The Overview of the Immunobiology of Interleukin-23 Associated With Immune-Mediated Inflammatory Disorders: A Narrative Review

BACKGROUND

Interleukin (IL)-23, a member of the IL-12 family, has emerged as an important cytokine that bridges the innate and adaptive immune systems and plays a critical role in the development of a wide spectrum of immune-mediated inflammatory disorders (IMIDs). It can be considered a gatekeeper of T helper 17 (Th17) cells development and expansion that subsequently produces several mediators that promote inflammation. The inhibition of IL-23 is a potential therapeutic approach for several inflammatory diseases, such as psoriasis, psoriatic arthritis, and inflammatory bowel disease.

OBJECTIVE

This work aims to address the overview of the immunobiology of IL-23 associated with some of the most frequent IMIDs and the current pipeline of its inhibition.

METHODS

We conducted a narrative review elucidating data about 1) the overview of the immunobiology of IL-23 associated with immune-mediated inflammatory disorders in specific diseases, such as psoriasis, psoriatic arthritis, and inflammatory bowel disease; 2) therapeutic approaches targeting the IL-23 pathway (IL-23 inhibitor drugs approved by international agencies); and 3) novel therapeutic perspectives. The search strategy was conducted in the relevant database with terms related to the proximity to IL-23 or immuno-mediated.

RESULTS AND CONCLUSIONS

Existing and emerging therapeutic biologics targeting the IL-23/IL-17 pathway are promising options to treat IMIDs while the knowledge of the pathophysiology of those conditions and the contribution of the IL23/IL-17 continues to grow. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.7017 Citation: Galli Sanchez AP, Castanheiro da Costa A, Del Rey C, et al. The overview of the immunobiology of interleukin-23 associated with immune-mediated inflammatory disorders. A narrative review. J Drugs Dermatol. 2023;22(4):375-385. doi:10.36849/JDD.7017.

A Review of the Global Guidelines on Surgical Margins for Nonmelanoma Skin Cancers

Background: Adequate treatment and follow-up of a patient with nonmelanoma skin cancer is of utmost concern for a clinician. However, there is a lack of international consensus on recommendations for surgical excision margins. Furthermore, lack of familiarity of the published guidelines leads to a variety in practice styles. Objective: To compare the consistency in global recommendations for surgical excision margins for basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma. Methods: A review of the current literature and global guidelines for surgical excision margins for basal cell carcinoma, cutaneous squamous cell carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma. Results: Upon review of international guidelines, variations do exist among guidelines for peripheral and deep surgical margins. Guideline recommendations were found to be more globally consistent in margin selection for low-risk basal cell carcinoma and low-risk cutaneous squamous cell carcinoma, however, least consistent when concerning margin selection for dermatofibrosarcoma protuberans and Merkel cell carcinoma. Conclusion: Although guidelines exist, there is a need for international collaboration and consensus to determine a more unified and evidence-based approach to surgical excision as a treatment for nonmelanoma skin cancer.

Skin cancer screening: recommendations for data-driven screening guidelines and a review of the US Preventive Services Task Force controversy

Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.

Neuroradiology critical findings lists: survey of neuroradiology training programs

BACKGROUND AND PURPOSE

The Joint Commission has identified timely reporting of critical results as one of the National Patient Safety Goals. We surveyed directors of neuroradiology fellowships to assess and compare critical findings lists across programs.

MATERIALS AND METHODS

A 3-question survey was e-mailed to directors of neuroradiology fellowships with the following questions: 1) Do you currently have a "critical findings" list that you abide by in your neuroradiology division? 2) How is that list distributed to your residents and fellows for implementation, if at all? and 3) Was this list vetted by neurology, neurosurgery, and otolaryngology departments? Programs with CF lists were asked for a copy of the list. Summary and comparative statistics were calculated.

