THE main cause of the onset of acne – a dermatological disease widespread especially in adolescence – has always been attributed to inflammation of the hair follicles. A study published in Science Translational MedicineHowever, it highlights for the first time the role of fibroblasts – multifunctional cells that make up connective tissue – in the pathogenesis of this disorder.
What is acne
The cutaneous manifestation of this disease is, unfortunately, always evident, and is often linked to the hormonal imbalance typical of adolescence and the consequent increase in sebum production. Acne has no definitive cure to date, and it is an often limiting condition from a social and psychological point of view which, if not treated properly, can reach the deeper layers of the skin and give rise to permanent scars. It is also a multifactorial disease that can be influenced (or aggravated) by external agents such as poor nutrition, stress, air quality and poor hygiene.
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The role of fibroblasts
According to the results of the new study, when the bacterium cutibacterium acnes (one of the main ones involved in the genesis of acne) infects the skin, the immune system also calls into question external cells that surround the infected hair follicles – where the actual dermatological lesions (such as blackheads and pimples) develop. These cells, called fibroblasts, can transform into fat cells according to a process that scientists have called “active adipogenesis”, giving rise to real acne breakouts. However, there would also be a secondary effect: adipogenesis would trigger the increase in the expression of a particular gene to which an antimicrobial protein, cathelicidin, is associated, which would help to curb bacterial infection.
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To determine how the fibroblasts respond to Cutibacterium acnes infections, the researchers took skin samples from six acne patients following a withdrawal of skin and drug treatments for at least 90 days. The samples revealed, in the tissue surrounding the infected hair follicles, the presence of “preadipocytes” – fibroblasts that were carrying out the transformation into fat cells – and cathelicidin, both symptoms of a localized immune response. The same experiment was also carried out on mouse models, and substantially validated the results obtained for human acne.
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Treatment with retinoids
Among the molecules most used in the treatment of acne are retinoids, molecules capable of preventing the accumulation of lipids and eliminating debris from infected pores. The experiment carried out by the researchers of this study showed that retinoids also act by promoting the production of cathelicidin by fibroblasts. To date, it is simply the discovery of a new mechanism of action of a drug already widely used in the treatment of acne. The prospect, however, is to be able to develop new targeted treatments that act specifically on fibroblasts and their ability to trigger an antimicrobial immune response to acne.