401
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Abstract
Psoriasis is an inflammatory skin disease that affects 1-3% of Caucasian populations and may be persistent, disfiguring and stigmatizing. There is a range of severity, but even when the affected body surface area is relatively limited the impact on day-to-day activities and social interactions may be significant. An understanding of the psychological burden and an appreciation that many patients are currently dissatisfied with their management has driven the development of more effective treatment. In recent years psoriasis has been the focus of intense investigation resulting in an improved understanding of the immunopathogenesis, and the development of new, targeted biological treatments.
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Affiliation(s)
- A MacDonald
- Alan Lyell Dermatology Centre, Western Infirmary, Glasgow, G11 6NT, UK.
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402
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Chang M, Li Y, Yan C, Callis-Duffin KP, Matsunami N, Garcia VE, Cargill M, Civello D, Bui N, Catanese JJ, Leppert MF, Krueger GG, Begovich AB, Schrodi SJ. Variants in the 5q31 cytokine gene cluster are associated with psoriasis. Genes Immun 2007; 9:176-81. [PMID: 18075513 DOI: 10.1038/sj.gene.6364451] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A multitiered genetic association study of 25 215 single-nucleotide polymorphisms (SNPs) in three case-control sample sets (1446 patients and 1432 controls) identified three IL13-linked SNPs (rs1800925, rs20541 and rs848) associated with psoriasis. Although the susceptibility effects at these SNPs were modest (joint allelic odds ratios (ORs): 0.76 to 0.78; P(comb): 1.3E-03 to 2.50E-04), the association patterns were consistent across the sample sets, with the minor alleles being protective. Haplotype analyses identified one common, susceptible haplotype CCG (joint allelic OR=1.27; P(comb)=1.88E-04) and a less common, protective haplotype TTT (joint allelic OR=0.74; P(comb)=7.05E-04). In combination with the other known genetic risk factors, HLA-C, IL12B and IL23R, the variants reported here generate an 11-fold psoriasis-risk differential. Residing in the 5q31 cytokine gene cluster, IL13 encodes an important T-cell-derived cytokine that regulates cell-mediated immunity. These results provide the foundation for additional studies required to fully dissect the associations within this cytokine-rich genomic region, as polymorphisms in closely linked candidate genes, such as IRF1, IL5 or IL4, may be driving these results through linkage disequilibrium.
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Affiliation(s)
- M Chang
- Celera, Alameda, CA 94502, USA
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403
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Stenderup K, Rosada C, Worsaae A, Clausen JT, Norman Dam T. Interleukin-20 as a target in psoriasis treatment. Ann N Y Acad Sci 2007; 1110:368-81. [PMID: 17911452 DOI: 10.1196/annals.1423.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Interleukin-20 (IL-20) is a new member of the IL-10 cytokine family discovered by a structural algorithm. IL-20 transgenic mice displayed skin abnormalities reminiscent of psoriasis, a finding that has prompted the investigation of this new interleukin in relation to this disease. This article reviews the role of IL-20 and its implication in psoriasis. It is shown that IL-20 and its receptors are found in human skin and that IL-20 is involved in proliferation, angiogenesis, and chemotaxis, all characteristics of psoriasis. We demonstrated that IL-20 induced the thickening of human epidermis in vivo; however, this thickening does not seem to be related to a direct effect of IL-20 on hyperproliferation since the growth of normal human epidermal keratinocytes (NHEKs) cultured in vitro was not affected by IL-20. On the other hand, in vitro, IL-20 stimulated human peripheral blood mononuclear cells (PBMCs) to produce proinflammatory cytokines and, in vivo, IL-20 in combination with PBMCs induced psoriasis. This may suggest that IL-20 indirectly exerts its proliferative effects on keratinocytes via immune cells present in the skin. Finally, we found that blocking IL-20 signaling in psoriasis improves psoriasis, suggesting that IL-20 is a potential target in psoriasis treatment.
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Affiliation(s)
- Karin Stenderup
- Department of Dermatology, Aarhus University Hospital, P.P. Oerumsgade 11, Bldg. 15, DK-8000 Aarhus, Denmark.
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404
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Fitch E, Harper E, Skorcheva I, Kurtz SE, Blauvelt A. Pathophysiology of psoriasis: recent advances on IL-23 and Th17 cytokines. Curr Rheumatol Rep 2007; 9:461-7. [PMID: 18177599 PMCID: PMC2893221 DOI: 10.1007/s11926-007-0075-1] [Citation(s) in RCA: 261] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
T helper (Th) 17 cells, a novel T-cell subset, have been implicated in the pathogenesis of psoriasis and other autoimmune inflammatory diseases. Interleukin (IL)-23 stimulates survival and proliferation of Th17 cells, and thus serves as a key master cytokine regulator for these diseases. In psoriasis, IL-23 is overproduced by dendritic cells and keratinocytes, and this cytokine stimulates Th17 cells within dermis to make IL-17A and IL-22. IL-22, in particular, drives keratinocyte hyperproliferation in psoriasis. Future targeting of these key cytokines is likely to lead to dramatic clinical improvement in patients with psoriasis. This review focuses on the numerous recent studies on the roles of IL-23 and Th17 cells in the pathogenesis of psoriasis.
