TY - JOUR A1 - Baur, Johannes A1 - Mathe, Katrin A1 - Gesierich, Anja A1 - Weyandt, Gerhard A1 - Wiegering, Armin A1 - Germer, Christoph-Thomas A1 - Gasser, Martin A1 - Pelz, Jörg O. W. T1 - Morbidity and oncologic outcome after saphenous vein-sparing inguinal lymphadenectomy in melanoma patients JF - World Journal of Surgical Oncology N2 - Background: Inguinal lymph node dissection (LND) is a surgical procedure with a high morbidity rate. Variations in surgical procedure, such as sparing of the saphenous vein, have been proposed to reduce surgical morbidity. While sparing of the saphenous vein has shown promising results in earlier studies, data for this procedure in melanoma patients are rare. In this retrospective study, we report 10-year findings on the effects of saphenous vein-sparing LND on surgical morbidity and oncologic outcomes in melanoma patients. Methods: A retrospective analysis of melanoma patients receiving inguinal LND in our facility between 2003 and 2013 was performed. Patients were divided into two groups: the saphenous vein resection group and the vein sparing group. Surgical morbidity, including wound infection, lymphatic fistula, severe bleeding, neurological complications, and chronic lymphedema, as well as regional recurrence-free survival were investigated. Results: A total of 106 patients were included in this study; of these, the saphenous vein was spared in 41 patients (38.7%). The rate of lymphatic fistula was 51.6 vs. 48.8%, wound infection occurred in 31.3 vs. 24.4%, and patients suffered from chronic lymphedema in 30.0 vs. 26.5% in V. saphena magna resection vs. sparing group. Differences observed, however, were not significant. No difference in regional recurrence-free survival between the two study groups was detected. Conclusions: The results of our retrospective analysis could not confirm the promising results reported in earlier studies. Thus, sparing of the saphenous vein appears to be optional. KW - malignant melanoma KW - inguinal lymph node dissection KW - regional recurrence KW - V. saphena magna Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157687 VL - 15 IS - 99 ER - TY - JOUR A1 - Wendlinger, Simone A1 - Wohlfarth, Jonas A1 - Kreft, Sophia A1 - Siedel, Claudia A1 - Kilian, Teresa A1 - Dischinger, Ulrich A1 - Heppt, Markus V. A1 - Wistuba-Hamprecht, Kilian A1 - Meier, Friedegund A1 - Goebeler, Matthias A1 - Schadendorf, Dirk A1 - Gesierich, Anja A1 - Kosnopfel, Corinna A1 - Schilling, Bastian T1 - Blood eosinophils are associated with efficacy of targeted therapy in patients with advanced melanoma JF - Cancers N2 - Background: Eosinophils appear to contribute to the efficacy of immunotherapy and their frequency was suggested as a predictive biomarker. Whether this observation could be transferred to patients treated with targeted therapy remains unknown. Methods: Blood and serum samples of healthy controls and 216 patients with advanced melanoma were prospectively and retrospectively collected. Freshly isolated eosinophils were phenotypically characterized by flow cytometry and co-cultured in vitro with melanoma cells to assess cytotoxicity. Soluble serum markers and peripheral blood counts were used for correlative studies. Results: Eosinophil-mediated cytotoxicity towards melanoma cells, as well as phenotypic characteristics, were similar when comparing healthy donors and patients. However, high relative pre-treatment eosinophil counts were significantly associated with response to MAPKi (p = 0.013). Eosinophil-mediated cytotoxicity towards melanoma cells is dose-dependent and requires proximity of eosinophils and their target in vitro. Treatment with targeted therapy in the presence of eosinophils results in an additive tumoricidal effect. Additionally, melanoma cells affected eosinophil phenotype upon co-culture. Conclusion: High pre-treatment eosinophil counts in advanced melanoma patients were associated with a significantly improved response to MAPKi. Functionally, eosinophils show potent cytotoxicity towards melanoma cells, which can be reinforced by MAPKi. Further studies are needed to unravel the molecular mechanisms of our observations. KW - melanoma KW - eosinophils KW - biomarker Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-275137 SN - 2072-6694 VL - 14 IS - 9 ER - TY - JOUR A1 - Køllgaard, Tania A1 - Ugurel-Becker, Selma A1 - Idorn, Manja A1 - Andersen, Mads Hald A1 - Becker, Jürgen C. A1 - Straten, Per thor T1 - Pre-Vaccination Frequencies of Th17 Cells Correlate with Vaccine-Induced T-Cell Responses to Survivin-Derived Peptide Epitopes JF - PLoS One N2 - Various subsets of immune regulatory cells are suggested to influence the outcome of therapeutic antigen-specific anti-tumor vaccinations. We performed an exploratory analysis of a possible correlation of pre-vaccination Th17 cells, MDSCs, and Tregs with both vaccination-induced T-cell responses as well as clinical outcome in metastatic melanoma patients vaccinated with survivin-derived peptides. Notably, we observed dysfunctional Th1 and cytotoxic T cells, i.e. down-regulation of the CD3\(\zeta\)chain (p=0.001) and an impaired IFN\(\gamma\)-production (p=0.001) in patients compared to healthy donors, suggesting an altered activity of immune regulatory cells. Moreover, the frequencies of Th17 cells (p=0.03) and Tregs (p=0.02) were elevated as compared to healthy donors. IL-17-secreting CD4\(^{+}\) T cells displayed an impact on the immunological and clinical effects of vaccination: Patients characterized by high frequencies of Th17 cells at pre-vaccination were more likely to develop survivin-specific T-cell reactivity post-vaccination (p=0.03). Furthermore, the frequency of Th17 (p=0.09) and Th17/IFN\(\gamma\)\(^{+}\) (p=0.19) cells associated with patient survival after vaccination. In summary, our explorative, hypothesis-generating study demonstrated that immune regulatory cells, in particular Th17 cells, play a relevant role for generation of the vaccine-induced anti-tumor immunity in cancer patients, hence warranting further investigation to test for validity as predictive biomarkers. KW - suppressor cells KW - melanoma patients KW - patient survival KW - cancer patients KW - Th17 KW - tumor immunity KW - blood Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-151509 VL - 10 IS - 7 ER - TY - JOUR A1 - Buhl, Timo A1 - Beissert, Stefan A1 - Gaffal, Evelyn A1 - Goebeler, Matthias A1 - Hertl, Michael A1 - Mauch, Cornelia A1 - Reich, Kristian A1 - Schmidt, Enno A1 - Schön, Michael P. A1 - Sticherling, Michael A1 - Sunderkötter, Cord A1 - Traidl‐Hoffmann, Claudia A1 - Werfel, Thomas A1 - Wilsman‐Theis, Dagmar A1 - Worm, Margitta T1 - COVID‐19 and implications for dermatological and allergological diseases JF - JDDG: Journal der Deutschen Dermatologischen Gesellschaft N2 - COVID‐19, caused by the coronavirus SARS‐CoV‐2, has become pandemic. A further level of complexity opens up as soon as we look at diseases whose pathogenesis and therapy involve different immunological signaling pathways, which are potentially affected by COVID‐19. Medical treatments must often be reassessed and questioned in connection with this infection. This article summarizes the current knowledge of COVID‐19 in the light of major dermatological and allergological diseases. It identifies medical areas lacking sufficient data and draws conclusions for the management of our patients during the pandemic. We focus on common chronic inflammatory skin diseases with complex immunological pathogenesis: psoriasis, eczema including atopic dermatitis, type I allergies, autoimmune blistering and inflammatory connective tissue diseases, vasculitis, and skin cancers. Since several other inflammatory skin diseases display related or comparable immunological reactions, clustering of the various inflammatory dermatoses into different disease patterns may help with therapeutic decisions. Thus, following these patterns of skin inflammation, our review may supply treatment recommendations and thoughtful considerations for disease management even beyond the most frequent diseases discussed here. KW - COVID-19 KW - dermatology KW - allergies Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217860 VL - 18 IS - 8 SP - 815 EP - 824 ER - TY - JOUR A1 - Glutsch, Valerie A1 - Amaral, Teresa A1 - Garbe, Claus A1 - Thoms, Kai-Martin A1 - Mohr, Peter A1 - Hauschild, Axel A1 - Schilling, Bastian T1 - Indirect Comparison of Combined BRAF and MEK Inhibition in Melanoma Patients with Elevated Baseline Lactate Dehydrogenase JF - Acta Dermato-Venereologica N2 - The approval of BRAF and MEK inhibitors has signifi-cantly improved treatment outcomes for patients with BRAF-mutated metastatic melanoma. The 3 first-line targeted therapy trials have provided similar results, and thus the identification of predictive biomarkers may generate a more precise basis for clinical deci-sion-making. Elevated baseline lactate dehydrogenase (LDH) has already been determined as a strong prog-nostic factor. Therefore, this indirect analysis compa-red subgroups with elevated baseline LDH across the pivotal targeted therapy trials co-BRIM, COMBI-v and COLUMBUS part 1. The Bucher method was used to compare progression-free survival, objective response rate and overall survival indirectly. The results show a non-significant risk reduction for progression in the subgroup with elevated baseline LDH receiving vemu-rafenib plus cobimetinib compared with dabrafenib plus trametinib and encorafenib plus binimetinib. Al-though an indirect comparison, these data might pro-vide some guidance for treatment recommendations in melanoma patients with elevated LDH. KW - melanoma KW - BRAF KW - lactate dehydrogenase Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230190 VL - 100 ER - TY - JOUR A1 - Benoit, Sandrine A1 - Scheurlen, Michael A1 - Goebeler, Matthias A1 - Stoevesandt, Johanna T1 - Structured diagnostic approach and risk assessment in mucous membrane pemphigoid with oesophageal involvement JF - Acta Dermato-Venereologica N2 - Oesophageal involvement in mucous membrane pemphigoid is considered rare, but it may be underdiagnosed. To assess the incidence of oesophageal involvement in a group of patients with newly diagnosed mucous membrane pemphigoid we retrospectively analysed the medical records of 30 consecutive patients with mucous membrane pemphigoid diagnosed between 2006 and 2016 at the Department of Dermatology, University Hospital Würzburg. Twenty-one patients (70%) reported symptoms indicative of oesophageal mucous membrane pemphigoid. Twelve patients (40%) underwent oesophagogastroduodenoscopy, and oesophageal pathology compatible with mucous membrane pemphigoid was endoscopically found in 9 cases (30%). In all patients indirect and direct immunofluorescence were performed. Patients with and without oesophageal involvement did not differ with regard to the results of indirect immunofluorescence on salt-split human skin and monkey oesophagus. Study results demonstrate the necessity of a standardized diagnostic work-up, including adequate tissue samples for direct immunofluorescence, to prevent underdiagnosis of oesophageal mucous membrane pemphigoid. KW - cicatricial pemphigoid KW - mucous membrane pemphigoid KW - oesophagogastroduodenoscopy KW - laminin 332 Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176191 VL - 98 ER - TY - JOUR A1 - Halfmann, Marie A1 - Castioni, Noah A1 - Wetzel, Lea A1 - Koopmann, Anne A1 - König, Sarah A1 - Schmieder, Astrid T1 - Effects of the COVID-19 pandemic on the mental health of medical students and young physicians in Germany: Gender-specific results of an online survey JF - Heliyon N2 - Background Healthcare workers and medical students faced new challenges during the COVID-19 pandemic. Processes within many hospitals were completely disrupted. In addition, the face to face teaching of medical students was drastically reduced. Those at risk of developing mental health problems appear to be younger health care workers and women. Objective To investigate potential COVID-19 pandemic-related gender differences in psychological distress among medical students and physicians in their first years of practice. Design and setting An anonymous survey was carried out online between December 1, 2021, and March 31, 2022, at the Mannheim Medical Faculty and the Würzburg Medical Faculty, Germany, after obtaining informed consent. Primary outcome measures were changes in anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS), and changes in participants' current quality of life using the WHO Quality of Life BREF. Results The results show wave-like courses for perceived anxiety and burden overlapping with the course of the COVID-19 incidence. In comparison to men, women showed a significant higher increase in HADS (p = 0.005) and a reduced life quality (p = 0.007) after COVID-19. Both sexes showed different frequencies of the factors influencing quality of life, with the presence of a previous mental illness and mean anxiety having a significant higher negative impact in women. Conclusion Future and young female physicians reported a disproportionate higher burden during COVID-19 compared to their male colleges. These observations suggest an increased need for support and prevention efforts especially in this vulnerable population. KW - mental health KW - Covid-19 KW - medical students KW - sex differences Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350502 SN - 2405-8440 VL - 10 IS - 1 ER - TY - JOUR A1 - Houben, Roland T1 - Reduced frequency of migraine attacks following coronavirus disease 2019: a case report JF - Journal of Medical Case Reports N2 - Background Severe acute respiratory syndrome coronavirus 2 is a virus affecting different organs and causing a wide variety and severity of symptoms. Headache as well as loss of smell and taste are the most frequently reported neurological manifestations of coronavirus disease 2019 induced by severe acute respiratory syndrome coronavirus 2. Here we report on a patient with chronic migraine and medication overuse headache, who experienced remarkable mitigation of migraine following coronavirus disease 2019. Case presentation For many years prior to the severe acute respiratory syndrome coronavirus 2 infection, a 57-year-old Caucasian male suffered from very frequent migraine attacks and for control of headaches he had been taking triptans almost daily. In the 16-month period before the outbreak of coronavirus disease 2019, triptan was taken 98% of the days with only a 21-day prednisolone-supported triptan holiday, which, however, had no longer-lasting consequences on migraine frequency. Upon severe acute respiratory syndrome coronavirus 2 infection, the patient developed only mild symptoms including fever, fatigue, and headache. Directly following recovery from coronavirus disease 2019, the patient surprisingly experienced a period with largely reduced frequency and severity of migraine attacks. Indeed, during 80 days following coronavirus disease 2019, migraine as well as triptan usage were restricted to only 25% of the days, no longer fulfilling criteria of a chronic migraine and medication overuse headache. Conclusion Severe acute respiratory syndrome coronavirus 2 infection might be capable of triggering mitigation of migraine. KW - migraine KW - triptan KW - severe acute respiratory syndrome coronavirus 2 KW - coronavirus disease 2019 KW - case report Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357327 VL - 17 ER - TY - JOUR A1 - Huttelmaier, Johanna A1 - Benoit, Sandra A1 - Goebeler, Matthias T1 - Comorbidity in bullous pemphigoid: up-date and clinical implications JF - Frontiers in Immunology N2 - Bullous pemphigoid is the most common autoimmune blistering disease in industrialized countries and particularly affects the elderly. In this patient population, comorbid diseases are frequent and may complicate management and treatment of bullous pemphigoid. A better understanding why distinct diseases are more frequent in bullous pemphigoid patients may lead to new pathophysiological insights and - as a consequence - result in better patient care. The association of bullous pemphigoid with neurological and psychiatric diseases is well known and confirmed by several case-control studies. Association with further diseases such as malignancy and metabolic diseases are still discussed controversially. In recent years new relationships between bullous pemphigoid and autoimmune as well as inflammatory skin diseases have been reported. This review provides a systematic overview on studies addressing comorbidity in bullous pemphigoid patients. Increasing the awareness of both, common and rare comorbid diseases, may enable clinicians to optimize patient support and individualized treatment of bullous pemphigoid. KW - bullous pemphigoid KW - autoimmune skin blistering disease KW - comorbidity KW - neurologic disease KW - metabolic disease KW - malignancy KW - inflammatory disease Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-321671 VL - 14 ER - TY - JOUR A1 - Goebeler, M. A1 - Bata-Csörgő, Z. A1 - Simone, C. de A1 - Didona, B. A1 - Remenyik, E. A1 - Reznichenko, N. A1 - Stoevesandt, J. A1 - Ward, E. S. A1 - Parys, W. A1 - Haard, H. de A1 - Dupuy, P. A1 - Verheesen, P. A1 - Schmidt, E. A1 - Joly, P. T1 - Treatment of pemphigus vulgaris and foliaceus with efgartigimod, a neonatal Fc receptor inhibitor: a phase II multicentre, open-label feasibility trial JF - British Journal of Dermatology N2 - Background Pemphigus vulgaris and pemphigus foliaceus are potentially life-threatening autoimmune disorders triggered by IgG autoantibodies against mucosal and epidermal desmogleins. There is an unmet need for fast-acting drugs that enable patients to achieve early sustained remission with reduced corticosteroid reliance. Objectives To investigate efgartigimod, an engineered Fc fragment that inhibits the activity of the neonatal Fc receptor, thereby reducing serum IgG levels, for treating pemphigus. Methods Thirty-four patients with mild-to-moderate pemphigus vulgaris or foliaceus were enrolled in an open-label phase II adaptive trial. In sequential cohorts, efgartigimod was dosed at 10 or 25 mg kg\(^{-1}\) intravenously with various dosing frequencies, as monotherapy or as add-on therapy to low-dose oral prednisone. Safety endpoints comprised the primary outcome. The study is registered at ClinicalTrials.gov (identifier NCT03334058). Results Adverse events were mostly mild and were reported by 16 of 19 (84%) patients receiving efgartigimod 10 mg kg\(^{-1}\) and 13 of 15 (87%) patients receiving 25 mg kg−1, with similar adverse event profiles between dose groups. A major decrease in serum total IgG and anti-desmoglein autoantibodies was observed and correlated with improved Pemphigus Disease Area Index scores. Efgartigimod, as monotherapy or combined with prednisone, demonstrated early disease control in 28 of 31 (90%) patients after a median of 17 days. Optimized, prolonged treatment with efgartigimod in combination with a median dose of prednisone 0·26 mg \(^{-1}\) per day (range 0·06–0·48) led to complete clinical remission in 14 of 22 (64%) patients within 2–41 weeks. Conclusions Efgartigimod was well tolerated and exhibited an early effect on disease activity and outcome parameters, providing support for further evaluation as a therapy for pemphigus. KW - pemphigus vulgaris KW - efgartigimod KW - pemphigus foliaceus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258328 VL - 186 IS - 3 ER - TY - JOUR A1 - Paudel, Rupesh A1 - Fusi, Lorenza A1 - Schmidt, Marc T1 - The MEK5/ERK5 pathway in health and disease JF - International Journal of Molecular Sciences N2 - The MEK5/ERK5 mitogen-activated protein kinases (MAPK) cascade is a unique signaling module activated by both mitogens and stress stimuli, including cytokines, fluid shear stress, high osmolarity, and oxidative stress. Physiologically, it is mainly known as a mechanoreceptive pathway in the endothelium, where it transduces the various vasoprotective effects of laminar blood flow. However, it also maintains integrity in other tissues exposed to mechanical stress, including bone, cartilage, and muscle, where it exerts a key function as a survival and differentiation pathway. Beyond its diverse physiological roles, the MEK5/ERK5 pathway has also been implicated in various diseases, including cancer, where it has recently emerged as a major escape route, sustaining tumor cell survival and proliferation under drug stress. In addition, MEK5/ERK5 dysfunction may foster cardiovascular diseases such as atherosclerosis. Here, we highlight the importance of the MEK5/ERK5 pathway in health and disease, focusing on its role as a protective cascade in mechanical stress-exposed healthy tissues and its function as a therapy resistance pathway in cancers. We discuss the perspective of targeting this cascade for cancer treatment and weigh its chances and potential risks when considering its emerging role as a protective stress response pathway. KW - atherosclerosis KW - bone KW - cartilage KW - endothelium KW - extracellular-regulated kinase 5 KW - Krüppel-like factor KW - mechanotransduction KW - mitogen-activated protein kinase KW - stress signaling KW - tumor Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261638 SN - 1422-0067 VL - 22 IS - 14 ER - TY - JOUR A1 - Frings, Verena Gerlinde A1 - Schöffski, Oliver A1 - Goebeler, Matthias A1 - Presser, Dagmar T1 - Economic analysis of the costs associated with Hidradenitis suppurativa at a German University Hospital JF - PLoS One N2 - Background and objectives Hidradenitis suppurativa (HS) significantly affects the patient`s quality of life and leads to multiple medical consultations. Aim of this study was to assess the utilization of medical care of HS patients. Patients and methods All patients presenting in 2017 for an outpatient, day patient and / or inpatient treatment with leading claim type HS at the Department of Dermatology, University Hospital Würzburg, were included. Primary outcome was the economic burden of HS patients, measured by resource utilization in €. Results The largest share of the direct medical costs for HS were the inpatient costs with a leading surgical diagnosis-related group (DRG). Antiseptics were the predominant topical prescription. While doxycycline was the most frequently prescribed systemic therapy, adalimumab was the main cost driver. The difference between in-patient (€ 110.25) and outpatient (€ 26.34) direct non-medical costs was statistically significant (p < 0.001). With regards to indirect medical costs, a statistically significantly higher loss of gross value added (inpatient mean € 1,827.00; outpatient mean € 203.00) and loss of production (inpatient mean € 1,026.00; outpatient mean € 228.00) could be noted (p < 0.001), respectively. Conclusions The present study on disease-specific costs of HS confirms that the hospital care of patients with this disease is cost-intensive. However, the primary goal of physicians is not and should not be to save costs regarding their patients`treatment, but rather the premise to utilize the existing resources as efficient as possible. Reducing the use of costly therapeutics and inpatient stays therefore requires more effective therapy options with an improved cost-benefit profile. KW - inpatients KW - outpatients KW - health insurance KW - dermatology KW - surgical and invasive medical procedures KW - health economics KW - psoriasis KW - indirect costs Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-261668 VL - 16 IS - 8 ER - TY - JOUR A1 - Glutsch, Valerie A1 - Wobser, Marion A1 - Schilling, Bastian A1 - Gesierich, Anja A1 - Goebeler, Matthias A1 - Kneitz, Hermann T1 - PRAME expression as helpful immunohistochemical marker in rhabdoid melanoma JF - Dermatopathology N2 - Background: Rhabdoid melanoma is a rare variant of malignant melanoma with characteristic cytomorphologic features. Due to the potential loss of conventional melanocytic