ArticlePDF Available

EVALUATION OF SYSTEMIC INFLAMMATORY BIOMARKERS AND RISK OF CARDIOVASCULAR DISEASE IN PSORIASIS VULGARIS PATIENTS

Authors:
Marwa Jassim at University of Basrah
Marwa Jassim
Khairallah A S Mohammed at Southern Technical University
Khairallah A S Mohammed
Naael Hussein Ali
Naael Hussein Ali
Naael Hussein Ali
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Ghadah Lateef Jassim
Ghadah Lateef Jassim
Ghadah Lateef Jassim
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Show all 5 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract

This is an observational case-control study. It was carried out at the dermatology outpatient clinic in Al Fayha'a teaching hospital during the period from November 2020 to June 2021. Doctor permission was obtained and the patient sign a consent form. A hundred and twenty participants of both sexes were randomly selected and categorized into three main groups: psoriasis, ischemic heart disease, and healthy control. The first group includes forty psoriasis patients who have classical psoriatic lesions with a well-demarcated salmon color plaque and silvery. There were 23 male and 17 female psoriatic patients with a median (30.50), age range: 7-71 years. The second group includes patients with well-documented ischemic heart disease diagnosed by a cardiologist. There were 17 male and 23 female cardiovascular diseases patients (control positive) with a median (41.50), age range: 13-70 years. Third group of forty participants represents apparently healthy subjects (control negative). There were 26 males and 14 females with a median (36), age range: 2-68 years as a control group. A total of 3 ml of peripheral whole blood was taken from patients, healthy controls and patients with cardiovascular diseases to be used for ELISA test for TPAI-1, VEGF-A, IL-17 and protein analyzer P54 according to manufacture protocol. The results revealed highly significant changes in the TPAI-1, VEGF-A, IL-17, hs-CRP in psoriatic patients comparing to the healthy group with a median of 2.9 ng/ml, 3552.5 ng/ml,75.9 ng/ml for IL-17 and 4.55 mg/L, respectively (P-value <0.0001). In the CVD group, there were also highly significant changes in these four parameters comparing to the control negative group with a median of 6.1 ng/ml for TPAI-1, 5434.00 ng/ml for VEGF-A,76.400 ng/ml for IL-17 and 9.4 mg/L for hs-CRP (p-value <0.0001). Psoriasis severity showed significant effect only on serum IL-17 levels, but no effect on TPAI-1, VEGF-A and hs-CRP. (2022) Evaluation of systemic inflammatory biomarkers and risk of cardiovascular disease in Psoriasis vulgaris patients. Biochem. Cell. Arch. 22, 635-640. DocID: https://connectjournals.com/03896.2022.22.635
Content uploaded by Khairallah A S Mohammed
Author content
All content in this area was uploaded by Khairallah A S Mohammed on Aug 06, 2022
Content may be subject to copyright.
EVALUATION OF SYSTEMIC INFLAMMATORY BIOMARKERS AND RISK
OF CARDIOVASCULAR DISEASE IN PSORIASIS VULGARIS PATIENTS
Marwa Jassim Abdulqader1*, Khairallah A. S. Mohammed2, Naael Hussein Ali3, Ghadah Lateef Jassim4
and Hasan Mohammed Abdullah Alrubay5
1College of Health and Medical Technology, Southern Technical University, Basrah, Iraq.
2Department of Medical Lab Technology, College of Health and Medical Technology, Southern Technical University, Basrah, Iraq.
3College of Medicine, University of Basrah, Basrah, Iraq.
4Department of Dermatology, Al Fayha’a Teaching Hospital, Member of Iraqi Scientific Committee, Iraq.
5Consultant Interventional Cardiologist, Basra Cardiac Center, Iraq.
