Circulating levels of hypoxia-inducible factor-1α and miR-210 are associated with photosensitivity in systemic lupus erythematosus patients

Background: miR-210, a key HypoxamiR, regulates the hypoxia and inflammation-linked hypoxia. Systemic lupus erythematosus (SLE), a chronic autoimmune disease, responsible for many pathological disorders, including photosensitivity. Objective: Finding the correlation between the circulating miR-210/HIF-1α levels and photosensitivity in SLE patients and other SLE-associated pathological complications, in a single-center case control study. Methods: Study population of 104 SLE Egyptian patients with photosensitivity, 32 SLE patients without photosensitivity, and 32 healthy subjects. SLE activity was assessed for all patients by SLE Disease Activity Index (SLEDAI). The clinical complications/manifestations and the hematological/serological analyses were recorded. HIF-α concentration was investigated by ELISA and miR-210 expression was analyzed by qRT-PCR. Results: The results revealed that circulating miR-210 was significantly increased in SLE/photosensitivity than SLE and controls. The additional occurrence of malar rash, oral ulcers, renal disorders or hypertension resulted in a higher expression of miR-210. SLEDAI activity status showed no effect on miR-210. Erythrocyte sedimentation rate, white blood cells, hemoglobin, platelets, the patients age and the disease duration were positively correlated with circulatory miR-210. HIF-α concentration was significantly induced in SLE/photosensitivity than SLE and controls. In SLE/photosensitivity, presence of renal disorders and hypertension resulted in highest HIF-α concentrations. A strong positive correlation was recorded between HIF-α concentration and circulatory miR-210 in SLE/photosensitivity patients (r = 0.886). Conclusion:: The dysregulation of circulating miR-210/ HIF-1α levels in SLE/photosensitivity‎ patients is controlled by the presence of additional pathological complications and supposed that hypoxia pathway might interact positively with the pathogenesis and illness progress of SLE.

Effect of dexamethasone on levels of inflammatory factors and EGF mRNA in rabbits suffering from oral ulcers

Purpose: To investigate the therapeutic effect of dexamethasone on rabbits suffering from oral ulcers, and the underlying mechanism(s) of action. Methods: A rabbit model of oral ulcer was established by applying 40 % glacial acetic acid solution to the oral buccal membranes of the animals. Three groups of rabbits were used. Changes in area of the oral ulcer were recorded after dexamethasone administration. Levels of epidermal growth factor (EGF) were assayed using reverse transcription PCR (RT-PCR), while MDA levels and expression levels of IL- 6, IL-8 and TNF-α were determined by enzyme-linked immunosorbent assay (ELISA). Local histopathological changes were examined histologically with the aid of hematoxylin and eosin (H & E) staining. Results: There were reductions in ulcer areas in group C on the 2nd, 4th and 7th days of dexamethasone administration, when compared with group B (p < 0.05). The EGF levels in the buccal mucosa of rabbits in groups B and C were significantly higher than those in group A (p < 0.05), while the highest EGF level was in group C (p < 0.05). The levels of MDA, IL-6, IL-8, and TNF-α significantly increased in groups B and C (p < 0.05). Results from H & E staining showed lower levels of inflammatory cells in group C than in group B, with visible proliferation of fibroblast cells and epithelial cells in group C after dexamethasone administration. Conclusion: Dexamethasone accelerates healing of oral ulcer by regulating EGF levels. This finding provides a new approach to the treatment of oral ulcers.

