Journal of Leukocyte Biology Myeloid cells, immune suppression, tumor immunology
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(Journal of Leukocyte Biology. 2001;69:719-726.)
© 2001 by Society for Leukocyte Biology

Green tea polyphenol (-)-epigallocatechin-3-gallate treatment to mouse skin prevents UVB-induced infiltration of leukocytes, depletion of antigen-presenting cells, and oxidative stress

Santosh K. Katiyar and Hasan Mukhtar

Department of Dermatology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106

Correspondence: Santosh K. Katiyar, Ph.D., Department of Dermatology, The University of Alabama at Birmingham, 1530 3rd Ave. South, Birmingham, AL 35294.. E-mail: skatiyar{at}uab.edu


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Ultraviolet (UV) radiation-induced infiltrating leukocytes, depletion of antigen-presenting cells, and oxidative stress in the skin play an important role in the induction of immune suppression and photocarcinogenesis. Earlier we have shown that topical application of polyphenols from green tea or its major chemopreventive constituent (-)-epigallocatechin-3-gallate (EGCG) prevents UV-B-induced immunosuppression in mice. To define the mechanism of prevention, we found that topical application of EGCG (3 mg/mouse/3 cm2 of skin area) to C3H/HeN mice before a single dose of UV-B (90 mJ/cm2) exposure inhibited UV-B-induced infiltration of leukocytes, specifically the CD11b+ cell type, and myeloperoxidase activity, a marker of tissue infiltration of leukocytes. EGCG treatment was also found to prevent UV-B-induced depletion in the number of antigen-presenting cells when immunohistochemically detected as class II MHC+ Ia+ cells. UV-B-induced infiltrating cell production of H2O2 and nitric oxide (NO) was determined as a marker of oxidative stress. We found that pretreatment of EGCG decreased the number of UV-B-induced increases in H2O2-producing cells and inducible nitric oxide synthase-expressing cells and the production of H2O2 and NO in both epidermis and dermis at a UV-B-irradiated site. Together, these data suggest that prevention of UV-B-induced infiltrating leukocytes, antigen-presenting cells, and oxidative stress by EGCG treatment of mouse skin may be associated with the prevention of UV-B-induced immunosuppression and photocarcinogenesis.

Key Words: Key words: • Green tea • (-)-epigallocatechin-3-gallate (EGCG) • ultraviolet radiation • immune suppression • oxidative stress • antigen-presenting cell


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Because oxidants or oxidant-induced oxidative stress plays an important role at least in initiation and promotion stages of multistage carcinogenesis [1 ], in recent years, antioxidants present in fruits, vegetables, and beverages that humans normally consume have received considerable attention as potential cancer chemopreventive agents [2 3 4 5 6 ]. Polyphenols present in green tea, most notably (-)-epigallocatechin-3-gallate (EGCG), have demonstrated remarkable antioxidant activity in various in vitro and in vivo model systems [7 ].

Solar ultraviolet (UV) radiation, particularly in the UV-B (290–320 nm) spectrum, is the primary cause of the vast majority of cutaneous malignancies each year in the United States [8 ]. Experimental studies have shown that solar UV radiation, particularly UV-B, has suppressive effects on the immune system [9 ], and exposure of UV-B to skin induces generation of reactive oxygen species (ROS), which can act as tumor initiators [10 ] as well as tumor promoters [11 ] by damaging critical cellular macromolecules such as DNA, proteins, and lipids. UV-B-induced immune suppression is also considered as a risk factor for skin cancer development [12 13 ]. Exposure of UV-B radiation causes a number of changes within the skin, which have been linked to immunosuppression; for example, UV-B irradiation reduces the density of epidermal Langerhans cells (LCs) [14 15 16 ] either by induced migration 17, 18] or by cell death [19 ], and UV-B exposure can cause infiltration of macrophages and granulocytes into the epidermis [20 ]. Furthermore, LCs and macrophages from UV-irradiated epidermis can induce hapten-specific immunosuppression and tolerance [21 22 ], suggesting that UV radiation causes functional alterations in these cells. Earlier, it was also shown that blocking of UV-induced infiltrating leukocytes using anti-CD11b antibody (specific for activated monocytes/macrophages) [23 ] or murine-specific soluble complement receptor type 1 [24 ] reversed UV-induced immunosuppression and tolerance induction. Studies have also shown that the growth of UV-induced skin tumors in mice is stimulated by the production of paracrine growth factors from infiltrating leukocytes [25 26 27 ]. These observations strongly suggest an important role of UV-B-induced infiltrating leukocytes in immunosuppression and cancer induction.

Regular intake of natural antioxidants has been suggested as a useful preventive strategy against the mutagenic and carcinogenic effects of solar UV radiation. Consistent with the idea of cancer chemoprevention, in earlier studies, we and others have shown the preventive effects of polyphenols isolated from green tea against UV radiation-induced skin inflammation, immunosuppression, and tumorigenesis in mouse models [reviewed in ref. 7 28 ]. Based on several in vitro and in vivo studies, it has become clear that EGCG is the major and most effective chemopreventive polyphenolic compound present in green tea, which is also a most potent antioxidant among many other naturally occurring antioxidants [7 28 ]. We have also shown that topical application of a green tea polyphenolic fraction (GTP) or EGCG before a single exposure of mouse skin to UV-B affords protection against UV-B-induced immunosuppression [29 30 ]. Because of the high antioxidant activity of polyphenols present in green tea, in recent years green tea extract increasingly has been used in skin care products [reviewed in ref. 28 ]. Thus, it is important to define the role of a polyphenolic constituent, specifically EGCG, on UV-B-induced markers of immunosuppression and skin cancer induction. Therefore, in the present study, we determined the possible mechanism of prevention of UV-B-induced immunosuppression and skin cancer induction by EGCG, using a C3H/HeN mouse model. EGCG (3 mg/mouse/3 cm2 of skin area) was topically applied to mouse skin before a single UV-B (90 mJ/cm2) exposure to determine whether EGCG will prevent UV-B-induced (1) infiltration of leukocytes, (2) infiltrating-leukocyte-caused induction of oxidative stress, and (3) migration or depletion of antigen-presenting cells (APCs) in the skin.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Animals
Pathogen-free female C3H/HeN mice were purchased from Harlan Sprague-Dawley (Indianapolis, IN). Mice were housed in a pathogen-free barrier facility in accordance with current U.S. Department of Agriculture, Department of Health and Human Services regulations and standards. Mice were kept in groups of four per cage and were acclimatized 3–4 days before use, subjected to a 12-h-light/12-h-dark cycle, and housed at 24 ± 2°C and 50 ± 10% relative humidity. Animals were fed Purina chow diet and water ad libitum.

