The effect of oral retinoid therapy on the normal human immune system.

Twenty four patients were studied prior to and after 6 and 12 weeks therapy with isotretinoin (17 patients) for acne and related disorders, or with etretinate (7 patients) for psoriasis and related disorders. Patients treated with isotretinoin had a significant reduction in natural killer cell activity at an effector: target cell ratio of 100: 1 at 12 weeks and also a reduction in natural killer cell numbers at this time. Patients treated with etretinate had elevated natural killer cell activity and a significant elevation of natural killer cell numbers at 12 weeks. Other tests which were performed and showed no significant change at 6 or 12 weeks compared with starting levels included lymphocyte transformation in response to phytohaemagglutinin, pokeweed mitogen and concanavalin A, total numbers of circulating T lymphocytes, B lymphocytes and T helper and T suppressor subsets, numbers of epidermal Langerhans cells and serum levels of IgA, IgM and IgE. In view of the involvement of natural killer cells in the initial phase of organ rejection, these results suggest that isotretinoin is the safer of the two retinoids if administration to renal transplant recipients is considered, particularly in the immediate post-transplant period.