Acta Derm Venereol 2021; 101:adv00568. [PMID: 34590148 PMCID: PMC9425564 DOI: 10.2340/actadv.v101.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Psoriasis is thought to be associated with a reduced life expectancy through systemic inflammation. A comparative, retrospective analysis of neutrophil-to-lympho-cyte ratio, a biomarker of systemic inflammation and cardiovascular risk, under 196 treatments with tumour necrosis factor-α and interleukin-12/23 antagonists was performed. Neutrophil-to-lympho-cyte ratio decreased significantly within 3 months of initiation of treatment and remained stable at reduced levels for at least 33 months. Dynamics were more pronounced and neutrophil-to-lympho-cyte ratio under treatment was lower in patients treated with tumour necrosis factor-α compared with interleukin-12/23 antagonists (geometric mean (95% confidence interval): 2.03 (1.9, 2.1) vs 2.63 (2.2, 3.2), respectively, p = 0.014). tumour necrosis factor-α antagonist treatment and baseline neutrophil-to-lympho-cyte ratio were independent predictors of a median low cardiovascular risk neutrophil-to-lympho-cyte ratio (< 2.15) during treatment (odds ratio (95% confidence interval): 0.53 (0.4-0.8) and 4.68 (1.0-19.1), p = 0.001 and p = 0.032, respectively). These results demonstrate a rapid and sustained reduction in biomarkers of systemic inflammation under biologic treatment. Furthermore, these data suggest class-specific effects on systemic inflammation, which may be relevant for the prevention of psoriasis co-morbidity by systemic treatment.
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Affiliation(s)
- Jochen H O Hoffmann
- Department of Dermatology, University of Heidelberg, DE-69120 Heidelberg, Germany. E-mail:
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40
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Ramcke T, Enk A, Gholam P. Folliculotropic Mycosis Fungoides in the Tumour Stage Mimics Venous Leg Ulcers. Acta Derm Venereol 2021; 101:adv00537. [PMID: 34427315 PMCID: PMC9425599 DOI: 10.2340/00015555-3903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Torben Ramcke
- Department of Dermatology, University Hospital Heidelberg, DE-69120 Heidelberg, Germany. E-mail:
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Winkler JK, Sies K, Fink C, Toberer F, Enk A, Abassi MS, Fuchs T, Blum A, Stolz W, Coras-Stepanek B, Cipic R, Guther S, Haenssle HA. Kollektive menschliche Intelligenz übertrifft künstliche Intelligenz in einem Quiz zur Klassifizierung von Hautläsionen. J Dtsch Dermatol Ges 2021; 19:1178-1185. [PMID: 34390156 DOI: 10.1111/ddg.14510_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | - Tobias Fuchs
- Forschungs- und Entwicklungsabteilung, FotoFinder Systems GmbH, Bad Birnbach
| | | | - Wilhelm Stolz
- Klinik für Dermatologie, Allergologgie und Umweltmedizin II, Krankenhaus Thalkirchner Straße, München
| | - Brigitte Coras-Stepanek
- Klinik für Dermatologie, Allergologgie und Umweltmedizin II, Krankenhaus Thalkirchner Straße, München
| | - Robert Cipic
- Klinik für Dermatologie, Allergologgie und Umweltmedizin II, Krankenhaus Thalkirchner Straße, München
| | - Stefanie Guther
- Klinik für Dermatologie, Allergologgie und Umweltmedizin II, Krankenhaus Thalkirchner Straße, München
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42
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Sies K, Winkler JK, Fink C, Bardehle F, Toberer F, Kommoss FKF, Buhl T, Enk A, Rosenberger A, Haenssle HA. Auswirkungen des „dunklen Rand‐Artefakts“ in dermatoskopischen Bildern auf die diagnostische Leistungsfähigkeit eines deep learning neuronalen Netzwerkes mit Marktzulassung. J Dtsch Dermatol Ges 2021; 19:842-851. [PMID: 34139087 DOI: 10.1111/ddg.14384_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/27/2020] [Indexed: 02/06/2023]
Abstract
