Endothelial Dysfunction in Psoriasis: An Updated Review

[Translated article] Triglyceride-glucose Index as a Predictor of Cardiovascular Events in Psoriatic Patients on Systemic Therapy: A 150-patient Observational Study

Psoriasis is consistently associated with an elevated cardiovascular risk. However, biochemical parameters are needed to predict cardiovascular events in these patients. Therefore, we conducted a retrospective cohort study with psoriatic patients undergoing systemic treatment to analyze the value of the triglyceride-glucose (TyG) index in predicting the development of major adverse cardiovascular events (MACE). A total of 150 patients were selected, 12 of whom developed MACE (11 myocardial infarctions and one stroke) after a median follow-up of 17 months. The highest quartile of the TyG index was associated with a greater risk of developing MACE (HR, 9.3; 95%CI, 1.1-78.9). The predictive capabilities of the TyG index for predicting these events showed an area under the curve of 0.75 (0.60-0.90), p=0.001. These results demonstrate that the TyG index could be useful in the early identification of psoriatic patients at high risk of developing MACE.

Triglyceride-Glucose Index as a Predictor of Cardiovascular Events in Psoriatic Patients on Systemic Therapy: A 150-Patient Observational Study

Psoriasis is consistently associated with an elevated cardiovascular risk. However, biochemical parameters are needed to predict cardiovascular events in these patients. Therefore, we conducted a retrospective cohort study with psoriatic patients undergoing systemic treatment to analyze the value of the triglyceride-glucose (TyG) index in predicting the development of major adverse cardiovascular events (MACE). A total of 150 patients were selected, 12 of whom developed MACE (11 myocardial infarctions and one stroke) after a median follow-up of 17 months. The highest quartile of the TyG index was associated with a greater risk of developing MACE (HR, 9.3; 95%CI, 1.1-78.9). The predictive capabilities of the TyG index for predicting these events showed an area under the curve of 0.75 (0.60-0.90), P=0.001. These results demostrate that the TyG index could be useful in the early identification of psoriatic patients at high risk of developing MACE.

S1PR1-biased activation drives the resolution of endothelial dysfunction-associated inflammatory diseases by maintaining endothelial integrity

G protein-coupled sphingosine-1-phosphate receptor 1 (S1PR1), a drug target for inflammatory bowel disease (IBD), enables immune cells to egress from lymph nodes, but the treatment increases the risk of immunosuppression. The functional signaling pathway triggered by S1PR1 activation in endothelial cells and its therapeutic application remains unclear. Here, we showed that S1PR1 is highly expressed in endothelial cells of IBD patients and positively correlated with endothelial markers. Gi-biased agonist-SAR247799 activated S1PR1 and reversed pathology in male mouse and organoid IBD models by protecting the integrity of the endothelial barrier without affecting immune cell egress. Cryo-electron microscopy structure of S1PR1-Gi signaling complex bound to SAR247799 with a resolution of 3.47 Å revealed the recognition mode for the biased ligand. With the efficacy of SAR247799 in treating other endothelial dysfunction-associated inflammatory diseases, our study offers mechanistic insights into the Gi-biased S1PR1 agonist and represents a strategy for endothelial dysfunction-associated disease treatment.

Association Between Systemic Inflammation, Metabolic Syndrome and Quality of Life in Psoriasis Patients

BACKGROUND/OBJECTIVES

Psoriasis is a chronic inflammatory autoimmune disease with important systemic and psychosocial impacts. The association with metabolic syndrome (MS) impairs disease severity and negatively influences patient-reported outcomes, particularly their quality of life as measured by the Dermatology Life Quality Index (DLQI). This study aims to investigate the relationship between systemic inflammation, DLQI scores and disease severity, focusing on the persistent impact of MS on patient outcomes after one year of treatment.

METHODS

This retrospective cross-sectional study included 150 psoriasis patients, with 74 also meeting the diagnostic criteria for MS. Clinical and inflammatory markers such as systemic immune-inflammatory index (SII), cytokines (IL-17A, IL-23), leptin, BMI and triglycerides were analyzed alongside PASI and DLQI scores.

