Standardized nailfold capillaroscopy in children with rheumatic diseases: a worldwide study.

OBJECTIVES: To standardly assess and describe nailfold videocapillaroscopy (NVC) assessment in children and adolescents with juvenile rheumatic and musculoskeletal diseases (jRMD) vs healthy controls (HCs). MATERIAL AND METHODS: In consecutive jRMD children and matched HCs from 13 centres worldwide, 16 NVC images per patient were acquired locally and read centrally per international consensus standard evaluation of the EULAR Study Group on Microcirculation in Rheumatic Diseases. A total of 95 patients with JIA, 22 with JDM, 20 with childhood-onset SLE (cSLE), 13 with juvenile SSc (jSSc), 21 with localized scleroderma (lSc), 18 with MCTD and 20 with primary RP (PRP) were included. NVC differences between juvenile subgroups and HCs were calculated through multivariable regression analysis. RESULTS: A total of 6474 images were assessed from 413 subjects (mean age 12.1 years, 70.9% female). The quantitative NVC characteristics were significantly lower or higher in the following subgroups compared with HCs: for density: lower in jSSc, JDM, MCTD, cSLE and lSc; for dilations: higher in jSSc, MCTD and JDM; for abnormal shapes: higher in JDM and MCTD; for haemorrhages: higher in jSSc, MCTD, JDM and cSLE. The qualitative NVC assessment of JIA, lSc and PRP did not differ from HCs, whereas the cSLE and jSSc, MCTD, JDM and cSLE subgroups showed more non-specific and scleroderma patterns, respectively. CONCLUSIONS: This analysis resulted from a pioneering registry of NVC in jRMD. The NVC assessment in jRMD differed significantly from HCs. Future prospective follow-up will further elucidate the role of NVC in jRMD.

Anti-endothelial cell antibodies are associated with apoptotic endothelial microparticles, endothelial sloughing and decrease in angiogenic progenitors in systemic sclerosis.

INTRODUCTION: Evidence has accumulated for the role of endothelial damage in systemic sclerosis (SSc) and the anti-endothelial cell antibodies (AECAs) might underlie vascular injury. AIM: Since endothelial microparticles (EMPs) and circulating endothelial cells (CECs) reflect endothelial damage, we aimed to investigate their possible relationship with AECAs in SSc. We examined whether AECAs could affect endothelial repair based on the number of endothelial progenitor cells (EPCs). MATERIAL AND METHODS: Forty-seven SSc patients were screened. The AECAs were identified in serum by indirect immunofluorescence. EPCs and CECs were isolated from the peripheral blood using anti-CD34-based immunomagnetic separation, whereas EMPs were analyzed in plasma. Flow cytometry was used to quantify EMPs, CECs and EPCs. RESULTS: AECAs were found in 21 (44.7%) SSc patients and were significantly associated with higher levels of total as well as apoptotic (AnnV+ and CD51+) EMPs, whereas activated (CD62E+/AnnV-) EMPs did not differ between groups. Patients with AECAs had significantly elevated total CECs as well as activated CD105+ CECs. Total endothelial progenitors did not differ between patients with or without AECAs; however AECAs was negatively associated with the population of EPCs that express VEGFR2 or Tie2 receptors. CONCLUSIONS: We found an association between AECAs and the severity of endothelial damage in SSc based on higher levels of total EMPs and CECs. In our study, AECAs were associated with apoptosis of ECs rather than their activation. We also identified a possible role of AECAs in the impairment of vascular repair in SSc as evidenced by significantly fewer angiogenic EPCs.

Acyltransferase skinny hedgehog regulates TGFß-dependent fibroblast activation in SSc.

