The keratin polypeptides of psoriatic epidermis

The polyacrylamide SDS electrophoretic pattern of protein extracted from the stratum corneum obtained by scraping the surface of involved skin of patients with psoriasis was different from that of uninvolved skin and normal controls. The pattern from superficial scales was similar to that of whole stratum corneum in the case of involved psoriatic epidermis but different in uninvolved and normal epidermis. These data indicate that the changes which are observed in the structural proteins during normal keratinization are not seen in involved psoriatic epidermis. In addition, the relative proportion of keratin polypeptides was different in involved psoriatic epidermis compared to normal skin. That these changes are not specific for psoriasis was shown by finding similar electrophoretic patterns with stratum corneum proteins from patients with other keratinizing disorders.     

Silencing of homeobox A5 gene in the stratum corneum of psoriasis

Analysis of psoriatic parakeratotic cells is helpful for understanding the pathogenesis of psoriasis. Methylation analysis can be performed on psoriatic scales, but it is unclear whether genes can be silenced by DNA methylation in psoriatic stratum corneum. The present study was conducted to detect genes silenced in psoriatic stratum corneum. Methylation array analysis with 485 577 probes, quantitative real‐time methylation‐specific PCR (RT‐MSP) and bisulphite sequencing were performed for 30 psoriatic scale samples, 6 fully developed psoriatic skin samples and 12 normal skin samples. Immunohistochemical staining of HOXA5 was performed for 29 psoriatic epidermal samples and 13 normal epidermal samples. The genome‐wide methylation array detected two CpG sites within CpG islands (CGIs) located in promoter regions of HOXA5 and LIAS that had methylation levels of >0.6 in at least one of the three psoriatic scale samples and of <0.2 in all three normal skin tissue samples (methylation rate range, 0.0‐1.0). RT‐MSP for HOXA5CGI, in which the primers were successfully developed, revealed that the average methylation level of 27 psoriasis scales (60.2%) is significantly higher than that of 9 normal skin samples (34.6%) (P=.013). Immunohistochemical staining revealed that HOXA5 protein was not expressed in the stratum corneum of fully developed psoriatic epidermis, but the protein was expressed in the stratum corneum of incompletely developed epidermis and normal epidermis. In conclusion, HOXA5 can be silenced in the stratum corneum of psoriasis. The silenced gene was identified by non‐invasive methylation analysis of psoriatic scales.     

Defective barrier function accompanied by structural changes of psoriatic stratum corneum

Although barrier function of psoriatic skin is shown to be decreased by measuring transepidermal water loss (TEWL), few reports exist examining other physical skin properties and components including stratum corneum hydration, natural moisturizing factor (NMF), free fatty acids (FFA), β‐sheet and α‐helix ratio of structural protein(s), and sebum content. We compared the skin properties and components of normal, involved and uninvolved skin of psoriasis. Using a corneometer and attenuated total reflection‐infrared spectrometer, we measured TEWL, stratum corneum hydration, NMF, FFA, β/α ratio and sebum in psoriasis vulgaris patients and healthy controls. TEWL and β/α ratio of involved psoriatic skin were significantly increased compared with uninvolved skin and normal control skin. In contrast, stratum corneum hydration , NMF and FFA, but not sebum, are significantly decreased in the involved skin compared with uninvolved skin and normal skin. TEWL and stratum corneum hydration returned to the normal levels following clinical improvement of the lesion. Barrier function and hydration of psoriatic skin are defective and secondary structure in stratum corneum protein is altered in the involved psoriatic skin.     