HINTERGRUND UND ZIELE Systeme künstlicher Intelligenz (durch "deep learning" faltende neuronale Netzwerke; engl. convolutional neural networks, CNN) erreichen inzwischen bei der Klassifikation von Hautläsionen vergleichbar gute Ergebnisse wie Dermatologen. Allerdings müssen die Limitationen solcher Systeme vor flächendeckendem klinischem Einsatz bekannt sein. Daher haben wir den Einfluss des "dunklen Rand-Artefakts" (engl. dark corner artefact; DCA) in dermatoskopischen Bildern auf die diagnostische Leistung eines CNN mit Marktzulassung zur Klassifikation von Hautläsionen untersucht. PATIENTEN UND METHODEN Ein Datensatz aus 233 Bildern von Hautläsionen (60 maligne und 173 benigne) ohne DCA (Kontrolle) wurde digital so modifiziert, dass kleine, mittlere oder große DCA zu sehen waren. Alle 932 Bilder wurden dann mittels CNN mit Marktzulassung (Moleanalyzer-Pro® , FotoFinder Systems) auf Malignitätsscores hin analysiert. Das Spektrum reichte von 0-1; ein Score von > 0,5 wurde als maligne klassifiziert. ERGEBNISSE In der Kontrollserie ohne DCA erreichte das CNN eine Sensitivität von 90,0 % (79,9 %-95,3 %), eine Spezifität von 96,5 % (92,6 %-98,4 %) sowie eine Fläche unter der Kurve (AUC, area under the curve) der "receiver operating characteristic" (ROC) von 0,961 (0,932-0,989). In den Datensätzen mit kleinen beziehungsweise mittleren DCA war die diagnostische Leistung vergleichbar. In den Bildersätzen mit großen DCA wurden allerdings signifikant höhere Malignitätsscores erzielt. Dies führte zu einer signifikant verminderten Spezifität (87,9 % [82,2 %-91,9 %], P < 0,001) sowie einer nicht signifikant erhöhten Sensitivität (96,7 % [88,6 %-99,1 %]). Die ROC-AUC blieb mit 0,962 (0,935-0,989) unverändert. SCHLUSSFOLGERUNGEN Die Klassifizierung mittels des CNN war bei dermatoskopischen Bildern mit kleinen oder mittleren DCA nicht beeinträchtigt, das System zeigte jedoch Schwächen bei großen DCA. Wenn Ärzte solche Bilder zur Klassifikation mittels CNN einreichen, sollten sie sich dieser Grenzen der Technologie bewusst sein.
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Affiliation(s)
| | | | | | | | | | - Felix K F Kommoss
- Abteilung Pathologie, Institut für Pathologie, Universitätsklinikum Heidelberg
| | - Timo Buhl
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Göttingen
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Mitri F, Enk A, Toberer F. [Axillary skin-colored papules in a young woman]. Hautarzt 2021; 73:86-87. [PMID: 34132859 DOI: 10.1007/s00105-021-04835-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- F Mitri
- Universitätshautklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - A Enk
- Universitätshautklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - F Toberer
- Universitätshautklinik Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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Winkler JK, Sies K, Fink C, Toberer F, Enk A, Abassi MS, Fuchs T, Blum A, Stolz W, Coras-Stepanek B, Cipic R, Guther S, Haenssle HA. Collective human intelligence outperforms artificial intelligence in a skin lesion classification task. J Dtsch Dermatol Ges 2021; 19:1178-1184. [PMID: 34096688 DOI: 10.1111/ddg.14510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/04/2020] [Accepted: 03/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Convolutional neural networks (CNN) enable accurate diagnosis of medical images and perform on or above the level of individual physicians. Recently, collective human intelligence (CoHI) was shown to exceed the diagnostic accuracy of individuals. Thus, diagnostic performance of CoHI (120 dermatologists) versus individual dermatologists versus two state-of-the-art CNN was investigated. PATIENTS AND METHODS Cross-sectional reader study with presentation of 30 clinical cases to 120 dermatologists. Six diagnoses were offered and votes collected via remote voting devices (quizzbox®, Quizzbox Solutions GmbH, Stuttgart, Germany). Dermatoscopic images were classified by a binary and multiclass CNN (FotoFinder Systems GmbH, Bad Birnbach, Germany). Three sets of diagnostic classifications were scored against ground truth: (1) CoHI, (2) individual dermatologists, and (3) CNN. RESULTS CoHI attained a significantly higher accuracy [95 % confidence interval] (80.0 % [62.7 %-90.5 %]) than individual dermatologists (75.7 % [73.8 %-77.5 %]) and CNN (70.0 % [52.1 %-83.3 %]; all P < 0.001) in binary classifications. Moreover, CoHI achieved a higher sensitivity (82.4 % [59.0 %-93.8 %]) and specificity (76.9 % [49.7 %-91.8 %]) than individual dermatologists (sensitivity 77.8 % [75.3 %-80.2 %], specificity 73.0 % [70.6 %-75.4 %]) and CNN (sensitivity 70.6 % [46.9 %-86.7 %], specificity 69.2 % [42.4 %-87.3 %]). The diagnostic accuracy of CoHI was superior to that of individual dermatologists (P < 0.001) in multiclass evaluation, with the accuracy of the latter comparable to multiclass CNN. CONCLUSIONS Our analysis revealed that the majority vote of an interconnected group of dermatologists (CoHI) outperformed individuals and CNN in a demanding skin lesion classification task.
