Compartmentalized Cytokine Responses in Hidradenitis Suppurativa

Theodora Kanni,Athina Savva,Jos W. van der Meer,Mihai G. Netea,Aikaterini Pistiki,Brigit Kersten,Vassiliki Tzanetakou,Frank L. van de Veerdonk,Evangelos J. Giamarellos-Bourboulis,Giorgos Bamias

doi:10.1371/journal.pone.0130522

Abstract

BackgroundFavorable treatment outcomes with TNF blockade led us to explore cytokine responses in hidradenitis suppurativa (HS).MethodsBlood monocytes of 120 patients and 24 healthy volunteers were subtyped by flow cytometry. Isolated blood mononuclear cells (PBMCs) were stimulated for cytokine production; this was repeated in 13 severe patients during treatment with etanercept. Cytokines in pus were measured.ResultsCD14brightCD16dim inflammatory monocytes and patrolling monocytes were increased in Hurley III patients. Cytokine production by stimulated PBMCs was low compared to controls but the cytokine gene copies did not differ, indicating post-translational inhibition. The low production of IL-17 was restored, when cells were incubated with adalimumab. In pus, high concentrations of pro-inflammatory cytokines were detected. Based on the patterns, six different cytokine profiles were discerned, which are potentially relevant for the choice of treatment. Clinical improvement with etanercept was predicted by increased production of IL-1β and IL-17 by PBMCs at week 8.ConclusionsFindings indicate compartmentalized cytokine expression in HS; high in pus but suppressed in PBMCs. This is modulated through blockade of TNF.

Highlights

Hidradenitis suppurativa (HS) is a chronic devastating skin disorder affecting areas rich in apocrine glands
Cytokine production by stimulated peripheral blood mononuclear cells (PBMCs) was low compared to controls but the cytokine gene copies did not differ, indicating post-translational inhibition
The low production of IL-17 was restored, when cells were incubated with adalimumab

Summary

Introduction

Hidradenitis suppurativa (HS) is a chronic devastating skin disorder affecting areas rich in apocrine glands. Nodules appear in the affected areas; they progressively become swollen and rupture with the release of pus. This process occurs repeatedly, ending to sinus tract formation and scars [1]. HS seems to indiscriminately affect the global population. HS has considerable impact on the quality of life of patients, often leading to loss of many working hours per month. The Dermatology Quality Life Index (DQLI) for HS is 8.9, being higher than any other skin disorder [3]. Favorable treatment outcomes with TNF blockade led us to explore cytokine responses in hidradenitis suppurativa (HS)

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