In Mdr2 mice, we found development of liver fibrosis and inflammation to require hepatic activation of γδ TCR cells and production of IL17 mediated by exposure to L gasseri. This pathway appears to contribute to development of cholestatic liver disease in patients.

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Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that is often severely painful due to nociceptive mechanisms (i.e. stimulation of cutaneous nociceptors). However, patient-reported pain character suggests that neuropathy may also drive HS pain in a subset of patients. Quantitative sensory testing (QST) can help identify neuropathic pain by testing for heightened and paradoxical pain responses in patients, but it is less feasible for routine clinical use compared with brief questionnaires. We therefore tested the suitability of a standardized neuropathic questionnaire (PainDETECT; PD-Q) for use as a surrogate clinical measure by directly comparing it with QST-identified neuropathic pain in HS. Methods: This observational, cross-sectional study included 22 adults with painful HS lesions who completed the PainDETECT questionnaire and underwent QST. A receiver operating characteristic (ROC) curve was generated and Cohen’s kappa, sensitivity, and specificity were examined at three scoring thresholds. Results: 14 participants (64%) exhibited dynamic mechanical allodynia and/or paradoxical thermal sensations in QST, which are characteristically found in neuropathic pain. According to the PD-Q, 8 participants (36%) were unlikely, 8 (36%) were possible, and 6 (27%) were likely to have neuropathic pain. A PD-Q score indicating possible or likely neuropathic pain (i.e. ≥13) demonstrated 82% agreement with QST-determined neuropathic pain (Cohen’s kappa = 0.61 (p = 0.004); sensitivity = 86%; specificity = 75%). Conclusion: The PD-Q demonstrates moderate agreement with QST in screening for neuropathic pain in HS and may be a helpful clinical tool.