CTLA4Ig-mediated blockade of T-cell costimulation in patients with psoriasis vulgaris
Judith R. Abrams, … , Susan L. Kelley, Sewon Kang
Judith R. Abrams, … , Susan L. Kelley, Sewon Kang
Published May 1, 1999
Citation Information: J Clin Invest. 1999;103(9):1243-1252. https://doi.org/10.1172/JCI5857.
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Article

CTLA4Ig-mediated blockade of T-cell costimulation in patients with psoriasis vulgaris

Abstract

Engagement of the B7 family of molecules on antigen-presenting cells with their T cell–associated ligands, CD28 and CD152 (cytotoxic T lymphocyte–associated antigen-4 [CTLA-4]), provides a pivotal costimulatory signal in T-cell activation. We investigated the role of the CD28/CD152 pathway in psoriasis in a 26-week, phase I, open-label dose-escalation study. The importance of this pathway in the generation of humoral immune responses to T cell–dependent neoantigens, bacteriophage φX174 and keyhole limpet hemocyanin, was also evaluated. Forty-three patients with stable psoriasis vulgaris received 4 infusions of the soluble chimeric protein CTLA4Ig (BMS-188667). Forty-six percent of all study patients achieved a 50% or greater sustained improvement in clinical disease activity, with progressively greater effects observed in the highest-dosing cohorts. Improvement in these patients was associated with quantitative reduction in epidermal hyperplasia, which correlated with quantitative reduction in skin-infiltrating T cells. No markedly increased rate of intralesional T-cell apoptosis was identified, suggesting that the decreased number of lesional T cells was probably likely attributable to an inhibition of T-cell proliferation, T-cell recruitment, and/or apoptosis of antigen-specific T cells at extralesional sites. Altered antibody responses to T cell–dependent neoantigens were observed, but immunologic tolerance to these antigens was not demonstrated. This study illustrates the importance of the CD28/CD152 pathway in the pathogenesis of psoriasis and suggests a potential therapeutic use for this novel immunomodulatory approach in an array of T cell–mediated diseases.

Authors

Judith R. Abrams, Mark G. Lebwohl, Cynthia A. Guzzo, Brian V. Jegasothy, Michael T. Goldfarb, Bernard S. Goffe, Alan Menter, Nicholas J. Lowe, Gerald Krueger, Michael J. Brown, Russell S. Weiner, Martin J. Birkhofer, Garvin L. Warner, Karen K. Berry, Peter S. Linsley, James G. Krueger, Hans D. Ochs, Susan L. Kelley, Sewon Kang

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Figure 4

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Quantitative histologic parameters measured in the 6 patients accrued to...
Quantitative histologic parameters measured in the 6 patients accrued to the CTLA4Ig 25 mg/kg dose group. In a and b, the number of epidermal CD3+ (T) cells and the number of Ki67+ (proliferating) keratinocytes per linear millimeter of surface are depicted over the period of observation. In c, the change in epidermal thickness over the first 78 days of the study period is shown. Epidermal thickness was calculated by quantitating the cross-sectional epidermal surface area beneath a 1-mm linear region of a representative histologic section using computer-assisted image analysis. Individual data points are an average derived from triplicate analyses. The mean percent changes at day 78 compared with day 1 in a–c were 82% (P < 0.001), 82% (P = 0.004), and 51% (P = 0.01), respectively. P values were based on a two-sided t test for no change at day 78 compared with day 1.