Original Article

Investigation of the PD-1/PD-L1 Expression in the Lesional Skins of Patients with Psoriasis

Author Affiliation(s)


Introduction: Psoriasis is an immune-mediated, chronic and inflammatory disease whose pathogenesis is affected by the interactions of several immune cells and cytokines. PD-1 is an inhibitor receptor that is expressed to a large extent in T lymphocytes and responsible for regulating autoimmunity and self-tolerance.

Objectives: In this study, we aimed to investigate the expression of PD-1/PD-L molecules in the lesioned skins of psoriasis patients.

Methods: The study included 30 psoriasis patients, and 15 healthy volunteers as the control group. Anti PD-1 and PD-L1 antibodies were applied to the skin biopsy samples that were collected from the patient and control groups. Cytoplasmic and membranous staining of PD-1 and PD-L1 were considered positive. The number of stained immune cells that was examined for each case.

Results: The percentage of the tissues with high PD-1 (+) and PDL-1 (+) immune cell counts were significantly higher in the psoriasis patients compared to healthy controls (P values = 0.004 and 0.002, respectively). A negative and statistically significant correlation was detected between PDL-1(+) immune cell numbers and PASI scores (P = 0.033, r=-0.57).

Conclusions: In the lesioned skin samples of psoriasis patients, the PD-1 and PD-L1 expressions were significantly higher in immune cells than that in the skin samples of the healthy controls. This study was the first investigation of the expression of PD-1/PD-L molecules in the immune cells in found the lesioned skins of psoriasis patients.

