Photochemotherapy in Psoriasis: A Review

Emerging Pathophysiological Targets of Psoriasis for Future Therapeutic Strategies

Psoriasis is a chronic autoimmune skin disorder which involves complex interactions between genes, keratinocytes, T-cells and inflammatory cells. It affects 2-3% population worldwide. Molecular biology and cellular immunology of psoriasis, when linked with biotechnology and genetic studies can help researchers to understand the pathophysiology of psoriasis. T-cells activation, keratinocyte hyperproliferation, and angiogenesis are the core mechanisms entailed in the development of psoriasis lesion. Investigators are trying to overcome the challenges of complex pathophysiology pathways involved in this disorder. The different possible hypotheses for its pathophysiology such as growth factors, enzymes, inflammation, and genetic factors mediated pathophysiology have been described in the present review paper in detail. Clinically available drugs only control the symptoms of psoriasis but are not effective for the treatment of the disorder completely and are also associated with some side effects such as itching, renal disorders, hematologic, nonmelanoma skin cancer, pulmonary, gastrointestinal toxicity, etc. This paper made an effort to understand the pathophysiological targets, discuss the research done so far and the treatments available for the effective management of psoriasis.

Treatment Strategies Against Psoriasis: Principle, Perspectives and Practices

BACKGROUND

Psoriasis is a genetically predisposed autoimmune disease mediated by cytokines released by the activated immune cells. It manifests inflammatory, scaly red or white silvery flaky skin which may be a fluid-filled lesion with soreness and itchiness. The prevalence rate of psoriasis is increasing day by day. Despite having such a high prevalence rate, the treatment of psoriasis is still limited. Hence, there is a need to rethink the various treatment strategies available in the allopathic as well as in the alternative systems of medicine.

METHODS

Various bibliographic databases of previously published peer-reviewed research papers were explored and systematic data culminated in terms of various treatment strategies used for the management of psoriasis. The prime focus is given towards modern as well as alternative systems of medicine such as phototherapy, a combination of phototherapy with pharmacotherapy such as Ayurveda, Yoga and naturopathy, Unani, Siddha, and Homeopathy to treat psoriasis.

RESULTS

A comprehensive review of 161 papers, including both research and review articles, was carried out to make the article readily understandable. The pathogenesis including inflammatory mediators and type of psoriasis is discussed before the treatment strategies to understand the pathophysiology of the disease. The uniqueness, procedure, advantages, and limitations of conventional, advanced, and traditional systems of medicine to treat psoriasis are discussed in detail. Emphasis has also been given towards marine sources such as fish oil, marine sponges, and algae.

CONCLUSION

Although there are many modern and alternative treatment strategies available to treat psoriasis, none of them have been proven to provide complete relief to patients. Moreover, they are associated with certain side effects. In order to overcome them, novel drug delivery systems have been utilized and found effective; however, their stability and safety become the major impediments towards their successful positioning. Traditional and alternative treatment strategies have found to be safe and effective but their use is localized to certain areas. In a nutshell, to achieve successful treatment of psoriasis, there is a need to focus on the development of stable and non-toxic novel drug delivery systems or the promotion of traditional systems to treat psoriasis.

Enhanced Malignant Phenotypes of Glioblastoma Cells Surviving NPe6-Mediated Photodynamic Therapy are Regulated via ERK1/2 Activation

To manage refractory and invasive glioblastomas (GBM)s, photodynamic therapy (PDT) using talaporfin sodium (NPe6) (NPe6-PDT) was recently approved in clinical practice. However, the molecular machineries regulating resistance against NPe6-PDT in GBMs and mechanisms underlying the changes in GBM phenotypes following NPe6-PDT remain unknown. Herein, we established an in vitro NPe6-mediated PDT model using human GBM cell lines. NPe6-PDT induced GBM cell death in a NPe6 dose-dependent manner. However, this NPe6-PDT-induced GBM cell death was not completely blocked by the pan-caspase inhibitor, suggesting NPe6-PDT induces both caspase-dependent and -independent cell death. Moreover, treatment with poly (ADP-ribose) polymerase inhibitor blocked NPe6-PDT-triggered caspase-independent GBM cell death. Next, it was also revealed resistance to re-NPe6-PDT of GBM cells and GBM stem cells survived following NPe6-PDT (NPe6-PDT-R cells), as well as migration and invasion of NPe6-PDT-R cells were enhanced. Immunoblotting of NPe6-PDT-R cells to assess the behavior of the proteins that are known to be stress-induced revealed that only ERK1/2 activation exhibited the same trend as migration. Importantly, treatment with the MEK1/2 inhibitor trametinib reversed resistance against re-NPe6-PDT and suppressed the enhanced migration and invasion of NPe6-PDT-R cells. Overall, enhanced ERK1/2 activation is suggested as a key regulator of elevated malignant phenotypes of GBM cells surviving NPe6-PDT and is therefore considered as a potential therapeutic target against GBM.