OBJECTIVES: Systemic sclerosis (SSc) is characterised by aberrant hedgehog signalling in fibrotic tissues. The hedgehog acyltransferase (HHAT) skinny hedgehog catalyses the attachment of palmitate onto sonic hedgehog (SHH). Palmitoylation of SHH is required for multimerisation of SHH proteins, which is thought to promote long-range, endocrine hedgehog signalling. The aim of this study was to evaluate the role of HHAT in the pathogenesis of SSc. METHODS: Expression of HHAT was analysed by real-time polymerase chain reaction(RT-PCR), immunofluorescence and histomorphometry. The effects of HHAT knockdown were analysed by reporter assays, target gene studies and quantification of collagen release and myofibroblast differentiation in cultured human fibroblasts and in two mouse models. RESULTS: The expression of HHAT was upregulated in dermal fibroblasts of patients with SSc in a transforming growth factor-ß (TGFß)/SMAD-dependent manner. Knockdown of HHAT reduced TGFß-induced hedgehog signalling as well as myofibroblast differentiation and collagen release in human dermal fibroblasts. Knockdown of HHAT in the skin of mice ameliorated bleomycin-induced and topoisomerase-induced skin fibrosis. CONCLUSION: HHAT is regulated in SSc in a TGFß-dependent manner and in turn stimulates TGFß-induced long-range hedgehog signalling to promote fibroblast activation and tissue fibrosis. Targeting of HHAT might be a novel approach to more selectively interfere with the profibrotic effects of long-range hedgehog signalling.

Imbalanced serum levels of Ang1, Ang2 and VEGF in systemic sclerosis: Integrated effects on microvascular reactivity.

INTRODUCTION AND AIM: Microangiopathy is a hallmark of systemic sclerosis (SSc). It is a progressive process from an early inflammatory and proangiogenic environment to insufficient microvascular repair with loss of microvessels. The exact underlying mechanisms remain ill-defined. Aim of the study was to investigate whether imbalanced angiopoietins/VEGF serum profile should be related in SSc to the altered microvascular reactivity characterized by aberrant angiogenesis and avascularity. MATERIALS AND METHODS: Serum levels of Angiopoietin-1 (Ang1), Angiopoietin-2 (Ang2) and VEGF were measured by ELISA in 47 SSc patients and 27 healthy controls. Microvascular alterations were assessed by nailfold videocapillaroscopy (NVC). RESULTS: Serum concentrations of Ang1 were significantly lower [mean (S.D.): 21516.04 (11,441.035) pg/ml], and Ang2 significantly increased [25,89.55 (934.225) pg/ml] in SSc as compared with the control group [Ang1: 28,457.08 (10,431.905) pg/ml; Ang2: 1556.23 (481.255) pg/ml, p < 0.01, respectively], whereas VEGF did not differ significantly. The ratios of Ang1/Ang2 and Ang1/VEGF were significantly lower in SSc patients (8.346 ±â€¯4.523 and 95.17 ±â€¯75.0, respectively) than in healthy subjects (17.612 ±â€¯6.731 p < 0.000001 and 183.11 ±â€¯137.73; p = 0.004]. Formation of giant capillaries with vascular leakage and collapse was associated with significant increase in VEGF and concomitant Ang1 deficiency. Capillary loss was related to significant increase in VEGF with respect to those with preserved capillary number (395.12 ±â€¯256.27 pg/mL vs. 254.80 ±â€¯213.61 pg/mL) whereas elevated Ang2 levels induced more advanced capillary damage as indicated by the presence of the "Late" NVC pattern. CONCLUSIONS: We found that serum levels of Ang1, Ang2 and VEGF are differentially expressed in SSc and altered Ang1/Ang2 profile might underlay the aberrant angiogenesis in SSc despite increase in VEGF. For the first time we identified that significant deficiency of Ang1 might be involved in early capillary enlargement, followed by collapse and lack of stable newly-formed vessels in VEGF-enriched environment, whereas Ang2 levels seem to increase later in disease progression and advanced microvascular damage ("Late" NVC pattern).

Clinical associations of serum leptin and leptin/adiponectin ratio in systemic sclerosis.