RESULTS

Patients with MS had significantly higher PASI and DLQI scores compared to those without MS, reflecting worse disease severity and quality of life (p < 0.01). Elevated SII levels were strongly associated with higher DLQI scores (p < 0.01). Despite considerable reductions in PASI scores over one year of treatment, DLQI scores indicated a persistent negative impact of MS on quality of life. Notably, markers of systemic inflammation, such as SII, leptin and cytokines, correlated positively with both PASI and DLQI scores, highlighting the role of systemic inflammation in disease burden.

CONCLUSIONS

This study underlines the significant role of systemic inflammation and metabolic comorbidities in amplifying the burden of psoriasis. The persistent impact of MS on quality of life despite clinical improvement underscores the need for comprehensive treatment approaches targeting systemic inflammation, metabolic health and psychosocial factors to improve long-term outcomes.

Stromal cells and epigenetics: emerging key players of chronic inflammatory skin diseases

Epigenetic alterations play a crucial role in developmental processes, tissue regeneration, and cellular differentiation. Epigenetic changes are dynamically reversible. Various drugs that target DNA methyltransferases or histone deacetylases have demonstrated their ability to restore normal epigenetic patterns in a number of diseases. While the involvement of epigenetic modifications has been identified in chronic inflammatory diseases, their specific impact on skin inflammation in stromal cells remains unclear. This mini-review explores the role of stromal cells in chronic inflammatory skin diseases, focusing on epigenetic modifications of stromal cells such as fibroblasts, lymphatic, and blood vascular endothelial cells in both healthy and diseased skin. We also provide an overview of recent findings that highlight the contribution of stromal cells, including fibroblasts, to inflammatory and remodeling processes through epigenetic changes in the context of chronic inflammatory conditions. Investigating epigenetic reprogramming of stromal cells might lead to novel strategies for treating chronic inflammatory skin diseases. [BMB Reports 2024; 57(11): 465-471].

Epicardial Adipose Tissue and Psoriasis: A Systematic Review and Meta-Analysis

Background: As a novel biomarker for cardiovascular diseases, epicardial adipose tissue (EAT) has been linked to psoriasis. We conducted an updated systematic review, building upon a previous report on the relationship between EAT and psoriasis. Methods: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials. The methodological quality of each study was assessed using the Newcastle-Ottawa Scale. The pooled mean difference (MD) or standardized mean difference (SMD) and the corresponding confidence interval (CIs) were calculated. Results: We included 10 studies with 1287 participants. Five of the included studies were of high methodological quality, while the other five were of moderate quality. The pooled data indicated that psoriasis patients had significantly increased EAT compared to individuals in the control group (SMD 1.53, 95% CI 0.61 to 2.45, 9 studies, 1195 participants). The subgroup analysis showed that psoriasis patients had significantly increased EAT thickness compared with the controls (SMD 2.45, 95% CI 0.73 to 4.17, 5 studies, 657 participants). Similarly, EAT area in single-slice CT images was significantly higher in the psoriasis group than in the control group (SMD 0.45, 95% CI 0.14 to 0.76, 2 studies, 195 participants). The EAT volume based on CT images appeared to be higher in the psoriasis group than in the control group, but the difference was not statistically significant (SMD 0.32, 95% CI -0.06 to 0.70, 2 studies, 343 participants). Conclusions: EAT, especially echocardiographic EAT thickness and CT-determined EAT area, was significantly associated with psoriasis, but CT-determined EAT volume was not.

