Department of Dermatology, Universidade do Oeste Paulista, São Paulo, Brazil.
Acta Derm Venereol. 2014 Jan;94(1):26-31. doi: 10.2340/00015555-1650.
Treatment of patients with immune-mediated inflammatory diseases with anti-tumour necrosis factor (anti-TNF) agents increases the risk of tuberculosis reactivation, suggesting that it may affect their cellular immune responses. We evaluated cellular immune responses of 12 severe psoriasis patients before and during infliximab treatment. Peripheral blood mononuclear cells were stimulated with phytohaemagglutinin, the superantigen enterotoxin B (SEB), a cytomegalovirus lysate (CMV), and Mycobacterium tuberculosis (Mtb) antigens. The lymphocyte proliferative and IFN-γ responses were evaluated. Treatment with infliximab did not lead to reduction in the IFN-γ and lymphoproliferative responses: it rather increased the overnight release of IFN-γ in phytohaemagglutinin and SEB stimulated cultures. This effect was most noted at the peak of the anti-TNF clinical effect and less prominent at its nadir. Immunoreactivity to CMV was also either unaffected or slightly increased by the anti-TNF. Of note, the IFN-γ and proliferative responses to Mtb by the two tuberculin skin test-reactors were also increased at the peak of infliximab, declining at its nadir. The deleterious consequences of TNF blockade in severe psoriasis patients undergoing infliximab treatment are apparently attenuated by the abbreviation of the immunosuppressive effect of TNF overexpression.
治疗患有肿瘤坏死因子（anti-TNF）的免疫介导的炎症性疾病的患者会增加结核分枝杆菌再激活的风险，这表明它可能影响其细胞免疫反应。我们评估了 12 例严重银屑病患者在英夫利昔单抗治疗前后的细胞免疫反应。用植物血凝素、超抗原肠毒素 B（SEB）、巨细胞病毒裂解物（CMV）和结核分枝杆菌（Mtb）抗原刺激外周血单核细胞。评估淋巴细胞增殖和 IFN-γ反应。英夫利昔单抗治疗并未导致 IFN-γ和淋巴增殖反应减少：相反，它增加了植物血凝素和 SEB 刺激培养物中 IFN-γ的过夜释放。这种作用在抗 TNF 临床效果的高峰时最为明显，在其低谷时不太明显。CMV 的免疫反应也不受抗 TNF 影响或略有增加。值得注意的是，两种结核菌素皮肤试验反应者对 Mtb 的 IFN-γ和增殖反应也在英夫利昔单抗的高峰时增加，在其低谷时下降。在接受英夫利昔单抗治疗的严重银屑病患者中，TNF 阻断的有害后果显然因 TNF 过度表达的免疫抑制作用的缩短而减轻。
