Interleukin(IL)-22, ein Zytokin der IL-10-Interferon-Familie, beeinflusst die Funktion von Gewebezellen, wirkt jedoch nicht auf Immunzellen. In dieser Arbeit konnte ich zeigen, dass IL-22 in Keratinozyten nur eine begrenzte Anzahl von Genen in ihrer Expression reguliert, was eine Hemmung der terminalen Differenzierung und eine Steigerung der antimikrobiellen Abwehr und der zellulären Mobilität bewirkt. Diese IL-22-Effekte konnten in vivo aufgrund ihrer Induzierbarkeit durch eine IL-22-Behandlung in Mäusen bestätigt werden und fanden sich darüber hinaus in der läsionalen Haut von Patienten mit Psoriasis wieder. Eine pathogenetische Rolle von IL-22 bei Psoriasis wurde durch eine gefundene Erhöhung der IL-22-Spiegel im Blut dieser Patienten und eine Korrelation dieser mit dem Schweregrad der Erkrankung untermauert. Eine Untersuchung der Wirkung von IL-22 auf Hepatozyten zeigte, dass IL-22 in diesen Zellen die Produktion des LPS-Bindungsproteins (LBP) steigert, welches in hohen Konzentrationen bakterielle Bestandteile neutralisiert. In vivo zeigte sich, dass eine IL-22-Gabe in der Maus eine verstärkte Expression von LBP in der Leber und erhöhte sytemische LBP-Spiegel bewirkt. Diese Hepatozyten-spezifische IL-22-Wirkung spiegelte sich bei Patienten mit Morbus Crohn in erhöhten systemischen LBP-Spiegeln wieder. Bei der Psoriasis steht vor allem der regenerative Phänotyp der Keratinozyten, gekennzeichnet durch eine verminderte terminale Differenzierung und eine gesteigerte Mobilität, im Vordergrund und bildet die Ursache für die klinisch sichtbaren epidermalen Veränderungen. Demgegenüber könnte bei Morbus Crohn IL 22 durch die Induktion von hepatozytärem LBP zur Neutralisierung von durch die gestörte Darmbarriere ins Blut translozierte bakterielle LPS zur lokalen Begrenzung der Entzündung beitragen. Ausgehend von diesen Beobachtungen wäre eine IL-22-Neutralisierung bzw. IL-22-Applikation ein innovativer Therapieansatz für die Behandlung von Psoriasis und Morbus Crohn. / Interleukin(IL)-22, a cytokine belonging to the IL-10-Interferon-family, regulates the function of tissue cells, but not of immune cells. Here, I could show, that in keratinocytes IL-22 regulates the expression of a limited number of genes leading to an inhibition of the terminal differentiation and an increase of the antimicrobial defense and cellular mobility. These IL-22 effects were also confirmed in vivo as they could be induced in mice by IL-22-treatment and moreover, were also found to be present in the lesional skin of psoriasis patients. A pathogenetic role of IL-22 in psoriasis was substantiated by the finding that IL-22 level are elevated in the blood of these patients and correlated with the disease severity. By investigating the influence of IL-22 on hepatocytes, I found an increase of LPS-binding protein (LBP) production by IL-22, a protein which neutralizes bacterial components at high concentrations. In vivo, IL-22 treatment of mice led to a high hepatic LBP expression and elevated blood LBP level. This hepatocyte-specific IL-22 effect was reflected in patients with crohn´s disease in elevated systemic LBP level. In psoriasis, especially the regenerative phenotype of keratinocytes, characterized by the distorted terminal differentiation and enhanced mobility, is a key feature and the basis for the clinically visible epidermal alterations. In contrast, in crohn´s disease by inducing hepatic LBP production IL-22 likely contributes to the neutralisation of LPS translocated into the blood via the distorted intestinal barrier and thereby to a local limitation of inflammation. Based on these observations a neutralisation or application of IL-22 would be an innovative therapeutic approach for the treatment of psoriasis and crohn´s disease, respectively.

No description available.

