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ABSTRACTS ORAL PRESENTATIONS O-01 O-02 Models for heritable skin diseases: correlation of morphological and molecular data Non-Herlitz generalize...

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Models for heritable skin diseases: correlation of morphological and molecular data

Non-Herlitz generalized junctional epidermolysis bullosa – correlation of gene mutation and electron microscopic feature

I. Hausser1, K. Aufenvenne2, A. Grall3, A. Nystroem4, P. Krieg5, J. S. Kern4, C. Andre3, F. Larcher6, M. Del Rio6, C. Weingart7, V. Oji2, L. Bruckner-Tuderman4, J. Fischer8, H. Traupe2 1 Dept. of Dermatology, EM-Lab, University Clinic Heidelberg and Core Facility Electron Microscopy Heidelberg University, Heidelberg, Germany; 2Dept. of Dermatology, University Clinic Mu¨nster, Mu¨nster, Germany; 3Centre National de la Recherche Scientifique, Institut de Ge´ne´tique et De´veloppement de Rennes, Rennes, France; 4Dept. of Dermatology, University Freiburg Medical Center, Freiburg, Germany; 5German Cancer Research Center, Heidelberg, Germany; 6Epithelial Biomedicine Division, CIEMAT and CIBERER-U714, Madrid, Spain; 7Clinic of Small Animals, Faculty of Veterinary Medicine, Freie Universita¨t Berlin; 8Institute for Human Genetics, University Clinic Freiburg, Freiburg, Germany A number of genodermatoses are characterized by distinct morphological markers which have been and are used for classification and diagnosis as well as for identifying causative gene mutations and pathogenetic pathways. Various types of animal models and organotypic cell cultures have been established to provide further insight into disease mechanisms and treatment. Selected examples are: (i) a spontaneous rat model for dominant epidermolysis bullosa revealing similar variability of anchoring fibril expression as in human patients; (ii) PNPLA1 as a new gene involved in autosomal recessive congenital ichthyosis pathology identified from a Golden Retriever breed spontaneously affected by lamellar ichthyosis; (iii) knockout mice for lipoxygenases expressing differential skin barrier defects and compensatory hyperkeratosis; (iv) a long-term skin-humanized mouse model for transglutaminase 1-deficient lamellar ichthyosis, obviously in some respects advantageous to organotypic cell cultures and successfully having been used for enzyme substitution therapy; (v) Persian cat with classical Ehlers-Danlos syndrome. Investigation of such monogenetic disease models can help to understand causal correlations between pathology and clinical manifestations and provide insights towards developing and evaluating novel causal therapies.

A. Ishiko1, K. Enosawa1, N. Iwase1, H. Kanto1, M. Ishii2, and K. Shibuya2 Dept of Dermatology and 2Surgical Pathology, School of Medicine, Toho University, Tokyo, Japan Non-Herlitz generalized junctional epidermolysis bullosa (nH-JEB) is a rare genodermatosis caused by mutation of gene encoding type 17 collagen or laminin 332. Here we report an nH-JEB case, which had been misdiagnosed as EB simplex for long time. The proband was 35-year-old male who had blister and erosion on the trunk and the extremities, nail deformities, hair loss and dental deformities. He had neither remarkable family history nor past history. Immunofluorescence (IF) study of a skin biopsy revealed low expression of collagen 17 (MAb D20) at basement membrane zone. Electron microscopic (EM) study revealed the dermo-epidermal separation at lamina lucida level. In addition, many dot-like structures were seen at lamina lucida beneath hemidesmosomes in non-blister area. Genetic analysis revealed that the patient was a heterozygote of c.2003-1G4C (intron 24) and c.3800delC (exon 52) mutations. The former may cause skipping of exon 25 (in frame), and the latter causes premature termination codon downstream. Thus nH-JEB was confirmed. In order to assess the dot-like structure at the lamina lucida, further IF study was performed using antibodies against different domains of collagen 17. As a result, the head (1A8C) and the tail (1D1) domains showed complete lack of immunoreactivity, whereas the proximal (D20) and the middle (233) extracellular domain showed marked decrease. This result indicates that the dot-like structure in the lamina lucida is composed of aberrant collagen 17 lacking head and tail domains. The gene mutation should have some other deleterious effect on the formation or shedding of collagen 17.




A Japanese case with Herlitz junctional epidermolysis bullosa

Ultrastructure of desmosomes as a diagnostic clue in a case of congenital skin fragility syndrome

K. Yoshida1, Y. Takada1, S. Hagiwara2, T. Masunaga3, A. Ishiko1 Dept of Dermatology and 2Dept of Neonatology, School of medicine, Toho University, Tokyo, Japan; 3Fundamental Research Laboratories, KOSE´ Corporation, Tokyo, Japan The proband was an 8-day-old boy, the third child of healthy unrelated Japanese parents. He was born in 39 weeks gestational age under normal spontaneous delivery, at weight 2665 g, with Apgar scores 9 and 10 at 1 and 5 min, respectively. He had neither gestational period problem, organ dysfunction nor family history of epidermolysis bullosa. The patient had erosions and blisters on the fingers, the right elbow and the perianal area soon after birth. Our initial diagnosis was nonHallopeau-Siemens type recessive dystrophic epidermolysis bullosa because the affected areas were limited mainly on his extremities. Then, nail dystrophy of hands and new blisters on friction areas appeared within 4 weeks of age, but large erosions were not seen on his trunk. Skin biopsy was taken from a new blister on the elbow. Surprisingly, immunofluorescence analysis using monoclonal antibody to g2 chain of laminin 332 demonstrated the complete loss of immunoreactivity. Monoclonal antibody against type IV collagen was positive on the floor of blister, whereas that against a6b4 integrin was positive on the roof. Electron microscopy revealed the blister within the lamina lucida. Hemidesmosomes and anchoring fibrils were normal. From these cilinicopathological findings, we diagnosed this case as Herlitz junctional epidermolysis bullosa. Genetic research is now on going. We emphasize importance of the morphological assessment by skin biopsy even though initial clinical feature was mild and limited to the extremities. Early and correct diagnosis is important to give appropriate medical supports and for genetic counseling.




