Lipids, proteins and corneocyte adhesion

The multi-factorial modes of action of urease in the pathogenesis of incontinence associated dermatitis

Background

Incontinence Associated Dermatitis (IAD) is a type of skin inflammation caused by chronic exposure to urine and/or faeces. Current treatment strategies involve creating a barrier between the skin and urine/faeces rather than targeting specific irritants. Urease expressing pathogens catalyse the conversion of urea, present in urine, into ammonia. The accumulation of ammonia causes an elevation in skin pH which is believed to activate faecal enzymes which damage skin, and opportunistic pathogens, which lead to secondary infections.

Objectives

To develop a better, multi-factorial model of IAD pathogenesis, including the effect of urease-expressing bacteria on skin, mechanism of damage of urease and urease-triggered activity of faecal enzymes and secondary pathogens. To study the effect of urease inhibition on preventing IAD skin damage.

Methods

Five separate studies were made using ex vivo porcine skin and in vivo human skin models. Measurements of the change in skin barrier function were made using skin impedance, trans-epidermal water loss (TEWL), stratum corneum moisture and pH. Skin was exposed to artificial urine, inoculated with various microbes, enzymes and chemicals to examine the influence of: 1) urease-positive Proteus mirabilis 2) ammonia, 3) combination of P. mirabilis and a faecal enzyme, trypsin, 4) combination of P. mirabilis and opportunistic pathogens, Candida albicans and Staphylococcus aureus, 5) inhibition of urease using acetohydroxamic acid (AHA) on barrier function.

Results

The urease-mediated production of ammonia had two principal effects: it elevated skin pH and caused inflammation, leading to significant breakdown in skin (stratum corneum) barrier function. Urease was found to further increase the activity of faecal enzymes and opportunistic pathogens, due to elevated skin pH. The urease inhibitor, AHA, was shown to have significantly reduced damage to skin barrier function, measured as its electrical resistance.

Conclusions

Targeted therapeutic strategies should be developed to prevent the manifestation of IAD, rather than creating a generic barrier between skin and urine/faeces. Urease has been identified as a crucial component in the manifestation of IAD, due to its role in the production of ammonia. Urease inhibition provides a promising therapeutic target to halt the progression of IAD.

Carbon dioxide foam bubbles enhance skin penetration through the stratum corneum layer with mechanical mechanism

Topical skin formulations often include penetration enhancers that interact with the outer stratum corneum (SC) layer to chemically enhance diffusion. Alternatively, penetration can be mechanically enhanced with simple rubbing in the presence of solid particles sometimes included to exfoliate the top layers of the SC. Our goal was to evaluate micron-sized carbon dioxide bubbles included in a foamed moisturizing formulation as a mechanical penetration enhancement strategy. We show that moisturizing foam bubbles cause an increase in SC formulation penetration using both mechanical and spectroscopic characterization. Our results suggest viscous liquid film drainage between coalescing gaseous bubbles creates local regions of increased hydrodynamic pressure in the foam liquid layer adjacent to the SC surface that enhances treatment penetration. An SC molecular diffusion model is used to rationalize the observed behavior. The findings indicate marked increased levels of treatment concentration in the SC at 2 h and that persists to 18 h after exposure, far exceeding non-foamed treatments. The study suggests an alternate strategy for increasing formulation penetration with a non-chemical mechanism.

Topical dexpanthenol effects on physiological parameters of the stratum corneum by Confocal Raman Microspectroscopy

BACKGROUND

Topical use of dexpanthenol presents well-established moisturizing properties and maintenance and repair of the skin barrier function, however, its exact action mechanisms are not completely elucidated. In this context, Confocal Raman Microspectroscopy is an optical method that enables non-invasive and non-destructive in vivo analysis with the sensitive acquisition of molecular changes in different skin layers. Herein, the aim was to evaluate the effects of topical dexpanthenol on the components and physiological parameters of the stratum corneum (SC).

MATERIALS AND METHODS

Ten healthy female subjects underwent skin evaluation by means of a Confocal Raman Spectrometer Skin Analyzer 3510. Spectral data were obtained from the skin of the anterior forearm region, before and 2 h after applying a cosmetic formulation containing or not containing 5% dexpanthenol.

RESULTS

Semiquantitative analysis of the natural moisturizing factor showed a significant decrease in content after 2 h of topical dexpanthenol application, while the analysis of the lamellar organization of intercellular lipids and the secondary structure of keratin showed a significant increase in hexagonal organization of lipids at the first half of the SC and a significant increase in β-pleated sheet conformation of keratin.

CONCLUSION

Effects of topical dexpanthenol on SC suggest a contribution in increasing fluidity of both lipidic and protein components of the SC and are compatible with dexpanthenol activity in maintaining adequate physiological conditions and preventing transepidermal water loss. This study also contributes to the elucidation of action mechanisms and other concurrent biochemical processes.

Using electrocardiogram electrodes to monitor skin impedance spectroscopic response when skin is subjected to sustained static pressure

Background

Impedance spectroscopy is a non-invasive technique which can be used to monitor skin barrier function, with potential applications in early-stage pressure ulcer detection. This paper describes how changes in skin impedance, due to mechanical damage of the stratum corneum by tape stripping or applied pressure, can be straightforwardly measured using commercial electrocardiogram electrodes and a relatively low-cost impedance analyser. Two models of pressure injury were studied, an ex vivo porcine and in vivo human skin model.

