Evaluation of CD40, its ligand CD40L and Bcl-2 in psoriatic patients.

Psoriasis is a chronic, recurrent, inflammatory disease. Recent investigations indicate an autoimmune pathogenesis of the disease. Apoptosis plays an important role in the regulation of immune mechanisms in many autoimmune diseases. Although CD40, CD40L, and Bcl-2 have already been studied in psoriatic skin lesions, little is known about their circulating forms. The aim of the present study was to evaluate the serum concentrations of Bcl-2, soluble CD40 and CD40L in psoriatic patients. The study was performed using ELISA kits in 39 psoriatic patients before treatment and after two weeks of topical ointment. Data was analyzed with respect to severity of psoriasis, duration of the disease, and coexisting psoriatic arthritis. Our results revealed that serum concentrations of soluble CD40 and CD40L before and after treatment were significantly higher (p < 0.01 and p < 0.001) in patients with psoriasis compared to the control group. Topical treatment of psoriatic lesions with dithranol ointment failed to decrease serum of CD40 and CD40L, which has not been described until now. There was no significant difference in serum Bcl-2 concentration between the compared groups. We did not find significant differences in serum concentrations of Bcl-2, CD40 or CD40L between patients with mild or severe psoriasis, nor any correlation between disease duration and the presence of psoriatic arthritis symptoms. Our data indicates upregulation of the CD40/CD40L system in psoriatic patients despite topical treatment and suggests their possible role in the pathogenesis of psoriasis.

[Genital herpes--epidemiological and clinical issue still of importance]. / Opryszczka narzadów plciowych--nadal istotny problem epidemiologiczny i kliniczny.

Genital herpes (gh) is one of the most frequent sexually transmitted diseases and the most frequent cause of genital ulcer diseases. Its etiological agent is herpes simplex virus type 1 (HSV-1) or 2 (HSV-2). The role of HSV-1 as a cause of gh is increasing, especially among adolescents in developed countries. The principal route of infection with HSV is asymptomatic viral shedding. The infection is life-long, despite treatment. The data on the prevalence and incidence of gh is incomplete, mainly because of insufficient laboratory diagnostics. The most important consequences of gh are: synergy with the infection with human immunodeficiency virus and the risk of fetal and neonatal infection during pregnancy and delivery. The authors present the most relevant and current data on the epidemiological, pathogenetic, clinical, diagnostic and therapeutic aspects of gh.

Effect of psoriasis activity on VEGF and its soluble receptors concentrations in serum and plaque scales.

Vascular endothelial growth factor (VEGF) demonstrating pro-angiogenic activity promote new blood vessel formation in psoriatic lesions. The aim of this study was to evaluate the serum concentrations of VEGF, its soluble receptors (sVEGF R1 and R2) and VEGF content in scales of patients with psoriasis. To analyze possible association with activity of the disease, serum and scales from plaques were collected from 59 patients with exacerbated chronic plaque-type psoriasis. Mean concentrations of VEGF and sVEGF R1 in sera of patients were respectively two and four times higher than in healthy controls. Serum VEGF and sVEGF R1, but not sVEGF R2 demonstrated significant correlation with psoriasis area and severity index (PASI). There was also significant correlation between VEGF levels in serum and scales. Serum sVEGF R1 concentration was significantly elevated even in patients with low psoriasis activity (PASI<10), whereas increase of serum VEGF became significant in patients with medium activity (PASI: 10-20). Levels of serum VEGF and sVEGF R1 were the highest in patients with PASI>20. We confirmed association of both serum and scales VEGF concentrations with degree of psoriasis activity and demonstrated predominant increase of sVEGF R1 vs. VEGF in serum of patients with low psoriasis activity.

Tumor necrosis factor-alpha-converting enzyme as a potential mediator of the influence of smoking on the response to treatment with narrowband ultraviolet B in psoriasis patients.

