Immunohistochemistry for histone h3 lysine 9 methyltransferase and demethylase proteins in human melanomas.

Methylation and demethylation of histone H3 lysine 9 (H3K9) play a role in the transcriptional regulation of several cancer-related genes and are closely associated with malignant tumor behavior. A novel study has recently demonstrated that SETDB1, a member of the H3K9 methyltransferases, accelerates tumor formation significantly in a zebrafish melanoma model. However, the expression of H3K9 methyltransferases including SETDB1 and demethylases has not been systematically examined in samples of human melanoma. Here, we used immunohistochemistry to examine the expression of the H3K9 methyltransferases, EHMT2 and SETDB1, and a H3K9 demethylase, LSD1, in 67 patients with melanoma. Overexpression of EHMT2, SETDB1, and LSD1 was observed in 14 (21%), 38 (57%), and 53 (79%) of the 67 patients, respectively. A significant relationship was observed between overexpression of EHMT2 or SETDB1 and aggressive tumor behavior such as lymph node metastasis and/or distant metastasis (P < 0.05), whereas no significant relationship was evident for LSD1 immunoreactivity. Univariate log-rank tests demonstrated that patients with melanoma overexpressing EHMT2 had a poorer outcome (P < 0.001), whereas overexpression of SETDB1 or LSD1 had no prognostic impact. These results suggest that overexpression of EHMT2 might be a prognostic marker in patients with melanoma.

BCL2 and BCLxL are key determinants of resistance to antitubulin chemotherapeutics in melanoma cells.

Malignant melanoma is refractory to various chemotherapeutics including antitubulin agents such as paclitaxel. Previous studies have suggested a link between ßIII-tubulin overexpression and paclitaxel resistance through alterations in the properties of the mitotic spindle. We found that paclitaxel treatment induced temporary mitotic arrest in 7 melanoma cell lines irrespective of the ßIII-tubulin level, suggesting that ßIII-tubulin had no significant influence on spindle properties. On the other hand, the amount of BCL2, an anti-apoptotic protein, was well correlated with paclitaxel resistance. Treatment of the paclitaxel-resistant cell lines with ABT-737, an inhibitor of BCL2 and BCLxL, or simultaneous knock-down of BCL2 and BCLxL dramatically increased the cells' sensitivity, while knock-down of MCL1, another member of the BCL2 family, had only a minimal effect. Our results suggest that the paclitaxel sensitivity of melanoma cells is attributable to apoptosis susceptibility rather than a change in spindle properties and that BCL2 and BCLxL play a pivotal role in the former.

Gypsy moth-induced dermatitis: a hospital review and community survey.

Lymantria dispar (gypsy moth [GM]) is found in most temperate forests. Although GM caterpillars are known to cause outbreaks of dermatitis, there have been few clinical/epidemiological studies of this problem. Here, we investigated GM caterpillar-induced health problems in a heavily infested area. We reviewed the records of 229 GM caterpillar-induced dermatitis patients treated at Kuzumaki Hospital and conducted a questionnaire survey covering all 2,891 households (7,770 residents) in Kuzumaki town. Affected areas were located primarily on the neck and arms. 180 patients (79%) did not notice direct contact with GM caterpillars on their affected areas. There were no significant differences in demographics, history, and symptoms between the group of patients with direct contact and those without direct contact. In the questionnaire survey, of the 4,871 people who responded (63%), 2039 people (42%) reported having dermatitis. When the data were adjusted for age, gender was not associated with dermatitis; however, the age groups 70-79 years and ≥80 years showed lower incidences of dermatitis. Those experiencing similar dermatitis the previous year had a significantly higher occurrence of dermatitis: odds ratio (OR)=42.4, 95% confidence interval (CI): 33.5-53.6. Thus, when GM infestation occurs, physicians should expect an outbreak of dermatitis.

Improvement of pustulosis palmaris et plantaris by periodontal infection control in a patient with chronic periodontitis.

BACKGROUND: Pustulosis palmaris et plantaris (PPP) is a chronic, inflammatory, autoimmune-type disease characterized by sterile pustules of skin. The skin inflammation is influenced by several factors such as drugs, sunlight, metabolic and psychogenic factors as well as metal allergy. Here, we report a rare case that intensive periodontal treatment might have contributed to the improvement of skin inflammation. RESULTS: Skin inflammation regressed 1 month after intensive periodontal treatment. Both CD4/CD8 ratio and % of B cells in the blood sample were slightly decreased corresponding to the improvement of periodontal inflammation. CONCLUSIONS: Infection control of periodontal lesions might be one of attractive therapeutic targets in management of PPP.

Immunohistochemical study of HER2 and TUBB3 proteins in extramammary Paget disease.