Objectives

Determine whether impedance spectroscopy may have potential utility in measuring the effect on skin of applied pressure on early-stage pressure injury.

Methods

Two models were utilized to measure the effect of pressure. Porcine model: 0, 7.5, 15 or 22.5 mmHg of pressure was applied for up to 24 h (N = 4) and monitored at various time intervals. Human Model: 88 mmHg of pressure was applied for four sets of three-minute intervals (N = 13) and post-pressure recovery was monitored for 4 h. For each model, skin impedance was monitored at 0.1 Hz-50 kHz using disposable Ag/AgCl electrodes. The data was analysed using Ordinary One-Way Analysis of Variance.

Results

Porcine model: after 24 h, the impedance of pressure-loaded skin was significantly reduced compared to the non-loaded control group (p ≤ 0.0001); this reduction in impedance was proportional to the degree of mechanical loading. Histology images of skin cross-sections provided qualitative evidence that the epidermis was structurally compromised by pressure. Human Model: the response of healthy skin to applied pressure displayed inter-variation. Participants with a significant change in skin impedance (p ≤ 0.01) also demonstrated signs of erythema.

Conclusions

This study suggests that using impedance spectroscopy to measure skin (stratum corneum) resistance may have utility in giving early warning of skin pressure injury prior to clinical symptoms, with a good correlation between observed erythema and reduction in skin resistance. Further work should be initiated on patients at risk of pressure injury to improve intervention strategies, including in darker skin tones where early-stage pressure injuries may not be visually distinct.

Corneocytes: Relationship between Structural and Biomechanical Properties

BACKGROUND

Skin is the interface between an organism and the external environment, and hence the stratum corneum (SC) is the first to withstand mechanical insults that, in certain conditions, may lead to integrity loss and the development of pressure ulcers. The SC comprises corneocytes, which are vital elements to its barrier function. These cells are differentiated dead keratinocytes, without organelles, composed of a cornified envelope and a keratin-filled interior, and connected by corneodesmosomes (CDs).

SUMMARY

The current review focusses on the relationship between the morphological, structural, and topographical features of corneocytes and their mechanical properties, to understand how they assist the SC in maintaining skin integrity and in responding to mechanical insults. Key Messages: Corneocytes create distinct regions in the SC: the inner SC is characterized by immature cells with a fragile cornified envelope and a uniform distribution of CDs; the upper SC has resilient cornified envelopes and a honeycomb distribution of CDs, with a greater surface area and a smaller thickness than cells from the inner layer. The literature indicates that this upward maturation process is one of the most important steps in the mechanical resistance and barrier function of the SC. The morphology of these cells is dependent on the body site: the surface area in non-exposed skin is about 1,000-1,200 μm2, while for exposed skin, for example, the cheek and forehead, is about 700-800 μm2. Corneocytes are stiff cells compared to other cellular types, for example, the Young's modulus of muscle and fibroblast cells is typically a few kPa, while that of corneocytes is reported to be about hundreds of MPa. Moreover, these skin cells have 2 distinct mechanical regions: the cornified envelope (100-250 MPa) and the keratin matrix (250-500 MPa).

The eye as the discrete but defensible portal of coronavirus infection

Oculo-centric factors may provide a key to understanding invasion success by SARS-CoV-2, a highly contagious, potentially lethal, virus with ocular tropism. Respiratory infection transmission via the eye and lacrimal-nasal pathway elucidated during the 1918 influenza pandemic, remains to be explored in this crisis. The eye and its adnexae represent a large surface area directly exposed to airborne viral particles and hand contact. The virus may bind to corneal and conjunctival angiotensin converting enzyme 2 (ACE2) receptors and potentially to the lipophilic periocular skin and superficial tear film with downstream carriage into the nasopharynx and subsequent access to the lungs and gut. Adenoviruses and influenza viruses share this ocular tropism and despite differing ocular and systemic manifestations and disease patterns, common lessons, particularly in management, emerge. Slit lamp usage places ophthalmologists at particular risk of exposure to high viral loads (and poor prognosis) and as for adenoviral epidemics, this may be a setting for disease transmission. Local, rather than systemic treatments blocking virus binding in this pathway (advocated for adenovirus) are worth considering. This pathway is accessible with eye drops or aerosols containing drugs which appear efficacious via systemic administration. A combination such as hydroxychloroquine, azithromycin and zinc, all of which have previously been used topically in the eye and which work at least in part by blocking ACE2 receptors, may offer a safe, cost-effective and resource-sparing intervention.

Barrier-disrupted skin: Quantitative analysis of tape and cyanoacrylate stripping efficiency by multiphoton tomography

Numerous studies have employed tape stripping (TS) or cyanoacrylate stripping (CS) to induce skin barrier disruption of the stratum corneum (SC) in human and porcine skin. However, the thickness of the remaining SC and the respective changes of the skin permeability have been rarely quantified. By using high-resolution multiphoton tomography, about 5 µm thick SC was found remaining on human skin after the performance of 30 times TS or 2 times CS. 50 tape strips or 4 times CS removed the entire human SC, but on porcine skin 2-3 µm thick SC was still left. TS can only reach the transition zone between the SC and the stratum granulosum because of the limited adhesion, whereas CS was able to remove viable skin layers. Permeation investigations on porcine skin revealed that the apparent permeability coefficient of the hydrophilic nitroxide spin 2,5,5-Tetramethyl-1-pyrrolidinyloxy-3-carboxylic acid increased 15-, 18-, and 21-fold when the SC amount remaining in the skin was 30%, 16%, and 8%, respectively. It is recommended to use at most 30 times TS or 3 times CS to obtain ex vivo barrier-disrupted skin that mimics diseased skin. The study provides quantitative information for the utility of TS and CS in skin penetration research.

