Dermatology Commons^™

The Acid Sphingomyelinase Inhibitor Imipramine Enhances The Release Of Uv Photoproduct-Containing Dna In Small Extracellular Vesicles In Uvb-Irradiated Human Skin, M. Alexandra Carpenter, Anita Thyagarajan, Madison Owens, Christina E. Borchers, Jeffrey B. Travers, Michael G. Kemp

Dermatology Faculty Publications

Nucleic acids, lipids, and other cell components can be found within different types of extracellular vesicles (EVs), which include apoptotic bodies (ABs), large extracellular vesicles (LEVs), and small extracellular vesicles (SEVs). Release of LEVs from cells can be reduced by genetic or pharmacological inhibition of the enzyme acid sphinogomyelinase (aSMase), and indeed several studies have demonstrated a role for the clinically approved aSMase inhibitor imipramine in blocking LEV release, including in response to UVB exposure. Given that exposure of keratinocytes to UVB radiation results in the generation of UVR photoproducts in DNA that can subsequently be found in association with …

Longitudinal Follow-Up Of Netherton’S Syndrome, K. Petit, Christina E. Borchers, Julian Trevino

Dermatology Faculty Publications

Netherton’s Syndrome (NS) is a rare, autosomal recessivegenodermatosis caused by mutations in SPINK5 which encodes LETKI, aserine protease inhibitor.2,4 Consequently, unopposed kallikrein activityresults in an impaired skin barrier and desquamation.2 A triad of atopy,ichthyosis linearis circumflexa, and trichorrhexis invaginata (“bamboohair”) is characteristic of this disease.1 Associated findings includehypereosinophilia and elevated IgE. Histologically, a nonspecificpsoriasiform hyperplasia and dermal lymphocytic infiltrate may beobserved.1,6 Clinically, NS is frequently misdiagnosed as atopic dermatitis(AD) and proves difficult to treat.2 Dupilumab, an IL-4/IL-13 inhibitor withFDA approval for the treatment of atopic dermatitis and prurigo nodularis,may be a promising therapy for patients with NS.3 We present alongitudinal …

Pretibial Myxedema: An Unusual Presentation, Dāsha Giger, Christina E. Borchers, Samia Borchers

Dermatology Faculty Publications

Pretibial myxedema presents with indurated nodules or plaques that can be erythematous or vary in color from purple-brown to yellow. It is noted that a peau d’orange appearanceis a characteristic finding. These lesions are typically located on the anterolateral aspect of the lower legs. Non-pitting edema of the shins that evolves into elephantiasis is anotherpotential presentation seen in pretibial myxedema. It is often associated with hyperthyroidism, particularly Graves disease and is more commonly seen in women than men.Typically, it presents during the third or fourth decade of life. Differential diagnoses include but are not limited to stasis dermatitis, hypertrophic lichen …

Exaggerated Cutaneous Responses In Patients With Hematologic Malignancy, Trang Nguyen, Christina E. Borchers, Julian Trevino

Dermatology Faculty Publications

Eosinophilic dermatosis of hematologic malignancy (EDHM) is a cutaneous manifestation rarely seen in Chronic lymphocytic leukemia (CLL) and chronic myelomonocytic leukemia (CMML). EDHM, first described in 19651, is identified by treatment-resistant pruritic papules, eosinophil-rich dermal lymphohistiocytic infiltrate, exclusion of other causes of tissue eosinophilia, and preexisting diagnosis of hematologic malignancy2. Similarly, arthropod hypersensitivity reactions, or insect bite hypersensitivity, also cause significant discomfort and morbidity in individuals with hematologic malignancies. Proposed treatments exist, but assessing exaggerated skin reactions as prognostic markers requires further study. We outline two clinical cases illustrating the potential spectrum of EDHM encounters.

Pyemotes Herfsi Dermatitis: A Case Of 17 Year Itch, Christina E. Borchers, Taylor Schaetzle, Samia Borchers

Dermatology Faculty Publications

No abstract provided.

A Case Of Blue Toes: Dic As The Initial Presentation Of Metastatic Pancreatic Adenocarcinoma, Bipul Gnyawali, Christina E. Borchers, Sarah Doell, Katherine House

Dermatology Faculty Publications

Disseminated intravascular coagulopathy (DIC) is the widespread deposition of thrombin and fibrin in microvascular circulation. It is a condition in which clots form throughout the body leading to blockage of small blood vessels. The pathologic clotting in DIC is due to the consumption of coagulation factors and platelets. Patients can present with complications of bleeding or vascular thrombi. Most common causes of DIC include sepsis, malignancy, pregnancy complications, major trauma, and surgery.