Alterations in the desquamation-related proteolytic cleavage of corneodesmosin and other corneodesmosomal proteins in psoriatic lesional epidermis

Background  Desquamation occurs after proteolysis of corneodesmosomal proteins, including corneodesmosin (CDSN), by proteases of the kallikrein family, particularly KLK7. Impaired desquamation is one of the features of psoriasis, and psoriasis-associated single nucleotide polymorphisms of the CDSN gene may potentially modify the proteolysis of the encoded protein.
Objectives  To test whether the proteolysis of CDSN and other corneodesmosomal components is altered in psoriatic epidermis.
Methods  Total protein extracts obtained by tape-stripping of nonlesional and lesional skin from 11 patients were compared by immunoblotting experiments.
Results  An almost intact form of CDSN that has never been observed previously in the normal upper stratum corneum was detected in the lesional skin extracts, showing an altered proteolytic processing of the protein. This form was also observed in the nonlesional skin extracts, but in lower amounts. For most patients, increased amounts of desmoglein 1, plakoglobin and of high molecular weight fragments of desmocollin 1 were detected in the lesional skin. For most of them, similar amounts of KLK7 were immunodetected in both nonlesional and lesional skin extracts. No particular differences were observed related to the psoriasis type, the HLA-Cw6 status of the patients or any particular CDSN polymorphisms.
Conclusions  We detected a near full-length form of CDSN that has not been previously observed in normal stratum corneum. The results suggest a reduced degradation of all corneodesmosomal proteins in psoriatic lesions which probably reflects the persistence of corneodesmosomes.     

Immunologic abnormalities in psoriasis: the inhibition of leucocyte migration by stratum corneum antigens

The migration inhibition of peripheral blood leucocytes by stratum corneum (SC) antigens extracted from psoriatic scales and normal skin was studied in 25 patients with psoriasis and 12 normal controls. In 44% of patients, the radius of the area of spontaneous migration in the absence of antigen was significantly reduced. 9 out of 25 psoriatic cases showed inhibition of leucocyte migration after the addition of both SC antigens. Migration inhibition with SC antigens was observed only in patients in whom the radius of spontaneous migration area appeared to be normal. The data did not confirm the evidence of delayed hypersensitivity to epidermal SC antigens in patients with psoriasis. The decrease of spontaneous leucocyte migration in psoriasis might be dependent on the influence of antibodies against stratum corneum and/or immune complexes coated on lymphocyte or leucocyte surface membrane.     

银屑病患者皮肤屏障功能受损的研究

目的 探讨银屑病患者皮肤屏障功能受损的实验依据,以指导临床辅助治疗银屑病。方法 60例银屑病患者运用无创性皮肤生理功能测试仪检测皮损角质层含水量、皮脂含量及经表皮水分流失（TEWL）。电镜观察皮损处细胞超微结构,同时运用免疫组化方法检测皮损处酸性神经酰胺酶的表达。结果 与正常皮肤比较,银屑病皮损角质层含水量降低（P < 0.01）,TEWL值增加（P < 0.01）,皮脂含量差异无统计学意义。电镜下,皮损颗粒层角质形成细胞中板层小体数量较正常对照组减少,分布紊乱,体积大小不等;免疫组化染色显示酸性神经酰胺酶表达明显减少。结论 银屑病皮肤屏障功能明显受损,因此,恢复皮肤屏障功能,加强保湿是银屑病重要的辅助治疗手段之一。     

Stratum corneum lipids in skin xerosis

Lipids of the stratum corneum are implicated in cohesion and desquamation of the stratum corneum as well as in the maintenance of normal barrier function. Evidence linking the intercellular lipids to such processes has mainly been derived from studies on acquired or inherited diseases of lipid metabolism manifesting abnormalities in the structure and the function of the stratum corneum. We have studied the composition of stratum corneum lipids in clinically normal individuals with typical xerosis or 'winter dry skin' in order to establish if the lipid composition differs from that of normal individuals, showing no signs of xerosis. The amount of total stratum corneum lipids was not related to xerosis (22.0 +/- 1.8 micrograms/cm2 for normal skin, and 26.3 +/- 2.9 micrograms/cm2 for severe xerosis), and no correlation was evident between polar lipids, cholesterol sulfate (2.8 +/- 0.5% for normal skin, and 1.6 +/- 0.2% for severe xerosis), or ceramides types I-VI, and dry skin. It therefore appears that dramatic changes in stratum corneum lipids are not detectable in normal 'winter dry' skin. However, a decreased proportion of neutral lipids (sterol esters, triglycerides), coupled to increased amounts of free fatty acids, were found associated to the severity of dry skin. Apart from a decline in the sebaceous function and in esterases activity, winter dry skin does not appear to be associated to dramatic changes in polar stratum corneum lipids.     