Calcipotriol/Betamethasone Dipropionate for the Treatment of Psoriasis: Mechanism of Action and Evidence of Efficacy and Safety versus Topical Corticosteroids

The combined treatment with calcipotriol (Cal) and betamethasone dipropionate (BDP) has emerged as the leading anti-psoriatic topical treatment. Fixed-dose Cal/BDP is available in different formulations, including ointment, gel, foam, and cream. This review examines the mechanism of action of Cal/BDP underlying its therapeutic effect and compiles the evidence regarding its efficacy and safety compared to monotherapy with topical corticosteroids. The dual-action of Cal/BDP targets the inflammatory pathways and abnormal keratinocyte proliferation, both of them fundamental mechanisms of psoriasis pathogenesis. A large number of randomized, double-blind studies support Cal/BDP superiority over topical corticosteroids, demonstrating its broad efficacy across several degrees of psoriasis severity and its capability to provide early significant clinical improvements. This increased efficacy is achieved without negative effects on the safety profile, since the incidence of adverse effects reported with Cal/BDP is usually similar to that of BDP and even lower than that of Cal alone. The combination therapy rapid onset of action, coupled with a simplified dosing regimen, has been identified as crucial for improving long-term adherence and patient outcomes. In conclusion, Cal/BDP is confirmed as a versatile, effective, and convenient option for the patient in psoriasis management.

Short-Term Variability of Both Brachial and Aortic Blood Pressure is Increased in Patients with Immune-mediated Chronic Inflammation

INTRODUCTION

Blood pressure (BP) variability (BPV) has emerged as an indicator of subclinical organ damage and an independent predictor of cardiovascular disease (CVD) morbidity and mortality in high-risk populations.

AIM

We aimed to assess short-term variability of both brachial and aortic BP in psoriasis, a common immune-mediated inflammatory disorder characterized by increased CVD risk.

METHODS

Psoriasis patients and non-psoriasis individuals had their BP assessed throughout a 24 h period (Mobil-O-Graph device). Brachial and aortic BPV during the 24 h and the respective daytime and nighttime periods was calculated from relevant ambulatory BP profiles. In-house software was applied to automatically calculate average real variability (ARV) of brachial and aortic systolic (bSBP, aSBP) and diastolic BP (bDPB, aDBP), and the weighted standard deviation (wSD) of 24 h bSBP/aSBP. 24 h pulse wave velocity (PWV) and augmentation index (AIx) were used as widely applied markers of arterial stiffness.

RESULTS

Psoriasis patients (n = 74) presented increased ARV of 24 h and daytime bSBP/aSBP, and increased ARV of 24 h and daytime bDBP/aDBP, compared to controls (n = 40). PWV and AIx correlated with ARV of 24 h bSBP/aSBP, daytime bSBP/aSBP, while PWV further correlated with ARV of nighttime aSBP. The observed associations with PWV, yet not AIx, with indices of BPV remained significant after adjusting for CVD risk factors.

CONCLUSIONS

This is the first study reporting increased 24 h variability of both brachial and aortic BP in psoriasis. The association of short-term BPV with arterial stiffness implies a potential role of BPV in terms of CVD risk stratification in patients with chronic immune-mediated inflammation.

The Use of Microbial Modifying Therapies to Prevent Psoriasis Exacerbation and Associated Cardiovascular Comorbidity

Psoriasis has emerged as a systemic disease characterized by skin and joint manifestations as well as systemic inflammation and cardiovascular comorbidities. Many progresses have been made in the comprehension of the immunological mechanisms involved in the exacerbation of psoriatic plaques, and initial studies have investigated the mechanisms that lead to extracutaneous disease manifestations, including endothelial disfunction and cardiovascular disease. In the past decade, the involvement of gut dysbiosis in the development of pathologies with inflammatory and autoimmune basis has clearly emerged. More recently, a major role for the skin microbiota in establishing the immunological tolerance in early life and as a source of antigens leading to cross-reactive responses towards self-antigens in adult life has also been evidenced. Gut microbiota can indeed be involved in shaping the immune and inflammatory response at systemic level and in fueling inflammation in the cutaneous and vascular compartments. Here, we summarized the microbiota-mediated mechanisms that, in the skin and gut, may promote and modulate local or systemic inflammation involved in psoriatic disease and endothelial dysfunction. We also analyze the emerging strategies for correcting dysbiosis or modulating skin and gut microbiota composition to integrate systemically existing pharmacological therapies for psoriatic disease. The possibility of merging systemic treatment and tailored microbial modifying therapies could increase the efficacy of the current treatments and potentially lower the effect on patient's life quality.