INTRODUCTION: Leptin and adiponectin have recently received the attention of researchers as attractive biomarkers in systemic sclerosis (SSc) because of their role in the inflammatory process, vascular function and fibrosis. We hypothesized that leptin and adiponectin may be associated with disease activity and severity in patients with SSc. AIM: To compare serum leptin, adiponectin and leptin/adiponectin levels in patients with SSc and healthy controls and to evaluate their possible relationship with frequently used laboratory markers and clinical findings. MATERIAL AND METHODS: The study included 48 Caucasian female patients with SSc and 38 healthy controls. Serum concentrations of leptin and adiponectin were measured in patients and controls using commercially available ELISA Kits (Quantikine ELISA Kit R&D Systems, Minneapolis, MN, USA). The results were assessed by the Mann-Whitney U-test and Spearman's correlation test. RESULTS: Leptin and adiponectin levels correlated with body mas index in SSc patients (r = 0.495, p = 0.000398 and r = -0.306; p = 0.0342) in contrast to healthy controls (p = 0.070 and p = 0.256, respectively), and, in SSc patients only, a strong negative correlation was observed between leptin and adiponectin serum levels (r = -0.314; p = 0.0312). Diffuse form of the disease (dcSSc) was associated with significantly lower serum adiponectin levels (8638.62 ±10382.62). Active disease was associated with significantly lower leptin concentration (13700.49 ±18293.32) and there was a significant negative correlation between leptin serum level and activity index score (r = -0.342; p = 0.0185). CONCLUSIONS: The results of our study indicate that leptin levels might correlate with disease activity and subtype in SSc patients.

Visfatin and chemerin levels correspond with inflammation and might reflect the bridge between metabolism, inflammation and fibrosis in patients with systemic sclerosis.

INTRODUCTION: Adipokines are regulatory molecules which act as mediators of the inflammatory, fibrotic and metabolic processes by interacting with the immune system. AIM: We hypothesized that chemerin and visfatin by pro-inflammatory properties play a significant role in inflammation in systemic sclerosis. To address this hypothesis, we determined serum chemerin and visfatin levels in SSc patients, compared with the control group and defined the correlations with clinical and laboratory parameters in SSc patients. MATERIAL AND METHODS: The study included 48 Caucasian female patients with SSc and 38 healthy subjects of the control group. Serum concentrations of selected adipokines were measured using commercially available ELISA Kits. RESULTS: Patients with SSc had higher chemerin levels (209.38 ±55.35 ng/ml) than the control group (182.71 ±33.94 ng/ml) and the difference was statistically significant (Z = 2.14, p = 0.032). The highest chemerin levels were found in dcSSc patients (242.46 ±95.82 ng/ml). We indicated a positive correlation of chemerin and visfatin with levels of inflammatory markers: CRP (r = 0.35, p = 0.013 for chemerin; r = 0.41, p = 0.003 for visfatin) and ESR (r = 0.31, p = 0.03 for chemerin; r = 0.30, p = 0.03 for visfatin). What is more, chemerin manifested a statistically significant positive correlation with the concentration of complement component C3 (r = 0.47, p = 0.001) and C4 (r = 0.29, p = 0.049), whereas visfatin correlated with C4 levels (r = 0.32, p = 0.029). CONCLUSIONS: The results of our study indicate that chemerin and visfatin as pro-inflammatory cytokines might represent new markers corresponding with inflammation in systemic sclerosis and might reflect the bridge between metabolism, inflammation and potentially, chemerin may also link inflammation with skin and lung fibrosis.

Anti-endothelial cell antibodies do not correlate with disease activity in systemic sclerosis.

