RESUMEN
The distinction between Sézary syndrome (SS) and benign erythrodermic inflammatory diseases (EID) is difficult to make both clinically and on skin biopsies, since histomorphology can provide nonspecific results. New markers of circulating malignant Sézary cells have been recently described, especially CD158k/KIR3DL2 and T-plastin, but it has not been yet determined whether they could help in the diagnosis of erythroderma in skin samples. In this study, 13 frozen skin specimens from 10 SS patients and 26 from EID were analyzed for CD158k/KIR3DL2 expression using immunohistochemistry with AZ158 mAb, which also recognizes the monomeric CD158e/KIR3DL1 receptor. Although positive in all SS samples, immunohistochemistry appeared to not reliably discriminate between SS and EID. Therefore in all samples disclosing a significant staining with AZ158 mAb, CD158k/KIR3DL2, CD158e/KIR3DL1 and T-plastin mRNA expression were analyzed on the same skin specimen using conventional and/or quantitative real-time reverse transcription (RT)-PCR. Interestingly, only CD158k/KIR3DL2 transcripts were found to be significantly overexpressed in skin biopsies from patients with SS (P<0.0001), including when normalization to CD3 expression was achieved (P=0.0003). In light of these findings, CD158k/KIR3DL2 transcripts appear to be a unique molecular marker of SS in skin samples, allowing differential diagnosis with benign EID in routine practice.
Asunto(s)
Biomarcadores de Tumor/genética , Dermatitis Exfoliativa/diagnóstico , Receptores KIR2DL2/genética , Síndrome de Sézary/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Empalme Alternativo , Anticuerpos Monoclonales , Biopsia , Criopreservación , Dermatitis Exfoliativa/patología , Dermatitis Exfoliativa/fisiopatología , Diagnóstico Diferencial , Femenino , Humanos , Inmunohistoquímica , Masculino , Glicoproteínas de Membrana , Proteínas de Microfilamentos , Persona de Mediana Edad , Fosfoproteínas/genética , ARN Mensajero/metabolismo , Receptores KIR2DL2/metabolismo , Síndrome de Sézary/patología , Síndrome de Sézary/fisiopatología , Piel/patología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/fisiopatologíaRESUMEN
The interpretation of cellular infiltrate from renal transplant recipients with borderline (BL) changes is still a challenging problem. To analyze the immune phenotype of such infiltrate, we quantified the mRNA expression of Foxp3 and interleukinL-10 and granzyme B (GB) in 15 kidney biopsies with BL changes. Controls were patients presenting type IA acute rejection and nonrejecting patients. Only levels of GB mRNA correlated significantly with response to antirejection therapy. Levels of Foxp3 mRNA in BL changes were intermediate between type IA acute rejection and nonrejecting controls. To determine the balance of alloagressive to graft-protecting T cells, we quantified the Foxp3/GB ratio. BL changes T cells infiltrate expressed a significantly higher Foxp3/GB ratio than that in IA acute rejection. These results suggest that T cell infiltrate from BL change exhibit a tolerogenic rather than a cytotoxic phenotype.
