Epidermal differentiation and carcinogenesis

Summary Skin, and more precisely the epidermis, plays a crucial role in our survival since it constitutes our first line of defense against our environment. A subtle equilibrium between proliferation and differentiation of keratinocytes, the main epidermal cell type, provides a continous self-renewal of the epidermis, maintaining the integrity of this protective barrier. It is now well established that pertubation of the normal balance between proliferation and differentiation can induce development of several diseases including cancer. The aim of my thesis was first to characterize new genes involved in the differentiation process of keratinocytes and the formation of the epidermis. We show that cornulin, encoded by the c1orf10 gene, is a new marker of epidermal differentiation, mainly expressed in the suprabasal layers of the epidermis. Structurally, cornulin belongs to the "fused genes" protein family and contains a functional calcium-binding domain as well as two repeated sequences of 60 amino acids, the function of which remain unknown. The second part of my work aimed to identify new proteins interacting with CYLD. When mutated, CYLD is responsible for cylindromatosis, a predisposition to benign tumors of skin appendages mainly located on the scalp. CYLD is implicated in the NF-κB signalling pathway. We have identified HBO1 and p30, two nuclear proteins, as potential CYLD partners. Since CYLD was described as a negative regulator of NF-icB-mediated transcription, we have tested the putative effect of HBO1 and p30 on the regulation of this signalling pathway. We have shown that only HBO1 is able to inhibit NF-κB-mediated transactivation. The mechanism of action of HBO1 is still under investigation but our results suggest that an unknown cofactor is involved in this process. Résumé La peau est cruciale à notre survie car elle est notre première ligne de défense contre notre environnement. L'épiderme qui forme cette barrière protectrice entre le corps et l'environnement extérieur est continuellement renouvelé suite aux agressions physiques, chimiques et biologiques répétées qu'il subit. Le but de ce renouvellement étant de garantir l'intégrité de cette barrière. Le keratinocyte est le principal type cellulaire trouvé dans l'épiderme. La formation d'une barrière active dépend essentiellement de la faculté des kératinocytes à proliférer et à se différencier. Il est aujourd'hui admis que tout déséquilibre entre l'activité de prolifération et de différenciation des kératinocytes est la cause du développement de plusieurs maladies, dont certains cancers. Le but de ce travail de thèse était, dans un premier temps d'identifier ou de caractériser de nouveaux gènes impliqués dans le processus de différenciation afin de mieux comprendre la formation de l'épiderme. Noús avons ainsi démontré que la cornulin, produit du gène c1orf10, est un nouveau marqueur de la différenciation épidermique, principalement exprimé dans les couches suprabasales de l'épiderme. D'un point de vue structural, nous avons montré que cette protéine appartient à la famille des « fused gene » et qu'elle possède un domaine de liaison au calcium qui est fonctionnel et deux séquences répétées de 60 acides aminés dont la fonction est encore inconnue. La seconde partie de cette thèse était dédiée à l'étude de la cylindromatose, une prédisposition génétique à la formation de tumeurs bénignes, principalement localisées sur la tête et due à des mutations du gène CYLD. Nous avons cherché de nouvelles protéines qui interagissent avec CYLD afin de mieux caractériser les voies de signalisation impliquées dans le développement de la maladie. Nous avons ainsi identifiés deux nouveaux partenaires potentiels de CYLD ; HBO1 et p30 CYLD ayant été décrit comme un régulateur négatif de la transcription médiée par NF-κB; nous avons testé l'implication de HBO1 et p30 au niveau de cette activité transcriptionnelle. Nous montrons que seul HBO1 est capable d'inhiber la transactivation d'un gène rapporteur régulé par NF-κB. Le mécanisme d'action de HBO1 n'est pas encore connu, néanmoins nos résultats suggèrent l'intervention d'un cofacteur qui reste à déterminer.

Carcinome de Merket: (r)évolution [Merkel cell carcinoma: (r)evolution].

Merkel Cell Carcinoma (CCM) is an aggressive cutaneous tumor of the elderly, which has become the second cause of mortality linked to skin cancer. This has led clinicians and scientists to devote more time to the study of this rare tumor, announcing to a revolution in our understanding, diagnosis and therapy of this cancer. We present here these recent advances, which illustrate the exponential growth of knowledge in the medical field, drawing comparisons with more frequent cancers such as melanoma and squamous cell carcinoma.

