Dissecting the impact of chemotherapy on the human hair follicle: a pragmatic in vitro assay for studying the pathogenesis and potential management of hair follicle dystrophy

Chemotherapy-induced alopecia represents one of the major unresolved problems of clinical oncology. The underlying molecular pathogenesis in humans is virtually unknown because of the lack of adequate research models. Therefore, we have explored whether microdissected, organ-cultured, human scalp hair follicles (HFs) in anagen VI can be exploited for dissecting and manipulating the impact of chemotherapy on human HFs. Here, we show that these organ-cultured HFs respond to a key cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC), in a manner that resembles chemotherapy-induced HF dystrophy as it occurs in vivo: namely, 4-HC induced melanin clumping and melanin incontinence, down-regulated keratinocyte proliferation, massively up-regulated apoptosis of hair matrix keratinocytes, prematurely induced catagen, and up-regulated p53. In addition, 4-HC induced DNA oxidation and the mitochondrial DNA common deletion. The organ culture system facilitated the identification of new molecular targets for chemotherapy-induced HF damage by microarray technology (eg, interleukin-8, fibroblast growth factor-18, and glypican 6). It was also used to explore candidate chemotherapy protectants, for which we used the cytoprotective cytokine keratinocyte growth factor as exemplary pilot agent. Thus, this novel system serves as a powerful yet pragmatic tool for dissecting and manipulating the impact of chemotherapy on the human HF.     

Arginine depletion as a mechanism for the immune privilege of corneal allografts

The cornea is an immune privileged tissue. Since arginase has been found to modulate T-cell function by depleting arginine, we investigated the expression of arginase in the cornea and its possible role in immune privilege using a murine transplant model. We found that both the endothelium and epithelium of murine corneas express functional arginase I, capable of down-regulating T-cell proliferation in an in vitro culture system. The administration of the specific arginase inhibitor N-hydroxy-nor-L-Arg to recipient mice resulted in an accelerated rejection of allogeneic C57BL/6 (B6) corneal grafts. In contrast, in vivo blockade of arginase activity had no effect in altering the course of rejection of primary skin grafts that express little, if any, arginase. In addition, the inhibition of arginase did not alter systemic T-cell proliferation. These data show that arginase is functional in the cornea and contributes to the immune privilege of the eye, and that modulation of arginase contributes to graft survival.     

Nonhuman primate placental MHC expression: a model for exploring mechanisms of human maternal-fetal immune tolerance

Placental contributions to the establishment of maternal-fetal immune tolerance, and placental influences on maturation and vascular development of the endometrium in the human have been difficult to explore directly. Although significant differences exist in organization and relevant gene expression between human and nonprimate placentas, the nonhuman primate has substantial potential to provide insights into the physiology of human pregnancy and maternal-fetal immune tolerance. In this report, we will summarize major histocompatability complex class I gene expression in the nonhuman primate placenta and present progress in characterizing the immune cells resident in the primate endometrium. Finally, we will outline new experimental approaches for modifying placental function now available to move research forward in this field.     

Progressive and destructive hair follicle infections in a murine cutaneous anthrax model

Hair follicles may allow pathogen entry because they represent potential barrier defects and because there is immunological privilege within actively growing follicles. Experimental cutaneous Bacillus anthracis infections in mice have previously shown prominent organism invasion and proliferation within hair follicles. For the present study, C57BL/6 mice were inoculated with B. anthracis (Sterne) spores onto abraded skin with either anagen (actively growing) or telogen (inactive) hair follicles; skin samples were evaluated by histologic methods and electron microscopy. The infections were found to progress similarly in either anagen or telogen hair follicles, with bacilli occasionally invading deeper sites in anagen hair follicles. The infections progressed from the surface inward, rather than growing outward from within the follicles. Infecting bacilli destroyed the hair follicle keratinocytes and were initially not contacted by inflammatory cells within the follicles. However, at 3-4 days after inoculation, inflammatory cells did contact and disperse the massed follicle bacilli and led to apparent resolution of the follicle infections. Therefore, in this model system B. anthracis initially attacks superficial sites in active or inactive hair follicles and then progresses inward, producing destructive infections of the hair follicles; these infections clear when the massed bacilli are eventually contacted and dispersed by inflammatory cells.     

The mouse as a model for the effects of MHC genes on human disease

As mice are often used to model human major histocompatibility complex (MHC)-associated diseases, it is important to understand how their MHC regions differ at the DNA level. The sequencing of the mouse MHC (H2 region) has enabled a detailed map of this region to be assembled for comparison with the human MHC. Here, Richard Allcock and colleagues outline the similarities between the human and mouse MHC regions and discuss notable differences that might affect disease models.     

