The inhibition of cutaneous T cell apoptosis may prevent resolution of inflammation in atopic eczema

Atopic eczema (AE) is characterized by the persistence of infiltrating T ly mphocytes in the dermis. To test the hypothesis that dysregulation of norma l T cell apoptosis may contribute to the pathogenesis and chronicity of AE we compared patients with a normal resolving immune response (Mantoux react ion (MR)) induced in healthy volunteers by cutaneous PPD injection. Signifi cantly less T cell apoptosis was observed in lesional skin of AE patients c ompared with either the peak or the resolution phase of the MR (P < 0.0001) . The low incidence of T cell apoptosis in AE was associated with significa ntly increased levels of Bcl-2 relative to Bax (P < 0.0001) and significant ly decreased CD95-L expression (P < 0.002) compared with the resolving MR. The cytokines IL-15 and interferon-beta (IFN-beta), which prevent activated T cell apoptosis, were expressed maximally on day 7 and day 14 of the MR, respectively. In contrast, AE patients expressed high levels of both IL-15 and IFN-beta in cutaneous lesions at the same time. This suggests that the co-expression of two anti-apoptotic cytokines, which are not found together during resolving cutaneous responses, may contribute to excessive T cell s urvival which leads to the persistence of inflammation in patients with AE.