Abstract
Psoriasis is an inflammatory autoimmune disease characterized by cutaneous lesions in plaques. It has been proposed that the immune response has a key role in the disease progression. Particularly, the Th17 cells through IL-17 can contribute to maintain the inflammatory process. The pathogenic Th17 phenotype has been described in human diseases and associated with high severity in inflammatory experimental models. However, it is not clear if the pathogenic phenotype could be present in the skin and peripheral blood as well as its possible association to severity in psoriasis. In the lesional skin, we found high infiltration of Th17 cells and the pathogenic phenotype, finding a correlation between the frequency of Th17 cells and the Psoriasis Area and Severity Index (PASI) score. In peripheral blood, we observed a pool of Th17 lymphocytes with potential to acquire pathogenic features. Interestingly, the percentage of pathogenic Th17 cells (CD4+ RORγt+ IFN-γ+) correlates with disease severity. Moreover, we distinguished three groups of patients based on their IL-17/IFN-γ production by Th17 lymphocytes, which seems to be related with a dynamic or stable potential to express these cytokines. Remarkably, we evaluated the cytokine production by Th17 cells as an immunological marker for the adequate selection of biologic therapy. We found that patients analyzed by this immunological approach and treated with antibodies against IL-17 and TNFα showed great improvement depicted by reduction in PASI and Dermatology Life Quality Index (DLQI) score as well as the percentage of Body Surface Area (BSA). Altogether, our results highlight the importance of the assessment of the pathogenic phenotype in Th17 cells as an immune personalized analysis with the potential to support the therapy choice in the clinical practice.
Highlights
Psoriasis is an inflammatory autoimmune skin disease with aberrant keratinocyte differentiation and epidermal thicknesses [1, 2]
We identified the presence of functional Th17 cells by the coexpression of the IL-17 and the master transcription factor RORγt in isolated cells from the lesional skin of psoriasis patients [27]
The results show a high presence of Th17 cells (52:7 ± 8%) in the lesional skin (LS) in contrast to the nonlesional skin
Summary
Psoriasis is an inflammatory autoimmune skin disease with aberrant keratinocyte differentiation and epidermal thicknesses [1, 2]. Psoriasis etiology is not completely understood; evidence has shown that the immune response is a key factor in the physiopathology due to the high quantities of inflammatory cytokines such as IL-17 and IL-22 and immune cell populations in skin lesions and peripheral blood (PB) [7,8,9]. Th17 lymphocytes are increased in the lesional skin and PB, contributing to the disease pathogenesis through IL-17 and IL-22 production [10, 11]. These cytokines promote the recruitment and activation of immune cells and increase keratinocyte proliferation, respectively [12, 13]. IL-17 upregulates the expression of TNFα, IL-6, and IL-8 by keratinocytes; these cytokines collaborate to maintain the inflammatory process [14, 15]
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