GWAS of Chronic Spontaneous Urticaria Reveals Genetic Overlap with Autoimmune Diseases, Not Atopic Diseases.

Although chronic spontaneous urticaria (CSU) is a common disease, GWASs of CSU are lacking. We aimed to identify susceptibility SNPs by performing a GWAS in Chinese Han adults with CSU. The discovery cohort included 430 CSU cases and 482 healthy controls. The GWAS findings were validated in 800 CSU cases and 900 healthy controls. Genetic, functional enrichment, and bioinformatic analyses of genome-wide significant SNPs were performed to assess the association between CSU and autoimmunity or atopy. Five genome-wide significant SNPs were identified: rs434124/LILRA3, rs61986182/IGHG1/2, rs73075571/TDGF1, rs9378141/HLA-G, and rs3789612/PTPN22. The first four SNPs were in linkage disequilibrium with autoimmune-related diseases‒associated SNPs and were cis-expression quantitative trait loci in immune cells. The five SNPs-annotated genes were significantly enriched in immune processes. Higher polygenic risk scores and allele frequencies of rs3789612∗T, rs9378141∗C, and rs73075571∗G were significantly associated with autoimmune-related CSU phenotypes, including positive antithyroglobulin IgG, positive anti-FcεRIα IgG, total IgE <40 IU/ml, and positive antithyroid peroxidase IgG but not with atopic or allergic sensitized CSU phenotypes. This GWAS of CSU identifies five risk loci and reveals that CSU shares genetic overlap with autoimmune diseases and that genetic factors predisposing to CSU mainly manifest through associations with autoimmune traits.

IgE and IgG Anti-Thyroid Autoantibodies in Chinese Patients With Chronic Spontaneous Urticaria and a Literature Review.

Immunoglobulin (Ig) E and IgG anti-thyroid autoantibodies (AAbs) play important roles in the immunopathogenesis of chronic spontaneous urticaria (CSU). To date, association of IgE and IgG AAbs with Chinese CSU patients has not been fully investigated. We aimed to explore prevalence rates of IgE and IgG AAbs in Chinese CSU patients and their association with clinical and laboratory parameters. Serum IgE and IgG AAbs against thyroid peroxidase (TPO) and thyroglobulin (TG), total IgE (tIgE) and specific IgEs were measured using enzyme-linked immunosorbent assay, chemiluminescence microparticle immunoassay and immunoblotting. Meta-analyses and literature review were conducted. The meta-analyses indicated that CSU cases were 4.98, 6.90 and 6.68 times more likely to have positive anti-TPO IgE, anti-TPO IgG and anti-TG IgG (all P < 0.001) compared with controls, respectively, and revealed a positive correlation between the prevalence rates of anti-TPO IgE and anti-TPO IgG (r = 0.53, P = 0.025). A total of 1,100 Chinese Han adult CSU patients and 1,100 ethnicity-, age- and sex-matched healthy controls were recruited from 15 centers. Prevalence rates of anti-TPO IgE, anti-TPO IgG, anti-TG IgE or anti-TG IgG in the patients were all significantly higher than those in the controls. Significant correlations were observed between prevalence rates of anti-TPO IgE and anti-TPO IgG (r = 0.297, P < 0.001) as well as between those of anti-TG IgE and anti-TG IgG in the patients (r = 0.137, P < 0.001). Patients with anti-TPO IgE or anti-TPO IgG had significantly lower tIgE levels (P < 0.001). Positive anti-TPO IgE, positive anti-TPO IgG and tIgE < 40 IU/mL were independent predictors of antihistamine-refractory cases. In conclusion, the prevalence rates of IgE and IgG AAbs in Chinese CSU patients are significantly elevated and reciprocally correlated. This study verifies the results of previous case-control studies of CSU patients from other populations and ethnicities.

Expert consensus on the use of omalizumab in chronic urticaria in China.

