ORGAN CULTURE OF ADULT HUMAN SKIN

Proliferation and differentiation of the epidermis in organ culture of adult human skin by the sponge matrix method were studied histologically and autoradiographically, and the following results were obtained: 1) On the first day of culture, mitotic figures were already observable in the epidermis. The outgrowth of epidermal cells at the margins of the explants started. On the second day, there was transformation to a zone that will be referred to as the newly formed stratum corneum in the upper epidermis. 2) On the third and fourth days, the increased growth of epidermal cells caused thickening of the epidermis. Simultaneously, Malpighian cells progressively differentiated into a cornified layer. 3) On and after the fifth day, the basospinous cell layer was reduced in thickness in most of explants. On the ninth and tenth days, DNA synthesis in the basal layer was still obvious, although the epidermis showed a thickness of only one or two cells overlaid with a large number of horny layers. 4) In the culture medium supplemented with corticosteroid, the epidermal growth was slightly depressed with lessened formation of stratum corneum in the early stages of culture as compared with the explants cultured in the basic medium. The reduction of the basospinous layer was scarcely notable after the fifth day. Even after 10-11 days, epidermal cells were well preserved and their stratified squamous architecture was less disorganized. It seemed that corticosteroid could prolong the survival of adult human skin in vitro. These findings indicate that this culture technique could be used as a model for organ culture of adult human skin.

Localized Cutis Marmorata Telangiectatica Congenita on the Back of a Young Man

We report the clinical and light microscopic features of a case of cutis marmorata telangiectatica congenita with a painful refractory ulcer that was found on the back of a young Japanese man. The ulcer was positioned on the upper back over the spinal bone. In addition to the anatomical location of the ulcer, the vascular ectases may have played a part in the refractory ulceration.

Characteristics of Skin Surface Morphology and Transepidermal Water Loss in Clinically Normal-Appearing Skin of Patients with Atopic Dermatitis: A Video-Microscopy Study

In patients with atopic dermatitis (AD), it is debatable whether clinically normal-appearing skin is equal to non-atopic normal skin. The aim of this study was to quantitatively evaluate the characteristics of normal-appearing skin of AD. We examined the value of skin surface morphological changes using a new, simple, computer-assisted method with a video microscope. We also investigated the physiological function as represented by transepidermal water loss (TEWL) levels in 44 patients with AD and 15 normal controls. The morphological changes were represented by a variation coefficient score that reflected the irregularity of skin ridges, named the surface irregularity index (SII). There were significant differences between the normal-appearing skin of AD and non-atopic normal skin in both SII (P<0.001) and in TEWL (P<0.01). Especially for the SII, there were significant differences between AD subgroups subdivided by peripheral blood eosinophil count (Eo), serum lactate dehydrogenase level, and clinical score. TEWL values were significantly higher in the high-Eo AD group (n=15) than in the low-Eo AD group (n=29) (P<0.05). These findings indicate that clinically normal-appearing skin of AD patients with high disease activity differs from non-atopic normal skin in both surface morphology and physiology and that these changes reflect the current disease activity.

Cancer-related anemia: Correlation analysis among serum levels of hemoglobin, IL-6, hepcidin, albumin, and erythropoietin

e20655

Background: Hepcidin is a peptide hormone that regulates iron re-utilization and has been implicated as causing anemia by restricting the delivery of iron to erythrocyte progenitors. A potent inducer of hepcidin in hepatocytes is IL-6, an inflammatory cytokine. In the present study, we investigated the relationship between cancer-related anemia and inflammatory activity, including the cytokines. Methods: Anemia in newly diagnosed patients (pts) with solid tumors or malignant lymphoma was studied excluding pts showing evidence of myelosuppression and hepatic and renal failure. The characteristics of anemia in cancer pts were compared with those in mice bearing human lung large cell cancer LC-6-JCK. Hematological assessment was conducted using clinical practice methods. Serum levels of cytokines were determined by ELISA. Hepcidin was measured by LC/MS/MS. Results: Thirty parameters were analyzed in 11 pts. Clustering analysis of the 30 parameters resulted in 3 clusters including hemoglobin (Hb)/albumin (Alb), IL-6/hepcidin/ferritin, and erythropoietin (EPO). Hb levels showed weak negative correlation with IL-6 and hepcidin and a positive correlation with Alb levels (R=0.763, P=0.006). In addition, IL-6 levels weakly correlated with hepcidin and Alb. Hepcidin correlated with ferritin (R=0.729, P=0.011). Correlations were observed between quality of life in cancer pts and anemia parameters including Hb and IL-6. Mice bearing LC-6-JCK tumors developed anemia with characteristic parameters similar to cancer pts with anemia ( Table ). A rat anti-mouse IL-6 receptor monoclonal antibody prevented the development of anemia in the LC-6-JCK model. Conclusions: Present results suggest that cancer-related anemia associates with IL-6, Alb and inflammatory acute phase reaction including hepcidin and ferritin. Further analysis of anemia in cancer pts and murine models would be useful for investigating the mechanisms of cancer anemia.

