A method for culturing human hair follicle cells

Clinical and photobiological differences between Japanese patients belonging to xeroderma pigmentosum (XP) variant and complementation group A were studied, especially focussing on XP variants. All of ten XP variant patients commonly manifested a delayed onset of pigmented freckles as the initial symptom around 5–7 years old without acute sun erythema, in contrast to the early manifestation of acute solar erythema during infancy in XP group A patients. Six XP variant patients tested showed normal and three showed low minimal erythema doses (MEDs), at the 24 h reaction peak after monochromatic u.v. (280–330 nm) irradiation, while XP group A patients had definitely low MEDs (280–350 nm) with abnormally delayed peaking of the erythema reaction at 72 h. In cell culture studies, all XP variant strains exhibited normal levels of 254 nm u.v.-induced, unscheduled DNA synthesis (UDS), 14–2 times more accumulation of excision DNA breaks by arabinofuranosyl cytosine and hydroxyurea due to a subtle defect in the later polymerization step of excision repair, and a slightly higher sensitivity to u.v. cell killing than did normal cells. With respect to the synergistic effect of caffeine on u.v. lethality, XP variant strains could be divided into caffeine-susceptible (eight cases) and caffeine-resistant (two cases) subgroups. The extent of excision-break acciunuladon was greater in the former subgroup than in the latter. All of eight XP variant patients whose cells showed caffeine potendation of u.v. lethality had already had skin malignancies, but two sib patients whose cells were caffeine-resistant had as yet had no neoplasm. It is strongly suggested that in XP variant, caffeine-susceptibility may be related to the development of neoplasms.     

Xeroderma pigmentosum variant associated with multiple skin cancers and a lung cancer.

A 65-year-old Japanese man with a xeroderma pigmentosum (XP) variant, XP127TO, is described. The XP127TO skin fibroblasts exhibited the typical XP variant characteristics of a 1.5-fold higher sensitivity than normal cells to the lethal effect of 254 nm ultraviolet (UV) light and the normal level of unscheduled DNA synthesis induced by 254 nm UV. Caffeine dose-dependently increased the cytotoxic effect of 254 nm UV on XP127TO cells. Clinically, the patient developed not only 3 cutaneous squamous cell carcinomas on sun-exposed areas but also an adenocarcinoma of the upper lobe of the right lung. A review of the 14 documented Japanese XP patients with nonskin malignancies indicates that the incidence of nonskin malignancy in XP patients is much lower than that of skin cancer in XP but higher than that in the general population.     

Assignment of three patients with xeroderma pigmentosum to complementation group E and their characteristics

Three cases belonging to xeroderma pigmentosum (XP) complementation group E were analyzed clinically and photobiologically. The three Japanese patients were a 50-yr-old female (XP80TO), a 42-yr-old female (XP81TO), and a 41-yr-old female (XP82TO). They were assigned to complementation group E by the cell hybridization study. All showed lowered minimal erythema doses between those of normal Japanese and XP group A subjects at wavelengths of 280, 290, and 300 nm of monochromatic ultraviolet (UV) light. Patients XP80TO and XP81TO, but not patient XP82TO, showed a delayed peak reaction at 48 h to UV erythema. All fibroblast strains from these patients had a reduced level of 40%-44% unscheduled DNA synthesis (UDS) after irradiation with 10 J/m2 of 254 nm UV. Primary cultured epidermal cells from these patients exhibited a relatively low level of UDS (ie, 38%-51% of normal epidermal cells). All of the group E fibroblast strains were twice as sensitive to 254 nm UV killing [n (extrapolation number) = 1.3-1.8, Do (mean lethal dose) = 2.2-2.8 J/m2)] as normal fibroblasts (n = 1.5, Do = 5.0 J/m2). All of the above group E patients had mild XP symptoms, but not neurological abnormalities, at the fifth decade of age. Patients XP80TO and XP81TO had developed skin malignancies (patients XP80TO developed three basaliomas; patient XP81TO developed two basaliomas) at the ages of 46 and 41 yr, respectively.     

