Assessment of work-related symptoms, perceived knowledge, and attitude among nail salon technicians.

OBJECTIVES: Beauty is a Lebanese stereotype, as Lebanese women often feel urged to decorate themselves. Recent studies have raised concerns about nail salon technicians' (NSTs) health and safety issues. The aim of our study was to evaluate the occupational symptoms reported by NSTs, to assess their knowledge and document their awareness regarding hazardous chemicals found in nail cosmetics. METHODS: NSTs completed a researcher-administered questionnaire. Data were gathered on sociodemographic characteristics, perceived knowledge, and safety issues. Work-related symptoms reported by NSTs were evaluated, and their responses were compared to those of the office employees. RESULTS: A total of 120 NSTs and 120 office employees were interviewed. Compared to the control group, NSTs reported a higher prevalence of work-related respiratory, dermal, and irritative symptoms, all significantly associated with smoking and a poor ventilation system. In addition, musculoskeletal complaints were common among NSTs and significantly linked to a poor ventilation system, an increased number of customers per day, and a longer service duration. Furthermore, a longer career duration was significantly associated with an increased prevalence of irritative symptoms. When a binary logistic regression was carried out, it demonstrated a 25 times higher prevalence of work-related symptoms among NSTs compared to the office employees. Interestingly, 84% of the respondents had an inaccurate knowledge of nail cosmetics' risks with their educational level acting as key factor. CONCLUSIONS: Based on these findings, it is warranted to perform a clinical assessment, implement a stringent regulatory framework, and improve knowledge toward nail cosmetics' risk.

Knowledge and Attitude Among Lebanese Women Toward Hazardous Chemicals Used in Nail Cosmetics.

Middle Eastern women seek frequently for self-adornment. Harmful effects of chemicals used in nail care services have involved women worldwide. This study was performed to determine Lebanese women's knowledge and attitudes toward adverse effects of compounds used in nail cosmetics. A national cross-sectional study was carried out using an online questionnaire and targeting women in Lebanon. Data was collected on sociodemographic characteristics, nail cosmetics' application, preventive measures, perceived knowledge and self-reported side effects associated with nail cosmetic's use. A total cumulative knowledge score was calculated to categorize consumer knowledge. A total of 573 women completed the survey. Young women with a high school education or beyond were overrepresented. Most of the participants preferred applying classic manicure and removers on a weekly basis. Over 82% had poor/fair knowledge about health hazards associated with chemical compounds used in nail cosmetics with their levels of education acting as a key factor. Skin and neurological symptoms were the more frequently self-reported symptoms. Interestingly, the use of a nail hardener was linked to a higher prevalence of headache, nausea, allergy, skin irritation, itching and burn. The prevalence of the three later symptoms was higher among gel users. Moreover, few participants read nail cosmetics' labels or questioned their safety. Although nail cosmetics' application was common among Lebanese women, there is poor knowledge regarding their harmful effects. Based on these findings, it is warranted to launch health awareness campaigns and introduce a cosmetovigilance system to ensure the safety of the consumer products.

Vaccine coverage for Lebanese citizens and Syrian refugees in Lebanon.

ARTICLE HISTORY: Following the refugee crisis in Lebanon, the on-going inflow of Syrian refugees presented new challenges to optimal immunization coverage for all the children living in the country. Healthcare facilities have been overburdened during this period and the country witnessed outbreaks of many infectious diseases. Thus, the evaluation of vaccine compliance for mandatory and non-mandatory vaccines as well as the factors affecting the vaccination rate among Lebanese residents and Syrian refugees is fundamental. BACKGROUND: Since 2012, Lebanon has hosted around 1.2 million Syrian refugees, a high number in a country whose population does not exceed 4.4 million. Healthcare facilities have been overburdened during this period, which has led to the spread of many infectious diseases, including outbreaks of measles, mumps and hepatitis. At the appearance of such outbreaks, it becomes essential to evaluate vaccine compliance and the factors influencing the vaccination rate among Lebanese residents and Syrian refugees in infants and children up to 15 y of age. METHODS: A total of 571 infants and children were recruited in Beirut and Mount Lebanon, two governorates that together host half of the Lebanese population. RESULTS: A very high rate of vaccine compliance was seen for mandatory vaccines, whereas an intermediate to very low rate of compliance was found for non-mandatory vaccines. Both bivariate and multiple regression analyses indicated that age group and regular consultation of a pediatrician were independently associated with immunization coverage. Bivariate analysis indicated that parental age, occupational and educational status of parents, family size and vaccine price were also independently associated with immunization coverage. Incomplete vaccination coverage was associated with socioeconomic factors. CONCLUSIONS: From these results, it becomes apparent that it may be necessary to reassess vaccination priorities considering the current socioeconomic situation.