[Table: see text]

No significant financial relationships to disclose.

Antitumor activity of chemoendocrine therapy in premenopausal (capecitabine [CAP] + tamoxifen [TAM]) and postmenopausal (CAP + letrozole [LET]) human breast cancer [BC] xenograft models

Abstract #2012

Background: The preferential treatment for estrogen receptor (ER)-positive metastatic or recurrent breast cancer is endocrine therapy unless it is life-threatening. CAP, an oral fluoropyrimidine, is activated to 5-FU by thymidine phosphorylase (TP) in tumors. We have evaluated the efficacy of endocrine therapy in combination with CAP in premenopausal and postmenopausal ER-positive human BC xenograft models.&#x2028; Methods: In a premenopausal BC model, ER-positive MCF7 cells were subcutaneously (sc) inoculated into nude mice which had been implanted sc with 0.25 mg 17β-estradiol pellets. The mice received 6 weeks oral therapy with vehicle, CAP (days 1-14, every 3 weeks) at the maximal tolerated dose (MTD) of 539 mg/kg or 2/3 MTD +/- TAM at 100 or 30 mg/kg/day. In a postmenopausal BC model, nude mice were ovariectomized and implanted sc with 1.5 mg androstenedione pellets the day before tumor cell inoculation. MCF7A25F3 cells, an aromatase gene transfectant of MCF7, were inoculated sc into the mice. The mice received 6 weeks' oral administration of vehicle, CAP (days 1-14, every 3 weeks) at 2/3 MTD +/- LET at 0.1 mg/kg/day. TP level in tumors was measured on the final day of the first treatment cycle by ELISA. In vitro ER reporter gene assays were performed by co-culturing MCF7 cells transfected with estrogen response element-GFP gene with stromal cells isolated from human BC tissues. Testosterone was added to the culture medium as a substrate for aromatase and the expression of GFP was measured.&#x2028; Results: In the premenopausal model, the antitumor activity of the combination therapy with CAP and TAM was significantly superior to that of each monotherapy (p&lt;0.001). In the postmenopausal model, the antitumor activity of the combination therapy with CAP and LET was also significantly superior to that of each monotherapy (p&lt;0.05). No augmentation of toxicity in terms of body weight loss was observed with the combination therapy in each xenograft model. In the premenopausal model, the tumor levels of TP were up-regulated (p&lt;0.05) by TAM treatment indicating that TAM might potentiate the antitumor activity of CAP. On the other hand, the tumor levels of TP remained unchanged by LET treatment in the postmenopausal model. In ER reporter gene assays, GFP expression was decreased by the addition of either 5'-deoxy-5-fluorouridine (5'-DFUR, an intermediate of CAP), 4-hydroxytamoxifen (4-OHT, active form of TAM) or LET in a concentration-dependent manner. 5'-DFUR showed at least additive inhibitory effect in combination with 4-OHT or LET.&#x2028; Conclusion: Chemoendocrine therapy using CAP might be a useful treatment modality for BC patients regardless of the menopausal status.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2012.

Effects of tacrolimus ointment on facial eruption, itch, and scratching in patients with atopic dermatitis

The action of tacrolimus ointment on pruritus in atopic dermatitis is still unclear. In this open study we investigated both the relationship between the severity of eruptions and the degree of itch and scratching in patients with atopic dermatitis and the effects of topical tacrolimus on these symptoms. Seventy adults with moderate to severe atopic dermatitis with facial eruptions that were recalcitrant to topical steroids applied a 0.1% tacrolimus ointment twice per day after discontinuation of topical steroid. The eruption scores and an assessment of the itch and scratching were recorded for 12 weeks. Oral antihistamine was prescribed at least one month before the study and continued unchanged during the study in each patient. The percentage reduction in the score of itch and scratching after two weeks (n=59) was significantly higher than in the score of eruption. Although there was no significant relationship between the severity of the eruptions and the degree of itch and scratching during steroid application, a relationship became significant after four weeks (n=59) of tacrolimus use by a one-factor ANOVA analysis. This suggests that tacrolimus ointment is effective for the itch and scratching in cases where degrees might be discrepant from the severity of eruptions in patients with recalcitrant facial eruptions of AD.