Xeroderma pigmentosum group D patient bearing lentigo maligna without neurological symptoms

A 35-year-old Japanese female patient with xeroderma pigmentosum (XP), registered as XP114TO, was assigned to complementation group D by the cell fusion complementation test. The patient had manifested moderate solar sensitivity and freckles by the age of 6 years. The skin phototest using 290- and 300-nm monochromatic ultraviolet (UV) light revealed slightly lowered minimal erythema doses at 24 h after irradiation. The XP114TO skin fibroblasts exhibited about the 6-fold higher sensitivity to the lethal effect of 254-nm UV as did normal cells. Unscheduled DNA synthesis (UDS) induced in XP114TO cells by 254-nm UV (10 J/m2) was 33% of normal, falling into the group D range of 25-50% UDS. The patient developed lentigo maligna on the right side of the nose. Unlike the typical XP group D cases in the West, she showed no neurological abnormalities.     

Do OKT6 positive Langerhans cells play a role in the suppression of ultraviolet-induced carcinogenesis?

Langerhans cells (LC) in epidermis are antigen presenting cells. LC may play a role in immune surveillance system and are considered to suppress development of ultraviolet (UV) induced skin cancers. We studied effect of UVB irradiation to LC of xeroderma pigmentosum (XP) and normal subjects by using OKT6 monoclonal antibody. When 3 minimal erythema dose (MED) of UVB were irradiated, density of OKT6 positive LC of XP began to decrease 6 hours after irradiation, and showed the least numbers on day 2 and returned completely to the pre-irradiation level on day 14. Further, after 3 MED irradiation, LCs of both normal subjects became the least on day 3 and returned to the pre-irradiation level on day 14. In XP variant and normal subjects, the number of LC in chronic sun-exposed skin decreased significantly in a similar way comparing to that of non-exposed skin. These results suggest that epidermal LC may not play an essential role in prevention of UV-induced tumor development.     

Clinical characteristics of three patients with UVS syndrome, a photosensitive disorder with defective DNA repair

Recently, we established a new category of photosensitive disorder termed UV^S syndrome. Cells from patients with UV^s syndrome have a similar UV sensitivity as xeroderma pigmentosum |XP) cells, but have a normal level of unscheduled DNA synthesis (UPS) unlike XP. UV^s syndrome is distinct from Cockayne syndrome ICS) or XP including XP variant (XP-V), as determined by studies of genetic factors using cell fusion, microinjection. and postreplication repair assays. In this study, we identified three Japanese patients with IIV syndrome: an 11-year-old girl, a 17-year-old male, and an 8-year-old boy. The first two patients were siblings, while the third was a case from a different family. All of these patients exhibited acute recurrent sunburn. Common clinical manifestations of these patients were slight erythema and dryness. a number of freckles on sun-exposed areas, and slight telangiectasia only seen on the cheek and nose. Patient J showed a lowered minimal erythema dose between 280 and 300 nm. The patients' fibroblasts showed similar characteristics to those in CS. such as UV sensitivity, and a failure of RNA synthesis (RRS) after UV irradiation, despite a normal level of UDS. Thus, UV^s syndrome is a new hereditary photosensitive disorder with clinical manifestations similar to a mild form of XP but showing the cellular characteristics of CS.     

Xeroderma pigmentosum variant with multisystem involvement.

BACKGROUND--Xeroderma pigmentosum (XP) is a hereditary disorder characterized by recessive inheritance and elevated rates of skin carcinogenesis. There are seven complementation groups (A through G) for which the genetic defect results in a failure to repair DNA damage from UV light and sunlight; one group, the variant, fails to replicate UV-damaged DNA correctly. Patients in XP groups A, B, D, and G have associated neurologic problems, the most severe being known as the DeSanctis-Cacchione syndrome. OBSERVATIONS--We describe a patient with XP from consanguineous parents who has severe multisystem involvement similar to that of the DeSanctis-Cacchione syndrome. Extensive laboratory investigation showed that cells from this patient exhibit DNA replication after irradiation with UV light that is characteristic of the XP variant. The cells also show normal sensitivity to UV light and normal excision repair, consistent with XP variant classification. The presence of the neurologic symptoms is quite unusual in an XP variant. CONCLUSION--Our patient clearly fits into the XP variant category based on normal survival, caffeine toxic reaction, photoproduct excision and repair, and the deficient replication of UV-damaged DNA. This patient seems to be rare, however, among XP variants in displaying severe neurologic symptoms. Because of the consanguineous parents, the possibility that some of this patient's findings are from non-XP-related abnormalities must also be entertained. However, other consanguineous patients with XP variant, eg, XPIOCA, have been described who do not show neurologic abnormalities. In view of the difficulty of defining an XP group from clinical symptoms alone, we urge the term xeroderma pigmentosum variant be used only in the context of the laboratory studies of patients with XP that contain normal repair but deficient semiconservative replication of UV-damaged DNA.     