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Affiliation(s)
- Erin Fitch
- Dermatology Service, Veterans Affairs Medical Center, 3710 Southwest US Veterans Hospital Road, Mail Code R&D 55, Portland, OR 97239, USA
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405
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406
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Abstract
Interleukin-15 (IL-15) is a pro-inflammatory cytokine expressed in several inflammatory disorders. Zhang et al. (2007, this issue) report a significant genetic association between IL-15 and psoriasis, which may involve increased stability of IL-15 mRNA. Among its several activities, IL-15 stimulates the expression of IL-17 by T-cells. Together with recent genetic and therapeutic evidence implicating IL-23, these findings suggest a genetic basis for Th17-mediated inflammation in psoriasis.
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407
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Büning C, Schmidt HHJ, Molnar T, De Jong DJ, Fiedler T, Bühner S, Sturm A, Baumgart DC, Nagy F, Lonovics J, Drenth JPH, Landt O, Nickel R, Büttner J, Lochs H, Witt H. Heterozygosity for IL23R p.Arg381Gln confers a protective effect not only against Crohn's disease but also ulcerative colitis. Aliment Pharmacol Ther 2007; 26:1025-33. [PMID: 17877509 DOI: 10.1111/j.1365-2036.2007.03446.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A recent study reported that a non-synonymous single nucleotide polymorphism (rs11209026, p.Arg381Gln) located in the IL23R gene is a protective marker for inflammatory bowel disease. AIM To analyse the frequency of p.Arg381Gln in three independent European inflammatory bowel disease cohorts and to evaluate how this variant influences disease behaviour. METHODS We assessed a European cohort of 919 inflammatory bowel disease patients and compared the IL23R p.Arg381Gln genotype frequency with 845 healthy controls. Inflammatory bowel disease patients originated from Germany [Crohn's disease (CD): n = 318; ulcerative colitis (UC): n = 178], Hungary (CD: n = 148; UC: n = 118) and the Netherlands (CD: n = 157). Ethnically matched controls were included. We performed subtyping analysis in respect to CARD15 alterations and clinical characteristics. RESULTS The frequency of the glutamine allele of p.Arg381Gln was significantly lower in inflammatory bowel disease patients compared with controls in a pooled analysis of all three cohorts (P < 0.000001) as well as in the individual cohorts (Germany: P = 0.001, Hungary: P = 0.02 and the Netherlands: P = 0.0002). The p.Arg381Gln genotype distribution was similar between CD and UC. We did not observe either statistical interactions between p.Arg381Gln and CARD15 variants or any significant associations between p.Arg381Gln genotype and subphenotypes. CONCLUSIONS The p.Arg381Gln IL23R variant confers a protective effect against both CD and UC, but does not determine disease phenotype.
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Affiliation(s)
- C Büning
- Department of Gastroenterology, Hepatology and Endocrinology, Charité, Campus Mitte, Universitätsmedizin Berlin, Berlin, Germany.
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408
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Lesueur F, Oudot T, Heath S, Foglio M, Lathrop M, Prud'homme JF, Fischer J. ADAM33, a new candidate for psoriasis susceptibility. PLoS One 2007; 2:e906. [PMID: 17878941 PMCID: PMC1975467 DOI: 10.1371/journal.pone.0000906] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Accepted: 08/23/2007] [Indexed: 11/19/2022] Open
Abstract
Psoriasis is a chronic skin disorder with multifactorial etiology. In a recent study, we reported results of a genome-wide scan on 46 French extended families presenting with plaque psoriasis. In addition to unambiguous linkage to the major susceptibility locus PSORS1 on Chromosome 6p21, we provided evidence for a susceptibility locus on Chromosome 20p13. To follow up this novel psoriasis susceptibility locus we used a family-based association test (FBAT) for an association scan over the 17 Mb candidate region. A total of 85 uncorrelated SNP markers located in 65 genes of the region were initially investigated in the same set of large families used for the genome wide search, which consisted of 295 nuclear families. When positive association was obtained for a SNP, candidate genes nearby were explored more in detail using a denser set of SNPs. Thus, the gene ADAM33 was found to be significantly associated with psoriasis in this family set (The best association was on a 3-SNP haplotype P = 0.00004, based on 1,000,000 permutations). This association was independent of PSORS1. ADAM33 has been previously associated with asthma, which demonstrates that immune system diseases may be controlled by common susceptibility genes with general effects on dermal inflammation and immunity. The identification of ADAM33 as a psoriasis susceptibility gene identified by positional cloning in an outbred population should provide insights into the pathogenesis and natural history of this common disease.
