Study of the Immunomodulation in the Hidradenitis Suppurativa and Evaluation of a New Therapeutic Strategy (IMOHS)

Study of the Immunomodulation of the Immune Response in Hidradenitis Suppurativa and in Vitro and ex Vivo Evaluation of a New Therapeutic Strategy (IMOHS)

Hidradenitis suppurativa (HS), also known as Verneuil's disease, is a chronic inflammatory dermatosis of the hair follicule located mainly in the skin folds (axillae, inguinal, submammary, etc.).

Currently, treatments are mainly limited to the use of broad-spectrum antibiotics in order to control outbreaks of hidradenitis suppurativa. Surgical treatment is the only curative treatment, but requires disfiguring removals with major scarring consequences.

Pathophysiologically, HS appears to be a primary abnormality of the pilosebaceous-apocrine unit, causing follicular occlusion, followed by the development of perifollicular cysts with commensal bacterial overgrowth, and finally rupture into the dermis causing an exaggerated inflammatory response. At present, few studies have examined the role of the regulatory immune system and its involvement in this disease.

We are also interested in analyzing the impact of new therapeutic strategies on hidradenitis suppurativa, and more particularly the impact of photodynamic therapy (PDT) which is a technique that has been used for a long time in dermatology, notably for the treatment of precancerous and cancerous lesions.

This technique has shown interesting results on inflammatory dermatoses such as acne.

This research consists in studying the immunomodulation of the immune response in HS and in evaluating a new therapeutic strategy based on PDT alone or in combination with antimicrobial peptides (PAMs).

Study Overview

• Status: Not yet recruiting
• Conditions: Hidradenitis Suppurativa
• Intervention / Treatment: Biological: Blood tests; Procedure: exeresis; Procedure: abdominoplasty

Detailed Description

Hidradenitis suppurativa (HS), also known as Verneuil's disease, is a chronic inflammatory dermatosis of the hair follicule located mainly in the skin folds (axillae, inguinal, submammary, etc.). The disease is characterized by pain, inflammatory nodules, abscesses, fistulas and hypertrophic " rope " scars that considerably alter the quality of life of patients.

Currently, the treatment is mainly limited to the use of broad-spectrum antibiotics in order to control the outbreaks of HS. This medical treatment is currently controversial because of the risk of inducing bacterial resistance. Surgical treatment is the only curative treatment, but requires disfiguring removals with major scarring consequences.

Pathophysiologically, HS appears to be a primary abnormality of the pilosebaceous-apocrine unit, which causes follicular occlusion, followed by the development of perifollicular cysts with commensal bacterial proliferation, and finally rupture into the dermis causing an exaggerated inflammatory response. At present, few studies have examined the role of the regulatory immune system and its involvement in this disease.

In the context of HS, it has recently been shown from patient samples that there is an abnormality concerning the stem cells present in the follicular bulb. It can be asked whether the abnormalities observed in hair follicle stem cells of HS patients could be the source of pro-inflammatory exosomes playing a role in HS flares.

The impact of new therapeutic strategies on hidradenitis suppurativa, and more particularly the impact of photodynamic therapy (PDT) which is a technique used for a long time in dermatology, notably for the treatment of precancerous and cancerous lesions will be also evaluated.

This technique has shown interesting results on inflammatory dermatoses such as acne with an " antibiotic " effect.

Thus, this research consists in studying the immunomodulation of the immune response in HS and in evaluating a new therapeutic strategy based on PDT alone or in combination with antimicrobial peptides (PAMs). This is a prospective observational multicenter study of type 3. This study is composed of two steps : first an in vitro part, secondly an ex vivo part allowing to validate the results obtained in vitro on human samples.

• Study Type: Observational
• Enrollment (Estimated): 20

Contacts and Locations

• Study Contact: Name: Amélie LANSIAUX, Md, PhD; Phone Number: +33320225269; Email: lansiaux.amelie@ghicl.net
• Study Contact Backup: Name: Anne-Sophie BLAIN, CRA; Phone Number: +33320225732; Email: blain.anne-sophie@ghicl.net

Study Locations

• France
  • Lille, France, 59020
    • Hôpital Saint Vincent-de-Paul, Service de Dermatologie-Vénéréologie
    • Contact: Marie LAMIAUX
  • Lomme, France, 59462
    • Hôpital Saint Philibert - Service de Chirurgie Viscérale
    • Contact: André DABROWSKI

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Subjects with hidradenitis suppurativa and subjects without hidradenitis suppurativa undergoing abdominoplasty

Description

Inclusion criteria for HS patients :

• Adult patients (≥18 years)
• Carrier of moderate to severe (Hurley grade ≥2) hidradenitis suppurativa of classical or gluteal phenotype
• Having an indication for surgical treatment (indication for excision)
• Not receiving immunomodulatory treatments (corticotherapy, biotherapy, apremilast, retinoids) or immunosuppressive treatments (methotrexate, ciclosporin) in the 6 months before inclusion, excluding antibiotics
• Agreement to participate
• Affiliated to social security

Inclusion criteria for control receiving abdominoplasty :