RESULTS

Fifty-one of 89 (57.3%) programs responded. Twenty-one of 51 (41.2%) programs had CF lists. Lists were distributed during orientation, sent via Web sites and e-mails, and posted in work areas. Eleven of 21 lists were developed internally, and 5 of 21, with the input from other departments. The origin of 5 of 21 lists was unknown. Forty CF entities were seen in 20 submitted lists (mean, 9.1; range, 2-23). The most frequent entities were the following: cerebral hemorrhage (18 of 20 lists), acute stroke (15 of 20), spinal cord compression (15 of 20), brain herniation (12 of 20), and spinal fracture/instability (12 of 20). Programs with no CF lists called clinicians on the basis of "common sense" and "clinical judgment."

CONCLUSIONS

Less than a half (41.2%) of directors of neuroradiology fellowships that responded have implemented CF lists. CF lists have variable length and content and are predominantly developed by radiology departments without external input.

WISE 2005: stroke volume changes contribute to the pressor response during ischemic handgrip exercise in women

The mechanism of the pressor response to small muscle mass (e.g., forearm) exercise and during metaboreflex activation may include elevations in cardiac output (Q) or total peripheral resistance (TPR). Increases in Q must be supported by reductions in visceral venous volume to sustain venous return as heart rate (HR) increases. Therefore, this study tested the hypothesis that increases in Q, supported by reductions in splanchnic volume (portal vein constriction), explain the pressor response during handgrip exercise and metaboreflex activation. Seventeen healthy women performed 2 min of static ischemic handgrip exercise and 2 min of postexercise circulatory occlusion (PECO) while HR, stroke volume and superficial femoral artery flow (Doppler), blood pressure (Finometer), portal vein diameter (ultrasound imaging), and muscle sympathetic nerve activity (MSNA; microneurography) were measured followed by the calculation of Q, TPR, and leg vascular resistance (LVR). Compared with baseline, mean arterial blood pressure (MAP) (P < 0.001) and Q (P < 0.001) both increased in each minute of exercise accompanied by a approximately 5% reduction in portal vein diameter (P < 0.05). MAP remained elevated during PECO, whereas Q decreased below exercise levels. MSNA was elevated above baseline during the second minute of exercise and through the PECO period (P < 0.05). Neither TPR nor LVR was changed from baseline during exercise and PECO. The data indicate that the majority of the blood pressure response to isometric handgrip exercise in women was due to mobilization of central blood volume and elevated stroke volume and Q rather than elevations in TVR or LVR resistance.

Lung cancer resection does not change characteristic serum proteomic profiles

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Background: Surface-enhanced laser desorption/ionisation time of flight mass spectrometry (SELDI-TOF-MS) has been proposed as a method for determining characteristic serum proteomic profiles that permit discrimination between cancer and non-cancer patients. The aim of this study was to test in a group of lung cancer patients the hypothesis, that these profiles ‘return to normal’ following tumour resection, as would be expected if they behave as conventional serological tumour makers. Methods: Serum samples were collected from 39 patients with non-small cell lung cancer, 1 day pre-surgery, 1 day post-surgery and, for 17 of these, approximately three months later; samples were also obtained from 38 non-cancer control subjects. All samples were subjected to SELDI-TOF-MS analysis on CM10 chips. Students t-tests were used to identify differentially expressed peaks in the profiles. Results: The SELDI profiles of the lung cancer sera compared to non-lung-cancer controls showed 19 significantly differentially expressed peaks (p<0.01), 14 of which were used to develop a neural network capable of discriminating between the two groups. Analysis of proteomic features showed that despite the absence of cancer in patients 3-months post-surgery, no statistically significant differences could be detected between the pre-treatment and 3-month post-operative samples from the same patients, including the 19 features that were found to discriminate between lung and non-lung cancer. One of the proteins significantly decreased in the serum of lung cancer patients was identified as transthyretin. Conclusions: SELDI can detect differentially expressed protein peaks characteristic of lung cancer compared to non-lung cancer patients but following surgical resection of the cancer, neither the pattern nor the individual peaks revert to the levels observed in non-lung cancer patients. The hypothesis that such differences would revert to normal after tumour removal was not supported. Work funded by Cancer Research UK

No significant financial relationships to disclose.

