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Effect of Avène Spring Water on the Activation of Rat Mast Cell by Substance P or Antigen

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  • Centre de Recherche Pierre Fabre Toulouse

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The biological activity of Avène water from two different springs ('Sainte Odile' and 'Val d'Orb') was studied in vitro on rat peritoneal mast cell activation. A dilution-dependent inhibition of both histamine and prostaglandin D2 antigen-induced release was observed when cells were preincubated with both Avène spring waters. They also inhibited histamine release triggered by substance P. The ability of Avène water to inhibit mast cell activation in vitro may be related with its antiallergic and anti-inflammatory properties and its use in hydrotherapy.
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Original Research Article
Skin Pharmacol Appl Skin Physiol 1998;11:111–116
Effect of Avène Spring Water on the
Activation of Rat Mast Cell by
Substance P or Antigen
F. Joly
a
M. Charveron
b
M.F. Ariès
b
J. Bidault
c
L. Kahhak
a
F. Beauvais
a
Y. Gall
b
a
SEPhRA (Société d’Etudes en
Pharmacologie: Recherche,
Applications), Paris;
b
Institut de Recherche
Pierre-Fabre, Faculté de Médecine
de Rangueil, Toulouse, and
c
CNRS URA 1159,
Les Plessis Robinson, France
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Key Words
Peritoneal mast cell
Avène spring water
Substance P
Antigen
Histamine
Prostaglandin D
2
OOOOOO OOOOO OOOOOO OOOOO OOOOOOOOOO OOOOOOOOOOOOOOO OOOOOOOOOOOOOOO OOOOOOOOOOOOOOO O
Abstract
The biological activity of Avène water from two different
springs (‘Sainte Odile’ and ‘Val d’Orb’) was studied in vitro on
rat peritoneal mast cell activation. A dilution-dependent inhi-
bition of both histamine and prostaglandin D
2
antigen-
induced release was observed when cells were preincubated
with both Avène spring waters. They also inhibited histamine
release triggered by substance P. The ability of Avène water to
inhibit mast cell activation in vitro may be related with its
antiallergic and anti-inflammatory properties and its use in
hydrotherapy.
OOOOOOOOOO OOOOO OO
Introduction
Avène spring water, known for its thera-
peutic properties in dermato-allergology, has
long been used to treat a variety of skin dis-
eases including atopic dermatitis, psoriasis,
eczema and urticaria. In vitro, Avène water
inhibits human basophil and mast cell aller-
gen-induced activation [1, 2]. Recently, it
was shown that incubation of cultured hu-
man skin fibroblasts with Avène water in-
creased the fluidity of the plasma membrane
suggesting that its primary impact is at this
level [3].
Mast cells play an important role in the
pathophysiological changes observed in cuta-
neous allergic and inflammatory reactions.
They release preformed mediators such as his-
tamine, hydrolytic enzymes and synthesize,
after antigenic challenge, the newly formed
mediator derived from membrane phospho-
lipids, prostaglandin D
2
(PGD
2
) [4, 5]. Fur-
thermore, recent studies indicate that the ner-
vous system may also influence cutaneous
Received: July 18, 1997
Accepted: Dec. 4, 1997
ABC
Fax + 41 61 306 12 34
E-Mail karger@karger.ch
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© 1998 S. Karger AG, Basel
1422–2868/98/0112–0111$15.00/0
This article is also accessible online at:
http://BioMedNet.com/karger
F. Joly
SEPhRA (Société d’Etudes en Pharmacologie: Recherche, Applications)
41, avenue du Général Sarrail
F–75016 Paris (France)
Tel. +33 01 46 32 70 47, Fax +33 01 46 31 02 77
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Skin Pharmacol Appl Skin Physiol
1998;11:111–116
Joly/Charveron/Ariès/Bidault/Kahhak/
Beauvais/Gall
Table 1.