Whole‐exome sequencing and host cell reactivation assay lead to a diagnosis of xeroderma pigmentosum group D with mild ultraviolet radiation sensitivity

A case of xeroderma pigmentosum (XP) group D in a 39‐year‐old Japanese man is reported. The patient had suffered from moderate to severe solar sensitivity and freckle‐like pigmented macules in sun‐exposed areas since 6 years of age, and developed skin malignancies such as squamous cell carcinoma, actinic keratosis, Bowen’s disease and basal cell carcinoma. The minimal erythema dose for ultraviolet (UV) radiation was decreased with a delayed peak reaction. The level of unscheduled DNA synthesis of fibroblasts from the patient was 70% of normal, while they expressed POLH, a gene product responsible for the XP variant. Whole‐exome sequencing indicated that the patient harbored a homozygous mutation of c.1802G>T, p.Arg601Leu in ERCC2. A genetic complementation test was carried out by host cell reactivation assay, which showed that the patient’s fibroblasts recovered only when they were transfected with XPD cDNA, confirming the diagnosis of XP‐D. Arg601Leu mutation in ERCC2 may be related to mild UV radiation sensitivity and moderate skin lesions.     

The relation between constitutional skin color and photosensitivity estimated from UV-induced erythema and pigmentation dose-response curves

In 54 healthy volunteers we assessed predictors of sensitivity to ultraviolet (UV) light, including Fitzpatrick's sun reactive skin types and constitutional skin color, and compared these with one another and with responses of the skin to UV irradiation, as determined experimentally by a minimal erythema dose (MED), a minimal melanogenic dose (MMD), and dose-response curves for UV-induced erythema and pigmentation. For these studies, a xenon arc solar simulator was used as the source of UV irradiation, and a chromameter interfaced with a computer for objective measurement of UV-induced erythema and pigmentation was employed. The skin type did not correspond well to the constitutional skin color, as measured by a chromameter prior to UV irradiation. Within each skin type, there were large ranges of MED and MMD values and great variability in the shapes of the dose-response curves. Constitutional skin color was also not a good predictor of the measured MED and MMD values but did appear to correlate with the steepness of the dose-response curves for erythema and for pigmentation. From these studies, we propose that objectively measured constitutional skin color is a better predictor of UV responses of the skin than skin type and that steepness of dose-response curves for erythema is a better measure of the response of the skin to UV irradiation than is a MED measurement.     

Abnormal erythemal response and elevated T lymphocyte HRPT mutant frequency in Cockayne''s syndrome

In three children with Cockayne's syndrome (CS), skin exposed to ultraviolet radiation responded transiently either with erythematous papules or an exaggerated sunburn-like response, without chronic actinic damage. Irradiation monochromator tests demonstrated an abnormal delay or reduction in the threshold to ultraviolet (UVB) irradiation-induced erythema similar to that of xeroderma pigmentosum (XP). As with XP there was an elevated frequency of mutants resistant to 6-thioguanine in circulating T lymphocytes. The mutant frequency in a single obligate heterozygote was normal. In contrast to XP, in the two CS individuals studied, adaptive cell-mediated immunity and natural killer cell function were normal. Because the risk of skin cancer is very high in XP but not in CS, the normal immune function in CS provides evidence that immune surveillance may be important in UV tumorigenesis.     

