Filaggrin inhibits generation of CD1a neolipid antigens by house dust mite–derived phospholipase

Lack of the skin barrier protein filaggrin worsens atopic dermatitis by allergenic activation of CD1a-reactive T cells. Bringing atopic dermatitis up to scratch Targeted therapies are transforming medicine, but complex diseases such as atopic dermatitis are difficult to target. Now, Jarrett et al. report a mechanism that links two contributors to atopic dermatitis pathogenesis—cutaneous inflammation and barrier dysfunction. They found that house dust mite allergen phospholipase (PLA2) can induce neolipid antigens in human skin. These antigens can then be presented by the nonclassical MHC family member CD1a to CD1a-restricted T cells, which contribute to inflammation. The skin barrier protein filaggrin can inhibit PLA2 and decrease this inflammation. Indeed, individuals with filaggrin mutations experience severe atopic dermatitis. These data suggest that barrier dysfunction and inflammation may be linked, and support PLA2 as a target for atopic dermatitis. Atopic dermatitis is a common pruritic skin disease in which barrier dysfunction and cutaneous inflammation contribute to pathogenesis. Mechanisms underlying the associated inflammation are not fully understood, and although Langerhans cells expressing the nonclassical major histocompatibility complex (MHC) family member CD1a are known to be enriched within lesions, their role in clinical disease pathogenesis has not been studied. We observed that house dust mite (HDM) allergen generates neolipid antigens presented by CD1a to T cells in the blood and skin lesions of affected individuals. HDM-responsive CD1a-reactive T cells increased in frequency after birth in individuals with atopic dermatitis and showed rapid effector function, consistent with antigen-driven maturation. In HDM-challenged human skin, we observed phospholipase A2 (PLA2) activity in vivo. CD1a-reactive T cell activation was dependent on HDM-derived PLA2, and such cells infiltrated the skin after allergen challenge. Moreover, we observed that the skin barrier protein filaggrin, insufficiency of which is associated with atopic skin disease, inhibited PLA2 activity and decreased CD1a-reactive PLA2-generated neolipid-specific T cell activity from skin and blood. The most widely used classification schemes of hypersensitivity suggest that nonpeptide stimulants of T cells act as haptens that modify peptides or proteins; however, our results show that HDM proteins may also generate neolipid antigens that directly activate T cells. These data define PLA2 inhibition as a function of filaggrin, supporting PLA2 inhibition as a therapeutic approach.