Serum abnormalities and lipid stratum corneum abnormalities in IFAP syndrome 1

A. Vahlquist1, M. Virtanen1, M. Hellstro¨m-Pigg2, A. Dragomir2, K. Ryberg3, N.J. Wilson4, L. Lu5, J.A. McGrath6, F.J.D. Smith4 Dept. Medical Sciences and 2Dept Immunology, Genetics and Pathology, Uppsala University, Sweden; 3Dept. Dermatology, Uddevalla Hospital, Sweden; 4Centre for Dermatology and Genetic Medicine, Univ. of Dundee, UK; 5The National diagnostic EB Lab., St Thomas Hospital, London, UK; 6Genetic Skin Disease Group, King’s College, London, UK We report the case of a girl presenting with fragile skin syndrome from birth, and later on alopecia and focal hyperkeratosis. At age 2 the skin fragility persisted, the hair was thin and sparse and pachyonichya was evident. The patient showed no signs of cardiomyopathy. The differential diagnosis at that stage included pachyonychia congenita, ectodermal dysplasia syndrome and desmosomal gene defects, all of which are caused by a multitude of different mutations on different genes. A skin punch biopsy was taken for transmission electron microscopy. This showed throughout the epidermis a pathological cytoskeleton, with the keratin intermediate filaments clumped around the nucleus and ending abruptly at some distance from the desmosomes. The desmosomal plaques and the other cell organelles had normal ultrastructure. There were no major defects of keratohyalin. This observation further directed the molecular analyses on the desmosomal genes including desmoplakin. Direct sequencing of DNA extracted from peripheral blood lymphocytes showed compound heterozygous mutations in exon 23 and exon 24 of desmoplakin gene, DSP. Both mutations lead to frameshift-induced premature terminations in desmoplakin synthesis. Immunhistochemistry confirmed the lack of desmoplakin staining in the patient’s epidermis. This case highlights the use of electron microscopy in directing further molecular analyses in the rare cases presenting with skin fragility syndrome. Given the known risk for development of cardiomyopathy in patients with desmoplakin defects, a close cardiac monitoring is planned for this patient. The knowledge that the parents were heterozygous for one desmoplakin gene mutation each could also add in parental counseling.







A. Pietrzak , J. Portoukalian , D. Crumrine , M. Michalska-Jakubus , D. Krasowska , D. Matosiuk , J. Szumiło1, J. Wron˜ski1, M. Schmuth2, M. Haftek3, P. Elias4, E. Dybiec1, and J. Kanitakis3 1 Medical University of Lublin, Departments of Dermatology, Venereology and Pediatric Dermatology, of Synthesis and Chemical Technology of Pharmaceutical Substances, of Clinical Pathomorphology, of Vascular Surgery and Angiology, and of Pediatric Radiology, Lublin, Poland; 2University of Lyon, EA4169 and Dept. of Dermatology, Ed. Herriot Hospital, Lyon, France; 3Veterans Hospital, Dermatology Service, San Francisco, USA; 4Dept. of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria Ichthyosis Follicularis with Atrichia and Photophobia (IFAP) is a rare genodermatosis belonging to the Mendelian Disorders of Cornification, which usually show epidermal barrier abnormalities. IFAP results from mutations in the MBTPS2 gene, involved in cholesterol homeostasis, therefore patients with IFAP are expected to have lipid abnormalities and impaired cholesterol metabolism. However serum and epidermal lipids have not been so far explored in IFAP patients. We have recently studied an 18-year-old male patient with IFAP caused by a novel MBTPS2 mutation and found severe disturbances in serum lipids with abnormal lipoprotein electrophoresis, similarly to his mother (asymptomatic mutation carrier). Herein, we present the results of epidermal lipid analysis in this patient and his healthy sister. Free and protein-bound stratum corneum (SC) lipids were purified from tape strips and were analyzed with HPTLC. Transmission electron microscopy combined with lanthanum permeation and analysis of the calcium gradient was used for assessment of skin biopsies. No noticeable qualitative differences were observed in the SC lipid profile between the subjects studied; however, a minor epidermal barrier abnormality was observed in the non-involved skin of the patient and his mother. Moreover, there was evidence of abnormal lamellar body content secretion and lamellar/non-lamellar phase separation. No evidence of cytotoxity was found. The clinically marginally-involved interfollicular epidermis of IFAP showed only discrete structural abnormalities of the SC barrier, despite prominent serum lipid abnormalities. Ultrastructural analysis of a psoriasiform lesion of the patient and quantitation of the SC lipid subsets should be performed to further elucidate this complex syndrome.

