Risk factors of rituximab-induced thrombocytopenia in patients with autoimmune bullous diseases.

Rituximab has been the mainstay treatment for autoimmune bullous diseases (AIBDs). Among the side effects of rituximab, rituximab-induced thrombocytopenia (RIT) is a rare but critical complication. However, there have been no reports or identification of risk factors for RIT in patients with AIBD. In our retrospective study, we compared rituximab-treated AIBD in patients with and without thrombocytopenia to explore the risk factors. In addition, we compared two different rituximab protocols (rheumatoid arthritis [RA] and lymphoma) in terms of the incidence and severity of thrombocytopenia. A total of 222 patients were enrolled, and 46 patients (20.7%) developed RIT. Multivariate logistic regression analysis identified age and chronic kidney disease (CKD) as significant factors for RIT. We also found that patients treated with the lymphoma protocol demonstrated a significantly higher mean post-rituximab platelet count compared with those on the RA protocol. This was the first analysis, to our knowledge, of risk factors for RIT in patients with AIBD. Individuals aged 70 or older and those with multiple comorbidities, particularly CKD, should be closely monitored for thrombocytopenia. For patients with CKD, it may be safer to use the lymphoma protocol for rituximab administration as it results in a lesser reduction in post-rituximab platelet count.

Efficacy of oral JAK1 or JAK1/2 inhibitor for treating refractory pruritus in dystrophic epidermolysis bullosa: A retrospective case series.

Refractory pruritus is the most distressing, disease-related symptom in patients with dystrophic epidermolysis bullosa (DEB), inducing an itch-scratch-blister cycle. Chronic inflammation is a hallmark of DEB, thus upregulation of inflammatory cytokines and Janus kinase (JAK) signaling may play a role in DEB-related pruritus. We retrospectively reviewed the medical records of DEB patients with refractory pruritus who were treated with either baricitinib, a JAK1/2 inhibitor, or upadacitinib, a selective JAK1 inhibitor. Patients received baricitinib (4 mg) or upadacitinib (15 mg) once a day for 2-32 weeks. A total of 12 DEB patients (six recessive DEB and six dominant DEB) were included in this study. The mean±SD baseline pruritus visual analog scale (VAS) score was 7.5 ± 1.7. Upadacitinib or baricitinib treatment resulted in a rapid and sustained decrease in itch. Four out of 12 patients (33.3%) and seven out of 10 patients (70%) showed a decrease of at least 3 points in the pruritus VAS score from baseline at weeks 2 and 4, respectively. The mean percentage changes from baseline in pruritus VAS scores at weeks 2 and 4 were -42.9% and -52.7%, respectively. Subgroup analysis showed greater reductions in the pruritus VAS score in the baricitinib group (n = 5) compared to the upadacitinib group (n = 7), and in patients with epidermolysis bullosa pruriginosa (n = 3) compared to other subtypes of DEB (n = 9); however, these differences did not reach statistical significance. Three out of 10 (33.3%) patients showed at least a 2-point reduction in pain intensity from baseline at week 4. Eight out of 12 patients (66.7%) also showed a reduction in the number of new blisters, which correlated with a reduction in the pruritus score. No patient discontinued treatment because of serious adverse events. Our results suggest that JAK1 or JAK1/2 inhibitors could be a promising treatment option for DEB-related pruritus. Long-term safety should be assessed in future studies.

Permselective Ionic-Shield for High-Performance Lithium-Sulfur Batteries.

Lithium-sulfur batteries (LiSBs) are promising next-generation batteries because of their low cost and high theoretical energy densities. Despite remarkable advances over the decades, polysulfide (PS) shuttling during battery cycling remains a challenge in the development of commercial LiSBs and is accelerated under practical conditions. Herein, we report a permselective ionic shield between the electrodes that blocks PS shuttles and passes Li ions to high-performance LiSBs. This shield is easily built onto the separator by ionic complexation and intermolecular bonding of functional polymers, thereby improving the battery performance and safety. The LiSB with the developed shield delivers a remarkable discharge capacity of 917 mAh g-1 after 1000 cycles at 2 C. In addition, the behavior of LiSBs under practical conditions that can realize a high energy density is investigated to achieve the optimal balance in this system. This study provides new insights into the imminent development of separators for practical LiSBs.

Microenvironmental network of clonal CXCL13+CD4+ T cells and Tregs in pemphigus chronic blisters.

