Tag Archives: Inflammatory disorders

Microbiology

Scabies: What it is, symptoms, treatment and more

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Talk about the stuff of nightmares. You have extremely itchy skin at bedtime, not to mention a pimple-like rash. What is it?

Those are fairly clear signs of scabies, a microscopic parasitic infestation where burrow under your and lay eggs there.

Scabies infection comes from prolonged contact, not just a quick brush against someone else’s skin. It can also be passed through bedding or clothing.

“Anyone who is diagnosed with scabies, as well as his or her sexual partners and other contacts who have had prolonged skin-to- with the infested person, should be treated,” the U.S. Centers for Disease Control and Prevention advises.

This “human itch mite” lives and lays eggs in the upper layer of the skin, according to the CDC.

About 200 million people worldwide have scabies at any one time, including up to 10% of children in , according to the World Health Organization.

Once the eggs hatch, the larvae can travel to the skin’s surface, spreading to other areas or other people, according to the Mayo Clinic.

What does scabies look like? It may resemble hives, tiny bites, knots under the skin or even eczema-like scaly patches, according to the American Academy of Dermatology (AAD). Sores may develop from scratching.

Under magnification, the mite is creamy-white, has eight legs and a round body. It is roughly the size of a needle tip, according to the Cleveland Clinic.

A doctor can best do this, but signs can include the rash and intense itching that worsens at night.

Mites are most commonly found between the fingers, around the fingernails, on elbows, wrists, at the belt line, in the genital area and around the nipples, according to the AAD.

Sometimes children will have an all-over rash, including their scalp. Infants typically have it on the palms and soles, according to the AAD.

Although scabies is contagious, children can typically return to school the day after treatment, according to an article recently published by HealthDay.

A severe form called crusted scabies, or Norwegian scabies, leads to widespread crusts on skin with hundreds or thousands of mites, instead of 15 or 20. It can impact someone with a weakened immune system, according to the AAD.

Scabies is commonly spread between or among members of the same household.

Crowded conditions can also contribute, according to the CDC. Outbreaks are common in nursing homes, prisons and child care facilities.

What causes scabies? It’s a mite known as Sarcoptes scabiei var hominis.

Incubation time ranges from just one to four days if you’ve had scabies before to four to eight weeks, the CDC said.

Scabies cause an “intense, unbearable itch,” according to a report published recently in the journal Frontiers in Medicine. This is caused directly by the mites and the body’s immune response to them.

A later rash can look like lines on the skin that are grayish or skin-colored, according to the Cleveland Clinic.

Scratching too much can cause a skin infection, such as impetigo, according to Mayo Clinic. Untreated scabies can even lead to complications such as chronic kidney disease, according to the Frontiers in Medicine report.

Scabies medications include creams and pills, according to the Mayo Clinic. The condition won’t resolve without treatment.

What is a good treatment for scabies? Apply a prescription cream that contains permethrin to clean skin on the entire body, including palms and soles of the feet. Children may also need it on the scalp.

Leave the cream on for eight to 14 hours before washing it off, the Cleveland Clinic advised.

The veterinary drug ivermectin, which gained fame during the pandemic as a failed treatment for COVID-19, can be used in small doses to treat parasites, according to a recent HealthDay story.

Just last summer, in the Solomon Islands initiated a mass rollout of ivermectin to treat an outbreak of scabies among children there.

“Scabies affects everyone, especially ,” Sarah Andersson, program manager of the rollout, said in a Murdoch Children’s Research Institute news release. “Rolling out the treatment for scabies to all communities in the Solomon Islands at the same time will contribute significantly to stopping the spread of scabies and preventing this debilitating condition.”

Ivermectin is given in two doses separated by a week or two under a doctor’s guidance. It shouldn’t be used by someone who is pregnant or lactating or in children weighing less than 35 pounds, according to the Cleveland Clinic.

Bumps and itching may persist for up to four weeks even though the mites are dead. Antihistamines can help with the itching, the Cleveland Clinic noted. Anyone who has had close contact with a person infected with scabies should also be treated.

Wash clothing and bedding in hot water followed by a hot dryer. Vacuum carpets and furniture well, especially if someone has had crusted scabies, the CDC recommends.

Copyright © 2023 HealthDay. All rights reserved.