Composition of the two Avène waters
tested
Val d’Orb Sainte Odile
pH 7.7 7.8
Resistivity ø/cm 2,915 2,353
Silica mg/l 12.1 14.0
Ca
2+
mg/l 59.0 42.7
Mg
2+
mg/l 26.0 21.2
Na
+
mg/l 4.6 4.8
K+ mg/l 0.8 0.8
HCO
3
mg/l 281 227
Cl
mg/l 4.2 5.4
SO
4
2–
mg/l 25.3 13.1
NO
3
2–
mg/l 1.0 1.4
NO
2
mg/l ! 0.02 ! 0.01
PO
4
3–
mg/l ! 0.05 0.3
F
mg/l ! 0.1 0.1
Br
mg/l ! 0.1 0.3
Arsenic Ìg/l 8 10
Bore Ìg/l 38 220
Cadmium Ìg/l ! 12
Chrome Ìg/l ! 5 ! 2
Copper Ìg/l ! 20 ! 5
Lead Ìg/l ! 5 ! 5
Iron Ìg/l 70 ! 5
Lithium Ìg/l ! 20 ! 0.1
Manganese Ìg/l ! 5 ! 2
Zinc Ìg/l ! 20 45
Strontium Ìg/l 110 100
inflammatory events through the activation
of immune cells by substance P, a neurotrans-
mitter [6, 7]. Substance P is a peptide which is
released by skin C fibers which are in the
immediate vicinity of mast cells. It can bind
to and activate mast cells of the serosal type
resulting in histamine release [5, 8].
The aim of the present study was to inves-
tigate the effect of Avène spring water on sub-
stance P- and antigen-induced degranulation
of PGD
2
release in rat peritoneal mast cells
which present the same functional character-
istics as human cutaneous mast cells.
Materials and Methods
Reagents
Substance P (Neosystem, Strasbourg, France),
HEPES, bovine serum albumin (BSA), mouse mono-
clonal IgE anti-dinitrophenyl (DNP), p-nitrophenyl-N-
acetyl-ß-D-glucosaminide, metrizamide (Sigma Chem-
ical Co., St. Louis, Mo., USA). DNP coupled to BSA
antigen was prepared according to Eisen [9] and stored
at –20
°
C.
Isolation and Purification of Rat Peritoneal Mast
Cells
Mast cells from male Wistar rats (200–300 g; Iffa-
Credo, L’Arbresle, France) were obtained following an
intraperitoneal injection of 15 ml of Tyrode’s buffer
(NaCl 137 mM, KCl 2.7 mM, glucose 5.6 mM,
NaH
2
PO
4
0.4 mM, NaHCO
3
10 mM, HEPES 4.2 mM,
BSA 0.25%, pH 7.4). After injection, the peritoneal cav-
ity was massaged for 2–3 min and the fluid collected.
The cell suspension was centrifuged (400 g, 5 min, 4
°
C)
and the pellet was resuspended in 2 ml of this buffer.
Mast cells were stained using toluidine blue solution
and counted. The number of peritoneal cells per rat var-
ied from 1.2 ! 10
7
to 1.7 ! 10
7
. Mast cells were puri-
fied on a metrizamide layer (22.5%) and then centri-
fuged (400 g, 20 min, 20
°
C). Cells at the interface were
excluded and the pellet, which contained mast cells, was
resuspended in Tyrode’s buffer. Prior to stimulation
with substance P, cells were washed by centrifugation
and resuspended in Tyrode’s buffer supplemented with
CaCl
2
0.3 mM and MgCl
2
0.5 mM. Before antigenic
stimulation, cells were resuspended in Tyrode’s buffer
containing CaCl
2
1.3 mM and MgCl
2
0.5 mM.
Avène Water
Avène waters from two different springs, ‘Sainte
Odile’ and ‘Val d’Orb’, were tested. The composition
of both Avène waters is presented in table 1. They were
supplied in glass bottles (Pierre Fabre Laboratory) and
stored at 4
°
C. Avène water was made isotonic prior to
use by dilution (9:1, v/v) in tenfold concentrated wash-
ing Tyrode. This solution was then diluted 1/2, 1/4 and
1/10 in Tyrode’s.
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Inhibition of Mast Cell Activation by
Avène Water
Skin Pharmacol Appl Skin Physiol
1998;11:111–116
113
Mast Cell Activation and Mediator Release
Substance P stimulation: Before activation, cells
were preincubated with Avène water (stock solution or
dilutions) for 30 min at 37
°
C. Cell suspensions were
then incubated with substance P (30 ÌM) for 5 min.
Antigenic stimulation: Cells were suspended in
Ca
2+
/Mg
2+
Tyrode’s buffer and sensitized with mono-
clonal IgE anti-DNP (1Ìg/ml) for 90 min, washed by
centrifugation (300 g, 5 min, 20
°
C), and finally resus-
pended in the control Tyrode’s buffer, Avène water
or its dilutions. Cells were stimulated with DNP-BSA
(40 ng/ml) for 10 min.
