Genetic analysis of seven patients with inherited ichthyosis and Nagashima­type palmoplantar keratoderma.

Inherited ichthyosis comprises a series of heterogeneous dermal conditions; it mainly manifests as widespread hyperkeratosis, xerosis and scaling of the skin. At times, overlapping symptoms require differential diagnosis between ichthyosis and several other similar disorders. The present study reports seven patients with confirmed or suspected to be associated with ichthyosis by conducting a thorough clinical and genetic investigation. Genetic testing was conducted using whole­exome sequencing, with Sanger sequencing as the validation method. The MEGA7 program was used to analyze the conservation of amino acid residues affected by the detected missense variants. The enrolled patients exhibited ichthyosis­like but distinct clinical manifestations. Genetic analysis identified diagnostic variations in the FLG, STS, KRT10 and SERPINB7 genes and clarified the carrying status of each variant in the respective family members. The two residues affected by the detected missense variants remained conserved across multiple species. Of note, the two variants, namely STS: c.452C>T(p.P151L) and c.647_650del(p.L216fs) are novel. In conclusion, a clear genetic differential diagnosis was made for the enrolled ichthyosis­associated patients; the study findings also extended the mutation spectrum of ichthyosis and provided solid evidence for the counseling of the affected families.

Role of co­inhibitory molecules in the treatment of psoriasis (Review).

Psoriasis is a common chronic inflammatory skin disease characterized by abnormal activation and infiltration of T-cells and excessive proliferation of keratinocytes (KCs). Its pathogenesis is complex and frequently accompanied by the imbalance of T-cell subpopulations, contributing to its development and further exacerbation. Therefore, the immune system, especially T-cells, is mainly involved in the pathogenesis of psoriasis. While T-cell activation not only requires the first recognition of T-cell receptor and major histocompatibility complex peptide, co-stimulatory and co-inhibitory pathways are reported to promote or dampen T-cell responses through a variety of mechanisms. In recent years, immuno-related agents have been applied in the treatment of numerous clinical diseases, including psoriasis, and are starting to show promising and potential therapy prospects in autoimmune skin diseases. The present review outlined the role of co-inhibitory molecules in the pathogenesis of psoriasis and their application in the treatment of psoriasis.

Efficacy and safety of combined microneedling therapy for androgenic alopecia: A systematic review and meta-analysis of randomized clinical trials.

OBJECTIVE: To provide dermatologists with more clinical experience in treating androgenetic alopecia, we evaluated the effect and safety of combined microneedling therapy for androgenetic alopecia. METHODS: Studies on combined microneedling for hair loss were comprehensively searched by us in PubMed, Excerpta Medica Database, and the Cochrane Library Database. The literature search spanned the period from 2012 to 2022. Inclusion and exclusion criteria were developed, and the literature was screened according to this criteria. The Cochrane Risk of Bias Tool was used to assess the quality of the studies. The researcher applied Revman 5.3 and Stata 15.1 software to analyze the data after extracting information from the data. RESULTS: Finally, 13 RCTs involving 696 AGA patients were included to compare the clinical effectiveness and adverse events of combined MN therapy with single MN therapy or single drug therapy for AGA. The results of meta-analysis showed as follows: (1) Hair density and diameter changes: The combined MN group was significantly better than any single treatment group, and the differences were statistically significant (MD = 13.36, 95% CI = [8.55, 18.16], Z = 5.45, p < 0.00001; MD = 18.11, 95% CI = [13.70, 22.52], Z = 8.04, p < 0.00001; MD = 13.36, 95% CI = [8.55, 18.16], Z = 5.45, p < 0.00001; MD = 2.50, 95% CI = [0.99, 4.02], Z = 3.23, p = 0.001); (2) the evaluation of satisfaction for efficacy: The doctor satisfaction rating of the combined MN group was significantly higher than that of any single treatment group, with statistical difference (RR = 2.03, 95% CI = [1.62, 2.53], Z = 6.24, p < 0.00001). The difference between the two groups regarding patients satisfaction was not significant (RR = 3.44, 95% CI = [0.67, 17.59], Z = 1.49, p = 0.14). (3) Safety: There was no statistical difference in the incidence of adverse reactions between combination therapy and monotherapy (RR = 0.83, 95% CI = [0.62, 1.12], Z = 1.22, p = 0.22). CONCLUSION: The combined MN group showed statistically significant improvement in hair density and diameter, and good safety compared with monotherapy.