Cutaneous Squamous Cell Carcinoma Staging May Influence Management In Users: A Survey Study., Vishal A. Patel, Catherine Mccullum, Andrew D. Sparks, Chrysalyne D Schmults, Sarah T Arron, Anokhi Jambusaria-Pahlajani

Dermatology Faculty Publications

PURPOSE: This study aims to determine whether there is consensus regarding staging and management of cutaneous squamous cell carcinoma (CSCC) across the various specialties that manage this disease.

MATERIALS AND METHODS: A survey regarding CSCC high-risk features, staging, and management was created and emailed to cutaneous oncology experts including dermatology, head and neck surgery/surgical oncology, radiation oncology, and medical oncology.

RESULTS: One hundred fifty-six (46%) of 357 invited physicians completed the survey. Depth of invasion (92%), perineural invasion (99%), histologic differentiation (85%), and patient immunosuppression (90%) achieved consensus (>80%) as high-risk features of CSCC. Dermatologists were more likely to …

Evaluation Of Sars-Cov-2 Spike S1 Protein Response On Pi3k-Mediated Il-8 Release, Christina E. Borchers, Anita Thyagarajan, Christine M. Rapp, Jeffrey B. Travers, Ravi P. Sahu

Dermatology Faculty Publications

A novel coronavirus related to a condition known as a severe acute respiratory syndrome (SARS) was termed as SARS Coronavirus-19 (SARS-CoV-2 or COVID-19), which has caused an unprecedented global pandemic. Extensive efforts have been dedicated worldwide towards determining the mechanisms of COVID-19 associated pathogenesis with the goals of devising potential therapeutic approaches to mitigate or overcome comorbidities and mortalities. While the mode of SARS-CoV-2 infection, its structural configuration, and mechanisms of action, including the critical roles of the Spike protein have been substantially explored, elucidation of signaling pathways regulating its cellular responses is yet to be fully determined. Notably, phosphoinositide …

Potential Involvement Of Microvesicle Particles In The Synergistic Effects Of Ultraviolet-B Radiation And Platelet-Activating Factor Receptor Agonists On Cytokine Production, Shweta Bhadri, Pariksha Thapa, Christina E. Borchers, Christine M. Rapp, Jeffery B. Travers

Dermatology Faculty Publications

Cytokines play a pivotal role in regulating inflammation, which is a condition that makes thetissue vulnerable to different pathological and physiological conditions. Thus, how cytokinesare regulated is an important area of study. Skin that receives ultraviolet B radiation (UVB),a major pro-oxidative stressor, results in the release of multiple cytokines and chemokineslike tumor necrosis factor (TNF)-alpha and interleukin (IL)-8. Previous studies from our groupand others have demonstrated synergistic release of TNF-alpha when UVB is combined withIL-1 or the lipid mediator Platelet-activating factor (PAF). Of interest, subcellularmicrovesicle particles (MVP) have been proposed to play an important role in intercellularcommunication. Moreover, UVB and …

Heightened Levels Of Microvesicle Particles Resulting From Combination Of Ethanol And Thermal Burn Injury, Chad Brewer, Azeezat A. Awoyemi, Christina E. Borchers, Jeffery B. Travers

Dermatology Faculty Publications

Ethanol, in combination with thermal burn injury, is a clinically significant problem resulting in an increase in morbidity and mortality due to acute multi-organ toxicity from excess systemic cytokine release. Moreover, murine models of intoxicated burn injury replicate the acEthanol, in combination with thermal burn injury, is a clinically significant problem resultingin an increase in morbidity and mortality due to acute multi-organ toxicity from excesssystemic cytokine release. Moreover, murine models of intoxicated burn injury replicate theacute toxic effects as well as a delayed systemic immunosuppression. Almost half of theadmitted hospital patients with burn injuries were alcohol intoxicated at the time …

Covid-19-The American Perspective., Karl Saardi, Vesna Petronic-Rosic

Dermatology Faculty Publications

No abstract provided.