Immunolocalization of fibroblast growth factor receptors in normal and wounded human skin

Fibroblast growth factors (FGFs) have been shown to play diverse roles in various tissues. To define their sites of action in normal human skin and during wound healing, we determined the protein expression of the four known fibroblast growth factor receptors (FGFRs) in normal and wounded human skin by immunohistochemistry. Four receptors (FGFR-1 to FGFR-4) showed distinct patterns of expression in normal skin. Expression of FGFR-1 was widespread in the epidermis, appendages, arrector pili muscles, blood vessels, and dermal fibroblasts. Intense expression of FGFR-2 and FGFR-4 was seen in the arrector pili muscles and smooth muscle cells of vessels. In the epidermis, the basal layer showed immunoreactivity for FGFR-2, whereas the suprabasal layers and the inner layers of hair follicles showed strong immunoreactivity for FGFR-3. In wounded skin, there was strong expression of FGFR-1 and FGFR-3, and moderate expression of FGFR-2 and FGFR-4 in the basal layer in newly forming epidermis. In granulation tissues, neocapillaries expressed all four FGFRs, fibroblasts/myofibroblasts expressed FGFR-1 and FGFR-3, and mononuclear inflammatory cells expressed FGFR-1 and FGFR-3. Our results suggest that the differences in the spatial patterns of FGFR expression in normal skin may generate functional diversity in response to FGFs and that in wounded skin, FGFs may function in wound healing via the induced FGFRs.

Cutaneous sarcoidosis successfully treated with topical tacrolimus

Sarcoidosis is a disorder characterized by macrophage- and T-cell-mediated responses to as yet unidentified infectious antigens or autoantigens. We describe a 62-year-old woman with a 10-year history of orange-yellow plaques of sarcoidosis on her face. Her cutaneous lesions responded to topical tacrolimus ointment after unsuccessful treatment with topical and systemic corticosteroids. No adverse effects were noted with topical tacrolimus in this patient. We discuss the mode of action by which this immunosuppressive agent may act against sarcoidosis.

Follicular lupus erythematosus: a new cutaneous manifestation of systemic lupus erythematosus

We report the clinical, histopathological and immunological features of follicular erythema and petechiae in a 30-year-old Japanese woman with systemic lupus erythematosus (SLE). Histology showed this eruption to constitute a cutaneous manifestation of SLE. To our knowledge, this is the first reported case of follicular erythema and petechiae in association with SLE. Accordingly, we propose that this rare eruption be termed 'follicular lupus erythematosus'.

Increased levels of serum tissue inhibitor of metalloproteinase-1 but not metalloproteinase-3 in atopic dermatitis

Matrix metalloproteinases and their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), contribute to inflammation-induced tissue destruction and subsequent remodeling for maintenance of tissue homeostasis. Since the production of these enzymes and their inhibitors is regulated by mediators such as proinflammatory cytokines and growth factors, elevated levels of serum TIMPs and/or MMPs have been documented in patients with several inflammatory disorders. In this study, we examined the role of TIMPs and MMPs in the pathogenesis of atopic dermatitis (AD) by evaluating the serum levels of TIMP-1 and MMP-3 in 40 patients with AD and 20 control subjects by ELISA. The serum TIMP-1 levels were significantly higher in AD patients in exacerbation status than in nonatopic subjects, whereas serum MMP-3 levels were not significantly different between them. As a result, AD patients revealed significantly elevated TIMP-1/MMP-3 ratios. The levels of serum TIMP-1 were significantly reduced in AD patients following conventional treatments. Significantly higher values of peripheral eosinophil counts, serum levels of IgE and lactate dehydrogenase, eruption score, and eruption area were noted in the AD patients with elevated TIMP-1 levels when compared with those with normal values. Moreover, the points of chronic eruptions such as lichenification and prurigo were significantly higher in the patients with elevated TIMP-1 levels than those with normal TIMP-1, while those of acute lesions such as oozy/microvesicles and oedema were not different between these groups. Serum TIMP-1 level may be a useful marker to estimate the long-term disease activity of AD.

