Robert Rissmann

Development of a murine model to evaluate the effect of vernix caseosa on skin barrier recovery

Abstract:  The aim of this study was twofold, that is the generation of a reliable model for skin barrier disruption and repair and to evaluate recovery of damaged skin after application of vernix caseosa (VC). VC was selected as its wound healing properties were suggested previously, but never clearly demonstrated. Five different levels of barrier disruption in mice, accomplished by tape‐stripping, were evaluated. Disruption models such as moderate, severe #1 and #2 (transepidermal water loss (TEWL) of 31 ± 2, 59 ± 4 and 66 ± 3 g/m2/h, respectively) showed complete recovery within 72 h. However, not all corneocytes were removed after tape‐stripping. Additionally, models such as severe #3 and #4 (TEWL of 73 ± 5 and 79 ± 6 g/m2/h, respectively) with a more severe disruption were evaluated. After tape‐stripping, all corneocytes were removed and the remaining epidermis was intact. However, model #3 still showed complete recovery within 72 h. With model #4, a crust was formed and almost complete recovery (approximately 90%) was obtained within only 8 days. The effect of VC application on recovery of disrupted skin was evaluated with model #3 and #4. Model #3 showed that application of VC predominantly influenced initial recovery and is therefore merely appropriate to study the effect of formulations in the initial recovery period. Topical application of VC on model #4 considerably increased initial and long‐term recovery. Moreover, VC application promoted rapid formation of stratum corneum and prevented epidermal thickening. These observations not only confirm the ability of VC to enhance barrier recovery, but also suggest potential use of this treatment clinically.

Lanolin-derived lipid mixtures mimic closely the lipid composition and organization of vernix caseosa lipids

The aim of the present study was to use semi-synthetic lipid mixtures to mimic the complex lipid composition, organization and thermotropic behaviour of vernix caseosa (VC) lipids. As VC shows multiple protecting and barrier supporting properties before and after birth, it is suggested that a VC substitute could be an innovative barrier cream for barrier deficient skin. Lanolin was selected as the source of the branched chain sterol esters and wax esters--the main lipid classes of VC. Different lipid fractions were isolated from lanolin and subsequently mixed with squalene, triglycerides, cholesterol, ceramides and fatty acids to generate semi-synthetic lipid mixtures that mimic the lipid composition of VC, as established by high-performance thin-layer chromatography. Differential scanning calorimetry and Fourier transform infrared spectroscopy investigations revealed that triglycerides play an important role in the (lateral) lipid organization and thermotropic behaviour of the synthetic lipid mixtures. Excellent resemblance of VC lipids was obtained when adding unsaturated triglycerides. Moreover, these lipid mixtures showed similar long range ordering as VC. The optimal lipid mixture was evaluated on tape-stripped hairless mouse skin in vivo. The rate of barrier recovery was increased and comparable to VC lipid treatment.

Rilonacept and canakinumab

Two new orphan medicines, rilonacept [1, 2] (Regeneron®) and canakinumab [3, 4] (Ilaris®), are indicated for the treatment of cryopyrin-associated periodic syndromes (CAPS). CAPS occur in a group of rare, inherited, inflammatory diseases where patients have a mutation in the NLRP3 (nucleotide-binding domain, leucine-rich family, pyrin domain-containing-3) gene encoding for cryopyrin, which is a regulator in the acute immune reaction. Both familial cold auto-inflammatory syndrome and Muckle–Wells syndrome belong to the CAPS group. Additionally, canakinumab may be used to treat other CAPS such as neonatal-onset multisystem inflammatory disease and familial cold urticaria. The indications for both drugs might be extended in future. Currently, these two drugs are being evaluated in more common diseases including rheumatoid arthritis and systemic-onset juvenile idiopathic arthritis [5, 6].

Skin barrier disruption by acetone: observations in a hairless mouse skin model

To disrupt the barrier function of the skin, different in vivo methods have been established, e.g., by acetone wiping or tape-stripping. In this study, the acetone-induced barrier disruption of hairless mice was investigated in order to establish a reliable model to study beneficial, long-term effects on barrier recovery after topical application. For both treatments (i.e., acetone treatment and tape-stripping) the transepidermal water loss directly after disruption and the subsequent barrier recovery profile were similar. Histological assessment showed significant lower number of corneocyte layers in acetone-treated and tape-stripped skin compared to untreated skin, while there was no statistical difference between the two treatments. Lipid analysis of acetone-treated skin revealed that only small fraction of lipids were extracted consisting of predominantly nonpolar lipids. Importantly, the ratio of the barrier lipids, i.e., cholesterol, free fatty acids and ceramides, remained similar between control and acetone-treated skin. This reflects the undisrupted lipid organization, as determined by small-angle X-ray diffraction measurements: the long-periodicity lamellar phase was still present after acetone treatment. Our results contradict earlier studies which reported no mechanical stratum corneum removal, a substantial extraction of lipids and disruption in lipid organization. In conclusion, our studies demonstrate that barrier disruption due to acetone treatment is mainly due to removal of corneocytes.

