Antigenic profile of human acrosyringium

Somatostatin receptors are strongly expressed in palmoplantar sweat glands and ducts: studies of normal and palmoplantar pustulosis skin

BACKGROUND

The acrosyringium is the target for inflammation in the chronic and intensely inflammatory skin disease palmoplantar pustulosis (PPP). The sweat-gland apparatus seems to be an immunocompetent structure that probably contributes to skin defence. Furthermore, the sweat gland and duct may be a hitherto unrecognized neuroendocrine organ.

AIM

To obtain further information about the neuroendocrine properties of the sweat-gland apparatus by examining expression of the somatostatin receptors (SSTRs) 1-5 in healthy palmar skin and in PPP skin.

METHODS

Biopsy specimens were taken from 25 patients with PPP and 25 healthy controls. Immunohistochemical analysis was used to investigate expression of SSTRs 1-5.

RESULTS

SSTRs 1-5 were expressed in both epidermal and endothelial structures. The staining intensity of the sweat-gland apparatus was more pronounced than that of the epidermis. Expression differed significantly between lesional PPP and normal plantar skin, with increased expression of SSTRs 3 and 4 in ducts in epidermis, and decreased expression of SSTR 1 in ducts in both papillary and reticular dermis. In specimens with pronounced inflammation, numerous dendritic cells with strong expression of SSTRs 1, 2 and 4 were seen, especially in the papillary dermis.

CONCLUSIONS

The presence of SSTRs in palmoplantar skin, and specifically at high density in the sweat glands and ducts, might be of particular importance in skin neuroimmunoendocrinology. Although the relevance of the changes in SSTR expression in PPP skin compared with normal skin is unclear, our hypothesis is that these differences might influence the function of both the neuroendocrine and neuroimmunological properties of palmoplantar skin, especially in the sweat-gland apparatus.

The cutaneous non-neuronal cholinergic system and smoking related dermatoses: studies of the psoriasis variant palmoplantar pustulosis

Palmoplantar pustulosis (PPP) is probably the inflammatory skin disease most strongly associated to smoking. The disease is common in middle-aged, smoking women, and is chronic, sometimes disabling and characterized by pustules, erythema and scaling on the soles and palms. It is often treatment-resistant. PPP patients have a co-morbidity with an increased risk of autoimmune thyroid disease, celiac disease/gluten intolerance, abnormal calcium homeostasis, diabetes type 2, and depression. The sweat gland apparatus is involved in the pathogenesis of PPP since a) the normal structure of the acrosyringium is abolished so the keratin pattern differs to that in normal palmar skin; b) granulocytes migrate outwards in the acrosyringium forming the pustule in the stratum corneum. Acetylcholine (ACh) is the main inducer of sweating. With immunohistochemistry the ACh synthesizing enzyme choline acetyltransferase (ChAT) and the ACh-degrading enzyme acetylcholinesterase (AChE) were found to be strongly expressed in the gland and duct as were the alpha-3 and alpha-7 nicotinic acetylcholine receptors (nAChRs). Smoking influenced the staining intensity of the enzymes and the alpha-3 nAChR in healthy subjects. In involved PPP skin there was a massive infiltration of granulocytes expressing ChAT and alpha-3 nAChR, and mast cells expressing AChE indicating a role for acetylcholine in inflammation. Cessation of smoking resulted in fewer pustules, and less scaling and erythema. The mechanisms for the effect of nicotine/smoking in PPP are still unknown but nicotine may lead to enhanced inflammation in consideration of the properties of the sweat duct and/or nicotine might facilitate autoimmune reactions.

Nonneoplastic disorders of the eccrine glands

Eccrine glands are uniquely susceptible to a variety of pathologic processes. Alteration in the rate of sweat secretion manifests as hypohidrosis and hyperhidrosis. Obstruction of the eccrine duct leads to miliaria. The excretion of drugs into eccrine sweat may be a contributory factor in neutrophilic eccrine hidradenitis (NEH), syringosquamous metaplasia (SSM), coma bulla, and erythema multiforme (EM). Alterations in the electrolyte composition of eccrine sweat can be observed in several systemic diseases, most notably cystic fibrosis. This article summarizes current knowledge of eccrine gland pathophysiology.

