Squamous cell carcinoma in organ transplant recipients: approach to management.

Skin cancer, particularly squamous cell carcinoma (SCC), continues to be a significant cause of morbidity and even mortality in organ transplant recipients (OTRs). As the number of organ transplant patients continues to increase, dermatologists will be faced with the challenge of diagnosing and managing their skin cancers. Evaluation, management and follow up of organ transplant recipients with high risk SCC will be discussed.

Botulinum A exotoxin for rejuvenation of the upper third of the face.

Botulinum A exotoxin, derived from the gram-positive anaerobe Clostridium botulinum, has proven to be safe and effective in the temporary treatment of facial rhytides. In order to obtain reproducible results and avoid complications, it is necessary to understand the relevant physiology and anatomic relationships. Technical considerations including injection technique, dilution, storage, and potential complications will be discussed.

Treatment of lentigo maligna.

Lentigo maligna (LM) is an indolent form of melanoma in situ with the potential to progress to invasive melanoma. Early detection and adequate treatment prior to development to invasive melanoma are essential. Definitive excision with negative margins is currently the treatment of choice for LM. Conventional excision, Mohs micrographic surgical excision, and nonexcisional methods of treatment of LM will be discussed.

Malignant melanoma: prevention, early detection, and treatment in the 21st century.

Malignant melanoma continues to present a significant public health problem as its incidence is rising faster than that of any other cancer in the US. At current rates, 1 in 74 Americans will develop melanoma during his or her lifetime. Management of melanoma is a complex issue requiring a multidisciplinary approach. The most effective method of protection against the development of melanoma is minimization of ultraviolet exposure from sunlight. Early detection and treatment are critical and result in improved patient survival rates. Surgical excision remains the mainstay of treatment but many new promising therapies are being investigated. It is hoped that increased public and professional awareness and education in all areas relating to the prevention, detection, and treatment of malignant melanoma will contribute to decreasing trends in the incidence and mortality from this cancer in the future.

Calcitonin gene-related peptide decreases expression of HLA-DR and CD86 by human dendritic cells and dampens dendritic cell-driven T cell-proliferative responses via the type I calcitonin gene-related peptide receptor.

These studies were performed to establish whether functional receptors for calcitonin gene-related peptide (CGRP) are present on human dendritic cells (DCs) and to investigate potential immunomodulatory effects of CGRP on DCs other than Langerhans cells. Reverse transcriptase-PCR revealed expression of mRNA for a type 1 CGRP receptor by mature and immature blood-derived DCs. Sequence analysis confirmed the identity of the type 1 CGRP receptor (CGRP-R1). Addition of CGRP (10-7 M) to mature and immature DCs resulted in mobilization of intracellular calcium. Treatment of immature DCs with CGRP (10-7 M), before and after maturation in monocyte-conditioned medium, resulted in decreased cell surface expression of HLA-DR MHC class II and the costimulatory molecule, CD86. Treatment of immature DCs with CGRP (10-7 M) also resulted in decreased expression of CD86, but expression of HLA-DR was unchanged. When CGRP-treated mature DCs were used to stimulate allogeneic T cells, proliferative responses were dampened (approximately 50%), especially at low DC:T cell ratios (1:360). This effect was not observed with CGRP-treated, immature DCs. In contrast, CGRP-treated mature or immature DCs were no less efficient than untreated DCs in driving syngeneic T cell-proliferative responses to staphylococcal enterotoxin B. We conclude that mature and immature DCs express type 1 CGRP receptors and that signaling through these receptors may dampen mature DC-driven T cell proliferation most likely via down-regulation of CD86 and HLA-DR.

Neuropeptide-mediated regulation of hapten-specific IgE responses in mice. I. Substance P-mediated isotype-specific suppression of BPO-specific IgE antibody-forming cell responses induced in vivo and in vitro.

The ability of substance P (SP) to regulate peak benzyl-penicilloyl (BPO)-specific IgE antibody-forming cell (AFC) responses in vivo and the ability of SP and other neuropeptides to regulate BPO-specific memory IgE AFC responses induced in vitro was determined. SP injected subcutaneously into BPO-keyhole limpet hemocyanin (BPO-KLH)-sensitized mice at the time of peak IgE responses suppressed these responses within 48 h (> 90%). The suppression obtained was IgE isotype-specific, dose-dependent, and transient. When spleen cells from immunized mice were cultured for 5 days with BPO-KLH, peak memory IgE AFC responses were induced in vitro. Inclusion of either SP or vasoactive intestinal peptide (VIP), but not neurotensin, serotonin, somatostatin, or gastrin, in cultures suppressed these responses in isotype-specific, dose-dependent fashion (approximately 70%). SP-, but not VIP-mediated suppression of IgE responses was abrogated by inclusion of anti-IFN gamma culture.

Neuropeptide-mediated regulation of hapten-specific IgE responses in mice. II. Mechanisms of substance P-mediated isotype-specific suppression of BPO-specific IgE antibody-forming cell responses induced in vitro.