Orientador: Maria Virgínia Costa Scarpa / Coorientador: Marlus Chorilli / Banca: Renata Fonsenca Vianna Lopez / Banca: Leila Aparecida Chiavacci / Resumo: Amplamente utilizado no tratamento de vários tipos de câncer e na psoríase, o metotrexato (MTX) é um quimioterápico, estruturalmente análogo do ácido fólico, que apesar de sua eficácia apresenta uma série de efeitos adversos, sendo a hepatotoxicidade o mais grave. Atualmente os sistemas nanoestruturados líquido-cristalinos de fase lamelar estão sendo utilizados como dispositivos para liberação modificada de fármacos, sendo vantajosos na liberação tópica de várias substâncias, conforme suas características de interação com o estrato córneo e as outras camadas da pele, evitando assim efeitos adversos sistêmicos. Os objetivos deste trabalho foram desenvolver sistemas nanoestruturados líquido-cristalinos de fase lamelar, acrescidos de MTX, caracteriza-los do ponto de vista físico, realizar a análise estrutural das formulações, através de microscopia de luz polarizada (MLP), espalhamento de raios-X a baixo ângulo (SAXS) e suas propriedades reológicas, executar os testes de estabilidade preliminar (TEP) das formulações, validar o método analítico para a quantificação de MTX por CLAE e executar ensaios de liberação, permeação e retenção in vitro. As formulações preparadas a partir da mistura do poliéter funcional siloxano (Dow Corning® 5329) como tensoativo, com silicone fluido de co-polímero glicol (Dow Corning® 193C) como fase oleosa titulados em fase aquosa, composta por tampão fosfato de potássio monobásico 0,01M pH 7,4, apresentaram fases líquido-cristalinas do tipo lamelar, confirmados pelos ensaios de MLP e SAXS. Os TEPs evidenciaram que as formulações A, B e C mantiveram-se estáveis durante o período do estudo. Os estudos do comportamento reológico das formulações apresentaram-se como fluidos pseudoplásticos não-newtonianos tixotrópicos ... / Abstract: Widely used in the treatment of some types of cancer, the methotrexate (MTX) is a chemotherapeutic, structurally analog of the folic acid, although its effectiveness, presents a series of adverse effect, being the most serious hepatotoxicity. Currently, the liquid crystal lamellar phase is being used of devices for modified release of drug demonstrated to be advantageous in the release topic of some substances, given to the characteristics of interaction with the stratum corneun and other layers of the skin, avoiding systemic adverse effects. The aims of this research had been to develop and to characterize liquid crystalline nanostructure systems of lamellar phase, increased of MTX of the physical point of view, also carry through the structural analysis of the formulations through by polarized light microscopy (PLM), small-angle X-ray scattering (SAXS) and rheological properties. Perform stability studies of the chosen formulations, validate the analytical method of quantification of MTX for High Performance Liquid Chromatography (HPLC) and carry through release assay, cutaneous permeation and skin retention in vitro for the chosen formulations. The formulations prepared by the mixture of polyether functional siloxane as surfactant, with silicone polyether copolymer as oily phase and phosphate buffer 0,01M pH 7,4 as aqueous phase demonstrating lamellar liquid-crystalline phases, confirmed by assays of PLM and SAXS. The stability studies showed that formulations A, B and C remained stable throughout the period of the study. The study of the rheological behavior of the formulations presented as not Newtonian pseudoplastic fluid and thixotropic ... / Mestre

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

Στην παρούσα εργασία πραγματοποιήθηκε γονιδιωματική ανάλυση της επίδρασης αντιψωριασικών φαρμάκων σε καλλιέργειες ανθρώπινων κερατινοκυττάρων με τη χρήση μικροσυστοιχιών DNA. Σε καλλιέργειες κυττάρων HaCaT χορηγήθηκαν τα παράγωγα του ρετινοϊκού οξέος all-trans retinoic acid (ATRA) και acitretin, σε διαβαθμισμένες δόσεις, προκειμένου να διαπιστωθεί η επίδραση τους στα κύτταρα. Μελετήθηκε η βιωσιμότητα των κυττάρων με τις δοκιμασίες της χρωστικής Trypan Blue και ΜΤΤ. Επιλέχθηκαν δύο συγκεντρώσεις (10^-6 και 10^-8 Μ) των φαρμάκων που αντιστοιχούσαν σε βιωσιμότητα κυττάρων περίπου 80%, οι οποίες χορηγήθηκαν εκ νέου σε καλλιέργειες κυττάρων HaCaT. Τα κύτταρα συλλέχθηκαν, έγινε