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LETTER TO EDITOR  
Year : 2017  |  Volume : 60  |  Issue : 3  |  Page : 447-448
The expression of interleukin-17 in cutaneous lesions of lupus erythematosus in pediatric-onset systemic lupus erythematosus


1 Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
4 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

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Date of Web Publication22-Sep-2017
 

How to cite this article:
Mittal GS, Kumar S, Thomas M, Jeyaseelan V, George R. The expression of interleukin-17 in cutaneous lesions of lupus erythematosus in pediatric-onset systemic lupus erythematosus. Indian J Pathol Microbiol 2017;60:447-8

How to cite this URL:
Mittal GS, Kumar S, Thomas M, Jeyaseelan V, George R. The expression of interleukin-17 in cutaneous lesions of lupus erythematosus in pediatric-onset systemic lupus erythematosus. Indian J Pathol Microbiol [serial online] 2017 [cited 2019 Dec 6];60:447-8. Available from: http://www.ijpmonline.org/text.asp?2017/60/3/447/215395


Editor,

Systemic lupus erythematosus (SLE) is the most common connective tissue disorder occurring in children. TH-17 cells and activated interleukin-23 (IL-23)/IL-17 axis play a key role in the pathogenesis of SLE [1] and possibly in SLE-related skin lesions, but studies related to the latter are scarce.[2],[3]

A pilot study was conducted to look for the expression of IL-17 in skin biopsies of specific and nonspecific lesions in pediatric-onset SLE (pSLE). The relationship, if any, between the expression of IL-17 and disease activity (Systemic Lupus Erythematosus Disease Activity Index-2000 [SLEDAI-2K]) score was also looked at. A hospital-based, cross-sectional study was done in the dermatology department with the approval of the Institutional Review Board and Ethics Committee. Representative skin lesions were biopsied in 27 consenting patients with pSLE (≤16 years); however, due to technical difficulties, skin specimens of only 22 patients were available for immunohistochemistry. These included 15 (68.2%) patients who had lupus-specific lesions and 7 (31.8%) with lupus-nonspecific lesions. Immunohistochemical staining was done with the anti-interleukin-17 antibody (Genetix Biotech Asia Pvt. Ltd, New Delhi) [Figure 1]. The expression of IL-17 was quantified independently by the primary investigator and the pathologist as the number of lymphocytes, fibroblasts and endothelial cells positive for IL-17 in 5 HPF and the average of the two readings was taken as the IL-17 count [Figure 1]. The disease activity score SLEDAI-2K was calculated for each patient. The SLEDAI-2K score ranged from 2 to 27 and the mean SLEDIA-2K score was 13.63. IL-17 expression and SLEDAI-2K score were correlated using Spearman's rho correlation coefficient (R).
Figure 1: Cutaneous vasculitis. Immunohistochemical staining with anti-interleukin-17 antibody – positively staining endothelial cells (vertical arrow), fibroblasts (horizontal arrow), and lymphocytes (arrowhead) (×400)

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In our study, positive IL-17 expression in the inflammatory cells (lymphocytes, fibroblasts and endothelial cells) was appreciated in both lupus-specific and lupus-nonspecific lesions [Table 1]. The mean IL-17 count of lupus-related lesions was 138 per 5 HPF (range: 24–400). The mean IL-17 count in lupus-nonspecific lesions and lupus-specific lesions was 146 and 134.2, respectively. The mean IL-17 count was higher in lesions of subacute LE (n = 3) than in acute cutaneous LE (n = 7) (P = 0.01) and chronic cutaneous LE (n = 5) (P < 0.01). This difference in the pattern of expression of IL-17 among the various lupus-specific lesions has not been previously reported.
Table 1: Interleukin-17 expression in lupus-specific and lupus-non-specific lesions

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There was no correlation between IL-17 expression in skin biopsies and the SLEDAI-2K score (R = −0.091). When analyzed separately, a negative correlation was seen in the case of lupus-specific lesions (R = −0.235) and a trend towards positive correlation was seen with regard to lupus-nonspecific lesions (R = 0.487).

Although serum IL-17 levels have been reported to correlate with the SLEDAI-2K score and cutaneous involvement in pSLE,[4] we did not observe a correlation between IL-17 expression in biopsies of lupus-related skin lesions and the SLEDAI-2K. There are no comparable studies in literature. No correlation was reported between IL-17 expression and Cutaneous Lupus Erythematosus Disease Area Severity Index (CLASI).[2] In addition, a recent study has reported a predominant role of interferon-γ (TH-1) than IL-17 (TH-17) axis in discoid lupus erythematosus.[5]

The positive expression of IL-17 in skin lesions of SLE as seen in our study strengthens the emerging role of IL-17 in the pathogenesis of SLE and organ damage.[1] Further, there may be a role for IL-17 blockade in the management of recalcitrant cutaneous LE.

Financial support and sponsorship

The study was funded by the FLUID, institutional research grant of Christian Medical College, Vellore, Tamil Nadu, India.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Yu C, Chang C, Zhang J. Immunologic and genetic considerations of cutaneous lupus erythematosus: A comprehensive review. J Autoimmun 2013;41:34-45.  Back to cited text no. 1
    
2.
Oh SH, Roh HJ, Kwon JE, Lee SH, Kim JY, Choi HJ, et al. Expression of interleukin-17 is correlated with interferon-α expression in cutaneous lesions of lupus erythematosus. Clin Exp Dermatol 2011;36:512-20.  Back to cited text no. 2
    
3.
Tanasescu C, Balanescu E, Balanescu P, Olteanu R, Badea C, Grancea C, et al. IL-17 in cutaneous lupus erythematosus. Eur J Intern Med 2010;21:202-7.  Back to cited text no. 3
    
4.
Rana A, Minz RW, Aggarwal R, Anand S, Pasricha N, Singh S. Gene expression of cytokines (TNF-α, IFN-γ), serum profiles of IL-17 and IL-23 in paediatric systemic lupus erythematosus. Lupus 2012;21:1105-12.  Back to cited text no. 4
    
5.
Jabbari A, Suárez-Fariñas M, Fuentes-Duculan J, Gonzalez J, Cueto I, Franks AG Jr., et al. Dominant Th1 and minimal Th17 skewing in discoid lupus revealed by transcriptomic comparison with psoriasis. J Invest Dermatol 2014;134:87-95.  Back to cited text no. 5
    

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Correspondence Address:
Renu George
Department of Dermatology, OPD Block, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_655_16

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