The role of cytokines in the pathophysiology of T cell mediated skin disease

Gene rearrangement in positive patch tests

Lymphoproliferative disorders are usually characterized by lymphoid infiltrates that demonstrate clonality in contrast to inflammatory or reactive infiltrates of the skin that are polyclonal without detectable monoclonal populations of T-cells. Probably the southern blot analysis of TCR gene rearrangement can help to delineate the reactive from the malignant processes. In this study, we applied the technique on benign reactive processes in the skin. We examined biopsies from positive patch tests from patients with a delayed hypersensitivity reaction. We found the same gene rearrangement configuration in 11 of 17 patients with positive patch tests. The extra band revealed in these cases was situated in the EcoR1 digested DNA lane at the 8.0 Kb, between the 2 germline bands at the 11 Kb and the 4 Kb respectively. This observation was not correlated to the degree of the inflammatory response or to the specific hapten induced reaction. This pattern was not found in any of 107 patients with malignant diagnoses, but also in six of 43 patients with benign diseases. The clinical implication may suggest the presence or development of clonality in benign inflammatory disorders.

Analyses of T-cell receptor beta-chain genes by Southern blotting in known and suspected cutaneous T-cell lymphoma. A study of 67 samples from 32 patients

In this study we have investigated the configuration of the T-cell receptor (TCR) beta-chain genes in benign cutaneous conditions (n = 5) and known (n = 22) or suspected (n = 5) cutaneous T-cell lymphoma (CTCL). Sequential biopsies from skin, lymph node, blood and/or bone marrow were available in 12 cases of the 22 confirmed CTCL, and a total of 67 samples were analysed. In the benign conditions, clonal rearrangements of the TCR beta-chain genes were seen in neither skin nor blood samples. In contrast, in CTCL clonal rearrangements were detected in all skin samples from plaque or tumour lesions of mycosis fungoides. Clonal TCR rearrangements were also present in skin and blood samples from two patients with Sèzary's syndrome, and in skin and blood samples from three of five patients with clinically suspected CTCL. In 10 patients with large cell lymphomas, clonal rearrangements were detected in skin samples in half of the cases. In the remaining patients, clonal TCR rearrangements could not be detected in the skin, but only in the blood and/or bone marrow specimens. Results from the analyses of sequential biopsies showed identical patterns of rearrangement in 11 patients. In the remaining patient, the pattern of rearrangement differed between skin and lymph node. These data confirm and extend previous reports and indicate that analysis of TCR beta-chain genes by Southern blotting forms a useful supplement to other methods for the diagnosis of known and suspected CTCL. They also emphasize the importance of studying not only skin, but also extracutaneous sites.

Skin disease-related T cells bind to endothelial selectins: expression of cutaneous lymphocyte antigen (CLA) predicts E-selectin but not P-selectin binding

Cutaneous lymphocyte antigen (CLA), defined by the HECA-452 antibody, is a cell surface glycoprotein found on a subset of T cells in peripheral blood that binds specifically to E-selectin. This marker is present on the majority of T cells at sites of cutaneous inflammation and immune responses. Based upon such evidence, an association between T cell CLA expression and skin homing has been proposed. To understand better this relationship, we asked whether putative disease-related, antigen-specific T cells expressed CLA. In this study, we employed T helper type 2 (TH2) T cell clones specific for house dust mite (Dermatophagoides pteronyssinus) antigens. These cells were derived from challenged skin of an individual known to react positively to epicutaneous challenge with this agent. In this study, we show that these cloned T cells showed very high homogeneous expression of CLA (nearly 500-fold higher than T cell clones derived from peripheral blood) and bound specifically to recombinant E-selectin. The CLA molecule on these cells was identified not only by HECA-452, but also by CSLEX-1, indicating that it contained sialyl-Le(x) (S-Le(x)) determinants. T cells cloned under similar conditions from peripheral blood were CLA negative or low and bound poorly to E-selectin. Surprisingly, both skin and blood clones bound comparably to P-selectin. This binding was independent of S-Le(x) or CLA expression. We conclude that in sensitized individuals, antigen-specific T cells expressing high levels of CLA localize in skin promptly after epicutaneous challenge. This localization is likely to involve the interaction of S-Le(x) determinants on the CLA molecule with E-selectin on the dermal microvasculature. We further conclude that T cells can interest with P-selectin on endothelium and that S-Le(x) does not appear to be necessary for this interaction.

