Endogenous Antimicrobial Peptides and Skin Infections in Atopic Dermatitis
Peck Y. Ong, M.D., Takaaki Ohtake, M.D., Ph.D., Corinne Brandt, B.S., Ian Strickland, Ph.D., Mark Boguniewicz, M.D., Tomas Ganz, M.D., Ph.D., Richard L. Gallo, M.D., Ph.D., and Donald Y.M. Leung, M.D., Ph.D.
Background The innate immune system of human skin contains antimicrobialpeptides known as cathelicidins (LL-37) and -defensins. In normalskin these peptides are negligible, but they accumulate in skinaffected by inflammatory diseases such as psoriasis. We comparedthe levels of expression of LL-37 and human -defensin 2 (HBD-2)in inflamed skin from patients with atopic dermatitis and fromthose with psoriasis.
Methods The expression of LL-37 and HBD-2 protein in skin-biopsyspecimens from patients with psoriasis, patients with atopicdermatitis, and normal subjects was determined by immunohistochemicalanalysis. The amount of antimicrobial peptides in extracts ofskin samples was also analyzed by immunodot blot analysis (forLL-37) and Western blot analysis (for HBD-2). Quantitative,real-time reverse-transcriptasepolymerase-chain-reaction(RT-PCR) assays were used to confirm the relative expressionof HBD-2 and LL-37 messenger RNA (mRNA) in the skin-biopsy specimens.These peptides were also tested for antimicrobial activity againstStaphylococcus aureus with the use of a colony-forming assay.
Results Immunohistochemical analysis confirmed the presenceof abundant LL-37 and HBD-2 in the superficial epidermis ofall patients with psoriasis. In comparison, immunostaining forthese peptides was significantly decreased in acute and chroniclesions from patients with atopic dermatitis (P=0.006 and P=0.03,respectively). These results were confirmed by immunodot blotand Western blot analyses. Real-time RT-PCR showed significantlylower expression of HBD-2 mRNA and LL-37 mRNA in atopic lesionsthan in psoriatic lesions (P=0.009 and P=0.02, respectively).The combination of LL-37 and HBD-2 showed synergistic antimicrobialactivity by effectively killing S. aureus.
Conclusions A deficiency in the expression of antimicrobialpeptides may account for the susceptibility of patients withatopic dermatitis to skin infection with S. aureus.
Source Information
From the Division of Allergy and Immunology, Department of Pediatrics, National Jewish Medical and Research Center, Denver (P.Y.O., I.S., M.B., D.Y.M.L.); the Department of Pediatrics, University of Colorado Health Sciences Center, Denver (M.B., D.Y.M.L.); the Division of Dermatology, Department of Medicine and Pediatrics, University of California, San Diego, and the Veterans Affairs San Diego Health Care System, San Diego (T.O., C.B., R.L.G.); and the Division of Pulmonary and Critical Care Medicine, Departments of Medicine and Pathology, School of Medicine, University of California, Los Angeles (T.G.).
Address reprint requests to Dr. Leung at the National Jewish Medical and Research Center, Department of Pediatrics, Rm. K926, 1400 Jackson St., Denver, CO 80206.
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