By combining their skills and experience, a team of Einstein scientists has developed a promising therapy for lupus skin lesions. Cutaneous lupus erythematosus affects only the skin. It occurs about as often as systemic lupus erythematosus, which affects the entire body, all too often including the skin.
Lupus patients are especially sensitive to ultraviolet light; exposure to it can lead to lesions on the face, ears, neck, arms, and legs. These lesions can begin as itchy, painful, swollen, or scaly rashes that can ultimately lead to scarring, hair loss, and significant changes in pigmentation.
Mild and limited cases can usually be controlled with ointments, but acute or widespread cases typically require oral, subcutaneous, or intravenous medications, such as steroids or methotrexate.
“These are heavy-duty therapies that require close monitoring and can cause potentially serious side effects, but sometimes we need to recommend them,” says Chaim Putterman, M.D., professor of medicine and of microbiology & immunology and chief of the division of rheumatology in the department of medicine at Einstein and Montefiore.
“However, it’s a personal decision,” he adds. “Many patients are understandably sensitive about their appearance and at times have to make difficult trade-offs.”
Tetrahydrocannabinol is the active component of marijuana.
A safer alternative is in the works: tiny particles filled with endocannabinoids—naturally occurring chemicals in the body that bind to the same receptors as tetrahydrocannabinol, the active component of marijuana. Since endocannabinoids can reduce inflammation, they could be valuable as a topical treatment for lupus lesions.
The idea originated with Adam Friedman, M.D. ’06, professor and interim chair of dermatology at George Washington School of Medicine and Health Sciences. Knowing that topically delivering endocannabinoids would be challenging, he joined forces with his longtime collaborator and father, Joel Friedman, M.D., Ph.D., professor of physiology & biophysics and of medicine. They used a nanoparticle drug delivery system they had developed during Adam’s time as an Einstein medical student and faculty member.
Together with Dr. Putterman and Samantha (Sammy) Chalmers, Ph.D., a postdoctoral scientist in the Putterman lab, the Friedmans tested nanoparticles encapsulating endocannabinoids on a mouse model of lupus.
Nanoparticles were applied to the shoulder region of mice with lupus skin lesions. After 10 weeks, the treated skin areas showed significant clinical and histological improvement compared to a control group treated with drugless nanoparticles. “In short, the particles cured the mice of skin disease,” Dr. Putterman says.
Curiously, the particles also cleared lesions on the faces and necks of the mice, where the nanoparticles hadn’t been applied. “We’re now looking into the endocannabinoids’ mechanism of action,” Dr. Putterman says. “The bottom line is that this treatment should be safer than taking oral steroids, most of which go to the liver and kidneys, with very little actually reaching the skin. With nanoparticles, just the opposite occurs.”