The stimulations were stopped on ice and superna-
tants and pellets were obtained by centrifugation at
4
°
C. Histamine content in supernatants and sonicated
cell pellets was assessed by ELISA (Bioadvance,
France). PGD
2
released in supernatants was measured
by radioimmunoassay (Amersham, France). ß-Hexo-
saminidase (ß-hex) activity (an index of degranulation)
in supernatants and sonicated cell pellets was quanti-
fied by the hydrolysis of p-nitrophenyl-N-acetyl-ß-D-
glucosaminide as previously described [10].
Statistical Analysis
Released histamine is expressed as a percentage of
total histamine content. Spontaneous histamine re-
lease was subtracted from all values to give the net
release percentage. The net percentage of ß-hex release
was calculated using the following formula: [(S – Sc) !
100]/[(S + P) – Sc], where S is the ß-hex activity in the
supernatant of antigen-challenged cells, P is the activi-
ty in the pellet of challenged cells, and Sc is the activity
in the supernatant of unchallenged cells. The Student’s
t test was used for statistical evaluation. p values ! 5%
were considered as significant.
Results
We compared Avène waters from the
springs, ‘Sainte Odile’ and ‘Val d’Orb’, com-
paratively with a distilled water control for
their effects on mast cell degranulation, mea-
sured as histamine and ß-hex release induced
by substance P or antigen. The viability of the
cell suspensions used in all experiments in the
presence of Avène water was verified by try-
pan blue exclusion (1 95%). In addition, spon-
taneous histamine or ß-hex release (! 6%)
were not increased by the treatment with
Avène water suggesting that the cell viability
was not affected.
Incubation of mast cells with Avène water
before peptidergic or antigenic stimulation in-
duced a statistically significant and dilution-
dependent inhibition of ß-hex and histamine
release with respect to distilled water without
significant difference between Sainte Odile
and Val d’Orb spring water (fig. 1, 2). Inhibi-
tions were 35 B 4% and 40 B 4% with undi-
luted Sainte Odile and Val d’Orb spring wa-
ter, respectively. ß-hex, contained in mast cell
secretory granules, was released in a quantita-
tive relation to histamine after the stimula-
tion with antigen or substance P. Interesting-
ly, the observed inhibition of enzyme release
was related to the reduction of histamine lib-
eration (33 B 4% and 38 B 1% for Sainte
Odile and Val d’Orb, respectively).
In contrast to peptidergic activation, anti-
genic stimulation of rat mast cells resulted in
the release of the newly formed mediator
PGD
2
, derived from membrane phospholip-
ids. Pretreatment of mast cells with Avène
water reduced release of this mediator from
146 B 6 pg/1 ! 10
6
cells to 69 B 5 pg and 104
B 3 pg/1 ! 10
6
cells for Sainte Odile and Val
d’Orb spring water, respectively (fig. 3).
Discussion
The usefulness of Avène spring water in
the treatment of skin diseases, particularly
atopic dermatitis, urticaria and psoriasis,
have long been recognized. Due to their re-
lease of mediators, mast cells are involved in
many different cutaneous and inflammatory
disorders [11]. We studied this spring water in
a pharmacological assay using rat serosal mast
cells as a representative model of human cuta-
neous mast cells. Both cell types can be stimu-
lated not only via the classical antigenic IgE-
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Skin Pharmacol Appl Skin Physiol
1998;11:111–116
Joly/Charveron/Ariès/Bidault/Kahhak/
Beauvais/Gall
Fig. 2.
Effect of Avène spring water on histamine
release induced by antigen. Sensitized mast cells,
preincubated (30 min, 37
°
C) with Avène water for
indicated dilutions or control buffer were stimulated
with DNP-BSA (40 ng/ml, 5 min). Results are ex-
pressed in percentages of histamine release in compari-
son to the total cell histamine content and are means of
duplicate determinations. They represent the mean B
SEM of 4 experiments. * p ! 0.05.
Fig. 1.
Effect of Avène spring water on histamine
release induced by substance P. Mast cells, preincu-
bated (30 min, 37
°
C) with Avène water for indicated
dilutions or control buffer were stimulated with sub-
stance P (30 ÌM, 5 min). Results are expressed in per-
centages of histamine release in comparison to the
total cell histamine content and are means of duplicate
determinations. They represent the mean B SEM of
4 experiments. * p ! 0.05; ** p ! 0.01; *** p ! 0.001.
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Inhibition of Mast Cell Activation by
Avène Water
Skin Pharmacol Appl Skin Physiol
1998;11:111–116
115
dependent pathway but also by the peptider-
gic pathway [5, 8].