*e-mail : marwajassim699@gmail.com
(Received 30 July 2021, Revised 19 September 2021, Accepted 25 September 2021)
ABSTRACT : This is an observational case-control study. It was carried out at the dermatology outpatient clinic in Al Fayha’a
teaching hospital during the period from November 2020 to June 2021. Doctor permission was obtained and the patient sign a
consent form. A hundred and twenty participants of both sexes were randomly selected and categorized into three main groups:
psoriasis, ischemic heart disease, and healthy control. The first group includes forty psoriasis patients who have classical
psoriatic lesions with a well-demarcated salmon color plaque and silvery. There were 23 male and 17 female psoriatic patients
with a median (30.50), age range: 7-71 years. The second group includes patients with well-documented ischemic heart disease
diagnosed by a cardiologist. There were 17 male and 23 female cardiovascular diseases patients (control positive) with a median
( 41.50), age range: 13-70 years. Third group of forty participants represents apparently healthy subjects (control negative).
There were 26 males and 14 females with a median (36), age range: 2-68 years as a control group. A total of 3 ml of peripheral
whole blood was taken from patients, healthy controls and patients with cardiovascular diseases to be used for ELISA test for
TPAI-1, VEGF-A, IL-17 and protein analyzer P54 according to manufacture protocol. The results revealed highly significant
changes in the TPAI-1, VEGF-A, IL-17, hs-CRP in psoriatic patients comparing to the healthy group with a median of 2.9 ng/ml,
3552.5 ng/ml,75.9 ng/ml for IL-17 and 4.55 mg/L, respectively (P-value <0.0001). In the CVD group, there were also highly
significant changes in these four parameters comparing to the control negative group with a median of 6.1 ng/ml for TPAI-1,
5434.00 ng/ml for VEGF-A,76.400 ng/ml for IL-17 and 9.4 mg/L for hs –CRP (p-value <0.0001). Psoriasis severity showed
significant effect only on serum IL-17 levels, but no effect on TPAI-1, VEGF-A and hs-CRP.
Key words : Psoriasis, cardiovascular disease, immune dysregulation.
How to cite : Marwa Jassim Abdulqader, Khairallah A. S. Mohammed, Naael Hussein Ali, Ghadah Lateef Jassim and Hasan
Mohammed Abdullah Alrubay (2022) Evaluation of systemic inflammatory biomarkers and risk of cardiovascular disease in
Psoriasis vulgaris patients. Biochem. Cell. Arch. 22, 635-640. DocID: https://connectjournals.com/03896.2022.22.635
Biochem. Cell. Arch. Vol. 22, No. 1, pp. 635-640, 2022 www.connectjournals.com/bca ISSN 0972-5075
DocID: https://connectjournals.com/03896.2022.22.635 eISSN 0976-1772
INTRODUCTION
Psoriasis is a chronic inflammatory skin disease with
a strong genetic predisposition and autoimmune
pathogenic role (Rendon and Schakel, 2019). Psoriatic
lesions are sharply demarcated silvery scale
erythematous plaques that characterize the most common
form of psoriasis, occasionally sterile pustules are seen.
The most common sites of involvement are the scalp,
elbows and knees, followed by the nails, hands, feet and
trunk (including the intergluteal fold). There are also
subcategories of psoriasis types. These appear differently
depending on the location of the body like scalp, nail,
palmoplantar psoriasis. Psoriasis is not contagious
regardless of type (Bilal et al, 2018). The worldwide
prevalence is about 2%, but varies according to the region
(Rousset and Halioua, 2018). Incidence data confirmed
a clear bimodal age pattern in psoriasis onset, with the
first and second peaks at around 30-39 and 60-69 years
of age, respectively, then decreased towards the end of
life (Iskandar et al, 2021). Approximately 125 million
people worldwide have psoriasis. Patients with psoriasis
experience substantial morbidity and increased rates of
inflammatory arthritis, cardiometabolic diseases and
mental health disorders (Armstrong and Read, 2020).
CONCLUSION
Psoriasis is a chronic inflammatory skin disease that
involves an ongoing systemic inflammatory process that
carries the high potential risk of developing cardiovascular
disease.