HPLC- and NMR-Based Chemical Profiling, Wound-Healing Potential, Anti-Inflammatory and Antibacterial Activities of Satureja pilosa (Lamiaceae), a Neglected Medicinal-Aromatic Herb

Satureja pilosa Velen. (Lamiaceae) is a perennial and melliferous aromatic-medicinal subshrub which is range-restricted in adjacent parts of Greece and Bulgaria and locally in Italy, known in Northern Greece as wild oregano ("agriorigani") and traditionally collected from the wild for culinary purposes. Since the ethnopharmacological data and modern biological activities of Satureja spp. suggest promising applications in skin conditions, the present study aimed to investigate the hitherto unknown phenolic content of cultivated S. pilosa and its potential biological activities, focusing mainly on wound-healing and anti-inflammatory effects. An HPLC-PDA-MS-targeted phytochemical investigation, along with NMR, allowed for the isolation and characterization of the main constituents, resulting in 18 compounds. Representative extracts and purified compounds were tested for wound-healing activity on NIH/3T3 fibroblasts. The butanol extract exhibited a significantly higher cell migration rate (73.4%) compared to aqueous (50.6%) and methanolic (49.6%) ones, enhancing the cell migration more rapidly at both concentration levels, whilst rosmarinic acid was the most potent among the isolated compounds, with a migration rate of 64.0% at the concentration level of 10-5 mg/mL, followed by 3,4-dihydrophenyllactic acid (54.7%). Moreover, potential effects on endothelial activation processes were explored, including the leukocyte-endothelial cell interaction during inflammatory processes and the migratory capacity during angiogenic actions, since these processes are commonly associated with skin diseases. Finally, extracts and purified compounds demonstrated weak antibacterial potential against two important pathogens (Staphylococcus aureus and Pseudomonas aeruginosa), suggesting that further investigation is warrented.

Inhibition of vascular endothelial growth factor-A downregulates angiogenesis in psoriasis: A pilot study

Background

Vascular Endothelial Growth Factor (VEGF)-A-mediated angiogenesis participates in the pathogenesis of psoriasis, thus inviting the hypothesis that anti-VEGF-A therapy could be beneficial in psoriasis. While anti-angiogenic agents are used in oncology and ophthalmology, these therapeutic strategies remain unexplored for the management of psoriasis.

Objective

Our objective was to investigate ex vivo how VEGF-A blockade impacts blood vessels, epidermis and immune cells in organ-cultured plaque and non-lesional skin from patients with psoriasis.

Methods

Skin biopsies from patients with psoriasis (n = 6; plaque and non-lesional skin) and healthy controls (n = 6) were incubated with anti-VEGF-A monoclonal antibody (bevacizumab, Avastin®) or a human IgG1 isotype control for 72-h in serum-free organ culture. CD31/LYVE-1, Ki-67, and mast cell tryptase expression were assessed by quantitative immunohistomorphometry. VEGF-A levels in plasma, PBMCs and skin culture supernatants were measured.

Results

Inhibition of VEGF-A blocked all free VEGF-A ex vivo, reduced blood vessel area and the number of blood vessel endothelial cells in plaques of psoriasis (*p < 0.05). The treatment effect correlated significantly with levels of VEGF-A in organ culture supernatants (r = 0.94; *p < 0.05) from plaque skin and with plasma levels of VEGF-A from patients with psoriasis (r = 0.943; *p = 0.017).

Conclusions

These ex vivo data are the first studies to objectively investigate the potential of VEGF-A inhibition as a novel adjuvant treatment strategy for psoriasis. Taken together, our data encourage further investigation by clinical trial to explore whether downregulating pathological angiogenesis has clinical utility, especially in patients with severe psoriasis or those with elevated levels of VEGF-A in plasma and/or skin.

