Human Actinic Keratosis Research Articles

HPV8-induced STAT3 activation led keratinocyte stem cell expansion in human actinic keratoses.

Despite epidermal turnover, the skin is host to a complex array of microbes, including viruses, such as HPV, which must infect and manipulate skin keratinocyte stem cells (KSCs) to survive. This crosstalk between the virome and KSC populations remains largely unknown. Here, we investigated the effect of HPV8 on KSCs using various mouse models. We observed that the HPV8 early region gene E6 specifically caused Lrig1+ hair follicle junctional zone KSC proliferation and expansion, which would facilitate viral transmission. Within Lrig1+ KSCs specifically, HPV8 E6 bound intracellular p300 to phosphorylate the STAT3 transcriptional regulatory node. This induced ΔNp63 expression, resulting in KSC expansion into the overlying epidermis. HPV8 was associated with 70% of human actinic keratoses. Together, these results define the "hit-and-run" mechanism for HPV8 in human actinic keratosis as an expansion of KSCs, which lack melanosome protection and are thus susceptible to sun light-induced malignant transformation.

Abstract LB111: Epigenetic mechanism underlying pathogenesis of skin photo-damage and actinic keratoses

Abstract Chronic skin exposure to solar ultraviolet B (UVB) radiation causes cutaneous inflammation, sun-burns and pre-malignant lesions known as Actinic Keratosis (AK). About 20% of AKs may progress to highly invasive malignant lesions known as Squamous Cell Carcinoma (SCC). These lesions carry multiple mutations in oncogenes and/or tumor suppressor genes. However, the molecular mechanism underlying AK is not incompletely defined. Here, we demonstrate that cutaneous UVB exposure leads to activation of bromodomain-4 (BRD4), an epigenetic modifier. We observed enhanced expression of BRD4 and its hyper-acetylation marks, H3K18ac and H3K27ac in AK, accompanied by elevated transcription of BRD4-target genes: MMP13, CXCL9, IL33, Apol19b, IL19 and Oasl2. Using confocal microscopy, we observed enhanced nuclear accumulation of BRD4 and H3K27ac in the sun-exposed lesional skin, AK and in SCC tissues from patients. Ptch+/−/SKH1 mice irradiated with to chronic UVB manifest similar molecular alterations in highly photo-damaged skin. By manipulating BRD4 expression in human skin SCC A431 cells, we identified two important BRD4-regulated signaling pathways, which may be involved in the molecular pathogenesis of AKs and SCCs. BRD4-mediated inflammatory cytokine signaling is regulated by EZH2-SOCS3-NFkB/STAT3 axis while Myc-Survivin-CDK4-E2F1 axis drives tumor cell hyper-proliferation. Co-localization of BRD4/H3K27ac and Survivin-E2F1 was contiguous from sun-burn skin to AK and SCC. We observed enhanced copy number of Myc in human AK lesional skin and associated SCCs. We also show that Myc-Survivin-CDK4-E2F1 axis is critical in driving the progression of tumor keratinocytes to highly invasive and fast growing SCCs. This signaling acts by enhancing the expression epithelial-mesenchymal transition transcription factors and other proteins involved in UVB-induced SCC development. 9cUAB30, a RXR agonist developed by us blocked BRD4 activation and its downstream signaling in A431 and SCC13 cells. Oral administration of 9cUAB30 abrogates UVB-induced inflammation and keratinocyte hyper-proliferation in murine skin in BRD4 dependent manner. 9cUAB30 treatment attenuates growth of human SCC xenograft tumors in highly immune-suppressed mice, a response which was significantly more profound when the drug was administered with a survivin inhibitor, LQZ-7I. These translational studies demonstrate that UVB-induced cutaneous BRD4 drives AK pathogenesis and their progression to invasive SCCs. Citation Format: Mahendra P. Kashyap, Rajesh Sinha, Rubina Shafi, Venkatram R. Atigadda, Craig A. Elmets, Mohammad Athar. Epigenetic mechanism underlying pathogenesis of skin photo-damage and actinic keratoses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB111.

