MicroRNA-145-5p regulates fibrotic features of recessive dystrophic epidermolysis bullosa skin fibroblasts.

BACKGROUND: Recessive dystrophic epidermolysis bullosa (RDEB) is a skin fragility disorder caused by mutations in the COL7A1 gene encoding type VII collagen, a cutaneous basement membrane component essential for epidermal-dermal adhesion. Hallmarks of the disease are unremitting blistering and chronic wounds with severe inflammation and fibrosis. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression also implicated in fibrotic processes. However, the role of miRNAs in RDEB fibrosis is almost unexplored. OBJECTIVES: Our study aimed to identify miRNAs deregulated in primary RDEB skin fibroblasts (RDEBFs) and to characterize their function in RDEB fibrosis. METHODS: Real-time quantitative polymerase chain reaction (qRT-PCR) was used to screen RDEBFs for expression levels of a group of miRNAs deregulated in hypertrophic scars and keloids, pathological conditions with abnormal wound healing and fibrosis. Contractility, proliferation and migration rate were evaluated by different in vitro assays in RDEBFs transfected with a miR-145-5p inhibitor. Expression levels of fibrotic markers and miR-145-5p targets were measured using qRT-PCR and western blot. RESULTS: The miR-143/145 cluster was upregulated in RDEBFs compared with fibroblasts from healthy subjects. RDEBFs transfected with a miR-145-5p inhibitor showed attenuated fibrotic traits of contraction, proliferation and migration, accompanied by reduced expression of the contractile proteins α-smooth muscle actin and transgelin. These effects were associated with upregulation of Krüppel-like factor 4 transcriptional repressor and downregulation of Jagged1, a known inducer of fibrosis. CONCLUSIONS: Our results highlight the profibrotic role of miR-145-5p and its regulatory networks in RDEB, shedding light on novel disease pathomechanisms and targets for future therapeutic approaches. What's already known about this topic? Recessive dystrophic epidermolysis bullosa (RDEB) is a highly disabling genetic skin disease caused by mutations in the collagen VII gene and characterized by unremitting blistering and defective wound healing, leading to inflammation and fibrosis. MicroRNAs (miRNAs) are post-transcriptional regulators of gene expression in health and disease, and their deregulation has been implicated in fibrotic skin conditions. To date, only miR-29 has been associated with injury-driven fibrosis in RDEB. What does this study add? In patients with RDEB, miR-145-5p is overexpressed in RDEB skin fibroblasts (RDEBFs), where it plays a profibrotic role, as its inhibition reduces RDEBF fibrotic traits (contraction, proliferation and migration). miR-145-5p inhibition in RDEBFs determines the reduction of contractile markers α-smooth muscle actin and transgelin through upregulation of Krüppel-like factor 4, a transcriptional repressor of contractile proteins, and downregulation of Jagged1 (JAG1), an inducer of fibrosis. What is the translational message? Our findings expand the knowledge on miRNA-driven pathomechanisms implicated in RDEB fibrosis. miR-145-5p and its targets (e.g. JAG1) could represent relevant molecules for the development of novel therapeutic strategies to counteract fibrosis progression in patients with RDEB.

Lack of K140 immunoreactivity in junctional epidermolysis bullosa skin and keratinocytes associates with misfolded laminin epidermal growth factor-like motif 2 of the ß3 short arm.