markers, histopathologic diagnosis is often challenging. We hypothesize that immunostaining for PReferentially expressed Antigen in MElanoma (PRAME) might have the potential to uncover the melanocytic origin of these dedifferentiated tumors. Methods: Four cases of rhabdoid primary melanomas were assessed by immunohistochemistry for expression of PRAME and conventional melanocytic markers. Immunohistochemical expression patterns were analyzed in the rhabdoid primaries and, if available, associated metastases. Results: All four cases of rhabdoid primary melanomas showed a strong nuclear positivity for PRAME, while the expression of conventional melanocytic markers S100, MART-1, SOX-10 and HMB-45 was variable between the analyzed cases. Conclusions: In summary, we report four cases of rhabdoid primary melanoma with high to intermediate expression of PRAME despite the partial and variable loss of other melanocytic markers. Hence, PRAME might facilitate the recognition of this highly aggressive entity to avoid misdiagnosis due to histopathologic pitfalls. KW - PRAME KW - rhabdoid differentiation KW - rhabdoid melanoma KW - immunohistochemistry KW - melanocytic markers Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-284115 SN - 2296-3529 VL - 9 IS - 2 SP - 148 EP - 157 ER - TY - JOUR A1 - Isberner, Nora A1 - Gesierich, Anja A1 - Balakirouchenane, David A1 - Schilling, Bastian A1 - Aghai-Trommeschlaeger, Fatemeh A1 - Zimmermann, Sebastian A1 - Kurlbaum, Max A1 - Puszkiel, Alicja A1 - Blanchet, Benoit A1 - Klinker, Hartwig A1 - Scherf-Clavel, Oliver T1 - Monitoring of dabrafenib and trametinib in serum and self-sampled capillary blood in patients with BRAFV600-mutant melanoma JF - Cancers N2 - Simple Summary In melanoma patients treated with dabrafenib and trametinib, dose reductions and treatment discontinuations related to adverse events (AE) occur frequently. However, the associations between patient characteristics, AE, and exposure are unclear. Our prospective study analyzed serum (hydroxy-)dabrafenib and trametinib exposure and investigated its association with toxicity and patient characteristics. Additionally, the feasibility of at-home sampling of capillary blood was assessed, and a model to convert capillary blood concentrations to serum concentrations was developed. (Hydroxy-)dabrafenib or trametinib exposure was not associated with age, sex, body mass index, or AE. Co-medication with P-glycoprotein inducers was associated with lower trough concentrations of trametinib but not (hydroxy-)dabrafenib. The applicability of the self-sampling of capillary blood was demonstrated. Our conversion model was adequate for estimating serum exposure from micro-samples. The monitoring of dabrafenib and trametinib may be useful for dose modification and can be optimized by at-home sampling and our new conversion model. Abstract Patients treated with dabrafenib and trametinib for BRAF\(^{V600}\)-mutant melanoma often experience dose reductions and treatment discontinuations. Current knowledge about the associations between patient characteristics, adverse events (AE), and exposure is inconclusive. Our study included 27 patients (including 18 patients for micro-sampling). Dabrafenib and trametinib exposure was prospectively analyzed, and the relevant patient characteristics and AE were reported. Their association with the observed concentrations and Bayesian estimates of the pharmacokinetic (PK) parameters of (hydroxy-)dabrafenib and trametinib were investigated. Further, the feasibility of at-home sampling of capillary blood was assessed. A population pharmacokinetic (popPK) model-informed conversion model was developed to derive serum PK parameters from self-sampled capillary blood. Results showed that (hydroxy-)dabrafenib or trametinib exposure was not associated with age, sex, body mass index, or toxicity. Co-medication with P-glycoprotein inducers was associated with significantly lower trough concentrations of trametinib (p = 0.027) but not (hydroxy-)dabrafenib. Self-sampling of capillary blood was feasible for use in routine care. Our conversion model was adequate for estimating serum PK parameters from micro-samples. Findings do not support a general recommendation for monitoring dabrafenib and trametinib but suggest that monitoring can facilitate making decisions about dosage adjustments. To this end, micro-sampling and the newly developed conversion model may be useful for estimating precise PK parameters. KW - dabrafenib KW - trametinib KW - hydroxy-dabrafenib KW - melanoma KW - BRAF mutation KW - volumetric absorptive micro-sampling (VAMS) KW - at-home sampling KW - drug monitoring KW - population pharmacokinetics Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288109 SN - 2072-6694 VL - 14 IS - 19 ER - TY - JOUR A1 - Wobser, Marion A1 - Goebeler, Matthias T1 - Special Issue “Cutaneous Lymphomas” JF - Cancers N2 - No abstract available KW - cutaneous lymphomas Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304180 SN - 2072-6694 VL - 15 IS - 5 ER - TY - JOUR A1 - Houben, Roland A1 - Celikdemir, Büke A1 - Kervarrec, Thibault A1 - Schrama, David T1 - Merkel cell polyomavirus: infection, genome, transcripts and its role in development of Merkel cell carcinoma JF - Cancers N2 - The best characterized polyomavirus family member, i.e., simian virus 40 (SV40), can cause different tumors in hamsters and can transform murine and human cells in vitro. Hence, the SV40 contamination of millions of polio vaccine doses administered from 1955–1963 raised fears that this may cause increased tumor incidence in the vaccinated population. This is, however, not the case. Indeed, up to now, the only polyomavirus family member known to be the most important cause of a specific human tumor entity is Merkel cell polyomavirus (MCPyV) in Merkel cell carcinoma (MCC). MCC is a highly deadly form of skin cancer for which the cellular origin is still uncertain, and which appears as two clinically very similar but molecularly highly different variants. While approximately 80% of cases are found to be associated with MCPyV the remaining MCCs carry a high mutational load. Here, we present an overview of the multitude of molecular functions described for the MCPyV encoded oncoproteins and non-coding RNAs, present the available MCC mouse models and discuss the increasing evidence that both, virus-negative and -positive MCC constitute epithelial tumors. KW - Merkel cell carcinoma KW - polyomavirus KW - T antigen Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305021 SN - 2072-6694 VL - 15 IS - 2 ER - TY - JOUR A1 - Marquardt, André A1 - Hartrampf, Philipp A1 - Kollmannsberger, Philip A1 - Solimando, Antonio G. A1 - Meierjohann, Svenja A1 - Kübler, Hubert A1 - Bargou, Ralf A1 - Schilling, Bastian A1 - Serfling, Sebastian E. A1 - Buck, Andreas A1 - Werner, Rudolf A. A1 - Lapa, Constantin A1 - Krebs, Markus T1 - Predicting microenvironment in CXCR4- and FAP-positive solid tumors — a pan-cancer machine learning workflow for theranostic target structures JF - Cancers N2 - (1) Background: C-X-C Motif Chemokine Receptor 4 (CXCR4) and Fibroblast Activation Protein Alpha (FAP) are promising theranostic targets. However, it is unclear whether CXCR4 and FAP positivity mark distinct microenvironments, especially in solid tumors. (2) Methods: Using Random Forest (RF) analysis, we searched for entity-independent mRNA and microRNA signatures related to CXCR4 and FAP overexpression in our pan-cancer cohort from The Cancer Genome Atlas (TCGA) database — representing n = 9242 specimens from 29 tumor entities. CXCR4- and FAP-positive samples were assessed via StringDB cluster analysis, EnrichR, Metascape, and Gene Set Enrichment Analysis (GSEA). Findings were validated via correlation analyses in n = 1541 tumor samples. TIMER2.0 analyzed the association of CXCR4 / FAP expression and infiltration levels of immune-related cells. (3) Results: We identified entity-independent CXCR4 and FAP gene signatures representative for the majority of solid cancers. While CXCR4 positivity marked an immune-related microenvironment, FAP overexpression highlighted an angiogenesis-associated niche. TIMER2.0 analysis confirmed characteristic infiltration levels of CD8+ cells for CXCR4-positive tumors and endothelial cells for FAP-positive tumors. (4) Conclusions: CXCR4- and FAP-directed PET imaging could provide a non-invasive decision aid for entity-agnostic treatment of microenvironment in solid malignancies. Moreover, this machine learning workflow can easily be transferred towards other theranostic targets. KW - machine learning KW - tumor microenvironment KW - immune infiltration KW - angiogenesis KW - mRNA KW - miRNA KW - transcriptome Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-305036 SN - 2072-6694 VL - 15 IS - 2 ER - TY - THES A1 - Demeter, Eran T1 - Retrospektive Untersuchung zur Häufigkeit von unerwünschten immunvermittelten Ereignissen unter Immuntherapie mit Nivolumab oder Pembrolizumab bei älteren und jüngeren Patient*innen T1 - Incidence of Immune-Related Adverse Events in Older and Younger Patients Receiving Immunotherapy with Nivolumab or Pembrolizumab: A Retrospective Analysis N2 - ICIs sind inzwischen integrales Therapiemittel vieler Tumoren, selbst in nicht metastasierten Stadien. Das Management von dabei eventuell entstehenden Nebenwirkungen bleibt wichtiger Bestandteil der Therapie vor allem im fortgeschrittenen Alter. Retrospektive Untersuchungen wie unsere tragen dazu bei, das in vielen klinischen Studien unterrepräsentierte Patientenkollektiv älterer Patienten in den klinischen Alltag sowie in Therapieentscheidungen und -planungen zu integrieren. Der primäre Studienendpunkt unserer Arbeit unterstützt wichtige Erkenntnisse anderer Studien, dass irAEs insgesamt unter älteren Patienten nicht häufiger auftreten. Zwischen allen drei Altersklassen von ~55, ~70 und ~80 Jahren zeigten sich keine signifikanten Unterschiede im Auftreten von irAEs aller Grade, wobei irAEs Grad III/IV etwas häufiger bei ~80-Jährigen auftraten. In unserem Fall stellten wir fest, dass auftretende irAEs im Alter häufiger behandelt wurden, und dass die Immuntherapie häufiger pausiert oder abgebrochen wurde. Zudem war der Anteil an Therapieabbrüchen unter den älteren Patienten wegen bestimmter Ereignisse wie TRAEs und dem Einsatz von Glukokortikoiden höher als bei jüngeren Patienten. Die Ergebnisse unserer Studie deuten außerdem darauf hin, dass selbst unter Polypharmazie und Multimorbidität irAEs nicht häufiger bei Älteren auftraten. Ebenso können wir die interessante Beobachtung verzeichnen, dass Patienten mit >5 Medikamenten und gleichzeitig >5 Erkrankungen signifikant mehr irAEs Grad III/IV aufwiesen oder mehr Patienten Glukokortikoide verabreicht bekommen haben. Auch der Anteil an Interventionsbedarf oder Therapieabbruch war hier in allen Altersklassen höher. Es stellt sich die Frage, inwiefern hohes Alter, Komorbidität und Polypharmazie Risikofaktoren für Interventionsbedarf oder Therapieabbruch in der Immuntherapie sind, und ob ihnen eher besondere Gewichtung als Risikofaktor zukommt als dem Alter selbst. N2 - ICIs are now an important part of the treatment of many tumors, even in the non-metastatic stage. Managing potential side effects is a significant aspect of treatment, particularly for elderly patients. Retrospective studies, such as the one presented here, help to integrate the underrepresented elderly patient population in many clinical trials into clinical practice, as well as into treatment decisions and planning. The primary outcome of this study supports the important findings of previous studies showing there is no overall increased incidence of irAEs in elderly patients. There were no significant differences in the occurrence of irAEs among the three age groups (~55, ~70, and ~80 years), although irAEs grade III/IV occurred slightly more frequently in patients aged ~80 years. In our study, we found that older patients who experienced irAEs required more medical intervention and that immunotherapy was interrupted or discontinued more frequently. Additionally, older patients experienced a higher incidence of treatment discontinuation due to events such as treatment-related adverse events (TRAEs) and the use of glucocorticoids when compared to younger patients. The study findings indicate that elderly patients do not have a higher incidence of irAEs, even in cases of polypharmacy and multimorbidity. However, patients of all age groups who were taking more than five medications and had more than five comorbidities experienced a higher incidence of irAEs grade III/IV. Additionally, more patients were administered glucocorticoids and had higher treatment discontinuation rates. The question arises as to whether advanced age, comorbidity and polypharmacy are more significant risk factors for discontinuing immunotherapy or medical intervention than age alone. KW - Immuntherapie KW - Ältere Patienten KW - Unerwünschte immunvermittelte Ereignisse KW - IrAEs Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-352586 ER - TY - JOUR A1 - Haake, Markus A1 - Haack, Beatrice A1 - Schäfer, Tina A1 - Harter, Patrick N. A1 - Mattavelli, Greta A1 - Eiring, Patrick A1 - Vashist, Neha A1 - Wedekink, Florian A1 - Genssler, Sabrina A1 - Fischer, Birgitt A1 - Dahlhoff, Julia A1 - Mokhtari, Fatemeh A1 - Kuzkina, Anastasia A1 - Welters, Marij J. P. A1 - Benz, Tamara M. A1 - Sorger, Lena A1 - Thiemann, Vincent A1 - Almanzar, Giovanni A1 - Selle, Martina A1 - Thein, Klara A1 - Späth, Jacob A1 - Gonzalez, Maria Cecilia A1 - Reitinger, Carmen A1 - Ipsen-Escobedo, Andrea A1 - Wistuba-Hamprecht, Kilian A1 - Eichler, Kristin A1 - Filipski, Katharina A1 - Zeiner, Pia S. A1 - Beschorner, Rudi A1 - Goedemans, Renske A1 - Gogolla, Falk Hagen A1 - Hackl, Hubert A1 - Rooswinkel, Rogier W. A1 - Thiem, Alexander A1 - Romer Roche, Paula A1 - Joshi, Hemant A1 - Pühringer, Dirk A1 - Wöckel, Achim A1 - Diessner, Joachim E. A1 - Rüdiger, Manfred A1 - Leo, Eugen A1 - Cheng, Phil F. A1 - Levesque, Mitchell P. A1 - Goebeler, Matthias A1 - Sauer, Markus A1 - Nimmerjahn, Falk A1 - Schuberth-Wagner, Christine A1 - Felten, Stefanie von A1 - Mittelbronn, Michel A1 - Mehling, Matthias A1 - Beilhack, Andreas A1 - van der Burg, Sjoerd H. A1 - Riedel, Angela A1 - Weide, Benjamin A1 - Dummer, Reinhard A1 - Wischhusen, Jörg T1 - Tumor-derived GDF-15 blocks LFA-1 dependent T cell recruitment and suppresses responses to anti-PD-1 treatment JF - Nature Communications N2 - Immune checkpoint blockade therapy is beneficial and even curative for some cancer patients. However, the majority don’t respond to immune therapy. Across different tumor types, pre-existing T cell infiltrates predict response to checkpoint-based immunotherapy. Based on in vitro pharmacological studies, mouse models and analyses of human melanoma patients, we show that the cytokine GDF-15 impairs LFA-1/β2-integrin-mediated adhesion of T cells to activated endothelial cells, which is a pre-requisite of T cell extravasation. In melanoma patients, GDF-15 serum levels strongly correlate with failure of PD-1-based immune checkpoint blockade therapy. Neutralization of GDF-15 improves both T cell trafficking and therapy efficiency in murine tumor models. Thus GDF-15, beside its known role in cancer-related anorexia and cachexia, emerges as a regulator of T cell extravasation into the tumor microenvironment, which provides an even stronger rationale for therapeutic anti-GDF-15 antibody development. KW - cancer microenvironment KW - immunotherapy KW - T cells KW - tumour immunology Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357333 VL - 14 ER - TY - JOUR A1 - Wobser, Marion A1 - Weber, Alexandra A1 - Glunz, Amelie A1 - Tauch, Saskia A1 - Seitz, Kristina A1 - Butelmann, Tobias A1 - Hesbacher, Sonja A1 - Goebeler, Matthias A1 - Bartz, René A1 - Kohlhof, Hella A1 - Schrama, David A1 - Houben, Roland T1 - Elucidating the mechanism of action of domatinostat (4SC-202) in cutaneous T cell lymphoma cells JF - Journal of Hematology & Oncology N2 - Background Targeting epigenetic modifiers is effective in cutaneous T cell lymphoma (CTCL). However, there is a need for further improvement of this therapeutic approach. Here, we compared the mode of action of romidepsin (FK228), an established class I histone deacetylase inhibitor, and domatinostat (4SC-202), a novel inhibitor of class I HDACs, which has been reported to also target the lysine-specific histone demethylase 1A (LSD1). Methods We performed MTS assays and flow cytometric analyses of propidium iodide or annexin V-stained cells to assess drug impact on cellular proliferation, cell cycle distribution, and survival. Histone acetylation and methylation as well as caspase activation was analyzed by immunoblot. Gene expression analysis was performed using NanosString technology. Knockdown and knockout of LSD1 was achieved with shRNA and CRISPR/Cas9, respectively, while the CRISPR/Cas9 synergistic activation mediator system was used to induce expression of endogenous HDACs and LSD1. Furthermore, time-lapse fluorescence microscopy and an in vitro tubulin polymerization assay were applied. Results While FK228 as well as 4SC-202 potently induced cell death in six different CTCL cell lines, only in the case of 4SC-202 death was preceded by an accumulation of cells in the G2/M phase of the cell cycle. Surprisingly, apoptosis and accumulation of cells with double DNA content occurred already at 4SC-202 concentrations hardly affecting histone acetylation and methylation, and provoking significantly less changes in gene expression compared to biologically equivalent doses of FK228. Indeed, we provide evidence that the 4SC-202-induced G2/M arrest in CTCL cells is independent of de novo transcription. Furthermore, neither enforced expression of HDAC1 nor knockdown or knockout of LSD1 affected the 4SC-202-induced effects. Since time-lapse microscopy revealed that 4SC-202 could affect mitotic spindle formation, we performed an in vitro tubulin polymerization assay revealing that 4SC-202 can directly inhibit microtubule formation. Conclusions We demonstrate that 4SC-202, a drug currently tested in clinical trials, effectively inhibits growth of CTCL cells. The anti-cancer cell activity of 4SC-202 is however not limited to LSD1-inhibition, modulation of histone modifications, and consecutive alteration of gene expression. Indeed, the compound is also a potent microtubule-destabilizing agent. KW - Cutaneous lymphoma KW - Epigenetic regulation KW - Histone deacetylase KW - HDAC KW - Lysine-specific methylase KW - LSD1 KW - Tubulin Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200703 VL - 12 ER - TY - JOUR A1 - Frings, Verena G. A1 - Roth, Sabine A1 - Rosenwald, Andreas A1 - Goebeler, Matthias A1 - Geissinger, Eva A1 - Wobser, Marion T1 - EBER in situ hybridization in subcutaneous aluminum granulomas/lymphoid hyperplasia: A diagnostic clue to differentiate injection-associated lymphoid hyperplasia from other forms of pseudolymphomas and cutaneous lymphomas JF - Journal of Cutaneous Pathology N2 - Background Subcutaneous vaccination or desensitization may induce persistent nodules at the injection sites. Without the knowledge of prior injection, histopathological work-up may be challenging. Objective Aim of this study was to contribute to the histopathological work-up of unclear subcutaneous nodules, especially their differentiation from cutaneous lymphoma. Methods We retrospectively reviewed clinical data and histopathological slides of four patients with subcutaneous nodules, which were suspected to suffer from cutaneous T- or B-cell lymphoma. Sections of these cases and 12 negative controls were stained with hematoxylin and eosin and a standardized immunohistochemical panel of B- and T-cell markers including EBER in situ hybridization as well as electron microscopy. Results In all cases, large histiocytes with granular cytoplasm compatible with intracellular aluminum hydroxide were present. EBER in situ hybridization revealed positive staining of these granular histiocytes while staining was absent in negative controls. Limitations Post hoc completion of medical history revealed that vaccination or specific immunotherapy had been applied before at the biopsy site in only three out of four patients; one patient was lost to follow-up. Conclusion EBER in situ hybridization is an adjunctive tool to differentiate aluminum-induced granuloma/lymphoid hyperplasia from other forms of pseudolymphoma and cutaneous B- or T-cell lymphomas. KW - RNA probe KW - aluminum granuloma KW - EBER in situ hybridization KW - lymphoid hyperplasia KW - pseudolymphoma Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258405 VL - 48 IS - 5 ER - TY - JOUR A1 - Glutsch, Valerie A1 - Schummer, Patrick A1 - Kneitz, Hermann A1 - Gesierich, Anja A1 - Goebeler, Matthias A1 - Klein, Detlef A1 - Posch, Christian A1 - Gebhardt, Christoffer A1 - Haferkamp, Sebastian A1 - Zimmer, Lisa A1 - Becker, Jürgen C A1 - Leiter, Ulrike A1 - Weichenthal, Michael A1 - Schadendorf, Dirk A1 - Ugurel, Selma A1 - Schilling, Bastian T1 - Ipilimumab plus nivolumab in avelumab-refractory Merkel cell carcinoma: a multicenter study of the prospective skin cancer registry ADOREG JF - Journal for ImmunoTherapy of Cancer N2 - Merkel cell carcinoma is a rare, highly aggressive skin cancer with neuroendocrine differentiation. Immune checkpoint inhibition has significantly improved treatment outcomes in metastatic disease with response rates to programmed cell death protein 1/programmed cell death 1 ligand 1 (PD-1/PD-L1) inhibition of up to 62%. However, primary and secondary resistance to PD-1/PD-L1 inhibition remains a so far unsolved clinical challenge since effective and safe treatment options for these patients are lacking.Fourteen patients with advanced (non-resectable stage III or stage IV, Union international contre le cancer 2017) Merkel cell carcinoma with primary resistance to the PD-L1 inhibitor avelumab receiving subsequent therapy (second or later line) with ipilimumab plus nivolumab (IPI/NIVO) were identified in the prospective multicenter skin cancer registry ADOREG. Five of these 14 patients were reported previously and were included in this analysis with additional follow-up. Overall response rate, progression-free survival (PFS), overall survival (OS) and adverse events were analyzed.All 14 patients received avelumab as first-line treatment. Thereof, 12 patients had shown primary resistance with progressive disease in the first tumor assessment, while two patients had initially experienced a short-lived stabilization (stable disease). Six patients had at least one systemic treatment in between avelumab and IPI/NIVO. In total, 7 patients responded to IPI/NIVO (overall response rate 50%), and response was ongoing in 4 responders at last follow-up. After a median follow-up of 18.85 months, median PFS was 5.07 months (95% CI 2.43—not available (NA)), and median OS was not reached. PFS rates at 12 months and 24 months were 42.9% and 26.8 %, respectively. The OS rate at 36 months was 64.3%. Only 3 (21%) patients did not receive all 4 cycles of IPI/NIVO due to immune-related adverse events.In this multicenter evaluation, we observed high response rates, a durable benefit and promising OS rates after treatment with later-line combined IPI/NIVO. In conclusion, our patient cohort supports our prior findings with an encouraging activity of second-line or later-line IPI/NIVO in patients with anti-PD-L1-refractory Merkel cell carcinoma. KW - Skin Neoplasms KW - CTLA-4 Antigen KW - Programmed Cell Death 1 Receptor KW - B7-H1 Antigen KW - Drug Therapy, Combination Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-304613 SN - 2051-1426 VL - 10 IS - 11 ER - TY - JOUR A1 - Bumiller-Bini Hoch, Valéria A1 - Kohler, Ana Flávia A1 - Augusto, Danillo G. A1 - Lobo-Alves, Sara Cristina A1 - Malheiros, Danielle A1 - Cipolla, Gabriel Adelman A1 - Winter Boldt, Angelica Beate A1 - Braun-Prado, Karin A1 - Wittig, Michael A1 - Franke, Andre A1 - Pföhler, Claudia A1 - Worm, Margitta A1 - van Beek, Nina A1 - Goebeler, Matthias A1 - Sárdy, Miklós A1 - Ibrahim, Saleh A1 - Busch, Hauke A1 - Schmidt, Enno A1 - Hundt, Jennifer Elisabeth A1 - Araujo-Souza, Patrícia Savio de A1 - Petzl-Erler, Maria Luiza T1 - Genetic associations and differential mRNA expression levels of host genes suggest a viral trigger for endemic pemphigus foliaceus JF - Viruses N2 - The long search for the environmental trigger of the endemic pemphigus foliaceus (EPF, fogo selvagem) has not yet resulted in any tangible findings. Here, we searched for genetic associations and the differential expression of host genes involved in early viral infections and innate antiviral defense. Genetic variants could alter the structure, expression sites, or levels of the gene products, impacting their functions. By analyzing 3063 variants of 166 candidate genes in 227 EPF patients and 194 controls, we found 12 variants within 11 genes associated with differential susceptibility (p < 0.005) to EPF. The products of genes TRIM5, TPCN2, EIF4E, EIF4E3, NUP37, NUP50, NUP88, TPR, USP15, IRF8, and JAK1 are involved in different mechanisms of viral control, for example, the regulation of viral entry into the host cell or recognition of viral nucleic acids and proteins. Only two of nine variants were also associated in an independent German cohort of sporadic PF (75 patients, 150 controls), aligning with our hypothesis that antiviral host genes play a major role in EPF due to a specific virus–human interaction in the endemic region. Moreover, CCL5, P4HB, and APOBEC3G mRNA levels were increased (p < 0.001) in CD4+ T lymphocytes of EPF patients. Because there is limited or no evidence that these genes are involved in autoimmunity, their crucial role in antiviral responses and the associations that we observed support the hypothesis of a viral trigger for EPF, presumably a still unnoticed flavivirus. This work opens new frontiers in searching for the trigger of EPF, with the potential to advance translational research that aims for disease prevention and treatment. KW - endemic pemphigus foliaceus KW - virus KW - genetic association KW - differential gene expression KW - autoimmune disease KW - environmental factors Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-270572 SN - 1999-4915 VL - 14 IS - 5 ER - TY - JOUR A1 - Schummer, Patrick A1 - Schilling, Bastian A1 - Gesierich, Anja T1 - Long‑Term Outcomes in BRAF‑Mutated Melanoma Treated with Combined Targeted Therapy or Immune Checkpoint Blockade: Are We Approaching a True Cure? JF - American Journal of Clinical Dermatology N2 - Approximately 50% of all melanomas harbor an activating BRAF mutation. In patients suffering from an advanced melanoma with such a somatic alteration, combined targeted therapy with a BRAF and MEK inhibitor can be applied to significantly increase the survival probability. Nevertheless, resistance mechanisms, as well as negative predictive biomarkers (elevated lactate dehydrogenase levels, high number of metastatic organ disease sites, brain metastasis), remain a major problem in treating melanoma patients. Recently, a landmark overall survival (OS) rate of 34% after 5 years of combined targeted therapy in treatment-naïve patients was reported. On the other hand, patients harboring a BRAF mutation and receiving first-line immune checkpoint blockade with ipilimumab plus nivolumab showed a 5-year OS rate of 60%. As indicated by these data, long-term survival can be reached in melanoma patients but it remains unclear if this is equivalent to reaching a true cure for metastatic melanoma. In this review, we summarize the recent results for combined targeted therapy and immunotherapy in advanced melanoma harboring an activating BRAF mutation and discuss the impact of baseline characteristics on long-term outcome. KW - BARF-mutated melanoma KW - combined targeted therapy KW - immune checkpoint blockade Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-234818 SN - 1175-0561 VL - 21 ER - TY - JOUR A1 - Reichel, Alexandra A1 - Grothaus, Julia A1 - Ott, Hagen T1 - Pityriasis lichenoides acuta (PLEVA) pemphigoides: A rare bullous variant of PLEVA JF - Pediatric Dermatology N2 - Although the clinical presentations of patients with pityriasis lichenoides et varioliformis acuta (PLEVA) may vary, bullae are not usually part of the clinical spectrum. To date, only two other cases of a bullous variant of PLEVA with evidence of autoantibodies against hemidesmosomal antigens have been reported. The term PLEVA pemphigoides was suggested for this unique clinical, pathological and serological combination of both PLEVA and bullous pemphigoid. KW - blisters KW - BP180 KW - dapsone KW - Pityriasis lichenoides Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218194 VL - 37 IS - 4 SP - 710 EP - 712 ER - TY - JOUR A1 - Bröcker, E. B. T1 - Pioneers in Dermatology and Venereology: an interview with Professor Eva-Bettina Bröcker JF - Journal of the European Academy of Dermatology and Venereology N2 - No abstract available. KW - interview KW - dermatology KW - venereology Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259460 VL - 35 IS - 6 ER - TY - JOUR A1 - Mohme, Sophia A1 - Schmalzing, Marc A1 - Müller, Cornelia S.L. A1 - Vogt, Thomas A1 - Goebeler, Matthias A1 - Stoevesandt, Johanna T1 - Immunizations in immunocompromised patients: a guide for dermatologists JF - JDDG: Journal der Deutschen Dermatologischen Gesellschaft N2 - The increasingly frequent use of immunomodulatory agents in dermatology requires the observance of specific recommendations for immunization. These recommendations are developed and regularly updated by the German Standing Committee on Vaccination (STIKO), an independent advisory group at the Robert Koch Institute. Dermatological patients on immunosuppressive treatment should ideally receive all vaccinations included in the standard immunization schedule. Additionally, it is recommended that they also undergo vaccination against the seasonal flu, pneumococci, and herpes zoster (inactivated herpes zoster subunit vaccine for patients ≥ 50 years). Additional immunizations against Haemophilus influenzae type B, hepatitis B and meningococci may be indicated depending on individual comorbidities and exposure risk. Limitations of use, specific contraindications and intervals to be observed between vaccination and immunosuppression depend on the immunosuppressive agent used and its dosing. Only under certain conditions may live‐attenuated vaccines be administered in patients on immunosuppressive therapy. Given its strong suppressive effect on the humoral immune response, no vaccines – except for flu shots – should be given within six months after rituximab therapy. This CME article presents current recommendations on immunization in immunocompromised individuals, with a special focus on dermatological patients. Its goal is to enable readers to provide competent counseling and to initiate necessary immunizations in this vulnerable patient group. Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217982 VL - 18 IS - 7 SP - 699 EP - 723 ER - TY - JOUR A1 - Trautmann, Axel A1 - Brockow, Knut A1 - Stoevesandt, Johanna T1 - Metamizole‐induced reactions as a paradigm of drug hypersensitivity: Non‐allergic reactions, anaphylaxis, and delayed‐type allergy JF - Clinical & Experimental Allergy KW - agranulocytosis KW - aspirin‐exacerbated respiratory disease KW - drug adverse reaction KW - drug allergy KW - drug hypersensitivity KW - exanthem KW - fixed drug eruption KW - urticaria Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217997 VL - 50 IS - 9 SP - 1103 EP - 1106 ER - TY - JOUR A1 - Reichel, Alexandra A1 - Röding, Kristina A1 - Stoevesandt, Johanna A1 - Trautmann, Axel T1 - De‐labelling antibiotic allergy through five key questions JF - Clinical & Experimental Allergy KW - allergy KW - antibiotic KW - algorithm Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215508 VL - 50 IS - 4 SP - 532 EP - 535 ER - TY - JOUR A1 - Schrüfer, Philipp A1 - Brockow, Knut A1 - Stoevesandt, Johanna A1 - Trautmann, Axel T1 - Predominant patterns of beta-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins JF - Allergy, Asthma & Clinical Immunology N2 - Background Penicillins and other beta-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific beta-lactams are scarce and inconsistent. We aimed to determine patterns of beta-latam allergy, i.e. the association of a clinical reaction type with a specific beta-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected beta-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results beta-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing beta-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all beta-lactam allergic patients tolerated at least one, usually several alternative substances out of the beta-lactam group. Conclusions We identified two patterns of beta-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type beta-lactam hypersensitivity. KW - amoxicillin KW - ampicillin KW - angioedema KW - drug adverse reaction KW - drug allergy KW - drug hypersensitivity KW - penicillin allergy KW - penicillin hypersensitivity KW - urticaria Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-231306 VL - 16 ER - TY - JOUR A1 - Benoit, Sandrine A1 - Goebeler, Matthias T1 - Mepacrine in recalcitrant cutaneous lupus erythematosus: old-fashioned or still useful? JF - Acta Dermato-Venereologica N2 - Treatment of recalcitrant cutaneous lupus erythematosus (CLE) is challenging. In situations where conventional treatment approaches fail mepacrine - an antimalarial/antiinfiammatory drug that has fallen into oblivion in the last decades might still be a promising option. We retrospectively analysed medical records of 10 patients with refractory CLE that were treated with mepacrine (100-200 mg/day) as mono- or combination therapy for various time intervals between 2001 and 2013 at the University Hospital Wurzburg. Mepacrine was generally well tolerated. Side effects were mild and usually resolved after reduction or cessation. Over 50% of the patients experienced amelioration of their symptoms despite a previously recalcitrant clinical course. Altogether, our data demonstrate that mepacrine still remains a useful and effective therapeutic option for otherwise treatment-resistant CLE. KW - classification KW - therapy KW - cutaneous lupus erythematosus KW - quinacrine KW - mepacrine KW - smoking Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149181 VL - 95 ER - TY - JOUR A1 - Stoevesandt, Johanna A1 - Keita, Dyamilatou Ulrike A1 - Goebeler, Matthias T1 - Disease-related burden and long-term outcome in orofacial granulomatosis: observations from a large single-centre cohort JF - Clinical and Experimental Dermatology N2 - There is a lack of standardized treatment recommendations for orofacial granulomatosis, a chronic inflammatory condition aetiologically related to Crohn disease. To assess clinical baseline parameters and treatment strategies, we retrospectively analysed 61 consecutive cases from our institutional database. Disease-related functional/psychological impairment and long-term outcomes were descriptively evaluated using a standardized self-reporting questionnaire. The median age of patients was 45 (7–77) years. Oral steroids were given in 41.0% of cases, but only produced short-term disease control, while response to steroid-sparing agents was inconsistent. Only a minority of patients reported relevant disease-related functional impairment in eating (21.7%) or speaking (4.3%), but the majority perceived psychological distress due to the cosmetic aspects of the disease (69.6%), comments from others (65.2%) and/or general anxiety/insecurity (73.9%). Regardless of the initial treatment, long-term outcomes after 71 months (range 7–304 months) were beneficial, with most patients being in complete remission (52.2%) or reporting only mild residual swelling (43.5%). KW - orofacial granulomatosis KW - Crohn disease KW - long-term outcome Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318412 VL - 47 IS - 6 SP - 1169 EP - 1173 ER - TY - JOUR A1 - Livingstone, E. A1 - Zaremba, A. A1 - Horn, S. A1 - Ugurel, S. A1 - Casalini, B. A1 - Schlaak, M. A1 - Hassel, J.C. A1 - Herbst, R. A1 - Utikal, J.S. A1 - Weide, B. A1 - Gutzmer, R. A1 - Meier, F. A1 - Koelsche, C. A1 - Hadaschik, E. A1 - Sucker, A. A1 - Reis, H. A1 - Merkelbach‐Bruse, S. A1 - Siewert, M. A1 - Sahm, F. A1 - von Deimling, A. A1 - Cosgarea, I. A1 - Zimmer, L. A1 - Schadendorf, D. A1 - Schilling, B. A1 - Griewank, K.G. T1 - GNAQ and GNA11 mutant nonuveal melanoma: a subtype distinct from both cutaneous and uveal melanoma JF - British Journal of Dermatology N2 - Background GNAQ and GNA11 mutant nonuveal melanoma represent a poorly characterized rare subgroup of melanoma with a gene mutation profile similar to uveal melanoma. Objectives To characterize these tumours in terms of clinical behaviour and genetic characteristics. Methods Patients with nonuveal GNAQ/11 mutated melanoma were identified from the prospective multicentre tumour tissue registry ADOREG, Tissue Registry in Melanoma (TRIM) and additional cooperating skin cancer centres. Extensive data on patient, tumour and treatment characteristics were collected retrospectively. Targeted sequencing was used to determine tumour mutational burden. Immunohistochemistry staining was performed for programmed death‐ligand 1 and BRCA1‐associated protein (BAP)1. Existing whole‐exome cutaneous and uveal melanoma data were analysed for mutation type and burden. Results We identified 18 patients with metastatic GNAQ/11 mutant nonuveal melanoma. Tumours had a lower tumour mutational burden and fewer ultraviolet signature mutations than cutaneous melanomas. In addition to GNAQ and GNA11 mutations (nine each), six splicing factor 3b subunit 1 (SF3B1), three eukaryotic translation initiation factor 1A X‐linked (EIF1AX) and four BAP1 mutations were detected. In contrast to uveal melanoma, GNAQ/11 mutant nonuveal melanomas frequently metastasized lymphatically and concurrent EIF1AX, SF3B1 and BAP1 mutations showed no apparent association with patient prognosis. Objective response to immunotherapy was poor with only one partial response observed in 10 treated patients (10%). Conclusions Our findings suggest that GNAQ/11 mutant nonuveal melanomas are a subtype of melanoma that is both clinically and genetically distinct from cutaneous and uveal melanoma. As they respond poorly to available treatment regimens, novel effective therapeutic approaches for affected patients are urgently needed. What is already known about this topic? The rare occurrence of GNAQ/11 mutations in nonuveal melanoma has been documented. GNAQ/11 mutant nonuveal melanomas also harbour genetic alterations in EIF1AX, SF3B1 and BAP1 that are of prognostic relevance in uveal melanoma. What does this study add? GNAQ/11 mutant nonuveal melanomas show metastatic spread reminiscent of cutaneous melanoma, but not uveal melanoma. GNAQ/11 mutant nonuveal melanomas have a low tumour mutational burden that is higher than uveal melanoma, but lower than cutaneous melanoma. What is the translational message? Primary GNAQ/11 mutant nonuveal melanomas are a subtype of melanoma that is clinically and genetically distinct from both cutaneous and uveal melanoma. As metastatic GNAQ/11 mutant nonuveal melanomas respond poorly to available systemic therapies, including immune checkpoint inhibition, novel therapeutic approaches for these tumours are urgently needed. KW - melanoma KW - GNAQ KW - GNA11 Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215434 VL - 183 IS - 5 SP - 928 EP - 939 ER - TY - JOUR A1 - Hamm, H. A1 - Wilsmann-Theis, D. A1 - Tsianakas, A. A1 - Gambichler, T. A1 - Taipale, K. A1 - Lauterbach, J. A1 - Freudensprung, U. A1 - Makepeace, C. T1 - Efficacy and safety of fumaric acid esters in young patients aged 10-17 years with moderate-to-severe plaque psoriasis: a randomized, double-blinded, placebo-controlled trial JF - British Journal of Dermatology N2 - Background Apart from biologics, no systemic drugs are approved in Europe for children with moderate-to-severe psoriasis. Retrospective observational studies have shown promising results for fumaric acid esters (FAE) in this setting. Objectives To show superiority of FAE over placebo in terms of treatment response after 20 weeks in children and adolescents aged 10–17 years. Methods In a multicentre, randomized, double-blind, placebo-controlled phase IIIb study, patients aged 10–17 years with moderate-to-severe plaque psoriasis requiring systemic therapy were randomized 2 : 1 to receive FAE (n = 91) or placebo (n = 43) over 20 weeks, followed by an open-label FAE treatment phase. The coprimary endpoints were ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) and Physician’s Global Assessment (PGA) score of 0 or 1 (clear or almost clear) at week 20. The study was registered with EudraCT number 2012-000035-82. Results At week 20, 55% [95% confidence interval (CI) 0·44–0·65] of FAE-treated patients achieved a PASI 75 response vs. 19% (95% CI 0·08–0·33) in the placebo group (absolute difference 36%, 95% CI 0·20–0·53; P < 0·001). In total, 42% (95% CI 0·32–0·53) in the FAE group vs. 7% (95% CI 0·01–0·19) in the placebo group achieved a PGA score of 0 or 1 at week 20 (absolute difference 35%, 95% CI 0·21–0·49; P < 0·001). During the double-blind period, drug-related adverse events occurred more frequently in patients receiving FAE compared with placebo (76% vs. 47%). Gastrointestinal disorders were the most common adverse events. Conclusions FAE administered over a period of 20 weeks demonstrated a better response than placebo; the difference was statistically significant and clinically meaningful. Application up to 40 weeks was generally well tolerated. However, further studies are required. KW - children KW - psoriasis KW - fumaric acid esters Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258318 VL - 185 IS - 1 ER - TY - JOUR A1 - Strobel, Katharina A1 - Sickenberger, Christina A1 - Schoen, Christoph A1 - Kneitz, Hermann A1 - Kolb-Mäurer, Annette A1 - Goebeler, Matthias T1 - Diagnosis and therapy of Mycobacterium marinum: a single-center 21-year retrospective analysis JF - Journal der Deutschen Dermatologischen Gesellschaft N2 - Background and Objectives In Europe, infections with Mycobacterium (M.) marinum are rare. We conducted a retrospective single-center study to assess the clinical spectrum of M. marinum infection and its diagnosis, treatment and outcome under real-world conditions. Patients and Methods Eighteen patients presenting with M. marinum infections between 1998 and 2018 were identified in the data warehouse of the University Hospital Würzburg and considered for detailed analysis. Results Twelve patients reported aquatic exposure. In 16/18 cases the upper extremities were affected. No invasive infections were detected. Mean time to diagnosis was 15 weeks. Histology revealed granulomatous inflammation in 14 patients while mycobacterial cultures were positive for M. marinum in 16 cases. Most patients received antibiotic monotherapy (14/18) while combination therapy was administered in four cases. Treatment (with a median duration of 10 weeks) was successful in 13 patients. Five patients were lost to follow-up. Conclusions Our retrospective analysis of M. marinum infections at a German tertiary referral center revealed a considerable diagnostic delay and the relevance of microbiological culture, PCR and histology for diagnosis. Monotherapy with clarithromycin (rather than doxycycline) appeared as a reasonable treatment option while immunosuppressed or -compromised patients and those with extended disease received combination therapy. KW - Mycobacterium marinum KW - diagnosis KW - therapy Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318428 VL - 20 IS - 9 SP - 1211 EP - 1218 ER - TY - JOUR A1 - Frings, Verena Gerlinde A1 - Goebeler, Matthias A1 - Schilling, Bastian A1 - Kneitz, Hermann T1 - Aberrant cytoplasmic connexin43 expression as a helpful marker in vascular neoplasms JF - Journal of Cutaneous Pathology N2 - Background Gap junctions consisting of connexins (Cx) are fundamental in controlling cell proliferation, differentiation, and cell death. Cx43 is the most broadly expressed Cx in humans and is attributed an important role in skin tumor development. Its role in cutaneous vascular neoplasms is yet unknown. Methods Fifteen cases each of cutaneous angiosarcoma (cAS), Kaposi sarcoma (KS), and cherry hemangioma (CH) were assessed by immunohistochemistry for expression of Cx43. Expression pattern, intensity, and percentage of positively stained cells were analyzed. Solid basal cell carcinomas served as positive and healthy skin as negative controls. Results Most cases of cAS presented with a strong Cx43 staining of almost all tumor cells, whereas endothelia of KS showed medium expression and CH showed mostly weak expression. In comparison with KS or cAS, the staining intensity of CH was significantly lower (P ≤ 0.001). All tissue sections of both cAS and KS were characterized by a mostly diffuse, cytoplasmic staining pattern of the vascular endothelia. None of those showed nuclear staining. Conclusion The high-to-intermediate expression of Cx43 observed in all cases of cAS and KS suggests that this Cx may play a role in the development of malignant vascular neoplasms and serve as a helpful diagnostic marker. KW - Kaposi sarcoma KW - cutaneous angiosarcoma KW - Cx43 KW - hemangioma KW - immunohistochemistry Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258412 VL - 48 IS - 11 ER - TY - JOUR A1 - Thomann, Anna Sophie A1 - Schneider, Theresa A1 - Cyran, Laura A1 - Eckert, Ina Nathalie A1 - Kerstan, Andreas A1 - Lutz, Manfred B. T1 - Conversion of Anergic T Cells Into Foxp3\(^-\) IL-10\(^+\) Regulatory T Cells by a Second Antigen Stimulus In Vivo JF - Frontiers in Immunology N2 - T cell anergy is a common mechanism of T cell tolerance. However, although anergic T cells are retained for longer time periods in their hosts, they remain functionally passive. Here, we describe the induction of anergic CD4\(^+\) T cells in vivo by intravenous application of high doses of antigen and their subsequent conversion into suppressive Foxp3\(^-\) IL-10\(^+\) Tr1 cells but not Foxp3\(^+\) Tregs. We describe the kinetics of up-regulation of several memory-, anergy- and suppression-related markers such as CD44, CD73, FR4, CD25, CD28, PD-1, Egr-2, Foxp3 and CTLA-4 in this process. The conversion into suppressive Tr1 cells correlates with the transient intracellular CTLA-4 expression and required the restimulation of anergic cells in a short-term time window. Restimulation after longer time periods, when CTLA-4 is down-regulated again retains the anergic state but does not lead to the induction of suppressor function. Our data require further functional investigations but at this stage may suggest a role for anergic T cells as a circulating pool of passive cells that may be re-activated into Tr1 cells upon short-term restimulation with high and systemic doses of antigen. It is tentative to speculate that such a scenario may represent cases of allergen responses in non-allergic individuals. KW - T cells KW - anergy KW - Tr1 KW - conversion KW - in vivo Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-241429 SN - 1664-3224 VL - 12 ER - TY - JOUR A1 - Kolb-Mäurer, Annette A1 - Sunderkötter, Cord A1 - Kukowski, Borries A1 - Meuth, Sven G. T1 - An update on Peginterferon beta-1a Management in Multiple Sclerosis: results from an interdisciplinary Board of German and Austrian Neurologists and dermatologists JF - BMC Neurology N2 - Background: Interferon (IFN) beta drugs have been approved for the treatment of relapsing forms of multiple sclerosis (RMS) for more than 20years and are considered to offer a favourable benefit-risk profile. In July 2014, subcutaneous (SC) peginterferon