CCL7 contributes to the TNF‐alpha‐dependent inflammation of lesional psoriatic skin

Chemokines are small chemotactic proteins that have a crucial role in leukocyte recruitment into tissue. Targeting these mediators has been suggested as a potential therapeutic option in inflammatory skin diseases such as psoriasis. Using quantitative RT‐PCR, we found CCL7, a chemokine ligand known to interact with multiple C‐C chemokine receptors, to be markedly increased in lesional psoriasis as opposed to atopic dermatitis, lichen planus, non‐lesional psoriatic and normal control skin. Surprisingly, this increase in CCL7 mRNA expression exceeded that of all other chemokines investigated, and keratinocytes and dermal blood endothelial cells were identified as its likely cellular sources. In an imiquimod‐induced psoriasis‐like mouse model, CCL7 had a profound impact on myeloid cell inflammation as well as on the upregulation of key pro‐psoriatic cytokines such as CCL20, IL‐12p40 and IL‐17C, while its blockade led to an increase in the antipsoriatic cytokine IL‐4. In humans receiving the TNF‐α‐blocker infliximab, CCL7 was downregulated in lesional psoriatic skin already within 16 hours after a single intravenous infusion. These data suggest that CCL7 acts as a driver of TNF‐α‐dependent Th1/Th17‐mediated inflammation in lesional psoriatic skin.     

Transition from symptomless to lesional psoriatic skin

Numerous investigations have been carried out to describe the cellular biological changes in lesional and symptomless psoriatic ski. Although these studies have increased our knowledge of the pathogenesis of psoriasis, our insight into the relevance of the individual changes in the whole pathogenic process is still limited. Studies on the transition between symptomless and lesional skin are of importance in assessing the pathogenic relevance of the individual aspects. In this paper, the literature is reviewed with respect to the transitional changes; in particular, studies on changes at the margin of the psoriatic lesion and the response of the symptomless skin to standardized injury are reviewed. From the available studies it may be concluded that changes in the stroma (i.e. increased expression of tenascin and increased endothelial alkaline phosphatase activity) are early pathogenic features. The appearance of a predominantly lymphocytic infiltrate, in particular the extravasation of CD4+ T lymphocytes, and the suprabasal expression of keratin 16 are intermediary stages. Relatively late in the pathogenesis are increased recruitment of cycling epidermal nuclei, parakeratosis, decreased expression of filaggrin and premature expression of involucrin. In order to discover the pathogenic relevance of molecules which might have an impact on the development of psoriasis, sequential studies during transition from symptomless to lesional skin are worthwhile.     

Increased lysophosphatidylcholine content in lesional psoriatic skin

Various cell stimuli occur via activation of phospholipase A₂, which hydrolyses polyunsaturated fatty acids from the sn-2 position of membrane phospholipids, resulting in the formation of polyunsaturated fatty acids and lysophospholipids. The level of lysophospholipids is determined by the balance between phospholipase A₂ activity and the rate of catabolism of the lysophospholipids. One of the lysophospholipid classes, lysophosphatidylcholine, has been shown to stimulate certain leucocyte activities which are of importance for the induction and maintenance of inflammation. In addition, it has been demonstrated that phospholipase A₂ activity is increased in psoriatic skin. In the present study, we analysed the levels of lysophosphatidylcholine, by thin layer chromatography, in lesional psoriatic skin, uninvolved psoriatic skin and normal skin. The lysophosphatidylcholine content, expressed as μmol lysophosphatidylcholine/μmol phosphatidylcholine, was 1.55, 0.21 and 0.12% in lesional psoriatic skin, uninvolved psoriatic skin and normal skin, respectively. The level of lysophosphatidylcholine was significantly elevated in lesional compared with uninvolved psoriatic skin (P= 0.004) and normal skin (P= 0.002). The increased lysophosphatidylcholine levels in psoriatic skin indicate that the phospholipase A₂ activation is not accompanied by a corresponding increase in the activity of enzymes catabolizing lysoPC. If present in biologically active concentrations, lysophosphatidylcholine may contribute to the induction and maintenance of the inflammatory and immunological processes occurring in lesional psoriatic skin.     

