Douglas A. Plager

Early cutaneous gene transcription changes in adult atopic dermatitis and potential clinical implications.

Abstract:  Atopic dermatitis (AD) is a common pruritic dermatitis with macroscopically non‐lesional skin that is often abnormal. Therefore, we used high‐density oligonucleotide arrays to identify cutaneous gene transcription changes associated with early AD inflammation as potential disease control targets. Skin biopsy specimens analysed included normal skin from five healthy non‐atopic adults and both minimally lesional skin and nearby or contralateral non‐lesional skin from six adult AD patients. Data were analysed on an individual gene basis and to identify biologically relevant gene networks. Transcription levels of selected genes were also analysed by quantitative PCR. Differential transcription occurring early in AD skin was indicated for (i) individual genes such as C‐C chemokine ligand (CCL)18, CCL13, and interferon‐α2 (IFNα2), (ii) genes associated with peroxisome proliferator‐activated receptor (PPAR)α‐ and PPARγ‐regulated transcription, and possibly for (iii) immunoglobulin J‐chain and heavy chain isotype transcripts. These data suggest that local changes in immunoglobulin‐associated transcription may favour IgE over secretory immunoglobulin (multimeric IgM and IgA) expression in AD skin. Decreased PPAR activity appears common to both AD and psoriasis, and reduced cutaneous IFNα2 transcription also appears characteristic of AD. Identification of these genes and pathways will direct future research towards controlling AD.

Gene Transcription Changes in Asthmatic Chronic Rhinosinusitis with Nasal Polyps and Comparison to Those in Atopic Dermatitis

Background Asthmatic chronic rhinosinusitis with nasal polyps (aCRSwNP) is a common disruptive eosinophilic disease without effective medical treatment. Therefore, we sought to identify gene expression changes, particularly those occurring early, in aCRSwNP. To highlight expression changes associated with eosinophilic epithelial inflammation, we further compared the changes in aCRSwNP with those in a second eosinophilic epithelial disease, atopic dermatitis (AD), which is also closely related to asthma. Methods/Principal Findings Genome-wide mRNA levels measured by exon array in both nasosinus inflamed mucosa and adjacent polyp from 11 aCRSwNP patients were compared to those in nasosinus tissue from 17 normal or rhinitis subjects without polyps. Differential expression of selected genes was confirmed by qRT-PCR or immunoassay, and transcription changes common to AD were identified. Comparison of aCRSwNP inflamed mucosa and polyp to normal/rhinitis tissue identified 447 differentially transcribed genes at ≥2 fold-change and adjusted p-value<0.05. These included increased transcription of chemokines localized to chromosome 17q11.2 (CCL13, CCL2, CCL8, and CCL11) that favor eosinophil and monocyte chemotaxis and chemokines (CCL18, CCL22, and CXCL13) that alternatively-activated monocyte-derived cells have been shown to produce. Additional transcription changes likely associated with Th2-like eosinophilic inflammation were prominent and included increased IL1RL1 (IL33 receptor) and EMR1&3 and decreased CRISP2&3. A down-regulated PDGFB-centric network involving several smooth muscle-associated genes was also implicated. Genes at 17q11.2, genes associated with alternative activation or smooth muscle, and the IL1RL1 gene were also differentially transcribed in AD. Conclusions/Significance Our data implicate several genes or gene sets in aCRSwNP and eosinophilic epithelial inflammation, some that likely act in the earlier stages of inflammation. The identified gene expression changes provide additional diagnostic and therapeutic targets for aCRSwNP and other eosinophilic epithelial diseases.

Extensive fractionation and identification of proteins within nasal lavage fluids from allergic rhinitis and asthmatic chronic rhinosinusitis patients.