beta-1a 125g dosed every 2weeks, a pegylated form of interferon beta-1a, was approved by the EMA for the treatment of adult patients with RRMS and in August 2014 by the FDA for RMS. Peginterferon beta-1a shows a prolonged half-life and increased systemic drug exposure resulting in a reduced dosing frequency compared to other available interferon-based products in MS. In the Phase 3 ADVANCE trial peginterferon beta-1a demonstrated significant positive effects on clinical and MRI outcome measures versus placebo after one year. Furthermore, in the ATTAIN extension study, sustained efficacy with long-term treatment for nearly 6years was shown. Main text In July 2016, an interdisciplinary panel of German and Austrian experts convened to discuss the management of side effects associated with peginterferon beta-1a and other interferon beta-based treatments in MS in daily practice. The panel was composed of experts from university hospitals and private clinics comprised of neurologists, dermatologists, and an MS nurse. In this paper we report recommendations regarding best practices for adverse event management, focussing on peginterferon beta-1a. Injection site reactions (ISRs) and influenza-like illness are the most common adverse effects of interferon beta therapies and can present a burden for MS patients leading to non-adherence and discontinuation of therapy. Peginterferon beta-1a shows improved pharmacological properties. In clinical trials, the adverse event (AE) profile of peginterferon beta-1a was similar to other interferon beta formulations. The most common AEs were mild to moderate ISRs, influenza-like illness, pyrexia, and headache. Current information on the underlying cause of skin reactions associated with SC interferon treatment, and the management strategies for these AEs are limited. In pivotal trials, ISRs were mainly characterized and classified by neurologists, while dermatologists were only rarely consulted. Conclusions This report addresses expert recommendations on the management of most relevant adverse effects related to peginterferon beta-1a and other interferon betas, based on literature and interdisciplinary experience. KW - multiple sclerosis KW - peginterferon bet-1a KW - interferon beta KW - flu-like symptoms KW - injection site reactions KW - management Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-224646 VL - 19 ER - TY - JOUR A1 - Wobser, Marion A1 - Roth, Sabine A1 - Appenzeller, Silke A1 - Houben, Roland A1 - Schrama, David A1 - Goebeler, Matthias A1 - Geissinger, Eva A1 - Rosenwald, Andreas A1 - Maurus, Katja T1 - Targeted deep sequencing of mycosis fungoides reveals intracellular signaling pathways associated with aggressiveness and large cell transformation JF - Cancers N2 - Introduction: Large-cell transformation (LCT) of mycosis fungoides (MF) has been associated with a higher risk of relapse and progression and, consequently, restricted prognosis. Its molecular pathogenesis has not been elucidated yet. Materials and Methods: In order to address molecular mechanisms of LCT, we performed hybrid capture panel-based sequencing of skin biopsies from 10 patients suffering from MF with LCT versus 17 patients without LCT including follow-up biopsies during clinical course, respectively (51 samples in total). The analyzed patients were attributed to three different groups based on the presence of LCT and clinical behavior. Results: While indolent MF cases without LCT did not show pathogenic driver mutations, a high rate of oncogenic alterations was detected in patients with LCT and aggressive clinical courses. Various genes of different oncogenic signaling pathways, including the MAPK and JAK-STAT signaling pathways, as well as epigenetic modifiers were affected. A high inter-individual and distinctive intra-individual mutation diversity was observed. Oncogenic RAS mutations were exclusively detected in patients with LCT. Conclusion: Our data demonstrate that LCT transition of MF is associated with increased frequency of somatic mutations in cancer-associated genes. In particular, the activation of RAS signaling — together with epigenetic dysregulation — may crucially contribute to the molecular pathogenesis of the LCT phenotype, thus conveying its adverse clinical behavior. KW - mycosis fungoides KW - cutaneous T-cell-lymphoma KW - panel sequencing KW - large cell transformation KW - CD30 Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250094 SN - 2072-6694 VL - 13 IS - 21 ER - TY - JOUR A1 - Stoevesandt, Johanna A1 - Hosp, Christine A1 - Kerstan, Andreas A1 - Trautmann, Axel T1 - Safety of 100 µg venom immunotherapy rush protocols in children compared to adults JF - Allergy, Asthma & Clinical Immunology N2 - Background: There is a paucity of studies examining the safety of venom immunotherapy (VIT) in children. We aimed to assess the incidence of anaphylactic side effects during rush VIT in a cohort of pediatric patients and adult controls. Methods: 72 consecutive cycles of VIT-buildup in 71 children/adolescents aged 7–17 years were retrospectively evaluated and compared to an adult control group (n = 981) with regard to baseline parameters (sex, causative venom, severity of index sting reaction, results of allergy testing, comorbidities) and the incidence of anaphylactic adverse reactions. Results: Compared to adults, severe index sting-induced anaphylaxis was significantly less common in children (P = .001). Children were more likely to suffer from bee venom allergy (P < .001) and showed higher levels of bee venom-specific IgE (P = .013), but lower serum tryptase concentrations (P = .014). The overall rate of VIT-induced anaphylactic reactions was higher in children than in adults (6.9% vs 2.5%, P = .046 by univariate analysis). In the final binary logistic regression model, however, only bee VIT (P = .039; odds ratio 2.25; confidence interval 1.04–4.87) and 5-day compared to 3-day buildup protocols (P = .011; odds ratio 2.64; confidence interval 1.25–5.57) were associated with an increased risk of treatment-induced anaphylaxis. All pediatric patients finally reached and tolerated the target maintenance dose of 100 µg. Conclusions: The higher anaphylactic reaction rate observed in pediatric patients may be attributed to a greater prevalence of bee venom allergy. VIT-induced anaphylaxis in children is usually mild and does not affect further updosing and maintenance of VIT. KW - anaphylaxis KW - bee KW - buildup phase KW - hymenoptera KW - pediatric KW - risk factor KW - vespula Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157830 VL - 13 IS - 32 ER - TY - JOUR A1 - Glutsch, Valerie A1 - Grän, Franziska A1 - Weber, Judith A1 - Gesierich, Anja A1 - Goebeler, Matthias A1 - Schilling, Bastian T1 - Response to combined ipilimumab and nivolumab after development of a nephrotic syndrome related to PD-1 monotherapy JF - Journal for ImmunoTherapy of Cancer N2 - Background High response rates of metastatic melanoma have been reported upon immune checkpoint inhibition by PD-1 blockade alone or in combination with CTLA-4 inhibitors. However, the majority of patients with a primary resistance to anti-PD-1 monotherapy is also refractory to a subsequent combined checkpoint inhibition. In BRAF wildtype patients with a primary resistance to PD-1 inhibitors, therapeutic options are therefore limited and immune-related adverse events (irAE) have to be taken into consideration when discussing a subsequent immunotherapy. Case presentation We report the case of a 68-year-old male patient with metastatic melanoma who experienced an acute renal failure with nephrotic syndrome due to a minimal change disease developing after a single dose of the anti-PD-1 antibody pembrolizumab. A kidney biopsy revealed a podocytopathy without signs of interstitial nephritis. Renal function recovered to almost normal creatinine and total urine protein levels upon treatment with oral steroids and diuretics. Unfortunately, a disease progression (PD, RECIST 1.1) was observed in a CT scan after resolution of the irAE. In a grand round, re-exposure to a PD-1-containing regime was recommended. Consensually, a combined immunotherapy with ipilimumab and nivolumab was initiated. Nephrotoxicity was tolerable during combined immunotherapy and a CT scan of chest and abdomen showed a deep partial remission (RECIST 1.1) after three doses of ipilimumab (3 mg/kg) and nivolumab (1 mg/kg). Conclusion This case illustrates that a fulminant response to combined checkpoint inhibition is possible after progression after anti-PD-1 monotherapy and a severe irAE. KW - PD-1 KW - Immune-related adverse event KW - Minimal change disease KW - Ipilimumab KW - Nivolumab Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201214 VL - 7 ER - TY - JOUR A1 - Hoesl, Christine A1 - Fröhlich, Thomas A1 - Posch, Christian A1 - Kneitz, Hermann A1 - Goebeler, Matthias A1 - Schneider, Marlon R. A1 - Dahlhoff, Maik T1 - The transmembrane protein LRIG1 triggers melanocytic tumor development following chemically induced skin carcinogenesis JF - Molecular Oncology N2 - The incidence of melanoma and nonmelanoma skin cancer has increased tremendously in recent years. Although novel treatment options have significantly improved patient outcomes, the prognosis for most patients with an advanced disease remains dismal. It is, thus, imperative to understand the molecular mechanisms involved in skin carcinogenesis in order to develop new targeted treatment strategies. Receptor tyrosine kinases (RTK) like the ERBB receptor family, including EGFR/ERBB1, ERBB2/NEU, ERBB3, and ERBB4, are important regulators of skin homeostasis and their dysregulation often results in cancer, which makes them attractive therapeutic targets. Members of the leucine‐rich repeats and immunoglobulin‐like domains protein family (LRIG1‐3) are ERBB regulators and thus potential therapeutic targets to manipulate ERBB receptors. Here, we analyzed the function of LRIG1 during chemically induced skin carcinogenesis in transgenic mice expressing LRIG1 in the skin under the control of the keratin 5 promoter (LRIG1‐TG mice). We observed a significant induction of melanocytic tumor formation in LRIG1‐TG mice and no difference in papilloma incidence between LRIG1‐TG and control mice. Our findings also revealed that LRIG1 affects ERBB signaling via decreased phosphorylation of EGFR and increased activation of the oncoprotein ERBB2 during skin carcinogenesis. The epidermal proliferation rate was significantly decreased during epidermal tumorigenesis under LRIG1 overexpression, and the apoptosis marker cleaved caspase 3 was significantly activated in the epidermis of transgenic LRIG1 mice. Additionally, we detected LRIG1 expression in human cutaneous squamous cell carcinoma and melanoma samples. Therefore, we depleted LRIG1 in human melanoma cells (A375) by CRISPR/Cas9 technology and found that this caused EGFR and ERBB3 downregulation in A375 LRIG1 knockout cells 6 h following stimulation with EGF. In conclusion, our study demonstrated that LRIG1‐TG mice develop melanocytic skin tumors during chemical skin carcinogenesis and a deletion of LRIG1 in human melanoma cells reduces EGFR and ERBB3 expression after EGF stimulation. KW - ERBB receptors KW - LRIG1 KW - melanoma KW - mouse model KW - skin carcinogenesis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-238925 VL - 15 IS - 8 SP - 2140 EP - 2155 ER - TY - THES A1 - Jonas, Wenzel Till T1 - Komparative Analyse des Einflusses zielgerichteter Therapeutika auf den immunologischen Phänotyp im BRAF-V600-mutierten Melanom T1 - Comparative Analysis of the Impact of Targeted Therapy on the Immunological Phenotype in BRAF-V600-mutated Malignant Melanoma N2 - Die Einführung von zielgerichteter Therapie und Immuntherapie hat die Behandlungsmöglichkeiten des Melanoms revolutioniert. Jedoch profitieren viele Patienten nicht langfristig von diesen Therapien. Derzeit werden klinische Studien durchgeführt, die zielgerichtete Therapie und Immuntherapie miteinander kombinieren. In dieser Arbeit wurden in vitro Untersuchungen an den drei BRAF-V600E-mutieren Melanomzelllinien UACC 257, Malme 3M und Sk-Mel 5 unter kombinierter MAPK-Inhibitortherapie durchgeführt. Es wurden die aus der klinischen Routine bekannten Kombinationen aus BRAF- und MEK-Inhibitor – Vemurafenib und Cobimetinib, Dabrafenib und Trametinib sowie Encorafenib und Binimetinib – verwendet. Es wurde untersucht, ob obige zielgerichtete Therapeutika einen Effekt auf immunologische Marker im Melanom haben und ob sich eine der Kombinationen in ihrer Wirkung signifikant von den übrigen unterscheidet. Mittels MTS-Assay und Zellzyklusanalysen konnte eine konzentrationsabhängige Wirkung der Inhibitoren gezeigt und in ihrer Wirkung vergleichbare Inhibitorkonzentrationen eingestellt werden. Unter kombinierter MAPK-Inhibitortherapie zeigte sich ein begrenzter Effekt auf die theoretische Immunogenität des Melanoms. So konnte eine erhöhte MHC-I-Expression (+14 %) und eine verminderte PD-L1-Expression (-24 %) gezeigt werden. Die gewählten Dosen an Inhibitoren induzierten keinen ER-Stress. Ebenso konnte keine Ekto-Calreticulin-Expression auf lebenden Zellen nachgewiesen werden. Zwischen den drei Inhibitorkombinationen zeigten sich keine signifikanten Unterschiede. Die in dieser Arbeit gezeigten begrenzten immunologischen Effekte unter kombinierter MAPK-Inhibitortherapie legen nahe, dass eine Kombination mit Immuntherapie in Teilen synergistisch wirken könnte. Hier sind die Ergebnisse weiterer Studien abzuwarten, die zielgerichtete und Immuntherapie miteinander kombinieren, um ein tiefgreifenderes Verständnis bzgl. etwaiger Synergien zu generieren. Da zwischen den Inhibitorkombinationen keine signifikanten Unterschiede hinsichtlich ihrer Wirkung auf die Immunogenität des Melanoms gefunden wurden, ist anzunehmen, dass sie sich grundsätzlich alle gleichermaßen für eine Kombination mit einer Immuntherapie eignen. Die gezeigte MHC-I-Erhöhung trat bereits bei geringen Inhibitorkonzentrationen auf. Möglicherweise genügt bei einer Kombination mit Immuntherapie bereits eine niedrige Dosis der zielgerichteten Therapie, um die Immuntherapie zu boostern. Um die Frage nach einer möglichen Kombinationstherapie fortwährend zu analysieren, sollten zusätzliche Aspekte der Immunogenität unter kombinierter MAPK-Inhibitortherapie untersucht und die Inhibitortitration zum Vergleich der zielgerichteten Therapeutika weiter präzisiert werden. N2 - The approval of targeted therapy and immunotherapy has revolutionized the treatment options for malignant melanoma. However, many patients do not benefit long-term from these therapies. Clinical trials combining targeted therapy and immunotherapy are currently ongoing. In this study, in vitro analyses were performed on the three BRAF-V600E-mutant melanoma cell lines UACC 257, Malme 3M and Sk-Mel 5 under treatment with combined MAPK inhibitor therapy. Combinations of BRAF inhibitors and MEK inhibitors known from clinical routine - vemurafenib and cobimetinib, dabrafenib and trametinib, and encorafenib and binimetinib - were used. We investigated whether above targeted therapies influence immunological markers in malignant melanoma and whether any of the combinations differ significantly in their effect from the others. Using MTS assay and cell cycle analyses, a concentration-dependent effect of the inhibitors was shown. Furthermore, inhibitor concentrations of comparable effect were adjusted. Combined MAPK inhibitor therapy demonstrated a limited effect on the theoretical immunogenicity of malignant melanoma. Increased MHC-I expression (+14%) and decreased PD-L1 expression (-24%) were shown. The selected doses of inhibitors did not induce ER stress. Similarly, no ecto-calreticulin expression was detected on viable cells. There were no significant differences between the three combinations of inhibitors. The limited immunological effects shown in this study using combined MAPK inhibitor therapy suggest that combination with immunotherapy may act partially synergistic. The results of further studies combining targeted therapy and immunotherapy should be awaited to generate a more profound understanding of any synergies. Since no significant differences were found between the inhibitor combinations regarding their effect on the immunogenicity of malignant melanoma, it can be assumed that they are all equally suitable for combination with immunotherapy. The shown increase of MHC-I already occurred at low inhibitor concentrations. Possibly even a low dose of the targeted therapy in combination with immunotherapy is sufficient to boost said immunotherapy. To further analyze the question of a possible combination therapy, additional aspects of immunogenicity under combined MAPK inhibitor therapy should be investigated and the inhibitor titration used to compare the targeted therapeutics should be further refined. KW - Melanom KW - Immunogenität KW - MAPK-Inhibitoren Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-323239 ER - TY - JOUR A1 - Kirsten, Natalia A1 - Ohm, Frenz A1 - Gehrdau, Kathrin A1 - Girbig, Gefion A1 - Stephan, Brigitte A1 - Ben-Anaya, Nesrine A1 - Pinter, Andreas A1 - Bechara, Falk G. A1 - Presser, Dagmar A1 - Zouboulis, Christos C. A1 - Augustin, Matthias T1 - Switching from adalimumab originator to biosimilar in patients with hidradenitis suppurativa results in losses of response — data from the German HS registry HSBest JF - Life N2 - Since 2021, adalimumab biosimilar ABP 501 can be used alternatively to adalimumab originator (ADAO) in the treatment of hidradenitis suppurativa (HS). Effectiveness and safety data remain scarce. We investigated the impact of switching from ADAO to ABP 501 on disease severity and the occurrence of adverse events (AEs) in patients with HS. We analyzed clinical data on patients enrolled in the German HSBest registry. Evaluation outcomes were assessed at three time points (baseline of originator (t0), prior to switching to biosimilar (t1) and 12 to 14 weeks after switching (t2)) and included patient-reported AEs and disease severity using the International Hidradenitis Suppurativa Severity Score System (IHS4) score. In total, 94 patients were switched from ADAO to ABP 501. Overall, 33.3% (n = 31/94) of the patients developed AEs and/or loss of response (LoR) within 12 to 14 weeks after switching. Of these, 61.3% (n = 19/31) experienced LoR but no AEs, 22.6% (n = 7/31) LoR combined with AEs and 16.1% (n = 5/31) AEs only. Our study showed that switching HS patients from ADAO to ABP 501 does significantly affect treatment effectiveness. Switching patients who are on remission maintenance therapy should be viewed critically. KW - hidradenitis suppurativa KW - biologics KW - TNF alpha KW - adverse drug reaction KW - biosimilar KW - drug effectiveness KW - switching KW - adalimumab KW - registry Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-288213 SN - 2075-1729 VL - 12 IS - 10 ER - TY - JOUR A1 - Banicka, Veronika A1 - Martens, Marie Christine A1 - Panzer, Rüdiger A1 - Schrama, David A1 - Emmert, Steffen A1 - Boeckmann, Lars A1 - Thiem, Alexander T1 - Homozygous CRISPR/Cas9 knockout generated a novel functionally active exon 1 skipping XPA variant in melanoma cells JF - International Journal of Molecular Sciences N2 - Defects in DNA repair pathways have been associated with an improved response to immune checkpoint inhibition (ICI). In particular, patients with the nucleotide excision repair (NER) defect disease Xeroderma pigmentosum (XP) responded impressively well to ICI treatment. Recently, in melanoma patients, pretherapeutic XP gene expression was predictive for anti-programmed cell death-1 (PD-1) ICI response. The underlying mechanisms of this finding are still to be revealed. Therefore, we used CRISPR/Cas9 to disrupt XPA in A375 melanoma cells. The resulting subclonal cell lines were investigated by Sanger sequencing. Based on their genetic sequence, candidates from XPA exon 1 and 2 were selected and further analyzed by immunoblotting, immunofluorescence, HCR and MTT assays. In XPA exon 1, we established a homozygous (c.19delG; p.A7Lfs*8) and a compound heterozygous (c.19delG/c.19_20insG; p.A7Lfs*8/p.A7Gfs*55) cell line. In XPA exon 2, we generated a compound heterozygous mutated cell line (c.206_208delTTG/c.208_209delGA; p.I69_D70delinsN/p.D70Hfs*31). The better performance of the homozygous than the heterozygous mutated exon 1 cells in DNA damage repair (HCR) and post-UV-C cell survival (MTT), was associated with the expression of a novel XPA protein variant. The results of our study serve as the fundamental basis for the investigation of the immunological consequences of XPA disruption in melanoma. KW - DNA repair KW - nucleotide excision repair KW - XPA KW - CRISPR KW - knockout KW - protein variant KW - melanoma KW - A375 Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-290427 SN - 1422-0067 VL - 23 IS - 19 ER - TY - JOUR A1 - Rauschenberger, Tabea A1 - Schmitt, Viola A1 - Azeem, Muhammad A1 - Klein-Hessling, Stefan A1 - Murti, Krisna A1 - Grän, Franziska A1 - Goebeler, Matthias A1 - Kerstan, Andreas A1 - Klein, Matthias A1 - Bopp, Tobias A1 - Serfling, Edgar A1 - Muhammad, Khalid T1 - T cells control chemokine secretion by keratinocytes JF - Frontiers in Immunology N2 - The massive infiltration of lymphocytes into the skin is a hallmark of numerous human skin disorders. By co-culturing murine keratinocytes with splenic T cells we demonstrate here that T cells affect and control the synthesis and secretion of chemokines by keratinocytes. While pre-activated CD8\(^+\)T cells induce the synthesis of CXCL9 and CXCL10 in keratinocytes and keep in check the synthesis of CXCL1, CXCL5, and CCL20, keratinocytes dampen the synthesis of CCL3 and CCL4 in pre-activated CD8\(^+\)T cells. One key molecule is IFN-γ that is synthesized by CD8\(^+\)T cells under the control of NFATc1 and NFATc2. CD8\(^+\)T cells deficient for both NFAT factors are unable to induce CXCL9 and CXCL10 expression. In addition, CD8\(^+\)T cells induced numerous type I IFN-inducible “defense genes” in keratinocytes encoding the PD1 and CD40 ligands, TNF-α and caspase-1. The enhanced expression of type I IFN-inducible genes resembles the gene expression pattern at the dermal/epidermal interface in lichen planus, an inflammatory T lymphocyte-driven skin disease, in which we detected the expression of CXCL10 in keratinocytes in close vicinity to the infiltration front of T cells. These data reflect the multifaceted interplay of lymphocytes with keratinocytes at the molecular level. KW - chemokine KW - keratinocytes KW - IFN KW - lichen planus KW - T cells KW - Nfatc1 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-195695 SN - 1664-3224 VL - 10 IS - 1917 ER - TY - JOUR A1 - Kosnopfel, Corinna A1 - Sinnberg, Tobias A1 - Sauer, Birgit A1 - Niessner, Heike A1 - Muenchow, Alina A1 - Fehrenbacher, Birgit A1 - Schaller, Martin A1 - Mertens, Peter R. A1 - Garbe, Claus A1 - Thakur, Basant Kumar A1 - Schittek, Birgit T1 - Tumour progression stage-dependent secretion of YB-1 stimulates melanoma cell migration and invasion JF - Cancers N2 - Secreted factors play an important role in intercellular communication. Therefore, they are not only indispensable for the regulation of various physiological processes but can also decisively advance the development and progression of tumours. In the context of inflammatory disease, Y-box binding protein 1 (YB-1) is actively secreted and the extracellular protein promotes cell proliferation and migration. In malignant melanoma, intracellular YB-1 expression increases during melanoma progression and represents an unfavourable prognostic marker. Here, we show active secretion of YB-1 from melanoma cells as opposed to benign cells of the skin. Intriguingly, YB-1 secretion correlates with the stage of melanoma progression and depends on a calcium- and ATP-dependent non-classical secretory pathway leading to the occurrence of YB-1 in the extracellular space as a