Methotrexate Mechanism of Action in Plaque Psoriasis: Something New in the Old View.

Background: Despite the era of biologic therapy in the management of psoriasis, methotrexate, the traditional backbone of psoriasis treatment, does not stop surprising us with what it can offer. Objective: In this study, we aimed to evaluate the peripheral expression and the serum levels of TWEAK in patients with psoriasis vulgaris before and after receiving methotrexate treatment. Methods: The study included 58 patients with moderate to severe psoriasis vulgaris, and 90 apparently healthy individuals as a control group. Before starting the treatment course, all patients were evaluated clinically using Psoriasis Area Severity Index (PASI) score and were subjected to TWEAK serum levels and peripheral expression measurement using ELISA and qRT-PCR techniques, respectively. After 12 weeks of treatment with methotrexate (intramuscular methotrexate; up to 30mg per week) the patients were re-evaluated both clinically and in the laboratory. Results: The baseline serum TWEAK levels and its peripheral mRNA expression in the patients group were significantly lower than those in the control group. After 12 weeks of treatment with methotrexate, the PASI scores were reduced significantly while the serum TWEAK levels and its peripheral expression were significantly elevated. Conclusion: Enhancing TWEAK expression and elevating its serum levels in psoriasis patients seems to be a newly observed mechanism of action of methotrexate.

Proteasome Subunit Beta Type-8 (PSMB8) Gene Polymorphisms in Vitiligo: A Possible Predictor of Auditory Involvement.

INTRODUCTION: Proteasome subunit beta type-8 (PSMB8) is a protein that contributes to the complete assembly of 20S proteasome complexes, which play a role in the pathogenesis of vitiligo. OBJECTIVE: The study aimed to evaluate the association between PSMB8 gene polymorphisms with vitiligo to assess its clinical significance among a sample of Egyptian patients with vitiligo. METHODS: Genomic DNA was isolated from blood samples of 100 patients with vitiligo and 100 control subjects, and detection of PSMB8 polymorphisms was done by real-time PCR. Data analysis was carried out for the entire cohort. Statistics were performed using software. Audiological evaluation was performed, including pure-tone audiometry, extended high-frequency audiometry, transient evoked otoacoustic emissions, and auditory brainstem response. RESULTS: There was a significant difference between PSMB8 genotypes and alleles distribution in patients and control groups. Ten percent of the study sample had sensorineural hearing loss. The patients with hearing loss were significantly older (P=0.0002), had significantly later age of onset (P=0.0007), longer duration (P=0.0021), higher body mass index (BMI) (P=0.045), and higher vitiligo area scoring index (VASI) scores (P=0.0015). All patients had extensive forms of vitiligo (generalized and universal). Regarding the VIT rs2071543 polymorphism, all of the patients with hearing loss were carrying the CA and AA genotypes. None of the patients carried the reference genotype, CC. The A allele of VIT rs2071543 was significantly associated with hearing affection (P=0.024). CONCLUSION: In our study, PSMB8 polymorphism was associated with the susceptibility to develop vitiligo and appeared to have clinical significance among the studied group of patients. Factors predicting auditory abnormalities should be further studied for early detection and management.

Serum biotin and zinc in male androgenetic alopecia.

BACKGROUND: Male androgenetic alopecia (MAGA) is caused by the conversion of the terminal to vellus hair. Zinc is one of the most studied trace elements in hair disorders and biotin is one of the most prescribed supplement for its treatment. OBJECTIVES: The study aimed to evaluate serum zinc and biotin levels in MAGA patients to answer the question if there is a value to add zinc or biotin as a supplements in the MAGA treatment. PATIENTS AND METHODS: Sixty MAGA patients and 60 age, sex, and body mass index-matched healthy volunteers were included. We measured serum biotin and zinc in all participants. RESULTS: Zinc (µg/dL) was lower significantly in patients compared to controls (P = 0.01), suboptimal biotin (ng/L) levels were in patients, and within normal values in controls (P = 0.01). A positive significant correlation was found between serum zinc and serum biotin (r = 0.489, P = 0.001). Serum zinc and biotin showed a nonsignificant correlation with age and disease duration. A non-significant relation was obtained between the MAGA grades, and zinc (P = 0.485) and biotin levels (P = 0.367). CONCLUSIONS: Serum zinc showed subnormal value and adding zinc supplement in MAGA treatment is recommended. Serum biotin showed a suboptimal level in MAGA patients that is not correlated with patients' age or disease severity. Biotin supplement in MAGA treatment may add value to hair quality and texture. We recommend future biotin evaluation in serum combined with its metabolites in MAGA patients' urine.