εκχύλιση του RNA και έλεγχος της ποιότητας του με ηλεκτροφόρηση (Bioanalyzer). Το RNA χρησιμοποιήθηκε για την in vitro μεταγραφή cDNA που σημάνθηκε με φθοριοχρώματα και άμεσα ακολούθησε υβριδισμός σε πλακίδιο μικροσυστοιχιών (OneArray) το οποίο περιείχε ανιχνευτές για όλο το ανθρώπινο γονιδίωμα μαζί με τους κατάλληλους μάρτυρες. Σε κάθε πλακίδιο υβριδίστηκαν ταυτόχρονα cDNA από κύτταρα στα οποία είχε χορηγηθεί ρετινοειδές και κύτταρα στα οποία δεν είχε χορηγηθεί. Η επεξεργασία των δεδομένων της σαρώσεως με ειδικό λογισμικό ανέδειξε 700 περίπου γονίδια που ρυθμίζονται θετικά ή αρνητικά σε στατιστικά σημαντικό βαθμό. Για την επαλήθευση των αποτελεσμάτων που προέκυψαν από τις μικροσυστοιχίες, επιλέχθηκαν 34 γονίδια τα οποία συμμετέχουν σε βασικές βιολογικές διεργασίες όπως πρωτεϊνοσύνθεση, κυτταρική σηματοδότηση, πολλαπλασιασμός, κυτταρική διαφοροποίηση, κυτταρικός θάνατος, φλεγμονή. Επιπρόσθετα, επιλέχθηκαν 22 γονίδια τα οποία έχουν επίσης κομβικό ρόλο σε σηματοδοτικά μονοπάτια και κυτταρικές λειτουργίες. Η επιλογή αυτή έγινε για να μελετηθεί πιο σφαιρικά η επίδραση των φαρμάκων σε βασικούς κυτταρικούς μοριακούς μηχανισμούς. Στο σύνολο των επιλεγμένων γονιδίων έγινε ποσοτική Real-Time PCR και για το σκοπό αυτό έγινε σχεδιασμός ειδικών εκκινητών. Η qRT-PCR εν τέλει, επιβεβαίωσε τα αρ-χικά αποτελέσματα από τα microarrays. Διαπιστώθηκε ότι η κυτταρική απόκριση στη χορήγηση των ρετινοειδών, εξειδικευμένα για κάθε δραστική ουσία και για κάθε δόση δεν είναι μονοσήμαντη, αλλά ότι ταυτόχρονα επάγονται λειτουργικά μονοπάτια με διαφορετικούς ρόλους. Επίσης διαπιστώθηκε ότι η μεταβολή κατά δύο τάξεις μεγέθους της δόσης που προσλαμβάνουν τα κύτταρα επάγει αντίρροπες κυτταρικές αποκρίσεις. Συγκεκριμένα, η ολιστική προσέγγιση της μεταβολής της γονιδιακής έκφρασης ανέδειξε ότι η χορήγηση ATRA σε συγκέντρωση 10^-6Μ στις κυτταροκαλλιέργειες ευνοεί την πρωτεϊνοσύνθεση και την διαφοροποίηση των κυττάρων ενώ ασκεί αντιφλεγμονώδη δράση. Η χορήγηση της δραστικής ουσίας ATRA στη δόση 10^-8Μ ευνοεί τη διαφοροποίηση των κυττάρων HaCaT σε μεγαλύτερο βαθμό από τον πολλαπλασιασμό τους. Επιπλέον, φαίνεται ότι σε αντίθεση με τη μεγαλύτερη δόση, ευνοείται η σύνθεση μορίων που επάγουν την φλεγμονή. Παρόμοια, η ασιτρετίνη στη δόση 10^-6Μ ευνοεί τη διαφοροποίηση των κυττάρων και την σύνθεση μορίων που επάγουν τη φλεγμονή. Η ασιτρετίνη στην μικρότερη δόση (10^-8 Μ) ευνοεί κύρια την διαφοροποίηση, λιγότερο τον πολλαπλασιασμό των κυττάρων και φαίνεται ότι προάγει σε σημαντικό βαθμό την απόπτωση. Οι μεγαλύτερες δόσεις των ρετινοειδών που μελετήθηκαν φαίνεται ότι είναι απαγορευτικές για τον πολλαπλασιασμό των κυττάρων σε αντίθεση με τις μικρότερες δόσεις. Επισημαίνεται ότι για τη θεραπεία της ψωρίασης όπου χρησιμοποιούνται, επιθυμητές δράσεις είναι η παραγωγή μορίων με αντιφλεγμονώδη δράση, ο περιορισμός του αυξημένου κυτταρικού πολλαπλασιασμού, αύξηση της κυτταρικής απόπτωσης και τέλος πολύ ση-μαντικό είναι η επιτυχής περάτωση της διαφοροποίησης των κυττάρων. Συμπερασματικά, η χρήση τεχνικών υψηλής απόδοσης, κύρια των μικροσυστοιχιών cDNA που επιτρέπουν την εκτεταμένη μελέτη του γονιδιώματος και της qRT-PCR για πιο στοχευμένη μελέτη, μπορούν να διαδραματίσουν σημαντικό ρόλο στην εξακρίβωση μοριακών μηχανισμών. / In the current project we performed gene expression profiling, using cDNA microarrays, when specific doses of derivatives of retinoic acid were applied in HaCaT cell culture. These specific drugs are used in the treatment of psoriasis but their exact effect in molecular level remains elusive. All-trans retinoic acid and acitretin were applied in gradient doses. Cell viability was monitored using MTT and Trypan blue assays. Two specific doses (10^-6 & 10^-8 M), in which cell viability was approximately 80%, were chosen for the treatment of HaCaT cells. Subsequently, the treated cells were collected and RNA was extracted using standard methods. At a next step, RNA quality was examined by electrophoresis (Bioanalyzer) and spectrometry. High quality RNA showing no traces of degradation was used as template for in vitro transcription. Finally, synthesis of fluoro-labeled cDNA was performed from RNA derived from both treated and untreated samples and was immediately hybridized to DNA microarray slides (OneArray). Analysis of the hybridization data was performed using specific software. As a result, 700 