Anti-CD4 monoclonal antibody therapy in severe psoriasis

J Autoimmun. 1992 Aug;5(4):465-77. doi: 10.1016/0896-8411(92)90006-c.


We report here the treatment of psoriasis, a chronic inflammatory skin disease characterized by uncontrolled keratinocyte proliferation, with BB14, a CD4 murine IgG1 antibody. Three patients with severe psoriasis were treated with anti-CD4 mAb infusions (0.2 mg/kg/day for the first patient, 0.4 mg/kg/day for 2 days and 0.8 mg/kg/day during the following days for the 2 others) for 7 or 8 days, without other therapy. Rapid clinical improvement, with major reduction of the Psoriasis Area Severity Index, was observed during 1 month after treatment. Moderate decreases in CD4+ blood cells occurred in the last two patients but not in the first one. Circulating T cells coated with anti-CD4 mAb were detectable during the first 48 h in the first patient and from day 1/2 to day 7/8 in the two others. The density of CD4 molecules on the surfaces of peripheral blood lymphocytes was decreased in all patients and remained low as long as anti-CD4 mAb was detectable in patient serum. The maximal 24 h residual mAb levels ranged from 0.3 microgram/ml in the first patient to 3.8 and 7.0 microgram/ml in the two others. The three patients produced IgM antibodies against the anti-CD4 mAb at day 7/8 or 15 and two patients had IgG antibodies at day 15. Lesional skin samples demonstrated (1) gradual improvement in parakeratosis, papillomatosis and acanthosis, (2) decreased expression of ICAM-1 and HLA-DR by keratinocytes, (3) an increase in CD1a+ Langerhans cell number, (4) partial decrease in epidermal T cell infiltrate and (5) no major change in the dermal infiltrate composed of CD3+, TcR alpha beta+, CD45Ro+, HLA-DR+ T cells. We conclude that anti-CD4 mAb administration can induce a rapid and major improvement in psoriatic lesions, with immunohistochemical changes different from those induced by cyclosporin A or 8-methoxypsoralen plus long wave UV light (PUVA) therapy. Our data provide strong evidence for a critical role of CD4+ lymphocytes in psoriasis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Monoclonal / therapeutic use*
  • Antigens, CD / biosynthesis
  • Antigens, CD1
  • CD3 Complex / biosynthesis
  • CD4 Antigens / immunology*
  • Cell Adhesion Molecules / biosynthesis
  • Cyclosporine / pharmacology
  • Female
  • HLA-DR Antigens / biosynthesis
  • Humans
  • Immunoglobulin G / therapeutic use
  • Immunoglobulin M / biosynthesis
  • Immunohistochemistry
  • Intercellular Adhesion Molecule-1
  • Maternal-Fetal Exchange
  • Middle Aged
  • PUVA Therapy
  • Pregnancy
  • Psoriasis / immunology
  • Psoriasis / pathology
  • Psoriasis / therapy*
  • T-Lymphocyte Subsets / immunology
  • Time Factors


  • Antibodies, Monoclonal
  • Antigens, CD
  • Antigens, CD1
  • CD3 Complex
  • CD4 Antigens
  • Cell Adhesion Molecules
  • HLA-DR Antigens
  • Immunoglobulin G
  • Immunoglobulin M
  • Intercellular Adhesion Molecule-1
  • Cyclosporine