• Adult patients (≥18 years)
• With no history of hidradenitis suppurativa or lesions suggestive of hidradenitis suppurativa (recurrent fold abscesses, recurrent fold suppuration, repeated draining in fold areas)
• With an indication for abdominoplasty surgery
• Not receiving immunomodulatory treatments (corticotherapy, biotherapy, apremilast, retinoids) or immunosuppressive treatments (methotrexate, ciclosporin) in the 6 months preceding inclusion, excluding antibiotics
• Agreement to participate
• Affiliated to social security

Criteria for non-inclusion of patients with HS :

• Immunosuppression, autoimmune disease(s), cancerous disease, or acute or chronic infectious disease
• Difficulty understanding or reading French
• Patients already included in a therapeutic interventional trial
• Patients under guardianship or curatorship
• Pregnant or breast feeding women
• Syndromic hidradenitis suppurativa, hidradenitis suppurativa of follicular phenotype

Criteria for non-inclusion of controls receiving abdominoplasty :

• Immunosuppression, autoimmune disease(s), cancerous disease, or acute or chronic infectious disease
• Difficulty understanding or reading french
• Patients already included in a therapeutic interventional trial
• Patients under guardianship or curatorship
• Pregnant or breastfeeding women

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patients with Hidradenitis suppurativa	Biological: Blood tests; For patients, it will be performed: a collection of blood samples (3 tubes of 5 mL) according to the usual medical management, in order to search for cardiovascular comorbidities associated with HS,; A collection of 3 EDTA tubes and 2 additional dry tubes of 5 mL each according to the needs of the study.; Procedure: exeresis; For patients, it will be performed: - 6 tissue samples from the total excision specimen: two samples from the acute inflammatory zone (nodule, abscess, fistula) of 1 cm3; two samples from the chronic lesion zone (scar) of 1 cm3 and two samples from the peri-lesion zone (in the margin) of 1 cm3 on fresh tissue.
Controls (coming for abdominoplasty)	Procedure: abdominoplasty; For the controls, 6 fresh skin samples of 1 cm3 each will be taken from the abdominoplasty operation: four in the center,; two in the margin

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of different types of immune cell populations	Prevalence of cell populations will be determined by cytometry	Day 0
Activation of lymphocytes	The activation state of circulating lymphocytes will be analyzed by flow cytometry using antibodies coupled to fluorochromes specifically targeting the following membrane markers: CD4, CD30, CD69, Anti-HLADR, CD152, CD197, CD25, CD8.	Day 0
Prevalence of innate lymphoid cells	The prevalence of innate lymphoid cells will be determines by cytometry	Day 0
Gene expression analysis	A microarray assay will be performed in order to determine the expression of genes of interest.	Day 0
Secretome analysis	The pg/mL concentrations of different cytokines in the serum of HS patients versus healthy controls will be determined using ELISA (Luminex™) in order to be able to determine the differences in activation of immune pathways : Th1/Th2, Th9/Th17/Th22/Treg, inflammatory cytokines, Immunosuppressive cytokine.	Day 0

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Size of exosomes	The size of exosomes will be measured by the Tunable resistive Pulse sensing method	Day 0
Concentration of exosomes	The concentration of exosomes will be measured by the Tunable resistive Pulse sensing method	Day 0
Quantification of antimicrobial peptides	Several antimicrobial peptides such as elafin/SHALP, dermcidin, S100A7/psoriasin, S100A8/calgranulin A, S100A9/calgranulin B, LL-37 (cathelicidin), h-βd1, h-βd2, h-βd3, h-βd4, ribonuclease 7, SLPI/ALP from HS patient serum versus blood baqs (control) as well as in supernatants of HS lesion tissue versus abdominoplasty tissue (control) cultured in microslices will be quantified by ELISA	Day 0
Quantification of wound healing	Wound healing capacity We will evaluate the ability to restore wound healing in in vitro HS models (HaCaT NCSTN-/-line) versus the healthy model (HaCaT wild type) by performing wound healing and migration assays (IBIDI) with and without the addition of exogenous PAMs lacking in HS.	Day 0
Efficacity of the Photodynamic Therapy (PDT)		Day 0

Collaborators and Investigators

• Sponsor: Lille Catholic University
• Investigators: Principal Investigator: Marie LAMIAUX, Lille Catholic University

Study record dates

Study Major Dates

• Study Start (Estimated): January 1, 2024
• Primary Completion (Estimated): June 30, 2025
• Study Completion (Estimated): June 30, 2026

Study Registration Dates

• First Submitted: January 12, 2022
• First Submitted That Met QC Criteria: January 12, 2022
• First Posted (Actual): January 26, 2022

Study Record Updates

• Last Update Posted (Actual): October 31, 2023
• Last Update Submitted That Met QC Criteria: October 30, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: surgery; Hidradenitis suppurativa; scars; fistulas; inflammatory nodules; abscesses
• Additional Relevant MeSH Terms: Sweat Gland Diseases; Skin Diseases; Infections; Bacterial Infections; Bacterial Infections and Mycoses; Skin Diseases, Infectious; Suppuration; Skin Diseases, Bacterial; Hidradenitis Suppurativa; Hidradenitis
• Other Study ID Numbers: RC-P00111

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No