BACKGROUNDPemphigus, a rare autoimmune bullous disease mediated by antidesmoglein autoantibodies, can be controlled with systemic medication like rituximab and high-dose systemic corticosteroids combined with immunosuppressants. However, some patients continue to experience chronically recurrent blisters in a specific area and require long-term maintenance systemic therapy.METHODSSkin with chronic blisters was obtained from patients with pemphigus. Immunologic properties of the skin were analyzed by immunofluorescence staining, bulk and single-cell RNA and TCR sequencing, and a highly multiplex imaging technique known as CO-Detection by indEXing (CODEX). Functional analyses were performed by flow cytometry and bulk RNA-Seq using peripheral blood from healthy donors. Intralesional corticosteroid was injected into patient skin, and changes in chronically recurrent blisters were observed.RESULTSWe demonstrated the presence of skin tertiary lymphoid structures (TLSs) with desmoglein-specific B cells in chronic blisters from patients with pemphigus. In the skin TLSs, CD4+ T cells predominantly produced CXCL13. These clonally expanded CXCL13+CD4+ T cells exhibited features of activated Th1-like cells and downregulated genes associated with T cell receptor-mediated signaling. Tregs are in direct contact with CXCL13+CD4+ memory T cells and increased CXCL13 production of CD4+ T cells through IL-2 consumption and TGF-ß stimulation. Finally, intralesional corticosteroid injection improved chronic blisters and reduced skin TLSs in patients with pemphigus.CONCLUSIONThrough this study we conclude that skin TLSs are associated with the persistence of chronically recurrent blisters in patients with pemphigus, and the microenvironmental network involving CXCL13+CD4+ T cells and Tregs within these structures plays an important role in CXCL13 production.TRIAL REGISTRATIONClinicalTrials.gov NCT04509570.FUNDINGThis work was supported by National Research Foundation of South Korea (NRF-2021R1C1C1007179) and Korea Drug Development Fund, which is funded by Ministry of Science and ICT; Ministry of Trade, Industry, and Energy; and Ministry of Health and Welfare (grant RS-2022-00165917).

Electropolymerisation Technologies for Next-Generation Lithium-Sulphur Batteries.

Lithium-sulphur batteries (LiSBs) have garnered significant attention as the next-generation energy storage device because of their high theoretical energy density, low cost, and environmental friendliness. However, the undesirable "shuttle effect" by lithium polysulphides (LPSs) severely inhibits their practical application. To alleviate the shuttle effect, conductive polymers have been used to fabricate LiSBs owing to their improved electrically conducting pathways, flexible mechanical properties, and high affinity to LPSs, which allow the shuttle effect to be controlled. In this study, the applications of various conductive polymers prepared via the simple yet sophisticated electropolymerisation (EP) technology are systematically investigated based on the main components of LiSBs (cathodes, anodes, separators, and electrolytes). Finally, the potential application of EP technology in next-generation batteries is comprehensively discussed.

Preparation and Characterization of Low CTE Poly(ethersulfone) Using Lignin Nano Composites as Flexible Substrates.

Polyethersulfone (PES) has outstanding thermal and dimensional stability. It is considered an engineering thermoplastic. However, its high coefficient of thermal expansion (CTE) hinders its use in automobiles, microelectronics, and flexible display areas. To overcome its high coefficient of thermal expansion (CTE), recent studies have focused on reducing its high CTE and improving its mechanical properties by adding nano-sized fillers or materials. The addition of nanofiller or nanofibrils to the PES matrix often has a positive effect on its mechanical and thermal properties, making it a flexible display substrate. To obtain ideal flexible substrates, we prepared polyethersulfone with lignin nanocomposite films to reduce CTE and improve the mechanical and thermal properties of PES by varying the relative ratio of PES in the lignin nanocomposite. In this study, lignin as a biodegradable nanofiller was found to show high thermal, oxidative, and hydrolytic stability with favorable mechanical properties. PES/lignin nanocomposite films were prepared by solution casting according to the content of lignin (0 to 5 wt.%). PES/lignin composite films were subjected to mechanical, thermo-mechanical, optical, and surface analyses. The results showed enhanced thermomechanical and optical properties of PES, with the potential benefits of lignin filler materials realized for the development of thermoplastic polymer blends.

Two cases of KRT1 mutation-associated epidermolytic ichthyosis without typical epidermolytic hyperkeratosis in the neonatal skin lesions.

