The Majority of Epidermal T Cells in Psoriasis Vulgaris Lesions can Produce Type 1 Cytokines, Interferon-γ, Interleukin-2, and Tumor Necrosis Factor-α,

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The Majority of Epidermal T Cells in Psoriasis Vulgaris Lesions can Produce Type 1 Cytokines, Interferon-γ, Interleukin-2, and Tumor Necrosis Factor-α, Defining TC1 (Cytotoxic T Lymphocyte) and TH1 Effector Populations:1 a Type 1 Differentiation Bias is also Measured in Circulating Blood T Cells in Psoriatic Patients Lisa M. Austin, Maki Ozawa, Toyoko Kikuchi, Ian B. Walters, James G. Krueger Journal of Investigative Dermatology Volume 113, Issue 5, Pages 752-759 (November 1999) DOI: 10.1046/j.1523-1747.1999.00749.x Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Cytokine expression related to differentiation status for the two primary effector types of lymphocytes. This diagram shows the rationale for cytokine comparisons shown in this study (Del Prete 1998). Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 In vitro ionomycin/PMA stimulation of T cells from both control and psoriatic blood T cells primarily induces IFN-γ, TNF-α, and IL-2. (A) Isotype control staining of stimulated control blood T cells. (B) Intracellular cytokine staining (in the presence of Brefeldin A), of freshly isolated normal control blood T cells (C) as compared with stimulated control blood T cells stained with the same anti-cytokine antibodies and (D) intracellular cytokine staining of stimulated psoriatic patient blood T cells. Isotype controls shown are typical for unactivated and activated T cells. The arrow points to the majority of IFN-γ+ T cells which are in the TNF-αhi region for both psoriatic and control blood. Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Psoriatic patients’ peripheral blood T cells contain larger populations of T1 cytokine producing cells. Cytokine expression in activated peripheral blood cells between control (n = 8–11) and psoriatic patients (n = 14). The psoriatic patients T cells have larger populations producing IFN-γ (p = 0.03) and TNF-α (p = 0.048). The percentage of CD69+ T cells demonstrates the similar number of permeabilized T cells expressing CD69 after stimulation with ionomycin/PMA in the presence of Brefeldin A. Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Patients’ T cells demonstrate a T1 differentiation shift with lower IL-4/IFN-γ ratios. (A) IFN-γversus IL-4 populations in peripheral blood T cells of control volunteers and patients, a patient sample is shown and (B) the psoriatic blood IL-4/IFN-γ ratio (n = 14) is lower than the ratio found in normal blood (n = 8) (p = 0.007). Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Lesional epidermal CD3+ T cells express T1 cytokines when stimulated in vitro. (A) representative dot plots of epidermal cells which show FSC (size) versus SSC (granularity) information in addition to CD3+ staining compared with its isotype control. For the following dot plots of CD3+ T cells, the first column shows unactivated epidermal T cells whereas the second column shows the in vitro activated epidermal T cells (B) IFN-γ and TNF-α, (C) IL-2, (D) IL-4, and (E) IL-10. Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 The size of populations expressing each cytokine is similar between the epidermis and blood. (A) The average size of the epidermal lesional population producing each cytokine was statistically similar (with marginal significances in some cases) to the peripheral blood population (B) IL-4:IFN-γ ratios were determined and also found to be similar for blood and epidermal T cells for each patient (n = 6 for patient matched samples). Although the majority of lesional epidermal T cells express CD69 on variable numbers of cells prior to ionomycin/PMA stimulation, these values represent the total CD69 expression of permeabilized T cells showing similar percentages between blood and skin T cells after ionomycin/PMA treatment in the presence of Brefeldin A. Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 7 Both CD8+ and CD4+ peripheral blood cells and epidermal cells from psoriatic patients can produce IFN-γ, TNF-α, and IL-2 after stimulation with ionomycin/PMA. (A) IFN-γ expression is consistently higher in the CD8+ population when compared with the CD4+ T cells in the epidermis (p = 0.03), with a similar finding in psoriatic blood (p = 0.01) and normal blood (p = 0.001, n = 11, not shown). (B) TNF-α expressing populations, whereas marginally significant (p = 0.07) between the subsets, are greater in the epidermal CD8 population than in the patients’ peripheral blood (p = 0.05). And, whereas there is still no difference between the subsets of TNF-α expressing cells in the psoriatic blood, in normal blood significantly more CD8+ CD3+ cells were expressing TNF-α than CD4+ CD3+ cells (p = 0.001, n =11, not shown). (C) Lesional CD8+ CD3+ populations were marginally larger than CD4+ CD3+ cells (p = 0.06) and were larger than IL-2+ CD8+ CD3+ populations in patient’s peripheral blood populations (p =0.04) whereas in both sources of peripheral blood cells, psoriatic and normal, more CD4+ T cells express IL-2 than CD8 T cells (p = 0.04 and p = 0.02, respectively). Cells were gated for CD8+CD3+ whereas the CD4+CD3+ information is based on both direct CD4+CD3+ gating (normal blood and two each of the psoriatic epidermal and psoriatic blood samples) and indirect CD8CD3+ gating, depending on sample availability (normal volunteers n = 11, psoriatic blood n = 6, psoriatic epidermis n = 3). Journal of Investigative Dermatology 1999 113, 752-759DOI: (10.1046/j.1523-1747.1999.00749.x) Copyright © 1999 The Society for Investigative Dermatology, Inc Terms and Conditions