Psoriasis: a novel risk factor for type 2 diabetes

Genome-wide Mendelian randomization study identifies therapeutic targets for diabetic microangiopathy

AIMS

This study aims to identify potential therapeutic targets for diabetic microangiopathy by integrating genome-wide association studies (GWAS) and Mendelian randomization (MR) analyses.

METHODS

A comprehensive analysis of GWAS datasets on diabetic microangiopathy was conducted by using two-sample MR to determine the causal effects of blood-expressed druggable genes at both the transcriptional and protein levels. Co-localization analysis was conducted to validate gene-trait associations, while phenome-wide association studies (PheWAS) explored broader phenotypic implications. Additionally, protein-protein interaction (PPI) networks were constructed to elucidate gene interactions and molecular docking was conducted to determine therapeutic druggability.

RESULTS

Nine candidate therapeutic targets (PSORS1C3, HLA-C, RAMP1, CTSG, SREBF1, BTN3A2, PPA1, PRKD2, and PPIG) were identified, with co-localization analysis confirming their involvement in diabetic microangiopathy. Among them, HLA-C exhibited associations with additional traits, suggesting the specificity of the remaining targets. Functional enrichment analysis indicated a predominant involvement of immune-related pathways, underscoring their relevance to the pathogenesis of diabetic microangiopathy. Furthermore, molecular docking studies revealed strong binding affinities.

CONCLUSIONS

This study provides compelling genetic evidence supporting the role of immune-related druggable genes in diabetic microangiopathy and identifies novel therapeutic targets for intervention.

Psoriasis increases the risk of Sjögren's syndrome: evidence from a propensity score-matched cohort study and transcriptomic analysis

BACKGROUND

Despite the well-documented immune dysregulation in both psoriasis and Sjögren's syndrome (SS), the specific link between these two autoimmune diseases has not been extensively explored. The present study aims to investigate the impact of psoriasis on the risk of SS.

METHODS

A retrospective cohort study using TriNetX data compared SS development in patients with psoriasis and controls using propensity score matching, Kaplan-Meier curves, and Cox models. Transcriptome data were analyzed to identify shared differentially expressed genes and pathways between the two diseases.

RESULTS

A total of 293,905 patients with psoriasis and an equal number of individuals without psoriasis were included. After propensity score matching, the baseline characteristics of both groups were balanced. During the follow-up period, 3339 patients with psoriasis and 1937 individuals without psoriasis developed SS. The Kaplan-Meier curves indicated a significantly higher risk of developing SS in the psoriasis group compared to the non-psoriasis group. Upon adjustment for multiple confounding factors, the risk of developing SS in the psoriasis group was 50% higher in the psoriasis group than the non-psoriasis group (hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.42-1.58). Subgroup analyses confirmed the elevated risk of SS associated with psoriasis. Patients with psoriatic arthritis (PsA) and those treated with biological agents had an even higher risk of developing SS. Transcriptomic analysis revealed potential shared pathogenesis of psoriasis and SS involving cellular proliferation, immune cell recruitment, cytokine secretion, and the interferon response to viral infections.

CONCLUSIONS

Psoriasis might increase the risk of developing SS, which is augmented by PsA. The overlapping immunological mechanisms may underlie the co-occurrence of psoriasis and SS.

Geographic Patterns in Psoriasis: An Observational Study of CorEvitas Psoriasis Registry

Background: How psoriasis disease characteristics, management, and outcomes each vary across the US is not fully understood. Objective: Assess regional disease characteristics for patients enrolled in CorEvitas Psoriasis Registry, report biologic initiations by class over the period, and evaluate regional outcome data for initiations with 6-month follow-up. Methods: Participants included new biologic initiations in CorEvitas Psoriasis Registry from 2014-2019 categorized into 7 different geographic regions: Northeast, East North Central, Mountain/West North Central, South Atlantic, East South Central, West South Central, and Pacific. Baseline demographics and disease characteristics are described by region. For participants with 6-month follow-up data, we report treatment patterns and treatment outcomes. Results: 7520 biologic initiations from 6320 patients were available. Over time, biologic initiations in most US regions within the Registry resulted in a pattern where IL-17 inhibitors were used most frequently, followed by IL-12/23 and IL-23 inhibitors, and lastly by TNF inhibitors. Baseline disease severity varied among regions with the East South Central reporting the largest proportion (25.1%) of very severe disease by body surface area. Frequencies of metabolic comorbid diseases varied between regions (obesity, diabetes, hyperlipidemia, each P < .001; hypertension P < .019), with the East South Central reporting the largest proportions. Rates of achieving PASI75 and IGA 0/1 varied at 6-months (P = .008 and P = .001, respectively), with the East South Central reporting the lowest frequencies. At 6-months 28.2% of biologic initiations in the East South Central were discontinued, of which 22% had switched to another therapy. Conclusion: Providers should be aware of regional trends in disease characteristics to improve overall care of psoriasis patients.