Nerve growth factor applied onto the olfactory epithelium alleviates degenerative changes of the olfactory receptor neurons following axotomy

The olfactory neuroepithelium of the mammalian nervous system manifests continuous neurogenesis throughout life. Recent studies suggest that neurotrophic factors and their receptors may play a role in the regulation of development and regeneration in the olfactory system. However, there have been very few in vivo studies investigating the effect of exogenous neurotrophic factors in the olfactory system. In the present study, nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) were administered into the rat olfactory mucosa for 5 days just after the transection of the olfactory nerve. We then examined the effect of exogenous neurotrophic factors on the degenerative changes in axotomized olfactory receptor neurons (ORNs). Further, we examined the location of their receptors, Trk A and Trk B. We found that both mature and immature ORNs expressed more intense signals for olfactory marker protein and beta-tubulin mRNAs, respectively, when NGF was applied to the axotomized olfactory neuroepithelium for 5 days, compared to the ORNs of saline-treated controls. BDNF at a 10 microg total dose did not show this effect. The effect of NGF applied onto the olfactory epithelium is consistent with the immunohistochemical finding that Trk A was present in the dendrites and axon bundles in normal and axotomized ORNs. These results suggest that NGF may protect the degenerative changes in mature and immature ORNs following axotomy through the binding to the Trk A receptor located on the surface of the olfactory epithelium.

Facilitated wound healing by activation of the Transglutaminase 1 gene

Transglutaminase 1 (TGase 1) is a Ca(2+)-dependent enzyme which catalyzes epsilon-(gamma-glutamyl)lysine cross-linking of substrate proteins such as involucrin and loricrin to generate the cornified envelope at the cell periphery of the stratum corneum. We have shown that disruption of the TGase 1 gene in mice results in neonatal lethality, absence of the cornified envelope, and impaired skin barrier function. Based on the importance of TGase 1 in epidermal morphogenesis, we have now assessed its role in wound healing. In neonatal mouse skin, TGase 1 mRNA as well as keratin 6alpha was induced in the epidermis at the wound edges as early as 2 hours after injury and that expression continued in the migrating epidermis until completion of re-epithelialization. The TGase 1 enzyme co-localized on the plasma membrane of migrating keratinocytes with involucrin, but not with loricrin, which suggests the premature assembly of the cornified envelope. Similar injuries to TGase 1 knockout mouse skins grafted on athymic nude mice showed substantial delays in wound healing concomitant with sustained K6alpha mRNA induction. From these results, we suggest that activation of the TGase 1gene is essential for facilitated repair of skin injury.

Soluble CD30 is more relevant to disease activity of atopic dermatitis than soluble CD26

It is suggested that CD30 and CD26 are surface molecules expressed on activated Th2 and Th1 cells, respectively. We examined plasma levels of soluble CD26 (sCD26) and sCD30 in patients with atopic dermatitis (AD) when their eruptions were aggravated and in non-atopic healthy controls, and then analysed the possible correlation between these values and the levels of several clinical markers. The plasma levels of both sCD30 and sCD26 were significantly higher in AD patients than in controls, both in exacerbation status and after conventional treatment. Multiple regression analyses showed that plasma sCD30 was a much better predictor of the levels of serum IgE, serum LDH and plasma sCD25, and the area and the score of AD eruption than sCD26, although elevated levels of both sCD30 and sCD26 are associated with these clinical predictors of AD. Importantly, sCD30 plasma levels decreased significantly in AD patients after conventional treatment, while no significant transition was noted in the concentration of sCD26. Moreover, a significant reduction of sCD30 levels was observed in the group of patients whose eruption score was reduced > 50%, whereas it was not in those < 50%. These findings provide evidence that the successful treatment of AD is associated with down-activation of Th2.

Apocrine acrosyringeal keratosis in association with syringocystoadenoma papilliferum

We report the clinical and histopathological features of a keratosis that developed in association with syringocystadenoma papilliferum. This tumour shows a pinkish, pedunculated, spherical nodule with a cerebriform surface and visible keratinous plugs. In addition to the typical features of syringocystadenoma papilliferum, the tumour shows many hyperkeratotic columns surrounded by acanthotic epidermis with the characteristics of trichilemmal keratinization and keratohyalin granules. This keratosis seems to be derived from the middle to lower portion of the apocrine acrosyringium, based on the distribution of keratohyalin granules and the direct connection with the apocrine acrosyringium in an early lesion. Accordingly, we propose to identify this rare keratosis as apocrine acrosyringeal keratosis.

