Limited Presence of IL-22 Binding Protein, a Natural IL-22 Inhibitor, Strengthens Psoriatic Skin Inflammation
Jérôme C. Martin, Kerstin Wolk, Gaëlle Bériou, Ahmed Abidi, Ellen Witte-Händel, Cédric Louvet, Georgios Kokolakis, Lucile Drujont, Laure Dumoutier,
This information is current as of September 25, 2021.
Jean-Christophe Renauld, Robert Sabat and Régis Josien J Immunol 2017; 198:3671-3678; Prepublished online 29 March 2017; doi: 10.4049/jimmunol.1700021
http://www.jimmunol.org/content/198/9/3671
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The Journal of Immunology
Limited Presence of IL-22 Binding Protein, a Natural IL-22 Inhibitor, Strengthens Psoriatic Skin Inflammation
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- Kerstin Wolk,{,‖,#,1 Gaelle Beriou,*{ Ahmed Abidi,* **
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Ellen Witte-Handel, Cedric Louvet,* Georgios Kokolakis, Lucile Drujont,*
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- Jerome C. Martin,*{,‖
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Laure Dumoutier,††,‡‡ Jean-Christophe Renauld,††,‡‡ Robert Sabat,{,‖,xx,2 and
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- Regis Josien*
Psoriasis is a chronic inflammatory disease resulting from dysregulated immune activation associated with a large local secretion of cytokines. Among them, IL-22 largely contributes to epithelial remodeling and inflammation through inhibiting the terminal differentiation of keratinocytes and inducing antimicrobial peptides and selected chemokines. The activity of IL-22 is regulated by IL-22 binding protein (IL-22BP); however, the expression and role of IL-22BP in psoriatic skin has remained unknown so far. Here we showed that nonaffected skin of psoriasis patients displayed lower expression of IL-22BP than skin of healthy controls. Furthermore, the strong IL-22 increase in lesional psoriatic skin was accompanied by a moderate induction of IL-22BP. To investigate the role of IL-22BP in controlling IL-22 during skin inflammation, we used imiquimod-induced skin disease in rodents and showed that rats with genetic IL-22BP deficiency (Il22ra22/2) displayed exacerbated disease that associated with enhanced expression of IL-22–inducible antimicrobial peptides. We further recapitulated these findings in mice injected with an anti–IL- 22BP neutralizing Ab. Hypothesizing that the IL-22/IL-22BP expression ratio reflects the level of bioactive IL-22 in psoriasis skin, we found positive correlations with the expression of IL-22–inducible molecules (IL-20, IL-24, IL-36g, CXCL1, and BD2) in keratinocytes. Finally, we observed that serum IL-22/IL-22BP protein ratio strongly correlated with psoriasis severity. In conclusion, we propose that although IL-22BP can control deleterious actions of IL-22 in the skin, its limited production prevents a sufficient neutralization of IL-22 and contributes to the development and maintenance of epidermal alterations in psoriasis. The Journal of Immunology, 2017, 198: 3671–3678.