Advancement through epidermis using tape stripping technique and Reflectance Confocal Microscopy

The tape stripping technique is increasingly used in research regarding skin barrier function. However, number of tape strips varies between studies, and literature considering advancement into stratum corneum/epidermis in relation to number of tape strips is scarce. The aim of this pilot study was to assess the advancement through epidermis using tape stripping technique in healthy volunteers. A total of ten healthy volunteers were included. From all volunteers 0, 5, 15 and 35 consecutive tape strips (D-squame) were taken from four adjacent skin areas on the middle volar forearm, followed by Reflectance Confocal Microscopy (RCM) of the four areas to assess epidermal thickness. Squame Scan was used to determine amount of protein removed. Stratum corneum was completely removed in all volunteers after 35 tape strips. Advancement into epidermis was predominantly achieved by the first 15 tape strips, removing 25% of the total epidermis, whereas 35 tape strips removed 33% of epidermis. Protein removal per tape decreased with increasing depth. Information on advancement into the epidermis according to number of tape strips taken, is a significant step forward. The possibility to obtain samples from different layers of epidermis may lead to an improved understanding of skin barrier properties.

Measurements of AMPs in stratum corneum of atopic dermatitis and healthy skin-tape stripping technique

Decreased levels of antimicrobial peptides (AMPs) in atopic dermatitis (AD) have previously been reported and have been linked to the increased susceptibility to skin infections found in AD patients. This study intents to identify AMPs: hBD-2, hBD-3, RNase7, psoriasin and LL-37 in AD patients and healthy controls, and determine concentrations in consecutive depths of the outer most skin layers. Tape stripping was used on lesional and non-lesional skin. From each skin site, 35 consecutive tape strips were collected and pooled in groups of 5. Commercially available ELISA kits were used to determine AMP concentration in stratum corneum samples. hBD-2, hBD-3, RNase7 and psoriasin were identified in stratum corneum samples. hBD-3-level was markedly higher in AD non-lesional skin compared to healthy controls, and a similar trend was observed for RNase7. Most AMPs were distributed evenly through 35 tape strips, implying a homogeneous distribution of antimicrobial defense in the outer most skin layers. The findings indicate that AD patients may not suffer from a general baseline deficiency in AMPs, and that the innate immune defense is present throughout the stratum corneum, both insights of importance for understanding the role of AMPs in AD.

Decrease of superficial serine and lactate in the stratum corneum due to repetitive frictional trauma

BACKGROUND

Repetitive frictional trauma can be induced in daily and occupational activities, such as daily ablutions with washcloths. The influence of frictional trauma on the skin barrier function, especially in the perspective of the components of stratum corneum (SC), has not yet been studied in detail. Raman spectroscopy is a noninvasive optical technique based on inelastic light scattering that is capable of measuring several components in the skin. In this study, we used Raman spectroscopy to investigate the change in natural moisturizing factor (NMF) components in the SC following repetitive physical friction.

METHODS

Six healthy volunteers, who were included in the study after obtaining an informed consent, performed repetitive washing with soap using nylon towels on the forearm twice a day for 2 weeks and used Raman spectroscopy to investigate the change in NMF components in the SC.

RESULTS

Compared with the control, which was washed with soap at the same frequency on the opposite forearm, a significant increase in the transepidermal water loss (TEWL) and a decrease in NMF, serine, and total lactate, responsible for maintenance the SC hydration and structuring and maintaining the epidermal barrier function, in the SC were found.

CONCLUSIONS

Increased TEWL and decreased NMF are considered as an etiology of atopic dermatitis (AD); therefore, our findings provide evidence that daily activities with repetitive frictional trauma may be related to the predisposition of AD.

Cutaneous Penetration-Enhancing Effect of Menthol: Calcium Involvement

Menthol is a naturally occurring terpene used as a penetration enhancer in topical and transdermal formulations. Literature shows a growing interest in menthol's interactions with the transient receptor potential melastatin 8. A decrease in extracellular Ca²⁺ due to the activation of the transient receptor potential melastatin 8 receptor produces inhibition of E-cadherin expression that is responsible for cell-cell adhesion. Because calcium is present in the entire epidermis, the purpose of this study is to evaluate whether the aforementioned properties of menthol are also related to its penetration-enhancing effects. We formulated 16 gels: (i) drug-alone (diphenhydramine or lidocaine), (ii) drug with menthol, (iii) drug, menthol, and calcium channel blocker (CCB; verapamil or diltiazem), and (iv) drug and CCB. In vitro studies showed no effect of the CCB on the release of the drugs either with or without menthol. In vivo experiments were performed for each drug/menthol/CCB combination gel by applying 4 formulations on a shaved rabbit's dorsum on the same day. Dermis concentration profiles were assessed with microdialysis. The gels containing menthol showed higher penetration of drugs than those without whereas the addition of the CCB consistently inhibited the penetration-enhancing effects of menthol. In summary, these findings strongly support the involvement of calcium in the penetration-enhancing effect of menthol.

