Characterization of cellular infiltrates in skin lesions of atopic eczema by means of monoclonal antibodies

Spinal cord lesions of myelitis with hyperIgEemia and mite antigen specific IgE (atopic myelitis) manifest eosinophilic inflammation

We report the neuropathological findings of spinal cord specimens obtained from two patients who had localized myelitis with hyperIgEemia and mite antigen specific IgE (atopic myelitis). Both cases showed mild spinal cord dysfunction, and the gadolinium-enhanced area of the isolated spinal cord lesion observed on MRI was biopsied, respectively. Neuropathologically, both cases showed many perivascular lymphocyte cuffings associated with disrupted vessels, and the infiltration of eosinophils in the spinal cord lesions. Both myelin and axons were lost in the lesions, which were associated with astrogliosis. These findings suggest that an allergic mechanism may play a role in this condition.

Characterization of the cutaneous inflammatory infiltrate in canine atopic dermatitis

Sections from lesional atopic, clinically normal atopic, and normal canine skin were investigated by light microscopy and an immunoperoxidase method using monoclonal antibodies specific for canine leukocyte antigens. We confirmed that skin-infiltrating cells of canine atopic dermatitis are constituted of mast cells, dendritic antigen-presenting cells, memory helper T-lymphocytes, low numbers of eosinophils and neutrophils, and rare B-lymphocytes. The presence of epidermal eosinophil microaggregates and clustered Langerhans' cells supports the hypothesis of epidermal allergen contact. The hyperplasia of epidermal T-cells expressing the gamma/delta T-cell receptor appears specific to canine atopic dermatitis compared with its human counterpart. This finding could be explained by an interspecies difference in skin immune systems or, alternatively, by an active participation of these epitheliotropic gamma/delta T-cells in the cutaneous allergic immune response in dogs. The paucity of dermal neutrophils in spontaneous lesions of canine atopic dermatitis is notably different from the neutrophil-rich late-phase reactions provoked by intradermal allergen injections in allergic dogs. This difference in the cellular infiltrate probably results from variations in the immune reaction between single and repeated allergen exposure as well as epidermal versus dermal antigen contact.

Atopic dermatitis--immunological abnormality and its background

The production of IgE is mainly regulated by cognate and/or non-cognate interaction between B cells and T cells. Two types of helper T cells are recognized in the murine system, Th1 and Th2, by the type of cytokine they produce. Several lines of evidence disclosed that unbalanced generation of Th2/Th1-like cells occurs in atopic disorders, such as atopic dermatitis, in which a high level of serum IgE is found in the majority of patients. Analysis of skin-derived immunocompetent cells, such as Langerhans cells and T cells, has provided us with a new understanding of the pathophysiology of atopic dermatitis. The recent progress in immunological aspects of atopic dermatitis is reviewed.

E-selectin and vascular cell adhesion molecule-1 as critical adhesion molecules for infiltration of T lymphocytes and eosinophils in atopic dermatitis

To study the temporal and spatial relationship between infiltrating T-cell subsets or eosinophils and cell adhesion molecules on endothelial cells in skin lesions of atopic dermatitis (AD), we undertook immunohistochemical analysis using monoclonal antibodies against surface markers of T cells, eosinophil granule proteins and cell adhesion molecules. Predominant mononuclear cells in acute and chronic skin lesions were CD3, CD4 and CD45RO positive helper-inducer/memory T cells. Their number was significantly and strongly correlated with the intensity of E-selectin expression. Eosinophils and deposition of eosinophil-derived granule proteins such as eosinophil cationic protein (ECP), major basic protein (MBP) and eosinophil peroxidase (EPO) were found constantly in acute lesions and only occasionally in chronic lesions. The total number of immunoreactive eosinophils and deposits of MBP, EPO and ECP were significantly and strongly correlated with the staining intensity of VCAM-1. In chronic lesions significant reduction of VCAM-1 expression paralleled occasional infiltration of eosinophils. Our results demonstrate the possibility that E-selectin and VCAM-1 are the critical adhesion molecules for trafficking of memory T cells and eosinophils, respectively, into skin lesion of AD. Persistent expression of the adhesion molecules may be related to prolongation of the skin lesion in AD.

The Langerhans cell: an underestimated cell in atopic disease

Langerhans cells (LC) are very potent antigen-presenting cells. In atopic disorders such as allergic rhinitis and atopic dermatitis LC are known to bear IgE surface molecules. IgE-positive LC can bind allergen and present it to T lymphocytes to induce an allergen-specific T-cell response and IgE synthesis. Therefore, IgE-bearing LC might play an important role in the triggering of the immune system to maintain ongoing IgE synthesis. The importance of the IgE-bearing LC in atopy has not been assessed but deserves further investigation to find out more about the part played by these cells, not only in the atopic disorders described here but also in others such as gastrointestinal allergy and allergic asthma.

Fc epsilon receptor II/CD23 positive lymphocytes in atopic dermatitis: II. Infiltration of Fc epsilon R II(+) T cells in the skin lesion

Cells expressing Fc receptors for IgE (Fc epsilon R II) were identified in skin from patients with atopic dermatitis (AD), eczematous dermatitis (ED), and in skin from normal nonatopic subjects, with the use of monoclonal antibodies to human lymphocyte Fc epsilon R II, H107, and to lymphoid cell-surface antigens by double immunofluorescence staining. Two to four percent of infiltrating mononuclear cells expressed Fc epsilon R II, and more than half of these cells were T epsilon cells in both acute and chronic AD lesions. Fc epsilon R II(+) T cells (T epsilon cells) bearing CD8 infiltrated preferentially acute lesions, whereas chronic lesions contained either CD8(+) or CD4(+) T epsilon cells, or both. Fc epsilon R II(+) cells rarely were present in ED lesions. There was no significant correlation between % Fc epsilon R II(+) peripheral blood mononuclear cells and the proportion of lesional Fc epsilon R II(+) cells, extent of skin lesions, or serum IgE levels, implying the selective accumulation of Fc epsilon R II(+) cells in the inflammatory infiltrate of AD. These observations suggest that the increased generation of Fc epsilon R II(+) cells in skin lesions, including CD8 (+) T epsilon cells, is involved in the pathogenesis of AD.

Immunophenotyping of the cutaneous infiltrate and of the mononuclear cells in the peripheral blood in patients with atopic dermatitis

Fourteen adult patients with chronic atopic dermatitis and active skin lesions had a skin biopsy and venous blood sample taken on the same day. Absolute numbers of circulating lymphocytes were normal in all patients. Fluorescence-activated cell sorter (FACS) analysis revealed normal numbers of total T lymphocytes and T-helper and T-suppressor subsets (helper:suppressor ratio, 2:1) in the atopic patients' peripheral blood, but an increase in circulating B lymphocytes and in HLA-D-related antigen-bearing cells. The skin biopsy showed a dermal infiltrate of predominantly T-helper lymphocytes (helper:suppressor ratio, 7:1). These cells showed strong HLA-DR plasma membrane staining. There was no HLA-DR staining in the membranes of epidermal keratinocytes. Using a monoclonal antihuman IgE, positive staining was observed in the dermis, though none was identified in the epidermis. The dermal anti-IgE staining was concentrated around clusters of T lymphocytes.