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2014 ; 134
(4
): 781-791.e1
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Mechanisms of abnormal lamellar body secretion and the dysfunctional skin barrier
in patients with atopic dermatitis
#MMPMID25131691
Elias PM
; Wakefield JS
J Allergy Clin Immunol
2014[Oct]; 134
(4
): 781-791.e1
PMID25131691
show ga
I review how diverse inherited and acquired abnormalities in epidermal structural
and enzymatic proteins converge to produce defective permeability barrier
function and antimicrobial defense in patients with atopic dermatitis (AD).
Although best known are mutations in filaggrin (FLG), mutations in other member
of the fused S-100 family of proteins (ie, hornerin [hrn] and filaggrin 2
[flg-2]); the cornified envelope precursor (ie, SPRR3); mattrin, which is encoded
by TMEM79 and regulates the assembly of lamellar bodies; SPINK5, which encodes
the serine protease inhibitor lymphoepithelial Kazal-type trypsin inhibitor type
1; and the fatty acid transporter fatty acid transport protein 4 have all been
linked to AD. Yet these abnormalities often only predispose to AD; additional
acquired stressors that further compromise barrier function, such as
psychological stress, low ambient humidity, or high-pH surfactants, often are
required to trigger disease. T(H)2 cytokines can also compromise barrier function
by downregulating expression of multiple epidermal structural proteins, lipid
synthetic enzymes, and antimicrobial peptides. All of these inherited and
acquired abnormalities converge on the lamellar body secretory system, producing
abnormalities in lipid composition, secretion, and/or extracellular lamellar
membrane organization, as well as antimicrobial defense. Finally, I briefly
review therapeutic options that address this new pathogenic paradigm.