Serum level of receptor activator of nuclear factor kappa-B ligand in patients with psoriasis.

BACKGROUND: Psoriasis usually precedes the onset of psoriatic arthritis by an average of 10 years in about 70% of patients. Receptor activator of nuclear factor kappa-B ligand (RANKL) is a natural and necessary surface-bound molecule, which is a ligand for osteoprotegrin and functions as a key factor for osteoclast differentiation and activation. OBJECTIVE: Evaluation of the serum level of RANKL in psoriasis and psoriatic arthritis and its correlation with severity of the disease as a trial to predict the occurrence of psoriatic arthritis in such patients. METHOD: This study included 80 subjects; 40 patients had chronic plaque psoriasis, 20 patients had chronic plaque psoriasis with psoriatic arthritis, and 20 were healthy controls. Patients with psoriasis were divided into three subgroups according to psoriasis area severity index score: mild, moderate, and severe. Serum RANKL levels were estimated for all subjects using enzyme-linked immunosorbent assay. RESULTS: Serum RANKL level in psoriatic arthritis was significantly higher compared to both patients with plaque psoriasis and control groups. Serum RANKL level significantly correlated to the severity of psoriasis, with a very high correlation coefficient in groups I and II. The diagnostic performance of serum RANKL level for the early prediction of psoriatic arthritis in patients with psoriasis was >170 pg/ml. CONCLUSION: Serum RANKL level could be considered as a useful diagnostic marker for the early prediction of psoriatic arthritis in patients with moderate and severe psoriasis. Assessment of soluble RANKL in psoriasis could identify those at increased risk for psoriatic arthritis, and anti-RANKL agents may be effective in decreasing incidence of psoriatic arthritis.

Autologus bone marrow stem cells in atrophic acne scars: A pilot study.

BACKGROUND: Acne scar is a very distressing and difficult problem for physicians and patients. Management of cutaneous scarring from acne can be challenging and confusing. The available modalities may be effective, having considerable morbidity and long downtime. Besides, they may not have the same efficacy in different skin types or acne scar types. OBJECTIVE: To evaluate the short-term safety and efficacy of autologous bone marrow (BM) stem cells (SCs) in treating atrophic acne scars. METHODS: Fourteen patients with moderate to severe atrophic acne scars were included. All patients were subjected to single session of autologous BMSCs therapy. Each patient received 5 µg/kg/day granulocyte colony-stimulating factor (G-CSF) as a single subcutaneous dose for 2 successive days before BM aspiration. The SC-containing solution was injected under each scar intradermally. The scars of the patients were clinically assessed both qualitatively and quantitatively before and after 6 months. The patients were given a preformed questionnaire Cardiff acne disability index (CADI) before and after treatment. RESULTS: After 6 months of the injection, there was significant improvement in the qualitative grading, quantitative grading and CADI scores. All types of scars showed significant improvement. No significant adverse effects were reported in any patient. CONCLUSION: Autologous BMSCs seem to be a safe and effective treatment option for the management of all types of atrophic facial acne scars.

A proliferation-inducing ligand in atopic dermatitis and vitiligo.

BACKGROUND: A proliferation-inducing ligand (APRIL) is a tumor necrosis factor (TNF) superfamily member ligand that stimulates B cells in vitro and in vivo. It also plays an important role in T cell activation and survival. OBJECTIVES: This study was conducted to evaluate serum levels of APRIL in patients with atopic dermatitis (AD) and vitiligo and their correlation with disease activity. METHODS: A total of 100 subjects were included; these comprised 40 AD patients, 40 vitiligo patients, and 20 control subjects. Serum APRIL levels were measured and their relationships with the severity of AD and activity of vitiligo evaluated according to scores on the SCORAD (SCORing of Atopic Dermatitis) and VIDA (Vitiligo Disease Activity) indices, respectively. RESULTS: The serum level of APRIL was significantly higher in AD patients than in the control group. Serum APRIL in patients with severe AD showed a statistically significant difference with serum APRIL in patients with either mild or moderate AD. Serum APRIL was significantly higher in vitiligo patients than in the control group. Differences in serum APRIL among patients with different VIDA scores were significant only between patients with VIDA scores of +1 and +4. Statistically significant positive correlations emerged between serum APRIL and activity of AD (r = 0.939) and vitiligo (r = 0.740). CONCLUSIONS: APRIL may play a role in the pathogeneses of AD and vitiligo and could be used as an objective marker for the assessment of AD severity and vitiligo activity. Further studies are required to clarify the precise mechanism of APRIL in the pathogeneses of AD and vitiligo and to test the possible use of APRIL inhibitors as novel modalities of therapy.

Toll-like receptor 9 in systemic lupus erythematosus, impact on glucocorticoid treatment.

AIM: To assess TLR9 expression in systemic lupus erythematosus (SLE) patients, its correlation with disease activity, and impact of TLR9 expression on the response to oral glucocorticoids. METHODS: Twenty-five active SLE, 15 inactive, and 15 control subjects were included. Anti-DNA, ANA, C3, C4, and TLR9 mRNA expressions were assessed. Active SLE patients only received oral steroid for 6 weeks. Post therapy, they were classified into steroid sensitive and steroid resistant. Data were reassessed after treatment. RESULTS: SLEDAI, anti-DNA, ANA, and TLR9 expressions were significantly higher in active SLE patients. Based on retrograde analysis, TLR9 expression was significantly higher in steroid-resistant versus steroid-sensitive group before treatment, with no significant difference between them after treatment. There was a significant positive correlation between TLR9 expression and SLEDAI score and anti-DNA and negative correlation with C3 and C4 in all patients. CONCLUSION: TLR9 may play a role in the pathogenesis of SLE and correlates with the disease activity. Corticosteroids have no effect on TLR9 expression, explaining lack of corticosteroid response in some SLE patients. TLR 9 expression can be used in predicting glucocorticoid response in active SLE patients. New treatment modalities targeting TLR9 expression may be of value in steroid-resistant patients.