IL-27 Production and Regulation in Human Dendritic Cells Treated with the Chemical Sensitizer NiSO4.

Allergic contact dermatitis (ACD) is a major cause of occupational skin disease, and nickel is among the most prevalent contact allergens. Dendritic cells (DC) play an important role in ACD and in the type of the ensuing immune response through differential phenotypes and cytokine production. The interleukin (IL)-12 cytokine family is composed of heterodimeric cytokines sharing homology at the subunit, receptors and signaling levels. We previously showed that nickel can upregulate the production of IL-12p40 and IL-23, both known to be pro-inflammatory. In this work, we aimed to extend our knowledge on nickel regulation of the IL-12 cytokine family by focusing on IL-27, a recently identified immunomodulatory cytokine from this family. We showed that nickel induced the production of IL-27 in human monocyte-derived DC (MoDC), regulating IL-22 production by human CD4+ T cells. We also showed that nickel was able to induce the expression of the two subunits of IL-27: il-27p28 and ebi3. Furthermore, we demonstrated that the production of IL-27 was dependent on the TLR4, p38 MAPK, NF-κB, and Jak-STAT signaling. However, IL-27 subunits were differentially regulated by these pathways. Indeed, both subunits were positively regulated by the TLR4 and NF-κB pathways, but only il-27p28 was also dependent on p38 MAPK and Jak-STAT pathways. Our results contribute to a better understanding of nickel-induced ACD by focusing on the IL-12 cytokine family and elucidating the mechanism of IL-27 regulation in human dendritic cells.

Nickel Sulfate Promotes IL-17A Producing CD4+ T Cells by an IL-23-Dependent Mechanism Regulated by TLR4 and Jak-STAT Pathways.

Allergic contact dermatitis, caused by nickel, is a delayed-type hypersensitivity reaction, and 14.5% of the general population may be affected in Europe. Among a wide range of cytokines, the IL-12 family has unique structural and immunological characteristics. Whereas IL-12p70 promotes T helper (Th) 1 cell polarization, IL-23 promotes Th17 cell development and both have been isolated from nickel-allergic patients. In this work, we were interested in understanding the mechanism behind nickel-induced Th17 cell development. We showed that nickel induced an early production of IL-23 in human monocyte-derived dendritic cells along with an increase in the expression of il-23p19 and il-12p40 mRNA. However, the production of a significant level of IL-12p70 required an additional signal such as IFN-γ. Moreover, nickel-treated monocyte-derived dendritic cells induced an increase in the percentage of IL-17A+ CD4+ T cells, an effect reduced by IL-23 neutralization. We then investigated the molecular mechanism of IL-23 production. Our results showed that toll-like receptor 4, p38 mitogen-activated protein kinase, and NF-κB were involved in IL-23 production induced by nickel. However, Jak-signal transducer and activator of transcription activation seems to maintain the IL-23/IL-12p70 balance by limiting IL-23 production and promoting Th1 polarization. These results indicate that nickel-induced Th17 cell development is dependent on the production of IL-23 by human monocyte-derived dendritic cells via toll-like receptor 4, p38 mitogen-activated protein kinase, NF-κB, and Jak-signal transducer and activator of transcription pathways.

An Evaluation of the Stemness, Paracrine, and Tumorigenic Characteristics of Highly Expanded, Minimally Passaged Adipose-Derived Stem Cells.

The use of adipose-derived stem cells (ADSC) in regenerative medicine is rising due to their plasticity, capacity of differentiation and paracrine and trophic effects. Despite the large number of cells obtained from adipose tissue, it is usually not enough for therapeutic purposes for many diseases or cosmetic procedures. Thus, there is the need for culturing and expanding cells in-vitro for several weeks remain. Our aim is to investigate if long- term proliferation with minimal passaging will affect the stemness, paracrine secretions and carcinogenesis markers of ADSC. The immunophenotypic properties and aldehyde dehydrogenase (ALDH) activity of the initial stromal vascular fraction (SVF) and serially passaged ADSC were observed by flow cytometry. In parallel, the telomerase activity and the relative expression of oncogenes and tumor suppressor genes were assessed by q-PCR. We also assessed the cytokine secretion profile of passaged ADSC by an ELISA. The expanded ADSC retain their morphological and phenotypical characteristics. These cells maintained in culture for up to 12 weeks until P4, possessed stable telomerase and ALDH activity, without having a TP53 mutation. Furthermore, the relative expression levels of TP53, RB, and MDM2 were not affected while the relative expression of c-Myc decreased significantly. Finally, the levels of the secretions of PGE2, STC1, and TIMP2 were not affected but the levels of IL-6, VEGF, and TIMP 1 significantly decreased at P2. Our results suggest that the expansion of passaged ADSC does not affect the differentiation capacity of stem cells and does not confer a cancerous state or capacity in vitro to the cells.