Time resolved collapse of a folding protein observed with small angle x-ray scattering

High-intensity, "pink" beam from an undulator was used in conjunction with microfabricated rapid-fluid mixing devices to monitor the early events in protein folding with time resolved small angle x-ray scattering. This Letter describes recent work on the protein bovine beta-lactoglobulin where collapse from an expanded to a compact set of states was directly observed on the millisecond time scale. The role of chain collapse, one of the initial stages of protein folding, is not currently understood. The characterization of transient, compact states is vital in assessing the validity of theories and models of the folding process.

An evaluation of partner notification for HIV infection in genitourinary medicine clinics in England

OBJECTIVE

To evaluate the feasibility and effectiveness of a standardized HIV partner notification programme within genitourinary medicine clinics in England.

DESIGN

A prospective survey of HIV partner notification activity over a 12-month period.

SETTING

Nineteen genitourinary medicine clinics in England.

PATIENTS AND PARTICIPANTS

A total of 501 eligible HIV-positive patients (either newly diagnosed or with whom partner notification had not been undertaken previously) seen during the study period.

MAIN OUTCOME MEASURES

The numbers of partners named by patients, and the number of contacts notified, counselled and HIV-tested.

RESULTS

Information on overall partner notification activity was obtained by reviewing available medical records of 471 patients; 353 (75%) had discussed partner notification with a health-care worker during the study period and 197 (42%) had undertaken partner notification. Detailed information on outcomes was obtained for only 70 patients who named 158 contacts as being at risk of acquiring HIV. Although 71 (45%) contacts were eventually notified, only 28 were subsequently seen in participating clinics. Almost all contacts (n = 27) requested HIV counselling and testing, and five were diagnosed HIV-positive. Patient referral was the most popular notification method chosen.

CONCLUSIONS

This study illustrates some of the practical difficulties that limit HIV partner notification within genitourinary medicine clinics. These include health-care workers' misgivings about undertaking partner notification, insufficient locating information to identify contacts, and migration of newly diagnosed patients, which prevents continuity and completion of notification. Nevertheless, HIV partner notification uncovered previously undiagnosed HIV infections. Further work needs to be undertaken in staff training and policy implementation if higher rates of partner notification and outcome measurements are to be achieved.

The heart and antiphospholipid antibodies in MRL-lpr/lpr mice

Our objective in this study was to determine possible associations between antiphospholipid antibodies (aPL) and histologically defined heart valve lesions in the MRL-lpr/lpr mouse, a suitable model for the antiphospholipid syndrome (APS). At monthly intervals, from 2 to 6 months of age, three MRL-lpr/lpr mice (two with anticardiolipin antibodies, one without) and two sex- and age-matched Balb/c mice (controls) were sacrificed for histological studies. Serum binding to phospholipids and DNA was studied at this time. We found thickened heart valves in 68% of MRL-lpr/lpr mice and in 80% of Balb/c mice, and no association with any of the antibodies tested was found. No evidence of coronary vasculitis or thrombi was found in any of the mice studied. Platelet counts in MRL-lpr/lpr mice were significantly lower (640.550 +/- 211.818 x 10(6)/ml) than in Balb/c mice (780.0 + 112.5 x 10(6)/ml) (p < 0.05), and no association was found between platelet counts and aPL. In this model of murine APS, aPL bear no importance in heart valve pathology.

Prenatal pericardiocentesis: its role in the management of intrapericardial teratoma

A fetus with intrapericardial teratoma had a large pericardial effusion diagnosed by echocardiography. Cardiac tamponade, a common cause of fetal death, was averted by intrauterine pericardiocentesis. Planned obstetric and neonatal management permitted surgical treatment before cardiorespiratory distress developed. The tumor was completely excised and the infant is asymptomatic.

Physiological features of pericardial constriction in the absence of pericardial disease

To sustain a clinical diagnosis of constriction it is classically held that the fibrous pericardium must be thickened and adherent to the surface of the heart. A case is presented in which leukaemic infiltration of the fat overlying the myocardium resulted in the physiological features of constriction, although all layers of the pericardium itself were normal. Constriction is thus a physiological diagnosis; it may develop in the absence of the classical anatomical findings.