free protein. Along with an elevated YB-1 secretion of melanoma cells in the metastatic growth phase, extracellular YB-1 exerts a stimulating effect on melanoma cell migration, invasion, and tumourigenicity. Collectively, these data suggest that secreted YB-1 plays a functional role in melanoma cell biology, stimulating metastasis, and may serve as a novel biomarker in malignant melanoma that reflects tumour aggressiveness. KW - melanoma KW - secretion KW - Y-box binding protein 1 KW - migration and invasiveness Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-211206 SN - 2072-6694 VL - 12 IS - 8 ER - TY - JOUR A1 - Cyran, Laura A1 - Serfling, Julia A1 - Kirschner, Luisa A1 - Raifer, Hartmann A1 - Lohoff, Michael A1 - Hermanns, Heike M. A1 - Kerstan, Andreas A1 - Bodem, Jochen A1 - Lutz, Manfred B. T1 - Flt3L, LIF, and IL‐10 combination promotes the selective in vitro development of ESAM\(^{low}\) cDC2B from murine bone marrow JF - European Journal of Immunology N2 - The development of two conventional dendritic cells (DC) subsets (cDC1 and cDC2) and the plasmacytoid DC (pDC) in vivo and in cultures of bone marrow (BM) cells is mediated by the growth factor Flt3L. However, little is known about the factors that direct the development of the individual DC subsets. Here, we describe the selective in vitro generation of murine ESAM\(^{low}\) CD103\(^{-}\) XCR1\(^{-}\) CD172a\(^{+}\) CD11b\(^{+}\) cDC2 from BM by treatment with a combination of Flt3L, LIF, and IL‐10 (collectively named as FL10). FL10 promotes common dendritic cell progenitors (CDP) proliferation in the cultures, similar to Flt3L and CDP sorted and cultured in FL10 generate exclusively cDC2. These cDC2 express the transcription factors Irf4, Klf4, and Notch2, and their growth is reduced using BM from Irf4\(^{-/-}\) mice, but the expression of Batf3 and Tcf4 is low. Functionally they respond to TLR3, TLR4, and TLR9 signals by upregulation of the surface maturation markers MHC II, CD80, CD86, and CD40, while they poorly secrete proinflammatory cytokines. Peptide presentation to TCR transgenic OT‐II cells induced proliferation and IFN‐γ production that was similar to GM‐CSF‐generated BM‐DC and higher than Flt3L‐generated DC. Together, our data support that FL10 culture of BM cells selectively promotes CDP‐derived ESAM\(^{low}\) cDC2 (cDC2B) development and survival in vitro. KW - dendritic cells KW - cDC2 subset KW - Flt3L KW - LIF KW - IL‐10 Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-312448 VL - 52 IS - 12 SP - 1946 EP - 1960 ER - TY - JOUR A1 - Krebs, Markus A1 - Behrmann, Christoph A1 - Kalogirou, Charis A1 - Sokolakis, Ioannis A1 - Kneitz, Susanne A1 - Kruithof-de Julio, Marianna A1 - Zoni, Eugenio A1 - Rech, Anne A1 - Schilling, Bastian A1 - Kübler, Hubert A1 - Spahn, Martin A1 - Kneitz, Burkhard T1 - miR-221 Augments TRAIL-mediated apoptosis in prostate cancer cells by inducing endogenous TRAIL expression and targeting the functional repressors SOCS3 and PIK3R1 JF - BioMed Research International N2 - miR-221 is regarded as an oncogene in many malignancies, and miR-221-mediated resistance towards TRAIL was one of the first oncogenic roles shown for this small noncoding RNA. In contrast, miR-221 is downregulated in prostate cancer (PCa), thereby implying a tumour suppressive function. By using proliferation and apoptosis assays, we show a novel feature of miR-221 in PCa cells: instead of inducing TRAIL resistance, miR-221 sensitized cells towards TRAIL-induced proliferation inhibition and apoptosis induction. Partially responsible for this effect was the interferon-mediated gene signature, which among other things contained an endogenous overexpression of the TRAIL encoding gene TNFSF10. This TRAIL-friendly environment was provoked by downregulation of the established miR-221 target gene SOCS3. Moreover, we introduced PIK3R1 as a target gene of miR-221 in PCa cells. Proliferation assays showed that siRNA-mediated downregulation of SOCS3 and PIK3R1 mimicked the effect of miR-221 on TRAIL sensitivity. Finally, Western blotting experiments confirmed lower amounts of phospho-Akt after siRNA-mediated downregulation of PIK3R1 in PC3 cells. Our results further support the tumour suppressing role of miR-221 in PCa, since it sensitises PCa cells towards TRAIL by regulating the expression of the oncogenes SOCS3 and PIK3R1. Given the TRAIL-inhibiting effect of miR-221 in various cancer entities, our results suggest that the influence of miR-221 on TRAIL-mediated apoptosis is highly context- and entity-dependent. KW - Cancer Cell Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-202480 VL - 2019 ER - TY - THES A1 - Schmid, Corinna T1 - p53-Inaktivierung im Melanom - ein therapeutischer Ansatzpunkt? T1 - p53-inactivation in melanoma - a therapeutical target? N2 - Die Therapiemöglichkeiten für Patienten im Melanom Stadium IV sind nach wie vor begrenzt und die Erkrankung nur selten heilbar. Eine mögliche Ziel¬struktur in der Melanom¬therapie der Zukunft könnte das im Melanom häufig genetisch wild¬typisch vorliegende p53 sein. Für vorliegende Arbeit wurden humane Melanomzelllinien, welche stabil mit einem p53-Reportergenkonstrukt transduziert waren, hinsichtlich ihrer p53-Expression, -Akti-vität und -Akti¬vierbarkeit untersucht. Alle verwendeten Melanom¬zell¬¬¬linien exprimierten p53 un¬ab¬hängig vom p53-Mutations¬status. Drei der sieben untersuchten p53-wild¬typischen Melanomzelllinien zeigten keine oder nur sehr niedrige p53-Reporter¬gen¬aktivität. Die anderen vier p53-wildtypischen Zelllinien dagegen waren durch hohe, mittels p53-Knockdown unterdrückbare Reportergen¬expression gekennzeichnet. Die Proliferation dieser Zellen in Gegenwart von aktivem p53 belegt, dass Melanomzellen eine hohe Toleranz gegenüber diesem Tumor¬suppressor besitzen können. Eine weitere Steige¬rung der p53-Expression und -Aktivität durch die Hemmung von MDM2 (mouse double minute 2) mit der Substanz Nutlin-3a führte in den Zellen mit messbarer p53-Aktivität jedoch zu einem G1-Zell¬zyklusarrest. Dies belegt die prinzipielle Eignung von p53 als mögliche thera¬peutische Zielstruktur. Aufgrund ihrer schlechten Biover¬füg¬barkeit und hohen Toxizität gelten MDM2-Inhibitoren bisher aber als ungeeignet für den klinischen Einsatz. Die Reduktion hoher therapeutischer Nebenwirkungen könnte durch eine Melanom-spezifische Reaktivierung von p53 gelingen. Eine mögliche negativ-modulierende Wirkung des Mela¬¬nom¬¬markers TRP2 (tyrosinase-related-protein 2) auf p53 wurde im Jahr 2010 von Sendoel et al. nach Unter¬suchungen am Fadenwurm C. elegans vorgeschlagen. TRP2 wird beim metastasierten Melanom in mehr als 80 % der Fälle exprimiert und wäre, handelte es sich beim Melanom um einen weit verbreiteten Regulationsmechanismus, ein interessantes Zielprotein, um die Aktivität von p53 zu steigern. Die dargestellten Ergeb¬nisse zeigen, dass TRP2 zwar in vier von fünf Melanomzelllinien exprimiert wurde, die Unterdrückung der TRP2-Expression jedoch weder spezifischen Einfluss auf die p53-Expression noch auf die p53-Reportergenaktivität zeigte. Auch das veränderte Wachs¬tums¬¬¬verhalten der Zellen nach Unterdrückung von TRP2 mittels drei unterschiedlicher shRNAs konnte im Rescue-Experiment, bei dem TRP nach seinem Knockdown ektop exprimiert wurde, keinem spezifischen Effekt von TRP2 auf die p53-Expression oder p53-Reporteraktivität zugeordnet werden. Auch in der TRP2-negativen Zelllinie führte die ektope TRP2-Expression nicht zu einer verminderten p53-Expression oder -Aktivität. Für das im Gegensatz zu MDM2 deutlich melanomspezifischere TRP2 konnte demensprechend kein sicherer regulatorischer Zusammenhang mit p53 dargestellt werden. Weitere Untersuchungen müssen zeigen, welche Bedeutung wildtypischem p53 im Melanom zukommt und ob sich weitere mögliche p53-Regulatoren als therapeutische Angriffspunkte eignen. N2 - The aim of this study was to investigate the role of wildtype and transcriptional inactive p53 and tyrosinase related protein 2 (TRP2) as potential regulator of p53 in melanoma cell lines. Nine human melanoma cell lines were transduced with a lentiviral pGreenFire™ reporter construct encoding luciferase and GFP under the control of a p53 responsive element. Western blots, luciferase and green fluorescent protein (GFP) assays were used to analyze p53-expression, -activity and -upregulation before and after knockdown of p53 and TRP2 by specific shRNAs. Moreover, melanoma cells were treated with Nutlin-3a, a specific inhibitor of the p53 ubiquitinase mouse double minute 2 homolog (mdm-2), to study its effect on cell proliferation using propidium iodide cell cycle FACS-analysis. Growth of melanoma cells in the presence of active p53 suggests that they tolerate high levels of p53. Furthermore this study shows that preexisting p53 activity can be upregulated by treating the cells with Nutlin-3a. This upregulation was associated with a clear cut cell cycle arrest while the low level p53 activity melanoma cell lines did not show any comparable effect. In contrast regulation of p53 by TRP2 seems not to be common in melanoma cell lines. This study could not depict specific effects on p53 activity alteration after TRP2 knockdown. The role of TRP2 as a potential regulator of p53 in melanoma stays questionable. In principle enhancement of preexisting p53 activity by treating melanoma cells with Nutlin-3a would be a suitable therapeutic target. However, due to its toxicity in humans it might be inappropriate for clinical applications. KW - Melanom KW - p53 KW - TRP2 KW - Nutlin Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-157853 ER - TY - JOUR A1 - Alrefai, Hani A1 - Muhammad, Khalid A1 - Rudolf, Ronald A1 - Pham, Duong Anh Thuy A1 - Klein-Hessling, Stefan A1 - Patra, Amiya K. A1 - Avots, Andris A1 - Bukur, Valesca A1 - Sahin,, Ugur A1 - Tenzer, Stefan A1 - Goebeler, Matthias A1 - Kerstan, Andreas A1 - Serfling, Edgar T1 - NFATc1 supports imiquimod-induced skin inflammation by suppressing IL-10 synthesis in B cells JF - Nature Communications N2 - Epicutaneous application of Aldara cream containing the TLR7 agonist imiquimod (IMQ) to mice induces skin inflammation that exhibits many aspects of psoriasis, an inflammatory human skin disease. Here we show that mice depleted of B cells or bearing interleukin (IL)-10-deficient B cells show a fulminant inflammation upon IMQ exposure, whereas ablation of NFATc1 in B cells results in a suppression of Aldara-induced inflammation. In vitro, IMQ induces the proliferation and IL-10 expression by B cells that is blocked by BCR signals inducing NFATc1. By binding to HDAC1, a transcriptional repressor, and to an intronic site of the Il10 gene, NFATc1 suppresses IL-10 expression that dampens the production of tumour necrosis factor-α and IL-17 by T cells. These data indicate a close link between NFATc1 and IL-10 expression in B cells and suggest NFATc1 and, in particular, its inducible short isoform, NFATc1/αA, as a potential target to treat human psoriasis. KW - B cells KW - psoriasis KW - interleukins KW - inflammation Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173053 VL - 7 ER - TY - THES A1 - Kervarrec, Thibault T1 - Histogenesis of Merkel cell carcinoma T1 - Histogenese des Merkelzellkarzinoms N2 - Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer. In approximately 80% of cases, genomic integration of the Merkel cell polyomavirus (MCPyV) is observed and overexpression of the two MCPyV T antigens (TAgs) is regarded as the main oncogenic determinant of MCPyV-positive MCC cases. However, the nature of the cells from which MCC arises is unknown. Therefore, the goal of the present work was to determine the cell of origin of MCC. First, we characterized MCC patients’ tumors and demonstrated a high similarity of MCPyV- negative MCC with extracutaneous neuroendocrine carcinoma while MCPyV-positive MCC differs from these two groups with respect to morphology, immunohistochemical profile, genetics, origin and behavior. Based on the analysis of a trichoblastoma/MCC combined tumor, we demonstrated that a MCPyV-positive MCC can arise following MCPyV integration in an epithelial cell. In addition, the high similarity between trichoblastoma cells and Merkel cell (MC) progenitors of the hair follicle suggests that these hair follicle cells may represent a general start point for the development of MCPyV-positive MCC. A contribution of the viral TAgs to the development of the characteristic Merkel cell-like MCC phenotype is suggested by experiments demonstrating induction of Merkel cell markers upon TAg expression in human primary keratinocytes or hair follicle cells. As potential mechanisms mediating these phenotypic changes, we identified the capability of MCPyV LT to repress degradation of master regulator of MC development, i.e. the transcription factor ATOH1. To conclude, our work suggests that MCPyV integration in epithelial cells of the hair follicle may represent an important path for MCC development. N2 - Das Merkelzellkarzinom (MCC) ist ein seltener und aggressiver Hautkrebs. In etwa 80% der Fälle wird die genomische Integration des Merkelzell-Polyomavirus (MCPyV) beobachtet und die Überexpression der beiden MCPyV-T-Antigene (TAgs) gilt als die wichtigste onkogene Determinante der MCPyV-positiven MCC-Fälle. Die Ursprungszelle des MCC ist jedoch bisher unbekannt. Daher war das Ziel der vorliegenden Arbeit, die Hinweise auf die Herkunftszelle zu generieren. ... KW - Merkel-Zellkarzinom KW - Merkel cell carcinoma KW - Histogenesis KW - Hair follicle KW - Polyomavirus KW - Histogenese Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-199750 ER - TY - JOUR A1 - Ballin, Nadja A1 - Hotz, Alrun A1 - Bourrat, Emmanuelle A1 - Küsel, Julia A1 - Oji, Vinzenz A1 - Bouadjar, Bakar A1 - Brognoli, Davide A1 - Hickman, Geoffroy A1 - Heinz, Lisa A1 - Vabres, Pierre A1 - Marrakchi, Slaheddine A1 - Leclerc‐Mercier, Stéphanie A1 - Irvine, Alan A1 - Tadini, Gianluca A1 - Hamm, Henning A1 - Has, Cristina A1 - Blume‐Peytavi, Ulrike A1 - Mitter, Diana A1 - Reitenbach, Marina A1 - Hausser, Ingrid A1 - Zimmer, Andreas D. A1 - Alter, Svenja A1 - Fischer, Judith T1 - Genetical, clinical, and functional analysis of a large international cohort of patients with autosomal recessive congenital ichthyosis due to mutations in NIPAL4 JF - Human Mutation N2 - Autosomal recessive congenital ichthyosis (ARCI) belongs to a heterogeneous group of disorders of keratinization. To date, 10 genes have been identified to be causative for ARCI. NIPAL4 (Nipa‐Like Domain‐Containing 4) is the second most commonly mutated gene in ARCI. In this study, we present a large cohort of 101 families affected with ARCI carrying mutations in NIPAL4. We identified 16 novel mutations and increase the total number of pathogenic mutations in NIPAL4 to 34. Ultrastructural analysis of biopsies from six patients showed morphological abnormalities consistent with an ARCI EM type III. One patient with a homozygous splice site mutation, which leads to a loss of NIPAL4 mRNA, showed additional ultrastructural aberrations together with a more severe clinical phenotype. Our study gives insights into the frequency of mutations, a potential hot spot for mutations, and genotype–phenotype correlations. KW - ARCI KW - ARCI EM type III KW - collodion baby KW - ichthyosis KW - NIPAL4 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212747 VL - 40 IS - 12 ER - TY - JOUR A1 - Thiem, Alexander A1 - Hesbacher, Sonja A1 - Kneitz, Hermann A1 - di Primio, Teresa A1 - Heppt, Markus V. A1 - Hermanns, Heike M. A1 - Goebeler, Matthias A1 - Meierjohann, Svenja A1 - Houben, Roland A1 - Schrama, David T1 - IFN-gamma-induced PD-L1 expression in melanoma depends on p53 expression JF - Journal of Experimental & Clinical Cancer Research N2 - Background Immune checkpoint inhibition and in particular anti-PD-1 immunotherapy have revolutionized the treatment of advanced melanoma. In this regard, higher tumoral PD-L1 protein (gene name: CD274) expression is associated with better clinical response and increased survival to anti-PD-1 therapy. Moreover, there is increasing evidence that tumor suppressor proteins are involved in immune regulation and are capable of modulating the expression of immune checkpoint proteins. Here, we determined the role of p53 protein (gene name: TP53) in the regulation of PD-L1 expression in melanoma. Methods We analyzed publicly available mRNA and protein expression data from the cancer genome/proteome atlas and performed immunohistochemistry on tumors with known TP53 status. Constitutive and IFN-ɣ-induced PD-L1 expression upon p53 knockdown in wildtype, TP53-mutated or JAK2-overexpressing melanoma cells or in cells, in which p53 was rendered transcriptionally inactive by CRISPR/Cas9, was determined by immunoblot or flow cytometry. Similarly, PD-L1 expression was investigated after overexpression of a transcriptionally-impaired p53 (L22Q, W23S) in TP53-wt or a TP53-knockout melanoma cell line. Immunoblot was applied to analyze the IFN-ɣ signaling pathway. Results For TP53-mutated tumors, an increased CD274 mRNA expression and a higher frequency of PD-L1 positivity was observed. Interestingly, positive correlations of IFNG mRNA and PD-L1 protein in both TP53-wt and -mutated samples and of p53 and PD-L1 protein suggest a non-transcriptional mode of action of p53. Indeed, cell line experiments revealed a diminished IFN-ɣ-induced PD-L1 expression upon p53 knockdown in both wildtype and TP53-mutated melanoma cells, which was not the case when p53 wildtype protein was rendered transcriptionally inactive or by ectopic expression of p53\(^{L22Q,W23S}\), a transcriptionally-impaired variant, in TP53-wt cells. Accordingly, expression of p53\(^{L22Q,W23S}\) in a TP53-knockout melanoma cell line boosted IFN-ɣ-induced PD-L1 expression. The impaired PD-L1-inducibility after p53 knockdown was associated with a reduced JAK2 expression in the cells and was almost abrogated by JAK2 overexpression. Conclusions While having only a small impact on basal PD-L1 expression, both wildtype and mutated p53 play an important positive role for IFN-ɣ-induced PD-L1 expression in melanoma cells by supporting JAK2 expression. Future studies should address, whether p53 expression levels might influence response to anti-PD-1 immunotherapy. KW - Melanoma KW - PD-L1 KW - CD274 KW - p53 KW - TP53 KW - JAK2 Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201016 VL - 38 ER - TY - JOUR A1 - Orouji, Elias A1 - Peitsch, Wiebke K. A1 - Orouji, Azadeh A1 - Houben, Roland A1 - Utikal, Jochen T1 - Oncogenic role of an epigenetic reader of m\(^6\)A RNA modification: YTHDF1 in Merkel cell carcinoma JF - Cancers N2 - Merkel cell carcinoma is a deadly skin cancer, which in the majority of cases is caused by the Merkel cell polyomavirus (MCPyV). The viral small T antigen is regarded as the dominant oncoprotein expressed in the tumor cells. We used genomic screening of copy number aberrations along with transcriptomic analysis to investigate regions with amplification that harbor differentially expressed genes. We identified YTHDF1, a protein that is a reader of N\(^6\)-methyladenosine (m\(^6\)A) RNA modifications, to have high copy gains and to be highly expressed in Merkel cell carcinoma. Importantly, we identified the presence of m\(^6\)A on small T antigen mRNA suggesting a relation between YTHDF1 amplification and MCPyV gene expression. Interestingly, knockdown of YTHDF1 in Merkel cell carcinoma (MCC) cell lines negatively affected the translation initiation factor eIF3 and reduced proliferation and clonogenic capacity in vitro. Furthermore, analysis of survival data revealed worse overall survival in YTHDF1\(^{high}\) MCC patients compared to YTHDF1\(^{low}\) patients. Our findings indicate a novel oncogenic role of YTHDF1 through m\(^6\)A machinery in the tumorigenesis of MCC. KW - Merkel cell carcinoma KW - Merkel cell polyomavirus KW - copy number variations KW - m\(^6\)A KW - RNA modification KW - epitranscriptome KW - YTHDF1 KW - epigenetic reader Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200815 SN - 2072-6694 VL - 12 IS - 1 ER - TY - JOUR A1 - Fan, Kaiji A1 - Zebisch, Armin A1 - Horny, Kai A1 - Schrama, David A1 - Becker, Jürgen C. T1 - Highly expressed miR-375 is not an intracellular oncogene in Merkel cell polyomavirus-associated Merkel cell carcinoma JF - Cancers N2 - miR-375 is a highly abundant miRNA in Merkel cell carcinoma (MCC). In other cancers, it acts as either a tumor suppressor or oncogene. While free-circulating miR-375 serves as a surrogate marker for tumor burden in patients with advanced MCC, its function within MCC cells has not been established. Nearly complete miR-375 knockdown in MCC cell lines was achieved using antagomiRs via nucleofection. The cell viability, growth characteristics, and morphology were not altered by this knockdown. miR-375 target genes and related signaling pathways were determined using Encyclopedia of RNA Interactomes (ENCORI) revealing Hippo signaling and epithelial to mesenchymal transition (EMT)-related genes likely to be regulated. Therefore, their expression was analyzed by multiplexed qRT-PCR after miR-375 knockdown, demonstrating only a limited change in expression. In summary, highly effective miR-375 knockdown in classical MCC cell lines did not significantly change the cell viability, morphology, or oncogenic signaling pathways. These observations render miR-375 an unlikely intracellular oncogene in MCC cells, thus suggesting that likely functions of miR-375 for the intercellular communication of MCC should be addressed. KW - miR-375 KW - antagomiRs KW - Merkel cell carcinoma KW - Hippo signaling KW - focal adhesion Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-200678 SN - 2072-6694 VL - 12 IS - 3 ER - TY - JOUR A1 - Ritter, Cathrin A1 - Fan, Kaiji A1 - Paulson, Kelly G. A1 - Nghiem, Paul A1 - Schrama, David A1 - Becker, Jürgen C. T1 - Reversal of epigenetic silencing of MHC class I chain-related protein A and B improves immune recognition of Merkel cell carcinoma JF - Scientific Reports N2 - Merkel cell carcinoma (MCC) is a virally associated cancer characterized by its aggressive behavior and strong immunogenicity. Both viral infection and malignant transformation induce expression of MHC class I chain-related protein (MIC) A and B, which signal stress to cells of the immune system via Natural Killer group 2D (NKG2D) resulting in elimination of target cells. However, despite transformation and the continued presence of virally-encoded proteins, MICs are only expressed in a minority of MCC tumors in situ and are completely absent on MCC cell lines in vitro. This lack of MIC expression was due to epigenetic silencing via MIC promoter hypo-acetylation; indeed, MIC expression was re-induced by pharmacological inhibition of histone deacetylases (HDACs) both in vitro and in vivo. This re-induction of MICs rendered MCC cells more sensitive to immune-mediated lysis. Thus, epigenetic silencing of MICs is an important immune escape mechanism of MCCs. KW - epigenetic silencing KW - Merkel cell carcinoma KW - MHC class I chain-related protein KW - skin cancer Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-167992 IS - 21678 ET - 6 ER - TY - THES A1 - Geiseler, Marina T1 - Klinische, histopathologische und immunphänotypische Charakterisierung der CD4+ klein-/mittelgroßzelligen kutanen T-Zell-Lymphoproliferation T1 - Clinical, histopathological and immunophenotypic characterization of CD4+ small / medium-sized cutaneous T-cell lymphoproliferative disorder N2 - Innerhalb der Gruppe der kutanen T-Zell-Lymphome ist die CD4+ klein-/mittelgroßzellige T-Zell-Lymphoproliferation (SMTCL) eine seltene und bisher als provisorisch erfasste Entität. Um genauere Kenntnisse zu Klinik und Verlauf, Histologie und Immunphänotyp zu gewinnen, untersuchten wir in dieser Fallserie an 95 Fällen entsprechende Charakteristika. Dabei konnten alle der bisher provisorisch definierten Eigenschaften der SMTCL bestätigt werden. Lediglich die 