Cardiovascular and Metabolic Diseases Comorbid with Psoriasis: Beyond the Skin

Identification of Hub Genes in Comorbidity of Psoriasis and Vitiligo Using Bioinformatics Analysis

Background

Psoriasis and vitiligo are two common autoimmune skin diseases with increased risk of comorbidities, but the common molecular mechanism about the occurrence of these two diseases is still unknown.

Objective

This study aimed to identify the combined genetic profiles and evaluate the potential mechanism underlying the occurrence of this complication.

Methods

The Gene Expression Omnibus (GEO) database was used to obtain the gene expression profiles of psoriasis (GSE30999) and vitiligo (GSE75819), and common differentially expressed genes (DEGs) were identified using GEO2R. DEGs were analyzed using functional enrichment analysis, protein-protein interaction (PPI) network and module construction, hub gene identification, and co-expression analysis. And hub genes were identified using Cytoscape software, and the gene expression of hub genes were validated in psoriasis (GSE13355) and vitiligo (GSE65127) datasets and immunohistochemistry at the clinical sample.

Results

A total of 164 common DEGs with the same trend (137 upregulated and 27 downregulated) were selected for subsequent analysis. Functional analysis emphasized the important roles of the cell cycle and mitotic cell division, cytoskeletal reorganization, and chromatin remodeling in the complications of these two diseases. Fourteen important hub genes were identified, including BUB1, CEP55, CDK1, TOP2A, CENPF, PBK, MELK, CCNB2, MAD2L1, NUSAP1, TTK, NEK2, CDKN3, and PTTG1. Cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) may be an important immune checkpoint in the pathogenesis of the comorbidities.

Conclusion

Our study identified hub genes and potential mechanisms underlying psoriasis and vitiligo complications. And we proposed a new spatio-temporal theory and the probable immune checkpoint for the pathogenesis of the comorbidity which may provide new ideas for the further research.

A Review of MicroRNAs and lncRNAs in Atherosclerosis as Well as Some Major Inflammatory Conditions Affecting Atherosclerosis

It is generally accepted that atherosclerosis is a chronic inflammatory disease. The link between atherosclerosis and other inflammatory diseases such as psoriasis, type 2 diabetes mellitus (T2DM), and rheumatoid arthritis (RA) via metabolic, inflammatory, and immunoregulatory pathways is well established. The aim of our review was to summarize the associations between selected microRNAs (miRs) and long non-coding RNAs (lncRNAs) and atherosclerosis, psoriasis, T2DM, and RA. We reviewed the role of miR-146a, miR-210, miR-143, miR-223, miR-126, miR-21, miR-155, miR-145, miR-200, miR-133, miR-135, miR-221, miR-424, let-7, lncRNA-H19, lncRNA-MEG3, lncRNA-UCA1, and lncRNA-XIST in atherosclerosis and psoriasis, T2DM, and RA. Extracellular vesicles (EVs) are a method of intracellular signal transduction. Their function depends on surface expression, cargo, and the cell from which they originate. The majority of the studies that investigated lncRNAs and some miRs had relatively small sample sizes, which limits the generalizability of their findings and indicates the need for more research. Based on the studies reviewed, miR-146a, miR-155, miR-145, miR-200, miR-133, and lncRNA-H19 are the most promising potential biomarkers and, possibly, therapeutic targets for atherosclerosis as well as T2DM, RA, and psoriasis.

The economic burden and quality of life of patients with psoriasis treated with biologics in China

BACKGROUND

Although biologics improve the quality of life of psoriasis patients, they also impose a substantial economic burden. There is a lack of research addressing the economic and humanistic impact of biologics in China.

OBJECTIVE

This cross-sectional investigation aims to assess the economic cost, quality of life, and patient satisfaction among individuals with psoriasis treated with biologics and non-biologics.

METHODS

From July 2021 to December 2022, eligible patients with psoriasis were recruited through both on-site and online questionnaire completion. The questionnaires collected sociodemographic data, clinical characteristics of psoriasis, economic costs associated with treatment, and the Dermatological Life Quality Index (DLQI).

RESULTS

481 patients with a mean age of 40.8 ± 13.4 years old were included and classified into a non-biologic (n = 195) and biologic (n = 286) treatment group. The direct medical cost for non-biologics patients was 7,249 CNY, accounting for 70.0% of the total cost, while biologics patients incurred 15,176 CNY, making up 94.3% of the total cost. The non-biologic group had higher costs related to hospitalization, self-purchase of drugs, and indirect costs than the biologic treatment group. Additionally, DLQI scores were higher in the non-biologic group.

CONCLUSION

Patients in the biologic group experienced a higher economic burden and better quality of life than those in the non-biologic group.