PURPOSE: The aim of the study was to analyze the relationship between smoking and the treatment with narrowband ultraviolet B (NB-UVB) in psoriasis patients and to examine the role of the soluble tumor necrosis factor-alpha receptor type one (sTNF-R1) in plasma and that of TNF-alpha-converting enzyme (TACE) released from peripheral blood mononuclear cells (PBMC) in this relationship. METHODS: The study has been conducted among 45 inpatients with plaque-type psoriasis vulgaris and 36 inpatients with other chronic inflammatory skin disorders from similar social background (controls). Taking into account the number of cigarettes smoked daily and the duration of smoking, subjects were classified as mild, moderate and heavy smokers. The severity of psoriasis was assessed using psoriasis area and severity index (PASI) score, concentrations of sTNF-R1 and TACE (expressed in ng/ml)--with quantitative sandwich enzyme immunoassays before (T(0)) and after 20 NB-UVB irradiations (T(20)). RESULTS: The pretreatment concentration of sTNF-R1 was 2.55+/-0.17 in patients and 1.79+/-0.13 in controls (P<0.05) and that of TACE - 2.62+/-0.34 and 1.29+/-0.25, P<0.05, respectively. PASI score correlated with sTNF-R1 and with TACE concentrations (R=0.40 and R=0.38, P<0.05, respectively). PASI score, sTNF-R1 and TACE concentrations were similar in mild, moderate and in heavy smokers. PASI score and TACE concentration declined significantly after treatment in three groups; the lowest TACE concentration at T(20) was noticed in mild smokers, the highest in heavy smokers (0.86+/-0.26 and 1.91+/-0.20, P<0.05, respectively). The post-treatment PASI score correlated with the intensity of smoking and with TACE concentration (R=0.50 and R=0.47, P<0.05, respectively). The strong correlation between the pretreatment TACE concentration and the treatment outcome was observed in heavy smokers (R=0.63, P<0.05). CONCLUSIONS: The baseline TACE concentration in PBMC may be of value in predicting the response to the treatment with NB-UVB in smoking psoriasis patients. Smoking may adversely influence this treatment and TACE may be one of mediators in this influence.

[Serological diagnosis of syphilis--current problems and controversies]. / Diagnostyka serologiczna kily--aktualne problemy i kontrowersje.

Serology remains the mainstay of diagnosis of syphilis. It's most important issues are: the knowledge of typical and atypical symptoms of the disease, the need of the testing in particular clinical and epidemiological situations, the interpretation of tests' results. The most frequent dilemmas and the relevance of serological tests in congenital syphilis and neurosyphilis, as well as the quality (standardization and reproducibility) of laboratory testing are discussed.

Plasma TGF-beta1, TIMP-1, MMP-1 and IL-18 as a combined biomarker of psoriasis activity.

Plasma levels of transforming growth factor (TGF)-beta1, tissue inhibitors of metalloproteinases (TIMP)-1, matrix metalloproteinase (MMP)-1 and interleukin (IL)-18 when analyzed separately demonstrate an association with psoriasis severity and treatment efficacy. To determine the highest correlation with the Psoriasis Area and Severity Index (PASI) score we carried out an analysis of these four proteins combined as the TTMI score. Concentrations of proteins were measured using an enzyme immunoassay in the plasma of 32 patients with chronic plaque-type psoriasis. The concentration of each biomarker was multiplied by the respective coefficient and the final individual TTMI score was the sum of these four values. TGF-beta1, TIMP-1 and IL-18 demonstrated significant positive correlation, whereas MMP-1 demonstrated significant negative correlation with the PASI score. The TTMI score calculated for individual patients varied from -79620 to 145713 (43050+/-8081) and demonstrated significant correlation with the PASI score. The lowest TTMI mean value was observed in patients with a PASI score <16 and the highest value was in patients with a PASI score >20. The combined measurement of plasma TGF-beta1, TIMP-1, MMP-1 and IL-18 has superior value as a biomarker of psoriasis activity in comparison with their separate analysis.