INTRODUCTION: Anti-endothelial cell antibodies (AECA) recognize endothelial cell proteins and are thought to play an important role in vascular damage observed in systemic scleroderma (SSc) and many other autoimmune diseases. In SSc, AECA were found to be more common in patients with pulmonary hypertension, digital ulcers and nailfold capillaroscopic changes. Until now, there have been no studies examining the association between AECA positivity with the activity and duration of the disease. AIM: To evaluate associations between the presence of AECA in sera of patients with SSc and internal organs involvement as well as disease activity. MATERIAL AND METHODS: Sera of 58 patients with SSc (50 with localized subtype and 8 with diffuse subtype) were examined for AECA presence using an indirect immunofluorescence technique. Several clinical and laboratory features were also evaluated as well as disease activity and disease duration. RESULTS: A significant association between positive AECA and a subtype of SSc (p = 0.021) was found, as well as between presence of digital ulcers and digital scars (p = 0.001), calcinosis (p = 0.02), acroosteolysis (p = 0.028) and a nearly significant association between AECA and lung fibrosis (p = 0.47). No association between disease duration, disease activity and AECA (p = 1.000 and 0.191, respectively) was present. CONCLUSIONS: Anti-endothelial cell antibodies are not associated with the activity of SSc. Digital ulcers, calcinosis and acroosteolysis are more common among AECA-positive patients suggesting that the presence of AECA might be an indicator of vascular complications development in SSc. Positive AECA among patients with lung fibrosis indicate their possible role in the development of lung disease. Further prospective studies including a greater number of patients are required.

The transcription factor GLI2 as a downstream mediator of transforming growth factor-ß-induced fibroblast activation in SSc.

OBJECTIVES: Hedgehog signalling plays a critical role during the pathogenesis of fibrosis in systemic sclerosis (SSc). Besides canonical hedgehog signalling with smoothened (SMO)-dependent activation of GLI transcription factors, GLI can be activated independently of classical hedgehog ligands and receptors (so-called non-canonical pathways). Here, we aimed to evaluate the role of non-canonical hedgehog signalling in SSc and to test the efficacy of direct GLI inhibitors that target simultaneously canonical and non-canonical hedgehog pathways. METHODS: The GLI inhibitor GANT-61 was used to inhibit canonical as well as non-canonical hedgehog signalling, while the SMO inhibitor vismodegib was used to selectively target canonical hedgehog signalling. Furthermore, GLI2 was selectively depleted in fibroblasts using the Cre-LoxP system. The effects of pharmacological or genetic of GLI2 on transforming growth factor-ß (TGF-ß) signalling were analysed in cultured fibroblasts, in bleomycin-induced pulmonary fibrosis and in mice with overexpression of a constitutively active TGF-ß receptor I. RESULTS: TGF-ß upregulated GLI2 in a Smad3-dependent manner and induced nuclear accumulation and DNA binding of GLI2. Fibroblast-specific knockout of GLI2 protected mice from TBRact-induced fibrosis. Combined targeting of canonical and non-canonical hedgehog signalling with direct GLI inhibitors exerted more potent antifibrotic effects than selective targeting of canonical hedgehog signalling with SMO inhibitors in experimental dermal and pulmonary fibrosis. CONCLUSIONS: Our data demonstrate that hedgehog pathways and TGF-ß signalling both converge to GLI2 and that GLI2 integrates those signalling to promote tissue fibrosis. These findings may have translational implications as non-selective inhibitors of GLI2 are in clinical use and selective molecules are currently in development.

Plasma endothelial microparticles reflect the extent of capillaroscopic alterations and correlate with the severity of skin involvement in systemic sclerosis.

