Disminución de los niveles plasmáticos de clusterina en pacientes con psoriasis / Decreased Plasma Levels of Clusterin in Patients With Psoriasis

RESUMEN

Introducción y objetivos: La psoriasis es una enfermedad inflamatoria crónica que se ha asociado a un incremento del riesgo cardiovascular. La clusterina (apolipoproteína J) es un componente de las lipoproteínas de alta densidad (HDL) y tiene un papel protector de la ateroesclerosis. El objetivo del estudio ha sido evaluar la clusterina y el factor inhibitorio de la migración del macrófago (MIF) plasmáticos en pacientes con psoriasis grave comparando grupos de pacientes con distintos riesgos cardiovasculares asociados. Material y métodos: Se estudiaron 21 pacientes con psoriasis grave (Psoriasis Area Severity Index [PASI] y Body Surface Area [BSA] > 10) y 11 controles sin enfermedad dermatológica. Se evaluaron los factores de riesgo cardiovascular según criterios del síndrome metabólico del Adult Treatment Panel III (ATP- III ) y la ateromatosis carotídea subclínica mediante ecografía doppler de carótidas. La clusterina y MIF plasmáticos se midieron mediante Enzyme-Linked Immuno Sorbent Assay (ELISA). Resultados: El 47% de los pacientes con psoriasis presentaba criterios de síndrome metabólico y el 33% presentó placa de ateroma carotídea. Se observó una disminución significativa de la clusterina plasmática (μg/ml) en pacientes con psoriasis respecto a controles (81,39 ± 27,30; n = 21, versus 117 ± 21,6, n = 11; p = 0,0017). El MIF plasmático (ng/ml) estaba aumentado significativamente en los pacientes con psoriasis y placa de ateroma carotídea respecto a los controles (53,22 ± 29,02; n = 6, versus 34,21 ± 9,65; n = 11; p = 0,0394). Conclusiones: La disminución de clusterina en pacientes con psoriasis sugiere una relación con la enfermedad y con la situación inflamatoria sistémica. El aumento de MIF en pacientes parece relacionarse con la presencia de factores de riesgo cardiovascular asociados y placa de ateroma carotídea (AU)

ABSTRACT

Introduction and objectives: Psoriasis is a chronic inflammatory disease that has been linked to increased cardiovascular risk. The glycoprotein clusterin (apolipoprotein J) is a component of high-density lipoproteins and has a protective role in atherosclerosis. The aim of the present study was to evaluate the plasma levels of clusterin and the proinflammatory cytokine macrophage migration inhibitory factor (MIF) in patients with severe psoriasis, comparing groups of patients with different risks of cardiovascular disease. Material and methods: Twenty-one patients with severe psoriasis (psoriasis area severity index and body surface area > 10) and 11 healthy controls with no dermatologic disease were studied. Cardiovascular risk factors were assessed according to the Adult Treatment Panel (ATP) IIIcriteria. Subclinical carotid atheromatosis was assessed by Doppler ultrasonography of the carotid arteries. Plasma clusterin and MIF levels were measured by enzyme-linked immunosorbent assay. Results: ATP-III criteria for metabolic syndrome were met by 47% of the patients, and 33% had carotid atheromatous plaque. Mean (SD) clusterin plasma levels were significantly lower in patients with psoriasis compared with controls (81.39 [27.30] micreg/mL for the 21 patients vs 117[21.6] g/mL for the 11 controls; P = .0017). MIF plasma levels (ng/ml) were significantly higherin patients with atheromatous plaque compared with controls (53.22 [29.02] for the 6 patientswith plaque vs 34.21 [9.65] for the 11 controls; P = 0.0394).Conclusions: The decreased plasma levels of clusterin in psoriatic patients suggested an association with the disease and might be an indicator of systemic inflammatory activity. Increased levels of MIF appear to be associated with cardiovascular risk factors and carotid atheromatous plaque (AU)