Type I Interferon: Potential Therapeutic Target for Psoriasis?

Background

Psoriasis is an immune-mediated disease characterized by aberrant epidermal differentiation, surface scale formation, and marked cutaneous inflammation. To better understand the pathogenesis of this disease and identify potential mediators, we used whole genome array analysis to profile paired lesional and nonlesional psoriatic skin and skin from healthy donors.

Methodology/Principal Findings

We observed robust overexpression of type I interferon (IFN)–inducible genes and genomic signatures that indicate T cell and dendritic cell infiltration in lesional skin. Up-regulation of mRNAs for IFN-α subtypes was observed in lesional skin compared with nonlesional skin. Enrichment of mature dendritic cells and 2 type I IFN–inducible proteins, STAT1 and ISG15, were observed in the majority of lesional skin biopsies. Concordant overexpression of IFN-γ and TNF-α–inducible gene signatures occurred at the same disease sites.

Conclusions/Significance

Up-regulation of TNF-α and elevation of the TNF-α–inducible gene signature in lesional skin underscore the importance of this cytokine in psoriasis; these data describe a molecular basis for the therapeutic activity of anti–TNF-α agents. Furthermore, these findings implicate type I IFNs in the pathogenesis of psoriasis. Consistent and significant up-regulation of type I IFNs and their associated gene signatures in psoriatic skin suggest that type I IFNs may be potential therapeutic targets in psoriasis treatment.     

Association between Alcohol, Smoking and HLA-DQAI＊0201 Genotype in Psoriasis

Psoriasis is a chronic skin disease triggered by genetic, environment or other risk factors such as infection, drugs, stress, moisture, alcohol, and smoking. A major psoriasis susceptibility locus at 6p21.3 has been identified. Further studies found that HLA-DQA1*0201 allele was associated with psoriasis. However, there were few data exploring an association between the environmental factors and susceptibility genes. In this study, the samples of 189 patients with psoriasis and 333 healthy controls were collected with their consent and were carried on analysis through polymerase chain reaction sequence-specific primer (PCR-SSP) method. The proportion of male psoriasis patients engaging in the smoking and alcohol was much higher than that of the control group (P<0.005). The HLA-DQA1*0201 allele was present at significantly higher frequency in the patients with psoriasis (OR=4.25, P<1.0 x 10(-6)). Association was found between smoking, alcohol and HLA-DQA1*0201 in male patients with psoriasis (OR>6.91, P<1.0 x 10(-4)).     

Psoriasis pathogenesis – Pso p27 constitutes a compact structure forming large aggregates

Psoriasis is a chronic inflammatory skin disease. The absence of microbial organisms as potential causal agents has given rise to the hypothesis that the inflammation is due to an autoimmune reaction. The defined inflamed areas of the skin lesions argue for an immunological disease with a local production of a causal antigen. Pso p27 is a protein generated in mast cells in psoriatic plaques, but not in uninvolved skin. We recently demonstrated that the Pso p27 is generated by cleavage of SerpinB3 (SCCA1) in the presence of mast cell associated chymase.In this communication we demonstrate by X-ray crystallographic analysis that the cleavage products associate into a complex similar to SCCA1, but with the reactive centre loop inserted into a 5-stranded central β-sheet.Native gel electrophoresis show that these Pso p27 complexes form large aggregates which may be of significance with respect to an immunogenic role of Pso p27.     

Psoriasis pathogenesis — Pso p27 is generated from SCCA1 with chymase

Psoriasis is a chronic inflammatory skin disease with unknown aetiology. Infiltration of inflammatory cells as the initial event in the development of new psoriatic plaques together with the defined inflamed areas of such lesions argues for an immunological disease with a local production of a causal antigen. The auto-antigen Pso p27 is a protein expressed in the skin lesions. We recently demonstrated that Pso p27 is homologous to the core amino acid sequences of squamous cell carcinoma antigens 1 and 2 (SCCA1/2) and it is apparently generated from SCCA molecules by digestion with highly specific endoproteases. In this communication we demonstrate the generation of Pso p27 from SCCA1 with extracts from psoriatic scale and even more remarkably, the generation of Pso p27 from SCCA1 in the presence of mast cell associated chymase. These findings open up for new therapeutic strategies in psoriasis and probably also in other autoimmune diseases as Pso p27 epitopes have been detected in diseased tissues from patients with various chronic inflammatory diseases.     