1172 Journal of Investigative Dermatology (2014), Volume 134

Multispectral imaging diagnostics of skin tumors

L. Pescitelli1, A. Pelagotti1, P. Ferrara1, C. Delfino1, G. Gerlini2, A. Piva3, L. Borgognoni2, F. Prignano4 1 CNR-INO, L.go E. Fermi 6, 50125 Firenze, Italy; 2Azienda Sanitaria Locale (ASL) 10, Florence, Italy; 3University of Florence, via di S. Marta, Florence, Italy; 4Department of Surgery and Translational Medicine, Section of Clinical, Preventive and Oncology Dermatology, University of Florence, Florence, Italy We propose a new diagnostic tools for pigmented lesions of the skin. Thanks to the fact that light propagates into the skin and reaches different depths depending on its wavelength, using a multispectral imaging device to acquire a set of images in the visible and near infrared range, this system is capable of imaging layers of structures located at increasing depths, (whereas with dermoscopy it is only possible to observe a bi-dimensional plane.) Dermoscopic criteria can be easily applied to describe each multispectral image, and dermatoscopic features are better detectable for some melanocytic nevi and some melanomas than with standard dermoscopic examination. New criteria are then proposed in order to take into account the structure layering. The first set of new parameters describe how the classic clinical ones vary across different images taken at increasing wavelengths. More features are then introduced, e.g. the longest wavelength where structures can be detected gives an estimate of the maximum depth reached by the pigmented lesion. The research was carried out in collaboration with the Regional Melanoma Referral Center of Tuscany in Italy. Together with the set of images at different wavelengths, for each pigmented lesion analyzed a clinical and a dermoscopic image were acquired. Of the 40 lesions acquired 30 underwent excision, followed by histopatological examination. Of those, 10 were melanomas, 2 were basal cell carcinomas and the remaining lesions were judged as common nevi. A first comparison between data of malignant and benign nevi was therefore possible, although the research is on-going and more data is being gathered.

& 2014 The Society for Investigative Dermatology




Human Cutaneous Membrane Basal Zone (HCBMZ) - Ultrastructural terminology revisited

Effects of proinflammatory cytokines in a skin three-dimensional model: a structural and ultrastructural study

A. Panuncio, K. Ceroni Hospital de Clı´nicas, Electron Microscopy Unit, UDELAR (Universidad de la Repu´blica), Montevideo, Uruguay Ultrastructural approach of the HCMBZ could be difficult because terms actually in use are confuse. We review in brief the terminology and suggest some modifications (quotation marks) as follows. The basal keratinocyte unit membrane has a dense cytoplasmic leaflet, an electronlucent intermediate layer and a thinner dermal electron dense leaflet (M line). The ‘‘outer plasmalemmal hemidesmosomal plate’’ (20–40 nm, PHP) was called attachment plate because in tangential sections, tonofilaments resemble to reach it. PHP is separated by a narrow electronlucent space from a thinner ‘‘inner hemidesmosomal plate’’; place were usually tonofilaments are really attached. The basal lamina (BL) or lamina densa is fixed to the plasmalemma by the ‘‘subplasmalemmal’’ lamina lucida, sometimes both were called together as basal membrane. In the middle aspect of the lamina lucida, facing each hemidesmosome, a small electron dense layer is seen: the H line, ‘‘supra-basal’’ dense plate or half plate. Anchoring filaments are thin perpendicular filaments that cross this structure. In order to avoid confusion with the next term described, we propose to call them anchoring ‘‘thin filaments’’. In the sub-basal region we recognize ‘‘dermal’’ anchoring fibrils (collagen ¼ col VII). They descend from BL into papillary dermis, surround collagen (col I–III) and end in anchoring plates (col IV–VII). We suggest to call them ‘‘dermal anchoring plates’’ to differentiate from the cytoplasmic plate mentioned. We expect that these little changes suggested could contribute to facilitate the comprehension of the HCMBZ ultrastructure and encourage beginners to do electron microscopic skin studies.

E. Donetti1, L. Cornaghi1, A. Gualerzi1, G. Sallese1, F.W. Baruffaldi Preis2, P. Romagnoli3, L. Pescitelli4, F. Ricceri4, F. Prignano4 1 Dipartimento di Scienze Biomediche per la Salute, Universita` degli Studi di Milano; 2I.R.C.C.S. Istituto Ortopedico Galeazzi, 3Dipartimento di Medicina Sperimentale e Clinica e 4Dipartimento di Chirurgia e Medicina Traslazionale, Universita` degli Studi di Firenze, Italy Psoriasis is an autoimmune disease in which epidermal keratinocytes and innate immunity effector cells play a pivotal role in the lesion formation. Among the cytokines involved in the pathogenesis and in the progression of the disease, tumor necrosis factor (TNF)-alpha and interleukin (IL)-17 are the most relevant. A three dimensional model of organotypic human skin cultures is a valuable approach for exposing epidermis to TNF-alpha and IL-17 as specific stimuli. Normal human skin explants were obtained from plastic surgery of healthy 20–40 year-old women (n ¼ 5) after informed consent. Bioptic fragments were cultured overnight in a DMEM medium and further divided before adding either 100 ng/ml TNF-alpha or 50 ng/ml IL-17. Cytokine treatment lasted 24 h. All samples were processed for light and transmission electron microscopy. Epidermal proliferation, expressions of terminal differentiation biomarkers (keratin 10, K10, and 14, K14) and of occludin were investigated by immunofluorescence. Both cytokines induced a strong inhibition of keratinocyte proliferation (more than 75% compared with their respective controls) and a non-continuous occludin expression in the granular layer. K10 and K14 immunolabellings were similar in all groups. TEM analysis did not show any ultrastructural alterations of basal keratinocytes and desmosomes were uniformly distributed throughout the epidermis, although intercellular spaces were slightly enlarged in suprabasal layers of cytokine-treated samples. These preliminary results suggest that TNF-alpha and IL-17 induce an altered homeostasis of the inner proliferative layer and of the upper granular layer, as shown by cell proliferation inhibition and occludin expression.



