Piotr Fiedor’s research while affiliated with Medical University of Warsaw and other places

Lymphogranuloma venereum (LGV) is a sexually transmitted disease that increases in incidence, particularly in more developed countries worldwide. LGV is caused by Chlamydia trachomatis serovars/genovars L1-3, including their subvariants, and in Europe mostly affects men who have sex with men (MSM). It can be asymptomatic but has now emerged as a frequent cause of severe proctitis/proctocolitis, especially in MSM. LGV has often been misdiagnosed as C. trachomatis serovars/genovars D-K infection. It is essential with accurate diagnosis that ensures appropriate treatment and protects the patient from complications and sequelae as well as from the consequences of misdiagnosis, e.g. as inflammatory bowel disease or cancer. We present a systematic review of LGV and two new LGV cases diagnosed in Poland.

Immunosuppressed patients are at higher risk of developing human papilloma virus (HPV) cancerous and precancerous lesions in the anogenital region Carcinogenesis after organ transplantation due to immunosuppressive therapy is the major cause of long-term negative transplantation results. This is a rationale for the improvement of transplantation programs with carcinogenesis risk stratification in patients referred for transplantation. There is a need for a study on HPV-related carcinogenesis also in terms of its risk factors in the population after organ transplantation. This study aimed to assess the morbidity of anogenital carcinoma in patients with HPV infection, including those after organ transplantation and evaluate risk factors for carcinoma occurrence in patients after organ transplantation and with HPV infection. Our analysis directly indicates the group of patients with a high risk of HPV-related oncological complications of immunosuppression in anogenital region.

Background The high risk of human papillomavirus (HPV) related anogenital lesions that lead to cancer in immunosuppressed renal transplant recipients (RTRs) has been previously reported (1,2). One of them, Verrucous carcinoma, is un uncommon low–grade squamous cell carcinoma (SCC) affecting skin and mucosa, often associated with chronic immunosuppression in patients after organ transplantation. RTRs are at overall increased risk of developing skin cancers, predominantly the non-melanoma subtypes, including malignances observed in recipients after preempive kidney transplantation (PKT) (3,4,5). The introduction of primary prevention, continuous monitoring in patients with known high-risk HPV, necessity of early diagnosis and treatment, prevention of malignancies in transplant recipients and long-term managing maintaining adequate immunosuppressive therapy, are necessary (6,7).

Two different techniques of vertical bone augmentation were compared to apply them to immunocompromised patients. One of them used autogenous bone graft; the other used xenograft. Thirty patients were involved in the study. Fifteen received autogenous ring shape grafts harvested from the mental region, and 15 received xenograft vertical tunnel augmentation. They have a total of 60 implants placed in the posterior region of the mandible (2 for each patient). Fixed full ceramic crowns were delivered. Two-year follow-up appointments after implant placement were made. Both autogenous bone grafts and xenografts showed similar long-term clinical regeneration outcome of vertical bone defects. Using autogenous bone rings simultaneously fixed by dental implants, the total treatment time and cost were shortened, but the traumatic reactions and complication rates were higher when compared to xenograft vertical tunnel augmentation. Due to the less traumatic character of the procedure, smaller complication rates and higher safety for the patients receiving chronic immunosuppression should avoid bone block augmentation and reap the benefits from vertical tunnel bone augmentation using xenograft materials.

The innovative microinvasive immediate implantation technique of dental implants insertion was described. The technique uses bovine xenograft material to restore the bone defect resulting from teeth pathologies and subsequent extraction. Ten patients had extractions of their premolar upper teeth and immediate implantations with xenograft socket augmentation. This unique procedure allowed primary stability of implant above 70 implant stability quotient in all cases. All of the implants healed without complications and were restored with screwed ceramic crowns. Two-year uneventful follow-ups confirmed alveolar xenograft condensation technique as a microinvasive and safe technique, especially for patients with compromised general health who may not undergo complicated restorative operations.

Background Nonhealing wounds can be a major clinical problem. Impaired wound healing is often related to massive tissue injury, concomitant wound healing deficiencies (chronic wounds), burn injury, or congenital conditions. We propose a novel biological dressing as an alternative surgical approach. The dressing is a form of an allogenic human skin graft equivalent with further use of allogeneic stem cells classified as an advanced therapy medicinal product. This new allogenic acellular human skin graft has been specifically developed to address the clinical indications for dressing wound lesions and promoting tissue repair in specific rare genetic diseases. Methods This case report illustrates the use of an acellular human skin allograft seeded with multipotent stem cells in the treatment of tissue injuries (burns), congenital conditions, and chronic wounds. Donor-tissue processing yields an acellular dermal matrix with integral collagen bundling and organization, as well as an intact basement membrane complex. Results Preclinical observations show prolonged viability of acellular human skin grafts with multipotent stem cells. This was confirmed with histological and electron-microscopic evaluation of biopsies, which demonstrated host-cell infiltration and neovascularization of the biological dressing. Moreover, the dressings were characterized by low immunogenicity, as confirmed by histology exam and T-cell proliferation assays in vitro. Conclusion Our data confirmed the safety and efficacy of the evaluated acellular human skin grafts, which may be used in patients with rare diseases, such as epidermolysis bullosa, burn injuries, and chronic wounds.

Patients eligible for solid organ transplant often lose their teeth and show numerous caries as well as periodontal and mucous membrane pathologies. The conventional methods of restoring teeth, including bridges and removable dentures, may result in progress of periodontal disease or even the creation of local source of general infection. Dental implants are not recognized as a therapeutic method in solid organ transplant recipients receiving immunosuppression because of the possibility of implant osseointegration disorders and suspicion as to the possibility of dysfunction of the transplanted organ and the spread of systemic infection. The authors present a case of the patient after liver transplant receiving immunosuppression treatment, who benefits from dental implants because of tooth loss. Three dental implants introduced because of the conventional loading protocol were healed and have osseointegrated without complication. Dental crown supported on them have restored the dental arches of the patient with good esthetic and functional effect. The results of treatment were stable in the 2-year follow-up period. No local signs of infection or general health disturbance were found. The function of the transplanted liver was unaffected.

Background Epidermolysis bullosa (EB) is a phenotypically diverse group of hereditary blistering disorders involving mutations in 20 different genes. Those debilitating disorders are currently incurable; however, there are a number of promising preclinical trials, where some treatments already approach the stage of early clinical trial. In this paper we introduce a novel surgical approach to the treatment of EB-induced ulcerations. The purpose of our study was to evaluate the safety and efficacy of a new biological dressing in the form of an allogenic human skin equivalent graft before using multipotent stem cells, classified as an advanced therapy medicinal product. Methods Implanted human acellular dermal matrices were prepared from the superficial layers of donated human skin. Scaffold sterilization was conducted via irradiation with the use of a linear electron accelerator. Following water-knife debridement, wounds were surgically covered with accordingly prepared grafts and dressed in burn-injury fashion. Subsequently, the wounds were monitored for infection and viability. Results Our data indicate that grafting as a potential new medicinal product was safe and effective in patients with rare diseases, such as EB, and may be used for stem cells to create new Advanced Therapy Medicinal Products. During a 200-day follow-up, we proved the safety of using human scaffolds (allogeneic graft) by observing no apparent infection or necrosis. Instead, we noted fewer required dressing changes, promoted wound healing, pain reduction, and an overall improvement in the quality of life in patients with EB. Conclusion The protocol for grafting allogenic acellular epidermal sheets is the most promising treatment for severely affected skin areas in EB patients to date.