Day 2 :
Keynote Forum
Lazaros I Sakkas
University of Thessaly, Greece
Keynote: Apremilast induces IL-10+ Bregs that are inversely correlated with IFN-γ+ and IL-17+ NKT cells in psoriatic arthritis and psoriasis
Biography:
Lazaros I. Sakkas is working as a Professor of Medicine and Rheumatology, Chairman, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly. He is also an Adjunct Assistant Professor, Temple University School of Medicine, Philadelphia, PA, USA (Jun 2003-present) and an Adjunct Professor, Center for Molecular Medicine, Old Dominion University, Norfolk, VA, USA (March-2010-March 2017). He is the President at the Institute for Rheumatic Diseases (2011-present). Co-Editor of the Mediterranean Journal of Rheumatology.
Abstract:
Background & Purpose: There is impairment IL-10+ regulatory B cells (IL-10+Bregs) in psoriatic arthritis (PsA) and psoriasis (Ps) and Bregs were inversely correlated with IL-17+ and IFNγ+ innate immune cells. Apremilast, a PDE4 inhibitor, increased IL-10+Bregs in PsA and Ps. Herein we explored the relationship of IL-10+Breg cells with NK and NKT cells producing the IFN-γ and IL-17 post-apremilast, a PDE4 inhibitor, treatment.
Methods: PBMCs from 8 PsA, 12 Ps patients, obtained at baseline and 6 months post-apremilast treatment, and 10 healthy controls (HCs) were studied. Flow cytometric analysis was carried out with MoAbs against CD56, CD16, CD3, CD7, CD19, CD24, CD27 and CD38. Intracellular IFN-γ, IL-17 and IL-10 following CpG (ODN2006) and PMA/ionomycin stimulation was also examined.
Results: The PsA baseline CD3+CD56+ (NKT) cells were increased compared to Ps patients and HCs (10.2±3.6 vs. 5.2±2.1 vs. 4.3±2.5 , p<0.05 for PsA vs. Ps and HC), but no difference in NK cells between PsA, Ps and HCs. Apremilast treatment did not significantly alter the total NKT and NK but decreased IFNγ+ and IL-17+ ΝΚΤ cells from PsA and Ps patients collectively (from 52.2±12.8 pre to 35.3±7.1 for IFNγ+ NKT and from 2.2±1.06 to 0.96±0.35 for IL-17+ NKT; p<0.05 for both subsets). IFNγ+ and IL-17+ ΝΚΤ cells from PsA and Ps patients inversely correlated with IL-10+ Bregs post-treatment. There was no correlation between memory Bregs and cytokine-producing NKT and NK cells.
Conclusion: Apremilast induces IL-10+ Bregs and decreases IFN-γ- and IL-17-producing NKT cells in PsA and Ps.
Keynote Forum
Donatini Bruno
Medicine Information Formation, France
Keynote: Severe acne treated with isotretinoin is associated with dysbiosis and its consequences
Biography:
Biography Bruno Donatini graduated in gastroenterology and immunology in 1991. He graduated in anti-aging in 2009. He developed expertise in small gut dysbioses by breath testing, sonography and detection of herpes-virus-DNA. He investigated the consequences of excessive destruction of HA by infectious agents on aging, dysimmunity or even malignant transformation of stem-cells.
Abstract:
Background & Aim: Acne is caused by Propionibacterium acnes and is sometime treated with isotretinoin. Propionibacteria may adhere to intestinal mucosa. Isotretinoin may induce mucosal side-effects. We investigated whether severe acne is associated with dysbiosis and its consequences.
Methods: All female patients consulting for the first time the same gastroenterologist were included into a prospective cohort study. Those with a medical history of severe acne were compared to a control group. The study stopped when 1,000 patients were included into the control group. Male patients were not included because gender influences small gut absorption, dysbiosis, immunity and body mass index. Age, body weight, body mass index, exhaled hydrogen or methyl acetate after fasting (measured by the MX6 of GazDetect France), medical history of allergy or auto-immune disease, oral herpes simplex 1/2 replication (medical history confirmed by qPCR run into a central laboratory, material: Amplix® from Alldiag®, reagents: Bioneer®) were collected. Normal level of fecal elastase excluded exocrine pancreatic insufficiency. Pre-albumin level was checked for all patients with a history of severe acne and was within the normal range.
Results: 1,054 patients were enrolled: 1,000 control, 54 with a medical history of severe acne, including 26 with isotretinoin received more than 6 months.
Patients with severe acne treated with isotretinoin have a lower body weight (56.9+/-9.9 versus 61.1+/-15 kg; p<0.05) and Body Mass Index (20.84+/-3.8 versus 22.85+/-5.2; p<0.05) than the control group (despite being younger (40+/-10 years versus 50+/-16).
Patients with severe acne treated with isotretinoin present with dysbiose: higher levels of H2 (7.3ppm+/-7 versus 4.6+/-6.9; p<0.05) and methylacetate (5.4+/-2.6 versus 3.9+/-4.4; p<0.05).