Disseminated Herpes Zoster with Decreased CD4 Counts in a HIV-Infected Patient.

Herpes zoster is typically a blister rash involving a single skin group, caused by the reactivation of primary varicella zoster virus infection. Disseminated herpes zoster refers to the presence of more than 20 small blisters outside the primary or adjacent skin, which is rare and usually occurs in individuals with weakened immune function. This case described a patient diagnosed with disseminated herpes zoster, with a decrease in CD4 count (379 cells/mm3) and certain skin lesions. He was subsequently screened positive for HIV. Also, we summarized other studies on the CD4 value of HIV patients with herpes zoster. Overall, for herpes zoster patients with decreased CD4 levels and certain skin manifestations, such as diffuse, ulcerative, or pustular lesions, clinicians should be aware of HIV infection.

Dermatosis Neglecta Based on Exanthematous Drug Eruption Following Head Trauma: A Case Report and Literature Review.

Dermatosis neglecta (DN) is a rare psychogenic dermatosis. To our knowledge, this is the first reported case of DN based on exanthematous drug eruption. We report a 68-year-old Chinese male patient who presented with thick, yellowish-brown crusting on his face and scalp and scaly skin for 6 days. Dermoscopy revealed diffusely distributed yellow-green serescrust-like plaques with different sizes and uneven thickness on a red background, and some demonstrated dot or globular hemorrhages. We considered DN and exanthematous drug eruptions based on the combination of the clinical medication and the history before the rash.

A Case of Gangrenous Herpes Zoster Complicated with Candida albicans Infection.

Background: Herpes zoster is a disease caused by varicella-zoster virus infection, which is characterized by dense clusters of vesicles distributed along unilateral bands of nerves and accompanied by neuralgia. Although the disease is self-limited, some patients may develop neurological, ocular, skin, or visceral complications. Case Presentation: We report a 65-year-old Chinese man with ulceration secondary to cutaneous blister rupture on the left lumbar abdomen, who was diagnosed with herpes zoster and did not respond to conventional treatment. Dermatological examination showed diffuse dark erythema with clear boundaries on his left waist and abdomen. Deep ulcers of different sizes were densely distributed with steep edges and relatively dry base, while yellow secretions and black scabs could be seen. Fungal microscopy showed a few pseudohyphae and clusters of spores. Meanwhile, the fungal culture of the secretions showed Candida albicans growth. Skin biopsy of the affected skin from the ulcer of the left abdomen revealed epidermal absence and clusters of spores in the superficial dermis. PAS staining was positive. The patient was diagnosed with gangrenous herpes zoster complicated with Candida albicans infection. After antifungal treatment based on the results of drug sensitivity, the patient's condition was improved. Conclusion: This case reveals the co-existence of herpes zoster and Candida albicans infection, expands our understanding of overlapping diseases, and provides value for clinical diagnosis and treatment.

Acrodermatitis Continua of Hallopeau Successfully Treated with Ustekinumab: A Case Report and Literature Review.

Acrodermatitis continua of Hallopeau (ACH) is a rare variant of pustular psoriasis that presents as a sterile pustular eruption of the periungual and subungual regions. It affects the skin and nail bed and can lead to distal phalangeal destruction as the disease progresses. ACH is an incurable disease that requires long-term maintenance therapy to prevent any complications. Because ACH is a variant of pustular psoriasis, it is commonly treated with anti-psoriatic therapies. Unfortunately, it is resistant to many available anti-psoriatic therapies, and there are no clinical guidelines for it; the treatment is therefore highly challenging. Current treatment strategies are mostly based on a few case reports and case series. In this study, we present a case of ACH in a 24-year-old man with a long history of severe skin lesions and overt onychodystrophy, successfully treated with Ustekinumab. In this patient, we observed rapid improvement in skin lesions and symptoms. Ustekinumab can considerably improve other symptoms besides plaque psoriasis. The treatment and excellent outcomes of Ustekinumab may provide clinical benefits to more patients and serve as a reference for other dermatologists.

