Normal numbers of phenotypic helper, suppressor, and total T cell populations in psoriasis vulgaris: quantitation by monoclonal antibodies

Genomic, phenotypic, and functional analyses of T cells in patients with psoriasis undergoing systemic cyclosporin A treatment

Recent studies have demonstrated that cyclosporin A (CyA) exerts a beneficial effect on psoriasis. It remains unclear, however, whether T-cell immune responses are definitely impaired in psoriasis and whether the anti-psoriatic effect of CyA is mediated by interference with T-cell activation. To study these questions, 20 patients with severe psoriasis were treated with oral CyA (5 mg/kg/d) for 12 weeks and examined for several phenotypic and functional properties of peripheral blood T cells before and after therapy. The analyses included CD3, CD4, and CD8 phenotypes, IL-2 production and IL-2 receptor expression following Con A stimulation, proliferative responses to PHA, and in vivo responsiveness to a foreign antigen, PPD. When the values of patients before therapy and healthy individuals were compared, no statistically significant differences were detected in any of these analyses. Furthermore, none of these T-cell properties were changed after 12 weeks of treatment. To assess possible minor mutations in T-cell-related genes in psoriasis, the T-cell receptor beta-chain locus was analyzed by Southern hybridization. With a cDNA probe for C beta 1, a polymorphic fragment of congruent to 9 kb was detected in Eco RI digests in one of 20 patients and in four of 10 healthy individuals examined. No polymorphism was detected in Bam HI digests in any individual. These results fail to support the hypothesis that a general or "systemic" alteration in T-cell immunity plays a central role in the pathogenesis of psoriasis and in the action of CyA against this skin disorder.

Characterization of skin-infiltrating lymphocytes in patients with psoriasis

In this study, skin-infiltrating cells in psoriasis patients were characterized in biopsies from both involved and uninvolved skin. Histologic examination of biopsies showed the presence of both CD4+ and CD8+ T cells and the lack of B lymphocytes. Skin biopsies were also placed in tissue culture medium supplemented with human serum, interleukin-2 (IL-2), and irradiated autologous blood lymphocytes. T lymphocytes grew from both plaques and univolved skin biopsies and consisted of a heterogeneous population of T-cell subsets. The immunophenotypic analysis of cultured cells was comparable to the histologic examination on frozen section, i.e., there was a greater number of CD4/CDw29+ cells than CD8+/CD45+ cells. Cultures were tested in the primed lymphocyte test (PLT) and cell-mediated lympholysis (CML) assays. All cultures tested demonstrated secondary proliferative but not cytolytic reactivity. The PLT results indicate that the cell cultures generated are autoreactive. This autoreactivity was found to be directed against non-human leukocyte antigens (HLA), i.e., minor HLA with some restriction to major HLA antigens.

Treatment of psoriatic arthritis by extracorporeal photochemotherapy

Five patients with long-standing seronegative arthritis resistant to conventional therapy and who also had psoriasis of the skin were treated with photopheresis. This mode of treatment combines a lymphocyte-enrichment procedure with 8-methoxypsoralen-photochemotherapy. There was a marked in vitro effect on treated lymphocytes, with a reduction of viability, proliferation and mitogen response. There was a slight to moderate clinical improvement in four of the five patients with regard to the strength of grip, swelling, pain, morning stiffness, the dosage of non-steroidal anti-rheumatic drugs and the radiographical changes. The skin lesions did not respond to photopheresis. Short-term side-effects were minimal and consisted of a temporary sensitivity of the eyes to light and signs of circulatory dysregulation immediately after treatment. This experimental therapy has some measurable but not dramatic effect in improving psoriatic arthropathy.