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Microbiology

AI model differentiates scalp psoriasis from seborrheic dermatitis

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A deep learning (DL) model based on dermatoscopic images can differentiate scalp psoriasis from seborrheic dermatitis, according to a study recently published in Frontiers in Medicine.

Zhang Yu, from Inner Mongolia Medical University in Hohhot, China, and colleagues developed a new diagnostic method for discriminating scalp psoriasis and seborrheic dermatitis based on a DL model. A total of 1,358 pictures from 617 with pathological and diagnostic confirmed (508 cases of psoriasis; 850 cases of seborrheic dermatitis) were randomly allocated into training, validation, and testing datasets (1,088, 134, and 136, respectively). The transfer learning technique was used to establish and train a DL model for differentiating the two diseases.

The researchers found that the DL model exhibited good sensitivity and specificity (96.1 and 88.2 percent), with an area under the curve (AUC) of 0.922. Compared with five dermatologists with various levels of experience, the DL model outperformed them for diagnosis of scalp psoriasis and seborrheic dermatitis. Comparable diagnostic performance can be achieved for nonproficient doctors with the assistance of the DL model and dermatologists proficient in dermoscopy.

Diagnostic performance was improved for one dermatology graduate student and two , with the AUC values increasing from 0.600, 0.537, and 0.575 to 0.849, 0.778, and 0.788, respectively; consistency of diagnosis was also improved with the kappa values increasing from 0.191, 0.071, and 0.143 to 0.679, 0.550, and 0.568, respectively.

“The DL can prevent the delay of patients’ treatment, tackle the development of the disease course, and improve the prognosis when encountering patients with ambiguous diagnoses,” the authors write.

Copyright © 2023 HealthDay. All rights reserved.

More information:
Zhang Yu et al, A deep learning-based approach toward differentiating scalp psoriasis and seborrheic dermatitis from dermoscopic images, Frontiers in Medicine (2022). DOI: 10.3389/fmed.2022.965423

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Microbiology

Review underscores links between climate change and nose and sinus conditions

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In a new review article, Johns Hopkins Medicine experts and collaborators across the U.S. emphasize that climate change—particularly global warming—is contributing to an increase in the rates and to greater severity of nasal and sinus diseases, such as seasonal allergies—conditions that affect 2 billion people worldwide.

The full review was published Dec. 28 in the journal International Forum of Allergy & Rhinology. Over 100 articles, spanning more than two decades of research, were selected for inclusion in the review.

The authors synthesized these studies to argue, and to add to already existing evidence, that rising and prolonged levels of humidity, increased levels of allergens (such as pollen), and delayed or early onset of seasons are contributing to a rising number of cases of allergic and nonallergic nasal and sinus diseases. These conditions include congestion and , chronic sinusitis and fungal sinus infections. The authors caution that among will widen gaps in health care access and exacerbate severity of these conditions.

The authors also advise using diverse and inclusive clinical and translational research approaches to design methods for diagnosis and treatment, as well as informing patients and the public about symptoms and treatments.

Corresponding and lead author Jean Kim, M.D., Ph.D., an associate professor and otolaryngologist at Johns Hopkins, says she and her collaborators view this article as a guide and call to action.

“Allergic and nonallergic diseases that affect the upper airways are gateway conditions to potentially more serious disorders of the respiratory system, including the diseases of the lower airways,” says Kim. “We’re hoping this will be a springboard for more collaboration among providers and our health care system so we can continue to advocate for these patients.”

More information:
Jean Kim et al, Climate change, the environment, and rhinologic disease, International Forum of Allergy & Rhinology (2022). DOI: 10.1002/alr.23128

Johns Hopkins University

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Microbiology

Scientists find that microRNA affects inflammation in lupus disease.

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A group of researchers from the Graduate School of Medicine at Nagoya University in Japan have discovered the impact of microRNA (miRNA) on inflammation in lupus in mice. They identified two miRNAs that are downregulated in the disease and an uncommon situation that occurs in which multiple miRNAs regulate the same set of genes.

Although the has many types of RNA, the most important is messenger RNA, which is involved in the creation of proteins in the body. The body also contains miRNA, which binds to regions of the messenger RNA to inhibit protein production and regulate several important bodily functions such as development, growth, and metabolism. Problems with miRNA are associated with several diseases including cancer and HIV. Now, the Nagoya University research group has identified the role of miRNA in , a disease in which the human immune system attacks itself. They published their findings in BMC Biology.