Soluble tumour necrosis factor-alpha receptor type 1 as a biomarker of response to phototherapy in patients with psoriasis.

The purpose of the study was to analyze the relationship between the serum concentration of soluble tumour necrosis factor-alpha type 1 (sTNF-R1), the severity of plaque-type psoriasis and therapeutic response. We compared sTNF-R1 in 25 patients treated with narrowband ultraviolet B (NB-UVB) radiation and 25 patients treated with systemic photochemotherapy (psoralen plus UVA-PUVA). The pretreatment Psoriasis Area and Severity Index (PASI) score and sTNF-R1 concentration were 16.32+/-5.26 and 1.99+/-0.40 ng ml(-1), respectively, in the group treated with NB-UVB, and 17.22+/-3.48 and 2.07+/-0.31 ng ml(-1), respectively, in the group treated with PUVA. The concentration of sTNF-R1 in healthy controls was 1.49+/-0.34 ng ml(-1) (p<0.05 compared with patients with psoriasis). The pretreatment PASI score correlated with sTNF-R1 in both treatment groups (r=0.46 and r=0.44, p<0.05). NB-UVB and PUVA gave similar therapeutic effects (the PASI score after 20 treatments was 4.42+/-1.67 in the NB-UVB-treated group and 5.55+/-2.10 in PUVA-treated patients); however, the sTNF-R1 concentration at the same time differed significantly: 1.52+/-0.37 ng ml(-1) and 1.98+/-0.39 ng ml(-1) (p<0.001), respectively. Moreover, the decline in sTNF-R1 in both treatment groups was significant only in patients in whom the duration of skin lesions was less than 3 months. The results suggest that the value of serum sTNF-R1 concentration as a marker of response to phototherapy may depend on duration of skin lesions and the treatment method.

Epidemiological and clinical analysis of pemphigoid patients in northeastern Poland in 2000-2005.

BACKGROUND: Epidemiological studies on pemphigoid, the most frequent group of autoimmune bullous diseases, are rare. The aim was to evaluate the incidence of pemphigoid in the Podlaskie voivodship (northeastern Poland), the prevalence of concomitant diseases and their treatment, and the efficacy and side effects of pemphigoid therapy. MATERIAL/METHODS: The study included 23 female and 12 male consecutive in-patients of the Department of Dermatology and Venereology, Medical University of Bialystok , between January 2000 and June 2006. Their sociodemographic data, diseases, and treatment before and after pemphigoid onset were analyzed. Diagnosis was confirmed using direct and/or indirect immunological studies. RESULTS: The annual incidence of pemphigoid was 4.47/million. Sixty percent of the patients lived in rural areas. Their mean age at diagnosis was 68.99 years in women and 67.25 years in men; five female patients were under 53 years. All patients were treated for other diseases prior to pemphigoid onset and the diseases could have been drug-induced in >30% of cases. Two patients had malignancies prior to pemphigoid onset, and neoplasmas were diagnosed afterwards in three. Prednisolone was a successful treatment in >60% of patients. Infections and osteoporosis were observed in 34.3% during therapy; one patient had sudden gastric hemorrhage. Seven patients died within the first year. CONCLUSIONS: The results confirm that pemphigoid affects mainly elderly people, usually being treated for other disorders; the disease may be more frequent in rural areas. In an aging society, the disease is expected to become a more serious therapeutic challenge.

Tumour necrosis factor alpha (TNF-alpha)-converting enzyme (TACE) and soluble TNF-alpha receptor type 1 in psoriasis patients treated with narrowband ultraviolet B.