5-Jahre-Überlebensrate zeigte sich mit 100% weitaus höher als die in der WHO-/EORTC-Klassifikation angegebenen 60–80%. Diese Bestätigung der provisorisch definierten Eigenschaften an einem größeren Kollektiv kann dazu beitragen, dass die SMTCL in die nächste Version der WHO-Klassifikation – durch ausreichende Daten gestützt – als definitive Entität aufgenommen werden kann. Insgesamt konnten in dieser Studie einige Faktoren, die mit einem weniger indolenten Krankheitsverlauf assoziiert sind, identifiziert werden. So zeigten klinisch ein initial bestehender generalisierter Hautbefall sowie eine extrafaziale Lokalisation der Läsion einen weniger indolenten Verlauf an. Auch Patienten, bei denen ein Verlust von CD2, CD3 oder CD5 bei den Tumorzellen festgestellt wurde, wiesen einen für die CD4+ SMTCL ungewöhnlichen und weniger indolenten Krankheitsverlauf mit häufigeren Rezidiven und seltenerem Erreichen einer kompletten Remission auf. Histopathologisch schien eine oberflächlichere Infiltrattiefe des Präparates sowie das Vorhandensein eines fokalen Epidermotropismus einen negativen prognostischen Wert zu besitzen. Bezüglich des Gesamtüberlebens hatten allerdings auch Patienten mit einem der identifizierten negativen prognostischen Faktoren eine exzellente Prognose. Bei Vorliegen eines dieser negativen Faktoren sollte jedoch eine engmaschigere klinische Überwachung erfolgen. N2 - Within the group of primary cutaneous T-cell lymphomas, CD4+ small / medium-sized T-cell lymphoproliferative disorder (SMTCL) is a rare and hitherto provisionally defined entity. In this case series we examined clinical, histopathological and immunophenotypic data in 95 SMTCL cases in order to gain more detailed knowledge of the corresponding characteristics of this entity. All the previously provisionally defined properties of SMTCL could be confirmed. Only the 5-year survival rate was, at 100%, much higher than the 60-80% reported in the WHO-/ EORTC-classification. This confirmation of the provisionally defined properties in a larger collective may help to make SMTCL a definitive entity in the next version of the WHO-/EORTC- classification, supported by sufficient data. Overall, several factors associated with less indolent disease progression could be identified in this study. Clinically, an initially existing generalized skin involvement as well as an extrafacial localization of the lesion indicated a less indolent course. Patients diagnosed with a loss of CD2, CD3 or CD5 in tumor cells also had a less indolent course: they showed more frequent relapses and achieved more seldom complete remission. Histopathologically, a more superficial infiltration depth and the presence of focal epidermotropism appeared to have a negative prognostic value. Still, patients with one of the negative prognostic factors identified also had an excellent prognosis in terms of overall survival. However, if one of these negative factors is present, clinical monitoring should be more closely. KW - Hautlymphom KW - Primär kutanes Lymphom KW - primary cutaneous lymphoma Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-184112 ER - TY - JOUR A1 - Fusi, Lorenza A1 - Paudel, Rupesh A1 - Meder, Katharina A1 - Schlosser, Andreas A1 - Schrama, David A1 - Goebeler, Matthias A1 - Schmidt, Marc T1 - Interaction of transcription factor FoxO3 with histone acetyltransferase complex subunit TRRAP modulates gene expression and apoptosis JF - Journal of Biological Chemistry N2 - Forkhead box O (FoxO) transcription factors are conserved proteins involved in the regulation of life span and age-related diseases, such as diabetes and cancer. Stress stimuli or growth factor deprivation promotes nuclear localization and activation of FoxO proteins, which—depending on the cellular context—can lead to cell cycle arrest or apoptosis. In endothelial cells (ECs), they further regulate angiogenesis and may promote inflammation and vessel destabilization implicating a role of FoxOs in vascular diseases. In several cancers, FoxOs exert a tumor-suppressive function by regulating proliferation and survival. We and others have previously shown that FoxOs can regulate these processes via two different mechanisms: by direct binding to forkhead-responsive elements at the promoter of target genes or by a poorly understood alternative process that does not require direct DNA binding and regulates key targets in primary human ECs. Here, we performed an interaction study in ECs to identify new nuclear FoxO3 interaction partners that might contribute to FoxO-dependent gene regulation. Mass spectrometry analysis of FoxO3-interacting proteins revealed transformation/transcription domain–associated protein (TRRAP), a member of multiple histone acetyltransferase complexes, as a novel binding partner of FoxO family proteins. We demonstrate that TRRAP is required to support FoxO3 transactivation and FoxO3-dependent G1 arrest and apoptosis in ECs via transcriptional activation of the cyclin-dependent kinase inhibitor p27\(^{kip1}\) and the proapoptotic B-cell lymphoma 2 family member, BIM. Moreover, FoxO–TRRAP interaction could explain FoxO-induced alternative gene regulation via TRRAP-dependent recruitment to target promoters lacking forkhead-responsive element sequences. KW - FoxO3 KW - TRRAP KW - transcription factors Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299820 VL - 298 IS - 3 ER - TY - JOUR A1 - Schrüfer, Philipp A1 - Stoevesandt, Johanna A1 - Trautmann, Axel T1 - Outcome of a de-labelling algorithm compared with results of penicillin (β-lactam) allergy testing JF - Allergy, Asthma & Clinical Immunology N2 - Background Penicillin allergy labels frequently impede guideline-directed treatment with a penicillin or other β-lactam antibiotics. Despite presumed allergy, targeted questioning may indicate a low probability of sensitization and permit reasonably safe administration of the antibiotic in question. In this study, we evaluated a standardized algorithm aiming to differentiate non-allergic patients from those with true allergic β-lactam hypersensitivity. Methods We retrospectively applied a de-labelling algorithm in 800 consecutive patients with suspected β-lactam hypersensitivity. All had undergone complete allergy work-up permitting to definitely exclude or diagnose β-lactam allergy between 2009 and 2019. Results In 595 (74.4%) out of 800 cases evaluated, β-lactam allergy could be excluded by negative challenge testing. IgE-mediated anaphylaxis was diagnosed in 70 (8.7%) patients, delayed-type hypersensitivity in 135 (16.9%). In 62 (88.6%) anaphylaxis cases, the algorithm correctly advised to use an alternative antibiotic. Accuracy was higher in patients with moderate to severe anaphylaxis (97.7%) compared to those with a history of mild reactions (73.1%). The algorithm correctly identified 122 (90.4%) patients with proven delayed-type hypersensitivity. It permitted de-labelling in 330 (55.5%) out of 595 patients with diagnostic exclusion of penicillin hypersensitivity, but failed to identify the remaining 265 (44.5%) as low-risk cases. Conclusions The algorithm detected 89.8% of cases with penicillin (β-lactam) allergy, sensitivity was optimal for moderate to severe anaphylaxis. Study data justify the implementation of a standardized de-labelling algorithm under close supervision in order to permit guideline-directed treatment and reduce the use of broad-spectrum antibiotics as part of an antibiotic stewardship program. KW - anaphylaxis KW - drug adverse reaction KW - drug allergy KW - drug exanthema KW - drug hypersensitivity KW - penicillin allergy KW - penicillin hypersensitivity Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299840 SN - 1710-1484 VL - 18 ER - TY - THES A1 - Wendlinger, Simone Alice T1 - Function of Peripheral Blood Eosinophils in Melanoma T1 - Funktion der Eosinophilen Granulozyten aus dem peripheren Blut im Melanom N2 - Despite accounting for only a small proportion of all skin cancers, malignant melanoma displays a serious health risk with increasing incidence and high mortality rate. Fortunately, advances in the treatment of malignant melanoma now prolong survival and enhance response and treatment efficacy. Established biomarkers help evaluate disease progression and facilitate choosing appropriate and individual treatment options. However, the need for easily accessible and reliable biomarkers is rising to predict patient-specific clinical outcome. Eosinophil infiltration into the tumor and high peripheral eosinophil counts prior and during treatment have been associated with better response in patients for various cancer entities, including melanoma. An analysis of a heterogeneous study cohort reported high serum ECP levels in non-responders. Hence, eosinophil frequency and serum ECP as a soluble eosinophil-secreted mediator were suggested as prognostic biomarkers in melanoma. We examined whether melanoma patients treated with first-line targeted therapy could also benefit from the effects of eosinophils. In total, 243 blood and serum samples from patients with advanced melanoma were prospectively and retrospectively collected before and after drug initiation. To link eosinophil function to improved clinical outcome, soluble serum markers and peripheral blood counts were used for correlative studies using a homogeneous study cohort. In addition, functional and phenotypical characterizations provided insights into the expression profile and activity of freshly isolated eosinophils, including comparisons between patients and healthy donors. Our data showed a significant correlation between high pre-treatment blood eosinophil counts and improved response to targeted therapy and by trend to combinatorial immunotherapy in patients with metastatic melanoma. In accordance with previous studies our results links eosinophil blood counts to better response in melanoma patients. High pre-treatment ECP serum concentration correlated with response to immunotherapy but not to targeted therapy. Eosinophils from healthy donors and patients showed functional and phenotypical similarities. Functional assays revealed a strong cytotoxic potential of blood eosinophils towards melanoma cells in vitro, inducing apoptosis and necrosis. In addition, in vitro cytotoxicity was an active process of peripheral eosinophils and melanoma cells with bidirectional features and required close cell-cell interaction. The extent of cytotoxicity was dose-dependent and showed susceptibility to changes in physical factors like adherence. Importantly, we provide evidence of an additive tumoricidal function of eosinophils and combinatorial targeted therapy in vitro. In summary, we give valuable insights into the complex and treatment-dependent role of eosinophils in melanoma. As a result, our data support the suggestion of eosinophils and their secreted mediators as potential prognostic biomarkers. It will take additional studies to examine the molecular mechanisms that underlie our findings. N2 - Obwohl das Maligne Melanom nur einen geringen Anteil aller Hautkrebsarten ausmacht, stellt es ein ernstzunehmendes Gesundheitsrisiko mit steigender Inzidenz und hoher Sterblichkeitsrate dar. Durch Fortschritte in der Behandlung des malignen Melanoms konnten die Überlebenszeit verlängert und das Ansprechen und die Wirksamkeit der Behandlung verbessert werden. Etablierte Biomarker helfen bei der Bewertung des Krankheitsverlaufs und erleichtern die Wahl geeigneter und individueller Behandlungsoptionen. Der Bedarf an leicht zugänglichen und zuverlässigen Biomarkern zur Vorhersage patientenspezifischer klinischer Ergebnisse nimmt zu. Die Infiltration von Eosinophilen in den Tumor und hohe periphere Eosinophilenzahl vor und während der Behandlung wurden mit einem besseren Ansprechen bei Patienten mit verschiedenen Tumorarten, einschließlich des Melanoms, in Verbindung gebracht. Eine Analyse einer heterogenen Patientenkohorte berichtete über hohe ECP-Serumspiegel bei Patienten, die nicht auf eine Melanombehandlung ansprechen. Daher wurden periphere Eosinophile im Blut und ECP im Serum, als löslicher, von Eosinophilen sekretierter Mediator, als prognostische Biomarker für das Melanom vorgeschlagen. Wir untersuchten, ob sich die positive Wirkung der peripheren Eosinophilen beim Melanom auf Patienten übertragen lässt, die mit einer zielgerichteten Erstlinientherapie behandelt werden. Insgesamt wurden 243 Blut- und Serumproben von Patienten mit fortgeschrittenem Melanom prospektiv und retrospektiv vor und nach Einleitung einer medikamentösen Behandlung gesammelt. Um die Eosinophilenfunktion mit einem verbesserten klinischen Ergebnis in Verbindung zu bringen, wurden lösliche Serummarker und periphere Blutbilder für korrelative Studien in einer homogenen Studienkohorte analysiert. Darüber hinaus lieferten funktionelle und phänotypische Charakterisierungen Einblicke in das Expressionsprofil und die Aktivität von frisch isolierten Eosinophilen. Vergleiche von Patienten und gesunden Spendern wurden ebenfalls durchgeführt. Unsere Daten zeigten, dass eine hohe prätherapeutische Eosinophilenzahl im Blut zu einer signifikanten Verbesserung des Ansprechens auf eine zielgerichtete Therapie und tendenziell zu einer Verbesserung des Ansprechens auf eine kombinatorische Immuntherapie bei Patienten mit metastasiertem Melanom beiträgt. In Übereinstimmung mit bereits publizierten Studien bringen unsere Ergebnisse eine erhöhte Eosinophilenzahl im Blut mit einem besseren Ansprechen bei Melanompatienten in Verbindung. Eine hohe prätherapeutische ECP- Serumkonzentration korrelierte mit dem Ansprechen auf eine Immuntherapie, nicht aber auf eine zielgerichtete Therapie. Eosinophile von gesunden Spendern und Patienten wiesen zudem funktionelle und phänotypische Ähnlichkeiten auf. Außerdem zeigten funktionelle Tests ein starkes zytotoxisches Potenzial von Eosinophilen gegenüber Melanomzellen in vitro. Periphere Eosinophile lösten Apoptose und Nekrose in den Melanomzellen aus. Darüber 3 hinaus war die Zytotoxizität in vitro ein aktiver Prozess zwischen peripheren Eosinophilen und Melanomzellen mit bidirektionalem Einfluss und erforderte eine enge Zell-Zell-Interaktion. Das Ausmaß der Zytotoxizität war dosisabhängig und zeigte eine Anfälligkeit für Veränderungen der physikalischen Faktoren wie der Adhärenz. Wir konnten Beweise für eine additive tumorizide Funktion von Eosinophilen und einer kombinatorischen zielgerichteten Therapie in vitro liefern. Zusammenfassend lässt sich sagen, dass diese Arbeit wertvolle Einblicke in die komplexe und behandlungsabhängige Rolle der Eosinophilen beim Melanom bietet. Unsere Daten unterstützen den Vorschlag, Eosinophile und die von ihnen sekretierten Mediatoren als potenzielle prognostische Biomarker zu verwenden. Weitere Studien sind erforderlich, um die molekularen Mechanismen unserer Beobachtungen zu entschlüsseln. KW - Melanom KW - Therapie KW - Granulozyten KW - Targeted therapy KW - Peripheral eosinophils KW - Malignant melanoma KW - Biomarker Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-301194 PB - Cancers (Basel) ER - TY - JOUR A1 - Maurus, K. A1 - Kosnopfel, C. A1 - Kneitz, H. A1 - Appenzeller, S. A1 - Schrama, D. A1 - Glutsch, V. A1 - Roth, S. A1 - Gerhard-Hartmann, E. A1 - Rosenfeldt, M. A1 - Möhrmann, L. A1 - Fröhlich, M. A1 - Hübschmann, D. A1 - Stenzinger, A. A1 - Glimm, H. A1 - Fröhling, S. A1 - Goebeler, M. A1 - Rosenwald, A. A1 - Kutzner, H. A1 - Schilling, B. T1 - Cutaneous epithelioid haemangiomas show somatic mutations in the mitogen-activated protein kinase pathway JF - British Journal of Dermatology N2 - Background Epithelioid haemangioma (EH) arising from the skin is a benign vascular tumour with marked inflammatory cell infiltration, which exhibits a high tendency to persist and frequently recurs after resection. So far, the underlying pathogenesis is largely elusive. Objectives To identify genetic alterations by next-generation sequencing and/or droplet digital polymerase chain reaction (ddPCR) in cutaneous EH. Methods DNA and RNA from an EH lesion of an index patient were subjected to whole-genome and RNA sequencing. Multiplex PCR-based panel sequencing of genomic DNA isolated from archival formalin-fixed paraffin-embedded tissue of 18 patients with cutaneous EH was performed. ddPCR was used to confirm mutations. Results We identified somatic mutations in genes of the mitogen-activated protein kinase (MAPK) pathway (MAP2K1 and KRAS) in cutaneous EH biopsies. By ddPCR we could confirm the recurrent presence of activating, low-frequency mutations affecting MAP2K1. In total, nine out of 18 patients analysed showed activating MAPK pathway mutations, which were mutually exclusive. Comparative analysis of tissue areas enriched for lymphatic infiltrate or aberrant endothelial cells, respectively, revealed an association of these mutations with the presence of endothelial cells. Conclusions Taken together, our data suggest that EH shows somatic mutations in genes of the MAPK pathway which might contribute to the formation of this benign tumour. KW - protein kinase pathway KW - Background Epithelioid haemangioma KW - somatic mutations Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258333 VL - 186 IS - 3 ER - TY - JOUR A1 - Esnault, Clara A1 - Schrama, David A1 - Houben, Roland A1 - Guyétant, Serge A1 - Desgranges, Audrey A1 - Martin, Camille A1 - Berthon, Patricia A1 - Viaud-Massuard, Marie-Claude A1 - Touzé, Antoine A1 - Kervarrec, Thibault A1 - Samimi, Mahtab T1 - Antibody–drug conjugates as an emerging therapy in oncodermatology JF - Cancers N2 - Antibody–drug conjugates (ADCs) are an emerging class of therapeutics, with twelve FDA- and EMA-approved drugs for hematological and solid cancers. Such drugs consist in a monoclonal antibody linked to a cytotoxic agent, allowing a specific cytotoxicity to tumor cells. In recent years, tremendous progress has been observed in therapeutic approaches for advanced skin cancer patients. In this regard, targeted therapies (e.g., kinase inhibitors) or immune checkpoint-blocking antibodies outperformed conventional chemotherapy, with proven benefit to survival. Nevertheless, primary and acquired resistances as well as adverse events remain limitations of these therapies. Therefore, ADCs appear as an emerging therapeutic option in oncodermatology. After providing an overview of ADC design and development, the goal of this article is to review the potential ADC indications in the field of oncodermatology. KW - antibody–drug conjugates KW - oncodermatology KW - melanoma KW - skin squamous cell carcinoma KW - cutaneous T-cell lymphoma and Merkel cell carcinoma Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-262192 SN - 2072-6694 VL - 14 IS - 3 ER - TY - JOUR A1 - Grimm, Johannes A1 - Hufnagel, Anita A1 - Wobser, Marion A1 - Borst, Andreas A1 - Haferkamp, Sebastian A1 - Houben, Roland A1 - Meierjohann, Svenja T1 - BRAF inhibition causes resilience of melanoma cell lines by inducing the secretion of FGF1 JF - Oncogenesis N2 - Approximately half of all melanoma patients harbour activating mutations in the serine/threonine kinase BRAF. This is the basis for one of the main treatment strategies for this tumor type, the targeted therapy with BRAF and MEK inhibitors. While the initial responsiveness to these drugs is high, resistance develops after several months, frequently at sites of the previously responding tumor. This indicates that tumor response is incomplete and that a certain tumor fraction survives even in drug-sensitive patients, e.g., in a therapy-induced senescence-like state. Here, we show in several melanoma cell lines that BRAF inhibition induces a secretome with stimulating effect on fibroblasts and naive melanoma cells. Several senescence-associated factors were found to be transcribed and secreted in response to BRAF or MEK inhibition, among them members of the fibroblast growth factor family. We identified the growth factor FGF1 as mediator of resilience towards BRAF inhibition, which limits the pro-apoptotic effects of the drug and activates fibroblasts to secrete HGF. FGF1 regulation was mediated by the PI3K pathway and by FRA1, a direct target gene of the MAPK pathway. When FGFR inhibitors were applied in parallel to BRAF inhibitors, resilience was broken, thus providing a rationale for combined therapeutical application. KW - melanoma KW - senescence KW - BRAF KW - tumor Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-177261 VL - 7 IS - 71 ER - TY - JOUR A1 - Wallstabe, Julia A1 - Bussemer, Lydia A1 - Groeber-Becker, Florian A1 - Freund, Lukas A1 - Alb, Mirian A1 - Dragan, Mariola A1 - Waaga-Gasser, Ana Maria A1 - Jakubietz, Rafael A1 - Kneitz, Hermann A1 - Rosenwald, Andreas A1 - Rebhan, Silke A1 - Walles, Heike A1 - Mielke, Stephan T1 - Inflammation-Induced Tissue Damage Mimicking GvHD in Human Skin Models as Test Platform for Immunotherapeutics JF - ALTEX N2 - Due to the rapidly increasing development and use of cellular products, there is a rising demand for non-animal-based test platforms to predict, study and treat undesired immunity. Here, we generated human organotypic skin models from human biopsies by isolating and expanding keratinocytes, fibroblasts and microvascular endothelial cells and seeding these components on a collagen matrix or a biological vascularized scaffold matrix in a bioreactor. We then were able to induce inflammation-mediated tissue damage by adding pre-stimulated, mismatched allogeneic lymphocytes and/or inflammatory cytokine-containing supernatants histomorphologically mimicking severe graft versus host disease (GvHD) of the skin. This could be prevented by the addition of immunosuppressants to the models. Consequently, these models harbor a promising potential to serve as a test platform for the prediction, prevention and treatment of GvHD. They also allow functional studies of immune effectors and suppressors including but not limited to allodepleted lymphocytes, gamma-delta T cells, regulatory T cells and mesenchymal stromal cells, which would otherwise be limited to animal models. Thus, the current test platform, developed with the limitation that no professional antigen presenting cells are in place, could greatly reduce animal testing for investigation of novel immune therapies. KW - inflammation-induced tissue demage KW - immunotherapeutics Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-229974 VL - 37 IS - 3 ER - TY - JOUR A1 - Heitmann, Johanna A1 - Frings, Verena G. A1 - Geier, Andreas A1 - Goebeler, Matthias A1 - Kerstan, Andreas T1 - Non-alcoholic fatty liver disease and psoriasis - is there a shared proinflammatory network? JF - Journal der Deutschen Dermatologischen Gesellschaft N2 - Psoriasis is an immune-mediated systemic inflammatory disease that is not limited to the skin but may be associated with arthritis, cardiovascular diseases, metabolic syndrome including diabetes and obesity and, as identified more recently, non-alcoholic fatty liver disease (NAFLD) that occurs in approximately 50 % of all patients with psoriasis. NAFLD is characterized by accumulation of fat in hepatocytes in the absence of excessive alcohol consumption. Over the last two decades, NAFLD has developed to the most common chronic liver disease with an estimated prevalence of 25 % in the Western population. NAFLD ranges from non-inflammatory or bland hepatic steatosis to inflammation of hepatic tissue (non-alcoholic steatohepatitis, NASH) and consecutive liver fibrosis. It is controversial whether the underlying systemic inflammation of psoriasis is contributing to development of NAFLD or if comorbid diseases such as obesity enhance NAFLD development. Recent findings indicate that cytokine-mediated inflammation through TNFα, interleukin (IL)-6 and IL-17 might be the common link between psoriasis and NAFLD. Considering the shared inflammatory pathways, IL-17 pharmacological blockade, which is already well-established for psoriasis, may be a promising strategy to treat both psoriasis and NAFLD. Therefore, early