IMO-8400, a toll-like receptor 7, 8, and 9 antagonist, demonstrates clinical activity in a phase 2a, randomized, placebo-controlled trial in patients with moderate-to-severe plaque psoriasis

BACKGROUND Aberrant toll-like receptors (TLRs) 7, 8, and 9 activation by self-nucleic acids is implicated in immune-mediated inflammatory diseases (IMIDs) such as psoriasis. In preclinical IMID models, blocking TLR-activation reduced disease severity. IMO-8400 is a first-in-class, oligonucleotide-based antagonist of TLRs 7, 8, and 9. We evaluated the short-term safety and proof-of-concept for efficacy of IMO-8400 in a first-in-patient phase 2 trial. METHODS Forty-six psoriasis patients were randomly assigned to IMO-8400 in four dose levels or placebo for 12weeks. Post-treatment follow-up was seven weeks. Primary outcome was incidence of adverse events. Secondary, exploratory outcomes included changes in psoriasis area and severity index (PASI). RESULTS IMO-8400 across all dose levels did not cause any serious or severe adverse events. The most common treatment-related adverse events were dose-dependent injection-site reactions. All IMO-8400 groups showed clinical improvement, but a clear dose-response relationship and statistically significant differences with placebo were not observed (P=0.26). Eleven (38%) of 29 subjects on IMO-8400 achieved ≥50% PASI-reduction, compared to 1 (11%) of 9 subjects on placebo. Five (17%) and 2 (7%) IMO-8400-treated subjects achieved PASI-75 and PASI-90, respectively, compared to none on placebo. CONCLUSIONS Short-term IMO-8400-treatment was well tolerated and reduced psoriasis severity. These findings warrant further investigation of endosomal TLR-antagonism as a therapeutic approach in psoriasis and other TLR-mediated IMIDs. TRIAL REGISTRATION EudraCT 2013-000164-28 and Clinicaltrials.govNCT01899729.

Mimicking vernix caseosa--preparation and characterization of synthetic biofilms.

The multiple protecting and barrier-supporting properties of the creamy, white biofilm vernix caseosa (VC) before and after birth suggest that a VC biomimetic could be an innovative barrier cream for barrier-deficient skin. The aim of this study was the rational design and preparation of synthetic biofilms mimicking the unique composition and properties of natural VC. Hexagonal, highly hydrated hyperbranched polyglycerol microgel particles (30 microm in diameter) were embedded in a synthetic lanolin-based lipid mixture using a micromixer. In these formulations, the water content of the particles (i.e. 50% and 80%), an additional lipid coating of the particles and different particle/lipid ratios were varied. Characterization with confocal laser scanning microscopy (CLSM) showed a homogeneous distribution of the labeled particles in the lipid matrix. Regarding structural appearance, particle density and distribution, the formulations with a high particle/lipid ratio (5:1) resembled native VC very closely. Comparable results between native VC and the synthetic formulations were obtained concerning water handling properties, thermotropic behavior while lower elasticity and lower viscosity were observed for the synthetic biofilms. The biofilm formulations were stable for at least 1 month at 4 degrees C. In conclusion, our formulations mimic natural VC very closely and are promising candidates for in vivo studies.

Effect of synthetic vernix biofilms on barrier recovery of damaged mouse skin

Abstract:  The aim of this work was to investigate whether topical application of synthetic biofilms supports and accelerates the recovery of the murine skin barrier, disrupted by sequential tape stripping. Therefore, various biofilms were applied topically on disrupted mouse skin to determine which formulation could improve barrier function, as was observed previously for the natural biofilm vernix caseosa (VC). The biofilms [i.e. particles (synthetic corneocytes) embedded in a synthetic lipid matrix] mimic closely the physicochemical properties and structure of VC. Various formulations were prepared using different particle:lipid ratios, particles with different initial water content and uncoated or lipid‐coated particles. It was observed that application of all tested formulations improved the skin barrier recovery rate and reduced crust formation and epidermal hyperproliferation. However, only one of the biofilms [i.e. B1; composed of uncoated particles with 50% (w/w) initial water content and particle:lipid ratio of 2:1] mimicked the effects of native VC most closely. This indicates the importance of the presence of individual components, i.e. barrier lipids and water, as well as the ratio of these components. Consequently, these observations suggest the potential use of this biofilm treatment clinically.

