Patients with psoriasis and psoriatic arthritis respond well to tumor necrosis factor α (TNFα) blockers in general; however, there is now mounting evidence that a small cohort of patients with rheumatoid arthritis who receive TNFα blockers develop psoriasis. This study was undertaken to explore the mechanisms underlying TNFα blockade–induced exacerbation of skin inflammation in murine psoriasis-like skin disease.
Skin inflammation was induced in BALB/c scid/scid mice after they received CD4+CD45RBhighCD25− (naive CD4) T cells from donor mice. These mice were treated with either anti–interleukin-12 (anti–IL-12)/23p40 antibody or murine TNFRII-Fc fusion protein and were examined for signs of disease, including histologic features, various cytokine levels in the serum, and cytokine or FoxP3 transcripts in the affected skin and draining lymph node (LN) cells. In a separate study, naive CD4+ T cells were differentiated into Th1 or Th17 lineages with anti-CD3/28 magnetic beads and appropriate cytokines in the presence or absence of TNFα. Cytokine gene expression from these differentiated cells was also determined.
Neutralization of TNFα exacerbated skin inflammation and markedly enhanced the expression of the proinflammatory cytokines IL-1β, IL-6, IL-17, IL-21, and IL-22 but suppressed FoxP3 expression in the skin and reduced the number of FoxP3-positive Treg cells in the draining LNs. TNFα also demonstrated a divergent role during priming and reactivation of naive T cells.
These results reveal a novel immunoregulatory role of TNFα on Th17 and Treg cells in some individuals, which may account for the exacerbation of skin inflammation in some patients who receive anti-TNF treatments.