Chronic expression of p16INK4a in the epidermis induces Wnt-mediated hyperplasia and promotes tumor initiation

p16INK4a (CDKN2A) is a central tumor suppressor, which induces cell-cycle arrest and senescence. Cells expressing p16INK4a accumulate in aging tissues and appear in premalignant lesions, yet their physiologic effects are poorly understood. We found that prolonged expression of transgenic p16INK4a in the mouse epidermis induces hyperplasia and dysplasia, involving high proliferation rates of keratinocytes not expressing the transgene. Continuous p16INK4a expression increases the number of epidermal papillomas formed after carcinogen treatment. Wnt-pathway ligands and targets are activated upon prolonged p16INK4a expression, and Wnt inhibition suppresses p16INK4a-induced hyperplasia. Senolytic treatment reduces p16INK4a-expressing cell numbers, and inhibits Wnt activation and hyperplasia. In human actinic keratosis, a precursor of squamous cell carcinoma, p16INK4a-expressing cells are found adjacent to dividing cells, consistent with paracrine interaction. These findings reveal that chronic p16INK4a expression is sufficient to induce hyperplasia through Wnt-mediated paracrine stimulation, and suggest that this tumor suppressor can promote early premalignant epidermal lesion formation.

DNA damage-inducible transcript 4 is an innate guardian for human squamous cell carcinoma and an molecular vector for anti-carcinoma effect of 1,25(OH)2 D3.

Cutaneous squamous cell carcinoma (SCC) is one of the most common non-melanoma skin cancers worldwide. While its exact tumorigenesis mechanisms is far from well-established and less satisfied therapeutic strategy can be clinically used nowadays. In this study, we intended to investigate the role of DNA damage-inducible transcript 4 (DDIT4) in human SCC. Firstly, we identified DDIT4 is significantly suppressed in human SCC tissue and cultured A431 cell line, and reduced DDIT4 accelerates keratinocytes proliferation but impedes the autophagy flux through mTORC1 pathway by affecting the downstream S6 Kinase1, 4E-BP1, Beclin1 and LC3 II/I. While 1,25(OH)2 D3 enhanced DDIT4 expression and activated autophagy and inhibit mTORC1 to take the effect of anti-proliferation and activating autophagy. Further, formation of direct vitamin D receptor (VDR)-DDIT4 transcription complex was verified by ChIP-qPCR, which showed the molecular mechanism of how 1,25(OH)2 D3 promotes DDIT4 transcription. Thirdly, xenograft tumor-bearing mice model treated by gradient concentrations of 1,25(OH)2 D3 revealed the obvious anti-carcinoma effect of 1,25(OH)2 D3 in vivo and DDIT4 acted the molecular vector of 1,25(OH)2 D3 through mTORC1. Lastly, elevated DDIT4 expression was verified in human actinic keratoses tissue, and chronic long-term ultraviolet (UV) irradiation on mouse disclosed UV could promote DDIT4 expression inside epidermis. Conclusively, our research suggested a novel molecular mechanism about the human SCC tumorigenesis and the pharmacological mechanism about how 1,25(OH)2 D3 take its anti-carcinoma role on human SCC, as well as a striking paradoxes that how UV irradiation plays the tumorigenesis effect but synchronously take a protective role in the early stage of SCC carcinogenesis.

Astragalin Attenuates UVB Radiation-induced Actinic Keratosis Formation.

Background: Actinic Keratosis (AK), is the most common precancerous skin lesion induced by the excessive Ultra-violet B (UVB) and is a significant threat to the public health. UVB exposure causes oxidative DNA damage and is considered to be a significant contributor to AK and subsequent development of skin cancer. Besides, activation of p38 MAPK also plays a significant role in the development of AK.Objective: This study aimed at the development of a nature compound which can inhibit UVB-induced AK.Method: MTS Cell Proliferation Assay Kit was used to detect the toxicity of astragalin. HE-staining, Immunohistochemical, Western blot and Enzyme Linked Immunosorbent Assay were applied to examine the clinicopathologic feature of AK and the change of p38 MAPK signal pathway treated with astraglin under the condition of UVB in vitro and in vivo.Results: In our clinical findings revealed that p38 MAPK, phospho-MSK1, and γ-H2AX were significantly highly expressed in human AK tissue than the normal healthy skin tissue. Moreover, in vitro studies showed that UVB induced the phospho-MSK1 and γ-H2AX in a time- and dose-dependent manner in HaCaT cells. Further, in vitro kinase assay demonstrated that astragalin could directly bind to p38 MAPK and suppress p38 MAPK activity. Furthermore, astragalin exhibited no toxicity and suppressed the UVB-induced expression of phospho-MSK1 and γ-H2AX by suppressing p38 MAPK activity in a time-dependent and dose-dependent manner in HaCaT cells. The in vivo studies with animal UV model demonstrated that astragalin inhibited UVB-induced expression of phospho-MSK1 and γ-H2AX in Babl/c mice.Conclusion: These results suggested that p38 MAPK is a direct valid molecular target of astragalin for the attenuation of UVB-induced AK. Furthermore, astragalin could be a potential promising novel natural therapeutic agent for the prevention and management of UVB-induced AK with high target specificity and low toxicity.

