Introduction: Staphylococcus aureus skin infection is an almost ubiquitous feature of patients with atopic dermatitis (AD). TLR1, 2 and 6 are important in immune sensing of these bacteria. The aim of this study was to determine whether defects in TLR1, 2 and/or 6 expression/function may explain the propensity to infection in humans and the NC eczema mouse model. Methods: Fibroblast cell lines from severe AD, nonatopic controls, and mouse embryonic fibroblasts (MEFs) from the NC, MSM/Ms wild-type strain and a 3T3 control strain TLR1, 2 and 6 expression were measured by qPCR and FACS. IL-6, TNF-α, TSLP and IL-33 production was measured by qPCR and ELISA at baseline and after stimulation with LPS, HKSA and a live strain of Staphylococcus aureus that produced only SEB. Results: No differences were found in either TLR expression or function in human fibroblasts derived from patients and controls. The MSM/Ms MEFs expressed significantly more TLR1 and 2, as well as exhibited high inflammatory profile after stimulation comparing with 3T3 and the NC MEFs. Live Staphylococcus aureus, but not HKSA, LPS or SEB, was a potent stimulus for the Th2-inducing cytokines (TSLP and IL-33), and induce cell death. Cytokines levels were found to be similar in AD and NC MEFs when compared to healthy controls. Conclusion: Eczema in both the human and NC mouse is not associated with abnormalities in fibroblasts TLR1, 2, and 6. Live, but not killed Staphylococcus aureus or its enterotoxin, is a potent inducer of TSLP and IL-33 in both species.

Occupational skin diseases is one of the most commonest occupational disease groups accounting for about a fifth of all occupational diseases in the UK. Current guidance from the HSE for skin health surveillance is the skin inspection by a responsible person in the workplace. The use of teledermatology can be attractive to reliably conduct skin surveillance in the workplace, and a tool box to take reproducible standardised photographs from the hands of workers in the workplace was developed. Aim of this thesis was to assess diagnostic accuracy and validity of this toolkit with visual inspection as criterion standard for the presence of minor or major hand dermatitis and by scoring the hands and photographs with the validated Hand Eczema Severity Index. Workers from four different occupations were recruited over a 7 month period and 332 workers were assessed on a repeatedly basis producing 1212 assessments. Skin hydration and transepidermal water loss was measured and a symptoms questionnaire was completed by every participant. A high prevalence of skin problems was found in our study: 70% of the participants presented at least once over the study period with minor or major skin symptoms. A high intrarater reliability compared to the visual assessment was shown for the teledermatologic assessment with an agreement of 88%, kappa of 0.79, and a positive likelihood ratio of 7.4 and negative likelihood ratio of 0.07; about 5% of participants with normal skin were over-diagnosed compared to the visual inspection. The interrater reliability was low. The biophysical parameter did not distinguish between normal and affected skin. The tool kit has shown to produce reliable and standardised high quality photographs, the assessment of the photographs showed a very good intrarater agreement to the criterion standard. The toolkit would allow regular skin surveillance with minimal interruption in the workplace and with reliable results from the assessment.