Efficacy and safety of upadacitinib for the treatment of moderate-to-severe atopic dermatitis: a meta-analysis of randomized clinical trials.

Introduction: Recent studies have confirmed the possibility of using upadacitinib for treating atopic dermatitis (AD). However, there is no meta-analysis to summarize and quantify the efficacy and safety of the drug, especially for adolescents with AD. Aim: To evaluate the overall efficacy and safety of upadacitinib in adults and adolescents with AD. Material and methods: We developed this systematic review and meta-analysis according to PRISMA guidelines. Risk-of-bias assessment tool, RoB2 (revised version 2019) was used for quality assessment. Results: Four RCTs were enrolled in the analysis, 3 of which on both adults and adolescents, while the other on adults only. For either adults or adolescents, the group treated with upadacitinib all had better performance than controls: EASI-75 (adults): RR = 4.68, 95% CI: 4.09, 5.35; NRS4 (adults): RR = 4.07, 95% CI: 3.15, 5.25; EASI-75 (adolescents): RR = 4.16, 95% CI: 2.70, 6.42; NRS4 (adolescents): RR = 4.52, 95% CI: 2.49, 8.21. Furthermore, upadacitinib 30 mg was more effective than 15 mg. For serious AEs, upper respiratory tract infection and headache, there was no significant difference between the upadacitinib group and controls. However, the treatment of upadacitinib may increase the risk of nasopharyngitis, increase blood creatine phosphokinase and cause acne. Conclusions: Upadacitinib seems to be a promising drug for AD. More long-term and larger-sized randomized clinical trials are required to further assess the safety and efficacy of upadacitinib for AD.

Diverse clinical and genetic characteristics of six cases of inherited epidermolysis bullosa.

Inherited epidermolysis bullosa (IEB) represents a group of rare genetic dermatoses comprising various phenotypes ranging from severe cutaneous and extracutaneous involvement to mild cutaneous fragility. Pathogenic variants have been identified in at least 20 genes responsible for IEB. In the present study, six cases of epidermolysis bullosa were recruited and subjected to a combination of clinical and genetic analysis. The family history of each case was surveyed. Whole exome sequencing was performed to identify the causative variation. The six patients showed typical EB symptoms. In all cases, WES detected the diagnostic variations of the COL7A1 or DST gene. A total of 10 variants were identified and verified. The findings of the present study further expanded the mutation spectrum of IEB, provided evidence for genetic counseling to the affected families, as well as highlighted the complexity of the pathogenesis of IEB.

Microneedling combined with compound betamethasone in treatment of severe alopecia areata: A case report.

Alopecia areata (AA) is a common inflammatory, non-cicatricial hair loss. At present, it is considered that its pathogenesis is an autoimmune disease specific to hair follicle organs mediated by T cells under the combined action of genetic and environmental factors. Treatment is challenging for children with severe AA who are resistant or intolerant to conventional treatment.Here, we treated a 3-year-old child with severe AA with microneedling combined with compound betamethasone. After 6 months of treatment, the patient's condition was significantly improved, and most of the primary hair loss areas had hair regeneration.

Efficacy and safety of baricitinib for the treatment of moderate-to-severe atopic dermatitis: A systematic review and meta-analysis of randomized clinical trials.

Atopic dermatitis (AD) is one of the most prevalent inflammatory skin diseases. Janus kinase (JAK) inhibitor baricitinib is a promising treatment for AD as shown in recent clinical trials. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) reporting the efficacy and safety of baricitinib. Data analysis was carried out using Cochrane Collaboration Review Manager 5.4 software and performed as risk ratios (RR) with 95% confidence intervals. Six RCTs involving a total of 2595 patients were included in the review. The meta-analysis revealed that patients in the baricitinib group had significantly higher rates achieving EASI75, EASI90, IGA-Response, SCORAD75, and Itch NRS improvement. Pooled analysis also showed no significant differences in treatment of emergent adverse events (TEAEs) between baricitinib and placebo groups. In conclusion, our meta-analysis showed that baricitinib has promising efficacy for moderate-to-severe AD with favourable safety files.