Balance of Treg vs. T‐helper cells in the transition from symptomless to lesional psoriatic skin

Background In the pathogenesis of psoriasis, proinflammatory T cells are strongly involved in the inflammatory process, where regulatory T‐cell (Treg) function is impaired. Objectives As effective Treg function is associated with a numerical balance between Treg and effector T cells, we wondered whether Treg/T‐helper cell ratios may be associated with certain stages of the inflammatory process. We opted for the margin zone model as a dynamic approach. Methods From nine patients with chronic plaque psoriasis, 3‐mm punch biopsies were obtained from the centre and margin of the lesion, perilesional skin and distant uninvolved skin. Skin biopsies of 10 healthy volunteers were included as a control. Samples were analysed using immunohistochemistry and immunofluorescence. Results In the transition from symptomless to lesional skin, a significant increase of CD3+, CD4+ and Foxp3+ cells was found. In seven of nine patients the ratio of Treg (Foxp3+) vs. CD4+ T cells was higher in the distant uninvolved skin than in the perilesional and lesional skin. Interestingly, the Foxp3/CD4 ratio in the distant uninvolved skin was even higher than in the skin of healthy controls. Notably, we found that most of the interleukin (IL)‐17 expression was not related to CD4+ cells, but to mast cells. Conclusions The relatively high Foxp3/CD4 ratio in symptomless skin of patients with psoriasis suggests an active immune controlling mechanism distant from the psoriatic plaque. In the margin and centre of the plaque the ratio appears skewed towards effector cells associated with inflammation. IL‐17, an important driver of the psoriatic process, is mostly related to mast cells, and only sporadically to T cells.     

Direct immunofluorescence in lesional and uninvolved skin in dle

Direct immunofluroscence was evaluated in 16 patients with DLE including 1 case of lupus profundus and 4 with disseminated DLE. A BMZ band with multiple immunoreactants was demonstrated in lesional skin in 14 patients (87.5%), while 2 had only single immunoreactants. C3 and lgM were the commonest reactants followed by lgG, lgA and fibrinogen. A perifollicular prominence was seen in several patients. Four patients showed a band in uninvolved skin. This may indicate a potential to develop SLE. ANA was also positive in 5 patients but ds DNS was negative.     

Perilesional vs. lesional skin changes in senile lentigo

BACKGROUND: Senile lentigo (SL) is a common component of photoaged skin. It is characterized by hyperpigmented macules which affect chronically irradiated skin mostly after 50 years of age. This study was undertaken to assess the basic morphology of SL on dorsum of hands. METHODS: A systematic comparison between lesional vs. perilesional skin using immunohistochemistry and electron microscopy was done to detect precursor lesions of SL and to determine whether melanocytes or keratinocytes were first affected in the evolution of lesions. RESULTS: In 12 cases studied, the main findings show that clusters of perilesional keratinocytes accumulate melanin in large melanosomial complexes, and that melanocytes counts are increased respective to total length of section in lesional skin, but the increment is probably due to the development of characteristic epidermal rete ridges. Melanocytes had overall a normal ultrastructure, with mostly quiescent features in perilesional skin and melanosomial transport seeming more active in lesional skin. CONCLUSIONS: Our data indicate that SL may represent a loss of epidermal melanin unit homeostasis due to chronic irradiation, where keratinocytic changes predominate over melanocytic changes. We hypothesize that abnormal pigment retention in keratinocytes is the primary defect in SL, which may partly explain the therapeutic effect of retinoids.     

Ex vivo culture of lesional psoriasis skin for pharmacological testing

BackgroundPsoriasis is a chronic, inflammatory skin disorder resulting from a complex interplay between immune and skin cells via release of soluble mediators. While a lot is known about the molecular mechanisms behind psoriasis pathogenesis, there is still a need for preclinical research models that accuratelyreplicate the disease.ObjectiveThis study aimed to develop and characterize ex vivo culture of psoriasis skin as a model for pharmacological testing, where the immunological events of psoriasis can be followed.MethodsFull thickness punch biopsies of lesional psoriasis skin were cultured in submerged conditions up to 144 h followingin situ T cell stimulation with rhIL-23 and anti-CD3 and anti-CD28 antibodies. The T cell mediated skin inflammation was assessed by gene and protein l analysis for a panel of inflammatory mediators. Tissue integrity and morphology were evaluated by histological analysis.ResultsT cell stimulation resulted in functional and psoriasis specificin situ activation of T cells. The expression levels of most of the proinflammatory mediators related to both immune and skin cells were comparable to these in freshly isolated tissue at 48 and 96 h of culture. Tissue integrity and morphology were sustained up to 96 h. Treatment with a corticosteroid reduced the expression of several pro-inflammatory cytokines and chemokines, whereas anti-IL-17A antibody treatment reduced the expression of the IL-17A downstream markers IL-8 and DEFB4.ConclusionBy preserving keyimmunopathological mechanisms of psoriasis, ex vivo culture of psoriasis skin can be used for the investigation of inflammatory processes of psoriasis and for preclinical drug discovery research.     

