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Rosacea: The Blessing of the Celts - An Approach to Pathogenesis Through Translational Research.

Abstract：

:Increased expression of cathelicidin antimicrobial peptide (CAMP) is related to the pathogenesis of rosacea. CAMP plays a crucial role in antimicrobial defences, such as the killing of mycobacteria. CAMP gene expression is regulated by vitamin D-dependent (VDR) and vitamin D-independent (C/EBPα) transcription factors. VDR-dependent CAMP expression is sufficient during the summer months in Nordic countries, but insufficient during Nordic winters, due to low ultraviolet (UV) levels. Historically, the Celts may have overcome this geographical disadvantage of deficient CAMP production during the winter through an as-yet undefined acquired mutation that activates the alternative vitamin D-independent CAMP promoter C/EBPα. C/EBPα is the downstream transcription factor of Toll-like receptor (TLR)-mediated innate immune reactions and endoplasmic reticulum (ER) stress responses. At the molecular level, all clinical trigger factors for rosacea can be regarded as ER stressors. A mutation-based upregulation of ER stress responsiveness in rosacea may thus explain patients' reduced threshold for ER stressors. It is notable that ER stress upregulates the potent lipid-mediator sphingosine-1-phosphate (S1P), which explains multiple pathological aberrations observed in rosacea skin. Enhanced ER stress/S1P signalling in rosacea appears to compensate for insufficient VDR-dependent CAMP expression, maintaining adequate CAMP levels during UV-deficient winter to combat life-threatening microbial infections, such as lupus vulgaris. Therefore, rosacea should not be considered as a disadvantage, but as evolution's blessing of the Celts which improved their survival. The concept presented here also explains the mechanism of Finsen's UV treatment of lupus vulgaris by UV- and ER stress-mediated upregulation of CAMP expression. Rosacea could therefore be described as the Celts' "inborn Finsen lamp".

journal_name

Acta Derm Venereol

journal_title

Acta dermato-venereologica

authors

Melnik BC

doi

10.2340/00015555-2220

subject

Has Abstract

pub_date

2016-02-01 00:00:00

pages

147-56

issue

eissn

0001-5555

issn

1651-2057

journal_volume

pub_type

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Rosacea: The Blessing of the Celts - An Approach to Pathogenesis Through Translational Research.