Scoping Review on the Use of Drugs Targeting JAK/STAT Pathway in Atopic Dermatitis, Vitiligo, and Alopecia Areata.

INTRODUCTION: The JAK/STAT signaling pathway is involved in the immune-mediated inflammatory skin diseases atopic dermatitis (AD), vitiligo, and alopecia areata (AA), and represents a potential target when developing treatments. So far, no drugs targeting this pathway have been approved for the treatment of dermatological diseases. We reviewed the use of drugs blocking the JAK/STAT pathway in the aforementioned diseases. METHODS: An a priori protocol was published. We used Joanna Briggs Institute Reviewer's Manual methodology to conduct the review and PRISMA Extension for Scoping Review (PRISMA-ScR) to report results. MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science databases were searched in a three-step approach on April 2019 by two researchers. RESULTS: Ninety-six mainly multicenter observational studies were included (66, 10, and 20 studies on AA, vitiligo, and AD, respectively). Tofacitinib and ruxolitinib were mainly used for the three diseases, and also upadacitinib, abrocitinib, baricitinib, cerdulatinib, delgocitinib, gusacitinib for AD, and baricitinib, PF-06700841, and PF-06651600 for AA. All patients with AD improved, whereas patients with vitiligo and patients with AA showed varied responses, including unresponsive cases. The safety profiles were similar for all drugs and diseases, mainly comprising mild or no adverse events. CONCLUSIONS: Evidence on the efficacy and safety of drugs targeting the JAK/STAT pathway for the treatment of patients with AD, vitiligo, or AA is increasing but is still of low quality.

Drugs targeting the JAK/STAT pathway for the treatment of immune-mediated inflammatory skin diseases: protocol for a scoping review.

INTRODUCTION: The Janus kinase and Signal Transducer and Activator of Transcription protein (JAK/STAT) pathway is known to be involved in inflammatory and neoplastic skin diseases, like psoriasis, atopic dermatitis, alopecia areata, vitiligo and melanoma. Improved knowledge of the components of this pathway has allowed the development of drugs, which act by inhibiting the pathway, blocking specific components. This offers new therapeutic opportunities. Although evidence on the use of JAK/STAT blockades in dermatological diseases is growing, none have been approved for use in treating skin diseases. The aim of this study is to develop an a priori protocol to broadly review the available evidence on the use of drugs targeting the JAK/STAT pathway in the treatment of dermatological diseases. METHODS AND ANALYSIS: For the conduction of the scoping review protocol, we will employ an established scoping review methodology described in the Joanna Briggs Institute manual. This methodology outlines a five-stage approach: (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data and (5) collate, summarise and report the results, with an optional consultation exercise. Finally, we will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to present the results. ETHICS AND DISSEMINATION: Since this is a review of the literature, ethics approval is not indicated. We will disseminate the findings from this study in publications in peer-reviewed journals as well as presentations at relevant national and international conferences.

Evolution of international collaborative research efforts to develop non-Cochrane systematic reviews.

This research-on-research study describes efforts to develop non-Cochrane systematic reviews (SRs) by analyzing demographical and time-course collaborations between international institutions using protocols registered in the International Prospective Register of Systematic Reviews (PROSPERO) or published in scientific journals. We have published an a priori protocol to develop this study. Protocols published in scientific journals were searched using the MEDLINE and Embase databases; the query terms "Systematic review" [Title] AND "protocol" [Title] were searched from February 2011 to December 2017. Protocols registered at PROSPERO during the same period were obtained by web scraping all non-Cochrane records with a Python script. After excluding protocols that had a fulfillment or duplication rate of less than 90%, they were classified as published "only in PROSPERO", "only in journals", or in "journals and PROSPERO". Results of data and metadata extraction using text mining processes were curated by two reviewers. These Datasets and R scripts are freely available to facilitate reproducibility. We obtained 20,814 protocols of non-Cochrane SRs. While "unique protocols" by reviewers' institutions from 60 countries were the most frequent, a median of 6 (2-150) institutions from 130 different countries were involved in the preparation of "collaborative protocols". The highest Ranked countries involved in overall protocol production were the UK, the U.S., Australia, Brazil, China, Canada, the Netherlands, Germany, and Italy. Most protocols were registered only in PROSPERO. However, the number of protocols published in scientific journals (924) or in both PROSPERO and journals (807) has increased over the last three years. Syst Rev and BMJ Open published more than half of the total protocols. While the more productive countries were involved in "unique" and "collaborative protocols", less productive countries only participated in "collaborative protocols" that were mainly published in PROSPERO. Our results suggest that, although most countries were involved in solitary production of protocols for non-Cochrane SRs during the study period, it would be useful to develop new strategies to promote international collaborations, especially with less productive countries.

Ovule discounting in an outcrossing, cryptically dioecious tree.

Ovule discounting denotes the reduction in the number of ovules available for cross-fertilization due to the interference of inferior pollen. Traditionally, ovule discounting has been discussed solely from the perspective of compromised outcrossing opportunities as a result of selfing, but the principle is more general. Here, we extend its applicability beyond the simple contrast between selfing and outcrossing by showing that, in the cryptically dioecious tree species Fraxinus ornus, ovule discounting through frequent outcrossing with inferior fathers also constitutes a substantial cost of mating. In F. ornus, hermaphrodites produce pollen capable of siring offspring, but these offspring are less viable than those sired by males and are inferred to produce few, if any, surviving progeny. In this paper, we used microsatellite markers to analyze the mating system and paternity in a wild population of F. ornus. We found that the effective number of sires per mother was low (N(ep) = 2.93 to 4.95), and that paternity was correlated among progeny sampled from the same mother, but not among progeny sampled from neighboring mothers. Despite the existence of a local spatial genetic structure (up to 30 m), we found no evidence of biparental inbreeding. There was negligible selfing by hermaphrodites, but they sired approximately one fourth of the seeds produced by other hermaphrodites. Given that these progeny are not inferred to reach reproductive maturity, this constitutes a substantial cost of ovule discounting in the broad sense. We discuss the possible reasons for why hermaphrodites invest resources into inferior pollen.

Paternal effects on functional gender account for cryptic dioecy in a perennial plant.

Natural selection operates on the mating strategies of hermaphrodites through their functional gender, i.e. their relative success as male versus female parents. Because functional gender will tend to be strongly influenced by sex allocation, it is often estimated in plants by counting seeds and pollen grains. However, a plant's functional gender must also depend on the fate of the seeds and pollen grains it produces. We provide clear evidence of a paternal effect on the functional gender of a plant that is independent of the resources invested in pollen. In the Mediterranean tree Fraxinus ornus, males coexist with hermaphrodites that disperse viable pollen and that sire seeds; the population would thus appear to be functionally androdioecious. However, we found that seedlings sired by hermaphrodites grew significantly less well than those sired by males, suggesting that hermaphrodites may be functionally less male than they seem. The observed 1 : 1 sex ratios in F. ornus, which have hitherto been difficult to explain in the light of the seed-siring ability of hermaphrodites, support our interpretation that this species is cryptically dioecious. Our results underscore the importance of considering progeny quality when estimating gender, and caution against inferring androdioecy on the basis of a siring ability of hermaphrodites alone.