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Tittes J, Brell J, Fritz P, Jonak C, Stary G, Ressler JM, Künig S, Weninger W, Stöckl J. Regulation of the Immune Cell Repertoire in Psoriasis Patients Upon Blockade of IL-17A or TNFα. Dermatol Ther (Heidelb) 2024; 14:613-626. [PMID: 38459237 PMCID: PMC10965886 DOI: 10.1007/s13555-024-01112-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/08/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Targeting of the proinflammatory cytokine interleukin 17A (IL-17A) or tumor necrosis factor alpha (TNFα) with the monoclonal antibodies (mAbs) ixekizumab or adalimumab, respectively, is a successful therapy for chronic plaque psoriasis. The effects of these treatments on immune cell populations in the skin are largely unknown. METHODS In this study, we compared the composition of cutaneous, lesional and non-lesional immune cells and blood immune cells in ixekizumab- or adalimumab-treated patients with psoriasis. RESULTS Our data reveal that both treatments efficiently downregulate T cells, macrophages and different subsets of dendritic cells (DCs) in lesional skin towards levels of healthy skin. In contrast to lesional skin, non-lesional areas in patients harbor only few or no detectable DCs compared to the skin of healthy subjects. Treatment with neither ixekizumab nor adalimumab reversed this DC imbalance in non-lesional skin of psoriatic patients. CONCLUSION Our study shows that anti-IL-17A and anti-TNFα therapy rebalances the immune cell repertoire of lesional skin in psoriatic patients but fails to restore the disturbed immune cell repertoire in non-lesional skin.
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Affiliation(s)
- Julia Tittes
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Jennifer Brell
- Institute of Immunology, Medical University of Vienna, Lazarettgasse 19, 1090, Vienna, Austria
| | - Pia Fritz
- Institute of Immunology, Medical University of Vienna, Lazarettgasse 19, 1090, Vienna, Austria
| | - Constanze Jonak
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Julia M Ressler
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sarojinidevi Künig
- Institute of Immunology, Medical University of Vienna, Lazarettgasse 19, 1090, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Johannes Stöckl
- Institute of Immunology, Medical University of Vienna, Lazarettgasse 19, 1090, Vienna, Austria
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Kulawik-Pióro A, Miastkowska M. Polymeric Gels and Their Application in the Treatment of Psoriasis Vulgaris: A Review. Int J Mol Sci 2021; 22:ijms22105124. [PMID: 34066105 PMCID: PMC8151792 DOI: 10.3390/ijms22105124] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 01/03/2023] Open
Abstract
Psoriasis is a chronic skin disease, and it is especially characterized by the occurrence of red, itchy, and scaly eruptions on the skin. The quality of life of patients with psoriasis is decreased because this disease remains incurable, despite the rapid progress of therapeutic methods and the introduction of many innovative antipsoriatic drugs. Moreover, many patients with psoriasis are dissatisfied with their current treatment methods and the form with which the drug is applied. The patients complain about skin irritation, clothing stains, unpleasant smell, or excessive viscosity of the preparation. The causes of these issues should be linked with little effectiveness of the therapy caused by low permeation of the drug into the skin, as well as patients’ disobeying doctors’ recommendations, e.g., concerning regular application of the preparation. Both of these factors are closely related to the physicochemical form of the preparation and its rheological and mechanical properties. To improve the quality of patients’ lives, it is important to gain knowledge about the specific form of the drug and its effect on the safety and efficacy of a therapy as well as the patients’ comfort during application. Therefore, we present a literature review and a detailed analysis of the composition, rheological properties, and mechanical properties of polymeric gels as an alternative to viscous and greasy ointments. We discuss the following polymeric gels: hydrogels, oleogels, emulgels, and bigels. In our opinion, they have many characteristics (i.e., safety, effectiveness, desired durability, acceptance by patients), which can contribute to the development of an effective and, at the same time comfortable, method of local treatment of psoriasis for patients.
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Affiliation(s)
| | - Małgorzata Miastkowska
- Correspondence: (A.K.-P.); (M.M.); Tel.: +48-1-2628-2740 (A.K.-P.); +48-1-2628-3072 (M.M.)
