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Pham NTU, Nguyen TV, Nguyen HT. HLA-Cw6 increases the risk of psoriasis and early onset before twenty-seven years of age among the Vietnamese population. Dermatol Reports 2024; 16:9854. [PMID: 38957641 PMCID: PMC11216135 DOI: 10.4081/dr.2023.9854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 07/04/2024] Open
Abstract
Psoriasis is a chronic inflammatory skin disease that affects people all over the world. It is linked to the HLA-Cw6 allele, which is more common in Caucasians than in Asians and varies across ethnic groups. We investigated the association between the disease severity and the onset age of HLA-Cw6 prevalence in Vietnamese psoriasis patients. In 121 psoriasis patients and 30 healthy controls, we looked at the relationship between HLA-Cw6 and clinical features. We found that patients with psoriasis had significantly higher levels of HLA-Cw6 (64.5%) than controls (26.7%) (p=0.0001), with an odds ratio of 4.98 (2.04-12.15). Positive HLA-Cw6 patients had a significantly lower mean age of psoriasis onset than negative HLA-Cw6 patients. Patients with mild psoriasis (100%) were more likely to have the AA genotype, while patients with moderate to severe psoriasis (47.2% and 59.0%, respectively) and those with high PASI scores (55.1% and 54.1%, respectively) were more likely to have the TA genotype. Thus, HLA-Cw6 is a major genetic risk factor for psoriasis in Vietnamese patients, especially early-onset cases. Variations in HLA-Cw6 genotypes also affect disease severity.
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Affiliation(s)
- Nhi Thi Uyen Pham
- Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City
- Hanoi Medical University, Hanoi
| | | | - Hao Trong Nguyen
- Ho Chi Minh City Hospital of Dermato-Venereology, Ho Chi Minh City
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Hernandez-Nicols BF, Robledo-Pulido JJ, Alvarado-Navarro A. Etiopathogenesis of Psoriasis: Integration of Proposed Theories. Immunol Invest 2024; 53:348-415. [PMID: 38240030 DOI: 10.1080/08820139.2024.2302823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Psoriasis is a chronic inflammatory disease characterized by squamous and erythematous plaques on the skin and the involvement of the immune system. Global prevalence for psoriasis has been reported around 1-3% with a higher incidence in adults and similar proportions between men and women. The risk factors associated with psoriasis are both extrinsic and intrinsic, out of which a polygenic predisposition is a highlight out of the latter. Psoriasis etiology is not yet fully described, but several hypothesis have been proposed: 1) the autoimmunity hypothesis is based on the over-expression of antimicrobial peptides such as LL-37, the proteins ADAMTSL5, K17, and hsp27, or lipids synthesized by the PLA2G4D enzyme, all of which may serve as autoantigens to promote the differentiation of autoreactive lymphocytes T and unleash a chronic inflammatory response; 2) dysbiosis of skin microbiota hypothesis in psoriasis has gained relevance due to the observations of a loss of diversity and the participation of pathogenic bacteria such as Streptococcus spp. or Staphylococcus spp. the fungi Malassezia spp. or Candida spp. and the virus HPV, HCV, or HIV in psoriatic plaques; 3) the oxidative stress hypothesis, the most recent one, describes that the cell injury and the release of proinflammatory mediators and antimicrobial peptides that leads to activate of the Th1/Th17 axis observed in psoriasis is caused by a higher release of reactive oxygen species and the imbalance between oxidant and antioxidant mechanisms. This review aims to describe the mechanisms involved in the three hypotheses on the etiopathogeneses of psoriasis.
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Affiliation(s)
- Brenda Fernanda Hernandez-Nicols
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Juan José Robledo-Pulido
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Anabell Alvarado-Navarro
- Centro de Investigación en Inmunología y Dermatología, Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
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3
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Talwar JV, Laub D, Pagadala MS, Castro A, Lewis M, Luebeck GE, Gorman BR, Pan C, Dong FN, Markianos K, Teerlink CC, Lynch J, Hauger R, Pyarajan S, Tsao PS, Morris GP, Salem RM, Thompson WK, Curtius K, Zanetti M, Carter H. Autoimmune alleles at the major histocompatibility locus modify melanoma susceptibility. Am J Hum Genet 2023; 110:1138-1161. [PMID: 37339630 PMCID: PMC10357503 DOI: 10.1016/j.ajhg.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
Autoimmunity and cancer represent two different aspects of immune dysfunction. Autoimmunity is characterized by breakdowns in immune self-tolerance, while impaired immune surveillance can allow for tumorigenesis. The class I major histocompatibility complex (MHC-I), which displays derivatives of the cellular peptidome for immune surveillance by CD8+ T cells, serves as a common genetic link between these conditions. As melanoma-specific CD8+ T cells have been shown to target melanocyte-specific peptide antigens more often than melanoma-specific antigens, we investigated whether vitiligo- and psoriasis-predisposing MHC-I alleles conferred a melanoma-protective effect. In individuals with cutaneous melanoma from both The Cancer Genome Atlas (n = 451) and an independent validation set (n = 586), MHC-I autoimmune-allele carrier status was significantly associated with a later age of melanoma diagnosis. Furthermore, MHC-I autoimmune-allele carriers were significantly associated with decreased risk of developing melanoma in the Million Veteran Program (OR = 0.962, p = 0.024). Existing melanoma polygenic risk scores (PRSs) did not predict autoimmune-allele carrier status, suggesting these alleles provide orthogonal risk-relevant information. Mechanisms of autoimmune protection were neither associated with improved melanoma-driver mutation association nor improved gene-level conserved antigen presentation relative to common alleles. However, autoimmune alleles showed higher affinity relative to common alleles for particular windows of melanocyte-conserved antigens and loss of heterozygosity of autoimmune alleles caused the greatest reduction in presentation for several conserved antigens across individuals with loss of HLA alleles. Overall, this study presents evidence that MHC-I autoimmune-risk alleles modulate melanoma risk unaccounted for by current PRSs.
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Affiliation(s)
- James V Talwar
- Department of Medicine, Division of Medical Genetics, University of California San Diego, La Jolla, CA 92093, USA; Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA 92093, USA
| | - David Laub
- Department of Medicine, Division of Medical Genetics, University of California San Diego, La Jolla, CA 92093, USA; Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA 92093, USA
| | - Meghana S Pagadala
- Biomedical Science Program, University of California San Diego, La Jolla, CA 92093, USA
| | - Andrea Castro
- Department of Medicine, Division of Medical Genetics, University of California San Diego, La Jolla, CA 92093, USA; Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA 92093, USA
| | - McKenna Lewis
- Department of Computer Science and Engineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Georg E Luebeck
- Public Health Sciences Division, Herbold Computational Biology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Bryan R Gorman
- Center for Data and Computational Sciences (C-DACS), VA Boston Healthcare System, Boston, MA 02130, USA; Booz Allen Hamilton, Inc., McLean, VA 22102, USA
| | - Cuiping Pan
- Palo Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto, CA, USA
| | - Frederick N Dong
- Center for Data and Computational Sciences (C-DACS), VA Boston Healthcare System, Boston, MA 02130, USA; Booz Allen Hamilton, Inc., McLean, VA 22102, USA
| | - Kyriacos Markianos
- Center for Data and Computational Sciences (C-DACS), VA Boston Healthcare System, Boston, MA 02130, USA; Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of Harvard and MIT, Cambridge, MA 02115, USA
| | - Craig C Teerlink
- Department of Veterans Affairs Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Julie Lynch
- Department of Veterans Affairs Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Richard Hauger
- VA San Diego Healthcare System, La Jolla, CA, USA; Center for Behavioral Genetics of Aging, University of California San Diego, La Jolla, CA, USA; Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, USA
| | - Saiju Pyarajan
- Center for Data and Computational Sciences (C-DACS), VA Boston Healthcare System, Boston, MA 02130, USA; Department of Medicine, Brigham Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Philip S Tsao
- Palo Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto, CA, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald P Morris
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
| | - Rany M Salem
- Division of Epidemiology, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Wesley K Thompson
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK 74136, USA
| | - Kit Curtius
- Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA 92093, USA; Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Maurizio Zanetti
- Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA; The Laboratory of Immunology, University of California San Diego, La Jolla, CA 92093, USA; Department of Medicine, Division of Hematology and Oncology, University of California San Diego, La Jolla, CA 92093, USA
| | - Hannah Carter
- Department of Medicine, Division of Medical Genetics, University of California San Diego, La Jolla, CA 92093, USA; Bioinformatics and Systems Biology Program, University of California San Diego, La Jolla, CA 92093, USA; Moores Cancer Center, University of California San Diego, La Jolla, CA 92093, USA.
