title: Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients.
abstract: Retinoids are used in the treatment of inflammatory skin diseases and malignancies, but studies characterizing the in vivo actions of these drugs in humans are lacking. Isotretinoin is a pro-drug for all-trans retinoic acid, which can induce long-term remissions of acne; however, its complete mechanism of action is unknown. We hypothesized that isotretinoin induces remission of acne by normalizing the innate immune response to the commensal bacterium Propionibacterium acnes. Compared with normal subjects, peripheral blood monocytes from acne patients expressed significantly higher levels of Toll-like receptor 2 (TLR-2) and exhibited significantly greater induction of TLR-2 expression following P. acnes stimulation. Treatment of patients with isotretinoin significantly decreased monocyte TLR-2 expression and subsequent inflammatory cytokine response to P. acnes after 1 week of therapy. This effect was sustained 6 months following cessation of therapy, indicating that TLR-2 modulation may be involved in the durable therapeutic response to isotretinoin. This study demonstrates that isotretinoin exerts immunomodulatory effects in patients and sheds light on a potential mechanism for its long-term effects on acne. The modulation of TLR-2 expression on monocytes has important implications in other inflammatory disorders characterized by TLR-2 dysregulation.
authors.affiliation: Department of Dermatology, Penn State University College of Medicine, Hershey, Pennsylvania 17033, USA.
authors.forename: Melanie C
authors.initials: MC
authors.lastname: Dispenza
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Wolpert
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Gilliland
authors.forename: Jenny P
authors.initials: JP
authors.lastname: Dai
authors.forename: Zhaoyuan
authors.initials: Z
authors.lastname: Cong
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Nelson
authors.forename: Diane M
authors.initials: DM
authors.lastname: Thiboutot
mesh_terms: D000152:Acne Vulgaris / Q000188:drug therapy* / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D016207:Cytokines / Q000096:biosynthesis; D003879:Dermatologic Agents / Q000627:therapeutic use*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D015474:Isotretinoin / Q000627:therapeutic use*; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000276:immunology; D008297:Male; D011425:Propionibacterium acnes / Q000187:drug effects / Q000276:immunology; D051195:Toll-Like Receptor 2 / Q000276:immunology*; D055815:Young Adult
chemical_list: D016207:Cytokines; D003879:Dermatologic Agents; C495342:TLR2 protein, human; D051195:Toll-Like Receptor 2; D015474:Isotretinoin