Epidermolytic ichthyosis (EI) is a rare genetic disorder of keratinization caused by mutations in either KRT1 or KRT10. Histopathologically, epidermolytic hyperkeratosis (EHK) is a hallmark of EI. Here, we report two EI cases in which KRT1 mutation was confirmed by molecular study, but without typical EHK present on skin biopsies performed within 1 week of age. Our cases demonstrate that EHK may not be evident in EI if skin biopsy is performed during the neonatal period.

FRTX-02, a selective and potent inhibitor of DYRK1A, modulates inflammatory pathways in mouse models of psoriasis and atopic dermatitis.

Dual-specificity tyrosine phosphorylation-regulated kinase 1 A (DYRK1A) has been proposed as a novel regulator of adaptive immune homeostasis through modulating T cell polarization. Thus, DYRK1A could present a potential target in autoimmune disorders. Here, we identify FRTX-02 as a novel compound exhibiting potent and selective inhibition of DYRK1A. FRTX-02 induced transcriptional activity of the DYRK1A substrate NFAT in T cell lines. Correspondingly, FRTX-02 promoted ex vivo CD4+ polarization into anti-inflammatory Tregs and reduced their polarization into pro-inflammatory Th1 or Th17 cells. We show that FRTX-02 could also limit innate immune responses through negative regulation of the MyD88/IRAK4-NF-κB axis in a mast cell line. Finally, in mouse models of psoriasis and atopic dermatitis, both oral and topical formulations of FRTX-02 reduced inflammation and disease biomarkers in a dose-dependent manner. These results support further studies of DYRK1A inhibitors, including FRTX-02, as potential therapies for chronic inflammatory and autoimmune conditions.

Clinical effect of omalizumab as an adjuvant treatment to rituximab in patient with refractory bullous pemphigoid.

Patients with refractory bullous pemphigoid (BP) achieve remission after rituximab treatment but require high-dose systemic corticosteroids until the remission. The aim of this retrospective study was to examine the clinical efficacy of omalizumab as an adjuvant treatment to rituximab in patients with refractory BP. Patients with BP receiving treatment with either rituximab monotherapy or rituximab plus omalizumab were considered for the study. The total dose of corticosteroids received for 60 days after administration of rituximab, mortality and relapse rates, and median time to relapse were also investigated. Of 49 patients included in the study, 25 received rituximab monotherapy and 17 received the combination therapy with rituximab and omalizumab. The rituximab plus omalizumab group showed shorter time to disease control with minimal treatment (15 days vs. 67.5 days, p < 0.001) and lower corticosteroid dose for 60 days after administration of rituximab (698.4 mg vs. 1087.4 mg of methylprednisolone, p < 0.001) compared to the rituximab monotherapy group. The results of this study suggest that combination therapy with rituximab and omalizumab can achieve disease control status faster than the rituximab monotherapy, reducing the total dose of corticosteroids.

Thin Solid Electrolyte Separators for Solid-State Lithium-Sulfur Batteries.

The lithium-sulfur battery is one of the most promising "beyond Li-ion" battery chemistries owing to its superior gravimetric energy density and low cost. Nonetheless, its commercialization has been hindered by its low cycle life due to the polysulfide shuttle and nonuniform Li-metal plating and stripping. Thin and dense solid electrolyte separators could address these issues without compromising on energy density. Here, we introduce a novel argyrodite (Li6PS5Cl)-carboxylated nitrile butadiene rubber (XNBR) composite thin solid electrolyte separator (TSE) (<50 µm) processed by a scalable calendering technique and compatible with Li-metal. When integrated in a full cell with a commercial tape-cast sulfur cathode (3.54 mgS cm-2) in the presence of an in situ polymerized lithium bis(fluorosulfonyl)imide-polydioxolane catholyte and a 100 µm Li-metal foil anode, we demonstrate stable cycling for 50 cycles under realistic operating conditions (stack pressure of <1 MPa and 30 °C).

Clinical impact and a prognostic marker of early rituximab treatment after rituximab reimbursement in Korean pemphigus patients.

