title: Up-regulated perforin expression of CD8+ blood lymphocytes in generalized non-anaphylactic drug eruptions and exacerbated psoriasis.
abstract: Perforin expressed in CD8+ cytotoxic T cells is known to mediate the lysis of target cells carrying microbial as well as tumor-associated antigens, and to be involved in autoimmune and transplant reactions. The aim of the present investigation was to study the role of perforin- and CD8-expressing effector lymphocytes from peripheral blood in patients with generalized inflammatory skin diseases. Mononuclear cells were separated from peripheral venous blood and permeabilized by 0.1% saponin. The co-expression of cytoplasmatic perforin and cell membrane-residing CD8 was determined in lymphocytes by immuno-flow cytometry. Patients affected by generalized macular-papular drug eruptions (n = 14), drug-unrelated acute urticaria (n = 10) and drug-independently exacerbated psoriasis (n = 11, PASI scores ranging from 25 to 35), as well as control individuals not affected by any inflammatory skin disease (n = 10) were enrolled. Additionally, n = 5 patients with drug-induced Stevens-Johnson syndrome (SJS) were included. The average proportion of CD8+ peripheral lymphocytes co-expressing perforin in generalized drug eruptions (68.8+/-24.9%) and exacerbated psoriasis (67.2+/-17.1%) differed significantly from the controls (43.5+/-11.6%; p 0. 05), whereas no significant difference for acute urticaria (58.2+/-23.1%) could be measured. In each of the 5 SJS patients treated by high dose systemic steroids the parameter substantially declined during the first 7 days after admission from an average value of 81. 6% down to 33.0%. Thus, as compared to controls we observed an increased perforin+ proportion of CD8+ lymphocytes in generalized drug eruptions and in exacerbated psoriasis but not in acute urticaria. Therefore the parameter showed some specificity as a marker of distinct inflammatory skin disorders, and proved to be useful in monitoring the disease activity of SJS under anti-inflammatory medication. Furthermore, the findings point to a possible crucial role of CD8+ lymphocytes in the pathogenesis of psoriasis.
authors.affiliation: Department of Dermatology and Venereology, Universitätsklinik für Dermatologie und Venerologie, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany. bernd.bonnekoh@medizin.uni-magdeburg.de
authors.forename: C
authors.initials: C
authors.lastname: Behrendt
authors.forename: H
authors.initials: H
authors.lastname: Gollnick
authors.forename: B
authors.initials: B
authors.lastname: Bonnekoh
mesh_terms: D000328:Adult; D000368:Aged; D018414:CD8-Positive T-Lymphocytes / Q000737:chemistry / Q000166:cytology / Q000378:metabolism*; D016022:Case-Control Studies; D003875:Drug Eruptions / Q000097:blood / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D008297:Male; D008562:Membrane Glycoproteins / Q000378:metabolism*; D008875:Middle Aged; D054353:Perforin; D052899:Pore Forming Cytotoxic Proteins; D011565:Psoriasis / Q000097:blood / Q000276:immunology*; D013262:Stevens-Johnson Syndrome / Q000097:blood / Q000276:immunology*; D013602:T-Lymphocytes, Cytotoxic / Q000378:metabolism; D015854:Up-Regulation
chemical_list: D008562:Membrane Glycoproteins; D052899:Pore Forming Cytotoxic Proteins; D054353:Perforin