PUVA-induced lichen planus pemphigoides

A 72-year-old woman had suffered from parapsoriasis en plaque (large plaque type) controlled by topically applied psoralen ultraviolet A (PUVA) therapy. The parapsoriasis lesions gradually disappeared, but numerous tiny red papules with pruritus appeared over the forearms and lower legs 120 days after starting PUVA therapy. These papules developed to form violaceous plaques. Histological findings demonstrated the characteristics of lichen planus. Two months later, tense bullae developed on the plaques and on uninvolved skin of the limbs. These were subepidermal, with linear deposits of IgG and C3 along the basement membrane zone (BMZ) in immunofluorescence of peribullous skin, and immunodeposits of type IV collagen along the floor of the bullae. We therefore, diagnosed lichen planus pemphigoides (LPP). Using systemic and topical steroid therapy, the lesions rapidly resolved and there has been no recurrence. This case suggests that the combination of basal cell injuries caused by chronic inflammation and PUVA therapy could expose BMZ components to autoreactive lymphocytes and induce LPP.

Glomeruloid hemangioma in POEMS syndrome shows two different immunophenotypic endothelial cells

The case of a Japanese woman with glomeruloid hemangioma, an initial marker for POEMS syndrome, is reported. Her cutaneous lesions were multiple and consisted of glomeruloid hemangiomas, cherry-type capillary hemangiomas, and a mixture of both. The specimens of glomeruloid hemangiomas were studied by paraffin section immunohistochemistry with a large panel of antibodies and electron microscopy, respectively. The lesions, whose size ranged from minute foci to large nodules, were composed of anastomosing vascular channels resembling renal glomeruli and had irregular lumina, often featuring capillaries and sinusoid-like spaces. The vascular channels were lined by a single layer of endothelial cells, which showed two types of cells. The capillary-type endothelium possessed large vesicular nuclei with open chromatin and large amount of cytoplasm. The sinusoidal endothelium possessed small basal nuclei with dense chromatin as well as scant amount of cytoplasm. The former cells had a characteristic CD31+/CD34+/UEA I+/CD68- phenotype. Some of these cells ultrastructurally showed intracytoplasmic lumen formation. The latter cells had a characteristic CD31+/CD34-/UEA I-/CD68+ phenotype. The present study shows that glomeruloid hemangioma has unique morphologic and immunologic features that differ from the traditional hemangiomas as well as littoral cell angioma of the spleen.

Topical mevalonic acid stimulates de novo cholesterol synthesis and epidermal permeability barrier homeostasis in aged mice

Extracellular lipids of the stratum corneum, which are composed of cholesterol, fatty acid, and ceramides, are essential for the epidermal permeability barrier function. With damage to the barrier, a decreased capacity for epidermal lipid biosynthesis in aged epidermis results in an impaired repair response. Mevalonic acid is an intermediate after the rate-limiting step in cholesterol biosynthesis, which is catalyzed by 3-hydroxy-3-methylglutaryl coenzyme A reductase. In the present study, we investigated the effect of topical mevalonic acid on the murine epidermal permeability barrier function, comparing it with that of cholesterol. Topical treatment with acetone caused linear increases in transepidermal water loss, in proportion to the number of treatments more rapidly in aged mice than in young mice. Administration of mevalonic acid on aged murine epidermis enhanced its resistance against damage and the recovery rate of barrier function from acute barrier disruption. In contrast, although cholesterol also had the same effect, it required a much higher amount than mevalonic acid. In young mice, neither mevalonic acid nor cholesterol had any effect on resistance against acetone damage nor the recovery rate from acetone damage. In the skin of mice topically administered with mevalonic acid, stimulation of cholesterol synthesis and 3-hydroxy-3-methylglutaryl coenzyme A reductase activity were both observed, whereas none was seen with stimulation by equimolar cholesterol. These data indicate that a topical application of mevalonic acid enhances barrier recovery in aged mice, which is accompanied by not only acceleration of cholesterol synthesis from mevalonic acid but also stimulation of the whole cholesterol biosynthesis.

The results of ingredient patch testing in contact dermatitis elicited by povidone-iodine preparations

10 cases of contact dermatitis which began during the application of povidone-iodine preparations were examined with patch tests using 2 kinds of povidone-iodine preparations and their ingredients, i.e., povidone-iodine, polyoxyethylene nonylphenyl ether and glycerin, and also the components of povidone-iodine, i.e., iodine and polyvinylpyrrolidone. All 10 cases reacted positively to the povidone-iodine preparations and povidone-iodine, 3 out of the 10 to polyoxyethylene nonylphenyl ether, 1 out of the 9 tested to iodine, while no positive response was found to glycerin or polyvinyl-pyrrolidone. It was difficult to distinguish between allergic responses from irritation, as responses to patches of povidone-iodine and its preparations usually include irritation at high frequencies. Based on comparison of results with a control group, however, those showing + or stronger reactions to 2% povidone-iodine at days 3 to 5 were considered to be allergic. Thus, 4 out of the 10 cases were considered as sensitization to povidone-iodine. Another 3 cases were found to be polyoxyethylene nonylphenyl ether sensitized, and another 1 iodine sensitized, while the patch test reactions of the other 2 were considered to have been elicited by irritation.