Chemicals and antibodies
Diaminobenzidine (DAB) reagent set was purchased from Kirkgaard and Perry (Gaithersburg, MD). Dihydrorhodamine 123 (DHR) was obtained from Molecular Probes (Eugene, OR). Monoclonal antibodies to inducible NO synthase (iNOS) [anti-macNOS; rat immunoglobulin (Ig) G2a] was purchased from Transduction Laboratories (Lexington, KY), and CD11b (anti-mac, M1/70; rat IgG2b) and Ia{approx}k (mouse IgG2b) antibodies were purchased from PharMingen (San Diego, CA). Purified EGCG was obtained as a gift from Yukihiko Hara (Mitsui Norin Co., Shizuoka, Japan).

For all experiments, EGCG was dissolved in acetone, and the required concentration in 0.2 mL of acetone was topically applied to the mouse skin 20 min before UV-B exposure. Treatment of EGCG 20 min before UV-B exposure of the skin allows sufficient time for it to be absorbed by the skin cells.

UV-B-irradiation of mice and skin punch biopsies
Forty-eight hours before UV-B exposure, mice were shaved with electric clippers and Nair depilatory lotion (Carter Products, New York, NY) was applied for 2 to 3 min. The time period of Nair lotion treatment was kept constant in each group of animals as well as in each set of experiments. Non-UV-B-exposed groups of mice also were shaved and received depilatory lotion for the same time period to maintain a same-treatment protocol. UV-B-irradiation was performed as described earlier [20 30 ]. Briefly, the razor-shaved and chemically depilated dorsal skin was exposed to UV irradiation from a band of six FS-40 fluorescent lamps from which short-wavelength UV-B (280–290 nm) and UV-C wavelengths not normally present in natural solar radiation were filtered out using Kodacel cellulose film (Eastman Kodak Co., Rochester, NY) [31 ]. After filtration with a Kodacel film, the majority of the resulting wavelengths of UV radiation were in the UV-B (290–320 nm) and UV-A range, which mimics the type of UV to which humans are generally exposed. The UV-B emission was monitored with an IL-443 phototherapy radiometer equipped with an IL SED 240 detector fitted with a W side angle quartz diffuser and a SC5 280 filter (all from International Light, Newburyport, MA) . During UV-B irradiation mice were housed in specially designed cages where they were held in dividers separated by Plexiglas. A single dose of 90 mJ/cm2 of UV-B was applied to the skin surface of each mouse.

Mice were sacrificed 48 h after UV-B irradiation by a cervical dislocation procedure. Skin punch biopsies of 5–6 mm in size were collected for immunostaining purposes and were frozen in optimal-cutting-temperature compound under liquid nitrogen immediately after removal. These skin biopsies were stored at -80°C for further use. All immunohistochemical and analytical assays were performed in skin samples collected at 48 h after UV-B irradiation of the mouse skin, because this is the peak time point for UV-B-induced infiltration of leukocytes [20 30 ].

Myeloperoxidase activity
Myeloperoxidase (MPO) activity in epidermal and dermal skin cytosols was determined by the procedure of Bradley et al. [32 ] with some modification [33 ]. In brief, the skin samples were taken from non-UV-B-exposed mouse skin as well as mouse skin at 48 h after UV-B exposure. Epidermis and dermis were separated using dispase enzyme as described earlier [30 ] after removing subcutaneous fat. The epidermis and dermis separately were homogenized in 50 mM potassium phosphate buffer, pH 6.0, containing 0.5% hexadecyltrimethyl-ammonium bromide, followed by sonication of the homogenate at 4° C for three 10-s bursts with a heat system sonicator equipped with a microprobe. For complete extraction of MPO from infiltrating neutrophils, the tissue homogenates were frozen and thawed three times, and each time sonication was repeated. The tissue homogenate thus obtained was centrifuged at 40,000 g for 15 min at 4°C, and the resulting supernatants from epidermis and dermis were used for MPO estimation.

MPO activity in supernatant (0.1 mL) was assayed by mixing with 50 mM phosphate buffer (2.9 mL), pH 6.0, containing 0.167 mg/mL of orthodianisidine dihydrochloride and 0.0005% hydrogen peroxide. The change in absorbance resulting from decomposition of H2O2 in the presence of orthodianisidine was measured at 460 nm using a Beckman DU 640 spectrophotometer. The results are expressed as the mean optical density/min/assay at 25°C, as previously described [33 ].