C32 human melanoma cell endogenous lectins: characterization and implication in vesicle-mediated melanin transfer to keratinocytes

To optimize skin pigmentation in order to help body prevention against UV radiation, the mechanism of melanin pigment transfer from melanocytes to keratinocytes must be elucidated. Melanin transfer to keratinocytes requires specific recognition between keratinocytes and melanocytes or melanosomes. Cell surface sugar-specific receptor (membrane lectin) expression was studied in human C32 melanoma cells, an amelanotic melanoma, by flow cytometry analysis of neoglycoprotein binding as an approach to the molecular specificity. Sugar receptors on melanocytes are mainly specific for alpha-L-fucose. Their expression is enhanced upon treatment by the diacylglycerol analogue 1-oleoyl-2-acetylglycerol, which can induce melanin synthesis in amelanotic human melanoma cells in a dose-dependent manner. Flow cytometry analyses showed a small-sized population of vesicles distinguishable from large cells by their fluorescence properties upon neoglycoprotein binding. Sorting indicated that the small-sized subpopulation is composed of vesicles produced by melanocytic cells. Upon vesicle formation, a selective concentration of sugar receptors specific for 6-phospho-beta-D-galactosides appears in the resulting melanocytic vesicles. Vesicles are recognized and taken up by cultured keratinocytes and a partial inhibitory effect was obtained upon cell incubation in the presence of neoglycoproteins, indicating a possible participation of sugar receptors in this recognition. The validity for such a model to help in understanding the natural melanin transfer by melanosomes is confirmed by electron microscopy, which demonstrates the presence of melanin inside keratinocytic cells upon incubation with melanocytic vesicles.

Inhibitory effect of 8-methoxypsoralen plus ultraviolet-A on interleukin-1 production by murine keratinocytes

We report the effects of 8-methoxypsoralen (8-MOP) plus ultraviolet-A (UV-A) irradiation on interleukin-1 (IL-1) production by murine epidermal keratinocytes, correlating its effect on IL-1 with cell viability, DNA synthesis, and 8-MOP-DNA photoadduct formation. Freshly isolated murine keratinocytes were treated with various doses of 8-MOP (5-100 ng/mL; incubation time, 30 min) plus 1 J/cm2 UV-A and cultured for 1-3 days. The IL-1/epidermal cell-derived thymocyte-activating factor (ETAF) activity in both supernatant and cell extract was reduced proportionately with increasing doses of 8-MOP/UV-A. Interleukin-1 inhibitors induced by 8-MOP plus UV-A were not detected in either supernatant or cell extract. A clear reduction of the IL-1 production was induced by the treatment as low as 15 ng/mL 8-MOP plus 1 J/cm2 UV-A, which led to the formation of 0.52 8-MOP photoadducts per million DNa bases and affected neither cell viability nor DNA synthesis of the treated cells. Cells treated with 100 ng/mL 8-MOP and 1 J/cm2 UV-A exhibited 57% suppression of IL-1 production in both 2- and 3-day culture samples. This treatment resulted in the formation of 3.8 photoadducts per million bases as well as significant abrogation of DNA synthesis although cell viability was unchanged. These observations provide some insights into the phototoxicity mechanisms of 8-MOP and the effect of PUVA therapy on the cytokine regulation in keratinocytes.

HLA-DR antigen expression in tonsillar epithelium. With special reference to focal infection

Palmoplantar pustulosis (PPP) has long been regarded as a tonsillar focal infection because tonsillectomy is so effective in its treatment. Immune mechanisms of focal infection have been discussed mainly with regard to humoral immunity as an autoimmune disease. The present immunological study demonstrates the expression of HLA-DR antigen in tonsillar epithelium. The patterns of the HLA-DR antigen appearance in the epithelium were categorized into 4 types, and the intensity was compared between hypertrophic tonsils, recurrent tonsillitis, and tonsils with PPP. In addition, paired fluorescent staining, a combination of CD3 and anti-HLA-DR antibodies, was performed. The activity of intraepithelial T-lymphocytes was determined as an index of the HLA-DR antigen expression. In an age matching study, HLA-DR antigen appeared in high intensity in tonsils with PPP. A close correlation was found between the appearance of HLA-DR antigens and activation of infiltrating T-lymphocytes. These findings suggest that the tonsillar epithelium plays an important role in focal infection.

Genotypic analysis of T-cell clones derived from cutaneous T-cell lymphoma lesions demonstrates selective growth of tumor-infiltrating lymphocytes

The nature of T cells contained within cutaneous lesions of cutaneous T-cell lymphoma (CTCL) has not been studied at the clonal level. T cells extracted from skin lesions of two CTCL patients were cloned by limiting dilution and propagated in interleukin-2 (IL-2) containing medium with periodic lectin stimulation. Twelve T-cell clones were derived from each patient. In both cases, genotypic analysis of the T-cell clones revealed that these clones had T-cell receptor (TCR) beta- and gamma-chain gene rearrangements distinct from the predominant, presumably malignant, clone present in the skin, lymph nodes, or blood. This suggests that they were derived from presumably reactive (non-malignant) T cells. Furthermore, these clones had gene rearrangements different from each other, indicating their multiple clonal origins. The failure to propagate in vitro the CTCL T-cell clone suggests that CTCL cells may have growth requirements different from normal T cells. Thus, conventional T-cell culturing methods using IL-2 and lectins as mitogen may selectively propagate the presumably reactive T cells contained within the skin lesions. The ability to selectively grow these reactive lesional T cells (so-called tumor infiltrating lymphocytes) raises the possibility that these cells could be used in adoptive immunotherapy.

