Experimental studies on topoisomerase inhibitor camptothecin as an antipsoriatic agent.

OBJECTIVES: To elucidate the therapeutic mechanism of topical camptothecin (CPT) in treating psoriasis and to detect the effects of CPT on keratinocyte proliferation, differentiation and apoptosis. METHODS: Mitotic numbers in mouse vaginal epithelium at estrus and numbers of scale with granular layer per 100 scales in mouse tail epidermis were determined in vivo. Experiments on cultured normal human keratinocytes were performed using the methods of crystal violet staining, absorbance-cell number converting, cell counting and quantitation of morphologic changes during differentiation, transglutaminase assay and nucleosomal enrichment assay. RESULTS: Inhibition of cell proliferation and promotion of cell differentiation by camptothecin were showed in animal models and were reconfirmed in cultured keratinocytes. Apoptosis was induced by camptothecin and was showed by activation of "tissue" transglutaminase and increase in nucleosomes. The endonuclease activity was reduced by an endonuclease inhibitor aurintricarboxylic acid. CONCLUSION: The therapeutic effects of camptothecin on psoriasis can at least partly be explained by its multiple effects on DNA as a topoisomerase inhibitor.

Camptothecin induces differentiation, tissue transglutaminase and apoptosis in cultured keratinocytes.

Cultured normal human adult keratinocytes were exposed to (S)-(+)- camptothecin over the concentration range 10(-5) to 10(-10) M. The dose-dependent inhibition of growth was recorded using cell counting. The induction of terminal differentiation was demonstrated by the relative increase in squamous and cornified cells, and the concomitant decrease in small, proliferative cells, with an overall decrease in total cell numbers on going from 10(-10) to 10(-6) M concentration of the drug. The induction of apoptosis was studied by assay of two types of transglutaminase, "tissue" and "keratinocyte", and by assay of histone-linked mono- and oligonucleosomes. Induction of apoptosis was accompanied with increase in "tissue" transglutaminase and in the amount of nucleosomes, the latter being indicative of endonuclease activity. This activity was sharply increased at a camptothecin concentration of 10(-5) M, and may have been facilitated by "tissue" transglutaminase at lower concentrations. The data suggest that camptothecin restricts keratinocyte growth by several mechanisms including apoptosis and emphasize its possible use in topical therapy for psoriasis.

Persistence of T-cell clones in psoriatic lesions.

BACKGROUND: We previously demonstrated a clonal dominance in the V beta 13.1 messages isolated from the lesional CD8+ T cells of psoriasis vulgaris, which suggested an interaction of V beta 13.1+ CD8+ T cells with skin antigens. OBJECTIVES: To determine whether the clonality observed accurately reflected a clonal population of infiltrating T cells or was skewed by an overabundance of messages from a small number of cells, and to extend our study of V beta gene usage by lesional CD8+ T cells to 9 new patients. DESIGN: Case study. SETTING: Patients were enrolled at the Psoriasis Research Institute in Palo Alto, Calif, and samples were analyzed at The Immune Response Corporation in Carlsbad, Calif. MAIN OUTCOME MEASURES: For the 2 previous patients, skin samples were sorted directly for V beta 13.1+ T cells, for which the T-cell receptors were sequenced. For the 9 new patients, CD8+ T cells were sorted and their T-cell receptor V beta gene usage measured using semiquantitative polymerase chain reaction with V beta-specific primers. RESULTS: The directly sorted V beta 13.1+ T cells exhibited clonal dominance in both patients. The dominant V beta 13.1 clone in each patient was the same as that found in the previous 2 biopsy specimens for which CD8+ T cells were sorted. Additionally, in 8 of the 9 new patients examined, we again found a preferential usage of V beta 3 and/or V beta 13.1 genes by the lesional CD8+ T cells. CONCLUSIONS: The clonality, which was found in the V beta messages of the sorted CD8+ T cells, accurately reflects the dominance of these clones in the infiltrating T cells. Moreover, the persistence in the same patient of the same clone for as long as 15 months and the overrepresentation of V beta 3 and/or V beta 13.1 in lesional CD8+ T cells in the new patients examined support the pathogenic role of T cells bearing these V betas.