Immune cell migration as a means to control immune privilege: lessons from the CNS and tumors

Summary:  Certain organs, such as the brain, eye, and gonads, are particularly sensitive to damage by inflammation. Therefore, these tissues have developed unique immunological properties that curtail inflammatory responses, a phenomenon termed immune privilege. In addition, by co-opting some of the regulatory cues operant in immune privilege in normal organs, tumors can evade immunosurveillance. While many different mechanisms contribute to immune privilege, there is evidence that leukocyte migration is an important checkpoint in its control. This hypothesis is based on the fact that leukocyte entry into these organs is restricted by physical barriers and that the collapse of these obstacles marks a critical step in the development of inflammatory/autoimmune disease at these sites. Numerous studies in a variety of experimental systems have characterized the molecular and cellular mechanisms involved in leukocyte homing to immune-privileged organs. Recently, two-photon microscopy has revealed critical insights into the events occurring in the extravascular space of immune-privileged organs, including locomotion patterns and interactive behavior of leukocytes in the interstitial space. Here, we review our current understanding of immune cell migration to and within immune-privileged organs and highlight how this knowledge may be exploited for immunotherapeutic purposes.     

Differential expression of cyclin D1 in the human hair follicle

The proliferation of keratinocytes in the hair follicle varies from slowly cycling, intermittently proliferating stem cells in the bulge to rapidly proliferating, transient cells in the bulb. To better understand the biological differences between these two compartments, we sought to identify differentially expressed genes using cDNA macroarray analysis. Cyclin D1 was one of 13 genes increased in the bulge compared to the bulb, and its differential expression was corroborated by quantitative real-time polymerase chain reaction (PCR) on the original samples. Using immunohistochemical staining, laser-capture microdissection (LCM) and quantitative real-time PCR, we localized cyclin D1 to the suprabasal cells of the telogen bulge and anagen outer root sheath (ORS). Surprisingly, cyclin D1, D2, and D3 were not detectable by immunohistochemistry in the rapidly proliferating hair-producing cells of the anagen bulb (matrix cells), while these cells were strongly positive for Ki-67 and retinoblastoma protein. In contrast, pilomatricoma, a tumor thought to be derived from matrix cells, was positive for cyclin D1, D2, and D3. Our results suggest that cyclin D1 may mediate the proliferation of stem cells in the bulge to more differentiated transient amplifying cells in the suprabasal ORS. In contrast, non-cyclin D1-proteins appear to control cell division of the highly proliferative bulb matrix cells. This non-cyclin D1-mediated proliferation may provide a protective mechanism against tumorigenesis, which is overridden in pilomatricomas. Our data also demonstrate that the combination of DNA macroarray, LCM and quantitative real-time PCR is a powerful approach for the study of gene expression in defined cell populations with limited starting material.     

TGF-β: a mobile purveyor of immune privilege

Summary:  Functionally barricaded immune responses or sites of immune privilege are no longer considered dependent on specific anatomical considerations, but rather, they can develop in any location where immunoregulatory cells congregate and express or release products capable of deviating the host response to foreign antigens. Among the pivotal molecules involved in orchestrating these ectopic sites of immune suppression is transforming growth factor-β (TGF-β), a secreted and cell-associated polypeptide with a multiplicity of actions in innate and adaptive immunity. While beneficial in initiating and controlling immune responses and maintaining immune homeostasis, immunosuppressive pathways mediated by TGF-β may obscure immune surveillance mechanisms, resulting in failure to recognize or respond adequately to self, foreign, or tumor-associated antigens. CD4⁺CD25⁺Foxp3⁺ regulatory T cells represent a dominant purveyor of TGF-β-mediated suppression and are found in infiltrating tumors and other sites of immune privilege, where they influence CD8⁺ T cells; CD4⁺ T-helper (Th)1, Th2, and Th17 cells; natural killer cells; and cells of myeloid lineage to choreograph and/or muck up host defense. Defining the cellular sources, mechanisms of action, and networking that distinguish the dynamic establishment of localized immune privilege is vital for developing strategic approaches to diminish or to embellish these tolerogenic events for therapeutic benefit.     

