Biomedical Research

Abstract

The imbalance in to oxidants and antioxidants leads to the condition called oxidative stress. The oxidative stress is considered as one of the etiopathological factors for development and /or exacerbation of psoriasis. Therefore we undertook this study to determine serum levels of oxidants (Malondialdehyde MDA, Nitric oxide NO) and antioxidants (Total Antioxidant Status TAS, Superoxide Dismutase SOD) and it’s correlation with severity of psoriasis. In present research work we have studied 90 clinically diagnosed psoriasis patients and 90 age and sex matched healthy control subjects. Our results showed increased concentration of oxidants; MDA, NO, and decreased concentration of TAS as well as activity of SOD in the serum of psoriasis patients. Observations of our study clearly indicate positive correlation of increasing serum oxidants and negative correlation of decreasing serum antioxidants with PASI scour i.e. severity of psoriasis.

Keywords

Oxidants, Antioxidants, Psoriasis.

Introduction

Psoriasis is the dermatological disorder characterized by hyperproliferation and inflammation of the skin. The symptoms of the psoriasis are erythema, itching, thicken-ing and scaling of the skin [1]. The psoriasis is majority affecting young or middle-aged adults although no age is exempted. Along with soles and palms as common areas, psoriasis also affects elbows, knees, scalps and sacral re-gion in symmetrical pattern [2].

The exact etiological factor for psoriasis is yet not clearly known but genetic factor, trauma, skin infection, drugs, emotional stress, alcohol and smoking etc. greatly influ-ences the clinical development of psoriasis [1]. The re-searchers are recently focused on oxidative stress as one of the important factor in pathogenesis of psoriasis. [3,4,5,6] This research work was aimed to determine the oxi-dative stress and it’s correlation with the severity of the psoriasis.

Material and Methods

Clinically diagnosed 90 psoriasis patients visiting derma-tology OPD of Raichur Institute of Medical sciences and Hospital Raichur and 90 age and sex matched healthy control subjects were studied. The patients were diag-nosed by Auspitz sign, clinical features of psoriasis like erythema, itching, thickening and scaling of the skin and histopathological examination whenever required. Psoria-sis patients of age group 20 to 60 years and without his-tory of any drug therapy for last two months were in-cludes in the study. The subjects with past or present his-tory of any disease like atherosclerosis, CHD, Diabetes Mellitus etc. which are affecting oxidative stress were excluded from the study. The severity of the psoriasis was determined by PASI score and patients were grouped as mild, Moderate and sever psoriasis.

Under all aseptic precautions 5 ml fasting blood sample was collected in the plain bulb and serum was separated after clot retraction. The serum was analyzed at the earli-est for levels of Malondialdehyde (MDA) [7], Nitric Ox-ide (NO) [8], Total Antioxidant Status (TAS) [9] and Su-peroxide Dismutase (SOD) [10] on the same day.

The results were compiled and the statistical analysis was done by using students ‘T’ test.

Results

Table 1 depicts the distribution of psoriasis patients ac-cording to PASI score, levels of serum MDA, NO, SOD, TAS of the controls and psoriasis patients. In presented study it was observed that, the MDA & NO concentrations in the serum of psoriasis patients were significantly high (p<0.001) as compared control levels. The serum MDA and NO levels were observed to be signifi-cantly increased (P<0.001) from mild to moderate and from moderate to the severe psoriasis patients. This in-creased concentration of serum MDA & NO were corre-lates positively with the severity of the psoriasis.

Table 1: Showing PASI score and values of MDA, NO, TAS, SOD in serum of psoriasis patients.

The activity of antioxidant enzyme SOD and concentra-tion of TAS in the serum of psoriasis patients were sig-nificantly low (p<0.001) as compared to control subjects. The serum SOD activity and TAS levels were observed to be decreased significantly (P<0.001) from mild to moder-ate and from moderate to severe psoriasis patients. The decreased serum SOD activity and TAS levels were corre-lates negatively with severity of the psoriasis.

Discussion

Psoriasis is the recurrent inflammatory skin disorder, characterized by marked increase in keratinocyte prolif-eration as well as abnormal differentiation. Recently re-searchers have focused on oxidative stress and its relation with psoriasis. It is proposed that oxidative stress is in-volved in the pathogenesis of the psoriasis [4].

Few studies had showed increased levels of MDA in pso-riatic skin, erythrocytes, and serum [11,12] of psoriasis patients as compared to the controls. Gornicki A, Gutsze A. [13] observed that MDA concentration was increased and activity of the antioxidant enzymes SOD and CAT were decreased in erythrocytes of psoriasis patients as compared to the control subject [14,12].

Rocha Pereira P., Silva. Rebelo A S., figuniredo A, Quini-tanilha A, Texeira F [4]. studied the oxidative stress of psoriasis patients in correlation with severity of the disease. He observed significantly increased concentration of plasma MDA, correlating positively, as well as low con-centration of Vit-E and Vit-A correlating negatively with the severity of the psoriasis. The concentration of plasma TAS was found significantly low in active psoriasis than in inactive psoriasis patients and controls. However, plasma TAS was found to be non-significantly low in inactive patients as compared to control subjects.

The concentration of MDA was found increased as well as activity of antioxidant enzymes SOD & CAT was de-creased, significantly in erythrocytes of psoriasis patients. [15] The observation of Relhan V, Gupta S., Dayal S, Pandde R., Lal H. [6] showed significantly high concen-tration of MDA in blood of psoriasis patients as compared to the controls.

The report of Gokhale N, Belgaunkar V., Pandit D., Shan-tanu D., Damle D. & Kharaeva Z, Gostova E, De Luca C, Raskovic D, Korkina L. [16,17] showed significantly high concentration of serum NO, correlating positively with the severity of chronic plaque psoriasis.