Oral and epicutaneous desensitization in urushiol contact dermatitis in guinea pigs sensitized by 2 methods of different sensitizing potency

This investigation was conducted to study the relationship between the different intensities of sensitization to urushiol induced by the maximization test method (MT) or by the ear-flank method (EF) in guinea pigs, and hyposensitization induced by repeated oral and/or epicutaneous administration of the allergen, and to compare the immune tolerance achieved between these routes of dosing. During the observation period of 10 weeks, both oral and epicutaneous administration produced hyposensitization to urushiol after weak sensitization by EF; however, only combined administrations via the oral and epicutaneous routes achieved hyposensitization after potent sensitization, while inadequate tolerance was induced by oral dosing and none by epicutaneous dosing. Thus, it is indicated that difficulty in establishing immune tolerance may increase with increasing intensity of primary sensitization, and that hyposensitizing potency tends to increase in the order epicutaneous, oral and combined (e.p.+p.o.) administrations of urushiol.

Virus-associated haemophagocytic syndrome caused by rubella in an adult

Haemophagocytic syndrome is a systemic clinicopathological entity characterized by systemic proliferation of benign haemophagocytic histiocytes, fever, cytopenia, abnormal liver function and, frequently, coagulopathy and hepatosplenomegaly. Its occurrence has been documented in association with viral, bacterial, fungal and parasitic infections, a wide spectrum of malignant neoplasms, autoimmune diseases and drugs. We report a case of rubella virus-associated haemophagocytic syndrome in a previously healthy 29-year-old woman. Blood tests showed cytopenia, especially severe thrombocytopenia, liver dysfunction, hyperferritinaemia and hypercytokinaemia. Bone marrow examination showed many mature histiocytes with active haemophagocytosis. A skin biopsy from the rash revealed perivascular lymphohistiocytic infiltrates with haemophagocytic histiocytes in the upper and mid-dermis. The patient was treated with antibiotics and immunoglobulin, and by supportive measures including platelet transfusion, and recovered completely.

Recurrent malignant proliferating trichilemmal tumour: local management with ethanol injection

We report a 59-year-old woman who exhibited a recurrent malignant proliferating trichilemmal tumour on the scalp for 1 5 years. The tumour was recalcitrant to conventional treatments such as chemotherapy, radiation or hyperthermia and we performed intratumoral ethanol injection as an alternative means of reducing tumour mass and obtaining haemostasis. Biopsy specimens obtained after the ethanol injection revealed oedema, haemorrhage in the dermis and degeneration of the tumour cells, showing vacuolization with pyknotic nuclei. For cases of recurrent skin tumours and for patients in poor clinical condition, intratumoral ethanol injection is likely to be a therapeutic alternative to surgery or other conventional treatments.

Defective stratum corneum and early neonatal death in mice lacking the gene for transglutaminase 1 (keratinocyte transglutaminase)

The stratum corneum of the skin serves as an effective barrier for maintenance of the internal milieu against the external environment. At the cell periphery of the stratum corneum is the cell envelope, a highly insoluble membranous structure composed of precursor proteins cross-linked by epsilon-(gamma-glutamyl)lysine bonds. Transglutaminase 1 (TGase 1; keratinocyte TGase), a membrane-bound isozyme of the TGase family, has been proposed to catalyze this process of assembly. Deficient cross-linking of the cell envelope in some patients with the autosomal recessive skin disorder lamellar ichthyosis (LI) and several mutations of the TGase 1 gene that have been identified in families with LI suggest the importance of this gene in production of the cell envelope. In this study, we generated mice lacking the TGase 1 gene, and we report that they have erythrodermic skin with abnormal keratinization. In their stratum corneum, degradation of nuclei and keratohyalin F-granules was incomplete and cell envelope assembly was defective. The skin barrier function of TGase 1-null mice was markedly impaired, and these mice died within 4-5 h after birth. These results clearly demonstrate that the TGase 1 gene is essential to the development and maturation of the stratum corneum and to adaptation to the environment after birth. Thus, these TGase 1 knockout mice may be a useful model for severe cases of LI.