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3
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Silvagni E, Bortoluzzi A, Ciancio G, Govoni M. Biological and synthetic target DMARDs in psoriatic arthritis. Pharmacol Res 2019; 149:104473. [PMID: 31585178 DOI: 10.1016/j.phrs.2019.104473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 09/30/2019] [Indexed: 12/29/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic multi-faceted immune-mediated systemic disorder, characterized by articular, cutaneous, enthesis, nail and spine involvement. Articular manifestations of PsA are particularly common and highly disabling for patients, while the heterogeneous clinical subsets of the disease are challenging for clinicians. In recent years, research has made many advances in understanding the pathogenesis of the disease from genetic, epigenetic and molecular points of view. New drugs are now available for the treatment of this condition, and, in particular, TNF-alfa inhibitors, historically the first biologicals approved in PsA, are now juxtaposed by new biological disease modifying anti-rheumatic drugs (bDMARDs) with different modes of action. Targeting IL-12/IL-23 p40 common subunit with ustekinumab, IL-17A with secukinumab and ixekizumab, T cells co-stimulation with abatacept, is now possible, safe and effective. Moreover, targeted synthetic molecules with oral administration are available, with the possibility to interfere with phosphodiesterase-4 and JAK/STAT pathways. Indeed, new drugs are under development, with the possibility to target selectively IL-17 receptor, IL-23, and other key molecular targets in the pathogenesis of this condition. In this narrative review, we provide an up-to-date overview of the current application of biological and targeted synthetic DMARDs in the field of PsA, with particular regard to the clinical significance of this possibility to target a higher number of distinct immune-pathways.
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Affiliation(s)
- Ettore Silvagni
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Ferrara, Italy
| | - Alessandra Bortoluzzi
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Ferrara, Italy
| | - Giovanni Ciancio
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Ferrara, Italy.
| | - Marcello Govoni
- Department of Medical Sciences, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Ferrara, Italy
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4
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Costanza G, Doldo E, Ferlosio A, Tarquini C, Passeri D, Cascella R, Bavetta M, Di Stefani A, Bonifati C, Agostinelli S, Centofanti F, Giardina E, Campione E, Bianchi L, Donati P, Morrone A, Orlandi A. Expression and potential role of cellular retinol binding protein I in psoriasis. Oncotarget 2018; 9:36736-36749. [PMID: 30613363 PMCID: PMC6298411 DOI: 10.18632/oncotarget.26314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022] Open
Abstract
Psoriasis is a diffuse chronic skin disorder characterized from accelerated epidermal turnover and inflammatory cell infiltrate. Retinoids influence keratinocyte proliferation and differentiation as well as inflammatory response. Cellular retinol binding protein (CRBPI) regulates intracellular vitamin A bioavailability and contributes to maintain skin homeostasis. The aim of present study was to investigate the expression of CRBPI and its role in the pathogenesis of skin psoriasis. Immunohistochemistry revealed more diffuse and increased CRBPI expression in all epidermal layers of human psoriatic lesions except in the stratum corneum. An imiquimod-induced psoriatic-like model documented the increase of skin lesional area and severity index score as well as of the severity of microscopic features as parakeratosis, papillomatosis and spongiosis in CRBPI-knockout compared to wild-type mice, associated to the increased keratinocyte CK17 and Ki-67 expression and the reduction of CK1, CRABPII and RXRα. Gene array of imiquimod-induced psoriatic skin documented the greater up-regulation of EGF/PDGF-related genes and down-regulation of EGR1 and pro-inflammatory IL-related genes in CRBPI-knockout compared to wild-type mice. Finally, CRBPI transfection in HaCaT cells increased AKT and NF-κB-related genes and proteins and down-regulated IL-2, IL-6 and IL-8 pro-inflammatory signalling. Although not recognized as a psoriatic susceptibility gene in our cohort of patients, the present data strongly supported the potential role of CRBPI to sustain keratinocyte proliferation and differentiation and to counteract pro-inflammatory genes expression in psoriatic lesions.
