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Serum aminoterminal propeptide of type III procollagen in the management of methotrexate-induced fibrogenesis
Volume 27 Number 1 July 1992
Correspondence 139
4. Agin PP, Desrochers DL, SayreRM. The relationship of immediate pigment darkening to minimal erythemal dose, skin type and eye color. Photodermatology 1985;2:28894. 5. Stanfield JW, Tarfare NS, Krochmal L, et a1. Threshold dose requirements for immediate pigment darkening. Poster presented at the 16th Annual Meeting oftheAmerican Society forPhotobiology, Colorado Springs, Colo, March 17, 1988. 6. Bissett DL, Hannon DP, Orr TV. Wavelength dependence of histological, physical and visible changes in chronically UV-irradiated hairless mouse skin. Photochem Photobiol 1989;50:763-9. 7. DeGruijl FR,Van derLeun JC. Action spectra for carcinogenesis. Abstract presented at the Second International Conference on the Biological Effects of UVA Radiation. Sponsored by the American Society of Photobiology. San Antonio, Tex, June26-28, 1991.
Serum aminoterminal propeptide of type III procollagen in the management of methotrexate-induced fibrogenesis To the Editor: We read with interest the article entitled, "The Pharmacology of Methotrexate" by E. A. Olsen (J AM ACAD DERMATOL 1991;25:306-18). As stated, liver fibrogenesis is a major concernin patients with psoriasis treated with methotrexate (MTX). Hence liver biopsies should be performed in these patients either before or within a fewmonths of starting MTX. In addition, repeat liver biopsies should beconductedafter a doseof1500mg. However, Dr. Olsen did not mentionserum aminoterminal propeptide of type III procollagen (PIIINP) measurementas an indicatorof a process that might lead to liver fibrogenesis in patients receiving long-term MTX treatment. Recently, Zachariae et a1. 1, 2 have reported that elevatedserumPIIINP levels couldreflect hepaticfibrosis in MTX-treated psoriasis patients.Theseauthors haveproposed that two increased serum PIIINP valuesin longterm MTX treatment should be an indication for a liver biopsy. With the use of this laboratory test, it wouldbe possibleto minimize the numberof liver biopsies, which might have some risks to these patients. Nazi! Kurkquoglu, MD, and Gul Oz, MD 10 Sokak 23/5 Bahcelievler 06490 Ankara, Turkey REFERENCES 1. Zachariae H, S~gaard H, Heickendorff L. Serum aminoterminal propeptide oftype III procollagen-a non-invasive testfor liver fibrogenesis inmethotrexate-treated psoriatics. Acta Derm Venereal (Stockh) 1989;69:241-4. 2. Zachariae H, Aslam HM, Bjerring P, et a1. Serum aminoterminal propeptide oftype III procollagen in psoriasis and psoriatic arthritis: relation toliver fibrosis andarthritis. JAM ACAD DERMATOL 1991;25:50-3.
Grafting of leg ulcers with undifferentiated keratinocytes To the Editor: I found the article by Brysk et al. (J AM ACAD DERMATOL 1991;25:238-44) an exciting one because it indicatesthere may be an effective and relatively nontraumatic therapy for a difficult clinical problem. However, one aspectof the article I did find unsatisfying was the lack of any real data on the medical status, age, nutritional status, or metabolicdisease of the six patients who underwentgrafting. It was also unclear as to what long-termmeasureswere initiated after grafting was performed. Were the excellent immediate and apparently longerterm results due to selective patient selection (althoughthe ulcerswereoflong duration, werethe patients healthierphysical specimens than is normal for most patientswith chronicvenousstasis ulcers?), and did the patients afterwardfollow an activelifestylewithout any extraordinary measures to protect the ulcers over the ensuing months to years? My surgicalcolleagues withwhom I havediscussedthis article point out to me that they believethey have little trouble getting grafts to take initially in apparently similar cases but have great difficulty maintaining these grafts overthe ensuing months to years; frankly they are skeptical that Brysk's cellculture techniquewill proveany more effective in the long term. Further information on the medical status of the patients treated by Brysk and colleagues and their long-term management would be helpfulin this regard. John C. Goodall, MD, FRCPC 216-1929 Russell Road
Ottawa, Ontario, Canada K1G 4G3
Reply To the Editor: We appreciate the query of Dr. Goodall concerning the medical status of our patients with stasis ulcers grafted with autologous undifferentiated keratinocytes and thelong-termmanagement ofthese patients. In the preliminarystudy reported,eight ulcers in six patientswere grafted.The patients were selected simply on the basis of havingfailed many other modalities of treatment and their willingness to participate in the studyand to return for follow-up observation and care. One patient was 39 years old and in good health with chronic lymphedema of one leg resulting from trauma that had occurred 20 years earlier. The other five patients were between 63 and 73 years of age. Each had at least one chronic medical problem, including hypertension (two patients),history of myocardialinfarction (two), congestive heart failure (one), diabetes (one), and rheumatoid arthritis (one). The patient in whom grafting wasunsuccessful had severe atherosclerosis. After each ulcerhad healed, the patient was fittedwith
Correspondence 139
4. Agin PP, Desrochers DL, SayreRM. The relationship of immediate pigment darkening to minimal erythemal dose, skin type and eye color. Photodermatology 1985;2:28894. 5. Stanfield JW, Tarfare NS, Krochmal L, et a1. Threshold dose requirements for immediate pigment darkening. Poster presented at the 16th Annual Meeting oftheAmerican Society forPhotobiology, Colorado Springs, Colo, March 17, 1988. 6. Bissett DL, Hannon DP, Orr TV. Wavelength dependence of histological, physical and visible changes in chronically UV-irradiated hairless mouse skin. Photochem Photobiol 1989;50:763-9. 7. DeGruijl FR,Van derLeun JC. Action spectra for carcinogenesis. Abstract presented at the Second International Conference on the Biological Effects of UVA Radiation. Sponsored by the American Society of Photobiology. San Antonio, Tex, June26-28, 1991.