Activation of the human transglutaminase 1 promoter in transgenic mice: terminal differentiation-specific expression of the TGM1-lacZ transgene in keratinized stratified squamous epithelia

Transglutaminase 1 (TGase 1) is a tissue-specific enzyme which is expressed in the keratinized stratified squamous epithelia and which catalyzes straightepsilon-(gamma-glutamyl) lysine cross-links of proteins to form the cell envelope at the periphery of cornified cells. A transient expression assay using a luciferase reporter gene linked to the 2.5 kb 5' upstream region of the human TGase 1 gene (TGM1) showed phorbol ester-responsive promoter activity in cultured normal human keratinocytes. To assess its promoter activity in vivo, we generated transgenic mice expressing the Escherichia coli beta-galactosidase gene (lacZ) directed by the 5' upstream region. beta-Galactosidase histochemistry revealed that the TGM1-lacZ transgene was expressed in terminally differentiating keratinocytes in upper layers of stratified squamous epithelia in embryonic, neonatal and adult transgenic mice. The expression pattern was similar to that of endogenous TGase 1 mRNA detected by in situ hybridization. Furthermore, topical application of a phorbol ester to adult tail skin enhanced expression of the transgene as well as TGase 1 mRNA in the epidermis. Thus, the 2.5 kb 5' upstream sequence of TGM1 includes elements regulating tissue- and terminal differentiation-specific gene expression in stratified squamous epithelia.

Merkel cell carcinoma with partial spontaneous regression: an immunohistochemical, ultrastructural, and TUNEL labeling study

We report a case of Merkel cell carcinoma that partially regressed after biopsy. A 76-year-old woman presented with an 1 month history of a rapidly enlarging nodule on her left cheek. After biopsy, the nodule reduced to almost half the size and was excised 1 month later. The excised specimen showed a dense cluster of lymphocytes and fibrosis around the tumor nests. In addition, lymphocytes showed apposition with tumor cells. An immunohistologically dense, even infiltration of CD4+ and CD8+ cells was found around the tumor nests, and more CD8+ cells than CD4+ cells were seen in the tumor nests. By electron microscopy (EM), apoptosis of tumor cells and lymphocytes was observed. Many apoptotic cells were also detected by in situ nick end-labeling (TUNEL) of DNA-breaks, especially in the marginal area of tumor nests surrounded by dense lymphocytic infiltrates. It seems likely that T-cell immunity, which induces apoptosis of tumor cells, may have been involved in tumor regression.

Verruciform xanthoma in association with a vulval fibroepithelial polyp

We report the clinical, light microscopic, immunohistochemical and ultrastructural features of a verruciform xanthoma that developed in association with a vulval fibroepithelial polyp. To our knowledge, this is the first time that this association has been reported. Immunohistochemical findings confirmed that the xanthoma cells were of a monocyte/macrophage lineage. In addition to typical histological characteristics, prominent vascular ectasias were detected in the deep dermis at the periphery of this lesion. The ectasias may play a part in pathogenesis.

Acute cutaneous barrier perturbation induces maturation of Langerhans' cells in hairless mice

Perturbation of the cutaneous water permeability barrier has been shown to result in many physiological events in keratinocytes, including upregulation of proinflammatory cytokine production. However, little is known about the effect of barrier disruption on Langerhans' cells (LC). In the present study, we examined whether acute barrier perturbation by acetone treatment or tape stripping affects the phenotypes and functions of LC in male hairless mice. Both procedures resulted in a two- to five-fold increase in the expression of MHC class II antigens, B7-2 and intercellular adhesion molecule-1 on LC, whereas no significant changes were detected in levels of B7-1. Levels of intracellular interleukin-1 beta, as determined by flowcytometry, were also increased 1 h after acetone treatment or tape stripping. LC obtained from barrier-disrupted mice induced a significant increase in syngeneic and allogeneic T-cell proliferation, compared to those from saline-treated mice. These results indicate that LC play a crucial role in maintaining cutaneous homeostasis against increasing exposure to external substances resulting from barrier disruption.