Immunohistochemical detection of CD11b+ cells
Immunostaining of CD11b was used as a cell surface marker of monocytes/macrophages and neutrophils. For immunohistochemical detection of CD11b+ cells, 6-µm-thick sections of frozen skin biopsies were used. After blocking nonspecific staining by normal goat serum [10% in phosphate-buffered saline (PBS)], sections were incubated with either rat anti-mouse CD11b monoclonal antibody or RIgG2b isotype control. After washing in Tris-HCl buffer, pH 7.5, endogenous peroxidase was blocked using 0.5% H2O2 in PBS buffer for 30 min. Sections were incubated with biotinylated rabbit anti-rat IgG (Vector) and thereafter with peroxidase-labeled streptavidin. After washing in PBS buffer, sections were incubated with DAB substrate with peroxidase enzyme. Sections were counterstained with methyl green for 1 h. The DAB-peroxidase reaction gave a brown reaction product, and the methyl green gave a blue nuclear counterstain.

Immunohistochemical detection of Ia+ cells (class II MHC+ cells)
Immunostaining of class II MHC+ Ia+ cells was used as a cell surface marker of APCs in C3H/HeN mouse skin. Immunostaining was performed to detect and localize Ia+ cells in UV-B-exposed and non-UV-B-exposed skin. Briefly, 6-µm-thick sections from frozen skin biopsies were fixed in cold acetone. After blocking nonspecific staining by using normal goat serum (10% in PBS), sections were incubated for 1 h with mouse anti-mouse Ia{approx}k antibody or its isotype control mouse IgG2b. After washing in PBS buffer, sections were incubated with peroxidase-labeled secondary antibody (anti-mouse IgG2b) in PBS buffer containing 0.2% bovine serum albumin and 10% goat serum. After washing in PBS buffer, sections were incubated with DAB substrate solution with peroxidase enzyme. Sections were counterstained with methyl green for 1 h.

Immunohistochemical detection of H2O2 producing cells
Immunohistochemical detection of H2O2 in normal as well as in UV-irradiated skin was performed as described earlier [34 ]. Briefly, 6-µm-thick frozen skin sections were incubated with 0.1 M Tris-HCl buffer, pH 7.5, containing 1 mg/mL of glucose and 1 mg/mL of DAB for 6 h at 37°C. Sections were then washed in distilled water and counterstained with methyl green.

Quantitative determination of intracellular release of H2O2 by cytometric analysis
Intracellular levels of H2O2 in epidermal and dermal cells were determined using DHR 123 as a specific fluorescent dye probe as described by Peus et al. [35 ] with some modification. Epidermal and dermal single-cell suspensions were prepared as described earlier [30 ]. Briefly, 106 cells each from different treatment groups were placed in separate wells of a 24-well tissue culture plate in duplicate. These cells were treated with DHR (5 µM) for 45 min. Reduced DHR is irreversibly oxidized and converted to the red fluorescent compound rhodamine 123 [36 ] by UV-B-induced intracellular release of H2O2. Plates were read on a Cytofluor II fluorescence plate reader with an excitation wavelength of 485 nm and an emission wavelength of 530 nm.

Immunohistochemical detection of iNOS expression
Immunohistochemical detection of iNOS expression was performed using frozen skin biopsies from different treatment groups. Briefly, 6-µm-thick skin sections were fixed in cold acetone for 10 min. After blocking nonspecific staining in 10% goat serum in PBS buffer, sections were incubated with anti-mouse iNOS (IgG2a) for 1 h at room temperature. After blocking endogenous peroxidase activity in 0.5% H2O2 in PBS buffer, sections were incubated with secondary-antibody anti-mouse IgG2a labeled with horseradish peroxidase. After washing in PBS buffer, sections were then incubated with DAB and peroxidase enzyme and counterstained with hematoxylene. The DAB-peroxidase reaction gave a brown reaction product, and the hematoxylene, a violet nuclear counterstain.

Quantitative determination of nitric oxide production
Nitric oxide levels were determined by measuring their stable degradation products, nitrate and nitrite, separately in epidermal and dermal cytosolic fraction. For accurate assessment of the total nitric oxide generated, we must monitor both nitrate and nitrite. In this procedure nitrate is enzymatically converted into nitrite by the enzyme nitrate reductase, followed by quantitation of nitrite using Griess reagent. Thus nitric oxide is estimated in the form of total nitrite formed, using a colorimetric nitric oxide assay kit (Oxford Biomedical Research, Inc., Oxford, MI) and by following the manufacturer’s protocol.

Analysis of CD11b+, Ia+, H2O2+, and iNOS+ cells
To compare marker-specific positively stained cells in different treatment groups, these cells were counted in the epidermis or dermis compartment of the skin at six–eight places in each section using an ocular micrometer grid with x200 magnification under Zeiss Axiophot microscope and Zeiss Plan-Neofluar objective. The ocular micrometer grid corresponds to 0.0625 mm2. CD11b-, Ia-, H2O2-, or iNOS-positive cells were counted at least in three sections per biopsy per animal. Immunostaining experiments were repeated at least in three animals per treatment group.

Microscopy and photography
Images from immunostaining experiments were obtained using a Zeiss Axiophot microscope (Thornwood, NY) and Kodak Ektachrome 160T film (Rochester, NJ). These images were scanned (SprintScan; Polaroid, Cambridge, MA) and formatted as Tag Image File Format (TIFF) images in Adobe Photoshop 5.0 software and Microsoft PowerPoint to make the composite figures.

Statistical analysis
The results were expressed as the mean plus or minus standard deviation. Statistical analysis of all the data between groups receiving UV-B exposure alone and those receiving EGCG treatment plus UV-B exposure was performed by Student’s t-test. The P value < 0.05 was considered statistically significant.


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Skin treatment with EGCG before UV-B exposure prevents infiltration of leukocytes, CD11b+ cells, and MPO activity
As shown in Figure 1A , UV-B irradiation of mouse skin was shown to induce infiltration of leukocytes when observed at the peak time point—48 h post-UV-B-irradiation. These infiltrating leukocytes were present in higher numbers in both epidermis and dermis (Fig. 1A , middle panel), compared with those in control non-UV-B-exposed skin (Fig. 1A , left panel). Qualitatively, we observed that topical treatment with EGCG before UV-B exposure markedly reduced the number of infiltrating leukocytes into the UV-irradiated skin (Fig. 1A , right panel), when compared with skin sites receiving UV-B without EGCG treatment (Fig. 1A , middle panel).