Avène spring water was effective in inhib-
iting mast cell activation, i.e. degranulation
and PGD
2
release induced by antigen or sub-
stance P. The ability of Avène spring water to
inhibit optical basophil degranulation and
mast cell histamine release has been reported
[1, 2]. In addition to studying histamine re-
lease, we have measured PGD
2
release and
mast cell activation by peptidergic stimula-
tion. The inhibitory effect of Avène spring
water on degranulation induced by substance
P is of particular interest because the mecha-
nisms underlying the neurogenic inflamma-
tion might be implicated in numerous patho-
logical processes such as chronic idiopathic,
cholinergic, heat and cold urticaria [12]. Fur-
thermore, the cutaneous proinflammatory ef-
fects of PGD
2
are well documented [13], and
in vivo studies demonstrated the presence of
histamine and PGD
2
in the different types of
urticaria mentioned above [14, 15]. Different
steps may constitute potential sites of cell per-
turbation leading to an inhibition of the stim-
ulation: primary interaction of substance P
(positively charged) with sialic acid residues
(negatively charged) or the cell membrane,
IgE receptor-ligand bridging, Ca
2+
entry fol-
lowing activation of membrane phospholi-
pases, etc. These hypotheses are consistent
with previous studies showing that Avène wa-
ter modified changes in the hydrodynamic
properties of cell membranes leading to an
increase in fluidity [3]. Furthermore, numer-
ous pathological processes, such as atopic ec-
zema and psoriasis, are linked to membrane
fluidity abnormalities [16]. The inhibitory ef-
fect of the thermal Avène spring water on
mast cell activation provides a physiological
mechanism that could explain its therapeutic
usefulness in controlling allergic or inflamma-
tory skin diseases.
Fig. 3.
Effect of Avène spring water on PGD
2
release induced by antigen. Sensitized mast cells,
preincubated (30 min, 37
°
C) with Avène water for
indicated dilutions or control buffer were stimulated
with DNP-BSA (40 ng/ml, 5 min). Results are ex-
pressed in pg per 1 ! 10
6
cells and represent the mean
B SEM of 4 experiments. * p ! 0.05.
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Skin Pharmacol Appl Skin Physiol
1998;11:111–116
Joly/Charveron/Ariès/Bidault/Kahhak/
Beauvais/Gall
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... With the increased interest of cosmetic industry in commercialized SPA waters as cosmeceuticals, an effort has been made to prove cellular effects, especially in France 33 . Well recognized European thermal centers as Avène and La Roche Posay have already promoted scientific studies validating their TW effects 27,[33][34][35][36][37] . However, in Portugal and to the best of our knowledge, only one study reporting the health benefits of a Portuguese TW has been published 38 . ...
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The benefits of thermal water in different diseases have been known since ancient times. Over the past decades, a re-assessment of the use of mineral water for the treatment of several pathologic conditions has taken place around the world. Today, water therapy is being practiced in many countries that have a variety of mineral springs considerably different in their hydrogeologic origin, temperature, and chemical composition. Thermal water and balneotherapy offer several advantages: this approach needs no chemicals or potentially harmful drugs; there are almost no side effects during and after treatment, and there is a low risk to the patient's general health and well-being. However, it is difficult to evaluate the efficacy of this therapeutic approach in clinical practice due to the complexity of molecular mechanisms underlying its efficacy. Here we review the current knowledge of the chemical, immunological, and microbiological basis for therapeutic effects of thermal water with a specific focus on chronic inflammatory skin diseases. We also describe recent evidence of the major dermatologic diseases that are frequently treated by balneotherapy with a remarkable rate of success. Moreover, we discuss the potential role of balneotherapy either alone or as a complement to conventional medical treatments.
... Moreover, the soothing and protective properties of thermal spring waters in sensitive skin (antioxidant or anti-ageing) are enhanced by the presence of trace elements such as selenium, strontium (Celerier et al., 1995). These properties have been demonstrated in many studies using human keratinocytes, fibroblasts or other response-appropriate cell lines (Seite et al., 2013;Joly et al., 1998). Furthermore, a recent study demonstrated the activity of salso-bromo-iodine water on mucous-secretory disorders, in particular it helped to improve the relationship between the mucous-protein complexes and the water: initially, this action was congestive, subsequently, it became an anti-catarrhal, anti-inflammatory, antiseptic and immunostimulant action (La Mantia et al., 2018). ...