Previous studies in our laboratory have shown that substance P (SP), injected into benzylpenicilloyl-keyhole limpet hemocyanin (BPO-KLH) sensitized mice at the peak of the benzylpenicilloyl (BPO)-specific IgE response, suppressed these responses in isotype-specific fashion within 48 h. These studies also showed that SP, but not neurotensin (NT), serotonin (5-HT), somatostatin (SOM) or gastrin, suppressed BPO-specific memory IgE antibody-forming cell (AFC) responses induced in vitro, also in isotype-specific fashion. To investigate the mechanisms by which SP suppressed BPO-specific IgE AFC responses were induced in vitro, these responses were induced by culturing spleen cells from BPO-KLH sensitized mice for 5 days with BPO-KLH with or without whole SP, amino terminal SP (SP 1-4: Arg-Lys-Pro-Lys), or carboxy terminal SP (SP 8-11: Phe-Gly-Leu-Met). In some experiments, the SP receptor antagonist (D-Pro2, D-Phe7, D-Trp9)-SP (D-SP) was included in culture. In other experiments anti-interferon monoclonal antibody (anti-IFN gamma mAb) was in culture. Whole SP and SP 8-11, but not SP 1-4, suppressed BPO-specific IgE AFC responses induced in vitro. The suppression obtained was IgE isotype-specific and dose-dependent. Inclusion of SP receptor antagonist (D-Pro2, D-Phe7, D-Trp9)-SP inhibited suppression of BPO-specific memory IgE AFC responses by SP or SP 8-11. The SP-mediated suppression of BPO-specific memory IgE responses appeared to involve interferon gamma (IFN gamma).

Regulation of hapten-specific memory IgE responses induced in vitro. Requirement for both Thy-1+ AsGM1+ and Thy-1+ AsGM1- cells and for IFN-alpha and IL-4.

The roles of Thy-1+ and AsGM1+ spleen cells and cytokines (IL-4, IL-5, IL-6, IFN-alpha, and IFN-gamma) in regulation of hapten-specific memory IgE antibody-forming cell (AFC) responses induced in vitro were examined. BALB/c mice, injected i.p. with benzylpenicilloyl-keyhole limpet hemocyanin (BPO-KLH) (10 micrograms) on days 0 and 21, were killed on day 60 or day 120. Numbers of BPO-specific IgGI, IgE, and IgA AFC in spleen were determined by enzyme-linked immunosorbent spot assay after 0 to 6 days of culture +/- BPO-KLH. BPO-specific AFC of all isotypes were detected in spleen on day 60, but not on day 120. Day 60 AFC responses did not persist in culture in that no AFC were detected by day 2 of culture +/- BPO-KLH. When either day 60 or day 120 cells were cultured for 3 days with BPO-KLH, BPO-specific AFC responses were induced, and peaked on day 5, with similar numbers of AFC of each isotype induced with day 60 and day 120 cells. On day 60, spleen contained two subsets of Thy-1+ cells: AsGM1- (approximately 32% of total cells) and AsGM1+ (approximately 4%). Depletion and reconstitution experiments established that both subsets were required for induction of BPO-specific IgE AFC responses. Cytokines could not substitute for the Thy-1(+)-depleted cells. However, when unfractionated day 60 cells were cultured with cytokines or anti-cytokine antibodies, BPO-specific IgE AFC responses induced were both IFN-alpha and IL-4 dependent; either increased or decreased by IFN-gamma, depending on its concentration, and unaffected by IL-5 or IL-6.

Control of IgE responses. 4. Isotype-specific suppression of peak BPO-specific IgE antibody-forming cell responses and of BPO-specific IgE in serum by muramyldipeptide or murabutide after administration to mice by gavage.

Muramyldipeptide (MDP) and murabutide (MB) suppressed hapten-specific IgE antibody-forming cell (AFC) responses in vivo. IgE responses were induced in BALB/c mice by intraperitoneal injection with benzylpenicilloyl-keyhole limpet hemocyanin (BPO-KLH) (10 micrograms) in aluminum hydroxide gel (Alum) on days 0, 21 and 42. On day 44, mice were fed (gavage) or injected subcutaneously with varying concentrations of MDP or MB (0.1-500 mg/kg). The mice were killed on days 45-70, and the numbers of BPO-specific IgM, IgG1, IgE, and IgA AFC in various lymphoid organs were determined in an enzyme-linked immunosorbent spot (ELISPOT) assay. In addition, levels of BPO-specific IgE in serum were determined by ELISA. Data are expressed as AFC/10(7) cells or as micrograms/ml. Feeding with MDP or MB on day 44 suppressed BPO-specific IgE AFC responses and serum levels of BPO-specific IgE within 48 h (day 46) (65-100% and approximately 50% decrease, respectively). With both molecules, the suppression was IgE isotype-specific, dose-dependent and transient. The suppression was also route-specific since it was obtained only when MDP or MB were given by gavage, and not when injected subcutaneously. These results show that peak antigen-specific IgE responses can be downregulated in vivo, in isotype-specific fashion, by a clearly defined class of molecules, MDP and MB, one of which, MB, is a candidate for clinical studies in man. The mechanism of suppression probably involves the modulation of gut-associated lymphoid tissue and mucosal immunity. The clinical implications are that pharmacologic agents of this type may be suitable for use in the therapeutic or prophylactic downregulation of IgE and, hence, in the therapy of IgE-mediated diseases in man such as allergic rhinitis, asthma, and other atopic diseases.