Essential Dynamics of an Effective Phototherapeutic Drug in a Nanoscopic Delivery Vehicle: Psoralen in Ethosomes for Biofilm Treatment

Appropriate localization of a drug and its structure/functional integrity in a delivery agent essentially dictates the efficacy of the vehicle and the medicinal activity of the drug. In the case of a phototherapeutic drug, its photoinduced dynamics becomes an added parameter. Here, we have explored the photoinduced dynamical events of a model phototherapeutic drug psoralen (PSO) in a potential delivery vehicle called an ethosome. Dynamic light scattering confirms the structural integrity of the ethosome vehicle after the encapsulation of PSO. Steady state and picosecond resolved polarization gated spectroscopy, including the well-known strategy of solvation and Förster resonance energy transfer, reveal the localization of the drug in the vehicle and the environment in the proximity of PSO. We have also investigated the efficacy of drug delivery to various individual bacteria (Gram-negative: Escherichia coli; Gram-positive: Staphylococcus aureus) and bacterial biofilms. Our optical and electron microscopic studies reveal a significant reduction in bacterial survival (∼70%) and the destruction of bacterial adherence following a change in the morphology of the biofilms after phototherapy. Our studies are expected to find relevance in the formulation of drug delivery agents in several skin diseases and biofilm formation in artificial implants.

Plants and plant products with potential antipsoriatic activity--a review

CONTEXT

Psoriasis vulgaris is a hyper proliferative, autoimmune skin disorder affecting 1-3% of the world's population. The prescribed synthetic drugs for the treatment of psoriasis are associated with severe side effects, thus, researchers around the globe are searching for new, effective, and safer drugs from natural resources.

OBJECTIVE

The present review has been prepared with an objective to compile exhaustive literature on pharmacological reports on antipsoriatic plants, plant products, and formulations. An attempt has been made to incorporate chemical constituents (with structures) isolated from different plants responsible for antipsoriatic activity and their possible mechanism of actions in this review.

MATERIALS AND METHODS

The review has been compiled using references from major databases like Chemical Abstracts, Medicinal and Aromatic Plants Abstracts, PubMed, Scirus, Google scholar, Open J Gate, Scopus, Science Direct and Online Journals, and includes 127 references.

RESULTS

A survey of literature revealed that extracts/fractions/isolates from 18 plants, 23 chemical constituents of plant origin and 40 plant-based formulations from various systems of medicine have been reported to possess antipsoriatic activity, and 37 antipsoriatic formulations containing plants have been patented.

CONCLUSION

Preliminary antipsoriatic activity studies have been carried out on crude extracts of traditionally used and medicinally promising plants. Such plants need to be explored properly with a view to isolate antipsoriatic constituents, and to evaluate their possible mode of actions so that these plant drugs could be exploited properly as potential antipsoriatic drugs.

Position paper--PUVA therapy. American Academy of Dermatology

PUVA, the combination of psoralen (P) and long-wave ultraviolet radiation (UVA), is being used increasingly in the management of psoriasis and several other dermatologic disorders. While the acute toxicity of this modality, which includes erythema and blistering of the skin, can be avoided with careful monitoring of the dosimetry of the administered radiation, the potential chronic toxicity remains a source of concern. Since psoralens and UVA are clearly mutagenic, carcinogenic, cataractogenic, and may have as yet poorly understood effects on the immune system, it is imperative that all patients treated with this modality be carefully monitored for the development of neoplasia and cataracts. PUVA therapy should only be administered using specialized equipment that can be accurately monitored for its spectral irradiance by physicians thoroughly familiar with the risks and benefits of the modality.

Spectroscopic study of the dar interaction and of the photoreaction between a new monofunctional psoralen: 3-carbethoxy psoralen, and DNA

3-carbethoxypsoralen (3-CPs) is a new linear psoralen derivative. Its dark interaction and photoreaction with DNA has been studied and compared with that of a well known bifunctional psoralen : 8-methoxypsoralen (8-MOP). 3-CPs is able to form in the dark a non covalent complex with native DNA. After irradiation of this complex with UV-A light (365 nm) 3-CPs is able to link covalently to DNA. Heat denaturation and renaturation patterns of treated DNA clearly show that, in contrast to 8-MOP, 3-CPs does not form DNA interstrand cross links. Fluorescence studies show that the photobinding of 3-CPs gives rise to the formation of monoadducts involving the 4',5' double bond of this molecule.