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Ramessur R, Corbett M, Marshall D, Acencio ML, Barbosa IA, Dand N, Di Meglio P, Haddad S, Jensen AH, Koopmann W, Mahil SK, Ostaszewski M, Rahmatulla S, Rastrick J, Saklatvala J, Weidinger S, Wright K, Eyerich K, Ndlovu M, Barker JN, Skov L, Conrad C, Smith CH. Biomarkers of disease progression in people with psoriasis: a scoping review. Br J Dermatol 2022; 187:481-493. [PMID: 35482474 PMCID: PMC9796834 DOI: 10.1111/bjd.21627] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Identification of those at risk of more severe psoriasis and/or associated morbidities offers opportunity for early intervention, reduced disease burden and more cost-effective healthcare. Prognostic biomarkers of disease progression have thus been the focus of intense research, but none are part of routine practice. OBJECTIVES To identify and catalogue candidate biomarkers of disease progression in psoriasis for the translational research community. METHODS A systematic search of CENTRAL, Embase, LILACS and MEDLINE was performed for relevant articles published between 1990 and December 2021. Eligibility criteria were studies involving patients with psoriasis (any age, n ≥ 50) reporting biomarkers associated with disease progression. The main outcomes were any measure of skin severity or any prespecified psoriasis comorbidity. Data were extracted by one reviewer and checked by a second; studies meeting minimal quality criteria (longitudinal design and/or use of methods to control for confounding) were formally assessed for bias. Candidate biomarkers were identified by an expert multistakeholder group using a majority voting consensus exercise, and mapped to relevant cellular and molecular pathways. RESULTS Of 181 included studies, most investigated genomic or proteomic biomarkers associated with disease severity (n = 145) or psoriatic arthritis (n = 30). Methodological and reporting limitations compromised interpretation of findings, most notably a lack of longitudinal studies, and inadequate control for key prognostic factors. The following candidate biomarkers with future potential utility were identified for predicting disease severity: LCE3D, interleukin (IL)23R, IL23A, NFKBIL1 loci, HLA-C*06:02 (genomic), IL-17A, IgG aHDL, GlycA, I-FABP and kallikrein 8 (proteomic), tyramine (metabolomic); psoriatic arthritis: HLA-C*06:02, HLA-B*27, HLA-B*38, HLA-B*08, and variation at the IL23R and IL13 loci (genomic); IL-17A, CXCL10, Mac-2 binding protein, integrin b5, matrix metalloproteinase-3 and macrophage-colony stimulating factor (proteomic) and tyramine and mucic acid (metabolomic); and type 2 diabetes mellitus: variation in IL12B and IL23R loci (genomic). No biomarkers were supported by sufficient evidence for clinical use without further validation. CONCLUSIONS This review provides a comprehensive catalogue of investigated biomarkers of disease progression in psoriasis. Future studies must address the common methodological limitations identified herein to expedite discovery and validation of biomarkers for clinical use. What is already known about this topic? The current treatment paradigm in psoriasis is reactive. There is a need to develop effective risk-stratified management approaches that can proactively attenuate the substantial burden of disease. Prognostic biomarkers of disease progression have therefore been the focus of intense research. What does this study add? This review is the first to scope, collate and catalogue research investigating biomarkers of disease progression in psoriasis. The review identifies potentially promising candidate biomarkers for further investigation and highlights common important limitations that should be considered when designing and conducting future studies in this area.
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Affiliation(s)
- Ravi Ramessur
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Mark Corbett
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - David Marshall
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Marcio L. Acencio
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Ines A. Barbosa
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Nick Dand
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Paola Di Meglio
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | | | | | - Witte Koopmann
- Department of Translational MedicineLEO Pharma A/SBallerupDenmark
| | - Satveer K. Mahil
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Marek Ostaszewski
- Luxembourg Centre for Systems BiomedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | | | | | - Jake Saklatvala
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Stephan Weidinger
- Department of Dermatology and AllergyUniversity Hospital Schleswig‐HolsteinKielGermany
| | - Kath Wright
- Centre for Reviews and DisseminationUniversity of YorkYorkUK
| | - Kilian Eyerich
- Department of Dermatology and AllergyTechnical University of MunichMunichGermany
- Division of Dermatology, Department of MedicineKarolinska InsitutetStockholmSweden
| | | | - Jonathan N. Barker
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
| | - Lone Skov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Curdin Conrad
- Department of DermatologyLausanne University Hospital CHUV & University of LausanneLausanneSwitzerland
| | - Catherine H Smith
- St John’s Institute of Dermatology, School of Basic & Medical Biosciences and Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & MedicineKing’s College LondonLondonUK
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Zhukov AS, Patrushev AV, Khairutdinov VR, Samtsov AV, Kryukov EV. New aspects of the pathogenesis of psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2022. [DOI: 10.25208/vdv1345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Psoriasis is a chronic multi-factorial immune-mediated inflammatory disease of skin and joints. The variety of clinical forms of dermatosis is consistent with various pathogenetic features of the disease progress which have been significantly supplemented and reviewed recently. Knowledge of these mechanisms will improve and personalize the prescribed therapy.
This study places the emphasis on modern ideas about the formation of T cell memory, the role of melanocytes and innate lymphoid cells. Development mechanisms of guttate and paradoxical psoriasis with important distinguishing characteristics are described separately.
Today, knowledge of the molecular basis of the disease progression has led to the creation and introduction of a number of highly effective targeted drugs into clinical practice. Further developments related to the inhibition of resident memory cells, innate lymphoid cells, as well as the study of guttate psoriasis perpetuation and the occurrence of paradoxical psoriasis will significantly increase the effectiveness of the therapy.
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Conrad C, Ortmann CE, Vandemeulebroecke M, Kasparek T, Reich K. Nail Involvement as a Predictor of Differential Treatment Effects of Secukinumab Versus Ustekinumab in Patients with Moderate to Severe Psoriasis. Dermatol Ther (Heidelb) 2021; 12:233-241. [PMID: 34870789 PMCID: PMC8776916 DOI: 10.1007/s13555-021-00654-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Patients with plaque psoriasis may experience varying levels of treatment response to different biologics, based on phenotypic characteristics and underlying genetic factors. Nail psoriasis is a common manifestation of psoriasis (approx. 50% of patients) and has been linked to the human leukocyte antigen-C*0602 (HLA-C*0602) allele, which in turn has been associated with differential treatment responses to certain drugs. Here we investigate whether nail involvement in patients with psoriasis can predict differential skin responses to two biologics with different modes of action, namely secukinumab (anti-interleukin-17A) and ustekinumab (anti-interleukin-12/23), to ultimately guide treatment choice. Methods Data were pooled from the CLEAR and CLARITY studies and stratified post hoc by nail involvement status at baseline. Psoriasis Area and Severity Index (PASI) 75 and 90 responses over 52 weeks and absolute PASI ≤ 3, ≤ 1, and 0 values at weeks 16 and 52, were assessed. Results Based on the medical history, 30.4% (269/886) of the patients in the secukinumab arm and 29.7% (265/891) of patients in the ustekinumab arm presented with nail involvement. Nail involvement status had little to no impact on the efficacy of secukinumab, as comparable responses were achieved for patients with and without nail involvement in terms of PASI 75/90, ≤ 3, and 0 responses; slightly lower PASI ≤ 1 reponses were achieved in patients with nail involvement. In the ustekinumab arm, patients with nail involvement achieved lower responses across all endpoints. Conclusions These findings indicate that nail involvement can serve as an observable prognostic factor for efficacy in skin psoriasis treatment and guide the choice between secukinumab and ustekinumab. Trial Registration CLEAR: NCT02074982; CLARITY: NCT02826603.
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Affiliation(s)
- Curdin Conrad
- Department of Dermatology, Lausanne University Hospital CHUV, Lausanne, Switzerland.
| | | | | | | | - Kristian Reich
- Translational Research in Inflammatory Skin Disease, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Galluzzo M, Manfreda V, Petruzzellis A, Bianchi L, Talamonti M. The value of genotyping patients for the presence of HLA-C in the personalized treatment of psoriasis. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1878022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Marco Galluzzo
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Valeria Manfreda
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Luca Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Marina Talamonti
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
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8
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Lee J, Smith WM, Goldstein DA. Birdshot chorioretinopathy presenting in a teenager. Am J Ophthalmol Case Rep 2020; 19:100807. [PMID: 32695925 PMCID: PMC7365988 DOI: 10.1016/j.ajoc.2020.100807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe clinical features of the youngest patient with well-documented HLA-A29-positive birdshot chorioretinopathy (BCR). Observations A 17-year-old female presented with poor night vision and floaters. Examination revealed bilateral vitritis, retinal vasculitis, and numerous cream-colored ovoid lesions in the fundus. Fluorescein angiography revealed bilateral optic disc leakage, large vessel leakage and diffuse capillary ferning. There were hundreds of small hypocyanescent spots evenly distributed in the posterior pole of both eyes on indocyanine green angiography. Workup was positive for HLA-A29.2. Systemic immunosuppression with adalimumab 40mg/0.4mL was initiated every two weeks and escalated to weekly dosing. The patient's early age of disease onset prompted evaluation of her parents. The mother's exam was normal and she was HLA-A29 negative. Examination of the father revealed peripapillary choroidal lesions as well as hypocyanescent spots on ICG. HLA-typing revealed the presence of HLA-A29.2. Conclusions and Importance BCR rarely occurs in the pediatric population. We present the youngest patient with well-documented BCR in the literature to highlight that this disease deserves consideration even in young patients. Interestingly, choroidal lesions were also found in an asymptomatic parent with HLA-A29.2 positivity.
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Affiliation(s)
- Jennifer Lee
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
| | - Wendy M Smith
- Uveitis Service, Mayo Clinic, Department of Ophthalmology, Rochester, MN, USA
| | - Debra A Goldstein
- Uveitis Service, Northwestern University, Feinberg School of Medicine, Department of Ophthalmology, Chicago, IL, USA
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9
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Pathogenesis of psoriasis in the "omic" era. Part II. Genetic, genomic and epigenetic changes in psoriasis. Postepy Dermatol Alergol 2020; 37:283-298. [PMID: 32774210 PMCID: PMC7394158 DOI: 10.5114/ada.2020.96243] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022] Open
Abstract
Psoriasis is a multifactorial disease in which genetic, environmental and epigenetic factors regulating gene expression play a key role. In the “genomic era”, genome-wide association studies together with target genotyping platforms performed in different ethnic populations have found more than 50 genetic susceptible markers associated with the risk of psoriasis which have been identified so far. Up till now, the strongest association with the risk of the disease has been proved for HLA-C*06 gene. The majority of other psoriasis risk SNPs are situated near the genes encoding molecules involved in adaptive and innate immunity, and skin barrier function. Many contemporary studies indicate that the epigenetic changes: histone modification, promoter methylations, long non-coding and micro-RNA hyperexpression are considered as factors contributing to psoriasis pathogenesis as they regulate abnormal keratinocyte differentiation and proliferation, aberrant keratinocytes – inflammatory cells communication, neoangiogenesis and chronic inflammation. The circulating miRNAs detected in the blood may become specific markers in the diagnosis, prognosis and response to the treatment of the disease. The inhibition of expression in selected miRNAs may be a new promising therapy option for patients with psoriasis.
