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Journal of Lipid Research, Vol. 44, 93-102, January 2003 Sphingosylphosphorylcholine is upregulated in the stratum corneum of patients with atopic dermatitis
* Department of Dermatology, Tokyo Women's Medical University, Tokyo Published, JLR Papers in Press, October 1, 2002. DOI 10.1194/jlr.M200225-JLR200
1 To whom correspondence should be addressed. e-mail: imokawag{at}dream.ocn.ne.jp
To clarify the functional relevance of sphingomyelin (SM) deacylase to the ceramide deficiency seen in atopic dermatitis (AD), we developed a new highly sensitive method and measured the metabolic intermediate sphingosylphosphorylcholine (SPC) that accumulates in the stratum corneum. SPC in intercellular lipids extracted from stratum corneum was reacted with [14C]acetic anhydride to yield [14C-C2]SM, which was then analyzed by TLC. In both the lesional and non-lesional stratum corneum obtained from patients with AD, there was a significant increase in the content of SPC over that of healthy control subjects. There was a reciprocal relationship between increases in SPC and decreases in ceramide levels of stratum corneum obtained from healthy controls, and from lesional and non-lesional skin from patients with AD. Comparison with other sphingolipids present in the stratum corneum demonstrated that there is a significant positive correlation between SPC and glucosylsphingosine, another lysosphingolipid derived from glucosylceramide by another novel epidermal enzyme, termed glucosylceramide deacylase. In contrast, there was no correlation between SPC and sphingosine, a degradative product generated from ceramide by ceramidase. These findings strongly suggest the physiological relevance of SM deacylase function in vivo to the ceramide deficiency found in the skin of patients with AD.
Abbreviations: AD, atopic dermatitis; Cdase, ceramidase; GlCdase, ß-glucocerebrosidase; PC, phosphorylcholine; SM, sphingomyelin; SMase, sphingomyelinase; SPC, sphingosylphosphorylcholine; Sph, sphingosine; TLC, thin layer chromatography Supplementary key words sphingomyelin deacylase barrier disruption ceramide deficiency
Intercellular lipids in the stratum corneum have been implicated as important determinants in the water-retaining properties (1, 2) and in the barrier function (3, 4) of the skin. Ceramides are major constituents of intercellular lipids, comprising more than 50% of them. Previously, we demonstrated that there is a marked reduction in the amount of ceramides in the stratum corneum in lesional and in non-lesional forearm skin of patients with atopic dermatitis (AD) (5), which suggested that the ceramide deficiency is an important etiologic factor for the barrier-disrupted and dry skin seen in AD. Subsequently, we found that the causative factor behind the ceramide deficiency in the stratum corneum of patients with AD is an abnormal expression of sphingomyelin (SM) deacylase in their epidermis (6). This enzyme hydrolyzes SM at the acyl site to yield free fatty acid and sphingosylphosphorylcholine (SPC) instead of the formation of ceramide and phosphorylcholine (PC) by sphingomyelinase (SMase). Direct enzymatic analysis of the stratum corneum or of the epidermis of patients with AD revealed that there are 9-fold or 3-fold increases, respectively, in the activity of SM deacylase in patients with AD compared with healthy normal controls (7). The sum of those findings demonstrates that the novel epidermal enzyme SM deacylase is expressed at high levels in the epidermis of patients with AD. The competition of this enzyme with SMase for the common substrate SM leads to the ceramide deficiency in the stratum corneum of patients with AD. Thus in this study, in order to clarify the physiologic and functional relevance of SM deacylase to the ceramide deficiency in the epidermis of patients with AD, we have determined whether the major metabolic intermediate, SPC, that is produced actually accumulates in the stratum corneum of patients with AD as a result of SM deacylase activity.
Materials SPC was purchased from Matreya Inc. (Pleasant Gap, PA). Sphingosine (Sph), glucosylsphingosine (GS), and ceramides were obtained from Sigma Chemical Co. (Saint Louis, MO). [Methyl-14C]acetic anhydride was purchased from Amersham. All other chemicals were of reagent grade.
