title: Cystatin M / E expression in inflammatory and neoplastic skin disorders.
abstract: BACKGROUND
  Cystatins are natural and specific inhibitors of endogenous mammalian lysosomal cysteine proteinases and exogenous microbial cysteine proteinases. Cystatins were shown to provide regulatory and protective functions against uncontrolled proteolysis in several disease processes. Recently we reported that cystatin M/E, which is a novel member of the cystatin gene family, has an unusually restricted expression pattern that is limited to skin. Although cystatin M/E possesses two distinct biochemical properties (it is a proteinase inhibitor and a substrate for transglutaminase) its physiological function is unknown. Disturbance of the balance between proteinases and their inhibitors can lead to irreversible damage as in chronic inflammatory reactions and tumour invasion.
  
  
  OBJECTIVE
  To examine the expression pattern of cystatin M/E in inflammatory conditions and neoplastic skin disorders in order to obtain possible clues on its function. Furthermore, we wished to determine whether cystatin M/E expression could discriminate between various types of neoplasia.
  
  
  METHODS
  Biopsy material of normal skin, atopic dermatitis and psoriatic lesional skin, healing excisional wounds in healthy volunteers, and several types of epidermal neoplasia (keratoacanthoma, actinic keratosis, basal cell carcinoma and squamous cell carcinoma) were used in this study. For comparison we studied the expression of cystatin M/E in squamous neoplasias from non-cutaneous origin. Affinity-purified polyclonal antibodies against cystatin M/E were used for immunohistochemical detection.
  
  
  RESULTS
  Cystatin M/E is constitutively expressed in the stratum granulosum of normal skin, sebaceous glands, eccrine sweat glands and the infundibular epithelium of hair follicles. Expression in atopic dermatitis and psoriasis was found to extend to several layers of the stratum spinosum. In wound healing, cystatin M/E was not found in the edge of migrating keratinocytes, but it was strongly expressed in the suprabasal layers of the neo-epidermis. In epidermal neoplasias cystatin M/E expression was only found in differentiated cells and keratinized cell nests.
  
  
  CONCLUSIONS
  Inflammation causes cystatin M/E to be expressed in the spinous cell layers where it colocalizes with transglutaminase for which it serves as a substrate. Speculatively, increased expression of cystatin M/E is compatible with a role in controlling increased levels of cysteine proteinases during inflammation and infection. Cystatin M/E expression in neoplastic epidermis is confined to well-differentiated cells and as such does not discriminate between benign and (pre)malignant epidermal neoplasias.
authors.affiliation: Department of Dermatology, University Medical Center St Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands. p.zeeuwen@derma.azn.nl
authors.forename: P L J M
authors.initials: PL
authors.lastname: Zeeuwen
authors.forename: I M J J
authors.initials: IM
authors.lastname: van Vlijmen-Willems
authors.forename: H
authors.initials: H
authors.lastname: Egami
authors.forename: J
authors.initials: J
authors.lastname: Schalkwijk
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000737:chemistry; D055332:Cystatin M; D015891:Cystatins / Q000032:analysis*; D015853:Cysteine Proteinase Inhibitors / Q000032:analysis*; D003876:Dermatitis, Atopic / Q000378:metabolism; D006801:Humans; D011565:Psoriasis / Q000378:metabolism; D012867:Skin / Q000737:chemistry; D012871:Skin Diseases / Q000378:metabolism*; D012878:Skin Neoplasms / Q000737:chemistry; D013542:Sweat / Q000737:chemistry; D014945:Wound Healing / Q000502:physiology
chemical_list: C525104:CST6 protein, human; D055332:Cystatin M; D015891:Cystatins; D015853:Cysteine Proteinase Inhibitors