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10
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Li J, Li X, He F, Zhao X, Hou R, Lin H, Shen J, Wu X, Liao Q, Xing J, Yi G, Li X, Zhang K. Cross-sectional study reveals thatHLA-C*07:02 is a potential biomarker of early onset/lesion severityof psoriasis. Exp Dermatol 2020; 29:639-646. [PMID: 32506489 DOI: 10.1111/exd.14127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/22/2020] [Accepted: 06/02/2020] [Indexed: 12/18/2022]
Abstract
Psoriasis is a common chronic autoimmune skin disease, with T cells playing a predominant role in its pathogenesis.Here, we aimed to investigate the relation of T cell repertoires (TCR) and major histocompatibility complex (MHC) in psoriatic patients to further understand mechanisms in disease pathogenesis.We conducted a cross-sectional study involving 9 pairs of monozygotic twins with inconsistent psoriasis and examined the TCR diversity and MHC haplotype ofthe individuals using multiple-PCR and high-throughput sequencing. Additionally, 665 psoriatic patients were applied to validate the relation of human leukocyte antigen (HLA)-class I allele HLA-C*07:02 and early onset or lesion severity of psoriasis.The immune diversity was lower in psoriatic patients compared with unaffected individuals within the twin pairs, although the difference was not significant.The clonotypes of TCR significantly decreased in psoriatic patients with high PASI score and early onset. HLA-C*07:02, a haplotype associated with psoriasis, was positively correlated with the diversity of the TCRV gene. Moreover, HLA-C*07:02 clustered in patients with high PASI and early onset. In the replication stage, we found that the PASI and onset age in psoriasis with HLA-C*07:02 were significantly different from those without HLA-C*07:02 and without HLA-C*06:02. Our observations indicate that HLA-C*07:02 is positively correlated with the diversity of TCRV gene in psoriasis, and maybe a potential biomarker of early onset/severe lesions of psoriasis.
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Affiliation(s)
- Junqin Li
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Xiaofang Li
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Fusheng He
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Xincheng Zhao
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Ruixia Hou
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Haoxiang Lin
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Juan Shen
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Xueli Wu
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Qijun Liao
- BGI Genomics, BGI-Shenzhen, Shenzhen, 518083, China
| | - Jianxiao Xing
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Guohua Yi
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Xinhua Li
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
| | - Kaiming Zhang
- Shanxi Key Laboratory of Stem Cells for Immunological Dermatosis, Institute of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, No. 5 Dong San Dao Xiang, Jiefang Road, Taiyuan, 030009, China
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11
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Tang L, Yao T, Fang M, Zheng X, Chen G, Li M, Wang D, Li X, Ma H, Wang X, Qian Y, Zhou F. Genomic DNA methylation in HLA-Cw*0602 carriers and non-carriers of psoriasis. J Dermatol Sci 2020; 99:23-29. [PMID: 32522384 DOI: 10.1016/j.jdermsci.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND HLA-Cw*0602 has long been established as one of the most important genetic biomarkers in psoriasis. However, the epigenetic and gene expression differences between HLA-Cw*0602 carriers and non-carriers has not yet been investigated. OBJECTIVE We aim to explore the whole-genome methylation and gene expression differences between HLA-Cw*0602 carriers and non-carriers. METHODS HLA imputation was performed to get landscape of variants in this region. Genome-wide DNA methylation was compared between positive and negative HLA-Cw*0602 groups. Eleven methylation loci were selected for further validation in additional 43 cases. For differentially methylated genes, GO and KEGG were used to annotate gene functions. RESULTS We imputed 29,948 variants based on the constructed HLA reference panels, and obtained 42 HLA-Cw*0602 carriers and 72 non-carriers. Significant methylation differences were detected at 4321 sites (811 hypo- and 3510 hypermethylated). The cg02607779 (KLF7, P = 0.001), cg06936779 (PIP5K1A, P = 0.002), cg03860400 (BTBD10, P = 0.017) and cg26112390 (GOLGA2P5, P = 0.019) were identified and validated to be the significant CpGs contributed to different HLA-C*0602 groups. Among the hypo- and hypermethylated sites, the top CpGs were in gene body and CpG island. CONCLUSION We performed the first whole-genome study on methylation differences between psoriatic individuals with or without HLA-Cw*0602, and found the key methylation sites which may contribute to the carrying status of HLA-Cw*0602. Methylation loci located in gene body and CpG island are more likely to affect the methylation levels in HLA-Cw*0602 carriers. This integrated analysis shed light on novel insights into the pathogenic mechanisms of genomic methylation in different HLA genotypes of psoriasis.
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Affiliation(s)
- Lili Tang
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Tianyu Yao
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Miaohong Fang
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Xiaodong Zheng
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Gang Chen
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Mengqing Li
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Dan Wang
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Xinyu Li
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Haining Ma
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Xiangru Wang
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Yunhong Qian
- The First Clinical Medical College of Anhui Medical University, Anhui Province, Hefei, China
| | - Fusheng Zhou
- Department of Dermatology, the First Affiliated Hospital, Anhui Medical University, Hefei, China; Institute of Dermatology, Anhui Medical University, Hefei, China; Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, China; State Key Laboratory Incubation Base of Dermatology, Anhui Medical University, Hefei, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China.
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12
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Shen M, Lim SWD, Tan ES, Oon HH, Ren EC. HLA Correlations with Clinical Phenotypes and Risk of Metabolic Comorbidities in Singapore Chinese Psoriasis Patients. Mol Diagn Ther 2020; 23:751-760. [PMID: 31473973 DOI: 10.1007/s40291-019-00423-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Psoriasis is a systemic, chronic inflammatory disease that not only afflicts the skin but is also associated with cardiovascular disease and metabolic syndrome. The strongest susceptibility loci for the disease is within the human leukocyte antigen (HLA) complex, though specific HLA allelic associations vary between populations. OBJECTIVE Our objective was to investigate HLA associations with clinical phenotypes of psoriasis and metabolic syndrome in Chinese psoriasis cases. METHODS We conducted an observational case-control study in Singapore with a cohort of psoriasis cases consecutively recruited from an outpatient specialist dermatological center (n = 120) compared with 130 healthy controls. RESULTS Significant HLA associations with psoriasis were observed with HLA-A*02:07, B*46:01, C*01:02, and C*06:02. The three-locus haplotype of A*02:07-C*01:02-B*46:01 was also significant (odds ratio [OR] 3.07; p = 9.47 × 10-5). We also observed an association between nail psoriasis and HLA-A*02:07 carriers (OR 4.50; p = 0.002), whereas C*06:02 carriers were less prone to have nail involvement (OR 0.16; p = 0.004). HLA-A*02:07 was also identified as a possible risk allele for hypertension (OR 2.90; p < 0.05), and C*01:02 was a possible risk allele for dyslipidemia (OR 3.36; p < 0.05), both known to be common comorbidities in patients with psoriasis. CONCLUSION Our results demonstrate the growing importance of discerning population-specific clinical phenotypes and their association with certain HLA alleles in psoriasis.
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Affiliation(s)
- Meixin Shen
- Singapore Immunology Network (SIgN), A*STAR, 8A Biomedical Grove, #03-06, Immunos Building, Singapore, 138648, Singapore
| | - Soon Wei Daniel Lim
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - Eugene S Tan
- National Skin Centre (S) Pte Ltd, 1 Mandalay Rd, Singapore, 308205, Singapore
| | - Hazel H Oon
- National Skin Centre (S) Pte Ltd, 1 Mandalay Rd, Singapore, 308205, Singapore.
| | - Ee Chee Ren
- Singapore Immunology Network (SIgN), A*STAR, 8A Biomedical Grove, #03-06, Immunos Building, Singapore, 138648, Singapore. .,Department of Microbiology and Immunology, National University of Singapore, 5 Science Drive 2, MD4, Level 3, Singapore, 117545, Singapore.
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Sandhu S, Sinha P, Shelly D, Bhatt S. A Rare Presentation of Concurrent Onset and Coexistence of Generalized Lichen Planus and Psoriasis in a Child. Indian Dermatol Online J 2020; 11:616-618. [PMID: 32832455 PMCID: PMC7413466 DOI: 10.4103/idoj.idoj_459_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/09/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Independently, psoriasis and lichen planus (LP) are common inflammatory skin conditions affecting around 2–3% and 1% of the population, respectively. However, the coexistence of both diseases is rare. Common immunological mechanisms with altered T-cell-mediated autoimmunity, cytokine milieu, and Koebner phenomenon play a role in their pathogenesis. As reviewed in the literature, psoriasis may independently be associated with other autoimmune conditions like vitiligo, alopecia areata, LP, and discoid lupus erythematosus. A rare co-occurrence of these two or three autoimmune diseases has been reported. Here, we report a case of a 10-year-old boy who presented with persistent nonpruritic multiple hyperpigmented scaly papules and plaques over the body since 6 months of age. Histopathology revealed features suggestive of both LP and psoriasis in the same section. A diagnosis of psoriasis–LP overlap was made, and the patient was managed with tab acitretin 25 mg daily and narrowband ultraviolet B (NBUVB) phototherapy with which he showed satisfactory clearance of the lesions.