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Figure 1. Effect of topical treatment of mouse skin with EGCG on UV-B-induced infiltration of leukocytes. Topical treatment of mouse skin with EGCG before UV-B exposure inhibited UV-B-induced infiltration of leukocytes, CD11b+ cells, and MPO activity measured at 48 h after UV-B exposure. (A) Pretreatment with EGCG inhibited UV-B-induced infiltration of leukocytes. Skin biopsies were processed by hematoxylin and eosin staining by a routine procedure. Black nuclei indicate the presence of cells. (B) Pretreatment of EGCG inhibited UV-B-induced infiltration of CD11b+ cells. Immunohistochemical detection of CD11b+ cells, a marker of monocytes/macrophages and neutrophils, was performed in frozen skin biopsies. Sections were stained with monoclonal antibodies to CD11b as described in Materials and Methods. CD11b+ cells are shown in brown, and a representative section of immunostaining from three independent experiments is shown. (C) Pretreatment of EGCG inhibited (P < 0.001) UV-B-induced activity of MPO in both epidermis and dermis. MPO activity was determined as a marker of tissue infiltration of leukocytes and assayed in both epidermal and dermal cytosolic fractions separately as described in Materials and Methods._art>

 
To determine whether these infiltrating cells were macrophages and neutrophils, we performed immunostaining of CD11b+ cells, which were used as cell surface markers of monocytes/macrophages and neutrophils. In control, non-UV-B exposed skin, CD11b+ cells were clearly seen in the dermis (Fig. 1B , left panel). Forty-eight hours after UV-B exposure, the number of CD11b+ cells was markedly higher in the UV-irradiated skin, both epidermis and dermis (Fig. 1B , middle panel), compared with control skin (Fig. 1B , left panel). Treatment with EGCG before UV-B exposure reduced the number of UV-B-induced infiltrating CD11b+ cells in both epidermis and dermis (Fig. 1B , right panel). Treatment of mouse skin with EGCG alone did not appear to alter the constitutive pattern of the resident cells in the skin when compared to the normal skin of the mice and also did not induce infiltration (data not shown). In UV-B-irradiated skin, epidermal thickness increased, and disruption ranged from damage to loss of normal keratinocyte stratification. This suggests that, in addition to direct UV damage of the skin, infiltrating CD11b+ cells also caused keratinocytic injury to the UV-B-exposed skin sites that may have resulted in keratinocyte disassociation and a breakdown in the structure of the UV-B-irradiated epidermis. Data presented in Figure 1 show that EGCG treatment protected the skin against UV-B-induced epidermal damage.

Furthermore, to confirm that EGCG treatment before UV-B exposure of the skin inhibits UV-B-induced infiltration of leukocytes in the UV-B irradiated sites, we determined the MPO activity in cytosolic fractions of epidermis and dermis separately in the different treatment groups. MPO was commonly used as a marker of infiltrating leukocytes (monocytes/macrophages and neutrophils) in skin after UV-B exposure. We found an increase in MPO activity both in epidermis and dermis 48 h after UV-B exposure of the skin when compared to that of the normal, non-UV-B-exposed skin (Fig. 1C) . The increase in MPO activity after UV-B exposure indicates an influx of leukocytes to the inflamed skin. Topical treatment with EGCG before UV-B exposure was found to inhibit MPO activity both in epidermis and dermis by 67 and 65%, respectively (P < 0.001). The decrease in MPO activity suggests the inhibition of UV-B-induced infiltration of leukocytes by EGCG treatment. This fact is also evident from Figure 1A and 1B , where we found that EGCG treatment inhibited UV-B-induced infiltration of leukocytes and specifically CD11b+ cell types.

Skin application of EGCG before UV-B exposure prevented UV-B-induced depletion of APCs or Ia+ cells
In C3H/HeN mice, detection of Ia+ cells was used as a marker of class II MHC+ cells, which represent APCs in the skin. In epidermis, these cells are also called LCs. UV exposure of the skin reduces the density of epidermal LCs [15 16 37 ] either by induced migration [17 18 ] or by cell death [19 ]. As shown by immunostaining (Fig. 2 ), UV-B exposure depleted the number of Ia+ cells both in the epidermis and the dermis (Fig. 2 , middle panel) when compared with normal, non-UV-B-exposed skin (Fig. 2 , left panel). Depletion of Ia+ cells was critical in the induction of immune suppression after UV-B exposure. We found that EGCG treatment before UV-B exposure inhibited the migration, depletion, or death of APCs (Ia+ cells) (Fig. 2 , right panel) when compared with skin exposed to UV-B alone (Fig. 2 , middle panel). This observation indicated that EGCG treatment protects APCs from the adverse effect of UV-B irradiation, and this may be one reason for protection by EGCG against UV-B-induced immunosuppression in mice [30 ].