A case of Dermatosparaxis/Ehlers-Danlos Syndrome (EDS) type VIIC: the role of electron microscopy in the diagnosis 1







J. Solomons , D. Cilliers , P. Coucke , S. Symoens , M. Cohen , F. M. Pope , G. Sobey , R. Black6, B. Wagner7 1 Department of Clinical Genetics, Oxford University Hospitals, Oxford, UK; 2Centre for Medical Genetics Ghent, Ghent University and University Hospital Ghent, Ghent, Belgium; 3Department of Paediatric Pathology, Sheffield Children’s Hospital, Sheffield, UK; 4NSCT Specialist EDS Service, Northwick Park Hospital, Harrow, Middlesex, UK; 5NSCT Specialist EDS Service, Sheffield Children’s Hospital, Sheffield, UK; 6Department of Obstetrics, Oxford University Hospitals, Oxford, UK; 7Electron Microscopy Section, Histopathology Department, Royal Hallamshire Hospital, Sheffield, UK Dermatosparaxis/EDS VIIC, a rare autosomal recessive inherited connective tissue disorder, is characterised by extreme skin fragility, premature rupture of membranes in pregnancy and spontaneous rupture of internal organs. Here we report a second patient with EDS VIIC presenting with congenital skull fractures and skin lacerations at birth, complications which may occur more frequently than previously thought in this condition. The third child of healthy consanguineous parents delivered by elective caesarean section, due to maternal hypertension, and forceps, by an experienced obstetrician. The infant was delivered with full thickness laceration of the skin adjacent to left eye, which extended posteriorly, and an 80% circumferential full thickness laceration around the neck were noted at birth. Skull fractures were suspected clinically, located lateral to the scalp laceration. One and a half hours after delivery the infant suffered a sudden bradycardia and died. At autopsy it was noted that, in addition to the haemorrhagic scalp, stitches had cut through the skin. Radiology confirmed fracture of the right parietal bone. As electron microscopy of dermis is often helpful in the investigation of a variety of matrix disorders, including the various subtypes of Ehlers-Danlos syndrome, this test was requested. Electron microscopy revealed that all the collagen fibrils were poorly formed having the so called hieroglyphic form. The hieroglyphic form of collagen fibrils are pathogonomic of EDS VIIC. To confirm the diagnosis, analysis of the ADAMTS2 gene was performed. This gene codes for the procollagen I N-proteinase involved in the cleavage of procollagens I, II and III.

Cutaneous manifestation of Kikuchi’s disease

K. Kanno1, M. Minami-Hori1, A. Ishida- Yamamoto1, H. Iizuka1, K. Komura2, K. Oikawa3, N. Miyokawa3 1 Dept. of Dermatology, Asahikawa Medical University, Asahikawa, Japan; 2Dept. of Internal Medicine Asahikawa Medical University, Asahikawa, Japan; 3Laboratory of Pathology, Asahikawa Medical College Hospital, Japan In December 2011, a 38-year-old Japanese man presented with a high grade fever, severe pain in both small and large joints, as well as bilateral cervical lymphadenopathy. He developed arthralgia in 2006 and 2008. Each episode subsided within 6 month, and no definitive diagnosis was confirmed. He had dark red erythematous atrophic plaques on his scalp, face, neck and upper back. He was referred to our department for his skin lesions. The initial diagnosis of the skin biopsy was discoid lupus erythematosus (DLE). Although he was treated with a medium dose of systemic steroids, the arthritis and lymphadenitis persisted. He received a lymph node biopsy three times, because lymphoma was suspected. The diagnosis of Kikuchi’s disease was made after the final lymph node biopsy. Skin lesions were initially mistaken for DLE. Re-examination of the skin biopsy revealed that the dermal cellular infiltrate was similar to that of the lymph node indicating that the skin lesions were manifestations of Kikuchi’s disease.



Bullous pemphigoid IgG induces BP180 internalization via a macropinocytic pathway

Ultrastructural contribution to the characterization of pathogenesis of lichen planus: classics and modern data