Quantitative proteomic analysis of human serum using tandem mass tags to predict cardiovascular risks in patients with psoriasis

Although biomarker candidates associated with psoriasis have been suggested, those for predicting the risk of cardiovascular disease (CVD) early in patients with psoriasis are lacking. We aimed to identify candidate biomarkers that can predict the occurrence of CVD in psoriasis patients. We pursued quantitative proteomic analysis of serum samples composed of three groups: psoriasis patients with and those without CVD risk factors, and healthy controls. Age/Sex-matched serum samples were selected and labeled with 16-plex tandem mass tag (TMT) and analyzed using liquid chromatography-mass spectrometry and subsequent verification with ELISA. Of the 184 proteins that showed statistical significance (P-value < 0.05) among the three groups according to TMT-based quantitative analysis, 98 proteins showed significant differences (> 2.0-fold) between the psoriasis groups with and without CVD risk factors. Verification by ELISA revealed that caldesmon (CALD1), myeloid cell nuclear differentiation antigen (MNDA), and zyxin (ZYX) levels were significantly increased in the psoriasis group with CVD risk factors. Further network analysis identified pathways including integrin signaling, which could be related to platelet aggregation, and actin cytoskeleton signaling. Three novel candidates (MNDA, ZYX, and CALD1) could be potential biomarkers for predicting CVD risks in psoriasis patients. We expect these biomarker candidates can be used to predict CVD risk in psoriasis patients in clinical settings although further studies including large validation are needed.

Psoriasis a Cause of Cardiovascular Diseases: A Review Article

Psoriasis is a severe, chronic inflammatory disease characterized by erythematous plaques across the extensor surfaces of the skin. Psoriasis has been linked to a higher threat of vascular events like myocardial infarction and stroke. Other associated cardiovascular disorders in the case of psoriasis include building up atherosclerosis, non-ischemic dilated cardiomyopathy, and psoriatic arthritis. Individuals can use International Classification of Diseases (ICD-9) codes to identify cardiovascular disease/comorbidities and related risk factors. The relation between pathophysiology and mechanism of psoriasis and the building up of fat and cholesterol in or on the arterial walls makes the association between psoriasis and cardiovascular diseases more obvious. There is very little research on the adverse effect of systemic treatment of psoriasis on cardiovascular events. Treatment of psoriasis includes mainly biologics and systemic therapy, including methotrexate as a first-line drug. An indirect relation between psoriasis-arthritis and cardiovascular diseases is being noted. Various risk factors contribute to psoriasis and are associated with cardiovascular disease, including smoking, hypertension, and obesity. Personal management to decrease the threat to the cardiovascular system in case of psoriasis can be achieved by changing lifestyle, which includes exercising and avoiding smoking. The criteria for identifying metabolic syndrome are discussed in this review article. Figure Rating Scales (FRS) were used for studying the risk prediction of various cardiovascular diseases. Individuals with atherosclerosis, hypertension and diabetes mellitus type-2 are at a higher risk of developing cardiovascular events and multiple chronic conditions in the case of psoriasis; hence they are part of the population at risk.

Serum Intestinal Metabolites are Raised in Patients with Psoriasis and Metabolic Syndrome

Purpose

Psoriasis is an immune-mediated chronic inflammatory disease. Metabolic syndrome (MetS) is characterized by central obesity, hypertension, dyslipidemia, diabetes and insulin resistance (IR). Increasing evidence indicates that psoriasis is associated with MetS. This study aimed to explore some metabolite indexes which could evaluate the severity or predict the risk of psoriasis patients associated with MetS.

Patients and methods

It was a case-control study conducted in Beijing Hospital of Traditional Chinese Medicine. Sixty healthy volunteers (HC), 100 patients with psoriasis (Ps), 100 patients with MetS (MetS) and 80 patients with both psoriasis and MetS (Ps+MetS) were entered between January 2016 and December 2018. Blood samples were taken after at least 12 hours fasting and the contents of trimethylamine N-oxide (TMAO), carnitine, choline and betaine in serum were measured by Liquid Chromatography Mass Spectrometry (LC-MS/MS). Besides, the serum levels of low-density lipoprotein (LDL), high-density lipoprotein (HDL), cholesterol (CHO), triglyceride (TG), blood glucose (BG), creatinine (Cr), urea nitrogen (BUN), uric acid (UA) were determined.

Results

The non-healthy groups had different degrees of dyslipidemia, Ps-MetS> Ps >MetS. Compared with HC, the Ps had a higher level of TG; The MetS had the lowest level of HDL; The Ps+Mets had the highest level of TG and CHO. The Ps and Ps+MetS both had high level of UA, but there was no difference between the two groups. As for intestinal metabolites, the Ps had significant differences in TMAO, carnitine, and betaine in comparison with HC. The MetS had the highest level of TMAO. There was positive correlation between PASI and TMAO and betaine.