REFERENCES
Apte R S, Chen D S and Ferrara N (2019) VEGF in signaling and
sisease: Beyond discovery and development. Cell 176, 1248-
1264.
Armstrong A W and Read C (2020) Pathophysiology, clinical
presentation and treatment of psoriasis: A review. JAMA 323,
1945-1960.
Bilal J, Malik S U, Riaz I B and Kurtzman D J B (2018) Psoriasis and
Psoriatic spectrum disease: A primer for the orimary care
physician. Am. J. Med. 131, 1146-1154.
Blauvelt A and Chiricozzi A (2018) The immunologic role of IL-17 in
Psoriasis and Psoriatic arthritis pathogenesis. Clin. Rev. Allergy
Immunol. 55, 379-390.
Braile M, Marcella S, Cristinziano L, Galdiero M R, Modestino L,
Ferrara A L, Varricchi G, Marone G and Loffredo S (2020) VEGF-
A in cardiomyocytes and heart diseases. Int. J. Mol. Sci. 21,
5294; https://doi.org/10.3390/ijms21155294
Carresi C, Mollace R, Macri R, Schcchitano M, Bosco F, Scarano F,l
Coppoletta A R, Guarnieri L, Ruga S, Zito M C, Nucera S,
Gliozzi M, Musolino V, Maiuolo J, Palma E and Mollace V
(2021) Oxidative stress Triggers defective autophagy in
endothelial cells: Role in atherothrombosis development.
Antioxidants 10,387; https://doi.org/10.3390/antiox10030387
Casciano F, Pigatto P D, Secchiero P, Gambari R and Reali E (2018) T
Cell hierarchy in the pathogenesis of psoriasis and associated
cardiovascular comorbidities. Front Immunol. 9, 1390.
Chen L and Tsai T F (2018) HLA-Cw6 and psoriasis. Br. J. Dermatol.
178, 854-862.
Fitch E, Harper E, Skorcheva I, Kurtz S E and Blauvelt A (2007)
Pathophysiology of psoriasis: recent advances on IL-23 and
Th17 cytokines. Curr. Rheumatol. Rep. 9, 461-467.
Gong J, Yang H, Qi D and Tang X (2020) The association of serum
vascular endothelial growth factor levels and psoriasis vulgaris:
A protocol for systematic review and meta-analysis. Medicine
99, e21565.doi: 10.1097/MD.0000000000021565
Hashimoto H, Kitagawa K, Hougaku H, Shimizu Y, Sakaguchi M,
Nagai Y, Iyama S, Yamanishi H, Matsumoto M and Hori M
(2001) C-reactive protein is an independent predictor of the rate
of increase in early carotid atherosclerosis. Circulation 104, 63-
7.
Iskandar I Y K, Parisi R, Griffiths C E M, Ashcroft D M and Global
Psoriasis A (2021) Systematic review examining changes over
time and variation in the incidence and prevalence of psoriasis
by age and gender. Br. J. Dermatol. 184, 243-258.
Kamath D Y, Xavier D, Sigamani A and Pais P (2015) High sensitivity
C-reactive protein (hsCRP) & cardiovascular disease: An Indian
perspective. Indian J. Med .Res. 142, 261-268.
Korman N J (2020( Management of psoriasis as a systemic disease:
what is the evidence? Br. J. Dermatol. 182, 840-848.
Krueger J G and Bowcock A (2005) Psoriasis pathophysiology: current
concepts of pathogenesis. Ann Rheum Dis. 64 (Suppl 2), ii30-6.
Li Y, Zong X, Cheng G, Zhao C, Zhang L, Hong Y, Wan Q, He R and
Wang Z (2017) Hs-CRP and all-cause, cardiovascular, and cancer
mortality risk: A meta-analysis. Atherosclerosis 259, 75-82.
Lockshin B, Balagula Y and Merola J F (2018) Interleukin 17,
inflammation and cardiovascular risk in patients with psoriasis.
