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Varin-Simon J, Haney EF, Colin M, Velard F, Gangloff SC, Hancock REW, Reffuveille F. D-enantiomeric antibiofilm peptides effective against anaerobic Cutibacterium acnes biofilm. Microbiol Spectr 2025:e0252324. [PMID: 40130849 DOI: 10.1128/spectrum.02523-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Accepted: 01/27/2025] [Indexed: 03/26/2025] Open
Abstract
The emergence of antibiotic resistance, biofilm formation, and internalization by host cells contribute to a high risk of chronic infections, highlighting the necessity to develop novel therapeutic strategies. Identification of natural host defense peptides (HDPs) with promising antimicrobial and antibiofilm activities led to the development of synthetic peptides with broad-spectrum efficacy. However, few studies have examined their effect on anaerobic bacterial species. This study aimed to test the effect of synthetic HDPs on Cutibacterium acnes, an anaerobe species involved in 10% of prosthesis joint infections (PJI). A preliminary screen identified three peptides (DJK5, AB009-D, and AB101-D) with promising activity against four C. acnes strains (two of which were isolated from PJI). A bactericidal effect was observed for the three peptides with 50% of planktonic bacteria killing for AB009-D and AB101-D after only 3 hours of contact. DJK5 and AB009-D inhibited the C. acnes adhesion on plastic and titanium supports with a 2-log decrease in bacterial cells. In the presence of peptides, the morphology of C. acnes cells was altered with an increase in cell length observed, especially for one of the non-PJI-related strains. Against mature biofilms, AB101-D was the most effective with an approximate 2-log decrease in adhered CFUs, indicating the induction of bacterial dispersion or death. DJK5 also inhibited C. acnes internalization by osteoblasts, with a reduction of the internalized bacteria quantity for three strains. Overall, this study demonstrates that synthetic HDPs are effective against anaerobic bacteria and hold promise as novel therapeutic candidates to prevent or treat C. acnes PJIs.IMPORTANCEThe emergence of antibiotic tolerance highlights the necessity to develop novel therapeutic strategies with promising antimicrobial but also antibiofilm activities. In this study, we tested the effect of synthetic host defense peptides (HDPs) on Cutibacterium acnes, an anaerobic species, rarely studied, whereas involved in 10% of prosthesis joint infections (PJI). In our study, we demonstrate that the selected synthetic HDPs are effective against this anaerobic bacteria, both as a preventive treatment (effect on planktonic growth, bacterial adhesion, and biofilm formation) and against internalization of C. acnes by osteoblasts, revealing that these peptides are promising as novel therapeutic candidates to prevent or treat C. acnes PJIs.
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Affiliation(s)
- Jennifer Varin-Simon
- Université de Reims Champagne-Ardenne, BIOS, Reims, Grand Est, France
- Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, Grand Est, France
| | - Evan F Haney
- Asep Medical Inc./ABT Innovations Inc., Victoria, British Columbia, Canada
- Department of Microbiology and Immunology, Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marius Colin
- Université de Reims Champagne-Ardenne, BIOS, Reims, Grand Est, France
- Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, Grand Est, France
| | - Frédéric Velard
- Université de Reims Champagne-Ardenne, BIOS, Reims, Grand Est, France
| | - Sophie C Gangloff
- Université de Reims Champagne-Ardenne, BIOS, Reims, Grand Est, France
- Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, Grand Est, France
| | - Robert E W Hancock
- Asep Medical Inc./ABT Innovations Inc., Victoria, British Columbia, Canada
- Department of Microbiology and Immunology, Center for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fany Reffuveille
- Université de Reims Champagne-Ardenne, BIOS, Reims, Grand Est, France
- Université de Reims Champagne-Ardenne, UFR Pharmacie, Reims, Grand Est, France
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Wu J, Wang X, Chai J, Yang J, Gao Y, Xiong W, Huang X, Gong Y, Chen X, Xu X. Cath-HG exhibits anti-acne activities via multiple mechanisms. Eur J Pharmacol 2025; 998:177493. [PMID: 40057159 DOI: 10.1016/j.ejphar.2025.177493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 02/27/2025] [Accepted: 03/06/2025] [Indexed: 03/17/2025]
Abstract
The overgrowth of Propionibacterium acnes and the subsequent inflammation possess critical roles during acne vulgaris development. Cath-HG, an antimicrobial peptide previously characterized for its antimicrobial, anti-inflammatory, human protease-regulating, LPS-binding, and platelet glycoprotein VI (GPVI) inhibitory properties, has not been studied in the context of acne vulgaris. Here, Cath-HG was found to show strong anti-bacterial activities against P. acnes by promoting agglutination of bacteria, inhibition of biofilm formation, and disruption of the bacterial membrane. It also suppressed reactive oxygen species (ROS) and sebum production induced by P. acnes in HaCaT cells and inhibited the enzymatic activity of lipases and hyaluronidase. Moreover, Cath-HG also bound to lipoteichoic acid (LTA) and significantly attenuated the production of inflammatory factors through Toll-like receptor 2 (TLR2) in RAW264.7 macrophages. Consistently, Cath-HG exhibited antimicrobial effects and exerted anti-inflammatory activity by suppressing the activation of the mitogen-activated protein kinase (MAPK) signaling pathway in a P. acnes-induced mouse model. Consequently, Cath-HG could be a promising candidate for treatment of acne vulgaris.