Conclusions

TMAO and betaine could serve as indexes reflecting the severity of psoriasis. TG, CHO, LDL and UA could serve as risk factors of MetS in psoriatic patients.

IL-17A promotes vascular calcification in an ex vivo murine aorta culture

BACKGROUND

Vascular calcification is characterized by mineral deposition in the vasculature, which is triggered by chronic systemic inflammation, including psoriasis. Psoriasis is an IL-17A-mediated inflammatory skin disease that is associated with exacerbated vascular calcification and high cardiovascular mortality. Although previous studies have shown that IL-17A induces vascular dysfunction in murine psoriasis models, it has not been clarified whether IL-17A induces vascular calcification. In this study, we investigated the potential vascular calcification-inducing effect of IL-17A in an ex vivo culture system.

METHODS

Thoracic and abdominal aortas from mice were cultured in a medium supplemented with inorganic phosphate and were treated with inflammatory cytokines (IL-1β, TNF-α, IL-6, and IL-17A). Vascular calcification was determined using micro-computed tomography (CT) and histological analyses.

RESULTS

IL-1β, TNF-α, and IL-6 did not significantly promote vascular calcification, whereas IL-17A significantly accelerated vascular calcification of the aorta, as indicated by the increased mineralized volume based on micro-CT analysis. Micro-CT and histological analyses also revealed that the promoting effect of IL-17A on vascular calcification was concentration dependent.

CONCLUSIONS

IL-17A significantly promoted vascular calcification in ex vivo cultured aortas, which suggests that this mechanism is involved in the increased risk of cardiovascular events in IL-17A-mediated inflammatory diseases.

Epidemiology and clinical features of pustular psoriasis: A 15-year retrospective cohort

Pustular psoriasis (PuP) is a rare variant of psoriasis with a unique immunopathogenesis, unlike its more prevalent plaque-type counterpart. However, data available are limited due to its low prevalence. This study aimed to describe the demographic profile, precipitating factors, clinical presentations, and treatments among patients with different PuP subtypes from a 15-year retrospective cohort study in Thailand. A total of 60 patients were included in this study. There was female predominance (73.3%) and mean age of onset was 38.1 ± 17.6 years. Generalized PuP (GPP) was the most prevalent subtype (80.0%), followed by acrodermatitis continua of Hallopeau (13.3%) and palmoplantar pustulosis (6.7%). Precipitating factors included corticosteroid withdrawal, upper respiratory tract infection, and pregnancy. One-third of PuP occurred concomitantly with other psoriasis variants, especially the plaque type. The most prescribed systemic and topical treatments were oral acitretin (60.0%) and topical corticosteroids (98.3%), respectively. Only two patients were treated with narrow-band ultraviolet B. In conclusion, four out of every five PuP patients in this center had GPP. Corticosteroid withdrawal, upper respiratory tract infection, and pregnancy are important precipitating factors. Coexistence with other psoriasis variants was identified in one out of every three patients. Acitretin remains the mainstay of systemic treatment.

Osteopontin Serum Concentration and Metabolic Syndrome in Male Psoriatic Patients

Psoriasis (Ps) is an immune-mediated inflammatory skin disease that is widely associated with the clinical features of metabolic syndrome (MetS), including hypertension, abdominal obesity, insulin resistance, type 2 diabetes and dyslipidemia. Osteopontin (OPN), a multifunctional protein involved in the modulation of inflammatory processes, may contribute to the development of atherosclerosis and MetS. Therefore, the aim of the study was the assessment of the correlation between OPN concentration in the peripheral blood and the presence of MetS as well as its particular components in the Ps patients. The study comprised 107 male Ps patients (50 patients with MetS and 57 without MetS) and 38 healthy volunteers (HVs). The concentration of OPN in serum was determined using enzyme-linked immunosorbent assay (ELISA) method. Fasting blood glucose and lipid profile components: total cholesterol (total CHOL), high-density lipoprotein cholesterol (HDL-CHOL), low-density lipoprotein cholesterol (LDL-CHOL), triglycerides (TG) were examined. Ps patients with MetS had significantly higher obesity, systolic blood pressure, TG, CHOL/HDL, LDL/HDL and TG/HDL ratios than Ps patients without MetS. OPN serum concentration was significantly higher in the Ps patients than in the HVs (p = 0.022) but not significantly different between the Ps patients with and without MetS (p = 0.275). OPN serum concentration in Ps patients correlated negatively with total CHOL (p = 0.004) and TG (p = 0.009). OPN is increased in Ps patients and may serve as a biomarker of some lipid abnormalities in them.

