Hepatitis C virus infection in patients with urticaria.
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Biomedical subjects
Publications and source records attributed to L Meunier.
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INTRODUCTION: The increased incidence of skin cancers is due to modifications of our behavior toward solar exposure. Photocarcinogenesis represents the sum of complex and intricate events that lead to the occurrence of skin cancers. CURRENT KNOWLEDGE AND KEY POINTS: In epidermal cells UV light induces lesions of DNA that lead to modifications in oncogene and tumor suppressor gene expression. UV-induced immunosuppression is also important for tumoral promotion. UV exposure decreases the number of Langerhans cells in the epidermis and modifies their antigen-presenting cell capacity. Numerous experimental data obtained in animal models clearly indicate the existence of a relationship between UV-induced immune suppression and skin cancers. In humans, growing evidence suggests that skin cancers and photoimmunosuppression are linked. FUTURE PROSPECTS AND PROJECTS: Better knowledge of mechanisms involved in UV-induced immune suppression is essential for developing new strategies aimed at photoprotection and cancer prevention.
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Eight randomised clinical trials of angiotensin converting enzyme (ACE) inhibitors versus placebo in myocardial infarction have been published in three years, including over 100,000 patients. High risk myocardial infarction carries a poor prognosis with a 25% death rate at 42 months in SAVE, 23% at 15 months in AIRE and 42% at 37 months in TRACE. This form of myocardial infarction benefits the most from treatment with ACE inhibitors: the relative reductions in risk for the previously mentioned trials were 19%, 27% and 22% respectively, and the absolute reductions in risk of death were 4% at 42 months, 6% at 15 months and 8% at 37 months, respectively. Studies including all forms of myocardial infarction involve populations at lower risk. The effects of ACE inhibitors on mortality are then less obvious: from 7.7% to 7.2% at 5 weeks in ISIS-4, from 7.1% to 6.3% at 6 weeks in GISSI-3, from 9.6% to 9.0% at 4 weeks in CCS-1, corresponding to relative reductions in the risk of death of 7%, 12% and 3% respectively and absolute reductions of the risk of death of 0.5% at 5 weeks, 0.8% at 6 weeks and 0.6% at 4 weeks, respectively. Who should be treated? All patients for 4 to 6 weeks or only high risk patients. When should treatment be started? Some investigators institute treatment from the first day but others think it prudent to wait until the second day. For how long? Four to 6 weeks would be sufficient to counteract ventricular remodelling while the benefits are sustained in the long term. But treatment should be continued long term in high risk patients. Which molecule, which dose and how many times, should it be taken per day? The logical answer is molecules with proven efficacy at the dose given in the clinical trials respecting the number of times indicated per day.
BACKGROUND: Cutaneous exposure to UVB radiation impairs the induction of contact hypersensitivity (CHS). Variable results have been found among studies examining the use of sunscreens to prevent UV-induced immunosuppression. OBJECTIVE: Our purpose was to determine whether solar-simulated exposure of human skin resulted in an impairment of CHS responses and whether the preapplication of an intermediate sun protection factor (SPF) sunscreen could prevent this locally UV-induced immunosuppression. METHODS: Irritant and CHS responses to dinitrochlorobenzene (DNCB) were randomly assessed in 160 human volunteers with or without UV exposure and with or without prior application of an SPF 15 sunscreen with high UVA protection. DNCB sensitization was performed 3 days after acute UV irradiation corresponding to 3 minimal erythema doses. RESULTS: After solar-simulated UV exposure, the percentage of positive responses to DNCB sensitization dropped from 95% to 50% (p = 0.003). Prior application of the sunscreen formulation did not modify the percentage of positive responses (90%) and maintained the immunization rate at 85% among volunteers exposed to UV. CONCLUSION: A localized sunburn can impair the afferent arm of CHS reactions in humans. The use of intermediate SPF sunscreens with high UVA protection adequately protects from the suppression of CHS responses that occurs after acute solar-simulated UV exposure.