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Figure 2. Effect of topical treatment with EGCG applied to mouse skin before UV-B exposure on UV-B-induced migration or depletion of APCs. Topical treatment with EGCG applied to mouse skin before UV-B exposure prevented UV-B-induced migration or depletion of APCs. Class II MHC+ Ia+ cells were immunohistochemically detected as a marker of APCs, using anti-mouse Ia{approx}k antibody. Frozen skin sections were processed for immunoperoxidase staining as detailed in Materials and Methods. Ia+ cells are dark brown. A few distinct Ia+ cells (APCs) are indicated by arrowheads in the epidermis. A representative cross-section of immunostaining from three independent experiments is shown._art>

 
Skin treatment with EGCG before UV-B exposure prevented UV-B-induced H2O2 production
UV-B-induced H2O2 production was determined to be a marker of oxidative stress in the skin. To demonstrate that UV-B-induced infiltration of leukocytes is the major source of oxidative stress, we detected and localized H2O2-producing cells by immunostaining as well as quantitative determination of their intracellular release by using DHR, a fluorescent dye probe. As shown by immunostaining in Figure 3A , we found that UV-B-induced infiltrating cells are the major source of H2O2 production. H2O2+ cells were clearly seen in both epidermis and dermis (Fig. 3A , middle panel). These H2O2+ cells were not observed in normal, non-UV-B-exposed skin (Fig. 3A , left panel). This observation also supported the notion that UV-B-induced infiltrating cells are the major source of H2O2 production. Quantitative analysis of H2O2 also revealed that EGCG treatment before UV-B exposure significantly inhibited UV-B-induced intracellular release of H2O2, both in epidermis and dermis, respectively, by 72 and 56% (P < 0.001) (Fig. 3B) . The inhibition of UV-B-induced H2O2 production by EGCG treatment further confirmed our observation that EGCG prevented UV-B-induced infiltration of leukocytes and convincingly suggested the antioxidant potential of EGCG. Furthermore, the inhibition of UV-B-induced H2O2 by EGCG in the epidermis may also have been partly a result of keratinocyte H2O2 production. It also appeared that, in EGCG-treated skin, epidermis was comparatively more intact and less damaged, as shown in Figure 3A .



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Figure 3. Effect of topical treatment of mouse skin with EGCG on UV-B-induced production of H2O2. Topical treatment of mouse skin with EGCG inhibited UV-B-induced production of H2O2. Immunohistochemical detection and quantitative assay of H2O2 was performed 48 h after UV-B exposure and used as a marker of UV-B-induced oxidative stress in the skin. (A). Immunohistochemical detection of H2O2-producing cells is shown as dark-brown staining, using DAB as a substrate. The detailed staining procedure is described in Materials and Methods. A representative section of immunostained cells from three independent experiments is shown. (B). Quantitative analysis of UV-B-induced intracellular release of H2O2 was performed in single-cell suspensions from epidermis and dermis separately, using dihydrorhodamine 123 as a fluorescence dye probe as described in Materials and Methods. _art>

 
Skin application of EGCG before UV-B exposure prevented UV-B-induced iNOS expression and NO production
As shown in Figure 1B , UV-B-induced infiltrating cells were predominantly CD11b+ (activated macrophages/neutrophils). Activated macrophages were an important source of iNOS expression, and the production of NO by these activated macrophages was central in the induction of inflammation. As shown by immunostaining (Fig. 4A ), higher numbers of iNOS+ cells were visible in the dermis of UV-B exposed skin (Fig. 4A , middle panel), whereas only a few were evident in normal skin (Fig. 4A , left panel). In EGCG-treated skin sections (Fig. 4A , right panel), iNOS+ cells were comparatively fewer in number than in sections of skin receiving only UV-B exposure (Fig. 4A , middle panel). EGCG treatment alone did not induce infiltration as well as expression of iNOS in the skin (data not shown). Quantitative analysis of NO production revealed that UV-B exposure to skin induced approximately fourfold and 10-fold greater NO production in epidermis and dermis, respectively (Fig. 4B) when compared to that in normal skin. EGCG treatment before UV-B exposure of the skin significantly (P < 0.001) inhibited NO production by 74 and 73%, respectively, in epidermis and dermis. The inhibition of UV-B-induced NO production by EGCG treatment also reflected the antioxidant potential of this green tea polyphenol.



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Figure 4. Effect of EGCG before UV-B exposure on expression of iNOS and NO production. Topical treatment of mouse skin with EGCG before UV-B exposure inhibited UV-B-induced expression of iNOS and NO production measured at 48 h after UV-B exposure. (A) Immunohistochemical detection of iNOS expression in activated macrophages was performed using rat anti-mouse iNOS antibody (anti-Mac) specific to activated macrophages as detailed in Materials and Methods. iNOS+ cells are shown in dark brown. A representative section of immunostained cells from three independent experiments is shown. (B) A quantitative assay of NO production in epidermal and dermal cytosols was performed using Griess reagents. _art>

 

    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Our study showed that pretreatment of mouse skin with EGCG inhibited UV-B-induced infiltration of leukocytes, specifically CD11b+ cells, into the skin. In previous studies, Hammerberg et al. (23) have shown that UV-induced class II MHC+ CD11b+ leukocytes that infiltrate the epidermis and dermis appear to mediate UV-induced immunosuppression. To prove their hypothesis, these authors gave in vivo anti-CD11b treatment to UV-irradiated mice, which restored contact sensitivity response completely. This restoration was associated with reduction in the infiltration of class II MHC+ CD11b+ Gr-1+ monocytes/macrophages into UV-irradiated skin [23 ]. In addition, anti-CD11b treatment provided partial protection against epidermal injury, in that the epidermal structure was better preserved and the keratinocytes were less severely damaged. We report similar observations in which UV-B-induced infiltration of leukocytes was blocked (Fig. 1A) by treatment with EGCG, which was also evident from reduction in infiltration of CD11b+ cells (Fig. 1B) , as well as reduced MPO activity (Fig. 1C) . MPO activity is also commonly used as a measure of total infiltrating neutrophil content found in inflamed UV-B-irradiated skin. Moreover, less damage to epidermal structure was also observed with the use of EGCG treatment before UV-B exposure of the skin.