The impact of methotrexate therapy with vitamin D supplementation on the cardiovascular risk factors among patients with psoriasis; a prospective randomized comparative study

BACKGROUND

Controlling psoriasis with various systemic treatments, including methotrexate, may significantly decrease associated cardiovascular risk problems.

OBJECTIVE

To assess the value of vitamin D supplementation on clinical response as well as changes in cardiovascular risk parameters in psoriasis patients treated with methotrexate.

METHODS

This prospective randomized comparative study included 30 patients with moderate to severe psoriasis divided randomly to receive either methotrexate alone (Mtx) or methotrexate plus intramuscular vitamin D (MtxD) for 3 months. Lipid profile, HsCRP, carotid intima-media thickness (CIMT) and blood pressure (BP) measurements were recorded before and after the therapy.

RESULTS

At end of study period, significant clinical improvement in both groups was observed. CIMT and systolic BP decreased in both groups but only statistically significant in Mtx group. HsCRP decreased in both groups but didn't reach statistical significance. We also observed, an increase in triglycerides and cholesterol levels in the Mtx group with the latter decreasing in the combined Mtx and vitamin D therapy group.

CONCLUSION

Treating psoriasis with methotrexate may decrease cardiovascular disease risk factors. Adding vitamin D supplementation to methotrexate may protect lipid homeostasis, specifically cholesterol and triglycerides.

Psoriasis in the geriatric population: A retrospective study in Asians

There is a paucity of data focusing on geriatric psoriatic patients. The clinical features were different among those with early-onset psoriasis and elderly-onset psoriasis among the geriatric population. From 2014 to 2018, a total of 290 geriatric psoriatic patients were retrospectively enrolled in our study. They were subclassified into two groups, early-onset (aged <60 years, n = 154) and elderly-onset (aged ≥60 years, n = 136). The characteristics and treatment course of these two groups were reviewed. Psoriasis of the elderly-onset group was generally milder than the early-onset groups (P < 0.05). Less nail involvement and arthritis were noted among the elderly-onset group (P < 0.05). There were four cases of erythrodermic psoriasis in the early-onset group and three cases of palmoplantar psoriasis in the elderly-onset group. Oral medication and biologics for treatment of psoriasis appeared to be safe among the geriatric psoriatic patients. Elderly-onset psoriasis has features which are distinct from early-onset psoriasis and may be a particular subtype, which needs further evaluation.

Novel anti-inflammatory therapies to reduce cardiovascular burden of psoriasis

Psoriasis mainly affects the skin and joints and has serious impacts on the physical, emotional, and financial life of patients. Recent studies have demonstrated that other comorbidities are frequently detected in psoriatic patients. A strong association with the development of cardiovascular diseases, such as hypertension, myocardial infarction, and stroke is responsible for the shortened (by 4.5‐5 years) life expectancy of severe psoriatic patients. Systemic inflammation plays an important role in the interrelationship between psoriasis and atherosclerotic plaque formation, which is a common immunopathogenic pathway that explains the multiorgan involvement in psoriasis. As far life‐threatening cardiovascular diseases are very often symptom‐free, the treating dermatologist's responsibility is to initiate interdisciplinary holistic patient care, which may lead to directly saved patients' lives. Holistic care of severe psoriatic patients should include regular cardiac monitoring using cardiovascular imaging modalities and functional testing to detect even subclinical coronary artery disease. Effective anti‐inflammatory treatment with biologic therapies may have beneficial effects on the cardiovascular state and may reduce the incidence of cardiac events. The authors review the latest findings on the shared immunopathogenic background of psoriasis and cardiovascular diseases and discuss the available data about the cardiovascular responses to the currently used biologic treatments.

Metabolic Syndrome and Psoriasis: A Case-Control Study in Kabul, Afghanistan

BACKGROUND

Psoriasis is a chronic inflammatory disease that is not limited to the skin. Recently, numerous studies have shown a positive association between metabolic syndrome and psoriasis.

OBJECTIVE

The current study aimed to examine the association of metabolic syndrome with psoriasis in an Afghan population.

METHODS

This was a case- control study including 114 patients with psoriasis and 114 controls aged ≥18 years admitted to the dermatology department of Maiwand Teaching Hospital in Kabul, Afghanistan. Height, weight, blood pressure, and waist circumference were measured in all subjects. Blood glucose, triglyceride, cholesterol, and high-density lipoprotein cholesterol levels were tested following overnight fasting. The modified National Cholesterol Education Program - Adult Treatment Panel III criteria were used for the diagnosis of metabolic syndrome.