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Affiliation(s)
- Gaetana Costanza
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.,San Gallicano Dermatology Institute, Rome, Italy
| | - Elena Doldo
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Amedeo Ferlosio
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Chiara Tarquini
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Daniela Passeri
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Raffaella Cascella
- Genetics Laboratory, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Mauro Bavetta
- Dermatology Unit, Tor Vergata University of Rome, Policlinic of Tor Vergata of Rome, Rome, Italy
| | - Alessandro Di Stefani
- Dermatology Unit, Tor Vergata University of Rome, Policlinic of Tor Vergata of Rome, Rome, Italy
| | | | - Sara Agostinelli
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Federica Centofanti
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Emiliano Giardina
- Genetics Laboratory, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Elena Campione
- Dermatology Unit, Tor Vergata University of Rome, Policlinic of Tor Vergata of Rome, Rome, Italy
| | - Luca Bianchi
- Dermatology Unit, Tor Vergata University of Rome, Policlinic of Tor Vergata of Rome, Rome, Italy
| | | | - Aldo Morrone
- San Gallicano Dermatology Institute, Rome, Italy
| | - Augusto Orlandi
- Anatomic Pathology Unit, Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy.,Catholic University "Our Lady of Good Counsel", Tirana, Albania
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5
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Hanssen SCA, van der Vleuten CJM, van Erp PEJ, Seyger MMB, van de Kerkhof PCM. The effect of adalimumab on the vasculature in psoriatic skin lesions. J DERMATOL TREAT 2018; 30:221-226. [DOI: 10.1080/09546634.2018.1506082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- S. C. A. Hanssen
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
| | | | - P. E. J. van Erp
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
| | - M. M. B. Seyger
- Department of dermatology, Radboud University Medical Centre, Nijmegen, GA, the Netherlands
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6
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Abstract
Psoriasis is a common skin disease that presents with well-demarcated patches of inflammation. Recurrent disease in fixed areas of the skin indicates a localized disease memory that is preserved in resolved lesions. In line with such concept, the involvement of tissue-resident immune cells in psoriasis pathology is increasingly appreciated. Langerhans cells (LCs) are perfectly placed to steer resident T cells and local tissue responses in psoriasis. Here, we present an overview of the current knowledge of LCs in human psoriasis, including findings that highlight pro-inflammatory features of LCs in psoriasis lesions. We also review the literature on conflicting data regarding LC localization and functionality in psoriasis. Our review highlights that further studies are needed to elucidate the molecular mechanisms that drive LCs functionality in inflammatory diseases.
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Affiliation(s)
- Liv Eidsmo
- Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Elisa Martini
- Department of Medicine Solna, Karolinska Institutet, Solna, Sweden.,Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
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7
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Raaby L, Rosada C, Langkilde A, Lauridsen KL, Vinter H, Ommen P, Kjellerup RB, Johansen C, Iversen L. Langerhans cell markers CD1a and CD207 are the most rapidly responding genes in lesional psoriatic skin following adalimumab treatment. Exp Dermatol 2017; 26:804-810. [PMID: 28109175 DOI: 10.1111/exd.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/29/2022]
Abstract
TNFα-, IL-23- and IL-17-targeting drugs are highly effective in the treatment of psoriasis. However, the precise molecular mechanism remains unknown. In psoriatic skin, the presence of Langerhans cells (LCs) is reduced, but the role of LC is poorly understood. The purpose of this study was to investigate the impact of TNFα and IL-23/IL-17 on the presence of LC in the skin during treatment. Therefore, psoriatic skin was investigated before and after 4 days of adalimumab or ustekinumab treatment. Furthermore, TNFα and IL-17A stimulation was investigated in an ex vivo model of epidermis and dermis from healthy normal skin kept in cultures at an air-liquid interphase for 4 days. In a gene array analysis, we found that the two LC markers, CD1a and CD207, were among the most up- or downregulated genes in psoriatic skin after anti-TNFα therapy. Validation showed that both mRNA expression and protein level followed the same pattern and became significantly upregulated after 4 days of treatment. No changes were seen after ustekinumab treatment. In the ex vivo skin model, a decrease in the CD1a level was seen after TNFα stimulation and it was caused by LC migration from epidermis. No response in LC migration was seen after IL-17A stimulation. Taken together, we demonstrated that changes in the LC level in epidermis precede the histological and clinical changes during adalimumab treatment in psoriatic skin. Furthermore, TNFα plays a prominent role in orchestrating LC migration in the skin. This seems not to be the true for the IL-23/IL-17A pathway.
