Stiffness-dependent LOX regulation via HIF-1 drives extracellular matrix modifications in psoriasis

Psoriasis is a common chronic inflammatory skin disease characterized by a thickened epidermis with elongated rete ridges and massive inflammatory immune cell infiltration. It is currently unclear what impact mechanoregulatory aspects in the dermis may have on disease progression. Using multiphoton second harmonic generation microscopy we found that the extracellular matrix (ECM) was profoundly reorganized within the dermis in psoriasis compared to healthy skin. Collagen fibers were highly aligned and assembled into thick, long collagen bundles, whereas the overall fiber density was reduced in psoriasis. This was particularly pronounced within dermal papillae extending into the epidermis. Further, the enzyme LOX, a crucial posttranslational modifier of ECM molecules, was highly upregulated in the dermis of psoriasis patients. In vitro functional and knock-down experiments identified a novel link between HIF-1 stabilization and LOX protein regulation in mechanosensitive skin fibroblasts. LOX secretion and activity directly correlated with substrate stiffness, and was independent of hypoxia and IL-17. Finally, scRNA-seq analysis identified skin fibroblasts expressing high amounts of LOX and other ECM-relevant genes and confirmed elevated HIF-1 expression in psoriasis. Our findings suggest a potential yet undescribed mechanical aspect of psoriasis stemming from disordered ECM architecture in the papillary dermis, which could initiate a positive feedback loop in fibroblasts driven by mechanical forces. This mechanism may contribute to tissue stiffening and diminished skin elasticity in psoriasis, potentially exacerbating its pathogenesis.