J. Am. Acad. Dermatol. 79, 345-352.
Malecic N and Young H S (2017) Excessive angiogenesis associated
with psoriasis as a cause for cardiovascular ischaemia. Exp.
Dermatol. 26, 299-304.
Mickalak-Stoma A, Bartosinska J, Kowal M, Juszkiewicz-Borowiec
M, Gerkowicz A and Chodorowska G (2013) Serum levels of
selected Th17 and Th22 cytokines in psoriatic patients. Dis.
Markers 35, 625-31.
Mora-Ruiz M D, Blanco-Favela F, Chavez Rueda A K, Logorreta-
Haquet M V and Chavez-Sanchez L ( 2019) Role of interleukin-
17 in acute myocardial infarction. Mol. Immunol. 107, 71-78.
Nakhwa Y C, Rashmi R and Basavaraj K H (2014) Dyslipidemia in
Psoriasis: A Case Controlled Study. Int. Sch. Res. Notices 2014,
729157.
Nestle F O, Kaplan D H and Barker J (2009) Psoriasis. N Engl J Med.
361, 496-509.
Niknezhad N, Haghighatkhan H R, Zargari O, Ghalamkarpour F,
Younespour S, Niknejad N, Alikhan A and Abdolllahimajd F
(2020) High-sensitivity C-reactive protein as a biomarker in
detecting subclinical atherosclerosis in psoriasis. Dermatol Ther.
33, e13628.
Olofsson B O, Dahlen G and Nilsson T K (1989) Evidence for increased
levels of plasminogen activator inhibitor and tissue plasminogen
activator in plasma of patients with angiographically verified
coronary artery disease. Eur. Heart J. 10, 77-82.
Piros E A, Szilverszter B, Vattay B, Maurovich-Horvat P, Szalai K,
Dosa E, Merkely B and Hollo P (2021) Novel anti-inflammatory
therapies to reduce cardiovascular burden of psoriasis. Dermatol.
Ther. 34, e14721.
Rendon A and Schakel K (2019) Psoriasis pathogenesis and treatment.
Int. J. Mol. Sci. 20, 1475; https://doi.org/10.3390/ijms20061475
Rousset L and Halioua B (2018) Stress and psoriasis. Int. J. Dermatol.
57, 1165-1172.
Solfvast-Kaier A, Paek S Y and Menter A (2019) Anti-IL17 therapies
for psoriasis. Expert Opinion on Biological Therapy 19, 45-54.
Terauchi G, Shinoda K, Sakai H, Kawashima M, Matsumoto C S,
Mizota A and Miyake Y (2019) Retinal function determined by
flicker ERGs before and soon after intravitreal injection of anti-
VEGF agents. BMC Ophthalmol. 19, 129.
Ticinesi A, Lauretani F, Nouvenne A, Porro E, Fanelli G, Maggio M
and Meschi T (2017) C-reactive protein (CRP) measurement in
geriatric patients hospitalized for acute infection. Eur. J. Intern.
Med. 37, 7-12.
Vaugan D E (2005) PAI-1 and atherothrombosis. J. Thromb. Haemost.
3, 1879-1883.
Zhang C, Wang N, Tan H Y, Guo W, Li S and Feng Y (2018) Targeting
VEGF/VEGFRs pathway in the antiangiogenic treatment of
human cancers by traditional Chinese medicine. Integr. Cancer
Ther. 17, 582-601.
640 Marwa Jassim Abdulqader et al
ResearchGate has not been able to resolve any citations for this publication.