Vascular endothelial growth factor 121 is the predominant isoform in psoriatic scales

Vascular endothelial growth factor (VEGF) is a powerful agent that causes hyperpermeability of blood vessels as well as endothelial cell proliferation. Recent investigations have revealed that production of VEGF increases in epidermis of psoriatic lesions, and the overproduced VEGF plays an important role in the pathogenesis of psoriasis. In this study, we used immunohistochemical staining as well as extraction of stratum corneum with physiological saline to further analyse VEGF produced in psoriatic lesions. Biological activity of VEGF in the psoriatic scales was assayed by cultured human umbilical vein endothelial cells in vitro. The immunohistochemical examination confirmed an increased production of VEGF in the keratinocytes of psoriatic lesions. In addition, we found that the content of VEGF contained in the psoriatic scales was approximately 50 times greater than that in normal stratum corneum. We also found that VEGF 121 isoform, which has an exclusive ability to cause hyperpermeability of blood vessels, was predominantly detected in psoriatic scales, suggesting a major role of VEGF 121 isoform on the altered structure of microvessels in psoriatic lesions.     

Sonography of the skin at 100 MHz enables in vivo visualization of stratum corneum and viable epidermis in palmar skin and psoriatic plaques

A main drawback of 20-25 MHz ultrasound units for skin imaging is their limited resolution. We used a transducer with a center frequency of 95 MHz and a resolution of 8.5 microm axially and 27 microm laterally - an almost 10-fold increase compared with 20 MHz. By means of a new scanning technology we reached a depth of field of 3.2 mm. We examined normal palmar skin, normal glabrous skin on the abdomen, the upper back, the calf and the dorsal forearm, and 35 lesions of psoriasis vulgaris. From 11 psoriatic plaques biopsies were taken for correlation with the sonograms. In normal palmar skin, the horny layer is represented as an echopoor band below the skin entry echo, traversed by echorich coils, which correspond to eccrine sweat gland ducts. The thickness of this band significantly increases after occlusive application of petrolatum. Its lower border is defined by an echorich line, representing the stratum corneum/stratum Malpighii-interface. Underneath, a second echopoor band is visible, which corresponds to the viable epidermis plus the papillary dermis, bordered by the scattered echo reflexes of the reticular dermis. This band is also visible in glabrous skin; however, the stratum corneum cannot be detected. In psoriatic lesions, the thickened horny layer appears echorich; after application of petrolatum, its echodensity decreases. Below, the acanthotic epidermis plus the dermis with the inflammatory infiltrate are represented as an echopoor band. There is an excellent correlation between the sonometric thickness of this band and the histometric thickness of the acanthosis plus the infiltrated dermis. Our results show that 100 MHz sonography is a valuable tool for in vivo examination of the upper skin layers.     

银屑病患者皮损表皮生长因子及其受体的检测

用抗表皮生长因子（ＥＧＦ）多克隆抗体、抗表皮生长因子受体（ＥＧＦＲ）单克隆抗体及ＡＢＣ免 疫酶标技术，对２０例寻常型银屑病患者皮损及１０例正常人皮肤进行观察。结果表明：①正常人皮肤及 银屑病非皮损区皮肤ＥＧＦ及ＥＧＦＲ主要分布在表皮基底细胞层及基底层上部。②银屑病进行期皮损 ＥＧＦ及ＥＧＦＲ分布于表皮各层，表皮中、上层含量明显升高。③经有效治疗消退期皮损ＥＧＦ及ＥＧＦＲ 从角质层开始消退，分布趋于正常。提示ＥＧＦ及ＥＧＦＲ对银屑病皮损角肮细胞过度增殖及异常分化起 重要作用。     