PURPOSE: The aim of the study was to examine the tumour necrosis factor alpha (TNF-alpha)-converting enzyme (TACE) concentration in peripheral blood mononuclear cells (PBMC) and its relationship with plasma concentration of soluble TNF-alpha receptor type 1 (sTNF-R1) and with the disease severity in psoriasis patients treated with narrowband ultraviolet B (NB-UVB). METHODS: The study has been conducted among 40 patients with plaque-type psoriasis vulgaris: 23 had only skin lesions (PV) and 17 had co-existing, inactive, psoriatic arthritis (PsA). Control blood samples were obtained from 20 healthy subjects. The assessment of the severity of skin lesions (using Psoriasis Area and Severity Index - PASI), TACE and sTNF-R1 concentrations (using quantitative sandwich enzyme immunoassays) have been performed at baseline (T 0) and after 20 NB-UVB irradiations (T 20). RESULTS: The baseline sTNF-R1 and TACE concentrations in all patients was higher than that in controls (2.55 +/- 1.67 vs. 1.70 +/- 0.15 ng/ml, P<0.001, respectively, and 2.62 +/- 0.32 vs. 1.31 +/- 0.30 ng/ml, P<0.001, respectively). The sTNF-R1 and TACE concentrations were lower in PV than in PsA patients (2.47 +/- 0.16 vs. 2.65 +/- 0.13 ng/ml, and 2.52 +/- 0.22 vs. 2.76 +/- 0.39 ng/ml, P<0.05, respectively). The baseline PASI correlated with sTNF-R1 and to TACE concentrations (R=0.48 and 0.39, P<0.05, respectively). The sTNF-R1 correlated to TACE concentration (R=0.52, P<0.05). The significant decline in sTNF-R1 and TACE concentrations at T 20 was noticed, TACE reached control values (1.20 +/- 0.44 ng/ml in PV patients and 1.16 +/- 0.48 ng/ml in PsA patients, respectively). CONCLUSION: TACE from PBMC can contribute to up-regulation of sTNF-R1 in patients with active psoriasis vulgaris and with psoriatic arthritis. It also can serve as a sensitive marker of the disease severity.

[The value of prophylactic serological tests for syphilis in the region of Bialystok in years 1994-2004 (before and after the introducing the health care system reform in Poland)]. / Profilaktyczne badania serologiczne w kierunku kily na bialostocczyznie w latach 1994-2004.

The prophylactic serological tests for syphilis (psts), belong to the principal methods of controling the spread of the disease. The aim of the study was to to analyze the epidemiological efficacy of psts performed in Bialystok region before and after the health care system reform. The results of psts performed in 1994-1998 (N = 752.787) and in 1999-2004 (N = 407.366) were analyzed. The average annual number of psts declined from 150.557 to 68.687 in two periods analyzed, respectively. The lowest number of tests performed (51.654) was noticed in 2004. Sixty-one of 117 (52.14%) and 30 of 52 (57.97%) syphilis cases have been detected owing to psts in two periods analyzed, respectively. The efficacy index of psts was highest in convicts or prisoners and in pregnant women in both periods (172,1 and 134,6 and 67,9 and 50,7, respectively). The significant decline in efficacy index was noticed for tests performed as periodic prophylactic examinations of employees and prior to employment. The results indicate that psts remain one of the most efficient methods of diagnosis and prevention of syphilis despite the decline in the number of the tests and the formal renouncement of the screening among convicts and prisoners since 2003. Low syphilis incidence rate in Poland can be, in part, own to diminished number of performed tests. There is a need for the parallel studies in other regions of Poland.

Selenium supplementation, soluble tumor necrosis factor-alpha receptor type 1, and C-reactive protein during psoriasis therapy with narrowband ultraviolet B.