Glucocorticoids inhibit dendritic cell maturation induced by Toll-like receptor 7 and Toll-like receptor 8.

GCs are widely prescribed to treat inflammatory disorders and autoimmune and allergic diseases. Their anti-inflammatory and immunosuppressive effects may be related, in part, to their ability to control the maturation and functions of DCs. Here, we report that GCs inhibit the maturation of human CD34-DCs induced by the TLR7 agonist imiquimod and the TLR8 agonist 3M-002. GCs down-regulate the expression of CD86, CD40, CD83, CCR7, and HLA-DR on DCs and inhibit IL-6 and IL-12p40 production by DCs following TLR7 and TLR8 stimulation. This inhibitory effect is abolished by RU486, suggesting a role for GR transcriptional activity. Our results also show that GCs do not affect TLR-mediated DNA-binding activity of NF-κBp65. We observe that GCs control the activation of JNK induced by TLR agonists, without affecting its upstream MKK4. However, p38MAPK activation is not affected by GCs. Concomitantly to JNK inhibition, we observe the induction of the DUSP MKP-1 but not of other DUSPs by GCs. However, although silencing of MKP-1 in DCs reverses GC-mediated JNK inhibition, no significant effect on GC-induced inhibition of DC maturation was evidenced. Our results show that GCs alter DC maturation in response to TLR7 or TLR8 through a mechanism involving GR transcriptional activity.

Evidence for chemical and cellular reactivities of the formaldehyde releaser bronopol, independent of formaldehyde release.

Formaldehyde and formaldehyde releasers are widely used preservatives and represent an important group of skin sensitizers. Formaldehyde is very often suspected to be the sensitizing agent of formaldehyde-releasers; however, many reported clinical cases of contact allergy to these molecules such as bronopol (2-bromo-2-nitropropane-1,3-diol) indicate negative skin reactions to formaldehyde suggesting a more complex mechanism. The aim of this study was to compare the chemical reactivity and biological activity of formaldehyde with those of two formaldehyde releasers: 2-bromo-2-nitropropane-1,3-diol and 1,3-dimethylol-5,5-dimethylhydantoin. A key step in the sensitization to chemicals is the formation of the hapten-protein antigenic complex via covalent binding between the chemical sensitizer and amino acids in proteins. The chemical reactivity of the three compounds was thus addressed using (13)C NMR analysis of adduct formation upon incubation with a set of nucleophilic amino acids. The biological activity was measured in two in vitro models based on dendritic cells and a monocytic cell line (CD34-DC and THP-1 model) through monitoring of a panel of biomarkers. The results obtained show that 2-bromo-2-nitropropane-1,3-diol produces low amount of free formaldehyde in physiological buffers but that its degradation generates various molecules including 2-bromoethanol. In addition, 2-bromo-2-nitropropane-1,3-diol also generates adducts with amino acids, not observed with formaldehyde alone, that could be explained by the reactivity of 2-bromoethanol. In parallel, in a cellular approach using the human monocytic THP-1 cell line, 2-bromo-2-nitropropane-1,3-diol activates THP-1 cells at concentrations that are not correlated to simple formaldehyde release. This observation is confirmed in the more physiological model CD34-DC. Moreover, in the THP-1 model, the expression profiles of several biomarkers are specific to 2-bromo-2-nitropropane-1,3-diol. Finally, the use in the cellular model of the pure degradation products identified by NMR reveals the reactivity of bromonitromethane. In contrast, 1,3-dimethylol-5,5-dimethylhydantoin presents chemical and biological reactivities similar to those of formaldehyde. Taken together, these data suggest that 2-bromo-2-nitropropane-1,3-diol is an atypical formaldehyde releaser, releasing low amounts of formaldehyde at physiological conditions but producing multiple degradation products among which 2-bromoethanol and bromonitromethane are potential candidates for explaining the specific allergic reactions to 2-bromo-2-nitropropane-1,3-diol.