Serum aminoterminal propeptide of type III procollagen in the management of methotrexate-induced fibrogenesis To the Editor: We read with interest the article entitled, "The Pharmacology of Methotrexate" by E. A. Olsen (J AM ACAD DERMATOL 1991;25:306-18). As stated, liver fibrogenesis is a major concernin patients with psoriasis treated with methotrexate (MTX). Hence liver biopsies should be performed in these patients either before or within a fewmonths of starting MTX. In addition, repeat liver biopsies should beconductedafter a doseof1500mg. However, Dr. Olsen did not mentionserum aminoterminal propeptide of type III procollagen (PIIINP) measurementas an indicatorof a process that might lead to liver fibrogenesis in patients receiving long-term MTX treatment. Recently, Zachariae et a1. 1, 2 have reported that elevatedserumPIIINP levels couldreflect hepaticfibrosis in MTX-treated psoriasis patients.Theseauthors haveproposed that two increased serum PIIINP valuesin longterm MTX treatment should be an indication for a liver biopsy. With the use of this laboratory test, it wouldbe possibleto minimize the numberof liver biopsies, which might have some risks to these patients. Nazi! Kurkquoglu, MD, and Gul Oz, MD 10 Sokak 23/5 Bahcelievler 06490 Ankara, Turkey REFERENCES 1. Zachariae H, S~gaard H, Heickendorff L. Serum aminoterminal propeptide oftype III procollagen-a non-invasive testfor liver fibrogenesis inmethotrexate-treated psoriatics. Acta Derm Venereal (Stockh) 1989;69:241-4. 2. Zachariae H, Aslam HM, Bjerring P, et a1. Serum aminoterminal propeptide oftype III procollagen in psoriasis and psoriatic arthritis: relation toliver fibrosis andarthritis. JAM ACAD DERMATOL 1991;25:50-3.
Grafting of leg ulcers with undifferentiated keratinocytes To the Editor: I found the article by Brysk et al. (J AM ACAD DERMATOL 1991;25:238-44) an exciting one because it indicatesthere may be an effective and relatively nontraumatic therapy for a difficult clinical problem. However, one aspectof the article I did find unsatisfying was the lack of any real data on the medical status, age, nutritional status, or metabolicdisease of the six patients who underwentgrafting. It was also unclear as to what long-termmeasureswere initiated after grafting was performed. Were the excellent immediate and apparently longerterm results due to selective patient selection (althoughthe ulcerswereoflong duration, werethe patients healthierphysical specimens than is normal for most patientswith chronicvenousstasis ulcers?), and did the patients afterwardfollow an activelifestylewithout any extraordinary measures to protect the ulcers over the ensuing months to years? My surgicalcolleagues withwhom I havediscussedthis article point out to me that they believethey have little trouble getting grafts to take initially in apparently similar cases but have great difficulty maintaining these grafts overthe ensuing months to years; frankly they are skeptical that Brysk's cellculture techniquewill proveany more effective in the long term. Further information on the medical status of the patients treated by Brysk and colleagues and their long-term management would be helpfulin this regard. John C. Goodall, MD, FRCPC 216-1929 Russell Road
Ottawa, Ontario, Canada K1G 4G3
Reply To the Editor: We appreciate the query of Dr. Goodall concerning the medical status of our patients with stasis ulcers grafted with autologous undifferentiated keratinocytes and thelong-termmanagement ofthese patients. In the preliminarystudy reported,eight ulcers in six patientswere grafted.The patients were selected simply on the basis of havingfailed many other modalities of treatment and their willingness to participate in the studyand to return for follow-up observation and care. One patient was 39 years old and in good health with chronic lymphedema of one leg resulting from trauma that had occurred 20 years earlier. The other five patients were between 63 and 73 years of age. Each had at least one chronic medical problem, including hypertension (two patients),history of myocardialinfarction (two), congestive heart failure (one), diabetes (one), and rheumatoid arthritis (one). The patient in whom grafting wasunsuccessful had severe atherosclerosis. After each ulcerhad healed, the patient was fittedwith