Graft-versus-host reaction affecting lesional skin but not normal skin in a patient with piebaldism

Summary A case of graft-vs.-host disease (GVHD) arising solely within an area affected by piebaldism is described. The patient, a 35-year-old woman with a single hypopigmented patch on the right leg present since birth, had received an allogeneic bone marrow transplant (BMT) from an HLA-identical sibling donor, for treatment of a myelodysplastic syndrome (MDS). Beginning on day + 38 post-BMT, the patch developed changes which were histologically consistent with GVHD. Syngeneic mixed epidermal cell-lymphocyte reaction (MECLR) testing of tissue from the patch, and from adjacent normal skin, showed differences which suggest that piebaldism-affected skin is immunologically different from normal skin. These findings may offer new insight into the pathophysiology of this disorder.     

Plasminogen activation in lesional skin of Pemphigus vulgaris type Neumann

Zymographic and immunological studies revealed that primarily tissue-type plasminogen activator and to a lesser extent urokinase-type plasminogen activator were present in fluids of pemphigus vulgaris (type Neumann) skin blisters. Furthermore, plasmin activity was detected in pemphigus blister fluids using chromogenic peptide substrate assays. In pemphigus, but not in control, suction blister fluids plasmin/₂-antiplasmin and plasmin/ ₂-macroglobulin complexes were found by immunoprecipitation or by testing in immunoassays after fractionation by molecular-sieve chromatography. Plasmin activity, detected by a low molecular weight chromogenic peptide assay, was ascribed to plasmin/₂-macroglobulin complexes. Since formation of plasmin/inhibitor complexes requires active plasmin, the finding indicates previous activation of plasminogen in pemphigus lesions.     

T lymphocytes in lesional skin of patients with dermatitis herpetiformis

Ten patients with dermatitis herpetiformis had biopsies taken from involved skin.Monoclonal antibodies and the avidin-biotin peroxidase staining technique were used to stain for T cells and Langerhans cells in skin sections. A significant increase in the number of CD3-positive T cells was observed in the upper dermis of involved compared with uninvolved skin (P<0.0005). Most of the T cells in involved skin were CD45RO-positive memory cells; CD4-positive T cells exceeded the number of CD8-positive T cells by a ratio of 4:1. In addition, CD1a-positive dendritic cells were observed within the clumps of T cells in involved dermis in nine of the 10 patients, but were absent from the dermis of uninvolved skin. Double immunofluorescent staining demonstrated that approximately 20–40% of the CD3-positive T cells were activated, and expressed the HLA-DR antigen. These findings suggest that activated T cells are involved in the pathogenesis of dermatitis herpetiformis skin lesions.     

Generation of terminal complement complexes in psoriatic lesional skin.

The complement system is thought to play an important role in the recruitment of neutrophils within the epidermis. In the present study we examined whether or not complement activation in psoriatic lesional skin results in the deposition of terminal complement complexes within the epidermis by measuring levels of SC5b-9 in the plasma and horny tissues of psoriatic patients. The levels of SC5b-9 in psoriatic plasma were significantly higher than those of controls or those of patients with atopic dermatitis. However, when the levels of SC5b-9 in the psoriatic plasma were compared before and after successful treatment of psoriasis, a significant reduction was observed after treatment. Studies of total protein extracts from lesional skin showed that, while no SC5b-9 was detected in the noninflammatory horny tissues, there were high levels of SC5b-9 in lesional horny tissues of psoriasis. By immunofluorescence using a monoclonal antibody to the C5b-9 neoantigen, deposition of C5b-9 was observed only in the stratum corneum of psoriatic skin. Thus the results of the present study suggests that in psoriatic lesional skin, the complement system is activated and that this complement activation proceeds all the way to the terminal step, generating membrane attack complex.     

Gone but not forgotten: lesional memory in psoriatic skin

One of the most frustrating aspects of treating psoriasis is the tendency of psoriatic skin lesions to recur after therapy has been discontinued. Not only do lesions recur, but they often recur in the same anatomical locations, expanding to the size they were before therapy. This engenders feelings of frustration and futility in both patients and the dermatologists who care for them. In this issue, Suárez-Fari?as and colleagues identified a gene set-the residual disease genomic profile-of psoriasis, suggesting the presence of both immunologic and structural abnormalities within healed psoriatic lesions. By understanding this "invisible lesion," we may be one step closer to curing psoriasis.