... The main anions present in the TSW are chlorides, sulfates and bicarbonates. The waters differ in the proportions among those bulk minerals as well as in the content of trace elements, such as zinc, copper, strontium, selenium, iron, manganese, silica, fluoride, bromide, etc. [82][83][84]. Since the Antiquity, bathing was regarded as more than a simple cleansing procedure. ...
Thesis
Human skin forms a unique interface between the body and the external environment. Its main role is to protect the internal organs from external factors. Its highly hydrophobic outermost layer, stratum corneum, has long been believed impermeable for highly hydrophilic compounds, including ions. Several studies proved this concept wrong, and recent research by Paweloszek et al. demonstrated the important contribution of facilitated transport in permeation of halide anions. Skin penetration of anions classified in Hofmeister series (of F-, Br-, I-, SCN, ClO4-) alone and in bi- and ternary mixtures in two experimental series was studied in vitro. All tested ions permeated viable skin within 24h. Among halides, the presence of F- reduced the penetration of Br- and I- in mixtures, and synergy between Br- and I- was observed. Within the second group (I-, SCN-, ClO4-) the inhibition of ClO4- penetration in the presence of other ions was observed. Finally, the impact of formulation of marketed thermal spring water (TSW) into emulsions (TSW/O, O/TSW, TSW/O/W) and liposomes on skin absorption of Ca2+ and Mg2+ was evaluated. Liposomes and emulsions promoted retention of Ca2+ and Mg2+ in skin layers as compared to TSW. Our results prove that the beneficial effects observed during treatment with TSW are associated with penetration of the minerals into and through the skin and are not only a surface action. In this thesis, we demonstrate the possibility of both anions and cations to penetrate viable skin in vitro, and we disclose the effects of mixing and formulating on skin penetration profiles
... Moreover, they have soothing and protective properties in sensitive skin (antioxidant or anti-ageing) that are enhanced by the presence of trace elements such as selenium, strontium and zinc [22][23][24]. These properties have been demonstrated in many studies using human keratinocytes, fibroblasts or other response-appropriate cell lines [6,25,26]. Therefore, they are considered as active substances when used in a cosmetic product. Skincare products such as emulsions or lotions containing TSW as aqueous phase are present on the market, which claim soothing and hydration properties. ...
Article
Objective: Thermal spring waters (TSW) are commonly used as active ingredients in cosmetics. Their biological activities directly depend on the ionic composition of the spring. However, in order to exhibit beneficial properties, the minerals need to reach viable skin layers. The present study addresses the incorporation of marketed TSW in model cosmetic formulations and the impact of the formulation on skin absorption of magnesium and calcium ions that are known to improve skin barrier function. Methods: Marketed TSW was introduced into five formulations. Liposomes were prepared using saturated or unsaturated phospholipids mixed with cholesterol by the thin layer evaporation technique. Emulsions water-in-oil (W/O), oil-in-water (O/W) or double: water-in-oil-in-water (W/O/W) were prepared by high shear mixing. Skin absorption of Mg2+ and Ca2+ from those formulations was studied in vitro using static Franz diffusion cells under infinite dose condition and under occlusion of the apparatus. Results: Mg2+ and Ca2+ penetrate skin samples from TSW. Encapsulating TSW into double emulsion (TSW/O/W) increased skin absorption of both cations of interest and kept the Ca2+ /Mg2+ ratio equal to that of TSW in each skin layer. The dermal absorption of Mg2+ from the double emulsion departs from both single emulsions. Application of liposome suspension improved the skin absorption of Ca2+ while keeping constant that of Mg2+ , leading to unbalanced Ca2+ /Mg2+ ratio inside skin. Conclusion: The beneficial effects of TSW are not only due to their action on the skin surface. Their active components, especially Ca2+ and Mg2+ cations reach viable skin layers in a formulation-dependent manner. The distribution of ions inside skin depends on the type of formulation.
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In this study the ability of Avene spring water to inhibit basophil degranulation was confirmed. The active principle is thermo-labile and inactivated by ultraviolet or gamma radiation. Inhibition of basophil degranulation occurred with immunological stimuli (e.g. antigen, anti-IgE) but not with the calcium ionophore A23187 as the secretory stimulus. Freeze drying did not impair the inhibitory properties of the spring water. Freeze dried samples were able to inhibit antigen-induced histamine release from human basophils or rat mast cells. The ability of Avene water to inhibit mast cell/basophil activation may be in part responsible for the anti-inflammatory effect of the spa water observedin vivo.
