Serum levels of angiogenesis-related factors in patients with psoriasis

VEGF in psoriatic arthritis: Systematic review and meta-analysis

Psoriatic arthritis (PsA), a chronic autoimmune disease of unclear aetiology, is associated with dysregulated angiogenesis due to the proliferation, migration, and differentiation of endothelial cells. Vascular endothelial growth factor (VEGF) plays a key role such that PsA patients exhibit skin and joint symptoms, e.g., pain and stiffness, with morphologic alterations in blood vessels. To more fully examine this phenomenon, a systematic review and meta-analysis compliant with the PRISMA guidelines (PROSPERO CRD42024572653) was conducted using subgroup and meta-regression analyses. Secondary analyses on disease activity and response to treatment were also included. In the twelve selected studies, VEGF was significantly higher in PsA vs healthy controls (SMD = 0.544, 95 % CI 0.253-0.835;p < 0.001) with moderate heterogeneity across studies. Subgroup analysis revealed that the SMD in prospectively conducted studies was significantly higher vs those conducted retrospectively (p = 0.005). Furthermore, methotrexate or sulfasalazine treatment did not affect VEGF which remained significantly higher than controls. Moreover, VEGF was lower in those with inactive disease and in those receiving disease modifying agents in pre-post studies. These findings suggest that VEGF is a promising candidate biomarker in PsA and worthy of further prospective studies to investigate its utility in monitoring disease progress and response to treatment.

Insight into adenosine pathway in psoriasis: Elucidating its role and the potential therapeutical applications

Psoriasis is an inflammatory skin disease, that can manifest as different phenotypes, however its most common form is psoriasis vulgaris (plaque psoriasis), characterized by abnormal keratinocyte proliferation, leading to characteristic histopathological signs of acanthosis, hyperkeratosis and parakeratosis. For many years, there has been a debate regarding whether keratinocyte dysfunction leads to immune system dysregulation in psoriasis or vice versa. It is now understood that epidermal hyperplasia results from immune system activation. Besides epidermal hyperplasia, psoriatic skin shows leukocyte infiltration, evident angiogenesis in the papillary dermis, characterized by tortuous, dilated capillaries, as well as oedema. There is substantial early evidence that adenosine is a key mediator of the immune response; it derives from ATP hydrolysis and accumulates into tissue in response to systemic and local stress conditions, hypoxia, metabolic stress, inflammation. Adenosine controls several cell functions by signalling through its 4 receptor subtypes, A1, A2A, A2B and A3. Evidence suggests that adenosine may play a role in psoriasis pathogenesis by controlling several immune cell functions, keratinocyte proliferation, neo-angiogenesis. Expression of adenosine receptor varies in psoriatic skin, and this can significantly impact on tissue homeostasis. Indeed, an altered adenosine receptor profile may contribute to the dysregulation observed in psoriasis, affecting immune responses and inflammatory pathways. Here, we discuss the role of adenosine in regulating the functions of the main cell populations implied in the pathogenesis of psoriasis. Furthermore, we give evidence for adenosine signalling pathway as target for therapeutic intervention in psoriasis.

Direct impact of psoriasis on gingival crevicular fluid levels of VEGF-A in periodontitis patients: a mediation analysis

Introduction

Emerging evidence suggests that psoriasis and periodontitis are linked via systemic inflammation. However, the role of angiogenesis as an additional connecting mechanism between these diseases remains unclear.

Methods

This case control study explored the effect of psoriasis on the gingival crevicular fluid (GCF) levels of vascular endothelial growth factor A (VEGF-A) in patients with different stages of periodontitis. Thirty-one patients with psoriasis (P) and thirty healthy controls (C) underwent physical and intraoral evaluations, with diagnoses confirmed by dermatologists and periodontists. GCF VEGF-A was measured using a multiplex-bead immunoassay. Statistical analyses included Fisher exact tests, Student's T-tests, linear regression models, and mediation analyses.

Results

Psoriasis patients had significantly lower GCF VEGF-A levels compared to controls (p=0.008). Psoriasis was negatively associated with GCF VEGF-A (p=0.006), while severe periodontitis was positively associated with GCF VEGF-A levels, regardless of tobacco use (p=0.027). Further analyses revealed that severe periodontitis significantly increased GCF VEGF-A levels only in the C group (p=0.038), but not in psoriasis patients (p>0.610). Mediation analyses confirmed a significant direct and total effect of psoriasis on GCF VEGF-A (p>0.002), with no significant indirect effect through periodontitis (p=0.699).