Over the past four years, a previously unrecognised family of innate effector cells has been identified. Their comprehensive functional capabilities range from lymphoid organogenesis, tissue remodelling, wound healing, immune protection and homeostasis to contribution to inflammation and allergic responses. Here we investigate the presence and function of type 2 innate lymphoid cells (ILC2) in the skin. We show that human ILC2 are resident in human skin and express RORA and GATA3, and skin homing receptors. ILC2 further infiltrate the skin after allergen challenge, where they produce the type 2 cytokines IL-5 and IL-13. Skin-derived ILC2 express the IL-33 receptor ST2, which is up-regulated during activation. Signalling via IL-33 induces type 2 cytokine and amphiregulin expression, and increases ILC2 migration. Atopic dermatitis (AD) is a chronic inflammatory skin disorder. Current evidence suggests that both skin barrier dysfunction and immune system abnormalities, particularly those of a type 2 phenotype, contribute to disease pathogenesis. We demonstrated that ILC2 are enriched in lesional skin biopsies from atopic patients and show higher expression of cytokine receptors, reflecting an activated phenotype. Down-regulation of E-cadherin is characteristic of filaggrin insufficiency, a cardinal feature of AD. Interestingly, E-cadherin binding to KLRG1 on human ILC2 dramatically inhibits IL-5 and IL-13 production. ILC2 may contribute to increases in type 2 cytokine production in the absence of the inhibitory E-cadherin ligation through this novel mechanism of barrier sensing. CRTH2, a receptor for prostaglandin D₂ (PGD₂), is expressed by human ILC2. However, the function of CRTH2 in these cells is unclear. We sought to determine the role of PGD₂ and CRTH2 in human ILC2 and compare it with that of the established ILC2 activators IL-25 and IL-33. PGD₂ binding to CRTH2 induced ILC2 migration and production of type 2 cytokines IL-4, IL-5, IL-13 and release of other pro-inflammatory cytokines IL-3, IL-8, IL-9, IL-21, GM-CSF, and CSF-1 in a dose-dependent manner. ILC2 activation through CRTH2 also upregulated the expression of IL-33 and IL-25 receptor subunits (ST2 and IL-17RA) suggesting a synergistic role. The effects of PGD₂ on ILC2 could be mimicked by the supernatant from activated human mast cells and inhibited by a CRTH2 antagonist. Therefore, PGD₂ can be considered as an important and potent activator of ILC2 through CRTH2 mediating strong inflammatory responses. Cell surface interaction mechanisms that activate ILC2 function are unknown. We observed the expression of NKp30 on ILC2 ex vivo and after culture. Using quantitative PCR we confirmed that ILCs express NKp30c splice variant, an immune-modulatory isoform. Incubation of ILC2 with the NKp30 ligand B7H6 and tumour cell lines expressing this protein induced production of type 2 cytokines. This interaction can be inhibited by NKp30 blocking antibodies. We further established that activation of NKp30 induces the canonical pathway of NFƙB signalling. Overall the work in thesis shows for the first time that ILC2 are resident in human skin and infiltrate rapidly after allergen challenge and in AD lesional skin. We have defined cytokine and lipid mediators that contribute to migration and activation of ILC2 and shown that KLRG1 and NKp30 act as inhibitory and activatory receptors respectively. The work defines novel pathways for barrier sensing and cutaneous inflammation, and identifies potential new targets for therapeutic intervention.

Se han revisado 37408 historias clínicas, para determinar la frecuencia de la dermatitis alérgica por la picadura de pulga (DAPP) y la distribución de las variables edad, sexo, raza y tipo de pelaje de los pacientes caninos que fueron llevados para consulta por primera vez a la Clínica Veterinaria de Animales Menores de la Facultad de Medicina Veterinaria de la Universidad Nacional Mayor de San Marcos, durante el período 2000 - 2004. Del total de historias clínicas, se encontró a 5.3% (1981/37408) de pacientes con dermatitis, de éstos el 16.4% (324/1981) fueron diagnosticados con dermatitis alérgica por picadura de pulga (DAPP) clínicamente. Las historias clínicas reportan lesiones características de la enfermedad constituidas en su mayoría por erupciones papulocostrosa, alopecia en la base de la cola, como consecuencia del auto traumatismo, asociada a la presencia de pulgas. Además, el mayor número de casos con DAPP se encontró en animales de raza pura (197/324), de 1 a 7 años de edad (243 de 324), de pelo medio (103 de 197) y sexo macho (177 de 324). Palabras Claves: Caninos, frecuencia, dermatitis alérgica por picadura de pulga (DAPP). / --- To determine the frequency of allergic dermatitis by flea bite and the distribution of 37408 cases according to age, sex, breed and type of hair coat of dogs clinically observed for the first time in the Samall Animal Clinic of the School of Veterinary Medicine of San Marcos University during the 2000 and 2004 period were reviewed. The were 5.30% (1981/37408) of patient with dermatitis and form them a 16.4% (324/1981) were allergic dermatitis by flea bite. Different characteristic skin lesions as popular crusted eruptions, alopecia of the tail as a consequence of auto traumatism associate to flea bite. Besides, the higher cases of allergic dermatitis by flea bite of pure breed (197 of 324) with croos breed dogs, from 1 to 7 years old (243 of 324), median hair coat (103 of 197) and males (177 of 324). Key Words: Canine, frequency, allergic dermatitis by flea bite.