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Affiliation(s)
- Fabienne Lesueur
- Centre National de Génotypage, Evry, France
- * To whom correspondence should be addressed. E-mail: (FL); (JF)
| | | | | | | | | | | | - Judith Fischer
- Centre National de Génotypage, Evry, France
- * To whom correspondence should be addressed. E-mail: (FL); (JF)
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409
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Guerini FR, Fusco C, Mazzi B, Favoino B, Nocera G, Agliardi C, Ceresa D, Valentino M, Mininni D, Zanzottera M, Ferrante P, Lombardi ML. HLA-Cw allele frequencies in northern and southern Italy. Transpl Immunol 2007; 18:286-9. [PMID: 18047939 DOI: 10.1016/j.trim.2007.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 08/14/2007] [Indexed: 01/28/2023]
Abstract
The evidence for HLA-Cw antigens' involvement in the modulation of the immune response in bone marrow transplantation, NK alloreactivity and the susceptibility and follow-up for different diseases has been growing in the recent years, but very few data on HLA-Cw distribution in healthy Italian subjects are available to date. This report presents an updated description of HLA-Cw frequencies in Italy, comparing data from the northern (Lombardia) and southern (Campania and Puglia) parts of the country. A total of 1101 healthy subjects of Italian origin were genotyped, and the results showed that HLA-Cw*04, Cw*07, Cw*12, and, in particular, Cw*0401, Cw*0701, Cw*1203, were the most frequent alleles found in all three regions analysed. Nevertheless, statistically significant differences were observed in Cw*07 distribution, which was more frequent in the southern than in the northern part of Italy (28.8% vs 22.4%; p=0.001; OR: 1.4; 95%CI: 1.14-1.73), and in Cw*12 distribution, which was more frequent in the north than the south (17.0% vs 12.4%; p=0.007, OR: 1.4; 95%CI: 1.10-1.91). These results, which give an improved pattern of distribution of HLA-Cw alleles in the Italian population, would be useful in bone marrow transplantation and anthropological studies. Moreover, due to the important role of HLA-Cw antigens in modulation of the immune response and NK alloreactivity, these data would be of interest in studies on susceptibility, follow-up and/or protection against different diseases.
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Affiliation(s)
- Franca R Guerini
- Laboratory of Molecular Medicine and Biotechnology, Don C. Gnocchi Foundation IRCCS, S. Maria Nascente, Milan Italy.
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410
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Guttman-Yassky E, Krueger JG. Psoriasis: evolution of pathogenic concepts and new therapies through phases of translational research. Br J Dermatol 2007; 157:1103-15. [PMID: 17714560 DOI: 10.1111/j.1365-2133.2007.08135.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Psoriasis is perhaps unique for a disease studied through translational science in that there is not an accepted animal model, yet many rounds of bidirectional translation have taken place that have helped to define disease pathogenesis and to advance therapy. In this review, we illustrate the evolution of new pathogenic concepts and the testing of new therapeutic agents through translational research in humans. We present a current view of disease pathogenesis that stems from research in patients and animal models, but with the perspectives (i) that disease models can advance or hinder the overall translational enterprise and (ii) that the research process must be firmly grounded in the pathophysiology of the actual human condition.
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Affiliation(s)
- E Guttman-Yassky
- Laboratory for Investigative Dermatology, The Rockefeller University, Box 178, 1230 York Avenue, New York, NY 10021, USA. Guttman-Yassky
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411
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Jariwala SP. The role of dendritic cells in the immunopathogenesis of psoriasis. Arch Dermatol Res 2007; 299:359-66. [PMID: 17680257 PMCID: PMC1978540 DOI: 10.1007/s00403-007-0775-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 06/18/2007] [Accepted: 07/20/2007] [Indexed: 12/21/2022]
Abstract
Psoriasis vulgaris is a chronic inflammatory skin disease that is marked by a complex interplay of dendritic cells (DCs), T-cells, cytokines, and downstream transcription factors as part of a self-sustaining type 1 cytokine network. As integral players of the immune system, DCs represent antigen-presenting cells that are crucial for efficient activation of T-cells and B-cells. DCs have also been linked to distinct chronic inflammatory conditions, including psoriasis. In the setting of psoriasis therapy, DC/T cell interactions serve as a potential target for biologic response modifiers. Here we describe the major DC subsets as well as the immunologic involvement of DCs within the context of psoriatic lesions.