CD8+ T-cells in psoriatic lesions preferentially use T-cell receptors V beta 3 and/or V beta 13.1 genes.

Restricted T-cell receptor V beta gene use in animal models of autoimmune disease has led to the development of strategies to treat autoimmune disease by targeting the T-cell receptors of the pathogenic T-cells. Restricted T-cell receptor gene use has been noted in human autoimmune diseases such as rheumatoid arthritis and multiple sclerosis. We report here the finding of restricted T-cell receptor gene use in psoriasis vulgaris, as well. Our results show an elevated skin (over PBL) expression of V beta 3 and/or V beta 13.1 messages in the CD8+ T-cells in a majority of patients studied. CDR3 sequence analysis on these two V beta s from the skin demonstrated monoclonality or marked oligoclonality. A second biopsy performed 3.5 to 8 months later in four patients, at the same or different lesions, again revealed an elevated V beta 3 and/or V beta 13.1 expression and clonality. Moreover, in three of the four patients, the same TcR V beta CDR3 rearrangement was found in both biopsies, although there was no V beta CDR3 homology noted between patients. In two patients in which V beta 3 and/or V beta 13.1 was not elevated in the CD8+ T-cell population, an increase in V beta 17 gene use and clonality was found. The persistence of V beta 3- and/or V beta 13.1-bearing CD8+ T-cells in lesions that did not undergo resolution suggests their role as effector cells rather than as regulatory cells. The effector function of these CD8+ T-cells is further supported by the clonality of TcR V beta sequence data, which indicates they are recruited and expanded in situ. The V beta s identified in this study are candidate targets for selective immunotherapeutic intervention in psoriasis.

Clinical testing of new drugs for lesional skin diseases such as psoriasis A new delivery system.

BACKGROUND/AIMS: Efficacy evaluation of new antipsoriatic drugs is difficult in the absence of good animal models. In the experimental treatment of psoriasis plaques, the administered dose of new drugs has to be kept at a minimum for safety reasons. The object is to introduce an extracorporeal system for experimental drug application based on the Alzet osmotic pump. METHODS: The system consists of four Alzet pumps from which the drug is delivered intradermally to lesional skin via a 21-gauge needle. Infusion may be continued for up to 2 weeks. Infusion sites are evaluated clinically by the scoring of scaling, erythema and thickness. Evaluation is also based on scoring of the cardinal microscopic features of psoriasis on a 0 to 19 weighted scale. RESULTS/CONCLUSION: The delivery system was screened using a number of drugs and found useful. The system is cheap and easy to operate.

Nerve growth factor increases the mitogenicity of certain growth factors for cultured human keratinocytes: a comparison with epidermal growth factor.

Newborn foreskin and adult skin keratinocytes (KTs) were cultured in 24-well plates using keratinocyte basal medium (KBM) either alone or supplemented with epidermal growth factor (EGF) or nerve growth factor (NGF), plus one of the following: insulin (INS), insulin-like growth factors (IGF)-1 or -2, transforming growth factor alpha (TGF alpha), basic fibroblast growth factor (bFGF). Culture was maintained until one group of cells reached about 30,000 cells/well, when cells were stained with crystal violet and the extracted dye used to quantify cell numbers. In some cases, cells were subjected to the hexosaminidase assay for enumeration. In KBM alone, EGF, IGF-1, IGF-2 and TGF alpha were mitogenic to newborn KTs. In addition, NGF increased the growth of adult KTs, possibly by mechanisms involving synergy with autocrine growth factors. EGF augmented the growth of newborn cells in the presence of each of the growth factors except TGF alpha, but adult cells exhibited only additive effects. In the presence of IGF-1 or IGF-2, NGF stimulated the growth of both newborn and adult cells by as much as 150% above purely additive increases in cell numbers. NGF amplifies the effects of most neurotrophic factors that are also KT mitogens and may therefore be significant in psoriatic lesions, where many of these factors are overexpressed, and in wound healing, in promoting KT growth.

CD8+ T cells in psoriatic lesions preferentially use T-cell receptor V beta 3 and/or V beta 13.1 genes.

