Bacterial toxins including staphylococcal enterotoxins (SEs) have been implicated in the pathogenesis of cutaneous T-cell lymphomas (CTCLs). Here, we investigate SE-mediated interactions between nonmalignant T cells and malignant T-cell
IntroductionThe etiology of cutaneous T-cell lymphoma (CTCL), the most common type of T-cell lymphoma, remains poorly understood, but occupational exposures, infectious agents, and genetic mutations have been proposed as etiologic factors (see reviews [1][2][3][4][5] ). Mycosis fungoides (MF) and the leukemic variant Sezary syndrome (SS) are the 2 major clinical variants of CTCL. In the initial phase, which can last a number of years, MF presents as flat erythromatous skin patches, resembling chronic inflammation seen in chronic skin infections, psoriasis, and eczema. In the later stages, MF lesions gradually form plaques and overt tumors and eventually involve lymph nodes and internal organs. The early skin lesions in CTCL contain a heterogeneous cell population, including malignant cells that phenotypically resemble normal activated CD4 ϩ T lymphocytes and a mixture of nonmalignant tumor-infiltrating T cells, dendritic cells, macrophages, and other inflammatory cells. 1-5 SS, a leukemic and erythrodermic variant of CTCL, is characterized by the presence of circulating lymphocytes with atypical cerebriform nuclei (Sezary cells) in the skin, lymph nodes, and peripheral blood. 1 It is a more aggressive form of CTCL, with a mean survival of 3 years from the time of diagnosis.The role of chronic inflammation as a critical component in tumor progression has recently attracted much attention. It has become clear that the tumor microenvironment, which is largely made up of inflammatory cells, is a component of the malignant tumors (reviewed in de Visser et al 6 ). For instance, viral-antigenspecific, tumor-infiltrating CD4 ϩ T cells enhanced the neoplastic progression into invasive cancer in a model of squamous epithelial cell carcinogenesis induced by human papilloma virus oncogenes. 7 Furthermore, gene-expression profiling in follicular lymphomas indicated that the patient survival correlated with the molecular features of nonmalignant immune cells present in the tumor at diagnosis. 8 Several lines of evidence suggest that in CTCL there is a cross talk between malignant and nonmalignant T lymphocytes, keratinocytes, and dendritic cells. [9][10] During the course of the disease, a shift in the composition of infiltrating T cells appears to take place and the interactions between malignant and nonmalignant cells change. In the early stages of the disease, the infiltrate consists primarily of nonmalignant T-helper 1 (TH1) cells and cytotoxic CD8 ϩ T cells that appear to control the malignant cells via inhibitory cytokines such as interferon gamma and, possibly, direct cytotoxicity. [11][12][13] At the later stages of the disease, TH2 cells and cytokines seem to predominate. 11,12 Because malignant cells derived from MF tumors produce large amounts of IL-5, IL-6, and IL-13, it is likely ...