Oxidative Stress Triggers Defective Autophagy in Endothelial Cells: Role in Atherothrombosis Development
Article
Full-text available
  • Mar 2021
Atherothrombosis, a multifactorial and multistep artery disorder, represents one of the main causes of morbidity and mortality worldwide. The development and progression of atherothrombosis is closely associated with age, gender and a complex relationship between unhealthy lifestyle habits and several genetic risk factors. The imbalance between oxidative stress and antioxidant defenses is the main biological event leading to the development of a pro-oxidant phenotype, triggering cellular and molecular mechanisms associated with the atherothrombotic process. The pathogenesis of atherosclerosis and its late thrombotic complications involve multiple cellular events such as inflammation, endothelial dysfunction, proliferation of vascular smooth muscle cells (SMCs), extracellular matrix (ECM) alterations, and platelet activation, contributing to chronic pathological remodeling of the vascular wall, atheromatous plague formation, vascular stenosis, and eventually, thrombus growth and propagation. Emerging studies suggest that clotting activation and endothelial cell (EC) dysfunction play key roles in the pathogenesis of atherothrombosis. Furthermore, a growing body of evidence indicates that defective autophagy is closely linked to the overproduction of reactive oxygen species (ROS) which, in turn, are involved in the development and progression of atherosclerotic disease. This topic represents a large field of study aimed at identifying new potential therapeutic targets. In this review, we focus on the major role played by the autophagic pathway induced by oxidative stress in the modulation of EC dysfunction as a background to understand its potential role in the development of atherothrombosis.
View
Novel anti‐inflammatory therapies to reduce cardiovascular burden of psoriasis
Article
Full-text available
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. This article is protected by copyright. All rights reserved.
View
The association of serum vascular endothelial growth factor levels and psoriasis vulgaris: A protocol for systematic review and meta-analysis
Article
Full-text available
  • Aug 2020
Background: In recent years, more and more attention has been paid to the role of skin microcirculation in the pathogenesis of psoriasis. The vascular network of the skin is mainly distributed in the dermis and the subcutaneous fat layer join. The microvessels are composed of terminal arterioles, arteriovenous capillaries, and postcapillary venules. Vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of psoriasis by promoting angiogenesis. The purpose of this study is to evaluate the relationship between serum VEGF and psoriasis vulgaris. Methods: Embase, CENTRAL, PubMed, China Biology Medicine Database, China National Knowledge Database, Wan Fang Database, and Chong Qing VIP Database will be searched to collect case-control studies and cohort studies and evaluate the relationship between serum VEGF and psoriasis vulgaris. The search time limits will be from the establishment of the database to December 2020. Two researchers will independently screen the studies, extract data, and evaluate the risk of bias of the studies. The Meta-analysis will be carried out with the RevMan5.3 software. The quality of all included studies will be evaluated by the Newcastle-Ottawa scale. Results: This study will evaluate the relationship between serum VEGF and the pathogenesis of psoriasis vulgaris. Conclusion: This study will provide a theoretical basis for the pathogenesis of psoriasis vulgaris. Osf registration number: DOI 10.17605/OSF.IO/6DV8P.
View
VEGF-A in Cardiomyocytes and Heart Diseases
Article
Full-text available
The vascular endothelial growth factor (VEGF), a homodimeric vasoactive glycoprotein, is the key mediator of angiogenesis. Angiogenesis, the formation of new blood vessels, is responsible for a wide variety of physio/pathological processes, including cardiovascular diseases (CVD). Cardiomyocytes (CM), the main cell type present in the heart, are the source and target of VEGF-A and express its receptors, VEGFR1 and VEGFR2, on their cell surface. The relationship between VEGF-A and the heart is double-sided. On the one hand, VEGF-A activates CM, inducing morphogenesis, contractility and wound healing. On the other hand, VEGF-A is produced by CM during inflammation, mechanical stress and cytokine stimulation. Moreover, high concentrations of VEGF-A have been found in patients affected by different CVD, and are often correlated with an unfavorable prognosis and disease severity. In this review, we summarized the current knowledge about the expression and effects of VEGF-A on CM and the role of VEGF-A in CVD, which are the most important cause of disability and premature death worldwide. Based on clinical studies on angiogenesis therapy conducted to date, it is possible to think that the control of angiogenesis and VEGF-A can lead to better quality and span of life of patients with heart disease.