Crosstalk Between Polygonatum kingianum, the miRNA, and Gut Microbiota in the Regulation of Lipid Metabolism.

Objectives: Polygonatum kingianum is a medicinal herb used in various traditional Chinese medicine formulations. The polysaccharide fraction of P. kingianum can reduce insulin resistance and restore the gut microbiota in a rat model of aberrant lipid metabolism by down regulating miR-122. The aim of this study was to further elucidate the effect of P. kingianum on lipid metabolism, and the roles of specific miRNAs and the gut microbiota. Key findings: P. kingianum administration significantly altered the abundance of 29 gut microbes and 27 differentially expressed miRNAs (DEMs). Several aberrantly expressed miRNAs closely related to lipid metabolism were identified, of which some were associated with specific gut microbiota. MiR-484 in particular was identified as the core factor involved in the therapeutic effects of P. kingianum. We hypothesize that the miR-484-Bacteroides/Roseburia axis acts as an important bridge hub that connects the entire miRNA-gut microbiota network. In addition, we observed that Parabacteroides and Bacillus correlated significantly with several miRNAs, including miR-484, miR-122-5p, miR-184 and miR-378b. Summary: P. kingianum alleviates lipid metabolism disorder by targeting the network of key miRNAs and the gut microbiota.

Pharmacological and metagenomics evidence of polysaccharide from Polygonum multiflorum in the alleviation of insulin resistance.

Total polysaccharide from Polygonum multiflorum (PS) and 2,3,5,4'-tetrahydroxy-stilbene-2-O-ß-D-glucoside (TSG) could relieve high-fat and high-sugar diet (HF-HSD) induced rats' insulin resistance (IR) by gut microbiota and host regulation. We found that PS and TSG significantly reversed the increase of fasting blood glucose and the decrease of glucose tolerance in HF-HSD induced IR rats. PS and TSG effectively reversed the imbalance of Firmicutes/Bacteroides caused by an HF-HSD, and significantly reduced the relative abundance of Proteobacteria. It also affected the functional genes of gut microbiota and regulated short-chain fatty acids (SCFAs) and its downstream signal protein molecules. Together, these results indicated that PS and TSG alleviated HF-HSD induced IR by promoting gut microbiota and host function. Thus, PS and TSG may be promising lead substances for developing IR inhibitors that could regulate gut microbiota and its molecular messenger SCFAs to remedy IR.

Water extract from processed Polygonum multiflorum modulate gut microbiota and glucose metabolism on insulin resistant rats.

BACKGROUND: The incidence of insulin resistance (IR) has rapidly increased worldwide over the last 20 years, no perfect solution has yet been identified. Finding new therapeutic drugs will help improve this situation. As a traditional Chinese medicine, PPM (processed Polygonum multiflorum) has widely been used in the clinic. Recently, other clinical functions of PPM have been widely analyzed. RESULTS: Administration of the water extract from PPM decreased the level of FBG, TC, and TG, and increased the level of FGC, thereby reducing the IR index and improving IR. Furthermore, Western blot analysis revealed that PPM significantly increased GPR43 and AMPK expression when compared with the MOD group, and GPR43, AMPK were known as glucose metabolism-related proteins. In addition, treatment with PPM can restore the balance of gut microbiota by adjusting the relative abundance of bacteria both at the phylum and genus level, and these changes have been reported to be related to IR. METHODS: Sprague Dawley (SD) rats were fed a high-fat diet and were gavaged daily with either normal saline solution or PPM for 12 weeks. Major biochemical indexes, such as fasting blood glucose (FBG), fasting glucagon (FGC), total cholesterol (TC), and triglyceride (TG) were measured. Then the protein expression of adenosine 5'-monophosphate -activated protein kinase (AMPK) and G protein-coupled receptor 43 (GPR43) was evaluated by using Western blot analysis. Moreover, the composition of gut microbiota was assessed by analyzing 16S rRNA sequences. CONCLUSIONS: Our findings showed that PPM reversed the increasing of FBG and the decreasing of IRI, PPM accelerated the expression of glucose metabolism-related proteins and regulated the intestinal microecological balance. Therefore, we hold the opinion that PPM may be an effective option for treating IR.