Vaccinia virus (VACV) is primarily known as a vaccine against its relative variola virus, the causative agent of smallpox. In the seventies of the 20th century, the vaccination campaign with VACV led to eradication of smallpox. Consequently, vaccination of the general population was stopped. Currently, the vaccination was reintroduced, namely among army and healthcare professionals. However, vaccination with VACV is accompanied with a high incidence of vaccination-related complications, namely among immunocompromised individuals. One of the complications is eczema vaccinatum, occuring in patients with atopic dermatitis. The laboratory of Dr. Melkova has focused on development of a model of eczema vaccinatum in mice Nc/Nga and on studies of pathogenesis of this complication. The goal of my diploma thesis is to contribute to characterization of imunopathogenesis of eczema vaccinatum in mice Nc/Nga infected either with VACV strain Western Reserve (WR) or with a recombinant VACV with the integrated cDNA for IRF-3 (Interferon Regulatory Factor 3; WR-IRF3). IRF-3 regulates the expression of interferon type I in response to viral infection. This recombinant virus has been constructed in the laboratory of Dr. Melková. The objective of my work was to verify the expression of the integrated cDNA for IRF-3 and to...

Orientador: Luiz Henrique de Araújo Machado / Resumo: Dermatite atópica (DA) canina é uma enfermidade alergoinflamatória de caráter crônico, da pele e orelha externa, geralmente de cães adultos jovens, induzida por distintos alérgenos. A afecção tem etiopatologia complexa e ainda não totalmente elucidada, dificilmente atingindo cura. Porém, há hoje, várias opções medicamentosas para o seu controle. O oclacitinib faz parte da recente remessa de medicamentos para tratamento e controle do prurido dos cães atópicos, com poucos efeitos colaterais. É um fármaco inibidor de janus quinase, com rápida ação e que age na ligação das citocinas aos receptores JAKs. Este trabalho teve como intuito avaliar a resposta inflamatória da pele de animais atópicos, antes e 30 dias após o tratamento com Oclacitinib comercial (Apoquel®), através da mensuração das interlucinas IL-1, IL-4, IL-6, IL-10, IL-17, IL-31, TNF-, IFN- e filagrina, pela técnica de imuno-histoquímica, além da resposta clinica ao tratamento pela avaliação do CADESI-4 e escore do prurido. Os 10 cães utilizados no estudo são provenientes do atendimento dermatológico do HV da UNESP-Botucatu e clínica particular de Sorocaba-SP. Apenas os escores do CADESI-4, do prurido e da IL-1, citocina inflamatória chave da imunidade inata e na patogênese da DA, apresentaram redução na análise estatística. Concluise que a IL-1 pode ter um papel importante na farmacocinética do oclacitinib e maiores estudos são necessários para confirmar a ação do oclacitinib sobre a produção e ligação da IL-1 aos ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Canine atopic dermatitis (DA) is a chronic inflammatory alergo disease of the skin and external ear, usually of young adult dogs, induced by distinct allergens. The disease has complex and still not fully elucidated etiopatology, hardly reaching cure. However, there are today several drug options for your control. Oclacitinib is part of the recent consignment of medications for treatment and control of the itching of atopic dogs, with few side effects. It is an inhibitor drug of Janus Kinase, with rapid action and acting in the binding of cytokines to jaks receptors. The objective of this work was to evaluate the inflammatory response of the skin of atopic animals before and 30 days after treatment with commercial oclacitinib (Apoquel®), through the measurement of interlukines il-1, IL-4, IL-6, IL-10, IL-17, IL-31, TNF-α, IFN-γ and Filagrin, by immunohistochemistry technique, in addition to clinical response to treatment by evaluation of Cadesi-4 and pruritus score. The 10 dogs used in the study are from the dermatological treatment of HV of UNESP-Botucatu and private Clinic of Sorocaba-SP. Only the scores of Cadesi4, pruritus and IL-1, the key inflammatory cytokine of innate immunity and the pathogenesis of DA, showed a reduction in the statistical analysis. It is concluded that IL-1 may play an important role in the pharmacokinetics of oclacitinib and further studies are needed to confirm the action of oclacitinib on the production and binding of IL-1 to cutaneous receptors... (Complete abstract click electronic access below) / Mestre

