|Year : 2020 | Volume
| Issue : 3 | Page : 1041-1044
Tissue expression of endothelial selectin in patients with atopic dermatitis
Azza G. A. Farag1, Dalia R. A. Sharaky2, Eman N El-Shafey1, Sawsan S Allam3
1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Pathology, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
3 Dermatology at Ministry of Health, Damanhour, Egypt
|Date of Submission||28-Feb-2019|
|Date of Decision||12-Mar-2019|
|Date of Acceptance||08-Apr-2019|
|Date of Web Publication||30-Sep-2020|
Sawsan S Allam
Dermatology at Ministry of Health, Damanhour, Behera
Source of Support: None, Conflict of Interest: None
To investigate the role of endothelial selectin (E-selectin) in atopic dermatitis (AD) through evaluation of the immunohistochemical expressions in lesional skin biopsies.
AD is a chronic, pruritic inflammatory skin disease that occurs most frequently in children. In AD, the inflammatory cascade is initiated by the release of proinflammatory cytokines from atopic keratinocytes.
Patients and methods
A total of 50 patients with AD and 10 healthy control participants were included in this case–control study. From all participants, skin biopsies were taken, and immunohistochemical staining by E-selectin monoclonal antibodies was done.
There were significant elevations in E-selectin cellular localization (P = 0.01) as well as dermal inflammatory infiltrates in AD cases than controls.
E-selectin participates in AD pathogenesis.
Keywords: atopic dermatitis, endothelial selectin, immunohistochemistry
|How to cite this article:|
Farag AG, Sharaky DR, El-Shafey EN, Allam SS. Tissue expression of endothelial selectin in patients with atopic dermatitis. Menoufia Med J 2020;33:1041-4
|How to cite this URL:|
Farag AG, Sharaky DR, El-Shafey EN, Allam SS. Tissue expression of endothelial selectin in patients with atopic dermatitis. Menoufia Med J [serial online] 2020 [cited 2020 Oct 29];33:1041-4. Available from: http://www.mmj.eg.net/text.asp?2020/33/3/1041/296709
| Introduction|| |
Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease. It follows a relapsing course . Usually, AD starts in early childhood and may represent the initial step of the so-called 'atopic March', which represents the natural history of atopic manifestations . The prevalence of allergic diseases including AD is increasing worldwide. In infants and children, the attack rate is two or three times higher compared with that in adults .
The manifestations of AD result from a complex interaction among environmental factors, skin barrier dysfunction, susceptibility genes, and immunological abnormalities .
Endothelial selectin (E-selectin) is expressed on the surface of the activated endothelial cell upon stimulation by inflammatory cytokines. In association with intercellular adhesion molecule-1, E-selectin enables adhesion of neutrophils, leukocytes, and monocytes on activated endothelium in the skin .
This study aimed to shed light on the role of E-selectin in AD pathogenesis through evaluation of its immunohistochemical expressions in involved skin in patients with AD compared with controls.
| Patients and Methods|| |
This case–control study included 50 patients with AD and 10 healthy volunteers (controls). They were selected from Dermatology Outpatient Clinics, Menoufia University Hospital, during the period from May 2016 to February 2017. A written consent form approved by the Committee of Human Rights in Research at Menoufia University was obtained from every participant or his or her parent before the study initiation. We included patients with AD from both sexes and who did not receive any topical (2 weeks) or systemic (1 month) treatment for AD before joining the study.
Any participant having any immunoinflammatory or allergic disorder and/or patients having any skin disease other than AD was excluded from the study.
The studied individuals were subjected to full history taking and clinical examination. The diagnosis of AD was made according to the criteria of Hanifin and Rajka . Punch biopsies of 4 mm were taken under local anesthesia from involved skin of each patient and matched sites of control participants. The specimens were fixed in 10% formalin solution and sent to Pathology Department, Faculty of Medicine, Menoufia University, where they were subjected to routine tissue processing to be embedded in paraffin blocks.
The method used for immunostaining was the streptavidin–biotin amplified system. In this system, the primary antibody for E-selectin was a polyclonal rabbit antibody raised against E-selectin with cat. YPA1378. It was received as concentrated 0.1 ml (1 mg/ml), with dilution titer 1:200 (Chongqing Biopsies Co., Cat No YPA1390, China) (www. Biospes.com).
