Preferential adherence of T lymphocytes and neutrophils to psoriatic epidermis

A Review on the Role of Ethylenediaminetetraacetic Acid (EDTA) in the Treatment and Understanding of Psoriasis

Psoriasis is a long-term, autoimmune inflammatory condition characterized by red, scaly plaques that can range from a few patches to total skin coverage. Over the past 60 years, and more recently, the metal-chelating agent ethylenediaminetetraacetic acid (EDTA) has proven increasingly useful in the treatment and understanding of psoriasis and related conditions. This review will analyze the current role and effectiveness of EDTA in clinical and non-clinical studies designed to improve the diagnosis and treatment of psoriasis in patients. Currently, EDTA demonstrates great medical benefit in the treatment of psoriasis as an antioxidant and as an inhibitor of beta-lipoprotein production. EDTA additionally functions well in research applications due to its ability to maintain red blood cell structural integrity. The authors find that the perceived impact of EDTA in the understanding and combating of psoriasis to be greatly underestimated and is therefore in need of increased awareness and attention by healthcare professionals, dermatologists, and clinical researchers.

Psoriatic keratinocytes prime neutrophils for an overproduction of superoxide anions

Psoriatic plaques result from an abnormal proliferation of keratinocytes associated with the local presence of T lymphocytes and neutrophils. The exact role of neutrophils in psoriatic lesions remains unclear. The present investigation was aimed at deciphering the capacity of psoriatic keratinocytes to alter in vitro functions of neutrophils. Blood neutrophils from healthy donors were incubated with psoriatic (PK) or healthy keratinocytes (HK) with and without IL-2-activated healthy T lymphocytes. The study was focussed on neutrophil capacity of adherence, viability and superoxide anion production. PK or HK with or without T lymphocytes similarly augmented neutrophil viability after 48 h of co-incubation. PK or HK did not directly activate the superoxide production by neutrophils. However, they both primed neutrophils for an increased fMLF-induced production of superoxide, an effect enhanced by the presence of T lymphocytes. PK were 1.5-fold more efficient than HK to augment this superoxide production. PK cultured with T lymphocytes induced the adhesion of neutrophils 4.7 times more efficiently than HK. The adherence of neutrophils was mediated through ICAM-1, LFA-1 and Mac-1, independently of bioactive lipids. The effects of PK and HK on neutrophil viability and priming were independent of direct cellular contact. In conclusion, keratinocytes can impact neutrophils by increasing their lifespan, and by priming them to overproduce superoxide. PK are more efficient than HK in priming neutrophils, an effect enhanced by T lymphocytes. These results indicate that neutrophils could contribute to psoriasis pathogenesis partly through their pathological interactions with PK.

Increased Neutrophil Adherence in Psoriasis: Role of the Human Endothelial Cell Receptor Thy-1 (CD90)

The chronic inflammatory skin disease psoriasis is characterized by prominent skin infiltration by neutrophils and microabscess formation. The adhesion of leukocytes and subsequent transmigration through the activated endothelium is one prerequisite for the accumulation of these cells in skin. In recent studies, the human Thy-1 (CD90) was characterized as an adhesion molecule on activated endothelial cells (ECs) mediating the adhesion of neutrophils via the interaction with the beta2-integrin Mac-1. Based on these novel findings, we compared the roles of Thy-1 and ICAM-1 in the adhesion of neutrophils from patients with psoriasis to activated ECs. The adhesion of peripheral blood neutrophils of patients suffering from psoriasis to Thy-1-transfected cells as well as to activated, Thy-1-expressing human dermal microvascular ECs (HDMECs) is distinctly increased in comparison to the adhesion of neutrophils from healthy controls. In contrast, adherence of psoriatic neutrophils to ICAM-1 transfectants is, if at all, only slightly enhanced compared to healthy controls. The interaction of healthy as well as psoriatic polymorphonuclear cells to Thy-1 transfectants and HDMECs was significantly inhibited by blocking Thy-1 on ECs or its receptor Mac-1 on neutrophils, indicating the importance of this interaction for the adhesion of neutrophils to activated endothelium. In conclusion, our data indicate that the adhesion of neutrophils to activated ECs mediated by Thy-1/Mac-1 interaction is an important attachment mechanism facilitating their subsequent migration into lesional psoriatic skin.