No apparent neurologic defect in a patient with xeroderma pigmentosum complementation group D

A 31-year-old female patient with xeroderma pigmentosum (XP) XP43KO was assigned to complementation group D by the cell-fusion complementation methods. Cultured XP43KO cells from our patient had the defective DNA repair phenotype showing a residual level of ultraviolet (UV)-induced unscheduled DNA synthesis (45% of normal) and an eightfold higher sensitivity to 254-nm UV killing, compared with normal cells. The phototest on the patient revealed the delayed maximum reaction to UV-B-induced erythema and lower minimal erythema doses at 290- and 300-nm monochromatic wavelengths. However, the XP43KO patient showed no apparent neurologic abnormalities and rather mild or moderate skin lesions at the age of 31 years, although DNA repair deficiency in XP43KO cells from our patient fell into the range of group D cells.     

A case of xeroderma pigmentosum group D determined by photobiological study

A case of xeroderma pigmentosum group D in 36-year-old woman (XP85TO) is reported. The patient had severe photosensitivity from age 4, and developed multiple basal cell epitheliomas and solar keratoses but exhibited no apparent neurological defects. A skin phototest by monochromatic ultraviolet light revealed a delayed peak of erythema 48 h after irradiation and lowered minimal erythemal doses. Unscheduled DNA synthesis induced in XP85TO cells was 36.0% in dermal fibroblasts and 32.6% in epidermal keratinocytes compared with normal cells. The XP85TO cells were sensitive to ultraviolet killing (n = 1.0, D0 = 0.80 J/m2). In complementation analysis, XP85TO cells did not complement with xeroderma pigmentosum group D cells. These results indicate that patient XP85TO had xeroderma pigmentosum group D. The Japanese group D patients including XP85TO case showed delayed onset of skin malignant tumors and neurological abnormalities, compared with the group D patients in Europe and the United States. These findings suggest a possible ethnic variation of the clinical phenotype, despite the similar repair defect and ultraviolet hyperssensitivity.     

Age-related changes in photosensitivity and cellular sensitivity to ultraviolet B in a xeroderma pigmentosum group E patient.

Skin phototesting and cellular sensitivity studies were performed in a patient with xeroderma pigmentosum (XP) complementation group E (XP80TO) at the ages of 50 and 55 years. She showed a reduced minimal erythema dose at both ages, but the dose at age 55 was much lower than that at age 50 when tested with monochromatic ultraviolet (UV) light (280, 290 and 300 nm). The cellular sensitivity to UVC (254 nm), UVB and UVA and UVC-induced unscheduled DNA synthesis were examined using fibroblasts obtained by skin biopsy at the ages of 50 and 55 (XP80TO-1 and XP80TO-2, respectively). DNA synthesis was similar in both cell lines. XP80TO-2 cells were more sensitive to UVB cytotoxicity than XP80TO-1 cells in both the dividing and quiescent phases, but both cell lines exhibited a similar sensitivity to UVC and UVA. These results suggest that the in vitro cellular sensitivity to UVB may correlate with the clinically observed erythema reaction. Further, the results suggest that some XP complementation group E cases at least may show an increase in photosensitivity in vivo and in vitro with aging.     

Law of reciprocity in UV erythema and cell killing

The dose rate effect of ultraviolet light (UV) was investigated from a view point of the law of reciprocity both in vivo and in vitro. The reciprocity in UV erythema reaction was examined in seven excision repair deficient xeroderma pigmentosum (XP) patients with monochromatic UV at wavelengths of 255 nm and 290 nm using a 1% neutral filter (NF) to reduce UV intensity to 1/100. For the in vitro study, the reciprocity in UV cell killing was examined in four normal and three excision repair deficient XP fibroblast strains using varied intensities to 1/100 at 254 nm. As in the results obtained by Satoh et al. in normal subjects, the law of reciprocity did not hold for erythema reaction in XP patients at 255 nm when the dose rate was changed a hundred fold. In the XP patients, the minimal erythema dose (MED) required by 1/100 intensity was on the average 1.57 times higher for 255 nm and 1.12 times higher for 290 nm as compared with MED without NF. On the other hand, the law of reciprocity was found to hold for cell killing in both normal and XP cells by 254 nm UV at the intensity range of 1:100.     