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In order to determine precisely the cellular density of surface molecules that are critical for antigen presentation in human epidermis, we utilized a quantitative immunofluorescence indirect assay and performed flow cytometric analysis of human epidermal cell (EC) suspensions. We first demonstrated that Tricolor-labeled streptavidin coupled to Cy-5 (SA-TC) was a reliable marker for non viable EC and that SA-TC+ EC accounted for the frequent nonspecific background of fluorescence due to isotype controls binding, although Langerhans cells (LC) and Keratinocytes (Kc) express Fc receptors for IgG on their surfaces. These results indicate that quantification of cell surface antigens on human EC requires the concomitant use of a marker of viability. Multicolor flow cytometric analysis allowed us to quantify CD1 molecules and major histocompatibility complex (MHC) antigens on viable human LC and Kc. Our results demonstrated a weak expression of MHC class I molecules on viable LC (163 +/- 19 x 10(3) molecules/cell) compared to viable Kc (785 +/- 110 x 10(3) molecules/cell). Mean antigen density of HLA-DR and CD1a molecules on viable LC were 579 +/- 82 x 10(3) molecules/cell and 1600 +/- 133 x 10(3) molecules/cell, respectively. Quantitative flow cytometry of viable EC may be proposed to evaluate the number of membrane antigens whose level of expression is related to cellular maturation or activation that occurs in skin diseases.
Leishmaniasis is a group of parasitic conditions due to a flagella protozoan of the Leishmania genus and transmitted to man by phlebotomine sandflies. Cutaneous leishmaniasis exists all over the world. Those of the Old World are, in the vast majority of cases, purely cutaneous and spontaneously regress in several weeks to several months. In general, local treatment is sufficient. Those of the New World, due to multiple leishmaniasis complexes, involve a major risk of developing into a secondary mucosal form when rapid means of identifying the genus are not available. First-line treatment consists of antimony derivatives. In endemic regions, prophylaxy remains essential.
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UNLABELLED: Because retinoic acid (RA) can alter photoaging of the skin and repeated ultraviolet (UV)-induced immunologic injury may play a role in chronic photoaging, we asked whether RA alters the acute photoimmunologic effects of UV radiation. Two sites from each volunteer were treated with 0.1% RA or vehicle continuously for 24 h before and 24 h after a 4-minimal erythema dose UVB exposure. RA did not function as a sunscreen, as determined by quantitating the increase in redness after 1 minimal erythema dose to vehicle- and RA-pretreated sites (n = 12). By flow cytometric analysis of epidermal cell suspensions harvested 3 d after the UV-EC, RA treatment did not protect CD1+ Langerhans cells from being depleted by UV light and did not modify the number of UV-induced infiltrating CD36+CD11b+CD1-DR+ macrophages. RA treatment did, however, result in a 40% downregulation of human leukocyte antigen (HLA)-DR expression on these infiltrating macrophages (p = 0.016) (n = 11), in conjunction with a decrease in alloantigen-presenting cell activity of RA-treated UV-EC as measured by T-cell proliferations. RA also induced a 72% inhibition of the autologous T suppressor-inducer cell proliferation induced by UV-EC (vehicle: 21,813 +/- 7,302 cpm; RA; 5,299 +/-635 cpm) (n = 3). The downregulation could be due to RA-modulated keratinocytes; RA-treated UV-EC keratinocytes depleted of CD1a+ and DR+ antigen-presenting cells displayed a greater ability, relative to similarly treated vehicle-EC keratinocytes, to inhibit alloantigen presentation. IN CONCLUSION: (i) in vivo RA treatment did not protect human Langerhans cells from being depleted by UV and did not block infiltration of macrophages into sunburned skin; and (ii) RA did decrease autologous and allogeneic T-cell reactivity induced by macrophage antigen-presenting cells in UV-exposed epidermis, at least in part by downregulating their HLA-DR expression and by upregulating inhibitory signals from UV-irradiated keratinocytes.