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Affiliation(s)
- Jiena Wu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China; NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Xilong Wang
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Jinwei Chai
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China; NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Jianxi Yang
- NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China
| | - Yihan Gao
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Weichen Xiong
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xiaowen Huang
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Yuxin Gong
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Xin Chen
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| | - Xueqing Xu
- Department of Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China; NMPA Key Laboratory for Research and Evaluation of Drug Metabolism, Guangdong Provincial Key Laboratory of New Drug Screening, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, China.
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Yu T, Chen J, Wu S, Jiang M, Han L, Ma Y. Potential functionality of Cutibacterium acnes extracellular vesicles in atopic dermatitis and acne vulgaris: A comparative proteomic analysis. Proteomics Clin Appl 2024; 18:e2300106. [PMID: 38639920 DOI: 10.1002/prca.202300106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 03/10/2024] [Accepted: 03/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Cutibacterium acnes is a commensal bacterium residing in healthy skin and plays a critical role in maintaining skin homeostasis. C. acnes has been considered closely related to acne vulgaris, while recent studies suggest that C. acnes and its metabolites may have a protective role in atopic dermatitis (AD) by modulating the immune system and maintaining skin homeostasis. Extracellular vesicles (EVs) are small membranous vesicles secreted by bacteria that participate in bacteria-host interactions. METHODS This study first compared C. acnes EVs from AD lesions (AD-EVs), acne lesions (Acne-EVs), and healthy skin (NC-EVs), using Label-free quantitative LC-MS/MS and validated differently expressed proteins by parallel reaction monitoring (PRM). Then Normal Human Epidermal Keratinocytes (NHEK) and human primary keratinocytes (KC) were treated with C. acnes EVs isolated from different groups, and the expressions of inflammatory factors were measured by quantitative real-time PCR and Western blotting. RESULTS Compared with the acne group, the AD group showed greater downregulation of proteins related to energy metabolism and carbon source utilization pathway. Differences in protein profile in AD and acne lesion-separated C. acnes EVs correspond to the abnormal sebum secretion pattern in both diseases. C. acnes EVs from different groups affected different expressions of Th1 and Th2 inflammatory factors and epidermal barrier markers in NHEK and KC, indicating different immunomodulatory potentials. CONCLUSIONS This study observed distinct proteomic differences between AD-EVs and Acne-EVs, and provided insights into the functional differences of C. acnes EVs in AD and acne.
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Affiliation(s)
- Tianze Yu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shi Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Jiang
- Department of Dermatology, SinoUnited Health, Shanghai, China
| | - Ling Han
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying Ma
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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Cheung CT, Lancien U, Corvec S, Mengeaud V, Mias C, Véziers J, Khammari A, Dréno B. Pro-inflammatory activity of Cutibacterium acnes phylotype IA 1 and extracellular vesicles: An in vitro study. Exp Dermatol 2024; 33:e15150. [PMID: 39113601 PMCID: PMC11605500 DOI: 10.1111/exd.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/27/2024] [Accepted: 07/21/2024] [Indexed: 12/01/2024]
Abstract
Acne is a chronic inflammatory skin condition that involves Cutibacterium acnes (C. acnes), which is classified into six main phylotypes (IA1, IA2, IB, IC, II and III). Acne development is associated with loss of C. acnes phylotype diversity, characterised by overgrowth of phylotype IA1 relative to other phylotypes. It was also shown that purified extracellular vesicles (EVs) secreted by C. acnes can induce an acne-like inflammatory response in skin models. We aimed to determine if the inflammatory profile of EVs secreted by C. acnes phylotype IA1 from an inflammatory acne lesion was different from C. acnes phylotype IA1 from normal skin, thus playing a direct role in the severity of inflammation. EVs were produced in vitro after culture of two clinical strains of C. acnes phylotype IA1, T5 from normal human skin and A47 from an inflammatory acne lesion, and then incubated with either human immortalised keratinocytes, HaCaT cells, or skin explants obtained from abdominoplasty. Subsequently, quantitative PCR (qPCR) was performed for human β-defensin 2 (hBD2), cathelicidin (LL-37), interleukin (IL)-1β, IL-6, IL-8, IL-17α and IL-36γ, and ELISA for IL-6, IL-8 and IL-17α. We found that EVs produced in vitro by C. acnes derived from inflammatory acne lesions significantly increased the pro-inflammatory cytokines and anti-microbial peptides at both transcriptional and protein levels compared with EVs derived from normal human skin. We show for the first time that C. acnes EVs from inflammatory acne play a crucial role in acne-associated inflammation in vitro and that C. acnes phylotype IA1 collected from inflammatory acne lesion and normal skin produce different EVs and inflammatory profiles in vitro.