Metastatic extramammary Paget disease (EMPD) is a potentially fatal malignancy for which effective chemotherapy and good biomarkers are desirable for management. We investigated the status of human epidermal growth factor receptor (HER2) and neuronal ß-tubulin isotype (class III ß-tubulin; TUBB3), whose overexpression is a factor involved in resistance of tumor cells to taxane derivatives) in 32 patients with EMPD. HER2 status was evaluated by immunohistochemistry followed by fluorescence in situ hybridization, and TUBB3 status was evaluated by immunohistochemistry. On the basis of the US Food and Drug Administration-approved criteria, 20 (63%) of the 32 EMPD tumors were found to overexpress HER2. Positive immunoreactivity for TUBB3 was observed in 7 (22%) of the 32 patients. Although some clinicopathologic variables (nodule formation, depth of tumor cells, presence of lymph node metastasis, and serum carcinoembryonic antigen level) were significantly associated with disease outcome (P < 0.05), HER2 gain or aberrant TUBB3 expression showed no significant correlation. However, the higher incidence of HER2 gain and the relatively lower incidence of aberrant TUBB3 expression suggested that HER2-targeted immunotherapy combined with taxane derivatives is warranted for metastatic EMPD, and that HER2 and TUBB3 status might be a good biomarker for determining the most appropriate therapeutic modality.

[Skin metastasis].

Clinical and histopathological findings of skin metastasis show much variation. When skin metastatic carcinoma is diagnosed by histopathologic evaluation of the involved skin, the treatment must be started as soon as possible after immediate identification of the primary internal organ and the stage of the disease. Furthermore, one must investigate and infer the type of primary tumor from the previous history of internal malignancy, immunohistochemical findings and/or the results of some imaging. When a primary organ is confirmed, consultation with the department specializing in primary tumors is required for close inspection and treatment. When the primary origin is unidentified, detailed discussion is required about the diagnosis and therapeutic examination among the specialized departments including dermatology.

Six cases of perforating pilomatricoma: Anetodermic changes with expression of matrix metalloproteinases.

Perforating pilomatricoma (PP) is a rare clinical variant of pilomatricoma presenting as a crusted or ulcerated nodule. Previous reports have suggested that the tumor cells perforate the epidermis through a process of transepithelial elimination. Here, we report six cases of PP and examine the mechanism of transepithelial elimination in PP. Histologically, the dermis above or around the tumor nest exhibited edema, dilated vascular spaces, sparse collagen bundles and absence of elastic fibers, suggesting anetodermic changes in all cases. Immunohistochemistry demonstrated many CD68-positive macrophages around the tumor nests. Matrix metallopeptidase (MMP)-9 and MMP-12 were expressed in the inflammatory cells and tumor cells, and were also present in the epidermis and fibroblasts in all cases. We speculate that in PP anetodermic change caused by MMP and elastases including MMP-9 and MMP-12 may precede elimination of the tumor.

Lichen amyloidosis induced on the upper back by long-term friction with a nylon towel.

Primary localized cutaneous amyloidosis can take several clinical forms. In Asia, macular amyloidosis caused by prolonged friction from a rough nylon towel or brush is common, and macular amyloidosis and lichen amyloidosis occasionally occur together, as so-called biphasic amyloidosis. We report herein the case of an 83-year-old Japanese man with lichen amyloidosis caused by prolonged nylon towel friction. This patient presented with unique symmetrical papular lesions on the upper back and shoulders. Lesions comprised slightly shiny, brownish, fine uniform papules approximately 0.5 mm in diameter, showing a partially linear, annular or rippled arrangement. Although this case was caused by prolonged nylon towel friction, no coexisting macular lesions could be found. To the best of our knowledge, this represents the first case of lichen amyloidosis induced by nylon towel friction in the absence of the macular amyloidosis that is usually observed in such cases. We instructed the patient to stop the habit of nylon towel rubbing and prescribed a topical steroid ointment and cepharanthine. After 6 months of treatment, papular lesions became clearly flatter.

The role of heparin-binding EGF-like growth factor and amphiregulin in the epidermal proliferation of psoriasis in cooperation with TNFalpha.