Keratinocyte-Derived Microvesicle Particles Mediate Ultraviolet B Radiation-Induced Systemic Immunosuppression, Langni Liu, Azeezat A. Awoyemi, Katherine E. Fahy, Pariksha Thapa, Christina E. Borchers, Benita Y. Wu, Cameron L. Mcglone, Benjamin Schmeusser, Zafer Sattouf, Craig A. Rohan, Amy R. Williams, Elizabeth E. Cates, Christina Kinsely, Lisa E. Kelly, Ji C. Bihl, David R. Cool, Ravi P. Sahu, Jinju Wang, Yanfang Chen, Christine M. Rapp, Michael G. Kemp, Ron Michael Johnson, Jeffrey B. Travers

Dermatology Faculty Publications

A complete carcinogen, ultraviolet B (UVB) radiation (290–320 nm), is the major cause of skin cancer. UVB-induced systemic immunosuppression that contributes to photocarcinogenesis is due to the glycerophosphocholine-derived lipid mediator platelet-activating factor (PAF). A major question in photobiology is how UVB radiation, which only absorbs appreciably in the epidermal layers of skin, can generate systemic effects. UVB exposure and PAF receptor (PAFR) activation in keratinocytes induce the release of large numbers of microvesicle particles (MVPs; extracellular vesicles ranging from 100 to 1000 nm in size). MVPs released from skin keratinocytes in vitro in response to UVB (UVB-MVPs) are dependent on …

Clinical And Diagnostic Imaging Manifestations Of Erdheim-Chester Disease, Avrey Thau, Roland Gazaille, Alejandro Calvo, Christina E. Borchers, Ronald E. Warwar, William Boyce, Joseph Blake

Dermatology Faculty Publications

Introduction: Erdheim-Chester disease (ECD) is a rare form of non-Langerhans-cell histiocytosis which typically presents with bilateral masses due to retro-orbital deposition, xanthelasma of the eyelids, cardiopulmonary manifestations, along with sclerosis and cortical thickening of the long bones, particularly in the lower extremities.

Case Report: We present the case of a 58-year-old male who presented to a local emergency department with a one day history of severe dizziness, diaphoresis, dyspnea, and intermittent diplopia. Imaging demonstrated bilateral symmetric retrobulbar masses. Subsequent imaging as well as orbital and bone marrow biopsies lead to the diagnosis of ECD.

Conclusion: Erdheim-Chester disease is a rare …

Accidental Silver Clay Tattoo: Mystery Finding In A Jewelry Smith, Tom Selby, Christina E. Borchers, Jeffery B. Travers, Samia Borchers

Dermatology Faculty Publications

Permanent tattoos result from the introduction of insoluble pigmentsinto the dermis. The mechanism can be intentional for cosmetic ormedical purposes, as with professional tattooing; or accidental asseen with carbon-related traumatic tattooing. Pigments are generallycomposed of various inorganic salts or metals. Pathology in non-inflamed tattoos will show dermal pigment granules of different sizesand shapes.1 Local inflammatory reactions can occur.Unintentional tattooing related to trauma involving asphalt, carbon,graphite, and gun powder are well known. Other cases involvingjewelry and fireworks have been reported in the literature.2,3 Similarissues arise with accidental placement of amalgam in the oralmucosa during dental procedures.4 We present an interesting caseof …

Atypical Mycobacterium Marinum: A Case Of Fish Tank Granuloma, Emily Wooton, Christina E. Borchers, Samia Borchers, Nicholas Shamma, Bernard Rose, Max Rubin

Dermatology Faculty Publications

Our case involves a 76-year-old female who presented to her family physician with a presumed infection on her right dorsal hand and wrist, which she believed to be secondary to a possible stick pin or spider bite at a department store while rummaging through jeans.

Human Botfly Infestation: Furuncular Myiasis, Rachel Rhee, Christina E. Borchers, Samia Borchers, Gregory Maupin, Jeffery Weinstein

Dermatology Faculty Publications

Dermatobia hominis is one of many species of botflies whose larvae is parasitic to humans and is uniquely indigenous to Central and South America. The larvae of the human botfly gain nutrients to survive by feeding underneath mammal skin. As a consequence, within 24 hours, small 2- 3mm painful, erythematous, draining, and purulent papules with a classical air-pore develop as the initial cutaneous sign. At first, the lesions resemble that of an insect bite, but over time they enlarge to 10-35mm in diameter with a surrounding area of induration. The most common areas where the larvae are cutaneously deposited include …

