title: Improvement of psoriasis after tonsillectomy is associated with a decrease in the frequency of circulating T cells that recognize streptococcal determinants and homologous skin determinants.
abstract: Exacerbation of chronic psoriasis can be associated with streptococcal throat infections, and T cells that respond to peptide sequences common to streptococcal M proteins and skin keratins have been detected in patients' blood. To our knowledge, we have conducted the first blinded, prospective study to assess the impact of tonsillectomy on psoriasis. Twenty-nine patients with chronic psoriasis and history of exacerbation after sore throat were randomly assigned to tonsillectomy (n = 15) or control (n = 14) groups and monitored for 2 y clinically and by enumeration of circulating skin homing T cells that respond to short homologous M protein or keratin peptides. Thirteen patients (86%) showed sustained improvement after tonsillectomy ranging from 30 to 90% reduction in disease severity. Furthermore, there was a close correlation between the degree of clinical improvement in individual patients and reduction in the frequency of peptide-reactive skin-homing T cells in their circulation. No corresponding clinical or immunologic changes were observed among the controls. These findings indicate that tonsillectomy may have a beneficial effect on chronic psoriasis because the palatine tonsils generate effector T cells that recognize keratin determinants in the skin.
authors.affiliation: Department of Immunology, Landspitali University Hospital, 101 Reykjavik, Iceland.
authors.forename: Ragna Hlin
authors.initials: RH
authors.lastname: Thorleifsdottir
authors.forename: Sigrun Laufey
authors.initials: SL
authors.lastname: Sigurdardottir
authors.forename: Bardur
authors.initials: B
authors.lastname: Sigurgeirsson
authors.forename: Jon Hjaltalin
authors.initials: JH
authors.lastname: Olafsson
authors.forename: Martin Ingi
authors.initials: MI
authors.lastname: Sigurdsson
authors.forename: Hannes
authors.initials: H
authors.lastname: Petersen
authors.forename: Sigurlaug
authors.initials: S
authors.lastname: Arnadottir
authors.forename: Johann Eli
authors.initials: JE
authors.lastname: Gudjonsson
authors.forename: Andrew
authors.initials: A
authors.lastname: Johnston
authors.forename: Helgi
authors.initials: H
authors.lastname: Valdimarsson
mesh_terms: D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000378:metabolism*; D001425:Bacterial Outer Membrane Proteins / Q000378:metabolism*; D002352:Carrier Proteins / Q000378:metabolism*; D002465:Cell Movement / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D018984:Epitopes, T-Lymphocyte / Q000276:immunology / Q000378:metabolism*; D005260:Female; D006801:Humans; D007633:Keratins / Q000276:immunology / Q000378:metabolism; D008231:Lymphopenia / Q000097:blood / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D014066:Palatine Tonsil / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies; D011565:Psoriasis / Q000276:immunology* / Q000473:pathology* / Q000601:surgery; D012867:Skin / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D016176:T-Lymphocyte Subsets / Q000276:immunology* / Q000378:metabolism / Q000382:microbiology; D014068:Tonsillectomy; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D018984:Epitopes, T-Lymphocyte; C014689:streptococcal M protein; D007633:Keratins