soriasis is a chronic inflammatory skin disease that affects ∼2% of the Caucasian population (1). Typical macrocruitment of further immune cells into the skin to create a selfsustained inflammatory milieu. Moreover, the high keratinocyte production of antimicrobial peptides prevents infections of the highly disturbed psoriatic epidermis. Among a range of immune mediators present in the psoriatic skin, an essential role for IL-23 and its downstream cytokine IL-17A in the maintenance of psoriatic lesions has been recently confirmed by the dramatic clinical success of their therapeutic blockade in these patients (4–7). Another major IL-23 downstream cytokine is the IL-10 family member IL-22. IL-22 is also present in large quantities in psoriatic lesions (8). Main producers of IL-22 include different CD4+ T cell
Pscopic skin alterations present as sharply demarcated, red,
and slightly raised lesions with silver-whitish scales. It is generally acknowledged that these skin changes result from chronic dysregulated activation of the cutaneous immune system that—by secreted cytokines—alters the biology of local tissue cells (2, 3). Epidermal keratinocytes respond by hyperproliferation and impairment of their terminal differentiation, leading to epidermal thickening, hypogranularity, and hyperkeratosis. At the same time, these cells secrete high amounts of chemokines enabling the re-
- ´
- Europeen des Sciences de la Transplantation et de l’Immunologie (IHU-Cesti) Proj-
ect. The IHU-Cesti Project is also supported by Nantes Metropole and the Pays de la Loire region. J.C.M. was supported by a grant from Centre Hospitalier Universitaire (CHU) Nantes (Appel d’Offre Interne 2013 RC14_0042); J.C.M. also received sup-
*Centre de Recherche en Transplantation et Immunologie UMR1064, INSERM, Universite de Nantes, 44093 Nantes Cedex 1, France; †Institut de Transplantation
´
Urologie Nephrologie, Centre Hospitalier Universitaire Nantes, 44093 Nantes Cedex
´
´
‡
- ´
- ´
- ´
- 1, France; Faculte de Medecine, Universite de Nantes, 44093 Nantes Cedex 1,
France; xLaboratoire d’Immunologie, Centre Hospitalier Universitaire Nantes, 44093 Nantes Cedex 1, France; {Psoriasis Research and Treatment Center,
- ´
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port from CHU Nantes through Annee Supplementaire d’Internat. G.B. was sup-
- ported by the Pays de la Loire Region through the IMmunoBIOtherapies et
- ´
- ´
- Dermatology/Medical Immunology, University Hospital Charite, D-10117 Berlin,
- Cellules Dendritiques Network. A.A. was supported by a French-Tunisian UTIQUE
grant from the 2015 Hubert Curien program. K.W. and R.S. were supported by Grant 01ZX1312A from the German Federal Ministry of Education and Research.
Germany; ‖Interdisciplinary Group of Molecular Immunopathology, University
- Hospital Charite, D-10117 Berlin, Germany; #Berlin-Brandenburg Center for Re-
- ´
- generative Therapies, University Hospital Charite, 13353 Berlin, Germany;
- ´
**Faculte des Sciences Mathematiques, Physiques et Naturelles, Universite de
- ´ ˆ
- Address correspondence and reprint requests to Dr. Jerome C. Martin at the current
address: Department of Oncological Science, Icahn School of Medicine at Mount
- ´
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Tunis El Manar, 2092 Tunis, Tunisia ††Ludwig Institute for Cancer Research,
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- Sinai, 1470 Madison Avenue, New York, NY 10029, Prof. Regis Josien, INSERM
‡‡
B-1200 Brussels, Belgium; Institut de Duve, Universite Catholique de Louvain,
´
- ˆ
- ´
- UMR1064-ITUN, CHU Nantes Hotel Dieu, Universite de Nantes, 30 Boulevard Jean
Monnet, 44093 Nantes Cedex 1, France, or Dr. Robert Sabat, Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, University
B-1200 Brussels, Belgium; and xxResearch Center Immunosciences, University
- ´
- Hospital Charite, D-10117 Berlin, Germany
1J.C.M. and K.W. contributed equally to this work and are cofirst authors. 2R.S. and R.J. contributed equally to this work and are colast authors.
Hospital Charite, Chariteplatz 1, D-10117 Berlin, Germany. E-mail addresses: [email protected] (J.C.M.), [email protected] (R.J.), or robert. [email protected] (R.S.)
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ORCIDs: 0000-0002-7689-4130 (K.W.); 0000-0002-8042-7885 (G.K.); 0000-0003- 1736-2131 (J.-C.R.); 0000-0001-7900-7413 (R.J.).
Abbreviations used in this article: IL-22BP, IL-22 binding protein; IMID, immunemediated inflammatory disease; PASI, psoriasis area and severity index; qRT-PCR,
- quantitative RT-PCR.
- Received for publication January 5, 2017. Accepted for publication March 1, 2017.