Lectin histochemistry of glycoconjugates in the feline hair follicle and hair

The distribution of glycoconjugate in the feline hair follicle and hair was studied by light and electron microscopic histochemical methods. The hair apparatus was found to contain considerable amounts of complex carbohydrates with different saccharide residues (alpha-D-mannose, beta-D-glucose, alpha-L-fucose, beta-N-acetyl-D-glucosamine). Variations of those were detected in the plasma membrane of the hair follicle cells during the course of their differentiation and keratinization, namely, alph-D-glucose, alpha-L-fucose and beta-N-acetyl-D-glucosamine in the suprabulbar and bulbar regions. The reaction level of sialic acid residues in the plasma membrane decreased in some cell layers during the course of differentiation. The results obtained from the present study indicated that interaction between saccharide residues of neutral carbohydrates and sialyl groups during the anagen phase might contribute to cell keratinization in hair follicles and hairs. It is discussed whether the existence of glycogen in outer root sheath cells might enable these cells to provide other hair apparatus cells with energy when necessary. Moreover, it became obvious from variations in sialyl residue distribution that cell differentiation processes terminate first of all in Huxley's and Henle's layers within the suprabulbar region of the hair follicle, as followed by the hair cortex.     

Alopecia areata: a tissue specific autoimmune disease of the hair follicle

The goal of this review is to introduce the immunologic community to alopecia areata as a model system for the study of tissue directed autoimmune disease. Alopecia areata is marked by autoimmune assault on the hair follicle resulting in hair loss. It is linked to HLA-DQ3 and evidence suggests it is mediated by T-lymphocytes with a TH1 cytokine profile. Hair follicles are an immune protected site with deficient MHC expression. Evidence is presented suggesting that alopecia areata results from loss of immune privilege with presentation of autoantigens. Alopecia areata is one of the most common human autoimmune conditions, with a lifetime risk of approximately 1.7%. Study of alopecia areata in humans is facilitated by the accessibility of scalp for biopsy. It is possible to transfer the condition with lesional human lymphocytes in a human scalp graft/SCID mouse model. There are also spontaneous animal models which share the features of the human condition. For these reasons, alopecia areata is a powerful model for study of the induction and pathogenesis of tissue directed autoimmune disease.     

Probing the effects of stress mediators on the human hair follicle: substance P holds central position

Stress alters murine hair growth, depending on substance P-mediated neurogenic inflammation and nerve growth factor (NGF), a key modulator of hair growth termination (catagen induction). Whether this is of any relevance in human hair follicles (HFs) is completely unclear. Therefore, we have investigated the effects of substance P, the central cutaneous prototypic stress-associated neuropeptide, on normal, growing human scalp HFs in organ culture. We show that these prominently expressed substance P receptor (NK1) at the gene and protein level. Organ-cultured HFs responded to substance P by premature catagen development, down-regulation of NK1, and up-regulation of neutral endopeptidase (degrades substance P). This was accompanied by mast cell degranulation in the HF connective tissue sheath, indicating neurogenic inflammation. Substance P down-regulated immunoreactivity for the growth-promoting NGF receptor (TrkA), whereas it up-regulated NGF and its apoptosis- and catagen-promoting receptor (p75NTR). In addition, MHC class I and beta2-microglobulin immunoreactivity were up-regulated and detected ectopically, indicating collapse of the HF immune privilege. In conclusion, we present a simplistic, but instructive, organ culture assay to demonstrate sensitivity of the human HF to key skin stress mediators. The data obtained therewith allow one to sketch the first evidence-based biological explanation for how stress may trigger or aggravate telogen effluvium and alopecia areata.     

The sinus hair follicle of the cat. Hair growth and hair cycle

The cat's sinus hair follicle is described histologically with special regard to structural characteristics and functional mechanisms of sinus hair growth and sinus hair cycle. Special features of both cornification of the inner epithelial root sheath and hair fixation, respectively, result in a loss of traction that is required for hair growth and hair expulsion. Instead, there is the outgrowing new anagen sinus hair that pushes the preceeding sinus hair upwards, and - secondly - there is a long-lasting cell pro- liferation. Cell proliferation - immunocytochemically detected with anti-proliferating cell nuclear antigen - continues in the preceeding sinus hair while the formation of a new, succeeding sinus hair follicle begins. No distinct, 'typical' catagen state of sinus hair follicle has been found even in a large number of collected specimens. These findings stress that the well known features of hair growth and hair cycle in the pelage hair follicle cannot be generalized and adopted in all details to the sinus hair follicle.     

Fine-needle aspiration biopsy as an adjunct to the diagnosis of a rare adnexal tumor of hair follicle origin: trichoblastoma

Fine-needle aspiration biopsy (FNAB) is a technique used increasingly for the investigation of primary and metastatic cutaneous tumors. Trichoblastoma is a rare benign skin appendage tumor of hair germ origin. We report the diagnosis by FNAB of a rare giant subcutaneous tumor, trichoblastoma, from an 81-yr-old woman with a subcutaneous mass in the interscapular area of her back. The cytologic characteristics of the tumor are discussed in detail in this report. The findings have been compared with the histologic features of the tumor after surgical excision. We have characterized several distinctive cytologic features that may aid in the diagnosis of this rare neoplasm. While most reported cases have been diagnosed from surgical excisional biopsy specimens, FNAB may also be a valuable tool for the accurate diagnosis of trichoblastoma in the proper clinical context.     