Distinct sets of alphabeta TCRs confer similar recognition of tumor antigen NY-ESO-1157-165 by interacting with its central Met/Trp residues.

Naturally acquired immune responses against human cancers often include CD8(+) T cells specific for the cancer testis antigen NY-ESO-1. Here, we studied T cell receptor (TCR) primary structure and function of 605 HLA-A*0201/NY-ESO-1(157-165)-specific CD8 T cell clones derived from five melanoma patients. We show that an important proportion of tumor-reactive T cells preferentially use TCR AV3S1/BV8S2 chains, with remarkably conserved CDR3 amino acid motifs and lengths in both chains. All remaining T cell clones belong to two additional sets expressing BV1 or BV13 TCRs, associated with alpha-chains with highly diverse VJ usage, CDR3 amino acid sequence, and length. Yet, all T cell clonotypes recognize tumor antigen with similar functional avidity. Two residues, Met-160 and Trp-161, located in the middle region of the NY-ESO-1(157-165) peptide, are critical for recognition by most of the T cell clonotypes. Collectively, our data show that a large number of alphabeta TCRs, belonging to three distinct sets (AVx/BV1, AV3/BV8, AVx/BV13) bind pMHC with equal antigen sensitivity and recognize the same peptide motif. Finally, this in-depth study of recognition of a self-antigen suggests that in part similar biophysical mechanisms shape TCR repertoires toward foreign and self-antigens.

The vasodilatory response of skin microcirculation to local heating is subject to desensitization.

BACKGROUND: In humans, local heating increases skin perfusion by mechanisms dependent on nitric oxide (NO). Because the vascular effects of NO may be subject to desensitization, we examined whether a first local thermal stimulus would attenuate the hyperemic response to a second one applied later. METHODS: Twelve healthy young men were studied. Skin blood flow (SkBF) was measured on forearm skin with laser Doppler imaging. Local thermal stimuli (temperature step from 34 to 41 degrees C maintained for 30 minutes) were applied with temperature-controlled chambers. We also tested the influence of prior local heating on the vasodilation induced by sodium nitroprusside (SNP), a donor of NO. RESULTS: On reheating the same spot after two hours, the response of SkBF (i.e., plateau SkBF at 30 minutes minus SkBF at 34 degrees C) was lower than during the first stimulation (mean+/-SD 404+/-212 perfusion units [PU] vs. 635+/-100 PU; P<0.001). There was no such difference when reheating after four hours (654+/-153 vs. 645+/-103 PU; P=NS). Two, but not four, hours after local heating, the response of SkBF to SNP was reduced. CONCLUSION: The NO-dependent hyperemic response induced by local heating in human skin is subject to desensitization. At least one part of the mechanism implicated consists of a desensitization to the effects of NO itself.

Opposing roles for calcineurin and ATF3 in squamous skin cancer.

Calcineurin inhibitors such as cyclosporin A (CsA) are the mainstay of immunosuppressive treatment for organ transplant recipients. Squamous cell carcinoma (SCC) of the skin is a major complication of treatment with these drugs, with a 65 to 100-fold higher risk than in the normal population. By contrast, the incidence of basal cell carcinoma (BCC), the other major keratinocyte-derived tumour of the skin, of melanoma and of internal malignancies increases to a significantly lesser extent. Here we report that genetic and pharmacological suppression of calcineurin/nuclear factor of activated T cells (NFAT) function promotes tumour formation in mouse skin and in xenografts, in immune compromised mice, of H-ras(V12) (also known as Hras1)-expressing primary human keratinocytes or keratinocyte-derived SCC cells. Calcineurin/NFAT inhibition counteracts p53 (also known as TRP53)-dependent cancer cell senescence, thereby increasing tumorigenic potential. ATF3, a member of the 'enlarged' AP-1 family, is selectively induced by calcineurin/NFAT inhibition, both under experimental conditions and in clinically occurring tumours, and increased ATF3 expression accounts for suppression of p53-dependent senescence and enhanced tumorigenic potential. Thus, intact calcineurin/NFAT signalling is critically required for p53 and senescence-associated mechanisms that protect against skin squamous cancer development.

Complications après hystérectomie pour cancers gynécologiques : Laparoscopie vs Laparotomie.