Preparation of stratum corneum
Purification of SPC from stratum corneum lipids
HPLC-mass spectrometry
Quantitative assay for SPC, GS, or Sph by N-acetylation with [methyl-14C]acetic anhydride
Lipid extraction To measure ceramide and lysosphingolipids, including SPC, GS and Sph, stratum corneum lipids were extracted with the modified method of Rawlings et al (13). In brief, stratum corneum was removed from the volar side of forearm skin by stripping with adhesive tape (P.P.S. Nichiban: 4 x 2.5 cm) three times. Next, the stratum corneum was separated from the adhesive tape by washing with n-hexane under ultrasonication (Bransonic B3200, Yamato Scientific Co.). The separated stratum corneum was dried and weighted (0.51.0 mg per sample) to express SCP amount as ng/mg stratum corneum weight. Sphingolipids, including ceramides, SPC, GS, and Sph, were extracted from the separated stratum corneum with chloroform-methanol (2:1, v/v) and were subjected to quantitation of ceramides, SPC, GS, and Sph.
Thin-layer chromatography for ceramide quantitation
Statistical analysis
SPC levels in the stratum corneum of healthy subjects To determine whether SPC exists in the stratum corneum of healthy subjects at substantial levels, HPLC-MS spectrometry was carried out using lipids extracted from the stratum corneum following their separation by TLC (Fig. 3A) . Figure 3B shows mass chromatograms of purified Sph-PC (20 ng) injected into the LC-MS, and peaks selected as the pseudo-molecular ions ([M-H]-) of the molecular species of Sph-PC at m/z 184 and m/z 465 were observed clearly. As shown in Fig. 3C , the mass spectrum of each of these molecular species was obtained and pseudo-molecular ions were detected with strong intensity at m/z 180 and m/z 456. Furthermore, ions due to the elimination of sphingosine from the molecules were also detected at m/z 184, although the intensity of those ions was rather weak. Mass chromatograms of the TLC-separated lipids (Fig. 3D) revealed that there are two peaks at 184 m/z and 465 m/z that correspond in molecular weight to PC and SPC, respectively. This chromatographic pattern is in agreement with that observed using the SPC standard (Fig. 3B) in which there are two similar peaks at 184 m/z and 465 m/z, which correspond in molecular weight to PC and SPC, respectively.
SPC is significantly increased in the stratum corneum of patients with AD compared with healthy controls Quantitative analysis of SPC in the stratum corneum of patients with AD revealed that there is a significant increase (148% for non-lesion and 297% for lesion, n = 4047, P < 0.01)) in the content of SPC/mg stratum corneum in the uninvolved and in the involved stratum corneum compared with age-matched healthy controls (Fig. 4A) . In contrast, there was no increase in the SPC content in the involved stratum corneum of patients with chronic eczema, which suggests that SPC is not upregulated as a simple result of the inflammation seen in AD. In a parallel study in which quantitative analysis of ceramides was also carried out using stratum corneum samples of a similar group of patients with AD, there was a significant decrease in the content of ceramide/mg stratum corneum (n = 5362, P < 0.01) in both the uninvolved and in the involved stratum corneum compared with age-matched healthy controls (Fig. 4B). Thus, there is a reciprocal relationship between SPC and ceramide levels among healthy controls, uninvolved and involved skin of patients with AD.
SPC correlates negatively with ceramide and positively with GS but not with Sph Comparison between the amounts of ceramide and SPC in the same individuals (Fig. 5A) demonstrated that there is a weak inverse relationship (n = 51, r = -0.44, P = 0.0012) between levels of ceramides and SPC that accumulate in the stratum corneum. Among control, uninvolved, and involved groups, there is the inverse relationship (n = 13, r = -0.641, P = 0.018) only in the involved AD group (Table 1). In this group used for correlation analysis, there is a significant decrease in the amounts of ceramide in the uninvolved and involved stratum corneum from patients with AD compared with healthy control (Table 2). In comparison with another lysosphingolipid, GS, which is derived from glucosylceramide by another novel epidermal enzyme termed glucosylceramide deacylase, which is significantly increased in the stratum corneum of patients with AD (12), there is a significant positive correlation (n = 30, r = 0.703, P < 0.01) between levels of SPC and GS (Fig. 5B). Among control, uninvolved, and involved groups, there is a significant positive correlation (n = 11, r = 0.687, P = 0.020) only in the involved AD group (Table 1). In this group used for correlation analysis there is a significant increase in the amounts of glucosylsphingosine in the uninvolved and involved stratum corneum from patients with AD compared with healthy control (Table 2). In contrast, comparison with Sph, which is a degradative product from ceramide by ceramidase, demonstrated that there is no correlation (n = 32, r = -0.182, P = 0.319.) between levels of SPC and Sph in the overall group (Fig. 5C) as well as the individual groups (Table 1). In this group used for correlation analysis, there is a significant decrease in the amounts of sphingosine in the uninvolved and involved stratum corneum from patients with AD compared with healthy control (Table 2).