D. Tsuruta and S. Hiroyasu Dept. of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan Bullous pemphigoid (BP) is an autoimmune blistering skin disease induced by autoantibodies against a 180 kDa bullous pemphigoid antigen BP180/collagen type XVII/BPAG2 (BP180). In at least animal models, BP180 autoantibody-antigen complex is insufficient to develop blisters, although involvement of complement and neutrophils is required. However, previous studies revealed that cultured keratinocytes treated with BP-IgG show a reduction in the adhesive strength and an expression of BP180. These results suggest that the autoantibodies may directly affect epidermal cell-extracellular matrix integrity. In this study, we, thus, explored the consequences of two distinct epithelial cells, 804G rat bladder cells and normal human epidermal keratinocytes, treated with BP-IgG, in particular the fate of BP180. First, we followed the fate of green fluorescent protein-tagged BP180 in 804G and normal human epidermal keratinocytes after BP-IgG clustering. After BP-IgG treatment, the adhesive strength of the cells to their substrate was decreased, and BP180 was internalized in both cell types, together with the early endosomal antigen-1, suggesting that internalization of BP-IgG occurs through endocytic pathway. By using various endocytosis inhibitors and a fluid-uptake assay, we next demonstrated that BP-IgG-induced BP180 internalization is mediated via a macropinocytic pathway. Moreover, a macropinocytosis inhibitor rescued a BP-IgG-induced reduction in the adhesive strength of cellsubstrate attachment. These results suggest that BP180 internalization induced by BP-IgG plays an important role in the initiation of BP.

V. Groma1, I. Legusa2, and M. Tarasovs1 Laboratory of Electron Microscopy, Institute of Anatomy and Anthropology, 2Riga Stradins University, Riga, Latvia; Clinical Centre for Skin and Sexually Transmitted Diseases, Riga, Latvia Lichen planus (LP) is an inflammatory disease of unknown etiology. Damaged keratinocytes via interaction with Langerhans cells cause dermal proliferation of lymphocytes. Finally, these recruiting macrophages, contribute to damage of the epidermis, in general, and the basal layer, in particular. Recent studies added additional data on the biological role of matrix metalloproteinases strongly involved in remodeling of extracellular matrix, vascular barriers, and basement membrane components. We studied punch biopsies with histologically confirmed diagnosis of LP by use of conventional electron microscopy, and combined these findings with immunohistochemical detection of metalloproteinases in various types of LP. The basal layer keratinocytes with disruption of the tonofibrillar system, irregular widening of intercellular spaces, occasional desmosomes lying free in the intercellular space, colloid bodies, convolution, replication, splitting of the basal membrane were accounted ultrastructurally. Melanocytes revealing cilia, macrophages and lymphocytes as well as fibroblasts demonstrating prominent dentation of the nuclear envelope, and surrounded by collagen microfibrills and elastic fibers appeared at the epidermal/dermal interface. The above mentioned changes of the basal layer were paralleled by moderate and strong expression of metalloproteinase-9 in a hypertrophic and follicular LP, accordingly. By contrast, LP pemphigoides demonstrated weak expression of MMP-9 to the basal layer of epidermis whereas intense expression in dermal lymphohistiocytic infiltrate. The reported ultrastructural findings in the basal layer of epidermis in LP are consistent with the findings by immunohistochemistry suggesting a complex interplay of keratinocytes and lymphocytes with other types of cells, as well as the possibility of damage mediated by the immune system.


www.jidonline.org 1173




Primary adenoid cystic carcinoma of the skin metastatic to the lymph nodes: immunohistochemical study of a new case 1





D. Rocas , C. Asvesti , A. Tsega , P. Katafygiotis , J. Kanitakis 1 Dept. of Dermatology, Ed. Herriot Hospital, Lyon, France; 2Dermatology Practice, Glyfada, Greece; 3Pathology Laboratory, Athens, Greece; 4Department of Pathology, Attikon University General Hospital, Haidari, Greece Adenoid cystic carcinoma is a particular type of glandular tumor mainly developing in the parotid gland and the breast, wherefrom it can extend/metastasize to the skin. Primary cutaneous adenoid cystic carcinoma (PCACC) is much rarer, with only 62 cases studied in detail so far. PCACC is usually regarded as apocrine in origin/differentiation, but its precise histogenesis is uncertain. PCACC has usually an indolent course, but can produce local recurrences and regional (lymphnode) and distant (pulmonary) metastases. We report a 47-year-old Greek woman with an erythematous tumor of the breast skin that had been present for 25 years, grew slowly and eventually metastasized to the axillary lymph-nodes. Microscopically the primary was made of deeply-basophilic cells arranged in dermal nodules of varying size, some of which showed a characteristic cribriform appearance, suggestive of adenoid cystic carcinoma. The lymph-node metastasis node that developed some months later showed a similar appearance. Both the cutaneous and lymph-node tumor expressed several (sweat-gland-related) antigens, including pan-keratin, keratin 7, Epithelial Membrane Antigen, S-100 protein, CD10, CD117, Ki67, but did not express keratin 20, estrogen- or progesterone- receptors, p63, GCDFP-15, c-erbB2/Her2, chromogranin, calretinin, Ep-CAM/CD326/Ber-EP4. Work-up for an underlying mammary tumor was negative, therefore the lesion was diagnosed as PCACC. Primary skin adenocarcinomas may be difficult to distinguish from underlying glandular tumors that metastasize or extend to the skin, and although immunohistochemistry may be of some help, the distinction is not always easy, as highlighted in the present case.