Cutaneous Invasive Ductal Carcinoma Masquerading As Pseudoxanthoma Elasticum, Christina E. Borchers, Hershel Dobkin, Zachary Ingersoll, Marc Handler

Dermatology Faculty Publications

In the United States, 214,880 women are diagnosed with breast carcinomaeach year, with an overall 5-year survival of 90%. When cutaneousmetastases are present, the 5-year survival is 24%. Invasive ductalcarcinoma (IDC) comprises 80% of all breast cancers, with 30% of womenhaving metastatic disease upon initial diagnosis. Cutaneous metastases ofbreast carcinoma occurs at a rate of 24% per primary breast malignancywith 70% of breast carcinoma cutaneous metastases being IDC subtype.Our patient presented as clinically exhibiting features of pseudoxanthomaelasticum (PXE), a genetic disease affecting connective tissue inintertriginous areas, but upon pathologic examination revealed metastaticIDC. Review of the literature has not elicited other …

Inter- And Intra-Physician Variation In Quantifying Actinic Keratosis Skin Photodamage, Benjamin Schmeusser, Christina E. Borchers, Jeffrey B. Travers, Samia Borchers, Justin Trevino, Max Rubin, Heidi Donnelly, Karl Kellawan, Lydia Carpenter, Shalini Bahl, Craig A. Rohan, Elizabeth Muennich, Scott Guenthner, Holly Hahn, Ali Rkein, Marc Darst, Nico Mousdicas, Elizabeth E. Cates, Ulas Sunar, Trevor J. Bihl

Dermatology Faculty Publications

We investigated the variations in physician evaluation of skin photodamage based on a published photodamage scale. Of interest is the utility of a 10-level scale ranging from none and mild photodamage to actinic keratosis (AK). The dorsal forearms of 55 adult subjects with various amounts of photodamage were considered. Each forearm was independently evaluated by 15 board-certified dermatologists according to the Global Assessment Severity Scale ranging from 0 (less severe) to 9 (the most progressed stage of skin damage). Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion. Results show substantial disagreement amongst the dermatologists on …

Mucin-Rich Vs. Mucin-Poor Endocrine Mucin-Producing Sweat Gland Carcinoma: A Comparison Of Two Cases, Christina E. Borchers, Michael Heaphy, Ronald E. Warwar, Nicholas Shamma

Dermatology Faculty Publications

No abstract provided.

Quantifying Skin Photodamage With Spatial Frequency Domain Imaging: Statistical Results, Jeffrey B. Travers, Chien Poon, Trevor J. Bihl, Benjamin Rinehart, Christina E. Borchers, Daniel J. Rohrbach, Samia Borchers, Julian J. Trevino, Max Rubin, Heidi Donnelly, Karl Kellawan, Lydia Carpenter, Shalini Bahl, Craig A. Rohan, Elizabeth Muennich, Scott Guenthner, Holly Hahn, Ali Rkein, Marc Darst, Nico Mousdicas, Elizabeth E. Cates, Ulas Sunar

Dermatology Faculty Publications

We investigated the change in optical properties and vascular parameters to characterize skin tissue from mild photodamage to actinic keratosis (AK) with comparison to a published photodamage scale. Multi-wavelength spatial frequency domain imaging (SFDI) measurements were performed on the dorsal forearms of 55 adult subjects with various amounts of photodamage. Dermatologists rated the levels of photodamage based upon the photographs in blinded fashion to allow comparison with SFDI data. For characterization of statistical data, we used artificial neural networks. Our results indicate that optical and vascular parameters can be used to quantify photodamage and can discriminate between the stages as …

Topical Photodynamic Therapy Induces Immunosuppression: Potential Role Of Lipid Mediator Platelet-Activating Factor, Christina E. Borchers, Christine M. Rapp, Elizabeth Cates, Amy Williams, Jeffery B. Travers

Dermatology Faculty Publications

opical photodynamic therapy (PDT), or blue light therapy, isa procedure using a photosensitizing agent, or precursoragent 5-aminolevulinic acid (5-ALA), and is commonly usedto treat precancerous actinic keratosis. The 5-ALA is takenup by skin lesions through targeting cells with high turnoverthat are metabolically active (malignant proliferation) andconverted to the photoactive drug protoporphyrin IX.Following exposure to blue light, significant cell destructionoccurs which has been linked to the generation of reactiveoxygen species (1). Though PDT is effective, several studieshave suggested that this procedure results inimmunosuppression, which might limit the effectiveness ofthis therapy. Our group has demonstrated previously thatexperimental PDT of keratinocyte cell lines …

