Ine [2], and retinoids [3]. However, long-term follow-up during these therapies is generally difficult because of cytotoxicity-related adverse effects, treatment failure, or patient dissatisfaction [4,5]. Recently, several biologic agents (biologics) have been reported for the treatment of psoriasis [6?]. Biologics have high target specificity and their use is associated with limited organ toxicity. However, the risk of cancer or infection during long-term use in patients with psoriasis has not been as yet investigated. IL-12 and IL-23 play important roles in the pathogenesis of psoriasis [9]. In psoriasis patients, IL-12 and IL-23 are involved in immune response mediated by helper Th1 [10] and Th17 [11,12]. IL-12 and IL-23 are heterodimers with a common psubunit. The binding of the subunits to their respective receptors activates specific intracellular signaling pathways [13,14]. Ustekinumab (StelaraH; Janssen Biotech, Inc., Horsham, PA), a fully human IgG1k monoclonal antibody, binds to the common p40 subunit of IL-12 and IL-23, and blocks activation of the receptors of these cytokines in dendritic cells and monocytes. Recent studies have shown significant effectiveness and safety of ustekinumab in moderate-to-severe plaquetype psoriasis during phase 2 [15] and phase 3 clinical trials [16?9]. However, IL-12 is known to have anti-cancer activity by promoting IFN-c production, therefore there is risk of cancer development due to immunosuppression. The effects of ustekinumab on the 1379592 production of IL-12/IL-23 are known but its effects on T cell function are not completely understood. In the present study, we investigated the influence of ustekinumab on T cell cytokine production, differentiation of ?naive T cells and on the T cell receptor repertoire diversity in psoriasis patients.Ustekinumab and Immune ResponseMaterials and Methods SubjectsFive psoriasis patients and five healthy volunteers were enrolled in this study. Patients with psoriasis eligible for the use of biologics were included in the study. Briefly, they fulfilled the rule of 10: Psoriasis Area and Severity Index (PASI)?0, and/or Body Surface Area (BSA)?0 , and/or Dermatology Life Quality Index (DLQI)?0. The phonotypical character and response to the biologics are shown in table 1.heat-inactivated fetal bovine serum (FBS, HyClone Laboratories, INC., South Logan, UT, USA), 2.0 mM L-glutamine, 100 U/ml penicillin, and 100 mg/ml streptomycin (Nacalai tesque, Kyoto, JAPAN).Purification of CD4+T CellsPBMCs were isolated and prepared as previously described [20]. Briefly, PBMCs were purified from heparinized peripheral venous blood using Ficoll-Hypaque (Sigma-Aldlich, St. Louis, MO) 12,13-Desoxyepothilone B chemical information density gradient centrifugation. Purification of CD4+ T cells was done by negative selection using the CD4+ T Cell Isolation Kit II (E-7438 biological activity Miltenyi Biotec, Bergisch Gladbach, Germany) according to the manufacturer’s instructions. PBMCs were incubated for 10 min with 20 ml of the antibody cocktail mixture followed by 15 min incubation with 20 ml of magnetic beads per 107 cells. Unconjugated CD4+ T cells were then isolated from PBMCs by indirect magnetic labeling using MiniMACS separation LS columns. The cell populations were sorted and analyzed by flow cytometry, and the purity of samples being between 96 and 99 .Psoriasis Treatment Protocol and 18325633 Blood Sampling ScheduleUstekinumab was administrated on weeks 0, 4, and 12. In principle, ustekinumab at a dose of 45 mg was administered intradermally during each th.Ine [2], and retinoids [3]. However, long-term follow-up during these therapies is generally difficult because of cytotoxicity-related adverse effects, treatment failure, or patient dissatisfaction [4,5]. Recently, several biologic agents (biologics) have been reported for the treatment of psoriasis [6?]. Biologics have high target specificity and their use is associated with limited organ toxicity. However, the risk of cancer or infection during long-term use in patients with psoriasis has not been as yet investigated. IL-12 and IL-23 play important roles in the pathogenesis of psoriasis [9]. In psoriasis patients, IL-12 and IL-23 are involved in immune response mediated by helper Th1 [10] and Th17 [11,12]. IL-12 and IL-23 are heterodimers with a common psubunit. The binding of the subunits to their respective receptors activates specific intracellular signaling pathways [13,14]. Ustekinumab (StelaraH; Janssen Biotech, Inc., Horsham, PA), a fully human IgG1k monoclonal antibody, binds to the common p40 subunit of IL-12 and IL-23, and blocks activation of the receptors of these cytokines in dendritic cells and monocytes. Recent studies have shown significant effectiveness and safety of ustekinumab in moderate-to-severe plaquetype psoriasis during phase 2 [15] and phase 3 clinical trials [16?9]. However, IL-12 is known to have anti-cancer activity by promoting IFN-c production, therefore there is risk of cancer development due to immunosuppression. The effects of ustekinumab on the 1379592 production of IL-12/IL-23 are known but its effects on T cell function are not completely understood. In the present study, we investigated the influence of ustekinumab on T cell cytokine production, differentiation of ?naive T cells and on the T cell receptor repertoire diversity in psoriasis patients.Ustekinumab and Immune ResponseMaterials and Methods SubjectsFive psoriasis patients and five healthy volunteers were enrolled in this study. Patients with psoriasis eligible for the use of biologics were included in the study. Briefly, they fulfilled the rule of 10: Psoriasis Area and Severity Index (PASI)?0, and/or Body Surface Area (BSA)?0 , and/or Dermatology Life Quality Index (DLQI)?0. The phonotypical character and response to the biologics are shown in table 1.heat-inactivated fetal bovine serum (FBS, HyClone Laboratories, INC., South Logan, UT, USA), 2.0 mM L-glutamine, 100 U/ml penicillin, and 100 mg/ml streptomycin (Nacalai tesque, Kyoto, JAPAN).Purification of CD4+T CellsPBMCs were isolated and prepared as previously described [20]. Briefly, PBMCs were purified from heparinized peripheral venous blood using Ficoll-Hypaque (Sigma-Aldlich, St. Louis, MO) density gradient centrifugation. Purification of CD4+ T cells was done by negative selection using the CD4+ T Cell Isolation Kit II (Miltenyi Biotec, Bergisch Gladbach, Germany) according to the manufacturer’s instructions. PBMCs were incubated for 10 min with 20 ml of the antibody cocktail mixture followed by 15 min incubation with 20 ml of magnetic beads per 107 cells. Unconjugated CD4+ T cells were then isolated from PBMCs by indirect magnetic labeling using MiniMACS separation LS columns. The cell populations were sorted and analyzed by flow cytometry, and the purity of samples being between 96 and 99 .Psoriasis Treatment Protocol and 18325633 Blood Sampling ScheduleUstekinumab was administrated on weeks 0, 4, and 12. In principle, ustekinumab at a dose of 45 mg was administered intradermally during each th.