RESULTS

In total, 51.8% of the cases and 44.7% of the controls were male. The average age of participants was 33.4±13.1 years in the case group and 41.1±15.4 years in the control group. The average duration of disease for psoriasis was 4.2 years with 5.6 years SD. The average PASI was 10.8 with 5.1 SD. More than half of the cases (62.3%) had moderate to severe psoriasis and 37.7% had mild psoriasis. The prevalence of metabolic syndrome was higher among patients with psoriasis compared to controls (36.8% vs 21.1%) with OR of 2.18 (p=0.009). In addition, overweight/obesity was more prevalent among cases compared to controls (65.8% vs 41.2%) with OR of 2.74 (p<0.001), whereas the waist circumference was not significantly different between the two groups. Furthermore, the mean levels of total cholesterol, triglyceride, and fasting blood glucose were also higher among patients with psoriasis compared to controls.

CONCLUSION

The results of the study confirm the association between psoriasis and metabolic syndrome. Hence, screening psoriatic patients for metabolic syndrome should be considered.

A brief guide to pustular psoriasis for primary care providers

Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque psoriasis. Pustular psoriasis may present as a recurrent systemic illness (generalized pustular psoriasis [GPP]), or as localized disease affecting the palms and/or soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or the digits/nail beds (acrodermatitis continua of Hallopeau [ACH]). These conditions are rare, but their possible severity and consequences should not be underestimated. GPP, especially an acute episode (flare), may be a medical emergency, with potentially life-threatening complications. PPP and ACH are often debilitating conditions. PPP is associated with impaired health-related quality of life and psychiatric morbidity, while ACH threatens irreversible nail and/or bone damage. These conditions can be difficult to diagnose; thus, primary care providers should not hesitate to contact a dermatologist for advice and/or patient referral. The role of corticosteroids in triggering and leading to flares of GPP should also be noted, and physicians should avoid the use of systemic corticosteroids in the management of any form of psoriasis.

High-sensitivity C-reactive protein as a biomarker in detecting subclinical atherosclerosis in psoriasis

Psoriasis is known to be associated with increased risk of cardiovascular diseases. High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and an independent risk factor for atherosclerosis. We aimed to assess the correlation between hs-CRP and subclinical atherosclerosis in psoriatic patients. In 60 patients with moderate to severe psoriasis and 60 age- and gender matched healthy controls, we evaluated the serum hs-CRP level and mean intima-media thickness of the common carotid artery (MIMT-CCA). Psoriatic patients had higher levels of hs-CRP (median, 2.25 mg/L; IQR, 0.98-3.80; and range, 0.29-11.60) than did those in the control group (median, 1.03 mg/L; IQR, 0.36-2.15; and range, 0.10-3.35). Psoriatic patients also had higher mean MIMT (0.74 ± 0.19 and 0.54 ± 0.12, respectively, and P < .0001) compared with healthy subjects. The serum level of hs-CRP was significantly correlated with MIMT (P < .0001). Our results indicate that psoriatic patients have a higher risk of subclinical atherosclerosis and hs-CRP may be a useful marker for future risk of cardiovascular diseases in these patients. So, not only does anti-inflammatory drugs play a key role in the treatment of psoriasis, but also they may reduce the risk of cardiovascular diseases by decreasing level of inflammatory markers including hs-CRP.

The role of the interleukin-23/Th17 pathway in cardiometabolic comorbidity associated with psoriasis

Alterations in the innate and adaptive immunity underpin psoriasis pathophysiology, with the Th17 cells subset now recognized as the fundamental cells in the key controlling pathway involved in its pathogenesis. Since psoriasis is a systemic disease with important comorbidity, further knowledge on the interleukin (IL)‐23/Th17 axis led to the hypothesis that there may be shared pathogenic pathways between primary skin disease and comorbidity. Psoriasis has been identified as a risk factor for cardiovascular and metabolic disease, and increasing evidence gives support to this epidemiological observation from the clinical‐pathologically field. As an example, increased levels of IL‐23 and IL‐23R have been found in human atherosclerotic plaque, and levels correlated with symptom duration and mortality. Also, upregulation of IL‐23/IL‐17 seems to play an important role in both myocardial damage and stroke, with interesting reports on deleterious effect neutralization after administration of related anti‐bodies in both associated conditions. In diabetic patients, increased levels of IL‐23/IL‐17 have also been observed and available data support a synergistic role of IL‐23/IL‐17 in β‐cells damage. In obesity, signs of an expansion of Th17 subset in adipose tissue have been reported, as well as elevated concentrations of IL‐23 in obese patients. In non‐alcoholic fatty liver disease, closely related to metabolic syndrome, but also in other mentioned cardiometabolic disorders, a predominance of IL‐23 and other related pro‐inflammatory factors has been identified as participating in their pathogenesis. Thus, the involvement of the IL‐23/Th17 axis in these shared psoriasis‐cardiometabolic pathogenic mechanisms is reviewed and discussed in the light of the existing preclinical and clinical evidence, including that from comorbid psoriasis patients.

