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Epidermal elafin expression is an indicator of poor prognosis in cutaneous graft-versus-host disease.

  • Brüggen MC Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria.
  • Petzelbauer P Skin and Endothelium Research Division, Department of Dermatology, Medical University of Vienna, Vienna, Austria.
  • Greinix H Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
  • Contassot E Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
  • Jankovic D Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
  • French L Department of Dermatology, University Hospital Zurich, Zurich, Switzerland.
  • Socié G Department of Hematology/Transplantation, AP-HP Hospital Saint Louis, Paris, France.
  • Rabitsch W Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
  • Kuzmina Z Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
  • Kalhs P Bone Marrow Transplantation Unit, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria.
  • Knobler R Division of General Dermatology, Department of Dermatology, Medical University of Vienna, Vienna, Austria.
  • Stingl G Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria.
  • Stary G Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria. Electronic address: georg.stary@meduniwien.ac.at.
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  • 2014-11-19
Published in:
  • The Journal of investigative dermatology. - 2015
Adult
Biopsy
Cohort Studies
Elafin
Epidermis
Female
Gene Expression Profiling
Gene Expression Regulation
Graft vs Host Disease
Hematopoietic Stem Cell Transplantation
Humans
Male
Microscopy, Fluorescence
Middle Aged
Prognosis
Real-Time Polymerase Chain Reaction
Transforming Growth Factor beta
Treatment Outcome
Tumor Necrosis Factor-alpha
English Graft-versus-host disease (GVHD) remains a common and potentially life-threatening complication of allogeneic hematopoietic stem cell transplantation. In the skin, GVHD can present in an acute (aGVHD), chronic lichenoid (clGVHD), or chronic sclerotic form (csGVHD). Measuring peripheral blood levels of the keratinocyte-derived protease inhibitor elafin has recently emerged as a promising tool for the diagnosis of cutaneous aGVHD. We evaluated whether the analysis of elafin expression in skin would allow distinguishing aGVHD from drug hypersensitivity rashes (DHR) and whether cutaneous elafin expression would correlate with disease severity or altered prognosis of aGVHD and clGVHD/csGVHD. Skin biopsies from aGVHD (n=22), clGVHD (n=15), csGVHD (n=7), and DHR (n=10) patients were collected and epidermal elafin expression and its association with diverse clinical/histological parameters were analyzed. Acute GVHD and DHR displayed varying degrees of elafin expression. No elafin was detectable in csGVHD, whereas the molecule was increased in clGVHD as compared with aGVHD. Elafin-high aGVHD/clGVHD lesions presented with epidermal thickening and were associated with poor prognosis-i.e., decreased overall survival in aGVHD and corticosteroid resistance in clGVHD. Although cutaneous elafin does not seem to discriminate aGVHD from DHR lesions, our study strongly suggests an association between cutaneous elafin expression and poor prognosis for patients with cutaneous GVHD.
Language
  • English
Open access status
bronze
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Persistent URL
https://sonar.ch/global/documents/251800
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