Journal Information
Vol. 98. Issue 8.
Pages 539-544 (October 2007)
Vol. 98. Issue 8.
Pages 539-544 (October 2007)
Original articles
DOI: 10.1016/S1578-2190(07)70509-7
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Analysis of Lymphocyte Populations in Psoriatic Plaques Following Inhibition of Tumor Necrosis Factor-α With Etanercept
Estudio de las Poblaciones Linfocitarias en las Lesiones de Psoriasis Tras el Bloqueo del Factor de Necrosis Tumoral Alfa con Etanercept
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L. Mahiquesa,
Corresponding author
laura_mahiques@aedv.es

Correspondence: Servicio de Dermatología. Hospital General Universitario de Valencia. Avda. Tres Cruces, s/n. 46014 Valencia. Spain.
, G. Pitarcha, J.L. Sánchez-Carazoa, A. Pérez-Ferriolsa, C.J. Sorianob, V. Alegrea
a Servicio de Dermatología, Hospital General Universitario de Valencia, Valencia, Spain
b Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
Article information
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Abstract
Introduction

Psoriasis is a disease with a strong immunological component in which there is a predominant T helper 1 cell-mediated immune response. Etanercept, a receptor for tumor necrosis factor a that blocks its action, is a new drug with proven efficacy in the treatment of psoriasis.

Objectives

The primary objective of this study was to assess the histological response to etanercept by analyzing the lymphocyte populations in psoriatic plaques. The secondary objectives were to assess the clinical response to the drug using the Psoriasis Area and Severity Index (PASI) and to analyze the effect of etanercept on peripheral blood lymphocyte populations.

Methods

Ten patients with plaque psoriasis and a PASI score greater than 10 were included in the study. A clinical assessment was performed in all patients along with a 4-mm skin punch biopsy of a plaque and analysis of peripheral blood lymphocyte populations at baseline and after 12 weeks of etanercept therapy at a dose of 50 mg per week.

Results

There was a significant reduction in different lymphocyte populations in the plaques following treatment with etanercept. The mean (SD) number of CD4+ T lymphocytes per microscopic field decreased from 16.93 (8.13) at baseline to 6.51 (3.46) after treatment with etanercept (P<007). CD8+ T lymphocytes also decreased from 17.73 (9.77) before treatment to 10.50 (9.4) after treatment (P<005). An overall improvement in PASI score was also observed: 33.30 (10.71) at baseline versus 15.20 (13.28) following treatment (P<008). Nine out of 10 patients showed improvement. No significant differences were observed in peripheral blood lymphocyte populations before and after treatment.

Conclusions

Etanercept leads to clinical improvement of psoriasis and reduces inflammatory infiltration of the lesions without affecting peripheral blood lymphocyte populations.

Key words:
psoriasis
lymphocytes
treatment
Resumen
Introducción

La psoriasis es una enfermedad de fuerte base inmune, con un predominio de respuesta inmune celular o Th1. Entre los nuevos fármacos que han demostrado eficacia está el etanercept, un receptor para el factor de necrosis tumoral alfa que bloquea su acción.

Objetivos

Como objetivos nos planteamos en primer lugar determinar la respuesta histológica a etanercept mediante la determinación de las poblaciones linfocitarias en las lesiones psoriásicas; y en segundo lugar, determinar la respuesta clínica al fármaco mediante el Psoriasis Area and Severity Index (PASI) y valorar el efecto de etanercept sobre las poblaciones linfocitarias en sangre.

Métodos

Tratamos 10 pacientes con psoriasis en placas con PASI > 10. Se les realizó una evaluación clínica, un punch de 4 mm en la placa y una determinación de poblaciones linfocitarias en sangre antes del comienzo y tras 12 semanas de tratamiento con etanercept 50 mg/semana.

Resultados

Hubo un descenso significativo en las distintas poblaciones linfocitarias de las lesiones tras el tratamiento con etanercept. Así, los linfocitos T CD4+ antes y después del tratamiento con etanercept registraron los siguientes valores: 16,93±8,13 y 6,51±3,46 (p<0,007), respectivamente. Y los linfocitos T CD8+ antes y después del tratamiento con etanercept registraron: 17,73±9,77 y 10,50±9,4 (p<0,005), respectivamente. El PASI mejoró globalmente tras 12 semanas de tratamiento. En un principio el PASI basal mostraba 33,30±10,71, y tras el tratamiento se registró 15,20±13,28, p<0,008. Nueve de los diez pacientes mejoraron y una paciente se mantuvo sin mejoría. No hubo diferencias significativas en las poblaciones linfocitarias sanguíneas antes y después del tratamiento.

Conclusiones

Etanercept es un fármaco que mejora clínicamente la psoriasis y disminuye la infiltración inflamatoria de las lesiones sin afectar a las poblaciones linfocitarias sanguíneas.

Palabras clave:
psoriasis
linfocitos
tratamiento
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Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
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