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Affiliation(s)
- Sunmeet Sandhu
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Preema Sinha
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Divya Shelly
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Siddharth Bhatt
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
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Stylianaki EA, Karpouzis A, Tripsianis G, Veletza S. Assessment of Gap Junction Protein Beta-2 rs3751385 Gene Polymorphism in Psoriasis Vulgaris. J Clin Med Res 2019; 11:642-650. [PMID: 31523338 PMCID: PMC6731047 DOI: 10.14740/jocmr3845] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 02/05/2023] Open
Abstract
Background Gap junction protein beta 2 (GJB2) upregulation in psoriasis transcriptome analysis as well as connexin 26 (Cx26, encoded by GJB2) expression upregulation in psoriatic plaques has already been substantiated. GJB2 rs72474224 and rs3751385 have been correlated with psoriasis vulgaris incidence in Chinese populations. Here we study the effect of rs3751385 in patients suffering from psoriasis vulgaris in a Caucasian Greek population at the prefecture of Thrace in Northern Greece. Methods One hundred and seventy-three (111 males and 62 females) psoriatic patients (108 were of early-onset psoriasis) and 171 matched controls were included in the study. Genomic DNA was extracted from peripheral blood leukocytes and genotyping was carried out by polymerase chain reaction-restriction-fragment length polymorphism (PCR-RFLP). Results A statistically significant lower frequency of C/T genotype in late-onset male psoriasis vulgaris (P = 0.029) as well as of T allele in female early-onset psoriasis vulgaris (P = 0.049) were ascertained. Conclusions On condition that all other genetic or environmental factors remain stable, the existence and possible interaction between GJB2 rs3751385 C and T alleles in male psoriatic patients may be considered as protective gene component against late-onset psoriasis appearance, while presence of the T allele in female might block the histogenetic mechanisms of early-onset psoriasis lesions.
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Affiliation(s)
- Elli-Anna Stylianaki
- Department of Biology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anthony Karpouzis
- Department of Dermatology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Gregory Tripsianis
- Department of Medical Statistics, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Stavroula Veletza
- Department of Biology, Faculty of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Abstract
Psoriasis is an (auto)immune-mediated disease that manifests as widespread
desquamative erythema. The TNF-α/IL-23/IL-17A axis is crucial to its
pathogenesis, which is demonstrated by its excellent therapeutic response to
biologics that target this axis. There is a strong association between
HLA-C*0602 and psoriasis, and researchers have identified autoantigens that are
restricted to this major histocompatibility class I molecule. These auto-Ags
include LL-37, A disintegrin and metalloprotease domain containing
thrombospondin type 1 motif-like 5 (ADAMTSL5), and keratin 17. IL-17A-producing
T cells have been identified in T cell populations that are reactive to these
auto-Ags. In addition, lipid Ags have surfaced as candidate auto-Ags that
activate IL-17A-producing T cells in a CD1a-restricted manner. In this article,
we review the candidate auto-Ags that may contribute to the activation of the
IL-17A-deviated immune response in psoriasis.
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Affiliation(s)
- Masutaka Furue
- 1 Department of Dermatology, Kyushu University, Fukuoka, Japan
| | - Takafumi Kadono
- 2 Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
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Abstract
Research on psoriasis pathogenesis has largely increased knowledge on skin biology in general. In the past 15 years, breakthroughs in the understanding of the pathogenesis of psoriasis have been translated into targeted and highly effective therapies providing fundamental insights into the pathogenesis of chronic inflammatory diseases with a dominant IL-23/Th17 axis. This review discusses the mechanisms involved in the initiation and development of the disease, as well as the therapeutic options that have arisen from the dissection of the inflammatory psoriatic pathways. Our discussion begins by addressing the inflammatory pathways and key cell types initiating and perpetuating psoriatic inflammation. Next, we describe the role of genetics, associated epigenetic mechanisms, and the interaction of the skin flora in the pathophysiology of psoriasis. Finally, we include a comprehensive review of well-established widely available therapies and novel targeted drugs.
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Boehncke WH, Brembilla NC. Unmet Needs in the Field of Psoriasis: Pathogenesis and Treatment. Clin Rev Allergy Immunol 2019; 55:295-311. [PMID: 28780731 DOI: 10.1007/s12016-017-8634-3] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In times of targeted therapies, innovative therapeutics become tools to further unravel the pathogenesis of the treated disease, thus influencing current pathogenetic concepts. Based on such paradigm shifts, the next generation of novel therapeutic targets might be identified. Psoriasis is a good example for the resulting most fruitful dialog between clinical and fundamental research. As a result of this, the key role of Th17 lymphocytes, some of their effector molecules, as well as mediators contributing to their maturation have been identified, many of these being targeted by some of the most effective drugs currently available to treat psoriasis. During this process, it became obvious that major parts of the puzzle remain yet to be uncovered or understood in much more detail. This review will therefore address the search for additional important effector cells other than Th17 lymphocytes, such as neutrophils, monocytes, and mast cells, mediators other than IL-17A, including some other IL-17 isoforms, and trigger factors such as potential autoantigens. This will lead to discussing the next generation of targeted therapies for psoriasis as well as treatment goals. These goals need to comprise both psoriasis as well as its comorbidities, as a comprehensive approach to manage the whole patient with all his health issues is urgently needed. Finally, given the substantial differences in resources available in different parts of the world, the global burden of psoriasis and options on how to care for patients outside developed countries will be assessed.
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Affiliation(s)
- Wolf-Henning Boehncke
- Divison of Dermatology and Venerology, Geneva University Hospitals, Geneva, Switzerland.
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Costanzo A, Bianchi L, Flori M, Malara G, Stingeni L, Bartezaghi M, Carraro L, Castellino G. Secukinumab shows high efficacy irrespective of HLA-Cw6
status in patients with moderate-to-severe plaque-type psoriasis: SUPREME study. Br J Dermatol 2018; 179:1072-1080. [DOI: 10.1111/bjd.16705] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/16/2022]
Affiliation(s)
- A. Costanzo
- Dermatology Unit; Department of Biomedical Sciences; Humanitas University; Via Alessandro Manzoni 113 Rozzano-Milan 20089 Italy
- Skin Pathology Laboratory; IRCCS Istituto Clinico Humanitas; Via Alessandro Manzoni 113 Rozzano-Milan 20089 Italy
| | - L. Bianchi
- Dermatology; Department of Systems Medicine; Policlinico di Tor Vergata; University of Rome Tor Vergata; Viale Oxford 81 Rome 00133 Italy
| | - M.L. Flori
- Dermatology Section; Department of Clinical Medicine and Immunological Science; University of Siena; Hospital S. Maria alle Scotte; viale Bracci Siena Italy
| | - G. Malara
- Dermatology Department; Grande Ospedale Metrapolitano; Bianchi Melacrino Morelli; 89124 Reggio Calabria Italy
| | - L. Stingeni
- Section of Clinical, Allergological and Venereological Dermatology; Department of Medicine; University of Perugia; Piazza Menghini 1 Perugia 06129 Italy
| | - M. Bartezaghi
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
| | - L. Carraro
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
| | - G. Castellino
- Novartis Farma S.p.A.; Via Saronnino Origgio VA 21042 Italy
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19
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Casciano F, Pigatto PD, Secchiero P, Gambari R, Reali E. T Cell Hierarchy in the Pathogenesis of Psoriasis and Associated Cardiovascular Comorbidities. Front Immunol 2018; 9:1390. [PMID: 29971067 PMCID: PMC6018171 DOI: 10.3389/fimmu.2018.01390] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/05/2018] [Indexed: 12/13/2022] Open
Abstract
The key role of T cells in the pathogenesis of cutaneous psoriasis has been well described in the last decade and the knowledge of the relative role of the different subsets of T cells in psoriasis pathogenesis has considerably evolved. Now, it is clear that IL-17A-producing T cells, including Th17/Tc17, have a central role in the pathogenesis of cutaneous psoriasis and therapies blocking the IL-17A pathway show high clinical efficacy. By contrast, the contribution of IFNγ-producing T cells has progressively become less clear because of the lack of efficacy of anti-IFNγ antibodies in clinical studies. In parallel, the role of CD8+ T cells specific for self-antigens has been revived and increasing evidence now indicates that in psoriatic skin the majority CD8+ T cells are present in the form of epidermal tissue-resident memory T cells. In the last years it also emerged the possibility of a contribution of T cell recirculation in the pathogenesis of psoriasis and its systemic manifestations. The aim of this review is to define a hierarchy for the different subsets of T cells in the T cell-mediated inflammatory cascade in psoriatic skin. This analysis will possibly help to distinguish the subsets that initiate the disease, those involved in the establishment of the self-sustaining amplification loop that leads to the cutaneous clinical manifestations and finally the subsets that act as downstream players in established lesions. Specific T cell subpopulations finally will be considered for their possible role in propagating inflammation at distant sites and for representing a link with systemic inflammation and cardiovascular comorbidities.
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Affiliation(s)
- Fabio Casciano
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Paolo D Pigatto
- Department of Dermatology and Venereology, I.R.C.C.S. Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy
| | - Paola Secchiero
- Department of Morphology, Surgery and Experimental Medicine and LTTA Centre, University of Ferrara, Ferrara, Italy
| | - Roberto Gambari
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Eva Reali
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy.,Laboratory of Translational Immunology, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
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Stawczyk-Macieja M, Szczerkowska-Dobosz A, Rębała K, Gabig-Cimińska M, Nowicki RJ, Haraś A, Cybulska L, Kapińska E. ERAP1 and HLA-C*06 are strongly associated with the risk of psoriasis in the population of northern Poland. Postepy Dermatol Alergol 2018; 35:286-292. [PMID: 30008647 PMCID: PMC6041718 DOI: 10.5114/ada.2018.76226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/13/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION HLA-C*06 is a major psoriasis genetic risk marker. Recent reports have been focused on the role of different polymorphisms within genes involved in the functioning of the epidermal barrier and antigen processing in the pathogenesis of psoriasis. Data on the association between genetic variants of LCE3B_LCE3C, CSTA, ERAP1, ZAP70 and this dermatosis in the population from Eastern Europe are lacking. AIM To compare the association between known genetic risk markers and psoriasis in a cohort of northern Polish patients with psoriasis and healthy controls. MATERIAL AND METHODS Based on previous studies' results, five susceptibility loci: HLA-C, LCE3C_LCE3B, ERAP1, ZAP70 and CSTA were selected for genotyping in 148 patients with chronic plaque psoriasis and 146 healthy controls. Each patient with this disease was clinically assessed with the Psoriasis Area and Severity Index. RESULTS The study population showed a significant association of psoriasis and a single nucleotide polymorphism in the ERAP1 - rs26653 (p = 3.11 × 10-5) and HLA-C*06 allele (p = 1.02 × 10-11) when compared with the control group. The presence of HLA-C*06 or rs26653 G allele significantly increased the risk of psoriasis by 2.4 times or twice, respectively. Carrying rs26653 C allele considerably decreased the risk of psoriasis by 1.5 times. CONCLUSIONS In the context of pathogenesis of psoriasis, our findings might give the evidence on disturbances in the proteolytic processing of N-terminal fragments of antigens presented via major histocompatibility complex class I to T cells.
