Mechanism Study on Inhibition of EPHA2 Expression Impaired Skin Barrier Function by Gefitinib

Previous studies have unequivocally established the efficacy of gefitinib, an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor (EGFR-TKIs), in the management of patients afflicted with advanced Non-Small Cell Lung Cancer (NSCLC). Nonetheless, the manifestation of cutaneous toxicities of varying severity has been observed to compromise patient survival outcomes and limit its clinical applicability. Elucidating the mechanistic underpinnings of gefitinib-induced dermal barrier dysfunction is imperative, as it holds the potential to inform future therapeutic strategies and facilitate the development of innovative pharmacological interventions. Utilising a multi-modal approach, this study employed network pharmacology and molecular docking techniques to identify potential etiological factors of gefitinib-induced dermal barrier dysfunction. Oral administration of gefitinib was conducted to establish a clinical model, followed by Haematoxylin and Eosin (HE) staining for epidermal and stratum corneum morphological assessment, and immunohistochemical quantification of Keratins 1 (K1) and K10 and Desmoglein-1 (DSG-1). Molecular expression levels of K10, K17, Claudin-4 (CLDN4), Interleukin-6 (IL-6), Tumour Necrosis Factor-α (TNF-α), and Ephrin Type-A Receptor 2 (EPHA2) were evaluated in HaCaT keratinocytes using Reverse Transcription Quantitative Polymerase Chain Reaction (RT-qPCR) and Western Blot assays. Additionally, EPHA2 mRNA and protein expression in murine cutaneous tissues were ascertained through RT-qPCR and Western Blot analyses. Network pharmacology and molecular docking implicated EPHA2 as a central mediator in gefitinib-induced epidermal barrier dysfunction pathways. In murine models, gefitinib administration resulted in palpebral desquamation and dorsal cutaneous erythema, accompanied by elevated expression of K1, K17, and DSG-1 and epidermal hyperplasia. Furthermore, gefitinib augmented K10, K17, IL-6, and TNF-α expression in HaCaT cells, significantly attenuated cellular viability, and suppressed CLDN4 expression. EPHA2 mRNA and protein expression were notably downregulated in both HaCaT cells and BALB/c murine models. Ephrin-A1 Fc, an EPHA2 agonist, effectively mitigated gefitinib-induced cutaneous damage and inflammation, while concurrently downregulating K10, K17, IL-6, and TNF-α expression in HaCaT cells and upregulating CLDN4 expression. Gefitinib appears to induce dermal barrier dysfunction via the downregulation of EPHA2 expression.