Serum Levels of IL-17 and IL-22 Are Reduced by Etanercept,but not by Acitretin,in Patients with Psoriasis: a Randomized-Controlled Trial

Introduction  There are no controlled trials comparing etanercept and acitretin efficacy and therapeutic mechanisms in psoriasis. Materials and methods  In the present study, 30 patients were given etanercept 50 mg twice weekly and 30 patients acitretin 0.4 mg/kg per day, both for 12 weeks. Before and after treatment, psoriasis area and severity index was calculated, and serum levels of interleukin (IL)-17, IL-22, and IL-23 were investigated. Results  After treatment, psoriasis area and severity index was significantly lower for both groups. However, etanercept-treated patients showed lower psoriasis area and severity index than acitretin-treated ones. Psoriasis patients showed higher IL-17 and IL-22 levels than controls, while no IL-23 was found in any serum. Furthermore, a correlation between IL-17 levels and psoriasis severity was found. Only etanercept was able to reduce IL-17 and IL-22 levels. Conclusions  Our findings suggest that etanercept is more effective than acitretin in the treatment of psoriasis and that it is able to affect Th17 system.     

The CD40/CD40 ligand system in the skin of patients with subacute cutaneous lupus erythematosus

OBJECTIVE: To investigate whether CD40 and CD40 ligand (CD40L) is expressed in the skin of patients with subacute cutaneous lupus erythematosus (SCLE). METHODS: Six female patients with SCLE were studied. Skin biopsies were obtained from lesional and healthy sunprotected skin. Frozen sections were stained immunohistochemically using monoclonal antibodies to CD4, CD40, and CD40L. As controls we used 5 patients with discoid LE (DLE), 5 with dermatomyositis (DM), 3 with lichen planus (LP), and 2 with erythema multiforme (EM), as well as the normal-appearing skin of 5 healthy volunteers. RESULTS: The CD40 was intensely expressed in all SCLE, DLE, and DM lesions, and only focally in healthy sunprotected skin specimens. The number of CD40+ cells in SCLE dermis was lower than in DLE, similar to that in DM, LP and EM, and higher than in SCLE sunprotected skin. CD40L+ cells infiltrated the SCLE, DLE, DM, LP, and EM lesional dermis, and were more numerous in SCLE lesional skin than in SCLE healthy sunprotected skin. CONCLUSION: We showed that the CD40/CD40L system may represent an important pathway of induction of SCLE lesions. The expression of such costimulatory system in healthy sunprotected skin also may signify that its abnormal activation is constitutive in SCLE, as previously observed in systemic LE.     

Occupational exposure and lung cancer risk in a coastal area of Northeastern Italy

Summary A case-control study of lung cancer and occupational exposure was conducted in a coastal area of Northeastern Italy where metallurgical and mechanical industries, docks and shipyards are located. Cases comprised 756 men who died of primary lung cancer in a 5-year period. Controls comprised 756 male subjects dying from other causes during the same period. Occupational exposures to lung carcinogens were assessed according to a job title-based approach, using two separate lists of industries/occupations recognized as being causally associated (list A) or suspected of being causally associated (list B) with lung cancer in humans. Exposure to asbestos was classified as absent, possible, or definite. After adjustment for cigarette smoking and place of residence, a significant association was found between lung cancer and occupations in both list A [relative risk (RR) = 2.25, 95% confidence interval (CI) = 1.68–3.03] and list B (RR = 1.33, 95% CI = 1.03–1.71). A significant excess risk was found for workers with definite exposure to asbestos as compared to those with no exposure to lung carcinogens (RR = 1.98, 95% CI = 1.42–2.75). Among occupations with recognized exposure to lung carcinogens other than asbestos, a significant excess risk for lung cancer was observed in iron and metalware workers. In occupational groups with definite exposure to asbestos, elevated risk estimates were found for shipyard workers, dockworkers, carpenters, and electricians. The combined effect of smoking and asbestos was found to be compatible with that expected under a multiplicative model. The overall population-attributable risk (ARp) for cigarette smoking was found to be 87.5%. The ARp estimate for occupations in list A was 16.0%. The estimate increased to 25.3% (95% CI = 16.2–34.4) when occupations in list B were included. The ARp estimate for possible or definite exposure to asbestos was 20.0% (95% CI = 11.5–28.5). With regard to the histologic types of lung cancer, significant associations were found between definite exposure to asbestos and squamous cell carcinoma (RR = 2.00, 95% CI = 1.28-–3.11), small cell carcinoma (RR = 2.11, 95% CI = 1.31–3.39), and adenocarcinoma (RR = 2.16, 95% CI = 1.32–3.53).