SDS-PAGE analysis of whole and fractionated psoriatic epidermis

The SDS-PAGE patterns of keratinous proteins extracted from whole epidermis and fractionated epidermal cells were studied. Those from the whole and fractionated epidermal cells of psoriatic involved skin showed an extra 58,000 dalton polypeptide in addition to the four major polypeptides (M.W.: 67,000, 63,000, 59,000 and 55,000) which were demonstrated to be common to normal epidermis and psoriatic-uninvolved epidermis. The stratum corneum of psoriatic involved skin did not contain a 67,000 dalton polypeptide which was present in the stratum corneum of normal and psoriatic uninvolved skin. The presence of the additional 58,000 dalton polypeptide may be due to abnormal synthesis of keratin proteins in the psoriatic epidermis, since this additional polypeptide was present in the lower living layers of the psoriatic epidermis as well. On the other hand, the absence of the 67,000 dalton polypeptide in the psoriatic stratum corneum may be due to enzymatic modifications during the transition from the living cell layers to the horny layer.     

Lipid composition of cohesive and desquamated corneocytes from mouse ear skin

An organ culture system has been used to examine differences in the lipid compositions of materials derived from cohesive and desquamated mouse ear stratum corneum. Within this culture system, skin explants display rates of cell replication and differentiation comparable to those observed in vivo for up to 2 weeks and, during this period, loosened or dishesive material accumulates at the surface. Lipid compositions were determined for both intact and loosened stratum corneum derived from cultured skin and also for freshly prepared stratum corneum. In all 3 cases, the profiles of the nonpolar lipids and the ceramides were essentially the same; some of the nonpolar lipids appeared to be of sebaceous origin. The only changes detected upon desquamation were reductions of cholesteryl sulfate and a second unidentified lipid of similar polarity. Cholesteryl sulfate constitutes 4-5% of the polar lipid in fresh stratum corneum or stratum corneum from organ culture. This is reduced to 0.4% in the desquamated material which accumulates in the culture system. The unidentified lipid decreases from 1-2% of the polar lipid in intact fresh or cultured stratum corneum to 0.1% in the desquamated material. The possible function of cholesteryl sulfate in corneocyte cohesion is discussed.     

Nanoscale infrared (IR) spectroscopy and imaging of structural lipids in human stratum corneum using an atomic force microscope to directly detect absorbed light from a tunable IR laser source

An atomic force microscope (AFM) and a tunable infrared (IR) laser source have been combined in a single instrument (AFM‐IR) capable of producing ~200‐nm spatial resolution IR spectra and absorption images. This new capability enables IR spectroscopic characterization of human stratum corneum at unprecendented levels. Samples of normal and delipidized stratum corneum were embedded, cross‐sectioned and mounted on ZnSe prisms. A pulsed tunable IR laser source produces thermomechanical expansion upon absorption, which is detected through excitation of contact resonance modes in the AFM cantilever. In addition to reducing the total lipid content, the delipidization process damages the stratum corneum morphological structure. The delipidized stratum corneum shows substantially less long‐chain CH₂‐stretching IR absorption band intensity than normal skin. AFM‐IR images that compare absorbances at 2930/cm (lipid) and 3290/cm (keratin) suggest that regions of higher lipid concentration are located at the perimeter of corneocytes in the normal stratum corneum.     