Dermatite atópica (DA) é uma dermatose inflamatória, de caráter crônico e recidivante, com alta prevalência mundial, caracterizada por eczema localizado ou generalizado, xerose cutânea e prurido intenso, mais comum em crianças, porém podendo acometer adultos, muitas vezes prejudicando de forma considerável a qualidade de vida dos pacientes e seus familiares. O diagnóstico de alergia inclui testes in vivo (testes cutâneos de hipersensibilidade imediata ou prick test) e testes in vitro com mensuração de anticorpos IgE no sangue. Está disponível método para detecção de alergia baseado no princípio de diagnóstico por componentes, o ImmunoCAP Immunosorbent Allergen CHIP (ImmunoCAP-ISAC) que marca a transição para o diagnóstico molecular de alergia. No presente estudo, tivemos por objetivos determinar o perfil de resposta IgE a alérgenos purificados, naturais ou recombinantes, em pacientes adultos com DA e comparar o valor do diagnóstico de alergia por componentes com métodos diagnósticos existentes. Foram selecionados 39 pacientes adultos com DA dentre aqueles Atendidos nos Ambulatórios de Alergia e Dermatologia do HCFMRP-USP. A idade dos pacientes variou de 14-66 anos (média ± DP 34,3 ± 2.1 anos), 64% mulheres. O tempo médio de doença foi de 16 anos. SCORAD médio foi de 36,6 (2-90). Média geométrica (MG) de IgE total foi 1,963 kU/L (24-63,000 kU/L). Alérgenos de ácaros foram dominantes, com sensibilização a Der p1 e a Der f1, Der p2 e Der f2 em 82% e 85% dos pacientes, com MG 27,6; 50; 39,2; 45,4 ISU-E respectivamente, seguidos de gato (38%), cachorro (36%) e pólen de gramíneas (36%). IgE para alérgenos de baratas, fungos, pólen de árvores, látex e veneno de insetos foi encontrada em menos de 20% dos pacientes em baixos níveis. Sensibilização para castanhas (33%) e camarão (31%) foram os alérgenos mais prevalentes entre os alimentos, enquanto a reatividade IgE para leite e ovo esteve presente em 10% ou menos dos pacientes, com baixos níveis de anticorpos IgE na maioria dos casos. Apenas 6 pacientes (15,4%) apresentaram IgE para o panalérgeno tropomiosina, e 3/39 (7,7%) foram negativos para todos os 112 componentes de alérgenos testados no ImmunoCAP-ISAC, com níveis de IgE total de 24, 38,7 e 156 kU/L. Concluímos que o perfil de sensibilização IgE entre os pacientes adultos com dermatite atópica difere daquele entre os pacientes com alergiarespiratória, apresentando menos sensibilização para baratas e para o panalérgeno tropomiosina, e difere ainda do perfil presente em crianças com DA, com predomínio de sensibilização IgE a castanhas e camarão, e baixa taxa de sensibilização a alérgenos de leite de vaca e ovo. / Atopic dermatitis (AD) is an inflammatory, chronic, relapsing dermatosis with a high global prevalence characterized by localized or generalized eczema, cutaneous xerosis and intense pruritus, more common in children, but it can affect adults, often causing considerable damage to the quality of life of patients and their families. The diagnosis of allergy includes in vivo tests (skin tests of immediate hypersensitivity or prick test) and in vitro tests with measurement of IgE antibodies in the blood. An allergy detection method based on the principle of component diagnosis is available, ImmunoCAP Immunosorbent Allergen CHIP (ImmunoCAP-ISAC), and marks the transition to the molecular diagnosis of allergy. In the present study, we aimed to determine the IgE response profile to purified, natural or recombinant allergens in adult patients with AD and to compare the value of component allergy diagnosis with existing diagnostic methods. Thirty-nine adult patients with AD were selected from among those attending the Outpatient Clinic of Allergy and Dermatology at HCFMRP-USP. The age of the patients ranged from 14-66 years (mean ± SD 34,3 ± 2.1 years), 64% women. The