Chronic urticaria (CU) is a debilitating skin disease that lasts for more than 6 weeks with wheals and/or angioedema, including chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU). In China, the prevalence of this disease is high, more than 1%, and on the rise. CU has a major impact on the quality of life (QoL) of patients who frequently experience sleep disturbance, depression, and anxiety. Nearly one-third of patients with CSU, in China, are resistant to second-generation H1-antihistamines (sgAHs), even at a fourfold dose (second line; off-label). Omalizumab is approved for the treatment of CSU treatment in Europe and shows remarkable efficacy and safety. In China, regulatory approval for the use of omalizumab is pending, and its use in clinical practice varies widely. Consensus on omalizumab CU treatment in China is urgently needed. The aim of this article is to propose a practical omalizumab treatment algorithm for the management of antihistamine-resistant CSU and CIndU in adults and special population including children and adolescents, and pregnant or breast feeding women, to guide daily clinical practice in China. In the development of this consensus, an expert group including mainly dermatologists, allergists, but also pulmonologists, ENTs, immunologists, and pediatricians in Allergic Disease Prevention and Control Committee, Chinese Preventive Medicine Association, reviewed the existing evidence and developed consensus on the use of omalizumab in CU patients from China. The goal of this consensus is to assist clinicians in making rational decisions in the management of refractory CU with omalizumab. The key clinical questions covered by the treatment algorithm are: 1) Omalizumab treatment routine strategy in both CSU and CIndU patients; 2) Recommended dose and treatment duration for different age stratification; 3) Treatment duration for CU patients with other allergic comorbidities; 4) Recommendation on omalizumab stopping strategy.

Primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions and an excellent response to systemic acitretin.

Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does not involve internal organs. It is clinically subclassified into 3 general categories and some rare variants. However, there is considerable overlap within the classification. Though there are a variety of therapeutic measures, the treatment is often unsatisfactory, particularly when the disease is severe and extensive. We describe a rare case of primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions that showed an excellent response to systemic acitretin.

Primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions and an excellent response to systemic acitretin

Abstract: Primary localized cutaneous amyloidosis is a skin-limited amyloidosis that does not involve internal organs. It is clinically subclassified into 3 general categories and some rare variants. However, there is considerable overlap within the classification. Though there are a variety of therapeutic measures, the treatment is often unsatisfactory, particularly when the disease is severe and extensive. We describe a rare case of primary localized cutaneous amyloidosis with lichen and poikiloderma-like lesions that showed an excellent response to systemic acitretin.

Seasonal variability in the biophysical properties of forehead skin in women in Guangzhou City, China.

BACKGROUND: Skin appearance is influenced by biophysical parameters. Seasonal changes affect the condition of normal skin and may trigger cutaneous disorders. OBJECTIVES: This study was undertaken to measure the effects of seasonal changes on biophysical parameters in the skin of female subjects living in Guangzhou City in southern China. METHODS: A cross-sectional study was conducted in 178 healthy, adult Chinese women in whom forehead skin was examined in all four seasons between March 2007 and February 2008. Commercially available, non-invasive devices were used to measure skin hydration, sebum content, pH, and transepidermal water loss (TEWL) in a closed environment under controlled and constant conditions of temperature and humidity. Correlations between skin parameters and climate conditions were investigated. RESULTS: There were significant seasonal changes in TEWL and pH (autumn and winter > spring and summer), skin hydration (spring and summer > autumn and winter), and sebum content (spring and summer > autumn and winter). Skin hydration was correlated with average temperature and humidity. Skin TEWL and skin pH were correlated with average temperature, humidity, and ultraviolet (UV) radiation levels. Skin sebum content was correlated with average humidity. CONCLUSIONS: Facial skin physiology showed seasonal variations in China. The reasons for the changes may refer to seasonal changes in temperature, humidity, and UV radiation.

Augmenting multi-instance multilabel learning with sparse bayesian models for skin biopsy image analysis.

Skin biopsy images can reveal causes and severity of many skin diseases, which is a significant complement for skin surface inspection. Automatic annotation of skin biopsy image is an important problem for increasing efficiency and reducing the subjectiveness in diagnosis. However it is challenging particularly when there exists indirect relationship between annotation terms and local regions of a biopsy image, as well as local structures with different textures. In this paper, a novel method based on a recent proposed machine learning model, named multi-instance multilabel (MIML), is proposed to model the potential knowledge and experience of doctors on skin biopsy image annotation. We first show that the problem of skin biopsy image annotation can naturally be expressed as a MIML problem and then propose an image representation method that can capture both region structure and texture features, and a sparse Bayesian MIML algorithm which can produce probabilities indicating the confidence of annotation. The proposed algorithm framework is evaluated on a real clinical dataset containing 12,700 skin biopsy images. The results show that it is effective and prominent.

Automated skin biopsy histopathological image annotation using multi-instance representation and learning.