Mechanisms of IL-12 synthesis by human dendritic cells treated with the chemical sensitizer NiSO4.

Allergic contact dermatitis, caused by metallic ions, is a T cell-mediated inflammatory skin disease. IL-12 is a 70-kDa heterodimeric protein composed of IL-12p40 and IL-12p35, playing a major role in the generation of allergen-specific T cell responses. Dendritic cells (DCs) are APCs involved in the induction of primary immune responses, as they possess the ability to stimulate naive T cells. In this study, we address the question whether the sensitizer nickel sulfate (NiSO(4)) itself or in synergy with other signals can induce the secretion of IL-12p70 in human monocyte-derived DCs (Mo-DCs). We found that IL-12p40 was produced by Mo-DC in response to NiSO(4) stimulation. Addition of IFN-gamma concomitantly to NiSO(4) leads to IL-12p70 synthesis. NiSO(4) treatment leads to the activation of MAPK, NF-kappaB pathways, and IFN regulatory factor 1 (IRF-1). We investigated the role of these signaling pathways in IL-12 production using known pharmacological inhibitors of MAPK and NF-kappaB pathways and RNA interference-mediated silencing of IRF-1. Our results showed that p38 MAPK, NF-kappaB, and IRF-1 were involved in IL-12p40 production induced by NiSO(4). Moreover, IRF-1 silencing nearly totally abrogated IL-12p40 and IL-12p70 production provoked by NiSO(4) and IFN-gamma. In response to NiSO(4), we observed that STAT-1 was phosphorylated on both serine and tyrosine residues and participated to NiSO(4)-induced IRF-1 activation. N-acetylcysteine abolished STAT-1 phosphorylation, suggesting that STAT-1 activation may be dependent on NiSO(4)-induced alteration of the redox status of the cell. These results indicate that p38 MAPK, NF-kappaB, and IRF-1 are activated by NiSO(4) in Mo-DC and cooperate for IL-12 production.

Acetaminophen and lipopolysaccharide act in synergy for the production of pro-inflammatory cytokines in murine RAW264.7 macrophages.

There is extensive evidence that pro-inflammatory cytokines produced by macrophages are involved in toxicity induced by drugs such as acetaminophen (APAP). We investigated the effect of subtoxic concentrations of acetaminophen in conjunction with bacterial lipopolysaccharide (LPS) on the expression of the pro-inflammatory cytokines TNFalpha and IL-1beta using the mouse macrophage cell line RAW264.7 as a model. APAP alone induced in a dose-dependent manner the production of TNFalpha and IL-1beta in this cell line. When LPS was added to APAP-treated cells, the increase in TNFalpha and IL-1beta production observed was higher than the sum of cytokine amounts produced with each agent alone, suggesting a synergistic mechanism. Moreover, we found that p38MAPK, JNK, and ERK were activated by APAP or LPS alone or in association. In our model, the NFkappaB signaling pathway was not involved in cytokine production induced by APAP. When inhibiting MAPKs using pharmacological inhibitors, we showed that p38MAPK inhibition abrogated the synergistic effect of APAP and LPS found for TNFalpha production but not for IL-1beta production. JNK and ERK have comparable roles in the production of the cytokines. Furafylline, a CYP1A inhibitor, and indomethacin, a PGHS inhibitor, exhibited a significant inhibitory effect on TNFalpha and IL-1beta production induced by the APAP and LPS combination. This work suggests that in macrophages, APAP and LPS can synergistically provoke the induction of pro-inflammatory cytokines, an effect involving the MAPK pathway and APAP bioactivation by CYP and PGHS.

TLR7 and TLR8 agonists trigger different signaling pathways for human dendritic cell maturation.

