1
|
Benezeder T, Gehad A, Patra V, Clark R, Wolf P. Induction of IL-1β and antimicrobial peptides as a potential mechanism for topical dithranol. Exp Dermatol 2021; 30:841-846. [PMID: 33629779 PMCID: PMC8247942 DOI: 10.1111/exd.14310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/27/2021] [Accepted: 02/13/2021] [Indexed: 01/01/2023]
Abstract
Topical dithranol is effective in autoimmune conditions like alopecia areata, inducing hair regrowth in a high percentage of cases. Exact mechanisms of dithranol in alopecia areata, with seemingly healthy epidermis besides altered hair follicles, are not well understood. To better understand dithranol's mechanisms on healthy skin, we analysed its effect on normal murine as well as xenografted human skin. We found a strong increase in mRNA expression of anti-microbial peptides (AMPs) (eg Lcn2, Defb1, Defb3, S100a8, S100a9), keratinocyte differentiation markers (eg Serpinb3a, Flg, Krt16, Lce3e) and inflammatory cytokines (eg Il1b and Il17) in healthy murine skin. This effect was paralleled by inflammation and disturbed skin barrier, as well as an injury response resulting in epidermal hyperproliferation, as observed in murine and xenografted adult human skin. This contact response and disturbed barrier induced by dithranol might lead via a vicious loop between AMPs such as S100a8/a9 (that led to skin swelling itself after topical application) and cytokines such as IL-1β to an immune suppressive environment in the skin. A better understanding of the skin's physiologic response to dithranol may open up new avenues for the establishment of novel therapeutics (including AMP-related/interfering molecules) for certain skin conditions, such as alopecia areata.
Collapse
Affiliation(s)
- Theresa Benezeder
- Department of DermatologyMedical University of GrazGrazStyriaAustria
- Department of DermatologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Ahmed Gehad
- Department of DermatologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - VijayKumar Patra
- Department of DermatologyMedical University of GrazGrazStyriaAustria
- Centre International de Recherche en InfectiologieInstitut National de la Santé et de la Recherche Médicale, U1111LyonFrance
| | - Rachael Clark
- Department of DermatologyBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
| | - Peter Wolf
- Department of DermatologyMedical University of GrazGrazStyriaAustria
| |
Collapse
|
2
|
Benezeder T, Painsi C, Patra V, Dey S, Holcmann M, Lange-Asschenfeldt B, Sibilia M, Wolf P. Dithranol targets keratinocytes, their crosstalk with neutrophils and inhibits the IL-36 inflammatory loop in psoriasis. eLife 2020; 9:e56991. [PMID: 32484435 PMCID: PMC7266641 DOI: 10.7554/elife.56991] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022] Open
Abstract
Despite the introduction of biologics, topical dithranol (anthralin) has remained one of the most effective anti-psoriatic agents. Serial biopsies from human psoriatic lesions and both the c-Jun/JunB and imiquimod psoriasis mouse model allowed us to study the therapeutic mechanism of this drug. Top differentially expressed genes in the early response to dithranol belonged to keratinocyte and epidermal differentiation pathways and IL-1 family members (i.e. IL36RN) but not elements of the IL-17/IL-23 axis. In human psoriatic response to dithranol, rapid decrease in expression of keratinocyte differentiation regulators (e.g. involucrin, SERPINB7 and SERPINB13), antimicrobial peptides (e.g. ß-defensins like DEFB4A, DEFB4B, DEFB103A, S100 proteins like S100A7, S100A12), chemotactic factors for neutrophils (e.g. CXCL5, CXCL8) and neutrophilic infiltration was followed with much delay by reduction in T cell infiltration. Targeting keratinocytes rather than immune cells may be an alternative approach in particular for topical anti-psoriatic treatment, an area with high need for new drugs.