Pairing with the correct messenger RNA target is determined by the “seed” of miRNA, a sequence that determines whether the miRNA can bind or not. The seed is like a “key” to the messenger RNA’s “lock.” However, this is complicated by the nature of miRNA’s interaction with messenger RNA as a single particle of messenger RNA may be regulated by multiple miRNAs and the miRNA-messenger RNA pairs do not have to be an exact match to exert an effect.

As the effects of a single miRNA on a binding receptor site tend to be modest, stronger effects are often regulated by multiple miRNAs working in concert. This occurs through two processes. The first of these processes is “neighborhood” miRNA co-targeting, where two nearby miRNAs affect messenger RNA. The second, is “seed overlap” miRNA co-targeting, which is similar to the neighborhood type except both have similar nucleotides, so they bind to messenger RNA in such a way that some of their nucleotides overlap.

Given that altered miRNA expression has been reported in lupus disease, researchers have long suspected a connection. Now, a group of scientists, headed by Professor Hiroshi Suzuki at the Department of Molecular Oncology, and Lecturer Noritoshi Kato and Researcher Hiroki Kitai at the Department of Nephrology at the Nagoya University Graduate School of Medicine, have performed miRNA expression profiling using mice with lupus to investigate the role of miRNA in the disease.

The researchers found that two microRNAs, miR-128 and miR-148a, were down-regulated in plasmacytoid dendritic cells in lupus patients. As plasmacytoid dendritic cells play a crucial role in antiviral immunity and antibody production, they have been implicated in the initiation and development of several autoimmune and , including lupus. Both miR-128 and miR-148a target a gene called KLF4, which is associated with inflammatory control and the production of cytokines that regulate the activity of the immune system.

“Assuming that the of the other miRNA are maintained, the downregulation of one miRNA can be compensated for by the other microRNA,” Suzuki explains. “However, when two miRNAs decrease simultaneously, as in lupus disease, alterations in their target—in this case KLF4—emerge.”

One of the most important findings of the study was that as miR-128 and miR-148a share common nucleotides, they can bind to messenger RNA using “seed overlap” miRNA co-targeting. “miR-128 and miR-148a target KLF4 through extensive ‘seed overlap’ miRNA cotargeting. In this case, it negatively regulates the production of inflammatory cytokines,” says Suzuki. “Therefore, this study collectively suggests the complexity of different modes of miRNA cotargeting and the importance of their perturbations in human diseases.”

The researchers also performed integrative analyses, discovering that “seed overlap” miRNA cotargeting of KLF4 is a prevalent feature in other species. “We found that the conserved overlap site of KLF4 is the same in most species between humans and Coelacanths,” said Suzuki. “Therefore, we expanded these findings by integratively analyzing seed overlap patterns of all miRNAs and the conservation patterns of ‘seed overlap’ target sites.”

Suzuki and the research team discovered two main conservation classes of miRNA target sites. The first was shared by eutherian mammals, including animals that have a placenta. The second was shared by other animals, including humans and Coelacanths, and has a stronger association with both “seed overlap” and “neighborhood” miRNA cotargeting.

“Our study provides a comprehensive view of ‘seed overlap’ miRNA cotargeting, which is very important for the process by which lupus develops from the viewpoint of gene regulation and miRNA evolution. These findings highlight the importance of miRNA co-targeting in human pathology and the unique evolutionary aspects of miRNA co-targeting and miRNA target site conservation,” Suzuki explains.

Suzuki also sees the potential of his research in treating lupus patients: “Testing for downregulation of the two miRNAs may help identify patients with high level of inflammation who may benefit from specific therapeutic development,” he says.

More information:
Hiroki Kitai et al, Systematic characterization of seed overlap microRNA cotargeting associated with lupus pathogenesis, BMC Biology (2022). DOI: 10.1186/s12915-022-01447-4

Journal information:
BMC Biology

Nagoya University

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Microbiology

Health concepts from PROMs can be classified into five domains for psoriasis

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Health concepts can be categorized into five domains across patient-reported outcome measures (PROMS) assessing health-related quality of life for psoriasis, according to research published online Jan. 10 in JAAD International.

