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CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 438-440
Inflammasome Related Mediators and Their Association with Disease Determinants in Chronic Plaque Psoriasis


1 Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication17-Sep-2021

Correspondence Address:
Sunil Dogra
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_624_20

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How to cite this article:
Chhabra S, Narang T, Bansal F, Sahu S, Dogra S. Inflammasome Related Mediators and Their Association with Disease Determinants in Chronic Plaque Psoriasis. Indian J Dermatol 2021;66:438-40

How to cite this URL:
Chhabra S, Narang T, Bansal F, Sahu S, Dogra S. Inflammasome Related Mediators and Their Association with Disease Determinants in Chronic Plaque Psoriasis. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 2];66:438-40. Available from: https://www.e-ijd.org/text.asp?2021/66/4/438/326133




Sir,

Psoriasis vulgaris (PV) is characterized by immune dysregulation leading to inappropriate activation of proinflammatory cytokines. In plaque-type psoriatic lesions, keratinocytes express IL-1β and IL-18 which regulate the expression of genes involved in the pathogenesis of psoriasis.[1] The biologic activity of these cytokines is regulated by inflammasomes through caspase 1 activation.[2] Inflammasomes are large intracellular multi-protein signaling complexes which are formed in response to diverse pathogenic stimuli and constitute a central nucleus around which the inflammatory response develops. These multimeric complexes consist of an assembly of three elements: a sensor protein (receptor), an adaptor protein, and an effector protein (caspases). This assembly generates an inflammatory response resulting in the production of IL-18 and IL-1β.[2] Normal inflammasome response is needed for an effective innate immune response but its exaggerated activity leads to deleterious effects on the organism resulting in a variety of immune-mediated and autoimmune conditions including psoriasis.[3] The present study was undertaken in PV patients to attempt to delineate the pattern of circulating markers of inflammasome activity (IL-1β, IL-18) and their relationship with disease determinants.

This prospective case-control study was performed on 40 newly registered consenting PV patients and 17 age- and sex-matched (P = 0.457 and 0.464, respectively) healthy controls. Demographic and disease data were recorded. Psoriasis area severity index (PASI) scores were determined at the initial visit. All included patients were outside a washout period of 2 months from systemic and 2 weeks from topical medication. Patients with known autoimmune disease, malignancy, or serious chronic systemic disease and pregnant and lactating women were excluded. The study was approved by the institutional ethics committee PGIMER, Chandigarh (PGI/IEC/2015/1507 dated 15-10-2015).

Whole blood samples (3 mL) were collected in plain tubes and sera were separated and stored at −80°C. Enzyme linked immunosorbent assay (ELISAs) for IL-18 (RayBiotech, GA, USA) and IL-1β (E biosciences, California, USA) were performed per manufacturer guidelines. Patients were stratified by sex (males vs. females), age at onset (early [≤40years] vs. late [>40 years]), severity (mild-to-moderate vs. severe; depending on the PASI scores), disease duration (≤5 vs. >5 years), associated systemic comorbidities, and disease status (stable vs. unstable). All statistical tests were performed using the IBM SPSS (version 22.0) software at a significance level of α =0.05 after testing the normality of the variables. An analysis of correlations of the subpopulations with various disease parameters in the patients was conducted. Group comparisons were made with the Chi-square test or Fisher's exact test.

[Table 1] summarizes the clinical characteristics of the patients. Most patients (n = 33, 82.5%) had early-onset disease. Patients with longer disease duration showed more severe disease (P = 0.032). Serum levels of IL-1β and IL-18 were significantly higher in patients (0.41 ± 0.38 and 34.4 ± 12.2 pg/mL, respectively) compared to controls (0.19±0.20 and 23.6 ± 7.9, respectively) (P < 0.05*) [Figure 1]. Individual cytokine levels were compared in different patient subgroups [Figure 2]. Neither cytokine showed a statistically significant correlation with disease severity. Serum IL-18 levels were found to be higher in patients with late-onset psoriasis (P = 0.044*). Patients with comorbidities showed statistically significant higher levels of both cytokines (P < 0.05). No significant correlations were observed between the cytokine concentrations and sex, duration, or disease status (P > 0.05).
Figure 1: Dot plots to compare serum IL-18 levels and IL-1β levels in patients with psoriasis vulgaris and healthy controls. Comparison of cytokine levels was performed using the unpaired t-test

