Journal of Clinical Immunology

, Volume 24, Issue 4, pp 361–369

Systemic Treatment with Either Cyclosporin A or Methotrexate Does Not Influence the T Helper 1/T Helper 2 Balance in Psoriatic Patients

  • Rob J. Rentenaar
  • Vera M. R. Heydendael
  • Frank N. J. Van Diepen
  • Menno A. de Rie
  • Ineke J. M. Ten Berge
Article

DOI: 10.1023/B:JOCI.0000029107.47085.1b

Cite this article as:
Rentenaar, R.J., Heydendael, V.M.R., Diepen, F.N.J.V. et al. J Clin Immunol (2004) 24: 361. doi:10.1023/B:JOCI.0000029107.47085.1b

Abstract

Cyclosporin A and methotrexate are highly effective drugs in the treatment of psoriasis. It was hypothesized that these therapies might modulate T helper cell cytokine secretion patterns or T cell migration patterns. Flow cytometric determination of interferon-gamma (IFNγ) and interleukin 4 (IL4) producing T helper cell frequencies, as well as of cutaneous lymphocyte associated antigen (CLA) expressing T cell frequencies was performed in patients suffering from severe psoriasis, before, during, and after a scheduled immunosuppressive regimen with either cyclosporin A or methotrexate. Both cyclosporin A and methotrexate treatment reduced the psoriasis area severity index score after 12 weeks of treatment. Cyclosporin A treatment reduced the frequencies of IL4-producing CD4pos T cells, without significantly affecting the T helper 1 to T helper 2 (Th1/Th2) balance but in conjunction with the decreasing number of peripheral blood eosinophil counts. In methotrexate-treated patients, the Th1/Th2 balance was unaffected. Cessation of both therapies resulted in increased numbers of IFNγ- as well as IL4-producing CD4pos T cells as compared to before initiation of oral therapy. Methotrexate, but not cyclosporin A, treatment reduced the frequencies of circulating skin-homing CLApos T cells. This effect was reversed by 4 weeks after withdrawal of methotrexate therapy. We conclude that (1) neither cyclosporin A nor methotrexate affects the balance between Th1 and Th2 cells; (2) exaggerated cytokine production by T helper cells after cessation of oral cyclosporin A or methotrexate drug treatment may contribute to the reappearance of psoriatic skin lesions; and (3) decrease of circulating skin-homing T cells may be responsible for part of the therapeutic effect of methotrexate in severe psoriasis.

Cyclosporin A methotrexate T lymphocytes interleukin CLA 

Copyright information

© Plenum Publishing Corporation 2004

Authors and Affiliations

  • Rob J. Rentenaar
    • 1
    • 2
  • Vera M. R. Heydendael
    • 3
  • Frank N. J. Van Diepen
    • 1
  • Menno A. de Rie
    • 3
  • Ineke J. M. Ten Berge
    • 1
    • 2
  1. 1.Laboratory for Experimental ImmunologyAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Renal Transplant Unit, Department of Internal MedicineAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of DermatologyAcademic Medical CenterAmsterdamThe Netherlands

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