Polysaccharides from Polygonatum kingianum improve glucose and lipid metabolism in rats fed a high fat diet.

OBJECTIVE: Polygonatum kingianum is a traditional Chinese medicine commonly used to treat diabetes and hyperlipidemia. Polysaccharides from Polygonatum kingianum could regulate glucose and lipid metabolism in high-fat diet (HFD) rats. METHODS: The gel permeation chromatography (GPC), liquid chromatography (HPLC) and chemical analysis were used to determine the molecular weight, monosaccharide composition, protein, polysaccharide and uronic acid content of the polysaccharide from Polygonatum kingianum, respectively. Total (PS) and high molecular weight (PSF) polysaccharides (> 100 KDa) were isolated and treated HFD rats for a 14-week period. TC, TG contents in blood samples were measured every two weeks, and HDL-C, LDL-C was measured at 12 and 14 weeks evaluating of blood lipids regulation activity of polysaccharide. The stool samples were used for 16S rDNA V4 highly variable region measurement method to regulate the role of polysaccharide in the intestinal microflora. The content of short chain fatty acid (SCFAs) in faeces was determined by gas chromatography (GC) to investigate the effect of polysaccharides on the content of SCFAs in the intestinal tract of rats. The expression of tight junction protein ZO-1 and occludin of intestinal tissue, and detection of the key protein expression in the LPS-TLR4/NFκB signaling pathway were detected by Western blot technique. RESULTS: We found that PS and PSF improved both diabetic symptoms and lipid metabolism. PS and PSF also modulated the gut microbiota composition, abundance and diversity of HFD rats, increased the relative abundance of short chain fatty acid (SCFA) producing bacteria and increased SCFA production, reduced intestinal permeability, relieved gastrointestinal inflammation, and improved lipid metabolism. CONCLUSION: Polygonatum kingianum polysaccharides regulated the abundance and diversity of the intestinal microbial community through increasing the relative abundance of SCFA-producing bacteria. This promotes recovery of the intestinal permeability barrier, inhibits LPS entry into the circulation, alleviates inflammation, and prevents glucose and lipid metabolic disorders.

Mitochondrial dysfunction in high-fat diet-induced nonalcoholic fatty liver disease: The alleviating effect and its mechanism of Polygonatum kingianum.

BACKGROUND: Mitochondrial dysfunction is an important mechanism of non-alcoholic fatty liver disease (NAFLD). Developing mitochondrial regulators/nutrients from natural products to remedy mitochondrial dysfunction represent attractive strategies for NAFLD therapy. In China, Polygonatum kingianum (PK) has been used as a herb and food nutrient for centuries. So far, studies in which the effects of PK on NAFLD are evaluated are lacking. Our study aims at identifying the effects and mechanism of action of PK on NAFLD based on mitochondrial regulation. METHODS: A NAFLD rat model was induced by a high-fat diet (HFD) and rats were intragastrically given PK (1, 2 and 4 g/kg) for 14 weeks. Changes in body weight, food intake, histological parameters, organ indexes, biochemical parameters and mitochondrial indicators involved in oxidative stress, energy metabolism, fatty acid metabolism, and apoptosis were investigated. RESULTS: PK significantly inhibited the HFD-induced increase of alanine transaminase, aspartate transaminase, total cholesterol (TC), and low density lipoprotein cholesterol in serum, and TC and triglyceride in the liver. In addition, PK reduced high density lipoprotein cholesterol and liver enlargement without affecting food intake. PK also remarkably inhibited the HFD-induced increase of malondialdehyde and the reduction of superoxide dismutase, glutathione peroxidase, ATP synthase, and complex I and II, in mitochondria. Moreover, mRNA expression of carnitine palmitoyl transferase-1 and uncoupling protein-2 was significantly up-regulated and down-regulated after PK treatment, respectively. Finally, PK notably inhibited the HFD-induced increase of caspase 9, caspase 3 and Bax expression in hepatocytes, and the decrease of expression of Bcl-2 in hepatocytes and cytchrome c in mitochondria. CONCLUSION: PK alleviated HFD-induced NAFLD by promoting mitochondrial functions. Thus, PK may be useful mitochondrial regulators/nutrients to remedy mitochondrial dysfunction and alleviate NAFLD.