OBJECTIVE: We examined the influence of supplementation with selenomethionine on soluble tumor necrosis factor-alpha receptor type 1 (sTNF-R1) and C-reactive protein (CRP) concentrations in patients with psoriasis who were treated with narrowband ultraviolet B. METHODS: Thirty-seven patients had narrowband ultraviolet B therapy five times a week and received 200 mug of selenium daily as selenomethionine (group 1, n = 19) or placebo (group 2, n = 18) for 4 wk. Assessment, performed at baseline, after 2 and 4 wk, and 4 wk after the end of treatment included measurement of the Psoriasis Area and Severity Index (PASI) and serum concentrations of selenium (micrograms per liter), sTNF-R1 (nanograms per milliliter), and CRP (milligrams per liter). Control sera were obtained from 20 healthy volunteers. RESULTS: Baseline PASI was 12.70 +/- 5.48 (13.02 +/- 6.25 in group 1 and 12.37 +/- 4.71 in group 2), selenium concentration was 50.55 +/- 9.54 (49.05 +/- 10.38 and 52.13 +/- 8.61, respectively), sTNF-R1 concentration was 1.91 +/- 0.38 (1.96 +/- 0.37 and 1.87 +/- 0.40, respectively), and CRP concentration was 25.34 +/- 8.27 (26.12 +/- 8.42 and 24.57 +/- 7.72). In controls, selenium concentration was 48.71 +/- 9.39 (P > 0.05 versus patients), sTNF-R1 concentration was 1.48 +/- 0.30 (P < 0.05), CRP concentration was <6. The baseline sTNF-R1 level correlated to PASI value (r = 0.40, P < 0.05) and CRP concentration (r = 0.36, P > 0.05). The treatment resulted in an almost parallel decrease in PASI in both groups. At 4 wk after the end of treatment, selenium concentrations were 83.77 +/- 5.13 in group 1 and 52.12 +/- 7.54 in group 2 (P < 0.05), sTNF-R1 concentrations were 1.72 +/- 0.27 and 1.47 +/- 0.26 (P < 0.05), and CRP concentrations were 7.72 +/- 4.23 and 8.15 +/- 3.32, respectively (P > 0.05). Selenium concentration correlated inversely with CRP in group 1. CONCLUSION: The results confirm that sTNF-R1 and CRP concentrations are increated in active psoriasis and that supplementation with selenomethionine for 4 wk in safe doses is ineffacious as adjuvant therapy in patients with psoriasis.

Effect of psoriasis activity on metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in plasma and lesional scales.

The aim of this study was to evaluate the association between psoriasis severity and concentrations of matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in plasma and scales from psoriatic lesions, measured with an enzyme immunoassay in 24 patients and analysed with respect to psoriasis area and severity index (PASI). The mean plasma concentrations of both proteins in psoriatic patients significantly exceeded the control values. The proteins were also detectable in scales. There was a significant correlation between plasma MMP-1 concentration and the disease duration. The PASI values showed significant positive correlation with plasma TIMP-1 and significant negative correlation with MMP-1 content in scales. The highest plasma MMP-1 concentration was observed in patients with mild forms whereas the highest plasma TIMP-1 concentrations were demonstrated in severe forms of psoriasis. Our results confirm the role of these proteins in pathogenesis of psoriasis. In severe forms, a decrease in both MMP-1 and TIMP-1 was observed in scales, suggesting their insufficient tissue expression, which can be a crucial element of psoriasis aggravation.

[The direct diagnosis of syphilis--modern standards and directions of development]. / Diagnostyka bezposrednia kily--wspólczesne standardy i kierunki badan.

The methods of direct diagnosis of syphilis developed slowly, in contrast to dynamic development of serological diagnosis of the disease. The authors present modern modes of identification of Treponema pallidum and directions of their modifications. The cultivation of Treponema pallidum in vitro, the different methods of nucleic acids amplifications and their practical application are discussed.

[Soluble tumor-necrosis-factor-alpha receptor type-1 as a marker of activity of psoriasis vulgaris and effects of its treatment]. / Rozpuszczalny receptor typu pierwszego dla tumor necrosis factor alfa jako wskaznik aktywnosci luszczycy zwyklej i skutecznosci jej leczenia.