Immunolocalization of interleukin-8 and proliferating cell nuclear antigen in gingival keratinocytes in patients with periodontitis

The aim of this study was to investigate the relation between local expression of IL-8 and the localization of neutrophilic granulocytes, using CD16 as a marker of neutrophils. We also investigated the correlation between IL-8 and epithelial proliferation using proliferating cell nuclear antigen (PCNA) as a marker of proliferation. The distribution of IL-8, CD16 and PCNA/cyclin was determined by immunocytochemical techniques. We used cryostat-cut sections from gingival biopsies harvested from 5 subjects with and 5 subjects without periodontitis. Our histological examination demonstrated that the localization of neutrophilic granulocytes in gingival tissue from patients with periodontitis did not correlate with the expression of IL-8. In all tissue sections from patients and controls, the inflammatory cells accumulated near the pocket epithelium and only a few leukocytes deviated from this pattern. In the patient group, keratinocytes not belonging to the pocket or junctional epithelium expressed IL-8 without any evidence of a chemoattractant effect on neutrophils. The marker of proliferation, PCNA/cyclin, was expressed in keratinocytes in the basal cell layer. The expression was less pronounced in the control group. Our finding that IL-8 was expressed in proliferating cells suggests that IL-8 may have a role in keratinocyte proliferation.

Inhibition of keratinocyte apoptosis by IL-15: a new parameter in the pathogenesis of psoriasis?

Keratinocytes (KC) are important source of and targets for several cytokines. Although KC express IL-15 mRNA, the functional effects of IL-15 on these epithelial cells remain to be dissected. Investigating primary human foreskin KC and HaCaT cells, we show here by semiquantitative RT-PCR and flow cytometric analysis that both translate IL-15 and IL-15R mRNA and express IL-15 and IL-15Ralpha protein on the cell surface, suggesting that human KC can employ IL-15 for juxtacrine signaling. While IL-15 exerted no significant effect on KC proliferation and IL-6 or IL-8 secretion, IL-15 inhibited both anti-Fas and methylcellulose-induced KC apoptosis in vitro. This is in line with the recognized potent anti-apoptotic effects of IL-15. IL-2, whose receptor shares two components with the IL-15R, failed to inhibit KC apoptosis. Together with the role of IL-15 in sustaining chronic immune reactions, this invited the question of whether a reduction of KC apoptosis by IL-15 may be involved in the pathogenesis of psoriasis, a chronic hyperproliferative inflammatory skin disease characterized by abnormally low KC apoptosis in the epidermis. Remarkably, compared with nonlesional psoriatic skin and skin of healthy volunteers, lesional psoriatic epidermis showed high IL-15 protein expression in the epidermis and enhanced binding activity for IL-15. Therefore, antagonizing the inhibitory effects of IL-15 on KC apoptosis deserves exploration as a novel therapeutic strategy in psoriasis management.

Interactions between non-immune host cells and the immune system during periodontal disease: role of the gingival keratinocyte

Periodontal disease and inflammatory dermatoses, such as psoriasis, are characterized by the accumulation of dense inflammatory infiltrates immediately beneath the epithelial cell layer of the gingiva and skin, respectively. Dermatologists are increasingly aware that the epidermal keratinocyte probably contributes to inflammatory disease progression by secreting a number of pro-inflammatory cytokines and expressing various adhesion molecules. In psoriatic lesions, it is now believed that epidermal keratinocytes may also act as antigen-presenting cells and participate directly in the superantigenic activation of T-cell clones, some of which may initiate, contribute to, or maintain the disease process. Although the role of the host response in periodontal disease has been extensively studied over the years, very little is known about the contribution of the gingival keratinocyte to the inflammatory response. The available published information is discussed in this review, and we suggest that, like its epidermal counterpart, the gingival keratinocyte may participate actively in the pathogenesis of periodontal disease.

Alterations in ICAM-1 and ELAM-1 expression in psoriatic lesions following various treatments

The expression of endothelial leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1) in psoriatic lesions was immunohistochemically examined before and after various single and combination therapies. The increased staining intensity of both adhesion molecules on the proliferated papillary venules in pretreated lesion was markedly reduced after cyclosporin-A monotherapy and etretinate therapy combined with oral eicosapentaenoic acid (EPA), psoralen plus ultraviolet-A radiation (PUVA) or ultraviolet-B radiation (UVB). Less pronounced alterations were observed with etretinate, EPA, PUVA, UVB, and topical corticosteroid alone. The epidermal expression of ICAM-1, on the other hand, faded out completely following any of the treatment measures. The findings suggest that cyclosporin-A monotherapy and the etretinate combination therapies have greater inhibitory effects on the endothelial expression of the adhesion molecules than the other monotherapies. Loss of the epidermal expression of ICAM-1 may be nonspecific to the treatment.