Psoriasis and cardiovascular disorders: association or epiphenomenon? Meta-analysis of observational studies

Psoriasis is a chronic inflammatory disease believed to be correlated with numerous cardiovascular risk factors including increased blood pressure, elevated blood cholesterol level, diabetes, inactivity, high body mass index (obesity) and dyslipidaemia. The present meta-analysis intends to assess the association between psoriasis and cardiovascular risk factors. Three hundred and fifty articles were primarily screened using NCBI MEDLINE/PubMed and Cochrane library from its inception until June 30, 2018. Of these, 26 observational studies depending upon the inclusion and exclusion criteria were included in the study with 17,672 psoriasis patients and 66,407 non-psoriasis subjects. The psoriasis patients were found to be at significantly increased risk of systolic blood pressure (SBP) [ORs 2.31 (95% CI 1.12, 4.74)], diastolic blood pressure (DBP) [ORs 2.31 (95% CI 1.58, 3.38)], abdominal obesity [ORs 1.90 (95% CI 1.45, 2.50)] and triglycerides [ORs 1.80 (95% CI 1.29, 2.51)] as compared to non-psoriasis subjects. The subgroup analyses of studies based on the continents revealed that psoriasis patients from Middle East are prone to higher risk factors of CVD including increased levels of triglyceride, cholesterol, DBP, SBP, fasting blood sugar, body mass index and decreased HDL levels, whereas psoriasis patients from European population reported increased LDL-C and waist circumference. The present study supports a significant association between psoriasis and incidence of major adverse cardiovascular events. Contrary to the previous literature, our finding suggests that hypertension is a highly associative condition in psoriasis. The findings of this study could be validated amongst well-defined cohorts of patients with psoriasis individually in different regions to confirm the implication of the study.

Bidirectional association between psoriasis and depression: Two longitudinal follow-up studies using a national sample cohort

BACKGROUND

Few studies have investigated the bidirectional association between psoriasis and depression. The aim of our study was to identify the association between psoriasis and depression.

METHODS

Data collected by the Korean Health Insurance Review and Assessment from 2002 to 2013 were used. In study I, psoriasis patients (n = 10,932) were matched 1:4 with control I group participants. In study II, depression patients (n = 60,383) were matched 1:4 with control II group participants. Matching was performed for age, sex, income, and region of residence. The stratified Cox-proportional hazard model was used to calculate the hazard ratio (HR) with crude and adjusted models.

RESULTS

In study I, the adjusted HR for depression was 1.13 (95% confidence interval (CI) = 1.03-1.24) in the psoriasis group compared to the control I group. In study II, the adjusted HR for depression was 1.11 (95% CI = 1.00-1.22) in the depression group compared to the control II group. In the subgroup analyses, the adjusted HRs for depression were 1.24 (95% CI = 1.00 - 1.53) in females aged < 40 years and 1.31 (95% CI = 1.04 - 1.66) in males aged ≥ 60 years. In the subgroup analyses from study II, the adjusted HRs for psoriasis were 1.56 (95% CI = 1.15 - 2.12) in males aged < 40 years and 1.35 (95% CI = 1.04 - 1.75) in males aged ≥ 60 years.

CONCLUSIONS

We suggest that psoriasis and depression might have a bidirectional association.

The Roles of Lipoprotein in Psoriasis

The association between psoriasis and cardiovascular disease risk has been supported by recent epidemiological data. Patients with psoriasis have an increased adjusted relative risk for myocardial infarction. As such, the cardiovascular risk conferred by severe psoriasis may be comparable to what is seen with other well-established risk factors, such as diabetes mellitus. Previous studies demonstrated that low-density lipoprotein (LDL) plays critical roles during atherogenesis. It may be caused by the accumulation of macrophages and lipoprotein in the vessel wall. Oxidized LDL (ox-LDL) stimulates the expression of adhesion molecules, such as ICAM-1 and VCAM-1, on endothelial cells and increases the attachment of mononuclear cells and the endothelium. Even though previous evidence demonstrated that psoriasis patients have tortuous and dilated blood vessels in the dermis, which results in the leakage of ox-LDL, the leaked ox-LDL may increase the expression of adhesion molecules and cytokines, and disturb the static balance of osmosis. Therefore, exploration of the relationship between hyperlipidemia and psoriasis may be another novel treatment option for psoriasis and may represent the most promising strategy.

