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ORIGINAL ARTICLE   Free accessfree

Giornale Italiano di Dermatologia e Venereologia 2018 June;153(3):316-25

DOI: 10.23736/S0392-0488.16.05427-4


language: English

Biomolecular index of therapeutic efficacy in psoriasis treated with anti-TNF-α agents

Luca BIANCHI 1, Gaetana COSTANZA 2, Elena CAMPIONE 1, 3 , Manuela RUZZETTI 1, Alessandro DI STEFANI 1, Laura DILUVIO 3, Emiliano GIARDINA 2, Raffaella CASCELLA 2, Paola CORDIALI-FEI 4, Claudio BONIFATI 4, Andrea CHIRICOZZI 5, Giuseppe NOVELLI 2, Fabrizio ENSOLI 4, Augusto ORLANDI 2, 3

1 Department of Dermatology, University of Rome Tor Vergata, Rome Italy; 2 Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome Italy; 3 Polyclinic of University Tor Vergata of Rome, Rome Italy; 4 Department of Clinical Pathology and Microbiology, and Clinical Dermatology, San Gallicano Institute, Rome Italy; 5 Department of Dermatology, University of Pisa, Pisa Italy


BACKGROUND: Clinical or quality of life assessments are currently available for psoriasis severity evaluation and therapeutic response. Laboratory scores focused to measure and follow treatment efficacy are lacking at present.
METHODS: A microscopic and biomolecular score was designed to monitor skin disease severity and clinical response to anti-psoriatic treatments. A susceptibility gene analysis on cellular retinoic acid binding protein-II (CRABP-II), acting on keratinocyte differentiation, was also performed. A Molecular Index of Therapeutic Efficacy (MITE) was defined by assembling morphometric/semiquantitative measurement of epidermal thickness, immunohistochemical Ki-67, keratin 17 and CRABP-II expression of lesional and non-lesional psoriatic skin biopsies before and after anti-tumor necrosis factor (TNF) α therapies. A 0-12 MITE score was correlated with Psoriasis Area and Severity Index (PASI) and Psoriasis Disability Index (PDI) scores and inflammation. Three CRABP-II SNPs were analyzed by TaqMan assay.
RESULTS: All parameters were highly expressed in psoriatic lesions and reduced after 12 weeks of anti-TNF-α treatments. MITE score strongly correlated with PASI and PDI values either before or after therapies (P<0.001 and P<0.001, respectively). Conversely, MITE values did not change after treatments of non-responder patients. CRABP-II did not result in a psoriatic susceptibility gene for the SNPs probes analyzed.
CONCLUSIONS: MITE score variations corresponded to the patients’ clinical improvement following anti-TNF-α treatments, with significant statistical correlation among MITE, PASI and PDI scores. If confirmed in a larger series and/or in different hyperproliferative and inflammatory dermatoses, MITE score could be proposed as additional monitoring system to evaluate treatment protocols in skin disorders and targeted biomolecular pathways supporting clinical efficacy.

KEY WORDS: Psoriasis - Patient outcome assessment - Inflammation - Therapeutics

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