Heparin-binding EGF-like growth factor (HB-EGF) and amphiregulin (AREG) are the members of EGF family that bind to common EGF receptor (EGFR) in the epidermis. However, the role of these two growth factors in epidermal hyperplasia of psoriasis has not been established. On the other hand, CD4+ T cells are responsible for the development of the psoriatic plaques. However, inflammatory cytokines, such as TNFalpha, IL-1beta and IFNgamma, inhibit the growth of human keratinocytes in vitro. The expression of HB-EGF, AREG and EGFR proteins in normal (n = 22) and psoriatic (n = 34) skin tissues was examined by immunohistochemistry. Then, the effects of HB-EGF and AREG on the growth of cultured adult normal human epidermal keratinocytes (NHEK-AD) with or without TH1 cytokines, such as TNFalpha, IL-1beta and IFNgamma, were examined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay, and the effects of these cytokines on the expression of EGFR mRNA in NHEK-AD were examined by real-time reverse transcriptase-polymerase chain reaction. The expression of HB-EGF and AREG in the epidermis was not specific to psoriatic plaques, but the distribution of positive cells throughout the epidermis was different between normal skins and psoriatic plaques. On the other hand, in the dermis and the papillary dermis, most of vascular endothelial cells and infiltrating mononuclear cells expressed both HB-EGF and AREG in normal skins and psoriatic plaques, and these positive cells were more frequent in psoriasis compared to normal skin. In the in vitro growth assay, HB-EGF, not AREG, stimulated the proliferation of NHEK-AD at the optimal concentration of 1 ng/ml. Furthermore, HB-EGF compensated the growth-suppressing effects of TNFalpha, IL-1beta and IFNgamma on NHEK-AD, and TNFalpha promoted the growth of NHEK-AD at the concentration of 2 and 20 U/ml in combination with HB-EGF and, in lesser extent, with AREG. However, TNFalpha did not affect the expression of EGFR mRNA in NHEK-AD. Growth factors and inflammatory cytokines produced in the dermis would be important for the epidermal proliferation in psoriatic plaques and TNFalpha may play a key role in cooperation with HB-EGF and AREG in the proliferation of epidermal keratinocytes at the psoriatic skin lesions.

Successful treatment of erythematotelangiectatic rosacea with intense pulsed light: Report of 13 cases.

Here, we describe the use of intense pulsed light (IPL) treatment for 13 cases of erythematotelangiectatic rosacea delivered in three sessions. For two-step irradiation, after the whole face had been irradiated using conventional IPL equipment covering a wide area, localized IPL spot irradiation was performed for visibly dilated capillaries. The therapeutic effect was evaluated by image analysis using Image J and scored by 10 dermatologists using two IPL instruments in combination. This therapeutic approach was found to be much more effective than irradiation using a single instrument. Our findings demonstrate that IPL irradiation using the present method can deliver a sufficient therapeutic effect even with a small number of treatment sessions. Although rosacea is difficult to treat, we believe that IPL can be therapeutically useful in such cases.

Carnosic acid, an inducer of NAD(P)H quinone oxidoreductase 1, enhances the cytotoxicity of ß-lapachone in melanoma cell lines.

NAD(P)H quinone oxidoreductase 1 (NQO1)-dependent antitumor drugs such as ß-lapachone (ß-lap) are attractive candidates for cancer chemotherapy because several tumors exhibit higher expression of NQO1 than adjacent tissues. Although the association between NQO1 and ß-lap has been elucidated, the effects of a NQO1-inducer and ß-lap used in combination remain to be clarified. It has previously been reported that melanoma cell lines have detectable levels of NQO1 expression and are sensitive to NQO1-dependent drugs such as 17-allylamino-17-demethoxygeldanamycin. The present study was conducted to investigate the involvement of NQO1 in ß-lap-mediated toxicity and the utility of combination treatment with a NQO1-inducer and ß-lap in malignant melanoma cell lines. Decreased expression or inhibition of NQO1 caused these cell lines to become less sensitive to ß-lap, indicating a requirement of NQO1 activity for ß-lap-mediated toxicity. Of note was that carnosic acid (CA), a compound extracted from rosemary, was able to induce further expression of NQO1 through NF-E2 related factor 2 (NRF2) stabilization, thus significantly enhancing the cytotoxicity of ß-lap in all of the melanoma cell lines tested. Taken together, the data presented in the current study indicated that the NRF2-NQO1 axis may have potential value as a therapeutic target in malignant melanoma to improve the rate of clinical response to NQO1-dependent antitumor drugs.

Methylation status of the SOCS3 gene in human malignant melanomas.

