Activation of Epidermal Toll-Like Receptor 2 Enhances Tight Junction Function: Implications for Atopic Dermatitis and Skin Barrier Repair I-Hsin Kuo,

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Activation of Epidermal Toll-Like Receptor 2 Enhances Tight Junction Function: Implications for Atopic Dermatitis and Skin Barrier Repair I-Hsin Kuo, Amanda Carpenter-Mendini, Takeshi Yoshida, Laura Y. McGirt, Andrei I. Ivanov, Kathleen C. Barnes, Richard L. Gallo, Andrew W. Borkowski, Kenshi Yamasaki, Donald Y. Leung, Steve N. Georas, Anna De Benedetto, Lisa A. Beck Journal of Investigative Dermatology Volume 133, Issue 4, Pages 988-998 (April 2013) DOI: 10.1038/jid.2012.437 Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Toll-like receptor 2 (TLR2) agonists enhance tight junction (TJ) function in primary human keratinocytes (PHKs). Transepithelial electrical resistance (TEER) was measured daily until day 8 in PHKs stimulated with (a) Staphylococcus aureus–derived peptidoglycan (PGN, n=3–7), (b) S. aureus–derived lipoteichoic acid (LTA, n=3), (c) Pam3CSK4, a TLR1/2 ligand (n=3–6), (d) Malp-2, a TLR2/6 ligand (n=5), (e) lipopolysaccharide (LPS), a TLR4 ligand (n=3), and (f) polyinosinic-polycytidylic acid (polyI:C), a TLR3 ligand (n=3–9). Malp-2, macrophage-activating lipopeptide-2; Pam3CSK4, N-palmitoyl-S-[2,3-bis(palmitoyl)-(2RS)-propyl]-(R)cysteinyl-alanyl-glycine. Data are presented as the mean±SEM by analyzing the area under the TEER curve normalized to the mean values for the control group (media alone). (g) PHKs grown on Transwell inserts were stimulated with the indicated concentrations of S. aureus–derived PGN, Pam3CSK4, and Malp-2 for 48hours and paracellular flux measured and compared with media alone. Data are expressed as a fold of media alone group; n=3; *P<0.05; **P<0.01; ***P<.001. NS, not significant. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Toll-like receptor 2 (TLR2) agonists induce tight junction (TJ) protein expression and subcellular localization. Primary human keratinocytes (PHKs) were treated with (a) Staphylococcus aureus–derived peptidoglycan (PGN; 0.2, 2, and 20μgml−1), Pam3CSK4 (0.1, 1, and 10μgml−1), Malp-2 (10, 100, and 1,000 ngml−1), and (b) lipoteichoic acid (LTA; 1 and 10μgml−1) for 48hours, and claudin-1 (CLDN1), occludin, Zonulae occludens 1 (ZO-1), and claudin-23 (CLDN23) protein levels were detected from whole-cell lysates by western blot analysis. Malp-2, macrophage-activating lipopeptide-2; Pam3CSK4, N-palmitoyl-S-[2,3-bis(palmitoyl)-(2RS)-propyl]-(R)cysteinyl-alanyl-glycine. Quantitative protein expression was determined by densitometry of bands after normalization to the housekeeping protein (β-actin). (c) Membrane and cytosolic protein lysates were made and TJ proteins were detected by western blot analysis after treating PHKs with PGN (20μgml−1) for 48hours. Representative blot of n=3 experiments. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Toll-like receptor 2 (TLR2)-neutralizing antibody inhibited Staphylococcus aureus–derived peptidoglycan (PGN) effect on tight junction (TJ) protein function and expression. (a) Transepithelial electrical resistance (TEER; n=5) and (b) paracellular flux (n=5) measurement at 48hours (day 2) in primary human keratinocytes (PHKs) treated with PGN (20μgml−1) and/or TLR2-neutralizing antibody (10μgml−1). Data are normalized to the control group (IgG2b treatment). (c) TJ mRNA (n=3) and (d) protein expression (representative blot of n=3 experiments) was observed in response to treatment with PGN (20μgml−1, 24 or 48hours, respectively) with or without TLR2-neutralizing antibody (5μgml−1). The expression was quantified by densitometry of bands and normalization to the housekeeping protein (β-actin). CLDN1, claudin-1; CLDN23, claudin-23; ZO-1, Zonulae occludens 1. *P<0.05; **P<0.01; ***P<0.001; #compared IgG2b+PGN with TLR2Ab+PGN. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Toll-like receptor 2 (TLR2) agonist enhances skin barrier repair. (a) Schema of modified Snapwell system used to measure transepithelial electrical resistance (TEER) and paracellular flux in full-thickness human or mouse epidermis. PBS, phosphate-buffered saline. Epidermal sheets from normal subjects were placed in modified Snapwell following tape stripping and treated with Pam3CSK4 (10μgml−1) for 24hours. (b) TEER (n=7 per group) and (c) paracellular flux (n=3 per group) were measured at 24hours. Pam3CSK4, N-palmitoyl-S-[2,3-bis(palmitoyl)-(2RS)-propyl]-(R)cysteinyl-alanyl-glycine. (d) Transepidermal water loss (TEWL) recovery curve after tape stripping mouse skin (wild type (WT), n=4; Tlr2−/−, n=4; time -1hour=baseline TEWL before tape stripping). (e) TLR2 agonist effect on TEER restoration at 24hours measured by modified Snapwell after murine barrier disruption by tape stripping (WT, n=5; Tlr2−/−, n=5). TEER absolute value at 24hours in control group is 227± 27ohms × cm2 (human epidermis) and 241± 44ohms × cm2 (WT mice epidermis). NS, not significant. *P<0.05; **P<0.01; ***P<0.001. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Reduced mRNA expression of Toll-like receptors 1 and 2 (TLR1 and TLR2) in epidermal sheets from atopic dermatitis (AD) subjects. Nonlesional AD epidermis (n=8) was compared with epidermis from nonatopic healthy control (NA; n=14–15) obtained from the same anatomical location. The relative mRNA expression level was normalized to glyceraldehyde-3-phosphate dehydrogenase (GAPDH; Mann–Whitney t-test). NOD2, nucleotide-binding oligomerization domain-containing 2; PGLYRP-3, peptidoglycan recognition protein 3; PGLYRP-4, peptidoglycan recognition protein 4; RVU, relative value unit. *P<0.05; NS, not significant. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 The reduced Toll-like receptor 2 (TLR2) expression observed in atopic dermatitis (AD) epithelium inversely correlates with measures of barrier integrity. (a) Representative paraffin-embedded skin biopsy samples from a nonatopic healthy control (NA; n=10), nonlesional AD (AD_NL; n=13), and lesional AD (AD_L; n=13) subjects stained for TLR2 are shown. The white dotted lines denote the epidermal–dermal junction. Bar=100μm. (b) Epidermal TLR2 staining intensity is shown (Mann–Whitney t-test). (c) The line represents the linear least square fit for TLR2 epidermal staining intensity versus transepidermal water loss (TEWL; Spearman’s nonparametric correlation (n=25); r=-0.654, P=0.0004). *P<0.05; ***P<0.001. Journal of Investigative Dermatology 2013 133, 988-998DOI: (10.1038/jid.2012.437) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions