Epidermal Langerhans Cells Drive Painful Diabetic Neuropathy in a Sex-dependent Manner

The interaction between non-neuronal cells and nerve endings in the epidermis significantly influences the development of various diseases, including Painful Diabetic Neuropathy (PDN). PDN is a common and challenging complication of diabetes, characterized by changes in skin innervation accompanied by neuropathic pain. While there is growing evidence that epidermal non-neuronal cells, such as resident immune cells, play a crucial role in the progression of PDN, the underlying mechanisms of this neuropathy remain poorly understood. In our studies, we utilized transgenic methods, pain behavioral assessments, and single-cell RNA sequencing (scRNAseq) in a clinically relevant high-fat diet (HFD) mouse model of PDN and skin biopsy samples from PDN patients, to investigate the role of epidermal Langerhans cells (LCs) in this condition. We observed an increased density of LCs in the skin of PDN male mice coinciding with the onset of mechanical allodynia. Furthermore, we found that LCs density correlated with small fiber degeneration in HFD mice and skin biopsies taken from well-characterized PDN patients compared to healthy controls. Importantly, the selective ablation of LCs using a diphtheria-toxin strategy was found to prevent nociceptive behavior in male mice. This indicates that LCs are both necessary and sufficient for the development of mechanical allodynia and spontaneous pain in HFD male mice. Interestingly, when LCs were ablated in HFD female mice, it did not prevent but rather promoted pain behavior, suggesting the existence of sex-specific mechanisms mediated by LCs. scRNAseq transcriptomic analysis of the paw epidermis from HFD mice, which included both males and females, revealed significant sex-mediated differences in the expression of specific target genes within this PDN model. In male mice, scRNAseq identified differentially expressed genes associated with axonal guidance and immune responses in LCs. Additionally, by integrating single-cell RNA data from the epidermis and dorsal root ganglia (DRG) of male mice, we uncovered altered communication between LCs and cutaneous afferents through Semaphorin-Plexin signaling pathways in PDN. These findings highlight LCs as key contributors to the development of PDN and suggest their potential as therapeutic targets for innovative treatments, particularly topical therapies aimed at modulating immune cell activity and neuroimmune communication in the skin. Our investigations of male and female mice indicate that LCs may play different roles in mechanical sensation under both normal and pathological conditions, such as PDN. This underscores the importance of considering sex differences when developing more effective treatments.