This work was supported by the National Research Agency via Investment into the Future Program Grant ANR-10-IBHU-005 for the Institut-Hospitalo Universitaire–Centre
Copyright Ó 2017 by The American Association of Immunologists, Inc. 0022-1767/17/$30.00 www.jimmunol.org/cgi/doi/10.4049/jimmunol.1700021
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23 reagent (rodent samples) (both from Applied Biosystems) and the StepOne Plus device (Applied Biosystems). Primers and double-labeled fluorescent probes were either self-designed (human IL-20, IL-22, IL-24, IL-22BP, and BD2) (26) or purchased from Applied Biosystems (all others). Expressions were normalized to HPRT using the 2-DD cycle threshold method, and results were expressed in arbitrary units.
populations and group 3 innate lymphoid cells (9). Because the expression of the membrane IL-22R is restricted to epithelial/ epithelioid cells (8), IL-22 assumes major cross-talk functions between immune and epithelial cells, especially at body barriers (10, 11). By inducing antimicrobial peptides and proinflammatory chemokines, as well as by inhibiting the terminal differentiation of keratinocytes, IL-22 has been shown to largely contribute to inflammation and epithelial remodeling of the psoriatic skin (12–16). Interestingly, the IL-22 activity is regulated by IL-22 binding protein (IL-22BP). IL-22BP is a soluble single chain receptor encoded by the gene IL22RA2 that specifically prevents the binding of IL-22 to IL-22R (17–20). Recently, we and others showed that conventional dendritic cell–derived IL-22BP exerts important inhibitory functions that impair the IL-22–mediated protection during acute colitis in rodents, although preventing potentially dangerous long-lasting proliferative effects on intestinal epithelial cells (21–23). Whether IL-22BP is expressed and plays a role in psoriatic skin inflammation is, however, unknown so far. Our study answers these questions in a translational approach using skin and blood samples from healthy control donors and psoriasis patients, in vitro experiments with human keratinocytes and reconstituted epidermis, and genetic deletion and pharmacological blockade approaches in rodents.
ELISA
Detection of blood serum levels of IL-22 and IL-22BP was performed using ELISA kits from Bio-Techne (Quantikine system) and Biozol (CloudClone), respectively.
Imiquimod-induced psoriasis-like skin inflammation
Psoriasis-like skin inflammation was induced in the right ear of Il22ra2+/+ and Il22ra22/2 rats, and in the back skin of C57BL/6J mice as previously described (27). Briefly, topical application of Aldara cream (3M Pharmaceuticals) was performed daily for 5 d. Skin thickness was measured daily with a Digimatic Caliper and the percentage of skin thickness increase relative to day 0 was calculated every day. Animals were sacrificed at day 5 for qRT-PCR and histopathological analyses on skin tissues. Skin sections were stained with H&E.
In vivo neutralization of IL-22BP
Anti–IL-22BP neutralizing Ab (28) or control isotype was injected i.p. at a dose of 10 mg/kg at days 21, 0, 2, and 4 in Aldara-treated mice.
Statistical analysis
Materials and Methods
Patients
Statistical analysis was performed with GraphPad Prism Software (GraphPad Software, San Diego, CA) or IBM SPSS Statistics 23.0 software (IBM, New York). Mean comparisons of unpaired samples were performed using the Mann–Whitney U test. The Wilcoxon matched-pairs signed-rank test (two-tailed) was used for paired samples. Correlations were calculated using the Spearman rank correlation test. The p values ,0.05 were considered statistically significant.
