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건선병소에서 Interleukin 1 Inhibitor의 분리 및 그 특성에 관한 연구
김낙인,김수남 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.1
Psoriasis is an inflammatory papulosquamous skin disease associated with rapid epideral proliferation. Several recent reports have implicated immunologic mechanisms in the pathogenesis of psoriasis. It has been demonstrated that the lymphocytic infiltrate in the dermis of psoriatic lesions is largely composed of T cells and macrophages. Immunohisto-chemical studies reveals that active psoriatic lesions are associated with epidermal influx of activated T cells, and HLA-DR expresson by keratinocytes, and presence of Langerhans cells in the dermal infiltrate. The presence of increased antigen presenting cell activity, macrophages and activated T cells In active psoriatic lesions suggest that alteration in immunologic cytokine regulation in the skin may play a role in of psoriasis. The author isolated epidermal interleukin-1 (IL-1) inhibitor from the cytosol of active psoriatic epidermis which has been purified by Fast Protein Liquid Chromatography(FPLC) and its functional activity charcterized. The epidermal IL-1 inhibitor consistently demonstrates a molecular weight of 30kD(n=4). It has not been observed in normal epidermis. The inhibitor is capable of partially inhibiting IL-1 activity four hours after exposure of the IL-1 responsive cell line, LBRM. 33 cell. to a pulse and washout of IL-1 and PHA. This suggested that an action on post receptor-binding events, since the activity of the inhibitor is not dependent on blocking the IL-1 receptor or binding to IL-1 itself. The inhibitor does not inhibit the response of an IL-2 dependent cell line, HT-2 cell, to production of IL-2. Despite their similarity in molecular weight the inhibitor is not transforming growth factor β(TGF-β), since experiments with a neutralizing monoclonal antibody against TGF-β failed to remove the activity. In addition, stimulation of human mononuclear cells with a specific antigen (tetanus toxoid) is not affected by the inhibitor. Based upon the molecular weight, inhibitory assay, and antibody neutralization experiments, the IL-1 inhibitor isolated from the cytosol of psoriatic epidermis is not like other known IL-1 inhibitors present in the epidermis or elsewhere. The inhibitory activity is restricted since it does not affect cell proliferation in general or all forms of T cell activation. The presence of the inhibitor in psoriatic epidermis suggests that may result in a selective propagation of T cell subsets activated by inhibitor-resistant mechanisms.
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김낙인 메디메디아코리아(주) 2003 피부과 전문의를 위한 Update in Dermatology Vol.1 No.4
Acritrtin은 건선치료에 단독 혹은 병용요법으로 효과적인 약물이며, 환자에게 투약할때 주의점이 요구된다 Acitretin은 알코올 존재 하여 etretinate로 전환되므로 가임기 여성에서는 투약을 중지하고도 3년간 피임기간이 필수적이다. 특히 임신 중이나 수유기, 간, 신장 질환 paraben 등 보존제에 알레르기가 있는 경우, 당뇨환자, 알코올중독자, 비만환자에서는 주의를 요한다. 따라서 acitretin 투여전 기본적으로 간 기능검사, 혈중지질 검사는 꼭 필요하며 치료중 2주 간격으로 지속적인 관리가 요구된다.
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