Activated keratinocytes present bacterial-derived superantigens to T lymphocytes: relevance to psoriasis

In the past, epidermal keratinocytes were felt to be primarily concerned with the barrier function of skin. During inflammatory and immune-mediated skin diseases, keratinocytes were only portrayed as being passive/inert targets for noxious agents produced by infiltrating leukocytes. This innocent bystander and/or 'brick and mortar' conceptualization of the keratinocyte must now be significantly modified to take into account the growing body of experimental in vitro and in vivo results that substantiate re-classification of keratinocytes as fully fledged members of the immune system (i.e. immunocytes). Because keratinocytes produce important primary cytokines, adhesion molecules, and mononuclear cell chemotactic factors; as well as functioning as accessory cells for resting T lymphocytes, they can initiate and perpetuate the inflammatory and immunological reactions in the skin which contribute to the pathobiology of psoriasis. This review will emphasize the dynamic contribution that epidermal keratinocytes make to cutaneous immunohomeostasis, with particular focus on the potential role of bacterial derived superantigens and their ability to stimulate resting T cell proliferation when presented by cytokine-activated keratinocytes.