Associations between Tumor Necrosis Factor-α Polymorphisms and Risk of Psoriasis: A Meta-Analysis

Background

Tumor necrosis factor-α (TNF-α) may play an important role in the recalcitrant inflammatory and hyperproliferative dermatosis of psoriasis, and there may be a relationship between TNF-α polymorphisms and psoriasis risk.

Methods

We performed a meta-analysis to evaluate the associations between TNF-α polymorphisms and psoriasis. Electronic searches of Pubmed, Embase, and Web of Science were performed for all publications on the associations between TNF-α polymorphisms and psoriasis through September 26, 2012. The pooled odds ratios (ORs) with their 95% confidence interval (95%CIs) were calculated to assess the associations.

Results

Sixteen case-control studies with a total of 2,253 psoriasis cases and 1,947 controls on TNF-α 308 G/A polymorphism and fourteen studies on TNF-α 238 G/A polymorphism with 2,104 cases and 1,838 controls were finally included into the meta-analysis. Overall, TNF-α 308 G/A polymorphism was significantly associated with decreased risk of psoriasis under three genetic comparison models (for A versus G: fixed-effects OR 0.71, 95%CI 0.62-0.82, P < 0.001; for AG versus GG: fixed-effects OR 0.67, 95%CI 0.57-0.78, P < 0.001; for AA/AG versus GG: fixed-effects OR 0.67, 95%CI 0.58-0.78, P < 0.001). In addition, TNF-α 238 G/A polymorphism was associated with increased risk of psoriasis under three genetic models (for A versus G: fixed-effects OR 2.46, 95%CI 2.04-2.96, P < 0.001; for AG versus GG: fixed-effects OR 2.69, 95%CI 2.20-3.28, P < 0.001; for AA/AG versus GG: fixed-effects OR 2.68, 95%CI 2.20-3.26, P < 0.001). Subgroup analysis by ethnicity identified a significant association between TNF-α 308 G/A polymorphism and decreased risk of psoriasis in both Caucasians and Asians and a significant association between TNF-α 238 G/A polymorphism and increased risk of psoriasis in Caucasians.

Conclusions

The meta-analysis suggests that TNF-α 308 G/A polymorphism is associated with decreased risk of psoriasis, while TNF-α 238 G/A is associated with increased risk of psoriasis.     

Die Verteilung der Gc-Phänotypen und Gc-Allele bei einigen Krankheiten (Diabetes mellitus,Leberparenchymschaden, Psoriasis vulgaris)

Zusammenfassung Bei 239 Probanden mit Diabetes mellitus, 213 Leberkranken—bes. Patienten mit akuter und chronischer Hepatitis sowie Lebercirrhosen—und 203 Kranken mit Psoriasis vulgaris wurden die Gc-Phänotypen bestimmt und mit der Gc-Typenverteilung bei 1733 gesunden Kontrollpersonen verglichen. Die Frequenz für das Allel Gc¹ beim Diabetes mellitus liegt mit 0,7490 sowie bei den Leberkrankheiten mit 0,7371 höher, bei der Psoriasis vulgaris mit 0,6749 niedriger als bei der gesunden Kontrollgruppe mit Gc¹ 0,7185. Der Unterschied im Vergleich der Diabetiker sowie der Leberkranken mit den Gesunden ist jedoch nicht signifikant. In der Gruppe mit Psoriasis vulgaris dagegen kommt der Phänotyp Gc2-1 signifikant häufiger vor als der Typ 1–1, allerdings ist diese Stichprobe in sich möglicherweise nicht hinreichend homogen.

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The frequency of the three Gc-phenotypes has been determined in 239 propositi with diabetes mellitus,213 patients with liver diseases—especially acute and chronic hepatitis as well as liver cirrhosis—and 203 persons with psoriasis vulgaris. The distribution in these diseases is compared with 1733 serum samples of healthy inhabitants of South-Niedersachsen with a Gc¹ frequency of 0,7185. The frequency of the gene Gc¹ in diabetes mellitus is 0,7490, in liver diseases 0,7371 and in psoriasis vulgaris 0,6749. These differences are statistically not significant in diabetes and in liver diseases. A significant difference has been found in psoriasis vulgaris between the both phenotypes Gc 1–1 and Gc 2-1 (X ²=10,7164, p(m=1)0,001). It may, however, be discussed wether this sample has a sufficient homogeneity.