View
High sensitivity C‐reactive protein as a biomarker in detecting subclinical atherosclerosis in psoriasis
Article
Full-text available
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 sixty 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 to 3.80 and range: 0.29 to 11.60) than did those in the control group (median: 1.03 mg/L IQR: 0.36 to 2.15 and range: 0.10 to 3.35). Psoriatic patients also had higher mean MIMT (0.74±0.19 and 0.54±0.12, respectively and P<.0001) compared to 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 patients. So, not only dose 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. This article is protected by copyright. All rights reserved.
View
Systematic review examining changes over time and variation in the incidence and prevalence of psoriasis by age and gender
Article
Full-text available
  • May 2020
Background There is a lack of any overview of changes over time and variation in the epidemiology of psoriasis with age and between genders. Objectives To perform a systematic review of published population‐based studies on variations in psoriasis incidence and prevalence with age and between genders, and to explore trends in psoriasis epidemiology over time. Methods Eleven electronic and regional databases were searched from their inception dates to October 2019. No language restrictions were applied. Studies where eligible if they reported on changes in psoriasis incidence and/or prevalence over time and/or by age group and gender. Results A total of 308 papers were critically appraised, of which 90 studies from 22 countries were included. Incidence data confirmed a clear bimodal age pattern in psoriasis onset, with the first and second peak at around 30‐39 and 60‐69 years of age, respectively, with evidence suggesting it presents slightly earlier in women than men. Whilst prevalence data showed an increasing trend with age until around 60 or 70 years, after which it decreases. Although there was lack of agreement on specific gender differences in psoriasis incidence and prevalence, a slight male predominance was reported in several studies. Studies worldwide suggested a stable or a slightly decreasing trend in psoriasis incidence, whilst an increasing trend in psoriasis prevalence has been consistently reported. One particular challenge faced was the vastly different methodologies used in the included studies, which contributed to some of the heterogeneity of the results. Conclusions Studies on changes over time in the occurrence of psoriasis have contributed to a greater appreciation of the increasing burden of the disease. However, further research is required to determine the reason driving the increase in psoriasis prevalence over time.
View
Management of psoriasis as a systemic disease: What is the evidence?
Article
Full-text available
  • Jun 2019
Background: Psoriasis is a chronic, systemic immune-mediated disease characterised by development of erythematous, indurated, scaly, pruritic and often painful skin plaques. Psoriasis pathogenesis is driven by pro-inflammatory cytokines and psoriasis is associated with increased risk for comorbidities, including, but not limited to, psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease and non-alcoholic fatty liver disease compared with the general population. Objective: To explore the pathophysiological relationship between psoriasis and its common comorbidities and discusses the need for new treatment paradigms that include strategies to reduce systemic inflammation in patients with moderate-to-severe psoriasis. Methods: This narrative review summarizes the published evidence related to the ability of biologic therapies to ameliorate the consequences of systemic inflammation in patients with psoriasis. Results: Current evidence suggests that preventing damage associated with inflammation and preventing development of future inflammatory damage and comorbidities may be a potentially achievable treatment goal for many patients with moderate-to-severe plaque psoriasis when biologic therapies are utilised early in the disease. Encouraging data from recent studies suggest that the loftier goal of reversing existing inflammatory damage and improving signs and symptoms of inflammatory comorbidities could also possibly be attainable. Conclusions: Results from ongoing prospective studies on the effects of biologics on markers of systemic inflammation in patients with psoriasis will strengthen the clinical evidence base that can be used to inform treatment decisions for patients with moderate-to-severe psoriasis.