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Prostaglandin (PG) D2 and histamine concentrations have been measured in blood draining cold-challenged forearm skin in patients with cold urticaria. Local venous concentrations of both histamine and PGD2 rose in four patients who developed a whealing response. Plasma histamine concentration increased from a mean resting value of 0.24 +/- 0.09 (SD) ng/ml to peak values of 16.9 to 96.6 ng/ml. Resting concentrations of PGD2 were below the limit of detection (5 pg/ml) in three patients and 62 and 27 pg/ml in the fourth. Peak plasma PGD2 concentration after challenge ranged from 166 to 279 pg/ml. Time course of histamine and PGD2 release was similar with peak concentrations at 6 and 10 minutes, respectively. The maximum clinical response occurred between 10 and 20 minutes after challenge. Our findings demonstrate that PGD2 is produced in association with mast cell degranulation in man, but the amount, relative to histamine, is low. Despite its high potency in production of inflammatory effects, PGD2 probably has only minor direct effects in cold urticaria, although it may act to potentiate other mediators.
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Substance P is an undecapeptide found in multiple sites throughout the central and peripheral nervous systems including small unmyelinated (type C) cutaneous nerve fibers. Previous studies demonstrated that antidromic stimulation results in substance P (SP) release from nerve endings, SP stimulates histamine release (HR) from rat mast cells in vitro, and intradermal SP in humans produces wheals identical to those induced by histamine. These studies suggest a possible role for SP as a link between neurologic events and cutaneous mast cell-mediated reactions. We therefore investigated SP-induced HR in an in vitro preparation of human skin mast cells. Human foreskin sections were incubated with varying concentrations of SP. Histamine was assayed using automated fluorimetry and release was calculated as a percentage of total tissue histamine. Substance P caused dose- dependent HR over a range from 10⁻⁵ M (1.3%) to 5 × 10⁻⁴ M (25.1%). Histamine release was optimal at 3 mM calcium and was blocked by pretreatment with calcium chelation. Naloxone failed to block HR. These studies suggest that HR from skin mast cells by SP may play a role in neural modulation of poorly understood inflammatory skin conditions.
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Substance P, a potent vasodilatory neuropeptide, is released from peripheral nerve endings of sensory neurons by various stimuli. Although in vitro incubation of rat and human mast cells with substance P causes their degranulation, it is not known whether inflammatory changes induced by substance P are mediated by degranulation of mast cells. We investigated this point by using genetically mast cell-deficient WBB6F1-W/Wv and WCB6F1-Sl/Sld mice. The s.c. injection of substance P induced degranulation of mast cells in the skin of WBB6F1-+/+ mice, and then a marked eosinophil infiltration around the degranulated mast cells. However, WBB6F1-W/Wv and WCB6F1-Sl/Sld mice showed little or no eosinophil infiltration in the skin after the injection of substance P. When the mast cell deficiency of WBB6F1-W/Wv mice was rescued either systemically by bone marrow transplantation or locally by injection of cultured mast cells, injection of substance P induced the infiltration of eosinophils, suggesting that substance P-induced eosinophil infiltration was mediated through degranulation of mast cells.
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We have demonstrated that, unlike mast cells of the lung, adenoids, tonsils and intestine, whose primary role is thought to be IgE-mediated host defence, human skin mast cells respond to neuropeptide stimulation with a rapid release of histamine and minimal generation of PGD2 and LTC4. This ability of skin mast cells to release mediators in response to neuropeptide stimulation is evidence in favour of a neuro-immune interaction within human skin which may have evolved to promote angiogenesis [70] or control cutaneous blood flow [71]. In this context, it is interesting to note that mast cells are found in particularly high numbers in the blush areas of the neck and face [72]. A knowledge of the functional heterogeneity of human mast cells, and of their responsiveness to neuropeptides in particular, will prove to be of great importance to our understanding of the role of mast cells in health and disease. Enhanced responsiveness of skin mast cells to neuropeptides may contribute to the aetiology of some forms of urticaria as suggested by the presence of enhanced weal responses of patients with chronic idiopathic urticaria to various non-immunological stimuli [73–76]. Furthermore, the high ratios of histamine to PGD2 (>1000∶1) [31, 32] in the venous effluent of thermally-challenged limbs of patients with heat- or cold-induced urticaria suggests mast cell activation by a neuropeptide rather than an immunological stimulus. However, the caveat applies that these two mediators may have been metabolised to different extents before reaching the sampling site.