Staphylococcal alpha-toxin tilts the balance between malignant and non-malignant CD4 T cells in cutaneous T-cell lymphoma.

is implicated in disease progression in cutaneous T-cell lymphoma (CTCL). Here, we demonstrate that malignant T cell lines derived from CTCL patients as well as primary malignant CD4 T cells from Sézary syndrome patients are considerably more resistant to alpha-toxin-induced cell death than their non-malignant counterparts. Thus, in a subset of Sézary syndrome patients the ratio between malignant and non-malignant CD4 T cells increases significantly following exposure to alpha-toxin. Whereas toxin-induced cell death is ADAM10 dependent in healthy CD4 T cells, resistance to alpha-toxin in malignant T cells involves both downregulation of ADAM10 as well as other resistance mechanisms. In conclusion, we provide first evidence that derived alpha-toxin can tilt the balance between malignant and non-malignant CD4 T cells in CTCL patients. Consequently, alpha-toxin may promote disease progression through positive selection of malignant CD4 T cells, identifying alpha-toxin as a putative drug target in CTCL.