TRAF1 Is Critical for DMBA/Solar UVR-Induced Skin Carcinogenesis

TRAF1 is a member of the TRAF protein family, which regulates the canonical and noncanonical NF-κB signaling cascades. Although aberrant TRAF1 expression in tumors has been reported, the role of TRAF1 remains elusive. Here, we report that TRAF1 is required for solar UV-induced skin carcinogenesis. Immunohistochemical analysis showed that TRAF1 expression is up-regulated in human actinic keratosis and squamous cell carcinoma. Invivo studies indicated that TRAF1 expression levels in mouse skin are induced by short-term solar UV irradiation, and a long-term skin carcinogenesis study showed that deletion of TRAF1 in mice results in a significant inhibition of skin tumor formation. Moreover, we show that TRAF1 is required for solar UV-induced extracellular signal-regulated kinase-5 (ERK5) phosphorylation and the expression of AP-1 family members (c-Fos/c-Jun). Mechanistic studies showed that TRAF1 expression enhances the ubiquitination of ERK5 on lysine 184, which is necessary for its kinase activity and AP-1 activation. Overall, our results suggest that TRAF1 mediates ERK5 activity by regulating the upstream effectors of ERK5 and also by modulating its ubiquitination status. Targeting TRAF1 function might lead to strategies for preventing and treating skin cancer.

A Mouse Model of Hyperproliferative Human Epithelium Validated by Keratin Profiling Shows an Aberrant Cytoskeletal Response to Injury

A validated animal model would assist with research on the immunological consequences of the chronic expression of stress keratins KRT6, KRT16, and KRT17, as observed in human pre-malignant hyperproliferative epithelium. Here we examine keratin gene expression profile in skin from mice expressing the E7 oncoprotein of HPV16 (K14E7) demonstrating persistently hyperproliferative epithelium, in nontransgenic mouse skin, and in hyperproliferative actinic keratosis lesions from human skin. We demonstrate that K14E7 mouse skin overexpresses stress keratins in a similar manner to human actinic keratoses, that overexpression is a consequence of epithelial hyperproliferation induced by E7, and that overexpression further increases in response to injury. As stress keratins modify local immunity and epithelial cell function and differentiation, the K14E7 mouse model should permit study of how continued overexpression of stress keratins impacts on epithelial tumor development and on local innate and adaptive immunity.

Abstract 806: Modeling human UV-induced skin cancer through genetic manipulation of Src-kinases and Srcasm

Abstract UV-induced skin cancer is the most common form of cancer and its incidence continues to increase. Novel in vivo models that mimic human UV-induced skin cancer are needed to further studies and evaluate new therapies. Keratinocyte growth is regulated through oncogenic signals from EGFR and Src-family tyrosine kinases (SFKs); these tyrosine kinases are primary drivers of keratinocyte growth in UV-induced skin cancer. At the proteomic level, activated EGFR and SFKs are negatively regulated by Srcasm which targets activated tyrosine kinases for lysosomal degradation. Studies have shown that SFK activity is increased and Srcasm levels are decreased in human cutaneous squamous cell carcinomas and related precancerous lesions. We hypothesized that genetic downregulation of Srcasm by gene deletion or lentivirally mediated shRNA knockdown would promote oncogenic signaling and keratinocyte growth thereby promoting UV-induced skin cancer. To test this hypothesis Srcasm null mice and Srcasm lentiviral knockdown in human keratinocytes were generated and studied. Western blotting of epidermal lysates from Srcasm null mice demonstrates that loss of Srcasm promotes activation of EGFR and Src kinases and decreases levels of p53, NICD and p21. Activation of the canonical Erk1/2, STAT-3 and PDK-1 oncogenic pathways also was seen in Srcasm null keratinocytes. The epidermis of Srcasm null mice exhibits a higher Ki-67 index of 8.7 +/- 2.0 compared to 1.5 +/- 1.1 in controls (p<0.001). UVB irradiation (500 mJ/cm2 × 15 doses) produced precancerous lesions in Srcasm null mice resembling human actinic keratoses but not in controls; the precancerous lesions show an increased Ki-67 index and activation of Src kinases, STAT-3 and PDK-1. Acute UVB irradiation (1200 mJ/cm2 × 1 dose) of Srcasm null mice induced prominent erythema, epidermal necrosis and a prominent increase in the TUNEL-positive index (14.0 vs 1.3). Srcasm knockdown in human keratinocytes accelerated keratinocyte growth 130%; it also increased levels of EGFR and accelerated the kinetics of EGFR and MAPK activation in response to EGF stimulation. In human keratinocytes, Srcasm knockdown accelerated cell growth post-UV exposure which could promote neoplasia. These data show that loss of Srcasm is associated with increased oncogenic signaling, impaired p53 function and keratinocyte proliferation. Loss of Srcasm promotes keratinocyte proliferation post-UV exposure leading to the early stages of UVB-induced cutaneous neoplasia. Citation Format: Xiaoping Yang, Sheila Shankar, Hiroshi Maeno, Micheal Gober, Christine Marshall, Tzvete Dentchev, John Seykora. Modeling human UV-induced skin cancer through genetic manipulation of Src-kinases and Srcasm. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 806. doi:10.1158/1538-7445.AM2015-806

