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Letter to the Editor| Volume 99, ISSUE 1, P65-68, July 2020

Increased expression of dermal LL37 may trigger migration of CCR7+ regulatory T cells in extramammary Paget’s disease

      LL37 is an autoantigen derived from keratinocytes that can bind to surface scavenger receptors expressed on myeloid dendritic cells (DCs), plasmacytoid DCs, and macrophages to recognize extracellular self-DNA [
      • Fabriek B.O.
      • Dijkstra C.D.
      • van den Berg T.K.
      The macrophage scavenger receptor CD163.
      ]. Among such scavenger receptors, CD163 is a specific surface marker of macrophages [
      • Van Gorp H.
      • Delputte P.L.
      • Nauwynck H.J.
      Scavenger receptor CD163, a Jack-of-all-trades and potential target for cell-directed therapy.
      ]. The expression of LL37 on myeloid cells in the dermis is controlled by proinflammatory cytokines such as IL-17 and TNF-α [
      • Fuentes-Duculan J.
      • Bonifacio K.M.
      • Hawkes J.E.
      • Kunjravia N.
      • Cueto I.
      • Li X.
      • et al.
      Autoantigens ADAMTSL5 and LL37 are significantly upregulated in active Psoriasis and localized with keratinocytes, dendritic cells and other leukocytes.
      ]. Since Paget’s cells produce CCL20 and recruit Th17 in the lesional skin of EMPD [
      • Sato Y.
      • Fujimura T.
      • Tanida K.
      • Lyu C.
      • Matsushita S.
      • Fujisawa Y.
      • et al.
      Malassezia-derived aryl hydrocarbon receptor (AhR) ligand augments CCL20/Th17/soluble CD163 pathogenic axis in extramammary Paget’s disease.
      ], the expression of LL37 in invasive EMPD might be increased after the dermal invasion of Paget’s cells. Since TAMs in EMPD secrete an array of chemokines in lesional skin [
      • Fujimura T.
      • Kambayashi Y.
      • Furudate S.
      • Asano M.
      • Kakizaki A.
      • Aiba S.
      Receptor Activator of NF-κB Ligand Promotes the Production of CCL17 from RANK+ M2 Macrophages.
      ], TAMs stimulated by LL37 might also play a critical role in the progression of EMPD.
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