To characterize the physiological role of SM deacylase in the epidermis of patients with AD, it was important to determine whether its enzymatic reaction product, SPC, is released into the epidermis and accumulates in the stratum corneum. By means of HPLC-mass chromatography, we were able to demonstrate that SPC exists in the superficial stratum corneum of healthy control skin. Since there are no known biological pathways that might lead to the generation of SPC other than SM deacylase (14), this suggests that SM deacylase functions to some extent even in the epidermis of healthy controls. This is also substantiated by our previous report (7), which described a low but significant level of SM deacylase activity in the epidermis of healthy controls. The existence of SPC in the stratum corneum further suggests that SPC generated from SM by the action of SM deacylase (probably in the interface between the granular and the stratum corneum layers) is transferred to and eventually accumulates in the stratum corneum during the keratinization process. The present quantitative analysis of SPC in the stratum corneum of patients with AD demonstrated that there is a significant up-regulation in the amount of SPC in uninvolved and involved stratum corneum from patients with AD compared with age-matched healthy controls. This contrasts with no increase in SPC in the involved stratum corneum of patients with chronic eczema, which suggests that the up-regulation of SPC in AD does not result from ordinary inflammation, but is associated with the altered lipid metabolism characteristic for AD. Parallel analysis of ceramides revealed that while there is a significant decrease in the content of ceramides in uninvolved and in involved stratum corneum of patients with AD, which is consistent with results previously reported (5), there is a reciprocal relationship between the increase in SPC and the decrease in ceramide in the stratum corneum of healthy controls, and of lesional and non-lesional skin from patients with AD. This inverse relationship between SPC and ceramides allows us to assume that the ceramide deficiency in AD can mainly be attributed to physiological factors responsible for the increased generation of SPC, which so far is thought to result only from the action of the recently discovered epidermal enzyme, SM deacylase (6). As novel properties of SM deacylase that are distinct from other deacylase enzymes reported by Ito et al (15), we have already characterized several enzymatic characteristics of this enzyme as follows (16); 1) using [palmitic acid-1-14C]SM as a substrate, a sharp pH dependency was found for its catalytic activity, with a peak at pH 5.0; 2) in contrast to the molecular weight of sphingolipid ceramide N-deacylase (52,000) found in bacteria (15), preparative sodium dodecyl sulfate-polyacrylamide gel electrophoresis using AD epidermis extracts revealed that the molecular weight of SM deacylase is 40,000 (16); 3) analytical isoelectric focusing (IEF) chromatography demonstrated that the pI values of SM deacylase, ß-glucocerebrosidase (GlCdase), SMase, and acid ceramidase (CDase) were 4.2, 7.4, 7.0, and 5.7, respectively, again suggesting that these enzymes and sphingolipid ceramide N-deacylase (with a pI = 6.97.4) are different from each other; 4) enzymatic analysis using the pI 4.2 protein partially purified by IEF, which contained no contamination with acid CDase, GlCdase, or SMase, showed that radio-labeled SPC was enzymatically liberated from [choline-methyl-14C]SM used as a substrate; and 5) the pI 4.2 protein purified from the stratum corneum extract of AD patients could hydrolyze N-[palmitoyl-1-14C]SM, but not N-[palmitoyl-1-14C]Cer, thus indicating that the SM deacylase is distinct from any known CDases or N-deacylases. These unique enzymatic properties allow us to assume that there is a new identity of this SM deacylase enzyme in the epidermis of patients with AD and that the expression and subsequent function of this novel enzyme is eventually responsible for the biochemical events leading to the ceramide deficiency in the stratum corneum of patients with AD. A similar accumulation of SPC has been observed in Niemann-Pick disease, which is associated with defects of SMase and results in the lipidosis for SM (17), although no data suggest that this SPC accumulation is linked to the expression of an SM deacylase-like enzyme. Although SPC accumulation has been speculated to result from a defect of SMase [because SPC is a substrate for SMase (17)], it would be intriguing to determine whether there is a similar up-regulated expression of SM deacylase in Niemann-Pick disease as that could also provide a