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Figure 2: Bar diagram showing cytokines' levels between different demographic and clinical subgroups within the patients

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Table 1: Baseline clinical and demographic characteristics of psoriasis patients and healthy controls

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Pietrzak et al.[4] observed significantly increased plasma IL-18 concentrations showing a linear correlation with PASI scores. They reported more severe disease (PASI scores 15–48) in their cohort of 12 patients.[4] We also found significantly increased levels of these cytokines in our group of North Indian psoriatic patients (n = 40) indicating their systemic activation. However, we did not observe any correlation with disease severity: most patients (n = 35) in our cohort had mild-to-moderate disease (mean PASI scores 4.02 ± 2.7), with only five patients having PASI>10.

Varma et al.[5] have also not observed any correlations between plasma levels of inflammasome-generated IL-1β and IL-18 with PASI scores in their cohort suggesting that the cutaneous manifestations are independent of inflammasome-dependent systemic inflammation.

The complex nature of PV worsens the patient's quality-of-life due to its association with other comorbidities and vascular complications.[6] In this study, serum cytokine levels were significantly elevated in patients with associated comorbidities as compared to those without, reiterating the fact that a systemic inflammatory state, with proinflammatory cytokines as potential coadjuvants, is a possible link between psoriasis and systemic comorbidities.[7]

Increased systemic levels of these proinflammatory cytokines exacerbate the systemic inflammatory process—a hallmark of PV.[6] Inflammasomes have been recently documented as important players in triggering systemic inflammation in psoriasis.[5] Moreover, IL-18 may be involved in the formation of Munro microabscesses and plaques.[8] Studies linking inflammasome activation and consequently increased proinflammatory cytokine production with Th17 responses might shed light onto newer molecular mechanisms of psoriasis pathogenesis, and help establish newer therapeutic and preventive approaches, ultimately improving the outcome for psoriatic patients.

Acknowledgment

Special thanks to Dr. Neha Joshi for her valuable suggestions regarding the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Perera GK, Di Meglio P, Nestle FO. Psoriasis. Annu Rev Pathol 2012;7:385-422.  Back to cited text no. 1
    
2.
Forouzandeh M, Besen J, Keane RW, de Rivero Vaccari JP. The inflammasome signaling proteins ASC and IL-18 as biomarkers of psoriasis. Front Pharmacol 2020;11:1238.  Back to cited text no. 2
    
3.
Dombrowski Y, Peric M, Koglin S, Kammerbauer C, Göss C, Anz D, et al. Cytosolic DNA triggers inflammasome activation in keratinocytes in psoriatic lesions. Sci Transl Med 2011;3:82ra38.  Back to cited text no. 3
    
4.
Pietrzak A, Lecewicz-Torun B, Chodorowska G, Rolinski J. Interleukin-18 levels in the plasma of psoriatic patients correlates with the extent of skin lesions and the PASI score. Acta Derm Venereol 2003;83:262-5.  Back to cited text no. 4
    
5.
Verma D, Fekri SZ, Sigurdardottir G, Eding CB, Sandin C, Enerbäck C. Enhanced inflammasome activity in patients with psoriasis promotes systemic inflammation. J Invest Dermatol 2021;141:586-95.e5.  Back to cited text no. 5
    
6.
Vena GA, Altomare G, Ayala F, Berardesca E, Calzavara-Pinton P, Sergio Chimenti S, et al. Incidence of psoriasis and association with comorbidities in Italy: A 5-year observational study from a national primary care database. Eur J Dermatol 2010;20:593-8.  Back to cited text no. 6
    
7.
Takeshita J, Grewal S, Langan SM, Mehta NN, Ogdie A, Voorhees AS, et al. Psoriasis and comorbid diseases: Epidemiology. J Am Acad Dermatol 2017;76:377-90.  Back to cited text no. 7
    
8.
Niu XL, Huang Y, Gao YL, Sun YZ, Han Y, Chen HD, et al. Interleukin-18 exacerbates skin inflammation and affects microabscesses and scale formation in a mouse model of imiquimod-induced psoriasis. Chin Med J (Engl) 2019;132:690-8.  Back to cited text no. 8
    


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