We sought to exploit glycosylated poly-L-lysine (pLK) to increase the uptake and biological antisense activity of a phosphorothioate oligonucleotide (pt-odn) [pt-odn complementary to the 3' noncoding region of intercellular adhesion molecule-1 (ICAM-1) (odn(ICAM-1))] complementary to the 3'-noncoding region of ICAM-1 in A549 cells. Dose-dependent inhibition of ICAM-1 expression was obtained (IC50 = 500 nM) through treatment of cells with odn(ICAM-1) complexed with pLK carrying fucose residues in the presence of 100 microM chloroquine. Alteration in the charge ratio between fucosylated pLK and pt-odn had a significant effect on the efficacy of inhibition (optimal conditions, charge ratio = 1.1). This effect was also dependent on the number of fucose moieties per pLK. Free pt-odn or pt-odn complexed with nonglycosylated pLK gave no inhibition at concentrations of < or = 2 microM. Two control pt-odn (one was targeted against an unrelated gene not present in these cells, gag(HIV), and the other had a randomized sequence) gave no inhibition of ICAM-1 expression in the presence or absence of pLK carrying fucose residues at concentrations of < or = 2 microM. When complexed with pLK carrying 100 fucose residues, the amount of cell-associated pt-odn was increased by 15-fold compared with the free pt-odn. Nongycosylated pLK also increased the amount of cell-associated pt-odn by >10 fold but did not alter the biological activity. These results demonstrate clearly the potential of glycosylated pLK as a pt-odn transporter.
Because UV-induced epidermal macrophages (UV-Mph) preferentially activate CD4+ T suppressor-inducer cells and induce tolerance, we hypothesized that they differentially up-regulate T cell early activation genes compared with constitutive epidermal APC, Langerhans cells. We used epidermal cells from UV-exposed (UV-EC) and control (C-EC) human skin to stimulate allogeneic CD4+ T lymphocytes. Reverse transcriptase-PCR revealed that both C-EC (Langerhans cells) and UV-EC (UV-Mph) induced 10(3)- to 10(6)-fold increases in IL-2 mRNA. However, while T cells stimulated by C-EC for 48 h showed a greater than 10(3)-fold increase in IL-2R alpha mRNA, those stimulated by UV-EC did not (n = 5, p = 0.004). Flow cytometry demonstrated that 4.1 +/- 2.3% of unstimulated CD4+ lymphocytes expressed cell surface IL-2R alpha, which increased to 15.7 +/- 1.8% upon stimulation by C-EC for 48 h, but stimulation by UV-EC failed to increase the IL-2R alpha+ population (n = 3, p = 0.038). The addition of neutralizing anti-TGF-beta Abs to UV-EC-stimulated cultures restored CD4+ cell surface IL-2R alpha expression to 12.9 +/- 0.2%. CD4+ T cell activation by UV-Mph is distinct from previously described models of tolerance such as Th2 activation (IFN-gamma mRNA was induced and IL-4 mRNA was not) and Th1 anergy (IL-2 mRNA levels induced by UV-EC and C-EC were similar). Furthermore, costimulatory signals were provided by UV-Mph; CTLA4-Ig and LFA-3-Ig fusion proteins and Abs to CD2, LFA-3, LFA-1, and ICAM-1 inhibited UV-Mph-induced T cell proliferation. Thus, the altered immune outcome induced by UV-Mph (tolerization) compared with Langerhans cells (sensitization) is reflected as a novel mechanism of initial CD4+ T cell early activation gene expression characterized by TGF-beta-dependent deficient IL-2R alpha expression.
Antigen-presenting (APC), suppressor T-cell-inducing macrophages infiltrate both human and murine epidermis after ultraviolet radiation (UVR) exposure. To determine their derivation, we prepared epidermal cell and dermal cell suspensions from human keratome biopsy specimens obtained from nonexposed skin and from UVB-irradiated sites (3 d after four times the minimal erythema dose). Simultaneous triple-marker flow cytometric analysis established the extended phenotype of macrophages infiltrating sunburned human epidermis (CD1a- CD1c- CD11b+ CD11c+ CD36+ Fc gamma RII+ DR+). This then enabled us to track dermal cells of this phenotype after UVR in relation to the heterogeneous DR+ populations in normal dermis. By both in situ immunohistology and cell suspension flow cytometry, UVR induced an expansion of bone marrow-derived DR+ cells in the perivasculature and sub-basement membrane zone of the papillary dermis. Despite an overall expansion of DR+ cells, the CD1a+ CD1c+ CD36- DR+ Langerhans-cell-like dendritic APC subset of dermal DR+ cells was depleted (p < 0.05), indicating that UVR-induced epidermal Langerhans cell loss (from 95% to 7% of DR+ epidermal cells) is not accounted for by Langerhans cell accumulation in the dermis. By contrast, UVR exposure induced a selective expansion of the dermal macrophage subset, which is phenotypically identical to the monocytic/macrophagic APCs that appear in the epidermis after UV injury (p < 0.01). Cell cycle analysis (to determine whether this expansion was accounted for entirely by infiltration) revealed no increase in the percentage of DR+ CD36+ UVR-exposed dermal cells in S/G2/M phase; however, the expanded DR+ CD36+ subset continued its already substantial level of proliferation unabated. Therefore, epidermal macrophages derive not only from transcapillary migration, but also from in situ proliferation of a dermal precursor. Taken together, these findings show that UVR creates an epidermal and dermal APC milieu which is dominated by monocytic/macrophagic cells, through depletion of cells of dentritic APC phenotype, and concomitant selective dermal expansion of a CD1a- CD1c- CD11b+ CD36+ Fc gamma RII+ DR+ (monocyte/macrophage) population.
