29 4 14 10 Studies on a Dissimilarity of Discoid Lesions of Cutaneous-limited Lupus Erythematosus and Those of Systemic Lupus Er ythematosus Ema OSAWA (Department of Dermatology, Saitama Medical School, Moroyama, Iruma-gun, Saitama 350-0495, Japan) To know the difference between discoid lesions of systemic lupus erythematosus(sle) and those of cutaneous lupus erhthematosus(cle), clinical, histopathological and immunohistiochemical studies were performed. Specimens of skin were obtained from 5 patients of CLE, 5 patients of SLE with discoid lesions, 5 patients of SLE with butterfly rash and 5 patients of Sjögren s syndrome (SJS) with annular erythema. Immunohistochemical analysis was studied using monoclonal antibodies to CD4, CD8, CD95, CD3, CD45RA, CD45RO, TCR, CD44, HLA-DR and CD20. The clinical difference between discoid lesions of SLE and those of CLE was the size, the number of discoid lesions, the extent of exudation, and the complication of other form of skin lesion. The histological difference between discoid lesions of SLE and those of CLE was the density and extent of infiltrating cells. The infiltrating cells of discoid lesions of CLE were densely observed compared with those of SLE. Between those lesions no obvious difference was seen in infiltrating cells stained with anti-cd4 and CD8, but CD4 expression was prominent in the discoid lesions of SLE. Although CD95 was expressed in the infiltrating cells and epidermis at discoid lesions of CLE and SLE, the infiltrating cells in SJS showed negative. This finding was thought to be the difference between LE groups and SJS. CD45RO expression was dominant compared with CD45RA expression in all lesions, and no difference was seen between CLE and SLE. It was concluded that some difference between discoid lesions of SLE and those of DLE was observed clinically, histopathologically, but it was not obvious immunohistol ogically. Keywords: CLE, SLE, discoid lesion, CD4, CD8, CD95, CD44, HLA-DR, CD45RO, CD45RA 1990 lupus erythematosus LE 810 14 3 22 1 cutaneous-limited LE CLESLE CLE intermediate LE ILE SLE DLE discoid lesion CLE ILE SLE 1-3
1 LE CLE SLE SLE Sjögren s syndrome SJS 1990 1996 20 CLE 5 SLE 5 5 SJS 5 1 SLE 1982 ACR 1993 ACR 3 4 m avidin-biotin peroxidase complex ABC CD3 DAKO, code No. M7193 1:10 CD4 Novo castra, code No. 297343, 1:20 CD8 Novo castra, code No. 297342, 1:40 CD44 DAKO, code No. M7082, 1:50 CD20 Novo castra, code No. 280054, M 1:200 CD45RA DAKO, code No. M0574 CD45RO DAKO, code No. M0742, 1:40 CD95 DAKO, code No. M3553, 1:8 HLA-DR Neo Markers, code No. #MS-133-P1, 1:50 Pan TCR ENDGEN, code No. EN-4506-10, 1:5 10 CD4 121 10 CD3 S-3308 DAKO CD44 S-2031 DAKO CD95 0.1 37 30 PBS 20 1 12 PBS 0.3 H 2 O 2 10 PBS DAB 1 2 0 3 0 1 1 30 2 30 70 3 70 100 1 CLE 5 SLE 5 CLE 45.8 SLE 32.8 CLE 3:2 SLE 1:4 CLE 4 1 SLE 1 4 CLE SLE CLE SLE 4 CLE 3 1 SLE 5 2 CLE 1 4 SLE CLE SLE 2 LE 1 1 SCLE 1
1 2 CLE SLE a : CLE 50 b : SLE 26 CLE SLE 2 CLE SLE 3 SLE 3/ CLE 1/ 5 SJS 5 1/ SLE CLE 3/ 5 CD4 CD8 SLE 1/ 5 1/ 5 CLE SLE CD8 CD4 SJS 4 1/ 1 3/ CD4 CLE SLE SJS 1/ CLE SLE SLE 1 0/ SJS 1 CLE SLE LE SJS CLE 1/ 1 1/ 3 0/ 1 SLE 1/ 1 1/ 4 SLE