Increased concentration of the oxidants and decreased concentration of antioxidants leads to oxidative stress, which indicates lipid peroxidation. This may lead to cell damage by continuous chain reactions. In addition, it may be responsible for activation of phospholipase A2, produc-tion of many mediators by arachidonate, deactivation of adenylate cyclase and activation of guanilate cyclase lead-ing to decrease in the cAMP/cGMP ratio responsible for epidermal proliferation [15,18].

Severin E, Nave B., Stander M, Ott R., Traupe H. [19] has observed no difference in the concentration of serum MDA as well as TAS in psoriasis patients and controls. Gavan N., Ruxandra Popa, Remus Orasan, Maibach H [20]. showed significantly high values of Plasma TAS and SOD activity in psoriasis patients.

In present study we observed significantly high values of MDA & NO as well as significantly low values of TAS & SOD activity in serum of psoriasis patients as compared to control values. We also found the positive correlation between increased MDA, NO in serum of psoriasis pa-tients with severity of psoriasis and the negative correla-tion between decreased TAS, SOD activity in the serum of psoriasis patients with severity of psoriasis. Our find-ing supports other studies showing oxidative stress and its involvement in pathogenesis of psoriasis.

References

1. McGrath JA, Eady RA, Pope FM. Anatomy and or-ganization of human skin. Rook’s T.B. Of Dermatology Volume One 7th edi. 2004, 3.1-3.84.
2. Uday Khopkar Papulosquamous diseases: Skin diseases & sexually transmitted infections. 5th Edi. Bhalani Publishers (Book Depot) Mumbai 2005.
3. Rocha Pereira P., Silva. Rebelo A S., figuniredo A, Quinitanilha A., Texeira F. The Inflammatory response in mild and in severe psoriasis British J. of Dermatol. 2004; 150(5); 917 – 928.
4. Rocha Pereira P., Silva I Rebelo A S., Figneredo A, Quintanilhas A, Teixeira F. Erythrocyte damage in mild and severe psoriasis. British J. of Dermatol. 2004; 150; 232 – 244.
5. Kiymat Baz M. Kokturk B.C.A, Yazici A C., Eskandari G, Guliz I.H. Api, Atik U. Oxidant /antioxidant status in patients with psoriasis. Yonsei Medical Journal. 2003;Vol 44;No 6; 987 – 990
6. Relhan V, Gupta S., Dayal S, Pandde R., Lal H. Blood thiol and Malondialdehyde level in psoriasis. The J. of Dermatol. 2002;29;399 – 403
7. Kei Satoh. Serum lipid peroxide in cerebrovascular disorders determined by a new colorimetric method. Clinica Chemica Acta 1978; 90; 37 – 43.
8. Najwa Cortas, Nabil Wakid. Determination of inor-ganic nitrate in serum in serum and urine by kinetic cadmium reduction method. Clinical chemistry 1990; 36 (8): 1440 – 1443.
9. Benzie I F F, Strain J J. The ferric reducing ability of plasma (FRAP) as a measure of ‘antioxidant power’ : the FRAP assay. Analytical Biochemistry; 1996; 239; 70 – 76
10. Kajari Das Luna Samanta and GBN Chainy. A modi-fied spectrophotometeric assay of superoxide dismutase using nitrite formation by superoxide radical IJBB; 2000; 37; 201 - 204
11. Rocha-Pereira P., Santos-Silva I R A., Figueiredo A, Quintaniha A, Teixeira F.. Dislipidemia and oxidative stress in mild and in sever psoriasis as a riskfor cardio-vascular disease. Clinica Chemica Acta; 2001; 303; 33 – 39.
12. Yildirim M, Inaloz HS, Baysal V., Delibas N.. The role of oxidants and antioxidants in psoriasis. JEADV 2003;17; 34 – 36
13. Gornicki A, Gutsze A. Erythrocyte membrane fluidity changes in psoriasis : an EPR study. J. Dermatological Sciences. 2001;27; 27 – 30
14. Vanizor Kural, Orem A., Gulsersn Cimsit, Yandi Y E, Calapoglu M. Evaluation of the atherogenic tendency of lipid and lipoprotein content and their relationship with oxidant- antioxidant syste in patients with psoria-sis.Clinica Chimica Acta. 2003; 328; 71 – 82.
15. Popov I, Lewin G. A deficient function of the antioxida-tive system of the organism as an aetiopathogenitic factor in psoriasis. Med. Hypothesis, 1991;35;229 – 236.
16. Gokhale N, Belgaunkar V., Pandit D., Shantanu D., Damle D. Study of serum nitric oxide levels in psoria-sis. Indian J. Of Dermatol,Venrol, and Leprology. 2005,71;3;175 – 178.
17. Kharaeva Z, Gostova E, De Luca C, Raskovic D, Korkina L. Clinical and biochemical effects of coen-zyme Q(10), vitamin E, and selenium supplementation to psoriasis patients. Nutrition; 2009; 25 (3): 295-302.
18. Voorhees JJ, Marcelo CL. Cyclic AMP, Cyclic GMP and glucocortcoids as potential regulators of epidermal proliferation and differentiation. J Invest Dermatol, 1975,69, 179-290
19. Severin E, Nave B., Stander M, Ott R., Traupe H. Total antioxidant capacity is normal in sera from psoriatic pa-tients despite elevated Bilirubin, tocopherol crystals and urate levels. Dermatol;1999;198;336 – 339.
20. Gavan N., Ruxandra Popa, Remus Orasan, Maibach H.. Effect of Percutaneous absorption of fluocinolone acetonide on the activity of superoxide dismutase and total antioxidant status in patients with psoriasis. Skin Pharmacol; 1997; 10: 178 -182.