Molecule guided laser ablation as a novel therapeutic strategy to control itch.

Itch is a major symptom of many chronic skin diseases that can exacerbate inflammation by provoking excessive scratching and causing skin damage. Here we develop a novel technology to control itch through molecular guided delivery of a phototoxic agent and near infrared (IR) illumination of the skin. Exploiting the selective binding of the pruritogen Interleukin-31 to itch sensing cells, we generate an engineered IL31SNAP ligand derivative (IL31K138A-SNAP) that binds to cells but does not evoke signaling or provoke scratching when injected in vivo. Conjugation of IL31K138A-SNAP to the photosensitizer IRDye700DX phthalocyanine (IR700) and injection of the skin results in long-term reversal of scratching behavior evoked by IL31 upon near IR illumination. We further develop a topical preparation of IL31K138A-SNAP-IR700 that strikingly, reverses behavioral and dermatological indicators in mouse models of Atopic Dermatitis (AD) and the genetic skin disease Familial Primary Localized Cutaneous Amyloidosis (FPLCA). We demonstrate that this therapeutic effect results from selective retraction of itch sensing neurons in the skin, breaking the cycle of itch and disruption of the skin9s barrier function. Thus, molecule guided photoablation is a powerful new technology for controlling itch and treating inflammatory skin diseases.