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Affiliation(s)
- Caroline T. Cheung
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy (INCIT)NantesFrance
| | - Ugo Lancien
- Nantes University, CHU Nantes Chirurgie Plastique, Reconstructrice et Esthétique et Centre de traitement des Brûlés, Hôtel‐DieuNantesFrance
| | - Stéphane Corvec
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy (INCIT)NantesFrance
- CHU Nantes Bacteriology DepartmentNantes UniversityNantesFrance
| | - Valérie Mengeaud
- Medical Direction, Laboratoires Dermatologiques Ducray, Les CauquillousLavaurFrance
| | - Céline Mias
- Pierre Fabre Dermo‐Cosmétique et Personal CareToulouseFrance
| | - Joëlle Véziers
- Nantes University, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeSNantesFrance
| | - Amir Khammari
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy (INCIT)NantesFrance
- Department of DermatologyNantes University, CHU Nantes, INSERMNantesFrance
| | - Brigitte Dréno
- Nantes University, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy (INCIT)NantesFrance
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Chen J, Lv Y, Shang W, Yang Y, Wang Y, Hu Z, Huang X, Zhang R, Yuan J, Huang J, Rao X. Loaded delta-hemolysin shapes the properties of Staphylococcus aureus membrane vesicles. Front Microbiol 2023; 14:1254367. [PMID: 37869662 PMCID: PMC10588482 DOI: 10.3389/fmicb.2023.1254367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background Membrane vesicles (MVs) are nanoscale vesicular structures produced by bacteria during their growth in vitro and in vivo. Some bacterial components can be loaded in bacterial MVs, but the roles of the loaded MV molecules are unclear. Methods MVs of Staphylococcus aureus RN4220 and its derivatives were prepared. Dynamic light scattering analysis was used to evaluate the size distribution, and 4D-label-free liquid chromatography-tandem mass spectrometry analysis was performed to detect protein composition in the MVs. The site-mutation S. aureus RN4220-Δhld and agrA deletion mutant RN4220-ΔagrA were generated via allelic replacement strategies. A hemolysis assay was performed with rabbit red blood cells. CCK-8 and lactate dehydrogenase release assays were used to determine the cytotoxicity of S. aureus MVs against RAW264.7 macrophages. The serum levels of inflammatory factors such as IL-6, IL-1β, and TNFα in mice treated with S. aureus MVs were detected with an enzyme-linked immunosorbent assay kit. Results Delta-hemolysin (Hld) was identified as a major loaded factor in S. aureus MVs. Further study showed that Hld could promote the production of staphylococcal MVs with smaller sizes. Loaded Hld affected the diversity of loaded proteins in MVs of S. aureus RN4220. Hld resulted in decreased protein diversity in MVs of S. aureus. Site-mutation (RN4220-Δhld) and agrA deletion (RN4220-ΔagrA) mutants produced MVs (ΔhldMVs and ΔagrAMVs) with a greater number of bacterial proteins than those derived from wild-type RN4220 (wtMVs). Moreover, Hld contributed to the hemolytic activity of wtMVs. Hld-loaded wtMVs were cytotoxic to macrophage RAW264.7 cells and could stimulate the production of inflammatory factor IL-6 in vivo. Conclusion This study presented that Hld was a major loaded factor in S. aureus MVs, and the loaded Hld played vital roles in the MV-property modification.
