CUTANEOUS COLONIZATION WITH STAPHYLOCOCCI INFLUENCES THE DISEASE-ACTIVITY OF SEZARY-SYNDROME - A POTENTIAL ROLE FOR BACTERIAL SUPERANTIGENS

It has previously been shown that circulating Sezary cells respond in vitro to superantigenic staphylococcal exotoxins in a manner that is r estricted by their V beta usage. This study was conducted to examine w hether cutaneous colonization with Staphylococcus aureus influences th e activity of the skin lesions of Sezary syndrome, and whether S. aure us isolated from patients with Sezary syndrome stimulates circulating Sezary cells in vitro. Two patients with Sezary syndrome, whose skin w as colonized with S. aureus, were treated with antibacterial agents, a nd the relation between the severity of the skin disease and the degre e of S. aureus colonization was assessed. In addition, the patients' p eripheral blood mononuclear cells were cultured in the presence of mit omycin C-treated S. aureus or superantigenic staphylococcal toxins. Th e antibacterial treatment improved the skin disease, and eliminated S. aureus in both patients. In one patient, 98% of the peripheral blood mononuclear cells bore V alpha 2V beta 17 of the T-cell receptor, indi cative of the presence of an extremely high percentage of circulating Sezary cells. The peripheral blood lymphocytes from this patient respo nded well in vitro to superantigenic staphylococcal enterotoxin (SE), but not to SEA or toxic shock syndrome toxin-1, or to mitomycin-treate d S. aureus isolated from the same patient. Cutaneous colonization by S. aureus influences the disease activity of CTCL, possibly by activat ion of Sezary cells by bacterial superantigenic exoproteins.