Discussion

Psoriasis and severe periodontitis are associated with GCF levels of VEGF-A in opposite and independent ways. In subjects with psoriasis, the impact of the dermatosis is direct with no mediation from periodontitis.

Abnormal dermal microvascular endothelial cells in psoriatic excessive angiogenesis

Psoriasis is characterized by excessive angiogenesis, with increased distortion and dilation of the dermal blood vessels. These vascular alterations are ascribed, at least in part, to the changes in dermal microvascular endothelial cell functions. However, despite the recognition of vascular normalization as an emerging strategy for the treatment of psoriasis, in-depth studies of human dermal microvascular endothelial cells (HDMECs) have been missing. The difficulty of isolation and culture of HDMECs has impeded the study of endothelial dysfunction in psoriasis. Researchers have done a great deal of work to study the abnormal characteristics of keratinocytes, fibroblasts, and leukocytes in psoriatic skin tissue. Recently, with successful isolation of HDMECs from psoriasis, great progress has been made in the elucidation of the pathogenic role of these cells in psoriasis. It is of great therapeutic significance to study the molecular mechanism of HDMECs in psoriasis. We review here the abnormalities of HDMECs in psoriasis.

An Overview of Growth Factors as the Potential Link between Psoriasis and Metabolic Syndrome

Psoriasis is a chronic, complex, and immunologically mediated systemic disease that not only affects the skin, but also the joints and nails. It may coexist with various other disorders, such as depression, psoriatic arthritis, cardiovascular diseases, diabetes mellitus, and metabolic syndrome. In particular, the potential link between psoriasis and metabolic syndrome is an issue worthy of attention. The dysregulation of growth factors could potentially contribute to the disturbances of keratinocyte proliferation, inflammation, and itch severity. However, the pathophysiology of psoriasis and its comorbidities, such as metabolic syndrome, remains incompletely elucidated. Growth factors and their abnormal metabolism may be a potential link connecting these conditions. Overall, the objective of this review is to analyze the role of growth factor disturbances in both psoriasis and metabolic syndrome.

Examining the functions of the vascular endothelial growth factor/hypoxia-inducible factor signaling pathway in psoriatic arthritis

Objectives

The present study aimed to examine the roles of the vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), and heme oxygenase-1 (HO-1) in psoriatic arthritis (PsA).

Patients and methods

In this cross-sectional study conducted between November 2020 and May 2021, 64 patients (43 female, 21 male; mean age: 43.2±10.4 years; range, 22 to 60 years) with active PsA were included in the patient group, and 64 healthy volunteers (43 female, 21 male; mean age: 42.8±10.5 years; range, 23 to 61 years) were included in the control group. The demographic features of all cases were recorded. The following indices were used to assess the activity of PsA: Bath Ankylosing Spondylitis Disease Activity Index, Disease Activity Score in 28 joints (DAS28), and Visual Analog Scale. Additionally, Disease Activity in Psoriatic Arthritis (DAPSA) and Psoriasis Area and Severity Index (PASI) were used to evaluate the patients. The biochemical parameters of the patients were calculated. The serum levels of VEGF, HIF, and HO-1 were determined using an enzyme-linked immunosorbent assay.

Results

When the molecule levels and clinical features of the groups were evaluated, it was found that the VEGF and HIF-1 levels were higher in the patient group compared to the control group (p<0.05). No difference was observed in the comparison of the HO-1 levels of the patient group and the control group (p<0.05). A positive correlation was found between VEGF, HIF-1, and HO-1 (p<0.05). A positive relationship was found between VEGF and HIF-1 and erythrocyte sedimentation rate, C-reactive protein, DAPSA score, and PASI score (p<0.05). It was also determined that there was a positive relationship between the HIF molecule and DAS28 (p<0.05).

Conclusion

According to the results obtained in the present study, VEGF and HIF play a role in the etiology of PsA, and the observation of intermolecular correlation suggests that these molecules move together in pathogenesis.