Peripheral blood mononuclear cell proliferative response against staphylococcal superantigens in patients with...

It has been recently hypothesized that superantigens play a precipitating or aggravating role in psoriasis. Aside from streptococcal infection, Staphylococcus aureus can be sometimes detected in the tonsils of patients with psoriasis arthropathy (PA), although its significance in the pathogenesis of PA is still unknown. These focal infections are thought to be a possible triggering factor of the arthralgia, as well as the cutaneous manifestations, in PA. In this study, we have investigated the response of peripheral blood mononuclear cells (PBMC) from patients with PA to staphylococcal superantigens and analyzed its association with clinical and laboratory findings. 3H-TdR uptake by PBMC was examined after 7 days' culture with concanavalin A (Con A), staphylococcal enterotoxin A (SEA), SEB and SEC1. Results showed that there was no significant difference in either the unstimulated or Con A-stimulated PBMC response between psoriasis vulgaris patients (PASI score < 10) (n = 15), PA patients (n = 11) and normal controls (n = 19). Among 11 PA patients, 8 patients responded most intensely to SEB, while 2 patients showed the strongest response to SEA, and another responded mainly to SEC1. The PBMC response against SEB in patients with PA (38,715 719 dpm, stimulation index (SI); 50.2 41.4) (mean SD) was significantly higher than that in normal controls (23,708 466 dpm, SI; 30.9 23.8) (p < 0.05), however, the difference between that of patients with PA and psoriasis vulgaris (33,428 467 dpm, SI; 42.8 30.6) did not reach significance. In addition, PBMC from psoriatic patients with a short episode of severe, disabling lumbago, which occured following sudden onset throat soreness, showed a stronger response against SEB (SI; 73.7 39.7), as compared with that of PA patients without such an episode (SI; 42.6 18.1). However this difference did not reach significance. Several immune abnormalities, including positive antinuclear antibodies or rheumatoid factor were observed mainly in the group experiencing such an episode of severe lumbago. Reverse transcriptase-polymerase chain reaction (RT-PCR) demonstrated that predominant expression of the T cell receptor (TCR) Vbeta 17 was commonly detected in both synovial tissues and paired peripheral bloods in two cases examined. In one case, Vbeta 12 was preferentially expressed, and in another case, Vbeta 10, 15 and 19 were also strongly expressed in the infiltrating lymphocytes in the synovial tissues. Our data raised the possibility that staphylococcal superantigens may also play an exacerbating role in PA.