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Affiliation(s)
- Marta Stawczyk-Macieja
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Rębała
- Department of Forensic Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Magdalena Gabig-Cimińska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, affiliated with the University of Gdansk, Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Haraś
- Department of Forensic Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Lidia Cybulska
- Department of Forensic Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Kapińska
- Department of Forensic Medicine, Medical University of Gdansk, Gdansk, Poland
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Furue K, Ito T, Tsuji G, Kadono T, Nakahara T, Furue M. Autoimmunity and autoimmune co-morbidities in psoriasis. Immunology 2018; 154:21-27. [PMID: 29315555 PMCID: PMC5904708 DOI: 10.1111/imm.12891] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/18/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022] Open
Abstract
Psoriasis is characterized by widespread scaly erythematous plaques that cause significant physical and psychological burdens for the affected individuals. Accelerated inflammation driven by the tumour necrosis factor-α/interleukin-23/interleukin-17 axis is now known to be the major mechanism in the development of psoriasis. In addition, psoriasis has an autoimmune nature that manifests as autoreactive T cells and is co-morbid with other autoimmune diseases, such as autoimmune bullous diseases, vitiligo, alopecia and thyroiditis. In this article, we review the recent topics on autoimmunity and autoimmune co-morbidities in psoriasis.
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Affiliation(s)
| | - Takamichi Ito
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Gaku Tsuji
- Department of DermatologyKyushu UniversityFukuokaJapan
| | - Takafumi Kadono
- Department of DermatologySt Marianna University School of MedicineKawasakiJapan
| | - Takeshi Nakahara
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
| | - Masutaka Furue
- Department of DermatologyKyushu UniversityFukuokaJapan
- Division of Skin Surface SensingDepartment of DermatologyKyushu UniversityFukuokaJapan
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22
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Prinz JC. Human Leukocyte Antigen-Class I Alleles and the Autoreactive T Cell Response in Psoriasis Pathogenesis. Front Immunol 2018; 9:954. [PMID: 29760713 PMCID: PMC5936982 DOI: 10.3389/fimmu.2018.00954] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 04/17/2018] [Indexed: 01/08/2023] Open
Abstract
Psoriasis is a complex immune-mediated inflammatory skin disease characterized by T-cell-driven epidermal hyperplasia. It occurs on a strong genetic predisposition. The human leukocyte antigen (HLA)-class I allele HLA-C*06:02 on psoriasis susceptibility locus 1 (PSORS1 on 6p21.3) is the main psoriasis risk gene. Other HLA-class I alleles encoding HLA molecules presenting overlapping peptide repertoires show associations with psoriasis as well. Outside the major histocompatibility complex region, genome-wide association studies identified more than 60 psoriasis-associated common gene variants exerting only modest individual effects. They mainly refer to innate immune activation and the interleukin-23/Th/c17 pathway. Given their strong risk association, explaining the role of the HLA-risk alleles is essential for elucidating psoriasis pathogenesis. Psoriasis lesions develop upon epidermal infiltration, activation, and expansion of CD8+ T cells. The unbiased analysis of a paradigmatic Vα3S1/Vβ13S1-T-cell receptor from a pathogenic epidermal CD8+ T-cell clone of an HLA-C*06:02+ psoriasis patient had revealed that HLA-C*06:02 directs an autoimmune response against melanocytes through autoantigen presentation, and it identified a peptide form ADAMTS-like protein 5 as an HLA-C*06:02-presented melanocyte autoantigen. These data demonstrate that psoriasis is an autoimmune disease, where the predisposing HLA-class I alleles promote organ-specific inflammation through facilitating a T-cell response against a particular skin-specific cell population. This review discusses the role of HLA-class I alleles in the pathogenic psoriatic T-cell immune response. It concludes that as a principle of T-cell driven HLA-associated inflammatory diseases proinflammatory traits promote autoimmunity in the context of certain HLA molecules that present particular autoantigens.
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Affiliation(s)
- Jörg Christoph Prinz
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany
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Abstract
Psoriasis is a multifactorial disease with a strong genetic background. HLA-Cw6 is one of the most strongly associated psoriasis susceptibility alleles. It is repeatedly observed to affect disease course, phenotypic features, severity, comorbidities and treatment outcomes. To the best of our knowledge, the roles of HLA-Cw6 in psoriasis have not yet been thoroughly reviewed. The worldwide frequency of the HLA-Cw6 allele varies greatly, with it being generally higher in white people than in Asians. The allele is associated with type I early-onset psoriasis. Stress, obesity and streptococcal pharyngitis are commonly observed in HLA-Cw6-positive patients. Phenotypically, HLA-Cw6 has been found to be associated with guttate psoriasis. In addition, patients carrying the allele are more likely to have arm, leg and trunk involvement, and the Koebner phenomenon. Patients with psoriatic arthritis with HLA-Cw6 more often have early onset and tend to show cutaneous symptoms before musculoskeletal symptoms. HLA-Cw6-positive patients have been shown in several studies to be more responsive to methotrexate and ustekinumab. However, this difference in ustekinumab efficacy was only moderate in a post-hoc analysis of a pivotal phase III study. HLA-Cw6 positivity also tends to be less frequent in high-need patients who fail conventional therapy. Small studies have also investigated the role of HLA-Cw6 in remission of psoriasis during pregnancy, and with the comorbidities of photosensitivity and atherosclerosis. Given the diverse nature of psoriasis pathogenesis, as well as the difference of HLA-Cw6 positivity in different ethnic groups, more studies are needed to confirm the role of HLA-Cw6 in psoriasis.
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Affiliation(s)
- L Chen
- Lake Erie College of Osteopathic Medicine, Bradenton, PA, U.S.A
| | - T-F Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
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Mobbs JI, Illing PT, Dudek NL, Brooks AG, Baker DG, Purcell AW, Rossjohn J, Vivian JP. The molecular basis for peptide repertoire selection in the human leucocyte antigen (HLA) C*06:02 molecule. J Biol Chem 2017; 292:17203-17215. [PMID: 28855257 DOI: 10.1074/jbc.m117.806976] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/18/2017] [Indexed: 12/31/2022] Open
Abstract
Human leukocyte antigen (HLA)-C*06:02 is identified as the allele associated with the highest risk for the development of the autoimmune skin disease psoriasis. However, the diversity and mode of peptide presentation by the HLA-C*06:02 molecule remains unclear. Here, we describe the endogenous peptide repertoire of ∼3,000 sequences for HLA-C*06:02 that defines the peptide-binding motif for this HLA allomorph. We found that HLA-C*06:02 predominantly presents nonamer peptides with dominant arginine anchors at the P2 and P7 positions and a preference for small hydrophobic residues at the C terminus (PΩ). To determine the structural basis of this selectivity, we determined crystal structures of HLA-C*06:02 in complex with two self-peptides (ARTELYRSL and ARFNDLRFV) and an analogue of a melanocyte autoantigen (ADAMTSL5, VRSRR-abu-LRL) implicated in psoriasis. These structures revealed that HLA-C*06:02 possesses a deep peptide-binding groove comprising two electronegative B- and E-pockets that coincide with the preference for P2 and P7 arginine anchors. The ADAMTSL5 autoantigen possessed a P7-Leu instead of the P7-Arg residue, but nevertheless was accommodated within the HLA-C*06:02 antigen-binding cleft. Collectively, our results provide the structural basis for understanding peptide repertoire selection in HLA-C*06:02.
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Affiliation(s)
- Jesse I Mobbs
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Patricia T Illing
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Nadine L Dudek
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia
| | - Andrew G Brooks
- the Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne 3000, Australia
| | - Daniel G Baker
- Janssen Research & Development, LLC, Horsham, Philadelphia, Pennsylvania 19044
| | - Anthony W Purcell
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia,
| | - Jamie Rossjohn
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia, .,the Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton 3800, Victoria, Australia, and.,the Institute of Infection and Immunity, Cardiff University, School of Medicine, Cardiff CF14 4XN, Wales, United Kingdom
| | - Julian P Vivian
- From the Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton 3800, Victoria, Australia, .,the Australian Research Council Centre of Excellence in Advanced Molecular Imaging, Monash University, Clayton 3800, Victoria, Australia, and
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Prinz JC. Autoimmune aspects of psoriasis: Heritability and autoantigens. Autoimmun Rev 2017; 16:970-979. [PMID: 28705779 DOI: 10.1016/j.autrev.2017.07.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/10/2017] [Indexed: 12/28/2022]
Abstract
Chronic immune-mediated disorders (IMDs) constitute a major health burden. Understanding IMD pathogenesis is facing two major constraints: Missing heritability explaining familial clustering, and missing autoantigens. Pinpointing IMD risk genes and autoimmune targets, however, is of fundamental importance for developing novel causal therapies. The strongest association of all IMDs is seen with human leukocyte antigen (HLA) alleles. Using psoriasis as an IMD model this article reviews the pathogenic role HLA molecules may have within the polygenic predisposition of IMDs. It concludes that disease-associated HLA alleles account for both missing heritability and autoimmune mechanisms by facilitating tissue-specific autoimmune responses through autoantigen presentation.