mean duration of illness was 16 years. SCORAD mean was 36,6 (2- 90). Geometric mean (GM) of total IgE was 1,963 kU / L (24-63,000 kU / L). Mite allergens were dominant, with sensitization to Der p1 and Der f1, Der p2 and Der f2 in 82% and 85% of the patients, with GM 27,6; 50; 39.2; 45.4 ISU-E respectively, followed by cat (38%), dog (36%) and grass pollen (36%). IgE for cockroach, fungus, tree pollen, latex and insect venom allergens was found in less than 20% of patients at low levels. Sensitization to nuts (33%) and shrimp (31%) were the most prevalent allergens among foods, while IgE reactivity to milk and egg was present in 10% or less of the patients, with low levels of IgE antibodies in most cases. Only 6 patients (15.4%) presented IgE for the pan-allergen tropomyosin, and 3/39 (7.7%) were negative for all 112 allergen components tested on ImmunoCAP-ISAC, with total IgE levels of 24; 38,7 and 156 kU / L. We concluded that the IgE sensitization profile among adult patients with atopic dermatitis differs from that among patients with respiratory allergy, presenting less sensitization to cockroaches and to the pan-allergen tropomyosin, andalso differs from the profile present in children with AD, with a predominance of IgE sensitization to nuts and shrimp, and low sensitization rate to cow\'s milk and egg allergens.

Orientador: José Antonio Marques / Coorientador: Sérgio Britto Garcia / Banca: Deborah Penteado Martins Dias / Banca: Paulo Aléscio Canola / Resumo: A Dermatite Digital Bovina (DDB) constitui uma das principais causas de graus elevados de claudicação em bovinos leiteiros, em função da dor que estes animais aparentam frente ao estímulo nocioceptivo. A hiperalgesia em alguns casos de dor crônica está relacionada à expressão exacerbada de fibras dos receptores vaniloides TRPV1, podendo haver forte correlação com casos crônicos da DDB. No presente estudo foram utilizados 15 bovinos, fêmeas, da raça Holandesa Preto e Branco, com idades de 2 a 7 anos, em lactação com pico médio de 47,85 L, mantidos em regime "free-stall". Durante o casqueamento realizado na propriedade, as lesões da DDB foram identificadas e divididas em quatro grupos, referentes aos quatro estágios da doença (inicial M1, clássico M2, intermediário M3 e crônico M4). Foram coletadas biópsias por meio de "punch" cutâneo (4mm). Além das lesões foram coletadas amostras de pele sadia de cada animal. Priori às biopsias realizou-se a dimensionamento das lesões, para média comparativa entre os estágios. Os fatores predisponentes ao aparecimento de lesões (idade, número de partos e pico de lactação) foram considerados. As biopsias foram processadas em laboratório e colocadas frente à reação imunológica com anticorpos anti-TRPV1 (Chemicon -USA). Posteriormente as fibras imuno-marcadas nos quatro grupos e pele sadia foram contabilizadas e comparadas. As dimensões das lesões foram analisadas pelo método estatístico descritivo e possuíam média de comprimento e largura no es... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Bovine Digital Dermatitis (BDD) is one of the main cause on high claudication levels at the dairy cattle, as a result of the pain that appear in those animal front of the nociceptive stimulus. Hyperalgesia in some chronic pain cases is related to the exacerbated expression of vanyloid TRPV1 fibers, and may have a hole on the chronic cases of BDD. In the present study, 15 Black and White Holstein cow was used, aged 2 to 7 years old, during lactation with mean peak of 47.85L, kept in the free-stall under the same diet. BDD lesions were identified and divided into 4 stages of the disease (initial M1, classic M2, intermediate M3 and chronic4), which skin are collected by dermal punch (4mm). In addition to the lesions, healthy skin samples were collected from each animal. Prior to the biopsies, the lesion dimensions were taken, for comparative average between the stages. Predisposing factors to the lesions appearance (age, number of births and lactation peak) were considered. The biopsies were processed at the laboratory and reacted with anti-TRPV1 antibodies (Chemicon -USA). The immuno-marked fibers