Data protection-compliant broad consent for secondary use of health care data and human biosamples for (bio)medical research: Towards a new German national standard

BACKGROUND

The secondary use of deidentified but not anonymized patient data is a promising approach for enabling precision medicine and learning health care systems. In most national jurisdictions (e.g., in Europe), this type of secondary use requires patient consent. While various ethical, legal, and technical analyses have stressed the opportunities and challenges for different types of consent over the past decade, no country has yet established a national consent standard accepted by the relevant authorities.

METHODS

A working group of the national Medical Informatics Initiative in Germany conducted a requirements analysis and developed a GDPR-compliant broad consent standard. The development included consensus procedures within the Medical Informatics Initiative, a documented consultation process with all relevant stakeholder groups and authorities, and the ultimate submission for approval via the national data protection authorities.

RESULTS

This paper presents the broad consent text together with a guidance document on mandatory safeguards for broad consent implementation. The mandatory safeguards comprise i) independent review of individual research projects, ii) organizational measures to protect patients from involuntary disclosure of protected information, and iii) comprehensive information for patients and public transparency. This paper further describes the key issues discussed with the relevant authorities, especially the position on additional or alternative consent approaches such as dynamic consent.

DISCUSSION

Both the resulting broad consent text and the national consensus process are relevant for similar activities internationally. A key challenge of aligning consent documents with the various stakeholders was explaining and justifying the decision to use broad consent and the decision against using alternative models such as dynamic consent. Public transparency for all secondary use projects and their results emerged as a key factor in this justification. While currently largely limited to academic medicine in Germany, the first steps for extending this broad consent approach to wider areas of application, including smaller institutions and medical practices, are currently under consideration.

Health burden in type 2 diabetes and prediabetes in The Maastricht Study

Mortality in type 2 diabetes, is determined not only by classical complications, but also by comorbidities, and is linked to hyperglycaemia and apparent even in prediabetes. We aimed to comprehensively investigate, in a population-based cohort, health burden defined as the presence of comorbidities in addition to classical complications and cardiometabolic risk factors, in not only type 2 diabetes but also prediabetes. Such population-based study has not been performed previously. Extensive phenotyping was performed in 3,410 participants of the population-based Maastricht Study (15.0% prediabetes and 28.6% type 2 diabetes) to assess presence of 17 comorbidities, six classical complications, and ten cardiometabolic risk factors. These were added up into individual and combined sum scores and categorized. Group differences were studied with multinomial regression analyses adjusted for age and sex. Individuals with type 2 diabetes and prediabetes, as compared to normal glucose metabolism (NGM), had greater comorbidities, classical complications, cardiometabolic risk factors and combined sum scores (comorbidities sum score ≥ 3: frequencies (95% CI) 61.5% (57.6;65.4) and 41.2% (36.5;45.9) vs. 25.4% (23.5;27.4), p-trend < 0.001; classical complications ≥ 2 (26.6% (23.1;30.1; P < 0.001 vs. NGM) and 10.1% (7.8;12.7; P = 0.065 vs NGM) vs. 8.0% (6.9;9.3)); cardiometabolic risk factors ≥ 6 (39.7% (35.9;43.4) and 28.5% (24.5;32.6) vs. 14.0% (12.5;15.6); p-trend < 0.001); combined ≥ 8 (66.6% (62.7;70.5) and 48.4% (43.7;53.1) vs. 26.0%(24.1;28.0), p-trend < 0.001). Type 2 diabetes and prediabetes health burden was comparable to respectively 32 and 14 years of ageing. Our population-based study shows, independently of age and sex, a considerable health burden in both type 2 diabetes and prediabetes, which to a substantial extent can be attributed to comorbidities in addition to classical complications and cardiometabolic risk factors. Our findings emphasize the necessity of comorbidities' awareness in (pre)diabetes and for determining the exact role of hyperglycaemia in the occurrence of comorbidities.