UV-B-induced suppression of the murine immune response to a contact sensitizer is mediated through alterations of APCs [38 39 ]. The initial effect of UV is on the constitutive APCs within the skin, epidermal LCs, and dermal LC-like APCs, such that cell death [19 ] or functional alteration [40 ] of these cells occurs. As a result of in vivo UV-B exposure, the constitutive skin APCs are no longer capable of initiating in vivo contact sensitivity responses [20 21 ] or stimulating in vitro Th1-type cells [41 ]. In our study, we found that EGCG treatment before a single UV-B exposure prevented migration or depletion of APCs from the UV-irradiated skin (Fig. 2) . It appears that the prevention of UV-B-induced migration or depletion of class II MHC+ Ia+ cells by EGCG may be associated with the prevention of UV-B-induced suppression of the immune responses to a contact sensitizer [30 ]. In addition to a prominent role played by APCs in immune responses, it has been shown that the induction of a state of tolerance to a contact sensitizer applied to UV-irradiated skin receiving a single UV dose is due to the appearance of tolerance-inducing infiltrating class II MHC+CD11b+ monocytes/macrophages in both mice [20 21 ] and humans [42 43 44 ]. Our observation that treatment with EGCG prevented UV-B-induced immunosuppression and tolerance induction [30 ] is probably related, therefore, to the prevention of UV-B-induced infiltration of CD11b+ cells in the UV-B-irradiated skin. Application of EGCG alone to normal, non-UV-B exposed, mouse skin sites did not induce infiltration of leukocytes or affect the constitutive cell structure of the skin and APCs (data not shown). Moreover, it is important to mention that EGCG showed a UV absorption peak at 270–273 nm, and, therefore, it is likely that EGCG treatment may absorb or block penetration of some short UV-B wavelengths (e.g., 280–290 nm) into the skin. It is certain that EGCG did not absorb or block the penetration of the whole UV-B wavelength range into the skin.

The UV-B-induced infiltrating leukocytes were found to be a major source of H2O2 (Fig. 3A and 3B) , iNOS expression (Fig. 4A) , and NO production (Fig. 4B) . Production of H2O2 and NO may thus create a state of oxidative stress in the skin and act as a tumor initiator [10 ] and tumor promoter [11 ]. Recently, Iwai et al. [45 ] suggested that UV-induced immune suppression might be mediated through ROS, at least in part. To confirm their observations, they found that application of glutathione as an antioxidant to the skin during irradiation significantly reversed UV-induced immunosuppression. Similar observations were made with the use of EGCG on mouse skin, in which EGCG treatment before a single dose of UV exposure inhibited the induction of oxidative stress in UV-irradiated skin. Thus the reduction in UV-B-induced oxidative stress by pretreatment with EGCG may be associated with the prevention of UV-induced suppression of immune responses.

UV-induced immune suppression is also considered a risk factor for skin cancer development [12 13 ]. Clinical observations have long documented an association between chronic inflammation and increased incidence of tumor formation at the inflammatory site [46 ]. The mediating agent(s) between inflammation and the development of the tumor at the inflammatory site has been proposed to be oxidative products produced by the inflammatory leukocytes [47 48 ]. As we found in our study that UV-induced infiltrating leukocytes are the potential source of H2O2 and NO production in the skin, these ROS may play an important role as a tumor initiator [10 ] and tumor promoter [11 ] by damaging macromolecules such as DNA, proteins, and lipids. The prevention of UV-induced infiltrating leukocytes and their ROS metabolites by skin treatment with EGCG may help in reducing oxidative stress in the skin. Therefore, reduction in UV-induced oxidative stress by EGCG may help in the reduction of mutagenic and carcinogenic effects of UV radiation.

In summary, our data demonstrated the potent preventive effects of EGCG in mouse skin against UV radiation-induced infiltration of activated leukocytes, which are the potential mediating agents of UV-induced suppression of immune responses and oxidative stress in the UV-irradiated skin. These factors all together make the skin more susceptible to various skin disorders including photoaging and skin cancer development. Together, on the basis of the data obtained in our animal model, we recommend an in-depth study to translate the preventive effects of GTPs in human skin.


    ACKNOWLEDGEMENTS
 
This work was supported by USPHS grants RO1 CA78809 and RO1 CA51802.

Received October 16, 2000; revised December 20, 2000; accepted December 21, 2000.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

