Ann Dermatol.  2014 Apr;26(2):203-208. 10.5021/ad.2014.26.2.203.

Immunohistochemical Analysis of Interleukin-17 Producing T Helper Cells and Regulatory T Cells Infiltration in Annular Erythema Associated with Sjogren's Syndrome

• Itoi S
• Tanemura A
• Tani M
• Kitaba S
• Terao M
• Murota H
• Oiso N
• Katayama I

• KMID: 2171656
• DOI: http://doi.org/10.5021/ad.2014.26.2.203

Abstract

BACKGROUND
Peculiar erythema known as annular erythema associated with Sjogren's syndrome (AESS) can be differentiated from autoimmune annular erythema and subacute cutaneous lupus erythematosus, both clinically and histologically. However, there are no detailed investigations on immune competent cells infiltration.
OBJECTIVE
Preferential infiltration of interleukin-17-producing T helper (Th17) cells and regulatory T (Treg) cells into the labial salivary gland is reported to play a role in maintaining mucoepithelitis in patients with Sjogren's syndrome. In this study, we evaluated Th17 and Treg cell infiltration into the lesional skin of AESS.
METHODS
We analyzed the numbers and infiltration patterns of Th17 and FoxP3 (+) Treg cells in seven cases of AESS using immunohistochemistry. Seven patients with systemic lupus erythematosus (SLE), atopic dermatitis (AD) and psoriasis vulgaris (PV), which are representatives of Th17 cell-involved skin disorders, were enrolled as disease controls.
RESULTS
Periappendageal and epidermal changes, such as follicular plugging and liquefaction, were evident in the annular erythema of SLE, not AESS, tissue samples. In AESS tissue samples, dense perivascular and periappendageal infiltration of lymph cells was observed in the middle-to-deep dermis, as previously described, in contrast to the superficial infiltration pattern observed in both AD and PV samples. While the total number of infiltrated lymphocytes was similar between AESS and SLE tissue samples, Th17 cells were found to be preferentially infiltrated in the middle-to-deep dermis in AESS samples.
CONCLUSION
These results suggest that an increased number and distribution of infiltration of Th17 cells is a preferential feature of AESS, rather than a characteristic feature of annular erythema of SLE.

Keyword

Annular erythema; Regulatory T cells; Sjogren's syndrome; Systemic lupus erythematosus; Th17 cells

MeSH Terms

Dermatitis, Atopic
Dermis
Erythema*
Humans
Immunohistochemistry
Interleukin-17*
Lupus Erythematosus, Cutaneous
Lupus Erythematosus, Systemic
Lymphocytes
Psoriasis
Salivary Glands
Sjogren's Syndrome*
Skin
T-Lymphocytes, Helper-Inducer*
T-Lymphocytes, Regulatory*
Th17 Cells
Interleukin-17

Figure

• 

  Fig. 1 Clinical and histopathological features of AESS, SLE, PV and AD patients. Histopathology at low magnification (immunohistochemical stain, ×20) is placed on the 2nd column and that at high magnification (immunohistochemical stain, ×100) is placed on the 3rd and 4th columns. The bar indicates 50 µm. AESS: annular erythema associated with Sjögren's syndrome, SLE: systemic lupus erythematosus, PV: psoriasis vulgaris, AD: atopic dermatitis.

• 

  Fig. 2 Total numbers of CD3 (+) T-cells, Th17 cells and FoxP3 (+) T-cells in the upper dermis (A) and middle-to-deep dermis (B) of the AESS, SLE, PV, and AD tissue samples. Increased numbers of Th17 cells and FoxP3 (+) Treg cells in the middle-to-deep dermis were observed in the AESS and SLE samples compared to that seen in the PV and AD samples. The bars indicate the mean±standard deviation. p-values of <0.05 and <0.01 are represented by * and **, respectively. HPF: high power field, AESS: annular erythema associated with Sjögren's syndrome, SLE: systemic lupus erythematosus, PV: psoriasis vulgaris, AD: atopic dermatitis.

• 

  Fig. 3 Infiltration patterns of CD3 (+) T-cells, Th17 cells and FoxP3 (+) T-cells in the AESS, SLE, PV and AD samples. The percentages of the cells were similar in the superficial (A) and middle-to-deep dermis (B) of the AESS and SLE samples. The bars indicate the mean±standard deviation. p-values of <0.05 and <0.01 are represented by * and **, respectively. AESS: annular erythema associated with Sjögren's syndrome, SLE: systemic lupus erythematosus, PV: psoriasis vulgaris, AD: atopic dermatitis, IL: interleukin.

• 

  Fig. 4 Infiltration of Th17 cells (red color) into the salivary gland in patient with Sjögren's syndrome (×200).

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