With digitisation and the development of computer-aided diagnosis, histopathological image analysis has attracted considerable interest in recent years. In this article, we address the problem of the automated annotation of skin biopsy images, a special type of histopathological image analysis. In contrast to previous well-studied methods in histopathology, we propose a novel annotation method based on a multi-instance learning framework. The proposed framework first represents each skin biopsy image as a multi-instance sample using a graph cutting method, decomposing the image to a set of visually disjoint regions. Then, we construct two classification models using multi-instance learning algorithms, among which one provides determinate results and the other calculates a posterior probability. We evaluate the proposed annotation framework using a real dataset containing 6691 skin biopsy images, with 15 properties as target annotation terms. The results indicate that the proposed method is effective and medically acceptable.

Changes of cathepsin B in human photoaging skin both in vivo and in vitro.

BACKGROUND: Cathepsin B plays an important role in cell cycle, extracellular matrix changes and cutaneous tumorigenesis: whether it plays a role in photoaged skin remains unknown. This study aimed to investigate the role of cathepsin B in skin photoaging in vivo and in vitro. METHODS: The expressions of cathepsin B were compared with immunohistochemical methods in solar exposed skin and solar protected skin of six healthy Chinese volunteers. The mRNA and protein expression of cathepsin B in ultraviolet light A (UVA) induced premature senescence fibroblasts in vitro were detected by real-time reverse transcription polymerase chain reaction (RT-PCR) and Western blotting technique. RESULTS: Decreased expression of cathepsin B was observed in photoaged skin compared with that of the solar protected skin. In the UVA induced, premature senescence fibroblasts, a lower expression of cathepsin B was detected by Western blotting and a decreased synthesis of cathepsin B mRNA in the same cells was revealed by real-time RT-PCR. CONCLUSIONS: The results demonstrated a significant negative correlation between skin photoaging and cathepsin B in vitro and in vivo. We propose that cathepsin B, besides matrix metalloproteinases and antioxidant enzymes, is involved in the process of skin photoaging in that it contributes to extracellular matrix remodelling and is a dominant protease in cellular apoptosis and senescence.

[Study of long-term toxicity on applying Solanum lyratum on rat skin].

OBJECTIVE: To observe the long-term toxicity of rats which we had applied Solanum lyratum Thunb gel on their skins daily for 90 days. METHODS: We had applied high and low doses of Solanum lyratum Thunb gel one time each day on healthy and punctured rats skins respectively for 90 days. The rats' characters were observed, and their blood routines, blood biochemistry index, anatomic and pathologic changes of their major organs were also detected. RESULTS: Rats' characters had no change, the results of all detections were normal. There was no significant difference between test groups and control group. Rats'major organs had no change in anatomy and pathology. CONCLUSION: No long-term toxic reaction can be found in the test of rats applied Solanum lyratum Thunb gel on their skins for a long term. It proves that it is safe using the normal dose of this gel on the skin in clinic.

[The preparation and quality control of Solanum lyratum Thunb Extract gel].

OBJECTIVE: To introduce the preparation and quality control of Solanum lyratum Extract Thunb gel. METHODS: The gel was prepared with Solanum lyratum Thunb Extract as main component and carbopol 940 as base material, and Solasodine was determined by TLCS. RESULTS: The preparation of this gel was feasible, its quality was reliable, its detection method was rapid, stable, and could be used to control the quality of Solanum lyratum Thunb Extract gel. CONCLUSIONS: Studies on Solanum lyratum Thunb Extract gel will find a new path for the treatment of eczema with mono traditional Chinese medicine.

[Predicting cancerization of condyloma acuminatum by testing expression of p16].

BACKGROUND & OBJECTIVE: About 3%-10% of condyloma acuminatum (CA) may develop into cancer. Some studies indicated that homologous deletion of p16 gene is a major factor that causes cancerization of CA. This study was to detect expression of P16 protein in CA tissues and its cancerization tissues, and to investigate relationship of abnormal expression of P16 and cancerization of CA. METHODS: A total of 75 skin biopsy specimens were collected, including 30 normal skin samples (control group), 35 CA samples, and 10 cancerized CA samples. Expression of P16 was tested by LSAB immunohistochemistry, and relationship of P16 and cancerization of CA was statistically analyzed. RESULTS: CA and normal skin tissues showed weakly positive expression of P16, no significant difference exist (P< 0.05). Cancerized CA tissues showed positive or strongly positive expression of P16, significantly stronger than CA and normal skin tissues (P< 0.05). CONCLUSIONS: Positive and strongly positive expression of P16 in CA tissue implied risk of cancerization of CA. P16 may be a useful predictor for cancerization of CA.