Recessive mutations in the LAMA3, LAMB3 and LAMC2 genes that encode laminin-332 (LM332) (α3a, ß3 and γ2 chains, respectively) cause different junctional epidermolysis bullosa (JEB) subtypes. Biallelic truncating mutations in any of these three genes usually lead to lack of protein expression resulting in the severe generalized JEB subtype, while missense or splice-site mutations in at least one allele lead to reduced expression typical of JEB generalized intermediate (JEB-gen intermed) or localized. Here, we molecularly characterized an adult patient with JEB showing negative skin staining for the anti-ß3 chain monoclonal antibody K140. This antibody recognizes an as yet unidentified epitope within the laminin ß3 short arm. The patient harbours a homozygous splice-site mutation resulting in highly aberrant transcripts with partial skipping of the LAMB3 exon that encodes the laminin epidermal growth factor-like motif 2 of the ß3 short arm (ß3-LE2). At the protein level, mutation consequences predict a misfolded ß3-LE2 motif and, indeed, we found that LM332 is correctly assembled but retained in the endoplasmic reticulum (ER) where it colocalizes with the lumenal ER chaperone protein BiP, leading to dramatically reduced secretion. Lack of K140 reactivity to mutant LM332 was confirmed by immunoprecipitation and Western blot analyses. Our findings not only identify the ß3-LE2 subdomain as the region recognized by K140, but also show that misfolding of LM332 structural motifs and subsequent protein retention in the ER is a common pathomechanism in JEB-gen intermed. In addition to its usefulness in antigen mapping diagnosis of JEB subtypes, this knowledge is relevant to the design of therapeutic strategies aimed at releasing ER-retained LM332 in JEB.

A truncating mutation in the laminin-332α chain highlights the role of the LG45 proteolytic domain in regulating keratinocyte adhesion and migration.

BACKGROUND: Altered function of laminin-332 (α3ß3γ2) consequent to mutations in the LAMA3, LAMB3 and LAMC2 genes causes junctional epidermolysis bullosa non-Herlitz (JEB-nH). JEB-nH patients suffer from skin blistering and have an increased risk of developing aggressive skin carcinomas in adulthood. Laminin-332 is proteolytically processed and its extracellular mature form lacks the α3 chain C-terminal globules 4 and 5 (LG45). The LG45 tandem has cell adhesion and protumorigenic properties. However, mutations that affect this domain are very rare and their functional effects in patients have not been explored to date. OBJECTIVE: To characterize molecularly an adult patient with JEB-nH and altered laminin-332 expression presenting multiple skin carcinomas, and to analyse LG45-mediated biological functions using keratinocytes from the patient. METHODS: A mutational search in laminin-332 genes was performed by hetero-duplex analysis. LAMA3 mRNA and laminin-332 protein levels in patient keratinocytes were investigated by real-time reverse transcriptase polymerase chain reaction and radioimmunoprecipitation assay, respectively. Keratinocyte migration was examined by scratch and Boyden chamber assays. RESULTS: We identified a homozygous LAMA3 mutation, p.Leu1648TrpfsX32, which truncates the last 45 amino acids of the carboxyl terminal LG5 subdomain. Gene expression studies revealed that the mutant transcripts were stable and even increased, precursor laminin-332 molecules were retained intracellularly and the amount of mature extracellular heterotrimers was reduced to about 50%. Finally, the patient's keratinocytes migrated faster than normal keratinocytes. CONCLUSIONS: Structural disruption of LG5 highlights the critical functions of the LG45 proteolytic region in precursor laminin-332 secretion and keratinocyte adhesion and migration. Perturbation of LG45 function might explain the non-aggressive behaviour of carcinomas in this patient.

MicroRNA-203 contributes to skin re-epithelialization.

Keratinocyte proliferation and migration are crucial steps for the rapid closure of the epidermis during wound healing, but the molecular mechanisms involved in this cellular response remain to be completely elucidated. Here, by in situ hybridization we characterize the expression pattern of miR-203 after the induction of wound in mouse epidermis, showing that its expression is downregulated in the highly proliferating keratinocytes of the 'migrating tongue', whereas it is strongly expressed in the differentiating cells of the skin outside the wound. Furthermore, subcutaneous injections of antagomiR-203 in new born mice dorsal skin strengthened, in vivo, the inverse correlation between miR-203 expression and two new target mRNAs: RAN and RAPH1. Our data suggest that miR-203, by controlling the expression of target proteins that are responsible for both keratinocyte proliferation and migration, exerts a specific role in wound re-epithelialization and epidermal homeostasis re-establishment of injured skin.

The court medical expert in France: changes in status.

In France the status of the court expert has undergone a significant change with the adoption of statute no. 2004-130 of 11 February 2004 and its implementing regulations no. 2004-1463 of 23 December 2004. This article looks at the two most outstanding aspects of this change in status: (i) the conditions for registering on a court of appeal list and, (ii) the practical details of the quality control of the court expert's work as exercised by the judge. The article concludes with a brief comparison with the expert witness situation in England and Wales.