genes (both up-regulated and down-regulated) were chosen for further analysis. Among them, 34 genes were chosen to validate the microarrays results by the use of quantitative Real-Time PCR. These genes appeared to play crucial role in basic cellular functions like protein synthesis, signal transduction, cell death, cell differentiation and proliferation. Furthermore, 22 additional essential genes that are related to the above processes were chosen in aim to examine drugs effects. The data processing revealed that the 10^-6 M dose of ATRA has a positive effect in protein synthesis, cell differentiation and anti-inflammatory action. Moreover ATRA at a concentration of 10^-8 M promotes differentiation more than proliferation and it has inflammatory effect as well as acitretin has in 10^-6 M dose. On the other, hand acitretin in 10^-8 M dose facilitates differentiation more than proliferation but mainly induces cell death. Generally, high doses (10-6 M) of the drugs inhibit cell proliferation more efficient than low doses (10-8 M). In fact, during psoriasis treatment, the anti-inflammatory action, inhibition of cell proliferation, induction of cell differentiation and cell death are considered desirable drug effects. Our study shows that cDNA microarray analysis represents a powerful tool that can be used for extended genomic studies and the results that are obtained can be validated and used for the elucidation of several molecular mechanisms.

Made available in DSpace on 2014-12-02T11:16:33Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-06-27Bitstream added on 2014-12-02T11:21:14Z : No. of bitstreams: 1 000693706.pdf: 2880957 bytes, checksum: 43d4b15dffaa346d602b5f57917996d4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Amplamente utilizado no tratamento de vários tipos de câncer e na psoríase, o metotrexato (MTX) é um quimioterápico, estruturalmente análogo do ácido fólico, que apesar de sua eficácia apresenta uma série de efeitos adversos, sendo a hepatotoxicidade o mais grave. Atualmente os sistemas nanoestruturados líquido-cristalinos de fase lamelar estão sendo utilizados como dispositivos para liberação modificada de fármacos, sendo vantajosos na liberação tópica de várias substâncias, conforme suas características de interação com o estrato córneo e as outras camadas da pele, evitando assim efeitos adversos sistêmicos. Os objetivos deste trabalho foram desenvolver sistemas nanoestruturados líquido-cristalinos de fase lamelar, acrescidos de MTX, caracteriza-los do ponto de vista físico, realizar a análise estrutural das formulações, através de microscopia de luz polarizada (MLP), espalhamento de raios-X a baixo ângulo (SAXS) e suas propriedades reológicas, executar os testes de estabilidade preliminar (TEP) das formulações, validar o método analítico para a quantificação de MTX por CLAE e executar ensaios de liberação, permeação e retenção in vitro. As formulações preparadas a partir da mistura do poliéter funcional siloxano (Dow Corning® 5329) como tensoativo, com silicone fluido de co-polímero glicol (Dow Corning® 193C) como fase oleosa titulados em fase aquosa, composta por tampão fosfato de potássio monobásico 0,01M pH 7,4, apresentaram fases líquido-cristalinas do tipo lamelar, confirmados pelos ensaios de MLP e SAXS. Os TEPs evidenciaram que as formulações A, B e C mantiveram-se estáveis durante o período do estudo. Os estudos do comportamento reológico das formulações apresentaram-se como fluidos pseudoplásticos não–newtonianos tixotrópicos ... / Widely used in the treatment of some types of cancer, the methotrexate (MTX) is a chemotherapeutic, structurally analog of the folic acid, although its effectiveness, presents a series of adverse effect, being the most serious hepatotoxicity. Currently, the liquid crystal lamellar phase is being used of devices for modified release of drug demonstrated to be advantageous in the release topic of some substances, given to the characteristics of interaction with the stratum corneun and other layers of the skin, avoiding systemic adverse effects. The aims of this research had been to develop and to characterize liquid crystalline nanostructure systems of lamellar phase, increased of MTX of the physical point of view, also carry through the structural analysis of the formulations through by polarized light microscopy (PLM), small-angle X-ray scattering (SAXS) and rheological properties. Perform stability studies of the chosen formulations, validate the analytical method of quantification of MTX for High Performance Liquid Chromatography (HPLC) and carry through release assay, cutaneous permeation and skin retention in vitro for the chosen formulations. The formulations prepared by the mixture of polyether functional siloxane as surfactant, with silicone polyether copolymer as oily phase and phosphate buffer 0,01M pH 7,4 as aqueous phase demonstrating lamellar liquid-crystalline phases, confirmed by assays of PLM and SAXS. The stability studies showed that formulations A, B and C remained stable throughout the period of the study. The study of the rheological behavior of the formulations presented as not Newtonian pseudoplastic fluid and thixotropic ...

No description available.

Introdução: A psoríase é uma doença sistêmica crônica, inflamatória e imuno- mediada, que afeta a pele, vasos e sistema osteomuscular. A inflamação é um fator de risco importante para a aterosclerose, e a psoríase está associada com risco aumentado de dislipidemia, diabetes, hipertensão, obesidade e esteato-hepatite não alcoólica. No entanto, o impacto da inflamação crônica sistêmica sobre a saúde vascular e aterosclerose permanece mal compreendido. Objetivos: Analisar a associação entre psoríase e aterosclerose subclínica com uma medição não invasiva, avaliada no ramo das artérias carótidas, usando a espessura médio-intimal (IMTc). O objetivo secundário foi comparar a IMTc entre os subgrupos psoríase: leve, moderada à psoríase/grave e artropática, com o grupo controle. Métodos: Neste estudo caso-controle transversal, 221 pacientes com psoríase (31,2% psoríase leve, 41,6% psoríase moderada/grave e 31,2% psoríase artropática) foram comparados com um grupo de 5.061 controles existentes recrutados a partir de um inquérito anterior (ELSA-Brasil HU-USP). Os critérios de inclusão compreendem os seguintes fatores: acima de 40 anos de idade para mulheres e 35 anos para homens; psoríase diagnosticada e clinicamente ativa, pelo menos há dois anos. Os critérios de exclusão foram: gravidez, presença de neoplasia, gota, artrite reumatóide e lúpus eritematoso sistêmico. Todos os participantes foram submetidos a exame médico, exame clínico e dados antropométricos recolhidos, bem como amostras de sangue para análise laboratorial. Em seguida, foram realizados exame de ultrassonografia das artérias carótidas direita e esquerda a fim de determinar IMTc. Ambos os lados analisados com média dos valores; quando aumentados foram utilizadas como um indicador da aterosclerose subclínica. Resultados: No grupo psoríase, o tempo médio de doença foi de 16 (± 13) anos. Em relação ao IMT da carótida (média dos lados direito e esquerdo), não observamos valores aumentados no grupo de psoríase, em comparação com o grupo controle, com os dados crus (P = 0,24 e P = 0,83, IMT esquerda e IMT direita, respectivamente). No entanto, quando o ajuste por sexo e idade (P = 0,038 e P < 0,0001, IMT para a esquerda e direita, respectivamente) e um ajuste multivariado para o risco cardiovascular, uma diferença significativa é encontrada (P = 0,028 e P < 0,0001, IMT esquerda e IMT direita, respectivamente) com valores mais elevados da carótida IMT no grupo de psoríase do que no grupo controle. Em consonância com isso, não foram observadas diferenças na IMT entre ameno, sub-grupos artrite psoriática moderado-grave e grupo controle (P = 0,50 e P = 0,52, respectivamente). Hipertensão, Hs CRP, IMC, HDL e LDL foram maiores nos pacientes com psoríase, em comparação com os controles (ambos p < 0,001). Conclusões: Na coorte brasileira, pacientes com psoríase apresentaram um perfil mais grave de fatores de risco cardiovascular do que os controles, em função do aumento da espessura da parede da artéria carótida encontrada nesses pacientes. O papel preciso da inflamação sistêmica crônica e outros fatores sobre a progressão da doença e comorbidades devem ainda ser elucidados . / Introduction: Psoriasis is a chronic systemic immune-mediated inflammatory disease affecting skin, vessels and osteomuscular system. Inflammation is an important risk-factor for atherosclerosis and psoriasis is associated with increased risk for dislipidemia, diabetes, hypertension, obesity and