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Affiliation(s)
- Line Raaby
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Cecilia Rosada
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Ane Langkilde
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hanne Vinter
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Pernille Ommen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Claus Johansen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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8
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Chow M, Lai K, Ahn R, Gupta R, Arron S, Liao W. Effect of Adalimumab on Gene Expression Profiles of Psoriatic Skin and Blood. J Drugs Dermatol 2016; 15:988-994. [PMID: 27538000 PMCID: PMC5995115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adalimumab is an anti-TNF biologic drug that is efficacious in the treatment of psoriasis. However, the effect of adalimumab on genome-wide gene expression changes in skin and peripheral blood is not well characterized.<BR /> METHODS Thirty adult subjects with > 10% body surface area of chronic plaque psoriasis were recruited for the study. Lesional skin and peripheral blood mononuclear cell samples prior to and one month following treatment with adalimumab were collected. The skin samples were analyzed using genome-wide RNAseq, and the blood samples were analyzed using genome-wide Affymetrix microarrays. Data preprocessing and analysis were conducted using the EdgeR and Affy packages in R/Bioconductor.<BR /> RESULTS In the skin, paired analysis before and after treatment revealed changes in pathways important to epidermal development and keratinocyte differentiation. Such important genes as keratin 6A and 6B, tubulin B6, desmocollin, and desmoglein 3 were among the top differentially expressed genes. In peripheral blood, pathways involved in hematopoetic cell lineage and immune response were found to be differentially expressed, including genes such as the Fc receptor-like A and 5, as well as immunoglobulin heavy chains. Using a principal components approach, we show that expression of genes in post-treatment skin more closely resembles that of healthy controls.<BR /> CONCLUSION Treatment of psoriasis with adalimumab appears to be associated with modulation of keratinocyte and epidermal proliferation in the skin and with immunologic changes in the blood. We discuss the ramifications of these findings for the treatment for psoriasis.<BR /><BR /> <em>J Drugs Dermatol</em>. 2016;15(8):988-994.
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Torres T, Romanelli M, Chiricozzi A. A revolutionary therapeutic approach for psoriasis: bispecific biological agents. Expert Opin Investig Drugs 2016; 25:751-4. [DOI: 10.1080/13543784.2016.1187130] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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Gupta R, Ahn R, Lai K, Mullins E, Debbaneh M, Dimon M, Arron S, Liao W. Landscape of Long Noncoding RNAs in Psoriatic and Healthy Skin. J Invest Dermatol 2015; 136:603-609. [PMID: 27015450 DOI: 10.1016/j.jid.2015.12.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 11/28/2022]
Abstract
We used RNA sequencing to study and characterize the long noncoding RNA (lncRNA) transcriptome in lesional skin from psoriasis patients before (PP) and after treatment (PT) with adalimumab and in normal skin from healthy individuals (NN). To this end, we sequenced total RNA from 18 psoriasis patients and 16 healthy controls. We merged three lncRNA reference datasets to create a single combined reference of 67,157 lncRNA transcripts with no overlaps. We identified differential expression of 971 lncRNAs between PP and NN, 157 between PP and PT, and 377 between PT and NN. Using differentially expressed lncRNAs between PP and NN, we identified a molecular lncRNA signature that distinguishes psoriatic skin from healthy skin. Furthermore, we performed an unsupervised hierarchical analysis that revealed distinct clustering of PP samples from NN. A coding noncoding network analysis revealed a large network of highly correlated lncRNA and protein coding transcripts that provided insight into the potential functions of unannotated lncRNAs. To the best of our knowledge, this description of both polyadenylated as well as nonpolyadenylated lncRNA transcripts in psoriasis has not been previously reported. Our findings highlight the potential importance of lncRNAs in the biology of psoriasis and response to treatment.