Granulocyte/macrophage colony-stimulating factor treatment of human chronic ulcers promotes angiogenesis associated with de novo vascular endothelial growth factor transcription in the ulcer bed.

Summary Background Granulocyte/macrophage colony-stimulating factor (GM-CSF), a cytokine with pleiotropic functions, has been successfully employed in the treatment of chronic skin ulcers. The biological effects underlying GM-CSF action in impaired wound healing have been only partly clarified. Objectives To investigate the effects of GM-CSF treatment of chronic venous ulcers on lesion vascularization and on the local synthesis of the angiogenic factors vascular endothelial growth factor (VEGF) and placenta growth factor (PlGF). Methods Patients with nonhealing venous leg ulcers were treated with intradermal injection of recombinant human GM-CSF, and biopsies were taken at the ulcer margin before and 5 days after administration. Wound vascularization was analysed by immunohistochemistry using antiplatelet endothelial cell adhesion molecule-1/CD31 and anti-alpha-smooth muscle actin antibodies. VEGF and PlGF transcription was assessed by in situ hybridization. To identify the cell populations transcribing VEGF within the ulcer bed, the VEGF hybridization signal was correlated with the immunostaining for different cell type markers on serial sections. Direct induction of VEGF transcription by GM-CSF was investigated in GM-CSF-treated cultured macrophages and keratinocytes. Results Blood vessel density was significantly increased in the ulcer bed following GM-CSF treatment. VEGF transcripts were localized in keratinocytes at the ulcer margin both before and after GM-CSF treatment, whereas a VEGF hybridization signal was evident within the ulcer bed only following administration. PlGF mRNA was barely detectable in keratinocytes at the ulcer margin and was not visibly increased after treatment. Unlike VEGF, a specific PlGF hybridization signal could not be detected in cells within the ulcer following GM-CSF administration. Monocytes/macrophages were the main cell population transcribing VEGF after GM-CSF treatment. In vitro analysis demonstrated that VEGF transcription can be directly stimulated by GM-CSF in a differentiated monocytic cell line, but not in keratinocytes. Conclusions Our data show that increased vascularization is associated with GM-CSF treatment of chronic venous ulcers and indicate that inflammatory cell-derived VEGF may act as an angiogenic mediator of the healing effect of GM-CSF in chronic ulcers.

The regional commission for medical accidents and nosocomial infections set up by French law.

The regional commission for conciliation and compensation for medical accidents, iatrogenic diseases and nosocomial infections (commission régionale de conciliation et d'indemnisation des accidents médicaux, affections iatrogènes et infections nosocomiales, CRCI) offers victims of such events the possibility of obtaining compensation without recourse to legal proceedings. We suggest various points of view about this commission set up by the French law no. 2002-303 of 4 March 2002: the composition, role and competence of the CRCI; the place of the expert's report; the opinion pronounced by the CRCI and its outcome, the compensation of victims and, finally, interaction with other procedures.

Immunostaining by complement C9: a tool for early diagnosis of myocardial infarction and application in forensic medicine.

Before the first 12 hours, diagnosis of early myocardial infarctions is always difficult for forensic pathologists. We tested complement C9 expression in 121 formalin-fixed and paraffin-embedded heart samples by an immunohistochemical procedure. The heart specimens were separated into four groups: 33 cases in group 1 with typical ischemic damages histologically located, 20 cases in group 2 with death related to myocardial infarction on the basis of ischemic presentation on electrocardiogram but no obvious histological ischemic damage, 35 cases in group 3 with severe coronary disease without cause of death found at the autopsy, and 33 cases in group 4 without sign of myocardial infarction and without coronary disease. In the first group, all 33 heart samples showed a well-defined C9 expression in the necrotic areas. The second group in 17 of 20 cases showed positive areas for C9 expression. In the other three heart specimens, only few stained cells were observed whereas the painful symptoms had begun less than 1 h before death. The third group showed C9 immunopositive areas in six of 35 cases, few stained cells in 8 cases, and no C9 deposition in the 21 other cases. The last group showed no staining area. To avoid nonspecific C9 staining due to tissue autolysis, we studied C9 expression during a controlled putrefactive process in four cases included in group 1; staining was found only in infarcted myocardial areas, and was observed up to ten days. Specificity of C9 expression was evaluated to be 100% [89.4 to 100%] and sensitivity to be 85% [62.11 to 96.79%]. In conclusion, evaluation of immunohistochemical expression of C9 appears to be a highly sensitive and specific marker of early myocardial infarction, useful in forensic medicine if survival is more than 1 h after the beginning of myocyte damage.