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Affiliation(s)
- Sunit P Jariwala
- Department of Internal Medicine, Albert Einstein/Montefiore Medical Center, 33 Teal Court, East Windsor, NJ 08520, USA.
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412
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Gudjonsson JE. Analysis of global gene expression and genetic variation in psoriasis. J Am Acad Dermatol 2007; 57:365. [PMID: 17637449 DOI: 10.1016/j.jaad.2007.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Revised: 02/12/2007] [Accepted: 02/25/2007] [Indexed: 11/22/2022]
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413
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Genetik der Psoriasis. MED GENET-BERLIN 2007. [DOI: 10.1007/s11825-007-0034-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Psoriasis ist eine chronische, entzündliche Hauterkrankung mit einer multifaktoriellen Vererbung. Als wichtigster Risikofaktor gilt derzeit das HLA-CW0602-Allel [bzw. ein Faktor in starkem LD („linkage disequilibrium“)], das insbesondere für die frühere Manifestationsform (< 40. Lebensjahr) prädisponiert und u. a. einen Einfluss auf die Schwere des Verlaufs hat. Durch genomweite Kopplungsanalysen konnten bisher 11 weitere Suszeptibilitätsloci, jedoch nur wenige Kandidatengene identifiziert werden, alle mit vergleichsweise geringem relativem Risiko (Odds-Ratio, OR). Weitere Aspekte der komplexen Ätiopathogenese dieser Erkrankung konnten in immunologischen Ansätzen, aufgrund von Therapieerfolgen mit Antikörpern gegen immunrelevante Moleküle und bei kandidatengenorientierten Assoziationsstudien aufgeklärt werden. Die pathophysiologischen und genetischen Befunde konvergieren zunehmend und zeichnen die Psoriasis als Erkrankung eines fehlgesteuerten immunologischen Regulationsprozesses zwischen Keratinozyten und Zellen des angeborenen und erworbenen Immunsystems aus.
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414
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Abstract
Psoriasis, a papulosquamous skin disease, was originally thought of as a disorder primarily of epidermal keratinocytes, but is now recognised as one of the commonest immune-mediated disorders. Tumour necrosis factor alpha, dendritic cells, and T-cells all contribute substantially to its pathogenesis. In early-onset psoriasis (beginning before age 40 years), carriage of HLA-Cw6 and environmental triggers, such as beta-haemolytic streptococcal infections, are major determinants of disease expression. Moreover, at least nine chromosomal psoriasis susceptibility loci have been identified. Several clinical phenotypes of psoriasis are recognised, with chronic plaque (psoriasis vulgaris) accounting for 90% of cases. Comorbidities of psoriasis are attracting interest, and include impairment of quality of life and associated depressive illness, cardiovascular disease, and a seronegative arthritis known as psoriatic arthritis. A more complete understanding of underlying pathomechanisms is leading to new treatments, which will be discussed in the second part of this Series.
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Affiliation(s)
| | - Jonathan Nwn Barker
- St John's Institute of Dermatology, Guy's Hospital Campus, King's College London, London, UK
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415
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416
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Zhao Y, Terron-Kwiatkowski A, Liao H, Lee SP, Allen MH, Hull PR, Campbell LE, Trembath RC, Capon F, Griffiths CEM, Burden D, McManus R, Hughes R, Kirby B, Rogers SF, Fitzgerald O, Kane D, Barker JNWN, Palmer CNA, Irvine AD, McLean WHI. Filaggrin null alleles are not associated with psoriasis. J Invest Dermatol 2007; 127:1878-82. [PMID: 17410197 DOI: 10.1038/sj.jid.5700817] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Psoriasis is a common skin disease with an etiology consistent with a multifactorial trait. Several psoriasis susceptibility loci are known, a number of which are also implicated in a predisposition to atopic dermatitis (AD), including the epidermal differentiation complex on chromosome 1q21. It has recently been shown in several replicate studies that prevalent null alleles for the filaggrin gene (FLG) on 1q21 are an important genetic factor in AD. Here, we examined the role of these FLG variants in psoriasis using case:control association studies comparing Irish and UK psoriasis cohorts (combined n=691) to ethnically matched populations (combined n=2117). No association was present for the two common European FLG mutations R501X and 2282del4 (combined chi2 P=0.989). In addition, the 3' end of the FLG open-reading frame was sequenced in a number of patients with differing types of psoriasis (plaque, guttate, palmoplantar, and late-onset), which excluded the possibility of a gain-of-function frameshift mutation such as those found in loricrin or certain keratin genes. These data suggest that FLG mutations are unlikely to be involved in genetic susceptibility to psoriasis and implies that there may be within-locus heterogeneity in chromosomal regions involved in both AD and psoriasis.
