Dominant lesional T cell receptor rearrangements persist in relapsing XXXX but are absent from nonlesional skin: evidence for a stable antigen-specific pathogenic T cell response in @entity1569 .

@entity1 @entity32 @entity1569 @entity272
In a previous study we reported that clonally expanded T cell receptor beta-chain rearrangements characterized the T cell receptor usage in @entity272 of @entity1569 and indicated antigen-specific T cell selection. To assess the relevance of clonal T cell expansion for disease progression, we now determined if select clonal T cell receptor rearrangements persisted over time and were present in nonlesional skin. Sequential biopsies were taken from @entity272 of two @entity1 . V-D-J junctional regions of T cell receptor beta-chain variable region gene families 2, 3, 6, 13S1, and BV17 were cloned and sequenced, as these particular BV gene families are preferentially selected in @entity272 . The lesional T cell receptor rearrangements were compared with the T cell receptor usage in nonlesional skin and in blood. Several T cell receptor beta-chain rearrangements with high transcript frequency in the first lesional biopsy were again found in sequential lesional biopsies taken as much as 3 y later from @entity1569 relapses. Only T cell receptor beta-chain rearrangements with low transcript abundance showed variability in that several clones appeared for the first time or disappeared. Although nonlesional skin also exhibited a restricted T cell receptor usage with clonal T cell receptor rearrangements, the T cell receptor usage in lesional and nonlesional skin differed nearly completely. The select lesional recurrence of identical T cell receptor rearrangements reveals that @entity32 in @entity1569 involves the same clonally expanded T cell populations and the same antigens over prolonged periods of time. It hereby suggests that specifically recruited and locally expanded T cell clones are permanently involved in psoriatic @entity32 and may play a crucial part in disease perpetuation.