Tissue Kallikrein Inhibitors Based on the Sunflower Trypsin Inhibitor Scaffold - A Potential Therapeutic Intervention for Skin Diseases

Tissue kallikreins (KLKs), in particular KLK5, 7 and 14 are the major serine proteases in the skin responsible for skin shedding and activation of inflammatory cell signaling. In the normal skin, their activities are controlled by an endogenous protein protease inhibitor encoded by the SPINK5 gene. Loss-of-function mutations in SPINK5 leads to enhanced skin kallikrein activities and cause the skin disease Netherton Syndrome (NS). We have been developing inhibitors based on the Sunflower Trypsin Inhibitor 1 (SFTI-1) scaffold, a 14 amino acids head-to-tail bicyclic peptide with a disulfide bond. To optimize a previously reported SFTI-1 analogue (I10H), we made five analogues with additional substitutions, two of which showed improved inhibition. We then combined those substitutions and discovered a variant (Analogue 6) that displayed dual inhibition of KLK5 (tryptic) and KLK7 (chymotryptic). Analogue 6 attained a tenfold increase in KLK5 inhibition potency with an Isothermal Titration Calorimetry (ITC) K_d of 20nM. Furthermore, it selectively inhibits KLK5 and KLK14 over seven other serine proteases. Its biological function was ascertained by full suppression of KLK5-induced Protease-Activated Receptor 2 (PAR-2) dependent intracellular calcium mobilization and postponement of Interleukin-8 (IL-8) secretion in cell model. Moreover, Analogue 6 permeates through the cornified layer of in vitro organotypic skin equivalent culture and inhibits protease activities therein, providing a potential drug lead for the treatment of NS.

The global mechanical properties and multi-scale failure mechanics of heterogeneous human stratum corneum

The outermost layer of skin, or stratum corneum, regulates water loss and protects underlying living tissue from environmental pathogens and insults. With cracking, chapping or the formation of exudative lesions, this functionality is lost. While stratum corneum exhibits well defined global mechanical properties, macroscopic mechanical testing techniques used to measure them ignore the structural heterogeneity of the tissue and cannot provide any mechanistic insight into tissue fracture. As such, a mechanistic understanding of failure in this soft tissue is lacking. This insight is critical to predicting fracture risk associated with age or disease. In this study, we first quantify previously unreported global mechanical properties of isolated stratum corneum including the Poisson's ratio and mechanical toughness. African American breast stratum corneum is used for all assessments. We show these parameters are highly dependent on the ambient humidity to which samples are equilibrated. A multi-scale investigation assessing the influence of structural heterogeneities on the microscale nucleation and propagation of cracks is then performed. At the mesoscale, spatially resolved equivalent strain fields within uniaxially stretched stratum corneum samples exhibit a striking heterogeneity, with localized peaks correlating closely with crack nucleation sites. Subsequent crack propagation pathways follow inherent topographical features in the tissue and lengthen with increased tissue hydration. At the microscale, intact corneocytes and polygonal shaped voids at crack interfaces highlight that cracks propagate in superficial cell layers primarily along intercellular junctions. Cellular fracture does occur however, but is uncommon.

STATEMENT OF SIGNIFICANCE

Human stratum corneum protects the body against harmful environmental pathogens and insults. Upon mechanical failure, this barrier function is lost. Previous studies characterizing the mechanics of stratum corneum have used macroscopic testing equipment designed for homogenous materials. Such measurements ignore the tissue's rich topography and heterogeneous structure, and cannot describe the underlying mechanistic process of tissue failure. For the first time, we establish a mechanistic insight into the failure mechanics of soft heterogeneous tissues by investigating how cracks nucleate and propagate in stratum corneum. We further quantify previously unreported values of the tissue's Poisson's ratio and toughness, and their dramatic variation with ambient humidity. To date, skin models examining drug delivery, wound healing, and ageing continue to estimate these parameters.

Tape Stripping Technique for Stratum Corneum Protein Analysis

The aim of this study was to investigate the amount of protein in stratum corneum in atopic dermatitis (AD) patients and healthy controls, using tape stripping technique. Furthermore, to compare two different methods for protein assessment. Tape stripping was performed in AD patients and healthy controls to collect stratum corneum samples and subsequently analysed with two different methods: Squame Scan, which gives an estimate of total protein (soluble and insoluble) and Micro BCA protein determination kit which measures soluble protein. Significant differences in cumulative protein content between AD lesional, AD non-lesional and healthy control skin was found using the Squame Scan as well as the Micro BCA protein determination kit. AD patients had significantly lower amount of protein, both total protein and soluble protein compared to healthy controls. Furthermore, soluble protein formed 82% of total protein in AD lesional skin, compared to 17-24% for AD non-lesional skin and healthy control. A decreasing amount of total protein with increasing stratum corneum depth was found for all skin types. Significant differences in stratum corneum protein content between AD lesional, AD non-lesional and healthy control skin were revealed, independent of method used.

Lipid composition and molecular interactions change with depth in the avian stratum corneum to regulate cutaneous water loss

The outermost 10-20 µm of the epidermis, the stratum corneum (SC), consists of flat, dead cells embedded in a matrix of intercellular lipids. These lipids regulate cutaneous water loss (CWL), which accounts for over half of total water loss in birds. However, the mechanisms by which lipids are able to regulate CWL and how these mechanisms change with depth in the SC are poorly understood. We used attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) to measure lipid-lipid and lipid-water interactions as a function of depth in the SC of house sparrows (Passer domesticus Linnaeus) in the winter and summer. We then compared these molecular interactions at each depth with lipid composition at the same depth. We found that in both groups, water content increased with depth in the SC, and likely contributed to greater numbers of gauche defects in lipids in deeper levels of the SC. In winter-caught birds, which had lower rates of CWL than summer-caught birds, water exhibited stronger hydrogen bonding in deeper layers of the SC, and these strong hydrogen bonds were associated with greater amounts of polar lipids such as ceramides and cerebrosides. Based on these data, we propose a model by which polar lipids in deep levels of the SC form strong hydrogen bonds with water molecules to increase the viscosity of water and slow the permeation of water through the SC.

