Role of CD 20+ T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis

Serena Fragiotta; Giorgio Mangino; Marco Iuliano; Concetta Potenza; Nicoletta Bernardini; Nevena Skroza; Enzo Maria Vingolo; Giovanna Romeo

doi:10.1016/j.cyto.2020.155253

Role of CD 20⁺ T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis

Cytokine. 2020 Dec:136:155253. doi: 10.1016/j.cyto.2020.155253. Epub 2020 Aug 25.

Authors

Serena Fragiotta¹, Giorgio Mangino², Marco Iuliano³, Concetta Potenza⁴, Nicoletta Bernardini⁵, Nevena Skroza⁴, Enzo Maria Vingolo¹, Giovanna Romeo⁶

Affiliations

¹ Department of Medico-Surgical Sciences and Biotechnologies, U.O.S.D. Ophthalmology, Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy.
² Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Center for Biophotonics, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy.
³ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy.
⁴ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy.
⁵ Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, A. Fiorini Hospital, Via Firenze 1, 04019 Terracina, Italy.
⁶ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Center for Biophotonics, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy. Electronic address: giovanna.romeo@uniroma1.it.

PMID: 32858439
DOI: 10.1016/j.cyto.2020.155253

Abstract

Objective: To assess the role of CD3⁺ CD20⁺ CD4^- CD8^- double-negative (DN) or CD3⁺CD20⁺ CD4/CD8⁺ T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis.

Design: A total of 76 patients (57.6 ± 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1α, IL1β, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFNγ, TNF-α, GMCSF.

Results: The CD3⁺CD4⁺/CD8⁺CD20⁺CD56^- T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler's layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3⁺CD4⁺/CD8⁺CD20⁺CD56^- T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller's layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13).

Conclusion: Our findings demonstrated that CD20⁺ T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.

Keywords: CD20+ T cells; Choroid; Ocular complications; Psoriasis; Retinal vessels.

Publication types

Clinical Trial

MeSH terms

Adult
Aged
Aged, 80 and over
Antigens, CD20 / immunology*
CD4-Positive T-Lymphocytes / immunology*
CD4-Positive T-Lymphocytes / pathology
CD8-Positive T-Lymphocytes / immunology*
CD8-Positive T-Lymphocytes / pathology
Chronic Disease
Eye Diseases / etiology
Eye Diseases / immunology*
Eye Diseases / pathology
Female
Humans
Male
Middle Aged
Psoriasis / complications
Psoriasis / immunology*
Psoriasis / pathology
Retinal Vessels / immunology*
Retinal Vessels / pathology

Substances

Antigens, CD20