A simplified method for studying fibrous proteins in psoriatic scales obtained by tape stripping

Polyacrylamide gel electrophoretic investigations were carried out on solubilized proteins from psoriatic and normal stratum corneum obtained by adhesive tape stripping. The proteins in the scales adhering to the tape were solubilized by incubating the tape in 1% sodium dodecyl sulphate (SDS) solution. The electrophoretic behaviour of these solubilized proteins on SDS-polyacrylamide gel was compared with the alpha-fibrous proteins (keratin) of callus. The proteins isolated from callus of normal human heel showed six main bands which were similar to those of the keratin isolated by the 8 M urea-mercaptoethanol method. The lesional skin of forty-five psoriatic patients consistently showed nine main bands on polyacrylamide gels, but only two main bands were observed in the non-lesional, non-heel skin. Six of these nine bands had mobilities and relative intensities almost identical with those of alpha-keratin extracted by the mercaptoethanol method, but the other three bands had greater mobilities on the gels. These results suggest that this technique may have considerable potential for studying changes in alpha-keratin in patients with psoriasis and other disorders of keratinization.     

New non‐invasive method for evaluation of the stratum corneum structure in diseases with abnormal keratinization by immunofluorescence microscopy of desmoglein 1 distribution in tape‐stripped samples

The corneodesmosomes in the stratum corneum are critical for the maintenance of stratum corneum integrity. To evaluate the normal and diseased keratinization states in the epidermis, we studied the distribution of desmoglein 1 (DSG1), a major component of corneodesmosomes, in samples of the stratum corneum obtained by tape stripping, a non‐invasive method. Samples were collected from lesional skin of four patients with psoriasis and three with lichen planus, and from non‐lesional skin of three volunteers. Upper stratum corneum cells were obtained by tape stripping and skin biopsies were obtained from adjacent sites. Tape‐stripped samples were examined by immunofluorescence microscopy using anti‐DSG1 monoclonal antibody, in combination with histopathology of skin biopsies. In normal human stratum corneum, which shows basket‐woven orthokeratosis, DSG1‐containing fluorescent dots were distributed on the lateral cell–cell contact areas of plasma membrane, but not on the dorsal/ventral plasma membrane, and formed a well‐ordered hexagonal network structure. In psoriatic stratum corneum, fluorescent dots were distributed throughout the cell membrane at ventral aspects of corneocytes as well as at the lateral cell–cell contacts. In lichen planus, fluorescent dots were distributed homogeneously and/or heterogeneously on the ventral surface in some cells. Adjacent cells lacked DSG1 at the lateral cell–cell contacts, but were instead separated by distinctive black‐gap lines. These results suggest that the intercellular adhesion by DSG1 may depend on the lateral plasma membrane in normal human stratum corneum, on the dorsal/ventral plasma membrane in lichen planus, and on both lateral and dorsal/ventral plasma membranes in psoriatic stratum corneum. Tape stripping and DSG1 immunofluorescence visualizes adhesion features of corneocytes and has considerable potential for evaluation of abnormal keratinization and the process of healing in response to treatment.     

Stratum corneum chymotryptic enzyme in psoriasis

Abstract Stratum corneum chymotryptic enzyme (SCCE) is a serine protease which may function in the turnover of the stratum corneum by means of degradation of intercellular adhesive structures between corneocytes. It is also potentially an epidermal activating enzyme for cytokines such as interleukin-1β. The aim of this work was to study the expression of SCCE in psoriatic epidermis by means of immunohistochemistry, and to elucidate the nature of the SCCE present in psoriatic scales by means of biochemical analyses. In comparison to normal skin the number of cell layers expressing SCCE in psoriatic lesions was consistently increased. In nonlesional psoriatic skin the pattern of SCCE expression varied. It was similar to the pattern in normal skin in some biopsies, whereas in other biopsies evidence of an increased expression of SCCE was found. By means of zymography and immunoblotting, extracts of psoriatic scales were found to contain active SCCE as well as enzymatically inactive SCCE precursor. Also the effects of inhibitors on the activity towards a chromogenic protease substrate in the extracts after partial purification by gel exclusion chromatography were compatible with the presence of enzymatically active SCCE. We conclude that the expression of SCCE in psoriasis may be upregulated, and that the conversion of inactive SCCE-precursor to active SCCE occurs in the psoriatic lesion. The possible role of SCCE in the pathophysiology of psoriasis remains to be elucidated, but should be considered in future studies. Received: 24 April 1998 / Received after revision: 1 October 1998 / Accepted: 16 October 1998     