Subpopulations of T lymphocytes in psoriasis patients and their changes during immunotherapy

The content of T-lymphocytes and their basic subpopulations T-helpers and T-suppressors have been studied by means of monoclonal antibodies in the peripheral blood of 104 patients with different forms of psoriasis (56 patients with psoriasis vulgaris, 25 with exudative psoriasis, 10 with psoriasis arthropathica, and 13 with erythrodermic psoriasis). In all forms of psoriasis with a slight alteration in T-lymphocyte content a significant dysbalance of T-helpers and T-suppressors was found that brought about a decrease in the correlation ratio T-helpers/T-suppressors (T-helpers/T-suppressors in patients suffering from psoriasis vulgaris, 1.55 +/- 0.12; in those with exudative psoriasis, 1.24 +/- 0.16; with psoriasis arthropathica, 1.33 +/- 0.16; with erythrodermic psoriasis, 1.33 +/- 0.18; the control showed 1.82 +/- 0.08). The decrease in T-helpers/T-suppressors to 1.2 and lower that corresponded to a more severe clinical course of the disease was revealed in 27 patients having psoriasis vulgaris, in 13 with exudative psoriasis, in 7 with psoriasis arthropathica, and in 9 with erythrodermic psoriasis. The dysbalance in T-helpers/T-suppressors was due to a decrease in T-helpers and an increase in T-suppressors. To normalize T-helpers/T-suppressors, 27 psoriatics (20 with psoriasis vulgaris, 6 with exudative psoriasis, 1 with erythrodermic psoriasis) received immunomodulators Thymalinum and Natrii nucleinas in addition to antipsoriatic therapy, which resulted in an increase in T-helper/T-suppressor ratio, on the average up to 1.74 +/- 0.16 (prior to treatment T-helper/T-suppressor ratio in these patients was 1.0 +/- 0.14) and was followed by a favorable clinical course (shorter periods of skin rash regression, prolonged remissions).(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of resistant severe psoriasis with systemic cyclosporine

Four patients with severe psoriasis have been treated with oral cyclosporine for 6 months. Two had generalized erythroderma and two had extensive plaque-type psoriasis; all had either become unresponsive to or were unable to use other accepted treatments. All four patients responded rapidly and were completely clear of psoriasis within 3 weeks of beginning therapy. Initial doses ranged from 7.5 to 8.5 mg/kg/day. Mild reversible nephrotoxicity occurred in the one patient whose cyclosporine trough level briefly exceeded 200 ng/ml. Cyclosporine may offer an alternative therapeutic modality in the management of erythrodermic or severe resistant plaque-type psoriasis. The effectiveness of cyclosporine in psoriasis underscores the putative role of cell-mediated immune factors in the pathogenesis of psoriasis.

Distribution of T-cell subpopulations in the peripheral blood of patients with erythrodermic psoriasis

In the present study the percentages of T cells and T-cell subsets, as defined by Fc receptors and monoclonal antibodies (OKT3, OKT4, OKT8, HLA-DR) were determined in the peripheral blood of 12 patients with psoriasis, including six patients with erythroderma and 6 with active, but limited disease. The patients with erythroderma were studied before treatment and 4-8 weeks following. The mean percentages of E-rosette-forming cells and T-cell subsets reactive with the monoclonal antibodies OKT3, OKT4 and OKT8 were within normal limits, as were the percentages of T mu-cells, irrespective of the extent or activity of the disease. The mean percentage of T gamma-cells was reduced in the patients with untreated erythrodermic psoriasis but not in the patients with limited disease. Comparison of the T gamma values in the erythroderma group before and after therapy showed a slight, but statistically significant increase (P less than 0.03). These results indicate a direct relationship between the T gamma deficit and the extent of skin involvement, and argue against a primary suppressor T-cell defect in psoriasis vulgaris.

Distribution of T-cell subsets as defined by monoclonal antibodies in skin lesions of psoriasis vulgaris

Cryostat tissue sections from skin lesions of 16 patients suffering from chronic stationary psoriasis vulgaris were assayed for the presence of distinct T-cell subpopulations with monoclonal antibodies. Using two pan-T surface markers (M-T 4-11 and Lyt 3) the total number of infiltrating T-cells was measured. This cell population was further dissected into Leu 3a (helper/inducer) and M-T 8-11 (cytotoxic/suppressor) positive subsets. Percentages of T-cell subpopulations were within the ranges found in healthy peripheral blood and were thus regarded as normal.