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | - Tobias Fuchs
- Department of Research and Development, FotoFinder Systems GmbH, Bad Birnbach, Germany
| | - Andreas Blum
- Public, Private and Teaching Practice, Konstanz, Germany
| | - Wilhelm Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Brigitte Coras-Stepanek
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Robert Cipic
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Stefanie Guther
- Department of Dermatology, Allergology and Environmental Medicine II, Hospital Thalkirchner Street, Munich, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Winkler JK, Haenssle HA, Enk A, Toberer F, Hartmann M. [Successful treatment of chronic prurigo with dupilumab]. Hautarzt 2021; 72:528-532. [PMID: 33180178 PMCID: PMC8169508 DOI: 10.1007/s00105-020-04721-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronische Prurigo ist durch anhaltenden Pruritus, teils einhergehend mit sekundären Kratzläsionen, gekennzeichnet. Die Abklärung der Genese ist von besonderem Stellenwert, wobei eine atopische Diathese häufig einen ätiologischen Faktor darstellt. Wir präsentieren einen Patienten mit chronischem Pruritus multifaktorieller Genese (atopische Diathese, chronische Niereninsuffizienz, Diabetes mellitus, Polyneuropathie). Nach multiplen erfolglosen Vortherapien behandelten wir den Patienten mit Dupilumab, worunter sich ein sehr positiver Erkrankungsverlauf mit deutlicher Besserung der Lebensqualität zeigte.
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Affiliation(s)
- Julia K Winkler
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Holger A Haenssle
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Alexander Enk
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Ferdinand Toberer
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Martin Hartmann
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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Schank TE, Forschner A, Sachse MM, Dimitrakopoulou-Strauss A, Sachpekidis C, Stenzinger A, Volckmar AL, Enk A, Hassel JC. Complete Metabolic Response in FDG-PET-CT Scan before Discontinuation of Immune Checkpoint Inhibitors Correlates with Long Progression-Free Survival. Cancers (Basel) 2021; 13:cancers13112616. [PMID: 34073477 PMCID: PMC8198795 DOI: 10.3390/cancers13112616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/30/2021] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Immunotherapy is the standard of care in patients harboring metastasized melanoma. However, once further tumor growth is stopped it remains unclear when immunotherapy can be safely ceased. This clinical question is increasingly raised especially in patients with a strong desire to discontinue therapy or in patients who are forced to pause treatment due to severe immune-related side effects. With our study we aim to provide data which may be helpful for clinicians and patients when treatment discontinuation is considered. Further prospective, multicenter studies are needed to further address this important clinical issue. Abstract Checkpoint inhibitors have revolutionized the treatment of patients with metastasized melanoma. However, it remains unclear when to stop treatment. We retrospectively analyzed 45 patients (median age 64 years; 58% male) with metastasized melanoma from 3 cancer centers that received checkpoint inhibitors and discontinued therapy due to either immune-related adverse events or patient decision after an (18F)2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) combined with a low-dose CT scan (FDG-PET-CT) scan without signs for disease progression. After a median of 21 (range 1–42) months of immunotherapy an FDG-PET-CT scan was performed to evaluate disease activity. In these, 32 patients (71%) showed a complete metabolic response (CMR) and 13 were classified as non-CMR. After a median follow-up of 34 (range 1–70) months, 3/32 (9%) of CMR patients and 6/13 (46%) of non-CMR patients had progressed (p = 0.007). Progression-free survival (PFS), as estimated from the date of last drug administration, was significantly longer among CMR patients than non-CMR (log-rank: p = 0.001; hazard ratio: 0.127; 95% CI: 0.032–0.511). Two-year PFS was 94% among CMR patients and 62% among non-CMR patients. Univariable Cox regression showed that metabolic response was the only parameter which predicted PFS (p = 0.004). Multivariate analysis revealed that metabolic response predicted disease progression (p = 0.008). In conclusion, our findings suggest that patients with CMR in an FDG-PET-CT scan may have a favorable outcome even if checkpoint inhibition is discontinued.