Understanding age-induced alterations to the biomechanical barrier function of human stratum corneum

BACKGROUND

The appearance and function of human skin are dramatically altered with aging, resulting in higher rates of severe xerosis and other skin complaints. The outermost layer of the epidermis, the stratum corneum (SC), is responsible for the biomechanical barrier function of skin and is also adversely transformed with age. With age the keratin filaments within the corneocytes are prone to crosslinking, the amount of intercellular lipids decreases resulting in fewer lipid bilayers, and the rate of corneocyte turnover decreases.

OBJECTIVES

The effect of these structural changes on the mechanical properties of the SC has not been determined. Here we determine how several aspects of the SC's mechanical properties are dramatically degraded with age.

METHODS

We performed a range of biomechanical experiments, including micro-tension, bulge, double cantilever beam, and substrate curvature testing on abdominal stratum corneum from cadaveric female donors ranging in age from 29 to 93 years old.

RESULTS

We found that the SC stiffens with age, indicating that the keratin fibers stiffen, similarly to collagen fibers in the dermis. The cellular cohesion also increases with age, a result of the altered intercellular lipid structure. The kinetics of water movement through the SC is also decreased.

CONCLUSIONS

Our results indicate that the combination of structural and mechanical property changes that occur with age are quite significant and may contribute to the prevalence of skin disorders among the elderly.

Epidermal permeability barrier in the treatment of keratosis pilaris

Objectives. To evaluate and compare the efficacy, safety, hydrating properties, and tolerability of 10% lactic acid (LA) and 5% salicylic acid (SA) in the therapy of keratosis pilaris (KP). Material and Method. Patients with KP were randomized for treatment with either 10% LA or 5% SA creams being applied twice daily for 3 months. The patients were clinically assessed at baseline and after 4, 8, and 12 weeks of treatment and 4 weeks after treatment. The functional properties of the stratum corneum (SC) were determined before treatment, 12 weeks, and follow-up phase by high-frequency conductance and transepidermal water loss (TEWL). Results. At the end of the trial, the mean reduction of the lesions from baseline was statistically significant for 10% LA (66%) and 5% SA (52%). During the treatment, higher conductance values were found on both group and this improvement was maintained until the follow up period. No significant differences in transepidermal water loss were observed after treatment. The adverse effects were limited to mild irritation localized on the skin without systemic side effect. Conclusion. The study demonstrated that 10% LA and 5% SA are beneficial to treat KP with the significantly clearance and marked improvement as by instrumental evaluation.

Skin stem cell hypotheses and long term clone survival--explored using agent-based modelling

Epithelial renewal in skin is achieved by the constant turnover and differentiation of keratinocytes. Three popular hypotheses have been proposed to explain basal keratinocyte regeneration and epidermal homeostasis: 1) asymmetric division (stem-transit amplifying cell); 2) populational asymmetry (progenitor cell with stochastic fate); and 3) populational asymmetry with stem cells. In this study, we investigated lineage dynamics using these hypotheses with a 3D agent-based model of the epidermis. The model simulated the growth and maintenance of the epidermis over three years. The offspring of each proliferative cell was traced. While all lineages were preserved in asymmetric division, the vast majority were lost when assuming populational asymmetry. The third hypothesis provided the most reliable mechanism for self-renewal by preserving genetic heterogeneity in quiescent stem cells, and also inherent mechanisms for skin ageing and the accumulation of genetic mutation.

Cellular changes that accompany shedding of human corneocytes

Corneocyte desquamation has been ascribed to either: 1) proteolytic degradation of corneodesmosomes (CD); 2) disorganization of extracellular lamellar bilayers; and/or 3) ‘swell-shrinkage-slough’ (SSS) from hydration/dehydration. To address the cellular basis for normal exfoliation, we compared changes in lamellar bilayer architecture and CD structure in DSquame® strips from the 1st vs. 5th stripping (‘outer’ vs. ‘mid’-stratum corneum [SC], respectively) from 9 normal adult forearms. Strippings were either processed for standard EM or for ruthenium (Ru-V)- or osmium-tetroxide (Os-V) vapor fixation, followed by immediate epoxy embedment, an artifact-free protocol that to our knowledge is previously unreported. CDs are largely intact in the mid-SC, but replaced by electron-dense (hydrophilic) clefts (lacunae) that expand laterally, splitting lamellar arrays in the outer SC. Some undegraded DSG1/DSC1 redistribute uniformly into corneocyte envelopes (CEs) in the outer SC (shown by proteomics, Z-stack confocal imaging and immunoEM). CEs then thicken, likely facilitating exfoliation by increasing corneocyte rigidity. In vapor-fixed images, hydration only altered the volume of the extracellular compartment, expanding lacunae further separating membrane arrays. During dehydration, air replaced water, maintaining the expanded extracellular compartment. Hydration also provoked degradation of membranes by activating contiguous acidic ceramidase activity. Together, these studies identify several parallel mechanisms that orchestrate exfoliation from the surface of normal human skin.