For analyses of skin expression, biopsies were obtained from adult healthy participants (22–63 y old [mean 6 SD: 44.0 6 10.9], 28.6% female), patients with plaque psoriasis (25–67 y old [mean 6 SD: 46.4 6 12.8], 22.7% female, 68.2% moderate to severe disease [psoriasis area and severity index (PASI) $10]), and patients with atopic dermatitis (22–40 y old [mean 6 SD: 30.0 6 7.7], 50.0% female, 100% moderate to severe disease). For analyses of blood mediators, blood samples were obtained from adult control participants (26–57 y old [mean 6 SD: 38.3 6 9.3], 72.0% female) and patients with plaque psoriasis (19–64 y old [mean 6 SD: 41.2 6 13.7], 61.1% female, 27.8% moderate to severe disease). The skin and blood samples were approved by the clinical institutional review board of
Results
Psoriatic skin shows relative IL-22BP deficiency
To assess whether IL-22BP could exert a regulatory role in psoriasis, we first analyzed IL22RA2 expression in the skin from psoriasis patients as well as from atopic dermatitis patients and healthy donors as comparison groups. Confirming our previous works (17, 20), constitutive expression of IL-22BP was found in healthy donors’ skin. IL-22BP was also detected in the nonaffected skin of psoriasis patients. However, although IL-22BP expression in atopic dermatitis appeared rather increased as compared with healthy donors, levels in the nonaffected skin of psoriasis patients were in fact lower (Fig. 1A). We next analyzed IL-22 and IL-22BP expression in paired biopsies from nonaffected, perilesional, and lesional skin of psoriasis patients. In line with previous studies including ours (8, 15, 29), IL-22 expression was almost absent in nonlesional skin but showed a strong upregulation in perilesional (∼1200-fold) and lesional (2500-fold) skins
(Fig. 1B). Importantly, in contrast to IL-22, the increase of IL-22BP expression was minimal in perilesional and lesional psoriatic skin (∼2-fold induction) (Fig. 1B). Thus, the very small IL-22/IL-22BP
ratio in nonlesional skin (0.01) was largely increased in perilesional and lesional psoriatic skin to ∼3 and 7, respectively.
´the Charite University Medicine, Berlin. Written consent was obtained from all participants. The study was conducted according to the principles of the Declaration of Helsinki.
Epidermis model
Underdeveloped EpiDerm-201 human epidermis models (MatTek) were cultured in inserts at the air–liquid interface as described previously (24) and stimulated or not (control) by supplementing the culture medium with either 20 ng/ml IL-22, 10 ng/ml IL-17A, a mixture of both, or 20 ng/ml IL-24 (all from R&D Systems, Wiesbaden-Nordenstadt, Germany). After 72 h, samples were taken for quantitative RT-PCR (qRT-PCR) analysis.
Animals
Il22ra22/2 and Il22ra2+/+ control littermate rats were generated on the Sprague-Dawley background using zinc-finger nucleases (Sigma-Aldrich, St. Louis, MO) at our local Rats Transgenesis Platform facility IBISA- CNRS as described previously (22). C57BL/6J mice were purchased from Centre d’Elevage Janvier (Le Genest-Saint-Isle, France). All animals were kept under specific pathogen-free conditions. All animal studies were conducted in accordance with the EU Directive 2010/ 63/EU for animal experiments, and the guidelines of the French Agriculture Ministry. These studies were approved by the Veterinary Departmental Services committee (E.44011).
Taken together, these data suggest that constitutive low levels of IL-22BP in nonlesional psoriatic skin and their limited upregulation in lesional skin could enable broadly unregulated IL-22 to be effective and therefore might contribute to the development and maintenance of epidermal alterations in these patients.
qRT-PCR analysis
Snap frozen skin samples or epidermis models were mechanically homogenized (25). Total cellular RNA was isolated using Invisorb RNA kit II (Invitek/Stratec Molecular) (human samples) or TRIzol reagent (Invitrogen) (rodent samples) according to the manufacturers’ instructions. Reverse transcription was performed using murine moloney leukemia virus reverse transcriptase (Invitrogen) following the manufacturer’s instructions. Quantitative PCR on reverse transcribed mRNA was performed using the Maxima Probe/ROX qPCR Master Mix (Thermo Fisher Scientific/ Fermentas) (human samples) or the TaqMan Fast Advanced Master Mix
IL-22BP deficiency exacerbates imiquimod-induced skin inflammation in the rat
In order to demonstrate that IL-22BP deficiency indeed strengthens IL-22–mediated pathogenicity in vivo during skin inflammation, we first took advantage of IL-22BP–deficient rats we generated recently (22) and characterized the impact of IL-22BP deficiency
- The Journal of Immunology
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FIGURE 1. Psoriatic skin shows a relative deficiency in IL-22BP expression. (A) Skin from healthy control donors (n = 11) and nonlesional skin from psoriasis patients (n = 9) and atopic dermatitis patients (n = 4) was analyzed for IL-22BP (IL22RA2) expression by qRT-PCR. Expression was normalized to HPRT transcripts. Mean 6 SEM data are shown; data were analysed using Mann–Whitney U test. (B) Paired nonlesional, perilesional, and lesional skin from psoriasis patients (n = 6–7) was analyzed for IL-22 and IL-22BP expression as in (A). Mean 6 SEM data are shown. Data were analysed using Wilcoxon matched-pairs signed-rank test. *p , 0.05, **p , 0.01, ***p , 0.001. n.s., not significant.