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Affiliation(s)
- Juan Chen
- Department of Pharmacy, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Yuhuan Lv
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
- Department of Clinical Laboratory, The 971st Hospital of Chinese People's Liberation Army Navy, Qingdao, China
| | - Weilong Shang
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Yi Yang
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Yuting Wang
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Zhen Hu
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Xiaonan Huang
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
| | - Rong Zhang
- Department of Pharmacy, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jizhen Yuan
- Department of Clinical Laboratory, The 971st Hospital of Chinese People's Liberation Army Navy, Qingdao, China
| | - Jingbin Huang
- Department of Pharmacy, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Xiancai Rao
- Department of Microbiology, College of Basic Medical Science, Army Medical University, Chongqing, China
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Luo R, Chang Y, Liang H, Zhang W, Song Y, Li G, Yang C. Interactions between extracellular vesicles and microbiome in human diseases: New therapeutic opportunities. IMETA 2023; 2:e86. [PMID: 38868436 PMCID: PMC10989913 DOI: 10.1002/imt2.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/21/2022] [Accepted: 01/14/2023] [Indexed: 06/14/2024]
Abstract
In recent decades, accumulating research on the interactions between microbiome homeostasis and host health has broadened new frontiers in delineating the molecular mechanisms of disease pathogenesis and developing novel therapeutic strategies. By transporting proteins, nucleic acids, lipids, and metabolites in their versatile bioactive molecules, extracellular vesicles (EVs), natural bioactive cell-secreted nanoparticles, may be key mediators of microbiota-host communications. In addition to their positive and negative roles in diverse physiological and pathological processes, there is considerable evidence to implicate EVs secreted by bacteria (bacterial EVs [BEVs]) in the onset and progression of various diseases, including gastrointestinal, respiratory, dermatological, neurological, and musculoskeletal diseases, as well as in cancer. Moreover, an increasing number of studies have explored BEV-based platforms to design novel biomedical diagnostic and therapeutic strategies. Hence, in this review, we highlight the recent advances in BEV biogenesis, composition, biofunctions, and their potential involvement in disease pathologies. Furthermore, we introduce the current and emerging clinical applications of BEVs in diagnostic analytics, vaccine design, and novel therapeutic development.
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Affiliation(s)
- Rongjin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Department of Spine Surgery, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Yanmin Chang
- Department of Neurology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Huaizhen Liang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Weifeng Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yu Song
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Gaocai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Jiang Z, Jin S, Fan X, Cao K, Liu Y, Wang X, Ma Y, Xiang L. Cannabidiol Inhibits Inflammation Induced by Cutibacterium acnes-Derived Extracellular Vesicles via Activation of CB2 Receptor in Keratinocytes. J Inflamm Res 2022; 15:4573-4583. [PMID: 35982758 PMCID: PMC9379120 DOI: 10.2147/jir.s374692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background Acne is a common inflammatory skin disease, while cannabidiol (CBD) is a representative non-psychoactive phytocannabinoid which has been proved to exert universal anti-inflammatory properties. This study aimed to explore the effect of CBD on acne inflammation induced by Cutibacterium acnes-derived extracellular vesicles (CEVs) in keratinocytes and reveal the underlying mechanisms. Methods Normal human epidermal keratinocytes (NHEKs) were stimulated by CEVs in the presence of CBD or vehicle. Interleukin (IL)-6, IL-8, and tumor necrosis factor (TNF)-α levels were examined by RT-PCR and ELISA. The expression of cannabinoid type-2 (CB2) receptor and transient receptor potential vanilloid type-1 (TRPV1) was detected by Western blotting. TNF-α levels in the presence of CB2 receptor antagonist (AM630) or TRPV1 antagonist (Capsazepine) were detected by RT-PCR. The activation of MAPK and NF-κB signaling pathways and the nuclear translocation of NF-κB p65 upon CBD treatment were analyzed by Western blotting and immunofluorescence assay, respectively. Results The expression of inflammatory cytokines (IL-6, IL-8 and TNF-α) in CEVs-stimulated NHEKs was suppressed by CBD. CB2 receptor expression was upregulated by CBD, whereas CEVs-promoted TRPV1 expression was downregulated by CBD. AM630 reversed TNF-α levels inhibited by CBD. Capsazepine exerted an inhibitory effect on CEVs-induced inflammation and had synergistic effect with CBD. The phosphorylation of ERK1/2 and NF-κB p65 and nuclear translocation of NF-κB p65 were induced by CEVs but reduced by CBD. Conclusion The results indicated that CBD could inhibit inflammation induced by CEVs in NHEKs, which was mediated by activation of CB2 receptor and enhanced by the TRPV1 antagonist, through inactivation of the MAPK and NF-κB signaling pathways. CBD might be a potential novel strategy for acne treatment in the future.
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Affiliation(s)
- Ziqi Jiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Shanglin Jin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Xiaoyao Fan
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Ke Cao
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Ye Liu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Xuan Wang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Ying Ma
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
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