Xeroderma pigmentosum patients belonging to complementation group F and efficient liquid-holding recovery of ultraviolet damage.

A 73-year-old woman with xeroderma pigmentosum (XP), XP107TO, was assigned to complementation group F. The fibroblast of this patient showed a reduced level (19%) of unscheduled DNA synthesis (UDS) compared with normal cells. XP107TO cells were 2.3 times more hypersensitive to ultraviolet C (UVC) than normal cells and in the same range of other XPF cells. A clinical case report of 2 patients belonging to XP group F is also described; together with these clinical findings, the characteristics of XP group F are discussed. These patients manifested mild clinical symptoms, developing skin cancer in later age, although acute sun sensitivity was observed in early age (usually a few months after birth). Fibroblasts derived from these patients showed a substantially reduced level of UDS, considering its mild clinical features. To analyze the discrepancy of low UDS level and late onset of skin cancer in XPF cells, we examined the UV sensitivity under density-inhibited condition using XPF cells. XP cells belonging to complementation group F showed marked enhancement of UV survival when they were held in a density-inhibited condition for 1-4 d after UV irradiation. The enhancement was also observed in normal and XP group A cells, but the recovery in these cell lines was less than that in XP group F cells. XP group F cells have been shown to possess slow and long-lasting excision repair capacity and this type of repair might be stimulated by holding through time of the repair process within one cell cycle.     

Diagnosis of eight groups of xeroderma pigmentosum by genetic complementation using recombinant adenovirus vectors

Because patients with xeroderma pigmentosum (XP) must avoid ultraviolet (UV) light from an early age, an early diagnosis of this disorder is essential. XP is composed of seven genetic complementation groups, XP‐A to ‐G, and a variant type (XP‐V). To establish an easy and accurate diagnosis of the eight disease groups, we constructed recombinant adenoviruses that expressed one of the XP cDNA. When fibroblasts derived from patients with XP‐A, ‐B, ‐C, ‐D, ‐F or ‐G were infected with the adenovirus expressing XPA, XPB, XPC, XPD, XPF or XPG, respectively, and UV‐C at 5–20 J/m² was irradiated, cell viability was clearly recovered by the corresponding recombinant adenoviruses. In contrast, XP‐E and XP‐V cells were not significantly sensitive to UV irradiation and were barely complemented by the matched recombinant adenoviruses. However, co‐infection of Ad‐XPA with Ad‐XPE increased survival rate of XP‐E cells after UV‐C exposure. When XP‐V cell strains, including one derived from a Japanese patient, were infected with Ad‐XPV, exposed to UV‐B and cultured with 1 mmol/L of caffeine, flow cytometry detected a characteristic decrease in the S phase in all the XP‐V cell strains. From these results, the eight groups of XP could be differentiated by utilizing a set of recombinant adenoviruses, indicating that our procedure provides a convenient and correct diagnostic method for all the XP groups including XP‐E and XP‐V.     

Spectral reflectance of human skin in vivo

A newly developed skin reflectance spectrophotometer was evaluated for measurements of both melanin pigmentation and erythema. Physiological changes in blood flow and blood content in normal humans were induced by compression with an arm cuff during recording of skin reflectance spectra. Reflectance spectra of UV-induced erythema were also recorded and compared with laser-Doppler flow measurements. Spectral reflectance measurements were found to be highly sensitive in determining minimal erythema, which was not clinically detectable. The measurements of erythema using reflectance spectroscopy and UV irradiation were very highly correlated (r = 0.996). It was possible to calculate the in vivo absorbance of oxygenized haemoglobin. The melanin pigmentation following UV irradiation was quantified by reflectance spectroscopy and correlates highly with the dose of UV irradiation (r = 0.995). Furthermore, regional variations in skin melanin and haemoglobin were analysed for fair Caucasian skin.     