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Affiliation(s)
- Yiwei Zhao
- Epithelial Genetics Group, Human Genetics Unit, Division of Pathology and Neuroscience, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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417
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Weichenthal M, Ruether A, Schreiber S, Nair R, Voorhees JJ, Schwarz T, Kabelitz D, Christophers E, Elder JT, Jenisch S. Filaggrin R501X and 2282del4 mutations are not associated with chronic plaque-type psoriasis in a German cohort. J Invest Dermatol 2007; 127:1535-7. [PMID: 17380114 DOI: 10.1038/sj.jid.5700771] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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418
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Abstract
Psoriasis is one of the most common human skin diseases and is considered to have key genetic underpinnings. It is characterized by excessive growth and aberrant differentiation of keratinocytes, but is fully reversible with appropriate therapy. The trigger of the keratinocyte response is thought to be activation of the cellular immune system, with T cells, dendritic cells and various immune-related cytokines and chemokines implicated in pathogenesis. The newest therapies for psoriasis target its immune components and may predict potential treatments for other inflammatory human diseases.
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Affiliation(s)
- Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, 1230 York Avenue, Box 178, New York, New York 10021, USA
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419
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Philipp S, Wolk K, Kreutzer S, Wallace E, Ludwig N, Roewert J, Höflich C, Volk HD, Sterry W, Sabat R. The evaluation of psoriasis therapy with biologics leads to a revision of the current view of the pathogenesis of this disorder. Expert Opin Ther Targets 2007; 10:817-31. [PMID: 17105370 DOI: 10.1517/14728222.10.6.817] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Psoriasis is a common chronic, recurring skin disease that is characterised by typical macroscopic and microscopic skin alterations. It is widely accepted that the immune system plays an important role in the pathogenesis of this disorder. Since the early 1990s, the dominant role of a subpopulation of T cells, so-called T1 cells, and their prominent cytokine IFN-gamma has been assumed in the pathogenesis of psoriasis. Surprisingly, the comparison of the therapeutic success of treatments with recombinant proteins directed against defined immunological structures shows that those that directly affect T cells (alefacept, efalizumab, Hu-max-CD4, OKTcdr4a) were clearly less effective than those targeting TNF-alpha (etanercept, adalimumab, infliximab). For this reason, the authors critically re-evaluated the view of psoriasis pathogenesis and postulate that in the majority of patients the T1 cells do not play a dominant role in the clinical, visible stage of this disease.
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Affiliation(s)
- Sandra Philipp
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, University Hospital Charité, Charitéplatz 1, D-10117 Berlin, Germany
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420
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Bos JD. Psoriasis, innate immunity, and gene pools. J Am Acad Dermatol 2007; 56:468-71. [PMID: 17317489 DOI: 10.1016/j.jaad.2006.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 11/29/2006] [Accepted: 12/04/2006] [Indexed: 11/17/2022]
Abstract
Recently, emphasis has shifted from T cells to innate (natural) immunity as the possible major culprit in psoriasis. All known elements of innate immune responses are up-regulated in psoriasis lesions, which must have a polygenetic origin. We hypothesize that urbanized populations have been under evolutionary pressure that selects for increased innate immunity responses because those offer relative but immediate protection from epidemic infections. That would have resulted in a changing gene pool, in which alleles of polymorphisms associated with increased innate immunity responses have amplified in these populations. Having too many of these genes together in one individual would result in a relatively low number of infections. On the other hand, it would also result in a higher prevalence of diseases related to increased innate immunity, such as psoriasis, and perhaps also multiple sclerosis and rheumatoid arthritis. Indeed, in indigenous people (Inuit, Aborigines, Ami) who have not been under this selection pressure, morbidity due to infections is high and the prevalence of psoriasis is low or even absent.