T cell receptor beta-chain gene rearrangement without gamma-chain gene rearrangement in cutaneous T cell lymphoma: an unusual finding

T cells from the blood and skin of a patient with cutaneous T cell lymphoma demonstrated rearrangement of the T cell receptor beta-chain gene in the absence of rearrangement of the gamma-chain gene. To our knowledge, this has not been previously reported. This finding was unexpected in light of prevailing concepts of T cell ontogeny. Potential explanations for it are discussed.

Proliferative responses of peripheral blood mononuclear cells from psoriatic patients to T lymphocyte-stimulating cytokines (IL-2, IL-3, IL-4, and granulocyte-macrophage colony-stimulating factor) and OK-432

We have examined the effects of four well-characterized cytokines with T lymphocyte-stimulatory activity, i.e., interleukin (IL)-2, IL-3, IL-4, and granulocyte-macrophage colony-stimulating factor (GM-CSF) on [3H]-thymidine incorporation in peripheral blood mononuclear cells (PBMs) obtained from patients with psoriasis. Under the influence of these cytokines, the incorporation of [3H]-thymidine into the PBMs was not different between psoriatic patients and healthy controls either in culture supplemented with pooled AB serum or with autologous serum. However, a potent immunopotentiator OK-432, which is a lyophilized preparation of penicillin-treated low virulence Su-strain of Streptococcus pyogenes group A3, induced significantly less incorporation of [3H]-thymidine into the PBMs from psoriatic patients than those from healthy controls [in both the culture supplemented with pooled AB serum (p less than 0.01) and that with autologous serum (p less than 0.01)]. This reduction in thymidine uptake was closely related to the disease activity as well as to the extent of skin lesions of the psoriatic patients. The defective immune response of PBMs from psoriatic patients to OK-432 probably reflects an abnormality at the level of interaction between monocytes and T cells or at the subsequent production and release of cytokines by them.

Characterization of intercellular adhesion molecule-1 and HLA-DR expression in normal and inflamed skin: modulation by recombinant gamma interferon and tumor necrosis factor

Lymphocytes bind to cultured keratinocytes that are treated with interferon gamma (IFN-gamma) and tumor necrosis factor (TNF). When the lymphocytes are preincubated with antibody to lymphocyte function associated antigen-1 (LFA-1), this adherence is inhibited. Because intercellular adhesion molecule-1 (ICAM-1) is a ligand for LFA-1, we studied the cellular expression of ICAM-1, as well as two other IFN-gamma-inducible antigens, (HLA) human lymphocyte antigens DR and DQ, in both normal and diseased skin. The modulation of these cell surface antigens by IFN-gamma and TNF with the use of short-term organ cultures of skin was compared with isolated keratinocytes grown in a conventional tissue culture system. While in normal skin, keratinocytes did not express HLA-DR, DQ, or ICAM-1, when organ cultures were supplemented with IFN-gamma, rapid induction of keratinocyte ICAM-1 expression occurred after 24 hours; HLA-DR but not DQ expression occurred after 48 hours. TNF also induced keratinocyte ICAM-1 expression (although to a lesser degree than IFN-gamma) but did not induce either keratinocyte HLA-DR or DQ expression. There was good correlation of keratinocyte expression of ICAM-1 and HLA-DR by IFN-gamma and TNF when the epidermis of the organ culture system was compared with the isolated keratinocytes grown in tissue culture. The presence of intraepidermal lymphocytes correlated extremely well with keratinocyte ICAM-1 expression but not with keratinocyte HLA-DR expression in psoriasis, atopic dermatitis, lichen planus, and mycosis fungoides. The intensity of endothelial cell expression of ICAM-1 correlated with the degree of dermal inflammation. We conclude that IFN-gamma, once produced by activated T lymphocytes in the dermis, may be of importance in lymphocyte trafficking in the epidermis by the induction of keratinocyte ICAM-1 expression. The use of the short-term organ culture system, in which there is inducible ICAM-1 expression, provides an experimental bridge between purely in vitro and in vivo investigations to further our understanding of the molecular basis for lymphocyte apposition to keratinocytes in the skin.