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Affiliation(s)
- Jörg Christoph Prinz
- Department of Dermatology, University Clinics, Ludwig-Maximilian-University of Munich, Munich, Germany.
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Rajesh D, Chowdappa C, Gurumurthy R, Kutty AVM, Balakrishna S. Profile of Tumour Necrosis Factor Alpha -308 G/A Gene Polymorphism in Psoriatic Patients in Karnataka, India. J Clin Diagn Res 2017; 11:GC01-GC04. [PMID: 28384885 DOI: 10.7860/jcdr/2017/24909.9411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/21/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tumour necrosis factor-alpha (TNFα) gene -308G/A polymorphism (rs1800629) are associated with psoriasis in several populations worldwide. Presently, there is no literature on the status of this polymorphism in the South Indian population. AIM To determine the profile of TNFα -308G/A polymorphism among psoriatic patients. MATERIALS AND METHODS This case-control study involved 74 patients with Psoriasis Vulgaris (PsV) and 74 age and gender matched healthy individuals. Patients were recruited from the Department of Dermatology of R.L. Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka, India, from March 2014 to March 2016. TNFα -308G/A polymorphism was genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. RESULTS The frequency of TNFα -308A allele 7.4% among psoriatic and 8.8% among non-psoriatic individuals. The difference was not statistically significant (p=0.82). CONCLUSION Our results indicate that TNFα gene -308G/A polymorphism is not a significant marker for the risk of developing PsV among South Indian (Karnataka) psoriatic patients.
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Affiliation(s)
- Deepa Rajesh
- Research Assistant, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Chaitra Chowdappa
- Postgraduate Student, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Rajesh Gurumurthy
- Assistant Professor, Department of Dermatology, Sri Devaraj Urs Medical College , Kolar, Karnataka, India
| | - A V Moideen Kutty
- Professor, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
| | - Sharath Balakrishna
- Assistant Professor, Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka, India
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Rajesh D, Gurumurthy R, Kutty AVM, Balakrishna S. Tumor necrosis factor alpha gene promoter -238G/A polymorphism increases the risk of psoriasis vulgaris in Indian patients. Int J Dermatol 2017; 56:307-311. [PMID: 28093730 DOI: 10.1111/ijd.13482] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/07/2016] [Accepted: 09/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumor necrosis factor alpha (TNFα) gene -238G/A polymorphism (rs361525) is associated with psoriasis in several populations worldwide. To the best of our knowledge, there is no information about this polymorphism in Indian psoriatic patients. This study was undertaken to fill the gap in knowledge. METHODS This case-control study involved 72 patients with psoriasis vulgaris (PsV) and 72 age and gender matched healthy individuals. TNFα -238G/A polymorphism was genotyped by PCR-RFLP method. RESULTS TNFα -238A allele was 5 times commoner in PsV patients than in the control group (P = 4.1 × 10-7 ; odds ratio [OR] = 6.5 [0.95 CI: 2.9-14.6]). Distribution of the genotypes in the two groups showed statistically significant difference in dominant genetic model (P = 2.3 × 10-7 ) and not in recessive genetic model (P = 2.5 × 10-1 ). Odds ratio for the occurrence of -238A genotype in PsV patients was 8.8 (0.95 CI: 3.5-20.2). The association showed no major difference when PsV patients were subgrouped into type I and type II categories and tested separately. Subgroup analysis on the basis of disease severity showed higher association with the moderate-severe subgroup (P = 2.4 × 10-9 , OR 15.4 [0.95 CI: 5.8-41.0]) than with mild subgroup (P = 1.3 × 10-2 , OR 3.8 [0.95 CI: 1.3-10.9]). CONCLUSIONS Our results indicate that TNFα gene -238G/A polymorphism increases the risk of developing psoriasis vulgaris among Indians. Also, the data show that severity and not the type affects the strength of association in this population.
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Affiliation(s)
- Deepa Rajesh
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Rajesh Gurumurthy
- Department of Dermatology, Sri Devaraj Urs Medical College, Kolar, India
| | - A V Moideen Kutty
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
| | - Sharath Balakrishna
- Department of Cell Biology and Molecular Genetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, India
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Hwang ST, Nijsten T, Elder JT. Recent Highlights in Psoriasis Research. J Invest Dermatol 2017; 137:550-556. [PMID: 28063651 DOI: 10.1016/j.jid.2016.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
This article highlights recent advances in the immunology, epidemiology, and genetics/genomics of psoriasis. Advances sometimes generate more questions, and this article makes an attempt to point out where controversies might exist in the literature. Many of the articles mentioned were published in the Journal of Investigative Dermatology, but many articles from the broader scientific literature are also cited, to provide context and to add further validity for some of these key findings. Among the themes we explore are the identification of antigens in psoriasis, the co-morbidities of psoriasis, and novel integrative approaches to genome-wide association studies.
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Affiliation(s)
- Samuel T Hwang
- Department of Dermatology, University of California, Davis, Sacramento, California, USA.
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Burg. 's Jacobplein 51, 3015 CA Rotterdam, The Netherlands
| | - James T Elder
- Department of Dermatology, University of Michigan, 1301 East Catherine, Ann Arbor, Michigan, USA; Department of Dermatology, Ann Arbor Veterans Affairs Hospital, 2215 Fuller Rd, Ann Arbor, Michigan, USA
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HLA-C*06:02 Allele and Response to IL-12/23 Inhibition: Results from the Ustekinumab Phase 3 Psoriasis Program. J Invest Dermatol 2016; 136:2364-2371. [DOI: 10.1016/j.jid.2016.06.631] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/08/2016] [Accepted: 06/29/2016] [Indexed: 12/21/2022]
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Stawczyk-Macieja M, Rębała K, Szczerkowska-Dobosz A, Wysocka J, Cybulska L, Kapińska E, Haraś A, Miniszewska P, Nowicki R. Evaluation of Psoriasis Genetic Risk Based on Five Susceptibility Markers in a Population from Northern Poland. PLoS One 2016; 11:e0163185. [PMID: 27658291 PMCID: PMC5033405 DOI: 10.1371/journal.pone.0163185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022] Open
Abstract
Psoriasis genetic background depends on polygenic and multifactorial mode of inheritance. As in other complex disorders, the estimation of the disease risk based on individual genetic variants is impossible. For this reason, recent investigations have been focused on combinations of known psoriasis susceptibility markers in order to improve the disease risk evaluation. Our aim was to compare psoriasis genetic risk score (GRS) for five susceptibility loci involved in the immunological response (HLA-C, ERAP1, ZAP70) and in the skin barrier function (LCE3, CSTA) between patients with chronic plaque psoriasis (n = 148) and the control group (n = 146). A significantly higher number of predisposing alleles was observed in patients with psoriasis in comparison to healthy individuals (6.1 vs. 5.2, respectively; P = 8.8×10−7). The statistical significance was even more profound when GRS weighted by logarithm odds ratios was evaluated (P = 9.9×10−14). Our results demonstrate the developed panel of five susceptibility loci to be more efficient in predicting psoriasis risk in the Polish population and to possess higher sensitivity and specificity for the disease than any of the markers analyzed separately, including the most informative HLA-C*06 allele.
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Affiliation(s)
- Marta Stawczyk-Macieja
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
- * E-mail:
| | - Krzysztof Rębała
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Aneta Szczerkowska-Dobosz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Joanna Wysocka
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Lidia Cybulska
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Ewa Kapińska
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Agnieszka Haraś
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Paulina Miniszewska
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Roman Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
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Thorleifsdottir RH, Sigurdardottir SL, Sigurgeirsson B, Olafsson JH, Petersen H, Sigurdsson MI, Gudjonsson JE, Johnston A, Valdimarsson H. HLA-Cw6 homozygosity in plaque psoriasis is associated with streptococcal throat infections and pronounced improvement after tonsillectomy: A prospective case series. J Am Acad Dermatol 2016; 75:889-896. [PMID: 27520394 DOI: 10.1016/j.jaad.2016.06.061] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Carriage of the HLA-Cw*0602 allele is associated with a particular set of clinical features and treatment responses in psoriasis. Tonsillectomy can improve psoriasis. OBJECTIVES We sought to evaluate whether HLA-Cw*0602 predicts a favorable outcome after tonsillectomy of patients with psoriasis. METHODS This prospective case series followed up 28 tonsillectomized patients with plaque psoriasis for 24 months. The Psoriasis Area and Severity Index, Psoriasis Disability Index, and Psoriasis Life Stress Inventory were used for assessment. Tonsils were swabbed for bacteria and patients genotyped for HLA-Cw*0602. RESULTS After tonsillectomy, HLA-Cw*0602 homozygotes showed significantly more improvement, compared with heterozygous and HLA-Cw*0602-negative patients. Thus, Psoriasis Area and Severity Index score was reduced by 82% in the homozygous patients compared with 42% and 31%, respectively (P < .001), Psoriasis Disability Index score improved by 87% compared with 38% and 41%, respectively (P < .001), and Psoriasis Life Stress Inventory score was 82% reduced compared with 60% and 54%, respectively (P < .001). The homozygotes more often had psoriasis onset associated with a throat infection (P = .007) and an increased frequency of streptococcal throat infections per lifetime (P = .038). LIMITATIONS Few patients were included and some data were retrospective. CONCLUSIONS Homozygous HLA-Cw*0602 carriage in plaque psoriasis may predict a favorable outcome after tonsillectomy.