Platelet activation: a promoter for psoriasis and its comorbidity, cardiovascular disease

Psoriasis is a chronic inflammatory skin disease with a prevalence of 0.14% to 1.99%. The underlying pathology is mainly driven by the abnormal immune responses including activation of Th1, Th17, Th22 cells and secretion of cytokines. Patients with psoriasis are more likely to develop cardiovascular disease (CVD) which has been well recognized as a comorbidity of psoriasis. As mediators of hemostasis and thromboinflammation, platelets play an important part in CVD. However, less is known about their pathophysiological contribution to psoriasis and psoriasis-associated CVD. A comprehensive understanding of the role of platelet activation in psoriasis might pave the path for more accurate prediction of cardiovascular (CV) risk and provide new strategies for psoriasis management, which alleviates the increased CV burden associated with psoriasis. Here we review the available evidence about the biomarkers and mechanisms of platelet activation in psoriasis and the role of platelet activation in intriguing the common comorbidity, CVD. We further discussed the implications and efficacy of antiplatelet therapies in the treatment of psoriasis and prevention of psoriasis-associated CVD.

Metabolic Syndrome Screening and Nutritional Status of Patients with Psoriasis: A Scoping Review

Background: Patients with plaque psoriasis have an increased risk of metabolic syndrome. However, no studies have assessed the nutritional status or screening methods of this population. Aims: This review aimed to identify and summarise metabolic syndrome screening criteria and the tools/methods used in nutrition assessment in patients with plaque psoriasis. Data synthesis: PubMed, Web of Science, Ovid and Scopus were searched from inception to March 2023, following the Arkensey and O'Malley framework, to identify articles that report nutritional assessment methods/tools and metabolic screening criteria. Twenty-one studies were identified. Overall, these studies used four different screening criteria to define metabolic syndrome. Patients with psoriasis had a high prevalence of metabolic syndrome and had a poor nutritional status compared to controls. However, only anthropometric measures such as weight, height and waist circumference were employed to determine the nutritional status. Only two studies assessed the vitamin D status. Conclusions: Patients with psoriasis have a poor nutritional status, and they are at risk of nutrient deficiencies. However, these health aspects are not routinely assessed and may increase the risk of malnutrition among these patients. Therefore, additional assessments, such as body composition and dietary assessment, are needed to determine the nutritional status to provide a suitable intervention.

Blunted Microvascular Reactivity in Psoriasis Patients in the Absence of Cardiovascular Disease, as Assessed by Laser Speckle Contrast Imaging

Psoriasis is associated with accelerated rates of cardiovascular disease (CVD). Laser Speckle Contrast Imaging (LSCI) is a novel, non-interventional technique for the dynamic assessment of microvascular endothelial dysfunction, which represents an early precursor of CVD. We investigated whether skin microvascular reactivity is impaired in psoriasis and whether an association exists with large artery stiffening. Skin microvascular reactivity was assessed with LSCI combined with post-occlusive reactive hyperaemia protocol in psoriasis patients and controls in the absence of established CVD. Arterial stiffness and central hemodynamics were assessed throughout a whole 24 h period with the Mobil-O-Graph device. Most LSCI indices of microvascular reactivity were impaired in psoriasis patients (n = 90) compared to controls (n = 45) [baseline flux; occlusion flux; peak-to-baseline magnitude; baseline cutaneous vascular conductance (CVC); percentage increase in CVC, p < 0.001 for all comparisons]. In multivariate analysis, psoriatic disease predicted the above markers independently of classical CVD risk factors. Augmentation index, peripheral pulse pressure, and central systolic/diastolic blood pressure correlated with LSCI microvascular responses in the study population (n = 135). Pulse wave velocity significantly correlated with nearly all LSCI parameters, while the association with baseline flux was independent of CVD risk factors and psoriatic disease in multivariate analysis (beta = 0.096, p = 0.039). This study provides evidence of altered skin microvascular responses in psoriasis by use of LSCI, and interaction with macrovascular dysfunction, before the establishment of overt CVD. A non-interventional approach of skin microcirculation with LSCI might be used as an early indicator of vascular health in psoriasis.