     

Validity of Diagnostic Codes and Prevalence of Physician-Diagnosed Psoriasis and Psoriatic Arthritis in Southern Sweden – A Population-Based Register Study

Objective

To validate diagnostic codes for psoriasis and psoriatic arthritis (PsA) and estimate physician-diagnosed prevalence of psoriasis and PsA in the Skåne region, Sweden.

Methods

In the Skåne Healthcare Register (SHR), all healthcare consultations are continuously collected for all inhabitants in the Skåne region (population 1.2 million). During 2005–2010 we identified individuals with ≥1 physician-consultations consistent with psoriasis (ICD-10). Within this group we also identified those diagnosed with PsA. We performed a validation by reviewing medical records in 100 randomly selected cases for psoriasis and psoriasis with PsA, respectively. Further, we estimated the pre- and post-validation point prevalence by December 31, 2010.

Results

We identified 16 171 individuals (psoriasis alone: n = 13 185, psoriasis with PsA n = 2 986). The proportion of ICD-10 codes that could be confirmed by review of medical records was 81% for psoriasis and 63% for psoriasis with PsA with highest percentage of confirmed codes for cases diagnosed ≥2 occasions in specialized care. For 19% and 29% of the cases respectively it was not possible to determine diagnosis due to insufficient information. Thus, the positive predicted value (PPV) of one ICD-10 code for psoriasis and psoriasis with PsA ranged between 81–100% and 63–92%, respectively. Assuming the most conservative PPV, the post-validation prevalence was 1.23% (95% CI: 1.21–1.25) for psoriasis (with or without PsA), 1.02% (95% CI: 1.00–1.03) for psoriasis alone and 0.21% (95% CI: 0.20–0.22) for psoriasis with PsA. The post-validation prevalence of PsA in the psoriasis cohort was 17.3% (95% CI: 16.65–17.96).

Conclusions

The proportion of diagnostic codes in SHR that could be verified varied with frequency of diagnostic codes and level of care highlighting the importance of sensitivity analyses using different case ascertainment criteria. The prevalence of physician-diagnosed psoriasis and PsA confirm other population-based studies, also after adjustment due to misclassification of disease.     

Evolution of Cooperation Patterns in Psoriasis Research: Co-Authorship Network Analysis of Papers in Medline (1942–2013)

Background

Although researchers have worked in collaboration since the origins of modern science and the publication of the first scientific journals in the eighteenth century, this phenomenon has acquired exceptional importance in the last several decades. Since the mid-twentieth century, new knowledge has been generated from within an ever-growing network of investigators, working cooperatively in research groups across countries and institutions. Cooperation is a crucial determinant of academic success.

Objective

The aim of the present paper is to analyze the evolution of scientific collaboration at the micro level, with regard to the scientific production generated on psoriasis research.

Methods

A bibliographic search in the Medline database containing the MeSH terms “psoriasis” or “psoriatic arthritis” was carried out. The search results were limited to articles, reviews and letters. After identifying the co-authorships of documents on psoriasis indexed in the Medline database (1942–2013), various bibliometric indicators were obtained, including the average number of authors per document and degree of multi-authorship over time. In addition, we performed a network analysis to study the evolution of certain features of the co-authorship network as a whole: average degree, size of the largest component, clustering coefficient, density and average distance. We also analyzed the evolution of the giant component to characterize the changing research patterns in the field, and we calculated social network indicators for the nodes, namely betweenness and closeness.

Results

The main active research clusters in the area were identified, along with their authors of reference. Our analysis of 28,670 documents sheds light on different aspects related to the evolution of scientific collaboration in the field, including the progressive increase in the mean number of co-authors (which stood at 5.17 in the 2004–2013 decade), and the rise in multi-authored papers signed by many different authors (in the same decade, 25.77% of the documents had between 6 and 9 co-authors, and 10.28% had 10 or more). With regard to the network indicators, the average degree gradually increased up to 10.97 in the study period. The percentage of authors pertaining to the largest component also rose to 73.02% of the authors. The clustering coefficient, on the other hand, remained stable throughout the entire 70-year period, with values hovering around 0.9. Finally, the average distance peaked in the decades 1974–1983 (8.29) and 1984–2003 (8.12) then fell over the next two decades, down to 5.25 in 2004–2013. The construction of the co-authorship network (threshold of collaboration ≥ 10 co-authored works) revealed a giant component of 161 researchers, containing 6 highly cohesive sub-components.

