Peter Morawski, PhD, is on a quest to find better treatments for autoimmune diseases that affect the skin. These diseases happen when T cells — immune cells that are supposed to help fight infections — get confused and start attacking healthy tissue.
This exploration starts with some important questions: How do T cells interact with other skin cells? What’s the difference between T cells that live in the skin and those that move between the skin and the blood? How are these interactions supposed to work in healthy skin — and what goes wrong in diseases like psoriasis and scleroderma?
Dr. Morawski and BRI bioinformatician Hannah DeBerg, PhD, built an “atlas” that answers many of these questions and details how immune cells in healthy skin behave.
“The skin is our biggest organ, but there’s still so much that we don’t know about it,” Dr. Morawski said. “So first, we need to understand what immune cells are supposed to do in health. That opens the door to understanding what goes wrong in disease.”
Understanding T Cells that Live in the Skin and Blood
Building an atlas of skin cells starts somewhere you might not expect: The Plastic and Reconstructive Surgery Department at Virginia Mason Franciscan Health (VMFH). Thanks to a partnership with their doctors and patients, BRI’s teams are able to study tissue that would otherwise be discarded — in this case, from people having procedures like tummy tucks.
“For years, skin diseases were studied through the blood, spleen or lymph nodes, but the skin is where the action happens,” Dr. Morawski said. “We now have better tools and technologies to collect and study actual human skin cells, which provides the most insight into skin diseases.”
Drs. Morawski and DeBerg used skin cells from these samples to create a roadmap and answer some critical unknown features of the skin, such as:
Characteristics and behaviors of T cells that live in the skin.
Characteristics and behaviors of T cells that move between the skin and the blood.
Interactions between T cells and other cells that live in the skin.
“One of the most interesting findings was that the T cells that move in and out of the skin tend to be the main drivers of inflammation,” Dr. Morawski said. “As opposed to the T cells that live in the skin long-term, which tend to be involved in fostering basic skin functions.”
Skin-Resident and Circulating T Cells in Skin Health
A Potential Driver of Scleroderma
All told, the research team mapped out seven different types of immune cells and 13 functions that each cell does. One cell type, CD103-expressing T cells, was especially interesting to Dr. Morawski because they help support healthy skin functions like wound healing.
He reasoned that if these T cells play a key role in keeping skin healthy, perhaps diseases may happen when something goes wrong with these cells. That’s exactly what he found in the CD103+ T cells from people with scleroderma.
“These cells are either becoming pathogenic or disappearing completely,” Dr. Morawski said. “Next, we want to learn more about exactly what’s happening and if and how these cells might drive scleroderma.”
The research team just landed an additional grant to study exactly that.
“Scleroderma is a tough nut to crack because it manifests in so many different ways. Some people have skin disease, others have joint pain or kidney problems,” Dr. Morawski said. “The more we learn about what drives disease and the many different symptoms it causes, the closer we get to better and more targeted treatments.”
The Team that Makes this Work Possible
This study was truly a team effort, with experts from across BRI exploring fundamental biology, finding meaningful patterns in data sets, and working with patients to collect samples.
“This is one of the few papers I’ve seen that involves scientists from every center at BRI — not to mention the VMFH doctors and patients and our partners in Austria and India who played a vital role in building skin-based culture systems,” Dr. Morawski said. “I’m very proud to have been part of this study with so many talented and dedicated scientists.”
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