The Antidiabetic Agent Metformin Inhibits IL-23 Production in Murine Bone-Marrow-Derived Dendritic Cells

Psoriasis is a chronic inflammatory skin disease, and its immune mechanism has been profoundly elucidated. Biologics targeting interleukin (IL)-23 have prevented the development of psoriasis. As major sources of IL-23, dendritic cells (DCs) play a pivotal role in psoriasis; however, the regulatory mechanism of IL-23 in DCs remains unclear. IL-36γ was reported to reflect the disease activity of psoriasis. Therefore, we hypothesized that IL-36γ may affect IL-23 production in DCs. To reveal the mechanism by which IL-36γ controls IL-23 production in DCs, we analyzed murine bone marrow-derived DCs (BMDCs) stimulated with IL-36γ. IL-36γ stimulation upregulated the mRNA and protein expression of Nfkbiz in BMDCs. Nfkbiz knockdown using siRNA transfection partially inhibited the upregulation of IL-23 mRNA expression induced by IL-36γ stimulation. Since NF-κB signaling regulates Nfkbiz expression and the anti-diabetic agent metformin reportedly modulates NF-κB signaling, we examined the effect of metformin treatment on IL-36γ-induced IL-23 production. Metformin treatment impaired the phosphorylation of NF-κB induced by IL-36γ stimulation with the subsequent downregulation of Nfkbiz, resulting in the inhibition of IL-23 production in BMDCs. These data provided evidence that metformin treatment can inhibit IL-36γ-mediated IL-23 production in BMDCs, which might contribute to the prevention of psoriasis.

Comparison of Behavioral Risk Factors and Cardiometabolic Comorbidities of Psoriatic Arthritis and Psoriasis: A Case-Control Study in Chinese Patients

Purpose

Comparison of risk factors and comorbidities could help indicate the underlying mechanisms of diseases. This study aimed to compare behavioral factors and cardiometabolic comorbidities of PsA/psoriasis versus healthy controls to implicate the similarities and differences in potential pathogenic mechanisms for further research.

Patients and Methods

A case-control study in Chinese patients with PsA or psoriasis and healthy controls was conducted. Clinical information based on patient-reported and measured outcomes were collected. Multivariable logistic regression was used to investigate the associations, in terms of adjusted odds ratios (AORs).

Results

We randomly selected 171 patients with PsA, 342 with psoriasis, and 1026 healthy controls from our database, matching by age and sex. Dyslipidemia (AOR=4.62 for PsA and 2.97 for psoriasis) and alcohol drinking (AOR=3.20 for PsA and 3.62 for psoriasis) were significantly associated with both diseases. Overweight was inversely associated with both PsA (AOR=0.46, P=0.002) and psoriasis (AOR=0.56, P=0.001), while obesity was associated with PsA (AOR=2.02, P=0.025) but not psoriasis (AOR=0.87, P=0.621). Subgroup analysis by onset age of psoriatic lesions showed that former smoking was significantly associated with early-onset psoriasis (AOR=2.44, P=0.016) but not PsA (AOR=0.59, P=0.329). Laboratory test indicated that both PsA and psoriasis were associated with altered lipid profile.

Conclusion

PsA and psoriasis in Chinese patients share common behavioral and cardiometabolic risk factors including dyslipidemia and alcohol consumption. There is a U-shape association between BMI and PsA/psoriasis.

Transcriptomic Analysis of the Mechanisms for Alleviating Psoriatic Dermatitis Using Taodan Granules in an Imiquimod-Induced Psoriasis-like Mouse Model

Taodan granules (TDGs) are clinically efficacious for treating psoriasis, buttheir specific mechanisms of action are unclear. In this study, we determined the concentrations of tanshinone IIA and curcumol using high-performance liquid chromatography (HPLC) to establish quality control parameters for assessing the mechanism of TDGs in treating psoriasis. Thereafter, a mouse model of psoriasis was treated with TDGs. TDGs attenuated imiquimod-induced typical erythema, scales, and thickening of the back and ear lesions in the psoriatic mouse model. Furthermore, PCNA and Ki67-positive cells were reduced in the epidermis of psoriatic lesions following TDG treatment. Finally, the sequencing results were verified using a multitude of methods, and the mechanism of action of TDGs against psoriasis was found to be via the upregulation of metabolic signaling pathways such as the Gly-Ser-Thr axis, the downregulation of immune and inflammatory pathways, and the decrease in Rac2 and Arhgdib concentrations. Overall, this study clarified the mechanism of TDG treatment for psoriasis and provided evidence for its clinical application.

Association between thiazolidinedione use and rheumatoid arthritis risk in patients with type II diabetes, a population-based, case-control study

AIM

A previous study revealed that PPARγ agonists have anti-inflammatory effects in rheumatoid arthritis (RA). Furthermore, some studies have shown that type 2 diabetes mellitus (T2DM) may elicit the development of RA. In this study, we aimed to investigate whether the use of thiazolidinediones (TZDs) is associated with a lower risk of developing RA in patients with T2DM.

