Abstract
Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) exerts an important role in inflammatory processes, lipids homeostasis, and cardiometabolic disorders that are closely associated with psoriasis. The aim of the study was to analyze the clinical and diagnostic value of serum PCSK9 concentrations and their connections with disease severity, inflammation, metabolic syndrome, and impact of systemic therapies in psoriatic patients. The study enrolled thirty-five patients with active plaque-type psoriasis and eighteen healthy volunteers served as controls. Blood samples were obtained before and after 12 weeks of treatment with methotrexate or acitretin. Serum PCSK9 concentrations were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) commercial kits. Morphological and biochemical parameters were assayed using routine laboratory techniques. Psoriatic patients showed significantly elevated levels of PCSK9 compared to controls (p < 0.01), mostly in patients with a mild and moderate course of psoriasis. PCSK9 concentrations correlated positively with BMI and triglyceride levels (p < 0.05). Interestingly, PCSK9 had a strong negative correlation with low-density lipoprotein levels and total cholesterol (p < 0.05). Three months of monotherapy with methotrexate significantly reduced PCSK9 level (p < 0.05), on the contrary, the acitretin group showed a further increase of PCSK9 levels (p < 0.05). PCSK9 seems to be a novel marker of psoriasis and a putative explanation of lipid disturbances, which are common in patients with psoriasis and are vital for the further developing of metabolic syndrome. Methotrexate should be considered as a treatment of choice in patients with an elevated PCSK9 concentration.
Highlights
Psoriasis is a systemic, immunometabolic, and still untreatable disease affecting 2%–4% of the general population worldwide
This assumption sheds new light into the real diagnostic and therapeutic significance of the protein, which is not a reliable marker of the inflammatory state in psoriasis. This is in line with the results of a meta-analysis conducted by Cao et al They demonstrated that inhibition of Proprotein convertase subtilisin/kexin type 9 (PCSK9) had no significant impact on high-sensitivity C-reactive protein (CRP) [40]
We investigated the effects on PCSK9 levels by monotherapy with methotrexate or acitretin
Summary
Immunometabolic, and still untreatable disease affecting 2%–4% of the general population worldwide This disease was considered as a solely dermatological condition, while recent studies have linked psoriasis to many comorbidities namely obesity, cardiometabolic events, diabetes mellitus type 2 (DM type 2), lipid disturbances, and liver dysfunctions [1,2,3]. The morbidity of psoriatic patients is significantly higher compared with the population, which is due to the increased risk of cardiovascular events, mainly myocardial infarction (MI) and thromboembolic disorders [4,5,6,7]. The aim of the study was to analyze the clinical and diagnostic value of serum PCSK9 concentrations and their connections with disease severity, inflammation, metabolic syndrome, and impact of systemic therapies in psoriatic patients. Methotrexate should be considered as a treatment of choice in patients with an elevated PCSK9 concentration
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