Haya A. Homsi, M.D., M.P.H., from the Cleveland Clinic, and colleagues identified and described the content captured by existing psoriasis PROMs. Thirteen psoriasis-specific, two dermatology-specific, and one generic PROM were assessed, with a total of 284 PROM items.

The researchers found that each item had an average of 2.28 health concepts; across all PROMs, there were 295 unique health concepts. The health concepts could be categorized into 25 subdomains, with five general domains: physical well-being, psychological well-being, social well-being, treatment, and vitality. Social and psychological well-being were the most frequently captured domains (40.5 and 32.4 percent, respectively). For each PROM, there were differences seen in the relative domains included.

None of the PROMs captured all five domains, and some had a relative emphasis on one domain, with Psoriasis Quality of Life Questionnaire-12 and Psoriasis Index Quality of Life emphasizing and Psodisk emphasizing physical well-being.

“PROMs provide valuable information to understand the lived experience of , which can be used to better individualize management in ,” the authors write. “This analysis provides a to guide clinicians and researchers for selecting which PROM is most relevant to their specific needs.”

Copyright © 2023 HealthDay. All rights reserved.

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Microbiology

Cold weather brings irritated skin—here’s how to treat eczema and other skin conditions and when to see a doctor

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In many parts of the U.S., the winter months bring frigid temperatures and drier conditions that can wreak havoc on the skin.

The primary role of the , as the largest organ in the body, is to act as a physical barrier to the external environment. When your skin is healthy, it helps protect you from allergens and infections. But in winter, when the outside temperature and humidity drop, skin can become especially irritated.

We are a dermatologist and a medical student who study a broad range of common skin conditions and the effects of the environment on skin health.

Heading into the winter months, a handful of common dermatological conditions can develop or worsen in response to the cold. These include eczema, chilblains, Raynaud’s phenomenon, cold urticaria and cold panniculitis. All are conditions that can be irritating and uncomfortable, and some are harder to treat than others. So it’s helpful to know when to manage these conditions on your own and when to see a dermatologist.

Eczema is an that causes dry and itchy skin and may be triggered by soaps and detergents, environmental or food allergens, hormonal changes and skin infections. There are numerous types of eczema, which often have overlapping symptoms.

Asteatotic eczema, also known as winter itch, is common in older adults. During the winter months, skin can become drier and, in some instances, cracked, fissured and inflamed.

Severe dryness may lead to itchiness and scratching. In turn, this can create open wounds that may allow allergens and bacteria to penetrate the skin and cause a rash or an infection.

This type of eczema typically occurs on the lower legs, but eruptions can occur anywhere on the skin, such as the trunk, arms and hands.

Keeping the skin hydrated is the primary treatment. Water-based lotions may worsen skin drying, so applying moisturizers with a high oil content—like petroleum jelly, mineral oil or Vaseline—on wet or damp skin is recommended. Hypoallergenic and anti-itch moisturizers designed specifically for eczema are also available.

Although eczema often affects infants, one form affects people 60 and older.

Other tips include replacing long hot baths with quick warm showers, switching to a milder soap, and using a room humidifier if the climate is dry. If itchiness and dryness persist, seek care from a dermatologist, who may prescribe a topical steroid.

Hand eczema may also worsen in the winter as your hands are frequently exposed to cold, dry air. Scaling, fissuring and bleeding on the hands is common. Minimizing exposure to hard or antibacterial soaps, along with using gentle cleansing products followed by applying a petroleum-based unscented moisturizer can improve symptoms.

Chilblains, also known as pernio, are small, itchy patches that can occur when the skin is exposed to cold and damp weather, resulting in swollen and painful bumps that affect the fingers, toes, ears and face. Poor circulation, blood vessel constriction, a history of autoimmune disease and being underweight may predispose people to chilblains.

Afflicted areas are painful, itchy, swollen and usually have a blueish to purple hue. In severe cases, blisters and ulcers may occur. But for most people, the condition tends to spontaneously resolve within one to three weeks.

Until that happens, it’s important to keep affected areas protected from the cold. If the sensitive area starts to blister, or if fevers, muscle aches and chills develop, it’s best to see a dermatologist or physician.

Pseudo-chilblains, also known as “COVID toes,” can be caused by COVID-19 infection. Chilblains associated with COVID-19 resemble the rash in chilblains—painful red to blue-colored nodules on the toes—but it is not specific to winter.