CD36 (OKM5) antigen expression on human mucosal epithelia is associated with keratinization type

The glycoprotein CD36 functions as a thrombospondin receptor and is expressed on a variety of cell types, including platelets, monocyte/macrophages, and endothelial cells. In human skin, the presence of CD36 on keratinocytes was initially found in lesional areas of T-cell mediated inflammatory dermatoses. Controversy still exists on the interpretation of this expression as an inflammatory or differentiation-associated marker. So far, only limited data are available on CD36 expression in oral epithelia. The present immunohistochemical study was therefore performed to determine the presence of CD36 on keratinocytes of healthy and disease-affected epithelia of the oral cavity in 80 biopsy specimens. As results, we found an inflammation-independent strong expression of CD36 in oral epithelia with ortho- and parakeratinization, such as the oral side of the gingiva, the hard palate, and the back of the tongue. Non-keratinized epithelia such as the gingival pocket epithelium, the soft palate, the lip, the buccal mucosa, and the side of the tongue were CD36 negative. We therefore suggest that CD36 expression in keratinocytes from oral epithelia is an epithelial differentiation marker.

Acrosyringeal concentration of necrotic keratinocytes in erythema multiforme: a clue to drug etiology. Clinicopathologic review of 29 cases

Erythema multiforme (EM) is caused by various insults, frequently an infectious agent or a drug. It is current practice that histologic identification of the precipitating factor is not possible. We have observed a pattern of acrosyringeal concentration of keratinocyte necrosis in certain cases of EM and retrospectively studied 29 consecutive cases of EM to establish clinicopathologic correlation for this finding. Acrosyringeal concentration was observed in 10 of 29 specimens, all 10 clinically drug related (Group 1). Nineteen specimens lacked this pattern (Group 2) of which 3 cases were clinically drug related (sensitivity = 0.8, specificity = 1.0). Eosinophils were present in the dermal infiltrate of 6 specimens from Group 1 and 2 specimens from Group 2 (p = 0.025). Acrosyringeal concentration of keratinocyte necrosis in EM occurs in drug-related cases and is more likely to be accompanied by a dermal inflammatory infiltrate containing eosinophils. Drug concentration in sweat may explain this pattern with subsequent toxic and immunologic mechanisms leading to the fully evolved lesion.

Drug-induced immune dysregulation as a cause of atypical cutaneous lymphoid infiltrates: a hypothesis

The authors encountered 22 patients in whom a skin biopsy showed atypical lymphoid hyperplasia and in whom a subsequent drug history showed indigestion of one or more agents before lesional onset. In 13 patients, the biopsy had been performed to rule out a diagnosis of malignant lymphoma, whereas the other nine the clinical impression was that of a drug eruption. Among the more frequently prescribed agents were calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, antidepressants, antihistamines, beta-blockers, benzodiazepines and lipid-lowering agents, all of which are either known to perturb lymphocyte function or have been implicated as a cause of pseudolymphomata. Twelve of the patients were on two or more of these drugs. The effect of drug modulation on the clinical course was assessed. The clinical presentations were as one or more erythematous plaques or multiple infiltrative papules, or as solitary nodules. The patient had been on one or more of the aforementioned drugs from 2 weeks to 5 years before developing the lesions. Resolution of the eruptions occurred in 17 patients within 1 to 32 weeks (mean, 7 weeks) of discontinuing the medication. Five additional patients had complete excision of solitary lesions without recurrence. A history of atopy, autoimmune disease, or previous carcinoma was elicited in five patients. All biopsy specimens showed atypical lymphoid infiltrates, which assumed one or more of the following patterns: mycosis fungoides (MF)-like, a lymphomatoid vascular reaction, lymphocytoma cutis and follicular mucinosis. Based on the histopathology of the biopsied lesions and the clinical course being one of lesional resolution after cessation of drug therapy or excision of a solitary lesion without subsequent recurrence, a diagnosis of drug-associated lymphomatoid hypersensitivity was established in all specimens. A diagnosis of drug-associated pseudolymphoma should be excluded before a diagnosis of cutaneous lymphoma is rendered, and should be considered if the patient is on a drug known to alter lymphocyte function, particularly in the setting of systemic immune dysregulation or multidrug therapy where agent may act synergistically or cumulatively to alter lymphoid function. The authors postulate that the drug may promote an aberrant immune response to an antigen that may be the drug itself or some other stimulus. A skin biopsy may be particularly helpful, as the lesions of drug-associated pseudolymphoma have a morphology distinctive from malignant lymphoma.