Epidermal Langerhans cell heterogeneity is poorly understood with regard to phenotypic characteristics, such as the expression of human leukocyte antigen (HLA)-DR, integrin, and Fc receptor molecules, as well as functional characteristics, such as the ability to process and present antigens or produce cytokines during various phases of immigration and maturation. Technical limitations of Langerhans cell number have limited functional assays on putative Langerhans cell subsets in in vivo epidermis. Therefore, we used flow cytometry for simultaneous phenotypic and functional assessment at the single-cell level within the Langerhans cell population. Freshly isolated human epidermal cell suspensions were stained with a battery of monoclonal antibodies, including anti-HLA-DR, -CD1a, -CD1c, -CD11c, -Fc gamma RII, and -Fc epsilon RI. Two distinct Langerhans cell subsets were identified by their different levels of HLA-DR expression. The DRHi subset expressed higher amounts of CD11c and exhibited greater cytoplasmic complexity and higher baseline calcium than the DRLo subset (p < or = 0.03 for each). Some subjects also expressed high levels of Fc epsilon RI in the DRHi, CD11cHi subset. To determine whether these phenotypic subsets may exhibit differential signal-transduction functional properties, Langerhans cells were partially enriched over Ficoll-Hypaque and their cytosolic mobilization after the addition of ionomycin was analyzed using the calcium indicator, indo-1, in conjunction with quantitative analysis of HLA-DR expression. By this real-time flow cytometric analysis, a new subpopulation was revealed within the DRLo Langerhans cell subset. This subset increased its cytosolic calcium concentration much more than the other two subsets (change in indo-1 blue:violet emission ratio of 37.33 +/- 2.34 in the Hi Flux DRLo subset versus 13.23 +/- 0.29 in the Lo Flux DRLo subset, and versus 7.6 +/- 2.99 in the Lo Flux DRHi subset). These data indicate that functional, as well as phenotypic, subsets of Langerhans cells exist within normal human epidermis. Their responses to physiologic stimuli may relate to maturational stage or the level of in vivo activation.
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INTRODUCTION: Skin cancer occurs more readily in more aggressive forms in immunodepressed subjects. We report the case of a patient with chronic lymphoid leukaemia and multiple skin carcinomas complicated with carcinomatous lymphangitis. CASE REPORT: A 63 year-old man with chronic lymphoid leukaemia, stage A in the Binet classification, had multiple epidermoid carcinomas on the trunk and face. The skin tumours were complicated with cervical lymph mode metastases, then a prethoracic carcinomatous lymphangitis with a rapidly fatal clinical course. DISCUSSION: Chronic lymphoid leukaemia and lymphomas are associated with a high incidence of skin carcinoma. The immunodepression inherent in the haematologic disease would appear to favor aggressive skin cancers. Our case was particularly severe since the carcinomatous lymphangitis was rapidly fatal.
Lichen planus is an immunologically mediated skin or mucous disease, which has recently been described in some patients with hepatitis C virus-related liver disease. We report 5 new cases of the association of hepatitis C with lichen planus, to be added to the 15 cases published in the literature. The sex ratio (female/male) was of 1.2. Lichen planus occurred more frequently in chronic active hepatitis (2/3 of cases) than in cirrhosis (1/3 of cases). Lichen planus manifestations were only mucous (30%), only cutaneous (40%) or both (30%). Mucous lesions were mainly observed in patients with cirrhosis (3/4 of cases). The onset of skin and hepatic manifestations was variable, with liver disease as the most frequent revealing symptom (60%). The influence of interferon remains unclear. However, it seemed to trigger more than to relieve lichen planus.