Allergic rhinitis (AR), chronic rhinosinusitis (CRS), and asthma are prevalent airway diseases that can have a substantial impact on a patients quality of life. MS analyses of biological fluids can effectively screen for proteins associated with disease processes, however, initial detection of diagnostic proteins is difficult due to protein complexity and dynamic range. To enhance the detection of lower abundance proteins, intact nasal lavage fluid (NLF) proteins from nonpolypoid AR and from asthmatic CRS patients were extensively fractionated prior to LC/MS/MS analysis. Pooled NLF samples were processed to remove low molecular weight molecules and high abundance plasma proteins. Anion exchange (AX) chromatography followed by RP-LC further separated the remaining intact NLF proteins. The resulting fractions were digested with trypsin and the peptides analyzed by LC/MS/MS. Spectra were searched with MASCOT, SEQUEST, and X!Tandem to obtain peptide identifications and subsequently analyzed by Scaffold software to identify parent proteins with at least 99% confidence. The 197 identified proteins are compared to those previously cited in the literature and the workflow evaluated to determine the usefulness for the detection of lower abundance proteins. This is the first extensive list of NLF proteins generated from CRS patients with coexisting asthma.

Eosinophil ribonucleases and their cutaneous lesion-forming activity.

Eosinophil granule proteins are deposited in cutaneous lesions in many human diseases, but how these proteins contribute to pathophysiology is obscure. We injected eosinophil cationic protein (ECP or RNase 3), eosinophil-derived neurotoxin (EDN or RNase 2), eosinophil peroxidase (EPO), and major basic protein-1 (MBP1) intradermally into guinea pig and rabbit skin. ECP and EDN each induced distinct skin lesions at ≥2.5 μM that began at 2 days, peaking at ∼7 days and persisting up to 6 wk. These lesions were ulcerated (ECP) or crusted (EDN) with marked cellular infiltration. EPO and MBP1 (10 μM) each produced perceptible induration and erythema with moderate cellular infiltration resolving within 2 wk. ECP and EDN localized to dermal cells within 2 days, whereas EPO and MBP1 remained extracellular. Overall, cellular localization and RNase activity of ECP and EDN were critical for lesion formation; differential glycosylation, net cationic charge, or RNase activity alone did not account for lesion formation. Ulcerated lesions from patients with the hypereosinophilic syndrome showed ECP and EDN deposition comparable to that in guinea pig skin. In conclusion, ECP and EDN disrupt skin integrity and cause inflammation. Their presence in ulcerative skin lesions may explain certain findings in human eosinophil-associated diseases.

A novel human homolog of eosinophil major basic protein.

Summary: Eosinophil major basic protein (MBP) contributes to host defense and disease pathophysiology. Chromosome 11 contains the genes for human MBP1 (hMBP1) and a second novel MBP, hMBP2, in the centromere to 11q12 region. Interestingly, greater similarity exists between human and murine MBP1 and MBP2 orthologs, respectively, than between hMBP1 and hMBP2, suggesting a gene duplication event prior to the divergence of humans and mice. There is abundant mRNA for hMBP1 in both bone marrow (eosinophils and basophils) and placenta, but hMBP2 mRNA is present only in bone marrow (eosinophils). Comparison of proximal promoters for hMBP2, hMBP1, and murine MBP1 (mMBP1) shows a conserved GATA transcription factor binding site (functionally active in hMBP1). However, whether a C/EBP binding site common to hMBP1 and mMBP1 is functionally conserved in hMBP2 remains unresolved. Similarly, the role of conserved putative IK2 and STAT binding sites in MBP transcriptional control remains unknown. Like hMBP1, hMBP2 is in the eosinophil secondary granule. However, hMBP2 is twofold less positively charged than hMBP1 (+8 versus +16 at neutral pH), and this difference may explain hMBP2s similar, but often less potent, in vitro biological activities. Overall, while conservation of hMBP2s amino acid sequence (63% identity with hMBP1) suggests a common function(s) with hMBP1, hMBP2s substantially reduced charge and the existence of the similar mMBP2 argue for additional, unique functions for hMBP2.

Gene transcription abnormalities in canine atopic dermatitis and related human eosinophilic allergic diseases