Protein expression of fibroblast growth factor receptor-1 in keratinocytes during wound healing in rat skin

Fibroblast growth factors have been shown to play important roles in wound healing. To define their sites of action, we examined the expression of fibroblast growth factor receptor-1 (FGFR-1) during burn wound healing in rat skin by immunohistochemistry and western blot analysis. In cryostat sections of intact skin, little or no staining was observed. After a burn, however, staining for FGFR-1 was found in newly forming epidermis. The suprabasal layer of such epidermis, composed mostly of regenerating keratinocytes, was stained intensely, whereas keratinocytes in newly forming hair follicles were devoid of staining. Staining gradually decreased week by week after wound closure and was hardly visible 10 weeks after the burn, when the thickness of the epidermis had returned to the normal level. Staining was also found in small blood vessels and capillaries of granulation tissues of the dermis. Western blot analysis using the same antiserum was performed in the newly forming epidermis 10 d after the burn. A single band was detected with an apparent molecular weight of 120 kDa, corresponding to the short membrane-bound form of rat FGFR-1. Our study indicates that FGFR-1 is expressed during wound healing, mainly in regenerating epidermis and to some extent in blood vessels of the dermis. Fibroblast growth factors may affect the proliferation and differentiation of epidermal keratinocytes as well as angiogenesis in the dermis via the FGFR-1 expressed during wound healing.

Calcium channel blockers suppress the contact hypersensitivity reaction (CHR) by inhibiting antigen transport and presentation by epidermal Langerhans cells in mice

Since Langerhans cells (LC) are the principal antigen-presenting cells among epidermal cells, treatments suppressing LC function may inhibit CHR. Although calcium channel blockers (CCB) have been shown to suppress the functions of several immunologically active cells, little is known about their effect on LC. In this study we show that pretreatment with topical 1% nifedipine or verapamil HCl significantly suppressed both the sensitization and elicitation phases of a CHR in mice. We then investigated whether CCB affected LC. Flow cytometric analysis of regional lymph node cells obtained 24 h after applying FITC demonstrated that topical CCB treatment significantly reduced the percentage of FITC+ NLDC-145+ cells, suggesting that CCB had suppressed antigen transport by LC. In vitro treatment with nifedipine or verapamil significantly suppressed the antigen-presenting capacity of LC in a dose-dependent manner. In addition, in vitro CCB treatment reduced the percentage of class II MHC antigen-positive epidermal cells and significantly suppressed class II MHC and B7-1 levels in LC, as determined by flow cytometry and reverse transcriptase-polymerase chain reaction, whereas surface expression of B7-2 and mRNA was only weakly reduced. Neither expression of CD45 nor the percentage of CD45+ cells were affected, suggesting that the effects of CCB on LC were not due to cytotoxicity. Our results suggest that CCB inhibit CHR, at least in part, by suppressing the functions of LC.

Angiosarcoma of the scalp associated with renal transplantation

A case of cutaneous angiosarcoma occurring in a 51-year-old male renal transplant patient is reported. Multiple violaceous nodules surrounded by poorly demarcated red to purple discoloration were found on his scalp. Immunosuppressants consisting of azathioprine and prednisolone had been administered during the 12-year period since the renal transplantation. We diagnosed the lesion clinically as a cutaneous angiosarcoma and performed a wide surgical excision. The histopathological findings confirmed the diagnosis and showed tumour cells in the peripheral margin. Postoperatively, the patient started immunotherapy with systemic administration of recombinant interleukin-2 (rIL-2), but he refused to continue it because of the acute rejection of the transplanted kidney induced by the rIL-2. Instead he received radiation therapy (total 7000 rad) of the scalp. Although no recurrence was noticed for 15 months after the completion of radiation, he died due to lung metastasis from angiosarcoma. We review the seven cases, including ours, of angiosarcoma after renal transplantation that are reported in detail in the literature.

Association of eosinophil granule major basic protein with atopic cataract

PURPOSE

To investigate the mechanism of atopic cataract development, we examined a tissue-destroying major basic protein, derived from eosinophils, in the anterior capsule of cataractous lenses and the aqueous fluid of atopic dermatitis patients.

METHODS

Major basic protein deposition in anterior capsule tissues was evaluated immunohistochemically using anti-major basic protein monoclonal antibody in three consecutive eyes from three atopic cataract patients and three consecutive eyes from three senile cataract patients. Also, major basic protein concentration in aqueous fluid obtained during cataract surgery was measured by radioimmunoassay in 12 consecutive eyes from 11 atopic cataract patients and 15 consecutive eyes from 15 senile cataract patients.

RESULTS

Immunohistochemical investigation demonstrated lens epithelial major basic protein deposition in all three atopic cataracts but not in any of the senile cataracts. Major basic protein was detected in the aqueous fluid by radioimmunoassay in four of the 12 atopic cataract eyes and ranged in concentration from 11 to 70 ng/ml. No major basic protein was detected in the aqueous fluid of the 15 senile cataract eyes.

CONCLUSION

Major basic protein in anterior capsule tissues and in the aqueous fluid of eyes with atopic cataract may be associated with the pathogenesis of atopic cataract.