Pemphigus is an autoimmune mucocutaneous blistering disease caused by autoantibodies against desmogleins. Rituximab effectively treats pemphigus by inducing remission and rapidly reducing corticosteroid dosage. In Korea, the high cost of rituximab had been a burden until the National Health Insurance began to cover 90% of rituximab costs via reimbursement for severe pemphigus patients. We analyzed 214 patients with pemphigus who were treated with their first round of rituximab. The time to initiate rituximab and the time to partial remission under minimal therapy (PRMT) were both significantly shorter after the rituximab reimbursement policy. The total steroid intake for PRMT and complete remission (CR) was less in patients who were diagnosed after the reimbursement. The interrupted time series (ITS) model, a novel analysis method to evaluate the effects of an intervention, showed a decrease in total systemic corticosteroid intake until PRMT after reimbursement began. In peripheral blood mononuclear cells from patients with pemphigus vulgaris, the relative frequencies of desmoglein 3-specific CD11c+CD27-IgD- atypical memory B cells positively correlated with the periods from disease onset to rituximab treatment and to PRMT and the total systemic corticosteroid intake until PRMT. We found that early rituximab therapy, induced by the reimbursement policy, shortened the disease course and reduced the total corticosteroid use by pemphigus patients. The decreased frequency of circulating desmoglein-specific atypical memory B cells can be used as a surrogate marker for a good prognosis after rituximab.

How Do Experts Treat Patients with Bullous Pemphigoid around the World? An International Survey.

Many treatments are currently proposed for treating patients with bullous pemphigoid (BP). We assessed treatment modalities of BP depending on the different countries, BP extent, and patients' comorbidities. We surveyed worldwide experts about how they treat patients with BP. A total of 61 experts from 27 countries completed the survey. Severe and moderate BP were treated with oral prednisone (61.4 and 53.7%, respectively) or superpotent topical corticosteroids (CSs) (38.6 and 46.3%, respectively). Conventional immunosuppressants were more frequently combined with oral prednisone (74.5%) than with superpotent topical CS (37.5%) in severe BP. Topical CSs were mainly used in Europe in mild (81.1%), moderate (55.3%), and severe (54.3%) BP. In the United States of America and Asia, systemic CSs were mainly proposed for treating severe (77.8 and 100%, respectively), moderate (70 and 77.8%, respectively), and also mild (47.1 and 33.3%, respectively) BP. Most experts reduced the initial dose of oral CS in patients with diabetes mellitus (48.1%) or cardiac insufficiency (40.2%) but rarely changed BP treatment in patients with neurological disorders or neoplasia. This survey showed major differences in the way patients with BP are treated between AmeriPac countries (United State of America, Latin America, and Australia) and Asia on the one hand and Europe and the Middle East on the other hand.

Novel Potassium-Competitive Acid Blocker, Tegoprazan, Protects Against Colitis by Improving Gut Barrier Function.

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder characterized by prolonged inflammation of the gastrointestinal tract. IBD can result from gut barrier dysfunction, altered gut microbiota, and abnormal intestinal immunity induced by environmental factors in genetically susceptible individuals. Proton pump inhibitors (PPIs) such as rabeprazole are frequently employed for gastric acid inhibition. However, long-term PPI administration can alter the intestinal microbiome composition, possibly worsening IBD severity. The present study revealed that tegoprazan, a potassium-competitive acid blocker, significantly improved colitis in mice and enhanced the intestinal epithelial barrier function. Tegoprazan alleviated gut microbiota dysbiosis and enhanced the growth of Bacteroides vulgatus. In turn, B. vulgatus alleviated intestinal inflammation by inhibiting epithelial adhesion of pathogenic bacteria. Unlike rabeprazole, tegoprazan did not induce gut dysbiosis. Our findings provide novel insights into the potential role of tegoprazan as an intestinal protectant for IBD and as a therapeutic agent for gastric acid-related diseases.

Therapeutic base editing and prime editing of COL7A1 mutations in recessive dystrophic epidermolysis bullosa.

Recessive dystrophic epidermolysis bullosa (RDEB) is a severe skin fragility disorder caused by loss-of-function mutations in the COL7A1 gene, which encodes type VII collagen (C7), a protein that functions in skin adherence. From 36 Korean RDEB patients, we identified a total of 69 pathogenic mutations (40 variants without recurrence), including point mutations (72.5%) and insertion/deletion mutations (27.5%). For fibroblasts from two patients (Pat1 and Pat2), we applied adenine base editors (ABEs) to correct the pathogenic mutation of COL7A1 or to bypass a premature stop codon in Pat1-derived primary fibroblasts. To expand the targeting scope, we also utilized prime editors (PEs) to correct the COL7A1 mutations in Pat1- and Pat2-derived fibroblasts. Ultimately, we found that transfer of edited patient-derived skin equivalents (i.e., RDEB keratinocytes and PE-corrected RDEB fibroblasts from the RDEB patient) into the skin of immunodeficient mice led to C7 deposition and anchoring fibril formation within the dermal-epidermal junction, suggesting that base editing and prime editing could be feasible strategies for ex vivo gene editing to treat RDEB.