Injection site reactions after subcutaneous oligonucleotide therapy

Oligonucleotides (ONs) are short fragments of nucleic acids, currently being investigated as therapeutic agents. When administered subcutaneously (sc), ONs cause a specific local reaction originating around the injection site, such as erythema, itching, discomfort and pain, including more severe manifestations such as ulceration or necrosis. These injection site reactions (ISRs) are common, but rather poorly described in the literature. With this review, we aim to provide an overview on the extent of the problem of ISRs, based on reported incidence. A structured literature search was performed to identify reported incidence and clinical features of ISRs which yielded 70 manuscripts that contained information regarding ISRs. The data from literature was combined with data on file available at our institution. All sc administered ONs described in the literature lead to the occurrence of ISRs. The percentage of trial subjects that developed ISRs ranged from 22 to 100% depending on ON. The majority of ONs caused ISRs in more than 70% of the trial subjects. The severity of the observed reactions varied between different ONs. Occurrence rate as well as severity of ISRs increases with higher doses. For chemistry and target of the compounds, no clear association regarding ISR incidence or severity was identified. All ONs developed to date are associated with ISRs. Overcoming the problem of ISRs might add greatly to the potential success of sc‐administered ONs. Knowledge of these skin reactions and their specific immunostimulatory properties should be increased in order to obtain ONs that are more suitable for long‐term use and clinically applicable in a broader patient population.

Pharmacokinetics and pharmacodynamics of oral mecamylamine - development of a nicotinic acetylcholine receptor antagonist cognitive challenge test using modelling and simulation.

A pharmacologic challenge model with a nicotinic antagonist could be an important tool not only to understand the complex role of the nicotinic cholinergic system in cognition, but also to develop novel compounds acting on the nicotinic acetylcholine receptor. The objective was to develop a pharmacokinetic–pharmacodynamic (PKPD) model using nonlinear mixed effects (NLME) methods to quantitate the pharmacokinetics of three oral mecamylamine doses (10, 20 and 30 mg) and correlate the plasma concentrations to the pharmacodynamic effects on a cognitive and neurophysiologic battery of tests in healthy subjects. A one-compartment linear kinetic model best described the plasma concentrations of mecamylamine. Mecamylamine’s estimated clearance was 0.28 ± 0.015 L min−1. The peripheral volume of distribution (291 ± 5.15 L) was directly related to total body weight. Mecamylamine impaired the accuracy and increased the reaction time in tests evaluating short term working memory with a steep increase in the concentration-effect relationship at plasma concentrations below 100 μg L−1. On the other hand, mecamylamine induced a decrease in performance of tests evaluating visual and fine motor coordination at higher plasma concentrations (EC50 97 μg L−1). Systolic and diastolic blood pressure decreased exponentially after a plasma mecamylamine concentration of 80 μg L−1, a known effect previously poorly studied in healthy subjects. The developed mecamylamine PKPD model was used to quantify the effects of nicotinic blockade in a set of neurophysiological tests in humans with the goal to provide insight into the physiology and pharmacology of the nicotinic system in humans and the possibility to optimize future trials that use mecamylamine as a pharmacological challenge.

Long periodicity phase in extracted lipids of vernix caseosa obtained with equilibration at physiological temperature

The outermost layer of the skin, the stratum corneum (SC), comprises the main barrier function between body and environment. The SC features a highly structured lipid organization: a short periodicity phase and a long periodicity phase (LPP) with a repeat distance of 6 and 13 nm, respectively. Like SC, vernix caseosa (VC), the creamy white skin-surface biofilm of the newborn, also contains barrier lipids, i.e. ceramides, cholesterol and free fatty acids. Aim of this study was to investigate whether isolated VC lipids also form the characteristic LPP. Several preparation methods were examined and only when the solution of the lipid mixture, isolated either from VC or SC, was dried under nitrogen at 37 degrees C and subsequently spread onto a support, the LPP was formed. When VC barrier lipids were first exposed to elevated temperatures and subsequently cooled down, the LPP was formed at around 34 degrees C, which is at a much lower temperature than observed with the lipids in SC. In conclusion, we showed for the first time that depending on the preparation method, (i) VC lipids also form the LPP and (ii) the LPP in VC lipids and SC lipids was obtained at a low equilibration temperature, mimicking the physiological condition.