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Affiliation(s)
- Ragna H Thorleifsdottir
- Section of Dermatology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Immunology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland; Department of Dermatology, Akademiska University Hospital, Uppsala, Sweden.
| | - Sigrun L Sigurdardottir
- Department of Immunology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Bardur Sigurgeirsson
- Section of Dermatology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jon H Olafsson
- Section of Dermatology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Hannes Petersen
- Department of Otolaryngology-Head and Neck Surgery, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin I Sigurdsson
- Department of Anesthesiology and Critical Care, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew Johnston
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Helgi Valdimarsson
- Department of Immunology, Landspitali-National University Hospital of Iceland, Reykjavik, Iceland
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Sukhov A, Adamopoulos IE, Maverakis E. Interactions of the Immune System with Skin and Bone Tissue in Psoriatic Arthritis: A Comprehensive Review. Clin Rev Allergy Immunol 2016; 51:87-99. [PMID: 26780035 PMCID: PMC6080719 DOI: 10.1007/s12016-016-8529-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Cutaneous psoriasis (e.g., psoriasis vulgaris (PsV)) and psoriatic arthritis (PsA) are complex heterogeneous diseases thought to have similar pathophysiology. The soluble and cellular mediators of these closely related diseases are being elucidated through genetic approaches such as genome-wide association studies (GWAS), as well as animal and molecular models. Novel therapeutics targeting these mediators (IL-12, IL-23, IL-17, IL-17 receptor, TNF) are effective in treating both the skin and joint manifestations of psoriasis, reaffirming the shared pathophysiology of PsV and PsA. However, the molecular and cellular interactions between skin and joint disease have not been well characterized. Clearly, PsV and PsA are highly variable in terms of their clinical manifestations, and this heterogeneity can partially be explained by differences in HLA-associations (HLA-Cw*0602 versus HLA-B*27, for example). In addition, there are numerous other genetic susceptibility loci (LCE3, CARD14, NOS2, NFKBIA, PSMA6, ERAP1, TRAF3IP2, IL12RB2, IL23R, IL12B, TNIP1, TNFAIP3, TYK2) and geoepidemiologic factors that contribute to the wide variability seen in psoriasis. Herein, we review the complex interplay between the genetic, cellular, ethnic, and geographic mediators of psoriasis, focusing on the shared mechanisms of PsV and PsA.
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Affiliation(s)
- Andrea Sukhov
- Department of Dermatology, University of California, Davis, 3301 C St. Suite 1400, Sacramento, CA, 95816, USA
| | - Iannis E Adamopoulos
- Department of Internal Medicine, Division of Rheumatology, Allergy and Clinical Immunology, School of Medicine, University of California, CA, Davis, USA
| | - Emanual Maverakis
- Department of Dermatology, University of California, Davis, 3301 C St. Suite 1400, Sacramento, CA, 95816, USA.
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Chen M, Wang Y, Yao X, Li C, Jiang M, Cui P, Wang B. Hypermethylation of HLA-C may be an epigenetic marker in psoriasis. J Dermatol Sci 2016; 83:10-6. [DOI: 10.1016/j.jdermsci.2016.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/13/2016] [Accepted: 04/13/2016] [Indexed: 10/22/2022]
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[Autoimmune reactions in psoriasis : Spotlight]. Hautarzt 2016; 67:432-7. [PMID: 27178039 DOI: 10.1007/s00105-016-3799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Psoriasis is a human leukocyte antigen (HLA)-associated T‑cell-mediated disorder. OBJECTIVES The role of the main psoriasis risk allele HLA-C*06:02 in disease manifestation and the mechanisms which activate the pathogenic T‑cell response in the skin of psoriasis patients remained elusive. MATERIALS AND METHODS Key to the immune pathogenesis of psoriasis was the analysis of the specificity of the infiltrating lesional psoriatic CD8(+) T cells RESULTS AND CONCLUSION Analyses of the lesional psoriatic T‑cell reactivity demonstrate that psoriasis is an autoimmune disease. It is based on an autoimmune response against melanocytes which is preferentially mediated by HLA-C*06:02 through autoantigen presentation. Here we discuss the mechanisms of this autoimmune response in the context of the polygenic psoriatic predisposition.
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Indhumathi S, Rajappa M, Chandrashekar L, Ananthanarayanan PH, Thappa DM, Negi VS. The HLA-C*06 allele as a possible genetic predisposing factor to psoriasis in South Indian Tamils. Arch Dermatol Res 2016; 308:193-9. [PMID: 26796545 DOI: 10.1007/s00403-016-1618-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/23/2015] [Accepted: 01/06/2016] [Indexed: 12/16/2022]
Abstract
Psoriasis is a multi-factorial heritable prototypical immune-mediated inflammatory disease, characterized by hyperproliferation of keratinocytes in the affected skin. There are no studies till date, to the best of our knowledge, about the association of HLA-C*06, the risk variant in the PSORS 1 susceptibility locus that confers the greatest risk for early onset of psoriasis, with the disease in South Indian Tamil patients with psoriasis. The present study was performed to determine the association of HLA-C*06 with psoriasis in the South Indian Tamil ethnic population. Three hundred and fifty-five cases of psoriasis and 360 healthy controls were included in this case-control study. Severity grading according to psoriasis area severity index (PASI) scoring was done in patients with psoriasis. PCR assays with sequence-specific primers (PCR-SSP) were used for specific detection of HLA-C*06. PCR with analysis of restriction fragment length polymorphism was used to distinguish between patients homozygous and heterozygous for HLA-C*06. We observed that those with the HLA-C*06-positive allele had a 3.5 times higher odds of having psoriasis compared to those without, [p < 0.0001, OR 3.5, 95 % CI (2.59-4.79)]. Among cases of psoriasis, it was noted that there was a significant association of HLA-C*06 positivity with female psoriatics [p = 0.006; OR 2.49 (1.28-4.87)] and early age of onset of psoriasis [p = 0.002; OR 2.04 (1.29-3.20)]. Our results suggest that the HLA-C*06 allele is positively associated with susceptibility to psoriasis, female gender and early onset of psoriasis in South Indian Tamils.
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Affiliation(s)
- S Indhumathi
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
| | - Medha Rajappa
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India.
| | - Laxmisha Chandrashekar
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - P H Ananthanarayanan
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006, India
| | - D M Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V S Negi
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Arakawa A, Siewert K, Stöhr J, Besgen P, Kim SM, Rühl G, Nickel J, Vollmer S, Thomas P, Krebs S, Pinkert S, Spannagl M, Held K, Kammerbauer C, Besch R, Dornmair K, Prinz JC. Melanocyte antigen triggers autoimmunity in human psoriasis. J Exp Med 2015; 212:2203-12. [PMID: 26621454 PMCID: PMC4689169 DOI: 10.1084/jem.20151093] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/04/2015] [Indexed: 12/21/2022] Open
Abstract
Psoriasis vulgaris is a common T cell-mediated inflammatory skin disease with a suspected autoimmune pathogenesis. The human leukocyte antigen (HLA) class I allele, HLA-C*06:02, is the main psoriasis risk gene. Epidermal CD8(+) T cells are essential for psoriasis development. Functional implications of HLA-C*06:02 and mechanisms of lesional T cell activation in psoriasis, however, remained elusive. Here we identify melanocytes as skin-specific target cells of an HLA-C*06:02-restricted psoriatic T cell response. We found that a Vα3S1/Vβ13S1 T cell receptor (TCR), which we had reconstituted from an epidermal CD8(+) T cell clone of an HLA-C*06:02-positive psoriasis patient specifically recognizes HLA-C*06:02-positive melanocytes. Through peptide library screening, we identified ADAMTS-like protein 5 (ADAMTSL5) as an HLA-C*06:02-presented melanocytic autoantigen of the Vα3S1/Vβ13S1 TCR. Consistent with the Vα3S1/Vβ13S1-TCR reactivity, we observed numerous CD8(+) T cells in psoriasis lesions attacking melanocytes, the only epidermal cells expressing ADAMTSL5. Furthermore, ADAMTSL5 stimulation induced the psoriasis signature cytokine, IL-17A, in CD8(+) T cells from psoriasis patients only, supporting a role as psoriatic autoantigen. This unbiased analysis of a TCR obtained directly from tissue-infiltrating CD8(+) T cells reveals that in psoriasis HLA-C*06:02 directs an autoimmune response against melanocytes through autoantigen presentation. We propose that HLA-C*06:02 may predispose to psoriasis via this newly identified autoimmune pathway.
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Affiliation(s)
- Akiko Arakawa
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Katherina Siewert
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, D-82152 Planegg-Martinsried, Germany
| | - Julia Stöhr
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Petra Besgen
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Song-Min Kim
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Geraldine Rühl
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, D-82152 Planegg-Martinsried, Germany
| | - Jens Nickel
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Sigrid Vollmer
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Peter Thomas
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Stefan Krebs
- Gene Center Munich, Ludwig-Maximilian-University, D-81377 Munich, Germany
| | - Stefan Pinkert
- German Cancer Research Center, D-69120 Heidelberg, Germany
| | - Michael Spannagl
- Laboratory of Immunogenetics and Molecular Diagnostics, Ludwig-Maximilian-University, D-81377 Munich, Germany
| | - Kathrin Held
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, D-82152 Planegg-Martinsried, Germany
| | - Claudia Kammerbauer
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Robert Besch
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
| | - Klaus Dornmair
- Institute of Clinical Neuroimmunology, Ludwig-Maximilian-University, D-82152 Planegg-Martinsried, Germany
| | - Jörg C Prinz
- Department of Dermatology, Ludwig-Maximilian-University, D-80337 Munich, Germany
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Sathishkumar D, George R, Daniel D, Peter JV. Clinical profile of childhood-onset psoriasis and prevalence of HLA-Cw6: a hospital-based study from India. Postgrad Med J 2015; 91:309-14. [DOI: 10.1136/postgradmedj-2014-133188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/19/2015] [Indexed: 12/27/2022]
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Sbidian E, Eftekahri P, Viguier M, Laroche L, Chosidow O, Gosselin P, Trouche F, Bonnet N, Arfi C, Tubach F, Bachelez H. National Survey of Psoriasis Flares after 2009 Monovalent H1N1/Seasonal Vaccines. Dermatology 2014; 229:130-5. [DOI: 10.1159/000362808] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 04/03/2014] [Indexed: 11/19/2022] Open
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Abstract
Psoriasis is a common chronic inflammatory skin disease with a spectrum of clinical phenotypes and results from the interplay of genetic, environmental, and immunological factors. Four decades of clinical and basic research on psoriasis have elucidated many of the pathogenic mechanisms underlying disease and paved the way to effective targeted therapies. Here, we review this progress and identify future directions of study that are supported by a more integrative research approach and aim at further improving the patients' life.
