P05 The aryl hydrocarbon receptor pathway is dysfunctional in atopic dermatitis

Abstract

Abstract Introduction and aims Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by epidermal barrier disruption and type-2 immune dysregulation. While treatment has improved with targeted biologics, clinical response varies, highlighting the need for additional therapeutic strategies. The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor and environmental sensor, which maintains skin barrier integrity and homeostasis by reducing inflammation. Upon activation, AHR induces the expression of CYP1A1, a biomarker of pathway activation and critical for AHR ligand metabolism. Tapinarof, a topical AHR agonist, is approved for psoriasis and is effective in phase III clinical trials in AD, highlighting the importance of this pathway in inflammatory skin disease. Nevertheless, AHR expression is increased in AD skin, leading to the hypothesis that the pathway is dysregulated, thus not exerting its anti-inflammatory effect. Methods Here we begin to perform a global investigation of the AHR pathway in AD. We measured AHR and CYP1A1 mRNA expression by quantitative real-time reverse-transcription polymerase chain reaction (qRT-PCR) in healthy and AD skin, with spatial mRNA expression assessed by RNAscope. We also investigated AHR mRNA expression in interleukin (IL)-4 stimulated (100 ng mL−1) normal human epidermal keratinocytes (NHEKs) using qRT-PCR. Results We found that AHR mRNA is significantly upregulated in lesional AD (n = 6) compared with healthy skin (n = 9; P < 0.05), whereas CYP1A1 mRNA expression shows a downward trend in lesional AD compared with healthy skin (P = 0.063). The AHR expression pattern differs in lesional AD (n = 7) compared with healthy skin (n = 8), with AHR localizing in the epidermal basal layer. Finally, IL-4 significantly upregulated AHR mRNA (n = 4 wells; P < 0.001) expression in NHEKs compared with unstimulated cells. Conclusions Overall, our data have uncovered a dysfunctional AHR pathway in AD, with increased AHR expression, possibly driven by the AD inflammatory milieu, but reduced pathway activation. Further investigations are required to fully dissect this pathway and maximize its potential as a therapeutic target for AD.