Clinical Implications of Intestinal Barrier Damage in Psoriasis
Received 18 November 2020
Accepted for publication 24 December 2020
Published 27 January 2021 Volume 2021:14 Pages 237—243
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Ning Quan
Mariusz Sikora,1 Albert Stec,1 Magdalena Chrabaszcz,1 Joanna Giebultowicz,2 Emilia Samborowska,3 Radoslaw Jazwiec,3 Michal Dadlez,3,4 Malgorzata Olszewska,1 Lidia Rudnicka1
1Department of Dermatology, Medical University of Warsaw, Warsaw, Poland; 2Department of Bioanalysis and Drug Analysis, Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, Warsaw, Poland; 3Mass Spectrometry Laboratory, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland; 4Institute of Genetics and Biotechnology, Biology Department, Warsaw University, Warsaw, Poland
Correspondence: Mariusz Sikora
Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, Warsaw 02-008, Poland
Tel +48 22 502 13 24
Fax +48 22 502 21 06
Background: An increasing amount of evidence suggests an association between increased intestinal permeability and the pathogenesis of chronic inflammatory diseases. However, the clinical significance of gut barrier dysfunction in psoriasis remains to be established.
Objective: To evaluate whether there are differences in disease activity, the severity of gastrointestinal symptoms and the blood concentration of bacterial metabolites in psoriatic patients with a normal and altered intestinal barrier.
Patients and Methods: Gut barrier integrity was assessed with the serum concentrations of claudin-3, a modulator of intestinal tight junctions and an intestinal fatty acid-binding protein, a marker of enterocyte damage. Gastrointestinal symptoms were evaluated with a validated questionnaire. The concentration of trimethylamine N-oxide (TMAO), a gut microbiota-associated metabolite, was measured with high-performance liquid chromatography.
Results: One hundred and fourteen patients with psoriasis were finally enrolled in the study – 68 with an altered gut barrier and 46 with a properly functioning intestinal barrier. Patients with an altered gut barrier showed a significantly higher score in the Gastrointestinal Symptom Rating Scale (3.20 vs 1.46, p< 0.001). Moreover, patients with psoriasis and a disrupted intestinal barrier demonstrated a higher disease activity (PASI: 19.7 vs 10.3, p< 0.001) and systemic inflammatory parameters (neutrophil-to-lymphocyte ratio: 2.86 vs 1.71, p< 0.001; C-reactive protein 3.76 vs 1.92; p< 0.05). The marker of bacterial translocation was significantly higher in psoriatic patients with damaged gut integrity (TMAO: 375.7± 51.9 vs 119.4± 27.5 ng/mL; p< 0.05).
Conclusion: The altered gut barrier in psoriasis is associated with gastrointestinal symptoms, systemic inflammatory profile and the increased blood concentration of gut microbiota-derived metabolite – TMAO. Intestinal barrier modulation represents a new promising therapeutic approach.
Keywords: gut barrier, microbiome, psoriasis, systemic sclerosis, TMAO
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