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Affiliation(s)
- Timo E. Schank
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany; (A.E.); (J.C.H.)
- Correspondence:
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tübingen, 72076 Tübingen, Germany;
| | - Michael Max Sachse
- Department of Dermatology, Allergology, and Phlebology, Hospital Bremerhaven Reinkenheide, 27574 Bremerhaven, Germany;
| | | | - Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, 69120 Heidelberg, Germany; (A.D.-S.); (C.S.)
| | - Albrecht Stenzinger
- Department of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (A.S.); (A.-L.V.)
| | - Anna-Lena Volckmar
- Department of Pathology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (A.S.); (A.-L.V.)
| | - Alexander Enk
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany; (A.E.); (J.C.H.)
| | - Jessica C. Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany; (A.E.); (J.C.H.)
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Machiraju D, Wiecken M, Lang N, Hülsmeyer I, Roth J, Schank TE, Eurich R, Halama N, Enk A, Hassel JC. Soluble immune checkpoints and T-cell subsets in blood as biomarkers for resistance to immunotherapy in melanoma patients. Oncoimmunology 2021; 10:1926762. [PMID: 34104542 PMCID: PMC8158029 DOI: 10.1080/2162402x.2021.1926762] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Different mechanisms lead to immune checkpoint inhibitor (ICI) resistance. Identifying clinically useful biomarkers might improve drug selection and patients’ therapy. We analyzed the soluble immune checkpoints sPD1, sPDL1, sLAG3, and sTIM3 using ELISA and their expression on circulating T cells using FACS in pre- and on-treatment blood samples of ICI treated melanoma patients. In addition, pre-treatment melanoma metastases were stained for TIM3 and LAG3 expression by IHC. Results were correlated with treatment response and progression-free survival (PFS). Resistance to anti-PD1 treatment (n = 48) was associated with high pre-treatment serum levels of sLAG3 (DCR: p = .009; PFS: p = .018; ROC cutoff >148 pg/ml) but not sPD1, sPDL1 or sTIM3. In contrast, resistance to ipilimumab plus nivolumab (n = 42) was associated with high levels of sPD1 (DCR: p = .019, PFS: p = .046; ROC cutoff >167 pg/ml) but not sPDL1, sLAG3 or sTIM3. Both treatment regimens shared a profound increase of sPD1 serum levels with treatment (p < .0001). FACS analysis revealed reduced frequencies of CD3+ CD8+ PD1 + T cells (p = .028) in anti-PD1-resistant patients, whereas increased frequencies of CD3+ CD4+ LAG3 + T cells characterized patients resistant to ipilimumab plus nivolumab (p = .033). Unlike anti-PD1 monotherapy, combination blockade significantly increased proliferating T cells (CD3+ CD8+ Ki67 + T cells; p < .0001) and eosinophils (p = .001). In melanoma metastases, an increased infiltration with TIM3+ or LAG3 + T cells in the tumor microenvironment correlated with a shorter PFS under anti-PD1 treatment (TIM3: p = .019, LAG3: p = .07). Different soluble immune checkpoints characterized checkpoint inhibitor-resistant melanoma. Measuring these serum markers may have the potential to be used in clinical routine.