They present more frequently with oral herpes simplex (30.4% versus 21.4%; p<0.05) or allergy (34.6% versus 15.7%) which suggests dysimmunity.
Conclusion: Isotretinoin is associated with dysbiosis (perhaps malabsorption) and signs of dysimmunity. A facilitating role of Propionibacterium cannot be excluded.
- Cosmetic Dermatology | Skin Cancer | Bacterial Skin Diseases | Research in Dermatology
Location: Holiday Inn Paris – Marne La Vallée
Chair
Lazaros I Sakkas
University of Thessaly, Greece
Co-Chair
Ranjan J Perera
Sanford Burnham Prebys Medical Discovery Institute, USA
Session Introduction
Idrianti Idrus
Hasanuddin University, Indonesia
Title: Scrofuloderma mimicking squamous cell carcinoma
Biography:
Idrianti Idrus is a student in Dermatology and Venereology Department in Hasanuddin University, Indonesia
Abstract:
Skrofuloderma also known as tuberculosis colliquativa cutis, is a subcutaneous tuberculosis that forms a cold abscess and secondary damage to the skin surface with skin lesions resemble the appearance of squamous cell carcinoma which is the second most common form of skin cancer. Skrofuloderma often experiences delays in diagnosis in both developing and industrialized countries today. A case of skrofuloderma was reported in a 44-year-old woman with massive lesions on her neck and mandibular region resembling squamous cell carcinoma and a history of soft tissue tumor on submandibular disease. Diagnosis based on anamnesis, physical examination and investigation in the form of tuberculin test showed positive results and histopathology. Patient treated with anti-tuberculosis drugs (OAT) as the primary choice of skrofuloderma therapy and showing shrinkage of lesion after completing one cycle therapy.
Wen-Shan Chen
Taichung Veterans General Hospital, Taiwan
Title: Imatinib-induced pemphigus foliaceus in a patient with gastrointestinal stromal tumor
Biography:
Wen-Shan Chen is working as Professor of Geology, Taiwan University, previously he was working as associate professor at Department of Geology, National Taiwan University.
Abstract:
A 59-year-old man was diagnosed one-year-ago with a gastrointestinal stromal tumor (GIST) and liver metastasis. Since the diagnosis, he has been under an oral, Imatinib 400 mg daily treatment without any concomitant medications or special health food. A half year into the treatment, he was presented to our dermatology clinic due to progressing, non-pruritic scaly eroded eruptions over his upper back and abdomen. An incisional skin biopsy taken from the lesion over his back revealed a subcorneal cleft with acantholysis, along with dyskeratotic cells in the granular layer of the epidermis. Direct immunofluorescence revealed remarkable intercellular deposits of both immunoglobulin G (IgG) and C3 within the upper epidermis, but without the deposits of IgM and IgA. Indirect immunofluorescence showed circulating IgG anti-intercellular substance antibodies at a titer of 1:160. A careful correlation between the clinical and pathologic pictures suggested a diagnosis of Imatinib-induced pemphigus foliaceus (PF). In summary, to the best of our knowledge, this is the ï¬rst case of Imatinib-induced PF ever reported in literature. We strongly believe that any observation of scaly, erytheamtous maculopapules in patients under Imatinib treatment should alarm the caring physicians, in light of the increasing popularity of prescribing this novel anticancer drug.
Yaghubi E
Tehran University of Medical Sciences, Iran
Title: L-carnitine supplementation in pemphigus vulgaris: A randomized controlled trial
Biography:
Yaghubi E is a student of public health sciences in Nutrition in Department of cellular and molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran. Her field of interests is lifestyle/diet in the prevention of cardiovascular and inflammatory diseases. Clinical/nutrition effects in relation to autoimmune diseases.
Abstract:
Background: Pemphigus Vulgaris (PV) is an autoimmune blistering disease of skin and mucus membranes. The first-line treatment for PV involves corticosteroids and immunosuppressive agents, which can cause various side-effects.Objective: The aim of this study was to investigate the impact of oral L-carnitine supplementation on oxidative stress index (OSI) and antioxidant capacity in patients suffering from PV. Methods: In this clinical study, 52 PV patients were enrolled and randomly assigned to receive either 2g L-carnitine (n=26) or placebo (n=26) for 8 weeks. The serum levels of carnitine, OSI, total oxidative capacity (TOC) and total ant-oxidative capacity (TAC) were measured before and after intervention. Data were analyzed by student t-test, paired t-test and analysis of covariance. Results: only 47 participants [LC group (n=24) and placebo group (n=23)] completed the trial. LC intake significantly decreased serum OSI (p<0.05). There were considerable increases in serum levels of TAC and carnitine. However, no significant difference was demonstrated in TOC serum between the LC and placebo groups. Additionally, within-group comparisons indicated a remarkable increase in serum carnitine (p<0.001) and a significant decrease in OSI (p=0.003) and TOC (p=0.01) in the supplemented group. No harmful effects were observed during the study. Conclusion: This is the novel study to examine the beneficial impacts of LC supplementation on inflammatory mediators in patients with PV. To confirm these results, further trials are warranted.