INTRODUCTION AND AIM: Endothelial microparticles (EMPs) are membrane-coated vesicles shed from endothelial cells and are considered markers of the endothelial state. It has been shown that total numbers of circulating EMPs are increased in patients with systemic sclerosis (SSc), but their clinical correlations have not yet been investigated in detail. We aimed to assess possible relationships between circulating EMPs and clinical as well as laboratory features among SSc patients with special attention to possible association with alteration in microvascular morphology objectified on nailfold videocapillaroscopy and clinical signs of microvascular complications. MATERIALS AND METHODS: The study included 47 SSc patients and 27 age- and sex-matched healthy controls. EMPs were identified with flow cytometry after staining platelet-poor plasma with combinations of fluorescent cell-specific monoclonal antibodies (anti-CD31, -51, -42b, -62E and Annexin V). The following types of EMPs were evaluated: total EMPs (CD31+/CD42b-), activated EMPs (CD62E+/AnnV-,) and apoptotic EMPs (CD62E+/AnnV+ or CD51+). Clinical evaluation of patients was obtained, including nailfold videocapillaroscopy. RESULTS: All types of EMPs were significantly elevated in SSc patients as compared with healthy controls. We found significant inverse correlation between severity of skin involvement and values of total EMPs (r=-0.32; p=0.02) and their levels tended to be lower in SSc patients with digital ulcers when compared to those without ischaemic skin lesions (p=0.09). Total EMPs and activated EMPs showed correlations with the number of ramified capillaries (r=-0.40 and r=0.37, respectively, p<0.05 for both). Moreover, total EMPs inversely correlated with the severity of capillary loss (r=-0.35, p<0.05) and their levels were significantly lower in patients with late NVC pattern with respect to those with early microangiopathy (p<0.05). On the other hand, active NVC pattern was characterized by strongly elevated levels of activated EMPs when compared to an early vascular alteration (p<0.05). CONCLUSIONS: Our results suggest that quantity and phenotype of circulating EMPs might indicate on molecular vascular damage with endothelial dysfunction and to reflect progressive loss of capillaries consequencing in microvascular insufficiency in SSc patients.

Resistin: a possible biomarker of organ involvement in systemic sclerosis patients?

OBJECTIVES: Resistin has strong pro-inflammatory and profibrotic properties, which are key pathogenetic processes in systemic sclerosis. We hypothesised that resistin may be associated with organ involvement and inflammatory process in SSc patients. To address this hypothesis, the aim of this study was to define serum resistin levels in SSc patients and control group and determine the correlation between this adipokine and internal organ involvement in SSc patients. METHODS: The study enrolled 48 Caucasian female patients with SSc and 38 healthy subjects of control group. Serum concentrations of resistin were measured using commercially available ELISA Kits (Quantikine ELISA Kit R & D Systems, Minneapolis, MN, USA). RESULTS: Patients with SSc had higher resistin levels [mean (SD): 10.2, (4.87)] than the control group [7.64, (4.43)] and the difference was statistically significant (p=0.017, p<0.05). We found statistically significant association between serum resistin and ILD, arthralgia and oesophageal involvement (r=0.31, p=0.042; r=0.48, p=0.001; r=0.32, p=0.034; respectively). Moreover, the assessment of the relation between plasma concentrations of resistin and inflammatory parameters in SSc patients indicated a positive correlation between resistin and C-reactive protein levels (r=0.37; p=0.011). CONCLUSIONS: The results of our study indicate that resistin levels might correlate with organ involvement and inflammatory process in SSc patients.

Evaluation of serum concentrations of the selected cytokines in patients with localized scleroderma.

INTRODUCTION: Localized scleroderma is an autoimmune disease primarily affecting the skin. The cause of disease remains unexplained although environmental factors are implicated, which are likely to be responsible for activation of the endothelium and subsequent inflammation leading to excessive synthesis of collagen and extracellular matrix components. AIM: To determine concentrations of interleukin (IL)-27, transforming growth factor (TGF)-ß1, TGF-ß2, IL-6, and sIL-6R in patients with localized scleroderma compared to controls and to assess the relations between their levels and laboratory markers. MATERIAL AND METHODS: The study encompassed 17 females with localized scleroderma (aged 25-67). The control group consisted of 30 age-matched healthy women. The blood was sampled from the basilic vein. Serum levels of cytokines were determined using ELISA. RESULTS: The TGF-ß2 levels were found to be significantly lower in patients with localized scleroderma compared to controls. Concentrations of TGF-ß1 were decreased in scleroderma patients when compared to controls but without statistical significance. There were no significant differences in serum IL-6, sIL-6R and IL-27 levels between patients and the control group; however, we found a significant positive correlation between the level of sIL-6 and ESR among subjects with localized scleroderma. CONCLUSIONS: The findings of decreased serum levels of TGF-ß1 and TGF-ß2 in patients with localized scleroderma demonstrate a possible association of these cytokines with pathogenesis of the disease. The results suggest also that sIL-6R is likely to be involved in inflammation in patients with localized scleroderma.