  1. Agarwal, R., Mukhtar, H. (1993) Oxidative stress in skin chemical carcinogenesis Fuchs, J. Packer, L. eds. Oxidative Stress in Dermatology ,207-241 Marcel Dekker New York, NY.
  2. Perchellet, J.-P., Perchellet, E. M. (1989) Antioxidants and multistage carcinogenesis in mouse skin Free Radic. Biol. Med. 7,377-408[Medline]
  3. Dragsted, L. O. (1998) Natural antioxidants in chemoprevention Arch. Toxicol. Suppl. 20,209-226[Medline]
  4. Hocman, G. (1989) Prevention of cancer: vegetables and plants Comp. Biochem. Physiol. B 93,201-212
  5. Yang, C. S., Lee, M. J., Chen, L., Yang, G. Y. (1997) Polyphenols as inhibitors of carcinogenesis Environ. Health Perspect. 105,971-976
  6. Wattenberg, L. W. (1990) Inhibition of carcinogenesis by naturally occurring and synthetic compounds Kuroda, Y. Shankel, D. M. Waters, M. D. eds. Antimutagenesis and Anticarcinogenesis, Mechanism II ,155-166 Plenum Publishing Corp. New York, NY.
  7. Katiyar, S. K., Mukhtar, H. (1997) Tea antioxidants in cancer chemoprevention J. Cellular Biochem. 27,59-67
  8. Miller, D. L., Weinstock, M. A. (1994) Nonmelanoma skin cancer in the United States: incidence J. Am. Acad. Dermatol. 30,774-778[Medline]
  9. Kripke, M. L. (1990) Photoimmunology Photochem. Photobiol. 52,919-924[Medline]
  10. Kligman, L. H., Akin, F. J., Kligman, A. M. (1980) Sunscreens prevent ultraviolet photocarcinogenesis J. Am. Acad. Dermatol. 3,30-35[Medline]
  11. Katiyar, S. K., Korman, N. J., Mukhtar, H., Agarwal, R. (1997) Protective effects of silymarin against photocarcinogenesis in a mouse skin model J. Natl. Cancer Inst. 89,556-566[Abstract/Free Full Text]
  12. Yoshikawa, T., Rae, V., Bruins-Slot, W., van den Berg, J. W., Taylor, J. R., Streilein, J. W. (1990) Susceptibility to effects of UVB radiation on induction of contact hypersensitivity as a risk factor for skin cancer in humans J. Invest. Dermatol. 95,530-536[Medline]
  13. Donawho, C. K., Muller, H. K., Bucana, C. D., Kripke, M. L. (1996) Enhanced growth of murine melanoma in ultraviolet-irradiated skin is associated with local inhibition of immune effector mechanisms J. Immunol. 157,781-786[Abstract]
  14. Toews, G. B., Bergstresser, P. R., Streilein, J. W., Sullivan, S. (1980) Epidermal Langerhans cell density determines whether contact hypersensitivity or unresponsiveness follows skin painting with DNFB J. Immunol. 124,445-453[Medline]
  15. Aberer, W., Schuler, G., Stingl, G., Honigsmann, H., Wolff, K. (1981) Ultraviolet light depletes surface markers of Langerhans cells J. Invest. Dermatol. 76,202-210[Medline]
  16. Noonan, F. P., Bucana, C., Sauder, D. N., DeFabo, E. C. (1984) Mechanism of systemic immune suppression by UV irradiation in vivo. II. The UV effects on number and morphology of epidermal Langerhans cells and the UV-induced suppression of contact hypersensitivity have different wavelength dependencies J. Immunol. 132,2408-2416[Abstract]
  17. Moodycliffe, A. M., Kimber, I., Norval, M. (1992) The effect of ultraviolet B irradiation and urocanic acid isomers on dendritic cell migration Immunology 77,394-399[Medline]
  18. Sontag, Y., Guikers, C. L. H., Vink, A. A., de Gruijl, F. R., van Loveren, H., Garssen, J., Roza, L., Kripke, M. L., van der Leun, J. C., van Vloten, W. A. (1995) Cells with UV-specific DNA damage are present in murine lymph nodes after in vivo UV irradiation J. Invest. Dermatol. 104,734-738[Medline]
  19. Tang, A., Udey, M. C. (1992) Effects of ultraviolet radiation on murine epidermal Langerhans cells: doses of ultraviolet radiation that modulate ICAM-1 (CD54) expression and inhibit Langerhans cell function cause delayed cytotoxicity in vitro J. Invest. Dermatol. 99,83-89[Medline]
  20. Cooper, K. D., Duraiswamy, N., Hammerberg, C., Allen, E., Kimbrough-Green, C., Dillon, W., Thomas, D. (1993) Neutrophils, differentiated macrophages, and monocyte/macrophage antigen presenting cells infiltrate murine epidermis after UV injury J. Invest. Dermatol. 101,155-163[Medline]
  21. Hammerberg, C., Duraiswamy, N., Cooper, K. D. (1994) Active induction of unresponsiveness (tolerance) to DNFB by in vivo ultraviolet-exposed epidermal cells is dependent upon infiltrating class II MHC+ CD11b (bright) monocytic/macrophagic cells J. Immunol. 153,4915-4924[Abstract]
  22. Cruz, P. D., Nixon-Fulton, J., Tigelaar, R. E., Bergstresser, P. R. (1989) Disparate effects of in vitro low-dose UVB irradiation on intravenous immunizations with purified epidermal cell subpopulations for the induction of contact hypersensitivity J. Invest. Dermatol. 92,160-165[Medline]
  23. Hammerberg, C., Duraiswamy, N., Cooper, K. D. (1996) Reversal of immunosuppression inducible through ultraviolet-exposed skin by in vivo anti-CD11b treatment J. Immunol. 157,5254-5261[Abstract]
  24. Hammerberg, C., Katiyar, S. K., Carroll, M. C., Cooper, K. D. (1998) Activated complement component 3 (C3) is required for ultraviolet induction of immunosuppression and antigenic tolerance J. Exp. Med. 187,1133-1138[Abstract/Free Full Text]
  25. Pekarek, L. A., Starr, B. A., Toledano, A. Y., Schreiber, H. (1995) Inhibition of tumor growth by elimination of granulocytes J. Exp. Med. 181,435-440[Abstract/Free Full Text]
  26. Sueng, L. P., Rowley, D. A., Dubey, P., Schreiber, H. (1995) Synergy between T-cell immunity and inhibition of paracrine stimulation causes tumor rejection Proc. Natl. Acad. Sci. USA 92,6254-6258[Abstract/Free Full Text]