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Affiliation(s)
- Rashmi Gupta
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Richard Ahn
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Kevin Lai
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Elizabeth Mullins
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Maya Debbaneh
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Michelle Dimon
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Arron
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
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12
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Goldminz AM, Suárez-Fariñas M, Wang AC, Dumont N, Krueger JG, Gottlieb AB. CCL20 and IL22 Messenger RNA Expression After Adalimumab vs Methotrexate Treatment of Psoriasis: A Randomized Clinical Trial. JAMA Dermatol 2015; 151:837-46. [PMID: 25946554 PMCID: PMC5788701 DOI: 10.1001/jamadermatol.2015.0452] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Methotrexate is a first-line systemic agent for treating of psoriasis, although its onset of effects is slower and overall it is less effective than tumor necrosis factor blockers. OBJECTIVE To differentiate the response of psoriatic disease to adalimumab and methotrexate sodium. DESIGN, SETTING, AND PARTICIPANTS Single-center, randomized, assessor-blind, 2-arm clinical trial of 30 patients from the outpatient dermatology center of Tufts Medical Center, enrolled from August 18, 2009, to October 11, 2011. Patients aged 18 to 85 years with chronic plaque-type psoriasis, a minimum Physician Global Assessment score of 3 (higher scores indicate more severe disease), and a psoriatic plaque of at least 2 cm were randomized in a 1:1 fashion to receive subcutaneous adalimumab or oral methotrexate. Skin biopsy specimens obtained at baseline and weeks 1, 2, 4, and 16 were given a histologic grade by blinded assessors to evaluate treatment response. Analyses were conducted from April 16, 2013, to January 5, 2015. INTERVENTIONS A 16-week course of subcutaneous adalimumab (40 mg every 2 weeks after a loading dose) or low-dosage oral methotrexate sodium (7.5-25 mg/wk). MAIN OUTCOMES AND MEASURES Changes in genomic, immunohistochemical, and messenger RNA (mRNA) profiles. RESULTS Methotrexate responders experienced significant downregulation of helper T-cell-related (T(H)1, T(H)17, and T(H)22) mRNA expression compared with methotrexate nonresponders. Comparisons among adalimumab-treated patients were limited by the number of nonresponders (n = 1). Between adalimumab and methotrexate responders, we found no significant differences in gene expression at any study point or in the expression of T-cell-related mRNA at week 16. Adalimumab responders demonstrated early downregulation of chemokine (C-C motif) ligand 20 (CCL20) mRNA (mean [SE] at week 2, -1.83 [0.52], P < .001; week 16, -3.55 [0.54], P < .001) compared with late downregulation for methotrexate responders (week 2, 0.02 [0.51], P = .96; week 16, -2.96 [0.51], P < .001). Similar differences were observed with interleukin 22 (IL22) mRNA showing early downregulation for adalimumab responders (week 2, -3.17 [1.00], P < .001; week 16, -3.58 [1.00], P < .001) compared with late downregulation for methotrexate responders (week 2, -0.44 [0.68], P = .64; week 16, -5.14 [0.68], P < .001). Analysis of variance findings for key mRNA and immunohistochemical marker expression over the study course were significant only for CCL20 (P = .03) and IL22 (P = .006) mRNA comparing adalimumab and methotrexate responders. CONCLUSIONS AND RELEVANCE Methotrexate is an immunomodulator with effects on helper T-cell signaling in psoriasis. Similar genomic and immunohistochemical response signatures and levels of mRNA downregulation at study completion among adalimumab and methotrexate responders suggest a disease-driven instead of therapeutic-driven pathway regulation. Adalimumab and methotrexate responses are differentiated by patterns of normalization of CCL20 and IL22 mRNA expression and may explain the varied onset and degree of clinical responses by each treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00932113.