The suppressors of cytokine signaling (SOCS) family inhibits not only Janus kinase (JAK)/signal transducers and activators of transcription (STAT) but also focal adhesion kinase (FAK) signaling pathways, and has tumor suppressor activity. Aberrant methylation in the promoter region of the SOCS3 gene frequently occurs in several types of human malignancy, and its transcriptional silencing is associated with malignant tumor behavior. In malignant melanomas, the expression and methylation status of the SOCS3 gene have not been elucidated. We therefore examined the methylation status and/or protein expression of the SOCS3 gene in 5 human malignant melanoma cell lines, 2 primary cultures of normal melanocytes, and surgically resected tumors (5 malignant melanomas and 2 melanocytic nevi). Four of the 5 melanoma cell lines and the 2 primary cultures of normal melanocytes expressed SOCS3 protein to various degrees, and only one melanoma cell line was negative. Expression of SOCS3 protein was inversely correlated with methylation status in the SOCS3 promoter region, and treatment with a demethylating agent (5-aza-2'-deoxycytidine) was able to induce expression of the protein in one melanoma cell line that was SOCS3-negative and another that was weakly positive. Three of the 5 primary malignant melanomas and one of the 2 melanocytic nevi showed aberrant methylation. These results suggest that inactivation of the SOCS3 gene by hypermethylation may be involved in the promotion of malignant behavior of melanomas.

Community validation of the U.K. diagnostic criteria for atopic dermatitis in Japanese elementary schoolchildren.

BACKGROUND: A simple list of diagnostic criteria for atopic dermatitis for use in epidemiological studies was developed by a U.K. working party. This list served well for both hospital patients with skin diseases and in general population within the U.K. OBJECTIVES: To validate the U.K. diagnostic criteria in Japanese elementary schoolchildren, we collected the questionnaires on regular health checkups, which had been completed by parents of schoolchildren in 2001/2002 and 2004/2005. METHODS: Elementary schoolchildren were examined by dermatologists in eight areas (16,152 children) in 2001/2002 and in three areas (3849 children) in 2004/2005. The questionnaire was distributed to the parents 2 weeks before the skin examination, completed by the parents and collected after the survey. RESULTS: In 2002/2002 comparing the U.K. diagnostic criteria with the findings on clinical examination used as the reference standard, the U.K. criteria (1-year prevalence measure) showed a sensitivity of 71.8%, specificity of 89.3% and positive predictive value of 44.7%. In 2004/2005 we confirmed that the U.K. criteria for a point prevalence measure showed a higher positive predictive value (59.9%) compared with that for 1-year prevalence measure (49.3%). CONCLUSION: Now that we know the sensitivity and specificity of the U.K. criteria in the population examined in this study, we will be able in the near future to estimate the prevalence of atopic dermatitis in a similar population with reverse operation by questionnaires alone using these criteria without examination by dermatologists. Therefore, the validation study of U.K. criteria could be useful for future epidemiologic surveys.

Calciphylaxis Presenting with Various Symptoms: A Case Report.

Calciphylaxis causes ischemia in multiple organs and skin ulcers owing to progressive calcification in small and medial arteries. It has a poor prognosis and often occurs in patients with hyperparathyroidism associated with end-stage renal failure and those undergoing hemodialysis. Here, we present a case of calciphylaxis associated with a wide range of symptoms, including lower thigh skin ulcers, a rectovaginal fistula, and femoral neck fracture. The patient underwent multiple treatments. However, she eventually died of cardiac failure.

Four cases of Morbihan disease successfully treated with doxycycline.

Morbihan disease (MD) is rosacea-like disease characterized by persistent lymphedema on the upper half of the face. Currently, there is no established standard treatment for MD. Recently, MD has been reported to be associated with the infiltration of mast cells. The aim of this study was to investigate the association of treatment response and mast cell infiltration in MD. We report four cases of MD that were successfully treated with long-term oral doxycycline therapy.

Myocardin-related transcription factor A (MRTF-A) activity-dependent cell adhesion is correlated to focal adhesion kinase (FAK) activity.

The regulation of cell-substrate adhesion is tightly linked to the malignant phenotype of tumor cells and plays a role in their migration, invasion, and metastasis. Focal adhesions (FAs) are dynamic adhesion structures that anchor the cell to the extracellular matrix. Myocardin-related transcription factors (MRTFs), co-regulators of the serum response factor (SRF), regulate expression of a set of genes encoding actin cytoskeletal/FA-related proteins. Here we demonstrated that the forced expression of a constitutively active MRTF-A (CA-MRTF-A) in B16F10 melanoma cells induced the up-regulation of actin cytoskeletal and FA proteins, resulting in FA reorganization and the suppression of cell migration. Expression of CA-MRTF-A markedly increased phosphorylation of focal adhesion kinase (FAK) and paxillin, which are important components for FA dynamics. Notably, FAK activation was triggered by the clustering of up-regulated integrins. Our results revealed that the MRTF-SRF-dependent regulation of cell migration requires both the up-regulation of actin cytoskeletal/FA proteins and the integrin-mediated regulation of FA components via the FAK/Src pathway. We also demonstrated that activation of the MRTF-dependent transcription correlates FAK activation in various tumor cells. The elucidation of the correlation between MRTF and FAK activities would be an effective therapeutic target in focus of tumor cell migration.