Psoriasis is an inflammatory skin disorder characterized by epidermal keratinocyte hyperproliferation in association with a cellular infiltrate. There is evidence that activated T cells play a role in psoriatic plaque formation. We examined the T-cell receptor beta-chain variable gene segment (V beta) use of epidermal T cells in shave biopsies of psoriatic lesions. Our results show increased expression of V beta 3 and/or V beta 13.1 messages in the CD8+, but not CD4+, T cells in the lesions of a majority of patients studied. Sequence analysis of complementarity-determining region 3 (CDR3) of these two V beta genes from the skin demonstrated monoclonality or marked oligoclonality. A second biopsy from the same or different lesions, performed 3.5-8 months later in four patients, again revealed increased V beta 3 and/or V beta 13.1 expression and clonality. Moreover, in three of the four patients, the same V beta CDR3 rearrangement was found in both biopsies, although there was no V beta CDR3 homology between patients. In two patients in which V beta 3 and/or V beta 13.1 was not increased, an increase in V beta 17 gene use and clonality was found. The clonality of V beta sequence data indicates these cells are recruited and expanded in situ. The persistence of V beta 3-and/or V beta 13.1-bearing CD8+ T cells in lesions that did not undergo resolution suggests their role as effector cells rather than as regulatory cells.

Neuropeptides modulate leukotriene B4 mitogenicity toward cultured human keratinocytes.

Neuropeptides released in skin from nerve fibers may interact with endogenous growth factors (or other mitogenic agents) to induce psoriasis lesions characterized by proliferating epidermal keratinocytes. The mitogenic effects of two neuropeptides, substance P (SP) and vasoactive intestinal peptide (VIP), on human adult and newborn keratinocytes were observed in the presence or absence of leukotriene B4 (LTB4) and leukotriene C4 (LTC4). In the presence of SP or VIP, LTB4 (but not LTC4) demonstrated substantial increase in thymidine incorporation into DNA, which was confirmed by cell-growth observations using the hexosaminidase assay. In the absence of either neuropeptide, LTB4 had only marginal effects, especially with adult (but not newborn) keratinocytes. With adult keratinocytes, LTB4 (but not LTC4) demonstrated synergy with both SP and VIP. VIP was mitogenic to keratinocytes at concentrations as low as 10(-12)M and exhibited a different dose-response curve depending on whether adult or newborn keratinocytes were used. The mitogenic effects of SP were abrogated by the SP antagonist spantide and those of VIP by the VIP antagonist [Ac-Tyr1, D-Phe2] growth-hormone-releasing factor (1-29) amide. This study suggests that the mitogenic effects of LTB4, which are elevated in psoriatic lesions, may be enhanced by the presence of neuropeptides, especially VIP. These effects can be reversed by antagonists that may have potential as drugs for the disease.

Peptide T improves psoriasis when infused into lesions in nanogram amounts.

In each of 14 patients, two small but comparable psoriatic lesions were infused for 2 weeks with either saline or a saline solution of peptide T (as its analog D-ala1-peptide T amide) at 10(-7) mol/L with Alzet osmotic pumps worn extracorporeally. During infusion, lesions were photographed and scored for clinical features of psoriasis on a 9-point scale. After another 7 days, biopsy specimens were taken from the infused sites, and sections were scored for features of psoriasis on a 19-point scale. The differences between means for data from saline- and peptide T-infused lesions were evaluated statistically. Peptide T-infused lesions improved clinically; scores decreased from a mean of 4.35 initially to 1.57 at biopsy, whereas control lesions changed from 4.43 to 3.57 (p less than 0.01 for 1.57 vs 3.57). Histologic scores were also significantly different (5.28 for peptide T vs 10.00 for controls, 0.05 greater than p greater than 0.02). This study provides evidence that intralesionally infused peptide T demonstrates some clearing effect in psoriasis.

Do dietary supplements of fish oils improve psoriasis?