detection of NAFLD and a better understanding of its pathophysiology in the context of the systemic inflammation in psoriasis is important with regard to individualized treatment approaches. KW - psoriasis KW - fatty liver disease KW - inflammation Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258424 VL - 19 IS - 4 ER - TY - JOUR A1 - Ickrath, Franziska A1 - Stoevesandt, Johanna A1 - Schulmeyer, Lena A1 - Glatzel, Caroline A1 - Goebeler, Matthias A1 - Kerstan, Andreas T1 - Metastatic Crohn's disease: an underestimated entity JF - Journal of the German Society of Dermatology N2 - Cutaneous metastatic Crohn’s disease (MCD) is a rare but challenging dermatologic manifestation of Crohn’s disease. It is histologically defined as the presence of non-caseating granulomas at skin sites separated from and non-contiguous to the gastrointestinal tract. Cutaneous metastatic Crohn’s disease should be distinguished from the much more frequent contiguous cutaneous manifestations of Crohn’s disease that present at perianal or, less common, peristomal sites with direct extension from the intestine to the adjacent skin. Versatile clinical presentation and the fact that occurrence can predate the initial diagnosis of Crohn’s disease may lead to misdiagnosis, delayed treatment and underreporting. As case numbers are small and randomized controlled studies on management are lacking, the therapeutic approach remains challenging and is often unsatisfactory. We here performed a systematic literature search identifying 264 published pediatric and adult cases of MCD and additionally report three of our own cases. Our review summarizes clinical characteristics, putative etiopathology, histologic findings, differential diagnoses and treatment options for MCD. KW - Cutaneous metastatic Crohn’s disease KW - treatment options KW - histologic findings Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-258435 VL - 19 IS - 7 ER - TY - JOUR A1 - Stepula, Elzbieta A1 - König, Matthias A1 - Wang, Xin‐Ping A1 - Levermann, Janina A1 - Schimming, Tobias A1 - Kasimir‐Bauer, Sabine A1 - Schilling, Bastian A1 - Schlücker, Sebastian T1 - Localization of PD‐L1 on single cancer cells by iSERS microscopy with Au/Au core/satellite nanoparticles JF - Journal of Biophotonics N2 - Programmed cell death‐ligand 1 (PD‐L1) is an important predictive biomarker. The detection of PD‐L1 can be crucial for patients with advanced cancer where the use of immunotherapy is considered. Here, we demonstrate the use of immuno‐SERS microscopy (iSERS) for localizing PD‐L1 on single cancer SkBr‐3 cells. A central advantage of iSERS is that the disturbing autofluorescence from cells and tissues can be efficiently minimized by red to near‐infrared laser excitation. In this study we employed Au/Au core/satellite nanoparticles as SERS nanotags because of their remarkable signal brightness and colloidal stability upon red laser excitation. False‐color iSERS images of the positive and negative controls clearly reveal the specific localization of PD‐L1 with SERS nanotag‐labeled antibodies. KW - gold nanoparticles KW - PD‐L1 KW - Raman KW - SERS Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212655 VL - 13 IS - 3 ER - TY - JOUR A1 - Weber, J. A1 - Glutsch, V. A1 - Geissinger, E. A1 - Haug, L. A1 - Lock, J.F. A1 - Schneider, F. A1 - Kneitz, H. A1 - Goebeler, M. A1 - Schilling, B. A1 - Gesierich, A. T1 - Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease JF - British Journal of Dermatology N2 - The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti‐programmed death‐1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long‐term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose‐optimized ipilimumab (1 mg kg−1) combined with nivolumab (3 mg kg−1), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN‐neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. KW - Immunotherapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-213520 VL - 183 IS - 3 ER - TY - JOUR A1 - Koch, Elias A. T. A1 - Petzold, Anne A1 - Wessely, Anja A1 - Dippel, Edgar A1 - Gesierich, Anja A1 - Gutzmer, Ralf A1 - Hassel, Jessica C. A1 - Haferkamp, Sebastian A1 - Kähler, Katharina C. A1 - Knorr, Harald A1 - Kreuzberg, Nicole A1 - Leiter, Ulrike A1 - Loquai, Carmen A1 - Meier, Friedegund A1 - Meissner, Markus A1 - Mohr, Peter A1 - Pföhler, Claudia A1 - Rahimi, Farnaz A1 - Schadendorf, Dirk A1 - Schell, Beatrice A1 - Schlaak, Max A1 - Terheyden, Patrick A1 - Thoms, Kai-Martin A1 - Schuler-Thurner, Beatrice A1 - Ugurel, Selma A1 - Ulrich, Jens A1 - Utikal, Jochen A1 - Weichenthal, Michael A1 - Ziller, Fabian A1 - Berking, Carola A1 - Heppt, Markus V. T1 - Immune checkpoint blockade for metastatic uveal melanoma: re-induction following resistance or toxicity JF - Cancers N2 - Re-induction with immune checkpoint blockade (ICB) needs to be considered in many patients with uveal melanoma (UM) due to limited systemic treatment options. Here, we provide hitherto the first analysis of ICB re-induction in UM. A total of 177 patients with metastatic UM treated with ICB were included from German skin cancer centers and the German national skin cancer registry (ADOReg). To investigate the impact of ICB re-induction, two cohorts were compared: patients who received at least one ICB re-induction (cohort A, n = 52) versus those who received only one treatment line of ICB (cohort B, n = 125). In cohort A, a transient benefit of overall survival (OS) was observed at 6 and 12 months after the treatment start of ICB. There was no significant difference in OS between both groups (p = 0.1) with a median OS of 16.2 months (cohort A, 95% CI: 11.1–23.8) versus 9.4 months (cohort B, 95% CI: 6.1–14.9). Patients receiving re-induction of ICB (cohort A) had similar response rates compared to those receiving ICB once. Re-induction of ICB may yield a clinical benefit for a small subgroup of patients even after resistance or development of toxicities. KW - uveal melanoma KW - immune checkpoint blockade KW - PD-1 KW - CTLA-4 KW - re-induction KW - treatment resistance KW - toxicity Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254814 SN - 2072-6694 VL - 14 IS - 3 ER - TY - JOUR A1 - Thomas, Anna C. A1 - Zeng, Zhiqiang A1 - Rivière, Jean-Baptiste A1 - O'Shaughnessy, Ryan A1 - Al-Olabi, Lara A1 - St.-Onge, Judith A1 - Atherton, David J. A1 - Aubert, Hélène A1 - Bagazgoitia, Lorea A1 - Barbarot, Sébastien A1 - Bourrat, Emmanuelle A1 - Chiaverini, Christine A1 - Chong, W. Kling A1 - Duffourd, Yannis A1 - Glover, Mary A1 - Groesser, Leopold A1 - Hadj-Rabia, Smail A1 - Hamm, Henning A1 - Happle, Rudolf A1 - Mushtaq, Imran A1 - Lacour, Jean-Philippe A1 - Waelchli, Regula A1 - Wobser, Marion A1 - Vabres, Pierre A1 - Patton, E. Elizabeth A1 - Kinsler, Veronica A. T1 - Mosaic activating mutations in GNA11 and GNAQ are associated with phakomatosis pigmentovascularis and extensive dermal melanocytosis JF - Journal of Investigative Dermatology N2 - Common birthmarks can be an indicator of underlying genetic disease but are often overlooked. Mongolian blue spots (dermal melanocytosis) are usually localized and transient, but they can be extensive, permanent, and associated with extracutaneous abnormalities. Co-occurrence with vascular birthmarks defines a subtype of phakomatosis pigmentovascularis, a group of syndromes associated with neurovascular, ophthalmological, overgrowth, and malignant complications. Here, we discover that extensive dermal melanocytosis and phakomatosis pigmentovascularis are associated with activating mutations in GNA11 and GNAQ, genes that encode Ga subunits of heterotrimeric G proteins. The mutations were detected at very low levels in affected tissues but were undetectable in the blood, indicating that these conditions are postzygotic mosaic disorders. In vitro expression of mutant GNA11\(^R183C\) and GNA11\(^Q209L\) in human cell lines demonstrated activation of the downstream p38 MAPK signaling pathway and the p38, JNK, and ERK pathways, respectively. Transgenic mosaic zebrafish models expressing mutant GNA11\(^R183C\) under promoter mitfa developed extensive dermal melanocytosis recapitulating the human phenotype. Phakomatosis pigmentovascularis and extensive dermal melanocytosis are therefore diagnoses in the group of mosaic heterotrimeric G-protein disorders, joining McCune-Albright and Sturge-Weber syndromes. These findings will allow accurate clinical and molecular diagnosis of this subset of common birthmarks, thereby identifying infants at risk for serious complications, and provide novel therapeutic opportunities. KW - uveal melanoma KW - G Protein KW - dermal melanocytosis KW - Sturge-Weber syndrom KW - cesioflammea KW - germline KW - phakomatosis pigmentovascularis Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-189689 VL - 136 IS - 4 ER - TY - JOUR A1 - Nothhaft, Matthias A1 - Klepper, Joerg A1 - Kneitz, Hermann A1 - Meyer, Thomas A1 - Hamm, Henning A1 - Morbach, Henner T1 - Hemorrhagic bullous Henoch-Schönlein Purpura: case report and review of the literature JF - Frontiers in Pediatrics N2 - Henoch-Schönlein Purpura (HSP) or IgA vasculitis is the most common systemic vasculitis of childhood and may affect skin, joints, gastrointestinal tract, and kidneys. Skin manifestations of HSP are characteristic and include a non-thrombocytopenic palpable purpura of the lower extremities and buttocks. Rarely, HSP may initially present as or evolve into hemorrhagic vesicles and bullae. We present an otherwise healthy 5-year-old boy with an acute papulovesicular rash of both legs and intermittent abdominal pain. After a few days the skin lesions rapidly evolved into palpable purpura and hemorrhagic bullous lesions of variable size and severe hemorrhagic HSP was suspected. A histological examination of a skin biopsy showed signs of a small vessel leukocytoclastic vasculitis limited to the upper dermis and direct immunofluorescence analysis revealed IgA deposits in vessel walls, compatible with HSP. To further characterize the clinical picture and treatment options of bullous HSP we performed an extensive literature research and identified 41 additional pediatric patients with bullous HSP. Two thirds of the reported patients were treated with systemic corticosteroids, however, up to 25% of the reported patients developed skin sequelae such as hyperpigmentation and/or scarring. The early use of systemic corticosteroids has been discussed controversially and suggested in some case series to be beneficial by reducing the extent of lesions and minimizing sequelae of disease. Our patient was treated with systemic corticosteroids tapered over 5 weeks. Fading of inflammation resulted in healing of most erosions, however, a deep necrosis developing from a large blister at the dorsum of the right foot persisted so that autologous skin transplantation was performed. Re-examination 11 months after disease onset showed complete clinical remission with re-epithelialization but also scarring of some affected areas. KW - henoch-schönlein purpura KW - vasculitis KW - hemorrhagic KW - bullae KW - children Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-201435 VL - 6 ER - TY - JOUR A1 - Schäfer, Kristina A1 - Bauer, Boris A1 - Donhauser, Julian A1 - Kerstan, Andreas A1 - Hamm, Henning T1 - Becker Naevus Syndrome of the Lower Body: A New Case and Review of the Literature JF - Acta Dermato-Venereologica N2 - Becker naevus syndrome is a rare epidermal naevus syndrome defined by the co-occurrence of a Becker naevus with various cutaneous, muscular and skeletal anomalies. In the majority of cases, abnormalities exclusively consist of ipsilateral hypoplasia of the breast, areola and/or nipple in addition to the naevus. Here, we report on a 42-year-old woman with an extensive Becker naevus reaching from the left buttock to the left calf verified on histological examination. In addition, there was marked hypoplasia of the fatty tissue of the left thigh confirmed by magnetic resonance imaging in contrast to hyperplasia of the fatty tissue of the left gluteal area. Underlying muscles and bones were not affected. There was no difference in leg lengths. In addition, we review and discuss the features of Becker naevus syndrome with emphasis on 10 reported cases with involvement of the lower body. KW - lower body KW - Becker naevus KW - Becker naevus syndrome KW - hypoplasia of fatty tissue Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171057 VL - 97 IS - 4 ER - TY - THES A1 - Jung, Lisa T1 - Nachweis von Autoantikörpern bei Patienten mit pruriginösen Hauterkrankungen T1 - Detection of autoantibodies in patients with pruritic skin diseases N2 - Pruritus tritt verstärkt bei älteren Menschen auf und ist mit vielen verschiedenen Dermatosen unterschiedlichen Ursprungs vergesellschaftet. Pruritus und ein fortgeschrittenes Lebensalter sind auch charakteristisch für die häufigste blasenbildende Autoimmundermatose, das bullöse Pemphigoid. Im prämonitorischen Stadium treten häufig nur Juckreiz und unspezifische Hautveränderungen auf. Das Prodromalstadium eines bullösen Pemphigoids dauert wenige Wochen bis zu mehreren Jahren. Ziel dieser Arbeit war es, die pruriginösen Erkrankungen Prurigo simplex subacuta [L28.2], Prurigo nodularis [L28.1], eosinophilenreiche Dermatitis [L30.8] und Prurigoform eines atopischen Ekzems [L20.0] im Hinblick auf das klinische, laborchemische und histologische Bild bei der Erstdiagnose der Erkrankungen auszuwerten. Insbesondere sollte überprüft werden, ob bei der Erstdiagnose typische Autoantikörper einer subepidermalen blasenbildenden Autoimmundermatose (BP180, BP230) nachgewiesen werden konnten und trotz des letzendlich ungewöhnlichen Erscheinungsbildes letztlich ein bullöses Pemphigoid vorgelegen haben könnte. Es erfolgte eine retrospektive Auswertung der oben genannten pruriginösen Erkrankungen, die über einen Zeitraum von über 10 Jahren in der Klinik für Dermatologie, Venerologie und Allergologie des Universitätsklinikums Würzburg behandelt wurden. Die Patienten wurden gemäß ICD-Kodierung in die vier oben genannten Gruppen unterteilt. Nebst Patientencharakteristika wurden die Parameter direkte Immunfluoreszenz (DIF), indirekte Immunfluoreszenz (IIF), ELISA-Testverfahren, Immunoblot, eosinophile Granulozyten, Gesamt-IgE, histologische Untersuchung, Dermographismus und Blasenbildung ausgewertet. Es konnten insgesamt 325 Patienten in die Studie eingeschlossen werden, bei denen bei der Erstdiagnose einer pruriginösen Erkankung eine IIF auf der humanen Spalthaut und/oder auf dem Affenösophagus als Substrat veranlasst wurde. Es konnten bei insgesamt 54 (16,7%) Patienten Autoantikörper gegen IgG oder IgA mittels IIF nachgewiesen werden. Bei 42 (76,4%) Patienten wurde eine weiterführende Diagnostik mittels DIF durchgeführt, die bei 37 (88,1%) Personen als negativ befundet wurde. Bei fünf (11,9%) Patienten konnten Autoantikörper gegen IgG, IgA und IgM nachgewiesen werden. Alle stammten aus der Gruppe mit einer Prurigo simplex subacuta [L28.2]. Bei diesen fünf Patienten wurde zusätzlich noch ein ELISA-Test durchgeführt. Nur bei einem Patienten konnten Autoantikörper gegen BP180 und Desmoglein 1 nachgewiesen werden. 66 Mit dieser Studie konnte aufgezeigt werden, dass bei Patienten mit den Erkrankungen Prurigo simplex subacuta [L28.2], Prurigo nodularis [L28.1], eosinophilenreiche Dermatitis [L30.8] und Prurigoform eines atopischen Ekzems [L20.0] keine erhöhte Bildung von Autoantikörpern gegen die dermoepidermale Junktionszone stattfindet. Dennoch sollte bei Patienten mit pruriginösen Erkrankungen eine serologische Untersuchung mittels IIF – und im Falle einer Positivität mittels ELISA und ggf. DIF durchgeführt werden, vor allem bei älteren Patienten, bei welchen der Pruritus als führendes Symptom beschrieben wird, um die Diagnose einer bullösen Autoimmundermatose sicher ausschließen zu können. Zudem sollte eine Verlaufskontrolle über mehrere Jahre erfolgen, um die Auswirkung des Pruritus als Trigger auf die Bildung von Autoantikörpern einer bullösen Autoimmundermatose zu verfolgen. N2 - Pruritus can be caused by many different dermatoses of different origin with older people suffering more often from pruritus. At the same time, Pruritus and advanced age are characteristics of the most common blistering autoimmune dermatosis, bullous pemphigoid. In the pre-monitoring stage, often only itching and non-specific skin changes occur. The prodromal stage of bullous pemphigoid lasts from a few weeks to several years. The aim of this work was to describe the pruritic diseases prurigo simplex subacuta [L28.2], prurigo nodularis [L28.1], eosinophil-rich dermatitis [L30.8] and prurigoform atopic eczema [L20.0] with regards to the clinical and laboratory-chemical aspects and to evaluate the histological picture in the initial diagnosis of the diseases. In particular, this work evaluated whether typical autoantibodies of a subepidermal blistering autoimmune dermatosis (BP180, BP230) could be detected in the initial diagnosis and whether bullous pemphigoid may have been present despite the unusual appearance. A retrospective evaluation of the above-mentioned pruritic diseases, which were treated over a period of more than 10 years in the Department of Dermatology, Venereology and Allergology of the University Hospital Würzburg, was carried out. The patients were divided into the four groups mentioned above according to ICD coding. In addition to patient characteristics, the parameters direct immunofluorescence (DIF), indirect immunofluorescence (IIF), ELISA test methods, immunoblot, eosinophilic granulocytes, total IgE, histological examination, dermographism and blistering were evaluated. A total of 325 patients was included in the study, in which an IIF was induced in the human split skin layer and/or in the monkey esophagus as substrate at the initial diagnosis of a pruritic disease. Autoantibodies against IgG or IgA could be detected in a total of 54 (16.7%) patients using IIF. In 42 (76.4%) patients, further diagnostics were carried out using DIF, of which 37 (88.1%) people were negative. Autoantibodies against IgG, IgA and IgM could be detected in five (11.9%) patients. All came from the group with prurigo simplex subacuta [L28.2]. An ELISA test was also performed on these five patients. As a result autoantibodies against BP180 and desmoglein 1 could only be detected in one patient. This study was able to show that patients with the diseases prurigo simplex subacuta [L28.2], prurigo nodularis [L28.1], eosinophilic dermatitis [L30.8] and prurigoform atopic eczema [L20.0] do not have an increased formation of autoantibodies against the dermoepidermal junction zone. Nevertheless, in patients with pruritic diseases, a serological examination using IIF - and in the case of positivity using ELISA and possibly DIF - should be carried out especially for elderly patients who describe pruritus as the leading symptom, in order to reliably diagnose bullous autoimmune dermatosis to be able to rule out. In addition, a follow- up examination should be carried out over several years in order to track the effect of pruritus as a trigger for the formation of autoantibodies in bullous autoimmune dermatosis. KW - Autoantikörper KW - Pruritus Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265254 ER - TY - THES A1 - Weiß, Neele T1 - Bedeutung des MEK5/ERK5-Signalwegs in der zielgerichteten Melanomtherapie T1 - Function of the MEK5/ERK5-Pathway in the targeted Therapy of Melanoma N2 - In dieser Dissertation wird der MEK5/ERK5- Signalweg als möglicher Angriffspunkt in der zielgerichteten Melanomtherapie identifiziert. Die Adressierung von ERK5 bietet eine Alternative, um einer Resistenzentwicklung gegenüber Inhibitoren des MAPK- Signalwegs entgegenzuwirken. Das maligne Melanom ist ein hochaggressiver Tumor mit steigender Inzidenz. Zunehmende Sonnenstunden im Rahmen des Klimawandels mit erhöhter Belastung der Haut durch UV-Strahlung werden die Problematik des malignen Melanoms für den Menschen in den nächsten Jahren weiter zunehmen lassen. Die Aktivierung des MEK5/ERK5- Signalwegs scheint eine Reaktion von Tumorzellen auf Therapiestress zu sein. Diese Aktivierung liefert den Melanomzellen einen Überlebensvorteil und verhindert ein langfristiges Therapieansprechen. ERK5 beeinflusst den Zellzyklus von Melanomzellen und ist somit möglicherweise von wichtiger Bedeutung in der Tumorgenese des malignen Melanoms. Patienten mit NRAS- Mutation profitieren auffallend weniger von einer gezielten MEKi-Therapie als solche mit BRAF Mutation. Für ersteres Patientenkollektiv steht aktuell lediglich die Immuntherapie zur Verfügung, wodurch oft nur ein kurzes, progressionsfreies Intervall erreicht werden kann und die Patienten häufig unter schweren Nebenwirkungen leiden. Grund für die problematische Behandlung könnte das häufige Auftreten einer basalen ERK5- Aktivierung in NRAS- mutierten Melanomen sein. Diese Arbeit liefert eine positive Prognose über den Nutzen einer ERK5- Inhibition als Erweiterung des Therapieschemas. Diese These gilt auch für Melanompatienten mit einer BRAF- Mutation. Patienten, die an einem malignen Melanom erkrankt sind, weisen zu 80% eine Mutation in einem dieser beschriebenen Onkogene auf. Die Arbeit lässt darauf schließen, dass eine ERK5- Inhibition in der Therapie von beiden Gruppen erfolgreich sein könnte und somit das Leben nahezu aller Melanompatienten betrifft. N2 - In this thesis, targeting the MEK5/ERK5- pathway is identified as a possible treatment option for maligant melanoma in order to prevent the development of resistances against inhibitors of the MAPK- pathway. The malignant melanoma is a highly aggressive tumor with an increasing incidence. A rising amount of sun exposure due to climate change will lead to increasing skin damage among the population and thus the malignant melanoma may emerge as an important medical problem throughout the following decade. The activation of the MEK5/ERK5 pathway seems to be a cellular response to therapeutic stress. It therefore results in sustained proliferation and survival in melanoma cells and prevents an efficiant therapy in the longterm. ERK5 has influence on the cell cycle progression of melanoma cells and could be of utmost importance for the tumorigenesis in malignant melanoma. Patients suffering from NRAS- mutant melanoma benefit remarkably less from MAPK-pathway targeting regimens than those with BRAF- mutation. In these cases immunotharpy remains as the only valuable treatment option yet barely achieving a short progression free survival with severe side effects. The obstacle of effective therapy could be the frequently found occurrence of a basal ERK5- activity especially observed in NRAS- mutant melanoma cells. Our data imply that MEKi/ERK5i co-treatment could provide a new therapeutic approach as an adjunct to targeted therapy of malignant melanoma improving its overall effectiveness. This discovery does not only apply for NRAS- mutant melanoma but also for patients with BRAF- mutation. In 80% of malignant melanoma the driver mutation can be found in one of these two oncogenes suggesting the majoryty of melanoma patients might benefit from MEK5/ERK5- Inhibition. KW - Melanom KW - MAP-Kinase KW - MEK5/ERK5 KW - Therapieresistenz Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-219073 ER - TY - JOUR A1 - Houben, Roland A1 - Ebert, Marlies A1 - Hesbacher, Sonja A1 - Kervarrec, Thibault A1 - Schrama, David T1 - Merkel Cell Polyomavirus Large T Antigen is Dispensable in G2 and M-Phase to Promote Proliferation of Merkel Cell Carcinoma Cells JF - Viruses N2 - Merkel cell carcinoma (MCC) is an aggressive skin cancer frequently caused by the Merkel cell polyomavirus (MCPyV), and proliferation of MCPyV-positive MCC tumor cells depends on the expression of a virus-encoded truncated Large T antigen (LT) oncoprotein. Here, we asked in which phases of the cell cycle LT activity is required for MCC cell proliferation. Hence, we generated fusion-proteins of MCPyV-LT and parts of geminin (GMMN) or chromatin