Systemic Sclerosis Presenting With Bilateral Retinal Cotton Wool Spots, Christina E. Borchers, Ronald E. Warwar

Dermatology Faculty Publications

Systemic sclerosis is a systemic inflammatory diseasecharacterized by a triad of autoimmune reactions,vasculopathy, and fibrosis due to collagen deposition. Thediffuse sclerosis type includes vascular abnormalities in theskin (puffy, taut, thickened skin, pitting of fingertips), soft tissues(arthralgias, myalgias), lungs (pulmonary hypertension,interstitial fibrosis), gastrointestinal tract (esophagealdysmotility, GERD), kidneys (scleroderma renal crisis), andheart (arrhythmias, heart failure).Rarely, systemic sclerosis can present with signs of retinalvascular occlusion and cotton wool spots in the eyes. Thefollowing case report describes a patient presenting with cottonwool spots as an early manifestation of systemic sclerosis.

Quantifying Photodamage By Noninvasive Mesoscopic Skin Imaging, Christina E. Borchers, Trevor Bihl, Chien Poon, Daniel J. Rohrbach, Samia Borchers, Julian Trevino, Max Rubin, Heidi Donnelly, Karl Kellawan, Lydia Carpenter, Shalini Bahl, Craig Rohan, Elizabeth Muennich, Scott Guenther, Holly Hahn, Ali Rkein, Marc Darst, Nico Mousdicas, Jeffery B. Travers, Ulas Sunar

Dermatology Faculty Publications

Ultraviolet light exposure is the major cause for photodamage. Pathologic effects of UVradiation include precancerous actinic keratosis which can progress into squamous cellcarcinoma. UV exposures commonly encountered include sunlight and indoor tanning bedexposure. Actinic neoplasia (precancerous actinic keratosis and non-melanoma skincancer) are highly prevalent in elderly patients with fair skin, and those with lower immunesystems. The impact on our healthcare system is substantial, as currently the averageannual cost to treat non-melanoma skin cancer is 5 billion dollars [1]. Though often asource of considerable morbidity due to extensive surgical procedures to remove the skincancers in the normal populations, squamous cell carcinomas …

A Case Of Eosinophilic Annular Erythema As A Presenting Sign For Autoimmune Hepatitis, Olabola Awosika, Kristin Totoraitis, Misty Eleryan, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Eosinophilic annular erythema (EAE) is a relatively new entity, clinically presenting as a figurate erythema. The cause of EAE remains obscure, but it has been associated with several chronic conditions and malignancies. We describe an unusual case of EAE developing before the onset of autoimmune hepatitis.

Profile Of Dupilumab And Its Potential In The Treatment Of Inadequately Controlled Moderate-To-Severe Atopic Dermatitis., Olabola Awosika, Lori Kim, Momina Mazhar, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Atopic dermatitis (AD) is a common inflammatory skin disorder that manifests as eczematous lesions, often associated with allergic rhinitis and asthma. Historically, moderate-to-severe disease has been managed with systemic immunosuppression, such as oral corticosteroids, which result in relapse and limiting side effects. Due to recent advancements in the identification of interleukin (IL)-4 and IL-13 as key mediators in AD, new biological agents have been developed for treatment. Dupilumab is a recently approved monoclonal antibody that targets the alpha subunit of the IL-4 receptor and, thus, downregulates activity of IL-4 and IL-13. This review discusses the profile of dupilumab and its …

Safety And Efficacy Of Apremilast Through 104 Weeks In Patients With Moderate To Severe Psoriasis Who Continued On Apremilast Or Switched From Etanercept Treatment: Findings From The Liberate Study., K Reich, M Gooderham, A Bewley, L Green, J Soung, R Petric, J Marcsisin, J Cirulli, R Chen, V Piguet

Dermatology Faculty Publications

Background

Apremilast, an oral phosphodiesterase‐4 inhibitor, has demonstrated efficacy in patients with moderate to severe psoriasis.

Objective

To evaluate long‐term efficacy and safety of apremilast in biologic‐naive patients with moderate to severe plaque psoriasis and safety of switching from etanercept to apremilast in the phase 3b LIBERATE trial.