non-alcoholic steatohepatitis. However, the impact of chronic systemic inflammation on vascular health and atherosclerosis remains poorly understood. Objectives: To examine the association between psoriasis and subclinical atherosclerosis assessed at the carotid artery branch using a non-invasive measurement of the intima-media thickness (IMTc). The secondary objective was to compare the IMTc between psoriasis subgroups: mild, moderate / severe psoriasis and arthropathica with control group. Methods: In this cross-sectional case-control study, 221 psoriasis patients (31.2% mild psoriasis, 41.6% moderate-severe psoriasis and 31.2% arthritic psoriasis) were compared with a group of 5,061 existing controls recruited from a previous investigation (ELSA-Brasil HU-USP). Inclusion criteria were: 40 y of age for women and 35 y of age for men; psoriasis diagnosed and clinically active for at least 2 years. Exclusion criteria were: pregnancy, neoplasia, gout, rheumatic arthritis and systemic lupus erythematosus. All participants were submitted to medical screening, clinical examination and had anthropometric data collected as well as blood samples for laboratorial analysis. Then, they undertook an ultrasound scan of the right and left carotid arteries in order to determine IMTc. Both sides were averaged and increased values were used as an indicator of subclinical atherosclerosis. Results: The psoriasis group the mean disease time was 16±13 years. In relation to the carotid IMT (right and left sides averaged), we did not observe increased values in the psoriasis group as compared to the control group, with crude data (P = 0,24 and P = 0,83, IMT left and IMT right respectively). However, when adjusting by sex, age (P = 0,038 and P < 0,0001, IMT left and IMT right respectively) and a multivariate adjustment for cardiovascular risk, a significant difference is found (P = 0,028 and P < 0.0001, IMT left and IMT right respectively) with higher carotid IMT values in the psoriasis group than in the control group. In line with this, no differences were observed in the IMT between mild, moderate-severe, psoriatic arthritis sub-groups and control group (P = 0.50 e P = 0.52, respectively). Hypertension, Hs CRP, BMI, HDL and LDL were higher in psoriasis patients as compared to controls (both p < 0.001). Conclusions: In the Brazilian cohort, psoriasis patients presented a more severe profile of cardiovascular risk factors than controls, with increased carotid arterial wall thickness being found in these patients. The precise role of chronic systemic inflammation and other factors on disease progression and comorbidities are yet to be elucidated

Introdução: A psoríase é uma doença sistêmica crônica, inflamatória e imuno- mediada, que afeta a pele, vasos e sistema osteomuscular. A inflamação é um fator de risco importante para a aterosclerose, e a psoríase está associada com risco aumentado de dislipidemia, diabetes, hipertensão, obesidade e esteato-hepatite não alcoólica. No entanto, o impacto da inflamação crônica sistêmica sobre a saúde vascular e aterosclerose permanece mal compreendido. Objetivos: Analisar a associação entre psoríase e aterosclerose subclínica com uma medição não invasiva, avaliada no ramo das artérias carótidas, usando a espessura médio-intimal (IMTc). O objetivo secundário foi comparar a IMTc entre os subgrupos psoríase: leve, moderada à psoríase/grave e artropática, com o grupo controle. Métodos: Neste estudo caso-controle transversal, 221 pacientes com psoríase (31,2% psoríase leve, 41,6% psoríase moderada/grave e 31,2% psoríase artropática) foram comparados com um grupo de 5.061 controles existentes recrutados a partir de um inquérito anterior (ELSA-Brasil HU-USP). Os critérios de inclusão compreendem os seguintes fatores: acima de 40 anos de idade para mulheres e 35 anos para homens; psoríase diagnosticada e clinicamente ativa, pelo menos há dois anos. Os critérios de exclusão foram: gravidez, presença de neoplasia, gota, artrite reumatóide e lúpus eritematoso sistêmico. Todos os participantes foram submetidos a exame médico, exame clínico e dados antropométricos recolhidos, bem como amostras de sangue para análise laboratorial. Em seguida, foram realizados exame de ultrassonografia das artérias carótidas direita e esquerda a fim de determinar IMTc. Ambos os lados analisados