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Affiliation(s)
- Devayani Machiraju
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Melanie Wiecken
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Faculty of Biosciences, University of Heidelberg, Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center and Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nina Lang
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Ingrid Hülsmeyer
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Jasmin Roth
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Timo E Schank
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Rosa Eurich
- Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Niels Halama
- Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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48
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Sies K, Winkler JK, Fink C, Bardehle F, Toberer F, Kommoss FKF, Buhl T, Enk A, Rosenberger A, Haenssle HA. Dark corner artefact and diagnostic performance of a market-approved neural network for skin cancer classification. J Dtsch Dermatol Ges 2021; 19:842-850. [PMID: 33973372 DOI: 10.1111/ddg.14384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/27/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Convolutional neural networks (CNN) have proven dermatologist-level performance in skin lesion classification. Prior to a broader clinical application, an assessment of limitations is crucial. Therefore, the influence of a dark tubular periphery in dermatoscopic images (also called dark corner artefact [DCA]) on the diagnostic performance of a market-approved CNN for skin lesion classification was investigated. PATIENTS AND METHODS A prospective image set of 233 skin lesions (60 malignant, 173 benign) without DCA (control-set) was modified to show small, medium or large DCA. All 932 images were analyzed by a market-approved CNN (Moleanalyzer-Pro® , FotoFinder Systems), providing malignancy scores (range 0-1) with the cut-off > 0.5 indicating malignancy. RESULTS In the control-set the CNN achieved a sensitivity of 90.0 % (79.9 % - 95.3 %), a specificity of 96.5 % (92.6 % - 98.4 %), and an area under the curve (AUC) of receiver operating characteristics (ROC) of 0.961 (0.932 - 0.989). Comparable diagnostic performance was observed in the DCAsmall-set and DCAmedium-set. Conversely, in the DCAlarge-set significantly increased malignancy scores triggered a significantly decreased specificity (87.9 % [82.2 % - 91.9 %], P < 0.001), non-significantly increased sensitivity (96.7 % [88.6 % - 99.1 %]) and unchanged ROC-AUC of 0.962 (0.935 - 0.989). CONCLUSIONS Convolutional neural network classification was robust in images with small and medium DCA, but impaired in images with large DCA. Physicians should be aware of this limitation when submitting images to CNN classification.
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Affiliation(s)
- Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Felicitas Bardehle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Felix K F Kommoss
- Department of Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Goettingen, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Albert Rosenberger
- Department of Genetic Epidemiology, University of Göttingen, Goettingen, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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49
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Hanner S, Stroh H, Enk A, Hoffmann J. [Cutaneous pseudolymphoma after hirudotherapy : Case report and review]. Hautarzt 2021; 73:152-155. [PMID: 33884433 PMCID: PMC8799561 DOI: 10.1007/s00105-021-04812-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/25/2022]
Abstract
Unter dem Begriff Pseudolymphom (PSL) versteht man eine benigne, reaktive Lymphoproliferation der Haut, die klinisch und/oder histologisch ein malignes Lymphom simulieren kann. Die genaue Ätiopathogenese ist bis heute nicht gänzlich geklärt. Man unterscheidet die primären, idiopathischen PSL ohne erkennbare Ursache von den sekundären PSL mit bekanntem Stimulus. Wir berichten über das Auftreten von Pseudolymphomen nach einer Behandlung mit medizinischen Blutegeln (Hirudotherapie). Bisher wurden nach bestem Wissen und Gewissen insgesamt nur 9 Fälle von kutanen PSL nach Hirudotherapie in der Literatur beschrieben.
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Affiliation(s)
- Susanne Hanner
- Hautklinik, Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Hannah Stroh
- Haut- und Laserzentrum Heidelberg, Dres. Durani, Bergheimer Str. 56a, 69115, Heidelberg, Deutschland
| | - Alexander Enk
- Hautklinik, Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Jochen Hoffmann
- Hautklinik, Universität Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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50
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Bertlich I, Hartschuh W, Fink C, Haenssle H, Enk A, Toberer F. Sudden reticular pigmentation of the face. J Cutan Pathol 2021; 49:593-596. [PMID: 33778983 DOI: 10.1111/cup.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ines Bertlich
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Wolfgang Hartschuh
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Christine Fink
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Holger Haenssle
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Alexander Enk
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
| | - Ferdinand Toberer
- University Hospital Heidelberg, Department of Dermatology, Heidelberg, Germany
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