UNLABELLED: The aim of the study was to examine the concentration of soluble tumor necrosis factor alpha type I (sTNF-R1) in patients with psoriasis vulgaris in relation to the severity of skin lesions and the effects of treatment. PATIENTS AND METHODS: the study was conducted among 34 patients. The assessment of the severity of skin lesions (Psoriasis Area and Severity Index -PASI), and the serum concentration of sTNF-R1 (ELISA) were performed at baseline and after 2 weeks of treatment. Control sera were obtained from 30 healthy volunteers. RESULTS: pretreatment PASI was 12.98 +/- 5.77 and after two-week treatment 6.17 +/- 2.12 (p < 0.05), sTNF-R1 concentration 1.88 +/- 0.41 ng/mL and 1.65 +/- 0.46 ng/mL, respectively (p < 0.05). Serum concentration of sTNF-R1 was significantly lower in controls (1.48 +/- 0.30 ng/mL) as compared with its pre-treatment level in psoriasis patients. A significant correlation between pre-treatment PASI and concentration of sTNF-R1 was found (r = 0.40, p < 0.05). CONCLUSION: serum concentration of sTNF-R1 can be a sensitive marker of activity of psoriasis vulgaris and decreases following the effective treatment.

[The role of metalloproteinases in psoriasis]. / Znaczenie metaloproteinaz w luszczycy.

Metalloproteinases play a crucial role in the destruction processes related to inflammation and carcinogenesis as well as in wound healing, morphogenesis and growth. Destruction of extracellular matrix proteins related to these enzymes activity and following damage of basement membranes favour angiogenesis and inflammatory infiltrations in psoriasis. Metalloproteina-ses activity can be controlled on different levels: genetic expression, enzyme activation or its inhibition. In this paper we discuss recently discovered role of metalloproteinases in the pathogenesis of skin diseases, including psoriasis. The most interesting seems to be results of research on possible application of metalloproteinases inhibitors in psoriasis treatment and usefulness of these enzymes measurement in the management of this disease.

[Lymphogranuloma venereum and HIV infection. A case report]. / Ziarnicawenerycznapachwin i zakazenie HIV. Opis przypadku.

We present a case of a young man with lymphogranuloma venereum in whom HIV infection was diagnosed.

Soluble tumor necrosis factor alpha receptor type 1 in psoriasis patients treated with narrowband ultraviolet B.

PURPOSE: The purpose of this study was to examine the influence of narrowband ultraviolet (NB-UVB) therapy on the serum concentration of soluble tumor necrosis factor receptor type 1 (sTNF-R1) in psoriasis patients. METHODS: Twenty-seven patients received NB-UVB therapy three to five times a week for 4 weeks. The assessment of skin lesions using psoriasis area and severity index (PASI) and serum concentration of sTNF-R1 was performed at the baseline, at 2, 4 and 4 weeks after treatment cessation. The sera of healthy subject were used as controls. RESULTS: The baseline PASI was 13.56 +/- 5.71, sTNF-R1 concentration was 1.89 +/- 0.43 ng/ml in patients and 1.48 +/- 0.30 ng/ml in controls (P < 0.05). The baseline PASI correlated to sTNF-R1 (r = 0.52, P < 0.05). The decline in concentrations of sTNF-R1 paralleled the decline of PASI achieved during therapy but still exceeded control values. CONCLUSION: The results of the study confirm the role of sTNF-R1 as a marker of psoriasis severity and efficacy of treatment. They also suggest that NB-UVB influences the serum level of sTNF-R1.

Pemphigus vegetans in a patient with lung cancer.

A 66-year-old woman with a history of lung cancer treated with radiotherapy 2-years prior to admission, was seen for mucosal and skin lesions of 3-month's duration. She had pustules involving intertriginous areas and erosions involving the oral mucosa. Histopathology of skin lesions and the results of direct and indirect immunofluorescence studies were consistent with the Hallopeau-type pemphigus vegetans. Additionally, circulating antibodies against skeletal muscles were detected in patient's serum. The patient was treated with immunosuppressive therapy and had an almost complete remission of skin and mucosal lesions within 1 month; however, the patient developed pneumonia with pyothorax, apparently related to recurrence of lung cancer.