The effect of ultraviolet radiation on the transforming growth factor beta 1/Smads pathway and p53 in actinic keratosis and normal skin

Ultraviolet (UV) radiation is considered to be essential for the progression of actinic keratosis (AK) to squamous cell carcinoma (SCC); however, the mechanisms have not been fully elucidated. To understand this process, the effects of UV radiation on the transforming growth factor beta 1 (TGFβ1)/Smads pathway and p53 in normal skin and AK were studied. Normal human skin and AK tissues were cultured and divided into the following four groups according to the UV radiation dose: 0 (control group), 5, 10, and 20 J/cm2. The tissues were radiated for four consecutive days; 24 h after radiation, the tissues were collected for investigation. Compared with the control group, greater proliferative inhibition and apoptosis were induced by UV radiation in normal skin than AK. The expression of TGFβ1, Smad7, and p53 was increased in AK and normal skin, while the level of TβRII was decreased. Smad2 was reduced in AK only. The expressions of TβRI, Smad3, and Smad4 were not significantly changed. The results demonstrated that although p53 was induced, suppression of the TGFβ1/Smads pathway by UV radiation might contribute to the progression of AK to SCC.

Immunohistochemical Detection of COX-2 in Feline and Canine Actinic Keratoses and Cutaneous Squamous Cell Carcinoma

Cyclooxygenase-2 (COX-2) overexpression and its causal role in epidermal carcinogenesis have been demonstrated in human actinic keratoses (AK) and cutaneous squamous cell carcinoma (SCC). The aim of this study was to determine immunohistochemically the level of expression of COX-2 in feline and canine AK (n=18), SCC (n=36) and inflammatory dermatoses (n=24). COX-2 immunoreactivity was detected in all feline and canine SCC. In all specimens, labelled basal and suprabasal neoplastic keratinocytes were localized within and below areas of superficial erosion or ulceration and only scattered deeper tumour cells were positively labelled. In most cases, positive immunoreactivity of keratinocytes was associated with the presence of granulocytes. COX-2 expression was detected in 3/9 canine and 4/9 feline cases of AK and in only one case was associated with inflammation. Inflammatory dermatoses were characterized by positively labelled epidermal and follicular basal and suprabasal keratinocytes that were always associated with granulocyte exocytosis. These results indicate that further study of the effect of using COX-2 inhibitors in the management and prevention of feline and canine cutaneous SCC is warranted. The association between inflammatory cells and COX-2 expressing epidermal cells opens a new line of research regarding the role of COX-2 in SCC oncogenesis. Moreover, further studies should investigate the role of COX-2 in the pathogenesis and management of AK in animals.