Distribution of interferon-gamma receptors in normal and psoriatic skin

Recent data suggest that imbalances in production and secretion of cytokines, in particular interferon-gamma (IFN-gamma), may be crucial in the pathogenesis of psoriasis. In order to exert its role on target cells, IFN-gamma has to interact with a specific cell membrane receptor termed the IFN-gamma-receptor (IFN-gamma R). We studied the distribution of IFN-gamma Rs in frozen skin biopsies from 25 psoriatics and 5 normal controls with two unrelated monoclonal antibodies, and compared its distribution with that of the IFN-gamma-inducible HLADR- and ICAM-1 antigens. In normal skin, IFN-gamma Rs were restricted to the basal cell layer; weak staining was found on scattered mononuclear cells in the papillary dermis. In 13/25 active psoriatic lesions, additional suprabasal immunoreactive foci, and in 5/25 cases, diffuse immunoreactivity of the entire epidermis were seen. No striking topographical similarities between the site and number of IFN-gamma R+, HLADR+ and ICAM-1+ keratinocyte foci were observed, suggesting that cytokines other than IFN-gamma induce HLADR-antigens on psoriatic keratinocytes in vivo. The restricted distribution of IFN-gamma R on the germinative cell layer in normal skin confirms the role played by IFN-gamma in the normal growth regulation of the epidermis. The de novo suprabasal expression of IFN-gamma R in psoriasis argues against the current hypothesis that IFN-gamma R are down-regulated due to a local excess of IFN-gamma or transforming growth factor alpha (TGF-alpha). Whether IFN-gamma Rs in psoriatic skin are functionally normal and involved in signal transmission, remains to be studied.

Melanocytes freshly isolated from normal human skin express the cell membrane receptor for the adhesive glycoprotein thrombospondin

Thrombospondin (TSP) is an adhesive protein with multiple binding sites, which is able to mediate several cell-to-cell and cell-to-matrix interactions, particularly through its cell membrane receptor (TSP-R). Because human keratinocytes are able to synthesize and express TSP, and as TSP is also localized at the dermal-epidermal junction in normal human skin, we questioned whether epidermal cells are able to bind available TSP, that is, to express TSP-R. To investigate this, we employed gold immunoelectron microscopy on epidermal cells freshly isolated from normal human skin; the TSP-R was detected by OKM5 monoclonal antibody. Epidermal cells showing ultrastructural characteristics of melanocytes were gold-stained on their plasma membrane, whereas keratinocytes, Langerhans cells and lymphocytes were unstained. Although functional studies are clearly necessary to clarify the role(s) played by the TSP-R on the cell surface of melanocytes, it is tempting to speculate that the TSP-R may be important for melanocyte adhesion to the dermal-epidermal junction and to keratinocytes. Such adhesion may not only subserve the steric localization of melanocytes, but also have important implications for those functional activities of melanocytes which have been shown to require close contact between these cells and adjacent keratinocytes and/or basement membrane components.