title: Increased corticotropin-releasing hormone (CRH) expression in cutaneous lupus lesions.
abstract: OBJECTIVE
  Corticotropin-releasing hormone (CRH) and pro-opiomelanocortin (POMC) axis activation leads to the production of hormones, such as adrenocorticotrophic hormone (ACTH) and the α-melanocyte stimulating hormone (α-MSH). Data regarding the role of these hormones in systemic lupus erythematosus (SLE) are scarce. In the present study we aim to evaluate the participation of this axis in the cutaneous involvement of SLE.
  
  
  METHODS
  Seventeen SLE patients were clinically evaluated, and biopsies from affected and unaffected skin of these patients were compared with 17 healthy control individuals. Immunohistochemical analyses for CRH, ACTH, α-MSH, and MC-1R were performed, and the serum levels of α-MSH, IL-1, IL-1ra, IL-6, IL-10, IL-12p70, IL-17, TNF-α, and IFN-γ were measured.
  
  
  RESULTS
  The affected skin of the SLE patients exhibited higher CRH expression in the deep dermis compared to the skin of the controls (p = 0.024), whereas the tissue expression of ACTH, cortisol, α-MSH and its receptor MC-1R were comparable in SLE patients and controls. Higher serum levels of IFN-γ (p = 0.041), TNF-α (p = 0.001) and IL-6 (p = 0.049) were observed in SLE patients compared with controls, while α-MSH levels were similar in both groups.
  
  
  CONCLUSIONS
  The novel finding of elevated CRH expression solely in the affected skin deep dermis supports the notion of a cutaneous local dysfunction of the CRH-POMC axis in the pathogenesis of cutaneous SLE lesions.
authors: Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors: M K
authors: MK
authors: Schmitz
authors: Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors: D A
authors: DA
authors: Botte
authors: Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors: M N
authors: MN
authors: Sotto
authors: Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors: E F
authors: EF
authors: Borba
authors: Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors: E
authors: E
authors: Bonfa
authors: Department of Internal Medicine, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil svmello@usp.br.
authors: S B V
authors: SB
authors: de Mello
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000032:analysis*; D000328:Adult; D001323:Autoantibodies / Q000097:blood; D016022:Case-Control Studies; D003346:Corticotropin-Releasing Hormone / Q000032:analysis*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000473:pathology*; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D000521:alpha-MSH / Q000032:analysis*
chemical_list: D001323:Autoantibodies; D016207:Cytokines; D000521:alpha-MSH; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone
keywords: Corticotropin-releasing hormone; pro-opiomelanocortin (POMC) axis; skin; systemic lupus erythematosus