Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts
Abstract
:1. Introduction
2. Results
2.1. IM Induces Thrombosis in Capillaries in AGW
2.2. Histopathology Confirmed Microthrombosis with Neutrophils
2.3. Immunofluorescence Analyses Demonstrated Early VWF Secretion and Formation of NETs
2.4. In Vitro Analyses Confirmed Endothelial Cell Activation and VWF Secretion after IM Stimulation
2.5. IM Superinduces IL-8 (CXCL8) Expression in HPV-E6/E7 Transfected HaCaT Cells
3. Discussion
4. Materials and Methods
4.1. Dermoscopic and In Vivo Confocal Laser Microscopy Evaluation of AGW
4.2. Biopsies of IM-Treated Anogenital Warts
4.3. Histomorphology, Immunohistochemistry, and Immunofluorescence
4.4. Cell Culture
4.5. ELISA
4.6. Transfection
4.7. RT-qPCR
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient #1 | Patient #2 | Patient #3 | Patient #4 | Patient #5 | Patient #6 | Patient #7 | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Timepoint [h] | 0 | 3 | 8 | 0 | 3 | 8 | 0 | 3 | 8 | 0 | 3 | 8 | 0 | 3 | 8 | 0 | 3 | 8 | 0 | 3 | 8 |
Hyperkeratosis | o | o | +++ | + | + | + | + | + | + | + | ++ | + | + | + | o | ++ | ++ | ++ | ++ | + | + |
Parakeratosis | o | o | o | o | o | o | o | o | o | o | + | o | o | o | o | o | + | + | + | + | + |
Spongiosis | o | o | + | o | o | o | o | o | ++ | o | o | ++ | o | o | o | o | o | + | o | + | + |
Pallor of the epidermis | o | o | + | + | ++ | ++ | o | o | ++ | o | + | ++ | o | + | ++ | o | + | + | o | + | + |
Necrotic, apoptotic keratinocytes | o | o | o | o | + | + | o | o | + | o | o | + | o | o | + | o | + | + | o | + | + |
Ballooning degeneration | o | o | o | + | o | ++ | o | o | ++ | o | o | ++ | o | o | +++ | o | o | + | o | + | + |
Reticulated degeneration | o | o | o | o | o | o | o | o | o | o | ++ | o | o | +++ | o | o | + | o | o | + | |
Extravasated erythrocytes around capillaries | o | o | + | o | + | ++ | o | o | +++ | o | o | +++ | o | o | ++ | o | o | + | o | o | o |
Thrombus in capillaries | o | o | o | o | o | o | o | o | + | o | o | + | o | o | + | o | o | + | o | + | + |
Thrombus in postcapillary venules | o | o | o | o | o | x | o | x | + | o | o | + | o | o | x | o | o | + | o | x | x |
Fibrinoid degeneration of vessel walls | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o |
Fibrin perivascular | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | o | + | o | o | o |
Extravasated erythrocytes around postcapillary venules | o | o | o | o | o | x | o | x | ++ | o | o | o | o | + | x | o | o | + | o | x | x |
Diapedesis of neutrophils | o | o | o | o | o | x | o | x | ++ | o | o | + | o | o | x | o | o | +++ | o | x | x |
Leukocytoclasia | o | o | o | o | o | + | o | o | ++ | o | o | o | o | o | + | o | o | + | o | o | o |
Intraepidermal neutrophils (MPO) | o | o | o | o | o | o | o | o | + | o | o | o | o | o | + | o | o | + | o | o | + |
Intravascular neutrophils (MPO) | o | o | + | + | ++ | ++ | o | + | +++ | o | o | +++ | o | ++ | ++ | o | + | +++ | o | ++ | +++ |
Perivascular neutrophils (MPO) | o | + | + | o | ++ | ++ | o | + | +++ | o | + | +++ | + | ++ | ++ | o | + | +++ | + | ++ | +++ |
Diapedesis neutrophils (MPO) | o | + | o | o | + | + | o | o | ++ | o | o | +++ | o | + | ++ | o | o | +++ | 0 | + | +++ |
Dermal T helper cells (CD4) | + | + | ++ | + | + | + | + | + | + | + | + | ++ | ++ | ++ | + | ++ | ++ | ++ | + | ++ | ++ |
Dermal cytotoxic T cells (CD8) | + | + | ++ | + | + | + | + | + | +++ | + | + | ++ | ++ | ++ | + | ++ | ++ | +++ | + | ++ | +++ |
Dermal macrophages (CD163) | + | + | + | + | + | + | + | + | + | + | + | + | + | + | + | ++ | ++ | ++ | + | ++ | ++ |
Patient #1 | Patient #2 | Patient #3 | Patient #4 | Patient #5 | Patient #6 | Patient #7 | |
---|---|---|---|---|---|---|---|
Gender | M | W | M | M | M | M | M |
Age | 27 | 22 | 22 | 28 | 50 | 62 | 64 |
History of warts | 24 months | 7 months | 6 months | 10 months | 12 months | 2 months | 12 months |
Location | Mons pubis, penile shaft | Labia maiora | Mons pubis | Mons pubis, penile shaft | Penile shaft | Penile shaft | Penile shaft |
Previous treatments | Cryotherapy Podophyllo-toxin | - | - | - | Cryotherapy | - | Cryotherapy |
Comorbidities | - | - | Gastro-esophageal reflux disease | - | - | Arterial hypertension, peripheral artery disease | Arterial hypertension |
HPV type | HPV 6 | HPV 6 | HPV 6 | HPV 6 | HPV 6 | HPV 6 | HPV 6 |
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Braun, S.A.; Bauer, A.T.; Németh, C.; Rózsa, A.; Rusch, L.; Erpenbeck, L.; Schloer, S.; Silling, S.; Metze, D.; Gerber, P.A.; et al. Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts. Int. J. Mol. Sci. 2022, 23, 13377. https://doi.org/10.3390/ijms232113377
Braun SA, Bauer AT, Németh C, Rózsa A, Rusch L, Erpenbeck L, Schloer S, Silling S, Metze D, Gerber PA, et al. Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts. International Journal of Molecular Sciences. 2022; 23(21):13377. https://doi.org/10.3390/ijms232113377
Chicago/Turabian StyleBraun, Stephan A., Alexander T. Bauer, Csongor Németh, Annamária Rózsa, Louisa Rusch, Luise Erpenbeck, Sebastian Schloer, Steffi Silling, Dieter Metze, Peter A. Gerber, and et al. 2022. "Immunothrombotic Mechanisms Induced by Ingenol Mebutate Lead to Rapid Necrosis and Clearance of Anogenital Warts" International Journal of Molecular Sciences 23, no. 21: 13377. https://doi.org/10.3390/ijms232113377