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Affiliation(s)
- Jan D Bos
- Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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421
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Queiro R, Gonzalez S, López-Larrea C, Alperi M, Sarasqueta C, Riestra JL, Ballina J. HLA-C locus alleles may modulate the clinical expression of psoriatic arthritis. Arthritis Res Ther 2007; 8:R185. [PMID: 17166285 PMCID: PMC1794531 DOI: 10.1186/ar2097] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2006] [Revised: 11/04/2006] [Accepted: 12/13/2006] [Indexed: 12/03/2022] Open
Abstract
The aim of the present study was to evaluate the relative contribution of human leukocyte antigen (HLA)-C locus alleles in determining the risk and the clinical expression of psoriatic arthritis (PsA). One hundred PsA patients were randomly selected and grouped into three disease subsets: oligoarthritis (n = 40), polyarthritis (n = 25) and spondylitis (n = 35). The HLA-C locus profile of this cohort was studied by methods based on molecular biology and was compared with that of 45 patients with psoriasis vulgaris and 177 healthy blood donors from the same ethnic origin. HLA-Cw*0602 was found associated with both psoriasis (odds ratio (OR) 6.2; 95% confidence interval (CI) 3.1 to 12.5; p < 0.0001) and PsA (OR 6.2; 95% CI 3.6 to 10.8; p < 0.0001); however, this allele was equally found among the PsA subsets. HLA-Cw6-positive patients showed a longer psoriasis-arthritis latency period (p = 0.012). HLA-Cw*0701 was found under-represented in PsA in comparison with controls (OR 0.5; 95% CI 0.3 to 0.9; p = 0.04), as was HLA-Cw*0802 (OR 0.3; 95% CI 0.08 to 1; p = 0.05). A positive association was found between psoriatic spondylitis and HLA-Cw*0702 (OR 5.0; 95% CI 1.4 to 25; p = 0.01). HLA-Cw*0602 seems to confer a general risk for psoriasis, but the presence of other HLA-C locus alleles may explain an additional arthritogenic risk. HLA-C alleles may modulate some aspects of the clinical expression of PsA, but these findings need confirmation.
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Affiliation(s)
- Ruben Queiro
- Rheumatology Service, Hospital Universitario Central de Asturias (HUCA), C/Celestino Villamil s/n. 33006, Oviedo, Spain
| | - Segundo Gonzalez
- Department of Functional Biology, University of Oviedo, C/Julian Claveria s/n. 33006, Oviedo, Spain
| | - Carlos López-Larrea
- Immunology Department, Hospital Universitario Central de Asturias (HUCA), C/Celestino Villamil s/n. 33006, Oviedo, Spain
| | - Mercedes Alperi
- Rheumatology Service, Hospital Universitario Central de Asturias (HUCA), C/Celestino Villamil s/n. 33006, Oviedo, Spain
| | - Cristina Sarasqueta
- Clinical Epidemiology Unit, Complejo Hospitalario Donostia, P° del Dr Beguiristain 111, 20014, San Sebastian, Basque Country, Spain
| | - Jose Luis Riestra
- Rheumatology Service, Hospital Universitario Central de Asturias (HUCA), C/Celestino Villamil s/n. 33006, Oviedo, Spain
| | - Javier Ballina
- Rheumatology Service, Hospital Universitario Central de Asturias (HUCA), C/Celestino Villamil s/n. 33006, Oviedo, Spain
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422
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Cargill M, Schrodi SJ, Chang M, Garcia VE, Brandon R, Callis KP, Matsunami N, Ardlie KG, Civello D, Catanese JJ, Leong DU, Panko JM, McAllister LB, Hansen CB, Papenfuss J, Prescott SM, White TJ, Leppert MF, Krueger GG, Begovich AB. A large-scale genetic association study confirms IL12B and leads to the identification of IL23R as psoriasis-risk genes. Am J Hum Genet 2007; 80:273-90. [PMID: 17236132 PMCID: PMC1785338 DOI: 10.1086/511051] [Citation(s) in RCA: 831] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 11/20/2006] [Indexed: 12/18/2022] Open
Abstract
We performed a multitiered, case-control association study of psoriasis in three independent sample sets of white North American individuals (1,446 cases and 1,432 controls) with 25,215 genecentric single-nucleotide polymorphisms (SNPs) and found a highly significant association with an IL12B 3'-untranslated-region SNP (rs3212227), confirming the results of a small Japanese study. This SNP was significant in all three sample sets (odds ratio [OR](common) 0.64, combined P [Pcomb]=7.85x10(-10)). A Monte Carlo simulation to address multiple testing suggests that this association is not a type I error. The coding regions of IL12B were resequenced in 96 individuals with psoriasis, and 30 additional IL12B-region SNPs were genotyped. Haplotypes were estimated, and genotype-conditioned analyses identified a second risk allele (rs6887695) located approximately 60 kb upstream of the IL12B coding region that exhibited association with psoriasis after adjustment for rs3212227. Together, these two SNPs mark a common IL12B risk haplotype (OR(common) 1.40, Pcomb=8.11x10(-9)) and a less frequent protective haplotype (OR(common) 0.58, Pcomb=5.65x10(-12)), which were statistically significant in all three studies. Since IL12B encodes the common IL-12p40 subunit of IL-12 and IL-23, we individually genotyped 17 SNPs in the genes encoding the other chains of these cytokines (IL12A and IL23A) and their receptors (IL12RB1, IL12RB2, and IL23R). Haplotype analyses identified two IL23R missense SNPs that together mark a common psoriasis-associated haplotype in all three studies (OR(common) 1.44, Pcomb=3.13x10(-6)). Individuals homozygous for both the IL12B and the IL23R predisposing haplotypes have an increased risk of disease (OR(common) 1.66, Pcomb=1.33x10(-8)). These data, and the previous observation that administration of an antibody specific for the IL-12p40 subunit to patients with psoriasis is highly efficacious, suggest that these genes play a fundamental role in psoriasis pathogenesis.