Tildrakizumab in the treatment of psoriasis - literature review

Psoriasis is a chronic, inflammatory disease. The incidence of its occurrence in developed countries is 1–4%. The aim of this study is to present the current state of knowledge and characterize the antibody tildrakizumab, which in March 2018 was approved by the FDA agency for use in adult patients with moderate to severe plaque psoriasis. The work presents the mechanism of action of tildrakizumab and the way it affects the immunological pathways associated with the pathogenesis of psoriasis. Recent studies indicate that interleukin 23 and its p19 subunit are a key target in the effective treatment of psoriasis. The paper also presents the latest clinical trials that present the safety profile and efficacy of tildrakizumab in the treatment of psoriasis. According to clinical trials, tildrakizumab is an effective and safe drug for use in adult patients in the treatment of moderate to severe psoriasis.

Increased risk of migraine in patients with psoriasis: A longitudinal follow up study using a national sample cohort

Both psoriasis and migraine are associated with inflammatory diseases. However, few studies have been conducted the increased risk of migraine in psoriasis patients. The aim of this study was to identify whether the psoriasis increases the risk of migraine. This study used the national cohort study data collected by the Korean Health Insurance Review and Assessment from 2002 to 2013. Patients with psoriasis (n = 11,071) and control participants (n = 44,284) were selected and matched 1:4 by age, sex, income, region of residence, and past medical history of hypertension, diabetes, and dyslipidemia. This study used Cox-proportional hazard model for calculating hazard ratio (HR) with crude and adjusted model. Stratification by age and sex was analyzed. Migraines occurred significantly more frequently in psoriasis patients than in control participants (adjusted HR = 1.16, 95% confidence interval (CI) = 1.04-1.31, P <.05). In the stratification analysis, migraines occurred significantly more frequently in psoriasis patients than in control participants only in the group of middle-aged males (adjusted HR = 1.62 95% CI = 1.22-2.13, P = .001). In conclusion, psoriasis might increase the risk of migraine.

Glucagon-like peptide-1 analogue liraglutide facilitates wound healing by activating PI3K/Akt pathway in keratinocytes

AIMS

Diabetes induces various skin troubles including foot ulcer. This type of skin ulcer is refractory but the pathogenesis is not so certain. Recent study show that glucagon-like peptide-1 (GLP-1) analogues reduce foot complications with diabetes (Pérez et al., 2015), however, the role of GLP-1/GLP-1R axis is not fully understood, and clear evidence of GLP-1 to facilitate wound closure is still lacking. In this study, we investigated whether a potent GLP-1R agonist liraglutide affects wound healing process.

METHODS

The expression of GLP-1R in HaCaT cells were indentified by quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and immunoblotting analysis. To assess the effect on wound closure in keratinocytes, we performed in vitro scratch assay using the IncuCyte system (Essen BioSciences, Ann Arborm MI). We applied ointment containing liraglutide on full-thickness wounds in the dorsum of female balb/c mice (n = 6) until healing. To investigate the effect on PI3K/Akt pathway, we used IncuCyte system in HaCaT treated with PI3K inhibitor and Akt inhibitor.

RESULTS

Keratinocytes expressed GLP-1R and liraglutide induced their migration. Liraglutide facilitated the wound healing in mice. Liraglutide upregulated keratinocyte migration via PI3K/Akt activation.

CONCLUSIONS

Our study suggests that liraglutide may be a potential target drug to improve skin ulcer with diabetes through its specific receptor GLP-1.

Synthesis and Biological Evaluation of Thalidomide Derivatives as Potential Anti-Psoriasis Agents

Several thalidomide derivatives were synthesized and evaluated for their anti-inflammatory activity. Introduction of the benzyl group to the parent thalidomide is unfavorable in which 2-(1-benzyl-2,6-dioxopiperidin-3-yl)isoindoline-1,3-dione (4a) was inactivated. However, the inhibitory activities on TNF-α and IL-6 expression in HaCaT cells were improved by the substitution of a chloro- or methoxy- group at the phenyl position of 4a. The IL-6 inhibitory activity decreased in an order of 5c (69.44%) > 4c (48.73%) > 6c (3.19%) indicating the 3-substituted derivative is more active than the 4-substituted counterpart, which in turn is more active than the 2-substituted counterpart. Among them, 2-[1-(3-chlorobenzyl)-2,6-dioxopiperidin-3-yl]isoindoline-1,3-dione (5c) was found to inhibit TNF-α and IL-6 expression in HaCaT cells with a higher potency than thalidomide and no significant cell cytotoxicity was detected at 10 μM. In psoriasis, Compound 5c reduced IL-6, IL-8, IL-1β and IL-24 in imiquimod-stimulated models. Our results indicated that compound 5c is a potential lead of novel anti-psoriasis agents. Structural optimization of compound 5c and its in vivo assay are ongoing.

