Elastase 2 is expressed in human and mouse epidermis and impairs skin barrier function in Netherton syndrome through filaggrin and lipid misprocessing

J Clin Invest. 2010 Mar;120(3):871-82. doi: 10.1172/JCI41440. Epub 2010 Feb 22.


The human epidermis serves 2 crucial barrier functions: it protects against water loss and prevents penetration of infectious agents and allergens. The physiology of the epidermis is maintained by a balance of protease and antiprotease activities, as illustrated by the rare genetic skin disease Netherton syndrome (NS), in which impaired inhibition of serine proteases causes severe skin erythema and scaling. Here, utilizing mass spectrometry, we have identified elastase 2 (ELA2), which we believe to be a new epidermal protease that is specifically expressed in the most differentiated layer of living human and mouse epidermis. ELA2 localized to keratohyalin granules, where it was found to directly participate in (pro-)filaggrin processing. Consistent with the observation that ELA2 was hyperactive in skin from NS patients, transgenic mice overexpressing ELA2 in the granular layer of the epidermis displayed abnormal (pro-)filaggrin processing and impaired lipid lamellae structure, which are both observed in NS patients. These anomalies led to dehydration, implicating ELA2 in the skin barrier defect seen in NS patients. Thus, our work identifies ELA2 as a major new epidermal protease involved in essential pathways for skin barrier function. These results highlight the importance of the control of epidermal protease activity in skin homeostasis and designate ELA2 as a major protease driving the pathogenesis of NS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Cytoplasmic Granules / enzymology
  • Cytoplasmic Granules / genetics
  • Epidermis / enzymology*
  • Epidermis / pathology
  • Gene Expression Regulation, Enzymologic*
  • Humans
  • Intermediate Filament Proteins / genetics
  • Intermediate Filament Proteins / metabolism*
  • Keratins / genetics
  • Keratins / metabolism
  • Lipid Metabolism*
  • Mice
  • Mice, Transgenic
  • Netherton Syndrome / enzymology*
  • Netherton Syndrome / genetics
  • Netherton Syndrome / pathology
  • Serine Endopeptidases / biosynthesis*
  • Serine Endopeptidases / genetics


  • Intermediate Filament Proteins
  • filaggrin
  • keratohyalin
  • Keratins
  • Serine Endopeptidases
  • pancreatic elastase II