Variant Type X91+ Chronic Granulomatous Disease: Clinical and Molecular Characterization in a Chinese Cohort

Purpose: We aimed to report the clinical and immunological characteristics of variant type X91+ CGD in a Chinese cohort.Methods: The clinical manifestations and immunological phenotypes of X91+ CGD patients were collected. Dihydrorhodamine (DHR) analysis was performed to evaluate neutrophil function. Gp91phox protein expression was determined by flow cytometry-based extracellular staining with the monoclonal antibody (mAb) 7D5. Results: X91+CGD patients accounted for 8% (7/85) of all patients with GCD. The median onset age in the 7 X91+ CGD patients was 4 months. Six patients received the same BCG vaccine strain, and three had probable BCG infections. Moreover, 4 patients were highly suspected of having Mycobacterium tuberculosis infection. Recurrent infections of the lungs and soft tissues (3/7) were the most common symptoms. Two patients had noninfectious recurrent oral ulcers and received interferon gamma (IFN-γ) treatment afterward. In our cohort, the stimulation index (SI) of the 7 X91+ CGD patients ranged widely from 1.9 to 67.5, while the SI ranged from 1.2 to 35.7 in patents with X910 CGD. The level of SI between these two groups was statistically significant (P<0.05). CYBB mutations associated with X91+CGD were usually located in or near the FAD and NADPH binding domains. Three new X91+ CGD related mutations (c.1462-2 A>T, c.1243C>T and c.925G>A) were identified. Conclusions: Variant type X91+ CGD may have varied severities of clinical manifestations. Moreover, the laboratory findings of X91+ CGD could present with a moderate neutrophil stimulation index. We should deepen our understanding of the X91+ variant CGD to prevent missed diagnosis.

A survey of patients with laryngotracheal stenosis on future clinical trial design

Background/Aims Laryngotracheal stenosis is a rare but devastating proximal airway fibrosis that restricts a patient’s ability to breathe. Treatment is primarily surgical and to date, there has never been a multi-institutional, randomized, prospective, and interventional clinical trial for a medical therapy to treat laryngotracheal stenosis. Therefore, we aimed to obtain patient feedback to guide successful trial design, recruitment, retention, and for identifying potential barriers to study participation. Methods Over 1000 members of an international laryngotracheal stenosis online support community (the Living with Idiopathic Subglottic Stenosis Facebook group) were sent two questionnaires for a proposed interventional double-blinded, randomized, placebo-controlled clinical trial. Results A total of 317 and 558 participants responded to the first and second surveys, respectively. The majority of participants (77%) were willing to consider enrollment, regardless of having a 50% chance of receiving placebo versus treatment (78%). The majority (84%) of participants were willing to travel 200 miles to participate for up to six in-person visits over 50 days. Specific side effects, including anemia/thrombocytopenia (72%) or risk of infection (69.3%) had the greatest impact on clinical trial participation with other side effects (peripheral edema (53%), oral ulcers (51%), and gastrointestinal side effects (41%)) having less impact. Conclusion Patients with laryngotracheal stenosis possess nuanced insight into their disease and treatment options. As a group, they are extremely motivated for better therapies. Future laryngotracheal stenosis clinical trials should focus on providing excellent side effect -related education and utilizing feedback from online advocacy groups to optimize recruitment and retention.

Role of Triphala Kwatha Gandusha in the management of Aphthous ulcer: A review study

Mukhapaka (Stomatitis) is a common ailment seen in general practice. The Pittaja Mukhapaka (Aphthous ulcer) is fully described in Ayurveda under the term Mukha rogas. Oral ulcers are estimated to impact 4% of the global population, with aphthous ulcers being the most frequent, affecting up to 25% of the global population. Psychological stress, hormonal impacts, dietary sensitivity, and nutritional insufficiency are the primary causes of Pittaja Mukhapaka (Aphthous ulcer). It is a painful and frequently recurring inflammatory disorder of the oral mucosa that can develop as a result of several well-defined disease processes. As a result, Gandusha is described as one of the key therapies in the Ayurvedic system of medicine for both preventing and treating oral cavity illnesses. Triphala (tri means three and phala means fruits) is an Ayurvedic preparation made up of three equal parts of Indian subcontinent herbal fruits: Terminalia belerica, Phyllanthus emblica, and Terminalia chebula. Triphala includes powerful antioxidants as well as other bioactive substances such as flavonoids, saponins, anthraquinones, amino acids, fatty acids, and different carbohydrates. As a result, it promotes the maintenance and promotion of oral hygiene by exerting a cleansing activity and strengthening the defence mechanism in the oral cavity. An attempt is made in this regard to discuss the role of Triphala Kwatha Gandusha in Pittaja Mukhapaka.