Like chilblains, Raynaud’s phenomenon is a skin condition characterized by an significant constriction of blood vessels in the fingers and toes in response to . The digits may turn red or blue, but they quickly flush red upon rewarming. Afflicted areas may also be numb or painful, and when severe, may develop ulcers.

To treat Raynaud’s phenomenon, it’s necessary to avoid cold-weather exposure. Ideally patients with Raynaud’s should dress for the cold in layers. At a minimum, make sure to wear gloves and insulated footwear. Avoid tobacco, caffeine and decongestants; they may cause blood vessels to constrict more. If symptoms don’t improve quickly—Raynaud’s due to cold typically gets better after only a few minutes—see a dermatologist or your physician, as Raynaud’s phenomenon can also be a manifestation of a more serious systemic disease, including cancer, infections and/or trauma.

Dry, cracked skin can lead to infections.

Cold urticaria is a skin rash believed to be triggered by an autoimmune response, which leads to the release of inflammatory molecules, including histamine.

Soon after the skin is exposed to sudden drops in temperature, wheals—also known as hives—may develop. These are reddish, itchy and swollen areas of skin. Such episodes can last for approximately two hours. Occasionally, other symptoms accompany the outbreak, including headache, chills, shortness of breath, abdominal pain and diarrhea.

People can test for cold urticaria using the ice cube test. This is done simply by placing an ice cube on an area of skin for five minutes; if you have cold urticaria, the skin will raise and itch within five to 15 minutes. Treatment involves avoiding cold exposure and using over-the-counter antihistamines.

For those who have experienced cold urticaria, swimming in cold water can be dangerous, as it can lead to loss of consciousness and drowning.

Cold panniculitis—which appears as enlarged, red and painful nodules on the skin—develops 12 to 72 hours after cold exposure.

Cases of cold panniculitis have been documented in children eating Popsicles and in adults undergoing whole-body cryotherapy, which is often used as treatment for chronic inflammatory conditions such as rheumatoid arthritis, or for improving post-exercise recovery.

Cold panniculitis is more common during childhood and usually resolves on its own by avoiding cold exposure and direct contact with frozen products.

Symptoms from winter skin conditions are often self-limiting and resolve on their own with adequate protection from the cold. But if symptoms do not resolve, you should see a licensed dermatologist, as cold-induced rashes may be a sign of a more concerning underlying health condition.

If visiting your dermatologist in person proves difficult, you may consider seeing a dermatologist virtually, as many and private practices now offer telehealth dermatology.

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation

The Conversation

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Microbiology

Study links specific outdoor air pollutants to asthma attacks in urban children

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Moderate levels of two outdoor air pollutants, ozone and fine particulate matter, are associated with non-viral asthma attacks in children and adolescents who live in low-income urban areas, a study has found. The study also identifies associations between exposure to the two pollutants and molecular changes in the children’s airways during non-viral asthma attacks, suggesting potential mechanisms for those attacks. The observational study is one of the first to link elevated levels of specific outdoor air pollutants in particular urban locations to distinct changes in the airways during asthma attacks not triggered by respiratory viruses, according to the investigators. The findings were published today in the journal The Lancet Planetary Health.

“The strong association this study demonstrates between specific air pollutants among children in impoverished urban communities and non-viral asthma attacks further augments the evidence that reducing air pollution would improve ,” said Hugh Auchincloss, M.D., acting director of the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH.

The study was conducted by the Inner City Asthma Consortium under the leadership of Matthew C. Altman, M.D., M.Phil., and Daniel J. Jackson, M.D.

Asthma is caused by chronic inflammation of the airways. During an asthma attack, the airway lining swells, muscles around the airways contract, and the airways produce extra mucus, substantially narrowing the space for air to move in and out of the lungs. Children who live in urban environments in the United States are at particularly high risk for attack-prone asthma. Asthma attacks provoked by respiratory virus infections—a common trigger—have been studied extensively, but those that occur independently of such infections have not.

In the current study, investigators examined the relationship between air pollutant levels and asthma attacks occurring in the absence of a respiratory virus among 208 children ages 6 to 17 years who had attack-prone asthma and lived in low-income neighborhoods in one of nine U.S. cities. Then the researchers validated the associations they found between air pollutant levels and non-viral asthma attacks in an independent cohort of 189 children ages 6 to 20 years with persistent asthma who also lived in low-income neighborhoods in four U.S. cities.

