Campione Elena, Cosio Terenzio, Pistoia Enrico Salvatore, Artosi Fabio, Shumack Ruslana Gaeta, Borselli Cristiana, Rivieccio Antonia, Caputo Valerio, Favaro Marco, Sorge Roberto, Pica Francesca, Bianchi Luca, Gaziano Roberta
Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.
Front Immunol. 2024 Dec 10;15:1508489. doi: 10.3389/fimmu.2024.1508489. eCollection 2024.
Fungi, including , may be a trigger or exacerbate psoriasis, especially in difficult to treat (DTT) areas, through the activation of IL-17/23 axis.
In this study, seventy patients with DDT psoriasis were enrolled to evaluate species and/or other opportunistic fungi colonization rate at baseline (T0) and the impact of apremilast on fungal load, clinical outcome, serum cytokine levels and biochemical serum profile of patients after 16, 24 and 52 weeks of treatment.
In our population, 33 (47%) patients were colonized by spp. at baseline. In 24 (34%) individuals was detected in the oral cavity while in the remaining 9 (13%) individuals the fungus was isolated from stool samples. Twenty subjects were colonized by only the species , whereas in the remaining 13 a combination of two or more species ( plus non- strains) was found in the oral cavity. Moreover, 27 (39%) patients were affected by onychomycosis. At 52 weeks, apremilast treatment induced a full recovery from colonization in 83% of patients colonized with a single species of (); while in those co-infected by two or more spp. induced a significant reduction (colony counts >10 CFU/mL) in fungal load was observed in comparison to baseline. Among patients with onychomycosis, 78% (21/27) of them presented a complete clinical resolution of nail psoriasis and concomitant nail infections. Finally, improvements in clinical scores i.e., PASI, NAPSI, DLQI, itch VAS, PAIN VAS, scPGA and sPGA-G and biochemical serum profile, as well as a significant decrease in serum IL-17A, TGF-β 1 and IL-10 levels (from 8.51 to 4.16 pg/mL; from 66.10 to 48.70 ng/mL and from 20.05 to 14 pg/mL, respectively) were observed in all patients.
Fungi may play a role in the psoriasis pathogenesis. Apremilast has been shown to ameliorate psoriasis signs and symptoms and counteract fungal overgrowth, probably by dampening inflammation, triggered by the fungal infections themselves. Thus, apremilast may represent an effective therapeutic approach in the treatment of DTT psoriasis and modulate the fungal colonization.
包括[具体真菌名称未给出]在内的真菌，可能通过激活白细胞介素-17/23轴引发或加重银屑病，尤其是在难治性（DTT）区域。
在本研究中，纳入了70例DTT银屑病患者，以评估基线（T0）时[具体真菌名称未给出]物种和/或其他机会性真菌的定植率，以及阿普米拉斯在治疗16、24和52周后对患者真菌负荷、临床结局、血清细胞因子水平和生化血清指标的影响。
在我们的研究人群中，33例（47%）患者在基线时被[具体真菌名称未给出]物种定植。在24例（34%）个体的口腔中检测到了[具体真菌名称未给出]，而在其余9例（13%）个体中，该真菌是从粪便样本中分离出来的。20例受试者仅被[具体真菌名称未给出]物种定植，而在其余13例中，在口腔中发现了两种或更多物种（[具体真菌名称未给出]加上非[具体真菌名称未给出]菌株）的组合。此外，27例（39%）患者患有甲癣。在52周时，阿普米拉斯治疗使83%的仅被单一[具体真菌名称未给出]物种（[具体真菌名称未给出]）定植的患者的[具体真菌名称未给出]定植完全恢复；而在那些被两种或更多[具体真菌名称未给出]物种共同感染的患者中，与基线相比，真菌负荷显著降低（菌落计数>10 CFU/mL）。在患有甲癣的患者中，78%（21/27）的患者甲银屑病和伴随的指甲感染实现了完全临床缓解。最后，在所有患者中均观察到临床评分即银屑病面积和严重程度指数（PASI）、指甲银屑病严重程度指数（NAPSI）、皮肤病生活质量指数（DLQI）、瘙痒视觉模拟评分（itch VAS）、疼痛视觉模拟评分（PAIN VAS）、静态医师全面评估（scPGA）和静态医师全球评估-改善（sPGA-G）以及生化血清指标有所改善，血清白细胞介素-17A、转化生长因子-β1和白细胞介素-10水平也显著降低（分别从8.51降至4.16 pg/mL；从66.10降至48.70 ng/mL和从20.05降至14 pg/mL）。
真菌可能在银屑病发病机制中起作用。已证明阿普米拉斯可改善银屑病的体征和症状，并对抗真菌过度生长，可能是通过抑制由真菌感染本身引发的炎症。因此，阿普米拉斯可能是治疗DTT银屑病的一种有效治疗方法，并可调节真菌定植。