Human magnetic sense is mediated by a light and magnetic field resonance-dependent mechanism.

Numerous organisms use the Earth's magnetic field as a sensory cue for migration, body alignment, or food search. Despite some contradictory reports, yet it is generally accepted that humans do not sense the geomagnetic field. Here, we demonstrate that a magnetic field resonance mechanism mediates light-dependent magnetic orientation in men, using a rotary chair experiment combined with a two-alternative forced choice paradigm. Two groups of subjects were classified with different magnetic orientation tendencies depending on the food context. Magnetic orientation of the subjects was sensitive to the wavelength of incident light and was critically dependent on blue light reaching the eyes. Importantly, it appears that a magnetic field resonance-dependent mechanism mediates these responses, as evidenced by disruption or augmentation of the ability to orient by radiofrequency magnetic fields at the Larmor frequency and the dependence of these effects on the angle between the radiofrequency and geomagnetic fields. Furthermore, inversion of the vertical component of the geomagnetic field revealed a non-canonical inclination compass effect on the magnetic orientation. These results establish the existence of a human magnetic sense and suggest an underlying quantum mechanical magnetoreception mechanism.

Highly Stable Potassium-Ion Battery Enabled by Nanoengineering of an Sb Anode.

We present the nanoengineering of Sb particles assisted by a conductive and stress-relieving network of carbon quantum dots (CQDs) and poly(3,4-ethylene dioxythiophene) poly(styrenesulfonate) (PEDOT:PSS), in the proper design of anode materials with high specific capacity and excellent stability for potassium-ion batteries (KIBs). The nanosized Sb particles are prepared by the CQDs as functional tuners in the morphology and surface, which tune the size to nanolevel and provide fast ionic channels and a soft matrix to relieve the volume changes. As the additional conductive and stress-relieving network layer, PEDOT:PSS offers enhanced electron/ion pathways and maintains the integrity of the Sb@CQD composite electrode. In the KIB, the prepared Sb anode exhibits battery performance with a high specific capacity of 480 mA h g-1 at 0.5 A g-1 and a high-capacity retention of 95.4% over 350 cycles.

Binder-Free and High-Loading Cathode Realized by Hierarchical Structure for Potassium-Sulfur Batteries.

Potassium-sulfur batteries have attracted significant research attention owing to the naturally abundant resources of potassium and sulfur, and have promising applications in large-scale energy storage systems. However, the sluggish reaction kinetics of K+ , low reaction activity of sulfur species, shuttling effect of polysulfides, and large volume change impede the development of these batteries. Moreover, the conventional electrode fabrication method with binders and current collectors renders it difficult to improve the areal sulfur loading and energy density. In this study, a binder-free and freestanding sulfur cathode is prepared by phase inversion and sulfurization of polyacrylonitrile. This sulfur cathode, with a hierarchically porous network, enables a high reversible capacity of 1345 mAh g-1 and a stable cycling performance with a capacity decay of 0.15% per cycle. Importantly, areal capacities of 3.1 and 4.2 mAh cm-2 are achieved even at high sulfur loadings of 3 and 7 mg cm-2 , owing to the favorable electron/ion transport in the cathode. The facile preparation method and excellent electrochemical properties reported herein can pave the way for developing high-performance K-S batteries.

Recycling respirator masks to a high-value product: From COVID-19 prevention to highly efficient battery separator.

COVID-19 is a pandemic that has caused serious disruption in almost every day-to-day life around the world, and wearing a mask is essential for human safety from this virus. However, masks are non-recyclable materials, and the accumulation of masks used every day causes serious environmental issues. In this study, we investigate the recycling of mask materials for addressing the environmental problems and transforming as a high value-added material through chemical modification of masks. The recycled mask is applied as a separator for aqueous rechargeable batteries, and shows outstanding safety and electrochemical performance than the existing separator. This approach will lead to an advanced energy technology considering nature after overcoming COVID-19.