Bullous pyoderma gangrenosum associated with pancytopenia of unknown origin.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown origin. Clinically it starts with a pustule, nodule or bulla that rapidly progresses and turns into a painful ulcer with raised, undermined borders. The etiopathogenesis of PG remains unknown. However it is frequently associated with systemic diseases such as inflammatory bowel disease (IBD), haematological disorders or arthritis. The latest multicentric retrospective analysis published by Ghazal et al. shows that anaemia has been observed very often in German patients suffering from PG (in 45.6% of 259) so this disorder is supposed to be a possible cofactor in the pathogenesis of PG. According to its progressive course, patients require intensive diagnostic procedures and rapid initiation of the treatment. In this article, we report a case of bullous pyoderma gangrenosum in association with pancytopenia of unknown origin, according to its diagnostic and therapeutic difficulties.

Serum Levels of Selected IL-1 Family Cytokines in Patients with Morphea.

Morphea/localized scleroderma (LoS) represents an inflammatory-sclerotic skin disease, the pathogenesis of which is not fully understood. Given the important role of IL-1 family cytokines in the development and therapy of inflammatory diseases, including systemic sclerosis, we analyzed the clinical significance of serum levels of selected IL-1 family cytokines (IL-1α, IL-1ß, IL-18, IL-33, IL-37 and IL-38) in LoS patients (n = 30) using the standardized disease assessment tools and comparison to healthy controls (n = 28). We also compared the pre- and post-treatment concentrations, i.e., before and after systemic (glucocorticosteroids and/or methotrexate) and/or topical (topical glucocorticosteroids and/or calcineurin inhibitors). Our findings did not reveal significant differences in baseline IL-1α, IL-1ß, IL-18, IL-33, IL-37 and IL-38 levels between LoS group and HCs; however, after treatment, there were marked changes in concentrations of IL-1α and IL-33 within LoS group as well as in comparison to HCs. We also found significant negative correlations between PGA-A and IL-1α concentration as well as between mLoSSI and IL-1α after treatment. Furthermore, we showed an inverse correlation of baseline IL-1ß levels with mLoSSI scores of borderline significance. We believe that IL-1α and IL-33, as well as Il-1ß, may be potential mediators and targets of interest in LoS.

Localized Blistering Eruption of the Face and Neck - A Case Study and Differential Considerations.

We describe a 36-year-old woman with erythematous lesions and well-tense blisters confined to the face and neck of two months history, without mucosal involvement and no triggering factors. A lesional skin biopsy showed a subepidermal blister. Direct immunofluorescence of peribullous skin identified linear deposits of IgG, IgA, and C3 complement along the basement membrane zone, whereas indirect immunofluorescence was negative. Using fluorescence overlay antigen mapping by laser scanning confocal microscopy, linear immunoglobulins deposits were found to be located above collagen IV and below laminin 332 (formerly named laminin 5), in a pattern typical of mucous membrane pemphigoid (formerly named cicatricial pemphigoid). Consequently, in terms of the clinical picture and confocal study, a rare variant of mucous membrane pemphigoid was established, namely Brunsting-Perry type. Combined therapy with oral prednisone and dapsone healed the lesions, leaving atrophic scars and milia. The paper also provides a review of previous reports on this item as well as a comprehensive differential diagnosis of facial blistering lesions.

Angiopoietins-1 and -2 are differentially expressed in the sera of patients with systemic sclerosis: high angiopoietin-2 levels are associated with greater severity and higher activity of the disease.