Shima Jahani
Tehran University of Medical Sciences, Iran
Title: Aloe vera effects on acute and chronic wound healing: A systematic review
Biography:
Shima Jahani is currently a Medical student at Tehran University of Medical Sciences and was honored to win Bronze Medal in National Olympiad of Informatic.
Abstract:
Although using Aloe vera is an ancient and traditional way for improving the wound healing process, clinical and molecular evidence still remained unclear. Up to now, several studies have assessed the efficacy of Aloe vera on healing. Systematic review on in vitro and in vivo studies including animal studies and clinical trials was conducted to determine the Aloe vera molecular interactions in damaged tissues and its effectiveness in clinic. We electronically searched related studies in PubMed, Cochrane Library and Scopus from 1918 till September 2017. Only papers discussing on healing activity of Aloe vera, aloe-derived products and a combination of Aloe vera and other dressings as a treatment of acute wounds specifically caused by lesions (in animal studies) or in post-surgery patients were included. There were no restrictions on any language of publication. Reviewer extracted data on study characteristics, patient characteristics, gross morphology of the intervention, frequency and duration and outcome measure. 41 studies were included in this review. In vitro studies showed that Aloe vera boosted the time and quality of wound healing by stimulating MMP 2, 3 and 9 vascular endothelial growth factor, transforming growth factor and even total collagen activity. In vivo studies demonstrated a significant difference in wound healing between control groups and aloe treated ones. Cumulative evidence on in vivo and in vitro studies ends to confirm that Aloe vera might be an effective intervention used in wound healing. Further, well-designed trials with adequate information should be conducted to determine the effectiveness of Aloe vera or its products.
Iraldo Bello Rivero
Center for Genetic Engineering and Biotechnology, Cuba
Title: HeberFERON as a therapeutic option for the treatment of advance and high risk basal cell carcinomas
Biography:
Iraldo Bello Rivero has completed his Masters in Chemistry at I.I.Mechnikov National University, Odessa, Ukraine and PhD from Havana University. He carried out Fellowships with Dr. Michel Aguet (1988) at Institute of Immunology and Virology, Zurich, Switzerland; with Dr. Erik Lundgren (1994) at Department of Molecular Biology, Umea University, Sweden and with Dr. Marco Soria (1995) at Department of Biological and Technological Research, San-Raffaele Scientific Institute, Italy. He was the Head of Clinical Trial Laboratory at CIGB (1994-2005). He has published more than 30 papers in reputed journals and received Cuban Academy of Sciences Awards (1990, 2006) and Public Health National Award (Cuba) in 2010 and 2016.
Abstract:
Methodology & Theoretical Orientation: The administration of the IFNs was performed perilesionally using doses from 3.5 to 10.5 MUI, 3 times a week for 3 weeks. PK/PD studies were conducted. All the patients included in the studies gave their consent for participation and the studies were approved by the ethics committees of the participating institutions and CECMED.
Findings: Clinical studies of HeberFERON revealed that this formulation generated a faster anti-tumor response than the IFNs separately, as well as a greater number of complete responses, which agrees with the results of the PK/PD that demonstrated a superior biological potency of HeberFERON. The follow-up studies of patients with BCC or SCCS who obtained complete responses (CR) showed that these remain at 5 years free of tumor and that the rate of appearance of new lesions decreased by 8 times. The aesthetic results of these treatments are very favorable and the use of the product is safe. A global analysis of 245 patients with BCC treated with HeberFERON shows a disease control of 98.6% with 61.9% CR and 88.4% objective response. BCC patients received intramuscular treatment with HeberFERON with encouraging results and improved quality of life.
Conclusion & Significance: HeberFERON is a new formulation of IFNs with curative capacity for non-melanoma skin tumors, with very favorable aesthetic results, safe and easy to use
Biography:
Abstract:
Background: Acrochordons have an irregular or smooth surface and most commonly located on eye lids, neck, axillae, trunk, groin and on the lumbar area. There are a few case reports of giant acrochordons including one reported on male external genitalia.
Case Report: A 50-year-old man with a pedunculated mass, diameter 9 cm, arising from right scrotum for 3 years ago. Body mass index is 27.3 kg/m2 and there was no pain, redness and no ulceration. The lesion was totally removed with CO2 laser under local anesthesia. Diagnosis was confirmed by histopathological examination.
Conclusion: The predisposing factor in this patient is obesity. Acrochordon can be removed with electrodesiccation, curved or serrated blade scissors, cryotherapy or even laser surgery. CO2 laser surgery under local anesthesia in this patient was cosmetically acceptable by simple procedure.