Imaging the distribution of sodium dodecyl sulfate in skin by confocal Raman and infrared microspectroscopy

Purpose

To image SDS distribution across different skin regions, to compare the permeability difference between porcine and human skin, and to evaluate the interaction between SDS and skin.

Methods

Full thickness porcine and human skin was treated with acyl chain perdeuterated SDS (SDS-d₂₅) at room temperature and at 34 °C for 3, 24 and 40 h. SDS distribution in skin was monitored by confocal Raman and IR microspectroscopic imaging. Permeation profiles of SDS-d₂₅ in skin were derived from the band intensities of the CD₂ stretching vibrations. The interaction between SDS and skin was monitored through the CH₂ and CD₂ stretching frequencies and the Amide I and II spectral region.

Results

SDS-d₂₅ penetrates both porcine and human skin in a time and temperature-dependent manner, with slightly higher permeability through the stratum corneum (SC) in porcine skin. When SDS permeates into the SC, its chains are more ordered compared to SDS micelles. The secondary structure of keratin in the SC is not affected by SDS-d₂₅.

Conclusion

The spatial distribution of SDS-d₂₅ in skin was obtained for the first time. Infrared microscopic imaging provides unique opportunities to measure concentration profiles of exogenous materials in skin and offers insights to interaction between permeants and skin.

Electronic supplementary material

The online version of this article (doi:10.1007/s11095-012-0748-y) contains supplementary material, which is available to authorized users.

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.

Graded delamination behavior of human stratum corneum

An in vitro adhesion test method has been adapted to quantify the through-thickness intercellular delamination energy of isolated human stratum corneum (SC). Both untreated and delipidized tissues were tested. Measured delamination energies were found to increase from approximately 3 J/m(2) near the surface to approximately 15 J/m(2) for the inner layers of the tissue. For delipidized SC, the location of the initial debond was located closer to the center of the tissue. Delamination energy values were elevated compared to untreated specimens, increasing from approximately 7 J/m(2) near the surface to approximately 18 J/m(2) for the inner layers of the SC. Further tests were run to measure delamination energies of SC as a function of hydration (15-100% relative humidity (RH)) at approximately 25 degrees C and as a function of temperature (10-90 degrees C) at several hydrations (15, 45, 100% RH). Delamination energies were observed to decrease with increasing hydration and increasing temperature with the most significant changes occurring for 100% RH conditioned SC. Additional SC was treated with pH-buffered solutions (pH 4.2, 6.7, 9.9) and selected surfactant solutions (1%, 10% wt/wt sodium dodecyl sulfate (SDS)) for comparison to untreated controls. While statistically significant differences were observed, the SC was found to be resistant to large changes in delamination energy with pH and 1% wt/wt SDS treatments with values in the range 4.2-5.1J/m(2) compared to control values of 4.4 J/m(2). More substantially elevated values were observed for SC treated with a 10%wt/wt SDS solution (6.6J/m(2)) and a chloroform-methanol extraction (11.2J/m(2)).

Stratum corneum defensive functions: an integrated view

Most epidermal functions can be considered as protective, or more specifically, as defensive in nature. Yet, the term "barrier function" is often used synonymously with only one such defensive function, though arguably its most important, i.e., permeability barrier homeostasis. Regardless of their relative importance, these protective cutaneous functions largely reside in the stratum corneum (SC). In this review, I first explore the ways in which the multiple defensive functions of the SC are linked and interrelated, either by their shared localization or by common biochemical processes; how they are co-regulated in response to specific stressors; and how alterations in one defensive function impact other protective functions. Then, the structural and biochemical basis for these defensive functions is reviewed, including metabolic responses and signaling mechanisms of barrier homeostasis. Finally, the clinical consequences and therapeutic implications of this integrated perspective are provided.

Mechanical properties of human stratum corneum: effects of temperature, hydration, and chemical treatment

An in vitro mechanics approach to quantify the intercellular delamination energy and mechanical behavior of isolated human stratum corneum (SC) in a direction perpendicular to the skin surface is presented. The effects of temperature, hydration, and a chloroform-methanol treatment to remove intercellular lipids were explored. The delamination energy for debonding of cells within the SC layer was found to be sensitive to the moisture content of the tissue and to the test temperature. Delamination energies for untreated stratum corneum were measured in the range of 1-8J/m(2) depending on test temperature. Fully hydrated specimen energies decreased with increasing temperature, while room-humidity-hydrated specimens exhibited more constant values of 2-4J/m(2). Lipid-extracted specimens exhibited higher delamination energies of approximately 12J/m(2), with values decreasing to approximately 4J/m(2) with increasing test temperature. The peak separation stress decreased with increasing temperature and hydration, but lipid-extracted specimens exhibited higher peak stresses than untreated controls. The delaminated surfaces revealed an intercellular failure path with no evidence of tearing or fracture of cells. The highly anisotropic mechanical behavior of the SC is discussed in relation to the underlying SC structure.

Estimation of the relative stratum corneum amount removed by tape stripping

BACKGROUND/PURPOSE

The tape stripping procedure is a suitable minimal invasive tool to study, e.g. the penetration and dermatopharmacokinetics of topically applied substances. In the present study, this procedure was used to remove the stratum corneum (SC) completely and to study the penetration of the UVA filter substance butyl methoxydibenzoylmethane after application in two different vehicles.