Canine atopic dermatitis (AD) is clinically similar to human AD, implicating it as a useful model of human eosinophilic allergic disease. To identify cutaneous gene transcription changes in relatively early inflammation of canine AD, microarrays were used to monitor transcription in normal skin (n=13) and in acute lesional AD (ALAD) and nearby visibly nonlesional AD (NLAD) skin (n=13) from dogs. Scanning the putative abnormally transcribed genes, several potentially relevant genes, some abnormally transcribed in both NLAD and ALAD (e.g. IL6, NFAM1, MSRA, and SYK), were observed. Comparison for abnormally transcribed genes common to two related human diseases, human AD and asthmatic chronic rhinosinusitis with nasal polyps (aCRSwNP), further identified genes or gene sets likely relevant to eosinophilic allergic inflammation. These included: (1) genes associated with alternatively activated monocyte-derived cells, including members of the monocyte chemotactic protein (MCP) gene cluster, (2) members of the IL1 family gene cluster, (3) eosinophil-associated seven transmembrane receptor EMR1 and EMR3 genes, (4) interferon-inducible genes, and (5) keratin genes associated with hair and nail formation. Overall, numerous abnormally transcribed genes were observed only in canine AD; however, many others are common to related human eosinophilic allergic diseases and represent therapeutic targets testable in dogs with AD.

Pimecrolimus reduces eosinophil activation associated with calcium mobilization.

Background: Pimecrolimus is a calcineurin inhibitor that inhibits T cell and mast cell activation and effectively treats atopic dermatitis. However, its effects on eosinophils, a cell type implicated in allergic disease pathology, are unknown. Therefore, we examined the effects of pimecrolimus on eosinophil superoxide anion production, degranulation and survival. Methods: Purified eosinophils from normal or atopic donors were incubated with serial dilutions of pimecrolimus (μM to nM) and then stimulated with platelet activating factor (PAF), interleukin 5 (IL5), secretory immunoglobulin A (sIgA) or Alternaria alternata (Alt) fungus extract. Eosinophil activation was monitored by cytochrome c reduction resulting from superoxide anion production and by a 2-site immunoassay for eosinophil-derived neurotoxin (EDN) in cellular supernatants, as a marker of degranulation. Eosinophil survival was measured by propidium iodide exclusion using flow cytometry after 4 days in culture. Results: Normal and atopic eosinophil superoxide anion production induced by PAF, and associated with increased intracellular calcium, was inhibited up to 37% with 1 μM pimecrolimus. However, superoxide anion production induced by IL5 and sIgA was not consistently inhibited. EDN release, which ultimately depends on calcium, was inhibited about 30% with PAF, IL5 and sIgA stimulation for normal and atopic donor eosinophils. Furthermore, calcium-dependent Alt-induced EDN release was inhibited up to 49% with nanomolar pimecrolimus. Finally, increased eosinophil survival promoted by IL5 and sIgA was not influenced by pimecrolimus. Conclusion: Pimecrolimus moderately inhibits eosinophil superoxide anion production and EDN release associated with calcium mobilization, which may contribute to its efficacy in treating atopic dermatitis.

Comparison of three staining methods to identify eosinophils in formalin-fixed canine skin

BACKGROUND Studies comparing the ability of staining methods to detect eosinophils in formalin-fixed canine skin are lacking. HYPOTHESIS/OBJECTIVES The aim of this study was to compare the effectiveness of eosinophil peroxidase monoclonal antibody (EPXmAb), Luna and haematoxylin and eosin (H&E) to detect eosinophils in fixed canine skin by assessing the following parameters: (i) specificity of eosinophil staining; (ii) extracellular eosinophil granule staining; (iii) tissue background staining; (iv) contrast between eosinophil and surrounding tissue staining; and (v) differences in the number of eosinophils detected by each stain. METHODS Three serial sections of formalin-fixed, paraffin-embedded tissues of predominantly eosinophilic skin diseases (n = 8), noneosinophilic skin diseases (n = 7) and normal canine skin (n = 1) were stained with the three stains. Each parameter was independently assessed and scored by two investigators. RESULTS Luna and EPXmAb were specific in detecting eosinophils. The EPXmAb was significantly more effective than Luna (P < 0.001) and H&E (P < 0.001) in its ability to detect extracellular eosinophil granules (i.e. to detect intact and released eosinophil granules). The EPXmAb showed significantly less background staining compared with Luna (P = 0.0005). Moreover, significantly more stain contrast was noted with EPXmAb compared with Luna (P = 0.003) and H&E (P < 0.001). There was no significant difference between the mean eosinophil counts among the three stains. CONCLUSION AND CLINICAL IMPORTANCE The three stains were shown to be useful to detect and quantify eosinophils in fixed canine skin. The EPXmAb-based immunohistochemical stain proved to be a novel tool to detect eosinophils in canine skin.