in the four groups and healthy skin were counted and compared. The lesion dimensions were analyzed by descriptive statistical method and had a M1 mean length/ width on M1 of 5,60mm±3,20 x 4,4±1,34mm, M2 of 12,60±6,46mm x 14,4±8,87mm, M3 of 21,60±3,36mm x 17,20±6,61mm and M4 of 21,60±3,36mm x 24,57±7,32mm. The thickness mean value in M1 of 1.80 ± 1.09mm, M2 of 6.20 ± 2.16mm, M3 of 7.40 ± 6.54mm and M4 of 8.85 ± 4.14mm. The predisposing factors results were analyzed separately with the number of lesions by Pearson Correlation statistic method (p <0.05). There was difference between more lesion and birth numbers. TPV1 fiber counts were analyzed by logarithmic scale (p <0.05), with a significant difference between the M4 group (chronic stage of DDB) and the other groups. / Mestre

Background: Staphylococcus aureus is an important trigger of flares in atopic dermatitis. The exact mechanisms by which S. aureus induces inflammatory responses and cell death in the skin epithelium is unclear. The aim of this thesis was to elucidate the cellular and molecular mechanisms by which S. aureus induces it's pathogenic effects on keratinocyte and fibroblast cell lines. Methods: Human keratinocytes (HEKa), and mouse embryonic fibroblasts (MEF) from the NC/Nga dermatitis prone mouse strain were used to investigate the induction of Th2-promoting cytokines (IL-33 and TSLP) and cell death by S. aureus. Cytokine levels were measured by ELISA and cytotoxicity by flow cytometry. Results: Live, but not killed S. aureus or other staphylococcal species, induced release of Th2-promoting cytokines (IL-33 and TSLP) and necrosis in both human and mouse cell lines. Cytokines were not induced by TLR2 ligands, and anti-TLR2 antibodies did not inhibit release, suggesting that the TLR2 pathway was not involved. By contrast, the release of cytokines was induced by a secreted, heat-labile factor/s and could be blocked by protease and PAR2 inhibitors, suggesting that the protease-PAR2 pathway was critical. NC/Nga mouse fibroblasts that lacked soluble IL-33 (sST2) receptor were more sensitive to the effects of S. aureus than control MEF. Conclusions: S. aureus is unique amongst staphylococcal species in it's ability to induce an inflammatory response and cytotoxicity in human keratinocytes and mouse fibroblasts. The protease-PAR2 pathway is critical to this bioactivity. Development of specific inhibitors of this pathway may provide novel therapies for treating S. aureus -induced eczema flares.

Publicación a texto completo no autorizada por el autor / Determina las manifestaciones clínicas atípicas de dermatitis atópica de los pacientes atendidos en el servicio de pediatría del Hospital Nacional Daniel Alcides Carrión. Callao – 2014. Este trabajo es de nivel cuantitativo, descriptivo de corte transversal. Se trabaja con una muestra no probabilística por conveniencia representada por 35 pacientes pediátricos. Se elabora una ficha de datos, donde se consigna las formas clínicas atípicas de la dermatitis atópica que son identificadas de acuerdo a las características de la lesión observada. Se determina la frecuencia de las lesiones, así como su asociación con el grupo etario y sexo. La severidad es medida de acuerdo al SCORAD. Se evidencia que de las manifestaciones clínicas diseminadas de dermatitis atópica, predomina el tipo numular con el 40% (14) seguido de pitiriasis alba con 31% (11) y tipo prurigo con el 26% (9). En las manifestaciones clínicas localizadas, se tiene que el 54% (19) son fisuras, seguido de eccema de dedos 43% (15) y queilitis 23% (8). En ambos sexos predomina la variedad clínica localizada tipo fisura, siendo de 31%(11) en el sexo femenino y 23%(8) en el masculino. La forma clínica diseminada tipo prurigo con 25.7% (9) es la más frecuente en el sexo masculino y la pitiriasis alba es la forma más frecuente 20% (7) en el sexo femenino. La mayor parte de la muestra presenta un SCORAD leve 77% (27). Concluye que la manifestación clínica más frecuente de dermatitis atópica en el Hospital Carrión es la tipo fisura con 54% (19), predominando en el sexo femenino, además este se asocia a un SCORAD moderado. / Tesis