Heterogeneity of fluorescence in psoriasis after application of 5-aminolaevulinic acid: an immunohistochemical study

BACKGROUND: Psoriasis has been shown to highly accumulate protoporphyrin IX (PpIX), but a variable distribution within plaques after fluorescence diagnosis is seen. It is unknown what causes this heterogeneity of fluorescence in psoriatic skin, despite adequate keratolytic treatment. Variations in fluorescence might explain the variable and the mostly partial clinical response of psoriasis seen after photodynamic therapy (PDT). OBJECTIVES: This study examines morphological and immunohistochemical differences in inhomogeneous PpIX-induced fluorescence in stable plaque psoriasis. MATERIALS AND METHODS: Fourteen patients with stable plaque psoriasis were included in this study. In each patient one psoriatic plaque was incubated with 20% 5-aminolaevulinic acid (ALA) ointment for 3 h after keratolytic treatment. Fluorescence diagnosis with ALA-induced porphyrins (FDAP) was performed and subsequently high- and low-fluorescent psoriatic skin samples were biopsied. Biopsies were investigated with respect to histological hyperkeratosis (thickness of stratum corneum), proliferation (Ki-67 antigen), keratinization (K10, filaggrin) and inflammation (CD3). Digital images acquired with FDAP were analysed using image analysis software. RESULTS: Inhomogeneous fluorescence was seen in 12 of the 14 plaques. A significantly thicker stratum corneum was found in low-fluorescent psoriatic skin compared with highly fluorescent skin. Fluorescence intensity and thickness of the stratum corneum proved to be negatively correlated. The variable-fluorescent parts of the lesional psoriatic skin showed no differences in epidermal proliferation, keratinization or inflammation. CONCLUSIONS: Heterogeneous ALA-induced fluorescence in psoriasis plaques related to inhomogeneous distribution of PpIX in the epidermis may result from differences in penetration of ALA and/or light within a plaque caused by differences in stratum corneum thickness. The variable clinical response seen after PDT in psoriasis could be explained by this. These findings are consistent with the general assumption that optimal desquamation prior to FDAP or PDT is required for the most favourable results.     

Hydration characteristics of pathologic stratum corneum--evaluation of bound water

We measured in vitro the hygroscopicity and bound (non-freezing) water of various samples of pathologic horny layer obtained from the lesions of senile xerotic skin and psoriasis vulgaris and the normal horny layer from glabrous skin and plantar horny layer. The amount of water taken up by pathologic stratum corneum was much smaller than that by normal horny layer in an environment at a high relative humidity (RH). Tightly bound primary water to stratum corneum measured by Karl Fischer's method was about 5 mg/100 mg of dry stratum corneum in all the samples studied, while less tightly bound secondary water was much smaller in amount in pathologic stratum corneum than in the controls, i.e., 31.7 mg/100 mg dry scale from senile xerosis and 27.2 mg/100 mg dry psoriatic scale as compared with 38.2 mg/100 mg dry normal stratum corneum from glabrous skin and 37.3 mg/100 mg dry normal plantar stratum corneum. We believe that the low hygroscopicity of the pathologic stratum corneum is due to this smaller capacity for secondary bound water, which is responsible for the development of a dry scaly appearance even at high RH.     

银屑病鳞屑中所含的银屑病相关抗原的分离及特征分析

目的研究银屑病鳞屑中所含的银屑病相关抗原的生物学特性以及在银屑病的发病中所起的作用。方法用胰酶－酚－水的方法提取抗原,蛋白质电泳（ＳＤＳ ＰＡＧＥ）和凝胶色谱的分离纯化方法,对银屑病病人的鳞屑中所含抗原进行纯化。结果银屑病鳞屑中含相关抗原ｐｓｏｐ２７,分子量大约为３００００道尔顿,并可和银屑病病人的血清发生反应。结论银屑病皮损中存在特异性抗原,可能为免疫学诊断提供依据。