Abstract
Psoriasis is strongly associated with streptococcal throat infection, and patients have increased occurrence of such infections. Psoriatic lesional T cells are oligoclonal, and T cells recognizing determinants common to streptococcal M-protein and keratin have been detected in patients' blood. We propose that CD8(+) T cells in psoriatic epidermis respond mainly to such determinants, whereas CD4(+) T cells in the dermis preferentially recognize determinants on the streptococcal peptidoglycan that might itself act as an adjuvant. The streptococcal association might reflect the concurrence of superantigen production promoting skin-homing of tonsil T cells, M-protein mimicking keratin determinants, and adjuvant effects of the peptidoglycan. Accordingly, improvement of psoriasis after tonsillectomy should be associated with fewer T cells that recognize keratin and streptococcal determinants.
Publication types
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
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Antigens, Bacterial / blood
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Antigens, Bacterial / immunology
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Antigens, Bacterial / metabolism
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Autoimmune Diseases / blood
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Autoimmune Diseases / immunology*
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Autoimmune Diseases / microbiology
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Bacterial Outer Membrane Proteins / blood
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Bacterial Outer Membrane Proteins / immunology
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Bacterial Outer Membrane Proteins / metabolism
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CD4-Positive T-Lymphocytes / immunology
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CD4-Positive T-Lymphocytes / metabolism
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CD8-Positive T-Lymphocytes / immunology
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CD8-Positive T-Lymphocytes / metabolism
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Carrier Proteins / blood
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Carrier Proteins / immunology
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Carrier Proteins / metabolism
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Dermis / immunology
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Epidermis / immunology
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Humans
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Keratins / immunology
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Molecular Mimicry*
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Palatine Tonsil / immunology
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Peptidoglycan / immunology
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Peptidoglycan / metabolism
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Psoriasis / blood
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Psoriasis / immunology*
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Psoriasis / microbiology
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Streptococcal Infections / complications*
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Streptococcal Infections / immunology
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Streptococcus / chemistry
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Streptococcus / immunology*
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Superantigens / immunology
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Tonsillitis / complications*
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Tonsillitis / immunology
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Tonsillitis / microbiology
Substances
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Antigens, Bacterial
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Bacterial Outer Membrane Proteins
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Carrier Proteins
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Peptidoglycan
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Superantigens
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streptococcal M protein
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Keratins