Lithium and psoriasis: cytokine modulation of cultured lymphocytes and psoriatic keratinocytes by lithium

The predominant cutaneous side effect of lithium is the exacerbation or aggravation of psoriasis, but the pathogenesis is still unclear. The hyperproliferation of keratinocytes and a dense lesional infiltrate of mononuclear cells are the hallmarks of psoriatic skin lesions. Interactions between keratinocytes and T cells are thought to be one reason for an increased secretion of proinflammatory cytokines and growth factors. To investigate whether lithium influences cytokines of the "psoriatic cytokine network', we established a coculture model with keratinocytes from psoriatic patients and from healthy controls cultured with HUT 78 lymphocytes and measured the cytokine levels of Il-2, Il-6, Il-8, IFN gamma and TGF alpha in the culture supernatants after treatment with lithium. Il-6 levels were slightly elevated in the supernatants obtained from psoriatic and control keratinocyte cultures after lithium treatment, but IFN gamma and Il-2 levels were elevated only in the lithium-treated cocultures with psoriatic keratinocytes. In contrast, these two cytokines were not affected by lithium in HUT 78 monocultures or in cocultures with normal epidermal cells. We also found slightly elevated TGF alpha levels in lithium-treated psoriatic cocultures but not in control cultures. We therefore demonstrated that lithium influences the cell communication of psoriatic keratinocytes with HUT 78 lymphocytes by triggering the secretion of TGF alpha, Il-2 and, massively, IFN gamma. It seems possible that lithium also influences similar parts of the psoriatic cytokine network in vivo.

Inhibition of lymphocyte adhesion to cytokine-activated synovial fibroblasts by glucocorticoids involves the attenuation of vascular cell adhesion molecule 1 and intercellular adhesion molecule 1 gene expression

OBJECTIVE

The aim of this study was to evaluate the ability of glucocorticoids to inhibit lymphocyte adhesion to human synovial fibroblasts.

METHODS

Adhesion of lymphocytes to cultured synovial fibroblasts was measured by counting the number of cells bound to fibroblasts. Surface expression of intercellular adhesion molecule 1 (ICAM-1) was measured by enzyme-linked immunosorbent assay, while vascular cell adhesion molecule 1 (VCAM-1) surface expression was measured by flow cytometry. ICAM-1 and VCAM-1 messenger RNA (mRNA) levels were assessed by Northern blot analysis.

RESULTS

Stimulation of synovial fibroblasts by the proinflammatory cytokines tumor necrosis factor alpha, interleukin-1beta, and interferon-gamma resulted in a dose-dependent increase in lymphocyte adhesion to synovial fibroblasts. This response was inhibited by preincubation of the cells with the synthetic glucocorticoid dexamethasone. Since lymphocyte adhesion to synovial fibroblasts is known to be mediated by VCAM-1 and ICAM-1, we examined the modulation of VCAM-1 and ICAM-1 expression in these cells. All 3 cytokines stimulated VCAM-1 and ICAM-1 surface and mRNA expression. Dexamethasone inhibited both VCAM-1 and ICAM-1 surface and mRNA expression in a dose-dependent manner, which correlated with the inhibition of lymphocyte adhesion.

CONCLUSION

Taken together, these results suggest that glucocorticoids may reduce inflammatory responses at extravascular sites by inhibiting the expression of these adhesion molecules, thereby reducing the adhesion of lymphocytes to connective tissue cells.

Suppressive effect of antioxidants on intercellular adhesion molecule-1 (ICAM-1) expression in human epidermal keratinocytes

Intercellular adhesion molecule-1 (ICAM-1) is strongly expressed by human epidermal keratinocytes during the course of inflammatory skin diseases. To test the possibility that reactive oxygen species produced in the skin during an inflammatory response affect ICAM-1 expression, cultured human epidermal keratinocytes were treated with H2O2 at concentrations that did not damage the cells, and cell-surface ICAM-1 expression was analyzed. Expression of ICAM-1 was induced on keratinocytes by treatment with 300 microM H2O2 for 1 h. The antioxidant N-acetyl-L-cysteine strongly inhibited H2O2-induced ICAM-1 expression, whereas the antioxidants pyrrolidine dithiocarbamate and alpha-tocopherol were less inhibitory. N-acetyl-L-cysteine also suppressed keratinocyte surface expression of ICAM-1 induced by the cytokines interferon-gamma (IFN-gamma) or tumor necrosis factor-alpha (TNF-alpha), whereas pyrrolidine dithiocarbamate and alpha-tocopherol suppressed IFN-gamma-induced surface expression but not TNF-alpha-induced expression. We found that N-acetyl-L-cysteine treatment reduced ICAM-1 mRNA levels when keratinocytes were stimulated with either IFN-gamma or TNF-alpha; however, pyrrolidine dithiocarbamate and alpha-tocopherol had no effect on either IFN-gamma- or TNF-alpha-induced ICAM-1 mRNA levels. Our results indicate that reactive oxygen species may be involved in the skin inflammatory process by increasing epidermal ICAM-1 expression and that some antioxidants may be effective in suppressing the epidermal ICAM-1 expression induced by reactive oxygen species and cytokines in inflammatory skin diseases.