METHODS

The amount of corneocytes removed by each tape strip from the flexor forearm of human volunteers was determined via their pseudo-absorption. In a second part, the penetration profiles of a UVA filter substance applied in two different vehicles were determined following the developed standard protocol using the tape stripping procedure in combination with UV/VIS spectroscopy.

RESULTS

The amount of corneocytes removed by each tape strip was related to the number of tape strips used for removal. Mean values with a deviation of less than 20% concerning the relative amount of SC removed by a constant number of tape strips were obtained. For instance, a relative amount of 66 +/- 12% was removed with the first 20 tape strips, while nearly the complete SC (95 +/- 3%) was removed using 50 tape strips. In addition, these results were used to estimate the relative SC amounts removed, studying the penetration of the UVA filter substance after application in two different vehicles. No significant differences between the distributions of the UV filter substance applied in both emulsions were obtained (P > 0.05).

CONCLUSIONS

The reported procedure for the estimation of the removed SC amount provides the possibility to avoid the complete removal of the SC and to compare the penetration characteristics obtained for different volunteers and different products in relation to the relative horny layer profile.

Cutaneous bioassay of salicylic acid as a keratolytic

Keratolytic efficacy of topical preparations containing salicylic acid was studied in humans utilizing adhesive tape stripping and quantifying SC removal by protein analysis. In combination with tape stripping, squamometry was used to evaluate the influence of salicylic acid on skin surface scaliness and desquamation. Furthermore, skin barrier perturbation and skin irritancy was recorded and related to the dermatopharmacological effect of the preparations. In contrast to squamometry, tape stripping combined with protein analysis was sensitive in detecting keratolytic effect of salicylic acid within hours of application. Importantly, whereas the pH of the preparations only minimally influenced efficacy, local dermatotoxicity was significantly increased at acidic pH. This indicates that the quest to increase the amount of free, non-dissociated SA is, in fact, counterproductive as the more acidic preparations resulted in skin irritation and barrier disruption.

Degradation of corneodesmosome proteins by two serine proteases of the kallikrein family, SCTE/KLK5/hK5 and SCCE/KLK7/hK7

Corneodesmosin (CDSN), desmoglein 1 (DSG1), and desmocollin 1 (DSC1) are adhesive proteins of the extracellular part of the corneodesmosomes, the junctional structures that mediate corneocyte cohesion. The degradation of these proteins at the epidermis surface is necessary for desquamation. Two serine proteases of the kallikrein family synthesized as inactive precursors have been implicated in this process: the stratum corneum chymotryptic enzyme (SCCE/KLK7/hK7) and the stratum corneum tryptic enzyme (SCTE/KLK5/hK5). Here, we analyzed the capacity of these enzymes to cleave DSG1, DSC1, and epidermal or recombinant forms of CDSN, at an acidic pH close to that of the stratum corneum. SCCE directly cleaved CDSN and DSC1 but was unable to degrade DSG1. But incubation with SCTE induced degradation of the three corneodesmosomal components. Using the recombinant form of CDSN, either with its N-glycan chain or enzymatically deglycosylated, we also demonstrated that oligosaccharide residues do not protect CDSN against proteolysis by SCCE. Moreover, our results suggest that SCTE is able to activate the proform of SCCE. These results strongly suggest that the two kalikreins are involved in desquamation. A model is proposed for desquamation that could be regulated by a precisely controlled protease-protease inhibitor balance.

Données structurales et ultrastructurales sur les lipides cutanés humains

The principal function of intercellular lipids of the epidermal horny layer is the constitution of an occlusive barrier and regulation of transepidermal water fluxes. Self-assembly of lipid bilayers and formation of multilayered structures can be observed in the intercellular spaces of the stratum corneum. Progressive organisation of lipids provokes the lateral displacements of hydrophilic compartments, squeezed aside along the lipid layers towards intercellular junctions (corneodesmosomes). Proteolytic enzymes contained in the hydrophilic material are thus delivered to the extracellular portions of cohesive junctional proteins. Consequently, modifications of the composition and structure of the stratum corneum lipids may influence epidermal desquamation through the regulation of corneodesmosome accessibility to extracellular enzymes.

Interrelation of permeation and penetration parameters obtained from in vitro experiments with human skin and skin equivalents

In a comparative study, two different in vitro cutaneous test systems were examined: (1) The Franz diffusion cell (FD-C), a test system to study drug permeation through the skin and to obtain data like steady state flux and lag time as well as permeability and diffusion coefficients. (2) The Saarbruecken penetration model (SB-M), a test system to investigate drug penetration into different skin layers and after varying incubation times to acquire values about the quasi steady state drug amounts in the stratum corneum (SC). Three drug concentrations (0.9, 0.45 and 0.225%) of a lipophilic model drug preparation, flufenamic acid in wool alcohols ointment, were applied on the skin's surface using 'infinite dose' conditions. Trypsin-isolated SC, heat-separated epidermis, full-thickness skin and reconstructed human skin (RHS) served as skin membranes in the FD-C, while the SB-M experiments were only carried out using full-thickness skin. Increasing steady state flux data and m(ss) values (steady state drug amount in the SC) were detectable after the application of rising drug amounts. Concerning the permeability of the used skin membranes in establishing barrier properties, the following rank order was observed: RHS>SC> or =epidermis>full skin. The flux data of the FD-C experiments for isolated SC, separated epidermis and RHS were linearly related with the m(ss) values of the SB-M investigations, allowing a direct comparison of permeation with penetration parameters. Concerning the drug amount in the SC, previous investigations succeeded in the establishment of an in vivo/in vitro correlation. Based on the results presented here, the prediction of drug amounts present in the SC after different incubation times in vivo is now possible after penetration as well as permeation experiments using the lipophilic model drug preparation, flufenamic acid in wool alcohols ointment.