Statistical analysis of data
Data were collected, tabulated, and statistically analyzed using a personal computer with statistical package for the social sciences (SPSS) version 15 program (IBM Corp., Armonk, New York, USA) released in 2011. IBM SPSS statistics for Windows, version 20.0. (IBM Corp.) Qualitative data were expressed as number and percentage. Quantitative data were expressed as arithmetic mean, SD, percentage, median, and range. For comparing qualitative variables, we used Fisher's exacts test.
| Results|| |
Demographic data of the studied participants and clinical characteristics of patients with AD are demonstrated in [Table 1]. Both the AD patient group and the control group were comparable regarding age (P = 0.44) and sex (P = 0.21) [Table 1].
|Table 1: Demographic and clinical data of patients with atopic dermatitis|
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Regarding E-selectin immunoreactivity of the studied participants, in the control group, E-selectin immunoreactivity was positive and showed cytoplasmic localization in nine control sections [Figure 1]. In AD patient group, E-selectin immunoreactivity was positive in 45 cases and showed cytoplasmic localization in most of them [Figure 2]. There were significant elevations in cellular localization (P = 0.01) in AD cases than controls. Moreover, in AD cases, E-selectin immunoreactivity in dermal inflammatory infiltrates was significantly expressed than controls (81 vs. 0%).
|Figure 1: Cytoplasmic expression of endothelial selectin in the control section (immunoperoxidase ×400 HPF).|
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|Figure 2: Cytoplasmic expression of endothelial selectin in the atopic dermatitis section (immunoperoxidase, ×200 high power field).|
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| Discussion|| |
AD is a chronic, highly pruritic, inflammatory and heterogeneous skin disease. It is characterized by periods of remission and relapse. AD usually arises in early childhood, often in infancy, and resolves by early teenage years. Approximately 5–10% of patients with AD have the disease extend into adulthood. The clinical phenotype that characterizes AD is the product of complex interactions among susceptibility genes, the host's environment, defects in skin barrier function, and systemic and local immunologic responses . AD occurs primarily in childhood affecting 15–30% of children, with 45% of cases occurring within the first 6 months of life, whereas 85% of cases diagnosed within the first 5 years . In line with this information, this study showed that the age of patients with AD ranged from 6 to 10 years with a mean ± SD of 6.18 ± 1.68 years, and the age of disease onset ranged from 3 to 7 years, with a mean of 4.3 ± 1.2 years. In agreement with our results, many researchers such as El-Naggar et al.  and Zeppa et al.  recorded that AD occurs most often in infants and children. Moreover, Edan et al.  reported that infantile and childhood stages had a higher prevalence ratio than all adulthood groups. The patients in this study included 14 males and 36 females. Following our finding, Edan et al.  reported that AD prevalence in girls was higher than boys. Moreover, Kim et al.  found that the prevalence of AD in girls (11.1%) was higher than that in boys (8.1%) (P < 0.005). On the contrary, Shultz et al.  and SelÇuk et al.  reported male predominance and Thomas and Myalil  observed that male to female ratio in AD is 1.5:1. However, Saito  reported that both sexes are equally affected by AD.
Regarding family history, of the studied 50 AD cases, 28 (54.5%) cases had a positive family history of atopic diseases. In agreement with this observation, Uehara and Kimura  studied the family history of AD in 529 children with AD and reported a positive family history of AD in 316 (59%) children. The role of family history in the development of AD has been reported by Peroni et al., Snijders et al., Lee-Wong et al.  and Bohme et al.. They stated that positive family history is a risk factor for AD in children up to 4 years with no difference between the maternal and paternal effect of atopic history. Of the children without parental atopic history, 27.1% developed AD, whereas of those with single or double parental atopic history, 37.9 and 50.0%, respectively, did so. We studied E-selectin immunoreactivity, and it was positive in 90% of control sections; supporting this result, Luo et al.  reported that E-selectin is an endothelial-specific adhesion molecule best known for its role in leukocyte adhesion. It is induced by inflammatory stimuli as well as in proliferating endothelial cells under noninflammatory conditions, suggesting that growth signals also regulate E-selectin. Noninflammatory expression of E-selectin is correlated with cellular proliferation in human microvascular endothelial cells. E-selectin was significantly higher in patients with AD than in healthy control participants. The observed upregulation of E-selectin in involved skin of patients with AD could be suggested to be mediated by the release of cytokines such as IL-4 from cells that reside development of Th2 cells, which are predominant in atopic inflammation . This enhanced tissue E-selectin expression in AD cases is important in the interaction with invading T lymphocytes in the epidermis and dermis. Thus, it may be hypothesized that the skin of patients with AD provides a special environment either for homing or for in loco differentiation of Th2 cells . Furthermore, in this study, dermal inflammatory infiltrates demonstrated a significant increase in E-selectin immunoreactivity in AD cases than controls. Supporting this finding, Jung et al.  reported that cytokines released by keratinocytes may provide the first signal for the induction of adhesion molecules in AD skin lesions and a concomitant increase in E-selectin expression on dermal cells.
| Conclusion|| |
E-selectin participates in AD etiopathogenesis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]