Genomic instability in human actinic keratosis and squamous cell carcinoma

OBJECTIVE: To compare the repetitive DNA patterns of human actinic keratoses and squamous cell carcinomas to determine the genetic alterations that are associated with malignant transformation. INTRODUCTION: Cancer cells are prone to genomic instability, which is often due to DNA polymerase slippage during the replication of repetitive DNA and to mutations in the DNA repair genes. The progression of benign actinic keratoses to malignant squamous cell carcinomas has been proposed by several authors. MATERIAL AND METHODS: Eight actinic keratoses and 24 squamous cell carcinomas (SCC), which were pair-matched to adjacent skin tissues and/or leucocytes, were studied. The presence of microsatellite instability (MSI) and the loss of heterozygosity (LOH) in chromosomes 6 and 9 were investigated using nine PCR primer pairs. Random Amplified Polymorphic DNA patterns were also evaluated using eight primers. RESULTS: MSI was detected in two (D6S251, D9S50) of the eight actinic keratosis patients. Among the 8 patients who had squamous cell carcinoma-I and provided informative results, a single patient exhibited two LOH (D6S251, D9S287) and two instances of MSI (D9S180, D9S280). Two LOH and one example of MSI (D6S251) were detected in three out of the 10 patients with squamous cell carcinoma-II. Among the four patients with squamous cell carcinoma-III, one patient displayed three MSIs (D6S251, D6S252, and D9S180) and another patient exhibited an MSI (D9S280). The altered random amplified polymorphic DNA ranged from 70% actinic keratoses, 76% squamous cell carcinoma-I, and 90% squamous cell carcinoma-II, to 100% squamous cell carcinoma-III. DISCUSSION: The increased levels of alterations in the microsatellites, particularly in D6S251, and the random amplified polymorphic DNA fingerprints were statistically significant in squamous cell carcinomas, compared with actinic keratoses. CONCLUSION: The overall alterations that were observed in the repetitive DNA of actinic keratoses and squamous cell carcinomas indicate the presence of a spectrum of malignant progression.

UVB-induced ERK/AKT-dependent PTEN suppression promotes survival of epidermal keratinocytes

Ultraviolet (UV) radiation in sunlight is the major environmental cause of skin cancer. PTEN (phosphatase and tensin homolog deleted on chromosome 10) is a proven critical tumor suppressor. We report here that UVB down-regulates PTEN in primary human keratinocytes, human HaCaT keratinocytes, and mouse skin. As compared to normal skin, the PTEN levels are reduced in human actinic keratosis, a precancerous skin lesion caused by solar UV. PTEN down-regulation is mediated by two mechanisms: (1) PTEN is cleaved by active caspase in apoptotic cells in which AKT activation is reduced; and (2) PTEN transcription is suppressed in surviving cells, and this suppression is independent of caspase activation and occurs in parallel with increased ERK and AKT activation. We report here that the combination of ERK and AKT activation is crucial for PTEN suppression in surviving cells following UVB irradiation. PTEN remains suppressed in these cells. AKT activation is higher in UVB-irradiated surviving cells as compared to UVB protected control cells. ERK and AKT pathways are involved in sustaining PTEN suppression in UVB-exposed cells. Increasing PTEN expression enhances apoptosis of keratinocytes in response to UVB radiation. Our findings indicate that (1) UVB radiation suppresses PTEN expression in keratinocytes, and (2) the ERK/AKT/PTEN axis may form a positive feedback loop following UVB irradiation. Identification of PTEN as a critical molecular target of UVB will add to our understanding of the pathogenesis of skin cancer.

Chemoprevention of Human Actinic Keratoses by Topical dl-α-tocopherol

Prior research shows that topical application of free, nonfatty acid-conjugated vitamin E (DL-alpha-tocopherol) prevents skin cancer in mice, as well as immunosuppression induced by UVB radiation. This study investigated the chemopreventive potential of DL-alpha-tocopherol in humans through monitoring surrogate end point biomarkers in sun-damaged skin. Contralateral arms of healthy human volunteers with actinic keratoses (AK) were randomly assigned to receive either 12.5% DL-alpha-tocopherol or placebo in a crème base for 6 months. Changes in number of AKs, levels of p53 protein expression, proliferating cell nuclear antigen, and polyamines were assessed along with skin and systemic vitamin E levels. Following treatment, plasma concentration levels of DL-alpha-tocopherol were unchanged, but skin levels were highly elevated (P < 0.001). Levels of p53 and proliferating cell nuclear antigen did not change significantly, whereas number of AKs declined insignificantly in both placebo and treatment arms. Regression models showed significant decreases in putrescine, spermidine, spermine, and total polyamine concentrations following treatment. Topically applied DL-alpha-tocopherol was substantially absorbed in skin, but the 6-month application did not significantly reduce numbers of preexisting AKs on moderately to severely sun-damaged forearms. Increases in polyamine synthesis are expected during tumor initiation and promotion; conversely, the significant reductions in polyamine levels resulting from the topical DL-alpha-tocopherol application are consistent with reductions in tumorigenesis potential. Topical tocopherol did not normalize established sun-induced lesions, but DL-alpha-tocopherol-induced reductions in polyamine metabolism are consistent with the inhibition of skin squamous cell carcinogenesis as seen in previous human trials and animal models.

