Th2-and Th22-polarising cytokines became statistically significant in cells from atopic patients relative to those from healthy controls. Fujita et al. (14) also confirmed the pluripotent Th-cell (Th1, Th2, Th17, Th22)-polarising capacity of freshly isolated skin-derived resident and inflammatory DCs, and they emphasised that the recruitment of disease-specific Th subsets is determined primarily by the microenvironment associated with chronic inflammation in AD. In an analogous experimental system, Reefer et al. (19) demonstrated that in DC-T cell co-cultures after TSLP, allergen or SEB stimulation, Th cells from AD patients produce Th2-type cytokines, although that study did not investigate Th22 cytokine expression. In our experiments, we also observed that unstimulated mDCs had a similar capacity to polarise Th1 cells in atopic and non-atopic individuals; however, this ability of atopic mDCs became impaired after stimulation. Consistent with the results of our study, Lebre et al. (20) found that CD1c+ DCs exhibit aberrant functions in AD patients because these cells could not induce a Th1 immune response, even in the presence of a strong Th1 stimulus.Due to the prevalent initiator but complex nature of mDCs in the skin's immune system, many therapeutic approaches target these cells via modifications of their function or the surrounding tissue microenvironment, that is, topical treatment of AD with calcineurin inhibitors and corticosteroids (21,22). Therefore, it is important to develop methods that are suitable for the investigation of the direct effects of newly developed therapies on DCs. Consequently, we want to emphasise a third point: that LSC is a useful technique to monitor mDC functions in vitro.
ConclusionsBecause of the low number of mDCs in the peripheral blood and the limited blood sample volume that is available, especially in childhood, it is challenging to directly investigate the function of these cells from patients. To our knowledge, we are the first to directly determine the intracellular cytokine profile and activation of circulating mDCs in AD patients using multiparametric laser scanning cytometry (LSC). Measurements utilising this slide-based technique allow for the analysis of specimens with low cell numbers (10 5 or less) but provide results with statistical relevance. Author contributions GN performed the research, did the LSC measurement, analysed the data and wrote the manuscript; DM and ZSB did the LSC measurement and analysed the data; KG contributed the blood samples, GM, AK and TD contributed to the research design, EGY, ER supervised the study, TB supervised the study and edited the manuscript, ASZ designed the study, wrote the manuscript and supervised the research group.
Acknowledgements
Conflict of interestsThe authors have declared no conflicting interests.
Supporting InformationAdditional Supporting Information may be found in the online version of this article: Appendix S1. Materials and methods. Table S1. Data on patients, activation and maturation markers and cytok...