Psoriasis, Cardiovascular Events, and Biologics: Lights and Shadows

Nowadays, it is well established a link between psoriasis and cardiovascular (CV) diseases. A series of different overlapping mechanisms including inflammation, homeostasis dysregulation, and genetic susceptibility are thought to underlie this association. Advances in understanding the molecular patterns involved in the complex scenario of psoriasis have highlighted a tight correlation with atherosclerosis. Indeed, common profiles are shared in term of inflammatory cytokines and cell types. In the last decade, the management of psoriasis patients has been revolutionized with the introduction of biological therapies, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-12/23, and IL-17 inhibitors. In clinical setting, the effectiveness of these therapies as well as the incidence of CV events is related to the type of biologics. In particular, anti-TNF-α agents seem to reduce these events in psoriasis patients whereas anti-IL-12/23 agents related CV events reduction still remain to clarify. It has to be taken into account that IL-12/23 inhibitors have a shorter post-marketing surveillance period. An even more restricted observational time is available for anti-IL-17 agents. IL-17 is associated with psoriasis, vascular disease, and inflammation. However, IL-17 role in atherosclerosis is still debated, exerting both pro-atherogenic and anti-atherogenic effects depending on the specific context. In this review, we will discuss the differences between the onset of CV events in psoriasis patients, referred to specific biological therapy and the underlying immunological mechanism. Given the development of new therapeutic strategies, the investigation of these inhibitors impact on heart failure outcome is extremely important.

Are quantitative histopathologic criteria capable of differentiating psoriasis from chronic dermatitis?

Background

There are overlapping features in histopathologic characteristics of psoriasis and chronic dermatitis, which sometimes make the correct diagnosis difficult.

Objective

The aim of this study was to compare the histopathologic diagnostic features of psoriasis with chronic dermatitis quantitatively.

Patients and methods

In this study, 30 patients with psoriasis and 30 patients with chronic dermatitis were included. Diagnosis of psoriasis or chronic dermatitis was based on clinicopathologic correlation. Photos of histopathologic slides were provided by LABOMED Digital Camera and LABOMED Microscope. Width and length of rete ridges, minimal thickness of suprapapillary plates, thickness of epidermis, thickness of hyperkeratotic layer, and minimal thickness of granular layer were determined using Pixel Pro software on micrometer scale.

Results

Suprapapillary plates and granular layer were significantly thicker in patients with chronic dermatitis compared with patients with psoriasis. The rete ridges were longer and wider, the epidermis was thicker, and the parakeratotic layer was also thicker in patients with psoriasis compared with patients with chronic dermatitis, and the difference between these corresponding parameters in the two groups was statistically significant except for thickness of parakeratotic layer. Moreover, the mean ratio of minimal suprapapillary plate’s thickness to epidermal thickness and the mean ratio of minimal granular layer’s thickness to parakeratotic layer’s thickness were significantly higher in patients with chronic dermatitis compared with those with psoriasis.

Conclusion

Despite overlapping histopathologic features in psoriasis and chronic dermatitis, quantitative histopathologic criteria might be valuable for differentiation of these two conditions. Ratios of minimal suprapapillary plate’s thickness to epidermal thickness and minimal granular layer’s thickness to parakeratotic layer’s thickness can be particularly helpful in this regard.

Therapeutic Apheresis in Metabolic Syndrome

BACKGROUND

The metabolic syndrome unites three pathologies of the person - obesity, arterial hypertension and diabetes. In recent years the progressing of such distribution covering from 2.5% to 3.8% of the population with increase twice each 10-15 years is noted. Even at maintenance of level of sugar at diabetes accumulation of the secondary metabolites breaking small vessels isn't excluded. At the same time many life-endangering complications develop.

OBJECTIVE

To identify the possibilities of plasmapheresis in the prevention and treatment of complications of metabolic syndrome.

METHOD

Analysis of the world literature data on complications of metabolic syndrome and methods of their treatment.

RESULTS

At metabolic syndrome the frequency of strokes and myocardial infarctions there is twice more often than in population. For 5-9 years the general life expectancy decreases. Disorders of microcirculation at diabetes lead to a retinopathy with total loss of sight, a nephropathy from the outcome in a renal failure, to polyneuropathy and diabetic foot syndrome with high risk of high level amputations of the lower extremities. At the same time medicamentous therapy is not able to prevent such complications and almost only way of removal of these pathological metabolites is therapeutic apheresis, mainly the plasmapheresis. Data from our own studies confirm the effectiveness of such tactics.

CONCLUSION

Plasmapheresis has to be applied not only to the correction of already critical conditions, but also to their prevention.

Autoimmunity and autoimmune co-morbidities in psoriasis

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.

Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment

Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.