A novel Src kinase inhibitor reduces tumour formation in a skin carcinogenesis model

The Src family tyrosine kinases are key modulators of cancer cell invasion and metastasis and a number of Src kinase inhibitors are currently in clinical development for the treatment of solid tumours. However, there is growing evidence that Src is also upregulated at very early stages of epithelial cancer development. We have investigated the role of Src in mouse skin, which is one of the most tractable models of epithelial homoeostasis and tumorigenesis. We found that Src protein expression and activity was regulated during the normal hair cycle and was increased specifically during the proliferative anagen phase and also in response to the tumour promoter 12-O-tetradecanoylphorbol-13-acetate (TPA). AZD0530, a selective Src inhibitor, prevented the TPA-induced proliferation of basal keratinocytes both in vivo and in vitro. Moreover, treatment with AZD0530 reduced papilloma formation following the well-established 7,12-dimethylbenz(a)anthracene/TPA skin carcinogenesis protocol but did not inhibit the subsequent proliferation of the papillomas. Furthermore, AZD0530 did not alter the malignant conversion of papillomas to squamous cell carcinoma suggesting a role for Src in early tumour development in the skin carcinogenesis model, rather than at later stages of tumour progression. Src expression and activity were also seen in human actinic keratoses that are hyperproliferative pre-malignant skin lesions, indicating that Src may also play a role in the early stages of human skin tumour development. Thus, Src inhibitors such as AZD0530 may therefore have chemopreventative properties in patients with hyperproliferative epidermal disorders.

Abstract ED09-01: Prevention of non-melanoma skin cancer with celecoxib

Abstract ED09-01 Cutaneous squamous cell and basal cell carcinomas are particularly common malignancies, the most common cause of which is overexposure to solar ultraviolet radiation. While physicians advise patients to apply sunscreens to prevent their occurrence, sunscreens are only modestly effective. In vitro studies and in vivo studies in animal models have suggested that prostaglandins and cyclooxygenase-2 (COX-2) play an important role in the development of non-melanoma skin cancers. In Skh-1 hairless mice, the cyclooxygenase inhibitor celecoxib has been reported to prevent UV-induced skin tumors. In addition, immunohistochemical examination of human actinic keratoses and squamous cell carcinomas has shown that COX-2 expression is increased, whereas expression of this enzyme is not observed in normal skin. In order to determine whether these experimental findings are applicable to humans, we have conducted a phase II/III double blind multicenter placebo controlled clinical trial examining the efficacy and safety of celecoxib in adult patients at risk for actinic keratoses and non-melanoma skin cancers. The studies offer the possibility of additional options for the prevention of this common malignancy. Citation Information: Cancer Prev Res 2008;1(7 Suppl):ED09-01.

Aminolaevulinic acid diffusion characteristics in ‘in vitro’ normal human skin and actinic keratosis: implications for topical photodynamic therapy

The response rate of aminolaevulinic acid (ALA)-based photodynamic therapy (PDT) in certain subtypes of actinic keratosis (AK), such as hypertrophic and hyperkeratotic lesions, is variable, an effect attributable to a supposed lack of ALA penetration. A detailed and depth-related profile of spatial ALA permeation in AK following drug administration would lead to a greater understanding of concentrations achievable before protoporphyrin IX biosynthesis and subsequent PDT. ALA penetration through excised normal human skin (NS) and AK lesions was evaluated using a cryostatic sectioning technique and radio-isotope counting following drug delivery using a novel, bioadhesive patch, loaded with 19, 38 or 50 mg/cm(2) ALA. Distinct differences in ALA concentration with respect to depth between AK and NS samples were shown, particularly within the superficial layers of the tissue structure, down to a depth of 1.0 mm. Patch application times were shown to influence ALA concentrations in tissue, but there was no clear correlation between ALA penetration in AK lesions taken from different body locations and from patients of different age. Similarly, the thickness of stratum corneum was not related to the ALA distribution profiles. Sizable variation in ALA concentration was a prominent feature of profiles through AK lesions, which may explain the variation of observed protoporphyrin IX production seen in the clinical implementation of AK PDT. That said, the results of this study show sufficient ALA penetration to a depth of 1.0 mm, which should be satisfactory for successful treatment of the majority of non-hyperkeratotic, hypertrophic AK using patch-based delivery methods.

