Epidermal growth factor receptor/mitogen-activated kinase inhibitor treatment induces a distinct inflammatory hair follicle response that includes collapse of immune privilege

豁免特权 毛囊 免疫系统 丝裂原活化蛋白激酶 医学 免疫学 癌症研究 激酶 生物 内科学 细胞生物学
作者
David Rutkowski,Rachel Scholey,John Davies,Derek Pye,Fiona Blackhall,Richard B. Warren,Francisco Jiménez,C.E.M. Griffiths,Ralf Paus
出处
期刊:British Journal of Dermatology [Wiley]
标识
DOI:10.1093/bjd/ljae243
摘要

Abstract Background Inhibitors of epidermal growth factor receptor (EGFRi) or mitogen-activated kinase (MEKi) induce a folliculitis in 75–90% of patients, the pathobiology of which remains insufficiently understood. Objectives To characterize changes in the skin immune status and global transcriptional profile of patients treated with EGFRi; to investigate whether EGFRi affects the hair follicle’s (HF) immune privilege (IP); and to identify early proinflammatory signals induced by EGFRi/MEKi in human scalp HFs ex vivo. Methods Scalp biopsies were taken from patients exhibiting folliculitis treated long term with EGFRi (‘chronic EGFRi’ group, n = 9) vs. healthy scalp skin (n = 9) and patients prior to commencing EGFRi treatment and after 2 weeks of EGFRi therapy (‘acute EGFRi’ group, n = 5). Healthy organ-cultured scalp HFs were exposed to an EGFRi (erlotinib, n = 5) or a MEKi (cobimetinib, n = 5). Samples were assessed by quantitative immunohistomorphometry, RNA sequencing (RNAseq) and in situ hybridization. Results The ‘chronic EGFRi’ group showed CD8+ T-cell infiltration of the bulge alongside a partial collapse of the HF’s IP, evidenced by upregulated major histocompatibility complex (MHC) class I, β2-microglobulin (B2 M) and MHC class II, and decreased transforming growth factor-β1 protein expression. Healthy HFs treated with EGFRi/MEKi ex vivo also showed partial HF IP collapse and increased transcription of human leucocyte antigen (HLA)-A, HLA-DR and B2 M transcripts. RNAseq analysis showed increased transcription of chemokines (CXCL1, CXCL13, CCL18, CCL3, CCL7) and interleukin (IL)-26 in biopsies from the ‘chronic EGFRi’ cohort, as well as increased IL-33 and decreased IL-37 expression in HF biopsies from the ‘acute EGFRi’ group and in organ-cultured HFs. Conclusions The data show that EGFRi/MEKi compromise the physiological IP of human scalp HFs and suggest that future clinical management of EGFRi/MEKi-induced folliculitis requires HF IP protection and inhibition of IL-33.

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