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Affiliation(s)
- Paola Di Meglio
- Molecular Immunology, Medical Research Council National Institute for Medical Research, London NW7 1AA, United Kingdom
| | - Federica Villanova
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom National Institute for Health Research GSTT/KCL Comprehensive Biomedical Research Centre, Guy's and St. Thomas' National Health Service Foundation Trust, London SE1 9RT, United Kingdom
| | - Frank O Nestle
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom National Institute for Health Research GSTT/KCL Comprehensive Biomedical Research Centre, Guy's and St. Thomas' National Health Service Foundation Trust, London SE1 9RT, United Kingdom
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Puig L, Julià A, Marsal S. Psoriasis: bases genéticas y patogenéticas. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:535-45. [DOI: 10.1016/j.ad.2012.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 11/08/2012] [Accepted: 11/17/2012] [Indexed: 01/05/2023] Open
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Abstract
Psoriasis is a chronic, inflammatory, immune-mediated skin condition with a prevalence of 0-11.8% across the world. It is associated with a number of cardiovascular, metabolic, and autoimmune disease co-morbidities. Psoriasis is a multifactorial disorder, influenced by both genetic and environmental factors. Its genetic basis has long been established through twin studies and familial clustering. The association of psoriasis with the HLA-Cw6 allele has been shown in many studies. Recent genome-wide association studies have identified a large number of other genes associated with psoriasis. Many of these genes regulate the innate and adaptive immune system. These findings indicate that a dysregulated immune system may play a major role in the pathogenesis of psoriasis. In this article, we review the clinical and genetic epidemiology of psoriasis with a brief description of the pathogenesis of disease.
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Affiliation(s)
- Rashmi Gupta
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
| | - Maya G Debbaneh
- University of California, San Francisco, Department of Dermatology, San Francisco, CA ; University of California, Irvine, School of Medicine, Irvine, CA
| | - Wilson Liao
- University of California, San Francisco, Department of Dermatology, San Francisco, CA
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43
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Abstract
Psoriasis is a chronic immunological disorder that affects the joints and skin. The disease is strongly correlated with genetic predisposition and environmental factors that can act as triggers of the innate and adaptive immune response. Once this immune response has begun many different signaling factors lead to inflammation and plaques which are visible throughout the body. As psoriasis progresses, it strongly affects the mental and physical health of the individual. This article reviews the different types of psoriasis, genetic and environmental triggers of psoriasis, the molecular progression of psoriasis, and current and future therapies.
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Affiliation(s)
- Sudesh S Raju
- Department of Chemistry, School of Arts and Sciences, University of Pennsylvania, 231 S. 34th Street, Philadelphia, PA 19104-6323, USA
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Radtke MA, Beikert FC, Augustin M. Nail psoriasis - a treatment challenge. J Dtsch Dermatol Ges 2013; 11:203-19; quiz 220. [PMID: 23425398 DOI: 10.1111/ddg.12054] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nail involvement in psoriasis is common and mostly occurs with other lesions but can also occur alone. Besides psychosocial and aesthetic impairments, patients often complain about functional impairment. Nail psoriasis is a predictor for more severe psoriasis, decreased quality of life, and a higher risk for the development of psoriatic arthritis. Onychomycosis and other differential diagnoses should be excluded prior to treatment. This article presents an overview of different clinical appearances of nail psoriasis, the essential diagnostic assessment before treatment, important differential diagnoses, and published data on treatment options for nail psoriasis.
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Affiliation(s)
- Marc A Radtke
- CVderm, Institute for Health Services Research in Dermatology and Nursing, University Medical Center of Hamburg-Eppendorf, Germany.
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Wu K, Reynolds N. Predicting response to anti-interleukin 12/23 treatment in psoriasis. Br J Dermatol 2013; 169:240-1. [DOI: 10.1111/bjd.12405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K.C.P. Wu
- Dermatological Sciences; Institute of Cellular Medicine; William Leech Building, Newcastle University Newcastle Upon Tyne NE2 4HH U.K
| | - N.J. Reynolds
- Dermatological Sciences; Institute of Cellular Medicine; William Leech Building, Newcastle University Newcastle Upon Tyne NE2 4HH U.K
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Umapathy S, Pawar A, Mitra R, Khuperkar D, Devaraj JP, Ghosh K, Khopkar U. Hla-a and hla-B alleles associated in psoriasis patients from mumbai, Western India. Indian J Dermatol 2012; 56:497-500. [PMID: 22121262 PMCID: PMC3221207 DOI: 10.4103/0019-5154.87128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Psoriasis, a common autoimmune disorder characterized by T cell-mediated keratinocyte hyperproliferation, is known to be associated with the presence of certain specific Human Leukocyte Antigen (HLA) alleles. AIM To evaluate distribution of HLA-A and HLA-B alleles and hence identify the susceptible allele of psoriasis from patients in Western India. MATERIALS AND METHODS The study design included 84 psoriasis patients and 291 normal individuals as controls from same geographical region. HLA-A and HLA-B typing was done using Serology typing. Standard statistical analysis was followed to identify the odds ratio (OR), allele frequencies, and significant P value using Graphpad software. RESULTS The study revealed significant increase in frequencies of HLA-A2 (OR-3.976, P<0.0001), B8 (OR-5.647, P<0.0001), B17 (OR-5.452, P<0.0001), and B44 (OR-50.460, P<0.0001), when compared with controls. Furthermore, the frequencies of HLA-A28 (OR-0.074, P=0.0024), B5 (OR-0.059, P<0.0001), B12 (OR-0.051, P=0.0002), and B15 (OR-0.237, P=0.0230) were significantly decreased in psoriasis patients. CONCLUSION This study shows the strong association of HLA-A2, B8, and B17 antigens with psoriasis conferring susceptibility to psoriasis patients from Western India, while the antigens HLA-A28, B5, and B12 show strong negative association with the disease.
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Affiliation(s)
- Shankarkumar Umapathy
- National Institute of Immunohaematology, Indian Council of Medical Research, 13 Floor, K.E.M. Hospital, Parel, Mumbai, India
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Nast A, Boehncke WH, Mrowietz U, Ockenfels HM, Philipp S, Reich K, Rosenbach T, Sammain A, Schlaeger M, Sebastian M, Sterry W, Streit V, Augustin M, Erdmann R, Klaus J, Koza J, Muller S, Orzechowski HD, Rosumeck S, Schmid-Ott G, Weberschock T, Rzany B. S3 - Guidelines on the treatment of psoriasis vulgaris (English version). Update. J Dtsch Dermatol Ges 2012; 10 Suppl 2:S1-95. [PMID: 22386073 DOI: 10.1111/j.1610-0387.2012.07919.x] [Citation(s) in RCA: 210] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psoriasis vulgaris is a common and often chronic inflammatory skin disease. The incidence of psoriasis in Western industrialized countries ranges from 1.5% to 2%. Patients afflicted with severe psoriasis vulgaris may experience a significant reduction in quality of life. Despite the large variety of treatment options available, surveys have shown that patients still do not received optimal treatments. To optimize the treatment of psoriasis in Germany, the Deutsche Dermatologi sche Gesellschaft (DDG) and the Berufsverband Deutscher Dermatologen (BVDD) have initiated a project to develop evidence-based guidelines for the management of psoriasis. They were first published in 2006 and updated in 2011. The Guidelines focus on induction therapy in cases of mild, moderate and severe plaque-type psoriasis in adults including systemic therapy, UV therapy and topical therapies. The therapeutic recommendations were developed based on the results of a systematic literature search and were finalized during a consensus meeting using structured consensus methods (nominal group process).
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Affiliation(s)
- Alexander Nast
- Division of Evidence Based Medicine (dEBM), Klinik für Dermatologie, Venerologie und Allergologie, Charité- Universitätsmedizin Berlin, Germany
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Chiu H, Huang PY, Jee SH, Hu CY, Chou CT, Chang YT, Hwang CY, Tsai TF. HLA polymorphism among Chinese patients with chronic plaque psoriasis: subgroup analysis. Br J Dermatol 2012; 166:288-97. [DOI: 10.1111/j.1365-2133.2011.10688.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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49
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Abstract
Psoriasis is a common relapsing and remitting immune-mediated inflammatory disease that affects the skin and joints. This review focuses on current immunogenetic concepts, key cellular players, and axes of cytokines that are thought to contribute to disease pathogenesis. We highlight potential therapeutic targets and give an overview of the currently used immune-targeted therapies.
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Affiliation(s)
- Gayathri K Perera
- St. John's Institute of Dermatology, King's College London, London SE1 9RT, United Kingdom.
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50
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Wu D, Wu Y, Liu J, Wang B, Zhang X. Association between HLA-Cw*0602 polymorphism and psoriasis risk: a meta-analysis. GENETICS AND MOLECULAR RESEARCH 2011; 10:3109-20. [DOI: 10.4238/2011.december.15.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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