Reactive infectious mucocutaneous eruptions associated with SARS-CoV-2 infection

Several dermatological manifestations are described in COVID-19. A 3-year-old boy presented with fever, painful oral ulcers with COVID-19 infection. A diagnosis of reactive infectious mucocutaneous eruptions (RIME) was made. He was worked up for the usual causes of RIME but were all negative. His severe acute respiratory syndrome corona virus-2 immunoglobulin M (SARS-CoV-2 IgM) was positive and he was managed with Intravenous hydrocortisone with which he improved dramatically. RIME might be the first/only manifestation of COVID-19 and it should be kept in mind.

Saliva and Serum Cytokine Profiles During Oral Ulceration in Behçet’s Disease

Behçet’s disease (BD) is a chronic, multi-systemic disorder of unknown aetiology typified by recurrent oral and genital mucocutaneous lesions, uveitis and vasculitis. Innate and adaptive immune system dysregulation has been implicated in pathogenesis with alterations in serum cytokine profiles. Few studies have investigated salivary cytokines in BD, despite more than 90% of BD patients first presenting with oral ulceration. The aim of this pilot study was twofold; firstly to investigate whether cytokine levels in matched serum and saliva samples show a differential profile in BD (with and without oral ulcers), recurrent aphthous stomatitis (RAS) and healthy controls (HCs), and secondly, to explore if any differential profiles in serum and/or saliva could provide a panel of cytokines with diagnostic and therapeutic potential for BD. Concentrations of 12 cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, TNF-β) were measured using the Human Th1/Th2 11-Plex FlowCytomix™ kit with IL-17A, in BD (N=20), RAS (N=6) and HCs (N=10). A differential range of cytokines was detected in serum and saliva with the majority of cytokine levels higher in saliva. The most prevalent salivary cytokines were IL-1β, IL-2, IL-8, IL-10 and TNF-α present in all samples in contrast to serum where the most prevalent cytokine detected was IL-8 (91.9%). The least abundant cytokine was IFN-γ in both saliva (43.2%) and serum (2.7%). After normalizing saliva for protein content, BD patients with oral ulcers (BD-MA) had significantly higher levels of salivary IL-1β (p=0.01), IL-8 (p=0.02), TNF-α (p=0.004) and IL-6 (p=0.01) than HCs. Notably, BD patients without oral ulcers (BD-MQ) also had significantly higher salivary IL-1β, IL-8 and TNF-α (p ≤ 0.05) than HCs. During relapsed (BD-RE) and quiet (BD-Q) systemic episodes, salivary IL-β and TNF-α were also significantly increased with IL-8 significantly higher only in BD-Q (p=0.02). BD oral ulcers signify a potential reactivation of systemic inflammation. Identifying cytokines released during asymptomatic episodes and oral ulceration might lead to targeted drug therapy to prevent recurrent oral ulcers and possible disease relapse. This is the first study to report salivary cytokine levels in BD. The detectable levels suggests cytokine profiling of BD saliva may provide an alternative, less invasive, sensitive procedure for frequent monitoring of disease activity and progression.

Behcet’s disease: a review

Behcet's disease (BD) is a complex systemic vasculitis with an etiopathogenesis that remains unclear. It has a strong geographic association as well as a genetic propensity linked to the HLA-B51 factor and interactions between genetic and environmental factors. The typical age of onset is 25 to 40 years old and it is more common in men, who also have a more severe condition. Occlusive vasculitis is the hallmark of this condition, which can affect vessels of all diameters. Oral ulcers, genital ulcers, skin lesions, pathergy reaction as well as involvement of other systems and organs such as ophthalmic, neurological and vascular lesions, among others, are used to make the diagnosis. Uncontrolled neutrophil activation, activation of the humoral and cell immune systems, toxic proteins and infectious agents such as herpes simplex and streptococci are all involved in their pathophysiology. Due to the heterogeneity and several systems affected, the treatment is individualized and focused on treating each clinical manifestation.