Clinical and biological studies of 26 cases of xeroderma pigmentosum in northeast district of Japan

Twenty-six patients with xeroderma pigmentosum (XP), who live in the Northeast (Tohoku) District of Japan, were examined for the clinical characteristics of UV-induced DNA synthesis (unscheduled DNA synthesis, UDS) and UV sensitivity of skin fibroblasts or lymphoblastoid cells, or both. A history of consanguineous marriage within two generations was found in 19 of 26 cases (73%). Two pairs of siblings showed similar manifestations and almost the same levels of UDS and of UV sensitivity. Squamous cell carcinoma, basal cell carcinoma, or both were observed on the exposed skin in 14 patients, but no malignant melanoma was found. Cancer had developed in approximately 71% (10/14) of the cancer-bearing patients by the age of 20, and 8 of them belonged to the UDS-deficient group. Neurological manifestations were associated with nine patients, including 3 with typical de Sanctis-Cacchione syndrome (DSC), and most of the cells derived from these patients had a UDS level less than 10% of that of the normal cells. A clear correlation between the levels of UDS and UV sensitivity, on the one hand, and the severity of clinical manifestations on the other could not be detected, but it seems that the UDS-deficient group is generally much more sensitive to UV in terms of cell killing and the induction of sister chromatid exchange (SCE) than the UDS-proficient group. After a photosensitivity test, one patient with mild skin manifestations showed distinct skin tanning without preceding erythema.     

Repair of 254 nm ultraviolet-induced (6-4) photoproducts: monoclonal antibody recognition and differential defects in xeroderma pigmentosum complementation groups A, D, and variant

Repair kinetics of ultraviolet (UV) light-induced (6-4) photoproducts in xeroderma pigmentosum complementation group A, D, and variant cells were studied by the enzyme-linked immunosorbent assay (ELISA) using a specific monoclonal antibody raised against (6-4) photoproducts, together with unscheduled DNA synthesis (UDS) and loss of T4 endonuclease V-susceptible sites (ESS). Group AXP35KO cells completely failed to repair both ESS (cyclobutane pyrimidine dimers) and antibody-recognizing (6-4) photoproducts until tested 24 h after irradiation, and had 2% early-time UDS. Group DXP43KO cells showed about 10% removal of both (6-4) photoproducts and ESS in 24 h, despite showing a residually higher level of 40% early-time and cumulative UDS. Thus, the results substantiated the extreme UV hypersensitivity of XP group A and D cells. However, XP52KO variant cells exhibited the normal level of UDS and ESS loss, but a slightly reduced repair of antibody-recognizing (6-4) photoproducts at 6 and 12 h after irradiation, which may account for a small UV hypersensitivity of the XP variant cells.     

Clinical and biological studies of 26 cases of xeroderma pigmentosum in Northeast District of Japan

Summary Twenty-six patients with xeroderma pigmentosum (XP), who live in the Northeast (Tohoku) District of Japan, were examined for the clinical characteristics of UV-induced DNA synthesis (unscheduled DNA synthesis, UDS) and UV sensitivity of skin fibroblasts or lymphoblastoid cells, or both. A history of consanguineous marriage within two generations was found in 19 of 26 cases (73%). Two pairs of siblings showed similar manifestations and almost the same levels of UDS and of UV sensitivity. Squamous cell carcinoma, basal cell carcinoma, or both were observed on the exposed skin in 14 patients, but no malignant melanoma was found. Cancer had developed in approximately 71% (10/14) of the cancer-bearing patients by the age of 20, and 8 of them belonged to the UDS-deficient group. Neurological manifestations were associated with nine patients, including 3 with typical de Sanctis-Cacchione syndrome (DSC), and most of the cells derived from these patients had a UDS level less than 10% of that of the normal cells. A clear correlation between the levels of UDS and UV sensitivity, on the one hand, and the severity of clinical manifestations on the other could not be detected, but it seems that the UDS-deficient group is generally much more sensitive to UV in terms of cell killing and the induction of sister chromatid exchange (SCE) than the UDS-proficient group. After a photosensitivity test, one patient with mild skin manifestations showed distinct skin tanning without preceding erythema.