licensing and DNA replication factor1 (CDT1). This allowed us to ectopically express an LT, which is degraded either in the G1 or G2 phase of the cell cycle, respectively, in MCC cells with inducible T antigen knockdown. We demonstrate that LT expressed only in G1 is capable of rescuing LT knockdown-induced growth suppression while LT expressed in S and G2/M phases fails to support proliferation of MCC cells. These results suggest that the crucial function of LT, which has been demonstrated to be inactivation of the cellular Retinoblastoma protein 1 (RB1) is only required to initiate S phase entry. KW - Merkel cell polyomavirus KW - large T antigen KW - cell cycle KW - Merkel cell carcinoma Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-218171 SN - 1999-4915 VL - 12 IS - 10 ER - TY - JOUR A1 - Glutsch, Valerie A1 - Kneitz, Hermann A1 - Gesierich, Anja A1 - Goebeler, Matthias A1 - Haferkamp, Sebastian A1 - Becker, Jürgen C. A1 - Ugurel, Selma A1 - Schilling, Bastian T1 - Activity of ipilimumab plus nivolumab in avelumab-refractory Merkel cell carcinoma JF - Cancer Immunology, Immunotherapy N2 - Background Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine cutaneous malignancy with poor prognosis. In Europe, approved systemic therapies are limited to the PD-L1 inhibitor avelumab. For avelumab-refractory patients, efficient and safe treatment options are lacking. Methods At three different sites in Germany, clinical and molecular data of patients with metastatic MCC being refractory to the PD-L1 inhibitor avelumab and who were later on treated with combined IPI/NIVO were retrospectively collected and evaluated. Results Five patients treated at three different academic sites in Germany were enrolled. Three out of five patients investigated for this report responded to combined IPI/NIVO according to RECIST 1.1. Combined immunotherapy was well tolerated without any grade II or III immune-related adverse events. Two out of three responders to IPI/NIVO received platinum-based chemotherapy in between avelumab and combined immunotherapy. Conclusion In this small retrospective study, we observed a high response rate and durable responses to subsequent combined immunotherapy with IPI/NIVO in avelumab-refractory metastatic MCC patients. In conclusion, our data suggest a promising activity of second- or third-line PD-1- plus CTLA-4-blockade in patients with anti-PD-L1-refractory MCC. KW - ipilimumab KW - Merkel cell carcinoma KW - resistance KW - avelumab KW - nivolumab Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-265635 SN - 14320851 VL - 70 IS - 7 ER - TY - JOUR A1 - Marquardt, André A1 - Solimando, Antonio Giovanni A1 - Kerscher, Alexander A1 - Bittrich, Max A1 - Kalogirou, Charis A1 - Kübler, Hubert A1 - Rosenwald, Andreas A1 - Bargou, Ralf A1 - Kollmannsberger, Philip A1 - Schilling, Bastian A1 - Meierjohann, Svenja A1 - Krebs, Markus T1 - Subgroup-Independent Mapping of Renal Cell Carcinoma — Machine Learning Reveals Prognostic Mitochondrial Gene Signature Beyond Histopathologic Boundaries JF - Frontiers in Oncology N2 - Background: Renal cell carcinoma (RCC) is divided into three major histopathologic groups—clear cell (ccRCC), papillary (pRCC) and chromophobe RCC (chRCC). We performed a comprehensive re-analysis of publicly available RCC datasets from the TCGA (The Cancer Genome Atlas) database, thereby combining samples from all three subgroups, for an exploratory transcriptome profiling of RCC subgroups. Materials and Methods: We used FPKM (fragments per kilobase per million) files derived from the ccRCC, pRCC and chRCC cohorts of the TCGA database, representing transcriptomic data of 891 patients. Using principal component analysis, we visualized datasets as t-SNE plot for cluster detection. Clusters were characterized by machine learning, resulting gene signatures were validated by correlation analyses in the TCGA dataset and three external datasets (ICGC RECA-EU, CPTAC-3-Kidney, and GSE157256). Results: Many RCC samples co-clustered according to histopathology. However, a substantial number of samples clustered independently from histopathologic origin (mixed subgroup)—demonstrating divergence between histopathology and transcriptomic data. Further analyses of mixed subgroup via machine learning revealed a predominant mitochondrial gene signature—a trait previously known for chRCC—across all histopathologic subgroups. Additionally, ccRCC samples from mixed subgroup presented an inverse correlation of mitochondrial and angiogenesis-related genes in the TCGA and in three external validation cohorts. Moreover, mixed subgroup affiliation was associated with a highly significant shorter overall survival for patients with ccRCC—and a highly significant longer overall survival for chRCC patients. Conclusions: Pan-RCC clustering according to RNA-sequencing data revealed a distinct histology-independent subgroup characterized by strengthened mitochondrial and weakened angiogenesis-related gene signatures. Moreover, affiliation to mixed subgroup went along with a significantly shorter overall survival for ccRCC and a longer overall survival for chRCC patients. Further research could offer a therapy stratification by specifically addressing the mitochondrial metabolism of such tumors and its microenvironment. KW - kidney cancer KW - pan-RCC KW - machine learning KW - mitochondrial DNA KW - mtDNA KW - mTOR Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-232107 SN - 2234-943X VL - 11 ER - TY - JOUR A1 - Stolze, Ina A1 - Trautmann, Axel A1 - Goebeler, Matthias A1 - Stoevesandt, Johanna T1 - Dangerous Leg Cramps: Severe Pustular Exanthema Caused by an Over-the-Counter Drug JF - Acta Dermato-Venereologica N2 - Abstract is missing KW - leg cramps KW - over-the-counter drugs KW - pustular exanthema KW - quinine KW - allergy Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-171285 VL - 96 ER - TY - JOUR A1 - Schmidt, Enno A1 - Sticherling, Michael A1 - Sárdy, Miklós A1 - Eming, Rüdiger A1 - Goebeler, Matthias A1 - Hertl, Michael A1 - Hofmann, Silke C. A1 - Hunzelmann, Nicolas A1 - Kern, Johannes S. A1 - Kramer, Harald A1 - Nast, Alexander A1 - Orzechowski, Hans‐Dieter A1 - Pfeiffer, Christiane A1 - Schuster, Volker A1 - Sitaru, Cassian A1 - Zidane, Miriam A1 - Zillikens, Detlef A1 - Worm, Margitta T1 - S2k guidelines for the treatment of pemphigus vulgaris/foliaceus and bullous pemphigoid: 2019 update JF - JDDG: Journal der Deutschen Dermatologischen Gesellschaft KW - pemphigus vulgaris KW - pemphigus foliaceus KW - S2k guidelines Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-217806 VL - 18 IS - 5 SP - 516 EP - 526 ER - TY - THES A1 - Rehlinghaus, Christine T1 - Retrospektive Evaluation der intravenösen Dexamethason- bzw. Methylprednisolon-Pulstherapie bei ausgeprägter Alopecia areata T1 - Retrospective evaluation of intravenous dexamethasone or methylprednisolone pulse therapy for severe alopecia areata N2 - Hintergrund: Bei der Entscheidung für eine intravenöse Kortikosteroid-Pulstherapie bei schweren Formen der AA ist die Abwägung von Therapieaufwand, Nebenwirkungen und Risiken einerseits und der Erfolgsaussicht andererseits von zentraler Bedeutung. Ziel: Ziel dieser retrospektiven Analyse war es daher, die Wirksamkeit und Sicherheit der intravenösen Kortikosteroid-Pulstherapie bei Patient:innen mit ausgeprägter AA klinikintern als qualitätssichernde Maßnahme zu untersuchen, prognostisch bedeutsame Faktoren für den Therapieeffekt zu ermitteln und hierdurch die beste Indikation herauszuarbeiten. Methode: 126 Patient:innen (13 Kinder und Jugendliche) erhielten Dexamethason 100 mg (122 Patienten) oder Methylprednisolon 20-30 mg/kg/KG (max. 1000 mg, 4 Patienten) an drei aufeinanderfolgenden Tagen für ein bis drei Zyklen. Ergebnisse: Patienten mit einer AA partialis bzw. diffusa zeigten im Hinblick auf ein vollständiges oder kosmetisch akzeptables Wiederwachstum die besten Ansprechraten (44,3%, n=43). Unter den Ophiasis-Patienten und den Patienten mit AA totalis/universalis sprach nur etwa ein Viertel auf die Therapie an (Ophiasis 23,8%, n=5; AA totalis/universalis: 25%, n=2). Schwerwiegende unerwünschte Nebenwirkungen wurden nicht beobachtet. Schlussfolgerung: In der vorliegenden Untersuchung ließen sich eine längere Bestandsdauer der Erkrankung und Erkrankungsepisode (über 6 Monate), ein schwerer Ausprägungsgrad (Ophiasis, AA totalis/universalis) und krankheitstypische Nagelveränderungen als wichtige ungünstige prognostische Faktoren nachweisen. Dagegen wirkten sich die untersuchten Kriterien Alter, Geschlecht, atopisches Ekzem und andere Erkrankungen des atopischen Formenkreises, Schilddrüsen- und Autoimmunerkrankungen in der Eigenanamnese sowie AA in der Familienanamnese nicht negativ auf den Behandlungserfolg aus. Patienten mit AA partialis und einer Bestandsdauer der AA von maximal 6 Monaten haben die besten Erfolgsaussichten. N2 - Background: When deciding in favour of intravenous corticosteroid pulse therapy for severe forms of AA, it is of central importance to weigh up the therapeutic effort, side effects and risks on the one hand and the prospects of success on the other. Aim: The aim of this retrospective analysis was therefore to investigate the efficacy and safety of intravenous corticosteroid pulse therapy in patients with pronounced AA within the clinic as a quality assurance measure, to determine prognostically significant factors for the therapeutic effect and thus to identify the best indication. Methods: 126 patients (13 children and adolescents) received dexamethasone 100 mg (122 patients) or methylprednisolone 20-30 mg/kg/KG (max. 1000 mg, 4 patients) on three consecutive days for one to three cycles. Results: Patients with AA partialis or diffusa showed the best response rates in terms of complete or cosmetically acceptable regrowth (44.3%, n=43). Among the ophiasis patients and the patients with AA totalis/universalis, only about a quarter responded to the therapy (ophiasis 23.8%, n=5; AA totalis/universalis: 25%, n=2). No serious adverse events were observed. Conclusion: In the present study, a longer duration of the disease and disease episode (more than 6 months), a severe degree of severity (ophiasis, AA totalis/universalis) and nail changes typical of the disease were found to be important unfavourable prognostic factors. In contrast, the investigated criteria of age, gender, atopic eczema and other atopic diseases, thyroid and autoimmune diseases in the patient's own medical history and AA in the family history did not have a negative effect on the success of treatment. Patients with AA partialis and a maximum duration of AA of 6 months have the best chances of success. KW - Alopecia areata Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-360711 ER - TY - JOUR A1 - Kervarrec, Thibault A1 - Samimi, Mahtab A1 - Guyétant, Serge A1 - Sarma, Bhavishya A1 - Chéret, Jérémy A1 - Blanchard, Emmanuelle A1 - Berthon, Patricia A1 - Schrama, David A1 - Houben, Roland A1 - Touzé, Antoine T1 - Histogenesis of Merkel Cell Carcinoma: A Comprehensive Review JF - Frontiers in Oncology N2 - Merkel cell carcinoma (MCC) is a primary neuroendocrine carcinoma of the skin. This neoplasia features aggressive behavior, resulting in a 5-year overall survival rate of 40%. In 2008, Feng et al. identified Merkel cell polyomavirus (MCPyV) integration into the host genome as the main event leading to MCC oncogenesis. However, despite identification of this crucial viral oncogenic trigger, the nature of the cell in which MCC oncogenesis occurs is actually unknown. In fact, several hypotheses have been proposed. Despite the large similarity in phenotype features between MCC tumor cells and physiological Merkel cells (MCs), a specialized subpopulation of the epidermis acting as mechanoreceptor of the skin, several points argue against the hypothesis that MCC derives directly from MCs. Alternatively, MCPyV integration could occur in another cell type and induce acquisition of an MC-like phenotype. Accordingly, an epithelial as well as a fibroblastic or B-cell origin of MCC has been proposed mainly based on phenotype similarities shared by MCC and these potential ancestries. The aim of this present review is to provide a comprehensive review of the current knowledge of the histogenesis of MCC. KW - merkel cell polyomavirus (MCPyV) KW - epithelial KW - fibroblast KW - B cell KW - Merkel cell carcinoma (MCC) KW - histogenesis KW - origin Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-325733 VL - 9 ER - TY - JOUR A1 - Brinker, Titus J. A1 - Hekler, Achim A1 - Hauschild, Axel A1 - Berking, Carola A1 - Schilling, Bastian A1 - Enk, Alexander H. A1 - Haferkamp, Sebastian A1 - Karoglan, Ante A1 - von Kalle, Christof A1 - Weichenthal, Michael A1 - Sattler, Elke A1 - Schadendorf, Dirk A1 - Gaiser, Maria R. A1 - Klode, Joachim A1 - Utikal, Jochen S. T1 - Comparing artificial intelligence algorithms to 157 German dermatologists: the melanoma classification benchmark JF - European Journal of Cancer N2 - Background Several recent publications have demonstrated the use of convolutional neural networks to classify images of melanoma at par with board-certified dermatologists. However, the non-availability of a public human benchmark restricts the comparability of the performance of these algorithms and thereby the technical progress in this field. Methods An electronic questionnaire was sent to dermatologists at 12 German university hospitals. Each questionnaire comprised 100 dermoscopic and 100 clinical images (80 nevi images and 20 biopsy-verified melanoma images, each), all open-source. The questionnaire recorded factors such as the years of experience in dermatology, performed skin checks, age, sex and the rank within the university hospital or the status as resident physician. For each image, the dermatologists were asked to provide a management decision (treat/biopsy lesion or reassure the patient). Main outcome measures were sensitivity, specificity and the receiver operating characteristics (ROC). Results Total 157 dermatologists assessed all 100 dermoscopic images with an overall sensitivity of 74.1%, specificity of 60.0% and an ROC of 0.67 (range = 0.538–0.769); 145 dermatologists assessed all 100 clinical images with an overall sensitivity of 89.4%, specificity of 64.4% and an ROC of 0.769 (range = 0.613–0.9). Results between test-sets were significantly different (P < 0.05) confirming the need for a standardised benchmark. Conclusions We present the first public melanoma classification benchmark for both non-dermoscopic and dermoscopic images for comparing artificial intelligence algorithms with diagnostic performance of 145 or 157 dermatologists. Melanoma Classification Benchmark should be considered as a reference standard for white-skinned Western populations in the field of binary algorithmic melanoma classification. KW - benchmark KW - artificial intelligence KW - deep learning KW - melanoma Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220569 VL - 111 ER - TY - JOUR A1 - Brinker, Titus J. A1 - Hekler, Achim A1 - Enk, Alexander H. A1 - Berking, Carola A1 - Haferkamp, Sebastian A1 - Hauschild, Axel A1 - Weichenthal, Michael A1 - Klode, Joachim A1 - Schadendorf, Dirk A1 - Holland-Letz, Tim A1 - von Kalle, Christof A1 - Fröhling, Stefan A1 - Schilling, Bastian A1 - Utikal, Jochen S. T1 - Deep neural networks are superior to dermatologists in melanoma image classification JF - European Journal of Cancer N2 - Background Melanoma is the most dangerous type of skin cancer but is curable if detected early. Recent publications demonstrated that artificial intelligence is capable in classifying images of benign nevi and melanoma with dermatologist-level precision. However, a statistically significant improvement compared with dermatologist classification has not been reported to date. Methods For this comparative study, 4204 biopsy-proven images of melanoma and nevi (1:1) were used for the training of a convolutional neural network (CNN). New techniques of deep learning were integrated. For the experiment, an additional 804 biopsy-proven dermoscopic images of melanoma and nevi (1:1) were randomly presented to dermatologists of nine German university hospitals, who evaluated the quality of each image and stated their recommended treatment (19,296 recommendations in total). Three McNemar's tests comparing the results of the CNN's test runs in terms of sensitivity, specificity and overall correctness were predefined as the main outcomes. Findings The respective sensitivity and specificity of lesion classification by the dermatologists were 67.2% (95% confidence interval [CI]: 62.6%–71.7%) and 62.2% (95% CI: 57.6%–66.9%). In comparison, the trained CNN achieved a higher sensitivity of 82.3% (95% CI: 78.3%–85.7%) and a higher specificity of 77.9% (95% CI: 73.8%–81.8%). The three McNemar's tests in 2 × 2 tables all reached a significance level of p < 0.001. This significance level was sustained for both subgroups. Interpretation For the first time, automated dermoscopic melanoma image classification was shown to be significantly superior to both junior and board-certified dermatologists (p < 0.001). KW - deep learning KW - melanoma KW - skin cancer KW - artificial intelligence Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-220539 VL - 119 ER - TY - JOUR A1 - Scholz, S. L. A1 - Cosgarea, I. A1 - Süßkind, D. A1 - Murali, R. A1 - Möller, I. A1 - Reis, H. A1 - Leonardelli, S. A1 - Schilling, B. A1 - Schimming, T. A1 - Hadaschik, E. A1 - Franklin, C. A1 - Paschen, A. A1 - Sucker, A. A1 - Steuhl, K. P. A1 - Schadendorf, D. A1 - Westekemper, H. A1 - Griewank, K. G. T1 - NF1 mutations in conjunctival melanoma JF - British Journal of Cancer N2 - Background Conjunctival melanoma is a potentially deadly eye tumour. Despite effective local therapies, tumour recurrence and metastasis remain frequent. The genetics of conjunctival melanomas remain incompletely understood. Methods A large cohort of 63 conjunctival melanomas was screened for gene mutations known to be important in other melanoma subtypes by targeted next-generation sequencing. Mutation status was correlated with patient prognosis. Results Frequent mutations in genes activating the MAP kinase pathway were identified. NF1 mutations were most frequent (n = 21, 33%). Recurrent activating mutations were also identified in BRAF (n = 16, 25%) and RAS genes (n = 12, 19%; 11 NRAS and 1 KRAS). Conclusions Similar to cutaneous melanomas, conjunctival melanomas can be grouped genetically into four groups: BRAF-mutated, RAS-mutated, NF1-mutated and triple wild-type melanomas. This genetic classification may be useful for assessment of therapeutic options for patients with metastatic conjunctival melanoma KW - cancer genetics KW - eye cancer Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-233329 VL - 118 ER - TY - JOUR A1 - Sondermann, Wiebke A1 - Utikal, Jochen Sven A1 - Enk, Alexander H. A1 - Schadendorf, Dirk A1 - Klode, Joachim A1 - Hauschild, Axel A1 - Weichenthal, Michael A1 - French, Lars E. A1 - Berking, Carola A1 - Schilling, Bastian A1 - Haferkamp, Sebastian A1 - Fröhling, Stefan A1 - von Kalle, Christof A1 - Brinker, Titus J. T1 - Prediction of melanoma evolution in melanocytic nevi via artificial intelligence: A call for prospective data JF - European Journal of Cancer N2 - Recent research revealed the superiority of artificial intelligence over dermatologists to diagnose melanoma from images. However, 30–50% of all melanomas and more than half of those in young patients evolve from initially benign lesions. Despite its high relevance for melanoma screening, neither clinicians nor computers are yet able to reliably predict a nevus’ oncologic transformation. The cause of this lies in the static nature of lesion presentation in the current standard of care, both for clinicians and algorithms. The status quo makes it difficult to train algorithms (and clinicians) to precisely assess the likelihood of a benign skin lesion to transform into melanoma. In addition, it inhibits the precision of current algorithms since ‘evolution’ image features may not be part of their decision. The current literature reveals certain types of melanocytic nevi (i.e. ‘spitzoid’ or ‘dysplastic’ nevi) and criteria (i.e. visible vasculature) that, in general, appear to have a higher chance to transform into melanoma. However, owing to the cumulative nature of oncogenic mutations in melanoma, a more fine-grained early morphologic footprint is likely to be detectable by an algorithm. In this perspective article, the concept of melanoma prediction is further explored by the discussion of the evolution of melanoma, the concept for training of such a nevi classifier and the implications of early melanoma prediction for clinical practice. In conclusion, the authors believe that artificial intelligence trained on prospective image data could be transformative for skin cancer diagnostics by (a) predicting melanoma before it occurs (i.e. pre-in situ) and (b) further enhancing the accuracy of current melanoma classifiers. Necessary prospective images for this research are obtained via free mole-monitoring mobile apps. KW - melanoma KW - skin cancer KW - artificial Intelligence KW - deep learning KW - prediction Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239263 VL - 119 ER - TY - JOUR A1 - Tappenbeck, Nils A1 - Schröder, Hannes M. A1 - Niebergall-Roth, Elke A1 - Hassinger, Fathema A1 - Dehio, Ulf A1 - Dieter, Kathrin A1 - Kraft, Korinna A1 - Kerstan, Andreas A1 - Esterlechner, Jasmina A1 - Frank, Natasha Y. A1 - Scharffetter-Kochanek, Karin A1 - Murphy, George F. A1 - Orgill, Dennis P. A1 - Beck, Joachim A1 - Frank, Markus H. A1 - Ganss, Christoph A1 - Kluth, Mark A. T1 - In vivo safety profile and biodistribution of GMP-manufactured human skin-derived ABCB5-positive mesenchymal stromal cells for use in clinical trials JF - Cytotherapy N2 - Background aims Human dermal ABCB5-expressing mesenchymal stromal cells (ABCB5+ MSCs) represent a promising candidate for stem cell–based therapy of various currently uncurable diseases in several fields of regenerative medicine. We have developed and validated a method to isolate, from human skin samples, and expand ABCB5+ MSCs that meet the guideline criteria of the International Society for Cellular Therapy. We are able to process these cells into a Good Manufacturing Practice–conforming, MSC-based advanced-therapy medicinal product. Methods To support the development of ABCB5+ MSCs for potential therapeutic topical, intramuscular and intravenous administration, we have tested our product in a series of Good Laboratory Practice–compliant nonclinical in-vivo studies addressing all relevant aspects of biosafety, including potential long-term persistence and proliferation, distribution to nontarget tissues, differentiation into undesired cell types, ectopic tissue formation, tumor formation and local tissue reaction. Results (i) Subcutaneous application of 1 × 107 ABCB5+ MSCs/animal and intravenous application of 2 × 106 ABCB5+ MSCs/animal, respectively, to immunocompromised mice did not result in safety-relevant biodistribution, persistence or proliferation of the cells; (ii) three monthly subcutaneous injections of ABCB5+ MSCs at doses ranging from 1 × 105 to 1 × 107 cells/animal and three biweekly intravenous injections of 2 × 106 ABCB5+ MSCs/animal, respectively, to immunocompromised mice were nontoxic and revealed no tumorigenic potential; and (iii) intramuscular injection of 5 × 106 ABCB5+ MSCs/animal to immunocompromised mice was locally well tolerated. Discussion The present preclinical in vivo data demonstrate the local and systemic safety and tolerability of a novel advanced-therapy medicinal product based on human skin-derived ABCB5+ MSCs. KW - stromal cells KW - stem cells KW - MSC KW - biodistribution KW - safety KW - ABCB5 KW - GMP KW - tumorigenicity KW - toxicity KW - persistence Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-240456 VL - 21 ER -