on the severity of skin lesions in the model of skin inflammation induced by imiquimod (30). Following daily topical application, TLR7 activation by imiquimod and inflammasome activation by the vehicle lead to an acute skin inflammatory process that critically depends on IL-23 and downstream mediators IL-17 and IL-22 (30–32). As expected, imiquimod application on the right ear of Il22ra2+/+ rats led to skin erythema and thickening within 5 d (Fig. 2A, 2B). Histological analyses confirmed the induction of
FIGURE 2. IL-22BP deficiency exacerbates imiquimod-induced psoriasis-like skin disease. Psoriasis-like skin disease was induced in the right ear of Il22ra2+/+ and Il22ra22/2 rats (n = 12 each). (A) Representative pictures of skin lesions at days 0 and 5. (B) Percentage of skin thickness increase (mean 6 SEM). (C) Representative hematoxylin–eosin–saffron staining of ear skin at days 0 and 5. Original magnification 3100 (D) Kinetics of IL-22 and IL-22BP (Il22ra2) expression in imiquimod-treated skin were assessed by qRT-PCR (n = 3 for each time point). (E) IL-17A, IFN-g, TNF-a, and IL-22 expression were analyzed by qRT-PCR at day 5 of imiquimod application. Expression was normalized to HPRT transcripts. Each symbol (square or triangle) corresponds to one rat. (F) Lipocalin-2 (Lcn2) and b-defensin-2 (Defb4) expression were analyzed by qRT-PCR at day 5 of imiquimod application. Expression was normalized to HPRT transcripts. Each symbol (square or triangle) corresponds to one rat. *p , 0.05, **p , 0.01, ***p , 0.001, Mann–Whitney U test.
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acanthosis, parakeratosis, Munro’s microabscesses, and dermal immune infiltration (Fig. 2C). Importantly, skin alterations were characterized by a strong induction of IL-22 and a moderate increase of IL-22BP, somehow mimicking the regulation of these two molecules in human psoriatic skin (Fig. 2D). Confirming our expectation that IL-22BP should negatively regulate IL-22 pathogenicity during skin inflammation, clinical and histological skin alterations were severely worsened in Il22ra22/2 versus Il22ra2+/+ littermate controls (Fig. 2A–C). In agreement with their more severe phenotype, enhanced expression of inflammatory cytokines, including IL-17A, TNF-a, and IFN-g, was detected in lesional skin of Il22ra22/2 rats (Fig. 2E). Moreover, concordant with exacerbated actions of IL-22 in the absence of IL-22BP, b-defensin-2 (BD2) and lipocalin-2 (LCN2), two antimicrobial peptides known to be induced by IL-22 in rodent epithelial cells (33, 34), showed significantly higher expression in the lesional skin of Il22ra22/2 versus Il22ra2+/+ littermate controls (Fig. 2F). Of note, there was no significant difference in the expression of these inflammatory cytokines and antimicrobial peptides in the skin of Il22ra22/2 rat versus Il22ra2+/+ littermate controls at steady state (data not shown).
Collectively, data obtained from rodent experiments thus argued in favor of a protective role of IL-22BP during skin inflammation through its ability to neutralize IL-22 pathogenic actions on keratinocytes.