Methods

Two hundred fifty patients were randomized to placebo, apremilast 30 mg BID or etanercept 50 mg QW through Week 16; thereafter, all patients continued or switched to apremilast through Week 104 (extension phase). Skin, scalp and nail involvement at Weeks 16, 52 and 104 were assessed using the Psoriasis Area and …

The Global Burden Of Scabies: A Cross-Sectional Analysis From The Global Burden Of Disease Study 2015., Chante Karimkhani, Danny V Colombara, Aaron M Drucker, Scott A Norton, Roderick Hay, Daniel Engelman, Andrew Steer, Margot Whitfeld, Mohsen Naghavi, Robert P Dellavalle

Dermatology Faculty Publications

Background

Numerous population-based studies have documented high prevalence of scabies in overcrowded settings, particularly among children and in tropical regions. We provide an estimate of the global burden of scabies using data from the Global Burden of Disease (GBD) Study 2015.

Methods

We identified scabies epidemiological data sources from an extensive literature search and hospital insurance data and analysed data sources with a Bayesian meta-regression modelling tool, DisMod-MR 2·1, to yield prevalence estimates. We combined prevalence estimates with a disability weight, measuring disfigurement, itch, and pain caused by scabies, to produce years lived with disability (YLDs). With an assumed zero …

The Efficacy And Safety Of Apremilast, Etanercept And Placebo In Patients With Moderate-To-Severe Plaque Psoriasis: 52-Week Results From A Phase Iiib, Randomized, Placebo-Controlled Trial (Liberate)., K Reich, M Gooderham, L Green, A Bewley, Z Zhang, I Khanskaya, R M Day, J Goncalves, K Shah, V Piguet, J Soung

Dermatology Faculty Publications

BACKGROUND: Apremilast, an oral, small-molecule phosphodiesterase 4 inhibitor, has demonstrated efficacy in patients with moderate-to-severe psoriasis.

OBJECTIVE: Evaluate efficacy and safety of apremilast vs. placebo in biologic-naive patients with moderate-to-severe plaque psoriasis and safety of switching from etanercept to apremilast in a phase IIIb, randomized, double-blind, placebo-controlled study (NCT01690299).

METHODS: Two hundred and fifty patients were randomized to placebo (n = 84), apremilast 30 mg BID (n = 83) or etanercept 50 mg QW (n = 83) through Week 16; thereafter, all patients continued or switched to apremilast through Week 104. The primary efficacy endpoint was achievement of PASI-75 at …

Review Of Applications Of Microneedling In Dermatology., Christopher Iriarte, Olabola Awosika, Monica Rengifo-Pardo, Alison Ehrlich

Dermatology Faculty Publications

Microneedling (MN) is a novel therapeutic modality in dermatology. Through physical trauma from needle penetration, MN induces a wound healing cascade with minimal damage to the epidermis. This allows for enhancement in the absorption of mainstay topical therapies across the thick stratum corneum. MN has become increasingly utilized over the last several years as it is a relatively simple procedure that is cost-effective, well tolerated, and offers both cosmetic and therapeutic benefits. The ability to treat localized areas of disease has led to numerous studies gauging its potential in focal diseases of inflammation, dyschromia, and photodamage. This review discusses the …

Sustained Nitric Oxide-Releasing Nanoparticles Interfere With Methicillin-Resistant Staphylococcus Aureus Adhesion And Biofilm Formation In A Rat Central Venous Catheter Model., Mircea Radu Mihu, Vitor Cabral, Rodney Pattabhi, Moses T Tar, Kelvin P Davies, Adam J Friedman, Luis R Martinez, Joshua D Nosanchuk

Dermatology Faculty Publications

Staphylococcus aureus is frequently isolated in the setting of infections of indwelling medical devices, which are mediated by the microbe's ability to form biofilms on a variety of surfaces. Biofilm-embedded bacteria are more resistant to antimicrobial agents than their planktonic counterparts and often cause chronic infections and sepsis, particularly in patients with prolonged hospitalizations. In this study, we demonstrate that sustained nitric oxide-releasing nanoparticles (NO-np) interfere with S. aureus adhesion and prevent biofilm formation on a rat central venous catheter (CVC) model of infection. Confocal and scanning electron microscopy showed that NO-np-treated staphylococcal biofilms displayed considerably reduced thicknesses and bacterial …