Immunity, Infection and Inflammation Programme, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, U.K.
Department of Dermatology, Andrology and STDs, Mansoura University, Mansoura, Egypt.
Br J Dermatol. 2018 Jul;179(1):127-135. doi: 10.1111/bjd.16336. Epub 2018 Apr 26.
Psoriasis is a chronic T-cell-mediated skin disease with marked social and economic burdens. Current treatments are unsatisfactory, with unpredictable remission times and incompletely understood modes of action. Recent advances in our understanding of the pathogenesis of psoriasis have identified the imbalance between CD4 T effector cells, particularly the T helper (Th)17 subset, and regulatory T cells (Tregs) as key to the development of psoriatic lesions, and therefore a novel therapeutic target.
To quantify in patients the effects of three commonly used psoriasis treatment modalities on the Th1, Th2, Th17 and Treg subsets, and to test whether any change correlates with clinical response.
Flow cytometry was used to enumerate Th1, Th2, Th17 and Treg subsets in blood and skin of patients with psoriasis before and after receiving any of the following treatments: narrowband ultraviolet B (NB-UVB), adalimumab and topical betamethasone-calcipotriol combination (Dovobet ) RESULTS: All patients responded clinically to the treatments. NB-UVB significantly increased the numbers of circulating and skin Tregs, while, by contrast, adalimumab reduced Th17 cells in these compartments, and Dovobet had dual effects by both increasing Tregs and reducing Th17 cells.
The differential effects reported here for the above-mentioned treatment modalities could be exploited to optimize or design therapeutic strategies to overcome the inflammatory drivers more effectively and restore the Th17-Treg balance in psoriasis.
银屑病是一种慢性 T 细胞介导的皮肤疾病，具有显著的社会和经济负担。目前的治疗方法并不令人满意，缓解时间不可预测，作用机制也不完全清楚。最近对银屑病发病机制的认识的进展表明，CD4 T 效应细胞（尤其是辅助性 T 细胞 17 亚群）与调节性 T 细胞（Tregs）之间的失衡是导致银屑病病变发展的关键，因此是一种新的治疗靶点。
定量评估三种常用银屑病治疗方法对 Th1、Th2、Th17 和 Treg 亚群的影响，并检测任何变化是否与临床反应相关。
采用流式细胞术检测银屑病患者治疗前后血液和皮肤中 Th1、Th2、Th17 和 Treg 亚群的数量。患者接受以下治疗之一：窄带紫外线 B（NB-UVB）、阿达木单抗和外用倍他米松-卡泊三醇复方（Dovobet）。
所有患者对治疗均有临床反应。NB-UVB 显著增加了循环和皮肤中的 Tregs 数量，而阿达木单抗则降低了这些部位的 Th17 细胞，Dovobet 则具有双重作用，既增加了 Tregs，又减少了 Th17 细胞。
本研究报告了上述治疗方法的不同作用，这些作用可能被利用来优化或设计治疗策略，以更有效地克服炎症驱动因素，并恢复银屑病中的 Th17-Treg 平衡。