Diagnostic criteria in Sézary's syndrome: a multiparameter study of peripheral blood lymphocytes in 32 patients with erythroderma

In order to define additional diagnostic criteria for the early diagnosis of Sézary's syndrome (SS), peripheral blood lymphocytes of 32 patients with erythroderma, including 8 patients with SS, 4 patients with erythrodermic mycosis fungoides, 14 patients with an erythroderma on the basis of atopic or chronic dermatitis, and 6 patients with erythrodermic psoriasis, were investigated by computer-assisted morphometry. The degree of nuclear indentation, expressed as the nuclear contour index (NCI), was measured on electron micrographs. The mean NCI and the percentages of cerebriform mononuclear cells (CMC), defined by a NCI greater than or equal to 6.5, were calculated. In addition, the percentages of lymphocytes, T and B cells, and the distribution of T-cell sub-populations as defined by Fc-receptors (T mu, T gamma) and monoclonal antibodies (OKT3, OKT4, OKT8, HLA-DR) were determined. Statistical analysis showed as most discriminating parameters for the differentiation between SS and benign forms of erythroderma: high percentages of lymphocytes (50% or more), an expanded OKT3+, OKT4+ population with an OKT4/OKT8 ratio greater than 10, a mean NCI value greater than or equal to 5.5, the presence of more than 20% CMC, as well as the presence of cells with a NCI greater than or equal to 11.5. The total leukocyte and lymphocyte counts, as well as the percentages of B, T, T mu, and T gamma cells had limited value for the early diagnosis of SS.

Enumeration of human lymphocyte subpopulations by immunofluorescence: a comparative study using automated flow microfluorometry and fluorescence microscopy

These studies reveal that the enumeration of peripheral blood mononuclear cells by fluorescence microscopy and automated flow microfluorometry show a high degree of correlation whether the cells came from normals, individuals with common variable immunodeficiency, chronic lymphocytic leukemia of B cell origin or chronic lymphocytic leukemia of T cell origin. There was excellent agreement between these two methods when counting positive cells stained by the pan-T monoclonal antibodies OKT3 and Leu-1, the helper T reagents OKT4 and Leu-3a, and the suppressor T antibodies OKT8 and Leu-2a. The values obtained for B cells using a pan-B (HB-2) cell antibody analyzed by fluorescence microscopy and automated flow microfluorometry gave a correlation coefficient of 0.86. The percentage of cells identified by antibodies with reactivities toward peripheral blood monocytes (MMA or Leu-M1), the HLA-DR determinant, and HNK-1 (Leu-7) positive cells gave correlation coefficients of 0.90, 0.90, and 0.80 respectively when compared by the 2 methods mentioned above. These data suggest that comparable values for lymphocyte subpopulations in human blood samples can be obtained using the most convenient and available technology.

Immunocompetent cells in psoriasis. In situ immunophenotyping by monoclonal antibodies

Immunocompetent cells in exacerbating untreated psoriasis vulgaris skin lesions were immunophenotypically studied by the application of a selection of monoclonal antibodies in a two-stage immunoperoxidase technique. Epidermal changes include: focal accumulation of immunoglobulins in the stratum corneum, as demonstrated by a mixture of monoclonal anti-kappa and anti-lambda antibodies; focal accumulation of OKM-1 positive but Mo-2 negative cells high in the epidermis, reflecting granulocytes in Munro's abscesses; a marked decrease in epidermal Langerhans cells with focal abnormal clumping and smaller dendrites, as demonstrated by monoclonal anti-HLA-DR and anti-T6 (OKT-6) antibodies; and, sporadic exocytosis of mainly T1 (Leu-1), T8 (Leu-2a) positive suppressor/cytotoxic T lymphocytes. The dermal infiltrates were found to consist mainly of partically activated T1 (Leu-1), T4 (Leu-3a) positive T-helper/inducer cells with a smaller compartment of T1 (Leu-1), T8 (Leu-2a) positive suppressor/cytotoxic lymphocytes. These cells were found in close apposition to T6 (OKT-6), HLA-DR positive Langerhans cells and further accompanied by a minor compartment of OKM-1, Mo-2 positive monocytes. No B-cells or plasma cells could be demonstrated in the dermis. Natural killer cells were observed only incidentally. These results fit best with the hypothesis that psoriasis is a chronic inflammatory condition as a result of persistent stimulation of T cells by immunogen(s) of epidermal origin.