Ocular immune privilege: the eye takes a dim but practical view of immunity and inflammation

The delicate visual axis that makes precise vision possible is highly vulnerable to the destructive potential of immunogenic inflammation. Immune privilege of the eye is the experimental expression of the way in which evolution has coped with the countermanding threats to vision of ocular infections and ocular immunity and inflammation. Ocular immune privilege has five primary features that account for its existence: blood:ocular barriers, absent lymphatic drainage pathways, soluble immunomodulatory factors in aqueous humor, immunomodulatory ligands on the surface of ocular parenchymal cells, and indigenous, tolerance-promoting antigen-presenting cells (APCs). Three manifestations of ocular immune privilege that have received the most extensive study are the intraocular microenvironment, which is selectively anti-inflammatory and immunosuppressive; the prolonged acceptance of solid tissue and tumor allografts in the anterior chamber; and the induction of systemic tolerance to eye-derived antigens. Anterior chamber-associated immune deviation is known to arise when indigenous, ocular APCs capture eye-derived antigens and deliver them to the spleen where multicellular clusters of these cells, natural killer T cells, marginal zone B cells, and gammadelta T cells create an antigen-presentation environment that leads to CD4(+) and CD8(+) alpha/beta T cells, which as regulators, suppress induction and expression of T helper cell type 1 (Th1) and Th2 immune expression systems. The ways the eye influences local and systemic immune responses to ocular antigens and pathogens carry risks to and benefits for mammalian organisms. As loss of sight is a powerful, negative-selecting force, the benefits of ocular immune privilege outweigh the risks.     

Physiology: A mathematical model of follicle dynamics in the human ovary

A mathematical model has been developed to describe the ratesof growth and death of follicles in human ovaries between 19and 50 years of age. It was based on the numbers of folliclesat three successive stages of development, which were obtainedby counting follicles in histological sections of ovaries from52 normal women. The model indicated that follicle dynamicswere age dependent, with a transition at 38 years of age whenthe rate of follicle disappearance increased. The rates of folliclegrowth increased at successive stages but did not change withage. The annual egress from stage III (consisting of follicleswith two or more granulosa cell layers) was affected by thedeclining numbers of small follicles, and corresponded to 31,nine and one follicles per day at 29–30, 39–40 and49–50 years of age respectively. The rate of death atstage I (representing small, resting follicles) was the onlyparameter which varied significantly with age: no evidence ofsignificant atresia was found for this stage in ovaries 38 yearsold, but there was significant death above this age. As a consequence,only 40% of follicles leaving stage I reached stage III in olderovaries and just 1500 follicles in toto remained at 50 yearsof age from the 300 000 present at 19 years. This high deathrate of small follicles appears to be responsible for advancingthe timing of ovarian failure, and therefore of menopause, tomidlife in our species.     

A vision of cell death: insights into immune privilege

Summary: Immune privilege is a term applied to several organs that have a unique relationship with the immune response. These sites prohibit the spread of inflammation since even minor episodes can threaten organ integrity and function. The most prominent examples of these are the eye, brain and reproductive organs where immune responses either do not proceed, or proceed in a manner different from other areas. Once thought to be a passive process relying on physical barriers, immune privilege can now be viewed as an active process that utilizes multiple mechanisms to maintain organ function. Recently there has been a renewed interest in immune privilege when it was shown that two privileged sites (the eye and testes) constitutively express FasL, which functions by killing lymphoid cells that invade these areas. Here we will examine the role of FasL in immune privilege and discuss how this molecule interacts with other elements of the inflammatory response to maintain organ integrity in the face of potentially damaging immune reactions.     

Histochemistry of the human hair follicle with consideration of anagen phases I to VI.

The hair follicle is composed of different epithelial layers under participation of mesenchymal and nerval factors. The present study is an attempt to localize differentiation and functional markers in the human hair follicle during anagen phases I to VI. Monoclonal antibody K 8.12 against keratins 13 and 16 showed an increasing reactivity with certain types of the follicle epithelia during anagen I to VI. Ki67 was expressed within the innermost layer of the outer hair root sheath. Scattered Ki67-positive matrix cells could be additionally identified during anagen V and VI but were absent in anagen I to IV. During anagen Merkel cells became more abundant in the bulbar area. Neuropeptide-like immunoreactivity expressed by bulbar (especially matrix) cells were evenly seen during the early anagen I and II. The findings are in favour of a neurohumoral modulatory role during anagen phases accompanied by an increase of expression of certain proliferation-associated antigens like keratin 16 and Ki67 among the complex epithelia of human hair follicles.