Objectif : Comparer les hystérectomies réalisées par laparoscopie à celles accomplies par laparotomie pour des pathologies gynécologiques malignes. Méthode : Etude basée sur 169 hystérectomies effectuées pour cancer de l'endomètre, du col ou de l'ovaire, pratiquées dans le service de gynécologie de la Maternité du CHUV de janvier 2002 à décembre 2009 sur des femmes âgées de 28 à 91 ans. Le but est de comparer deux différentes voies d'abord chirurgicales qui sont la laparotomie et la laparoscopie en terme de durée d'hospitalisation, d'indications, de complications per et post opératoires mineures et majeures et de nécessité de reprise ou d'une ré-hospitalisation. Résultats: Cette étude compte 169 patientes, dont 126 hystérectomies réalisées par laparotomie et 43 accomplies par laparoscopie. Les deux groupes sont similaires en terme d'âge (âge moyen : 63ans), d'indice de masse corporelle (26 vs 25) et de parité (1.5 enfants). Le temps opératoire est semblable entre les deux groupes (211 vs 219 minutes). Des hémorragies (pertes sanguines de plus de 1000ml) surviennent dans 24.6% des hystérectomies par laparotomie et dans 11.63% des hystérectomies par laparoscopie. Il existe une différence statistiquement significative entre la nécessité d'une transfusion peropératoire et les deux différentes voie d'abord (p=0.045). Une transfusion peropératoire a été nécessaire dans 13.22% des laparotomies contre seulement 2.33% des laparoscopies. La durée d'hospitalisation est significativement plus longue pour les patientes ayant subi une hystérectomie par laparotomie (12 vs 6 jours; p<0.001). Les complications peropératoires et postopératoires mineures dépendent de manière significative de la voie d'abord (p=0.01 ; p= 0.025). On observe des complications peropératoires dans 31.75% des laparotomies et dans 11.63% des laparoscopies. Les complications postopératoires mineures sont observées dans 28.57% des laparotomies et dans 11.63% des laparoscopies. Dans 7.14% des laparotomies on observe une complications postopératoire majeure et aucune de sont apparues lors d'hystérectomie par laparoscopie. La nécessité de reprise, de ré-opération ou de ré-hospitalisation n'est statistiquement pas différente entre la laparoscopie et la laparotomie. Conclusion : On observe un avantage significatif en faveur de l'hystérectomie par laparoscopie avec une réduction de la durée d'hospitalisation, ainsi que des complications peropératoires et postopératoires mineures et majeures, moins importantes.

Functional analysis of altered channel-activating protease-1 (CAP1) expression in the skin

Summary : The skin is a complex organ that protects the body against entry of pathogens and supplies a relatively dry and impermeable barrier to water loss. This barrier function is mainly provided by the epidermis, which is the outermost layer of the skin. Serine proteases are involved in skin physiology and it is known that mutations or alterations in their expression can lead to skin diseases. In order to investigate the importance of the regulated expression of CAPI/Prss8, a membrane bound serine protease expressed in the epidermis, we developed transgenic mice ectopically expressing CAPI/Prss8 in the skin. These animals exhibited a phenotype characterized by scaly skin, epidermal hypertrophy, inflammation and scratching behavior. This phenotype could be completely abolished in mice lacking the proteinase activated receptor 2 (PAR2) revealing PAR2 as a potential in vivo downstream target of CAP 1 /Prss8. We could also provide evidence of a CAP1 /Prss8 function independent of its catalytic activity. Additionally, mice ectopically expressing PAR2 in the skin developed a skin phenotype very similar to CAPI/Prss8 transgenic animals, supporting the hypothesis of PAR2 activation by CAPI/Prss8. We could furthermore demonstrate an inhibitory effect of the serine protease inhibitor nexin-I on CAPI/Prss8, since nexin-1 transgenic expression negated the skin phenotype observed in CAPI/Prss8 transgenic mice. CAP1/Prss8 and PAR2 transgenic animals, and the understanding of the interaction between CAPl/Prss8 and PAR2, can be helpful in developing potential CAPI/Prss8 and PAR2 inhibitory molecules that may be used as drugs to treat ichthyoses-like skin diseases. Résumé : La peau est un organe complexe qui protège le corps contre l'entrée des pathogènes et forme une barrière imperméable qui empêche la déshydratation. Cette fonction de barrière est surtout fournie par l'épiderme, la couche la plus superficielle de la peau. Le bon fonctionnement de cet organe est permis, entre autres, par les protéases à sérine qui sont des enzymes dont l'altération peut causer des maladies de la peau. Pour étudier l'importance de la régulation de CAP1/Prss8, une protéase à sérine exprimée au niveau de l'épiderme, des souris génétiquement modifiées, dans lesquelles CAP1/Prss8 est exprimé d'une manière ectopique dans la peau, ont été générées. Les animaux transgéniques pour CAP1/Prss8 présentent une peau squameuse, un épiderme hypertrophique, des processus inflammatoires et se grattent. Ce phénotype a pu être complètement guéri lorsque le gène de PAR2, un récepteur qui règle l'activité des cellules de l'épiderme, est inactivé chez la souris. Ceci montre que PAR2 est une cible de CAP1/Prss8 dans le système étudié. Des études expérimentales suggèrent de plus que l'effet de CAP1/Prss8 dans ce modèle ne dépend pas de son activité enzymatique. En dernière analyse, il a été démontré que l'expression transgénique de nexin-1, un inhibiteur des protéases à sérine exprimé dans la peau, a la capacité d'améliorer la peau squameuse et l'épiderme hypertrophique causés par CAP1/Prss8 transgénique. Les animaux transgéniques pour CAP1/Prss8 et PAR2, et la compréhension du mécanisme d'interaction entre eux, pourraient aider à développer et à tester des molécules inhibitrices de CAP1 /Prss8 et PARI qui pourraient alors être utilisées comme médicaments pour traiter des maladies de la peau comme les ichthyoses.