OBJECTIVES: The aim of the study was to investigate serum concentration of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in SSc patients and to correlate Ang-1 and -2 levels with clinical manifestations. METHODS: Serum levels of Ang-1 and -2 were determined by ELISA in 47 SSc patients and 27 healthy controls matched for age and sex. RESULTS: In SSc patients, Ang-1 was significantly lower [mean (s.d.): 21,666.09 (11,516.06) pg/ml], while Ang-2 was significantly increased [2739.60 (1009.25) pg/ml] when compared with the control group [Ang-1: 28607.13 (10,506.93) pg/ml; Ang-2: 1706.28 (556.28) pg/ml, P < 0.01, for both comparisons]. No correlation was observed between Ang-1 and -2 levels. Serum concentrations of Ang-2 correlated with the modified Rodnan skin score (P < 0.01, r =0.422), the European Scleroderma Study Group (EScSG) disease activity index score (P < 0.001, r =0.403), ESR (P < 0.05, r = 0.366) and CRP concentration (P < 0.05, r =0.292), and showed inverse correlation with diffusing capacity for carbon monoxide (DL(CO)) (P < 0.01, r = -0.281). Ang-2 was significantly increased in SSc patients with more advanced capillary damage, as indicated by the presence of late capillaroscopic pattern, than in those with less severe microangiopathy (active pattern), and in SSc patients with intermediate/late stage of disease than in SSc subjects with early disease. In multivariate regression analysis, Ang-2 was independently associated with the EScSG activity index [ß-coefficient (ß = 0.305, P= 0.038], ESR (ß= 0.390, P =0.006) and, inversely, with the presence of digital ulcers (ß =-0.426, P = 0.003). CONCLUSIONS: Differential expression of Ang-1/Ang-2 might contribute to the pathogenesis of SSc. Ang-2 might be a new biomarker of disease activity in SSc.

Laser Therapy for the Treatment of Morphea: A Systematic Review of Literature.

Morphea, also known as localized scleroderma (LoS), comprises a set of autoimmune sclerotic skin diseases. It is characterized by inflammation and limited thickening and induration of the skin; however, in some cases, deeper tissues might also be involved. Although morphea is not considered a life-threatening disease, the apparent cosmetic disfigurement, functional or psychosocial impairment affects multiple fields of patients' quality of life. Therapy for LoS is often unsatisfactory with numerous treatments that have only limited effectiveness or considerable side effects. Due to the advances in the application of lasers and their possible beneficial effects, the aim of this study is to review the reported usage of laser in morphea. We present a systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, Web of Science, and Google Scholar databases. We identified a total of twenty relevant studies (MEDLINE n = 10, Cinahl n = 1, Central n = 0, Scopus n = 2, Web of Science n = 5, Google Scholar n = 2) using laser therapy for LoS. Eight studies were focused on the use of PDL, six on fractional lasers (CO2 and Er:YAG), four on excimer, and two on either alexandrite or Nd:YAG.

Preliminary observations on ANGPT1 and ANGPT2 polymorphisms in systemic sclerosis: ANGPT2 rs2442598 and rs3739390 are associated with disease susceptibility and diffuse disease subtype.

INTRODUCTION: Angiopoietin-1 (Ang-1) and -2 (Ang-2) concentrations were found to be associated with systemic sclerosis (SSc). OBJECTIVES: We explored whether single nucleotide polymorphisms of Ang-1 (ANGPT1) and Ang-2 (ANGPT2) genes can predict SSc susceptibility in Polish Caucasian patients. PATIENTS AND METHODS: Genotyping by reverse transcriptase­polymerase chain reaction and Sanger sequencing was performed in 48 patients with SSc and 38 controls. RESULTS: Individuals with the CC genotype of ANGPT2 rs2442598 were 3.29-fold more likely to develop SSc (odds ratio [OR], 3.288; 95% CI, 1.212­8.915; P = 0.02) compared with those carrying the CT variant. Subgroup analysis revealed that the G allele, CG, and CG+GG genotypes of ANGPT2 rs3739390 were associated with a 9-fold higher risk to develop a diffuse form of the disease compared with the C allele or CC genotype (OR, 9.00; 95% CI, 2.102­38.519; P = 0.002 and OR, 9.00; 95% CI, 1.112­72.824; P = 0.03, respectively) and patients carrying the CG variant presented with higher serum Ang-2 levels than those carrying the CC variant (P = 0.001). On the contrary, the likelihood of a diffuse disease subtype was 8.77-fold lower for the TT+AT than for the AA genotype of ANGPT1 rs2507800 (OR, 0.114; 95% CI, 0.014­0.932; P= 0.04). The C allele of ANGPT2 rs3739390 was associated with a 4.83-fold lower risk of digital ulcers (OR, 4.833; 95% CI, 1.089­21.437; P= 0.03). CONCLUSIONS: We concluded for the first time in the literature that the ANGPT2 rs2442598 polymorphism might represent a susceptibility locus for SSc, whereas the ANGPT2 rs3739390 and ANGPT1 rs2507800 variants may affect the disease profile.

