Demehri Shadmehr, Morimoto Mitsuru, Holtzman Michael J, Kopan Raphael
Department of Developmental Biology and Division of Dermatology, Washington University School of Medicine, Saint Louis, Missouri, United States of America.
PLoS Biol. 2009 May 19;7(5):e1000067. doi: 10.1371/journal.pbio.1000067.
Asthma is a common allergic lung disease frequently affecting individuals with a prior history of eczema/atopic dermatitis (AD); however, the mechanism underlying the progression from AD to asthma (the so-called "atopic march") is unclear. Here we show that, like humans with AD, mice with skin-barrier defects develop AD-like skin inflammation and are susceptible to allergic asthma. Furthermore, we show that thymic stromal lymphopoietin (TSLP), overexpressed by skin keratinocytes, is the systemic driver of this bronchial hyper-responsiveness. As an AD-like model, we used mice with keratinocyte-specific deletion of RBP-j that sustained high systemic levels of TSLP. Antigen-induced allergic challenge to the lung airways of RBP-j-deficient animals resulted in a severe asthmatic phenotype not seen in similarly treated wild-type littermates. Elimination of TSLP signaling in these animals blocked the atopic march, demonstrating that high serum TSLP levels were required to sensitize the lung to allergic inflammation. Furthermore, we analyzed outbred K14-TSLP(tg) mice that maintained high systemic levels of TSLP without developing any skin pathology. Importantly, epidermal-derived TSLP was sufficient to trigger the atopic march, sensitizing the lung airways to inhaled allergens in the absence of epicutaneous sensitization. Based on these findings, we propose that in addition to early treatment of the primary skin-barrier defects, selective inhibition of systemic TSLP may be the key to blocking the development of asthma in AD patients.
哮喘是一种常见的过敏性肺部疾病,常影响有湿疹/特应性皮炎(AD)病史的个体;然而,从AD发展到哮喘(即所谓的“特应性进程”)的潜在机制尚不清楚。在此我们表明,与患有AD的人类一样,具有皮肤屏障缺陷的小鼠会出现类似AD的皮肤炎症,并易患过敏性哮喘。此外,我们还表明,皮肤角质形成细胞过度表达的胸腺基质淋巴细胞生成素(TSLP)是这种支气管高反应性的全身性驱动因素。作为一种类似AD的模型,我们使用了角质形成细胞特异性缺失RBP - j且全身TSLP水平持续较高的小鼠。对RBP - j缺陷动物的肺气道进行抗原诱导的过敏性激发,会导致严重的哮喘表型,而在同样处理的野生型同窝小鼠中未观察到这种表型。消除这些动物体内的TSLP信号传导可阻断特应性进程,这表明需要高血清TSLP水平才能使肺部对过敏性炎症敏感。此外,我们分析了维持全身高TSLP水平但未出现任何皮肤病变的远交系K14 - TSLP(tg)小鼠。重要的是,表皮来源的TSLP足以引发特应性进程,在没有经皮致敏的情况下使肺气道对吸入性过敏原敏感。基于这些发现,我们提出,除了早期治疗原发性皮肤屏障缺陷外,选择性抑制全身性TSLP可能是阻断AD患者哮喘发展的关键。