Conclusions

Our study reveals the existence of a growing research community in which collaboration is increasingly important. We can highlight an essential feature associated with scientific collaboration: multi-authored papers, with growing numbers of collaborators contributing to them, are becoming more and more common, therefore the formation of research groups of increasing depth (specialization) and breadth (multidisciplinarity) is now a cornerstone of research success.     

The Effects of FeCl<Subscript>3</Subscript> and Fe–EDTA on the Development of Psoriasis

The effects of FeCl₃ and Fe–EDTA on the development of psoriasis were studied in the mouse model of vaginal epithelium and tail epidermis. The mitoses of vaginal epithelial cell in female mice of their estrogenic stage and the formation of granular cell layers in male mouse tail scale were observed. Mice were randomly divided into eight groups and treated with normal saline, methotrexate, and different doses of two iron forms, FeCl₃ and Fe–EDTA, respectively, for 10 days. To explore the influence of FeCl₃ and Fe–EDTA on the excretion of Cu, Fe, Zn, Ca, Mg, Mn, and Se, the concentration of those elements in liver and kidney was analyzed by atomic absorption spectrometry. The different doses of FeCl₃ or Fe–EDTA could obviously inhibit the mitoses of vaginal epithelial cell (p< 0.05) and promote the formation of granular cell layers in mice tail scale (p < 0.05). No statistically significant results were found between the groups of FeCl₃ and Fe–EDTA, and between experimental groups and methotrexate group acted as the positive control (p>0.05). Compared with the negative group, the concentrations of Cu, Fe, Zn, Ca, Mg, Mn, and Se in liver and kidney of experimental groups and positive control group were not significantly changed (p > 0.05). FeCl₃ and Fe–EDTA are as effective as methotrexate on inhibiting hyperplasia of epidermal cells and increasing the formation of granular cell layers, and the concentrations of Cu, Fe, Zn, Ca, Mg, Mn, and Se in liver and kidney of experimental groups and positive control group were not significantly changed compared with the negative group, possibly retarding the development of psoriasis.     

Diagnosis of “Rheumatoid Variants”: Ankylosing Spondylitis,the Arthritides of Gastrointestinal Diseases and Psoriasis,and Reiter's Syndrome

Four rheumatic diseases—ankylosing spondylitis, the arthritis accompanying ulcerative colitis or regional enteritis, psoriatic arthropathy, and Reiter''s syndrome—formerly considered to be forms of rheumatoid arthritis, are now distinguished from that disorder and should be recognized by the physician as entities. These arthritides may be distinguished from each other by a number of clinical and radiographic characteristics, principally (1) the roentgenographic appearance of the spine when spondylitis is present, (2) the location of periosteal new bone formation, (3) the location of arthritis in the joints of the limbs, and (4) the presence of characteristic skin lesions.     

First-In-Human,Phase 1, Randomized,Dose-Escalation Trial with Recombinant Anti–IL-20 Monoclonal Antibody in Patients with Psoriasis

Background

The current trial was a first-in-human clinical trial evaluating the safety, tolerability, pharmacokinetics, pharmacodynamics, and preliminary efficacy of the recombinant monoclonal anti−interleukin-20 (IL-20) antibody, NNC0109-0012, which targets the inflammatory cytokine IL-20.

Methods

In total, 48 patients aged 18 to 75 years with moderate to severe stable chronic plaque psoriasis with affected body surface area ≥15% and physician global assessment score ≥3 were enrolled in this randomized, double-blind, multicenter, placebo-controlled, phase 1 dose-escalation trial. Patients were randomized within each single dose cohort (0.01, 0.05, 0.2, 0.6, 1.5, or 3.0 mg/kg) or multiple dose cohort (0.05, 0.2, 0.5, 1.0, or 2.0 mg/kg; 1 dose every other week for 7 weeks) of NNC0109-0012 or placebo in a 3:1 ratio. In the expansion phase, 7 patients were randomized to weekly doses of 2.0 mg/kg NNC0109-0012 or placebo for 7 weeks. The primary objective, safety and tolerability, was assessed by evaluating adverse events (AEs). Additional endpoints included pharmacokinetics, pharmacodynamics, and clinical response (assessed using the Psoriasis Area and Severity Index [PASI] score).

