Downregulation of Semaphorin 4A in keratinocytes reflects the features of non-lesional psoriasis

Reviewer #1 (Public Review):

Summary:

In this study, Kume et al examined the role of the protein Semaphorin 4a in steady-state skin homeostasis and how this relates to skin changes seen in human psoriasis and imiquimod-induced psoriasis-like disease in mice. The authors found that human psoriatic skin has reduced expression of Sema4a in the epidermis. While Sema4a has been shown to drive inflammatory activation in different immune populations, this finding suggested Sema4a might be important for negatively regulating Th17 inflammation in the skin. The authors go on to show that Sema4a knockout mice have skin changes in key keratinocyte genes, increased gdT cells, and increased IL-17 similar to differences seen in non-lesional psoriatic skin, and that bone marrow chimera mice with WT immune cells and Sema4a KO stromal cells develop worse IMQ-induced psoriasis-like disease, further linking expression of Sema4a in the skin to maintaining skin homeostasis. The authors next studied downstream pathways that might mediate the homeostatic effects of Sema4a, focusing on mTOR given its known role in keratinocyte function. As with the immune phenotypes, Sema4a KO mice had increased mTOR activation in the epidermis in a similar pattern to mTOR activation noted in non-lesional psoriatic skin. The authors next targeted the mTOR pathway and showed rapamycin could reverse some of the psoriasis-like skin changes in Sema4a KO mice, confirming the role of increased mTOR in contributing to the observed skin phenotype.

Strengths:

The most interesting finding is the tissue-specific role for Sema4a, where it has previously been considered to play a mostly pro-inflammatory role in immune cells, this study shows that when expressed by keratinocytes, Sema4a plays a homeostatic role that when missing leads to the development of psoriasis-like skin changes. This has important implications in terms of targeting Sema4a pharmacologically. It also may yield a novel mouse model to study mechanisms of psoriasis development in mice separate from the commonly used IMQ model. The included experiments are well-controlled and executed rigorously.

Weaknesses:

A weakness of the study is the lack of tissue-specific Sema4a knockout mice (e.g. in keratinocytes only). The authors did use bone marrow chimeras, but only in one experiment. This work implies that psoriasis may represent a Sema4a-deficient state in the epidermal cells, while the same might not be true for immune cells. Indeed, in their analysis of non-lesional psoriasis skin, Sema4a was not significantly decreased compared to control skin, possibly due to compensatory increased Sema4a from other cell types. Unbiased RNA-seq of Sema4a KO mouse skin for comparison to non-lesional skin might identify other similarities besides mTOR signaling. Indeed, targeting mTOR with rapamycin reveres some of the skin changes in Sema4a KO mice, but not skin thickness, so other pathways impacted by Sema4a may be better targets if they could be identified. Utilizing WTKO chimeras in addition to global KO mice in the experiments in Figures 6-8 would more strongly implicate the separate role of Sema4a in skin vs immune cell populations and might more closely mimic non-lesional psoriasis skin.

Reviewer #2 (Public Review):

Summary:

Kume et al. found for the first time that Semaphorin 4A (Sema4A) was downregulated in both mRNA and protein levels in L and NL keratinocytes of psoriasis patients compared to control keratinocytes. In peripheral blood, they found that Sema4A is not only expressed in keratinocytes but is also upregulated in hematopoietic cells such as lymphocytes and monocytes in the blood of psoriasis patients. They investigated how the down-regulation of Sema4A expression in psoriatic epidermal cells affects the immunological inflammation of psoriasis by using a psoriasis mice model in which Sema4A KO mice were treated with IMQ. Kume et al. hypothesized that down-regulation of Sema4A expression in keratinocytes might be responsible for the augmentation of psoriasis inflammation. Using bone marrow chimeric mice, Kume et al. showed that KO of Sema4A in non-hematopoietic cells was responsible for the enhanced inflammation in psoriasis. The expression of CCL20, TNF, IL-17, and mTOR was upregulated in the Sema4AKO epidermis compared to the WT epidermis, and the infiltration of IL-17-producing T cells was also enhanced.

Strengths:

Decreased Sema4A expression may be involved in psoriasis exacerbation through epidermal proliferation and enhanced infiltration of Th17 cells, which helps understand psoriasis immunopathogenesis.

Weaknesses:

The mechanism by which decreased Sema4A expression may exacerbate psoriasis is unclear as yet.