Keratinocytes, neutrophils, IL-17 – the “three pillars” of psoriatic inflammation

The aim of this review is to analyze the role of neutrophils and the mechanisms of “keratinocyte– neutrophil” communication involving IL-17 in the immunopathogenesis of psoriasis based on published scientific data. Psoriasis is a chronic autoimmune disease, characterized by abnormal interactions between epidermal and immune cells. Keratinocytes, when exposed to trigger factors, release alarmins, antimicrobial peptides, autoantigens, cytokines (IL-1b, IL-6, TNFa, G-CSF), chemokines (CXCL1, CXCL2, CXCL8), which promote the activation of skin dendritic cells, IL-23 production, Th17 differentiation, IL-17 secretion, and attract neutrophils to the skin. In the peripheral blood of patients with psoriasis, along with an increase in the absolute neutrophil count, there is an accumulation of activated low-density granulocytes and aged neutrophils with an increased ability to form neutrophil extracellular traps (NETs) and migrate into affected skin; the level of circulating NETs also increases. In the skin, neutrophils realize their proinflammatory potential through degranulation, the formation of IL-1a, IL-1b, IL-6, reactive oxygen species, and NETosis, during which additional externalization of autoantigens occurs. Furthermore, neutrophils “suppliers” of IL-17 to the epidermis. IL-17, via IL-17RA signaling in keratinocytes, enhances the production of neutrophil-activating antimicrobial peptides (S100A7), chemokines (CXCL8), cytokines (IL-1b, IL-6, G-CSF). These cytokines can be transferred from keratinocytes to neutrophils via exosomes and induce the expression of IL-6, IL-8, TNFa, as well as NETosis, which can lead to the release of IL-17. Through NETs, epidermal neutrophils can stimulate TLR4 expression in keratinocytes and the production of IL-36g, CXCL8, CXCL1, lipocalin-2, which enhance the activation and recruitment of new neutrophils into the skin. NETs also induce the synthesis of b-defensin-2 in keratinocytes, which reduces the likelihood of developing infections in affected skin areas. Thus, in psoriasis, the interaction keratinocytes-neutrophils with the participation of IL-17 results in the formation of a “vicious circle” of inflammation. IL-17 also promotes keratinocyte hyperproliferation and impaired differentiation, which, as shown in the zebrafish model, may be due to disruption of cytone-mediated interactions between cells of different epidermal layers. The experimental and clinical data available to date and further study of the “keratinocyte–neutrophil–IL-17” system can form the basis for the selection of new diagnostic and prognostic biomarkers and the development of new therapeutic approaches for psoriasis.

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