Collapse
Affiliation(s)
| | - Clemens Painsi
- State Hospital KlagenfurtKlagenfurt am WörtherseeAustria
| | - VijayKumar Patra
- Department of Dermatology, Medical University of GrazGrazAustria
| | - Saptaswa Dey
- Department of Dermatology, Medical University of GrazGrazAustria
| | - Martin Holcmann
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of ViennaViennaAustria
| | | | - Maria Sibilia
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of ViennaViennaAustria
| | - Peter Wolf
- Department of Dermatology, Medical University of GrazGrazAustria
| |
Collapse
|
3
|
Benezeder T, Wolf P. Resolution of plaque-type psoriasis: what is left behind (and reinitiates the disease). Semin Immunopathol 2019; 41:633-644. [PMID: 31673756 PMCID: PMC6881414 DOI: 10.1007/s00281-019-00766-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/27/2019] [Indexed: 12/18/2022]
Abstract
Psoriasis is a chronic inflammatory skin disease that involves numerous types of immune cells and cytokines resulting in an inflammatory feedback loop and hyperproliferation of the epidermis. A more detailed understanding of the underlying pathophysiology has revolutionized anti-psoriatic treatment and led to the development of various new drugs targeting key inflammatory cytokines such as IL-17A and IL-23. Successfully treated psoriatic lesions often resolve completely, leaving nothing visible to the naked eye. However, such lesions tend to recur within months at the exact same body sites. What is left behind at the cellular and molecular levels that potentially reinitiates psoriasis? Here, we elucidate the cellular and molecular “scar” and its imprints left after clinical resolution of psoriasis treated with anti-TNFα, anti-IL-17, or anti-IL-23 antibodies or phototherapy. Hidden cytokine stores and remaining tissue-resident memory T cells (TRMs) might hold the clue for disease recurrence.
Collapse
Affiliation(s)
- Theresa Benezeder
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria.,Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, 8036, Graz, Austria.
| |
Collapse
|
4
|
|
5
|
Wolf P, Weger W, Patra V, Gruber-Wackernagel A, Byrne SN. Desired response to phototherapy vs photoaggravation in psoriasis: what makes the difference? Exp Dermatol 2018; 25:937-944. [PMID: 27376966 DOI: 10.1111/exd.13137] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 12/13/2022]
Abstract
Psoriasis commonly responds beneficially to UV radiation from natural sunlight or artificial sources. Therapeutic mechanisms include the proapoptotic and immunomodulating effects of UV, affecting many cells and involving a variety of pro- and anti-inflammatory cytokines, downregulating the Th17/IL-23 response with simultaneous induction of regulatory immune cells. However, exposure to UV radiation in a subset of psoriasis patients leads to exacerbation of the disease. We herein shed light on the predisposing factors of photosensitive psoriasis, including genetics (such as HLA-Cw*0602 or CARD14), gender and coexisting photodermatoses such as polymorphic light eruption (PLE) in the context of potential molecular mechanisms behind therapeutic photoresponsiveness or photoaggravation. UV-induced damage/pathogen-associated molecular patterns, damage to self-coding RNA (signalling through Toll-like receptors), certain antimicrobial peptides and/or inflammasome activation may induce innate immunity, leading to psoriasis at the site of UV exposure when there is concomitant, predisposing resistance against UV-induced suppression of the adaptive immune response (like in PLE) that otherwise would act to reduce psoriasis.
Collapse
Affiliation(s)
- Peter Wolf
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Wolfgang Weger
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | - VijayKumar Patra
- Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Graz, Austria
| | | | - Scott N Byrne
- Cellular Photoimmunology Group, Infectious Diseases and Immunology, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
6
|
Painsi C, Hirtenfelder A, Lange-Asschenfeldt B, Quehenberger F, Wolf P. The Prevalence of Periodontitis Is Increased in Psoriasis and Linked to Its Inverse Subtype. Skin Pharmacol Physiol 2017; 30:324-328. [DOI: 10.1159/000481544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/15/2017] [Indexed: 01/06/2023]
|
7
|
Holstein J, Fehrenbacher B, Brück J, Müller-Hermelink E, Schäfer I, Carevic M, Schittek B, Schaller M, Ghoreschi K, Eberle FC. Anthralin modulates the expression pattern of cytokeratins and antimicrobial peptides by psoriatic keratinocytes. J Dermatol Sci 2017; 87:236-245. [PMID: 28673488 DOI: 10.1016/j.jdermsci.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psoriasis is an inflammatory skin disease with aberrant keratinocyte proliferation, presumably as a result of immune cell activation. Th17 cytokines like IL-17A and IL-22 are critically implicated in epidermal thickening, altered keratinocyte differentiation and production of innate factors such as antimicrobial peptides. Psoriasis treatment options include modern targeted therapies using anti-cytokine antibodies and traditional non-targeted treatments like anthralin (dithranol). While the mode of action of anti-cytokine antibodies is defined, the effects of topical anthralin on psoriatic skin are not fully understood. OBJECTIVE This study aims to unravel the direct effects of anthralin on keratinocyte proliferation, differentiation and production of psoriasis-associated factors. METHODS We tested the effects of anthralin on cell proliferation, cytokeratin expression and changes in the expression of antimicrobial peptides using primary keratinocytes and 3D psoriasis tissue models with and without stimulation of the psoriasis-promoting cytokines IL-17A and IL-22. Moreover, we compared the findings derived from monolayer and multilayer cultures to data derived from lesional skin of patients with psoriasis before and under treatment with anthralin. RESULTS Our study shows that anthralin directly induces cell apoptosis in vitro in monolayer cultures but not in 3D psoriasis tissue models treated with IL-17A and IL-22. Yet, keratinocyte proliferation as determined by Ki-67 staining is impaired by anthralin in vivo. In lesional skin but not in 3D psoriasis tissue models anthralin rapidly normalizes cytokeratin (CK)16 expression. Furthermore, anthralin directly inhibits DEFB4 expression in vitro and in vivo, while other antimicrobial peptides and cytokines studied like IL-6 and IL-8 are regulated differently in vitro and in vivo. CONCLUSIONS Our results show that anthralin directly regulates DEFB4A expression. However, its beneficial effects on psoriasis cannot be explained by direct effects on keratinocyte differentiation or cytokine expression.