The investigators followed the children prospectively for up to two respiratory illnesses or approximately six months, whichever came first. Each illness was classified as viral or non-viral and as involving an or not. The researchers matched each illness with air quality index values and levels of individual air pollutants recorded by the Environmental Protection Agency in the relevant city on the dates surrounding the illness. The investigators subsequently adjusted their data for city and season to decrease the impact of these variables on the findings.

The scientists found that asthma attacks had a non-viral cause in nearly 30% of children, two to three times the proportion seen in non-urban children, according to previously published reports. These attacks were associated with locally elevated levels of and ozone in outdoor air. The investigators linked changes in the expression of specific sets of genes that play a role in airway inflammation to elevated levels of these two pollutants by analyzing nasal cell samples obtained from the children during respiratory illnesses. Some of the identified gene-expression patterns suggest that unique biological pathways may be involved in non-viral asthma attacks.

Given the study findings, it will be important to develop and test different strategies to see if they prevent or reduce pollution-associated asthma attacks in urban children. These strategies may include treatments designed to counteract the harmful effects of elevated levels of outdoor air pollutants on airway linked to non-viral , and devices for personalized monitoring of local outdoor air pollutant levels to inform asthma management.

More information:
MC Altman, et al. Relationships of outdoor air pollutants to non-viral asthma exacerbations and airway inflammatory responses in urban children and adolescents: a population-based study. The Lancet Planetary Health (2023). www.thelancet.com/journals/lan … (22)00302-3/fulltext

Journal information:
The Lancet Planetary Health

NIH/National Institute of Allergy and Infectious Diseases

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Microbiology

Nearly 10 percent of psoriasis patients have high risk for liver fibrosis

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About 10 percent of patients with psoriasis have a high risk for advanced liver fibrosis, according to a systematic review and meta-analysis published online Dec. 15 in Frontiers in Medicine.

Tanat Yongpisarn from Mahidol University in Bangkok and colleagues examined the prevalence of psoriasis patients who have a high or low risk for advanced liver fibrosis and examined for liver fibrosis using data from identified from a systematic literature review.

The researchers found that the pooled prevalence was 9.66 percent for patients with psoriasis at high risk for advanced liver fibrosis, while the pooled prevalence was 77.79 percent for patients at low risk for advanced liver fibrosis. The prevalence of advanced liver fibrosis was lower in studies that recruited methotrexate-naive patients versus methotrexate-user cohorts (4.44 versus 12.25 percent). For those of ages older than 50 years, with body mass index greater than 30 kg/m², , hypertension, dyslipidemia, and metabolic syndrome, the pooled odds ratios were 2.20, 3.67, 6.23, 2.82, 3.08, and 5.98, respectively.

“In this and meta-analysis, we discover that 9.66 percent of people with psoriasis are at high risk of having advanced liver fibrosis, necessitating further investigation and management. While 77.79 percent of the population is considered low risk, the remaining 22.21 percent requires further testing,” the authors write. “We hope to inform practitioners and future researchers about the high prevalence of advanced liver fibrosis in psoriasis patients, as well as the critical need for screening.”

2023 HealthDay. All rights reserved.

More information:
Tanat Yongpisarn et al, Liver fibrosis prevalence and risk factors in patients with psoriasis: A systematic review and meta-analysis, Frontiers in Medicine (2022). DOI: 10.3389/fmed.2022.1068157

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Microbiology

Antibody treatment improves chronic food allergy symptoms in young adults, study finds

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A weekly dose of dupilumab, a monoclonal antibody, led to a reduction of symptoms and tissue improvement in young adults and adolescents with eosinophilic esophagitis (EoE), according to a new study published in the New England Journal of Medicine. The study analyzed data from two phase 3 clinical trials and involved an international group of researchers, including those from Children’s Hospital of Philadelphia (CHOP).

EoE is a chronic food allergy that affects the esophagus, the tube that connects the mouth to the stomach. Triggered by certain foods, the disease occurs when eosinophils, a type of white blood cell, accumulate in the esophagus causing pain and injury. If untreated, the in the esophagus can become stiff and scarred, leading to narrowing of the esophagus, as well as other medical complications including food impaction and choking.