Inducibility and expression of microvascular endothelial adhesion molecules in lesional, perilesional, and uninvolved skin of psoriatic patients

Previous studies have demonstrated 1) that patterns of inducible endothelial cell expression of endothelial leukocyte adhesion molecule-1 (ELAM-1) and vascular cell adhesion molecule-1 (VCAM-1) in response to cytokines varies both with anatomic position within the dermal microvasculature and with the presence of perivascular inflammatory infiltrates, and 2) that the anatomic architecture of the dermal superficial plexus (SVP) is altered in inflamed lesional but not in univolved skin of psoriatic patients. The present study was designed to evaluate the pattern of cytokine inducibility of ELAM-1 and VCAM-1 in altered dermal microvessels of psoriatic patients. At the light microscope level, preculture biopsies of uninvolved and perilesional skin were indistinguishable by morphology and ELAM-1 and VCAM-1 expression were virtually absent. In contrast, biopsied lesional skin showed elongated capillary loops and increased numbers of T cells compared to uninvolved and perilesional skin. The dermal microvasculature of the SVP of lesional skin contained ELAM-1+ in 29.4% of vessels and VCAM-1+ endothelial cells in 8.7% of vessels. After 24 h of organ culture in medium supplemented with tumor necrosis factor and interleukin-4, ELAM-1+ endothelial cells in the SVP were increased significantly in uninvolved (from mean 0.5% to 27% of vessels), perilesional (from mean 5.5% to 41.8% of vessels), and lesional skin (from mean 29.4% to 45.7% of vessels). VCAM-1 was not inducible on SVP endothelial cells in uninvolved skin but VCAM-1+ endothelial cells were increased significantly in perilesional (from mean 0.7% to 23.7% of vessels) and lesional skin (from mean 8.7% to 41.4% of vessels). In uninvolved and perilesional skin ELAM-1 and VCAM-1 were confined to endothelial cells below the rete. In contrast, endothelial cells of the intrapapillary part of the capillary loop of lesional skin became cytokine responsive, in that ELAM-1 and VCAM-1 could be induced at this site. By immunoelectron microscopy, expression was most intense on the luminal surface of venular endothelial cells and at the interendothelial junctions. In conclusion, we have presented evidence that the cytokine responsiveness of microvascular endothelial cells is altered in psoriasis in a pattern that may explain both the circumscribed nature and the epidermal involvement of the psoriatic plaque.

Endothelial cell adhesion molecules in psoriasis

Skin biopsies from patients with psoriasis and normal controls were examined for the expression of cell adhesion molecules including intercellular adhesion molecule-1 (ICAM-1), endothelial leukocyte adhesion molecule-1 (ELAM-1), HECA-452 and 4D10, using an immunoperoxidase techique. This study demonstrates that psoriatic skin exhibits a wide variety of markers of endothelial cell activation which are either induced or increased in expression (ICAM-1, ELAM-1 & 4D10). Moreover, ICAM-1 & HECA-452 are also expressed on leukocytes. These antigens may facilitate the adhesion of inflammatory cells to endothelium and antigen-presenting cells in psoriatic skin. Thus, they may play a role in faciliating the infiltration of leukocytes into psoriatic skin.

The immunopathology of psoriasis

Psoriasis is a common chronic skin disorder affecting 2% of the general population. Present evidence strongly suggests that it is an immunologically mediated disease; the evidence includes the results of disease association studies linking psoriasis to certain MHC antigens and immunohistochemical studies revealing early influx into lesions of activated T lymphocytes. Accumulation of these cells in skin is mediated by upregulated expression of leukocyte adhesion molecules on vascular endothelium and epidermal keratinocytes and by production of proinflammatory and chemotactic cytokines. Activation of cell-mediated immune mechanisms in lesional skin is highlighted by the increased antigen-presenting capacity of Langerhans cells isolated from psoriatic skin compared to normal skin. The nature of the antigens precipitating psoriasis, however, remains unknown although a role for streptococcal superantigens has been postulated. These studies have led to the belief that immunotherapy may hold great promise for the treatment of psoriasis. Indeed both cyclosporin A and FK506 are effective therapies and evidence suggests that anti-CD4 antibodies may be of great value.