Keywords : autoimmunity, immunohistochemistry, PD1, PDL-1, psoriasis


1. Mahil SK, Capon F, Barker JN. Update on psoriasis immunopathogenesis and targeted immunotherapy. Semin Immunopathol. 2016;38(1):11-27. DOI: 10.1007/s00281-015-0539-8. PMID: 26573299. PMCID: PMC4706579. 2. Zamani RM, Aslani S, Salmaninejad A, Javan MR, Rezaei N. PD-1/PD-L and autoimmunity: A growing relationship. Cell Immunol. 2016;310:27-41. DOI: 10.1016/j.cellimm.2016.09.009. PMID: 27660198. 3. Keir ME, Liang SC, Guleria I, et al. Tissue expression of PD-L1 mediates peripheral T cell tolerance. J Exp Med. 2006;203(4):883-895. DOI: 10.1084/jem.20051776. PMID: 16606670. PMCID: PMC2118286. 4. Hamza A, Roberts D, Su S, Weber RS, Bell D, Ferrarotto R. PD-L1 Expression by Immunohistochemistry in Salivary Duct Carcinoma. Ann Diagn Pathol. 2019;40:49-52. DOI: 10.1016/j.anndiagpath.2019.04.001. PMID: 30978575. PMCID: PMC6599643. 5. Adamczyk M, Krasowska D. PD1/PD-L1 pathway in psoriasis and psoriatic arthritis: a review. Postepy Dermatol Alergol. 2021;38(6):925-930. DOI: 10.5114/ada.2021.112274. PMID: 35125995. PMCID: PMC8802966. 6. Sharpe AH, Pauken KE. The diverse functions of the PD1 inhibitory pathwayNat Rev Immunol. 2018;18(3):153-167. DOI: 10.1038/nri.2017.108. PMID: 28990585. 7. Belum VR, Benhuri B, Postov MA, et al. Characterisation and management of dermatologic adverse to events to agents targeting the PD-1 receptor. Eur J Cancer. 2016;60:12-25. DOI: 10.1016/j.ejca.2016.02.010. PMID: 27043866. PMCID: PMC4998047. 8. Bonigen J, Raynaud-Donzel C, Hureaux J, et al. Anti-PD1-induced psoriasis: a study of 21 patients. J Eur Acad Dermatol Venereol. 2017;31(5):e254-e257. DOI: 10.1111/jdv.14011. PMID: 27739129. 9. Sibaud V, Meyer N, Lamant L, Vigarios E, Mazieres J, Delord JP. Dermatologic complications of anti-PD-1/PD-L1 immune checkpoint antibodies. Curr Opin Oncol. 2016;28(4):254-263. DOI: 10.1097/CCO.0000000000000290. PMID: 27136138. 10. Peled M, Strazza M, Azoulay-Alfaguter I, Mor A. Analysis of Programmed Death-1 in Patients with Psoriatic Arthritis. Inflammation. 2015;38(4):1573-1579. DOI: 10.1007/s10753-015-0132-2. PMID: 25663558. 11. Fujiwara H, Maeda Y, Kobayashi K, et al. Programmed Death-1 Pathway in Host Tissues Ameliorates Th17/Th1-Mediated Experimental Chronic Graft-versus-Host Disease. J Immunol. 2014;193(5):2565-2573. DOI: 10.4049/jimmunol.1400954. PMID: 25080485. 12. Hwang SJE, Carlos G, Wakade D, et al. Cutaneous adverse events (AEs) of anti-programmed cell death (PD)-1 therapy in patients with metastatic melanoma: A single-institution cohort. J Am Acad Dermatol. 2016;74(3):455-461.e1. DOI: 10.1016/j.jaad.2015.10.029. PMID: 26793994. 13. Sibaud V. Dermatologic Reactions to Immune Checkpoint Inhibitors: Skin Toxicities and Immunotherapy. Am J Clin Dermatol. 2018;19(3):345-361. DOI: 10.1007/s40257-017-0336-3. PMID: 29256113. 14. Voudouri D, Nikolaou V, Laschos K, et al. Anti-PD1/PDL1 induced psoriasis. Curr Probl Cancer. 2017;41(6):407-412. DOI: 10.1016/j.currproblcancer.2017.10.003. PMID: 29096940. 15. Kato Y, Otsuka A, Miyachi Y, Kabashima K. Exacerbation of psoriasis vulgaris during nivolumab for oral mucosal melanoma. J Eur Acad Dermatol Venereol. 2016;30(10):e89-e91. DOI: 10.1111/jdv.13336. PMID: 26388113. 16. Elousa-Gonzalez M, Pampin-Franco A, Mazzuchelli-Esteban R, et al. A case of de novo palmoplantar psoriasis with psoriatic arthritis and autoimmune hypothyroidism after receiving nivolumab therapy. Dermatol Online J. 2017;23(8):13030/qt12n4m6pm. PMID: 29469753. 17. Ellis S, Vierra AT, Millsop JW, Lacouture ME, Kiuru M. Dermatologic toxicities to immune checkpoint inhibitor therapy: A review of histopathologic features. J Am Acad Dermatol. 2020;83(4):1130-1143. DOI: 10.1016/j.jaad.2020.04.105. PMID: 32360716. PMCID: PMC7492441. 18. Bartosinska J, Zakrzewska E, Raczkiewicz D, et al. Suppressed Programmed Death 1 Expression on CD4+ and CD8+ T Cells in Psoriatic Patients. Mediators Inflamm. 2017;2017:5385102. DOI: 10.1155/2017/5385102. PMID: 29180838. PMCID: PMC5664337. 19. Bartosinska J, Zakrzewska E, Purkot J, et al. Decreased blood CD4+PD-1+ and CD8+PD-1+ T cells in psoriatic patients with and without arthritis. Postepy Dermatol Alergol. 2018;35(4):344-350. DOI: 10.5114/ada.2018.75609. PMID: 30206445. PMCID: PMC6130132. 20. Jung CJ, Yang HJ, Bang SH, et al. Clinicoprognostic and Histopathological Features of Guttate and Plaque Psoriasis Based on PD-1 J Clin Med. 2021;10(21):5200. DOI: 10.3390/jcm10215200. PMID: 34768720. PMCID: PMC8584888. 21. Kim DS, Je JH, Kim SH, et al. Programmed death-ligand 1, 2 expressions are decreased in the psoriatic epidermis. Arch Dermatol Res. 2015 Aug;307(6):531-8. doi: 10.1007/s00403-015-1588-5. Epub 2015 Jul 2. PMID: 26133691. 22. Çetinözman F, Jansen PM, Willemze R. Expression of programmed death-1 skin biopsies of benign inflammatory vs. lymphomatous erythroderma. Br J Dermatol. 2014;171(3):499-504. DOI: 10.1111/bjd.12934. PMID: 24601935. 23. Bommarito D, Hall C, Taams LS, Corrigall VM. Inflammatory cytokines compromise programmed cell death-1 (PD-1)-mediated T cell suppression in inflammatory arthritis through up-regulation of soluble PD-1. Clin Exp Immunol. 2017;188(3):455-466. DOI: 10.1111/cei.12949. PMID: 28245522. PMCID: PMC5422858.

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