Persistence of both peripheral and non-peripheral corneodesmosomes in the upper stratum corneum of winter xerosis skin versus only peripheral in normal skin

To understand the biochemical abnormalities that underlie the reduced desquamation observed in dry skin, we analyzed corneodesmosome degradation in normal and winter xerosis skin. Western blotting of total proteins from corneocytes obtained by varnish-strippings from the legs of 56 volunteers with normal (26) or xerotic (30) skin was performed using antibodies specific for (corneo)desmosome proteins. In the whole population, the amounts of desmoglein 1 and plakoglobin were found to be correlated, but were not related to the amounts of corneodesmosin. This suggests simultaneous proteolysis for the former proteins differing from that of corneodesmosin. Neither entire desmoplakins nor any proteolysis-derived fragments were detected. The amounts of corneodesmosin, desmoglein 1, and plakoglobin detected were found to be significantly higher in xerotic compared with normal skin extracts. Conventional and freeze-fracture electron microscopy showed the absence of nonperipheral corneodesmosomes in the upper stratum corneum of normal skin but the presence of a significant number of these structures in the same layer of winter xerosis skin. These results provide a more precise description of the proteolysis of corneodesmosome components in the upper cornified layer of the epidermis. They support previous studies demonstrating the importance of corneodesmosome degradation in desquamation and reveal that the nonperipheral corneodesmosomes, which are totally degraded during maturation of the stratum corneum in normal skin, persist in winter xerosis, probably leading to abnormal desquamation.

Drug distribution in human skin using two different in vitro test systems: comparison with in vivo data

PURPOSE

Two in vitro test systems used to study drug penetration into human skin--the Franz diffusion cell (FD-C) and the Saarbruecken penetration model (SB-M)--were evaluated, and the results were compared with data gained under analogous in vivo conditions.

METHODS

Excised human skin was used in all in vitro experiments. Flufenamic acid dissolved in wool alcohols ointment, was chosen as a model drug, and the preparation was applied using 'infinite dose' conditions. To acquire quantitative information about the drug penetration, the skin was segmented into surface parallel sections at the end of each experiment, first by tape stripping the stratum corneum (SC), and second by cutting the deeper skin layers with a cryomicrotome. The flufenamic acid was extracted from each sample and assayed by high performance liquid chromatography (HPLC). For in vivo experiments, only the tape stripping technique was used.

RESULTS

a) Drug penetration into the SC: In both in vitro test systems the total drug amounts detected in the SC were found to increase over the different incubation times. Similar conditions were obtained in vivo, but on a lower level. Using Michaelis-Menten kinetics, the m(max) value was calculated for the skin of two donors. The relations of the m(max) values for the FD-C and the SB-M closely correspond (1.26 [donor 1] and 1.29 [donor 2]). A direct linear correlation of the drug amount in the SC and the time data were found for in vivo with both in vitro test systems. b) Drug penetration into the deeper skin layers: The detected drug amounts in the deeper skin layers continuously increased with the incubation time in the SB-M, while in the FD-C, only very small drug amounts were observed after incubation times of 30 and 60 minutes. It was also noticed, that the drug amounts rose steeply at time points 3 and 6 hours. Additional studies showed a remarkable penetration of water into the skin from the basolateral acceptor compartment in the FD-C. This could explain the different drug transport into the deeper skin layers between the two in vitro test systems.

CONCLUSIONS

Both in vitro models showed comparable results for the drug penetration into the SC and a robust correlation with in vitro data. Different results were obtained for the deeper skin layers. Whether a correlation between in vitro and in vivo data is also possible here has to be investigated by further experiments.

Stratum corneum, corneodesmosomes and ex vivo percutaneous penetration

The stratum corneum is composed of cornified keratinocytes, joined together with corneodesmosomes and embedded in the relatively hydrophobic intercellular substance. Formation of this horny layer and its constant desquamation are fundamental processes leading to the establishment of an efficient epidermal barrier. We examined structural changes occurring in the stratum corneum ex vivo, in order to better understand the mechanisms regulating corneocyte desquamation at the epidermal surface and influencing percutaneous penetration of exogenous substances. Morphologic modifications were induced by occlusion, increasing the tissue hydration, or by application of propylene glycol, a hydrophilic solvent of small molecular size. Distribution of the major epidermal antigens, markers of terminal differentiation, was studied immunohistochemically and showed no modification related to the tissue alteration. Skin samples were fixed in paraformaldehyde and either postfixed in OsO4 and embedded in Epon or postfixed in RuO4 and embedded in epoxy and acrylic resins. Structural composition and spatial organization of the elements present in the intercorneocyte spaces were evaluated ultrastructurally, with special attention paid to the fate of corneodesmosomes. Our results suggest that the spontaneous organization of lipids excreted into the intercellular spaces and constitution of the lamellar multilayers in the lower stratum corneum are at the origin of partition of the intercellular compartment to the hydrophobic and hydrophilic domains. The latter, compatible with the proteinic contents, seem to be displaced by the hydrophobic components undergoing reorganization, towards the invariable hydrophilic foci represented by corneodesmosomes. This mechanism may be involved in the delivery of proteolytic enzymes, thus contributing to the progressive degradation of corneodesmosomal proteins.