Collapse
Affiliation(s)
- Julia Holstein
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Birgit Fehrenbacher
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Jürgen Brück
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Eva Müller-Hermelink
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Iris Schäfer
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Melanie Carevic
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Birgit Schittek
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Martin Schaller
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany.
| | - Franziska C Eberle
- Department of Dermatology, University Medical Center Tübingen, Eberhard Karls University, Liebermeisterstr. 25, D-72076 Tübingen, Germany
| |
Collapse
|
8
|
Painsi C, Patscheider M, Inzinger M, Lange-Asschenfeldt B, Quehenberger F, Wolf P. Patient perspectives on treating psoriasis with classic inpatient dithranol therapy: a retrospective patient survey. J Dtsch Dermatol Ges 2016; 13:1156-63. [PMID: 26513076 DOI: 10.1111/ddg.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Evidence of the efficacy of dithranol and patient perspectives on the treatment is scant. PATIENTS AND METHODS Using a telephone interview survey, we collected retrospective data from 63 patients (41 men [65.1 %] and 22 women [34.9 %]) who had been treated with classic inpatient dithranol (CID). PsoRA (www.psoriasisregistry.at) was used to obtain clinical data and treatment responses, which were then correlated with the interview responses. RESULTS Fifty-two (82.5 %) patients achieved a PASI75 and 51 (81 %) a PASI90 response within a median of 12.5 (range: 3 to 25) days. Ten out of twelve (83 %) patients showed a satisfactory response to CID (PASI75 or greater reduction) despite the fact that they had previously failed to adequately respond to methotrexate, oral retinoids, cyclosporine, or ustekinumab. Overall, patients recalled a median recurrence-free interval of four (95 % CI: 3-9) months after responding to CID, which was positively correlated with the patients' recommendation of (p = 0.018) and their overall high satisfaction with the treatment (p = 0.012). CONCLUSIONS Despite the known limitations of CID, this survey indicates that dithranol remains a highly efficacious and valuable treatment option as induction therapy in psoriasis. CID can be effective in patients who have failed to respond to systemic therapy, including traditional agents and biologics.
Collapse
Affiliation(s)
- Clemens Painsi
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Department of Dermatology, State Hospital Klagenfurt, Klagenfurt, Austria
| | | | - Martin Inzinger
- Department of Dermatology, Medical University of Graz, Graz, Austria.,Department of Internal Medicine, Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | | | - Franz Quehenberger
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| |
Collapse
|
9
|
Painsi C, Patscheider M, Inzinger M, Lange-Asschenfeldt B, Quehenberger F, Wolf P. Die Behandlung der Psoriasis mit klassischer, stationärer Dithranol-Therapie: eine retrospektive Patientenbefragung. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.70_12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Clemens Painsi
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Graz; Graz Österreich
- Abteilung für Dermatologie und Venerologie; Klinikum Klagenfurt; Klagenfurt Österreich
| | - Michael Patscheider
- Abteilung für Dermatologie und Venerologie; Klinikum Klagenfurt; Klagenfurt Österreich
| | - Martin Inzinger
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Graz; Graz Österreich
- Universitätsklinik für Innere Medizin; Klinische Abteilung für Rheumatologie und Immunologie; Medizinische Universität Graz; Graz Österreich
| | | | - Franz Quehenberger
- Institut für Medizinische Informatik; Statistik und Dokumentation; Medizinische Universität Graz; Graz Österreich
| | - Peter Wolf
- Universitätsklinik für Dermatologie und Venerologie; Medizinische Universität Graz; Graz Österreich
| |
Collapse
|