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423
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Boyman O, Conrad C, Tonel G, Gilliet M, Nestle FO. The pathogenic role of tissue-resident immune cells in psoriasis. Trends Immunol 2007; 28:51-7. [PMID: 17197238 DOI: 10.1016/j.it.2006.12.005] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 11/21/2006] [Accepted: 12/18/2006] [Indexed: 11/28/2022]
Abstract
Psoriasis is a common chronic inflammatory skin disease, the study of which might also be of considerable value to the understanding of other inflammatory and autoimmune-type diseases, such as rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis and diabetes mellitus. There is clear evidence that T cells and dendritic cells have a central role in psoriasis. Based on recent data from humans and animal models, we propose that a psoriasis lesion can be triggered and sustained by the local network of skin-resident immune cells. This concept focuses attention on local, rather than systemic, components of the immune system for rationalized therapeutic approaches of psoriasis and possibly also other chronic inflammatory diseases.
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Affiliation(s)
- Onur Boyman
- Division of Immunology and Allergy, University Hospital of Lausanne (CHUV), CH-1011 Lausanne, Switzerland.
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424
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Reich K, Hüffmeier U, König IR, Lascorz J, Lohmann J, Wendler J, Traupe H, Mössner R, Reis A, Burkhardt H. TNF polymorphisms in psoriasis: Association of psoriatic arthritis with the promoter polymorphismTNF*-857 independent of thePSORS1 risk allele. ACTA ACUST UNITED AC 2007; 56:2056-64. [PMID: 17530646 DOI: 10.1002/art.22590] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Single-nucleotide polymorphisms (SNPs) of the tumor necrosis factor gene TNF at positions -238 and -308 have been associated with psoriasis vulgaris and psoriatic arthritis (PsA). The strong linkage disequilibrium (LD) at chromosome region 6p21, a region known to harbor risk factors for psoriasis susceptibility (PSORS1) other than just SNPs of the TNF gene, renders the interpretation of these findings difficult. The aim of this study was to analyze several SNPs of the TNF gene and its neighboring LTA gene for independent and dependent carriage of the PSORS1 risk allele. METHODS SNPs in the promoter of the TNF (-238G/A, -308G/A, -857C/T, and -1031T/C), LTA (+252A/G), TNLFRSF1A (+36A/G), and TNLFRSF1B (+676T/G) genes were genotyped in 375 psoriasis patients, 375 PsA patients, and 376 controls. The Trp- Trp-Cys-Cys haplotype of the CCHCR1 gene (CCHCR1*WWCC) was used as an estimate of the risk allele PSORS1. RESULTS Whereas we were able to confirm the previously described strong association of allele TNF*-238A with psoriasis, our study revealed that this association was completely dependent on carriage of the PSORS1 risk allele. For PsA, but not psoriasis vulgaris without joint involvement, a strong association with the allele TNF*-857T (odds ratio 1.956 [95% confidence interval 1.334-2.881]; corrected P = 0.0025) was also detected in patients negative for the PSORS1 risk allele. CONCLUSION Our results indicate that there are genetic differences between psoriasis vulgaris patients with and without joint manifestations. While the previously reported association between TNF*-238A and psoriasis seems to primarily reflect LD with PSORS1, TNF*-857T may represent a risk factor for PsA that is independent of the PSORS1 allele.
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425
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Mallbris L, Ritchlin CT, Ståhle M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep 2006; 8:355-63. [PMID: 16973109 DOI: 10.1007/s11926-006-0065-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of the population. Recent studies indicate that psoriasis is associated with an increased risk of comorbidity and mortality compared to the general population. It appears that patients with psoriasis have a higher prevalence of metabolic disorders such as diabetes, hypertension, obesity, and hyperlipidemia, as well as a higher frequency of cigarette smoking. These concomitant diseases can complicate the treatment of psoriasis. Even though the etiology of these associations is elusive, physicians should be aware of them and take active steps to reduce the risk profiles of patients with psoriasis and psoriatic arthritis, in order to lessen mortality and comorbidity.
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Affiliation(s)
- Lotus Mallbris
- Department of Medicine, Dermatology Unit, Karolinska Institutet, 171 76 Stockholm, Sweden.