com média dos valores; quando aumentados foram utilizadas como um indicador da aterosclerose subclínica. Resultados: No grupo psoríase, o tempo médio de doença foi de 16 (± 13) anos. Em relação ao IMT da carótida (média dos lados direito e esquerdo), não observamos valores aumentados no grupo de psoríase, em comparação com o grupo controle, com os dados crus (P = 0,24 e P = 0,83, IMT esquerda e IMT direita, respectivamente). No entanto, quando o ajuste por sexo e idade (P = 0,038 e P < 0,0001, IMT para a esquerda e direita, respectivamente) e um ajuste multivariado para o risco cardiovascular, uma diferença significativa é encontrada (P = 0,028 e P < 0,0001, IMT esquerda e IMT direita, respectivamente) com valores mais elevados da carótida IMT no grupo de psoríase do que no grupo controle. Em consonância com isso, não foram observadas diferenças na IMT entre ameno, sub-grupos artrite psoriática moderado-grave e grupo controle (P = 0,50 e P = 0,52, respectivamente). Hipertensão, Hs CRP, IMC, HDL e LDL foram maiores nos pacientes com psoríase, em comparação com os controles (ambos p < 0,001). Conclusões: Na coorte brasileira, pacientes com psoríase apresentaram um perfil mais grave de fatores de risco cardiovascular do que os controles, em função do aumento da espessura da parede da artéria carótida encontrada nesses pacientes. O papel preciso da inflamação sistêmica crônica e outros fatores sobre a progressão da doença e comorbidades devem ainda ser elucidados . / Introduction: Psoriasis is a chronic systemic immune-mediated inflammatory disease affecting skin, vessels and osteomuscular system. Inflammation is an important risk-factor for atherosclerosis and psoriasis is associated with increased risk for dislipidemia, diabetes, hypertension, obesity and non-alcoholic steatohepatitis. However, the impact of chronic systemic inflammation on vascular health and atherosclerosis remains poorly understood. Objectives: To examine the association between psoriasis and subclinical atherosclerosis assessed at the carotid artery branch using a non-invasive measurement of the intima-media thickness (IMTc). The secondary objective was to compare the IMTc between psoriasis subgroups: mild, moderate / severe psoriasis and arthropathica with control group. Methods: In this cross-sectional case-control study, 221 psoriasis patients (31.2% mild psoriasis, 41.6% moderate-severe psoriasis and 31.2% arthritic psoriasis) were compared with a group of 5,061 existing controls recruited from a previous investigation (ELSA-Brasil HU-USP). Inclusion criteria were: 40 y of age for women and 35 y of age for men; psoriasis diagnosed and clinically active for at least 2 years. Exclusion criteria were: pregnancy, neoplasia, gout, rheumatic arthritis and systemic lupus erythematosus. All participants were submitted to medical screening, clinical examination and had anthropometric data collected as well as blood samples for laboratorial analysis. Then, they undertook an ultrasound scan of the right and left carotid arteries in order to determine IMTc. Both sides were averaged and increased values were used as an indicator of subclinical atherosclerosis. Results: The psoriasis group the mean disease time was 16±13 years. In relation to the carotid IMT (right and left sides averaged), we did not observe increased values in the psoriasis group as compared to the control group, with crude data (P = 0,24 and P = 0,83, IMT left and IMT right respectively). However, when adjusting by sex, age (P = 0,038 and P < 0,0001, IMT left and IMT right respectively) and a multivariate adjustment for cardiovascular risk, a significant difference is found (P = 0,028 and P < 0.0001, IMT left and IMT right respectively) with higher carotid IMT values in the psoriasis group than in the control group. In line with this, no differences were observed in the IMT between mild, moderate-severe, psoriatic arthritis sub-groups and control group (P = 0.50 e P = 0.52, respectively). Hypertension, Hs CRP, BMI, HDL and LDL were higher in psoriasis patients as compared to controls (both p < 0.001). Conclusions: In the Brazilian cohort, psoriasis patients presented a more severe profile of cardiovascular risk factors than controls, with increased carotid arterial wall thickness being found in these patients. The precise role of chronic systemic inflammation and other factors on disease progression and comorbidities are yet to be elucidated