Results

AEs were reported in 85% of patients (n = 40) in the initial study phases (NNC0109-0012, 83%; placebo, 92%) and in 4 of 7 patients in the multiple-dose expansion phase. One serious AE was reported but was judged not to be causally related to NNC0109-0012. No dose-limiting toxicities were reported. NNC0109-0012 pharmacokinetics was similar to other monoclonal antibodies, with an average half-life of approximately 3 weeks. There was a dose-proportional increase in area under the curve and maximum concentration after single dosing. No substantial changes in pharmacodynamic parameters were observed. The expansion phase was terminated early due to apparent lack of PASI improvement.

Conclusion

Single and multiple doses of NNC0109-0012, ranging from 0.05 to 3.0 mg/kg, were well tolerated in patients with psoriasis and exhibited pharmacokinetics similar to that of other monoclonal antibodies.

Trial Registration

ClinicalTrials.gov NCT01261767     

The Content of Elements in Rainwater and its Relation to the Frequency of Hospitalization for Arterial Hypertension, Chronic Obstructive Pulmonary Disease, and Psoriasis in Opole Voivodship, Poland During 2000–2002

The content of chemical elements in rainwater is a suitable indirect indicator of its presence in airborne dust, sometimes referred to as rain fallout. Rainwater is considered a suitable monitor for environmental or natural pollution. The yearly content of chemical elements in rainwater may be considered as a good indicator for determining the influence of these environmental factors on the human body. We decided to investigate the relationship between chemical elements in rainwater and the frequency of hospitalizations for arterial hypertension, chronic obstructive pulmonary disease, and psoriasis. There is a mild correlation between zinc and cadmium and cases of arterial hypertension. For obstructive pulmonary disease, there is a strong correlation with the content of potassium, calcium, iron, manganese, lead and nickel, and with chloride, sulfide, total nitrogen, and nitrites. There is also a mild correlation with magnesium, zinc, copper, cadmium and chromium, and with ammonium nitrogen. In cases of hospitalization for psoriasis, a correlation was revealed with such elements as potassium, ammonium nitrogen, and phosphorus.     

Gender Differences in Correlations Between the Content of Elements in Rain Water and the Frequency of Hospitalization for Arterial Hypertension, Chronic Obstructive Pulmonary Disease, and Psoriasis in Opole Voivodship, Poland, During 2000–2002

The aim of this work is to show and give a plausible explanation to gender-dependent differences in correlations between the content of selected elements in rainwater and the frequency of hospitalization by reason of arterial hypertension, chronic obstructive pulmonary disease (COPD), and psoriasis in the area of Opolskie Voivodeship, Poland, during the period 2000-2002. The elements analyzed were sodium, potassium, calcium, magnesium, manganese, iron, total phosphorus, total nitrogen, ammonium nitrogen, zinc, copper, lead, cadmium, nickel, chromium, chloride, nitrate, and sulfate. Hospitalization due to arterial hypertension was more frequent in women, whereas those for COPD and psoriasis were more frequent in men. In the case of women hospitalized for arterial hypertension, the correlations were low, except for zinc (r = 0.47) and for cadmium (r = 0.43). In men hospitalized for COPD, all of the correlation coefficients were higher than 0.4, except for phosphorus. The coefficients for nickel, ammonia nitrogen, and total nitrogen ranged from 0.5 to 0.6 and the remaining elements from 0.6 to 0.7. In women, the correlation was limited to five elements where the coefficient was r > 0.4 for chloride, calcium, nitrate, phosphorus, and chromium. In cases of hospitalization for psoriasis, the correlation in men was between 0.4 and 0.5 for chloride, phosphorus, copper, lead, and total nitrogen and greater than 5 for sulfate, potassium, calcium, iron, manganese, nitrate, and ammonium nitrogen. The correlation in women was between 0.48 and 0.5 for ammonium nitrogen and phosphorus.