NOTCH3 T6746C and TP53 P72R Polymorphisms Are Associated with the Susceptibility to Diffuse Cutaneous Systemic Sclerosis.

Introduction. NOTCH pathway and TP53 protein are involved in the development of fibrosis and autoimmune disorders, respectively. The aim of this study was to evaluate the role of single nucleotide polymorphisms (SNPs) of NOTCH3 and TP53 genes and serum anti-TP53 antibodies with the susceptibility, clinical subset of systemic sclerosis (SSc), and clinical profile of SSc patient, particularly with lung involvement and disease activity. Objects and Methods. 124 white Polish SSc patients (101 with limited cutaneous SSc-lcSSc, and 23 with diffuse cutaneous SSc-dcSSc) and 100 healthy individuals were included in the study. Patients were assessed for the presence of autoantibodies and interstitial lung disease. Two SNPs at position 6746 of NOTCH3 and TP53 genes and serum anti-TP53 antibodies with the susceptibility, clinical subset of systemic sclerosis (SSc), and clinical profile of SSc patient, particularly with lung involvement and disease activity. RESULTS: The genotypic frequencies of the NOTCH3 and p=0.03; χ 2 = 4.63). There was no significant difference between SSc patients and the control population in allele frequencies of both SNPs. The CT + CC genotypes of NOTCH3 and p=0.03; p=0.03; p=0.03; TP53 genes and serum anti-TP53 antibodies with the susceptibility, clinical subset of systemic sclerosis (SSc), and clinical profile of SSc patient, particularly with lung involvement and disease activity. p=0.03. CONCLUSION: The CT + CC genotypes of NOTCH3 gene and PR + RR genotypes of the TP53 gene increased the risk of dcSSc development. Moreover, genotypes of CT + CC were associated with the active form of SSc suggesting the role of the NOTCH pathway in the pathogenesis of this disease.NOTCH3 and TP53 genes and serum anti-TP53 antibodies with the susceptibility, clinical subset of systemic sclerosis (SSc), and clinical profile of SSc patient, particularly with lung involvement and disease activity.

Atherosclerotic risk among children taking antiepileptic drugs.

Epilepsy is a common chronic neurological disorder that requires long-term or sometimes lifetime therapy. Recent evidence indicates that prolonged use of antiepileptic drugs (AEDs) might modify some vascular risk factors; however, the influence of AED therapy on the development of atherosclerosis has been the subject of controversy. Some epidemiological studies have reported a higher prevalence of ischemic vascular disease among epileptic patients on AEDs, while in other studies the mortality due to atherosclerosis-related cardiovascular disease in treated epileptics has been observed to be lower than in the general population. The etiology of atherosclerosis-related vascular diseases in epileptic patients has not been fully clarified. Since atherosclerotic vascular alterations may start early in life, this review focuses on major atherogenic risk factors among epileptic children, including altered metabolism of homocysteine, disordered lipid profiles, and increased lipoprotein (a) serum levels, as well as thyroid hormone deficiency with special concern for clinical implications.