Abstract Glucocorticoids are the most important and widely used treatment modality in dermatology. A large variety of topical as well as systemic preparations is available. Most patients treated with glucocorticoids respond quickly to the treatment, but some are considered insensitive or even resistant to glucocorticoid therapy. Currently, there is no known measurable variable, through which the response can be predicted. Glucocorticoids mediate their actions through glucocorticoid receptors (GR). Several isoforms of GR exist, but the α (GRα) and β (GRβ) isoforms are clinically the most important. Based on previous studies, it has been proposed that the abundance of GR isoforms or the GRβ: GRα –ratio could affect individual responsiveness to corticosteroid treatment. In particular, up-regulation of GRβ expression has been shown to be linked to resistance to corticosteroid treatment. This thesis comprises three sub-studies. Firstly, we wanted to determine whether GRα and GRβ are expressed in inflammatory skin diseases. Secondly, we examined if the expression is altered by corticosteroid treatment in eczema atopicum, bullous pemphigoid and psoriasis. Finally, we measured the effects of a topical vitamin D3 analogue (calcipotriol) combined with betamethasone compared with betamethasone monotherapy on inflammatory biomarkers of psoriasis. Our studies provide detailed novel data about the expression of GRα and GRβ. GRα and GRβ were shown to be expressed in the blood lymphocytes and lesional skin of patients with eczema atopicum, bullous pemphigoid and psoriasis, as well as in the skin of patients with eczema nummulare, lichen simplex chronicus and lichen ruber planus. Systemic corticosteroid treatment was shown to affect the expression of GRα and GRβ in eczema atopicum and bullous pemphigoid, but the inconsistent variation in their expression between patients prevented us from drawing firm conclusions. Neither GRα nor GRβ as a single marker were found to be a suitable predictor of corticosteroid responsiveness. Clinical and laboratory analyses showed that topical treatment of psoriasis with calcipotriol/betamethasone combination ointment is more beneficial measured by both than betamethasone monotherapy. / Tiivistelmä Glukokortikoideja (”kortisoni”) käytetään tulehduksellisten ihotautien hoidossa paikallisesti tai systeemisenä lääkkeenä. Suurin osa potilaista reagoi hoitoon nopeasti, mutta osalla hoitovaste on heikompi tai ilmenee hitaasti. Tällä hetkellä ei tunneta keinoja ennustaa luotettavasti kortisonihoidon vastetta. Glukokortikoidit vaikuttavat elimistössä glukokortikoidireseptorien (GR) kautta. Glukokortikoidireseptorista tunnetaan useita alatyyppejä, joista tärkeimmät ovat α (GRα) ja β (GRβ). Aiemman tiedon pohjalta on pidetty mahdollisena, että GR-alatyyppien suhteella tai määrällä on merkitystä kortisonivasteen syntymisessä. Erityisesti on arveltu, että ylimäärä GRβ:aa voisi estää kortisonihoidon vaikutusta. Tässä väitöskirjassa tavoitteena on ollut selvittää, tapahtuuko GR-alatyyppien ilmenemisessä muutoksia tulehduksellisia ihosairauksia sairastavilla potilailla sekä tutkia, miten kortisonihoito vaikuttaa GR-tasoihin atooppista ihottumaa, pemfigoidia ja psoriaasia sairastavilla potilailla. Lisäksi olemme verranneet paikallishoitoa pelkällä kortisonivoiteella D-vitamiinijohdos kalsipotriolin ja kortisonin yhdistelmähoitoon psoriaatikoilla. Tutkimus on antanut uutta yksityiskohtaista tietoa GRα:n ja GRβ:n esiintymisestä ihossa ja tulehdussoluissa ihosairauksia sairastavilla potilailla. Tutkimustulosten perusteella voidaan todeta, että GRα ja GRβ esiintyvät atooppista ihottumaa, pemfigoidia ja psoriaasia sairastavien potilaiden ihossa ja veren tulehdussoluissa sekä nummulaari-ihottumaa, neurodermatiittia ja punajäkälää sairastavien potilaiden ihossa. Suun kautta annettu kortisonihoito vaikuttaa GRα- ja GRβ–lähetti-RNA:n ilmenemiseen, mutta potilaskohtaiset erot ovat suuret, eikä kumpikaan, GRα tai GRβ, sovellu yksinään ennustamaan kortisonihoidon vastetta. Paikallisella kortisonihoidolla D-vitamiinijohdos kalsipotrioliin yhdistettynä on suotuisampi vaikutus psoriaasin tulehduksellisiin välittäjäaineisiin ja tulehdussoluihin kuin pelkällä paikallisella kortisonihoidolla.