Dendritic cells (DCs) play an important role in bridging innate and adaptive immunity. These APCs have the ability to recognize specific molecular signatures of pathogens through TLRs. In particular, the intracellular TLR7 and TLR8, mediating the recognition of ssRNA by DCs, play a major role in the immune response during viral infection. Although differences have been identified between TLR7 and TLR8, in terms of cellular expression and functions, the signaling pathways that lead to DC maturation following TLR7 or TLR8 engagement are largely unknown. We compared the signaling pathways involved in human CD34-DC maturation induced by agonists selective for TLR7 (imiquimod) or TLR8 (3M002). TLR7 and TLR8 activation up-regulated CCR7, CD40, CD86, and CD83 expression and IL-6 and IL-12p40 production. However, only TLR8 activation led to IL-12p70 production and il-12p35 mRNA expression. We found that upon TLR7 and TLR8 activation, JNK and NF-kappaB positively regulated the expression of CCR7, CD86, CD83, and CD40 and the production of IL-6 and IL-12p40. However, although p38MAPK participated in the up-regulation of maturation markers in response to TLR7 activation, this kinase exerted an inhibitory effect on CD40 expression and IL-12 production in TLR8-stimulated DCs. We also showed that the Jak/STAT signaling pathway was involved in CD40 expression and cytokine production in TLR7-stimulated DCs but negatively regulated CD83 expression and cytokine secretion in DCs activated through TLR8. This study showed that TLR7 and TLR8 activate similar signaling pathways that play different roles in DC maturation, depending on which TLR is triggered.

Metallic haptens induce differential phenotype of human dendritic cells through activation of mitogen-activated protein kinase and NF-kappaB pathways.

Dendritic cells (DCs) play a major role in the regulation of immune responses to a variety of antigens (Ag) and haptens which participate in the process of DC maturation. Indeed, metallic haptens are able to induce DC maturation in vitro but the mechanism of this maturation is not well understood. We and others have already shown that NiSO(4) activates p38 mitogen-activated protein kinases (p38MAPK), c-jun N-terminal kinase (JNK), extracellular signal-regulated kinase (ERK) and the transcription factor NF-kappaB during the early events of DCs maturation. However, the effect of other metallic haptens on DC maturation is still poorly understood. In the present study, using dendritic cells derived from CD34(+) cord blood cells, we showed that both NiSO(4) and CoCl(2) induced the expression of CD86, CD83, HLA-DR and CD40 and the production of IL-6 in human DCs while K(2)Cr(2)O(7) induced only a slight upregulation of CD86. Interestingly, only NiSO(4) was able to induce the production of IL-12p40. NiSO(4) and CoCl(2) but not K(2)Cr(2)O(7) were able to activate the MAPK pathway and the transcription factor NF-kappaB. The role of MAPKs in metals-induced DC maturation was then evaluated using well-described pharmacological inhibitors. Our results suggest that p38MAPK activation regulates the expression of CD86 and CD83 induced by NiSO(4) while it only affects the expression of CD83 induced by CoCl(2). IL-6 production induced by NiSO(4) and CoCl(2) strongly depended on all MAPKs. IL-12p40 synthesis after NiSO(4) treatment was regulated by both p38MAPK and JNK pathways whereas ERK may play an inhibitory role. Our results show that both NiSO(4) and CoCl(2) activate similar signaling pathways that are playing different roles in DC maturation depending on the hapten used.

NF-kappaB plays a major role in the maturation of human dendritic cells induced by NiSO(4) but not by DNCB.

Dendritic cell (DC) activation is a critical event for the induction of an immune response to haptens. Although signaling pathways such as mitogen-activated protein kinase (MAPK) family members have been reported to play a role in DC activation by haptens, little is known about the implication of the nuclear factor kappa B (NF-kappaB) pathway. In this work, we showed that NiSO(4) induced the expression of HLA-DR, CD83, CD86, and CD40 and the production of interleukin (IL)-8, IL-6, and IL-12p40 in human DCs, whereas DNCB induced mainly the expression of CD83 and CD86 and the production of IL-8. NiSO(4) but not DNCB was able to activate the degradation of IkappaB-alpha leading to the binding of the p65 subunit of NF-kappaB on specific DNA probes. Inhibition of the NF-kappaB pathway using BAY 11-7085 prevents both CD40 and HLA-DR expression and cytokine production induced by NiSO(4). However, BAY 11-7085 only partially inhibited CD86 and CD83 expression induced by NiSO(4). In addition, p38 MAPK and NF-kappaB were independently activated by NiSO(4) since SB203580 did not inhibit NF-kappaB activation by NiSO(4). Interestingly, we also showed that DNCB inhibited the degradation of IkappaB-alpha induced by tumor necrosis factor-alpha leading to alteration of CD40, HLA-DR, and CD83 expression but not of CD86 and CCR7. Extensive modifications of DC phenotype by NiSO(4) in comparison to DNCB are probably the consequence of NF-kappaB activation by NiSO(4) but not by DNCB.