  27. Sueng, L. P., Seung, S. K., Schreiber, H. (1995) Antigenic cancer cells that escape immune destruction are stimulated by host cells Cancer Res 55,5094-5100[Abstract/Free Full Text]
  28. Katiyar, S. K., Ahmad, N., Mukhtar, H. (2000) Green tea and skin Arch. Dermatol. 136,989-994[Abstract/Free Full Text]
  29. Katiyar, S. K., Elmets, C. A., Agarwal, R., Mukhtar, H. (1995) Protection against ultraviolet-B radiation-induced local and systemic suppression of contact hypersensitivity and edema responses in C3H/HeN mice by green tea polyphenols Photochem. Photobiol. 62,855-861[Medline]
  30. Katiyar, S. K., Challa, A., McCormick, T. S., Cooper, K. D., Mukhtar, H. (1999) Prevention of UVB-induced immunosuppression in mice by the green tea polyphenol (-)-epigallocatechin-3-gallate may be associated with alterations in IL-10 and IL-12 production Carcinogenesis 20,2117-2124[Abstract/Free Full Text]
  31. Learn, D. B., Beard, J., Moloney, S. J. (1993) The ultraviolet C energy emitted from FS lamps contributes significantly to the induction of human erythema and murine ear edema Photodermatol. Photoimmunol. Photomed. 9,147-153[Medline]
  32. Bradley, P. P., Priebat, D. A., Christensen, R. D., Rothstein, G. (1982) Measurement of cutaneous inflammation: estimation of neutrophil content with an enzyme marker J. Invest. Dermatol. 78,206-209[Medline]
  33. Katiyar, S. K., Matsui, M. S., Elmets, C. A., Mukhtar, H. (1999) Polyphenolic antioxidant (-)-epigallocatechin-3-gallate from green tea reduces UVB-induced inflammatory responses and infiltration of leukocytes in human skin Photochem. Photobiol. 69,148-153[Medline]
  34. Dannenberg, A. M., Jr, Schofield, B. H., Rao, J. B., Dinh, T. T., Lee, K., Boulay, M., Abe, Y., Tsuruta, J., Steinbeck, M. J. (1994) Histochemical demonstration of hydrogen peroxide production by leukocytes in fixed-frozen tissue sections of inflammatory lesions J. Leukoc. Biol. 56,436-443[Abstract]
  35. Peus, D., Vasa, R. A., Beyerle, A., Meves, A., Krautmacher, C., Pittelkow, M. R. (1999) UVB activates ERK1/2 and p38 signaling pathways via reactive oxygen species in cultured keratinocytes J. Invest. Dermatol. 112,751-756[Medline]
  36. Royal, J. A., Ischiropoulos, H. (1993) Evaluation of 2',7'-dichlorofluorescin and dihydrorhodamine 123 as fluorescent probes for intracellular H2O2 in cultured endothelial cells Arch. Biochem. Biophys. 302,348-355[Medline]
  37. Toews, G. B., Bergstresser, P. R., Streilein, J. W., Sullivan, S. (1980) Epidermal Langerhans cell density determines whether contact hypersensitivity or unresponsiveness follows skin painting with DNFB J. Immunol. 124,445-453
  38. Greene, M. I., Sy, M. S., Kripke, M. L., Benacerraf, B. (1979) Impairment of antigen presenting cell function by ultraviolet radiation Proc. Natl. Acad. Sci. USA 76,6591-6595[Abstract/Free Full Text]
  39. Noonan, F. P., Kripke, M. L., Pedersen, G. M., Greene, M. I. (1981) Suppression of contact hypersensitivity in mice by ultraviolet irradiation is associated with defective antigen presentation Immunology 43,527-533[Medline]
  40. Tang, A., Udey, M. C. (1991) Inhibition of epidermal Langerhans cell function by low dose ultraviolet B radiation: ultraviolet B radiation selectively modulates ICAM-1 (CD54) expression by murine Langerhans cells J. Immunol. 146,3347-3355[Abstract]
  41. Simon, J. C., Cruz, P. D., Jr, Bergstresser, P. R., Tigelaar, R. E. (1990) Low dose ultraviolet B-irradiated Langerhans cells preferentially activate CD4+ cells of the T helper 2 subset J. Immunol. 145,2087-2091[Abstract]
  42. Cooper, K. D., Oberhelman, L., Hamilton, T. A., Baadsgaard, O., Terhune, M., LeVee, G., Anderson, T., Koren, H. (1992) UV exposure reduces immunization rates and promotes tolerance to epicutaneous antigens in humans: relationship to dose, CD1a-DR+ epidermal macrophage induction, and Langerhans cell depletion Proc. Natl. Acad. Sci. USA 89,8497-8501[Abstract/Free Full Text]
  43. Baadsgaard, O., Fox, D. A., Cooper, K. D. (1988) Human epidermal cells from ultraviolet light-exposed skin preferentially activate autoreactive CD4+ 2H4+ suppressor-inducer lymphocytes and CD8+ suppressor/cytotoxic lymphocytes J. Immunol. 140,1738-1744[Abstract/Free Full Text]
  44. Cooper, K. D., Fox, P., Neises, G., Katz, S. I. (1985) Effects of ultraviolet radiation on human epidermal cell alloantigen presentation: initial depression of Langerhans cell-dependent function is followed by the appearance of T6- DR+ cells that enhance epidermal alloantigen presentation J. Immunol. 134,129-137[Abstract]
  45. Iwai, I., Hatao, M., Naganuma, M., Kumano, Y., Ichihashi, M. (1999) UVA-induced immune suppression through an oxidative pathway J. Invest. Dermatol. 112,19-24[Medline]
  46. Rosin, M. P., Anwar, W. A., Ward, A. J. (1994) Inflammation, chromosomal instability, and cancer: the schistosomiasis model Cancer Res. 54(Suppl),1929s-1933s[Medline]
  47. Trush, M. A., Seed, J. L., Kensler, T. W. (1995) Oxidant-dependent metabolic activation of polycyclic aromatic hydrocarbons by phorbol ester-stimulated human polymorphonuclear leukocytes: Possible link between inflammation and cancer Proc. Natl. Acad. Sci. USA 82,5194-5198
  48. Weitzman, S. A., Clark, E. P., Stossel, T. P. (1985) Phagocytes as carcinogens: malignant transformation produced by human neutrophils Science 227,1231-1233[Abstract/Free Full Text]



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