In theory, a number of skin and systemic diseases with an inflammatory component should be improved by dietary intake of certain polyunsaturated fatty acids, usually of marine origin. The most significant is eicosapentaenoic acid, which may substitute for arachidonic acid in tissue. Inflammation mediators derived from the former compound are much less active biologically, and also can inhibit the chemotactic behavior of leukotrienes derived from arachidonic acid. A number of studies have appeared describing the effects of such dietary manipulation in patients with psoriasis. Some reports credit fish oil ingestion with moderate improvement of the disease, but problems in the design of these studies have led to criticism of the results.

Effects of nordihydroguaiaretic acid, phloretin, and phloridzin on the activity of adenylate cyclase, lipoxygenase and hexose transport, and growth of cultured keratinocytes.

Compounds related to the flavonoid group of natural products may have potential as antipsoriatic drugs. The dihydrochalcone phloretin, its glycoside derivative phloridzin, and the structurally related compound nordihydroguaiaretic acid (NDGA) were selected for study. Phloretin and NDGA strongly inhibited keratinocyte growth but had no effect on isoproterenol-stimulated adenylate cyclase; phloridzin had no effect on growth but potentiated the response of the enzyme. None had any effect on phosphodiesterase. Neither phloretin or phoridzin inhibited lipoxygenase or, surprisingly, decreased deoxyglucose transport. Phloretin and NDGA should be considered antipsoriatic agents.

Topical minoxidil therapy for androgenetic alopecia. A 30-month study.

Seventy-two adult male patients were entered into a double-blind, placebo-controlled investigation using 2% to 3% topical minoxidil solution for androgenetic alopecia. Fifty-nine patients completed the initial 12 months, and continued to use 3% topical minoxidil solution in an open study design. Hair regrowth (as measured by hair counts and bald-area diameters) was noted in all treatment groups at four months, and appeared to peak at approximately 12 months. At 30 months, mean hair counts had decreased from the 12-months level, but remained elevated over baseline counts, while mean bald-area diameters returned to baseline. However, 70% of the patients who did continue to use the drug for 30 months had 50% or more hairs than when they originally started the drug therapy. A subset of patients appeared to sustain a continued increase in hair counts after 12 months. No systemic side effects were noted.

L-serine potentiates the mitogenic effects of growth factors on cultured human keratinocytes.

L-Serine increased the growth of passaged human foreskin keratinocytes in terms of DNA and protein per dish of cells, and potentiated the mitogenic effects of serum and epidermal growth factor, and also insulin, keratinocyte growth factor, and a bovine pituitary extract. The effects of serine were apparent with as little as 0.05 mM. The stimulatory effects of these various growth factors were additive, without synergism. Exposure to L-[3H]serine resulted in labeling of the phospholipids phosphatidyl (Ptd) serine, Ptd ethanolamine, sphingomyelin, and, to a slight extent, Ptd choline. The time course of labeling suggested synthesis of Ptd serine was initiated; Ptd serine was converted to Ptd ethanolamine; little methylation of Ptd ethanolamine to form Ptd choline took place. Separation of nonradioactive phospholipids and phosphorus assay of individual lipids showed that serine-supplemented cells had only slightly increased content of Ptd serine and Ptd ethanolamine. The significance of these for activation of protein kinase C is discussed.

Characterization of alpha- and beta-adrenergic agonist stimulation of adenylate cyclase activity in human epidermal keratinocytes in vitro.

Adrenergic receptors are responsible for selective recognition and binding of catecholamines and may in turn have an effect on epidermal cell growth and maturation via adenosine-3',5'-monophosphate (cAMP). Using endogenous catecholamines and drugs specific for alpha- and beta-receptor subtypes, we have characterized the adrenergic receptor coupled to adenylate cyclase in cultured human epidermal keratinocytes. The relative potency order of stimulation of adenylate cyclase was: isoproterenol greater than epinephrine much greater than norepinephrine. The predominant adrenergic receptor is of the beta 2-subtype, as also confirmed by use of the selective antagonists propranolol, butoxamine, and atenolol. No evidence of alpha-adrenergic receptor mediation of adenylate cyclase was noted with the alpha 2-specific agonist, clonidine. Phenylephrine, the alpha 1-specific agonist, affected cAMP formation but this response could not be totally inhibited with prazosin, suggesting an unknown mechanism of action. Human keratinocytes retained the same beta-adrenergic receptor potency order properties throughout growth and maturation.