Exosomes are naturally occurring small membrane-enclosed nanovesicles that modulate the immune system and mediate communication between cells and the transport of cellular components. Although the field of exosome research in cancer progression is expanding, there are very few studies on the role of exosomes in immune-mediated inflammatory diseases. This study shows, for the first time, the presence of circulating exosomes in patients with psoriasis, in particular in those with moderate-to-severe psoriasis, through IL-17A-producing exosomes. Further larger studies are required, to evaluate the effect of systemic treat ments on exosome production. Exosomes are involved in modulating the immune system and mediating communication between cells. The aim of this study was to investigate the involvement of exosomes in psoriasis. Exosomes from patients with psoriasis were analysed by nanoparticle tracking analysis and protein expression was analysed by western blotting. The concentration of HSP70 was determined by an enzyme-linked immunosorbent assay, and concentrations of interleukin (IL)-1β, IL-2, IL-6, IL-10, IL-17A and tumour necrosis factor alpha (TNF-α) were determined by flow cytometry. Based on the severity of psoriasis, evaluated by body surface area (≤ 10% vs. > 10%), 2 groups of patients were compared (49 with mild psoriasis and 71 with moderate-to-severe psoriasis). The number (2.52×10 11 ± 2.29×10 10 vs. 1.79×10 11 ± 1.93×10 10 , p = 0.19) and size (94.44 ± 22.00 nm vs. 96.87 ± 28.30 nm, p = 0.72) of exosomes and the concentration of HSP70 in the exosomes were not significantly different in the 2 groups of patients. IL-17A exosome levels were significantly higher in patients with moderate-to-severe psoriasis compared with those with mild psoriasis (p = 0.02). There were no significant differences in levels of TNF-α, IL-1, IL-2, IL-6 and IL-10. This study shows, for the first time, the presence of circulating exosomes in patients with psoriasis. These data confirm the involvement of circulating exosomes in psoriasis, in particular in moderate-to-severe psoriasis, through IL-17A-producing exosomes.
The main localization of SARS-CoV-2 infection is the respiratory tract. Digestive and otorhinolaryngological localizations are also reported. More recently, dermatological manifestations have been reported during Coronavirus disease-19 (COVID-19). We report a case of a labial angioedema in a patient with confirmed COVID-19.
weeks after the onset of osimertinib administration, with a bone marrow biopsy yielding a diagnosis of severe aplastic anemia. Symptoms of drug-induced aplastic anemia have been found to develop from days to months after initiation of treatment with the offending drug. 4 The present patient had taken L. bifidus, ethyl icosapentate, eldecalcitol, lansoprazole, amlodipine, and sitagliptin phosphate hydrate for more than 2 years, with none of these agents having previously been associated with aplastic anemia. Osimertinib was therefore most likely the cause of aplastic anemia in the proband, although other causes cannot be completely ruled out. As far as we are aware, this would be the first report of a case of osimertinib-induced severe aplastic anemia.Aplastic anemia is a rare hematopoietic stem cell disorder that results in pancytopenia and hypocellularity of bone marrow and can be acquired, hereditary, or idiopathic. Acquired aplastic anemia has been causally associated with many agents including drugs. The three major causes of acquired aplastic anemia are direct toxicity, metabolitedriven toxicity, and immune-mediated mechanisms, 5 with the pathogenesis of osimertinib-associated aplastic anemia being unknown. Other EGFR TKIs have not been found to induce irreversible bone marrow failure, suggesting that EGFR inhibition itself is not a cause of aplastic anemia.In conclusion, physicians should be aware of the risk for aplastic anemia in patients treated with osimertinib. Such patients should therefore be monitored carefully, and the frequency of this severe adverse effect should be determined.
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