mechanism for the production of SPC in that disease as it does for AD (6, 7, 16). A similar accumulation of substrates and reaction products by corresponding N-deacylase enzymes has been found in Gaucher disease, in which there is an accumulation of glucosylceramide and GS due to a defect of GlCdase activity (18). In Gaucher disease, there has been no explanation for the accumulation of GS in terms of the action of the corresponding N-deacylase, namely glucosylceramide deacylase. Thus, GS accumulation has also been speculated to result from a defect of GCDase since GS can serve as a substrate for that enzyme (18). Similarly, the possible existence and expression of glucoslyceramide deacylase in Gaucher disease would provide a reasonable mechanism for the upregulation of GS. Another similar relevance of N-deacylase for the generation of pychosine has been reported in globoid cell leukodystrophy (GLD) or Krabbe's disease (19). The primary defect of GLD is a deficiency in galactosylceramidase activity, which leads to the accumulation of galactosylceramide and its metabolic intermediate galactosylsphingosine. This was speculated to be produced by deacylation of galactosylceramide (19), although there was no evidence for the expression of galactosylceramide deacylase in GLD. Such altered lipid metabolisms associated with genetic defects, which lead to the accumulation of lipid substrates and deacylated metabolic intermediates, strongly suggest the principle that defects of metabolic enzymes might induce corresponding alternative pathways in which those substrates are converted to corresponding lysoforms by deacylation. Such a possible induction of an alternative pathway following the loss of metabolic enzymes has been reported in a Gaucher-like mouse induced by a glucosylceramidase inhibitor that shows the accumulation of GS in tissue (20).
As a physiological and biochemical factor leading to the ceramide deficiency, we have found that SM deacylase is expressed at high levels (35-fold higher than in controls) in the epidermis of patients with AD, which results in the generation of SPC rather than ceramide. Consistent with the upregulation of SM deacylase activity in AD, there is a significant decrease (0.730.68-fold) in ceramide as well as a significant increase (1.53.0-fold) in SPC. Since increased or decreased ratios of SM deacylase activity and SPC or ceramide levels in healthy controls and patients with AD occur at similar levels, this suggests the relevance of the ceramide deficiency to the increased SM deacylase activity that results in the accumulation of SPC. On the other hand, the degree of the increased levels of SPC (6.526.5 ng/mg) is far less than the degree of the decreased levels of ceramide ( In conclusion, we have elucidated in this study the functional relevance of SM deacylase to the ceramide deficiency that is an essential etiologic factor for the dry and barrier-disrupted skin of patients with AD. Interestingly, the enzymatic reaction product, SPC, which is an essential surrogate to determine whether SM deacylase is functioning in situ in the epidermis, is significantly up-regulated in the uninvolved and in the involved stratum corneum of patients with AD compared with healthy controls, and is reciprocally related to the decreased levels of ceramides in a similar group of patients with AD. SPC has been shown to be a potent biologically active substance capable of stimulating expression of intercellular adhesion molecule-1 (23), of activating transglutaminase in human keratinocytes (24), and of enhancing melanogenesis in human melanocytes (25). These stimulatory effects of SPC reflect the clinical symptoms seen in the skin of patients with AD, which suggests that the abundant generation of SPC in AD epidermis acts as a potent activator in situ. Taken together, the increased accumulation of SPC in the stratum corneum of patients with AD suggests that the novel epidermal enzyme, SM deacylase, is expressed in situ at significant levels in the epidermis of AD patients. This results in the production and accumulation of SPC, which leads in turn to the ceramide deficiency seen in the stratum corneum of those patients. It is likely that the biogenesis of SM deacylase may be relevant to the pathogenesis of AD, if AD can be considered a ceramide-deficient disease.
This study was performed as a part of a research project on Control of Atopic Dermatitis by Skin Care: Regulatory Factor of Cutaneous Permeability and was supported by the special coordination funds of the Ministry of Education, Culture, Sports, Science and Technology, Japan.
Submitted on
June 12, 2002
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