Gene expression profiling in psoriatic scalp hair follicles: clobetasol propionate shampoo 0.05% normalizes psoriasis disease markers

BACKGROUND

Clobetasol propionate shampoo is effective and safe in treatment of scalp psoriasis (SP). Gene expression profiling of psoriatic skin biopsies led to the identification of numerous disease-related genes. However, it remained unknown whether the gene expression profile of hair follicles of SP patients was also affected.

OBJECTIVES

To determine whether psoriasis-related genes are differentially regulated in the hair follicles of SP patients and whether the modulation of these genes can be correlated with clinical severity scores.

METHODS

A single arm, open study was conducted in three centres. SP patients received daily treatment with clobetasol propionate shampoo. At Baseline, Weeks 2 and 4, investigators assessed clinical severity parameters and collected scalp hair follicles in anagen phase. Total RNA extracted from hair follicles was used to determine the expression level of 44 genes, which were reported previously to be upregulated in the skin of psoriasis patients.

RESULTS

RNA of good quality and sufficient quantity was obtained from hair follicles of psoriasis patients and healthy volunteers (HV). The expression level of 10 inflammation-related genes was significantly increased in psoriatic hair follicles. The patient's exploratory transcriptomic score, defined as the mean fold modulation of these 10 genes compared with HV, correlated with clinical severity scores. Clobetasol propionate shampoo was effective in decreasing both the exploratory transcriptomics and the clinical severity scores.

CONCLUSION

Hair follicles of SP patients are affected by the inflammatory process. The change in the expression level of inflammation-related genes correlates with the severity of the disease.

DNA determination of human hair bulbs in normal and androgenetic alopecia

We carried out a cytophotometric study of the DNA content of matrix cells from normal hair follicles and those affected by androgenetic alopecia (early and established baldness), using the Feulgen technique. We thereby obtained a 2C reference value from lymphocyte nuclei from normal skin, from which we established a 2C-4C and 4C DNA content. The results obtained showed 71.75% of matrix cells in normal scalp to have a 2C content, while the remaining 28.25% was distributed between the values of 2C-4C and 4C. However, in early baldness, the number of 2C cells dropped to 48%, with a notable increase in cell populations with a 2C-4C and 4C content, which varied from 29.45% and 22.55% respectively. Finally, in established baldness, the 2C values decreased to as low as 29.56%, with the percentage of cells with a 2C-4C content reaching 38.71% and those of 4C, 31.73%.

Keratinocyte differentiation in psoriatic scalp: morphology and expression of epithelial keratins

The morphology of hair follicles was examined in psoriatic scalp biopsies and compared with normal scalp. In scalp psoriasis the lower outer root sheath and hair matrix were not affected by the psoriatic changes, although there was an irregular expansion in the proximal lower outer root sheath. This area has been characterized, by the presence of keratin K19-containing cells, as the putative stem cell region. In addition, marked shrinkage of the sebaceous glands was seen in the psoriatic scalp, as previously reported. A panel of monospecific monoclonal antibodies to individual epithelial keratins was used to analyse scalp specimens immunohistochemically. Keratin expression in scalp was generally unaffected by psoriasis, except for widespread expression of suprabasal keratins K16 and K17 in suprabasal interfollicular psoriatic scalp epidermis. Simple epithelial keratins K8 and K18 were not found in follicular epithelium from either normal or psoriatic scalp, using multiple monospecific antibodies. This study shows that keratin K17 is induced suprabasally during epidermal hyperproliferation, and cannot therefore be considered a hair follicle-specific keratin.

Cell kinetic study of human and mouse hair tissues using anti-bromodeoxyuridine monoclonal antibody

To determine sites of cell proliferation in hair tissues, in vitro and in vivo labeling with bromodeoxyuridine (BrdU) and immunohistochemical demonstration of BrdU incorporation sites by anti-BrdU monoclonal antibody were performed on human and mouse hairs and hair follicles. The germinative area of the hair bulb of human anagen hair was divided into three portions: (A) the upper and inner portion, (B) the middle portion and (C) the lowest outer portion. A-cells intermingled with melanocytes, were regarded as germinative cells of the hair cortex. B-cells appeared to develop into Huxley's layer, cuticle of inner root sheath (IRS), and hair cuticle. C-cells seemed to develop into bulbar outer root sheath (ORS), the innermost cell (IMC) layer of the ORS and Henle's layer. The suprabulbar portion, where the ORS abruptly increased in thickness, was found to be the fourth main germinative portion (D). The ORS cells, except for the IMCs, seemed to originate mostly from the D-cells. In the late anagen phase, first, C-cells became BrdU negative, then, A- and B-cells gradually turned negative, and finally, D-cells lost their germinative activity. In catagen and telogen hair tissues, BrdU-positive cells were found in the two outer cell layers in the ORS. The structure of anagen hair tissues seems to be maintained by the coordinated mitotic activities of characteristically distributed germinative cells of various hair cell layers. The sequential cessation of mitotic activity of these cells is associated with the morphological changes from anagen through catagen to telogen. These findings were common to both human and mouse hair tissues.