Efficiently Capturing Mitochondria-Targeted Constituents with Hepatoprotective Activity from Medicinal Herbs.

Targeting mitochondria as a hepatic-protective strategy has gained attention, because of their important roles in energy production, adjustment of apoptosis, and generation of reactive oxygen species. To promote the discovery of natural mitochondria-targeted hepatic-protectants, we established a hepatocellular mitochondria-based capturing method by coupling affinity ultrafiltration with liquid chromatography/mass spectrometry (LC/MS), which is suitable for identifying mitochondrial ligands from medicinal herbs (MHs). After evaluating the feasibility of the method, it was applied for capturing mitochondria-targeting constituents from Peucedani Radix extract. A total of 10 active compounds were identified by LC/MS, all of which were newly identified mitochondrial ligands. The mitochondria-remedying activity of 4 of the 10 hits was confirmed by pharmacological tests in vitro. Additionally, the hepatic-protective abilities of 4 hits were verified in both carbon tetrachloride-damaged liver L02 cells and mice. These results indicated that the method could be used for identifying hepatic mitochondria-targeting constituents in MHs, which might be beneficial for hepatic-protective development.

Identification of Mitochondrial Ligands with Hepatoprotective Activity from Notopterygii Rhizoma et Radix Using Affinity Ultrafiltration/Liquid Chromatography/Mass Spectrometry.

In recent years, the incidence of diseases associated with hepatic injury has increased in prevalence. Targeting the mitochondria to protect liver function has gained momentum due to their central role in energy production, apoptotic cell death, oxidative stress, calcium homeostasis, and lipid metabolism. In this study, we employed a hepatic mitochondria-based centrifugal ultrafiltration/liquid chromatography/mass spectrometry method (CM-HMC) to identify hepatic mitochondria ligands from medicinal herbs (MHs) including Notopterygii Rhizoma et Radix (NRR) that possess hepatic-protective effects. A total of 4 newly identified mitochondrial ligands were successfully identified by CM-HMC. The mitochondria-regulating activities of 3 of the 4 hits were confirmed using isolated mitochondria. The hepatic-protective effects of one of these hits were validated in carbon tetrachloride-damaged human liver L02 cell models. We have thus identified new natural hepatic-protectants that enhance our understanding of the hepatic-protective mechanisms of MHs. CM-HMC was proven to efficiently screen for mitochondrial ligands from MHs.

Integrated metabolomic profiling for analysis of antilipidemic effects of Polygonatum kingianum extract on dyslipidemia in rats.

AIM: To identify the effects and mechanism of action of Polygonatum kingianum (P. kingianum) on dyslipidemia in rats using an integrated untargeted metabolomic method. METHODS: A rat model of dyslipidemia was induced with a high-fat diet (HFD) and rats were given P. kingianum [4 g/(kg•d)] intragastrically for 14 wk. Changes in serum and hepatic lipid parameters were evaluated. Metabolites in serum, urine and liver samples were profiled using ultra-high performance liquid chromatography/mass spectrometry followed by multivariate statistical analysis to identify potential biomarkers and metabolic pathways. RESULTS: P. kingianum significantly inhibited the HFD-induced increase in total cholesterol and triglyceride in the liver and serum. P. kingianum also significantly regulated metabolites in the analyzed samples toward normal status. Nineteen, twenty-four and thirty-eight potential biomarkers were identified in serum, urine and liver samples, respectively. These biomarkers involved biosynthesis of phenylalanine, tyrosine, tryptophan, valine, leucine and isoleucine, along with metabolism of tryptophan, tyrosine, phenylalanine, starch, sucrose, glycerophospholipid, arachidonic acid, linoleic acid, nicotinate, nicotinamide and sphingolipid. CONCLUSION: P. kingianum alleviates HFD-induced dyslipidemia by regulating many endogenous metabolites in serum, urine and liver samples. Collectively, our findings suggest that P. kingianum may be a promising lipid regulator to treat dyslipidemia and associated diseases.