View
Retinal function determined by flicker ERGs before and soon after intravitreal injection of anti-VEGF agents
Article
Full-text available
  • Jun 2019
  • BMC Ophthalmol
Background To evaluate the retinal function before and soon after an intravitreal injection of an anti-vascular endothelial growth factor (anti-VEGF) agents. Methods Seventy-nine eyes of 79 patients that were treated by an intravitreal injection of an anti-VEGF agent for age-related macular degeneration (AMD), diabetic macular edema (DME), or retinal vein occlusion (RVO) with macular edema (ME) were studied. The RETeval® system was used to record 28 Hz flicker electroretinograms (ERGs) from the injected and non-injected eyes before (Phase 1, P1), within 2 h after the injection (P2), and 2 to 24 h after the injection (P3). Patients were grouped by disease or by the injected agent and compared. The significance of the changes in the implicit times and amplitudes was determined by t tests. Results The amplitudes were not significantly different at the three phases. The implicit time of the injected eye was 31.2 ± 3.2 msec at P1, and it was not significantly different at P2 (31.7 ± 3.1 msec) but it was significantly longer at P3 (32.2 ± 3.3 msec, P < 0.01, ANOVA for both). The implicit time in the non-injected fellow eye was 30.5 ± 3.3 msec at P1, and it was significantly longer at P2 (31.1 ± 3.2 msec) and phase 3 (31.3 ± 3.4 msec, P < 0.01, ANOVA for both). Conclusions The results indicate that an intravitreal anti-VEGF injection will increase the implicit times not only in the injected eye but also in the non-injected eye soon after the intravitreal injection.
View
Pathophysiology, Clinical Presentation, and Treatment of Psoriasis. A Review
Article
  • May 2020
  • J Am Med Assoc
Importance Approximately 125 million people worldwide have psoriasis. Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders. Observations Plaque psoriasis is the most common variant of psoriasis. The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments. Plaque psoriasis is associated with a number of comorbidities including psoriatic arthritis, cardiometabolic diseases, and depression. For patients with mild psoriasis, topical agents remain the mainstay of treatment, and they include topical corticosteroids, vitamin D analogues, calcineurin inhibitors, and keratolytics. The American Academy of Dermatology-National Psoriasis Foundation guidelines recommend biologics as an option for first-line treatment of moderate to severe plaque psoriasis because of their efficacy in treating it and acceptable safety profiles. Specifically, inhibitors to tumor necrosis factor α (TNF-α) include etanercept, adalimumab, certolizumab, and infliximab. Other biologics inhibit cytokines such as the p40 subunit of the cytokines IL-12 and IL-13 (ustekinumab), IL-17 (secukinumab, ixekizumab, bimekizumab, and brodalumab), and the p19 subunit of IL-23 (guselkumab, tildrakizumab, risankizumab, and mirikizumab). Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis. Oral treatments include traditional agents such as methotrexate, acitretin, cyclosporine, and the advanced small molecule apremilast, which is a phosphodiesterase 4 inhibitor. The most commonly prescribed light therapy used to treat plaque psoriasis is narrowband UV-B phototherapy. Conclusions and Relevance Psoriasis is an inflammatory skin disease that is associated with multiple comorbidities and substantially diminishes patients’ quality of life. Topical therapies remain the cornerstone for treating mild psoriasis. Therapeutic advancements for moderate to severe plaque psoriasis include biologics that inhibit TNF-α, p40IL-12/23, IL-17, and p19IL-23, as well as an oral phosphodiesterase 4 inhibitor.
View
VEGF in Signaling and Disease: Beyond Discovery and Development
Article
  • Mar 2019
The discovery of vascular endothelial-derived growth factor (VEGF) has revolutionized our understanding of vasculogenesis and angiogenesis during development and physiological homeostasis. Over a short span of two decades, our understanding of the molecular mechanisms by which VEGF coordinates neurovascular homeostasis has become more sophisticated. The central role of VEGF in the pathogenesis of diverse cancers and blinding eye diseases has also become evident. Elucidation of the molecular regulation of VEGF and the transformative development of multiple therapeutic pathways targeting VEGF directly or indirectly is a powerful case study of how fundamental research can guide innovation and translation. It is also an elegant example of how agnostic discovery and can transform our understanding of human disease. This review will highlight critical nodal points in VEGF biology, including recent developments in immunotherapy for cancer and multitarget approaches in neovascular eye disease.
View