Ultrastructural changes induced by mechanical stimulation of the aged skin

M. Haftek1, A. Jeudy2, E. Colomb1, F. Fanian2, P. Humbert2 University Lyon 1, EA4169 ‘‘Physiological, clinical and therapeutic aspects of the skin barrier function’’, INSERM US 7- CNRS UMS 3453- SFR Lyon-Est Sante´, Lyon; 2Research and Studies Center on the Integument (CERT), Department of Dermatology, Clinical Investigation Center (CIC BT506), INSERM UMR1098, FED4234 IBCT, University of Franche-Comte´, Besanc¸on, France Mechano-transduction consists in the conversion of mechanical signals into biochemical responses. The impact of mechanical stimulation on dermal fibroblasts and on the structure of conjunctive tissue has been previously demonstrated whereas loss of mechanical tension appears to be the major factor underlying decreased collagen synthesis in aged skin. We examined structural changes induced in human facial skin after 2 months of mechanical stimulation. Skin biopsies were taken under local anesthesia in 10 subjects, on the treated and non-treated sides, after 24 sessions of massage with a new medical device (LPG systems, Valence, France). Tissue samples fixed in 3% paraformaldehyde were embedded in LRWhite resin and used for immunodetection of alpha-SM actin, whereas 2% glutaraldehyde fixation with 1 % OsO4 post-fixation preceded Epon embedding and standard ultrastructural examination. Separate tissue fragments were used for in vitro assays, i.e.: dosage of hyaluronic acid, elastin, type-I collagen, MMP9 and retraction of dermis equivalent with isolated fibroblasts. Biometrological assessments were also performed. A significant improvement of various clinical signs associated with skin aging was noted after treatment and correlated well with an increased expression of the dermal components revealed biochemically. Ultrastructural signs of fibroblast activation were accompanied by remodeling of the dermal structure in 4 out of 10 cases. SM actin was present in virtually all fibroblasts and was only increased in the good responders (half of the subjects). Our results confirm the restructuring effect of the mechano-stimulation procedure in some patients presenting age-related changes in their facial skin.




Aberrant retinoic acid binding protein-2 expression accelerates skin ageing

Developmental alterations of physical properties and components of neonatal-infantile stratum corneum of upper thighs and diaper-covered buttocks during the first year of life

D. Passeri, G. Costanza, A. Di Stefani, M. G. Scioli, E. Doldo, A. Orlandi Department of Anatomic Pathology, Tor Vergata University of Rome, Italy Retinol and derivatives have important roles in growth and differentiation of several tissues, including skin. Cellular retinol binding and retinoic acid binding proteins play relevant and distinct roles in the intracytoplasmic retinoid trafficking. The expression of cellular retinoic acid binding protein-2 (CRABP-2) influences keratinocyte differentiation and retinoic acid-induced transcriptional activities. We previously documented that CRABP-2 expression is markedly reduced in poorly differentiated squamous cell carcinomas; moreover, two-stage skin carcinogenesis induced more frequent and severe skin tumors in CRABP-2 knock-out compared to wild-type C57Bl/6 mice compared to wild-type C57Bl/6 mice. We investigated if reduced expression of CRABP-2 influences skin ageing. We – quantified - observed that keratinocyte layers and basal keratinocyte proliferation rate were reduced in 18–27 month-old CRABP-2 knock-out compared to wild-type C57Bl/6 mice of the same mean age. Moreover, ultrastructural investigation revealed that the number of lamellar bodies and the quantity of secreted content at the interface of stratum corneum and stratum granulosum appears reduced in old CRABP-2/ keratinocytes compared to those of old wild-type C57Bl/6 mice. So, signs of skin ageing appeared more severe in CRABP-2 knock-out compared to wild-type mice. Our data suggest that aberrant cellular retinol and retinoic acid binding protein expression concurs to accelerate skin ageing. Targeted therapeutic interventions aimed to restore CRABP-2-mediated intracellular retinoid trafficking can amplify a successful retinoid therapy to counteract skin ageing.

O-17 Epidermal lamellar granule secretion starts before the establishment of intercellular permeability barrier A. Ishida-Yamamoto, S. Igawa, M. Kishibe, and H. Iizuka Dept. of Dermatology, Asahikawa Medical University, Asahikawa, Japan Tight junctions (TJs) form a single layered network in simple epithelia. TJs are important for both barrier functions and vesicular transport. Epidermis is stratified epithelia and lamellar granules (LGs) are secreted from the stratum granulosum (SG) in a sequential manner. Previously, continuous TJs and paracellular permeability barriers were found in the second layer (SG2) of SG in mice, but their fate and correlation with LG secretion have been poorly understood. We studied epidermal TJ-related structures in humans and in mice and found occludin/ZO-1 immunoreactive multilayered networks spanning the first layer of SG (SG1) and SG2. Paracellular penetration tracer passed through some TJs in SG2, but not in SG1. LG secretion into the paracellular tracer positive spaces started below the level of TJs of SG1. Polarized intracellular transport of LGs started by the third layer of SG. Our study suggests that polarized transportation and secretion of LGs are not dependent upon establishment of intercellular tracer permeability barrier function of TJs in the mammalian epidermis.

