Epidermal Inactivation of the Glucocorticoid Receptor Triggers Skin Barrier Defects and Cutaneous Inflammation Lisa M. Sevilla, Víctor Latorre, Ana Sanchis,

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Epidermal Inactivation of the Glucocorticoid Receptor Triggers Skin Barrier Defects and Cutaneous Inflammation Lisa M. Sevilla, Víctor Latorre, Ana Sanchis, Paloma Pérez Journal of Investigative Dermatology Volume 133, Issue 2, Pages 361-370 (February 2013) DOI: 10.1038/jid.2012.281 Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Mice with keratinocyte-restricted inactivation of glucocorticoid receptor (GR) (GR epidermal knockout (GREKO)) exhibit impaired epidermal barrier formation. (a) Immunoblotting showing GR loss in epidermis (EPID) of newborn (NB) and adult mice but not in other tissues. (b) Immunofluorescence of tail epidermal whole mounts showing absence of GR in hair follicles (hf) and sebaceous glands (sg) in addition to interfollicular epidermis (ife). Bar=100μm. (c) Impaired epidermal barrier formation of GREKO mice. Epidermal maturation assessed by toluidine blue staining in late (E16.5 to E18.5) GREKO and wild-type (WT) embryos. GREKO mice showed delayed and altered epidermal barrier formation (red arrows) that did not follow the dorsoventral and anteroposterior pattern of WT mice (white arrows). Lines indicate the progression of epidermal maturation in WT (white) versus mutant (red) mice. Journal of Investigative Dermatology 2013 133, 361-370DOI: (10.1038/jid.2012.281) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Abnormal epidermal differentiation and proliferation in glucocorticoid receptor epidermal knockout (GREKO) newborn mice. (a) Hematoxylin and eosin (H&E)–stained GREKO and wild-type (WT) postnatal (P) skin sections. Dotted line: epidermal (epi)–dermal (der) border. Arrows: hyperkeratosis. Asterisk: stratum corneum (SC) detachment. Bar=100μm. (a′) Epidermal thickness quantitation; Student's t-test; *P<0.05; **P<0.005. (b–f) P0 skin samples. (b) Electron microscopy; asterisks: SC detachment. Bar=20μm (left), 3μm (right). (c) Nile red staining; polar (red) and nonpolar (green). Bar=100μm. (d) Immunostaining. CDSN, corneodesmosin; FIL, filaggrin; K6, keratin 6; LOR, loricrin. Black thick arrows: specific staining. White arrows: lack of staining. Thin arrows: parakeratosis. Asterisks: SC detachment. Bar=100μm (H&E), 50μm (immunostaining). (e) BrdU-positive keratinocytes (n=12). Mean values±SD are shown. Student's t-test; *P<0.05. (f) Immunoblotting. Journal of Investigative Dermatology 2013 133, 361-370DOI: (10.1038/jid.2012.281) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Gene expression changes and skin phenotype indicate an intrinsic epidermal stress response of glucocorticoid receptor epidermal knockout (GREKO) mice to barrier disruption. (a) Selected list of differentially expressed genes in GREKO relative to wild-type (WT) newborn epidermis grouped by gene ontology. (b) RT-QPCR validation of selected genes was performed in an independent experiment with at least three individuals of each genotype. (c) Increased degranulation of mast cells and elevated numbers of macrophages indicate an abnormal immune response in GREKO mice. Normal mast cells in WT dermis (black arrows) and degranulated mast cells in the upper dermis of GREKO mice (red arrows) are indicated. F480 antibody–stained macrophages. Bars=100μm (outer panels), 50μm (middle panels). Journal of Investigative Dermatology 2013 133, 361-370DOI: (10.1038/jid.2012.281) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Altered signaling in glucocorticoid receptor epidermal knockout (GREKO) epidermal keratinocytes. (a) Increased extracellular signal–regulated kinase (ERK) activity in GREKO epidermis. Immunostaining shows phosphorylated ERK in wild-type (WT) and GREKO suprabasal keratinocytes (arrowheads) and in basal keratinocytes (arrows) of GREKO epidermis (n=8). Bar=100μm (large panels), 65μm (insets). (b) Immunoblotting (left) and quantitation (right) demonstrates increased phosphorylated signal transducer and activator of transcription (p-STAT3)/STAT-3 and p-AKT/AKT ratios as well as elevated S100A9 levels in GREKO newborn epidermis (n=12). Actin was used as a loading control. Mean values±SD are shown. Asterisks denote statistically significant differences among genotypes, as determined by Student's t-test (*P<0.05). Journal of Investigative Dermatology 2013 133, 361-370DOI: (10.1038/jid.2012.281) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Exacerbated inflammatory responses to epidermal challenge of glucocorticoid receptor epidermal knockout (GREKO) adult mice. (a) Hematoxylin and eosin (H&E)–stained skin sections of control (vehicle, V) and dexamethasone (Dex)-treated GREKO and wild-type (WT) adult mice (n=8). Bar=50μm. (b) Quantitation of BrdU-positive keratinocytes in a (n=8). Mean values±SD; Student's t-test; *P<0.05. (c) H&E-stained skin sections showing exaggerated stress response in GREKO adult mice on topical SDS and acute phorbol ester (PMA) treatment (n=18). Asterisks: intraepithelial inflammatory infiltrates. Bar=100μm (upper); 60μm (lower). (d) Immunostaining of skin sections in c using K6 and phosphorylated extracellular signal–regulated kinase (p-ERK) antibodies. Bars=100μm. (e) Immunostaining of skin sections (untreated and SDS-treated) using STAT3. Bar=100μm. (e′) Immunoblotting of skin sections in e using signal transducer and activator of transcription 3 (STAT3) and phosphorylated (p)-STAT3 antibodies. Actin, loading control. Journal of Investigative Dermatology 2013 133, 361-370DOI: (10.1038/jid.2012.281) Copyright © 2013 The Society for Investigative Dermatology, Inc Terms and Conditions