T82 大澤 絵麻 表 2 図 3 CLE SLE の円板状紅斑の組織学的所見 CLE の円板状紅斑 図 2a と同一症例 a. HE 弱拡大像 血管並びに付属器周囲で浸潤細胞は密であり 真皮深層に までおよんでいる b. HE 強拡大像 付属器周囲の密な浸潤を示す SLE の円板状紅斑 図 2b と同一症例 c. HE 弱拡大像 CLE に比し 浸潤細胞の密度は低く浸潤細胞は真皮中層に とどまっている d. HE 強拡大像 付属器周囲の軽度な細胞浸潤を示す 1/ 陽性が 3 例 1/ 陽性が 2 例で 円板状紅 斑に比べ染色強度が高くみられた 6 CD45RA CLE と SLE の円板状紅斑 SLE 蝶形紅斑の浸潤細 胞は 1 0/ で 範囲および強度とも低く LE 群 の間に差はみられなかった 7 CD45RO CLE と SLE の円板状紅斑 SLE 蝶形紅斑 SJS 環 状紅斑の浸潤細胞は 1 2/ ± で これらの間 に差はみられなかった しかし 浸潤細胞において CD45RA に比し発現は どの群でも高くみられた 8 CD44 表 4 図 7 CLE と SLE の円板状紅斑 SLE の蝶形紅斑では 表皮細胞間 付属器 浸潤細胞に陽性がみられたが 表皮においては CLE の円板状紅斑に比して SLE の 円板状紅斑 蝶形紅斑のほうが強く発現していた 9 HLA-DR 表 5 CLE と SLE の円板状紅斑 SLE 蝶形紅斑 SJS 環状 紅斑では 表皮 0 1/ 浸潤細胞 0 1/ で これらの間に差は無かった
3 CLE SLE SLE SJS 4 CD44 5 HLA-DR CLE SLE SLE SJS 1/
T84 大澤 絵麻 図 4 CLE SLE の円板状紅斑における抗 CD4 抗体免疫組織染色所見 a CLE の円板状紅斑 図 2a と同一症例 浸潤細胞に 3/ b SLE の円板状紅斑 図 2b と同一症例 浸潤細胞に 4/ 図 5 CLE SLE の円板状紅斑の抗 CD8 抗体免疫組織染色所見 a CLE の円板状紅斑 図 2a と同一症例 浸潤細胞に 4/ b SLE の円板状紅斑 図 2b と同一症例 浸潤細胞に 2/ 図 6 CLE SLE の円板状紅斑 ならびに SJS の環状紅斑と抗 CD95 抗体免疫組織染色所見 a CLE の円板状紅斑 図 2a と同一症例 浸潤細胞に 2/ b SLE の円板状紅斑 図 2b と同一症例 浸潤細胞に 3/ c シェーグレン症候群の環状紅斑の臨床所見 30 歳 女 d c の抗 CD95 抗体免疫組織染色所見 浸潤細胞に 0/
7 CLE SLE CD44 a CLE 2a 3/ b SLE 2b 4/ CLE SLE LE SLE CLE 12) 3 4) CLE SLE CLE SLE SLE CLE SLE CD4 CD8 SLE CD4 CLE CD8 CLE 4) CD4 5,6 ) CLE SLE CLE SLE CD4/CD8 SLE CLE SLE Fas Fas Fas L FasL T FAP-1 7 Fas Fas ligand ligation CD95 Fas CLE SLE CD95 8) SLE CLE CD95 SJS LE SJS CD45RA CLE SLE CD45RO CLE SLE CD45RA CD45RO 9 TCR SLE TCR 10 TCR 11 CLE SLE SLE T 12 SLE CD45RA CD45RO TCR T cell Harris CD44 DLE
13 CD44 SLE 14 CD44 CLE SLE SJS CD44 SJS CLE SLE CLE SLE 1) 1990;32:1139-49. 2) 1997;51:128-33. 3) MB. Deruma 1997;5:9-17. 4) 1 1999.p165-71. 5) Rijlaarsdam JU, Nieboer C, de Vries E, Willemze R. Character rizayion of the dermal infiltrates in Jessner s lymphocytic infiltrate of the skin, polymorphous light er uption and cutaneous lupus erythematosus: differential diagnostic and pathogenetic aspects: J Cutan Pathol 1990;17;2-8. 6) MOOK No7 1986.p1-11. 7) 1997;86:74-8. 8) Nakajima M, Nakajima A, Kayagaki N, Honda M, Yagita H,Okumura K. Expression of Fas ligand and its receptor in cutaneous lupus: implication in tissue injury. Clin Immunol and immunopathol 1997; 83:223-9. 9) Hasan T, Stephansson E, Ranki A. Distribution of naïve and memor y T cell in photoprovoked and spontaneous skin lesions discoid of lupus er ythematosus and polymorphous light eruption. Act Derm Venereol. 1999;79;433-42. 10)Robak E, Blonski JZ, Bartkowiak J, Niewiadomska H, Sysa-Jedrzejowska A, Robak T, Circulating TCR cells in the patients with systemic lupus erythematosus. Mediators Inflamm. 1999;8;305-12. 11)Volc-Platzer B, Anegg B, Milota S, Pickl W, Fisher G, Accumulation of T cells in chronic cutaneous lupus erythematosus, J Invest Dermatol 1993;100; 84s-91s. 12)Shiohara T, Moriya N, Gotho C, Hyakawa J, Nagashima M, Saizawa K, et al. Loss of epidermal integrity by T cell-mediated attack induces long-term local resistance to subsequent attack. I. Induction of resistance correlates with increases in Thy-1+ epi dermal cell numbers. J Exp Med. 1990;171:1027-41. 13)Harris AJ, Dean D, Burge S, Wojnarowska F. Change in CD44 isoform expression during inflammator y skin disease. Clin and Exp Dermatol 1997;22:128-33. 14)Estess P, DeGrendele HC, Pascual V, Siegelman MH, Functional acutivation of lymphocyte CD44 in peripheral blood is marker of autoimmune disease activity. J Clin Invest. 1998; 1173-82. 2002 The Medical Society of Saitama Medical School