METHODS

Based on the Taiwan National Health Insurance Research Database, we conducted a nationwide case-control study. The selected cases were patients with T2DM who were diagnosed with RA between 2000 and 2013. The controls were retrieved at a ratio of 1:4 by propensity score matching. Logistic regression was conducted to evaluate whether TZD use lowers the risk of RA in patients with T2DM. The dose-response effect was examined according to the total TZD dose, within 2 years before the index date (the first diagnosis date of RA), and TZD doses were divided into four groups by cumulative Defined Daily Dose (cDDD): <30, 31-90, 91-365, and >365 cDDDs.

RESULTS

A total of 3605 cases and 14 420 controls were included in this study. After adjusting for age, sex, baseline comorbidities, the results demonstrated that TZD use did not significantly reduce the risk of RA in patients with T2DM (adjusted OR = 0.91, 95% CI 0.81-1.02). In the subgroup analysis by total TZD exposure dose within 2 years, 91-365 cDDDs of TZD had a lower risk of RA development, aOR = 0.87 (95% CI 0.71-1.06) and >365 cDDDs of TZD, aOR = 0.85 (95% CI 0.73-1.01). In the trend test, P was <.05.

CONCLUSIONS

TZD use might reduce the risk of RA in patients with T2DM, but it was non-statistically significant. Further research is necessary to assess this association.

Prevalence of psoriasis and associated risk factors in China: protocol of a nationwide, population-based, cross-sectional study

INTRODUCTION

Psoriasis is a chronic inflammatory skin disease which could lead to serious complications and increased risk of cardiovascular diseases. Psoriasis was recognised as a serious non-communicable disease with important public health impact by member states in the World Health Assembly resolution in 2014. However, data on psoriasis epidemiology are scarce worldwide, especially from low-income and middle-income countries. Only a few epidemiological studies on psoriasis have been conducted in parts of China, mostly without appropriate sampling design and data analysis.

AIM

This study aims to obtain the prevalence of psoriasis in China and relevant risk factors through a nationwide, population-based study with adequate statistical design.

METHODS AND ANALYSIS

This is a cross-sectional study to be conducted in 60 sites across China. A multistage, cluster random sampling design is used. Participants should have local household registration or be residing in the survey area for at least 6 months during the past year. The presence of psoriasis is ascertained independently by two certified dermatologists. If any discrepancies in the diagnosis occur, consensus will be met via discussion. All participants will be interviewed with a questionnaire to collect sociodemographic and disease information. The field survey will be implemented from October 2018 to June 2019. All statistical analyses will be conducted using survey procedures in SAS V.9.2 software to adjust for the complex sample design.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the ethics committee of the Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College (Nanjing, China). A written informed consent will be obtained from all participants before the questionnaire survey. Findings of the study will be disseminated through publications in peer-reviewed journals.

Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance

BACKGROUND

Psoriasis is associated with an increased risk of cardiovascular disease (CVD) at younger ages that is not identifiable by traditional risk factors. Screening for subclinical atherosclerosis with ultrasound has only been investigated in carotid arteries. Femoral artery ultrasound has never been considered for this purpose. The link between psoriasis and accelerated atherosclerosis has not yet been established.

OBJECTIVE

To study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis in psoriasis. We also investigated its possible relationship with changes in insulin resistance.

METHODS

We conducted a cross-sectional study in 140 participants, 70 patients with moderate-to-severe psoriasis and 70 healthy controls, matched 1:1 for age, sex, and BMI. Femoral and carotid atherosclerotic plaques were evaluated by ultrasonography. Insulin resistance was assessed by the homeostasis model assessment method (HOMA-IR).

RESULTS

Femoral atherosclerotic plaque prevalence was significantly higher in patients with psoriasis (44.64%) than in controls (19.07%) (p<0.005), but no significant difference was found in carotid plaque prevalence (p<0.3). Femoral plaques were significantly more prevalent than carotid plaques (21.42%) among patients with psoriasis (p<0.001). In the regression analysis, insulin resistance was the most influential determinant of atherosclerosis in psoriasis and C-reactive protein the most significant predictor of insulin resistance.

CONCLUSIONS

Ultrasound screening for femoral atherosclerotic plaques improves the detection of subclinical atherosclerosis in patients with psoriasis, whereas the study of carotid arteries is not sufficiently accurate. Insulin resistance appears to play a greater role in the development of atherosclerosis in these patients in comparison to other classical CVD risk factors.