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Affiliation(s)
- Ari M Goldminz
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Mayte Suárez-Fariñas
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
| | - Andrew C Wang
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Nicole Dumont
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
| | - Alice B Gottlieb
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
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13
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D'Amico F, Trovato C, Skarmoutsou E, Rossi GA, Granata M, Longo V, Gangemi P, Pettinato M, Mazzarino MC. Effects of adalimumab, etanercept and ustekinumab on the expression of psoriasin (S100A7) in psoriatic skin. J Dermatol Sci 2015; 80:38-44. [PMID: 26276441 DOI: 10.1016/j.jdermsci.2015.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psoriasis is a chronic inflammatory skin disease. It is characterized by immune cell activation and altered epidermal differentiation. S100A7 (psoriasin) is overexpressed in psoriasis, suggesting a determinant role of this protein in inflammation and keratinocyte differentiation. OBJECTIVE The purpose of this study was to investigate the expression of S100A7 in the skin from psoriatic patients undergoing biological therapy with adalimumab, etanercept or ustekinumab. METHODS S100A7 expression and distribution were analyzed by immunohistochemistry. RESULTS S100A7, overexpressed in epidermal keratinocytes of psoriatic lesions, was downregulated, under the biological therapy with adalimumab, etanercept or ustekinumab, only in patients achieving a PASI score<15. CONCLUSIONS Dysregulation of S100A7 may represent a non-negligible player in the maintenance of psoriasis and the relative epidermal changes. Blockage of S100A7 may represent an additional therapeutic approach in the treatment of psoriasis.
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Affiliation(s)
- Fabio D'Amico
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy.
| | - Chiara Trovato
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Evangelia Skarmoutsou
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Giulio A Rossi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Mariagrazia Granata
- Department of Biomedical and Biotechnological Sciences, University of Catania, Italy
| | - Valentina Longo
- Unità Operativa Complessa di Dermatologia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Pietro Gangemi
- Servizio di Anatomia Patologica, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
| | - Maurizio Pettinato
- Unità Operativa Complessa di Dermatologia, Azienda Ospedaliera Universitaria Policlinico-Vittorio Emanuele, Catania, Italy
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Raaby L, Langkilde A, Kjellerup RB, Vinter H, Khatib SH, Hjuler KF, Johansen C, Iversen L. Changes in mRNA expression precede changes in microRNA expression in lesional psoriatic skin during treatment with adalimumab. Br J Dermatol 2015; 173:436-47. [PMID: 25662483 DOI: 10.1111/bjd.13721] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-α inhibition is an effective treatment for moderate to severe plaque-type psoriasis. A change in the cytokine expression profile occurs in the skin after 4 days of treatment, preceding any clinical or histological improvements. MicroRNAs (miRNAs) are important post-transcriptional regulators of gene expression, but miRNA expression has never been studied in psoriatic skin during treatment. OBJECTIVE To investigate changes in miRNA expression in psoriatic skin during adalimumab treatment and to compare results with changes in miRNA expression in a mouse model of Aldara-induced psoriasis-like skin inflammation. METHODS Punch biopsies were obtained from nonlesional and lesional psoriatic skin during adalimumab treatment. In the mouse model of Aldara-induced skin inflammation, biopsies were obtained from TNF-α knockout (KO), IL-17A KO and wild-type mice. miRNA expression levels were analysed with microarray, reverse transcriptase quantitative polymerase chain reaction and in situ hybridization. RESULTS In psoriatic skin, no changes in miRNA expression were seen 4 days after treatment initiation. After 14 days of treatment, the expression of several miRNAs was normalized towards the level seen in nonlesional skin before treatment. miR-23b expression increased after 14 days of treatment and remained high for 84 days, despite unaltered levels at baseline. In the mouse model of Aldara-induced skin inflammation, the level of miR-146a increased, whereas no regulation was seen for miR-203, miR-214-3p, miR-125a, miR-23b or let-7d-5p. CONCLUSIONS This study demonstrates that the changes seen in the cytokine expression levels after 4 days of treatment with adalimumab are not facilitated by early changes in miRNA expression.
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Affiliation(s)
- L Raaby
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - A Langkilde
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - R B Kjellerup
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - H Vinter
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - S H Khatib
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - K F Hjuler
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - C Johansen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - L Iversen
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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