1174 Journal of Investigative Dermatology (2014), Volume 134

Masako Minami-Hori1, Mizue Fujii1, Wakana Nomura1, Kyoko Kanno1, Akemi IshidaYamamoto1, Yuki Miyauchi2, Tsutomu Fujimura2, Mitsuyuki Hotta2, Yutaka Takagi2, Takashi Kitahara2, Yoshinori Takema2, and Hajime Iizuka1 1 Department of Dermatology, Asahikawa Medical University, Asahikawa, Hokkaido, Japan; 2Kao Corporation, Haga-Gun, Tochigi, Japan Although physical properties of neonatal-infantile stratum corneum (SC) change drastically after birth, precise location-specific analysis has not yet been fully elucidated. To determine the chronological alterations of skin properties and functions of SC in the thighs and diaper-covered buttocks of infants during the first year of life. The measurements were performed daily between the third and seventh day, and then at 1, 3, 6, 9, 12 month, respectively. Nineteen children and their mothers were subjected to the measurements described below consecutively for 6 times. The skin surface configuration has changed during the measurements. The SC water content in the thighs of the neonates was lower than in those of their mothers. The SC water content in the buttocks of neonates was slightly higher than in the thighs. The SC content values obtained from both thighs and the buttocks of neonates increased rapidly during the first month of life. The neonatal barrier function was better than that of their mothers at both sites, which decreased significantly during the first year. This correlated most significantly with the total amount of ceramides and specifically o-hydroxy fatty acid-esterified CERs. Ester-binding sebum was lower than in mothers with a more marked decrease at the buttocks. The alterations of natural moisturizing factors and free fatty acids had no significant correlation with SC function. The neonatal-infantile SC in the thighs and diaper-covered buttocks show location-specific developmental alterations during the first year of life.

O-18 Tight junction (TJ)-like structures contribute to the compensatory hyperkeratosis in claudin-1 –deficient patient with Ichthyosis, Hypotrychosis and Sclerosing Cholangitis (IHSC) syndrome

M. Haftek1, R. Abdayem1, E. Colomb1, S. Hadj-Rabia2 University Lyon 1, EA4169 ‘‘Physiological, clinical and therapeutic aspects of the skin barrier function’’, INSERM US 7- CNRS UMS 3453- SFR Lyon-Est Sante´, Lyon; 2MAGEC – Dept. of dermatology - IFR 94, Hoˆpital Necker, Paris, France In newborn mice, TJs play an important function in controlling transepidermal water flux, because animals with the invalidated claudin-1 gene are unable to survive after birth, as they suffer from a rapid severe dehydration. Additionally, this observation underscores the essential role of claudin1 in TJ function. Naturally occurring human mutants that fail to produce claudin-1 develop IHSC syndrome (formerly called NISCH) but survive after birth and their premature death is due to dysfunction of their liver and renal simple epithelia. Thickening of the stratum corneum (SC) observed in IHSC syndrome may be interpreted as the tissue’s successful attempt to compensate for the compromised TJ function. As TJ-like structures, which persist in the SC, may contribute to the SC cohesion and participate in the regulation of its desquamation rate, we have quantified these riveting points in our IHSC patient and compared their expression to that observed in normal individuals. Ultrastructure of glutaraldehyde and OsO4 -fixed, Epon-embedded skin samples was examined and number of typical fusions between the apico-lateral portions of corneocyte envelopes was recorded. TJ-like structures were observed in 80% of such intercorneocyte contacts, a strikingly increased frequency compared to 40% encountered in normal skin (n ¼ 20). It appears that in our patient with IHSC syndrome, the SC retention and, thus, hyperkeratosis is linked to an over-expression of TJ-like structures. Therefore, TJs may also influence epidermal barrier function in a manner independent from their molecular composition.





Langerhans cells lacking Birbeck granules in cutaneous free flaps employed in the oral cavity 1



Christine M. Betts , C. Baldovini , and Maria P. Foschini 1 DIMES - Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna Medical School, Via San Giacomo 14, and 2DIBINEM - Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology ‘‘M. Malpighi’’, at Bellaria Hospital, Bologna, Italy Langerhans cells (LC) are specialized cells located in the skin and mucosa, whose function is antigen recognition, degradation and presentation to the immune system. LC are positive for CD1A and Langerin, while at ultrastructure show intracytoplasmic organelles, called Birbeck granules (BG). Purpose of the present study is to analyse the characteristics of LC in cutaneous free flaps employed to repair tissue defects resulting from removal of oral squamous cell carcinoma (OSCC). Materials and methods: two cases who underwent surgery for OSCC, developed a second OSCC on the cutaneous free flap applied after the surgical removal of the primary carcinoma. Sections from selected block of the primary OSCC, the surrounding non neoplastic oral mucosa and from the second OSCC and the surrounding cutaneous skin, were cut and stained with anti CD1A and Langerin antibodies. In addition small fragments were subsequently micro-dissected from the same paraffin blocks and processed for electron microscopy. Results: Immunohistochemistry: all the specimens showed LC positive both for CD1A and Langerin. On ultrastructure, cells with clear cytoplasm and convoluted nuclei reminiscent of LC were well evident. These latter cells completely lacked BG in their cytoplasm. Discussion: The present study is the first describing LC in cutaneous free flaps implanted on the oral cavity and demonstrating Langerin positive LC lacking BG. The existence of LC devoid of BG has been recently described in the skin of an otherwise healthy man having a point mutation on the Langerin gene.