Dépistage des cancers en pratique clinique: une place privilégiée pour le partage de la décision. [Cancer screening in clinical practice: the value of shared decision-making]

Shared decision-making approach to uncertain clinical situations such as cancer screening seems more appropriate than ever. Shared decision making can be defined as an interactive process where physician and patient share all the stages of the decision making process. For patients who wish to be implicated in the management of their health conditions, physicians might express difficulty to do so. Use of patient decision aids appears to improve such process of shared decision making. L'incertitude quant à l'efficacité de certains dépistages de cancers et du traitement en cas de test positif rend l'application du partage de la décision particulièrement appropriée. Le concept du partage de la décision peut être défini comme un processus interactif où le médecin et le patient partagent les étapes du processus de décision. Face aux patients qui désirent être impliqués dans les décisions concernant leur santé, les médecins peinent parfois à le faire. Or, l'utilisation d'outils d'aide à la décision est un moyen efficace de favoriser ce partage de l'information et, si souhaité par le patient, de la décision.

Preserved capillary density of dorsal finger skin in treated hypertensive patients with or without type 2 diabetes.

OBJECTIVES: Capillary rarefaction is a hallmark of untreated hypertension. Recent data indicate that rarefaction may be reversed by antihypertensive treatment in nondiabetic hypertensive patients. Despite the frequent association of diabetes with hypertension, nothing is known on the capillary density of treated diabetic patients with hypertension. METHODS: We enrolled 21 normotensive healthy, 25 hypertensive only, and 21 diabetic (type 2) hypertensive subjects. All hypertensive patients were treated with a blocker of the renin-angiotensin system, and a majority had a home blood pressure ≤135/85 mmHg. Capillary density was assessed with videomicroscopy on dorsal finger skin and with laser Doppler imaging on forearm skin (maximal vasodilation elicited by local heating). RESULTS: There was no difference between any of the study groups in either dorsal finger skin capillary density (controls 101 ± 11 capillaries/mm(2) , nondiabetic hypertensive 99 ± 16, diabetic hypertensive 96 ± 18, p > 0.5) or maximal blood flow in forearm skin (controls 666 ± 114 perfusion units, nondiabetic hypertensive 612 ± 126, diabetic hypertensive 620 ± 103, p > 0.5). CONCLUSIONS: Irrespective of the presence or not of type 2 diabetes, capillary density is normal in hypertensive patients with reasonable control of blood pressure achieved with a blocker of the renin-angiotensin system.