Dusting for Fingerprints

Although speculations abound, the relative contribution of UVA and UVB to human skin cancer is largely unknown. Investigators in Australia used fine microdissection of human actinic keratoses (AKs) and squamous cell carcinomas (SCCs) to look for the mutational fingerprints of UVA, UVB, and reactive oxygen species. Eight primary SCCs and eight AKs were collected from 16 patients and microdissected by …

From actinic keratosis to squamous cell carcinoma.

The development of actinic keratosis (AK) and squamous cell carcinoma (SCC) is the result of a complex sequence of events initiated by exposure to ultraviolet (UV) light. The application of sunscreens prior to sun exposure has been reported to reduce the incidence of AK. The initial damage takes place in the DNA and most of the UV-induced lesions in the DNA are repaired. However, mutations may occur as a result of base mispairing of the cell and its DNA replicate before the DNA lesion is repaired. The genes involved in the repair process are also potential UV targets. Mutations in the tumour suppressor gene p53 are a common feature of AK and SCC. The hairless mouse is the best available animal model, in which lesions resembling human AK (papillomas), keratoacanthomas and SCCs may be induced. This model of multistage carcinogenesis offers an excellent tool for mechanistic studies. The relative efficacy of UV wavelengths (action spectrum) that induce SCC has been determined using the hairless mouse as a model. The action spectrum has been extrapolated to humans skin and is recognised worldwide.

Cyclooxygenase-2 expression in murine and human nonmelanoma skin cancers: implications for therapeutic approaches.

Inflammatory stimuli result in the production of cutaneous eicosanoids, which are known to contribute to the process of tumor promotion. Cyclooxygenase (COX), the rate-limiting enzyme for the production of prostaglandins (PG) from arachidonic acid, exists in at least two isoforms, COX-1 and COX-2. COX-1 is constitutively expressed in most tissues and plays various physiological roles, whereas increased COX-2 expression is known to occur in several types of epithelial neoplasms. Enhanced PG synthesis is a potential contributing factor in UVB-induced nonmelanoma skin cancers (NMSC). Increased COX-2 staining occurs in murine skin neoplasms after chronic exposure to carcinogenic doses of UVB. In this study, immunohistochemical and Western blot analyses were employed to assess longitudinally COX-2 expression in a standard mouse UVB complete carcinogenesis protocol and in human basal cell carcinomas (BCC) and squamous cell carcinomas (SCC). During UVB irradiation of mice, COX-2 expression consistently increased in the hyperplastic skin, the benign papillomas and the SCC. COX-2 expression was also increased in human actinic keratoses, SCC and BCC as well as in murine SCC and BCC. The pattern of COX-2 expression was quite variable, occurring in a patchy distribution in some lesions with staining confined mainly to suprabasal cell layers. In general, COX-2 expression progressively became more extensive in benign papillomas and well-differentiated murine SCC. The staining was predominantly cytoplasmic and perinuclear in some focal areas in tissue stroma around both murine and human tumors. Western blot analysis confirmed negative COX-2 expression in normal skin, whereas acute UVB exposure resulted in increased enzyme expression, which continued to increase in developing papillomas and SCC. Because of the evidence indicating a pathogenic role for eicosanoids in murine and human skin neoplasms, we performed studies to assess the anti-inflammatory and anticarcinogenic effects of green tea extracts, which are potent antioxidants. Acute exposure of the human skin to UVB (minimum erythema dose x 4) caused a transient enhancement of the COX-2 expression, which reverted to baseline within hours; however, in murine skin the expression persisted for several days. Pretreatment with the topically applied green tea extract (1 mg/cm2) largely abrogated the acute COX-2 response to UVB in mice or humans. In summary, enhanced COX-2 expression serves as a marker of epidermal UVB exposure for murine and human NMSC. These results suggest that COX-2 inhibitors could have potent anticarcinogenic effects in UVB-induced skin cancer.

Activated ras genes occur in human actinic keratoses, premalignant precursors to squamous cell carcinomas

Activated ras genes occur in human actinic keratoses, premalignant precursors to squamous cell carcinomas