O-21 3


A. Stanley , C. Brakebusch , F. Quondamatteo Skin and Extracellular Matrix Research Group at NUI Galway Anatomy, Galway, Ireland; 2 Anatomy NUI Galway, Galway, Ireland; 3BRIC, University of Copenhagen, Copenhagen, Denmark RhoA and Rac1 are two members of the Rho GTPase family of proteins. Rho GTPase proteins can act as molecular switches by cycling between an inactive and an active state. In their active, GTPbound, state they can function as signalling molecules by binding and activating specific effector proteins. This can control several biological activities including the reorganisation of the actin cytoskeleton. Many in vitro studies have therefore linked these proteins to the formation and stabilization of cell-cell junctional complexes as well as to a stable cellular interaction with the epidermal basement membrane, suggesting them as essential factors to the structural integrity of the skin epithelium. We have carried out an ultrastructural analysis of various aspects of the interfollicular epidermis of mice carrying a deletion of either Rac1 or Rho A which, in skin, was restricted in keratinocytes. Transmission electron microscopic (TEM) analysis was carried out in Galway, whereas the tissue was provided by the Brakebusch Lab (BRIC, Copenhagen, Denmark), where housing, treatments, and sacrifice of the mice, took place according to the local animal ethics guidelines and with corresponding ethical approval. TEM analysis included qualitative study and quantitative analysis of the integrity of the DEJ. The data of our investigation support the notion that in vivo these proteins, at least when deleted individually, are dispensable for maintaining the integrity of the ultrastructure of the interfollicular epidermis.


Chao-Kai Hsu1,2, Hans I-Chen Harn3, Hsi-Hui Lin3, Yang-Kao Wang3, Shyh-Jou Shieh4, Chao-Ming Cheng5, Julia Yu-Yun Lee2, and Ming-Jer Tang3* Institute of Clinical Medicine; 2Department of Dermatology; 3Department of Physiology; 4 Department of Surgery, National Cheng-Kung University College of Medicine and Hospital, Tainan, Taiwan; 5Institute of Nanoengineering and Microsystems, National Tsing Hua University, Hsinchu, Taiwan Keloids are pathological scars characterized by excessive extracellular matrix (ECM) production and prone to form in the body area with increased skin tension. Caveolin-1 (Cav-1) is the principal coat protein of caveolae, functioning as mechanosensor(s) and lipid regulation. Cav-1 is found downregulated in various fibrotic disorders, such as idiopathic lung fibrosis and systemic sclerosis. We investigated the expression of Cav-1 in keloid, and how Cav-1 regulates the mechanical properties of keloid fibroblasts (KFs) as well as ECM production. Primary cultures of dermal fibroblasts from keloid tissue were used for the in vitro studies, and we selected the location- and age-matched normal skin as control. Cav-1 expression in vivo and in vitro were both found decreased in keloid by immunofluorescence and Western blot studies. KFs were measured softer than normal fibroblasts (NFs) using atomic force microscopy. Knocking down Cav-1 by siRNA was associated with cell softening and higher ECM production in NFs, but not in KFs. In conclusion, the expression of Cav-1 in keloid is downregulated, which may be associated with their changes in mechanical properties and their hyper-responsiveness to mechanical stimulation.



Keratinocyte restricted deletions of Rho A and Rac1 do not substantially alter the ultrastructure of the interfollicular epidermis in mice 1,2

The role of caveolin-1 in keloid pathogenesis: from a mechanobiological view

Bridging molecules in basement membrane: Nidogen-1 but not Nidogen-2 deposition in skin basement membranes depends on the binding module III4 of the laminin c1 chain

S. Mokkapati1, M. Bechtel1, A. Fleger-Weckmann1, M. Koch2, W. Bloch3, N. Smyth4, I.Hausser5, HJ. Stark6, D. Breitkreutz6, and R. Nischt1 University Hospital of Cologne, 1Dept. of Dermatology and 2Dept. of Prosthetic Dentistry, and 3 German Sport University Cologne, Inst. of Cardiology and Sport Medicine, Dept. of Molecular and Cellular Sport Medicine, Cologne, Germany; 4School of Biological Science, University of Southampton, Southampton UK; 5Dept. of Dermatology, EM-Lab, University Clinic, University of Heidelberg, and 6German Cancer Research Center, Div. of Genetics of Skin Carcinogenesis, Heidelberg, Germany Nidogen-laminin interactions are considered to be crucial for basement membrane (BM) assembly. Previously, testing this in skin-organotypic 3D-coculture, we could block BM assembly by a peptide harboring the nidogen binding module III4 of the laminin g1 chain (g1III4) or by complete nidogen depletion. According to ultrastructure also hemidesmosomes and basal keratin filament associations were abolished which could be reversed by recombinant nidogen-1 or -2. Contrarily, in skin nidogen depletion prevented BM formation in small vessels but not at the dermo-epidermal junction which revealed only sparse defects in basal cell-BM attachment, shown by immunofluorescence and electron microscopy. Surprisingly, the phenotype differed considerably in mice lacking the III4-module in the 1 chain. Thus, in g1III4-deficient mice BMs appeared normal including ultrastructural features. Furthermore, while nidogen-1 deposition was strongly reduced, nidogen-2 patterns were unchanged, indicating differences in cell- and tissuespecific functions of both nidogens and their laminin interactions. Mice with additional deletion of the laminin g3 chain, which contains a g1-like nidogen binding module, showed a further reduction of nidogen-1 in the dermo-epidermal BM, again without affecting nidogen-2. Apparently, in vivo only nidogen-1 deposition is critically dependent on the ‘‘classical’’ nidogen binding III4-modules of the laminin g1 and g3 chains, whereas nidogen-2 is independently recruited either by binding in an alternative way to laminin or to another BM protein. Confirming this, more recent studies on binding properties of recombinant nidogen fragments and functional mapping in nidogen-deficient 3D-cocultures revealed that specifically the G3 domain of nidogen2 (not of nidogen-1) could bridge laminin and collagen IV.

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