The Janus kinase inhibitor JTE-052 improves skin barrier function through suppressing signal transducer and activator of transcription 3 signaling Wataru.

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The Janus kinase inhibitor JTE-052 improves skin barrier function through suppressing signal transducer and activator of transcription 3 signaling Wataru Amano, DVM, Saeko Nakajima, MD, PhD, Hayato Kunugi, PhD, Yasuharu Numata, MS, Akihiko Kitoh, MD, PhD, Gyohei Egawa, MD, PhD, Teruki Dainichi, MD, PhD, Tetsuya Honda, MD, PhD, Atsushi Otsuka, MD, PhD, Yukari Kimoto, MS, Yasuo Yamamoto, MS, Atsuo Tanimoto, MS, Mutsuyoshi Matsushita, PhD, Yoshiki Miyachi, MD, PhD, Kenji Kabashima, MD, PhD Journal of Allergy and Clinical Immunology Volume 136, Issue 3, Pages 667-677.e7 (September 2015) DOI: 10.1016/j.jaci.2015.03.051 Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 IL-4/IL-13 dominantly downregulated gene groups involved in keratinocyte differentiation. A, Heat map of genes in TESTSKIN treated with IL-4/IL-13 in the absence (left) or presence (right) of JTE-052 (n = 3). B, Enriched GO terms for genes with altered expression induced by IL-4/IL-13. C-E, Correlation analyses between the genes differentially expressed in (C) IL-4/IL-13–treated samples (Bioset; Bs1) and genes with altered expression in AD skin (GSE16161; Bs2; Fig 1, C), Bs1 and IL-4/IL-13 plus JTE-052-treated samples (Bs3; Fig 1, D), and Bs3 and Bs2 (Fig 1, E). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 The JAK inhibitor promoted keratinocyte differentiation. Vehicle or the JAK inhibitor JTE-052 was applied to the culture medium for 5 days in the presence (A-D) or absence (E-G) of IL-4/IL-13. Fig 2, A, Effects of JTE-052 on FLG and LOR mRNA expression of NHEKs in the presence of IL-4/IL-13. Effects of the compound were calculated and represented as percentage change from mean control value. Fig 2, B, FLG and LOR protein production in TESTSKIN. Fig 2, C, Immunofluorescent staining of STAT3 and STAT6 (green) or β-actin (red) in NHEKs. Fig 2, D, Phosphorylation of STAT3 and STAT6 in TESTSKIN. Fig 2, E, Effects of JTE-052 on FLG and LOR mRNA expression in NHEKs. Fig 2, F, FLG protein production in TESTSKIN. Fig 2, G, Relative density of the FLG monomer to glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in TESTSKIN (n = 6). Fig 2, A and E, Data represent the average of 3 independent experiments ± SEMs. *P < .05 versus vehicle (t test). #P < .05 versus IL-4/IL-13 treatment (Steel test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 STAT3, but not STAT6, is a predominant negatively acting transcriptional factor for keratinocyte differentiation. A, Phosphorylation of STAT3 and STAT6 in NHEKs. B and C, Silencing effects of siRNAs on STAT mRNA (n = 7 of each group; Fig 3, B) and protein (Fig 3, C) expression. D and E, FLG and LOR mRNA expression in the absence (Fig 3, D) or presence (Fig 3, E) of IL-4/IL-13. F,CCL26 and CXCL6 mRNA expression in the presence of IL-4/IL-13 (n = 7 of each group). Data are presented as means ± SEMs. *P < .05 versus control siRNA (Dunnett test). #P < .05 versus control siRNA (Steel test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 4 Topical administration of the JAK inhibitor ameliorated barrier disruption in NC/Nga mice (n = 7 or 8). A, Time course of total clinical severity scores. B, Clinical photographs of NC/Nga mice on day 28. C, TEWL of the ear of NC/Nga mice on day 28. D, FLG protein and phosphorylated STATs in the epidermis of NC/Nga mouse ear on day 28. E, NMF concentration in the epidermis of NC/Nga mice ear on day 28. *P < .05 versus vehicle-treated mice (t test). †P < .05 versus vehicle-treated mice (Wilcoxon rank sum test). #P < .05 versus JTE-052–treated mice at day 0 (Steel test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 5 The JAK inhibitor ameliorated barrier function in a mouse model of dry skin. A, TEWL of the ear of dry skin model mice. B,Flg mRNA expression in the ear on day 3. C, Immunohistochemical analysis of FLG protein (green) in the ear on day 7. Nuclei were counterstained with DAPI (blue). Scale bar = 50 μm. D, NMF concentration in the epidermis of the ear on day 7 (n = 4). *P < .05 versus vehicle-treated mice (t test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 6 The JAK inhibitor enhanced NMF and FLG protein expression in human skin. A, Representative image of grated human skin on athymic nude mice. B, Total amount of NMF in the vehicle- or 0.5% JTE-052–treated area (integral value of SC depth from 0-28 μm). C, H&E staining (upper panel) and immunostaining of FLG (lower panel, red) of histologic sections from grafted human skin. Scale bar = 50 μm. *P < .05 versus vehicle treatment (t test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 7 Model of the molecular mechanism of STATs in AD skin. IL-4 and IL-13 induce phosphorylation of STAT3 and STAT6 through JAK activation in the epidermis of patients with AD. Activated STAT3 downregulates keratinocyte differentiation–related proteins, leading to barrier disruption in accordance with decreased NMF levels and increased TEWL. On the other hand, activated STAT6 upregulates chemoattractants, such as CCL26 and CXCL6, leading to skin inflammation. Topical administration of JTE-052 inhibits phosphorylation of both STAT3 and STAT6 and normalizes barrier disruption and skin inflammation. Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Correlation analyses between gene expression changes. A, Correlation analysis between genes differentially expressed in IL-4/IL-13–treated samples compared with vehicle-treated samples (Bioset; Bs1) and genes with altered expression in AD skin compared with healthy control skin (Bs2). B, Correlation analysis between the genes differentially expressed on IL-4/IL-13 plus JTE-052–treated samples compared with IL-4/IL-13–treated samples (Bs3) and Bs1. C, Correlation analysis between Bs2 and Bs3. The bars indicate P values of each correlation. Arrows indicate the direction of gene expression (red, upregulation; blue, downregulation). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Phosphorylation of STAT1, STAT2, and STAT5 in the presence or absence of IL-4/IL-13 in TESTSKIN by using Western blotting. Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Phosphorylation of STAT3 in NHEKs. A, NHEKs were incubated in the presence or absence of 100 ng/mL IL-4/IL-13 with or without 1000 nmol/L JTE-052 for 24 or 120 hours. B and C, Effects of JTE-052 on phosphorylation of STAT3 (Fig E3, B) and LOR protein production (Fig E3, C) in TESTSKIN. Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E4 The JAK inhibitor ameliorated ear-swelling responses in an antigen-induced chronic allergic dermatitis model in NC/Nga mice. Mice were orally administrated with JTE-052 or cyclosporine (A) or topically applied with JTE-052 or tacrolimus (B) once daily. *P < .05 versus vehicle (Dunnett or Steel test). Journal of Allergy and Clinical Immunology 2015 136, 667-677.e7DOI: (10.1016/j.jaci.2015.03.051) Copyright © 2015 American Academy of Allergy, Asthma & Immunology Terms and Conditions