Modulation of cholinergic marker expression by nerve growth factor in dorsal root ganglia.

The presence of cholinergic markers in sensory ganglia has suggested a possible functional role of acetylcholine both as a cofactor of morphogenesis in embryonic life and in sensory transduction during adult life. Acetylcholine, in fact, is able to excite cutaneous nociceptors and to modulate noxious stimuli. Nerve growth factor (NGF) overexpression induces the survival of nociceptive neurons, the expression of their specific markers, and hyperalgesia. On the other hand, NGF modulate the levels of cholinergic markers in several area of nervous system. Considering these observations, the present work aims to investigate whether NGF is able also to control the expression of cholinergic markers in chick sensory neurons in culture. We selected three developmental stages (E8, E12, and E18) representative of different phases of chick embryo development and performed observations on culture in which NGF was omitted at the plating time, withdrawn after the initial 24 hr of culture or maintained for 48 hr. In the experimental protocol devised, NGF did not significantly affect cell survival. At E12 a 48 hr treatment with NGF causes a significant but limited increase in acetylcholinesterase activity; activity increase was not observed when NGF was removed after 24 hr. No changes in acetylcholinesterase activity were observed at E8 and E18 stages. NGF appears to be more effective in the modulation of choline acetyltransferase activity. At E12, in fact, about a doubling of enzyme activity was measured after 24 or 48 hr of treatment with NGF. A response was also found at E18, when a 50% increase in choline acetyltransferase activity was observed just after 24 hr treatment. The behavior of muscarinic receptors in response to NGF differs compared to the two cholinergic enzymes. At E8 and E12 a profound increase in muscarinic receptor expression was observed. Conversely, at E18 NGF produces a 50% reduction of receptors. Considering these observations and the demonstrated role of muscarinic receptors in the desensitization of nociceptors, the reduction of muscarinic receptors in DRG after NGF treatment is in agreement with the proposed algogenic action of NGF in the skin.

Placenta growth factor is induced in human keratinocytes during wound healing.

Placenta growth factor (PlGF) is a dimeric glycoprotein, structurally and functionally related to the vascular endothelial growth factor, a potent angiogenic/permeability factor known to play a role in the neoangiogenesis during wound repair. In this study we evaluated the expression of PlGF in human keratinocytes and investigated its possible role in wound healing. Northern blot analysis on cultured keratinocytes revealed a 1.7 kb mRNA transcript and reverse transcriptase-polymerase chain reaction allowed the detection of two PlGF isoforms generated by alternative RNA splicing. PlGF and vascular endothelial growth factor homodimers as well as vascular endothelial growth factor/PlGF heterodimers could be detected in keratinocyte conditioned medium. Increased expression of both PlGF mRNA and protein was observed upon treatment of keratinocytes with epidermal growth factor, transforming growth factor-alpha, transforming growth factor-beta, and interleukin-6, all cytokines present at the wound site during the early phase of repair. The analysis of human full-thickness healing wounds revealed appreciable levels of PlGF mRNA and protein in the migrating keratinocytes starting from day 3 after injury, and increasing at day 5. At day 7 PlGF mRNA was no longer detectable, while the protein was still expressed by migrating suprabasal keratinocytes. At day 13, when the wound had reepithelialized, PlGF immunostaining was completely negative. By in situ hybridization an intense signal for PlGF was also found on endothelial capillaries adjacent to the wound. These data demonstrate that keratinocytes are a source of PlGF during wound healing in vivo and indicate a role for this factor in the neoangiogenesis process associated with cutaneous wound repair.

Evaluation of biological stress markers in police officers.

This study was performed on 18 police officers, in order to evaluate relations between behavior and the activity of the main hormonal systems implicated in stress management. All subjects were male volunteers with more than 2 years on the job, a type A psychological profile according to Friedman and Rosenman, suffering from no mental or physical illness. The experimental setting used to study the role of different stress factors consisted of a series of tests that re-created stressful situations that the subject might encounter in his job. The study showed that during stressful states, not only did peripheral secretion of catecholamines increase, but that the ratio of epinephrine to norepinephrine was a determinant factor. Epinephrine secretion which was elevated at the beginning, decreased when the stressful situation was clarified or controlled, whereas norepinephrine secretion remained elevated as long as the subject had to remain alert. Cortisol secretion seemed to depend upon anticipation of the stressful event more than its actual happenning.

[Cannabis: toxicokinetic focus and methodology of urinary screening]. / Le cannabis: mise au point toxicocinétique et méthodologie du dépistage urinaire.

Cannabis is the most commonly used illicit drug in the world. The major psychomimetic compound is delta 9-tetrahydrocannabinol. The major effects consist in alterations of sensory perception, cognition, motor coordination and self-perception. Procedures designed to detect cannabis use have been developed since 1988. The traditional approach is to screen urine by immunoassay and to submit positive samples for confirmation by gas chromatography and mass spectrometry. There continue to be many difficulties in interpreting the results because of the biotransformations of delta 9-tetrahydrocannabinol.

[Variation of sphenoidal angle of human skull in the course of aging]. / Variation de l'angle sphénoïdal du crâne humain en fonction du vieillissement.

The degree of the cranial base flexion is a major parameter in the study of the evolution of verbal communication in mankind. The variability of this area among modern humans has received little attention. In the present study, a sample of 330 modern human skulls have been used to characterize the changes in the angle of the cranial base flexion with age, and its possible relationships with gender and ethnic origin. Statistical analysis of the results show significant changes with age. Two conclusions emerged: i) the debate regarding Neanderthal speech should also consider the effect of age on the cranial base; and ii) the sphenoidal angle can be used as an ageing criterion in forensic and anthropological studies.

[Urinary screening of drugs of abuse among drivers involved in road accidents]. / Le dépistage urinaire des psychotropes illicites chez les conducteurs de véhicules accidentés.

Driving under the influence of drugs is a growing cause of traffic injuries. Therefore the Abbott Laboratories established a study to estimate the consumption of opiates, cannabinoids, cocaine and amphetamines among young adults involved in a road accident and to compare with a control group. Analytical procedure chosen include an anonymous collection of urines. Drugs are screened by fluorescence polarization immunoassay. Positive samples are confirmed by gas chromatography/mass spectrometry. Results do not show any difference between the two groups.

[Temporomandibular joint pain-dysfunction syndrome after whiplash injury. Medico-legal problems in common law]. / SADAM après "coup du lapin" (mouvement de fléau). Problèmes médico-légaux en droit commun.

In four cases, the authors analyse the medical and legal factors which lead the expert to his conclusions in french law, concerning temporo-mandibular joint dysfunction after whiplash injury indemnification. An uncertain direct link between the injury and the damage together with the patient's dental prior state to the accident, lead to retain an incomplete legal imputability. The compensation awarded to the victim will consist of an overvalued extra-patrimonial damage which will eventually be able to balance a low physiological deficit price.

Maxillary canine microwear in Dryopithecus from Spain.

The three functional domains of the upper canines of Dryopithecus from Spain are analysed through microscopic examination. Evidence is presented that shows a food choice in concordance with open woodland habitat.

Craniofacial dysmorphism in Mozart's skull.

Mozart's craniofacial dysmorphism shown in his portraits and in the skull held by the Mozarteum in Salzburg (Austria) helps to document the role of pathology in human identification. The specific syndrome is formed by a premature synostosis of the metopic suture (PSMS) in association with an abnormally shaped skull.