Current treatments for EoE involve food elimination diets, proton-pump inhibitors (PPIs), swallowed topical glucocorticoids, and, in some cases, esophageal dilation. However, anywhere from 30 to 40% of patients may not respond to first-line treatments, and some of the treatments have unwanted side effects.

Given that growing evidence suggests that type 2 cytokines play key roles in EoE, researchers have investigated using dupilumab to treat the condition. Dupilumab is a monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, two cytokines that are key and central drivers of type 2 inflammation.

Dupilumab is approved for the treatment of several type 2 , including , asthma, and EoE, and a phase 2 trial involving adults with active EoE showed that a weekly 300mg dose of dupilumab reduced symptoms and improved esophageal tissue.

In the phase 3 trial described in the study, researchers assessed the efficacy and safety of dupilumab in patients 12 years and older, with the treatment administered weekly or every two weeks, compared to placebo. They found that 300mg of dupilumab given subcutaneously every week reduced symptoms and improved histologic outcomes, whereas a dose every other week improved histologic outcomes but did not improve symptoms.

“The results of this phase 3 trial give hope to patients and families who have historically had limited options to treat EoE,” said study co-author Jonathan Spergel, MD, Ph.D., Chief of the Allergy Program at Children’s Hospital of Philadelphia and the Stuart E Starr Chair of Pediatrics. “This study shows that dupilumab is a good treatment option for patients with EoE and not only reduces symptoms but also targets the root cause of the disease.”

More information:
Evan S. Dellon et al, Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis, New England Journal of Medicine (2022). DOI: 10.1056/NEJMoa2205982

Journal information:
New England Journal of Medicine

Children’s Hospital of Philadelphia

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Microbiology

Uncovering the relationship between fatty liver disease and COVID-19

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Dr. Jawaher Alharthi, from the Westmead Institute and medical research, University of Sydney, Australia, and her colleagues have discovered how COVID-19 increases the risk of fatty liver disease and how the latter is increasing the severity of COVID-19, aiding the development of potential treatments for these patients.

Metabolic dysfunction associated fatty liver disease (MAFLD) affects one-in-four adults and nearly one-in-10 children worldwide. Globally, MAFLD is the most frequent kind of chronic liver disease.

Liver disease is a silent killer. Most people don’t know they have a liver problem until it’s advanced and they develop liver scarring, and, in severe cases, liver failure and deadly cancer. Its complications, however, are not limited to liver disease. It is strongly associated with several other cardiometabolic diseases such as Type 2 diabetes and cardiovascular diseases.

In response to COVID-19, the host (humans) mounts an whose delicate balance determines the course of illness.

Severe COVID-19 is associated with exacerbated immune and hyperinflammatory responses and inflammatory macrophages can induce a cytokine storm leading to .

A new study by researchers at the Westmead institute for , University of Sydney, have discovered how COVID-19 increases the risk of fatty liver disease and how is the latter increasing the severity of COVID-19, aiding the development of potential treatments for these patients.

Dr. Jawaher Alharthi, the first author of this work said, “The relationship between and COVID-19 considered a bit of a mystery, as we do not know how and why both diseases increases the risk of each other. Our research team led by professor Mohammed Eslam conducted a large and detailed genetic and molecular study and identified that gene called MBOAT7 associated with the severity of both MAFLD and COVID-19.”

“This gene, plays an important role in the regulation of immune and inflammatory responses upon COVID-19. A disruption in the activity of the MBOAT7 gene could increase the chances of increase cytokines production and tissues damage and ,” Dr. Alharthi said.

The epigenome is a set of markers that determines not just , but genes themselves and influenced by environment, diet, and hormones.

“Interestingly, we also identified that disruption of MBOAT7 may ‘preprogram’ the cell epigenome and prime it to respond severely to even a weak stimulation upon COVID-19 that ultimately increases tissue damage.”

The findings are published in the journal Nature Communications.

More information:
Jawaher Alharthi et al, A metabolic associated fatty liver disease risk variant in MBOAT7 regulates toll like receptor induced outcomes, Nature Communications (2022). DOI: 10.1038/s41467-022-35158-9

Journal information:
Nature Communications

University of Sydney

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