Background: Activation of T cells is believed to play a critical role in the pathogenesis of psoriasis. Recently, it has been proposed that psoriasis is a T-cell-mediated autoimmune reaction triggered by bacterial superantigen. Objective: We investigated whether patients with chronic plaque psoriasis bear superantigen-producing Staphylococcus aureus on the skin or the throat. Methods:S. aureus producing exfoliative toxin, staphylococcal enterotoxin B or toxic shock syndrome toxin 1 was isolated from the skin and throat of 100 psoriasis patients using Western blot analysis and polymerase chain reaction. Results: Only 5, 4 and 9 patients had super-antigen producing S. aureus identified on lesional skin, nonlesional skin and throat, respectively. The vast majority of patients did not bear superantigen-producing S. aureus.Conclusion: We believe that superantigens are not essential in sustaining disease activity but may, instead, be exacerbating or triggering factors for some psoriasis patients.

1.
Valdimarsson H, Baker BS, Jonsddottir I, Powles A, Fry L: Psoriasis: A T-cell-mediated autoimmune disease induced by Staphylococcus superantigen? Immunol Today 1995;16: 145–149.
2.
Prinz JC, Grob B, Vollmer S, Trommler P, Strobel I, Meurer M, Plewig G: T cell clones from psoriasis skin lesions can promote keratinocyte proliferation in vivo via secreted products. Eur J Immunol 1994;24:593–598.
3.
Prinz J, Braun-Falco O, Meurer M, Daddona P, Reiter C, Rieber P, Riethmuller G: Chimeric CD4 monoclonal antibody in treatment of generalized pustular psoriasis. Lancet 1991;338: 320–321.
4.
Nicolas JF, Chamchick N, Thivolet J, Windenes J, Morel P, Revillard JP: CD4 antibody treatment of severe psoriasis. Lancet 1991; 338:321.
5.
Ellis CN, Gorsulowsky DC, Hamilton TA, Billings J, Brown M, Headington K, Cooper K, Baadsgaard O, Duell E, Annesley T: Cyclosporin improves psoriasis in a double-blind study. JAMA 1986;256:3110–3116.
6.
Kotzin B, Leung D, Kappler J, Marrack P: Superantigens and their potential role in human diseases. Adv Immunol 1993;54:99–165.
7.
Tokura Y, Yagi J, O’Malley M, Lewis JM, Takigawa M, Edelson RL, Tigelaar E: Superantigenic staphylococcal exotoxins induce T-cell proliferation in the presence of Langerhans cells or class II-bearing keratinocytes and stimulate keratinocytes to produce T-cell-activating cytokines. J Invest Dermatol 1994;102: 31–38.
8.
Leung DYM, Walsh P, Giorno R, Norris DA: A potential role for superantigens in the pathogenesis of psoriasis. J Invest Dermatol 1993; 100:225–228.
9.
Leung DYM, Travers JB, Norris DA: The role of superantigens in skin disease. J Invest Dermatol 1995;105:37S–42S.
10.
Whyte JJ, Baughman PD: Acute guttate psoriasis and streptococcal infection. Arch Dermatol 1964;89:350–356.
11.
Marples RR, Heaton CL, Kligman AM: Staphylococcus aureus in psoriasis. Arch Dermatol 1973;107:568–570.
12.
Lewis HM, Baker BS, Bokth S, Powles AV, Garioch JJ, Valdimarsson H, Fry L: Restricted T-cell receptor Vβ gene usage in the skin of patients with guttate and chronic plaque psoriasis. Br J Dermatol 1993;129:514–520.
13.
Chang JCC, Smith LR, Froning KJ, Schwabe BJ, Laxer JA, Caralli LL, Kurland HH, Karasek MA, Wilkinson DI, Carlo DJ, Brostoff SW: CD8+ T cell in psoriatic lesions preferentially T-cell receptor Vβ3 and/or Vβ13.1 genes. Proc Natl Acad Sci USA 1994;91:9282–9286.
14.
Leung DYM, Travers JB, Giorno R, Norris DA, Skinner R, Aelion J, Kazemi LV, Kim MH, Trumble AE, Kotb M, Schlievert PM: Evidence for streptococcal superantigen-driven process in acute guttate psoriasis. J Clin Invest 1995;96:2106–2112.
15.
Bour H, Demidem A, Garrigue J-L, Krasteva M, Schmitt D, Claudy A, Nicolas J-F: In vitro T cell response to staphylococcal enterotoxin B superantigen in chronic plaque type psoriasis. Acta Derm Venereol (Stockh) 1995; 75:218–221.
16.
Baker BS, Bokth S, Powles A, Garioch JJ, Lewis H, Valdimarsson H, Fry L: Group A streptococcal antigen-specific T lymphocytes in guttate psoriatic lesions. Br J Dermatol 1993;128:493–499.
17.
Yokote R, Tokura Y, Furukawa F, Takigawa M: Susceptible responsiveness to bacterial superantigens in peripheral blood mononuclear cells from patients with psoriasis. Arch Dermatol Res 1995;287:443–447.
18.
Boehncke E-H, Dressel D, Zollner TM, Kaufmann R: Pulling the trigger on psoriasis. Nature 1996;376:777.
19.
Sugai M, Inoue S, Hino T, Kuwabara M, Hong Y-M, Miyake Y, Suginaka H: Purification of staphylococcal exfoliative toxin by high pressure liquid chromatography. Zentralbl Bakteriol 1990;273:5–11.
20.
Sakurai S, Suzuki H, Machida K: Rapid identification by polymerase chain reaction of staphylococcal exfoliative toxin serotype A and B genes. Microbiol Immunol 1995;39:379–386.
21.
Ignatov KB, Chistyakova LG, Shemchukova OB, Gorodetskaya SB, Kiselev VI: Cloning of the Staphylococcus aureus enterotoxin B gene obtained by the polymerase chain reaction, and its expression in Escherichia coli cells. Bioorganicheskaya Khimiya 1993;19:75–80.
22.
Johnson WM, Tyler SD, Ewan EP, Ashton FE, Pollard DR, Rozee KR: Detection of gene for enterotoxins, exfoliative toxins, and toxic shock syndrome toxin 1 in Staphylococcus aureus by the polymerase chain reaction. J Clin Microbiol 1991;29:426–430.
23.
Boehncke W-H, Dressel D, Manfras B, Zollner TM, Wettstein A, Bohm BO, Sterry W: T-cell receptor repertoire in chronic plaque-stage psoriasis is restricted and lacks enrichment of superantigen-associated Vβ regions. J Invest Dermatol 1995;104:725–728.
24.
Strange P, Skov L, Lisby S, Nielsen PL, Baadsgaard O: Staphylococcal enterotoxin B applied on intact normal and intact atopic skin induces dermatitis. Arch Dermatol 1996;132:27–33.
25.
Saloga J, Leung DYM, Reardon C, Giorno RC, Born W, Gelfand W: Cutaneous exposure to the superantigen staphylococcal enterotoxin B elicits a T-cell-dependent inflammatory response. J Invest Dermatol 1996;106:982–988
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