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426
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Patel S, Xi ZF, Seo EY, McGaughey D, Segre JA. Klf4 and corticosteroids activate an overlapping set of transcriptional targets to accelerate in utero epidermal barrier acquisition. Proc Natl Acad Sci U S A 2006; 103:18668-73. [PMID: 17130451 PMCID: PMC1693720 DOI: 10.1073/pnas.0608658103] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Premature infants are at an increased risk for infections and dehydration because of incomplete development of the epidermis, which attains its essential function as a barrier only during the last stages of in utero development. When a premature birth is anticipated, antenatal corticosteroids are administered to accelerate lung epithelium differentiation. One pleiotropic, but beneficial, effect of antenatal corticosteroids is acceleration of skin barrier establishment by an unknown mechanism. In mice, the transcription factor Klf4 is both necessary and sufficient, within a developmental field of competence, to establish this skin barrier, as demonstrated by targeted ablation and transgenic expression of Klf4, respectively. Here, we report that Klf4 and corticosteroid treatment coordinately accelerate barrier acquisition in vivo. Transcriptional profiling reveals that the genes regulated by corticosteroids and Klf4 during the critical window of epidermal development significantly overlap. KLF4 activates the proximal promoters of a significant subset of these genes. Dissecting the intersection of the genetic and pharmacological pathways, regulated by KLF4 and corticosteroids, respectively, leads to a mechanistic understanding of the normal process of epidermal development in utero.
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Affiliation(s)
- Satyakam Patel
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892
| | - Zong Fang Xi
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892
| | - Eun Young Seo
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892
| | - David McGaughey
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892
| | - Julia A. Segre
- National Human Genome Research Institute, National Institutes of Health, 49 Convent Drive, Bethesda, MD 20892
- *To whom correspondence should be addressed. E-mail:
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427
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Abstract
Psoriasis is a common inflammatory skin disease characterized by infiltration of inflammatory cells into the epidermis and altered keratinocyte differentiation. Psoriasis is currently thought of as a T-cell mediated 'Type-1' autoimmune disease. Gene expression changes in psoriasis lesions have been well documented, and strongly support an important role for tumor necrosis factor and interferon gamma signal pathways in its pathogenesis. The strongest genetic determinant of psoriasis identified to date lies within the class I region of the multiple histocompatibility locus antigen cluster, although its low penetrance implicates a requirement for other genetic risk factors. Multiple genome-wide linkage and an increasing number of association studies have been carried out, leading to multiple linkage peaks, and the identification of potential low risk variants. A number of these variants lie within genes encoding components of the immune system. However, the functional relationships between predisposing genetic variation is unclear, and presumably involves genetic susceptibility factors affecting both immune cell activation and keratinocyte differentiation. The interaction of environmental trigger factors with genetic effects is also not understood, but provide further evidence for the complex basis of this disease.
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Affiliation(s)
- Y Liu
- Department of Genetics, Washington University School of Medicine, St Louis, MO 63110, USA
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428
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Affiliation(s)
- Steven G E Marsh
- Anthony Nolan Research Institute, Royal Free Hospital, London, UK.
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429
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Mrowietz U, Elder JT, Barker J. The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients. Arch Dermatol Res 2006; 298:309-19. [PMID: 17021761 PMCID: PMC1705513 DOI: 10.1007/s00403-006-0707-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 08/31/2006] [Accepted: 09/04/2006] [Indexed: 02/08/2023]
Abstract
It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of comorbidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.
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Affiliation(s)
- Ulrich Mrowietz
- Department of Dermatology, University of Kiel, Schittenhelmstrasse 7, 24105 Kiel, Germany.
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430
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Nomenclature for Factors of the HLA System, Update May 2006. Hum Immunol 2006. [DOI: 10.1016/j.humimm.2006.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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431
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Marsh SGE. Nomenclature for factors of the HLA system, update May 2006. Int J Immunogenet 2006. [DOI: 10.1111/j.1744-313x.2006.00624.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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432
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Abstract
Previous studies have localized the psoriasis susceptibility 1 (PSORS1) locus to the proximal major histocompatibility complex class I region, but approximately a dozen genes in the candidate region have thus far been genetically inseparable. According to a team of researchers in the United States and Germany, the primary genetic association has now been worked out, implicating HLA-Cw6 "after all." The results integrate genetics and immunology, further reinforcing our emerging understanding of psoriasis.
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Affiliation(s)
- James T Elder
- University of Michigan Medical Center, Department of Dermatology, Ann Arbor, Michigan, USA.
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433
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Editors' Picks. J Invest Dermatol 2006. [DOI: 10.1038/sj.jid.5700358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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