The detection of serological factors in acute ulcerative colitis indicating a favourable short-term prognosis

Large-intestinal epithelial cells were obtained from operation specimens and by biopsy at sigmoidoscopy from 16 patients with acute severe mucosal ulcerative colitis and II control subjects with normal large-bowel mucosa. The ability of lymphocytes to release 51Cr label from large-intestinal epithelial cells was quantitatively assessed as percentage lymphocyte activity. The mean +/- standard deviation of percentage lymphocyte activity in 16 patients with acute ulcerative colitis on admission to hospital (88 +/- 8) was significantly greater than that in II normal subjects (16 +/- 8) (P is less than 0.01). In each study, samples of autologous serum were added to two reactions between lymphocytes and autologous large-intestinal epithelial cells. The results in the seven patients who came to urgent colectomy differed significantly from those in the nine who responded to corticosteroids. The mean +/- S.D. of percentage serological inhibition of lymphocyte activity in the group coming to colectomy was 44 +/- 16, and in those responding to steroids 12 +/- 5. When the serum of these patients was studied for immunofluorescent autoantibodies to normal human colonic mucosa, none of the seven patients treated by colectomy had detectable autoantibodies, in contrast with three of the nine patients with a more favourable short-term prognosis, in that they responded to steroid treatment.

The in-vitro action of lymphocytes on autologous colon epithelial cells in ulcerative colitis

The action in culture of peripheral blood lymphocytes on autologous large-intestinal epithelial cells was studied in 13 patients with severe mucosal ulcerative colitis. Two different methods were used to measure lymphocyte activity. These showed that autologous-lymphocyte-induced release of isotopic label and detachment in monolayer culture of large-intestinal epithelial cells was increased in acute ulcerative colitis when compared with findings in the same studies in six normal subjects. Subsequently in four of the six patients who responded to cortisone it was shown that lymphocyte activity against epithelial cells returned to the normal range. Further control studies showed little lymphocyte activity against autologous skin and ileum, suggesting that autologous-lymphocyte-induced damage of large-intestinal epithelial cells is a tissue-specific reaction in patients with acute ulcerative colitis. The absence of reactivity in other colonic inflammatory diseases also suggested that such increased in vitro lymphocyte activity is disease-specific for ulcerative colitis.

Lymphoblastic response to autologous colon epithelial cells in ulcerative colitis in vitro

The blastic transformation in vitro of peripheral blood lymphocytes was measured by the 72-hour uptake of tritiated thymidine ((3)H-6-thymidine) in 23 patients with mucosal ulcerative colitis, three patients with acute Crohn's colitis with rectal involvement, and seven normal subjects. The 23 patients with ulcerative colitis were subdivided into three groups, graded according to severity into seven with acute, severe, nine with active, chronic, and seven with quiescent disease. In the control cultures of lymphocytes without any added potential stimulant the uptake of (3)H-6-thymidine in the clinical subgroup of seven patients with acute, severe ulcerative colitis was significantly greater than in seven normal subjects (p<0.01). This contrasted with a reduced uptake of (3)H-6-thymidine by lymphocytes from seven patients with acute severe colitis when compared with seven normal subjects after stimulation with phytohaemagglutinin-P (PHA-P) (p<0.01). In further duplicate cultures of lymphocytes specifically stimulated by an equal number of viable autologous rectal epithelial cells, the uptake of (3)H-6-thymidine was significantly greater in seven patients with acute severe colitis when compared with seven normal subjects (p<0.01). The results in three patients with acute Crohn's colitis with rectal involvement showed no such evidence of lymphocyte sensitivity to autologous rectal epithelial cells and their uptake of (3)H-6-thymidine lay within the normal range.Evidence that the degree of lymphoblastic transformation was related to the clinical severity of ulcerative colitis was provided by the results obtained in the unstimulated and epithelial cell stimulant cultures. The uptake of (3)H-6-thymidine was directly related to the clinical severity of ulcerative colitis in the three subgroups studied. In addition, four of the seven patients with acute severe colitis were studied later in clinical remission. They were then found to have a significantly reduced uptake of (3)H-6-thymidine in response to autologous rectal epithelial cells (p < 0.01).