Origin of the neutron skin thickness of 208Pb in nuclear mean-field models

We study whether the neutron skin thickness Δrnp of 208Pb originates from the bulk or from the surface of the nucleon density distributions, according to the mean-field models of nuclear structure, and find that it depends on the stiffness of the nuclear symmetry energy. The bulk contribution to Δrnp arises from an extended sharp radius of neutrons, whereas the surface contribution arises from different widths of the neutron and proton surfaces. Nuclear models where the symmetry energy is stiff, as typical of relativistic models, predict a bulk contribution in Δrnp of 208Pb about twice as large as the surface contribution. In contrast, models with a soft symmetry energy like common nonrelativistic models predict that Δrnp of 208Pb is divided similarly into bulk and surface parts. Indeed, if the symmetry energy is supersoft, the surface contribution becomes dominant. We note that the linear correlation of Δrnp of 208Pb with the density derivative of the nuclear symmetry energy arises from the bulk part of Δrnp. We also note that most models predict a mixed-type (between halo and skin) neutron distribution for 208Pb. Although the halo-type limit is actually found in the models with a supersoft symmetry energy, the skin-type limit is not supported by any mean-field model. Finally, we compute parity-violating electron scattering in the conditions of the 208Pb parity radius experiment (PREX) and obtain a pocket formula for the parity-violating asymmetry in terms of the parameters that characterize the shape of the 208Pb nucleon densities.

Damn Platonism! Concrete Persons' Skin, Flesh and Bodies: Three Phases of a Won Battle in Miquel Àngel Riera's poetry

The aim of this article is to show how, throughout M. A. Riera's poetry, an evident anti-metaphysical sensibility can be easily detected, which in its turn makes the poet to praise concrete person's skin, flesh and bodies, thus avoiding any personal Platonic or idealistic experience of human love. In the author's opinion, an accurate reading of his poems makes us discover Plato and Platonism as one of the great responsible thinkers for the contempt of carnal love, which has been undoubtedly the origin of a real human pain as a result of denying the somatic side of eros.

Plasticity of protein expression during culture of fetal skin cells.

In order to gain insight into the biology of fetal skin during culture, cellular proteins were studied during four culture passages (P00, P01, P04 as well as P10) using high-resolution two-dimensional (2-D) gel electrophoresis and mass spectrometry (MS). Bioinformatic analyses were focused on a region of each gel corresponding to pI between 4 and 8 and M(r) from 8000 to 35 000. In this area, 373 +/- 42 spots were detected (N = 18). Twenty-six spots presented an integrated intensity that increased in the higher passages, whereas five spots showed a progressively lower intensity in subsequent passaging. MS analysis was performed on spots that were unambiguously identified on preparative 2-D gels. Among the 26 spots showing an increased size between P00 and P10, 9 were identified, and corresponded to 3 proteins: (i) peptidyl-prolyl cis-trans isomerase A (P05092; cyclophilin A or cyclosporin A-binding protein), (ii) triosephosphate isomerase (P00938), and (iii) enoyl-CoA hydratase (P30084). Among these nine identified spots, three were absent at P00, but were present at P10. They corresponded to isoforms of peptidyl-prolyl cis-trans isomerase and triosephosphate isomerase, respectively. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) analyses of the acidic isoforms of triosephosphate isomerase showed modifications of cysteine residues to cysteic acid. All these isoforms were clearly present in the skin cells of a 4-year-old child, as well as in skin cells from a 80-year-old man, at P00. These observations probably reflect either an oxidative stress related to cell culture, or, alternatively, maturation, differentiation and the aging of the cells.

Sentinel lymph node biopsy in nonmelanoma skin cancer patients.

The management of lymph nodes in nonmelanoma skin cancer patients is currently still debated. Merkel cell carcinoma (MCC), squamous cell carcinoma (SCC), pigmented epithelioid melanocytoma (PEM), and other rare skin neoplasms have a well-known risk to spread to regional lymph nodes. The use of sentinel lymph node biopsy (SLNB) could be a promising procedure to assess this risk in clinically N0 patients. Metastatic SNs have been observed in 4.5-28% SCC (according to risk factors), in 9-42% MCC, and in 14-57% PEM. We observed overall 30.8% positive SNs in 13 consecutive patients operated for high-risk nonmelanoma skin cancer between 2002 and 2011 in our institution. These high rates support recommendation to implement SLNB for nonmelanoma skin cancer especially for SCC patients. Completion lymph node dissection following positive SNs is also a matter of discussion especially in PEM. It must be remembered that a definitive survival benefit of SLNB in melanoma patients has not been proven yet. However, because of its low morbidity when compared to empiric elective lymph node dissection or radiation therapy of lymphatic basins, SLNB has allowed sparing a lot of morbidity and could therefore be used in nonmelanoma skin cancer patients, even though a significant impact on survival has not been demonstrated.