title: Variable levels of apoptotic signal-associated cytokines in the disease course of patients with Stevens-Johnson syndrome and toxic epidermal necrolysis.
abstract: OBJECTIVE
  Keratinocyte death is a hallmark of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). Apoptotic signal-associated cytokines, such as TNF-α, sFasL, granulysin, sTRAIL and IFN-γ have been reported to participate in keratinocyte apoptosis. However, their levels are variable, which hampers the elucidation of the role of these cytokines. We sought to determine whether cytokine levels vary with disease course.
  
  
  METHODS
  The serum cytokine levels of 24 patients and blister fluid of 10 were analysed by enzyme-linked immunosorbent assay on the first day of their admission to hospital and were evaluated at different time points in the disease course. Meanwhile, surface markers (CD3, CD4, CD8, CD1a, CD14, CD16+56 and CD68) of blister fluid cells were measured by flow cytometry.
  
  
  RESULTS
  The concentrations of all cytokines in the serum and blister fluid were higher than those in the controls and were more elevated in the blister fluid than in the serum. Moreover, sTRAIL, IFN-γ and TNF-α quantities were relatively stable, while those of sFasL and granulysin decreased rapidly in the disease course. On the first day, CD8+ T and natural killer cells were predominant in the blister fluid but their relative percentage diminished gradually, while that of CD14+ cells increased.
  
  
  CONCLUSIONS
  Our study confirmed there are high but variable levels of these cytokines in SJS/TEN, especially in the early phase and different tendencies are manifested in the disease course.
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Yongsheng
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Du
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Yanyun
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Jinran
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Xiaoqun
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Dermatology, Huashan Hospital, Shanghai, China.
authors.forename: Jinhua
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D000943:Antigens, Differentiation / Q000378:metabolism*; D017209:Apoptosis; D001768:Blister / Q000378:metabolism*; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood* / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015398:Signal Transduction; D013262:Stevens-Johnson Syndrome / Q000097:blood* / Q000378:metabolism; D055815:Young Adult
chemical_list: D000943:Antigens, Differentiation; D016207:Cytokines
keywords: Stevens-Johnson syndrome; apoptosis; keratinocyte; toxic epidermal necrolysis